Dear Dr. Gottlieb,
 
My son has been anxious and distractible since he was about five years old.  So of course he had difficulty in school as he just couldn't pay attention to his work.  In addition, he was quite shy and didn't make friends easily but we thought all of this would improve with time. 

We never thought he had any kind of learning disability because he was not hyperactive. 

On the contrary, he was always a very sweet kid and did what he was told. Except with homework.  That was always a struggle as he would go to his room and emerge later having accomplished nothing. 

Eventually, he would argue with us and say that he was stupid and couldn't get it right anyway.  

Thinking the problem was primarily anxiety, he saw a therapist for two years. 

It was primarily talk therapy and he liked going, so I think it helped a bit.  But the following year when he got into middle school, things got worse.  He had more difficulty in school and became more withdrawn and started to behave like he just didn't care. 

That's when the arguing started.  I guess held of fear and frustration, I began to push him harder thinking that maybe he was being lazy. 

Of course deep down I knew this was the worst thing to do, but I felt out of control.  When his seventh grade teacher said he might be depressed, we grew very concerned and took him to the pediatric neurologist she recommended. 

After a 45 minute interview the doctor said that he had ADD and should take medication.  We were shocked at how quickly he made the diagnosis.  By now, the symptoms have been so disruptive to our family life that there is constant tension. 

My son is against medicine, yet I need to help my child focus and help him to be a successful student. I'm very hesitant to believe my son has ADD since it wasn't diagnosed until 7th grade.

Dear worried Mom,

My heart goes out to you and your son. 

I can understand your fear and frustration as it must have looked like your precious child was slipping away.  And I can certainly understand your sons feelings. 

Like your son, I was inattentive in school and began to see failing grades in elementary school.  And because I received no help, I continued to do poorly in school straight through college. 

But worse than that was the great shame I felt as a child.  Like your son, my parents called me lazy.  

Yet I knew I was trying as hard as I could, so I figured that if I'm not lazy I must be stupid.  I suffered with those feelings of shame and inferiority for many years. 

Fortunately, you realize there is a problem and have been trying to do something about it for a long time.Unfortunately, like many parents, you have been unable to find a clear understanding of what's happening and what to do about. 

First, nobody can diagnose ADD or any other learning disability in a 45 minute evaluation.  And before ADD is diagnosed, other things have to be ruled out if possible. 

Like anxiety, depression, food allergies, family conflict and dozens of other things.  In addition, not every mental health professional is trained in the diagnosis and treatment of ADD, so before you make an appointment, find out there background. 

Once other things are ruled out and you have a competent professional working with you, this evaluation should include family history, interviews with parents and school officials in addition to spending time with the child. Putting that label on any child after 45 minutes is, frankly, ridiculous.

Medication is another issue. 

For children with severe ADD and ADHD it can be life altering. 

But as we all know our children are overdiagnosed and overmedicated.  If you were to decide to give him medication, one of the side effects could be increased anxiety. 

On the other hand, there is a possibility that medication could help with his inattentiveness.  

There is even a possibility that the stimulant medication could calm him down internally and he might feel more comfortable with himself. 

But that doesn't mean he has ADD, nor does it mean he should take medication. All it means is that the medication could help with some of his symptoms but we have yet to figure out what the problem is.

When I spoke with you on the telephone, you told me that you finally took him to psychologist Richard Selznick who is director of the Cooper University Hospital learning Center in Cherry Hill who did a thorough assessment of your son and family. 

And I am thrilled with what you have told me. 

First, after getting the results of the assessment, all of you are learning more about what your son really needs to be successful. 

Many kids are not good at communicating their real needs, but kids with learning disabilities have even more difficulty.

So now that you are understanding one another better, you can all begin to plan constructive strategies including communication with school, help at home and other interventions. 

There is a very real possibility that once he gets the help he needs, you might find that his anxiety and insecurity diminishes.  If not, psychotherapy could also be included in the treatment plan at a later time. 

Richard Selznick, author of "The Shutdown Learner" will be joining me on my web chat Tuesday

This chat will be an open discussion about what it takes to make changes in our lives and how we can begin letting go of the assumptions we have been making for years.

Jake contemplating his first step

I have a new friend named Jacob and we recently celebrated his first birthday.  Of course he had no idea what was going on but he did taste cake for the first time.  He loved it. Apparently he's read all of the books on developmental psychology because he's doing everything he supposed to do at the right time:  crawling, babbling, fingers in everything.

 Jake is adorable and happy, and he is now standing on his own.  And once he realizes he is standing on his own he gets scared and sits down. Perhaps you’ve observed what comes next. Perhaps you’ve experienced it yourself. As an adult.

Last week my little friend was at my house with his babysitter when he pulled himself up on her leg.  When he let go, she took a step back.  And there he stood, wobbling a bit with eyes as wide as saucers.  That's when he reached his hand out for her to secure him, but she didn't take it.  Instead, she held her hand just beyond his grasp.  And there he stood;  unsteady and looking for security from someone he trusted.   He slowly began to sit on the floor, but before his diaper made contact, he righted himself and again reached out to the babysitter.  But she merely encouraged Jake to take the step necessary to reach her hand.  I watched as his eyes and his little chest seemed to be moving rapidly.  I wanted desperately save him from his distress. And then it happened, just like we knew it would.  He took his step. We all applauded. My eyes welled up with tears.

In the Hebrew Bible, God says to Abraham: "Leave your father's house."  In effect, leave what is familiar -- leave what you have known to be "home" in order to begin the journey of your life.  Neurologically speaking, that's what Jake did.  He chose not to sit down and crawl. He embarked instead on the unfamiliar, having no idea what would happen.  In the process, he literally took the first step in his journey of life.

To grow, we must loosen our grasp on what seems familiar. There is no easier way.  Abraham had to leave his father’s house. The rest of us must leave the narrative we’ve spun for ourselves – the story of who we are, how we behave and what we need in order to feel better or happy or secure. 

"She" says she has been in a marriage without love and can't live that way anymore. She says he is not capable of love.  She says she has tried for many years to live up to his expectations.  She says she was insecure from the beginning of the marriage because her father never loved her properly.  She says she is entitled to have her needs met. Once her needs are met, she says, she will be happy or secure. That's her narrative.  Every word may be true, but not very helpful.  And the more she suffers, the more deeply she believes that narrative to be true, the worse she feels. 

Think about your narrative and how it defines who you are.  Are you a leader or a victim or a workaholic? Perhaps you are a chronic caretaker or depressive or disabled or insecure or disordered in some other way.  Is your unhappiness because of the person you are living with, working with or is it caused by your upbringing or your genetics?  Will happiness come when you have enough money, love, when your children are grown and secure or do you believe it will never come?  The answers to these questions are part of your narrative.

What if  what you think you need is not really what you need, and all of those explanations for your unhappiness are not accurate?  What if the things you think will make you happy won't make you happy?

When we release our grasp on our narrative, we find ourselves  in exactly the same place Jake was as he stood on the floor, alone, reaching out, not knowing what would happen the very next moment. In other words, very, very scared – and then, with one small step, able to take a giant leap into your new future.

Tuesday's chat will be an open discussion about what it takes to make changes in our lives and how we can begin letting go of the assumptions we have been making for years.

With the divorce rate just under 50 percent, most who get divorced remarry, creating a stepfamily. And anyone who has ever been in a stepfamily knows that they are complicated to say the least! This chat will be about many of the issues stepfamilies face and how they can be resolved. Dan is joined today by Dr. Wednesday Martin, author of 'Stepmonster: A New Look at Why Real Stepmothers Think, Feel and Act the Way We Do.'

With the divorce rate just under 50% most who get divorced remarry creating a stepfamily.  And anyone who has ever been in a stepfamily knows that they are complicated to say the least!  Tuesday's web chat will be about many of the issues stepfamilies face and how they can be resolved.  The next letter illustrates a classic problem in stepfamilies:

Dear  Dan,

I think I am having some stepfamily problems.  My husband and I are in a relatively new second marriage.    He has one son and I have a daughter. 
 
Last night my son  had 2 friends over, it was late when my husband returned home from a long day and he was tired and hungry. Nevertheless, not only did he not say hello to the girls, he didn't even acknowledge their presence.  The next morning when he left for work, the girls were still there and he still didn't acknowledge them.

 I am put off by this, as I feel an acknowledgement is priority for everyone all the time.  Later I told him it was important to me that he acknowledge the children.  He said he did not feel like it was necessary or that my daughter would have really cared last night, they were doing their thing.   I thought my husbands lack of consideration to my feelings and my request was hurtful, however I have decided to let it go or he will become angry  and think I am a nag.

Lastly, if his daughter was at our house and his friends were over, he would have greeted him.  He will from time to time greet my kids, on his terms though, he decides when to greet and not to .

So is this a case of "I have made my bed and now sleep in it" or is there a way to reason?

Struggling in a stepfamily                                 

Dear struggling,

Shortly before I received your e-mail, I received one from a fellow in Haverford who was considering marrying for the second time and asked my advice.  I told them his timing was perfect because this is the time to begin talking about what it means to be a family.

When people get married for the first time, they bring in a set of expectations and experiences from their family of origin and rarely do partners see the world through the same lens as both have a different vision of what it means to be family.  But when they get married a second time, those expectations have been modified by everyone's battle experience which is usually negative.  So everyone usually comes to these families with some anxiety and apprehension and many carry baggage from the previous marriage.

So the questions about what does it mean to be in family, be married, be a man/woman, be a parent should be discussed way back in the beginning of the process.  And the children should also be brought in to the discussion.

Every stepfamily I've treated has struggled with issues of loyalty.  Biological parents feel loyal to their children who have already suffered.  Meanwhile, this loyalty can do great harm to the fragile new marriage.  This is a complicated and difficult issue as children really do suffer when there is divorce and do need to support of their parents.  But when a child of divorce has lived alone with a parent for a while, they are not going to be happy about sharing time and space.  All of these things need to be talked out with everyone in the family.  It's very important that stepfamilies do not divide by biology.  And although this is may be difficult for the first few years as everyone tries to get to know one another, it's very important not to have secret alliances.

So, struggling, even though you may have not had these discussions, it's never too late.  You see, there are always stories behind the story.  When you say how important it is to be acknowledged, that sounds like a high stakes issue from childhood and may have nothing to do with your daughter.  I don't know why your husband won't acknowledge the children, but there is a story about that also.

And the most important issue is the fact that you are hurt.  If something is happening in your marriage that is hurting you, that's never okay.  That doesn't necessarily mean that your husband should change his behavior to address your pain, but it does mean that the two of you have to talk about this.

And please keep in mind blended families are difficult and so are second marriages.  As far as I am concerned, what makes the prognosis better is devotion.  If the two of you are devoted to this relationship and this family, you might still need counseling, but you should do pretty well.

In my last entry I talked about my daughters experience when the wheelchair charger arrived on time at our hotel in Haifa. Once she realized everyone in our group had been worried about me and was thrilled that the problem was resolved, she told me she felt less alone with these problems for the first time in her life.
So all of this leads me to the people:

 It is said that when you put two Israelis together and you have at least three opinions, probably more.  These are people who are not afraid to express their opinions and not afraid to argue about them.  But there is a quality of family in this nation state.  I guess living with existential threat every day certainly helps people feel as one.  In America, we experienced it for about 48 hours after 9/11.  In Israel, they experience it every day since 1946, if not thousands of years before.
When we experienced trauma as individuals, the effects are different than when we experience trauma as community.  When we experience abuse or disability or any other form of trauma, we experience nice ourselves as different from the larger culture.  But when it is a cultural trauma like 9/11 or even World War II, we share something important.  This was the case at that little hotel in Haifa when Debbie and I both felt less alone.  That feeling would only be reinforced throughout the following week.
 
Although I cherish the beauty and the history of Israel, what made this trip special was watching my family.  There was much I couldn't see because of wheelchair access, intense heat, but because I sat back, I was able to see things the others were not.  For example, we visited an ancient synagogue in what looked like a working-class Arab neighborhood.  I sat on the bus with Sam and Pat as they quickly got bored with the synagogue and returned.  In a few minutes a young boy about 10 years old came up to the bus and asked Sam his name.  He said his name was Sultan (pronounced Sool tan) and said to Sam "play football" which is soccer in most of the world? Sam said no, but he would try.  Sultan hollered something I couldn't understand to a friend or relative in an apartment building, but one of the words was football.  In a few minutes and older boy and a few girls appeared and there was my grandson playing soccer in the parking lot with a few Arab kids. I was moved to tears as I was reminded how much our children have to teach us.
 
Sam at the wall:
as many of you know, Sam is on the autism spectrum and has his own way of looking at the world.  Some of his observations are pristine and remarkable, some are just damn cute and some are a combination of both.
  The next day we visited the old city in Jerusalem.  This is the most precious and holy site of the three Abrahamic religions and at the same time, a bustling small metropolis that looks as though it's been unchanged in 2000 years. Debbie was careful to explain to Sam the meaning of the Western Wall as one of the holiest places in the world.  When the time came, I was unable to go as the cobblestones made it almost impossible for me to pass.  Our rabbi, Barry Schwartz already had been building a relationship with Sam so he volunteered to take him to the wall where both of them prayed.
When Sam got back, he gave his mother the full report: "mommy, I know I prayered the right way because I was with the Rabbi.  But when I got done prayering, the Rabbi wasn't so I need shadow puppets on the wall.  And you know what, the sun was perfect for shadow puppets.  And I think I know why, because that is a very special place.  Anyway, when I was done that I touched the wall and one of the notes fell out and I didn't know what to do.  So I quickly picked it up and put it back in the wall and I think it will be okay now because, you know, the five second rule."
And that was Sam's experience praying with my Rabbi at a sacred place.
 
As our time in Israel wound down, we visited the Dead Sea.  This is the lowest place on earth and a body of water that is evaporating rapidly.  It's also a body of water with a salt content of nearly 40%, which makes it impossible to sustain life.  It also makes it impossible to sink!  One of my not so hidden agendas in going to Israel was to float in the Dead Sea with Sam.  It was over 100° that day, but I was determined.  So I slowly navigated my wheelchair over about 200 yards of cobblestones resting under the occasional tree.  By the time I arrived at the city, Sam had already been in there and wasn't very happy about it as he had a rash on his back and the high salt content was painful.
When I got near the shore, three or four of my fellow travelers helped me out of my wheelchair and into a plastic lawn chair and carried me into the water.  The rest of my group slowly circled around as my nurse slid me off the chair and allowed me to float. Many were taking pictures and some were crying as Sam got back in the water just to be with his pop and then both his parents joined us.  As the four of us floated together for the first time in our lives, our group surrounded us and quite spontaneously sang a Hebrew song of joy.  There I was feeling self-conscious, grateful, loved and in love all at the same time.
It everything I dreamed and more.  I fell in love with the land, my fellow travelers, my religion and my family al l over again.
 

There is just so much to say and so many stories about this experience that I will do it in pieces.  Overall, the trip was magical, difficult, fun, deeply spiritual, difficult, intimate, wonderful, difficult and worth every minute.

The first three days:
  We just never know what the next moment holds for us, we assume we do and that gives us the illusion of security. But on a trip to a place like Israel, we can even pretend to know what will be happening around the corner.  This was the case last week on the first day of our adventure to the holy land.  I sat overlooking the beauty of the Galilei in northern Israel with my precious grandson Sam, my daughter, son-in-law and 25 soon to be dear friends from my synagogue in South Jersey.  I had been to this beautiful and interesting land twice before, but this trip was about living out a personal dream.  I wanted to introduce Debbie the land of our ancestors and tell her about my deepest wish to have Sam come back here for his bar mitzvah. So there we were sitting on the grounds of a kibbutz, watching the body of water that Jesus is said to have walked on, just trying to absorb the meaning of the moment. Bedtime was early that night as we had arrived that morning after a 12 hour flight.  So shortly after my nurse put me into bed, she plugged in my wheelchair as we routinely do, but this time was different.  The battery charger blew out all of the circuits and in turn blew out the charger.  All of a sudden being in a remote part of an exotic land on the Sabbath went from a deep spiritual experience to: "holy s**t, what now?"I could add a little more drama to the story like how the wheelchair almost ran out of charge before we got a new charger, but everything was resolved in 36 hours.Just like a dead charger was unexpected, so was the group's response to seeing the new one.  We had been promised that it would be in the lobby of a hotel in Haifa when we arrived the next day but all 25 of us were nervous about it.  And when we saw the brown box in the lobby there was an air of anticipation but when we plugged it in and found success, there was applause.  Debbie later told me that when she heard that applause, she felt like she was part of a large caring support network for the first time in her life.