parenting

RECENT POSTS

Son, Mom, Psychiatrists Reflect On Finding Your Own Way With ADHD

Peter and Ellen Braaten (courtesy)

Peter and Ellen Braaten (courtesy)

Peter Braaten, now 20, still retains an indelible third-grade memory of being unable — simply unable — to stay seated in a reading circle. “And I just started walking around, because that’s what made me feel okay at the time. And the teacher said, ‘No, sit down, sit down.’ And I basically just couldn’t sit there, because I felt unsettled at the time. And I just couldn’t read, I wasn’t getting into it, so I kept pacing, kept pacing…”

Ellen Braaten, PhD, Peter’s mother and the chief child neuropsychologist at Massachusetts General Hospital, is an expert on Attention Deficit Hyperactivity Disorder, but that doesn’t mean it was easy to cope with it in her son. She recalls the “humbling” experience of going to IEP — Individual Education Program — meetings with school staff as a parent rather than an expert: “Peter has seen me in IEP meetings where I’ve had to yell at them…”

They share their experiences in the podcast above with Dr. Gene Beresin, director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital, and the Center’s associate director, Dr. Steve Schlozman, who treated Peter. One central message from the podcast, Dr. Beresin says: “As with every psychological problem, we all have to find out what works for us. Because what works for one person is not necessarily what works for all. There are no magic bullets. No platitudes. No simplistic answers.” But Peter is now earning all A’s in community college, helped in part by academic coaching and regular exercise. The post below supplements the podcast above.

By Peter Braaten, Ellen Braaten and Gene Beresin
Guest contributors

Peter:

One of the most difficult things for me about being diagnosed with ADHD (especially at such an early age) was understanding this as a helpful push in the right direction. It was very hard for me to appreciate what a “diagnosis” means. Does it just mean a guide for treatment? Well, that might be fine for a doctor, but in my experience it is not good guide for others. In some ways, it significantly influences the ways others view you. Some understand what it means, while others don’t — some adults around me did not even believe it exists or just seemed to disregard it.

‘I have gotten in trouble more times than days I’ve lived on this planet.’

Context is what I find difficult with this diagnosis. It is really something that affects every aspect of your life, which is why it is so hard for other people (teachers, parents, etc.) to understand what it means for an individual to have ADHD. A diagnosis in itself does not inform others around you what tasks are easy or difficult. It does not differentiate effort levels. So for me, some activities have been pretty easy to accomplish, while others are very hard, if not impossible, without some kind of coaching. And the amount of energy that it takes me to do different projects is highly variable. But only I know this, and a teacher, parent, friend might not know what I am going through — they are not living my life.

We live in a world where results are everything. Too often I have been told to just ‘try harder.’ Well, ‘trying hard’ just doesn’t cut it anymore – it is not so simple if you have ADHD, and especially if you have problems with organization in some tasks. I have gotten in trouble more times than days I’ve lived on this planet because I complete 85% of an assignment, task, or any kind of job. And then when I just cannot do the rest, others around get angry, frustrated, or don’t understand. And worse, I get really down on myself! Continue reading

Work-Family Crunch: Parents Resort To ER To Get Kids Back Into Daycare

(Bob Reck via Compfight)

(Bob Reck via Compfight)

Some of the tension between work and family is inevitable. If your child comes down with the flu on the very day you’re supposed to give a major presentation, there’s just no way you can be everywhere you’re needed at the same time.

But a study just out in the journal Pediatrics shows that the discrepancy between the sick-child policies at many daycare centers and accepted medical wisdom could often make the work-family crunch harder than it has to be. (Meanwhile, a day-long White House “summit” today is looking at ways to ease that crunch for American parents, from promoting more flexible work schedules to paid maternity leaves.)

From the study’s press release:

Substantial proportions of parents chose urgent care or emergency department visits when their sick children were excluded from attending child care, according to a new study by University of Michigan researchers.

The study, to be published June 23 in Pediatrics, also found that use of the emergency department or urgent care was significantly higher among parents who are single or divorced, African American, have job concerns or needed a doctor’s note for the child to return.

Previous studies have shown children in child care are frequently ill with mild illness and are unnecessarily excluded from child care at high rates, says Andrew N. Hashikawa, M.D., M.S., an emergency physician at  C.S. Mott Children’s Hospital. This is the first national study to examine the impact of illness for children in child care on parents’ need for urgent medical evaluations, says Hashikawa.

In the study, 80 percent of parents took their children to a primary care provider when their sick children were unable to attend child care. Twenty-six percent of parents also said they had used urgent care and 25 percent had taken their children to an emergency room.

“These parents may view the situation as a socioeconomic emergency,” Dr. Hashikawa says.

He got interested in this topic, he told me, when he was a med student working in an ER, and one night, a family brought in children who looked fine, they just had a little bit of red in their eyes. “And it was midnight, and I asked them, ‘Why are you here?’ I was just so curious. And they said ‘Well, I’ve got to work, I’m not going to get paid, and I really need a doctor’s note for both my work and for my daycare so I can send them back.’”

A bit more of our conversation, lightly edited:

How much does daycare keep kids out unnecessarily?

There are different ways to look at it…A Maryland study showed that for every one appropriate exclusion (from daycare) approximately five or six were inappropriate exclusions. I did a study from a daycare provider standpoint: If we gave you a hypothetical scenario, how many of these kids would you send home that probably didn’t need to be excluded? It seemed that 57% of kids would be unnecessarily excluded at that point.

The American Academy of Pediatrics has guidelines on when children should actually be kept home, right? Continue reading

Unraveling My Childhood Asthma: Did Motherhood Cure It?

By Sarah Baker
Guest contributor

I recently started singing lessons — a rather mind-blowing pursuit, since for much of my life, singing was out of the question. How can you sing when you can’t even breathe?

At 18 months old, while my dad, mom, older brother and I were driving from Virginia to San Francisco for my father’s new Naval deployment, I started wheezing. The asthma attack landed me in the hospital.

Emergency room visits and hospital stays punctuated my childhood and early adulthood. I could have been a tour guide of any Intensive Care Unit: “Over on the right is a shot of adrenaline, or epinephrine — try that first. If that doesn’t work, try the nebulizer on the left and IV over there.” These visits became so routine that as I got older, I often told the doctors and nurses what medicines I needed: Prednisone. Albuterol. Theophylline. These were the mainstays, but there were many others over the years. I took them in such large doses that one time they made my blood toxic.

Circa 1970: The author, center, with her brother and mother, shortly before the discovery of her mom's fatal brain tumor.  (Courtesy)

Circa 1970: The author, center, with her brother and mother, shortly before the discovery of her mom’s fatal brain tumor. (Courtesy)

Emergency was a word my family understood. My mother was diagnosed with a brain tumor when I was 3 years old; she was 28. For five years, until her death, she battled her disease in and out of the hospital, too. I went to Bethesda Naval and she went across the state to Johns Hopkins in Baltimore. I don’t remember ever seeing her hospital nor do I recall her ever seeing mine.

A Motherless Child’s Stress

Asthma is a disease of the respiratory system. It is serious business. Seneca, the Roman philosopher and Stoic dedicated an essay to it, called “Asthma,” in which he said that of all the ailments he’d suffered, asthma was the worst of them all. “Doctors have nicknamed [asthma] ‘rehearsing death,’ he wrote.

But asthma also has a powerful psychological or psycho-social component; with symptoms potentially exacerbated by emotional stress. As a child, I never realized it, but looking back I see it clearly: for all my suffering, asthma distinguished me. Got me noticed. In a childhood of disorder — marked by my mother’s death, and family chaos and constant moving — my own illness provided order. It wasn’t until the birth of my first child that my symptoms truly ceased. Continue reading

Mom’s Memo To Schools: Please, Make These Random Half-Days Stop

May I share with you the delights of my children’s April school schedule? They get out at 12:40 because of parent-teacher conferences on these days sprinkled through the month: Tues., April 1; Weds., April 9; Tues., April 29. Oh, yes, and just when you thought it was safe, one more on May 7. (Plus they’re off April 18-25 for spring vacation.)

That’s in addition to our new regular Friday early dismissals at 1:40. When we got word of that, one mother I know said to the superintendent, “You must really hate parents.”

I don’t think the administration hates us, but I do think that perhaps we haven’t spoken up loudly enough about the logistical stress these half-days create. And they’re common around the state, from year-round early-release Tuesdays in Newton to April half-Wednesdays in Westwood.

They’re an old tradition. Many of us remember the joys of occasional half days from our own school years. You know, back when our mothers were mostly housewives. Now, virtually all mothers work, and I venture to say that virtually all working parents wish that all our public schools provided universal, affordable after-school care.

(Photo: Rachel Zimmerman)

(Photo: Rachel Zimmerman)

Or at the very least, reliable after-school care on random half-days. At our school, a team of mothers has created a “half-day matinee,” gathering all the children who need looking after for a movie that runs until the normal 2:30 dismissal time. But their altruistic efforts are in danger of being overwhelmed by demand: More than 200 children have been coming to the movies this month, straining even their heroic volunteer powers.

“First-world problems,” you may say, and I’d agree but go a step further: This is specifically a first-world middle-class problem. Continue reading

Marathon Reflection: How To Raise Secure Children In An Insecure World?

Police clear the area at the finish line of the 2013 Boston Marathon as medical workers help injured following the explosions. (Charles Krupa/AP)

Police clear the area at the finish line of the 2013 Boston Marathon as medical workers help the injured following the explosions. (Charles Krupa/AP)

One year ago, on the day of the Boston Marathon bombing, Dr. Gene Beresin shared advice on how to talk to children about the frightening event. Here, a year later, he and Dr. Paula Rauch, a fellow professor of psychiatry at Harvard Medical School, help parents draw broader lessons about how best to help children face such stresses and even grow through them.

By Drs. Paula K. Rauch and Gene Beresin
Guest contributors

For the most affected families, April 15th, 2013 was a life-changing event. For many in our community it produced a lesser, but still significant, set of challenges, and for some facing other family adversity or chronic stresses, it may have seemed like a minor event with little personal impact.

Regardless of how personal or significant the marathon bombing and its aftermath were for you, every one of us will face life challenges within our families and in the larger community. How can we face stressful experiences in ways that support our children’s resilience, and help them grow through those challenges? How do we raise secure, confident children in an uncertain world?

Start small

Children develop confidence and competence by facing new experiences, difficult transitions and unavoidable frustrations throughout childhood. Life continually presents a child with developmental challenges, such as falling asleep alone in a crib, saying goodbye at a new preschool, facing the first day of school with a sea of unfamiliar faces, dealing with a relentlessly annoying peer, being cut from the travel team, and, for some teens, making this month’s tough decisions about college.

It is often tempting as a parent to want to smooth over these challenges, alleviate uncertainty and facilitate a child’s comfort and success. But it is important to recognize that these age-appropriate frustrations and disappointments are essential for building lifelong coping skills. Children need to learn how to manage new and difficult situations, and while parents cannot solve the challenges for a child, they can provide appreciation and emotional support for that child’s efforts. Living through a multitude of such experiences makes the normal feelings of distress more familiar and less frightening.

Face serious challenges together Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading

Why To Exercise Today, Moms: For The Kids, Of Course

mikebaird/flickr

mikebaird/flickr

My 11-year-old daughter recently asked if she could take a hot yoga class with me. My first reaction was negative: it’s too hot, it’s not “fun” and it’s one of the few things I do that’s truly mine — 90 minutes in which I don’t have to worry about anyone else’s needs.

Of course, I said yes. And I’m glad I did. She made it through class, and was totally into it (though she wished there’d been more “tricks” and less pose-holding).

“That was great, Mom,” she said afterwards. “When’s the next class?” And whether she becomes a yoga fan or not, I consider those 90 minutes to be a small gift: another way for me to show her how strong and able a body can be, and how good it feels. It doesn’t much matter if it’s yoga or running or swimming or playing ultimate frisbee — our kids are clearly taking their physical activity cues from us.

A new study out of the U.K. confirms this: researchers report that physical activity levels in mothers and their pre-school kids are directly associated. The study, published in the journal Pediatrics, suggests that interventions to promote more physical activity among mothers (who, understandably, are often exhausted, harried and not great at fitting exercise into busy, kid-filled days) might also benefit their young children.

Here’s some of NPR’s report on the study of 554 mothers and their kids:

Mothers’ increased physical activity boosted children’s moderate and vigorous activity overall…

It’s not entirely clear whether it’s the mother’s activity that influences her child’s, or if mothers are more active because they’re busy keeping up with a playful child, says Esther van Sluijs, a behavioral epidemiologist at the University of Cambridge and the study’s lead author.

But busy mothers don’t have to drop all other priorities to play with their children all day. Van Sluijs says just small changes – walking to the park instead of driving or playing a good game of tag instead of a board game – can make a difference. Continue reading

Must-Read: New Yorker Piece On Newtown Shooter’s Father

Connecticut State Police lead children from the Sandy Hook Elementary School in Newtown, on Dec. 14, 2012. (AP Photo/Newtown Bee, Shannon Hicks)

Connecticut State Police lead children from the Sandy Hook Elementary School in Newtown, on Dec. 14, 2012. (AP Photo/Newtown Bee, Shannon Hicks)

Warning: Do not start reading the gifted writer Andrew Solomon’s New Yorker piece on Peter Lanza, father of Sandy Hook Elementary School shooter Adam Lanza, if you have anything urgent to do.

Once you start, you won’t be able to stop — at first, because you’re hoping for some kind of answer to the unanswerable. Then because you find yourself feeling such pity for this man who could truly have no idea that his son would morph into a monster. (“I want people to be afraid of the fact that this could happen to them,” Peter Lanza tells Andrew Solomon.) And ultimately because it offers the first truly detailed, even intimate look into the Lanza family’s life, and you can’t stop hunting for clues to the ultimate evil, even though you know you’re doomed to failure.

For me, the biggest revelation was that it was not Peter Lanza who chose estrangement from his son. Soon after the December, 2012 shooting, when it was reported that Adam Lanza hadn’t seen his father for two years, I jumped to the conclusion that father had abandoned son, perhaps fueling rage at that abandonment.

But Solomon’s sensitive narration describes the distance as coming only from the son, who, through adolescence, seemed to sink ever further from weirdness — Asperger’s, social isolation — into deep distress and pathology. Adam started refusing to see his father, and stopped returning his emails, and neither parent seemed willing to force the issue. Solomon writes:

I wondered how Peter had felt through this period. “Sad,” he said. “I was hurt. I never expected that I would never talk to him again. I thought it was a matter of when.” He asked, “How much do you accommodate the demands and how much do you not? Nancy tended to, as did I.” Peter added, “But I think he saw that he could control her more than he could control me.” 

And the closest thing I found to a takehome message:

All parenting involves choosing between the day (why have another argument at dinner?) and the years (the child must learn to eat vegetables). Nancy’s error seems to have been that she always focussed on the day, in a ceaseless quest to keep peace in the home she shared with the hypersensitive, controlling, increasingly hostile stranger who was her son. She thought that she could keep the years at bay by making each day as good as possible, but her willingness to indulge his isolation may well have exacerbated the problems it was intended to ameliorate.

Readers, your own reactions?

New Reason To Ban TV In Kid’s Bedroom: An Extra Pound A Year

(Aaron Escobar/Wikimedia Commons)

(Aaron Escobar/Wikimedia Commons)


By Jamie Bologna
Guest contributor

We’ve known for a long time that obesity is among the greatest health risks confronting Americans.

We also know that the challenge for many people starts early. In fact, children who are overweight or obese between the ages of three and five are five times more likely to be overweight or obese as adults.

Now, there’s new research out today that adds to our understanding about one risk factor for childhood obesity: televisions in kids’ bedrooms.

Radio Boston’s Anthony Brooks spoke with Diane Gilbert-Diamond, an assistant professor of Community and Family Medicine at Dartmouth and the lead author of a new study on childhood obesity and television. The conversation, edited:

AB: Professor Gilbert-Diamond, we’ve known for some time that TV viewing is an established risk factor for childhood obesity—what further information did you uncover in this study?

We found that even after accounting for TV viewing, having a TV in the bedroom is associated with about one extra pound of weight gain a year.

About 60 percent of adolescents have TVs in their bedroom. Forty percent of kids have TVs by the age of six.

Just having the TV there, not even necessarily turning it on, just having it there?

We presume that kids with a TV in their bedrooms are watching them. But having the TV in the bedroom, no matter how much TV they’re watching, is associated with more weight gain.

Any idea about what’s behind this connection between weight gain and having a TV in the bedroom?

Our study couldn’t look at the mechanism directly, but we think that what’s going is that kids with a TV in their bedroom have more disrupted sleep. So, for instance, they may stay up later watching TV or may have poorer quality sleep after seeing the bright screen or watching exciting TV shows late at night.

Every phone, every laptop, every tablet can now be used as a TV. Is the lesson here that parents should really lay down much stricter rules about screen time in their bedrooms? Continue reading

Sibling Study Finds No Long-Term Breastfeeding Benefits For Kids

(5-month old baby, Wikimedia Commons)

(5-month old baby, Wikimedia Commons)

When Ohio State sociologist Cynthia Colen embarked on the biggest study yet of the long-term effects of breastfeeding, she expected it to yield still more evidence of “breast is best.”

Her research focuses on the health gaps between rich and poor, and she anticipated findings that would underscore the high price paid by poor and working-class mothers, whose jobs often stand in the way of breastfeeding.

But the data did not go there.

Previous research had reported a variety of long-term breastfeeding benefits in children, ranging from slightly higher IQs to lower risks of Attention Deficit Disorder. But those studies had mainly compared children across different families.

Dr. Colen’s study, published in the journal Social Science & Medicine, looked at thousands of siblings within families, comparing those who were bottle-fed to those who were breastfed.

And all the previously reported long-term benefits evaporated.

“I was shocked,” she said. “I thought, ‘Of course there’s going to be some confounding. We know that children who are breastfed are much more likely to come from middle-income families; to have parents with higher levels of education; they’re more likely to be white; more likely to live in middle-class or safe neighborhoods — all these things that we know are going to impact these long-term child outcomes.’ But I didn’t expect such a dramatic reduction.”

So, in this study spanning 25 years of data on more than 8,000 children ages 4 to 14, the long-term benefits of breastfeeding dwindled down to virtually nothing?

“Nothing. Exactly.”

Yikes. It takes courage to question breastfeeding benefits these days. So let’s be clear: Dr. Colen is by no means against breastfeeding. On the contrary. And the evidence for the short-term benefits of breastfeeding is overwhelmingly clear, from improved immunity for the baby to healthier weight for both baby and mother. But, she says, “We need to just get a more balanced conversation going.”

“I’m not saying that women shouldn’t breastfeed and I’m not saying that breastfeeding is not beneficial,” she said. But “I think we have to be honest and try to understand more about what breastfeeding can and cannot do for women and their children, and to start to expand the conversation to these larger social and economic factors that we need to address.”

Those social and economic factors include the need for better maternity leaves and more affordable daycare — as well as higher school quality, safer neighborhoods, more family-friendly jobs. Dr. Colen argues for taking a more careful look at what happens in a child’s life beyond infancy, and for understanding that breastfeeding may be difficult to the point of impossibility for some groups of women. (Interesting paper: Is Breastfeeding Truly Cost-Free?) Continue reading