Sunday, April 20, 2014
Inquirer Daily News

Mental Health

POSTED: Tuesday, March 11, 2014, 5:30 AM
(iStockphoto)

A 20-year-old college student talked to me about recent suicides on college campuses: “When a suicide happens to someone your own age, it is so sad that it doesn’t feel real. Even if you don’t know the person, you may have mutual friends on Facebook. The person may look happy on Facebook and then you are shocked to see ‘R.I.P.’  messages."

Young people everywhere are upset about suicides among their peers. As parents, we are worried when suicide touches the lives of our children. Here are some observations about suicide among young people, and some suggestions as to how parents can help reduce the risk factors and offer emotional support.

Suicide rates for 18- to 24-year-olds, both students and non-students, come from the National Violent Death Reporting System.  The 2001 data was collected from four states (CT, ME, UT, WI) and two counties (Allegheny PA, San Francisco CA) and is derived from 181 suicide victims.  Most of the suicide victims were male (88%), white (89%) and non-students (80%).  According to the data, college students actually had a lower risk of suicide than people their age who were not in school. Use of firearms (51%) or suffocation or hanging (37%) were the most common methods. Students were less likely to use firearms than non-students.

POSTED: Tuesday, March 4, 2014, 4:00 AM
Teenage girls are sexually assaulted with alarming frequency and many will go on to develop post traumatic stress disorder (PTSD). (iStockphoto)

Teenage girls are sexually assaulted with alarming frequency and many will go on to develop post traumatic stress disorder (PTSD).  If left untreated, PTSD can make life hell for the sufferer for years after the original trauma, and increase the likelihood of other problems – most common are anxiety, depression, substance abuse, and self-destructive behaviors. 

But what treatment is appropriate – not to mention effective – for PTSD in girls who have been sexually abused?  A very important study, recently conducted right here in Philadelphia, points to a type of cognitive-behavioral therapy (CBT) known as prolonged exposure (PE). 

Typically, sufferers of PTSD go to great – and understandable – effort to avoid memories or reminders of the traumatic event. Even if the individual with PTSD attends therapy for relief, they will often avoid bringing up the trauma. Many well-meaning therapists, fearful of increasing their patients’ distress, will allow the avoidance.

POSTED: Thursday, February 27, 2014, 5:30 AM
(iStockphoto)

This happens all the time:  A tearful teen sits before me, describing pretty crippling depression or anxiety, and sometimes both. We are in a session, I am her therapist, and I am nodding sympathetically. 

Then I ask the fateful question: “What time did you go to bed last night?”  

I am alarmed by her answer, “like, maybe 1:30?”  I am even more horrified to learn that she typically clocks between five to seven hours of sleep a night and “maybe a little more” on weekends. 

POSTED: Thursday, February 20, 2014, 5:30 AM
(iStockphoto)
Picky eating can be inconvenient, annoying, and worrisome, but is it actually harmful to your child?  That depends on how long it lasts and its severity. Most children tend to go through a vexing icky-picky phase when they are toddlers – that’s developmentally normal. What’s also developmentally normal is that children gradually come out of this phase and expand their diet beginning in the late preschool/early kindergarten years and then continue to diversify the range of foods they eat comfortably and enthusiastically into adulthood. 

By contrast, long-term picky eaters continue to eat food similar to the color of bride dresses, favoring variations on the theme of white, cream and beige (e.g., cereal, bagels, chicken nuggets, and plain buttered noodles). They are highly reluctant to try new foods, rigidly brand loyal, and uncommonly (often hysterically) sensitive to changes in the appearance, quality, or quantity of a preferred food.

Prolonged picky eating becomes unsafe in several ways.  First, a diet of soft, carbohydrate-based finger foods is naturally lacking in the vitamins and minerals that derive from a diverse diet, which leads to nutritional compromise even if the child remains normal weight

POSTED: Tuesday, December 3, 2013, 5:30 AM

A significant part of my work as a cognitive-behavioral therapist specializing in anxiety and related disorders is providing families with recommendations for good resources. “Good resources,” in these cases, are usually books and websites that offer general, up-to-date information on the disorder for which I am treating the child, as well as sound suggestions for at-home interventions (i.e., parent manuals).  Of course I provide such psychoeducation in session, but I like parents to be able to hear the information more than once, from more than one source, and for it to be accessible to them outside of the therapy hour.

What I do not want is for families to garner information or recommendations for treatments from “unsafe” sources – that is, sources that provide information that is not scientifically supported or has been directly contradicted by science.  In fact, I explicitly warn families about this, because there is so much misinformation on the web. During initial sessions, when giving my families handouts printed with what I think are the best and safest sources of information on their child’s disorder and treatment for that disorder, I typically say: “Please DO NOT put the name of your child’s diagnosis into Google search and hit ‘return.’ You will receive millions of hits, many of them from untrustworthy sources having something to sell, and you will feel even more overwhelmed than you already do.  Instead, start with these I am recommending – you can always read more later.”

I've given my recommendations for resources on obsessive-compulsive disorder, for children who have difficulty with pill swallowing, tic disorders and school refusal. What follows are my current recommendations for good resources on trichotillomania and other habit disorders.

POSTED: Tuesday, November 26, 2013, 5:30 AM
(iStockphoto)

On the surface, people with eating disorders may look normal or may look like they are struggling with their weight. Under the surface, there is so much more. 

The different eating disorders are like “apples and oranges:”

  • Anorexia nervosa (AN) is weight loss in a person who believes that he or she is “fat” despite being underweight.
  • Bulimia nervosa (BN) is repeated episodes of binge eating coupled with behaviors intended to prevent weight gain, such as vomiting, fasting or excessive exercise (“purging”). Binging leads to feelings of loss of control and panic over weight gain. Purging gives a temporary sense of control and relief.  However, feelings of shame and disgust lead to a vicious cycle of binging and purging.
  • Binge eating disorder (BED) is repeated episodes of binge eating without purging behaviors. 

Why teens and why eating disorders?  The peak onset of eating disorders is between the ages of 12 and 25   AN peaks twice: ages 12 to 14 and ages 17 to 18.  BN tends to peak later in adolescence and early adulthood.  Some of the reasons for these years of increased risk have to do with genetics, neurotransmitters, social pressures to be thin, and the normal weight gain during puberty.  For AN, there is often a stimulus, such as a young teen girl who reacts to a comment like “it looks like you’ve put on weight” by severely restricting the food that she is eating. For BN, onset often follows an attempt at dieting.

POSTED: Thursday, November 14, 2013, 5:30 AM
Filed Under: Flaura Winston | Mental Health | Tips
(iStockphoto)

Right now, thousands of children in the Delaware Valley are recovering from an injury, and they rely on their families to help them heal. While it is important to tend to their wounds and rehabilitation, it is just as important for parents to remember to look beyond the physical injuries. Injury is stressful for children and their families, and sometimes stress reactions can get in the way of recovery. 

Whether it’s a dog bite or a broken arm caused by a motor vehicle crash, the impact of injury for your child goes beyond the physical. In the first few days after an injury, many injured children feel upset, jumpy or worried at times, and many parents do, too. Despite what you might think, it’s not just the most severe injuries that can lead to strong emotional reactions. Any injury that is frightening for you or your child can lead to traumatic stress symptoms. These can include reliving what happened, avoiding reminders of what happened, and difficulty sleeping, eating, or concentrating. It may be helpful to rate your child’s and your own reactions over the first few weeks after an injury. Here’s how.

A recent Children’s Hospital of Philadelphia research review shows that unfortunately about 1 in 6 injured children -- and a similar percentage of parents -- experience more severe and persistent traumatic stress, lasting more than a month and getting in the way of full recovery.  

POSTED: Wednesday, September 11, 2013, 6:00 AM
(iStockphoto)

A significant part of my work as a cognitive-behavioral therapist specializing in anxiety and related disorders is providing families with recommendations for good resources. “Good resources,” in these cases, are usually books and websites that offer general, up-to-date information on the disorder for which I am treating the child, as well as sound suggestions for at-home interventions (i.e., parent manuals).  Of course I provide such psychoeducation in session, but I like parents to be able to hear the information more than once, from more than one source, and for it to be accessible to them outside of the therapy hour.

What I do not want is for families to garner information or recommendations for treatments from “unsafe” sources – that is, sources that provide information that is not scientifically supported or has been directly contradicted by science.  In fact, I explicitly warn families about this, because there is so much misinformation on the web. During initial sessions, when giving my families handouts printed with what I think are the best and safest sources of information on their child’s disorder and treatment for that disorder, I typically say: “Please DO NOT put the name of your child’s diagnosis into Google search and hit ‘return.’ You will receive millions of hits, many of them from untrustworthy sources having something to sell, and you will feel even more overwhelmed than you already do.  Instead, start with these I am recommending – you can always read more later.”

I've given my recommendations for resources on obsessive-compulsive disorder, and for children who have difficulty with pill swallowing. What follows are my current recommendations for good resources on tics.

I recently gave my recommendations for resources on obsessive-compulsive disorder. What follows are my current recommendations for good resources for children who have difficulty with pill swallowing
Read more at http://www.philly.com/philly/blogs/healthy_kids/How-can-I-help-my-child-swallow-pills.html#I1sPmuLFsaKopRgd.99
I recently gave my recommendations for resources on obsessive-compulsive disorder. What follows are my current recommendations for good resources for children who have difficulty with pill swallowing
Read more at http://www.philly.com/philly/blogs/healthy_kids/How-can-I-help-my-child-swallow-pills.html#I1sPmuLFsaKopRgd.99
About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
Also on Philly.com:
Stay Connected