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Grief and Loss – Tip Sheet: Understanding Acute Grief

Introduction Experiencing the Pain of Grief
“Normal Grief” Adjusting to a Changed Environment
Searching Behavior Going Forward Emotionally
Four Major Tasks The Support of Family and Friends
Accepting the Reality of the Loss Grief Becomes More Manageable

Introduction

For every loss there is a grief reaction. Some losses are minor and the grief is manageable. Other losses, though, will have a significant impact and may lead to depression or an extended grief response.

Usually, the most difficult loss is the death of a loved one. Many persons reach adulthood without having experienced a loss by death, and they are unfamiliar with the grieving process.

In fact, American society is uncomfortable with death and with open expressions of grief, and prefers that people hide their feelings and emotions. Added to this is the organizational approach to grief that often allows an employee only a week to bury a loved one and mourn the loss before returning to work. As a result, bereaved persons are forced to hide their grief in public and act as though they have completed grieving and are "back to normal." This is the opposite of what we now know about grief, about how important it is to talk about the loss and to experience the grief.

Denying the significance of the loss can make grief harder and can extend the grief process. Another concern is that most individuals and their families don’t know what to expect with acute grief. They become concerned that what they or family members are experiencing isn’t normal.

It is important to note here that grief may be different depending on the age of the person experiencing the loss. Childhood and adult grief are not generally experienced in the same way. This article deals with adult grief.

“Normal Grief “

The characteristics of normal or natural grief were first documented in 1944 when psychiatrist Erich Lindemann studied families who had lost a loved one in a nightclub fire. His findings have been called "the symptomatology of acute grief." That means there are certain symptoms or behaviors that are expected during the first six weeks or so after the death of a loved one, the time that is referred to as the acute grief process.

Depending on whether a death was expected, or sudden and tragic, grief may begin with the inability to fully grasp what has happened. This is a state of shock or numbness, and usually happens for the first week or two after the death. Acute grief also includes intense emotional and bodily distress occurring in waves lasting from 20 to 60 minutes. People often describe this as a sensation of grief "washing over them." It includes a feeling of tightness in the throat, a choking feeling with shortness of breath, an empty feeling in the stomach, and weakness in muscles. It also includes what is described as intense "mental pain."

In addition, acute grief includes crying and sobbing, restlessness (a person can’t sit still or paces back and forth), excessive sighing, a loss of appetite and a loss of sexual drive. Sleep problems are also common. These physical symptoms can be combined with depression, deep sadness, and being unable to concentrate.

Searching Behavior

There are two more aspects of normal grief that should be mentioned. The first is what is called "searching behavior." The grieving person is preoccupied with thoughts of the dead loved one. They simply can’t stop thinking about them. These thoughts may include responses that are like auditory or visual hallucinations. They think they see their loved one on a bus or on a crowded street, or they think they hear his or her voice or hear the car pull into the garage at the usual time each night. These thoughts are caused by psychological cues (instances that mentally trigger thoughts of the deceased loved one) and will decrease in time. Persons who are grieving are often frightened when this occurs, and fear that they are going crazy. It is helpful to note that these instances are common and normal during acute grief.

The second factor that people sometimes worry about is the use of linking objects that help the grieving person feel connected to their loved one. Wearing or sleeping with a piece of clothing or item belonging to their loved one may bring great comfort. Frequently, people note that the article still has the scent of the person who has died. Perhaps they can still smell their loved one’s perfume or cologne or shampoo. Perhaps it was a clothing item that was frequently worn, or a possession such as a necklace or ring that had special meaning for their loved one. The items may vary, but the idea is the same — that the items help to keep a person linked to the loved one who is gone. This, too, is normal grieving behavior, and the need for the linking object will decrease over time.

Four Major Tasks

Many people ask how long grief lasts. Others ask if it will ever end. Death ends a life; it does not end a relationship. However, after the death, that relationship must change to deal with the grief and loss. This change involves four major tasks. 

First – Accepting the Reality of the Loss

First is accepting the reality of the loss. The person comes to realize that their loved one is gone and nothing can bring him or her back. 

Second – Experiencing the Pain of Grief

The second task is experiencing the pain of grief. People sometimes think they can avoid the feelings of grief, or they may try and postpone it in some way. They may return to work in a day or two, and their behavior — often described as "how well they are handling it" — may be rewarded by people noting how strong or stoic they are. However, a person can’t move on in life by denying the death or the feelings that the loss has evoked. 

Third – Adjusting to a Changed Environment

Adjusting to a changed environment in which the loved one is missing is the third task. How a person does this depends on many things. Some individuals want to dispose of their loved one’s clothes and belongings immediately. Others leave things as they were before the death and ease into change. It is up to the grieving individual to make this decision and others should not try to impose what they think is best. Experts suggest that major decisions, like moving or selling the house, be put off for several months or even a year so that there is time to make a thoughtful decision. 

Fourth – Going Forward Emotionally

The final task is going forward emotionally. This doesn’t mean forgetting about the loved one who has died, but it means thinking differently about the emotional tie to that person. The person who has died will always be a part of an individual's life, but they can’t be a part of their day-to-day life going forward. Their memory can, their love can, but their physical presence can’t be.

Grief experts estimate that it takes at least one year to move through the grief process. (Note, they do not use terms like "finish grieving," "resolve the loss," or "get over the loss.") Two to three years may be a more realistic estimate.

A full year is considered a minimum, because it takes a year to experience all of the anniversary dates and holidays with the loved one gone. During these special times, symptoms of acute grief may come back for awhile. This, too, is normal and will lessen with time.

The Support of Family and Friends

The support of family and friends is important in the grief process. Sometimes, however, this may not be enough, or all family members are trying to manage their own grief and don’t have much emotional support to give to one another. At other times, especially when the death was expected, family and friends might think a person should be able to manage the loss and "get back to normal" quickly. Or they may say unhelpful things. Usually they simply don’t know how to help. They don’t know what to say. In fact, no matter what they say, it won’t change the fact that a loved one has died and that this is the cause of pain and great sadness. But it does help to know that they are caring and are trying to be supportive during a very difficult time.

Some people who are grieving feel better talking to someone outside the family or outside their circle of close friends. If a person needs help in dealing with grief, is seriously depressed, cannot cope with everyday life, or feels that their grief is getting worse, professional help should be sought. Social workers, clergy, or funeral directors are excellent places to begin. They frequently have lists of support groups and therapists who specialize in grief counseling. Also, many hospice programs offer support programs, and these frequently are open to all persons regardless of whether or not the dying person was cared for by that particular hospice.

Grief Becomes More Manageable

Little by little, and day by day, grief becomes more manageable. People may think that their life can never be normal again, and in a way, they are right. It can never be exactly like it was when their loved one was alive. But eventually the acute pain of grief recedes somewhat, and a "new, normal" takes the place of old patterns and ways of doing things.

The person who has suffered the loss can still get in touch with their grief at any time, and it may often appear unbidden, but it is no longer all-consuming. When that happens, the bereaved person has moved out of the acute phase of grief and is moving forward with life.

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Early Childhood Development Tip Sheet – What’s So Terrible About Being Two?

Introduction

So what's up when a kid reaches age two? Many parents are ready to pull their hair out when their kids reach this age… and it continues for about a year to a year and a half.

Parents of younger infants are lulled into a sense of ease when their son or daughter reaches about 6 months. By this time infants are usually sleeping well through the night, able to sit in a high chair, can amuse themselves with play and are enthralled with mom and dad's gaze and smile. To many, parenting at this stage appears easy and there is no way of anticipating just what lies ahead.

By 24 months however, toddlers may be bored with static toys, they are generally quite mobile – able to walk at a brisk pace for multiple steps and highly explorative. Herein lies the set-up for the terrible twos, unless prepared.

Two-year-olds have this marvelously inquisitive mind, but absolutely no experience from prior learning to understand "safe or harmful", "good or bad", "right or wrong". As such, they simply set out to explore the world, as it is available to them. Until they learn or experience otherwise, all objects are neutral. Objects have no inherent worth and are not yet known for causing either pleasure or pain. It's only when the child experiences the object can they determine its value. Value to the two-year-old is usually a function of the pleasure an object can bring to the child. Pleasure is derived from touch, taste, sight, sound and scent. Some things are pleasurable and "fun", while others offer neither amusement nor any particular pleasure. Other items, like the taste of a sour lemon, may cause displeasure and children soon learn to avoid these.

Understanding Normal Childhood Development

Knowing this about normal childhood development, the challenge facing parents is to pre-empt negative outcomes from their child's exploration and learning while maximizing the opportunity for positive outcomes. To reduce frustration and maximize the opportunity for your child's learning and pleasure consider the following:

  1. By this stage of life, if you haven't already baby-proofed the home, do so. It is reasonable to put away the fancy glass and china that adorns the coffee table, have safety latches on cupboard doors and gates on the stairs. Your child will explore and this is normal and healthy, so get on your knees, look at your home from your child's point of view and fix anything that can cause harm. You will be more relaxed if you are less concerned about household safety hazards.
  1. Telling a two-year-old what not to do, doesn't mean they will know what to do. As such, they may stop doing what you have told them, but may go on to another equally disturbing activity. It is reasonable to tell a child to stop doing something, but not sufficient. Every time you tell a child what not to do, follow it up by redirecting the child to what they can do and be specific. So if you say, "Go play", this gives the child permission to do almost anything, whereas if you tell the child, "You can play with the blocks or the dolls", this more clearly directs the child to approved activities.
  1. Children do need to learn safe from harmful, right and wrong, good and bad. When your child does do something you deem inappropriate, tell them so in a firm voice. However, don't stop there. Next direct them to other approved activities and soon after let them know how they are playing well.
  1. Self-esteem grows the more the child gains mastery over their environment and self. While some areas may be off-limits, other areas should be structured to allow exploration and play. A lower drawer in the kitchen filled with plastic bowls and utensils offers the child a safe and inviting area to learn and have fun. Consider what other places and activities are acceptable for your child and make them available.
  1. Parents should always try to control their emotions and not become verbally or physically abusive.

So often parents of two-year-olds feel like all they say is "No". Use the above suggestions and you may find yourself saying "Yes" more often and those "terrible twos" may just be a little easier. By the time your child is 42 to 48 months, they will have learned much and will better understand what is safe or dangerous, right or wrong. It will be easier.

Use the suggestions and give it time.

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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.

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Healthy Parenting Current Trends – Strategies of Parenting

Introduction

When providing therapy it is common to see patterns, especially within families. More and more, I am seeing two types of kids in my practice. There are kids who make mistakes, experience natural and logical consequences of their actions, and make better choices. Those kids are easy to deal with from a parenting standpoint, because they seem to learn from their mistakes.

Most parenting programs advocate that parents need to create consequences that fit the misbehavior. For example, a child who is late for a basketball game loses car privileges for the weekend. Tommy doesn't brush his teeth. The parent withdraws snacks for the day and explains that sugar causes decay and if Tommy is unwilling to brush the decay out of his teeth they will not allow him extra sugar. Sandy doesn't do her homework and loses chat time from the computer, because homework comes before social time. You get the concept.

The second type of kid is the one who makes mistakes and doesn't seem to be affected by their choices or the consequences imposed upon them. This poses a problem for parents. Understandably, parents want to impose consequences that will make a difference in their child's life.

Parenting Strong-Willed Children

Parents with strong-willed children come in frustrated and discouraged because they cannot figure out what they can do to get their children to make better decisions. Their children consistently want to do things their way. If you look at the behaviors, it seems like everything revolves around them and they have no regard as to how their actions affect others. For this type of kid I recommend a parenting approach that teaches "the lessons of life".

The parents job is to reinforce societal rules and if a child breaks a rule the parent needs to find a consequence that matches the "misbehavior". That's all they can do. Their job is to be consistent and set up guidelines. They can't force a child to conform. The child has to figure that out for themselves.

The sad part is, the parents understandably want a formula for change. It's scary to think that there isn't a recourse to get a child to conform, but many kids have to do it their way despite the fact that it's the wrong way. Luckily, these kids usually figure it out in their mid- to late 20s, after they have been totally independent and have experienced the "school of hard knocks".

If you have one of these types of kids, and you are consistently using the strategy that when A happens (misbehavior), then B occurs (the consequence), know that you are doing absolutely everything you can to help that child make better decisions. You are laying the groundwork and building the foundation for that child to eventually figure it out.

Kids need their parents to validate and encourage them. They need their parents to love them unconditionally. Obviously, the crux of parenting is being there for your child. Emotionally, financially, and physically. When kids make mistakes repeatedly, it may require that you withdraw some of the emotional, financial, and physical support. You are teaching them the consequences of life and societal norms.  Also, trust your instincts.  If you think something is wrong, investigate it.  Perhaps a social worker can help.

Here is the good news. Kids who are strong-willed usually figure it out as adults. So, continue to keep the faith, and most importantly, take care of yourself in the process. Why focus on yourself? Raising one of these types of children can take a toll on your mental health. You are not a failure if your child has to learn from the "school of hard knocks". Be consistent. Stay emotionally detached. Yet, love them unconditionally. They will appreciate it…at age 29.

To read more by Carol Jurgenson-Sheets, ACSW, LCSW go to http://www.carolthecoach.com/products.htm

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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.

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Family Safety Tip Sheet – Recognizing the Signs of Domestic Violence

Introduction

You may be a victim of    domestic violence (also known as interpersonal partner abuse)  if you have some or all of the following characteristics:

  1. Over functioning or overachieving: You may tend to take on more than a reasonable share of responsibilities. You may have a high need to succeed and please others. Your abuser’s failure to accept responsibility may force you to compensate for his/her behavior.  
  2. Feeling powerless: You may feel as though you have no control over your life. You may be immobilized by fear and feel that you “have to take it.” Decisions about family, friends, and activities are based on how the abuser will react.  
  3. Feelings of guilt or shame: You may feel guilty over failure of a marriage or relationship. This is often reinforced by the abuser who blames the victim for all that goes wrong. Guilt over failure may be accompanied by shame for “putting up” with the abuse.  
  4. Continuous hope: You maintain hope for positive change in the abuser’s conduct. Others may try to intervene and tell you that you do not deserve to be treated this way, but you may continue to hope.  
  5. Previous abuse: A significant portion of abuse victims were abused earlier in their lives within or outside of the family. Many also had mothers who were abused by their partners.  
  6. Decreased self-esteem: You may underestimate your true abilities and level of achievement. Self-esteem is likely to be eroded over time by constant criticism from the abuser such as name-calling, put-downs, and belittling your achievements.  
  7. Identity concerns: You may lack a firm sense of individualization and autonomy. You may feel incomplete without a partner. Your identity may be or become strongly dependent upon your role as a partner/wife/mother.  
  8. Passive/dependent behavior: You may accept the traditional feminine role, often to an exaggerated degree. Your behavior may be reinforced by economic dependency and increasing feelings of helplessness and fear as the abuse continues.  
  9. Self-blame: The abuser blames you, and you may begin to believe it over time. You may accept responsibility for the abuser’s actions. Anger turned inward often produces guilt.  
  10. Fear and denial: You may fear the abuser’s anger, but you may also deny and minimize this fear. Denial and minimization are common coping strategies for surviving the abuse.  
  11. Stress: You may have severe stress reactions (headaches, stomachaches, sleeplessness, anxiety, etc.). You may spend an increasing amount of time trying not to make the abuser angry.  
  12. Social isolation: You may be isolated from family, friends, neighbors, and other forms of support, usually not by choice. The abuser may criticize and blame family and friends.  
  13. Determination and bravery: You are very strong physically, mentally, emotionally, and spiritually. Your strength helps you survive.
  14.   

    Characteristics of an Abuser

    An abuser may have some or all of the following characteristics (There is no typical, easily identifiable abuser. The characteristics that follow may not be present in every abuser and are not necessary for their behavior to be considered abusive.):

    1. Dual personalities: Abusers are often described as having a “Dr. Jekyll and Mr. Hyde” personality and are generally not known in the community as violent persons. Usually, abusers refrain from physical aggression outside of the home or other private settings. Attitude and behavior may change immediately once they are in a private place–where they think it is “safe” to be abusive. Abusers may be loving, kind, and remorseful at times, but this is all part of maintaining power and control.  
    2. Extreme jealousy: An abuser may suspect you of being unfaithful without any rational reason or evidence to support such a belief. An abuser may be jealous of any meaningful relationships you have with others, including those with parents, siblings, children, or friends.  
    3. Controlling and possessive behavior: An abuser may control your access to money, social relationships, job opportunities, and may monitor all your activities by making you account for any time apart or money spent. An abuser may treat you as a “possession” and may engage in seemingly “playful” but unwelcome use of force during sex.  
    4. Emotional dependency: An abuser may be emotionally dependent on you and may make constant demands for reassurance and gratification. An abuser may be hypersensitive to anything interpreted as criticism and may be critical of others and difficult to please.  
    5. Poor self-esteem: An abuser may feel inadequate about a variety of things, including (but not limited to) masculinity, sexuality, providing for the family, and parenting. These feelings may be masked by an extremely tough or “macho” image.
    6. Roles: Abusers tend to enforce rigid gender roles or believe in the traditional male “head of the household” role.  
    7. Blame: Abusers may blame other people or circumstances for their behaviors, feelings, and problems.  
    8. Abusive history: A high proportion of abusers experienced abuse as children or witnessed abuse between their parents and learned this behavior (but this does not excuse their actions).  
    9. Unpredictability: Abusers’ actions may be unpredictable, and you may feel as though you never know what the abuser will do next. Abusers may hold others, especially you, to unrealistically high expectations.  
    10. Social isolation: Abusers may have few friends outside the family and may have poor social skills. However, abusers may also be “social charmers” and have a lot of friends, none of whom would think they would be abusive (see “Dual personality” above).  
    11. Cruelty: Abusers may be cruel not only to you but to children and animals as well. They may be preoccupied with violence, guns, knives, etc.  
    12. Inappropriate use and display of anger: Abusers may use anger if they do not get what they want. They may display anger as verbal abuse, physical touching of any kind without your consent (even a kiss), threats of violence, and breaking/destroying objects of value to you.

      

    Resources:

      

    To access local services nationwide contact the National Domestic Violence Hotline at: 800.799.7233 or visit their website at www.ncadv.org. This website has a lot of current domestic violence information for consumers.
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    The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.

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    Obsessions and Compulsions Real Life Story – Compulsion for Clutter Poses Home Hazard


    Introduction
    The trim-looking Orangevale home has a secret. Inside are towering piles of stuff that fill the rooms, line every hallway and block doorways. Leaning against the walls are unopened portable grills, rolls of Christmas gift wrap, and empty boxes and bags.


    The only place for a visitor to sit is on a folding chair that the 83-year-old homeowner places 4 feet inside the home’s entryway. She stands chatting with her elbow resting on a nearby pile.


    “What you see is in every room,” explained the woman, who has been counseled by Sacramento County Adult Protective Services about the health dangers of her jampacked home. “It’s just stuff I didn’t want to throw away.”


    The woman asked not to be identified because of her embarrassment over her situation. But the condition is a serious problem that frustrates social workers, building inspectors, landlords and, most of all, worried relatives.


    Older people can fall in the mess or be killed in clutter-caused fires. They can lose their homes because the junk keeps them from properly maintaining the property.



    Compulsive Hoarding
    An estimated 600,000 to 1.2 million people suffer from compulsive hoarding syndrome, a difficult-to-treat condition that is attracting more research and intervention.


    Later this month, more than 100 professionals will participate in a special presentation by Sacramento County Adult Protective Services.


    While compulsive hoarding is not unique to seniors, they often get identified because of age-related concerns such as falls that can threaten their independence.


    “It’s not a character flaw. It’s not laziness,” said Karron Maidment, a research associate with the Obsessive Compulsive Disorder research program at UCLA, who will teach the Sacramento seminar. “They’re trying so hard to do things perfectly and getting so overwhelmed that they put everything off. If they can’t do it right, they’re not going to do it at all.”


    The difference between ordinary clutter and hoarding is based on criteria established by mental health professionals.


    Hoarders accumulate stuff that others regard as useless to such a degree that living spaces can’t be used for their original purposes, causing distress or impairing the hoarders’ well-being.


    They save everything, because it could be needed later or could be useful to someone else. Throwing away anything creates anxiety.


    Building inspectors have found people living on porches or in cars because there was no room to sleep in their homes. Hoarders may not get needed repairs for the stove or toilet, because they don’t want to let anyone inside the house.



    A Hidden Behavior
    Randy Frost, one of the foremost researchers on hoarding and a psychology professor at Massachusetts’ Smith College, believes the number of people afflicted is underestimated because it’s a hidden behavior.


    Frost said: “I find it absolutely amazing the number of people who are coming out of the woodwork when people hear about the research I do. ‘I have an uncle, a friend or a neighbor.’ ”


    Many are comforted just to learn they are not alone and that the problem has a name, he said. Some of the most commonly hoarded materials are newspapers, mail, clothes and containers.


    Frost compared how hoarders feel about discarding stuff to how anyone else would feel about throwing away their much-needed driver’s license.


    “They have the same kind of view of virtually everything,” he said. “There’s something about the act of acquiring it, the sense of having it even though it’s never used or opened, that is powerful.”


    Families often think they can help by cleaning up. But without the help of a mental health counselor, Frost cautioned the hoarder no longer will trust relatives and the home will be filled again.


    “We see lots and lots of fractured families over this,” said Frost. One of the more successful approaches he’s used is to provide hoarders with factual information, because they are often curious about their own behavior.


    Maidment works with them on their decision-making skills during a six-week intensive program at UCLA. One box of stuff at a time, she goes over one item at a time to help them learn how to make the decisions about what to discard or keep.


    “We encourage them to take a risk and throw it away and tolerate the anxiety it causes,” said Maidment. “It’s practice making decisions. It’s very, very time consuming.”



    Professional Help Is Crucial
    Dr. Paul Munford, a professor of psychiatry at UC Davis School of Medicine and a clinical psychologist with the Anxiety Treatment Center of Northern California, said professional help is crucial.


    “It takes active involvement on the part of the therapist, which would include going to the home, surveying the situation and trying to help the person come up with a plan,” said Munford.


    Some cases surface when city or county building inspectors decide a home is unsafe. They can then order a cleanup and bill the homeowner for the costs.


    The 83-year-old woman in the Orangevale home has been counseled about the dangers of having so much stuff in her house by Judy Kietzman, a social worker with Adult Protective Services.


    Kietzman said she’s talked to the woman and her family about getting exit doorways cleared for safety. She said she’ll be closing the case, because the woman has a right to live as she wants as long as the neighbors don’t complain about health dangers.


    The Orangevale woman, who has owned her home for more than 40 years, explained that she could get everything organized if she had more shelves or could afford a garden shed.


    “Where I dropped it, that’s where it stays,” she said of the waist-high towers of stuff. She wondered if her behavior has anything to do with having grown up in an orphanage where she had to share everything.


    “I’m not worried about it. It’s mine, and nobody can take it away from me.”


    Helping a Hoarder

    Here are do’s and don’ts for intervention:


    Do:



    • Make contact face-to-face.
    • Use a soft, gentle approach and let the hoarder tell his/her story.
    • Treat the hoarder with respect and dignity.
    • Remain calm and factual but caring and supportive.
    • Evaluate the situation for safety.
    • Refer the hoarder for medical and mental health evaluation.
    • Go slowly and expect gradual changes.
    • Reassure the hoarder that others will try to help and work with him/her.
    • Involve the hoarder in seeking solutions.
    • Work with other agencies to maximize resources.

    Don’t:



    • Hospitalize unless there is a clear plan for what this is to accomplish.
    • Force interventions.
    • Be critical or judgmental about the hoarder’s environment.
    • Use the hoarder’s first name unless he/she gives permission.
    • Press the hoarder for information that appears to make him/her uncomfortable.

    Source: Los Angeles Department of Mental Health, Older Adults Services Division




    Reprinted with permission of the Sacramento Bee

    About Attention-Deficit Hyperactivity Disorder

    What is ADHD? Hyper-Impulsive Behavior
    It’s All in a Name What About Adults?
    How Can I Be Sure My Child Has It? What Causes It?
    Inattention How Is ADHD Treated?

    What Is Attention-Deficit Hyperactivity Disorder?

    Attention-deficit hyperactivity disorder (ADHD) is a group of chronic disorders that begin in childhood and in some cases, last through adulthood. It is one of the most common childhood conditions, affecting anywhere from 4 to 12 percent of school-aged children, boys three times more often than girls.

    Children and adults with ADHD have difficulty sitting still, controlling impulsive behavior, paying attention, and concentrating. Nearly every aspect of life can be affected not only for the sufferer but also for those around them. Children and adults with ADHD often have low self-esteem, perform poorly at work and in school, and experience troubled personal relationships.

    It's All In a Name

    If you are confused about the terms that have been used over the years to describe this disorder, you are not alone. ADHD has also been called attention-deficit disorder (ADD), hyperactivity, and even minimal brain dysfunction. Nowadays, experts refer to it simply as ADHD because this term more accurately describes the full range of the condition.

    You may have also encountered some people, even within the medical community, who dismiss the condition and chalk up the behavior to normal kid stuff. Even experts have disagreed on how ADHD should be diagnosed and whether it is real. In 1998, however, The National Institute of Mental Health concluded it was a legitimate condition. The challenge lies in accurately diagnosing ADHD. Not only is there no one definitive diagnosis, but also many of its symptoms and behaviors, when not done to excess, are normal for active, healthy children. Children who are bright, quick learners share some of the same restless behaviors with ADHD children. Likewise, children with adjustment problems who withdrawal may also be misdiagnosed with ADHD.

    So, How Can I Be Sure It's ADHD and Not Just a Phase My Child Is Going Through?

    Consistency is the key.

    At times, nearly all-young children seem to be out of control. They may race from room to room, crash into furniture, shriek, and refuse to listen to parents or teachers. Other times they may drift off into their own world, forgetting to finish a project or appearing not to hear you when you call their name. This does not mean your child has ADHD.

    An accurate diagnosis of ADHD requires that your child experience the symptoms for a full six months and in a variety of settings, not just at school or at home. This way, a clinical social worker or doctor can be certain that the behavior is not simply an issue with the teacher or a classmate, or with the parents or a sibling. Likewise, the symptoms must be severe enough to affect your child's ability to function in these settings.

    Here are some of the signs and symptoms of ADHD:

    Inattention

    • Often loses things, has difficulty organizing self
    • Is easily distracted
    • Often has trouble sustaining attention during tasks or play
    • Often does not follow through on instruction
    • Often does not appear to be listening when directly spoken to
    • Often avoids tasks that require sustained mental effort, such as homework
    • Often makes careless mistakes in school or with other activities

    Hyperactivity-Impulsive Behavior

    • Often interrupts or intrudes on others' conversations or games
    • Often has trouble waiting his or her turn
    • Often fidgets with hands or feet or squirms in seat
    • Often gets up and leaves seat in class or chair at dinner table when it's not appropriate
    • Often talks excessively
    • Often climbs or runs excessively when it's not appropriate

    Children with ADHD can also be especially sensitive to outside stimuli such as sights, sounds, and touch. When over stimulated, they can easily become out of control, giddy, aggressive or even physically or verbally abusive.

    What About Adults?

    If you find yourself dozing off during a lecture or daydreaming when you should be focused on the task at hand or restless in a traffic jam, you may not necessarily have ADHD. But if you exhibit at least two of the three core symptoms – inattention, hyperactivity, and impulsive behavior, you may meet the criteria for diagnosis.

    Bear in mind that ADHD always begins in childhood and may not continue into adulthood.

    Adults with ADHD may also have mood swings, a low stress tolerance and problems with relationships.

    What Causes It?

    No one is entirely certain. While scientists continue to research the exact cause, they do know that these factors play a role in the disorder:

    • Altered brain function – In children with ADHD, the part of the brain that regulates attention, planning and motor control seem to be less active. Also, low levels of the brain chemical dopamine may be to blame.
    • Heredity – Most children with ADHD have at least one relative with the disorder, while almost one-third of all men with ADHD have children who are also diagnosed.
    • Maternal exposure to toxins, smoking and drug use – Alcohol or drug use by pregnant women may reduce the activity of nerve cells that produce dopamine. Likewise, pregnant women exposed to environmental poisons such as dioxins run a greater risk of having a child with ADHD.

    How Is ADHD Treated?

    While ADHD can't necessarily be cured, a combination of treatment strategies can help a sufferer effectively manage the symptoms. A clinical social worker or primary care doctor can help you to come up with a long-term treatment plan that will work best for you.

    A combination of medication and therapy are most frequently used. These include psychotherapy, behavior therapy, social skills training, support groups and family therapy.

    The most commonly prescribed medicines for treating ADHD are psycho stimulants (e.g. Ritalin). For those who don't respond to this approach, doctors will often prescribe antidepressants.

    If a more severe form of ADHD is left untreated in children, dire consequences may result. A child may develop serious, lifelong problems such as poor grades, failed relationships and inability to keep a job.

    Remember, it's no shame to admit that you need help, whether it's for your child, your spouse, a friend or yourself.

    Related Articles:

    Suicide Prevention Real Life Story – Don’t Remember Me











    Dottie Wormser of Hampden Township looks at photographs of her son, Mark Wormser, who took his life by hanging at age 15 in November 2000. (Jason Minick/The Sentinel)


    Most teens deal with adolescent angst and emerge as healthy young men and women.


    But some don’t.

    Suicide is the third leading killer of youth between the ages of 15-24.

    Warning signs of depression and suicide often are attributed to normal teenage behavior — making it difficult for parents and teachers to respond to youth in crisis. In addition, some question whether schools should play any role in providing mental health services for troubled students.

    The Sentinel takes a look at these sensitive issues in a four-part series that starts today with the story of Dottie Wormser’s struggle to lead a normal life in the wake of her son Mark’s Nov. 14, 2000 decision to take his own life.


    Graduation — the right of passage to adulthood. In this case, Cumberland Valley High School, Class of 2004.

    This should have been the happiest night of their young lives. Instead, it was filled with moments of crushing sadness.










    Mark Wormser’s CV classmates included him in their yearbook.


    The class was short two members— two outwardly happy, healthy young men who each seemed destined to accomplish great things and change lives.

    But they chose death instead.

    Mark Wormser, 15, of Hampden Township, was in therapy when he took his life in 9th grade. The product of an otherwise happy home, he began cutting himself during the summer of 2000 and quickly descended into a personal hell culminating with his death at home on Nov. 15.

    Fast forward three-and-a-half years. Tragedy again touched the lives of classmates when popular senior Corey Bischof, 18, disappeared and was found dead of a self-inflicted gunshot wound in May 2004. Starting quarterback for the wildly successful CV Eagles football team, Bischof’s death stunned the entire community.

    Family members and friends of both teenagers were left to grapple with the obvious question: why?

    “You take it very personally that the love I had for Mark wasn’t enough to keep him going,” says Dottie Wormser, Mark’s mother. “I have to remind myself that Mark just couldn’t see past his problems.”

    A piece of Dottie Wormser died with her son. Her road to peace and recovery has been bumpy. The Wormsers’ Hampden Township house burned to the ground two months after Mark died. Years of therapy followed the tragedy.

    Today, Wormser lives in New Cumberland and leads the Suicide Survivors Group that meets monthly at Polyclinic Hospital in Harrisburg.

    And she continues to heal a little bit each day.

    “It doesn’t come after me like a sledgehammer anymore,” she says of the pain.

    This is her story.

    A tragic day

    Wormser understands all too well the hell the Bischofs are living. She has lived it since returning home from work the day she discovered Mark had hung himself.

    “I look at it as Mark took himself out of his own personal hell and put me in it,” she says quietly at her kitchen table.

    Wormser says her youngest son “seemed to enjoy life.” He looked forward to the things typical 15-year-olds do — getting a driver’s license and his first job.

    A Florida Marlins baseball fan, Mark rode skateboards in the summer and snowboards in the winter. He studied karate. He wrote poetry and had a girlfriend he loved. Proficient in computers, he talked of becoming Microsoft-certified or even attending West Point after high school.

    Mark was the kid who sought out wandering students in the hallways and pointed them in the right direction, his mother says. He was known as “Little Worm,” while older brother Kevin was the original “Worm.”

    “Mark had an eye out for how other people were doing,” Wormser says. “He was very charming. That’s not to say we didn’t have typical teenage ups and downs because we did.”

    She recalls no specific incidents that led her to believe Mark would take his own life. He was a normal teenager, she says, and that includes typical “rebellious behavior.”

    Mark toyed with coloring his hair, but he never did. He was surprised when his mother gave her permission for him to pierce his ears. He never did. Once early that summer, Mark ran away and was gone all night. That episode was quickly forgotten.

    “He was spending a lot of time on the Internet, but he said he was chatting with his friends,” Wormser says. “That was a mistake I guess — having the computer in his room.”

    She later discovered that Mark’s webpage included observations on suicide.

    A change

    Mark’s mood changed for the worse the summer before his death.Hewithdrew, spending more time in front of the computer.

    Finally, his mother suspected he was cutting himself.

    “I had seen the scratches on his arm and he’d say ‘The cat scratched me’ or ‘I was roughhousing with the dog,’” Wormser recalls.

    Later, Mark admitted he had cut himself “to prove to himself that he was alive,” she says. A picture in a spare bedroom shows Mark skateboarding that summer while wearing a long-sleeved coat. Wormser now believes he was hiding self-inflicted wounds on his arms.

    She recognized the cry for help and got Mark into therapy. Unfortunately, she was unaware of the depths of his depression — underscored in the poetry he wrote and the suicidal messages she later read on his website.

    “There were some dark places in that poetry,” she says. “He was so good at hiding things from me I guess.”

    As therapy progressed, Wormser became a vigilant protector of her son, making nightly phone calls from work and urging him to make morning promises regarding his own safety.

    “I made him promise not to take his life that day,” she says, recalling a typical conversation. “I did whatever I thought I needed to do to keep him going.”

    The two-week program at PinnacleHealth was “very focused,” Wormser says. “Unfortunately, Mark balked at most of it. He wasn’t doing a lot to open up or cooperate.”

    The program took place in October. Mark wrapped it up a day early and did not go back. Still, the Wormsers had high hopes.

    “I didn’t have a lot of anxiety about it because I knew that kids who cut themselves are not generally suicidal,” Wormser recalls. “I thought we had a pretty clear road ahead of us. I thought he’d get the help he needed and we’d be OK.

    “After we discovered he was suicidal, I don’t remember much about that time. I know we had a great deal of difficulty getting him to go to therapy.”

    Mark was prescribed Prozac. His mother later learned he stopped taking the drug sometime before his death.

    Initially, “he showed no hesitation,” she recalls. “He took it very willingly. I thought he was taking it. I probably should have watched him take them every day.”

    Wormser concedes the likelihood that “as a parent you’re looking for signs that your child is better or over (the crisis).”

    ‘Tried several times to get through’

    Wormser frequently called home from work to check on her sons. The night Mark died, she believes he was on the computer for several hours.

    “I don’t have a clear picture of what happened that night,” Wormser says. “I tried several times to get through that evening and I never did.”

    Returning home after her 3-11 p.m. shift, Wormser found Mark’s lifeless body.

    She futilely tried to revive him with CPR. A suicide note in his pocket revealed 13 wishes. Among the most disturbing is Mark’s wish “not to be remembered.”

    “Everybody wonders why,” Wormser says. “Why would this wonderful boy not want to be remembered?”

    Wormser feared for Kevin and became fiercely protective or her remaining son. Research indicates family members of a suicide victim are susceptible to repeating the tragedy. Wormser admits the thought crossed her mind once or twice.

    “I remember thinking wouldn’t it be nice to join Mark,” she says. “I wanted to be there to guide him through the afterlife.”

    Wormser has few memories of the days and weeks following her son’s death.

    “I remember going to plan his funeral with the funeral director,” she says. “It was something that I had to do for my son. For the first week or so you’re kind of on autopilot.”

    Mark’s best friend insisted on speaking and did so quietly. Another friend played “Amazing Grace” on the bagpipes.

    Every so often, Wormser hears from someone who was at Mark’s funeral. Most of the time she does not remember having seeing that person.

    She calls her work as a nurse at Harrisburg Hospital “my saving grace” and credit co-workers for keeping her alive.

    “After Mark died, I remember thinking the best thing that would happen to me was I would go to work. It kept me sane for awhile. But for the first few months, it wouldn’t take more than five minutes for Mark to creep into my mind. Anything and everything would remind me of him…

    “For months and months the first year,” she adds that “every time I drove home from work I would almost always cry because it would be all that pent-up anxiety from being at work.”

    Therapy helped Wormser work through the grieving process.

    “For those first few months my thoughts of Mark were almost never happy memories,” she says. “Now it’s very comforting to know I can think about Mark… and I rarely cry. I wonder if that isn’t because I cried all the tears out of me. Now mostly I tend to feel like I want to cry when I find out about somebody else who has lost somebody to suicide.

    “I remember the first day I didn’t shed a tear for Mark,” she says, “and I felt so guilty. It got to be about 10 (p.m.) or so and I remembered I hadn’t shed a tear for Mark… I was berating myself for not crying for my son.”

    A graduation remembrance

    Principal Dominic Cavallaro urged CV families to remember both Mark Wormser and Corey Bischof during the class’ June 8 graduation ceremonies at The Giant Center in Hershey.

    In the front row, Wormser and a friend sat with the Bischofs. Random thoughts raced through her mind as Cavallaro spoke: “Don’t cry… Don’t make a fool out of yourself… Be strong for the Bischofs…”

    Candles were lit in honor of Wormser and Bischof and their parents were called forward to receive diplomas meant for their deceased sons.

    “I was told by people in the audience that it was very moving and very touching,” Wormser says.

    Although she still cries easily when talking about her late son, the graduation represented a healing of sorts.

    “A certain calm came over me since his graduation,” she says. “I don’t feel that inner churning that I feel a lot when I think about Mark.”

    Helping to ease the pain

    Dottie Wormser might not have survived were it not for her suicide support group.

    Now she is taking over as facilitator of the group — which meets the first Wednesday of every month at Polyclinic Hospital, 1 Landis, Simpson Board Room, 2501 N.Third St., Harrisburg.

    A licensed social worker, Ned Hoffner, ran the support group for the last seven years. About 8-10 people attend — some for many years.

    “We have parents, we have grandparents, we have siblings, we have spouses,” he says. “While the pain is still there for them, they’ve moved on to some degree. That pain will always be there for them but they’ve found a better way to control it.”

    Most of the members in the group have lost someone younger than 21, Hoffner notes. “At this time, the makeup of the group is everybody’s grieving a male,” he adds.

    Sponsored by WomanCare Resource Center, the group meets from 7-9 p.m.

    Young males often choose hanging

    Hanging and other forms of suffocation have overtaken guns as the chief means of suicide among American youngsters aged 10-14, according to statistics released last summer.

    Researchers from the Centers for Disease Control and Prevention say they first noticed the trend in the early 1990s. By the end of that decade, suffocations had surpassed self-inflected shootings.

    Health officials said they do not know why the switch occurred and whether it had anything to do with the use of trigger locks, lock boxes and other measures taken to keep guns out of youngsters’ hands.

    By contrast, suffocations are often carried out with common household items such as belts, ropes or plastic bags.

    The CDC reports 96 suicides by suffocation among Americans aged 10-14 in 1992.

    The number rose to 163 in 2001, with firearm suicides dropping from 172 to 90 during the same period.

    Suffocation suicides also rose among teens aged 15-19 during the same period (from 333 deaths a year to 551).

    Firearms remain the most common means of suicide for that group, although the number of deaths from self-inflicted shootings dropped from 1,251 a year to 838, the CDC says.

    Overall, the suicide rate for ages 10 to 19 fell by about a quarter, from 6.2 deaths per 100,000 people in 1992 to 4.6 per 100,000 in 2001, the CDC adds.



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