Uncategorized

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The art of dealing with misbehaving children

KatieBy Katie Parker, Clinical Training Coordinator, Therapist New Oakland

There’s been a lot of controversy in America lately about how authority enforcement personnel treat the people they’re paid to protect. In many nationally publicized situations, the police have come under intense scrutiny for a number of alarming incidents that resulted in the death of unarmed citizens.

  • An officer killed teenager like Michael Brown in Ferguson, Missouri
  • A group of New York City police encircled Eric Garner who was taken down and choked to death
  • Freddie Gray died from injuries incurred in a police van in Baltimore

New Oakland doesn’t deal with cases like those, but on a daily basis we have any number of incidents where young people with illnesses and disabilities act out aggressively, and we are ethically, morally and legally required to deescalate situations safely, without harm inflicted.

Whether it’s the police or mental health providers, the rules of engagement are made clear in the extensive training we undergo, and when authority figures are either improperly trained or fail to act inappropriately, the consequences can be severe.

A case in a Frankfort, Kentucky, elementary school had some of us at New Oakland aghast. An 8-year-old boy and a 9-year-old girl, both weighing misbehaveabout 55 pounds, were put in handcuffs by a “school resource officer.” Both children had been disruptive and both had been diagnosed with ADHD (attention deficit hyperactivity disorder), a behavioral disorder which includes “hyperactivity, impulsivity and difficulty paying attention.”

Kentucky state regulations ban school officials from physically restraining students.”Shackling children is not okay. It is traumatizing, and in this case it is also illegal,” Susan Mizner, disability counsel for the ACLU, said in a news release. A resulting lawsuit says that the experience caused “a severe mental health crisis” and the resource officer called for a “medical crisis team.” The girl was taken by ambulance to a hospital for a psychiatric assessment and treatment.

New Oakland complies with CPI, the Crisis Prevention Institute, which advocates non-violent crisis intervention. Each child in our care has an individualized education plan, and in over 99% of the situations that occur with us we never touch a child. For those with autism, even simple body contact can be traumatizing and lead to out-of-control escalation.

New Oakland uses the teachings of the Crisis Prevention Institute, CPI, which uses a team approach as a last resort when a situation requires physical intervention with a focus on CARE, WELFARE, SAFETY and SECURITY. However, most of the situations that occur can be de-escalated with verbal interventions and never require violent crisis intervention.  For those with autism, even simple body contact can be traumatizing and exacerbate the problem.

The key to CPI training is to recognize and respond to behavior levels before they escalate to crisis. We are skilled in identifying when a child is starting to have a problem. Early and effective verbal intervention can help defuse a situation and avoid a crisis all together.

We offer choices and set limits. We’re careful to never make unenforceable threats and ultimatums, such as, “You better behave or else!” To translate to a school setting we may say, “You can stay here and do your work or you can sit with me in the principal’s office.” The child may not have control of his symptoms, but can make choices.  We offer simple, clear options that we must be able to enforce. We use a calm and non-threatening tone. No matter how frustrated we may feel, we can’t get in a child’s face. If we escalate, the child escalates.

What’s true in all walks of life is that how you say things oftentimes carries more weight than what you actually say. Non-verbal behavior, such as how close you stand can be very important. Personal space can communicate respect and caring. That’s why kinesics, also known as body language, is so important. Our gestures and facial expressions, like rolling our eyes, putting our hands on our hips or shaking a finger must be avoided. That’s ego and power struggle. We ignore insults and do not take anger personally recognizing that the acting out individual is symptomatic.

Police work and the work of those in the mental health field can be extremely pressure-filled and challenging. The best professionals stay calm under pressure and pride themselves on performing the proper techniques without panicking. That serves two purposes: doing what’s best for those you are serving and feeling pride in doing one’s job effectively despite the circumstances we may face.

Abusing the brain: The dark side of America’s favorite game

FCBK 1By Eli Zaret, New Oakland Community Liaison

Football is as American as apple pie. We invented it; we’re the only ones who play it and we spend hundreds of millions of hours watching it each fall. From Pee Wee league to the NFL, football is a national passion that creates tens of billions in revenue each year and is built into the fabric of our lives.

What we would love to wish away, but can’t, is its systematic the destruction of the human body – particularly the brain, that, btain3
quite tragically, is as much a part of the game as is its many skill elements. The brain is a soft organ surrounded by spinal fluid and protected by a hard skull. The fluid acts like a cushion to keep your brain from banging into your skull. But when your head is hit hard, even with a helmet on, the brain can crash into the skull and cause a concussion.

I’ve stood on the sidelines during NFL games, and the speed and impact of the collisions has to be seen and heard up close to be fully appreciated. These men are flying weapons, and no amount of protection can spare their bodies and brains from being continually rattled and potentially destroyed.  And until the last few years, due to ignorance and the macho nature of the game, players were sent back into action after incurring a concussion putting them at even greater risk of suffering permanent brain damage.

On July 6, a federal judge approved a settlement reached between the NFL and more than 4,500 of its former players, many of whom say their brains were completely or partially demolished as a result of playing football. The league had initially agreed to $765 million in damages. The judge lifted that cap. It simply isn’t enough.

New Oakland is all about conditions of the brain and its chemistry. Mental illness is pervasive – 1 in 4 Americans have a diagnosable disorder and most can be treated successfully with therapy and medication. But CTE, chronic traumatic encephalopathy, is degenerative and irreversible, and is only preventable by not allowing the brain to suffer multiple high-impact collisions. Besides memory loss, confusion, anxiety and impaired judgment, it causes impulse control problems, aggression, depression, suicidal tendencies, Parkinsonism and progressive dementia. That’s why many former NFL players are taking their own lives rather than live with the pain and deterioration of their brains.

Certain CTE cases in particular have rocked the NFL establishment and made the public acutely aware:

  • 2011: Chicago Bear defensive back Dave Duerson shot himself in the heart at 50. He left a note saying “Please, see that my brain is given to the N.F.L.’s brain bank.” His autopsy showed severe CTE and Duerson became the first highly publicized case to bring the crisis to light.
  • 2012: San Diego Charger linebacker Junior Seau, 43, put a shotgun to his chest and pulled the trigger, so as to preserve his brain for postmortem research. His autopsy also showed severe CTE
  • 2015: Denver defensive back Champ Bailey called for theretirement of former teammate Wes Welker who suffered untold concussions including three during a nine-month stretch in 2013. It shows how deeply the crisis has penetrated the bubble within which football players formerly existed.

seauThe latest controversy is that when Seau is to be inducted at the upcoming NFL Hall of Fame ceremony on August 6th, his family will not be allowed to speak on his behalf. Seau, who had severe CTE, had wanted his daughter Sydney to induct him. His family had filed a wrongful death suit against the NFL in 2013. The league doesn’t want any of it being brought up at a celebration.

With the NFL’s CTE crisis becoming so well publicized, President Obama made headlines a few years back saying that he wouldn’t want his son playing football. Who can blame him? And it isn’t only football under attack. Even girls’ youth soccer has concussion issues from collisions and using the head to advance the ball.

Though the NFL has been seriously faulted for denying and covering up the concussion controversy for many years, the fact remains that technology has been unable to create a concussion proof helmet. The players are simply too big, fast and strong. There is no solution other than to avoid playing altogether.

On the first day of football practice back in high school, our coach was lecturing the players on team rules. When it came to cigarette smoking he became particularly impassioned, saying, “If God meant us to smoke he would have given us a chimney.” I remember thinking that that was a pretty clever line. Then my friend Bruce Cook, a wide receiver raised his hand and said, “And if he meant us to play football, he would have given us a helmet.”

We tried to hold back from laughing and, needless to say, the coach didn’t appreciate the wisecrack. But I’ve thought back often about how omniscient my old pal really was. What was a joke back then has now become the harshest of realities.

 

 

 

 

 

 

 

 

 

Oh, to be a teenager again? No thanks!

By Eli Zaret, New Oakland Community Liaison

My least favorite years were from about 14-17. I’ve never felt more clueless and less “cool.” I had a simmering sense of social awkwardness and often teenfelt overwhelmed and fearful, like the world was moving ahead without me and I couldn’t get in step. My carefree elementary school life was long gone and pressure to fit in was troubling. In later years, I explained it away as stemming from the standard social and emotional challenges of teenage angst:

  • Starting to separate from my parents
  • Finding a peer group that met my needs
  • Dealing with girls and desire
  • Figuring out who I really was

According to Richard A. Friedman, a professor of clinical psychiatry at Cornell University, new research adds another critical level of understanding to explain teenage fear and anxiety. It seems that several regions and circuits of the brain mature at very different rates.

“There is a darker side to adolescence,” Friedman writes, “that, until now, was poorly understood: a surge during teenage years in anxiety and
fearfulness. Largely because of a quirk of brain development, adolescents, on average, experience more anxiety and fear and have a harder time learning how not to be afraid than either children or adults.”

He explains that the brain circuit for processing fear — the amygdala — develops way ahead of the prefrontal cortex, the seat of reasoning and
executive control. This means that adolescents have a brain that is wired with an enhanced capacity for fear and anxiety, but is relatively underdeveloped when it comes to calm reasoning.

angst1The fear circuit is a two-way street. While we have limited control over the fear alarm from our amygdala, our prefrontal cortex can effectively exert top-down control, giving us the ability to more accurately assess the risk in our environment. Because the prefrontal cortex is one of the last brain regions to mature, adolescents have far less ability to modulate emotions than younger children and adults.

So maybe that explains why I’d muster the courage to call a girl to ask her out — and then gutlessly hope she wouldn’t answer the phone. I felt like such a loser. If I’d only known it was all about my irregularly developing brain chemistry. But — oh no – there’s more!

Even though adolescents are so prone to anxiety, they’re also risk takers and novelty seekers. Outwardly, that seems counter-intuitive. With all the fear and anxiety coursing through their minds, you’d logically think that they’d be risk averse – that they wouldn’t skateboard down concrete stair railings or do flips off motocross bikes.

Unfortunately, the brain’s reward center, just like its fear circuit, matures earlier than the prefrontal cortex. And the reward center drives much of teenagers’ risky behavior. This behavioral paradox also helps explain why adolescents are particularly prone to injury and trauma. The top three killers of teenagers are accidents, homicide and suicide.

New Oakland’s 170 therapists and psychiatrists have long realized that that’s why cognitive behavior therapy, which is basically designed to reason away bad or irrational behavior, doesn’t work very well with anxiety ridden teenagers whose brain wiring has yet to mature.

Friedman notes that many of the adults that he’s treated with various anxiety disorders, most often trace the origin of the problem to their teenage years. They typically report an uneventful childhood rudely interrupted by adolescent anxiety. For many, the anxiety was inexplicable and came out of nowhere.

My fear and anxiety seemed to come into better balance once I got to college. I still experienced anxiety – we all do – but I better understood its source and was able to deal with it.

So if you’ve got a teenager that is uptight, anxious and fearful – while also engaging in risky, counter-productive behaviors, it should all make a little more sense.

But if your child’s fear and anxiety is extreme, it may not go away when he or she reaches adulthood. New Oakland specializes in child and adolescent psychology. Feel free to call and talk to one of our therapists. We get it – and we’ll get your teen back on track.