Author Karen Young, from Hey Sigmund, denotes that anxiety is a learned habit, as long as you give in to it, it will never subside but if you break it down and analyze it, you will see all the components that are possible to fix.

Not only do children learn from experience, but so does the amygdala. This part of the brain, that’s responsible for anxiety, can recognize a trigger as a threat and associate it with anxiety. Once the child is triggered, the anxiety typically gets worse before it gets better in an attempt to avoid the “threat”. As a parent, it is your job to help your child from recognizing school as a threat. Now I know this is easier said than done, but it is possible. The difficult part is getting the brain to learn that it can feel calm and safe without avoiding school. When children go back to school, whether that is in person or through distance learning, they are separated from the only thing they know that will keep them safe, a parent. It is important to remind them that you will be right there waiting for them at school or after their virtual lessons.

Below are some strategies Young suggested easing the level of anxiety that children and teens may experience when they go back to school:

• Try to avoid avoidance, take it off the table: As long as you do not give your child an option to avoid school, they will have to learn how to be brave and resilient faster. Their reward is seeing you after school. Practicing attending in person or online will help them to move away from avoidance behaviors and fight the anxiety.  

• Protecting them is understandable but not a permanent solution: Remember that school may also trigger anxious thoughts, feelings, maybe a sick tummy, and an increased heart rate. As a parent, it is your first instinct to protect them from ever having to ever experience these emotions again. However, protecting them also never allows them to feel the weight of these emotions, or to give them the practice necessary in managing and decreasing their anxiety. In the future, they could turn to avoidance instead of persevering through their hardships. Instead, little by little, you can re-associate their feelings of anxiety with positivity and teach them how to be brave now.

• Help them feel safe, even when they aren’t with you: First validate their feelings, that it is understandable to feel scared. Let them know that anxiety is not a weakness, it is an emotion that everyone has, so it is okay to feel. Their brain may register this as a threat but this is when you, as a parent, step in and reassure them to look at the aspects they can control. Even when you aren’t there next to their side, they can feel safe because they set their situation up for success.

• Ease the relationship between them and their teacher: In order to make their relationship stronger, ensure that your child’s teacher is putting in the time to check in on your child and getting to know them by having a conversation with their teacher. By doing so, your child will see that it is safe to have a conversation with more and more adults because they feel safe with them. All it takes is a little interest and a caring attitude to make someone feel more welcomed. Distance learning can make this a little more challenging, but many teachers have been able to create ways to connect with children appropriately.

• Remember, your tone matters: A warm, loving, empathetic tone goes a lot farther than a harsh, low monotone voice. Your child will register this tone as a threat and view it as a punishment. Instead, reinforce your child’s actions by first expressing that you still love them, but that their actions were not the greatest choice. Your child will see that you truly are trying to take an interest in their well-being.

• Let them know they will be taken care of: Going back to school and getting back into the groove of things is always difficult, no matter the age. Young recommends to “validate how hard it is, and reaffirm that you know they will be taken care of at school” by acknowledging their feelings. Remember, they don’t need to agree with you, just be willing to try.  Distance learning or Virtual learning can help this transition and interrupt the anxiety “flow” and provide more opportunities to check in and reconnect with children.

• Sometimes all you can do is go with the flow: If your child feels overwhelmed, which is easy to understand, let them take a moment to take a step back and breathe for a second, whether this is going out for a walk or getting some food into their system. Let them know that you have been there too and you see them and that you know they can get through this    (Young). This takes patience and practice, because their brain won’t catch on right away, only until they know they can return to the present in a calm state of mind based on experience. 

Their sadness, hopelessness, and anxiety is not a permanent behavior. Even though it may be hard to do so now, slightly push them out of their safe bubble from being home all summer towards brave behavior.  They may not know it now, but they can persevere and have courage to get through the hard things that school brings, you may just have to believe it for the both of you for a little until then.

For more information on how we can help your child and family cope with going back to school during the COVID-19 pandemic, please contact us. For more information on therapy, visit our website at Hilber Psychological Services. To learn how we can help you and your children with Anxiety, please contact us. HPS is available and open for Telehealth Video Visits and In-person sessions.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD.

References:

Young, Karen. “How to Manage Back-to-School Anxiety – What Children and Teens Need From Us.” Hey Sigmund. https://www.heysigmund.com/how-to-manage-back-to-school-anxiety-what-children-and-teens-need-from-us/

Author Wes Crenshaw illustrates that poor sleep and attention deficit disorder (ADHD or ADD) are actually related. In detail, Crenshaw notes that “Poor sleep can lead to ADHD-like symptoms and complicate a diagnosis.” In fact, researchers, in the “ADHD Is a Myth” crowd, found that individuals with ADHD are declared to have sleep apnea, narcolepsy, or primary insomnia. It is then suggested that parents should start monitoring their child’s sleep patterns; ”quality of sleep must be considered in making an ADHD diagnosis” (Crenshaw). 

In crenshaw’s experience of working with two dozen teens and young adults for sleep studies, he found that the best solution to poor sleep patterns resulting from ADHD is stimulant medication. Results show that “Some teens will sleep better after beginning stimulants [and] A few will have daytime sleepiness despite taking them” (Crenshaw). Be aware that by treating ADHD with stimulants, sleep patterns will improve for some people while remaining or possibly limiting the effectiveness of the treatment for others, especially those with ADHD-related insomnia. Crenshaw notes that ”we find the Daytrana patch helpful for those with stimulant-induced insomnia, because it’s the only medication that can be shut off early (by removing the patch).” 

For those who have not had sleep problems before and have not overused napping but start to lose sleep after starting a medication, it is recommended that either they stop using stimulants and/or switch to a non-stimulant for ADHD. However, Crenshaw declares that “if the stimulants are working, we prefer to tinker with their timing and release to improve sleep.” This is why it’s important “to assess sleep problems before any medication is prescribed” (Crenshaw).

When trying to help teens develop a consistent sleep-cycle, it is import to remember that the results will not be apparent right away. Children, especially teens and those with ADHD, will first resist having restrictions on when they can sleep. For example, when trying ”to help a client manage stimulants and sleep, [scientists learned] that the client is staying up late and, in extreme cases, reversing the sleep-wake cycle” (Crenshaw). This is why good sleep is critical in treating one‘s poor habits and crucial to understanding the ADHD-sleep conundrum (Crenshaw). Because, if they do start to have a regular cycle, their quality of sleep will improve. 

In efforts to try to help teens with ADHD sleep better, try to 

1. Make time for it. Eight hours are recommended, especially with an hour of prep time. 

2. Turn off screens. They wake up our brains even more with all of the games and light they produce. 

3. Say goodnight to the (artificial) sun. It is important to shut off/block out (using shades) all artificial light in the evening. The body will then signal the brain that the night cycle is coming and that it should start preparing for sleep. 

4. Rise with the light. Progressively increase the brightness of a light in one’s bedroom (by using a timer) like the rise of the sun. 

5. No napping. Although ”many teens compensate for poor sleep by taking naps” (Crenshaw), researchers discovered that naps actually cause unhealthy sleep. In actuality, a 10- to 15-minute nap in mid-afternoon is recommended instead; “These may improve functioning and improve sleep” (Crenshaw).

For more information on therapists at Hilber Psychological Services can help your children and your family with parenting, sleep hygiene, and ADHD symptoms, please visit our website or contact us. 

For more information on how Neurofeedback services can assist your child with ADHD and sleep issues without the use of medications, please contact San Diego Center for Neurofeedback.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD.

Reference

Crenshaw, Wes. “What Comes First: ADHD or Sleep Problems?” ADDitude. 18, June 2019. https://www.additudemag.com/adhd-sleep-problems-solutions/

In the article “What Is Executive Function? 7 Deficits Tied to ADHD,” author Russell Barkley discusses that an executive function “is the cognitive process that organizes thoughts and activities, prioritizes tasks, manages time efficiently, and makes decisions.” This is essentially the project manager for your brain.

Executive function skills are skills that motivate us to keep moving forward whether that is with a project or daily activities. Barkley states that ”Individuals with executive dysfunction often struggle to analyze, plan, organize, schedule, and complete tasks at all…” These executive functions are executed by the prefrontal cortex of the brain. 

Barkley notes that there are four circuits in the ADHD Brain and Executive functions:

• The “What” Circuit: Goes from the frontal lobe — linked to working memory and helps guide us on daily activities 

• The “When” Circuit: Goes from the prefrontal area to the cerebellum — it is the timing circuit of the brain —it determines the sequence in which we do tasks — explains why people with ADHD often have difficulties with time management.

• The “Why” Circuit: Goes from the frontal lobe to the central part of the brain to the amygdala — linked to our emotions —  helps us make final decisions based on how we feel. 

• The “Who” Circuit: Goes from the frontal lobe to the very back of the hemisphere —  where self-awareness originates from. 

By understanding these four circuits and relating them to those who have ADHD, you can see what types of symptoms an individual may or may not have with certain deficits with emotion regulation, time management and memory deficits. 

Executive functions helps people reach goals and future plans. Furthermore, ”it’s about how we behave toward our future goals and what mental abilities we need to accomplish them” (Barkley).

Executive function is determined by the strength of these seven skills and how they affect/change one’s behavior and self regulation:

1. Self-awareness

2. Inhibition

3. Non-Verbal Working Memory

4. Verbal Working Memory

5. Emotional Self-Regulation

6. Self-motivation

7. Planning and Problem Solving

These seven executive functions develop over time generally in chronological order. People who exhibit classic ADHD symptoms may have trouble with these seven executive functions. For example, those with ADHD who have problems with inhibition may have impulsive behaviors.

With awareness of these executive functions, parents can look for a professional evaluation to determine if their child has ADHD early on before it is apparent in their learning or grades at school. Then, those with ADHD can use knowledge, tools, techniques, and other treatments to improve their executive functions over time. 

For more information on how Hilber Psychological Services can help you or your child/teen with ADHD and executive functions, please visit our website or contact us for more questions.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD

Reference
Barkley, Russell and ADHD Editorial Board. “What Is Executive Function? 7 Deficits Tied to ADHD.”  ADDitude. 3 Oct. 2019. https://www.additudemag.com/7-executive-function-deficits-linked-to-adhd/

In the article “The Building Blocks of a Good ADHD Diagnosis,” author Thomas Brown notes that ADHD should not be taken lightly and a complete diagnostic workup with multi-step procedures and a medical history review should be ordered and understood by the patient. An evaluation is recommended to be completed by an experienced licensed psychologist in order to provide the full evaluation and avoid a misdiagnosis.

In an ADHD evaluation, the clinician has several options to determine if your child has ADHD and would likely include the following steps or refer to another clinician who can provide a full psychological assessment that includes these steps.

Clinical interview: Find the root causes of ADHD by talking directly to the patient: “Why do you think you (or your child) may have ADHD?” “When? How do you notice it? When is this difficulty most evident? Has this pattern existed most of your child’s life, or is it something that started happening recently?”

Brown states that ”the clinician’s job is to identify patterns that may point to ADHD, or recognize that symptoms actually stem from something else.” Brown notions that a clinical review should cover:

• Challenges, symptoms

• Strengths, skills

• Family life, day-to-day stressors

• For children: school performance — grades, tests (including standardized test scores and how long they take to complete tests), whether or not they can complete homework on their own or need a parent’s help, etc.

• For adults: work performance — deadlines, productivity, etc.

• General health — including sleep and eating habits

• Family medical history, including other possible instances of ADHD

• Drug use (both prescribed and illicit)

• Previous evaluations (if any) and their results

• Related and comorbid conditions — mood disorders, anxiety, and learning disabilities are common in people with ADHD

DSM-V Symptom Review: Determine if a patient has the ADHD symptoms (at least 6 of the 9) listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V). 

Normed rating scales: These rating scales (Connors Scales, BASC, the Brown ADD Scales, or the Barkley scales) are used to see where a patient is at relative to others their age given their rated symptoms in various situations. Brown declares that “it is also often helpful for adults to have someone who knows them well complete a scale from their perspective.”

Standardized psychological assessments: There are many psychological tests that could help evaluate one’s reading, writing, and math skills that could help determine where one’s strengths and weaknesses lie and what could help. Sometimes ADHD is misdiagnosed if these assessments are not completed as there are other factors that affect focus and concentration, such as anxiety, depression, or learning disabilities. Brown states that “the vast majority of children with ADHD have at least one specific learning problem [which could] overlap genetically and in terms of functions like working memory. These tests include Woodcock-Johnson Test of Cognitive Abilities, Wechsler Individual Achievement Test (WIAT), Wechsler Intelligence Scale for Children (WISC-V).

Physical exam: Because ADHD-like symptoms are sometimes caused by internal medical problems such as thyroid conditions, physical exams ensure that a medical problem has not been overlooked and may be requested by the clinician.

In Brown’s opinion the following evaluation tools may be used in some cases to add to an ADHD assessment, however these are not known to be accurate tools for such an evaluation.

• Brain imaging: “ADHD is not a problem of brain structure, rather, it’s about communication within the networks of the brain” (Brown). However brain imaging may be helpful in providing Neurofeedback Treatment, which is a known treatment for ADHD symptoms.

• Online “reaction” tests: These tests dictate whether a subject has ADHD based on their ability to hit or retain from hitting a certain key every time a particular target comes into view. 

• Genetic testing: The testing of a few genes to see if they make up the genes in ADHD. 

ADHD Diagnosis Red Flags:

• Too quick to grab the prescription pad: When a clinician or doctor does not take their time to do a full evaluation but instead quickly prescribes a medication for ADHD.  

• Failure to include information from the school: When a clinician does not review a patient’s sense of how they function to the fullest by completing rating scales or interviewing closely related persons, teachers, or parents as part of the clinical interview.  

• Failure to use rating scales and psychological assessments: If a clinician does not decide to use rating scales and psychological assessments, then they will likely base their diagnosis of the patient’s symptoms on their personal opinion which can lead to a misdiagnosis. 

• Too fundamentalist about symptoms: If your clinician is too strict on the 6 symptom rule and neglects you from having the possibility of getting a prescribed medication to adhere to your ADHD because you only have 5 of the symptoms, then that is a red flag. 

• Saying, “Don’t worry, it’ll pass!” When your clinician dismisses you or your child’s concerns about ADHD symptoms that are disrupting your life and mental health.  

After the full assessment is completed a complete understanding of why the ADHD symptoms are present and what the next steps would be in managing the symptoms. A good report of the evaluation will provide specific recommendations for treatment along with an accurate diagnosis.

For more information on how Hilber Psychological Services can help you with understanding your or your children’s ADHD symptoms and the next steps for ADHD treatment, as well as connect you with experienced psychologists who can provide an evaluation, please contact us.

References

Brown, Thomas. “The Building Blocks of a Good ADHD Diagnosis.” Additude. 11, Oct.  2019. https://www.additudemag.com/how-to-get-diagnosed-for-adhd-ensuring-a-good-evaluation/