1. Eating Disorders: Survival Guide for Parents with Eating Disordered Children
   Guest: Dr. Cris Haltom

2. Help For Parents Of Children With Eating Disorders
   Guest: Dr. Ted Weltzin

3. How to Help Your Child Deal With Bullies
   Guest: Kathy Noll

4. Mood Disorders in Children
   Guest: Trudy Carlson

5. Parenting Difficult Children
   Guest: Howard Glasser

6. Protecting your Children from Sexual Predators
   Guest: Debbie Mahoney

7. Special Education Law
   Guests: Pete and Pam Wright

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Online chat transcript about how to parent a difficult child.

Howard Glasser, M.A. is our guest and talks about coping with a child who has a behavioral disorder like Oppositional Defiance Disorder (ODD) or Conduct Disorder (CD). Mr. Glasser is the executive director of the Tucson Center for the Difficult Child and is the author of Transforming the Difficult Child: The Nurtured Heart Approach.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Parenting the Difficult Child." Our guest is Howard Glasser, M.A., Executive Director of both the Tucson Center for the Difficult Child and the Children's Success Foundation and is the author of Transforming the Difficult Child: The Nurtured Heart Approach.

Mr. Glasser maintains that most ordinary methods of parenting and teaching inadvertently backfire when applied to Attention Deficit Disorder (ADHD) and other challenging children (like those with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD), despite the best of intentions. Mr. Glasser says his approach, which he claims achieves great results almost always without the need for medications or long-term treatment, works the best.

Good evening, Mr. Glasser and welcome to HealthyPlace.com. We appreciate you being our guest tonight. So we're all on the same track, could you please define for us the phrase: "difficult child?"

Howard Glasser: I like the word, intense. A child can be intense for many reasons, such as emotional, temperament, neurological or biochemical reasons. It almost doesn't matter, they are simply overwhelmed with the intensity that they have.

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David: In your book, you mention that one of the common themes of these "difficult children" is that they become stuck in patterns of negativity that they can't seem to get out of. First, what do you mean by that? And, secondly, why do they get stuck in these patterns?

Howard Glasser: The teacher and the parent really decide if the child is out of the reach of their strategies when they see the child getting worse. Some children simply form the impression based on their experiences and observations that they get more out of people, bigger reactions, more animation and emotion and excitement, when things are going wrong. Our responses to positive things are relatively low-key in terms of the "energy" we radiate. The child feels relatively invisible for the good things they do and starts to feel more successful when they involve us in relation to their negativity. They get stuck when they continue to feel, confirmed by our responses, that the above is true. They are not out to get us, they are out to get the "energy" and are drawn by the stronger force of the bigger payoff.

David: The problem is, for many parents, they try everything under the sun to change the child's behavior, but the troubling behavior continues. Then the parents become frustrated, angry, and tired. What's a parent to do under these circumstances, where nothing seems to work?

Howard Glasser: Yes, the more the frustration, the bigger the lecture, the louder the yeller. Thus, the bigger the "reward" to the negativity, which is the last thing the parent wants to do. It happens very unintentionally. The trick is to create a much stronger "experience " of success and response to success.

David: So what you are saying is very similar to that old parenting adage: "whether it's a positive or negative response, as long as the child gets a response, it's better than no response at all."

Howard Glasser: That's true. It's like a check that has a one followed by six zeros. The child hasn't checked to see that there's a negative sign in front of it.

I can give you an example. In the world of conventional parenting, that does work with easier children. When we ask a child to do a task and they do, we say "thank you" or "good job". We're "radiating" a very modest amount of energy. When they don't follow the instruction, we tend to evolve our response to more high key reactions.

David: So maybe you can give us some instructions on how to be "more positive" with our children?

Howard Glasser:Normal parenting is the culprit. We subtly give evidence that the child gets "more" through adversity. First let me say that "catching children being good" is less than optimal for the challenging child. At the end of the day, the parent or teacher of a challenging child only has a few successes to report. It's too disempowering.

The secret is in having strategies that literally "create" a powerful level of success. And here are a few ways to "cheat" in this beneficial manner. I like to confront children with their successfulness. One great method is to appreciate their success when the rules are NOT being broken. Therefore, at any given moment, there is almost always success in this manner. The problem is that we typically bring up the word "rule" when it's been broken and most adults wind up richly "rewarding" the child with a lot of energy under those circumstances. They are definitely not in a receptive mode to hear the message and we've accidentally deepened their impression that they get more mileage out of negativity.

I find that complements like "I love the self-control you are using now by not arguing and not using bad words" not only gives us much more opportunity to nurture successes, but it gives the child a chance to experience themselves as successful in relation to the rules and to feel valued.

David: We have a lot of audience questions. Let's get to a few of those:

KFIELD: Hi. I came into this chat tonight because my husband and I really need help with our 13 year old son. He seems to thrive off the negative and that is a lot of what he is getting lately. My son has been involved with the juvenile court system three times since August and he doesn't seem to be learning from it. His probation officer feels he has no respect for authority and actually thrives off this negative feedback he is receiving. How do you focus on the positive without ignoring the negative. I feel like that is giving in?

Howard Glasser: I agree with you that ignoring the negative is NOT the answer. The answer is in first playing hardball with successes, while not giving energy to the negativity WHILE STILL having a simple way of saying "you broke a rule" and absolutely delivering a consequence. It's actually not that hard to do. I've worked with over 1,000 court cases in this age group in the last five years.

David: I bet for the parents, Mr. Glasser, you have to do a lot of "biting your tongue" during the negative stuff, at least initially.

Howard Glasser: The power of a consequence is only optimal when there's a lot of energy to successes and none to negativity.

snorider: Mr. Glasser, I understand the "larger reward for success," but then what does one do about the disagreeable behavior? How does one react to that?

Howard Glasser: Once a parent understands that it's so easy to fall in the trap of feeding the negativity and they take a stand to refuse to do that, it's really not that hard. Some parents get to be masters at it very quickly.

For example, let me tell you why these kids are often so great at Nintendo. While the child's playing the game, the world makes total sense. The incentives are clear and the limits are clear. All the evidence of success, the bells and whistles and the scoring, happens when things are both going right and not going wrong. If they break a rule, they simply get a consequence without the big deal or the energy. That structure creates a scenario where they want to excel and they don't want to break rules. We can transpose that to life.

auntamber2: You mentioned that a child can be intense for many reasons, including neurological, emotional and biochemical. I would like to understand HOW using more positive reinforcements can correct biology--if we are dealing with a severe mental illness (my 9 year old son is bipolar).

Howard Glasser: I work with ODD (Oppositional Defiant Disorder), ADHD (Attention Deficit Hyperactivity Disorder) and Bipolar children all the time. The reversal comes from strengthening the undeveloped pathways or creating new pathways of health. You need to believe in the miraculous. I do, because I've seen so many transformations where a child moves entirely to using their intensity in positive ways.

David: To reiterate, you are saying, when it comes to correcting a child's behavior, be clear, but low-key about it. Save your high energy levels for praising positive things about your child.

Howard Glasser: That's a good summary. The only thing I'd add is that a huge typical approach to negativity is to give a lecture or a stern reprimand. The parent will always feel that they are being clear. However, from my point of view: a two minute lecture to a difficult child, no matter how good the lecture, is two minutes of negative "reward" and a five minute lecture is five minutes of "reward".

David: Here's another audience question:

lostime: What happens if you are throwing a "happy praise parade" for every success, and still dealing with a kid-o who melts down unpredictably, and becomes aggressive and violent?

Howard Glasser: That could happen. Most parents will interpret this as the praise is not working. On the contrary, it is working but the child has not quite shifted to believing that they can keep you involved through success. They don't trust it yet and they simply resort to the old guaranteed way of getting the bigger responses.

Also, typical praise like "good job" or "thank you," etc., is definitely not powerful enough for a challenging child. They need greater proof that they've really been seen and that they don't have to go to the trouble of acting-out to have you involved and to not be invisible.

David: Can you give us an example of the type of praise, then, that would get through to a challenging child?

Howard Glasser: Great question! Besides giving recognition when rules aren't being broken, another powerful way to promote feelings of success is to be very appreciative of the values you hold; like respect, responsibility, good attitude, good self-control, etc., when even a glimmer of those things are happening. The problem is that even though we are all desperately trying to teach those qualities, we mostly bring those words up when the child has been disrespectful or irresponsible and we wind up rewarding the very thing we least want to reward with our energized responses.

I like cheating in this regard. If I walk up to students, and even when nothing special appears to be happening, I will confront them with their good choices. For instance: "Billy, I really like that you are choosing to be respectful right now. You are focused on the work and you're not getting distracted."

Another example is: "Alex, I appreciate that you are being responsible right now. You came in the class and got started on your journal without being told. It's also showing me a good attitude." I don't want to fall into the trap of waiting for a bad attitude or irresponsibility to happen for him to feel visable. I don't give the child a chance to fail. Even a consequence can become a success when used strategically. I always congratulate a child when they've finished their consequence and gotten back into control. They still might need to do what they were asked to do, but they've been successful in getting their consequence over.

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David: Mr. Glasser's website is here: http://www.difficultchild.com. We have two excellent sites that deal with parenting difficult children. One is Parenting the Challenging Child. The other is the Child Development Institute.

troubleholt: My daughter completely failed the 4th grade. She's now been placed in 5th grade this year. She's doing good even after failing last year. Should I concern myself with what happened last year or should I go from the here and now?

Howard Glasser: I would definitely go on from here. Many teachers are simply in the same boat of trying to use normal techniques with kids who will never respond and your daughter's response this year is an indication that the teacher is skillful and can engage her successfulness.

dogre: My 16 year old son goes to a therapeutic boarding school . He has a diagnosis of ADD (Attention Deficit Disorder), ODD (Oppositional Defiant Disorder) and possible Conduct Disorder. No meds now. Could we make this work for him and how long might it possibly take? How could we accomplish it with him not living at home?

Howard Glasser: I worked with several parents of 16 year olds in the same situation this last summer. They began by promoting the accelerated level of energizing success on their visits and via the phone. They also began their stand on refusing to energize negativity while the child was still away.

AJ111: How do you suggest handling the ODD behavior when the child is out of control, i.e., screaming, name calling, slamming doors, back talking? I'm not sure of the best way to handle this and make it clear this is not acceptable.

Howard Glasser: You must always begin before the incidents, knowing full well that future incidents will happen. The more intense the child, the more intense the intervention. With Oppositional Defiant Disorder, what is called for is a strong or forceful use of giving verbal recognition to the child when the rules are not being broken. That's how you need to teach the rules, through successes. Then, to promote successes, you'll need to have some kind of credit system that's an extension of your mission. When those are in place, then you are in a position to simply deliver an unceremonious consequence.

Most people are under the false impression that the harsher the consequence or the more powerfully we reprimand or scold, the greater the impact. That couldn't be further from the truth. The power of a consequence comes from the delivery in an unceremonious way. The irony is that if you get the level of success high enough and remove the response to negativity, you can have an amazingly simple consequence work. The child has to test to discover that there's no longer a big response to negativity, only a result. All the big response now is for various successes.

Zigweegwee: My 11-year-old son consistently reacts negatively to any positive comments. How can I get him to desire the positive?

Howard Glasser: This is not uncommon. He doesn't yet trust that he can keep you involved through his success and needs you to convince him that he doesn't any longer need to go to the trouble of being negative to keep you involved. To be more convincing, you need to make the positives more substantial by using more specifics and more details. You'll need to do more of them, and to give more juice to the ones you do through voice quality and putting more heart and authenticity in your comments of appreciation.

KFIELD: I don't mean to sound desperate, but if I don't find something that works for my son between now and January 8th when he is off probation, he will go to juvenile detention for doing anything wrong and he doesn't seem to understand that he is the only one who has control over this. He truly believes that no matter how hard he tries, he will still end up in trouble.

Howard Glasser: You can create a tremendous turnaround quickly with strategies that are powerful enough. I can tell you are very motivated and that will be your best resource. I really recommend reading my book, Transforming the Difficult Child. It will take you through the steps. It's currently the best-selling book on ADHD (Attention Deficit Hyperactivity Disorder and ODD (Oppositional Defiant Disorder).

Many people have just read the book and, by following the recommendations alone, have reported great transformations. The good news is when an intense child shifts his intensity to success, he becomes way above average. The intensity is an asset. That's why I try not to medicate. It makes the intensity go away and that's a great loss. The outcomes without meds is so much better. Everyone gets to enjoy the new intensity and best of all the parent winds up feeling like the hero. Who deserves that honor more?

Elise123: Does your approach work for kids with high functioning autism or other neurological disorders?

Howard Glasser: I've used the approach with a few dozen children with autism and FAS with very good results.

David: Thank you, Mr. Glasser, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. 

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. https://www.healthyplace.com

Howard Glasser: Thank you, everyone.

David: Good night.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

Online Conference Chat with Trudy Carlson About Mood Disorders in Children

Trudy Carlson author of several books on depression and suicide, including "The Life of a Bipolar Child: What Every Parent and Professional Needs to Know," is the guest speaker.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. We have only been open for 2 weeks. This is our first online conference. Our conference tonight is on "Mood Disorders in Children". Our guest is Trudy Carlson, author of several books on depression and suicide including The Life of a Bipolar Child: What Every Parent and Professional Needs to Know. She holds a masters degree and has taught many classes on the university level including child, adolescent and developmental psychology; the psychology of the exceptional child and personality and mental hygiene. Her son suffered bipolar depression, ADHD (attention deficit hyperactivity disorder) and an anxiety disorder, and while still a teenager, died by suicide.

I want to welcome you to the HealthyPlace.com site, Trudy. I'm wondering, with all the education and training you had, were you surprised by your son's tragic death?

Trudy Carlson: Like every other parent, I didn't expect my son to die. I knew he was very ill, but he was seeing a good psychiatrist and we assumed he would eventually be well. Depression is like every other disease and unfortunately, some people, who are very seriously ill, die from their illness.

David: Your son had a mixture of mood disorders- bipolar, anxiety, ADHD. What are the most important things a parent needs to be aware of when dealing with these types of disorders?

Trudy Carlson: Ben said that my understanding that it wasn't his fault was the most important thing for him. Bipolar kids can have a number of social problems and learning problems which makes school very difficult.

David: I think it's a pretty common feeling among people who suffer from psychiatric disorders that somehow they are to blame for what's going on. And that furthers their depression. What can be done to help bipolar children through these social and learning difficulties?

Trudy Carlson: Right, depression in children is marked by low self-esteem. Because they have difficulty with concentration, they often have trouble achieving. This further hurts self-esteem. Children need support. If they can get it from their parents and their school, it helps a lot. But this means that parents and teachers need to learn as much as they can about childhood depression. I am a strong believer that since depression and anxiety as so common among children and it interferes with school achievement, all children should undergo a self-completed screening twice a year.

David: Trudy, here are a few audience questions:

Noele: What advice would be on the top of your list to tell our kids in their hours of need how to deal with the lack of a social life?

Trudy Carlson: That is a tough question. My own son often felt very uncomfortable unless I was there to help him. If the youngster can get medical help that reduces his depression, he will gain self-esteem and this should help. I think the most important thing is to give him a sense of hope. I think many of these children need to be in a group where social skills are taught. Parents may have to find other parents to set up such a group.

lotsoff: How much should the parents push the schools to mainstream their "special" children?

Trudy Carlson: I don't know if all mainstreaming works that well. I think that the parents and the child need to think about what is right for them. Since anxiety is a common disorder that accompanies both unipolar and bipolar disorder, if a mainstream classroom is too anxiety-arousing for the child, it isn't clear that it is helpful.

specialk: Miss Carlson, I have a three-year-old grandson that is having problems at school and to me is exhibiting signs of depression and or bipolar. What should be done at this point?

Trudy Carlson: Many depressed children do well in regular classrooms when they have a teacher who understands they need support.

lotsoff2: Bravo, bravo!!! So many parents want for themselves and miss what is best for their child...on the mainstreaming issue.

Trudy Carlson: If you can find a doctor who will listen carefully to all of your concerns, you have taken a major step forward. Since most bipolar children have the symptoms of ADHD and, in fact, have more symptoms of ADHD than kids who have this disorder but aren't bipolar, this should help all of you in the process of diagnosis. Mood stabilizers, such as lithium and anticonvulsants, are often prescribed. You may need to go to a specialist to get a final diagnosis.

David: Not only is it tough on kids Trudy, but for parents who have children with mood disorders it can be extremely trying. Did you find that so in your personal life? And what would you recommend to parents here tonight to help themselves deal with the stress?

Trudy Carlson: Everyone needs support. Families of children with bipolar illness need the same things that families with children with diabetes need. They not only need medication, but they also need to learn as much about the illness as possible. They also need the support of others who have this condition. They need to structure their lives to avoid situations that make their illness worse. They need to be careful about diet and exercise. Most of all, they need to know that they are not alone, that this illness is not their fault. And there is nothing like talking with others who have been there. One more comment. Anything that parents can do to reduce the stress in their lives, the better. You don't have an easy life. Don't expect so much of yourself.

David: Here are some more audience questions:

Marile: I have bipolar and my stepson is at least ADHD. He just got kicked out of school for behavior problems. I know that most of his problems were related to the medicine, but our family is still disrupted! We are going to go to a new medical doctor to see what she can do for him. We are also going to therapy for anger management. Do you have any other suggestions?

Trudy Carlson: My husband has bipolar, but we did not know this for some time. He is bipolar II, so his symptoms were predominantly depression and the hypomania was very mild. So, we did not understand what was going on with our son for some time. I realized that he had a learning disability, but the school system did not. This was back in the 1980s when schools didn't know anything about ADHD. Now, all of us would like to teach the school systems about bipolar. If your stepson has most of the many symptoms of ADHD, one wonders if he doesn't have bipolar Once he is placed on a mood stabilizer, his behavior will improve.

I don't know if many teachers understand that bipolar kids also often have symptoms of conduct disorders and oppositional defiant disorder. My own son was mildly oppositional. I think I was one of the few people who recognized this.

StarFire: Trudy, I don't have a problem with academics. I'm 17 and almost a sophomore in college. However, I have very great problems with the social aspect. It is not hard for me to meet people online and I have a great personality but I'm almost afraid to be around people in real life. Do you have any suggestions as to how I can go about being with others? It gets very lonely and that only depresses me further.

Trudy Carlson: This social issue is a terrible problem. In the book I wrote on Learning Disabilities, I suggested the formation of a social club for kids. They need training and experience in social situations. Adults have found support groups to be so helpful. I think it is about time that kids experience that kind of support. Bipolar kids have so many symptoms in common with ADHD kids that a group for ADHD would be an appropriate place for them.

David: Here's an audience comment relating to bipolar symptoms and then another question:

Patt: Trudy, that's why I think your book is so important. Teachers (and parents) need to recognize the symptoms and suggest treatment, rather than everyone thinking: "oh, that's just Johnny!"

David: If you are interested, you can purchase Trudy's book: "The Life of a Bipolar Child: What Every Parent and Professional Needs to Know".

samsmom: My 10-year-old son wants to know how he can handle rages at school.

Trudy Carlson: Dr. Burns has a wonderful workbook called: Ten Days to Self Esteem. In that workbook, you will learn many cognitive behavioral techniques that will help you.

David: Here are a few more audience comments relating to our conversation tonight:

Dandy: I've had good results with home-schooling my bipolar step-daughter. But it's really hard to be 24/7 "on duty" as mom and teacher.

Noele: Yes, but even with special school and medication some children feel alone and almost like they hear someone whispering that they are different and crazy. They want to fit in, they have the knowledge of behavior issues yet lack the skills to carry them through. Then what?

David: Here's a question, Trudy, about changes in hormones as your child reaches puberty:

monkeysmom700: Due to the intense counseling my 12-year-old son has been through in the past year, he seems miles ahead of his peers in dealing with adversity. He is fairly stable at this point, almost to where we forget he has bipolar until he has a swinging day. As he heads into the teen years, should we expect the hormonal changes to amplify his mood swings?

Trudy Carlson: I believe that most youngsters who become bipolar experience this at the age of 15-20 year old. Hormones do play a significant role in the onset of depression in girls who didn't experience depression until puberty. If you son is on mood stabilizer medication that is working well for him, he may be very fortunate to avoid serious swings in adolescence. But since the field of child and adolescent psychiatry is still so new, I don't know of any studies that have looked at the question of increased problems for children during adolescence. The big concern would be to keep him on any mood-stabilizing medication that has worked well for him in the past.

worn_out: As a father of a 25-year-old daughter who has had type I diabetes since age 6, I know that most children care little about their illnesses. They just want to be like everyone else. It was difficult to keep her on her insulin, diet, etc. How do you manage children with mood disorders?

Trudy Carlson: Support groups that confront the issue of medication compliance are very important. I have a nephew and niece who have been diabetic since they were extremely young. My nephew says that sticking to the diet is tough. I won't lie to you and say that there is any magical answers to what is a very difficult problem.

David: An audience comment, then another question:

Noele: OK, WE as parents need to find any resource to set up our own group therapy groups of social skills even if its making our kids counselors do this I have been working on this for some time and I will achieve this it EXACTLY what my son needs and maybe your sons or daughters so Parent UNITE now and lets get on it in schools AEA and in our community.

Victoria: I have a 14-year-old boy that was diagnosed six years ago with ADD. When the medication didn't work, I went from doctor-to-doctor trying to convince them that it was more likely to be depression because of the family history. But doctors are reluctant to prescribe antidepressants for children. Why is that?

Trudy Carlson: If your son has bipolar illness, he will need a mood stabilizer rather than an antidepressant. Doctors would be hesitant to prescribe an antidepressant because if he is bipolar, it would make him worse. But if he is clearly not bipolar, and there is no history of bipolar illness in your family, then you might ask if he would consider using a medication like Wellbutrin. That is an antidepressant that has been used to help some people with ADHD. But please remember that I am not a doctor and he needs to get a doctor's opinion. Also remember that if he should be bipolar, that medication may not be helpful.

David: I also want to mention here, there's a big controversy going on right now about doctors over-prescribing psychiatric medications like Ritalin and Prozac to young kids...as young as 2-5 years old. And the pharmaceutical companies haven't done any testing in that area. So, as a parent, it's very important to watch out for that. It is very difficult to properly diagnose children at that age.

Trudy Carlson: Yes, unless the doctor first rules out bipolar illness, Ritalin and Prozac could make the child's symptoms worse.

David: Audience responses to the medication issue:

Marili: Good point David, it is so difficult to know if some of the children's behavior is "normal" or just plain ole rebellion!

Victoria: But no one seems to actually make a diagnosis. He is on Effexor right now, which is the same as everyone else in the family.

specialk: They put me on Wellbutrin for bipolar as well as Zoloft and Klonopin.

Funny Face: Trudy, is it common for more than one child in a family to be bipolar?

Trudy Carlson: I went to the bipolar conferences that are held in Pittsburgh every other year. At one conference, I met a lady whose mother and father were both bipolar. In that case, several of the children inherited the condition. If only one parent is bipolar, the occurrence is approximately 17%. Some of the time, children will have another form of depression.

David: If you are interested, you can purchase Trudy's book: The Life of a Bipolar Child: What Every Parent and Professional Needs to Know.

Lou1: How do I convince my 12-year-old daughter that she needs to be in a special class? She argues this with me all the time. We've tried mainstreaming, it's just too much for her to handle.

Trudy Carlson: I wonder if your 12-year-old daughter would be willing to have some sort of compromise. Would she be willing to be in the special class some of the time and be mainstreamed at other times? Or have you tried this already?

Lou1: Trudy that has been tried already. It didn't work out.

David: Well, I know it's getting late and you're on the east coast.

Trudy Carlson: I can't tell you how much fun it was. I enjoyed the conference.

David: I appreciate you being here tonight. We had about 100 people come in and out of the conference and I think we all learned a lot.

Noele: Trudy, thank you!

Trudy Carlson: If you ever want to chat some other time, I will be happy to come back

David: We will definitely have you back again. Thank you for being our guest and I want to thank those of you in the audience for coming tonight and participating.

Marili: David, I think this was very successful! I'm glad I was not working tonight! Thanks for your time too!

Victoria: Thank you Trudy.

specialk: Good night all and I will return. Thanks Trudy and David.

David: Good night everyone.

Disclaimer: Please note that HealthyPlace.com is NOT recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor and/or therapist BEFORE you implement them or make any changes in your treatment or lifestyle.

Kathy Noll is our guest.
Millions of boys and girls are involved every year in fights on school grounds. Many are physically threatened and also robbed. How can your children protect themselves from bullies and from violence at school?

Kathy wrote the book "Taking the Bully by the Horns". She'll discuss what you, as a parent, can do to help your child deal with bullies and/or prevent them from becoming one.

David HealthyPlace.com moderator.

The people in blue are audience members.

David: Good Evening. I'm David Roberts, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "How to Help Your Child Deal With Bullies".

Some children, today, have been bullied to the point of feeling nothing, feeling numb. They are withdrawn and hopeless.

In a recent study, 77% of the students said they had been bullied. And 14% of those who were bullied said they experienced severe (bad) reactions to the abuse. Did you know that over 6 million boys and 4 million girls are involved in fights every year on school grounds? Many are physically threatened, while a large number of students are also robbed. And with school violence, seemingly, being an everyday occurrence now, what are you going to do when the bully comes calling?

Our guest is Kathy Noll, author of the book: "Taking The Bully By The Horns."

Good evening Kathy, and welcome to HealthyPlace.com. Thank you for joining us tonight. So everyone is on the same track, please define a bully for us.

Kathy: Thanks David, and hello everyone. A bully is a person who has low self-esteem and feels he or she needs to put another person down, in order to make him or herself feel bigger.

David: How does a bully become a bully?

Kathy: There are many different ways. He or she may have been bullied themselves, or it could be the negative influence of peers or the media. It also could be because he is angry either at his own self esteem, or from the bullying he/she received.

David: How does the bully choose his target? What characteristics make the other person "the victim"?

Kathy: Mostly, bullies pick on another child who is younger or smaller than him or herself, because they are easier to control. I should mention that victims are also chosen if they hang their heads low, walk with their shoulders slouched or seem like "loners".

David: In your book, you mention different levels of being a bully -- "mean", "meaner", "meanest". Can you explain the different levels to us?

Kathy: The different levels depend on whether the bullying is verbal, or physical. Physical is the worst case scenario. The "mean" bully may tease you verbally, while the "meanest" bully is the one who is physically violent. That's the one you need to stay away from at all costs.

David: As a parent, what should I do to help my child deal with these types of situations?

Kathy: First, if you feel your child is being bullied, you need to get him or her to admit it. That is the first step. There are also signs to look for, to know if your child is being bullied:

• change in behavior
• lack of concentration
• torn clothing, bruises
• loses money a lot
• depression, fearful, mood swings
• stomach aches, head aches

Don't question victims intently or ask anything that might make them feel they have done anything wrong. Broach the subject obliquely, giving them the option to talk about it or not. Let them know that you are willing to listen at any time. When they start to talk, listen carefully to what they have to say. Let them decide if they want to handle the situation themselves or if they want you to get involved.

Letting them handle it themselves will help with their self-esteem, but if they ask your advice, you could help them come up with acceptable responses to the bully, if say, the bullying is verbal and/or teasing.

David: You mentioned "getting your child to admit he/she is being bullied." Do kids usually keep that a secret? And, if so, why?

Kathy: They are afraid they will get in trouble somehow; that they somehow provoked or asked for this. They might be accused of being a bully themselves. They are also afraid of looking like a "loser" if they admit to being the "victim".

David: I remember, as a child, being bullied one day, and I came home with a black eye. My dad taught me how to defend myself and hit the other person, if necessary. I know that was a different era, but do you still recommend that to parents today?

Kathy: It does help to know some martial arts. But they should only be used as a last resort. There are many lawsuits today due to kids using their skills to "show off" what they've learned. Martial Arts were originally developed, to be used after a more peaceful means of settling the situation have failed. That is what my book is about.

David: Kathy, here are some audience questions:

karen_river: We have a bully who lives behind us and is in my daughter's class, again this year. They are both 9 years old. He's constantly putting her down, degrading her, acting like he knows everything and she is stupid. She does, at times, want to play with him. Sometimes, and at moments, he can be nice to her. What can she do or say to him when he acts like this? I feel she needs to stand up for herself (her beliefs), but his comments/remarks really bother her. Thanks.

Kathy: Make sure she knows she's OK. Explain to her how the bully is the one with the problem. He has low self-esteem and feels pretty bad about himself. Putting others down - he thinks - will make himself feel better. Don't mistake arrogance for high self-esteem. You could help her work on acceptable responses such as "why are you treating me this way? I never did anything to you."

David: What if the bully continues to taunt a child. What do you recommend for dealing with that?

Kathy: You should then, keep your child away from that child, or have a talk with the bully's parents.

David: And that brings the question, when do you think it's right for the parents to get involved in any bully situation?

Kathy: Most bullying takes place on school grounds. There, the kids are the teacher's responsibility, although many feel their only job is to teach. However, there are also many loving and caring teachers who want to get involved, and they need to be told and get involved to stop these incidences. If the teachers won't do anything to help, you can file a police report.

schmidt85: How do you "make sure" she knows she's OK? For junior high kids, that is almost an impossibility if they are on the receiving end of the bully stuff. The "bully" is the one with the self-confidence, and in my experience, the one whose parents allow and encourage that type of behavior.

Kathy: Generally, parents of bullies fall into two categories: They are either very permissive and allow their kids to get away with anything, or they are very abusive. Again, don't mistake arrogance for high self-esteem. Many studies have shown bullies have low self-esteem. If they appear the opposite, it is an act; a show they put on. Again, their main goal is to control.

David: That's an interesting point that Schmidt85 brings up. Is the bully kid receiving "approval" from his/her parents to be a bully, so he continues on with his bully behavior?

Kathy: That is quite possible. All cases are individual and as unique as people are. But yes, many bully kids also have bully parents. Most of the time you don't know, or you won't admit, that you are a bully.

sunnstar: My parents talked to the bully's parents, and the bullies even bullied me more. How do you deal with that kind of situation?

Kathy: Yeah, many times a bully will come back at you harder for "snitching" on them. Again, since most of the bullying takes place on school grounds, you must get the teachers/principal involved. They need to keep an eye on situations like that. Again, if they don't, people need to file police reports.

David: Here are a couple of audience comments, then we'll continue with the questions:

momof7: I would agree with the low self-esteem issue. They feel important when they can put down others.

sunnstar: I believe it is true because the parents of my bullies, abused me more, and then started treating my parents badly too.

Rich005: I was wondering if there were studies on adults who were bullied earlier in life. I was bullied in elementary school and high school. Quite an unhappy time. I'm wondering if there are any residual side-effects that we can have later in life, even after the bullying has ended?

Kathy: My book, "Taking the Bully by the Horns" is based on Dr. Carter's best-selling book "Nasty People". This book is about adult bullying or invalidation.

Most of those people started out as victims and remained victims throughout their adult life. Both of these books are available on Amazon.

David: What about the idea of "ignoring" the bully and, if the bully is engaging in verbal bullying, just not responding.

Kathy: Yes, that works. If the bullying is verbal, sometimes it's best to either ignore it, because if they aren't getting a rise out of you, it is not fun for them anymore. Or if you laugh along with them at what they are saying, again, it's not working for them, it's not fun for them, and they will probably move onto someone else.

David: What does the bully get out of bullying?

Kathy: There could be any number of things. Let's say a bully has a large nose. He may "bully" someone else who has glasses because he wants to distract from himself. Sometimes a bully bullies because he started out as a victim and feels if he/she becomes the "bully", he can no longer be hurt by anyone ever again. Or so he thinks.

David: So is that a common theme...going from victim to bully?

Kathy: Yes, in my book, I call this the "Bully Cycle". Bullies creating more bullies.

Bev_1: Why is it that children of one who was bullied, also get bullied?

Kathy: You mean, the parents were victims and so are their children? Perhaps because they never learned how to improve their own self-esteem or hold their own heads high and feel good about themselves, and so it's hard for them to teach those skills to their children.

David: Here's a related question on that exact point, Kathy:

sunnstar: I know this chat is about children being bullied. I was bullied so severely as a child that I developed social phobia as an adult. To this day, I still get picked on, no matter where I go. I notice that I send a vibe out that I am an easy target. Do you have any advice? Thanks.

Kathy: Have you tried getting professional help? Dr. Carter has helped many people with his "Center for Self-Esteem." And yes, you must be putting out that vibe. And since you are suggesting that here, you know you are. So you need to start feeling better about yourself. There is nobody out there that is any better than you, and if you could get into everyone's head, you'd find out that everyone has different levels of fear and are lacking in self-confidence to some degree.

David: We had a conference last week on self-esteem. You can read the transcript. It was a very good conference with lot's of information.

CATSnHARDROCK: Although we love each other immensely, my girlfriend and I have a tendency to bully one another on certain occasions and I just don't understand where this comes from.

Kathy: Again, fear and lacking in self-confidence. There needs to be open communication to identify the problem. And focusing on the problem not the person, and attacking the problem not the person. Listening with an open mind, and treating a person's feelings with respect, and taking responsibility for your own actions. Not walking away from a problem, but trying to openly discuss it and find a resolution.

David: Kathy, do kids grow out of being bullies, or do they grow up to be big bullies?

Kathy: That could go either way, depending on how many victims stood up to them, how many teachers or parents disciplined them, and if they finally realized how much they have been hurting people.

David: Back to children victims, is there a difference between being a girl victim and a boy victim? And are there different methods used to handle bullies?

Kathy: It's interesting, according to the US Justice Department, there are more girls who are BULLIES than boys! Girls bullying other girls is the big issue now. I know the school violence with guns and bombs is the most serious issue today, but the most common is girl clicks. Girls tend to talk about each other and hang out in groups where they will ostracize each other. They tend to rely heavily on using put downs and gossip, however, most physical fights are between boys, and many girls have gotten quite good at it as well!

David: Should girls use different methods to cope with bullies than boys?

Kathy: No, they should both learn to stand up to the bullies, girls or boys. That is the first step.

Bev_1: With so much bullying, my son doesn't want to go to school. He is 10. How do I get him to go without him getting so distressed about it?

Kathy: Ask your son if he has any ideas on how he can change his situation. Encourage him to resolve it on his own to help improve his self-esteem and listen with an open mind and offer solutions. If his fear is great because of a particular bully, notify the teacher. There are times when this can be done "anonymously," so that the bully doesn't come back harder. Instead of giving names of the victims, just say to either the teacher or the bully's parents, that this child has been causing a lot of grief to other students and needs to be talked to and stopped.

schmidt85: What if you notify the teacher, the teacher notifies the kid's parents, and the bully just gets worse?

David: What if things are so bad, your kid just won't go back to school. Then what?

Kathy: I know a lot of parents write me and have taken their kids out of school to either homeschool them or move them into another school. It's sad how your life is forced to change because of fear and the violence of another person. If the bullying is that bad, again, the police will get involved, and you need to file a report.

David: As a parent, that's a very difficult situation because you don't want to send your child back to be hurt, whether it's physical or emotional.

Kathy: Yes, and even though the physical is the most life-threatening, the verbal will carry the deeper scars throughout life.

dotwhat: Bullying and aggressive taunting is at epidemic proportions today. Do you think schools should start teaching kids not to bully, name-call, and fight?

Kathy: Yes, many schools have a "No tolerance" policy for those situations.

David: Kathy, I always like to give our audience concrete things they can carry home with them from each conference. So I want to go over a few things here:

First of all, if your child is the victim of a verbal bully, what would you suggest the child do and the parent do if the bullying continues to escalate?

Kathy: If the bullying is verbal, the first thing to do is ignore it. If this doesn't work, try laughing along. If this doesn't work, avoid the bully if you can. If you are becoming an emotional wreck because of it, you need to talk to the parents and teachers. Your grades will drop when you have to focus on fear instead of learning.

David: What about physical bullying and if it continues to escalate? And here, I'm talking about taunting, pushing and shoving, and fighting without a weapon?

Kathy: You need to first try to settle the conflict peacefully - talking it out. If the bully doesn't want to talk and continues to hurt you, avoid him at all costs. If he still goes after you, it's good to know martial arts, to walk to school in groups not alone, to avoid alleyways...and at this point, the school, parents, and police should be involved.

David: And finally, Kathy, at what point do you recommend that the parents become involved in intervening?

Kathy: The parents can become involved at any point. Even in the beginning, if the child comes to you for help. He may not feel he can handle the conflict on his own and may ask you for ideas and assistance. But, most definitely, when you are threatened with bodily injury.

David: Now, I know that some parents have the attitude: "well son or daughter, it's time you grow up and learn to handle this on your own". Is that a good thing?

Kathy: Yes, teach them responsibility. Teach them that their actions have consequences and to take responsibility for their own actions. Also to apologize when they know they are at fault.

David: Maybe I didn't make myself clear. I'm referring to telling your child (the victim) to figure out a way to deal with the bully on their own?

Kathy: Don't do that if they are asking you for help. Many bullies are created when parents lack in supervision.

David: Thank you, Kathy, for being our guest tonight. And I want to thank everyone in the audience for coming and participating. I hope you found it helpful. 

Kathy: Thanks David. And thank you everyone. I hope you found the information tonight to be both interesting and helpful.

David: Good night everyone.

Disclaimer: Please note that HealthyPlace.com is NOT recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor and/or therapist BEFORE you implement them or make any changes in your treatment or lifestyle.

Online Conference Transcript

Debbie Mahoney Her former next door neighbor molested her son. Since then, Debbie has devoted her life to keeping children safe. She is the Founder and President of the child protection group, Safeguarding Our Children - United Mothers (SOC-UM). She has a new book out called "Innocence Lost."

David HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts and I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Protecting Your Children From Sexual Predators". Our guest, Debbie Mahoney, is author and founder of the child protection group Safeguarding Our Children-United Mothers (SOC-UM), which is a site inside the HealthyPlace.com Abuse Issues Community. We'll be discussing why children are at risk, what are the behavioral indicators of an abused child, how do you report child abuse, and the most important safety tips you need to know -- BEFORE anything bad happens to your child.

Debbie's son fell prey to her former next-door neighbor, and since 1996, Debbie's devoted her life and personal resources, and a lot of her energy, to protecting children. She also just came out with a new book called "Innocence Lost," which goes into more detail about some of the child abuse issues we'll be discussing tonight.

Good Evening, Debbie and welcome to HealthyPlace.com. We appreciate you being here tonight. How old was your son when he was abused by your former neighbor?

Debbie: Thank you for having me. Brian was between the ages of 10 and 12.

David: So, this occurred over a two year period. Did you have any idea what was going on?

Debbie: No. I had no idea. If I knew, I would have stopped it. Like most children, Brian did not disclose the abuse.

David: How did you find out?

Debbie: I found out because the perpetrator belonged to the group NAMBLA, a pedophile ring and there was a perpetrator in prison who gave up Jonathan Tampico's name. They did a search on his house and found a project that Brian and I had worked on. They found the school project and the police called me and that's when Brian disclosed.

David: So, I'm sure it came as a complete surprise to you, and an unpleasant one at that. I say that because I'm sure that's the situation most parents find themselves in -- after the fact.

Debbie: It was horrible. It's one of the worst nightmares a parent discovers. I was overwhelmed with guilt because I didn't know the child abuse was occurring.

David: Since tonight's topic is on "prevention," as you look back now, and it's been several years since this abuse happened, what do you think about?

Debbie: There were signs that something was wrong and I didn't know what those signs were. I attributed those signs of child abuse to other things, such as puberty, and just being a boy. But there were signs that abuse was occurring, which is why I'm a proponent of educating children.

David: You mentioned there were signs that abuse was occurring to your son, what are the warning signs that parents should be aware of?

Debbie: There are a variety of warning signs of child abuse. Behavioral indicators such as anger, chronic depression, poor self esteem, lack of confidence, problems relating with peers, weight change, age-inappropriate understanding of sex, frightened by physical contact or closeness, unwilling to dress or undress in front of others, nightmares, change in behavior, going from happy go lucky to withdrawn, change in behavior toward a particular person, suddenly finding excuses to avoid that person, withdrawals, self-mutilation.

It's important to remind people that any one of these signs of child abuse can be attributed to something and they should seek help through a mental health professional.

David: We, the general public, tend to think those child molesters are a certain "type," seedy people who can be easily spotted. Maybe that comes from TV and the movies. Is that a true portrayal?

Debbie: No. People who are child molesters are usually in a position of trust. They can be teachers, coaches, lawyers, police officers, family, friends. Child molesters are good at manipulation and are not wearing trench coats. The statistics for child sexual abuse are as follows:

• One-quarter of children sexually abused are abused by a biological parent.
• One-quarter of children are sexually abused by stepparents, guardian, etc.
• And one-half of children are sexually abused by someone that the child knows.

So three quarters are abused by someone other than the biological parent, but someone that the child knows.

David: Debbie, here are a few audience questions:

Eagle: How did you know he was part of NAMBLA?

Debbie: We found that out later. We didn't know that at the time. I found out during the investigation. The same man had top-secret government clearance, he worked at one of our national weapons labs and was a former big brother, and a tutor at a former school, and my next door neighbor.

lpickles4mee: What about all of these people just getting out of jail and moving in the neighborhoods?

Debbie: If we are talking about public disclosure, then I agree. Parents have a right to know. The recidivism rate for a convicted sex offender is higher than any other crime.

David: So considering that some molesters are "trusted" individuals, teachers, lawyers, even police officers, how can a parent reasonably protect their child from sexual predators, short of locking them up in a room 24/7?

Debbie: Well, I believe giving parents the info on who these sexual predators are. Public disclosure and educating children is the biggest advantage we can give our children. We can teach our children to be safe, not fearful. The biggest asset a sex offender has is silence, the secret nature of the crime.

David: How about giving us 3 specific things that parents here tonight can carry with them when they leave, dealing with protecting their child?

Debbie: We need to stop this from being a topic we don't discuss but a topic we do discuss openly. We can teach children that if someone tries to touch them in ways that make them uncomfortable or afraid, or in parts of their body that is covered in bathing suits, that they should tell. We can go down and find out the registered sex offenders in our area. If we find out one of the neighbors is a sex offender, you need to talk to your child and tell them if that person approaches them that they need to tell their parents. We can tell parents that children do not disclose because they believe that what happened is their own fault. They think they will get in trouble. They don't want to break up the family, if it is a family member doing the abusing. They don't think they will be believed. They are afraid for their families or themselves. And the main reason children do not disclose is because they feel dirty.

It is important that we talk to the child, but be careful not to make the child fearful.

Cindee12345: Is there a web site that we could look up past sexual offenders names?

Debbie: There are various states that have databases online but not all states. For instance, California has 40,000 registered sex offenders and only part of California database of sex offenders are online. Some states show their pictures, but it varies depending on the state.

shycat: Why do people molest? Are they out of control? Are they sick in the head? Does anyone know?

Debbie: We do believe that the majority of sex offenders were abused themselves as children.

Eagle: Here in the UK, you have no access to child abuser records. How do we protect in any other way which is related?

Debbie: Well, my first suggestion for the UK is to find some way to pass legislation to make sex offender databases open to the public. Next, parents should be informed about this subject and inform their children.

TOBI: How do you feel about the June 24th MBLD movement - Candles in windows. June 24th is the day all boy-lovers pronounce their love of children. If you see these "white" candles, notify your local police or call the FBI. Do not approach them yourself. MBLD - stands for Man-Boy Love.

Debbie: Boylovers are male pedophiles sexually attracted to boy children and they have the largest organized community on the internet. Thank you TOBI, excellent response.

TOBI: We also need to educate AGAINST placing your children's photos on personal web pages.

Debbie: That's absolutely correct TOBI. Your website is listed in my book :)

Charles: How much should we say to our children and when? Are we asking them to understand grown-up things before they are ready?

Debbie: Well, I think you can talk to children depending on their age. You can't talk to a three-year-old about sexual abuse but you can talk about good touch and bad touch. Good communication skills with your child are very important, and just talking about safety one time is not enough. It has to be continual.

goinggone: How do you make children talk about sexual abuse when it does happen. My children did not tell and they were old enough to know to tell, 14 and 15.

Debbie: Well, as I said earlier, children don't disclose for a variety of reasons. The child may not disclose because of what the pedophile may tell the child. The pedophile might tell children "I will hurt you, I will hurt your family, no one will believe you, I love you and this is how people show their love, this is a game two people play when they like each other, etc." I'm so sorry to hear about the abuse of your children. I hope you and your children are receiving therapy.

goinggone: Yes, we all went through therapy. We have moved forward, but I am still looking to find a way to help children to speak up, to not be afraid.

David: You talked about the behavior signs which might indicate abuse. How does a parent actually determine if their child has been abused?

Debbie: Parents need to seek professional help if you suspect something is going on. Don't try to diagnose or confirm the problem yourself.

David: What are the steps involved in reporting abuse?

Debbie: It is important to know that most cases of child molestation do not happen right away. There is a period of courtship, or grooming, that occurs in order to lower the inhibitions of the child. Call your local law enforcement agency or child protective services. If your child has disclosed abuse, don't question him or her further. Let the local law enforcement agency handle the questioning. They are the experts, let them do their job. Ask the police department if they are going to videotape the interview with the child. Videotaping often cuts down the request for further interviews. Write down all the info the child says to you, or to others, and anything else that is relevant. Keep a diary of events including details that occur with the police and protective services and/or district attorney. Call victim services and see what is available. You can get their number through the district attorney's office.

David: Here's the link to Debbie Mahoney's book: "Innocence Lost" and to her site, SOC-UM, which is a site inside the HealthyPlace.com Abuse Issues Community.

Here's an audience question, Debbie:

guardian: I know, for myself, that when I found out about my daughter's abuse, I was stunned. Now, we are going to court in two weeks and it is frightening. Was it frightening for you?

The hard part is to go through what she is going to have to face in court. I don't think I can stay in the room when she testifies. Is that wrong of me? We want to do something so that he is not working in schools around children.

Debbie: My heart goes out to you. Your daughter may not want you there when she testifies. But if she wants you there, you should be there no matter how difficult it is. It is perfectly normal that you feel that way, guardian.

David: Was your son's perpetrator prosecuted?

Debbie: Yes. He was prosecuted two times. He was prosecuted in 1990 and received a 6-year sentence. He spent 2 1/2 in prison and got out. He had a technical violation and went back in. But while he was out, the police found the largest stash of child pornography in the Bay area in his storage facility under a false name he used. He's now sitting in federal prison.

David: Here are a few audience comments:

Eagle: Just an excuse. I am an abuse survivor and cannot see how a survivor can abuse another kid.

Debbie: The majority of children who are abused do not abuse when they are adults.

shycat: But my brother molested me when we were both young.

Cindee12345: I have a sibling that is currently in counseling. She has told me that she was sexually abused by her father and brothers. She also told me that the sexual abuse is still going on and that my sons were sexually abused by her brothers. If my sister says she has proof that the sexual abuse is still going on, I believe it. So I contacted social service and sheriff. They both told me to trust my sons.

David: What was it like for you, as a parent, to have to go through the investigation process and then into the courtroom?

Debbie: I wanted to do everything I could do to help the law enforcement to ensure that this person could not harm another child, which is why I have fought so hard for registering sex offenders. Going to the courtroom was scary but the prosecution was a great validation for my son and these children need to know that what happened to them is not their fault.

David: Was it a difficult time for you emotionally, or were you so angry and so involved in the prosecution of the offender that helped you get through it emotionally?

Debbie: I think for the first 2 years after I found out about the abuse I was in a daze. I was so involved in law enforcement and finding info about child molesters. I was angry but there is no longer any anger.

David: Debbie, what is it like to be a victim of child abuse?

Debbie: It is so devastating that you don't want to see any other child go through what my son when through.

David: Besides real-world sexual predators, which are difficult enough to deal with, we now have people on the internet who disguise themselves as nice people who prey on children. What can parents do to protect their children from these people?

Debbie: Make sure the computer is placed in an area that allows being monitored by the parents, such as the family room. Prior to allowing children net access, sit down with your child and explain to them that people are not necessarily who they claim to be. Tell your children never to receive files or pictures. Set a time limit for using the net. Tell your child never to meet a person they met online, in real life. Parents can also check the cache and the history to find out what their children are accessing.

David: There's also software available that allows parents to set limits on where their children can go on the net.

Once again, for our audience information, here is the link to the SOC-UM's webpage.That stands for Safeguarding our Children - United Mothers. Debbie is the founder and president. And here's the link to Debbie Mahoney's book: "Innocence Lost."

We appreciate you coming tonight Debbie and sharing this important information with us.

Debbie: Thank you very much for having me. The most important thing we can do is protect our children.

David: And thank you to the audience for coming and participating. I hope you found it helpful. Good night everyone.

Debbie: Good Night

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Disclaimer: Please note that HealthyPlace.com is NOT recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor and/or therapist BEFORE you implement them or make any changes in your treatment or lifestyle.

Dr. Ronald Potter-Efron, MSW, Ph.D., author of: "Rage: A Step-by-Step Guide to Overcoming Explosive Anger" discusses the differences between rage and anger, what causes someone to go into a rage and how to control your anger (anger management).

Natalie is the HealthyPlace.com moderator.

The people in blue are audience members.

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Natalie: Good Evening. I'm Natalie, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Rage: Overcoming Explosive Anger". Our guest is Dr. Ronald Potter-Efron, MSW, Ph.D., author of: "Rage: A Step-by-Step Guide to Overcoming Explosive Anger ". He is a psychotherapist in private practice in Eau Claire, WI, who specializes in anger management, mental health counseling, and the treatment of addictions.

Good evening and welcome Dr. Potter-Efron.

Dr. Potter-Efron: Hello and thanks for the invitation.

Natalie: In your book, Rage you say that rage is not just extreme anger. What is it, then, and how do you differentiate it from intense anger?

Dr. Potter-Efron: The two are quite different in several ways:

First, anger is goal-directed. By that, I mean that an angry person wants something specific. Rage is threat-directed. The individual believes he or she is threatened and is trying to relieve the threat.

Second, rage is a Dr. Jekyll and Mr. Hyde experience. The person having it feels like the rage is happening without his or her consent. There's a sense of disbelief, a "what is happening here to me" event.

Third, ragers sometimes lose conscious awareness of their activity. They have rage blackouts that last from seconds to hours. This doesn't happen with anger.

Fourth, ragers often lose control of themselves in amazing ways. It's not unusual, for instance, for them to report that it took seven grown men to pull them away from the person they were attacking. I've even had 120 women tell me this.

Natalie: A section of your book is entitled "The Raging Brain," and in it, you talk about the differences between the brains of ragers and non-ragers. Explain this.

Dr. Potter-Efron: Think of all of us having less than perfect brains but some brains are even less perfect than others. Three types of brain problems may be associated with raging, but none all the time. These are:

1. Damage to the temporal lobes on the sides of the brain. These are easily injured. Damage can lead to instant total meltdowns seemingly triggered by nothing at all. Best medication for this is anti-convulsants such as Tegretol (Carbamazepine).
2. Under-functioning pre-frontal lobes. This affects a person's problem-solving ability and makes them more likely to blow up in total frustration.
3. Over-functioning anterior cingulate gyrus. This leads to obsessive thought processes, an inability to let go of insults that can slowly or quickly build up to a rage episode.

Natalie: That's very interesting. What are some of the psychological and emotional factors involved in rage, and are there common experiences that ragers report having in childhood or in their early lives?

Dr. Potter-Efron: Each type of rage has its own psychological issues so let me defer on that question until later when we discuss the 4 types of rage.

Children can and do rage, probably more than adults, because they have relatively poor controls over their anger. Let's make a distinction between a goal-directed tantrum ("I want that ice cream cone!) and a true rage ("I can't stop screaming even though I don't know why I'm doing this"). And, of course, early childhood traumatization, sensitizes children to become adults who rage.

Natalie: You talk about the four different kinds of rage. What are they?

Dr. Potter-Efron: Survival rage. A response to a threat to physical survival such as rape, assault, etc. Here's an example. A client of mine was about to be beaten by his father when he was 16 years old. The last thing he remembers is screaming "NO." Two hours later he awoke from his rage state to discover his father lying unconscious (not dead) on the floor. His father weighed over 250 pounds.

Impotent rage. The threat here is to the human need for control over one's life. Frustration builds when someone feels helpless to alter significant problems. One example could be finding out your child has terminal cancer.

Shame-Based rage. Now the threat is to one's respected place in the community (and to self-respect). Some people react with rage to times when they feel disrespected.

Abandonment rage. This time the threat is the loss of an intimate relationship. "I can't live without you" leads to jealousy and desperate attempts to maintain a relationship.

Natalie: Is raging more common in men or women, or does it occur at about the same rate in each population?

Dr. Potter-Efron: Men vs. Women. Probably the rates are about the same. Since men are stronger, they may be more dangerous when raging, but some women are amazingly powerful when raging and weapons increase the risk.

Natalie: Let's imagine a hypothetical client who comes to you and says, "My rages are ruining my life. I can't control them. They've nearly ruined my marriage and gotten me fired from jobs." What's the first thing you do with this client to get his rages under control?

Dr. Potter-Efron: a) I have questionnaires in my book, Rage: A Step-by-Step Guide to Overcoming Explosive Anger, that help people identify that they rage, what kind of rages they have, and the details of specific rages. Getting as much information as possible as quickly as you can is the first step.

b) Ask the rager what he or she has done in the past to stop or lessen rages. They probably know from past experience what works best (For instance, getting away for a couple days or going to an AA meeting or taking a medicine).

c) Get that person to promise to do whatever works immediately, reminding them of the risks if they fail to do so. Find out if they really can and will take these immediate safety measures.

d) If there is any doubt, get them to agree to an emergency referral to a psychiatrist for appropriate medications.

e) All that buys time to develop a longer-term game plan.

Natalie: In addition to the four types of rage we've already discussed, you include a chapter called "Seething Rage, Personal Vendettas, and Rampage." This title calls up scenes from the frightening news stories we've all seen about a disgruntled employee or an angry ex-spouse who seemingly "snaps" and unleashes a torrent of violence. How do you prevent this kind of rage?

Dr. Potter-Efron: Seething rages are like underground fires. People seethe often without anybody realizing how furious about life they are. Then they sometimes explode in a hail of gunfire, going on Columbine and Virginia Tech type rampages. The best approach here is to get people to discuss their resentments before they build up into hatreds. Seethers need help learning to let go of the past and get into the present. Forgiveness work helps with some people but it is a long-term process. Also, like impotent ragers, they need to direct their fury in some effective direction such as politics or advocacy.

Natalie: Last year a study came out about that concluded that intermittent explosive disorder is more common than previously thought. What is IED, how many ragers actually have it, and why is there a controversy surrounding this diagnosis?

Dr. Potter-Efron: IED stands for intermittent explosive disorder, said to affect perhaps 7% of the population over a lifetime. It is the only diagnostic category for anger and violence in the psychological diagnostic book (The DSM-4) and so has become kind of a garbage can. IED fits best for people who usually are in control but periodically "meltdown." That's what most ragers do so it's the best single diagnosis for rage.

Natalie: What role does substance abuse play in rage?

Dr. Potter-Efron: I have one client now who got drunk 3 days in a row and had the only 3 rages of his life on those days. However, usually, there's not that clear-cut a link. Instead, intoxication lowers internal restraints against raging and clouds one's judgment at the same time. Long-term use might contribute to brain damage that then increases the likelihood for rage.

Natalie: Thank you, Dr. Potter, now we're going to get some questions from the audience.

lisa8467: Are some people genetically predisposed to rage disorders, or is it a learned behavior?

Dr. Potter-Efron: Some people are probably more genetically susceptible. Some people endure brain damage later in life and I think it can be a learned behavior if modeled by parents and reinforced strongly.

notgoodenough: I don't have rage, but I seem to be angry all the time. I yell at people for no reason. I was wondering what I can do to stop being angry?

Dr. Potter-Efron: First, make a promise to yourself to stop yelling, shouting, etc. -- Not a promise to try but a promise to act. Then learn all you can about the details of how you get mad. Change even one thing in the pattern (first I do this, then this, then this, etc.). And that's a good start. Find people you trust and are calm and act "as if" you were them.

Cali: I am very obsessive. This leads to extreme anger, but not necessarily rage. My medications help to a point. Is there anything else I can do to help keep this under control?

Dr. Potter-Efron: Cognitive thought challenging works best with obsessing. You have to find a real positive thought that you can insist goes into your brain. The positive thought then helps dislodge the obsessive one.

felinine: My rage seems to build up from anger to rage. How can I spot the build up and stop it?

Dr. Potter-Efron: There are always clues that a rage is building up. Physical (breathing...) Mental ("I can't take it") Spiritual even (What's happening to me?). Get all the information you can about how the pattern builds up. Take a time out before you blow, not after. Enlist support from trusted others who will tell you that you are starting to lose control and listen to them when they tell you.

toughgal: How do I somehow break the cycle and stop that anger before it starts, and if it DOES start how do I get my husband to point it out to me so that I can stop it?

Dr. Potter-Efron: I can't answer the first part because I don't know you. Regarding the next question, the 2 of you need to be a team. Raging is really dangerous and destructive. You need his help but you also need to make sure you listen to him, not punish him, for telling you what he sees.

jbrinar: Besides the obvious of giving them clues and letting them know it is building up, what can you do for a child's rage that gets so out-of-control they put holes in walls and break things? The rage is so built up, they will not listen to rationality.

Dr. Potter-Efron: Children who rage mostly need protection while they are having the rage. You have to intervene very early as you probably know, before they lose control. I suggest a set few phrases that you say only when they are beginning to lose it, along with a clear direction when you say it. That helps cut down their confusion. Very simple couple word phrases.

lyda027: Can you talk about instant rage seemingly from nowhere?

Dr. Potter-Efron: Some rages seem to appear from nowhere for absolutely no reason. If that happens consistently, I think you must consider medications. If you can't see it coming, you can't stop it. But also keep looking for cues, subtle cues, that you're beginning to lose control.

Kimby: My boyfriend has shame based rage, I think, and is very controlling. What is the most effective treatment for this type of rage/behavior?

Dr. Potter-Efron: Shame-based rage centers on clients taking in five critical messages about themselves: I am good, I am good enough, I belong, I am lovable, I exist. The last is ultimately the most important and the most difficult to achieve. The best thing you can do is to consistently let that person know you hold him/her in respect because respect is what shame-based ragers yearn for.

Hippy. How do we get rid of the rage that has been held inside for years? Feel fearful to even disagree with another person. What if it ever comes out?

Dr. Potter-Efron: You're describing a seething rage. Try letting a little bit of it out in a very safe place. With friends or therapists perhaps. Often the fear of having a rage is worse then the rage would be if you let it emerge.

angelicababy: What is the best way to deal with someone who is clearly in the midst of having a raging fit?

Dr. Potter-Efron: Safety is the only consideration. Talk is useless. Just try to keep the rager and yourself safe. Call 911 if need be and you can. Wait to talk until after the rage has been spent.

amayzingme: What type of medication works well with rage?

Dr. Potter-Efron: Several sometimes work. Anti-convulsants like Tegretol (Carbamazepine) are most common. Also SSRI antidepressants and also Ritalin (Methylphenidate)-like medications for people who need help keeping their frontal lobes working right.

Natalie: Our time is up tonight. Thank you, Dr. Potter-Efron, for being our guest. We appreciate you coming and speaking to us about rage and anger.

Dr. Potter-Efron: Thank you. It was an honor.

Natalie: Thank you, everybody, for coming. I hope you found the chat interesting and helpful. For more information on the rage and how to control it, you can purchase Dr. Potter-Efron's book Rage: A Step-by-step Guide to Overcoming Explosive Anger.

We also have another transcript from an earlier chat: Anger Management for Uncontrollable Anger, Explosive Rage.

Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

Medications. Our visitors are always asking about psychiatric medications. "What's this medication used for? What are it's side-effects? The dosage seems to high for me."

Our guest, Dr. Lorraine Roth, will be discussing all aspects of psychiatric medications and taking your personal questions.

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Dr. Roth is a Diplomate of the American Board of Psychiatry and Neurology specializing in the practice of Psychopharmacology -- medication for the treatment of psychiatric disorders.

• Some of the non-psychotic conditions for which medication is prescribed include depression, anxiety, panic attacks, phobias, eating disorders, and obsessive-compulsive disorders.
• Psychotrophic medication is usually necessary for the treatment of the major psychiatric disorders, such as schizophrenia, manic-depression (bipolar affective disorder), and major recurrent depression.

Dr. Roth practices in the Chicago area, and is licensed to practice medicine in both Illinois and North Carolina. A graduate of the University Of Texas Medical Branch at Galveston, Texas, Dr. Roth received her Medical Degree in 1979. She completed her residency in Psychiatry at the Duke University Medical Center in Durham, North Carolina, in 1983. Dr. Roth also completed a fourth-year post-graduate fellowship in Forensic Psychiatry through Duke University, at the Federal Correctional Institution in Butner, North Carolina.

Dr. Lorraine Roth specializes in the practice of Psychopharmacology. She discusses the best medications for psychiatric disorders and the side-effects of medications.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Psychiatric Medications". Our guest is psychiatrist, Lorraine Roth, M.D.

Dr. Lorraine Roth is a board-certified psychiatrist based in Chicago, Illinois. She specializes in psychopharmacology, medication for the treatment of psychiatric disorders.

David: Good Evening Dr. Roth and welcome to HealthyPlace.com. We appreciate you being here tonight.

Has science gotten to the point where most of the psychiatric disorders can be attributed, at least in part, to a brain chemical imbalance?

Dr. Roth: We think we know most of the biochemical pathways evolve in many psychiatric disorders, but we don't have everything at this point in time.

David: Do you picture a time, in the not too distant future, when there will be a psychiatric medication for most mental illnesses that will give the patient significant relief?

Dr. Roth: We already have medications which can give a considerable amount of relief for most psychiatric disorders. Personality disorders or character problems are more or less unable to offer help, medication wise.

David: Why is it that, for some people, finding the right medication is still a "hit and miss" type of thing?

Dr. Roth: Medicine is not perfected in terms of knowing precisely which meds will work for any one individual. It's not unlike the antibiotics that work for some and not others.

David: As I understand it, there are no blood or other types of tests that can pinpoint which brain chemical may be out of whack. So, is choosing the right medication still a matter of trial and error?

Dr. Roth: For the most part, yes. But there are certain tests that can be run for certain conditions, but it is far from being an exact science in this point in time.

David: Can you elaborate on that a bit? Explain more about these tests and what they are used for?

Dr. Roth: Most of the tests are used in research settings, for example, we can test cortisol levels to determine if someone is responding to an antidepressant but we can't test to see exactly which antidepressant is going to work the best.

David:Since many of these medications are fairly new, do patients have to worry about the long-term effects of taking them?

Dr. Roth:That depends on which meds you are concerned about. Some meds have to be watched more closely for long-term effects. Others, you do not have to worry about side-effects.

David:One last question from me before we start taking some audience questions. Today, all types of doctors, not just psychiatrists, can prescribe psychiatric medications. What's your thought about this and having people going to their family physician and getting antidepressants, anti-anxiety medications, etc.?

Dr. Roth:There is no problem for mild symptoms, such as temporary insomnia, transient stressors, etc., but for more serious illnesses, you would probably want someone more familiar with psychiatric medications and patients.

David:By the way, which medications do patients have to worry about the long-term effects?

Dr. Roth:Medications which are called anti-psychotic, which may cause long-term movement disorder or meds which may affect the thyroid glands.

David:We have a lot of questions from the audience, so let's get started Dr. Roth.

hawthorne:I have epilepsy controlled by medication and my doctor has put me on Serzone for Panic Disorder. I'm a little bit scared of taking it as I have heard it can cause seizures. Do I need to be concerned?

Dr. Roth:Probably not, if you are taking the recommended dose. It is very important with antidepressants like serzone to take exactly what is prescribed and not taking extra.

cd:Which medications affect the thyroid gland?

Dr. Roth: Lithium is probably the most common culprit, but it is nothing to be to concerned about if you are taking it because it can be checked on a regular basis for any significant problems that may arise.

Annie1973:I have severe depressive disorder with anxiety. I have had problems with side-effects on most medications. Due to my history with drug abuse and suicide attempts, my doctor won't prescribe a few medications that do work for more than a short while. Any suggestions? I only take Buspar at the moment and it does very little.

Dr. Roth:That would be very difficult for me to comment on. Given what you have told me, I would probably do the same thing your doctor is doing. I would prescribe the meds that work best but in small amounts.

David:For a more detailed look at the various medication side-effects, visit our psychiatric medications pharmacology.

lambieschmoo: There is a lot of talk about the negative effects of long-term SSRI use. Could you please comment on this?

Dr. Roth:To my knowledge, there are very few long-term problems with SSRIs. Generally, they are safer than most other classes of antidepressants.

David:Do patients taking medications like antidepressants, mood stabilizers, anti-anxiety medications, have to worry about becoming "addicted" to them?

Dr. Roth:For the most part, no. None of the antidepressants, mood stabilizers have addictive potential. Some of the anti-anxiety medications can be addicting, but only in very few people. Anti-anxiety medications are very safe.

David:On the same subject, here's an audience question:

Hysign3: Dr. Roth, could you please tell me the proper way to get off Ativan? I take .5mg twice a day and 1mg at bedtime and I am having bad side-effects from it.

Dr. Roth: If you are having bad side-effects of medications, you should stop taking it. However, if you can withdraw, that is highly recommended. You should talk to your doctor about a withdrawal schedule. It would be dangerous to stop it all at once.

DottieCom1:What are the consequences of lifetime use of high doses of Sinequan?

Dr. Roth: That is one of the older tricyclic antidepressants. There are no long-term side-effects problems with Sinequan when taken as directed.

Dana1:I've had severe Generalized Anxiety Disorder (GAD) and Phobias for 20 years now. I am in setback and have $4000.00 in books and tapes. Any suggestions on anything new to change my thinking besides Cognitive Behavioral Therapy (CBT)? And, can one "program" the mind to not fear the mornings and symptoms?

Dr. Roth:There are many meds which can be helpful for Generalized Anxiety Disorder (GAD) and phobias. I would imagine you have been on some of them. If not, you should talk to a doctor to prescribe medication for your condition.

David:Because some people are without insurance, or on a limited budget, given the choice of medications vs. therapy for depression, anxiety disorders, bipolar disorder, and OCD (Obsessive-Compulsive Disorder), which would you recommend?

Dr. Roth:Meds and therapy together work best. A county mental health clinic may offer treatment on a sliding scale, which you can afford without insurance. See if your county has one.

David:But if you can't get in on a program, which would you recommend-- the medications or the therapy?

Dr. Roth:Medications should work more quickly to relieve the most problematic symptoms. Some meds are relatively less expensive.

tears2: Why does it seem that SSRIs work great for about 6 months, then stop working?

Dr. Roth:They shouldn't quit working. It may be that the depression or other symptoms are relapsing or getting worse and a higher dosage may be required from time-to-time.

dano:Why do many psychiatric drugs cause weight gain?

Dr. Roth:We don't know the answer to that. We can only speculate and identify the drugs that are known to do that.

AllWithin: Does Zyprexa cause weight gain?

Dr. Roth:Yes, it does. It may be the most notorious drug for weight gain. It is also one of the best anti-psychotics on the market.

David:So, I guess what you are suggesting, Dr. Roth, is that there's a trade-off in many psychiatric drugs. Many have side-effects. Hopefully, the benefits outweigh the medication side-effects.

Dr. Roth:It's all a question of benefits and risks. That applies to surgery and all medications we have. There is nothing in all of medicine that has no side-effects or risks, and we always have to weigh them.

dhill: Why don't doctors encourage parents/patients to try other avenues first? e.g. counseling, realistic thinking, etc.?

Dr. Roth:That should depend on the symptoms of the illness. If the symptoms are not causing major dysfunction, then therapy can be very helpful and is all that is needed. But if the symptoms are serious, for example keeping you out of work, then the psychiatric medications are needed.

David:We all see or hear ads for medication trials. "Free Checkups and Medications". When people with no insurance hear that, they take that as an opportunity to get help. What do you think about the clinical trials for medications, and are patients at-risk participating in them?

Dr. Roth: I hope they would check out parties that are conducting the research. If it is a well-known medical hospital or school, it is a great opportunity to get the latest care for free. Keep in mind, that without research programs, we would have no meds at all!!

wishing_A:Do you know of any medications that could be tried on a child of 12 that has been diagnosed with ADHD (Attention Deficit Hyperactivity Disorder), Intermittent Explosive Disorder, and Disruptive Behavior Disorder?

Dr. Roth:I generally treat adults, but I'm aware of many meds which we have which would be appropriate for a trial in such a child. Many of them are the same medications used for adults but in smaller dosages.

iglootoo1:My 16 year old son takes 30 mg a day of Adderall for ADHD (Attention Deficit Hyperactivity Disorder) Inattentive. He feels better able to focus, but still claims he "cannot" remember to write things down to keep track of assignments, etc. Is this "learned helplessness" or a short-term memory problem that won't be helped with medication? He sounds so sincere when he says he can't, I don't know what to believe and want to understand.

Dr. Roth:I doubt that it is a short-term memory problem. I also would not attribute it to learned helplessness. Some people are naturally "absentminded" and this may be the problem. Be Positive! He sounds like he's doing well.

David:Now here's an adult ADD (adult Attention Deficit Disorder) question, Dr. Roth:

Richardsbb:What medications would you recommend for an adult diagnosed with ADD (Attention Deficit Disorder), Inattentive type?

Dr. Roth:If ADD is the correct diagnosis, then one should prescribe the same meds that would be prescribe for a child with that diagnosis.

David:And those would be?

Dr. Roth: The stimulants, like Ritalin, and the antidepressants. For "inattentiveness" one would want to be certain they are not dealing with a petit-mal type of seizure disorder.

tracy565:Have you heard of the new drug, Pagoclone, and does it seem to have positive results with panic disorder?

Dr. Roth:I have not heard of that drug. I'm not sure that you have spelled it right.

cd: I was on Effexor (Venlafaxine) for about six weeks, then went off after hearing about withdrawal. I have been having weird brain jumbling. Why is this? I called my doctor and he said Effexor is one of the safest anti-depressants. Is it really, and what is this brain scrambling stuff?

Dr. Roth: You might have been talking Paroxetine. One should never go off meds quickly and that may be a withdrawal response. I have not heard of such a symptom but no meds should be stopped abruptly.

David: What are the consequences of sudden withdrawal from some of these medications?

Dr. Roth: It can be different depending on the medication. Anti-anxiety medications are the most dangerous to stop abruptly. Discontinuation of anti-depressants may cause a relapse of depression. Likewise, stopping lithium may cause a manic relapse.

David: Why are anti-anxiety medications the most dangerous and what can happen?

Dr. Roth: Stopping a moderately high dose too fast for some time can cause a seizure.

Serena32: Is there a danger in taking more than one antidepressant at a time or being on too many psychotropics at the same time.

Dr. Roth: Certain anti-depressants should never be combined. These are primarily MAO inhibitors. One also has to avoid certain foods while on these MAO inhibitors.

David: And that's something you can get from your doctor or pharmacist.

lilly2:Is it necessary to take medications to recover from eating disorders such as anorexia and bulimia?

Dr. Roth:Medications can be helpful with those disorders. But they can be helped a great deal with psychotherapy also.

insight:Can you please comment on the relation between root causes of illness and psychiatric medications. There is concern that although medications can aid healing, and/or control symptoms, it can also interfere with healing - again depending on the root cause and the psychiatric illness involved. Your response to this would be appreciated.

Dr. Roth:You can't always wait to learn the root cause of an illness before prescribing medications. If a person is suffering from severe symptoms, such as sleeplessness or more severe symptoms of depression, then meds can relieve these symptoms so a person can concentrate and make therapy work for them. They can't use therapy if they can't think clearly.

David:What do you think about alternative medications or herbs for some of these disorders, i.e. St. Johns Wort, etc.

Dr. Roth:St. Johns Wort is one of the most widely prescribed meds in Europe. If someone wants to try it, they should try it, but you need to make sure that over-the-counter medications are not interfering with your prescription medication.

anonymous1:A friend of mine started on an antidepressant for the first time ever at three pills a day as prescribed by her doctor, only to go into seizures. Is this sort of thing common? Would this still have happened if the pills had been introduced more slowly to her system?

Dr. Roth:That depends on the dose of each pill, but it is very uncommon. I have never had a patient go into a seizure from medications. I wonder if she has an underlying seizure disorder?

David:Interesting you say that Dr., that you've never had a patient go into a seizure from medications because I'm getting a lot of questions about that and comments on experiencing that.

Michael A:My question pertains to my 13 yr old OCD (Obsessive-Compulsive Disorder) sufferer. He's on Paxil, Risperdal and Clonazepam. Is anything known about the long-term effects of using these drugs, particularly Riperdal?

Dr. Roth:Risperdal is the newest medication of those listed, and it has less known side-effects than other meds in it's class. If he is on a low dose, he should have nothing to worry about at this point.

David:For a more detailed look at the various medications, their effects and side-effects, view our psychiatric medications chart.

Whispers_with_in:Is there any medication that works well with someone who has been diagnosed Dissociative Identity Disorder - (DID)?

Dr. Roth: I would use a low dose antipsychotic medication and possibly some antidepressants.

David:For those who asked, this is Dr. Roth's website: http://www.deardrroth.com.

Dr. Roth, when a person starts taking psychiatric medications, should you plan on taking them for the rest of your life?

Dr. Roth: Again that depends on what the disorder is. If someone has a major disorder which has relapsed at least one or more times, it may be necessary to stay on it for the long-term. If it doesn't recur or recurs mildly, then it may not be necessary.

Mother of 4: Is Ritalin one of those drugs that you have to watch more closely?

Dr. Roth:Ritalin is fairly safe when taken as directed, but it can be abused.

Lori Varecka:I have an Eating Disorder and sometimes purge. None of the meds that I have taken has done me much good. Do you have a suggestion? Right now, I am on Effexor, but I had to decrease the dose because of visual disturbances.

Dr. Roth:If you can get psychotherapy with a therapist you feel comfortable with, who is knowledgeable about Eating Disorders and can see you at least once a week, I would recommend it.

Sharon1: Why is it that some of the antidepressants cause anxiety, but are given to people with anxiety disorders?

Dr. Roth:If anyone experiences the side-effect of anxiety from anti-depressants, they probably should be on a different antidepressant.

David:Also, I might mention here, for whatever reason, many people don't contact their doctor fast enough, if at all, to tell the doctor about the side-effects they are experiencing. This is very important to do. You don't have to be afraid to let your doctor know what's going on. In fact, it's very important that your doctor does know, so you can get the best care possible.

Funny Face1:My son is bipolar. He also has an alcohol problems. Isn't it true that the alcohol negates, or at least lessens, the benefits of the medication?

Dr. Roth: It can be dangerous to combine alcohol with medication, especially if he is drinking heavily, but he probably should stay on the meds in any case.

David: What are the effects of combining alcohol and let's say antidepressants or anti-anxiety medications?

Dr. Roth: It will probably increase both the sedating and the intoxicating effects. That can be very dangerous.

Brenda1:What about side-effects of medications, especially sexual dysfunction. Is there a way to deal with these?

David:And can you address that for both women and men?

Dr. Roth:Yes, that usually requires the meds dosage be adjusted, but it may also require trying a different medication if the side-effects are too problematic.

Sandrea:I have been on Prozac for 10 years and have tried to go off but I can't. I have noticed some strange behavior modes.

Dr. Roth:If the behavior changes have occurred only recently, it is unlikely it is due to Prozac. If you have been on Prozac for 10 years, and if your mood is disturbed recently, then you may need to try another antidepressant.

Henney Penney:I've heard that a medication that is effective for someone for one period of time, may not be effective when they try it again in the future. Have you found this to be true? And have you found that a medication can just become less effective over time even if there has been no change in the dosage taken?

Dr. Roth:Yes, I have seen this happen from time-to-time. I usually try to slightly increase the dose but sometimes you have to try another medication.

miri:What role should a patient play in creating medication strategies? How can a patient become well-informed with so many psychiatric medications available?

Dr. Roth:It is important the patient be completely honest about medication side-effects and any other medication or substances they are taking. You can ask your doctor and pharmacist to explain each medication, their benefits and side-effects. No one can be expected to learn about all the medications available.

stef: I've suffered from major clinical depression since 1988, the birth of my last child, at which time I also had a tubal ligation. After many years of medication, I am going to try ECT (electroconvulsive therapy, electroshock therapy) and my first appointment is next week. What are your feelings on this type of treatment?

Dr. Roth:ECT is extremely safe and effective. If you have failed to get any benefits from a full trial of different meds, then ECT is a good option for you.

lprehn:My teenage daughter is on Prozac for Obsessive-Compulsive Disorder (OCD) and experiences bizarre dreams and also naps often during the day and has difficulty being awakened. Is this common? Any suggestions?

Dr. Roth:If these bizarre dreams are in the daytime and sedation has occurred as a side-effect of the Prozac, then she has to be on a different medication. Those medication side-effects are unacceptable.

Chlo:Aside from Prozac, does any other medication seem effective for treating bulimia?

Dr. Roth:Yes. Probably any antidepressant could be helpful. It is worth trying different ones if the first one doesn't work. Make sure you give it a full trial though.

flitecrew:I have a girlfriend who is bipolar and recently has become alarmed about some articles about the dangers of psychiatric drugs. She would like to know if there is a possibility of ever getting off all of them?

Dr. Roth:If she's true bipolar with significant symptoms, she may require medication long-term. However, that can be challenged, but she should do so with her doctor's supervision.

David: There has been talk about some of the antidepressants like Paxil, Zoloft, causing suicidal ideations and other types of "out of the ordinary" behavior. For instance, the court case that just concluded where the man held up the bank (no history of prior criminal behavior) and was acquitted after the jury was told he was taking Prozac and this type of behavior is a side-effect. What's your opinion about that?

Dr. Roth:I question these kinds of anecdotal stories. Prozac has been prescribed to hundreds of millions of patients worldwide with rare instances of such dramatic side-effects. I question that medications are responsible for such side-effects.

chuk69:Is there any herbal medicine that helps for anxiety, panic disorder?

Dr. Roth:I don't study the herbal medications but there are books on herbal medicines which can found in the library, if someone's interested.

KcallmeK: I have bipolar disorder, ADD inattentive type with temporal lobe issues, and I might be premenopausal. Distractibility is getting out of hand. For instance, I left my car running for almost 2 hours, not knowing I had left it on. Any suggestions?

Dr. Roth:I would hope that you have had some trials of medications. You have mentioned several different disorders, each of which can be treated with different medication. You should be in the care of a psychiatrist who can prescribe and combine meds properly to provide relief for you.

LauraE: How do you suggest starting a "medication holiday" if you are on a stimulant, and is it okay to not take them on weekends?

Dr. Roth: It depends on the medications and dosage. Medication holidays are not highly recommended anymore. Doctors used to recommend medication holidays but they are not considered to be helpful and can cause relapses.

derf: In regards to pregnancy and fetal health: what's worse? Being depressed (unmedicated) in pregnancy or being medicated (with new antidepressants) during pregnancy?

Dr. Roth: Depression is better left untreated in pregnancy unless the symptoms are so severe that the woman is in danger of suicide. If at all possible, it is much better to avoid medication during pregnancy. In severe cases, you should choose "electroshock therapy" as an option.

des: Do you know anything about DHEA?

Dr. Roth: I have read about it but I do not know if it has any medical place at this point in time.

Helen: Is long-term psychotropic medication considered necessary after just one manic episode?

Dr. Roth: No. One can't determine that medication is needed on a long-term basis unless the patient has relapsed after a proper withdrawal of the medication.

David: I know it's getting late. I want to thank Dr. Roth for being our guest tonight. I know we had tons of questions and hopefully, we can get to them at a future conference. Dr. Roth's website is at http://www.deardrroth.com.

Dr. Roth: Thank you very much for inviting me. I have enjoyed the conference very much and look forward to working with you in the future.

David: So everyone knows, we keep transcripts of all our conferences. You can find the list of topics here.

For a more detailed look at the various psychiatric medications, their effects and side-effects, you can check our psychiatric medications pharmacology.

I want to thank everyone in the audience for coming and participating. Good night everyone.

Crisis therapist, Dr. Elizabeth Stanczak, talks about dealing with grief, dealing with loss, depression and feeling depressed, in light of the attack on the World Trade Center buildings and the Pentagon.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David:Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I'm glad you had the opportunity to join us, especially under these difficult circumstances. These last few days have been traumatic for everyone.

Our topic tonight is "Coping with the Psychological Impact of the Attack on the U.S.." Our guest is trauma psychologist, Elizabeth Stanczak Ph.D., who is the Clinical Manager of Assured Behavioral Health in San Antonio, Texas. Dr. Stanczak has been a member of a Critical Incident Team and has expertise in critical incident therapy (crisis therapy).

First though, I want to make a couple of comments. Everyone here at HealthyPlace.com hopes that you, your family members and friends are safe. This is an enormous, and for many, an unexpected tragedy. We have our trained support group hosts on the site to help those who are having difficulty coping. They have done a wonderful job and have volunteered their time beyond anyone's expectations. It's really appreciated.

On our homepage: http://www.healthyplace.com we have a lot of information to help you cope. On the left-hand side of the page, there are videos and articles on loss and grief. While some may not pertain to your exact situation, the information contained there will apply to what's going on now. On the right-side of our homepage, under the heading "Daily News," you can read articles on the psychological aspects of dealing with the attack. As the horror of this event and the human aspects of the tragedy begin to settle in, some of you may feel depression beginning to takes its grasp. We have a lot of information on depression and how to cope with it in the HealthyPlace.com Depression Community. On the left side of the page, look through the sites, depression conference transcripts and online depression journals, diaries.

Good evening, Dr. Stanczak, and welcome to HealthyPlace.com. Today was a special day for me because for the first time I began to feel the emotional impact of what has happened. On Tuesday, I was amazed and caught up in the unbelievability of the attack on the United States and the images of the planes crashing into the World Trade Center buildings in New York City and watching the building crumble to the ground. It was surreal to me.

As the story progressed on TV today, I began to see and hear stories from people searching for their relatives and friends. One man on Good Morning America, told the story of how he and his wife were very close and how they would see each other off at the airport when they would fly on separate business trips. After saying goodbye to his wife at the airport in Boston on Tuesday morning, he went to work and later, to his horror, would discover his wife was on the plane that crashed into one of the towers. It was a very sad story. Diane Sawyer, the anchor on Good Morning America, was crying and I was in tears. My heart has been heavy all day. So the first question is -- is this normal?

Dr Stanczak: Good evening, and thank you for having me. First, I must say that I am not a "trauma psychologist". I am, however, a psychologist with training in crisis intervention.

Yes, it sounds very normal and healthy to me.

David:How would you recommend that most of us handle these feelings that we have right now?

Dr Stanczak: I think we must first remember that we are all different. Some of us may find solace talking with friends and family and some of us may need to seek assistance from mental health professionals.

David:How do you know when it's time to get professional help? I ask this because this could be a long, drawn out event, especially if we start retaliating militarily?

Dr Stanczak: If you start having thoughts or moods that interfere with your daytime functioning, problems sleeping that interfere with daytime functioning or problems interacting with close family members or friends, you might want to consider seeking help.

David: This being a mental health site, I'm wondering if extreme emotional events like this can produce stronger reactions in individuals who are already dealing with psychological issues like abuse, depression, self-injury, etc.?

Dr Stanczak: Most people do quite well when given the opportunity to grieve and will not need professional assistance. We tend to underestimate just how healthy and strong people really are and how much stress they can effectively handle. However, there will be certain cases where this additional stress will compound existing problems. Very few people will be involved in self-destructive behaviors, but many may feel overwhelmed by the additional stressors. In these cases, the individual should probably consult with a mental health professional.

David:What is your opinion about constantly staying tuned to the TV or radio for the "latest" events or constantly watching traumatic scenes repetitively?

Dr Stanczak: Returning to a more normal routine is very important, however, it is human nature to be curious and to seek additional information. There is nothing wrong with being transfixed with the events as they occur, just as we were transfixed by the lunar landings.

David:One other question, what about our children? Should we let them watch everything on TV and how should we explain this to them, if at all, in your opinion?

Dr Stanczak: It is very important that the parents explain these events. In fact, it would be preferable to having them watch the TV. It is also important, to redirect the child to any positive aspect that can be identified, such as: focusing on the heroes who are searching through the rubble, or the victims successfully rescued. It might also help to have the child write a letter to either President Bush, the heroes involved, or even the group or groups that perpetrated this horrible act.

The important thing is to have the child express his or her feelings. Also, get them back into their normal routines as quickly as possible. They need to know what to expect in their day. Also, assure them that they are secure.

David:We have many audience questions for you Dr. Stanczak. Here's the first one:

majorca: Hi, I was in tower number 4 and saw the two planes go into the towers. Actually the second one went through all of our hearts. Then I evacuated the building but all I could do was stare at the towers in disbelief. When the towers came down, I had to run for my life. As I did, I helped people who were stranded or injured but still left many behind who never made it. I still feel the helplessness and haven't been able to sleep haunted by the images of the carnage. How can I get through this?

Dr Stanczak: Your feelings are very, very normal, and transient. You will never forget the events that have occurred. But, you will find that, with time, it will be easier to function more normally. I would be worried about you if you were not feeling these things. The important thing here is that you are having a normal response to an abnormal, horrific situation. Rest assured that all of America is having feelings similar to your, and that we are all frustrated by our inability to help more.

C.U.:I keep replaying the part when the plan crashed into the building, and although I only flew in air transportation once, in a small helicopter, after seeing that tragic event I'm scared to fly in an airplane ever. I'm only 16, but I will always remember the day I saw an event that left nearly 4,000 people's lives severely disrupted and left the country shocked and in disbelief of what has happened. How will I get over a fear of flying?

Dr Stanczak: First of all, this fear you have is probably transient. If it, for some reason, does persist, there are effective therapies that will allow you to overcome your fear. If you feel comfortable, I would encourage you to discuss these feelings with your relatives and friends. Incidentally, I would be afraid to fly in a helicopter.

luckysurvivor: I am having a terrible time with loss. I lost a job recently, then my best friend walked out on me and then this tragedy in NYC/DC- it's like more then I can handle and I am feeling a total emptiness almost hopeless now. Am I crazy?

Dr Stanczak: No, you're overwhelmed. Again, after what you have experienced, I would be worried if you weren't experiencing these feelings. I suggest taking some time to attend to your own needs. Seek recreation, companionship, and rest. If these uncomfortable feelings persist, for more than a month you might want to consider consulting with a therapist. I am sorry for your many losses.

oblivion1: I'm still in a state of shock not believing what happened. It's very hard for me to grieve and this makes me feel that I don't have a true heart. I have so many of the news papers but I have not read any of them. I can't watch TV anymore. I don't know what is wrong with me.

Dr Stanczak: There is nothing wrong with you. Each of us deals with extreme stress in different ways. This may be your way of dealing or coping. Again, it does not become pathological until it begins to significantly interfere with your daytime functioning. I suspect that, with time, you will find yourself becoming more involved in the events happening around you. Your shock is understandable and we all share it. I was in my car when I heard the news and responded by screaming "NO" repeatedly as if that would somehow change the horrific events. I then begged that it was a news error. I now grieve and cope by trying to assist others.

David:Some people, Dr., are extremely angry at all Arabs or people from the Middle East. Is that rational and is that healthy or unhealthy at this point?

Dr Stanczak: It is not rational, but unfortunately, it is normal. We are not always the rational, thinking beings that we think we are. It is human nature to stereotype even though stereotyping leads us to commit errors in judgment.

I would encourage those people to examine their bitterness and to focus on the positive circumstances surrounding this terrible event. I would also encourage those individuals to become involved in efforts to make the situation better rather than worse. For example, one of the first acts I performed was donating blood to our local blood bank.

One can also look at how this event has brought us together as a nation. Still strong, still wonderful. We should also recognize and be thankful for the tremendous support we are receiving from the world community.

David:Here's the next audience question:

HPC-Karen: As a HealthyPlace.com support group host, what are the things we can do to help users who come to the site?

Dr Stanczak: First of all, assure people that their feelings are quite natural and normal. Do not try to force help upon those who do not want such help. Recognize that people are much stronger and healthier than we sometime give them credit. Also, some types of help may actually be harmful. We don't want people thinking they are sick. And we certainly don't want to make them sick. Our assistance should be sought, and specific to the individual in need. Encourage people to resume as normal a lifestyle as possible. If indeed someone needs psychological help provide them with a referral. I also encourage the chat rooms and the support offered therein.

David:Here are a few audience comments on what's been said so far this evening, then we'll continue with the questions:

C.U.: When I heard about all this, I wasn't mad at the Arabs, I was mad at what they did. They killed a lot of people and they probably are going to get themselves hurt soon too. In this fighting between countries NO ONE IS A WINNER everyone loses something, and it causes "massive destruction".

Ny: My feelings are that standing alone we are weak but by standing as one, it will show that we are a strong nation and that we will prevail and not let anyone perform acts of terrorism on anyone again.

bunnyears: I feel anger at the people here in this USA that are not caring about this.

confussed1980: I am dealing with being raped and when I saw the news of what happened, I completely freaked.

HPC-Whiteswan: My condolences to you all who have lost a loved one.

bunnyears: I have tried to cry but the tears don't come. I go to work, but then I just sit there.

Dr Stanczak: You may not be able to cry, and you may not be able to focus on your work, but I commend you for thinking and trying.

DAwn.Marie: I do not understand why this had to happen.

David: Here's the next question:

Clover Imp: Although my boyfriend was unharmed in the World Trade Center tragedy, I still suddenly feel like I am going to lose him. I call him many times a day just to make sure he's okay. Also, even though I am afraid of him leaving me, I've started pushing him away. What do you suggest to stop this?

Dr Stanczak: You're having some irrational thoughts, just as all humans do. I would consider short-term consultation with a therapist who employs cognitive behavioral therapy. You can contact your State Psychological Association for a referral.

Liser217: I am personally scared of war. Even more so, there is talk of the end of the world. Do you think this is hype or is it a reality?

Dr Stanczak: Hype. Being a prior Military Intelligence Analyst, I find it highly unlikely that the world will end. As for war, there will most likely be some action taken to show the world that this will not be tolerated or go unpunished. This is my personal opinion. By the way, everyone is either afraid of war or a liar.

David: Here's an audience comment:

annibelle: What makes me sad is that the same people who consider this a tragedy only seem to want to extend the tragedy with retaliation and ultimately: war

majorca: Dr., do you have any advice for New Yorkers as to what else we can do to cope with the aftermath of this tragedy and while we wait to hear about our missing loved ones?

Dr Stanczak: Good points!

About the aftermath, I have been watching the news and think that New Yorkers have amazing stamina and patience, even though they may not recognize it.

The anxiety of being in limbo may at times seem unbearable. However, we all manage somehow to muddle through until the crisis is resolved and life returns to as normal as possible. I wish there was more I could say. God bless you!

Ny: I am having a really hard time discussing this with my children. They just don't understand what has happened or why I am crying when I talk to them about what has happened to the United States. I'm just not exactly sure on what I should and shouldn't tell them.

Dr Stanczak: First of all, it is hard for adults to understand, it makes no rhyme or reason. Thus, naturally, children will have a hard time making sense out of the recent events. The best you can do is to be a resource for them to come to when they have questions and then to answer those questions to the best of your ability. The children will take our lead. We, as adults, will demonstrate to them how they can respond. We, therefore, try to present the best role model we can.

DAwn.Marie: This has been very triggering for me. How can I get back what has been lost from this, my feeling of safety? I am scared to leave my house. Is this normal?

Dr Stanczak: Just like the questioner above, you are experiencing some irrational thoughts which are shared by all of us. It is important for you to first recognize that these thoughts are irrational and to replace them with a more rational view. This is hard for people to do on their own and they often consult with a psychologist.

true: I have a eating disorder and the only thing this has done for me is trigger me big time. I'm not sure why?

Dr Stanczak: This is your response to stress and loss of control. You should consult with your therapist about the best way to re-establish more normal eating habits as soon as possible and to help you deal more appropriately with this increase in your stress level.

David:We have a couple of people from overseas who have questions, Dr. Stanczak:

jen seven: Although I live in Australia, I have been deeply affected by this tragedy. However, I have a medical condition which means I can't cry (no tears) and I don't know how to deal with my feelings.

Dr Stanczak: I think you're doing it very well. You are participating in a group activity, you are communicating your thoughts and feelings, and your are supporting your fellow humans in America. No tears required. Thank you so much for being there, I feel better just knowing you're with us!

bumblebee34: I am from Australia and I feel so distressed with the events in the US. So sad. I can't keep the TV off, I'm just watching it all day and I've been having nightmares. I don't know what to do, I'm not coping and I suffer from depression as well.

Dr Stanczak: First of all, your feelings are normal. Many of us are experiencing the exact same things. Rest assured that these phenomena are transient and that you will feel better in the future. It takes longer for some of us than others. The word Depression is used in various ways, if you feel that you are suffering truly a clinical depression, I encourage you to consult with your mental health care provider. Best wishes.

David:Here's an audience comment from a visitor from the UK:

bluechickpea: Just a comment. I am from the UK, and although this doesn't affect us in the UK nearly as greatly as it does the people in America, I really feel that I and all of us in other nations around the world can't do enough to help and support America at this time. I just wish I personally had enough words to say to people who have been left devastated by this tragedy, but from the UK to America, we all send our thoughts and prayers.

Dr Stanczak: Thank you for your support. Just your kind words and thoughts provide more comfort than you can ever imagine.

HPC-Whiteswan: I'm from Canada and I also experience flashbacks of my own abuses. The situation triggered many emotions during the past few days

Barbs: After seeing all this on TV Tuesday, I had nightmares that night about my past abuse. How am I supposed to live with this tragedy occurring in real life while reliving my abuse at night?

Dr Stanczak: It is not uncommon for stressful events to aggravate existing unresolved problems. I would encourage you to bring this issue to your mental health provider, as I really can not offer psychotherapeutic services over the internet. Good luck to you!

membee: I feel guilty about my mental illness when others have loved ones who've died. What should I do?

Dr Stanczak: You are experiencing what is commonly called "survivor's syndrome". There is nothing to feel guilty about. If these feelings persist you should discuss them with your therapist. However, I know that many of us have re-evaluated our problems and concerns in light of recent events.

David:To those in the audience, we also welcome your comments on our special bulletin board called "Tragedy Support-Attack on the U.S."

Thank you, Dr. Stanczak, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active and very caring community here at HealthyPlace.com.

Thank you, again, Dr. Stanczak, for joining us tonight.

Dr Stanczak: Thank you for allowing me to participate tonight. I have been honored by your invitation. Good night.

David: Here are a few extra audience comments that came in late. I thought I'd post them for all to see.

Liser217: Just wanted to say goodnight everyone. Keep hope in your hearts. And have faith in each other.

majorca: In the name of all New Yorkers I want to thank those of you who pray for us and who have had us on your mind since the tragedy occurred. I also want to thank those of you especially who have donated blood or similar or who have volunteered in any way. I think NYC is showing not only our fellow Americans but also the world that we are one, that we can cope with even the worst scenario and that we are indeed the beacon of freedom and of hope. Let's all unite together as one nation.

David: Good night.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment. What occurs in this conference is by way of information and providing helpful ideas for dealing with situations; it is not intended to provide you with psychotherapy or medical advice.

In-depth coverage of typical classroom behavioral management procedures for students with ADHD.

These procedures for managing behaviors difficulties are arranged in order from mildest and least restrictive to more intensive and most restrictive procedures. Some of these programs may be included in 504 plans or Individualized Educational Programs for children with AD/HD. Typically, an intervention is individualized and consists of several components based on the child's needs, classroom resources, and the teacher's skills and preferences.

1. Classroom rules and structure

Use classroom rules such as:

• Be respectful of others.
• Obey adults.
• Work quietly.
• Stay in assigned seat/area.
• Use materials appropriately.
• Raise hand to speak or ask for help.
• Stay on task and complete assignments.
• Post the rules and review them before each class until learned.
• Make rules objective and measurable.
• Tailor the number of rules to developmental level.
• Establish a predictable environment.
• Enhance children?s organization (folders/charts for work).
• Evaluate rule-following and give feedback/consequencesconsistently.
• Tailor the frequency of feedback to developmental level.

2. Praise of appropriate behaviors and choosing battles carefully

• Ignore mild inappropriate behaviors that are not reinforced by peer attention.
• Use at least five times as many praises as negative comments.
• Use commands/reprimands to cue positive comments for children who are behaving appropriately ? that is, find children who can be praised each time a reprimand or command is given to a child who is misbehaving.

3. Appropriate commands and reprimands

• Use clear, specific commands.
• Give private reprimands at the child's desk as much as possible.
• Reprimands should be brief, clear, neutral in tone, and as immediate as possible.

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4. Individual accommodations and structure for the child with ADHD

• Structure the classroom to maximize the child's success.
• Place the student's desk near the teacher to facilitate monitoring.
• Enlist a peer to help the student copy assignments from the board.
• Break assignments into small chunks.
• Give frequent and immediate feedback.
• Require corrections before new work is given.

5. Proactive interventions to increase academic performance -- Such interventions can prevent problematic behavior from occurring and can be implemented by individuals other than the classroom teacher, such as peers or a classroom aide. When disruptive behavior is not the primary problem, these academic interventions can improve behavior significantly.

• Focus on increasing completion and accuracy of work.
• Offer task choices.
• Provide peer tutoring.
• Consider computer-assisted instruction.

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6. "When-then" contingencies (withdrawing rewards or privileges in response to inappropriate behavior) -- Examples include recess time contingent upon completion of work, staying after school to complete work, assigning less desirable work prior to more desirable assignments, and requiring assignment completion in study hall before allowing free time.

7. Daily school-home report card (instruction packet available at http://wings.buffalo.edu/adhd) -- This tool allows parents and teacher to communicate regularly, identifying, monitoring and changing classroom problems. It is inexpensive and minimal teacher time is required.

• Teachers determine the individualized target behaviors.
• Teachers evaluate targets at school and send the report card home with the child.
• Parents provide home-based rewards; more rewards for better performance and fewer for lesser performance.
• Teachers continually monitor and make adjustments to targets and criteria as behavior improves or new problems develop.
• Use the report card with other behavioral components such as commands, praise, rules, and academic programs.

8. Behavior chart and/or reward and consequence program (point or token system)

• Establish target behaviors and ensure that the child knows the behaviors and goals (e.g., list on index card taped to desk).
• Establish rewards for exhibiting target behaviors.
• Monitor the child and give feedback.
• Reward young children immediately.
• Use points, tokens or stars that can later be exchanged for rewards.

9. Classwide interventions and group contingencies -- Such interventions encourage children to help one another because everyone can be rewarded. There is also potential for improvement in the behavior of the entire class.

• Establish goals for the class as well as the individual.
• Establish rewards for appropriate behavior that any student can earn (e.g., class lottery, jelly bean jar, wacky bucks).
• Establish a class reward system in which the entire class (or subset of the class) earns rewards based on class functioning as a whole (e.g, Good Behavior Game) or the functioning of the student with AD/HD.
• Tailor frequency of rewards and consequences to developmental level.

10. Time out -- The child is removed, either in the classroom or to the office, from the ongoing activity for a few minutes (less for younger children and more for older) when he or she misbehaves.

11. Schoolwide programs -- Such programs, which include schoolwide discipline plans, can be structured to minimize the problems experienced by children with AD/HD, while at the same time help manage the behavior of all students in a school.

Sources:

• National Resource Center on ADHD

next: What Causes Attention Deficit Disorder/ADHD?

Detailed info on behavior modification for ADHD children and the positive impact of providing stimulant medication plus therapy.

Behavior Modification Techniques For Treatment of Children and Adolescents with ADHD

Psychosocial treatment is a critical part of treatment for attention-deficit/hyperactivity disorder (AD/HD) in children and adolescents. The scientific literature, the National Institute of Mental Health, and many professional organizations agree that behaviorally oriented psychosocial treatments -- also called behavior therapy or behavior modification -- and stimulant medication have a solid base of scientific evidence demonstrating their effectiveness. Behavior modification is the only nonmedical treatment for AD/HD with a large scientific evidence base.

Treating AD/HD in children often involves medical, educational and behavioral interventions. This comprehensive approach to treatment is called "multimodal" and consists of parent and child education about diagnosis and treatment, behavior management techniques, medication, and school programming and supports. The severity and type of AD/HD may be factors in deciding which components are necessary. Treatment should be tailored to the unique needs of each child and family.

This fact sheet will:

• define behavior modification
• describe effective parent training, school interventions and child interventions
• discuss the relationship between behavior modification and stimulant medication in treating children and adolescents with AD/HD

Why use psychosocial treatments?

Behavioral treatment for AD/HD is important for several reasons. First, children with AD/HD face problems in daily life that go well beyond their symptoms of inattentiveness, hyperactivity and impulsivity, including poor academic performance and behavior at school, poor relationships with peers and siblings, failure to obey adult requests, and poor relationships with their parents. These problems are extremely important because they predict how children with AD/HD will do in the long run.

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How a child with AD/HD will do in adulthood is best predicted by three things -- (1) whether his or her parents use effective parenting skills, (2) how he or she gets along with other children, and (3) his or her success in school¹. Psychosocial treatments are effective in treating these important domains. Second, behavioral treatments teach skills to parents and teachers that help them deal with children with AD/HD. They also teach skills to children with AD/HD that will help them overcome their impairments. Learning these skills is especially important because AD/HD is a chronic condition and these skills will be useful throughout the children's lives².

Behavioral treatments for AD/HD should be started as soon as the child receives a diagnosis. There are behavioral interventions that work well for preschoolers, elementary-age students, and teenagers with AD/HD, and there is consensus that starting early is better than starting later. Parents, schools, and practitioners should not put off beginning effective behavioral treatments for children with AD/HD^3,4.

What is behavior modification?

With behavior modification, parents, teachers and children learn specific techniques and skills from a therapist, or an educator experienced in the approach, that will help improve children's behavior. Parents and teachers then use the skills in their daily interactions with their children with AD/HD, resulting in improvement in the children's functioning in the key areas noted above. In addition, the children with
AD/HD use the skills they learn in their interactions with other children.

Behavior modification is often put in terms of ABCs: Antecedents (things that set off or happen before behaviors), Behaviors (things the child does that parents and teachers want to change), and Consequences (things that happen after behaviors). In behavioral programs, adults learn to change antecedents (for example, how they give commands to children) and consequences (for example, how they react when a child obeys or disobeys a command) in order to change the child's behavior (that is, the child's response to the command). By consistently changing the ways that they respond to children's behaviors, adults teach the children new ways of behaving.

Parent, teacher and child interventions should be carried out at the same time to get the best results^5,6. The following four points should be incorporated into all three components of behavior modification:

1. Start with goals that the child can achieve in small steps.

2. Be consistent -- across different times of the day, different settings, and different people.

3. Implement behavioral interventions over the long haul?not just for a few months.

4. Teaching and learning new skills take time, and children's improvement will be gradual.

Parents who want to try a behavioral approach with their children should learn what distinguishes behavior modification from other approaches so they can recognize effective behavioral treatment and be confident that what the therapist is offering will improve their child's functioning. Many psychotherapeutic treatments have not been proven to work for children with AD/HD. Traditional individual therapy, in which a child spends time with a therapist or school counselor talking about his or her problems or playing with dolls or toys, is not behavior modification. Such "talk" or "play" therapies do not teach skills and have not been shown to work for children with AD/HD^2,7,8.

References

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How does a behavior modification program begin?

The first step is identifying a mental health professional who can provide behavioral therapy. Finding the right professional may be difficult for some families, especially for those that are economically disadvantaged or socially or geographically isolated. Families should ask their primary care physicians for a referral or contact their insurance company for a list of providers who participate in the insurance plan, though health insurance may not cover the costs of the kind of intensive treatment that is most helpful. Other sources of referrals include professional associations and hospital and university AD/HD centers (visit www.help4adhd.org for a list).

The mental health professional begins with a complete evaluation of the child's problems in daily life, including home, school (both behavioral and academic), and social settings. Most of this information comes from parents and teachers. The therapist also meets with the child to get a sense of what the child is like. The evaluation should result in a list of target areas for treatment. Target areas -- often called target behaviors -- are behaviors in which change is desired, and if changed, will help improve the child's functioning/impairment and long-term outcome.

Target behaviors can be either negative behaviors that need to stop or new skills that need to be developed. That means that the areas targeted for treatment will typically not be the symptoms of AD/HD -- overactivity, inattention and impulsivity -- but rather the specific problems that those symptoms may cause in daily life. Common classroom target behaviors include "completes assigned work with 80 percent accuracy" and "follows classroom rules." At home, "plays well with siblings (that is, no fights)" and "obeys parent requests or commands" are common target behaviors. (Lists of common target behaviors in school, home and peer settings can be downloaded in Daily Report Card packets at http://ccf.buffalo.edu/default.php.)

After target behaviors are identified, similar behavioral interventions are implemented at home and at school. Parents and teachers learn and establish programs in which the environmental antecedents (the As) and consequences (the Cs) are modified to change the child's target behaviors (the Bs). Treatment response is constantly monitored, through observation and measurement, and the interventions are modified when they fail to be helpful or are no longer needed.

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Parent Training

Behavioral parent training programs have been used for many years and have been found to be very effective^9-19.

Although many of the ideas and techniques taught in behavioral parent training are common sense parenting techniques, most parents need careful teaching and support to learn parenting skills and use them consistently. It is very difficult for parents to buy a book, learn behavior modification, and implement an effective program on their own. Help from a professional is often necessary. The topics covered in a typical series of parent training sessions include the following:

• Establishing house rules and structure
• Learning to praise appropriate behaviors (praising good behavior at least five times as often as bad behavior is criticized) and ignoring mild inappropriate behaviors (choosing your battles)
• Using appropriate commands
• Using "when-then?" contingencies (withdrawing rewards or privileges in response to inappropriate behavior)
• Planning ahead and working with children in public places
• Time out from positive reinforcement (using time outs as a consequence for inappropriate behavior)
• Daily charts and point/token systems with rewards and consequences
• School-home note system for rewarding behavior at school and tracking homework^20,21

Some families can learn these skills quickly in the course of 8-10 meetings, while other families -- often those with the most severely affected children--require more time and energy.

Parenting sessions usually involve an instructional book or videotape on how to use behavioral management procedures with children. The first session is often devoted to an overview of the diagnosis, causes, nature, and prognosis of AD/HD. Next, parents learn a variety of techniques, which they may already be using at home but not as consistently or correctly as needed. Parents then go home and implement what they have learned in sessions during the week, and return to the parenting session the following week to discuss progress, solve problems, and learn a new technique.

Parent training can be conducted in groups or with individual families. Individual sessions often are implemented when a group is not available or when the family would benefit from a tailored approach that includes the child in sessions. This kind of treatment is called behavioral family therapy. The number of family therapy sessions varies depending on the severity of the problems^22-24. CHADD offers a unique educational program to help parents and individuals navigate the challenges of AD/HD across the lifespan. Information about CHADD's "Parent to Parent" program can be found by visiting CHADD's Web site.

When the child involved is a teenager, parent training is slightly different. Parents are taught behavioral techniques that are modified to be age-appropriate for adolescents. For example, time out is a consequence that is not effective with teenagers; instead, loss of privileges (such as having the car keys taken away) or assignment of work chores would be more appropriate. After parents have learned these techniques, the parents and teenager typically meet with the therapist together to learn how to come up with solutions to problems on which they all agree. Parents negotiate for improvements in the teenagers? target behaviors (such as better grades in school) in exchange for rewards that they can control (such as allowing the teenager to go out with friends). The give and take between parents and teenager in these sessions is necessary to motivate the teenager to work with the parents in making changes in his or her behavior.

References

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Applying these skills with children and teens with AD/HD takes a lot of hard work on the part of parents. However, the hard work pays off. Parents who master and consistently apply these skills will be rewarded with a child who behaves better and has a better relationship with parents and siblings.

School Interventions for Students with ADHD

As is the case with parent training, the techniques used to manage AD/HD in the classroom have been used for some time and are considered effective^2,25-31. Many teachers who have had training in classroom management are quite expert in developing and implementing programs for students with AD/HD. However, because the majority of children with AD/HD are not enrolled in special education services, their teachers will most often be regular education teachers who may know little about AD/HD or behavior modification and will need assistance in learning and implementing the necessary programs. There are many widely available handbooks, texts and training programs that teach classroom behavior management skills to teachers. Most of these programs are designed for regular or special education classroom teachers who also receive training and guidance from school support staff or outside consultants. Parents of children with AD/HD should work closely with the teacher to support efforts in implementing classroom programs. (To read more about typical classroom behavioral management procedures, please see Appendix A.)

Managing teenagers with AD/HD in school is different from managing children with AD/HD. Teenagers need to be more involved in goal planning and implementation of interventions than do children. For example, teachers expect teenagers to be more responsible for belongings and assignments. They may expect students to write assignments in weekly planners rather than receive a daily report card. Organizational strategies and study skills therefore need to be taught to the adolescent with AD/HD. Parent involvement with the school, however, is as important at the middle and high school levels as it is in elementary school. Parents will often work with guidance counselors rather than individual teachers, so that the guidance counselor can coordinate intervention among the teachers.

Child Interventions

Interventions for peer relationships (how the child gets along with other children) are a critical component of treatment for children with AD/HD. Very often, children with AD/HD have serious problems in peer relationships^32-35. Children who overcome these problems do better in the long run than those who continue to have problems with peers³⁶. There is scientific basis for child-based treatments for AD/HD that focus on peer relationships. These treatments usually occur in group settings outside of the therapist's office.

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There are five effective forms of intervention for peer relationships:

1. systematic teaching of social skills³⁷

2. social problem solving^22,35,37-40

3. teaching other behavioral skills often considered important by children, such as sports skills and board game rules⁴¹

4. decreasing undesirable and antisocial behaviors^42,43

5. developing a close friendship

There are several settings for providing these interventions to children, including groups in office clinics, classrooms, small groups at school, and summer camps. All of the programs use methods that include coaching, use of examples, modeling, role-playing, feedback, rewards and consequences, and practice. It is best if these child-directed treatments are used when a parent is participating in parent training and school personnel are conducting an appropriate school intervention^37,44-47. When parent and school interventions are integrated with child-focused treatments, problems getting along with other children (such as being bossy, not taking turns, and not sharing) that are being targeted in the child treatments are also included as target behaviors in the home and school programs so that the same behaviors are being monitored, prompted and rewarded in all three settings.

Social skills training groups are the most common form of treatment, and they typically focus on the systematic teaching of social skills. They are typically conducted at a clinic or in school in a counselor?s office for 1-2 hours on a weekly basis for 6-12 weeks. Social skills groups with children with AD/HD are only effective when they are used with parent and school interventions and rewards and consequences to reduce disruptive and negative behaviors^48-52.

There are several models for working on peer relationships in the school setting that integrate several of the interventions listed above. They combine skills training with a major focus on decreasing negative and disruptive behavior and are typically conducted by school staff. Some of these programs are used with individual children (for instance, token programs in the classroom or at recess)^31,53,54 and some are schoolwide (such as peer mediation programs)^55,56.

Generally, the most effective treatments involve helping children get along better with other children. Programs in which children with AD/HD can work on peer problems in classroom or recreational settings are the most effective^57,58. One model involves establishing a summer camp for children with AD/HD in which child-based management of peer problems and academic difficulties are integrated with parent training^59-61. All five forms of peer intervention are incorporated in a 6-8 week program that runs for 6-9 hours on weekdays. Treatment is conducted in groups, with recreational activities (e.g., baseball, soccer) for the majority of the day, along with two hours of academics. One major focus is teaching skills in and knowledge of sports to the children. This is combined with intensive practice in social and problem-solving skills, good team work, decreasing negative behaviors, and developing close friendships.

Some approaches to child-based treatment for peer problems fall somewhere between clinic-based programs and intensive summer camps. Versions of both are conducted on Saturdays during the school year or after school. These involve 2-3 hour sessions in which children engage in recreational activities that integrate many of the forms of social skills intervention.

Finally, preliminary research suggests that having a best friend may have a protective effect on children with difficulties in peer relations as they develop through childhood and into adolescence^62,63. Researchers have developed programs that help children with AD/HD build at least one close friendship. These programs always begin with the other forms of intervention described above and then add having the families schedule monitored play dates and other activities for their child and another child with whom they are attempting to foster a friendship.

References

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It is important to emphasize that simply inserting a child with AD/HD in a setting where there is interaction with other children -- such as Scouts, Little League or other sports, day care, or playing in the neighborhood without supervision -- is not effective treatment for peer problems. Treatment for peer problems is quite complex and involves combining careful instruction in social and problem-solving skills with supervised practice in peer settings in which children receive rewards and consequences for appropriate peer interactions. It is very difficult to intervene in the peer domain, and Scout leaders, Little League coaches, and day-care personnel are typically not trained to implement effective peer interventions.

What about combining psychosocial approaches with ADHD medication?

Numerous studies over the last 30 years show that both medication and behavioral treatment are effective in improving AD/HD symptoms. Short-term treatment studies that compared medication to behavioral treatment have found that medication alone is more effective in treating AD/HD symptoms than behavioral treatment alone. In some cases, combining the two approaches resulted in slightly better results.

The best-designed long-term treatment study -- the Multimodal Treatment Study of Children with AD/HD (MTA) -- was conducted by the National Institute of Mental Health. The MTA studied 579 children with AD/HD-combined type over a 14-month period. Each child received one of four possible treatments: medication management, behavioral treatment, a combination of the two, or the usual community care. The results of this landmark study were that children who were treated with medication alone, which was carefully managed and individually tailored, and children who received both medication and behavioral treatment experienced the greatest improvements in their AD/HD symptoms^44,45.

Combination treatment provided the best results in improving AD/HD and oppositional symptoms and in other areas of functioning, such as parenting and academic outcomes⁶⁴. Overall, those who received closely monitored medication management had greater improvement in their AD/HD symptoms than children who received either intensive behavioral treatment without medication or community care with less carefully monitored medication. It is unclear whether children with the inattentive type will show the same pattern of response to behavioral interventions and medication as have children with combined type.

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Some families may choose to try stimulant medication first, while others may be more comfortable beginning with behavioral therapy. Another option is to incorporate both approaches into the initial treatment plan. The combination of the two modalities may enable the intensity (and expense) of behavioral treatments and the dose of medication to be reduced^65-68.

A growing number of physicians believe that stimulant medication should not be used as the only intervention and should be combined with parent training and classroom behavioral interventions^66,69-70. In the end, each family has to make treatment decisions based on the available resources and what makes the best sense for the particular child. No one treatment plan is appropriate for everyone.

What if there are other problems in addition to AD/HD?

There are evidence-based behavioral treatments for problems that can co-exist with AD/HD, such as anxiety⁷¹ and depression⁷². Just as play therapy and other non-behaviorally based therapies are not effective for AD/HD, they have not been documented to be effective for the conditions that often occur with AD/HD.

This fact sheet was updated in February 2004.

© 2004 Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).

References

Suggested Reading for Professionals

Barkley, R.A. (1987). Defiant children: A clinician's manual for parent training. New York: Guilford.

Barkley, R.A., & Murphy, K.R. (1998). Attention-deficit hyperactivity disorder: A clinical workbook. (2nd ed.). New York: Guilford.

Chamberlain, P. & Patterson, G.R. (1995). Discipline and child compliance in parenting. In M. Bornstein (Ed.), Handbook of parenting: Vol. 4. Applied and practical parenting. (pp. 205?225). Mahwah, NJ: Lawrence Erlbaum Associates.

Coie, J.D., & Dodge, K.A. (1998). Aggression and antisocial behavior. In W. Damon (Series Ed.) & N. Eisenberg (Vol. Ed.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development. (5th ed., pp.779?862). New York: John Wiley & Sons, Inc.

Dendy, C. (2000). Teaching teens with ADD and ADHD: A quick reference guide for teachers and parents. Bethesda, MD: Woodbine House.

DuPaul, G.J., & Stoner, G. (2003). AD/HD in the schools: Assessment and intervention strategies (2nd ed.). New York: Guilford.

Forehand, R., & Long, N. (2002). Parenting and the strong-willed child. Chicago, IL: Contemporary Books.

Hembree-Kigin, T.L., & McNeil, C.B. (1995). Parent-child interaction therapy: A step-by-step guide for clinicians. New York: Plenum Press.

Kazdin, A.E. (2001). Behavior modification in applied settings. (6th ed.). Belmont, CA: Wadsworth/Thomson Learning.

Kendall, P.C. (2000). Cognitive-behavioral therapy for anxious children: Therapist manual (2nd ed.). Ardmore, PA: Workbook Publishing.

Martin, G., & Pear, J. (2002). Behavior modification: What it is and how to do it. (7th ed.). Upper Saddle River, NJ: Prentice-Hall, Inc.

McFayden-Ketchum, S.A. & Dodge, K.A. (1998). Problems in social relationships. In E.J. Mash & R.A. Barkley (Eds.). Treatment of childhood disorders. (2nd ed., pp 338?365). New York: Guilford Press.

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Mrug, S., Hoza, B., & Gerdes, A.C. (2001). Children with attention-deficit/hyperactivity disorder: Peer relationships and peer-oriented interventions. In D.W. Nangle & C.A. Erdley (Eds.). The role of friendship in psychological adjustment: New directions for child and adolescent development (pp. 51?77). San Francisco: Jossey-Bass.

Pelham, W.E., & Fabiano, G.A. (2000). Behavior modification. Psychiatric Clinics of North America, 9, 671?688.

Pelham, W.E., Fabiano, G.A, Gnagy, E.M., Greiner, A.R., & Hoza, B. (in press). Comprehensive psychosocial treatment for AD/HD. In E. Hibbs & P. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice. New York: APA Press.

Pelham, W.E., Greiner, A.R., & Gnagy, E.M. (1997). Children's summer treatment program manual. Buffalo, NY: Comprehensive Treatment for Attention Deficit Disorders.

Pelham, W. E., Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 27, 190-205.

Pfiffner, L.J. (1996). All about AD/HD: The complete practical guide for classroom teachers. New York: Scholastic Professional Books.

Rief, S.F., & Heimburge, J.A. (2002). How to reach and teach ADD/AD/HD children: Practical techniques, strategies, and interventions for helping children with attention problems and hyperactivity. San Francisco: Jossey-Bass.

Robin, A.L. (1998). AD/HD in adolescents: Diagnosis and treatment. New York: Guilford Press.

Walker, H.M., Colvin, G., & Ramsey, E. (1995). Antisocial behavior in school: Strategies and best practices. Pacific Grove, CA: Brooks/Cole Publishing Company.

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Walker, H.M., & Walker, J.E. (1991). Coping with noncompliance in the classroom: A positive approach for teachers. Austin, TX: ProEd.

Wielkiewicz, R.M. (1995). Behavior management in the schools: Principles and procedures (2nd ed.). Boston: Allyn and Bacon.

Suggested Reading for Parents/Caregivers

Barkley, R.A. (1987). Defiant children: Parent-teacher assignments. New York: Guilford Press.

Barkley, R.A. (1995). Taking charge of AD/HD: The complete, authoritative guide for parents. New York: Guilford.

Dendy, C. (1995). Teenagers with ADD: A parents' guide. Bethesda, MD: Woodbine House

Forehand, R. & Long, N. (2002) Parenting and the strong-willed child. Chicago, IL: Contemporary Books.

Greene, R. (2001). The explosive child: A new approach for understanding and parenting easily frustrated, chronically inflexible children. New York: Harper Collins.

Forgatch, M., & Patterson, G. R. (1989). Parents and adolescents living together: Part 2: Family problem solving. Eugene, OR: Castalia.

Kelley, M. L. (1990). School-home notes: Promoting children's classroom success. New York: Guilford Press.

Patterson, G.R., & Forgatch, M. (1987). Parents and adolescents living together: Part 1: The basics. Eugene, OR: Castalia.

Phelan, T. (1991). Surviving your adolescents. Glen Ellyn, IL: Child Management.

Internet Resources

Center for Children and Families, University at Buffalo, http://wings.buffalo.edu/adhd

Comprehensive Treatment for Attention Deficit Disorder, http://ctadd.net/

Model Programs

The Incredible Years
http://www.incredibleyears.com/

Triple P: Positive Parenting Program
http://www.triplep.net/

The Early Risers Program
August, G.J., Realmuto, G.M., Hektner, J.M., & Bloomquist, M.L. (2001). An integrated components preventive intervention for aggressive elementary school children: The Early Risers Program. Journal of Consulting and Clinical Psychology, 69, 614?626.

CLASS (Contingencies for Learning Academic and
Social Skills)
Hops, H., & Walker, H.M. (1988). CLASS: Contingencies for Learning Academic and Social Skills manual. Seattle, WA: Educational Achievement Systems.

RECESS (Reprogramming Environmental Contingencies for Effective Social Skills)
Walker, H.M., Hops, H., & Greenwood, C.R. (1992). RECESS manual. Seattle, WA; Educational Achievement Systems.

Peabody Classwide Peer Tutoring Reading Methods
Mathes, P. G., Fuchs, D., Fuchs, L.S., Henley, A.M., & Sanders, A. (1994). Increasing strategic reading practice with Peabody Classwide Peer Tutoring. Learning Disabilities Research and Practice, 9, 44-48.

Mathes, P.G., Fuchs, D., & Fuchs, L.S. (1995). Accommodating diversity through Peabody Classwide Peer Tutoring. Intervention in School and Clinic, 31, 46-50.

COPE (Community Parent Education Program)
Cunningham, C. E., Cunningham, L. J., & Martorelli, V. (1997). Coping with conflict at school: The collaborative student mediation project manual. Hamilton, Ontario: COPE Works.

next: Behavioral Management for ADHD Children in the Classroom

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35. McFayden-Ketchum, S.A., & Dodge, K.A. (1998). Problems in social relationships. In E.J. Mash & R.A. Barkley (Eds.), Treatment of childhood disorders (2nd ed., pp 338-365). New York: Guilford Press.

36. Woodward, L.J., & Fergusson, D.M. (2000). Childhood peer relationship problems and later risks of educational under-achievement and unemployment. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 41, 191-201.

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The information provided in this sheet was supported by Grant/Cooperative Agreement Number R04/CCR321831-01 from the Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. This fact sheet was approved by CHADD's Professional Advisory Board in 2004.

Source: This fact sheet was updated in February 2004.
© 2004 Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).

For further information about AD/HD or CHADD, please contact:

National Resource Center on AD/HD
Children and Adults with Attention-Deficit/Hyperactivity Disorder
8181 Professional Place, Suite 150
Landover, MD 20785
1-800-233-4050
http://www.help4adhd.org/

Please also visit the CHADD Web site at http://www.chadd.org/

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