On Nov.7–Making Peace with Suicide–a recommended new and powerful book!

November 6, 2014November 6, 2014Na'ama Yehuda Articles and references, Books, Resources and links, Trauma and Development Tags: Adele and the Penguin, Adele Ryan McDowell, compassion, Grief, healing, Making Peace with Suicide, New Book, Special, Suicide, Trauma, Understanding Leave a comment

Launching November 7, 2014!

Making Peace with Suicide: A Book of Hope, Understanding, and Comfort

By: Adele Ryan McDowell, PhD

Sometimes a new book comes along that deserves a special shout out–this is one !

I am delighted to help spread the word about Adele McDowell’s new, powerful, and heart opening book.

I’ve known Adele for almost 18 years now, and she is the real deal: knowledgeable, compassionate, deeply empathetic, super-sensitive, and down-to-earth. She understands human suffering and human potential, the depths of pain and the triumphs of spirit, the reality of trauma and the tangible hold of hope.

The combination of her skill and personality make her the best person to approach and manage such a tender topic, and she does so with much heart and practical advice.

The book is filled with information and much needed explanations to one of the most heart-wrenching realities of human connection and loss. It is also filled with anecdotes, candid testimonies, and personal paths through grief and healing.

Read it!

Join the launching celebration on November 7 and be one of the first to own a copy!

Get it on November 7, 2014!

Making Peace with Suicide: A Book of Hope, Understanding, and Comfort

By: Adele Ryan McDowell, PhD

Get it on Amazon November 7! http://www.amazon.com/dp/0982117620/ref=pe_385040_121528360_TE_dp_1

About the book:

Insightful, compelling, and compassionate, Making Peace with Suicide: A Book of Hope, Understanding, and Comfort takes a good hard look at the world-wide phenomena of suicide.

This book is designed for anyone who has lost a loved one to suicide and felt that sucker punch of grief; for anyone who is in pain, walking unsteadily, and considering suicide as an option; and for anyone who works with, guides, or counsels those feeling suicidal and/or suffering the profound grief from a suicidal loss.

Making Peace with Suicide includes stories of courage, vulnerability, and steadfastness from both the survivors of suicidal loss as well as the unique perspective of the formerly suicidal. It offers shared wisdom and coping strategies from those who have walked before you. It explores the factors leading to suicide and the reasons why some do and some don’t leave suicide notes.

Making Peace with Suicide sheds light on the phenomena of suicide vis-à-vis our teens, the military, new mothers, as an end-of-life choice, and asks if addiction is a form of slow suicide. It provides a seven-step healing process and opens the door to consider suicide and the soul, the heart lesson of suicide, and the energies of suicide.

If suicidality has impacted your life, Making Peace with Suicide is a must-read! You will be guided through the unknown territory, given insights to allow understanding, stories to help you heal, and ways to make peace with a heart wide-open. Making Peace with Suicide is good medicine for the body, mind, and soul.

Praise for Making Peace with Suicide

“Suicide is one of our most painful, difficult, confusing and wounding of human experiences. Dr. Adele McDowell addresses this topic with love and beauty. She non-judgmentally restores empathy, compassion and understanding. She courageously offers deep tending in a “place of primal pain.” And she is comprehensive, sharing the history, complexity, universality, and even positive dimensions of this mysterious act. Whether you are contemplating or have survived the attempt, lost someone to suicide, or counsel and help these populations, Adele McDowell’s Making Peace with Suicide will bring you hope, healing, compassion and understanding.”

–Edward Tick, PhD; Director, Soldier’s Heart; Author, War and the Soul and Warrior’s Return

“With sensitivity and compassion, Making Peace with Suicide explores the depth and breadth of suicide and offers insights and healing. This book is essential reading.”

–C. Norman Shealy, MD, PhD

“No topic could be more timely than suicide. This remarkable book addresses people who have contemplated ending their lives as well as those who have to deal with the aftermath of those who succeeded. But it will also be invaluable to mental health workers and military chaplains, especially those who deal with young people who have been bullied and veterans with PTSD. For such a complex topic, Dr. McDowell’s writing style is reader-friendly and the stories she presents may well evoke tears. Her wise recommendations include teaching self-mastery techniques to help people cope with the stress of a success-oriented society. I have read many books on this sensitive topic, but none with the breadth and scope of Making Peace with Suicide.”

–Stanley Krippner, PhD; Co-author, Personal Mythology: The Psychology of Your Evolving Self and Haunted by Combat: Understanding PTSD in War Veterans

“Finally. A book that explains—in the simplest of terms, in a non-sensational, non-academic manner—the phenomenal, worldwide epidemic we call suicide. If you read one book on mental illness and how it affects our world, READ THIS ONE!”

–Ginny Sparrow, Editor, American Association of Suicidology

“Adele bravely and compassionately tackles a topic that many people avoid discussing—suicide. Yet in the understanding of it, the confusion and sense of loss is greatly eased. Making Peace with Suicide is rich with insight and healing methods all intended to help heal the void we feel when we lose a loved one to suicide. It’s also written for those who are suicidal to help them understand their pain and despair, and to let them know there is always help and there is always hope. I wish I had this book to read when my best friend took her life.”

–Carol Ritberger, PhD, author of Healing Happens with Your Help: Understanding the Hidden Meaning behind Illness

“This powerful book, written by a psychologist and former suicide-hotline responder, speaks to us all, about a present epidemic, surrounded by shame, taboo and secrets. Offering many personal stories, Adele helps the reader to find peace speaking to both those who believe they’re the only person who has ever felt this desperate and to the survivors whose lives are thrown into turmoil. This excellent book, full of useful resources, is essential for everybody who feels alone with their issues of life or death, bringing greater understanding, acceptance and comfort.

–Christine Page, MD, seminar leader & author of The Healing Power of the Sacred Woman

“As a minister/therapist for more than thirty years as well as a wife who lost her military husband to suicide, I have never found a more compassionate, effective book on suicide and its aftermath. This book serves many needs and highlights the myriad ways in which suicide changes one’s life direction. I cannot say strongly enough how powerful and helpful this book is.”

–Rev. Colleen E. Brown, Unity minister

“The loss of a loved one by any means is traumatic. When the loss is by suicide, in addition to the grief of the loss itself, survivors are often left riddled with guilt, anger, shame, and endless questioning, by both themselves and by others. In Making Peace with Suicide, Dr. McDowell gently and brilliantly weaves vital suicide survivor education with comforting and inspirational thoughts and quotes, all designed to direct the reader on a path of healing, resolution and peace. A must-read for anyone who has been touched by the tragedy of suicide and left to answer the question, ‘Why?’ ”

—Carole Brody Fleet, award-winning and bestselling author of Widows Wear Stilettos…; Happily Even After…; and When Bad Things Happen to Good Women…

“A subject such as this is never easy to digest. However, with Adele’s wisdom and guidance through her experience, this is a must read. We are in a new world now. Let Adele’s wisdom guide you with her insights for a new perspective on suicide.”

–Mona Delfino, author of The Sacred Language of the Human Body

Get Making Peace with Suicide on Amazon, November 7!

Being sensitive: A blessing or a curse?

July 15, 2014July 15, 2014Na'ama Yehuda Anecdotes of Life, Articles and references, Good stuff!, Quotes, Reflections, Speech Language Pathology, Trauma and Development Tags: Adele and the Penguin, children, development, Emotional Regulation, Highly-Sensitive-People, NaamaYehuda, parenting, Sensitivity 4 Comments

In her great blog Adele and the Penguin, Adele Ryan McDowell posts about all manner of lovelies (well worth peeking in!). Her recent post is about sensitivity, about those of us who may be labeled “too sensitive” or “highly sensitive people.”

http://adeleandthepenguin.com/is-being-sensitive-a-blessing-or-a-curse/

Reading it made me think–and not for the first time (Adele’s blog posts do that–they touch the everyday in novel and eye-opening and heart-opening ways).

The highly-sensitive people thing? Yep. I can totally relate …

So can many of my little clients.

Personally I don’t see being sensitive as a bad thing. Like any quality, I think the ability itself is neutral. It is how we react to it, what we do with it, how it affects our lives, and whether it adds or detracts from the person we are and can become, that is the most important aspect of it to me.

There seems to be more good than bad in sensitivity. Creative people are often sensitive. Artists, writers, thinkers, inventors. I certainly see more positive than negative in the more sensitive children who come to see me. They perceive the world minutely, they read people amazingly well (even if they don’t always know how to verbalize it), they feel deeply.

They are also, all too often, overwhelmed. There is too much, everything, everywhere, from everyone. In reaction, they snail in, lash out, fidget, shut down, alternate being acutely perceptive and deeply numbed out. They can have spectacular tantrums, meltdowns for seemingly nonsensical slights, go from happy to weepy in a blink of an eye. They get all kinds of acronym diagnoses, sometimes rightfully, often not … They can walk through the days feeling raw, exposed, vulnerable, tender, empathetic, perceptive, disorganized and evocative.

Emotional regulation is a must for all children to learn. Without ability to do so and find a place of calm attention–they will struggle at school, in public, in getting along. All caregivers of children are tasked with the teaching and modeling of emotional regulation to the children in their lives. It is even more crucial for highly-sensitive children … who can tax even the most patient caregiver. The sensitive children need more help, much more help, to learn to regulate, to know when they need to take a break, to recognize the beginning of overwhelm and be able to apply a tool for grounding.

They need more time. To play. To rest. To think. To cuddle. To get bored. To dream. To get used to new things. To gather their courage to try. It is a luxury of time all too many of them do not get these days, in our modern world that does not make it easy to be sensitive.

Our world–and within it the education system and children’s schedules–is currently calibrated for very low sensitivity: there is information everywhere and increased pace galore. Blinking screens, beeping car horns and phone messages, jingles of all manners, multi-sensory bombardment, loud, fast, multitasking everywhere. There is stimulation all the time. Every. Where.

Wake up and rush to school, bend over homework in the car to complete what didn’t get done the night before because there was a birthday party and soccer practice. After a long day at school in a class of 30 and no recess or playground because it rained and a two hour assembly in a noisy auditorium followed by lunch in an equally ruckus lunchroom, grab your bag and gobble down dinner on the way from dance to chess before you go home and try to do homework with the TV in the background, someone angry with tech-support on the phone, the vacuum and the dishwasher rumbling along. Get a math problem wrong and dissolve in tears onto a kicking puddle of misery on the floor. It is not the math problem. It is the everything and that little bump of difficulty simply toppled tolerance. Everyday stuff mushrooming to a thunderstorm.

Sometimes I think that sensitive people may be better calibrated for slower life … for long walks from place to place, bigger nature around them, more connection with animals (and their highly regulating energies), more connection to the earth and its calming breath.

It is not how most children grow up anymore, and it is not about going back to lack of modernity (there’s much to be said for running water, electricity, and even the Internet …). However, it is about helping children–especially sensitive children–learn how to stop, pause, breathe, step away, maintain boundaries.

All children need that. Sensitive children need it even more. Their drama-streak, their tantrums, their meltdowns, their whining, begging, shutting-down are all their ways of communicating to us that they need our help to manage. That they are feeling raw and need a hug, a pause, a hand.

What to do?

First what not to do … It is not about ‘helping them grow thick skin’ or expecting them to ‘suck it up’ or ‘toughen up.’ Shame has yet to heal any sensitivity. Expecting one to be what they are not will not resolve anything other than create a distance and thicker pain, not skin.

What does work?

Try to keep things simple. Establish routines and try to maintain them reasonably consistent (we’re not talking OCD here, just predictability). Make time for quiet. At the very least relegate a certain space in the house that is off-screens: a place to read, do homework, dream. Be aware of competition–of stimuli, that is–if there is much background noise you cannot control, consider noise-canceling earphones for the child to wear when they need to concentrate. Keep it comfortable: temperature and clothing, yes, but also tone of voice and your own emotional regulation. Sensitive kids pick up on your state of mind and internalize it. It filters in. It gets under their skin. They are too young to manage your adult feelings for you … and they already have plenty of their own. Keep it soothing: quiet cuddling, snuggling together with a book or a few precious moments at the end of day, offer comfort when they are distraught. Let them know you see them, hear them, feel for their discomfort. It is real.

Sensitivity is like a fragile gift. It is precious, it is beautiful, it can light up the room and make for excellent potential. It is also delicate and needs some special care. It calls for careful holding in times of transition. It needs a very safe space, for sure.

Have no worries, if you treat your child’s sensitivity (and yours, if you need to) with care and … yes, sensitivity … you will not spoil them. To the contrary, you will teach them how to control and modulate their hyper-acute-perceptions. They will learn from your attuned care how to keep aware without drowning in information, how to keep empathetic without taking on other people’s needs, how to keep their senses vibrating brilliantly without becoming blinded or overwrought. They will learn from you to take time to breathe, to pause, to consider. They will recognize their own cues and clues and find ways to respond to them healthily.

They will blossom like the rare delicate beings that they are. Come fully wonderfully into their own. Sensitivity seen, understood, utilized, known.

What Do Babies Think? An excellent Ted Talk

June 13, 2014Na'ama Yehuda Video Articles and references, Good stuff!, Resources and links, Things Kids Say Tags: Alison Gopnik, babies, development, Logic, NaamaYehuda, Scientific thinking, Ted Talks, Video, What do babies think Leave a comment

An acquaintance once stunned me and a colleague when she noted she believes that, “babies are basically a lump of meat just lying there until they are 10 months old.”

After I collected my jaw from the floor, I went on a long winded explanation (okay, tirade …) about all the things that we know and that prove infants are anything but lumps of meat until they reach 10 months old. In fact, they are active learners and interactively relating beings from the very moment they are born. Babies are so visibly actively engaged that I recall my absolute incredulity at the very notion that anyone can think them “lumps of meat just lying there.”

Well, they are not “just lying there,” not one iota so. Don’t know how the notion got into this acquaintance’s head, but she was wrong.

This fabulous Ted Talk is a great (and I admit far less tirade-like) way of explaining some of how they are very much the opposite. It is well-worth listening to. In it Alison Gopnik describes some things you may not think babies can do, as well as how they might be doing them.

Oh, and don’t miss the adorable ‘little scientist thinker’ video embedded in her talk. He defines “cute”!

What Do Babies Think?

http://www.ted.com/talks/alison_gopnik_what_do_babies_think?

Dreams–Fabulous exercise re-blogged

June 10, 2014Na'ama Yehuda Articles and references, Good stuff!, Quotes, Reflections, Resources and links Tags: Adele and the Penguin, Dreams, Exercise, Fun, NaamaYehuda, play, Quote, reblogged 2 Comments

How about a dream exercise?

Check out this latest fun and fabulous post from Adele Ryan McDowell’s excellent blog:

http://adeleandthepenguin.com/how-about-a-dream-exercise/

And to send you happily along your way,

a little blessing if you may …

“May your dreams be filled

with laughter and play

to last you through

the merriest day!”

[Na’ama Yehuda]

“A” is for Average?

June 9, 2014June 9, 2014Na'ama Yehuda Anecdotes of Life, Articles and references, Reflections, Resources and links, Speech Language Pathology Tags: Average, Excellence, Good grades, GPA, Inflated Grades, NaamaYehuda, Normal distribution, parenting, speech-language-pathology, Testing Leave a comment

The woman on my answering machine sounded anxious: “I got your name from a friend of mine. You come highly recommended and you really helped her kids. I know you are really busy but can you please call me back about my child? I have a 5th grader who really needs your help.”

I called her back. Based on her wording–and her urgency–I fully expected to hear details about a child who is falling behind academically. A child with teachers worrying about difficulty with vocabulary, comprehension, attention, expressive writing, memory, fluency, or a combination. Possibly a referral from an orthodontist about tongue thrust issues, or about stuttering. Or hearing remediation.

The mother’s pleading was real enough, but the cause for it surprised me (though it ought not to–this is not the first time!): Her son, entering 6th grade in the fall, was receiving “only B+ and A-” on his reports and tests. She wanted “to give him some extra help so he can do better at school.”

Being a clinician, I don’t see children unless there is cause to see them. Normally developing children don’t usually need speech-language-therapy. Still, sometimes parents don’t know how to exactly explain the difficulties their children are experiencing, so to be sure there is no issue needing remediation, I probed some more: was there a particular reason she thought he should be better than he was already doing? What were her son’s strengths and weaknesses, did he receive assistance in the past? Though the child’s grades were very respectable, especially for a highly competitive private school, grades don’t tell the whole story about a child’s abilities. Also, some children can be good students and still perform below their actual potential because their actual ability is excellent, not average. It is important then to find out what holds them back. Was that the issue here? Why would a mother worry about a child’s basically good–if not exceptional–academics?

From the information the mother provided, it seemed that the child’s ERBs were average and that his IQ test (which had been required for his school admission at the time), showed average abilities in both verbal and performance measures. His vocabulary scores have always been age-appropriate. He conversed well in two languages, and read voraciously. The child was solidly within the 60th percentile or so in all measures. Moreover, the mother reported that he is a happy, social, kind young man with many interests, who enjoys sports and likes most his teachers. Even by the mother’s own account, the child was doing well.

And yet, as she was seeking ‘help’, apparently not well enough.

There are several issues in why this is a problem. One is that grades can be inflated so that they do not actually reflect a child’s abilities in a race to showcase a higher class/school average than may otherwise be warranted. It doesn’t have to happen in all schools to be a problem. Paradoxically ‘partial inflation’ would even make it worse: if some schools inflate grades and push “B”s to look like “A”s, then a “B” in a school that does not inflate grades can appear a failure in comparison even though the measured ability is the same.

Another problem is that in today’s competitive education and unrealistic expectation for ‘above average’ performance from everyone (a statistical impossibility), even good is no longer good enough. Even a ‘real’ B, is not seen as adequate for a student who may well be a B-student. Average is unacceptable. Excellence is required. B and A- are not sufficient. Especially not when there are the of A+ and even A++ or A+++

In a timely article in CounselingResource, Gordon Shippey, a Licensed Professional Counselor from Atlanta, touches on this very topic, as well as the realities of grade inflation. His article, “A is for “Acceptable”, is a must read.

Among many other things, Shippey notes: “If A was acceptable, there would need to be A+, A++ and A+++. In fact we’d need as many different gradations as could reasonably be detected. This would give exceptional students something to aim for beyond “A.”

Actually there ARE already the A+ and A++ and A+++ as realities in some schools. Students now no longer aim for 100 on a test (that became ‘merely acceptable’) but feel the pressure need to get ’105 or 110 or more for ‘bonus’ or a ‘truly well done job.’ It may give excellent students some margin of distinction, but it does not release the squeeze on others, for whom even an “A” no longer seems okay.

When I went to school, 100 was as high as you could get. It meant perfection. It meant no errors, best performance. Full stop. Now 100 is ‘almost best’ and ‘almost excellent’; and an A paper or even an A+ paper does not equate with remarkable.

The bell curve did not shift, but the names we call each place on the curve did. A no longer depicts a small portion of children with superior performance (7% or so, of students). Now A is for Average.

Normal Grade Distribution Curve

There is something seriously wrong when average performance for an average student is looked at as failure. Average children are not stupid. Average means “as expected.” Average means “okay.” Children with average school performance are presenting skills equivalent to what is expected of the majority of children their age. Expecting all children to be ‘above average’ is not realistic. Pushing a good-effort B student to get only “A”s (and above) is a recipe for stress and worry, for frustration, disillusion, anxiety.

I certainly understood the mother’s plea. She was being carried along in the currents of requirements and expectations Shippey speaks about, and she believed–and her belief was strongly reinforced by teachers’ notes, societal pressure and the higher-education reality–that it was required of her child to be remarkable. Remarkable is the new ‘expected.’

Grades used to be a measure of a child’s ability and effort. We rightfully demanded that children to do their best and put an honest effort, but it was pretty clear that not everyone could be at the top of the class. By definition, this cannot be.

Nowadays, grades are not so much a measure of a child’s ability and effort as they are an artificial soup made of an (often unfair) measurement of a teacher’s skills, a school’s ranking and a district’s relative superiority. Grades are measured for political gain and their manufacture sustains a multimillion industry of ever reinvented ‘teaching programs’ (and recently, ‘common-core’ goals), which are rarely developed by educators. Grades are big business. Less so about the kids.

The saddest part is, that children know it.

Children always sense unfairness or hypocrisy, they may not know to explain it but they feel when they are in a halls of mirrors. They realize that they are cogs in a machine. They perceive that they are being measured by academic yardsticks that do not really measure them and yet they are to be judged solely by.

The system needs to change. It is unhealthy, and children are reflecting it–in anxiety, depression, disillusion, burn-out, anger, attitude, apathy, a sense of invisibility and impossible demands.

In the meanwhile, the dilemma of this mother (and many other parents)–and in a way mine as a clinician who can hone a child’s ability or give them a leg up–is whether to feed into the system and push that child forward. Whether to put him into intense tutoring and ask him to perform beyond his skills and at the price of other areas of development; or leave him to learn at his normal (if average) rate and enjoy his childhood at the price of his potential future.

If it were your child, your potential client, what would you have done?

Keeping Children Safe–a how to resource!

June 8, 2014Na'ama Yehuda Anecdotes of Life, Articles and references, Good stuff!, Resources and links, Trauma and Development Tags: Communication, education, Empowering Our Children, infancy to adolescence, Keeping children safe, NaamaYehuda, parenting, Sexual abuse prevention, themamabeareffect 2 Comments

When it comes to keeping children safe from sexual abuse, many parents are baffled as to what to do. They don’t want to scare their children or give them ideas about the world being unsafe, and at the same time worry that lack of safety skills may place their children in danger of being exploited.

Parents don’t know when to start, how to bring the topic up, what to say (and what not to say). Many prefer to not bring up the issue at all, or focus only on ‘stranger-danger’–even though 90% of child sexual abuse happens in the hands of people familiar to the child (and upward of 75% by caregivers). It is difficult to conceive that children can be harmed this way. No one wants to believe that people they may know could be unsafe. We want to believe we can keep them safe from everything and everyone. Always. Moreover, the whole issue can bring up painful memories in those who pushed away their own experience of inappropriate touch.

Embarrassment, too, often complicates caregivers’ discourse about sexual abuse, as does worry about questions that one may not know how to respond to or that would raise issues of immodesty.

Even among those parents and caregivers who do discuss safety and sexual-abuse prevention, many don’t realize that keeping children safe goes beyond a one-time ‘talk’ about the topic.

Fortunately, there are resources like the one below, which do an excellent job introducing the issue of safety and body boundaries in children, from infancy through to adolescence. It is a very good place to start!

If you are a parent or a caregiver–read it. It may give you information or suggestions you did not think of before. If you are not a direct caregiver–share this with others who are. They will thank you. More importantly, the children would be safer.

http://www.themamabeareffect.org/empowering-our-children.html

Of course, children’s safety extends well beyond sexual abuse prevention. Verbal and physical abuse, bullying, and neglect are other sad realities for all too many children. We all should be vigilant to notice, intervene, and seek help for any child at risk. Any risk. It is our responsibility as adults to do so.

This resource, and other educational and practical tools for improving child safety are only one step and target certain risks, but are still immensely important to read and incorporate. This offers a very good start. Following these recommendation can help.

The reality is that even with all the information and education possible, we may not be able to stop some things from happening once. However, with good information and open communication, we can at the very least teach our children what to listen to (and what not to listen to or believe), and we can reinforce clearly how they can come to us with any discomfort, concern, worry, or imposed secret. This can help can minimize the likelihood of the unwanted happening. Just as important if not more–by providing children with good, ongoing, open communication about their bodies, their right to safety and honoring their intuition–we can ensure that what might happen will not escalate and will not happen again. Because they’ll come to us. Because they’ll tell. Because we will make it stop.

Click. Read. Learn. Share.

http://www.themamabeareffect.org/empowering-our-children.html

ADHD or Trauma?–The Likelihood for Mistaken Diagnosis

May 14, 2014May 14, 2014Na'ama Yehuda Articles and references, Resources and links, Speech Language Pathology, Trauma and Development Tags: ACEs, ADHD, Article, Brain, Children's Health, Diagnosis, Healthline, Hypervigilance, NaamaYehuda, Research, Therapy, Trauma 2 Comments

A new study shows that a child with an ADHD diagnosis is more likely to have also experienced stress and trauma early in life.

Clinicians working with traumatized children and adolescents have long noticed–and noted–that it was not unusual for children with trauma histories to be diagnosed (and possibly all too often misdiagnosed) with ADHD.

What complicates the clinical picture is that a child can have ADHD and trauma history (or Autism and trauma history). In fact, children with ADHD and children with communication disorders are more likely to be maltreated than children without these issues.

As the article below states, and what is very important to take into account, is the need to rule out trauma as the cause–or contributor–to the child’s clinical presentation, rather than simply assume that a distracted, inattentive child has ADHD. Assessment needs to address the possibility of trauma, and intervention approaches must be adjusted accordingly. For example, medication for ADHD may not be appropriate for a child whose inattentiveness is due to hypervigilance. It is crucial to ensure that past trauma be treated and ongoing trauma be addressed, so that the child can let go of the coping skills adopted to manage overwhelm.

The article is copied below. You can also read it on the original webpage by clicking on the title below. For more information about trauma and development, click here.

News Analysis: Are We Misdiagnosing Childhood Traumas as ADHD?

http://www.healthline.com/health-news/misdiagnosing-childhood-trauma-as-adhd-050614

Children with attention deficit hyperactivity disorder (ADHD) receive a diagnosis based on their behavior: age-inappropriate fidgeting, inattentiveness, hyperactivity, and trouble sitting still and concentrating. However, according to new research presented today at the Pediatric Academic Societies annual meeting in Vancouver, Canada, these behaviors may also be linked to childhood trauma.

A research team analyzed data about 65,680 children ages 6 to 17. (The data was taken from the 2011-2o12 National Survey of Children’s Health.) The children’s parents answered questions about whether their kids had been diagnosed with ADHD, how severe their symptoms were, and whether they were taking any ADHD medications. The parents also reported on whether the children had had any of nine adverse childhood experiences (ACEs): poverty, divorce, the death of a parent or guardian, domestic violence, neighborhood violence, substance abuse, incarceration, familial mental illness, or discrimination.

“Diagnoses of ADHD have increased over the last decade, and there has been a concomitant rise in stimulant medication use,” said Nicole Brown, an assistant professor of pediatrics at the Children’s Hospital at Montefiore and lead author of the study, in an interview with Healthline. “Many of my patients also experience trauma during childhood, which often exacerbates ADHD symptoms and poses diagnostic challenges with respect to teasing out whether their symptoms directly result from the trauma they experience.”

About 12 percent of the children who participated in the survey had been diagnosed with ADHD. Parents reported that these children had also experienced higher rates of all of types of ACEs than children without ADHD.

The children with ADHD were also more likely to have experienced a greater number of adverse events. Seventeen percent of children with ADHD had experienced four or more ACEs, as opposed to 6 percent of children without ADHD. The children who had dealt with four or more ACEs were almost three times are likely to be using an ADHD medication as children with three or fewer ACEs, and their parents rated their ADHD as being more severe.

ADHD and Trauma: The Chicken and the Egg

How is ADHD connected to stress and trauma? There could be a number of explanations.

First, it’s possible that doctors are simply mistaking the signs of trauma in children for ADHD. “What we find is that there is often an overlap in the symptoms of children who have ADHD and children who have experienced trauma, particularly small children,” said Alicia Lieberman, professor and vice chair for academic affairs at the University of California, San Francisco, Department of Psychiatry and the director of the Child Trauma Research Program at San Francisco General Hospital, in an interview with Healthline. “The inability to concentrate, the fidgetiness, the inability to pay attention, the distractibility, the restlessness, and the irritability are often behaviors that trigger a diagnosis of ADHD. And often, the people making the diagnosis do not ask what happened to the child, what kind of experiences the child has had.”

Brown agrees that this may explain her findings. “Studies have also shown that symptoms of post-traumatic stress disorder (PTSD) or acute stress disorder resulting from adverse life events closely resemble ADHD symptoms, so there is a high likelihood for clinicians to diagnose ADHD and overlook a possible trauma history,” she said.

Another explanation is that children with ADHD may be more likely to get into trouble and to experience traumatic events as a result. “Children with ADHD can become more impulsive, can be more annoying to parents that might be depleted, so children with ADHD might be at greater risk for being maltreated or getting into accidents, which might in turn trigger PTSD,” explained Lieberman.

Finally, researchers know that stress in the early life environment might affect the development of the brain. “It’s also possible that being exposed to a traumatic event increases the likelihood of developing psychiatric disorders that have a range of manifestations, including anxiety, post-traumatic stress disorder, and ADHD,” Lieberman said.

“When a child is presenting difficult behavior, the first thing to ask is ‘What happened to the child?’ rather than ‘What is wrong with the child?’”

Under this lens, ADHD is only one of many possible outcomes that can result from early-life trauma. And even then, ADHD might just be a sign of what’s to come. “We know that early life adversity produces developmental changes consistent with ADHD, but it produces many other effects as well,” explained Regina Sullivan, a professor of child and adolescent psychiatry at the New York University School of Medicine. “As a child is developing, and there’s a neurobehavioral deficit, how that is expressed changes during development. ADHD can sometimes be symptoms of neurobehavioral problems that will emerge later in development.”

Sullivan added, “Early life trauma and stress can interact with genetics to produce different disorders based on the age the trauma was experienced and the particular type of stress or trauma. Different-aged children, and children with different genetics, and children with different personalities, will respond differently to a given stress.”

Are We Medicalizing Stress?

Rising rates of ADHD diagnosis and medication use raise the question: are we turning normal levels of life stress into a medical condition? Lieberman points out that more than 60 percent of children report that they have been exposed to some kind of victimization in the previous year, and more than 10 percent have had five or more exposures. For many children, ACEs aren’t rare, they’re the norm.

And when kids are under stress, they’re more likely to act out. “When a child is presenting difficult behavior, the first thing to ask is ‘What happened to the child?’ rather than ‘What is wrong with the child?’” said Lieberman. “The recommendation that the authors of the study make about the importance of screening for trauma exposure in every child that is showing symptoms that can be associated with ADHD is extraordinarily important and timely.”

In these circumstances, medications probably aren’t the answer. “While stimulant medications may prove beneficial for some children, they may not be the most effective management strategy for all children,” said Brown. “Children with ADHD diagnoses who have experienced trauma may additionally benefit from specific behavioral interventions that are tailored to addressing their underlying trauma histories.”

However, Sullivan cautions against drawing too many conclusions about a child’s past from his or her diagnosis of ADHD. “Not all children with ADHD have had early life adversity,” she said. ADHD also isn’t necessarily a sign of other disorders to come. “Sometimes, when someone has ADHD, they maintain those ADHD symptoms throughout life, changing somewhat, but they still have the diagnosis of ADHD.”

It will be many years before the root causes of ADHD are fully understood. Until then, doctors must try to figure out which symptoms are caused by trauma, while also ensuring that children with ADHD get proper treatment for the disorder itself.

Pendred Syndrome–a Query

May 6, 2014May 6, 2014Na'ama Yehuda Articles and references, Queries, Resources and links, Speech Language Pathology Tags: Audiology, Balance, Deafness, Diagnosis, Genetic, Goiter, hearing loss, Information, NaamaYehuda, Pendred Syndrome, Query, speech-language-pathology 4 Comments

A query from a parent:

“My son was just diagnosed with Pendred syndrome. He already has hearing aids from when we discovered he has hearing loss when he was 8 months old, but he needs stronger ones now because his hearing got much worse. The doctor said that he may end up deaf and that we need to check his thyroid, too. My son is already getting PT with early intervention because he is not walking yet at 18 months but we’re going to put him in speech therapy, too. What is Pendred syndrome and is it true my husband and I gave it to him? Will the therapy help with his hearing? There’s so much technical stuff and I’m really worried.”

Dear Worried Mom,

Of course you are worried. It would be overwhelming for any parent to have their child diagnosed with a problem, let alone one that can continue to affect them and that may change with time. A good step is to seek more information–as you are doing now, and hopefully will continue to do.

I’m glad that your son is already getting amplification (i.e. hearing aids) and that they are going to be adjusted/changed to reflect the change in his hearing–this is very important, and is a big step of helping him develop the best way possible. Am glad that he’s getting PT, too, if his motor skills can use some help; and that you are going to begin Speech-Language-Therapy with him, to ensure he makes the most out of his hearing and that his speech and language can develop as well as possible.

I hope that your pediatrician and the clinicians you’ll be working with (in Early Intervention, the ENT, the Audiologist, etc) will refer you to more information about Pendred syndrome, hearing loss, and rehabilitation of hearing loss in young children. Do let them know you are concerned and discuss your worries with them–I am quite confident that they will have resources, support, and more specific answers for you.

In the meanwhile, here’s a summary of some of the main features and issues in Pendred syndrome. This is not in any way a comprehensive review of Pendred or what the course of it would be in your son’s case. Nor is it a specific recommendation as to what to do in your son’s case, but I hope this overview will nonetheless give you some information to start with.

Pendred syndrome is a genetic disorder that causes early hearing loss in children. The syndrome is named after Vaughan Pendred, the physician who first described people with the disorder. It is actually the most common syndromal form of deafness in children–it is estimated that Pendred syndrome accounts for 5-10% of hereditary deafness cases! It is an autosomal recessive disorder (which basically means that both parents need to be carriers of the recessive gene–but the parents often have no symptoms and often don’t know that they carry the gene), and is associated with abnormalities of the cochlea, sensory-neural hearing loss, and diffuse thyroid enlargement (goiter). It can also sometimes create problems with balance.

Children who are born with Pendred syndrome may begin to lose their hearing at birth or soon after birth (like in your son’s case), and often lose hearing by the time they are three years old. The hearing loss is sensory-neural in type. When hearing is present at birth, it will usually worsen over time, with some children with Pendred syndrome becoming totally deaf (but not all, some children do have residual hearing or a lesser hearing loss). The hearing loss in Pendred syndrome is usually bilateral (in both ears), although one ear may have more hearing loss than the other.

Childhood hearing loss has many causes. Researchers believe that 50 to 60 percent of cases are due to genetic causes, and 40 to 50 percent of cases are from environmental causes (e.g. substances that damage the inner ear, such as certain antibiotics or chemotherapy medications).

The first part of a diagnosis of Pendred syndrome often includes the discovery of a hearing loss via a child failing a screening test or the presence of a hearing loss being found. Not all hearing loss in childhood is related to Pendred Syndrome, so the clinicians evaluate many things before considering the diagnosis and it can indeed take a bit of time before things are known for sure. Things like the kind, timing, amount, and pattern of hearing loss; the anatomy of the inner ear structures; the child’s balance and thyroid, etc. All these can help the health care professional determine whether to seek genetic testing and imaging tests for the inner ear, and to conclude whether a child has Pendred syndrome or some other type of progressive deafness.

Pendred syndrome can make the thyroid gland grow larger (when a thyroid gland grows too large and can visually bulge on the lower neck, it is called a goiter). The thyroid is a small, butterfly-shaped gland in the front of the neck, just under the ‘Adam’s apple’ and just above the collarbones. It plays an important role in the way the body uses energy from food, as well as in normal growth and development. Some thyroid issues in childhood (e.g. Grave’s Disease) can cause growth problems. However, in Pendred syndrome children often develop properly even if their thyroid is affected and their levels of thyroid hormones are usually normal. Not everyone with Pendred syndrome gets a goiter, and it typically develops in adolescence or early adulthood. Not all goiters are problematic, but if a goiter becomes large, it can impact breathing and swallowing and then treatment may be necessary. So an endocrinologist (doctor trained with diseases and disorders that involve the hormonal/endocrine system) is probably a good person to get involved even if only for followup.

By the way, it is still not clear to scientists why some people with Pendred have more issues than others (e.g. some have goiter and others don’t).

Alongside hearing loss, Pendred syndrome also can affect the vestibular system, which is the system which controls balance. The good news is that most children and adults with Pendred learn to adapt to whatever vestibular dysfunction they have and can manage routine tasks and daily balance requirements well. That said, because of the vestibular issues, some babies with Pendred syndrome may start walking later than other babies.

To get a bit technical: It is believed that Pendred syndrome is caused by mutations (i.e. changes) in a gene called SLC26A4(formerly known as the PDS gene) on chromosome 7. To be born with Pendred syndrome, a child would need to inherit two mutated SLC26A4 genes—one from each parent. Because it is a recessive gene, the parents are only carriers of the mutation (i.e. they don’t have the syndrome themselves). In a family where both parents are carriers, a child has a chance of 1:4 to be born with Pendred, and a 1:2 chance to be born a carrier. It is often recommended that if people are concerned about the possibility of Pendred (e.g. in a child or future children) that they seek genetic testing and counseling.

The anatomy of the inner ear is often viewed through imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT), which allows viewing the cochlea and the vestibular system. The cochlea is the spiral-shaped part of the inner ear that converts sound into electrical signals that are then sent along to the brain through the auditory nerve. A healthy cochlea has two-and-a-half turns, but some persons with Pendred syndrome may have a cochlea with only one-and-a-half turns. The vestibular system includes a part called vestibular aqueduct. It is a kind of a bony canal that runs from the vestibule (the part of the inner ear between the cochlea and the semicircular canals) and the inside of the skull. Inside the vestibular aqueduct there is a fluid-filled tube called the endolymphatic duct, which ends with a balloon-shaped sac. People with Pendred syndrome may have an enlarged vestibular aqueduct, and the endolympatic duct and sack may also be enlarged.

Below is an image of the inner ear in some people with Pendred syndrome, taken from: http://www.nidcd.nih.gov/health/hearing/pages/pendred.aspx

When it comes to helping children with Pendred: First of all, to minimize the risk of worsening hearing loss, children with Pendred syndrome may be advised to wear head protection when engaged in activities such as bicycle riding and skiing (to avoid trauma to their head). They may be advised to avoid contact sports or situations that can lead to extreme, rapid changes in pressure such as scuba diving or hyperbaric oxygen treatment.

Like with your son, the treatment of children with Pendred syndrome indeed often involves a team of specialists. These could include an audiologist, speech-language-pathologist, otolaryngologist, endocrinologist, geneticist, physical therapist, and primary care physician. Not all need to see the child all the time, and not necessarily throughout childhood, but it is always good to have those who are working with the child communicate with each other as need be so that they can coordinate goals and needs and work as a team. Don’t be shy about asking professionals to collaborate–they can’t and won’t do so without your consent.

Hearing amplification (hearing aids, and for those who need them: cochlear implants) can greatly minimize the impact of hearing loss on language and development. Children with Pendred syndrome should start early treatment with a speech-language-pathologist, to help gain communication skills and learn how to maximize their use of their hearing aids or cochlear implant. So I think it is probably an excellent thing for your son to begin with an SLP now, when any gaps or difficulties, if there are any, hadn’t had a chance to grow wide. In addition to hearing rehabilitation through working on discriminating, identifying, understanding, and processing sounds and language better, speech-language-pathologists can also help children with Pendred syndrome with speech, voice, and language development. The hearing itself may not be made better, but how the child used the hearing they have can be get a lot better with treatment. Treatment can help minimize the impacts of hearing loss on development, language, communication, and learning. Physical therapy can help with balance issues, and help aid with motor-goals (such as walking, and later running, climbing, and so on).

It seems that your son is already up to a good start, by having a parent who is interested in getting more informed about his condition and who is seeking to follow through on the best treatment plan for him. I wish you and your son all the best, and a lovely, joyful, satisfying healthy childhood.

Happy Flying!

April 18, 2014April 18, 2014Na'ama Yehuda Anecdotes of Life, Articles and references, Good stuff! Tags: belief, children, compassion, Creativity, Loss, Magic, Principal, school, Tooth-Fairy, Vancouver Leave a comment

This is the sweetest story of an eight year old with a lost tooth and an obliging tooth fairy, but most of all, it is the story of a principal who understood, and did what he could.

And that, as we know, is a lovely whole lot!

Here is the story from Vancouver:

Principal Writes Letter to Tooth Fairy

A letter from a B.C. principal to the Tooth Fairy on behalf of an eight-year-old girl has gone viral after it was posted on the school’s Facebook page.

Avery Patchett is in Grade 3 at James Hill Elementary School in Langley and last week she lost her third tooth during class. Her teacher gave her a necklace to help her keep the tooth safe, but when she went outside at recess to play she tripped and fell, knocking the tooth into the dirt.

“When I was running up the stairs, maybe my tooth necklace was loose,” said Avery. She was upset that she had lost her tooth as she wanted to give it to the Tooth Fairy that night.

“When I tripped and lost it, I lost it forever,” she said. “I looked a couple of times and I still haven’t found it because the tooth looks like rocks.”

That is when her principal, Chris Wejr, stepped in to help.

Avery came to him crying about what had happened. “She was upset because she had lost her lost tooth and she was worried the Tooth Fairy wasn’t going to come,” said Wejr.

“I said ‘well, I’ve sent a letter to the Tooth Fairy before and it worked’ and I said ‘what do you think about us sitting down and writing up a formal letter with our logo on it and everything and giving that to the tooth fairy?’”

So they wrote a letter together and Avery took it home to give to the Tooth Fairy.

“She gave me five dollars,” she said.

Wejr had previously helped a student at his former school through a similar experience and said it is important to help kids in this way and to share these stories. When he posted the letter on the school’s Facebook page, it immediately generated a huge response.

“It shows that people want to hear the positives,” he said. “There’s so many incredible caring moments that happen in schools every day and they don’t get shared, so we try to share the positive moments that happen at school once in a while.”

Avery’s mom Debbie said she did not expect this at all from her child’s principal. “I just thought, ‘wow, it’s a really nice gesture’,” she said.

“He took something really small and made this a memory for her that will last forever, and it is a small gesture, but it means everything,” she added. “We hear so many horrible stories every day, it’s nice to hear this story, this small little story, this little gesture.”

Wejr said the lesson here is that sometimes adults need to stop and make sure they show kids they care and help them in moments of distress.

“Sometimes the small things can really have a large impact if we just take the time,” he said.

To see a video clip of the story, click here.

Clapping, singing, and Peek-A-Boo

April 8, 2014April 8, 2014Na'ama Yehuda Anecdotes of Life, Articles and references, Resources and links, Speech Language Pathology Tags: activities, advice, Child Development, everyday suggestions, language development, parenting, questions, speech-language-pathology Leave a comment

A query came from another young mother:
“I have a six-month-old baby and I’m a single mom without much money to take her to mommy-and-me classes and such. Are there games or activities I can do with my baby at home to help her language development? She’s healthy and doing everything she’s supposed to do at this age, the doctor says. Thanks, Doing My Best.”

Dear “Doing My Best”,

It sounds to me like you are on the right path already by even wanting to know how to do more with your little one! Being a single mom is difficult, let alone having limited funds. The good news is that you don’t need to spend money on classes and expensive toys and gadgets–YOU, and things you already have at home, are the best ‘tools’ for your baby–you likely have everything you need already!

Babies have an innate ability to develop language, and are marvels in how they manage to make meaning of the world around them. Almost all they need for it is you and exposure to language through you–their caregiver. She needs your attention, sensitivity, time, and commitment. There are many things you can do during your everyday activities with her that would foster comprehension, listening, turn-taking, sound production, connection, shared attention and cognitive development–all the makings of language and communication development.

Language exposure is important, so talk to your child about everything you do. Use her name when you call her, look at photos of herself and yourself and other people she knows–point to the photos and tell her who these are. Books are great, as well. Read to her every night–it is never too early to start and make it a habit. Board books are sturdy and great fun, and you can let her turn the pages if she wants (lift-flap books where she can ‘find’ things are fun, too).

You don’t need to buy many books–maybe just get a few favorites. Borrow the rest at the library. Take her with you if you can and choose the books together. Make this part of your fun time. You don’t need to read every word in a book, either–flow with it, narrate the pictures, respond to her reactions (e.g. “yes, you are touching the lion, that’s the lion and he can roar… and that’s the giraffe, look how tall it is! It can reach all the way up in the tree!”). Make book-reading part of your connecting and listening time.

Everyday activities are excellent opportunities for language exposure: narrate whatever you are doing together, when you are out on a walk, in the playground, food shopping, or doing household chores (she can help …) such as folding laundry, straightening up, or mushing cooked veggies for her food (“Oh, here’s your red shirt! Let’s fold your shirt so we can put it in your drawer. Look how nice and clean it is! Now…where are your socks–here’s one sock, and here’s the other… You want to hold the socks? Here you are. Oh, aren’t you smart! You know they go on your feet! Let’s put them on–one sock on this foot, and another sock for that foot …”) etc.

Take turns by playing games like peek-a-boo, clapping, nursery songs that have predictable body movements (the wheels on the bus, itsy-bitsy spider … borrow a CD from the library if you don’t remember them, you’ll know them by heart in no time…). Take turns banging on things to make noise together (you don’t need to spend money on a drum, an upside down pot with a spoon works great, too …), build a ‘tower’ from a few blocks and knock it down, then build again and let her knock it down (plastic cups or containers work well. You can fill closed containers with some dried beans of pasta if you want–for heft and sound–just make sure they are sealed tight!). Babies love repetition, so be ready to do this quite a few times.

You can roll a ball back and forth, pick up toys together (it may take a while, if she decides that taking out of the box is just as much if not more fun!), hand her spoons to put in the drawer, fill and empty a basket of lemons or oranges (no items smaller than a Ping-Pong ball, because they can be a chocking hazard), fill and empty a cup with water during bath-time.

Model symbolic play: ‘feed’ the stuffed animals and dolls with a spoon, put them to bed, ‘offer’ them a bottle. Put them in the stroller and take them for a walk in the house, play peek-a-boo with the dolls and let her have a turn, as well.

Through it all, talk to her. Listen to what she is ‘saying’ (babbling…) back. Comment about what you are doing. Comment a lot about what she is doing, her expressions, the sounds she’s making, how she might be feeling, how she makes you feel. Praise her for achievements (picking up a cheerio and managing to get it into one’s little mouth is no small feet of coordination!), let her know you are interested and that she is interesting, lovable, adorable, and fun.

Language development is closely related to and develops right alongside cognition, motor ability, sensory ability, listening, and understanding things about the world (e.g. you let go of the spoon with sweet potato on it, and it falls on the ground, making pretty splatter…! Mommy picks it up and wipes the floor, and when you let go of it, it falls again! How fun!…). Use your everyday interactions with your little one to comment on your world and hers, on your shared experiences. You don’t need commercial specific toys: let her play with wooden spoons, plastic containers (these can nestle, and you can also put things in them…and take things out…), an empty seltzer bottle with some pasta in it, pots and pans. A dish-towel makes a great ‘peek-a-boo’ cover, and a blanket for the teddy bear, too.

Babies and toddlers are utterly and preciously amazing. She’s already learning every day, and you have the opportunity to be her most important connection, attachment figure, playmate, and teacher–all in one. Enjoy her, and I wish the two of you oodles of fun!