“He who fears he will suffer, already suffers from his fear.” -Michel de Montaigne

I attended a powerpoint presentation recently, given by a nationally renowned psychiatrist, who provided an excellent overview of modern day psychiatry in America. It was quite disturbing to learn that the most widely prescribed psychiatric drug is Xanax. More bad news is the Center for Disease Control and Prevention (CDC) reporting a sharp increase in fatal overdoses of prescription drugs. In fact, if you look at the top fifteen most prescribed psychotropic drugs, you will find Ativan (at #3), Valium (#8) and Klonopin on the list as well. If your regular doctor is prescribing them, they can’t be all that bad, right?

The History of Benzodiazepines

Many of you reading this article may not know that all four medications are classified as “minor tranquilizers” and are from the same family of drugs, called benzodiazepines. The first “benzo” sold in America was Librium in 1960, followed quickly by Valium, which was the number one prescribed psych med for most of the 1970′s and is still high on the list. When Xanax became available in 1981, it was marketed as the best drug for panic attacks. Certainly Pfizer did a great job of marketing, making Xanax the big winner–the most popular psychiatric drug in America–but is this really the best treatment for anxiety?

Some of you who are reading this article may currently be taking one of these drugs as prescribed by your doctor. I am a psychotherapist, not a doctor, and I am not offering medical advice here. Rather, I am offering information so that you, as a consumer or interested family member, can have more facts at your disposal. Unfortunately, hugely expensive, clever commercials flash onto our screens daily, touting one promising drug or another for various psychiatric conditions. Given how debilitating anxiety can be, it is no wonder that we reach for something, anything, to fix it.

Without going deeply into the chemical composition of benzodiazepines (such information is readily available on line), they offer short-term sedation, muscle relaxation, seizure prevention, and anxiety reduction. Xanax (also known as alprazolam) and Ativan (lorazepam) are short-acting, usually providing temporary relief in 15-30 minutes. Klonopin (clonazepan) and Valium (diazepam) are longer-acting. In general, benzodiazepines are safe and effective in the short term when used as prescribed. What is highly controversial is their long-term use for anxiety disorders, and whether or not they should be the first line of attack for the anxiety that often accompanies depression.

For people who can’t get on an airplane without breaking into a cold sweat, the use of this form of medication is a life-saver. One of my clients (who had not taken any drugs) recently told me that one of the flight attendants told her she should take Valium next time because she was making everyone on the airplane nervous. Medications like this are used routinely for surgical procedures where the doctor wants the patient awake but not anxious. After a traumatic event or loss, the use of short-term anti-anxiety agents can be the only way some people can get any sleep. These are just a few of the appropriate uses of these medications.

The Dark Side of Xanax (and Other Benzodiazepines)

There is a dark side to this story. First, all benzodiazepines are addictive and have the potential to be abused. They are known by street names like zannie bars, school buses, white ladders, totem poles, tonka toys, and zanners. They can lead to a physical and/or psychological dependence. If dependence develops, it can be extremely difficult for a person to stop using the medication because withdrawal symptoms may occur. Typical withdrawal symptoms include sleep disturbances, irritability, increased nervousness, and muscle cramps. If someone has been abusing them at high doses, the withdrawal effects could include psychosis, epileptic-type seizures, coma, or even death.

From the reports of doctors working in rehab facilities and from the self-report of dozens of clients I have seen, they say it can be more difficult to get off of benzo’s than to detox from heroin. They wished someone had warned them before they began long-term use of these meds. There are some excellent resources if think you might be addicted and you want to know more about this topic. That being said, never stop taking any psychiatric medication suddenly or without the supervision of your doctor.

Another important fact is that when Xanax is combined with alcohol or many other drugs, its effects are magnified. We all know the dangers that come with drinking and driving, or other ways that drugs can impair judgment. Given that the benzo’s can affect physical coordination, they can be particularly dangerous for the elderly. They can also interfere with memory–I have worked with college kids who have suffered blackouts from the mixing of alcohol and benzo’s.

Third–and perhaps most importantly–there are other effective treatments out there for panic attacks, and these treatments are not dangerous or addictive. Panic attacks and other anxiety disorders are usually treated successfully with psychotherapy and when medication is needed, with safer, non-addictive antidepressants. Another important component of good treatment is the education of both the patient and significant others. The cure of panic disorder involves the sufferer understanding that the panic attack itself, although horribly uncomfortable and frightening, is not fatal and will ultimately end.

In order to recover completely, the panicking person must remain in the phobic situation long enough for the panic attack to lessen on its own. Learning that you can face a feared event–and conquer your fear–is a turning point. If instead, you simply pop a pill, you might think that only the pill will bring relief rather than learning effective strategies for self-soothing and breathing through the discomfort.

Studies have shown that Americans report higher levels of anxiety than most anywhere in the world. Can that really be true? We are certainly not the only nation that is overwhelmed with problems. In fact, we have more wealth and resources than most. So why have we become a nation with millions of Americans being tranquilized artificially? Is it possible that we have begun to confuse real cases of anxiety–a painful diagnosable disorder–with the normal, inevitable pain of being human?

What do a 45-year-old professor, several well-educated parents, a retired psychotherapist, a concerned husband, and a college student all have in common? These are people suffering–or intimately connected to someone suffering–from clinical depression who didn’t know it.

How, in this day and age, with so much information available, is it possible that depression can still go undiagnosed and therefore untreated? Perhaps this is part of the reason why the blog “Depression Part Two” on Hyperbole and a Half  just went viral (besides how extraordinarily creative it is). Here are some reasons why smart people can miss the signs of depression:

1. Depression can creep up on you.

Not all depression is so severe that you can’t stop crying or get out of bed. For many people, the feelings of sadness manifest as a growing disinterest in life’s activities. What used to be fun or interesting seems unimportant or shallow. You don’t feel like going to your friend’s birthday party so you make up an excuse. You feel bored by the books or TV shows that used to appeal to you. You don’t notice how, little by little, you are pulling back from others, spending more time alone, locked in your room.

2. Depression seems to be a logical response to life’s challenges.

Since depression often worsens or can be triggered by loss or stress, you figure that you are responding appropriately to what is indeed a painful time in your life. You may have broken up with a boyfriend, had difficulties at work, done poorly on a school assignment, or moved away from a supportive environment. When you don’t snap out of it, even when your life circumstances appear to get better, you don’t realize that your negative mood state has persisted for months or even years. 

3. Some depression manifests as extraordinary irritability rather than sadness.

One of the most commonly misunderstood or overlooked manifestations of depression is hypersensitivity or irritability. People around you tell you that you are constantly cranky. You seem annoyed (and feel annoyed) at every little thing. People or activities that you didn’t like before become intolerable. One of my clients, Sally, upset her husband and kids because she yelled at the TV announcers and seemed critical and judgmental about everything. Only when I inquired about whether Sally might be depressed, did she realize that she was sleeping an inordinate amount of time and no longer had any appetite. She never felt sad, just incessantly irritable.

4. Some depression manifests as extreme anxiety.

Many people do not realize that anxiety is a frequent companion of depression. Mark, a local college student, came to see me because of paralyzing test anxiety and social phobia. Since he did not feel sad and never cried, Mark attributed all of his problems to his fears. Only after a thorough assessment that revealed his gradual weight gain since high school, his difficulty with sleeping, his growing disinterest in sports (which had been his passion), did Mark realize that his anxiety was one of many symptoms of his depression.

5. If you’ve been depressed your whole life, it just seems normal.

I worked with Randall, a 54-year-old math professor, who never said a word about being depressed. He had even had bouts of suicidal thoughts on and off since he was a teenager. Randall’s mother was chronically unhappy, and his father was an alcoholic. Surrounded by a family of unhappy people, this client thought of his mood state as normal. It never occurred to him that he might learn to treat himself more generously. To be happy was unthinkable in Randall’s world.

6. You have been raised to be stoic in the face of any form of pain.

Justina came into therapy because her child was having problems adjusting to school. She insisted initially that everything was fine in her life. It was only when her son told her that he was afraid to go to school because he thought his mom might hurt herself that Justina began to talk about how difficult it was to get out of bed every morning. As we talked further, she described her upbringing in a highly religious family where she was not allowed to complain. Her parents taught her to be grateful for her privileged life in a world where others suffered from poverty and religious persecution. Justina’s shame about what she saw as her personal weakness had kept her from talking about how badly she felt.

7. You feel hopeless, believing nothing will change how you feel.

Another group of people just soldier on, convinced that there is nothing anyone could do to help. Since depression causes people to withdraw from life, to stop reaching out to others, and to be immobilized by insecurity and anxiety, the idea that their misery is unchangeable becomes a self-fulfilling prophecy. The very things that loved ones do to try to help–telling the depressed person to exercise, go out more, drink less, and look at the bright side–are the very things that the depression makes impossible.

Do any of these sound familiar? If so, you are not alone. There are numerous resources both here at PsychCentral and elsewhere. And thank you to blogger Allie Brosh for her willingness, not only to share her own struggles with depression, but to do so with both humor and hyperbole. Hope comes in many forms.

“Nature, we are starting to realize, is every bit as important as nurture. Genetic influences, brain chemistry, and neurological development contribute strongly to who we are as children and what we become as adults.” -Stanley Turecki, M.D.

Sue and Alan Richardson are like so many other distressed parents who reach out to our counseling clinic. They have three kids. Two have been launched successfully, and they have warm relationships and good communication. Sue and Alan are devastated because one of their kids, now 19, is such a problem. Samantha struggled with depression beginning in junior high, rages at them on occasion, tried to make it at college but couldn’t stand the pressure, and has bounced back home again. What went wrong? They parented all three kids similarly but Samantha was always more difficult and highly sensitive.

Stopping the Blame Game

Parents often get blamed or blame themselves for any problem that shows up in their children. We now know that every baby is born with certain innate inherited characteristics or temperament. Temperament is, by definition, the part of a child’s personality that is not caused by good or bad parenting. Built-in traits will affect each child’s style of interacting with people, places and things throughout their lifetime. The research validates what many parents knew intuitively all along. Some babies are easy, and some are more challenging. Because it is almost taboo to say something negative about one child or to compare your kids, many parents don’t get the support that they need when struggling with a more difficult child.

The Nature Vs. Nurture Debate

The debate about just how much of our behavior and personality is genetic vs. environmental, or nature vs. nurture, has raged on for the last hundred years. Twenty or thirty years ago, in an ongoing effort to understand why people behave in certain ways, both good and bad, researchers focused more on the nurture side, examining things like the family environment or types of parenting that were correlated with problems or resiliency in children. In the past ten years, with advances in technology that have helped us unravel more of the mysteries of both genetics and also how the brain works, the pendulum has swung back towards the important impact of a child’s genetic make-up, the nature side of the debate.

Kids Can Be Easy, Difficult, and Slow to Warm Up

The truth, of course, of why we are the way we are, lies somewhere in the middle. Each of us is the product of both our biology (nature) and our social learning (nurture). Beginning in the 1950′s, researchers Thomas, Chess, Birch, Hertzig and Korn, launched the New York Longitudinal Study, which rated young infants on nine characteristics and followed them as they grew up. They discovered that sixty-five percent of babies readily fit into one of three categories: easy, difficult, and slow-to-warm-up.

Of the sixty-five per cent, forty percent fit the easy pattern, readily adapting to new experiences, generally exhibiting positive moods, with normal eating and sleeping patterns. In contrast were the ten percent who fell into the difficult pattern, These babies were very emotional, crying a lot, often irritable and fussy, with irregular eating and sleeping patterns. Another fifteen percent were slow to warm up, typically withdrawing from new situations and people, only adapting to new people or environments after repeated exposure.

The other thirty-five per cent were more subtle combinations of each of nine factors that comprise temperament including activity levels, adaptability, intensity, moodiness, and distractibility. Researchers have found that these broad patterns of temperamental qualities are remarkably stable into adulthood and are also found in children across all cultures. Think about your children, yourself or your mate and what might be the innate differences between you.  (Here is a link to a list of all nine characteristics and further reading).

How Well Does Your Child Fit with You?

Now let’s come back to the story of the Richardson family and the hundreds of thousands like them. Because of temperament, some children adapt quickly and easily to family routines and get along with siblings, but others who are more active, intense, shy, or moody may have a difficult time adjusting. The frustrating, negative interactions between these children and their parents or siblings can cause enormous stress and friction between the parents and within the family.

Once you have learned more about your child’s temperament as well as your own, you can see how some children “fit” better with some adults. If your temperament is vastly different from that of your child, it is easy to think something is terribly wrong with one or both of you. Further exploration of temperament can help parents spot the trouble areas, notice problems of poor fit, and come up with strategies for adapting to their child’s unique strengths and weaknesses.

For example, a slow-paced parent may be irritated by a highly active child or vice versa; or if both parent and child are highly sensitive and intense, lots of conflict could result. What may appear at first glance to be a behavioral problem may actually be a mismatch between a parent’s temperament (and their resultant parenting style) and their child’s. Sometimes one child seems to bring out the worst in both parents. Or conversely, sometimes one parent seems to bring out a difficult child’s strengths.

Not all kids are alike, and some kids take parents with almost superhuman powers of patience and persistence. Taking the first step–from blame to understanding–is crucial. We are each born with a given temperament as well as a myriad of other strengths and challenges. Out of our genetic grab bag, are the building blocks of character, mysteriously designed to blend destiny with free will.

“There exists, for everyone, a sentence – a series of words – that has the power to destroy you. Another sentence exists, another series of words, that could heal you. If you’re lucky you will get the second, but you can be certain of getting the first.”                                                                                            -Author Philip K. Dick

It will probably come as no surprise that I have been writing since I could put pen to paper–that’s my bias. That being said, I’m not sure what I would have done without it. In my teen years and early adulthood when I would never (and did never) set foot in a therapy office, I created a safe space in my journals to express everything I couldn’t talk about. Years later, when I began my journey of self-exploration and healing in early adulthood, I was able to reflect with new eyes on everything I had written. What had I learned, if anything, and what was I supposed to learn from the lessons life was giving me?

If you are not in therapy because you don’t believe in it, can’t afford it, or it’s against your religion, writing may help you. If you are in therapy, writing may help you deepen your experience and make yourself the hero of your journey. If you are a parent, and want to know how to help your child deal with the recent traumas from Boston or Newtown, here are some ideas. What is the story you tell yourself about your life and what do you want it to be?

The Health Benefits of Writing

There is now a considerable body of research showing how powerful it can be to write about difficult events. Psychologists James Pennebaker, at the University of Texas and Joshua Smyth at Syracuse have found that written expression can reduce both anxiety and depression, improve immune function, lower stress levels, improve grades in college, and help people recover from trauma. What can be learned from their findings?

1. It is better for our health and well-being to express our negative feelings.

Allow yourself to have ALL the feelings that you have without judging yourself. You can tear these pages up when you are through so no one will ever see them but you. This exercise is particularly helpful for those of you who avoid conflict and never get openly angry, or for the tough types out there who never show fear or vulnerability. Although it is often preferable to talk to a “real” person such as a family member, friend or counselor, not everyone feels comfortable sharing painful truths about themselves. So even if you have no one to talk to, it is better to express yourself in writing than not at all.

2. Venting emotions is the first step in a process.

Just as the first sessions of therapy typically involve telling your story, and if you are dealing with loss or trauma, telling it with lots of emotion–the first time you write about a painful event, it will often be raw and emotional. Allow all your feelings to emerge–even if they don’t make sense–but keep on writing until you come out the other side. Suppressing or denying our “negative” feelings can make us sick or depressed but equally counter-productive is simply dwelling on only the dark side. It is easy to get stuck in resentment, but not good for our ultimate recovery from stressful life events. Describing negative emotions in moderation is most effective.

3. Writing about our problems can bring some needed distance and new perspective to bear on the situation.

After thoroughly venting about what happened, turn your attention towards what meaning you have attached to your life story. Do you notice any patterns or themes that emerge from your experiences? Are you frozen in a victim role, blaming others for all of your problems, or are you stuck in a self-defeating interpretation where you judge yourself as bad or wrong no matter what happened? A crucial aspect of the process, if it is to bring healing, is to get deeper insights into the complexity of what happened. Since most things in life are not so black and white as when we are responding with raw emotion, this part of writing allows us to view what happened from multiple perspectives. What realizations emerge as you write freely about what happened and how you responded?

4. For writing to be healing, we must find the positive parts of the story.

I often ask people to write about what was the silver lining in their painful loss or experience. In facing hardship, most people learn that they had far more courage and strength than they ever imagined. What did you learn about yourself that you never knew before? What is the sentence that is, as Dicks poetically put it, “destroying” you? It is usually a sentence of hopelessness such as “I am permanently damaged,” or “No one will ever love me.” A sentence that can open the door to change might start with, “Up until now”, fill in the blank….”I have chosen the wrong people to be my friends,” or “I have been afraid,” but “I have learned from this experience”…..fill in the blank with a new awareness…”that I am incredibly resilient” or “that I can make new choices.”

In the majority of the research on the effectiveness of this simple tool, people are asked to write about events for twenty minutes a day for just three days in a row. Even with this short amount of focussed writing, the benefits are significant. Imagine if each of us took the time to write about whatever life events still remain mired in negativity, if only once a week for a few months. My guess is that the healing power of words, if cast in the light of new understanding, will bring greater compassion for ourselves and for others. It has helped me find my voice and to be more grateful for the gifts that have come even at the darkest times. Try it, and let me know what you find.

“Everybody needs beauty as well as bread, places to play in and pray in, where nature may heal and give strength to body and soul.”  ~John Muir

In my last blog on the growing numbers of kids being diagnosed with ADHD, I wondered out loud about the potential negative effects in our modern culture of things like: too much time spent indoors, too little sun and exercise, too many electronics, and not enough sleep. Rather than dwell on the causes of our problems, let’s consider what we can do to reduce the impact of stress on the lives of both adults and children. Not from a medical psychiatric perspective, but from the perspective of everyday life.

Ask yourself this question: Do you or your kids suffer from Nature-Deficit Disorder?

This wonderful name was coined by journalist Richard Louv with the publication of Last Child in the Woods. His newest book, The Nature Principle: Human Restoration and the End of Nature-Deficit Disorder, offers a new vision of the future, in which our lives are equally immersed in nature and in technology.

What do we already know about the positive effects of time spent outdoors, immersed in nature?

Rachel and Stephen Kaplan, environmental psychologists from the University of Michigan, are internationally known for their research on the effect of nature on people’s relationships and health.The Kaplans got involved in studying the effects of nature back in the 1970s, and since then have done extensive research on “restorative environments” to understand the psychological benefits of time spent in nature and what types of natural environments stimulate health and reduce stress.

In order to work or study efficiently, we need to maintain focused attention on the task at hand–something that everyone struggles with–most especially those with Attention Deficit Disorder or ADHD. Too much focused attention can lead to mental fatigue and increased stress. One remedy for this fatigue is exposure to nature. The wilder the better, but even a little bit helps. Office workers with a view of nature are happier and healthier at work; kids do better academically; hospital stays are shorter with windows to nature; exercisers who walk outside in pleasant environments walk longer.

Positive Effects for Kids with ADHD

ADHD kids who participate in activities conducted in natural outdoor environments concentrate better and show less impulsivity. Published in The American Journal of Public Health, Frances Kuo conducted a national study comparing the effects of after school activities conducted in green outdoor settings versus those conducted in both built outdoor and indoor settings. Controlling for the amount of physical activity, type of activity, preference for nature, or timing of medication, they concluded that time spent in nature reduces ADHD symptoms.

The authors concluded that, “While medications are effective for most children with ADHD, they are ineffective for some, and other children cannot tolerate them…and a green dose or series of green doses might conceivably reduce the need for medication by 1 dose per day, allowing growing children to recover their appetites in time for dinner and get a good night’s sleep. These studies, and hundreds of others, add to the growing body of literature that shows how exposure to nature has profound effects on the health and well being of children and adults alike.

The Benefits of More Time in Nature for Children:

1. Kids get along better.  Research has found that children who play in nature have more positive feelings about each other. There is something about being in a natural environment together that stimulates social interaction. Another study showed how play in a diverse natural environment can reduce or eliminate bullying. In several studies, researchers have found that some of the kids who benefit most are those with attention and learning challenges.

2. Imaginative processes are enhanced.  Early experiences with the natural world have been positively linked with a sense of wonder. Children are more likely to use their imagination outdoors.

3. Cognitive development is improved. Curiosity and wonder are strong motivators that make children more eager to learn. When children play in natural environments, their play is more diverse. Creative play, in turn, nurtures language and collaborative skills. Spending time in natural environments helps improve their awareness, reasoning and observational skills.

4. Physical health is improved. Children who play regularly in natural environments show more advanced motor fitness, including coordination, balance and agility. They get sick less often. Just getting their hands in the dirt can bring exposure to “good bugs” that stimulate the immune system.

5. Kids are less stressed out. Nature buffers the impact of life stress on children and helps them deal with adversity. The greater the amount of nature exposure, the greater the benefits. Nature helps children develop powers of observation and creativity and instills a sense of peace and connection to the planet. Haven’t you noticed how kids can do whatever they need to do when they are out in the wild? They can just sit and stare at bugs or scream at the top of their lungs.

6. Kids are more psychologically mature.  A boost in maturity comes from the increased independence and autonomy that free play in nature encourages. Children with more contact with nature score higher on tests of concentration and self-discipline. The more green, the better the scores. In a study of kids with ADHD, it was found that those who played in windowless indoor settings had significantly more severe symptoms than kids who played in grassy outdoor spaces. School classrooms with outdoor views even help.

7. Kids are more likely to love and protect the environment. When people like John Muir and Teddy Roosevelt spent time in places like Yosemite Valley, they realized that these wild places were “America’s treasures,” needing our stewardship and protection. In order to teach children how to treasure nature, kids must be allowed to explore it in their own way, and be given the time and opportunity to “dig in” and immerse themselves in its mysteries. Like a perfect mother, the earth welcomes us all with open arms.

I have spent countless hours in deep discussion with both parents and professionals questioning why so many kids are being diagnosed these days with Attention Deficit Disorder (ADD) or Attention Deficit with Hyperactivity (ADHD). Is there some causal contributor in our food or environment? Is it due to changes in parenting practices? School environments? The increase in technology in everyday life? The lobbying power of drug companies? All of the above?

What Are the Facts?

The number of American children leaving doctors’ offices with an attention deficit hyperactivity disorder (ADHD) diagnosis has risen 66% in 10 years, according to a Northwestern study. ”The magnitude and speed of this shift in one decade is likely due to an increased awareness of ADHD,” explains first author Craig Garfield, M.D., perhaps causing more physicians to diagnose the disorder. Researchers also found that psychostimulants have remained the most common medication, prescribed to 87% of children with ADHD in 2010.

No matter what the reason, it is frightening to think about.  Not only are kids being given psychiatric medications at younger ages, more young adults than ever before are now taking ADHD medications, usually powerful and addictive amphetamines like Adderall. In the past four years, IMS Health reported that the number of monthly prescriptions has more than doubled for Americans ages 20 to 39. The use and abuse of stimulants is on the rise.

Far too many kids, once 18 and away from home, decide on their own to get a prescription. Certainly some of these kids have legitimate difficulty keeping up with their studies because of real attention problems. Countless others look up the symptoms on the web and act the part. A 2010 study  by researchers at the University of Kentucky compared two groups of college students– those diagnosed with ADHD and others with faked symptoms–and found they were indistinguishable on the standard tests typically given. Once your kids become adults, there is nothing much that parents can do. But, is there anything you can do NOW to stem the tide? I think so.

What Can Parents Do?

When you think about some of your happiest memories as a child, what do you remember? My husband spent countless hours of his childhood playing on his own or with pals in the woods near his home. No adults supervising. Hours building forts, throwing acorns, damming the creek, climbing trees, playing hide-n-go-seek.

And mine? Summer nights with a dozen kids of all ages, catching fireflies in jars, playing kick-the-can while being dive-bombed by bats. Or going to the dump in Wisconsin with my dad, where we were almost guaranteed to see bears or other animals foraging after dark.

Even as recently as the 1970′s, American kids still spent most of their free time exploring and playing outdoors, using the sidewalks, streets, playgrounds, parks, and vacant lots with little or no restriction or adult supervision.Throughout all but the last tiny sliver of human history, adults and children alike were in constant relationship to nature, working with its rhythms of dark and light, sometimes in harmony, often struggling with its unpredictability. Two hundred years ago, most children were still surrounded by fields and farms. Little by little since then, our lives have become more urbanized.

Sunshine Lowers ADHD Rates

Enter a glimmer of hope. A new study  published in the journal, Biological Psychiatry, found that fewer children have attention-deficit hyperactivity disorder where sunshine is plentiful so they can play outdoors. Study leader Martijn Arns from the Netherlands suggests a link between increased screen time in the hours leading up to bedtime, less quality sleep, and attention problems. So here’s what parents can do: get your kids playing outside during the day and to sleep early at night. Nix the computers and gameboys right before bed.

What if part of the cause of the epidemic of childhood disorders–not just ADHD but depression, anxiety, and childhood obesity too–comes from our kids being deprived of their relationship to good old Mother Earth? What is even part of the problem is that simple: too much time indoors, too little sun and exercise, too many electronics, not enough sleep…These are simple solutions to a complicated problem. But as parents, these are variables that you CAN control. Have at it.

“Too many people spend money they earned..to buy things they don’t want..to impress people that they don’t like.”                                    -Will Rogers

In Smitty’s family, there was never enough money. His parents amassed huge debts, constantly bought things they could not afford, and were even now trying to borrow money from Smitty. When Hilary and Justin made impassioned demands for the latest fashion items or video games, Smitty always said no and Sally wanted to say yes.

Sound familiar? Disagreements about money–how hard you should work, how much you should save or spend, and who gets to make the decisions about it–are often the cause of conflict in families. What are some of the important lessons that parents should be teaching their kids about money? What do you wish that you had learned as a child about money that could have saved you a lot of time and trouble?

#1 Start teaching your kids about the connection between work and money when they are little. Money does not grow on trees.

Start by giving your child an allowance when they are as young as six years old. Make it clear what kinds of expenditures the money is for. Some parents link allowance money to household chores. The disadvantage of this strategy is that kids get the message that they should be paid to help out. I think it’s better if kids are taught to pitch in simply because they are members of the family, not because they are paid. No one pays Mom or Dad to make dinner. You explain that you are giving your kids an allowance so that they can learn about money. Period.

#2 Almost all success in life comes from hard work, persistence, and practice.

Talk to your kids about what you do at your job, and take them with you to work if you can so they really get the picture. Tell them about the jobs you did as you were growing up and what you were paid. Teach them about how the people that work hard, get to work on time, are responsible and thorough, tend to get promotions and pay raises. Make sure they know that there is no job that is all fun, but that satisfaction and more choices come from working hard and being financially independent.

#3 Teach your kids how to save money and the pleasure in delayed gratification.

Money gives people, young and old, more choices and greater opportunities. Educating, motivating, and empowering children to become regular savers and investors will enable them to keep more of the money they earn and do more with the money they spend.The best way to encourage sound spending habits is to exhibit them. Make a special trip to go to the bank and open up a savings account with your child. You can also pay interest on money your child saves at home and show them how money grows.

#4 Teach your kids the difference between needs and wants.

Even young kids can understand the difference between the things we need such as food, shelter, or basic clothing and the things we want, such as toys, games, brand new designer clothing, vacations, or eating out. When planning a trip to the grocery store, get your children involved in making a shopping list and sticking to it. This will teach them to avoid impulse buying. If there is something special they want (not need), allow them to use their allowance money.

#5 Teach your kids about having a budget so they begin to understand how much things cost.

Going to the grocery store is often a child’s first spending experience. SInce most families spend about a third of their take-home pay on grocery and household items, teaching kids about costs and comparative shopping is essential. Have your kids cut out coupons, compare prices for the same item, and learn about buying items on sale. Allow an older child to help you plan economical meals, avoid waste, and use leftovers efficiently. Talk around the dinner table about pros and cons before buying a big item. Encourage them to use common sense, and show them how to do research on-line before making major purchases.

#6 Teach your kids about charity and the gift of giving back.

Did you know that lower income families give a higher percentage of their earnings to charity than higher income earners? Perhaps because these families really understand the difference between needs and wants. Just as kids can easily learn to save one tenth or more of their allowance, they can be taught from early on the importance of giving to others. Exposing kids to others less fortunate builds numerous strengths–compassion, empathy, and awareness to name a few–and it shows them one more thing that money can buy–life-saving help for others. In an era where far too many parents complain about their kids sense of entitlement, these are important lessons to start teaching early.

What do YOU do when you are trying to get your way? You may be lobbying to go to a certain restaurant that your husband hates. You may be wanting to spend money on something your wife thinks is unnecessary. You may be trying to get your kids to change into clean clothes before your company arrives.

Most of us use different approaches depending on who we are dealing with (friend or telemarketer), what we learned from our role models, and what we imagine might be effective.Think about how you might go about trying to get your way when the person you are trying to convince is resistant–and also happens to be your mate.

Less than two per cent of married couples proudly report never having had a disagreement. The rest of us mere mortals don’t know how that is even possible. Since conflict is an inevitable part of our romantic relationships, it is clearly something important to be smart about. What are the most effective ways to have influence over someone else? (Even though all the self-help books tell us that the only person we can change is ourselves, not surprisingly we are constantly trying to change our partner in little to big ways).

Various Methods of Influencing People: The Good and the Not So Good Ways

Here are the most commonly observed approaches. Most of us have probably tried our hand at all of them. Although I describe them as “strategies,” I don’t mean to imply that the person using each tactic has always made a conscious and deliberate choice to try to get their partner to change via this method. Often we simply fall into the habit of communicating in certain ways–even when they don’t serve us or our relationship.

#1: Compliance-based or the “If you do what I want, I will make your life so much better” strategy

This is an approach where one person tries to get the other to do what is desired by offering positive rewards or incentives to get the other to comply. It can be effective, especially in inducing short-term behavior change. Examples would be “If you make the dinner, I’ll do the dishes,”  or “If you come to bed early tonight, we can snuggle.” This approach backfires if it feels like bribery or is perceived as manipulative and controlling such as in “If you lose twenty pounds, I’ll get you a new wardrobe.”

 #2: Coercion-based or the “You better do it, or else!” strategy

In this more openly aggressive approach, the person wanting to change the other uses any or all forms of threat to try to get compliance.  This might include the use of punishment, criticizing, ridiculing or minimizing the partner’s point of view, or simply using anger, pouting or silence to try to get the other to submit. Examples would be, “You’ll be sorry if you don’t apologize,” or “All your friends think you are nuts when you do that.”

#3: Rational-based or the “Let me tell you all the reasons I am right and you are not” strategy

This method of influence uses logic and reasoning to try to win your partner over. Your husband tries to explain how if you let the baby cry, she will not be spoiled, or your wife lists all the health benefits of  your joining the gym. Of course, what one person finds reasonable is not always universal. This tactic can also come across judgmental and condescending.

#4: Relationship-based or the “You should do this for the good of the relationship” strategy

In this approach, you try to elicit change by putting the conflict or desired behavior change into the context of harmony, explaining why the desired response is appropriate given the value both partners place on the relationship. Since in a close relationship, both partners want to please each other, simply mentioning the relationship and emphasizing its importance is a good  reason to consider the change being requested. In this strategy, you couch your request as “normally expected” or “ideal” for the strength of the relationship itself rather than for your personal desires alone.

What does research tell us about what works best?

Clever researchers from Texas A & M, published in the Journal of Experimental Social Psychology, observed the naturally occurring strategies used by couples trying to resolve a problem in their relationship, and to see which strategy would be most effective. To do so, they videotaped 123 couples discussing an issue that had been a recent source of disagreement, one in which one or both partners desired change, typically because they disapproved of the other partner’s offending opinions or behaviors.Here’s what they found.

The only effective strategy was #4,  the relationship focused one. Greater use of logic and reasoning was not necessarily conducive to change, and greater use of coercion was counterproductive, leading people to move farther away from compromise or agreement. For those of you interested in effective marketing, Robert Cialdini, best-selling author of Influence, discusses the application of these findings to the business world as well.

The other interesting finding was that the more one person used any of the strategies above, the more their partner used that same strategy in return. In addition, the more one person began to change opinions or positions, the more the partner changed as well. This mirroring was equally true when one person took a negative, polarizing stance. Even in a ten minute discussion, this dance was readily apparent. So next time you are having a disagreement with your beloved, ask yourself the question, “Do I want to be close or do I want to be right?” You are looking into a mirror either way.

Mr. and Mrs. Harrison called to request family therapy after their 13-year old son called Child Protective Services. When a social worker arrived at their home on a quiet suburban street, Mrs. H was horrified and embarrassed. What Billy called abuse was his parents’ seizing of his Xbox after they caught him playing at 1 a.m. on a school night. When he refused to hand it over voluntarily, his father grabbed the machine and threatened to throw it out the window. 

What Ever Happened to My Sweet Child?

Although power struggles between children and parents are a normal and predictable part of social and emotional development, they typically escalate when children start to grow into teenagers. The strength of some teens’ emotional reactions blow their parents away. Just as power surges occasionally knock out your home’s electricity, creating at least temporary havoc, so can these emotional outbursts bring normal life to a sudden halt.

The sudden intensity of power struggles often come as a shock to parents raising their first teenager. Sometimes the first kid glides through adolescence with very little drama but the second-born makes the challenge. Emotions escalate and often cruel words are spoken on both sides. Kids accuse parents of being mean, unfair, crazy, out of touch…parents call their kids selfish, disrespectful, lazy and disobedient. Is there any way to avoid the pain, the guilt, and the worry of this stage of development?

The Unpredictable Effects of Hormones

Unfortunately, the answer is yes and no. Some of the reason that power struggles can escalate to new levels has to do with the biology of adolescence itself. As boys (starting anywhere between 9 and 15) and girls (starting anywhere between 7 and 13) move into and through puberty, they have their own internal surges to contend with–namely the flood of hormones necessary to ensure normal development. Because of hormones, your son or daughter will have stronger emotions than ever before, feeling overly sensitive, highly anxious or becoming easily upset.

Although it can be difficult for everyone involved to deal with all of these new emotions, it is helpful for parents especially to remember it is the “puberty brain” trying to adjust. Your kids are typically not trying to hurt you on purpose, and it is just as confusing for them as for you. This means that your son may not even realize why he is arguing about an issue this week that didn’t bother him last week.

Rapid mood changes are part of the process which can add further confusion, because sometimes the angry, rebellious 14 year-old becomes a vulnerable and needy 9 year-old again. In one moment, your kid can’t stand you, and in the next, she wants you to tuck her in bed. Parents don’t know when it’s OK to be close and when they’re not wanted.

Why Don’t We Agree Anymore?

Once again, there’s good news and bad news. Young kids are very black and white in their thinking. As critical thinking skills begin to develop during puberty, kids are now able to think in gray areas. With this increase in thinking complexity comes a lot more questioning of authority. Whereas a six year-old may well do something because you asked them to, a twelve year-old will want to know why and will argue with you. Power struggles often start when parents continue to expect compliance without conversation, compromise, and even argument.

Most parents are terrified their kids will give into peer pressure and begin using drugs and alcohol, become sexually active too soon, or will stop caring about school. One of the important ways that kids learn to develop strong values is by talking about them–yes, arguing even–with their parents. If your teen trusts and cares about you, he or she will question your beliefs about politics, religion, rules, and values. Parents want to encourage this dialogue which means learning to listen–even when your teen is emotional or passionate in their tone of presentation. Learn to ask probing questions. Avoid the temptation to talk down to your teens. Any whiff of condescension will only infuriate them.

Are Teens Wired the Same: Enter Neuroscience

The capacity to reason and to make good (typically less risky) decisions comes from the frontal lobes of the brain. Although teens might well reach their full height and weight by 16, we now know that the prefrontal cortex is not fully wired up until long past adolescence, around the age of 25. Nature designed the brains of teens to be highly responsive to everything in their environment which, on the positive side, promotes curiosity and learning. On the down side, teens often lack the insight to see the long-range implications of the choices they are making.

A Few Helpful Reminders for Your Parental Survival Kit

1. Expect power surges when your kid is in puberty.

2. Don’t take it personally. There’s a whole lot of biological changing going on.

3. Set clear rules and boundaries with appropriate consequences when calm and unemotional.

4. Agree to disagree with each other but practice listening so that you stay connected and communicating.

5. Check out the 10 Keys to a happy, loving family and take the test with your teen.

“Everything is a battle and we can’t stand it any more.”  These are the first words spoken by Sylvia, mother of two, and her husband quickly agreed. “We can’t get the kids to school on time, get them to turn off their electronic devices, do their homework, or go to bed without resistance and stalling. Can you help us?”

If this sounds like your house, there is light at the end of the tunnel. And the answer does not have to involve spanking, shouting, nagging, criticizing or coercing. Although power struggles between parents and their children are exceedingly normal–especially in adolescence–they should not be the norm of everyday life. What’s a parent to do and why do we get into power struggles in the first place?

A crucial component in the development of a healthy personality is gaining a sense of autonomy.

Starting around the age of two, children demonstrate their desire for increased independence by discovering the power of the word “NO!” and “mine”. Toddlers have a strong desire to figure things out for themselves, and when they succeed, they gain a sense of self-confidence and self-control. This stage has come to be known as “the terrible twos” because it can take parents by surprise when their sweet baby begins to have a mind of her own. In truth, it would be terrible if this stage didn’t happen.

Power struggles stem from a natural urge in children to have control over their choices.

Too many parents interpret their child’s resistance as defiance or lack of respect for authority. This sounds pretty bad, doesn’t it? In fact, when a parent thinks about resistant behavior in this way, it makes it far more likely that the parent will react to the kid’s non-compliance with an overly intense emotional response such as increased annoyance and anger. When setting limits with kids, the less emotional the better. By asserting himself, your child is building a stronger, more separate self. Kids need to learn to be independent by practicing how to stand up for themselves. If you have a healthy bond with your child, she will feel safe enough to test these behaviors with you.

Although conflict is inevitable, parents should still be in charge.

Even though children grow and learn by pushing back against the demands of their parents, it is essential that parents learn how to make reasonable demands, set appropriate limits, and teach their children the tools of social and emotional intelligence. Some parents–often those raised in overly controlling, authoritarian, or abusive families–are so upset by any conflict that they allow the children too much power. Like the family described above and thousands like them, this “solution” leads to disaster. Although children need to learn how to assert themselves, parents lacking sufficient authority create kids with too much entitlement. The world does not grant anyone unlimited freedom.

Ways to Avoid Ongoing Power Struggles

Tip #1: Catch your child being good.

All children–and adults–want to be seen, loved and appreciated. If parents are too busy or distracted to notice positive behaviors in their kids, the kids will quickly learn that negative attention is better than no attention at all. It is far more effective to reinforce the positive before your child starts to act out. This can be done by thanking him for getting in the car on time or for clearing her plate from the table rather than complaining about misbehaviors. Children want to know what their parents value and, typically, want to please them more than upset them.

Tip #2: Set clear limits and make requests of the behaviors you desire rather than telling them what not to do.

Instead of constantly using “don’t” commands (“Don’t bring your cell phone to the table,” or “Don’t interrupt when I’m talking.”), try phrasing your demands in a positive way,  clearly stating the desired behavior. (“Please leave your cell phone in your room before dinner,” or “I want you to listen to me and then I am happy to listen to you.”) Limits that are clear, positive, and consistently enforced become appropriate guidelines for children’s behavior. Too few or too many limits create fear, anxiety, or anger.

Tip #3: Give your child choices whenever possible as well as appropriate ways to assert their autonomy.

When parents are constantly telling the child what to do and what not to do, power struggles are the likely result. Given how many things we demand of our kids because of health and safety (bedtimes, homework, healthy meals, schedules, etc.), it is crucial to figure out what aspects of life they can assert control over. Do you let your child dress themselves (even if you don’t think the clothes match), choose books to read, participate in meal choices, determine what chores they would like to do, or spend their allowance as they choose? It is wiser to focus on the major issues and to let go of the minor ones.

Tip #4: Practice the art of detachment.

Many battles can be avoided by saying nothing and walking away. Remember the old advice about counting to ten when you can tell that you are about to blow your top. It can be far more powerful to say no once and if your child gets upset or throws a tantrum, say nothing and walk out of the room. If trapped in the car, turn on the radio. If your child is old enough to be left alone, talk a walk or a hot bath. By timing yourself out, you also are modeling a great tool for your kids. Take a few deep breaths, and tell them you will talk to them later.

Tip #5: Take good care of yourself and get the social support that you need from your partner, friends, and other parents.

Parenting is the hardest job there is. It is 24/7, 7 days a week, 365 days of the year. With no sick pay or vacation time, it is easy for the best of parents to get burned out. Make sure you get small breaks daily, a night away weekly if possible, and some adults-only vacation times. To be loving and effective parents, we need to strive for balance in our lives. Although it may feel like there are never enough hours in the day, make the time. You are worth it–and your kids will feel the difference.