Exposure to severe conflict between parents increases the likelihood that children themselves will exhibit high levels of aggressive behaviours in various interpersonal relationships (for example with their peers, teachers or parents). In fact, a large body of research demonstrates that conflict between parents is associated with an increased risk for psychological problems among children in all families, whether the parents are together or apart. In our work with the Family Court, where the care of children is being disputed between parents or other caregivers, we see a lot of anxious children who are caught in the middle of intense conflict between the adults who are meant to be taking care of them. This conflict is usually born of longstanding relationship problems between the adults. Children will go to extraordinary lengths to try and stop the conflict – they may lie to the first parent about the second parent if they think this will make the first parent happier (and vice versa); they will behave badly simply to interrupt the parents’ battle, and would rather be getting into trouble from the parents than have the parents fighting with each other; they will withdraw from one or other of the parents in an attempt to avoid the distress of the anxiety caused by the conflict; they may behave very strangely in order to draw the parents’ attention away from each other; and they may try and keep everyone happy by being incredibly obedient and compliant (which isn’t normal all the time!). In any case, parents owe it to their children to protect them from severe, unresolved conflict, and children have the right to grow up in environments unmarked by violence of any kind.

The spate of celebrities, such as Brooke Shields and Courtney Cox, who have publicised their experiences, has been very positive in that it has helped women realise that ‘it can happen to anyone’. However, there are still a number of barriers that prevent women from seeking help. Often women realise something is not right, but find it difficult to distinguish between normal levels of distress or tiredness and distress that warrants help. Women also don’t want to say that they are having difficulty coping, and therefore struggle on alone.

Maintaining good mental health in the postnatal period can help both prevent, and recover, from postnatal depression or anxiety. It’s important to plan regular weekly time without the baby. Often things reach crisis point before everyone rallies to help. It’s much better to take a preventative approach. Often just knowing that you have, for example, a couple of hours break each Sunday morning, can keep you going. Physical activity is also a helpful way to manage low mood and anxiety even if this is just a short morning walk with the baby. Usual household chores and outings can feel overwhelming, so by planning activities for specific times in advance, most important things get done. The more social support you have from friends and family, the less vulnerable you will be to anxiety and stress. Mothers’ groups can be a good way to connect with other mothers. But it is important to seek out like-minded others who are willing to be honest. If you’re in a mothers’ group where everyone is saying things are perfect, you won’t relate to them. Develop a list of what works best for you for those times when you feel down or anxious. Your list might include; going for a walk, a bath, being outside in the sunshine, or putting on some music. Most importantly tell someone, such as your partner, a family member, midwife or GP if you are finding it difficult to cope. There is well researched treatment available for Postnatal depression and anxiety that does not necessarily include medication. There are also a number of support agencies and health professionals in Christchurch who work in this specific field. Further information about postnatal depression and anxiety can be obtained from www.mothersmatter.co.nz

Dr Michelle McCarthy is in private practice. She can be contacted at The Anxiety Clinic and Centre for Cognitive Behavioural Therapy.

Myths
NOT TRUE Children with ADHD are deliberately naughty or bad children.
NOT TRUE ADHD is just youthful high spirits.
NOT TRUE Every child who displays some symptoms of ADHD has it.
There may be other reasons for children having symptoms which mimic ADHD. For example, children who have been abused either sexually or physically, or whose parents have recently separated often display some of the above behaviour. That’s why it is extremely important for the assessment and diagnosis to be thorough and done by qualified professionals who, as much as possible, try to rule out any other causes for a child’s symptoms
NOT TRUE Children with ADHD are incapable of concentrating at all.
Most children with ADHD are often able to concentrate for quite long periods of time on specific activities or hobbies – for example, watching videos they enjoy. In some, this ability to hyperfocus is extraordinary and has led some experts to comment that attention deficit might more accurately be called attention inconsistency.
NOT TRUE Everything that is wrong with the child is ADHD (e.g., all learning and behaviour problems are part of the ADHD).
NOT TRUE If you have ADHD you are not responsible for your behaviour and therefore can be excused for it (i.e., don’t have to face the consequences).
Causes of ADHD
Even though a lot of research into ADHD has gone on around the world, its exact cause is still unknown. It is likely that there are not one, but several causes, which, when they occur together, become ADHD.
Studies of computerised tomography or CT brain scans show that children with ADHD seem to have brain circuits which are wired a little differently from other people’s. This results in the brain having trouble processing the messages it receives – a little bit like a telephone exchange which gets overloaded with calls. This may happen to the infant’s brain in pregnancy, in babyhood, or it may just be an individual variation which has received more notice in the last 40 years. It does not seem to be caused just by a poor diet, yeast infections, allergies or food colourings as some people have thought, although these may be factors in the overall ADHD picture. It is also not caused by bad parenting although often a child’s behaviour will have earned plenty of negative attention in and outside of the family or whanau by the time ADHD is recognised.
Risks factors for developing ADHD
There is thought to be a genetic element to most ADHD, that is, it runs in families. Studies have shown that brothers or sisters of children with ADHD have two to three times the risk of having it as well.
ADHD often occurs with other child mental health problems. These may exist alongside or develop as a result of ADHD. For example, some children with ADHD will have Oppositional Defiant Disorder, Conduct Disorder or experience anxiety or depression. Learning difficulties which are unrecognised also present a risk for serious mental health problems, as they affect progress at school and self-esteem.
ADHD and its associated problems are serious if untreated because they can put young people at risk for accidents, drug or alcohol abuse problems, or suicide.
Living with Attention Deficit / Hyperactivity Disorder
The most important thing to remember about having a child with ADHD is that, like all children, they need love, affection, nurturing and clear rules. Sometimes this is hard to remember when whole days of nagging seem to be the rule rather than the exception at home and everywhere else.
A child with ADHD may have chalked up quite a lot of frustrations and failures before his/her problem is recognised. Some parents worry about the label ADHD and wonder if they have caused it to happen, or failed their child in some way. They may feel anger that this has happened to their family or whanau, or upset that other family or whanau members have dismissed the child’s behaviour as being normal. Others will be relieved that the problem they’ve lived with over a number of years finally has a name.
For the child, knowing he/she has ADHD can be a relief. Often though, children feel there is something really wrong with them. ADHD needs to be carefully explained to them in a way that they can understand and learn to handle. Brothers, sisters and friends, too, may need an explanation that can help them to stop teasing or provoking the child with ADHD.
Some children who have to take medicine to help their symptoms say it is like admitting that something scary is wrong with them and worry that they are retarded or crazy – labels they’ve probably heard before.
In two-parent homes it is important for parents to support each other with managing their child’s behaviour. Consistency is essential. Often one parent will say that the child is “perfectly all right when he is with me.” This can be infuriating for the other parent. For single parents, having a child with ADHD is even more difficult. Have at least one supportive friend outside the family or whanau that you can confide in.
Treatment of Attention Deficit / Hyperactivity Disorder
Summary of treatment options
There is no magic pill to make ADHD disappear, and medication should not be used as a substitute for other appropriate interventions, including educational and psychosocial. It is a complicated condition generally best managed by a mixed treatment programme which may include the following components.
Medication
The main kind of medication are used in the treatment of ADHD are stimulants; antidepressants are only very occasionally prescribed. The same medications are used for both children and adults. It is important that the progress of a child on medication for ADHD is checked and the treatment reviewed regularly with regular weight and height checks if stimulants are taken. You are entitled to know the names of any medicines prescribed; what symptoms they are supposed to treat; how long it will be before they take effect; how long they will have to be taken for and what their side effects (short and long-term) are.
Psychosocial treatments
Psychosocial treatments are non-medical treatments which look at the child or young person’s thinking, behaviour, relationships and environment, including their culture. The main psychosocial treatments for ADHD include behaviour management and social skills training to ensure encouragement and support for the child at home and at school. Other psychosocial treatments may include individual psychological therapy or family therapy to help young people and their families and whanau understand the condition and to make positive changes in their lives and relationships.
All types of therapy/counselling should be provided to children, adolescents and their families and whanau in a manner which is respectful of them, and with which they feel comfortable and free to ask questions. It should be consistent with and incorporate their cultural beliefs and practices.
Complementary therapies
Complementary therapies that enhance the young person’s life may be used in addition to psychosocial treatments and prescription medicines.

This article is an excerpt from www.mentalhealth.org.nz

James has always been a bit sensitive – hates loud noises, complains about the labels in his clothes, and is a “picky” eater. He has always found it difficult to settle to a task (unless it’s something on the computer, Playstation, or TV), been a bit distractible, and found it hard to wait for things. While he loves to play soccer and tennis, his handwriting is messy and he was a bit slow learning how to manage shoelaces. While he has very strong language skills, he finds maths hard, or battles to organise his thoughts to write stories.

This profile of strengths and difficulties is associated with a brain that is “wired” a bit differently from the usual. Children with this kind of profile may have social problems and they worry about a range of things, or worry about one particular thing. Those with strong language skills ask questions about their worries, or “talk themselves through” their activities. They have difficulties with the give and take of relationships. They can be “in your face” at times, or seem unaware of other peoples’ feelings. One of the really confusing aspects of their behavior is that it can vary from day to day – one day they can do everything they’re asked to do and the next day they can’t. Their strong oral language can lead parents and teachers to have expectations that are unrealistic. Just because a child has a highly developed vocabulary, doesn’t mean that he can write a well-structured story within a particular time-frame.

Sensory sensitivities may be most problematic during early childhood when feeding, washing hair or cutting nails becomes a battleground; inattention and distractibility may become more noticeable when a child is put into a structured teaching environment; specific learning difficulties may become more obvious in middle to late childhood as academic demands increase; motor planning and sequencing problems become more evident as children are expected to become more independent in their self-care. Anxiety may be a longstanding feature, with worry about upcoming events or changes in familiar routines. Social difficulties may appear at preschool with some boisterous or aggressive behavior, or withdrawn or solitary play.

A first step is to find out how the child’s brain works. An assessment of the child’s intellectual functioning can tease out the ways that his brain processes information, and an assessment by an occupational therapist can clarify how the child’s brain makes sense of sensory information from the eyes, ears, and skin. The psychologist helps to make sense of these assessments and gives practical recommendations making life easier for the child and his family. Parents might need to stop making assumptions about why the child is not completing homework; doing chores; having a tantrum when asked to put away their toys, or being whiney. While being oppositional may explain some of the behaviors, it’s also possible that tiredness or difficulties with remembering and carrying out directions is involved.

Unusual children can have above average intelligence, and may even be described as “gifted”. However, that does not mean to say that all of their abilities are at the same level. Difficulties with visual tracking (following a line of text across a page); problems with attention or organisation; and struggles with planning and sequencing information or activities can have a significant effect on children’s all-round behavior. Differences in abilities can result in frustration for everyone – particularly the child. Self confidence and the feeling that they are capable individuals can suffer as a result of these differences, and sometimes children become reluctant to try things out for fear of failure. Undetected, these difficulties may contribute to negative outcomes in adolescence, such as school failure, mood and anxiety problems, and poor peer relationships. If parents are puzzled by their child’s inconsistent abilities or contradictory behavior, observing what makes it harder or easier will provide clues as to how the child works in the world.

While the principles of changing any behavior are fundamentally the same, parents respond quite differently to their child’s anxiety and anger. When parents perceive that their child is anxious, they become anxious themselves – there are few things that distress a parent more than thinking that their child is afraid. In this state, parents may relax their rules in an attempt to make sure they don’t make the child more afraid. This may have the undesired effect of making the child more anxious – as the parent withdraws control, the child feels less secure. In contrast, when parents perceive that their child is angry, they may be prompted to fight back – taking the child’s antisocial behavior as a personal attack or feeling intimidated. In this state, parents may retaliate with anger, trying to halt the aggression with force. But, if the child’s ‘fight’ behaviors are driven by anxiety, the parent’s forceful response is likely to increase the child’s anxiety.

How do you tell the difference between an angry outburst and an anxious outburst? Given that anger is a normal human reaction to perceived injustice or being thwarted, and anxiety is a normal human reaction to perceived threat or danger, you may get an insight into the child’s behavior by checking out the event that set off the outburst. Take the example of an 8-year old girl whose 10-year old brother won’t let her have a turn on the computer. She complains, “George won’t let me on the computer!”, and it turns out that she has hit George. She may be angry because she wants to play a game and she thinks it’s unfair or feels blocked in her desire to play, or she may be anxious because she cannot finish her homework project on the computer and worries about the consequences of not finishing. In both cases, a parent will ensure that the child has fair access to the computer, but the quality of the parent’s response is likely to be different in each case. In the case of the game-time on the computer, the parent may insist that the children themselves work out a time-sharing system, and in the case of the unfinished project, the parent may intervene to insist that the computer be preferentially available for homework. However, in both cases, there may be some consequence for hitting George, as a zero-tolerance attitude to aggression is important.

(Adapted from  www.attachmentexperts.com)

What is Attachment?

Attachment is the deep and enduring connection established between a child and caregiver in the first several years of life. It profoundly influences every component of the human condition – mind, body, emotions, relationships and values. Attachment is not something that parents do to their children; rather, it is something that children and parents create together, in an ongoing reciprocal relationship. Attachment to a protective and loving caregiver who provides guidance and support is a basic human need, rooted in millions of years of evolution. There is an instinct to attach: babies instinctively reach out for the safety and security of the "secure base" with caregivers; parents instinctively protect and nurture their offspring. Attachment is a physiological, emotional, cognitive and social phenomenon. Instinctual attachment behaviors in the baby are activated by cues or signals from the caregiver (social releasers). Thus, the attachment process is defined as a "mutual regulatory system" – the baby and the caregiver influencing one another over time.
Beyond the basic function of secure attachment – providing safety and protection for the vulnerable young via closeness to a caregiver – there are several other important functions for children:

• Learn basic trust and reciprocity, which serves as a template for all future emotional relationships.
• Explore the environment with feelings of safety and security ("secure base"), which leads to healthy cognitive and social development.
• Develop the ability to self-regulate, which results in effective management of impulses and emotions.
• Create a foundation for the formation of identity, which includes a sense of competency, self-worth, and a balance between dependence and autonomy.
• Establish a prosocial moral framework, which involves empathy, compassion and conscience.
• Generate the core belief system, which comprises cognitive appraisals of self, caregivers, others, and life in general.
• Provide a defense against stress and trauma, which incorporates resourcefulness and resilience.

Children who begin their lives with the essential foundation of secure attachment fare better in all aspects of functioning as development unfolds. Numerous longitudinal studies have demonstrated that securely attached infants and toddlers do better over time in the following areas:

• Self-esteem
• Independence and autonomy
• Resilience in the face of adversity
• Ability to manage impulses and feelings
• Long-term friendships
• Relationships with parents, caregivers, and other authority figures
• Prosocial coping skills
• Trust, intimacy and affection
• Positive and hopeful belief systems about self, family and society
• Empathy, compassion and conscience
• Behavioral performance and academic success in school
• Promote secure attachment in their own children when they become adults

What is an Attachment Disorder?

More and more children are failing to develop secure attachments to loving, protective caregivers. These children are left without the most important foundation for healthy development. They are flooding our child welfare system with an overwhelming array of problems – emotional, behavioral, social, cognitive, developmental, physical and moral – and growing up to perpetuate the cycle with their own children. Research has shown that up to 80% of high risk families (abuse and neglect, poverty, substance abuse, domestic violence, history of maltreatment in parents’ childhood, depression and other psychological disorders in parents) create severe attachment disorders in their children. Since there are one million substantiated cases of serious abuse and neglect in the U.S. each year, the statistics indicate that there are 800,000 children with severe attachment disorder coming to the attention of the child welfare system each year. This does not include thousands of children with attachment disorder adopted from other countries.
Disrupted and anxious attachment not only leads to emotional and social problems, but also results in biochemical consequences in the developing brain. Infants raised without loving touch and security have abnormally high levels of stress hormones, which can impair the growth and development of their brains and bodies. The neurobiological consequences of emotional neglect can leave children behaviorally disordered, depressed, apathetic, slow to learn, and prone to chronic illness. Compared to securely attached children, attachment disordered children are significantly more likely to be aggressive, disruptive and antisocial. Teenage boys, for example, who have experienced attachment difficulties early in life, are three times more likely to commit violent crimes. Disruption of attachment during the crucial first three years can lead to what has been called "affectionless psychopathy", the inability to form meaningful emotional relationships, coupled with chronic anger, poor impulse control, and a lack of remorse.
Attachment disorder is transmitted intergenerationally. Children lacking secure attachments with caregivers commonly grow up to be parents who are incapable of establishing this crucial foundation with their own children. Instead of following the instinct to protect, nurture and love their children, they abuse, neglect and abandon.
Children who begin their lives with compromised and disrupted attachment are at risk for serious problems as development unfolds:

• Low self-esteem
• Needy, clingy or pseudoindependent
• Decompensate when faced with stress and adversity
• Lack of self-control
• Unable to develop and maintain friendships
• Alienated from and oppositional with parents, caregivers, and other authority figures
• Antisocial attitudes and behaviors
• Aggression and violence
• Difficulty with genuine trust, intimacy and affection
• Negative, hopeless and pessimistic view of self, family and society
• Lack empathy, compassion and remorse
• Behavioral and academic problems at school
• Perpetuate the cycle of maltreatment and attachment disorder in their own children when they reach adulthood

Attachment Disorder: What you may see

Attachment disorder affects all aspect of a child’s functioning. A child may display some combination of the following primary symptoms:

• Behavior: oppositional and defiant, impulsive, destructive, lie and steal, aggressive and abusive, hyperactive, self-destructive, cruel to animals, irresponsible, fire setting.
• Emotions: intense anger and temper, sad, depressed and hopeless, moody, fearful and anxious (although often hidden), irritable, inappropriate emotional reactions.
• Thoughts: negative beliefs about self, relationships, and life in general ("negative working model"), lack of cause-and-effect thinking, attention and learning problems.
• Relationships: lacks trust, controlling ("bossy"), manipulative, does not give or receive genuine affection and love, indiscriminately affectionate with strangers, unstable peer relationships, blames others for own mistakes or problems, victimizes others/victimized.
• Physical: poor hygiene, tactilely defensive, enuresis and encopresis, accident prone, high pain tolerance, genetic predispositions (e.g., depression, hyperactivity).
• Moral/Spiritual: lack of faith, compassion, remorse, meaning and other prosocial values, identification with evil and the dark side of life.

What Can Cause Attachment Disorder?

Listed below are situations and experiences that place children at high-risk for developing attachment disorders:

Parental/Caregiver Contributions:

• Abuse and/or neglect
• Ineffective and insensitive care
• Depression: unipolar, bipolar, postpartum
• Severe and/or chronic psychological disturbances: biological and/or emotional
• Teenage parenting
• Substance abuse
• Intergenerational attachment difficulties: unresolved family-of-origin issues, history of separation, loss, maltreatment
• Prolonged absence: prison, hospital, desertion

Child Contributions:

• Difficult temperament; lack of "fit" with parents or caregivers
• Premature birth
• Medical conditions; unrelieved pain (e.g., inner ear), colicky
• Hospitalizations: separation and loss
• Failure to thrive syndrome
• Congenital and/or biological problems: neurological impairment, fetal alcohol syndrome, in utero drug exposure, physical handicaps
• Genetic factors: family history of mental illness, depression, aggression, criminality, substance abuse, antisocial personality

Environmental Contributions:

• Poverty
• Violence: victim and/or witness
• Lack of support: absent father and extended kin, isolation, lack of services
• Multiple out-of-home placements: moves in foster care system, multiple caregivers
• High stress: marital conflict, family disorganization and chaos, violent community

 “My 6-year old is disrespectful, cheeky and demanding”, “My 12-year old is ungrateful for all the support I give him”, “My 9-year old has terrible rages that I can’t control”, “My 10-year old becomes very wound up about little things”, “My teenager won’t do anything I ask and rejects me” – parents often ask us for advice about how to manage these and other parenting dilemmas. They have tried the strategies they know and, while some things work for a while, the problem remains.
The fact is that children don’t come with a manual. So how do we find ways to teach them how to manage themselves, contribute to a household, cope with disabilities, be thoughtful of others, or fulfill their potential? Most of the strategies we have in our “parenting toolbox” come from our own experiences of being parented, in our families of origin. It’s important for parents to think about their experiences of being parented. A parent can think about one thing they think their parents did well as parents, and one thing they think their parents did poorly. From this information they can get important clues to their own parenting style, and then think about alternative strategies and identify obstacles to parenting effectively.
Parents tend to either continue or avoid the patterns that their parents set up. So, a dad might talk about how his father worked such long hours that he didn’t attend many school sport events or take an active role in his sports interests, and how disappointing that was for him. As a result, he makes a particular effort to take an active interest in, and be present at, all of his son’s sporting activities. When we ask the son about his father’s involvement in his life, he complains that his dad is always on his back about practicing and taking part in competitions. What may be happening is that the dad is trying to ensure that his son doesn’t suffer from the neglect he suffered at the hands of his own father, and has ended up being overinvolved and pushy with his son. He doesn’t know where to draw the line between being involved and being intrusive – and how would he? He knows that he doesn’t want to be uninvolved like his father was, but he has no model of how to be an involved dad and, as a result, he tends to go to the other extreme. In another case, a dad talks about being severely physically punished when he was a boy and how this “didn’t do me any harm and taught me the rules”. This dad may perpetuate the cycle of physical abuse in the mistaken belief that it is the most effective way to socialize children. The fact is that he may have no other strategies in his “parenting toolbox”.
In another example, a mum tells us how she admired the way that her parents instilled strong family values in her, and recalls how her close-knit family supported each other when her mother died of cancer at a relatively young age. She remembers family times together in her family of origin, and therefore deems Saturday nights to be “family night” with no exceptions allowed. The family play games or watch a video with treat-type foods. She also likes to have the children accompany her to visit extended family on Sunday. When we ask her 13-year old son and 16-year old daughter about their family life, they complain that they aren’t allowed to socialize with their friends on Saturday nights or just “blob out” on Sundays.  They have sporting and other commitments on Saturdays and feel resentful that they have little time to do what they want in the weekend. In this case, the mum is trying to ensure that her children have the same degree of family commitment that stood her family in good stead when they were in crisis. However, she only has one model of how to do this – the model provided by her family of origin – and doesn’t know how to adapt that model to the needs of her growing family who may never have to face the crisis she did. In another case, a mum describes her parents as overprotective, never allowing her to experiment with social or physical experiences. As a result, she pushes her children to try new experiences and encourages independence when they may not be mature enough to cope with these challenges.
Even when parents know about effective strategies, they may have considerable difficulty implementing them, finding conflict too distressing to tolerate long enough to be firm and consistent. Sometimes these parents report that there was either significant unresolved conflict in their family of origin or conflict was not allowed at all. Living with parents whose arguments are unresolved or who do not allow any argument or conflict to take place, makes children anxious about conflict. Since there has been no model of conflict being allowed and being resolved, there is considerable distress associated with conflict – it is feared, elicits intense negative reactions and a feeling of helplessness. These parents find it particularly difficult to manage conflict with their children. This may be because their own childhood distress and feelings of helplessness resurface when confronted with the intense emotions associated with a child who is having a tantrum or who is verbally or physically abusive. Often, these parents are unable to be firm, fair and consistent in their management strategies and either withdraw or give in, thereby avoiding the conflict and its painful emotions. Alternatively, they may become verbally or physically abusive themselves, producing a “fight” response to the perceived danger of a child out of control.
Alternatively, parents may struggle to implement effective strategies when they have experienced the same kinds of difficulties as their children are experiencing. For example, a parent who suffered learning difficulties or bullying will find it difficult to tolerate these problems in his child. His reactions may be to become angry (as he felt when he faced these issues as a child) or to overprotect his child (in an attempt to spare his child the distress he felt). Unfortunately, a child who is being bullied needs empathy and problem-solving rather than anger and overprotection.
To summarise, there are at least two problems that get in the way of effective parenting. One is the influences of our own parents and the models of parenting they gave us. We may slavishly adhere to those or reject them completely, leaving us without a flexible model to cope with our own families in the current era and circumstances. The second is the reactivation of our own childhood distress that prevents us from being able to stand back from our children’s despair and provide a calm, firm, and unafraid container for their distress. The solution to these two problems is first to recognize the contribution of these influences in our parenting, and second to think out (or ask for ideas about) more flexible parenting strategies that take into account our own child’s needs rather than our remembered needs as children. Understanding and managing our own reactions to our children’s behavior makes us more effective parents.