Children with attention deficit disorder - ADHD/ADD may be difficult to parent. They may have trouble understanding important directions. Children with attention deficit hyperactivity disorder - ADHD/ADD are usually in a constant state of activity. This can be a challenge to adults. You may need to change your home life a bit to help your child. Here are some things you can do to help:

Organize your schedule at home. Set up specific times for waking up, eating, playing, doing homework, doing chores, watching TV or playing video games and going to bed. Write the schedule on a backboard or a piece of paper and hang it where your child will always see it. If your child can't read yet, use drawings or symbols to show the activities of each day. Explain any changes in routine in advance. Make sure your child understands the changes.

Set up house rules. Make the rules of behavior for the family simple, clear and short. Rules should be explained clearly. It's important to explain what will happen when the rules are obeyed and when they are broken. Write down the rules and results of not following them. Hang this list next to the schedule. The punishment for breaking rules should be fair, quick and consistent.

Be positive. Tell your child what you want rather than what you don't want. Reward your child regularly for any good behavior--even little things such as getting dressed and closing doors quietly. Children with ADHD often spend most of their day being told what they are doing wrong. They need to be praised for good behavior.

Make sure your directions are understood. First, get your child's attention. Look directly into his or her eyes. Then tell your child in a clear, calm voice specifically just what you want. Ask your child to repeat the directions back to you. It's usually better to keep directions simple and short. For difficult tasks, give only one or two directions at a time. Then congratulate your child when he or she completes each step.

Be consistent. Only promise what you will deliver. Do what you say you are going to do. Repeating directions and requests many times doesn't work well. When your child breaks the rules, warn only once in a quiet voice. If the warning does not work, follow through with the punishment that you promised. (Avoid physical punishment. This often makes matters worse).

Make sure someone watches your child all the time. Because they are impulsive, children with ADHD need more adult supervision than other children their age. Make sure your child is supervised by adults all day.

Watch your child around his friends. It's hard for children with ADHD to learn social skills and social rules. Be careful to select playmates for your child with similar language and physical skills. Invite only one or two friends at a time at first. Watch them closely while they play. Reward good play behaviors often. Most of all, don't allow hitting, pushing and yelling in your house or yard.

Help with school activities. School mornings may be difficult for children with ADHD. Get ready the night before--lay out school clothes and get the book bag ready. Allow enough time for your child to get dressed and eat a good breakfast. If your child is really slow in the mornings, it's important to make enough time to dress and eat.

Set up homework routine. Pick a regular place for doing homework. This place should be away from distractions such as other people, television and video games. Break homework time into small parts and have breaks. For example, give your child a snack after school, let him play for a few minutes, then start homework time. Stop frequently for short "fun breaks" that allow your child to do something enjoyable. Give your child lots of encouragement, but let your child do the school work.

Focus on effort, not grades. Reward your child when he tries to finish school work, not just for good grades. You can give extra rewards for earning better grades.

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A study about employers' views on employment restrictions for young people with four medical conditions -asthma, epilepsy, attention deficit hyperactivity disorder (ADHD), and insulin dependent diabetes mellitus.

B J Bateman, F Finlay

Arch Dis Child 2002;87:291-292

The purpose of this study was to gain employers' views on employment restrictions for young people with four medical conditions - asthma, epilepsy, attention deficit hyperactivity disorder (ADHD), and insulin dependent diabetes mellitus (IDDM).

METHODS

A questionnaire was sent to Directors of Occupational Health and Personnel of 15 national companies and recruitment offices of the Royal Navy, RAF, Army, and the police. Respondents were asked for details of policies for applicants with asthma, epilepsy,ADHD, and IDDM and potentially unsuitable jobs.

RESULTS

Response rate was 75%. Specific conditions will be considered separately.

Asthma

The Armed Forces had clear policies-asthma is generally incompatible with service requirements. Exceptions may be considered for those: (a) who have been asymptomatic during the previous four years; and (b) whose earlier symptoms did not require long term/maintenance therapy with theophyllines, nebulisers, or steroids, unless associated with a proven chest infection.

Only two companies had policies. Free text comments included: "our policy originally excluded asthmatics from soldering, but now asthmatics are not 'screened out' as proper extraction systems are in place"; "isocyanate spraying jobs are unsuitable".

Epilepsy

The Armed Forces have clear guidelines-those with epilepsy or those who have had more than one seizure after the age of 5 are unfit for enlistment. Those who have had a single seizure more than four years before entry, and are off treatment, may gain entry to a restricted number of trades, provided that there is no evidence of predisposition to epilepsy. Those who had febrile convulsions at less than 5 years of age, without subsequent seizures, may be enlisted in all trades.

Four companies had specific policies. Comments included: "certain jobs are excluded by law or 'common sense', e.g. heavy goods vehicle driver, work involving fast moving unguarded machinery"; "for jobs involving 'safety critical' work the risk of fits would have to be very low".

ADHD

The Armed Forces stated that candidates with hyperactivity, uncomplicated by violence or criminality, absent for more than two years without treatment, may be fit for enlistment.
Respondents from the police forces were unaware of candidates declaring ADHD, but stated that "psychiatric/ developmental history is important in considering police recruits".
Although no company had an ADHD policy, several made comments: "I'm not sure how many would declare this"; "employment may depend on medication side effects".

IDDM

Individuals with IDDM are excluded from the Armed Forces and police. Only two companies had policies. Comments included: "some jobs are precluded by law, e.g. pilot, HGV driver, all other cases will be considered on their merits"; "consideration would be given to difficulties arising out of unsociable working".

DISCUSSION

Some medical conditions restrict employment choices; early advice may help career planning. (1) This is the rationale behind colour vision screening, but even this may not be done adequately. One respondent said: "one common preemployment problem is colour blindness; in severe cases certain jobs are unsafe, e.g. electrician, or inappropriate, e.g. accurate colour matching-sadly a significant number are not advised that their choice of career may be restricted, so it may be a severe blow to be rejected".

Companies varied in their individual policies. Many referred to the Disability Discrimination Act (DDA) (2): "the Disability Discrimination Act makes it legally necessary to consider all candidates, bearing in mind that most can be accommodated by making reasonable adjustment to the job". Exceptions quoted were asthmatics working with chemicals, or those with epilepsy working at heights.

Many respondents referred to the DVLA guidelines in relation to driving or jobs working with machinery. (3) These guidelines produced for medical practitioners are sent to all doctors except paediatricians; they are not thought to need this information. Many paediatricians are unaware of regulations regarding group 2 vehicle licences-those with IDDM are excluded as are those with epilepsy until fit free for more than 10 years off treatment.

The Armed Forces have strict guidance for enlistment. (4) Recruits must be fit to serve anywhere in the world, in all environments where medical care and drug supply may be limited. Their physicians encourage interested young people to personally contact them when making career decisions. The police distinguish between employment of officers and support staff. There was variation between forces in policies. One excluded candidates using any inhalers, while others specified only steroid inhalers.

Respondents appeared currently unaware of potential employees declaring ADHD; as this condition is diagnosed more frequently, inevitably it will need to be addressed. Approximately half of the young people diagnosed with ADHD will continue to have significant problems with concentration, impulsivity, and social interaction which may lead to work difficulties. (5) There appears to be little guidance- ADHD is not indexed in the Royal College of Physicians, Faculty of Occupational Medicine textbook. (6)

As this study was in progress, "Connexions" was launched. This national government funded service (for 13-19 year olds) aims to identify barriers to progress in education and employment. Connexions personal advisors can make contact with employers who have specific enquiries, acting as advocates for young people.

Conclusion

The DDA2 has made most civilian jobs accessible, but there remain significant restrictions in the Armed Forces and police. Paediatricians need training to fulfil two potential roles: as advocates nationally, lobbying to ensure that restrictions are based on evidence; and secondly to actively discuss career decisions with our patients. "Connexions" may be useful for this second role.

Authors' affiliations
B J Bateman, F Finlay, Bath & North East Somerset Primary Care Trust, UK
Correpondence to: Dr B J Bateman, Child Health Department, Bath NHS House, Bath BA1 3QE, UK;
Accepted 8 May 2002

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REFERENCES

1 Hall DMB. Health for all children, 3rd edn. Oxford: Oxford Unversity Press, 1996.
2 Disability Discrimination Act 1995 (c. 50). London: The Stationery Office, 1995.
3 Drivers Medical Group. "At a glance". Guide to the current medical standards of fitness to drive. Swansea: DVLA, 2002.
4 Finnegan TP. Fifty years of PULHHEEMS-the British Army's system of medical classification. Ann Acad Med2001;30:556-7.
5 Hechtman L. Predictors of outcome in children with ADHD. Pediatr Clin North Am1999;46:1039-53.
6 Cox R, Edwards F, Palmer K. Fitness for work. Oxford: Oxford University Press, 2002.
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Thoughtful quotes about growing and aging.

Words of Wisdom

"Try to keep your soul young and quivering right up to old age, and to imagine right up to the brink of death that life is only beginning. I think that is the only way to keep adding to one's talent, to one's affections, and one's inner happiness." (George Sand)

"What a blessing it is to outlive your self-judgments and harvest your failures." (Rachel Naomi Remen)

"How old would you be, if you didn't know how old you was?" (Satchel Paige)

"To grow mature is to separate more distinctly, to connect more closely." (Hugo Von Hofmannsthal)

"Suffer the growing pains." (Liv Ullman)

"To grow up is to assume responsibility for the child within." (author unknown)

"Every human being on this earth is born with a tragedy, and it isn't original sin. He's born with the tragedy that he has to grow up. A lot of people don't have the courage to do it." (Helen Hayes)

"...for in every adult there lurks a child- an eternal child, something that is always becoming, is never completed, calls for unceasing care, attention, and education. That is the part of the human personality that wants to develop and become whole." (Carl Jung)

"You don't stop laughing because you grow old; you grow old because you stop laughing." (Michael Pritchard)

"The man who views the world at fifty the same way he did at twenty has wasted thirty years of his life." (Muhammad Ali)

"To grow old is to pass from passion to compassion." (Camus)

"He not busy being born is busy dying." (Bob Dylan)

"The years teach much which the days never know." (Waldo Emerson)

"Nothing is inherently and invincibly young except spirit. And spirit can enter a human being perhaps better in the quiet of old age and dwell there more undisturbed than in the turmoil of adventure." (George Santayana)

"Don't forget the lessons your mistakes have taught you or you'll learn them all over again." (Dan Folgelberg)

"To be seventy years young is sometimes far more cheerful and hopeful than to be forty years old." (Oliver Wendell Holmes Jr.)

"Do our experiences become more marvelous with age or is it just that we don't realize when they occur how really beautiful and precious they are?" (Joseph Cambell)

"Old age, to the unlearned, is winter; to the learned, it is harvest time."

"They saw a woman in a wheel chair taking quiet pleasure in her view. It was a mirage. She was really a young girl on tiptoes. Arms outstretched. Ready to run. Everything wonderful waited for Elizabeth Quigley." (Helen Van Slyke)

"The evening of life brings with it its own lamp." (Joseph Joubert)

next:Happiness

People share information on Passionflower, Pedi-Active for treating ADHD symptoms naturally, plus story on Pedi-Active A.D.D. manufacturer admitting to unsubstantiated ADHD claims.

Natural Alternatives for ADHD

Passionflower - Passiflora incarnata

The following is excerpted from the Health Search newspaper published by Wilson Publications, Owensboro, KY 42303

Popular since the Aztec civilization as a sedative, diaphoretic and analgesic, passionflower has numerous chemicals to beneficially influence the brain, nervous system and the circulation. Non-toxic, it is widely used in childhood nervous conditions.

As a sedative, passionflower is a preferred herb for treating insomnia; one wakes rested without a sedated feeling. As an antispasmodic it is helpful in Parkinson's disease, asthma especially with much spasmodic activity, seizures and hysteria.

Pedi-Active

Pedi-Active Nature's Plus website describes this as follows...

"Pedi-Active is a precisely calibrated formula designed for the active child. Each naturally sweetened, delicious chewable tablet supplies a complete profile of the most advanced neuronutrients available, including a diversified combination of phosphatidylserine, DMAE and activated soy phosphatides. Pedi-Active is a state-of-the art nutritional supplement that naturally complements an active child's delicate system. Choose the Pedi-Active tablets or the convenient Pedi-Active Liposomal Spray, and supplement either with the naturally delicious Pedi-Active Bar."

Nature's Plus - Visit their website for more information or to order and if anyone has tried it please let us know so that we can post something here.

Please note that Nature's Plus make the following statement on their web page "These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."

Mary writes...

"I muscle test my son to see what supplements he needs. He does call for Pedi-Active in spurts. He says it helps him concentrate and it does seem to help.

We will continue to use it.

Muscle testing is a form of kineseology that can be life saving. You test each vitamin by holding it close to your body and asking whether you need it or not. Your body will answer the questions you ask. It sounds really weird. But my son and I lived in a toxic house and were VERY ill. I was taught this method of testing vitamins and it pulled me off the death bed. THE most important technique I ever learned.

I live in USA. I think that everyone needs to learn this technique. I wrote down all the supplements that you had in alternative treatments and tested them on my son. Found out that he needs Nutri-kids School Aid, Gotu Kola and NAET.

Fortunately I know how to do NAET, so we will continue using it. So I am adding the Nutri-kids school Aid and Gotu Kola to his daily muscle testing vitamins. I test my own vitamins at least three times a day as I am still dealing with mercury toxicity. I want to thank you for you web page. I am on my way there next to find out where to get the Nutrikids.

Again, I can not tell you how important the muscle testing techniques is. I know several people who use it. There are a few methods of doing it."

Rhonda writes......

"Thanks for the opportunity to speak about Pedi-active. I have a 6 year old PDD-NOS child who has problems regulating his activity in school. Pedi-active is the only product that has given him any results. I have tried at least a dozen different products and have always come back to pedi-active."

Valerie writes......

"I am a strong advocate for pedi-active. Although I don't feel it is the cure all, it has definitely helped by taking the "edge" off things. My son is attention deficit inattentive type-without hyperactivity. I tried so many alternatives, many of which helped, but I could only take them so far (like neurofeedback). I was reluctant to try pediactive because I don't like medication (natural or chemical). I did some research which was difficult because info on this product is hard to come by, but I determined that the product was safe, so I tried it. My son used to have outbursts (screaming, punching walls, slamming doors, ete.). He doesn't have them when he is taking these vitamins. He takes 2 tablets twice a day. He loves them, and he says he feels better when he takes them. They are expensive-so when I run out, sometimes it takes a while before I can get him more. Two weeks is his limit before he falls back into old behaviors and starts with the outbursts. I also noticed that it takes a while for the vitamins to build up in his system and for the outbursts to subside. He was in a behavior management class, but is now mainstreamed. He still has a behavior chart, but does well as long as he's on the vitamins. Like I said, the vitamins alone are not a cure all. He has other supports to help him, but he's on no medication. I am considering increasing his dosage-trying the vitamins 3 times a day-to see if it makes a difference. It will be worth the money. I will let you know.

Valerie"

In addition to the above information you should also be aware of the following...

Wednesday August 16 2000, 5:19 pm Eastern Time FTC Charges Dietary Supplement Co.
By DAVID HO
Associated Press Writer
WASHINGTON (AP) -- The Federal Trade Commission charged a New York company Wednesday with making unsubstantiated claims that its dietary supplement can treat children with attention disorders.

Natural Organics Inc., of Melville, N.Y., advertises that its Pedi-Active A.D.D. supplement can alleviate symptoms of attention deficit hyperactivity disorder and improve the attention span of children who have difficulty focusing on schoolwork, the FTC said in a statement.

"ADHD is a serious condition, and parents who are concerned about it should talk to their children's doctors about appropriate treatment," said Jodie Bernstein, director of the FTC's Bureau of Consumer Protection. She asserted that the company's ads prey on parents seeking alternative treatments.

Physician-prescribed stimulants and behavior therapy are the most common treatment for ADHD, which affects up to 2.5 million school-age children in the United States.

Gerald Kessler, chief executive of Natural Organics, said his company had numerous scientific studies to support its advertising.

"We have asked the FTC to have their experts meet with our experts to determine the validity of studies. They have refused to allow this to happen," Kessler said. "We're going to fight this every step of the way."

The company, which does business as "Nature's Plus," markets and sells a variety of dietary supplements through independent retail stores. Sixty tablets of Pedi-Active A.D.D. sell for $12.56.

This is the FTC's fifth action involving products marketed to treat ADHD. While the commission's complaint begins a legal process seeking to stop future unsupported claims, it doesn't mean any laws have been broken.

Natural Organics stands its ground on FTC challenge
September 01, 2000

NEW YORK (Reuters Health) - A Melville, New York-based marketer of dietary supplements intends to fight Federal Trade Commission charges that the company made unsubstantiated claims about a product offered as an alternative for treating attention deficit hyperactivity disorder (ADHD).

Natural Organics Inc. said that the FTC's allegations involving its Pedia-Active A.D.D. tablets are false and that the company has begun a process of contesting the charges.

"I'm not going to back down. I hate bullies," CEO Gerald Kessler told Reuters Health in a candid interview, during which he promised to return all profits from the sale of the tablets to help children with attention deficit disorder (ADD).

The FTC last month charged Natural Organics and owner Kessler with falsely claiming that the company's Pedia-Active tablets would improve the attention span and scholastic record of children with ADHD and those who have difficulty focusing on school work.

Kessler said that Natural Organics' problems with the FTC began 3-1/2 years ago, when the commission claimed that the company's studies were insufficient. In fact, Kessler said that the company submitted some 200 studies, including 18 double-bind studies, which substantiate its claims for Pedia-Active.

"We're certainly not somebody who goes out and makes claims without verification," he said.

Thus far, Kessler charged, the FTC has failed to produce a single study to support the allegations and has refused to allow its scientists meet with the company's scientists to resolve the issue. "They kept trying to harass us into signing something and we said we're not going to do that," he fumed.

The FTC said that it is seeking to bar Natural Organics from making false claims about treating ADHD and from using the name "A.D.D." or any name that suggests its product can treat or mitigate ADHD.

In a statement issued last month, Jodie Bernstein, director of the FTC's Bureau of Consumer Protection, said that consumers are put in "a rough spot" when they can't trust the claims in the ads, particularly for "parents who are trying to do the best for their kids."

But Kessler, who speaks passionately, about natural alternatives to the prescription hyperactivity drug Ritalin, says he, too, is trying to right by parents. As a child, Kessler also experienced the symptoms commonly labeled as ADD or ADHD, a behavioral disorder estimated to affect some 2.5 million school-aged children in the US.

"I was hyperactive, let's put it that way," Kessler said. "They didn't call it ADD." That is one reason, he explained, that he founded the company 29 years ago.

Kessler spoke about the FTC challenge after being contacted for comment by Reuters Health. He said that the company had not received the commission's complaint until days after the FTC announced the charges to the press and that its communication with the company "has just been token."

Vowing to fight to the finish, Kessler questioned the FTC's motives. "If the agenda isn't to protect Ritalin and Ciba-Geigy and the drug industry, what is it?" he asked.

For Release: July 31, 2001
Natural Organics Settles FTC Charges That They Made Unsubstantiated ADHD Treatment Claims

Natural Organics, Inc., based in Melville, New York, and its president, Gerald Kessler, have agreed to settle Federal Trade Commission charges that they made unsubstantiated claims that their dietary supplement product -- Pedi-Active A.D.D -- would mitigate or effectively treat Attention Deficit/Hyperactivity Disorder (ADHD) or its symptoms. The FTC also had alleged that the respondents, in their advertisements, made claims that Pedi-Active A.D.D. would improve the attention span and scholastic performance of children who have difficulty focusing on school work. The proposed consent agreement to settle the charges would prohibit the respondents from making claims about the ability of Pedi-Active A.D.D. or any other food, drug or dietary supplement to treat not only ADHD in children, but also any childhood disease or mental disorder, unless they possess competent and reliable scientific evidence to support such claims.

ADHD is a behavioral disorder which affects up to 2.5 million school-aged children in the United States. ADHD's symptoms -- inattention and/or impulsiveness and hyperactivity -- are common in nearly all children at various times. However, in children with ADHD, the symptoms are chronic and age inappropriate. The disorder can severely affect a child's school performance, family relationships and social interactions.

In August 2000, the FTC issued an administrative complaint against Natural Organics, which does business as "Nature's Plus." Natural Organics markets Pedi-Active A.D.D., as well as several hundred other dietary supplement products. The company sold Pedi-Active A.D.D. through independent retail stores for approximately $14.00 for 60 tablets. The FTC's complaint alleged that Natural Organics represented through print ads, a brochure, an informational letter and on its Website that Pedi-Active A.D.D. would treat or mitigate ADHD or its symptoms, including inattention and poor scholastic performance, without having a reasonable basis to substantiate those claims.

The proposed consent agreement announced today would prohibit the respondents from claiming that Pedi-Active A.D.D., or any food, drug or dietary supplement, would improve the attention span of children, would improve the scholastic performance of children, or can treat or mitigate ADHD in children, unless they have reliable scientific evidence to substantiate those claims. In addition, the proposed settlement would require the respondents to possess and rely upon competent and reliable scientific evidence before claiming that any food, drug or dietary supplement marketed for children can treat or cure any disease or mental disorder.

The proposed agreement would also prohibit Natural Organics from using "A.D.D." or any other name that represents that Pedi-Active A.D.D. or any substantially similar product marketed to children can treat or mitigate ADHD, unless they have competent and reliable scientific evidence that the product is effective in treating or mitigating ADHD.

The consent agreement would allow the respondents to make representations for drugs or dietary supplements that are specifically permitted by the Food and Drug Administration.

The Commission vote to accept the proposed consent agreement and place it on the public record was 5-0. A summary of the proposed consent agreement will be published in the Federal Register shortly. The agreement will be subject to public comment for 30 days, until August 30, 2001, after which the Commission will decide whether to make it final. Comments should be addressed to the FTC, Office of the Secretary, 600 Pennsylvania Avenue, N.W., Washington, D.C. 20580.

Ed. Note: Please remember, we do not endorse any treatments and strongly advise you to check with your doctor before using, stopping or changing any treatment.

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More safety data on older antipsychotics make them first choice for use during pregnancy.

Women typically have been counseled to avoid using psychiatric medications during pregnancy because of known or unknown risks of prenatal exposure to these medications. But data suggest that pregnancy does not protect women from new onset or relapse of psychiatric disorders. This is particularly true for women who have disorders such as schizophrenia or bipolar illness, which is also now treated with antipsychotics, according to Dr. Lee Cohen, director of the perinatal psychiatry program at Massachusetts General Hospital, Boston. Therefore, women with schizophrenia who stop their antipsychotics are at a great risk for relapse, at which point they frequently pursue behaviors that can be harmful to them and their fetuses, he noted.

The newer atypical antipsychotics are becoming first-line treatment for many people with schizophrenia because they do not have some of the side effects of the older medications and they appear to result in better acute and long-term responses. They are also increasingly being used for a range of other psychiatric disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, anxiety disorders, and depression. But most of the available reproductive safety data come from literature on the typical antipsychotics and are several decades old, he pointed out. These data suggest that there is no increased risk of congenital malformations associated with first-trimester exposure to high-potency antipsychotics like haloperidol (Haldol) or midpotency antipsychotics like perphenazine (Trilafon).

There also appear to be no safety issues when these drugs are used in labor and delivery or postpartum, and there is literature suggesting that these agents are not problematic when used during lactation, said Dr. Cohen, also associate professor of psychiatry, Harvard Medical School, Boston. "Therefore in our clinic, it is our standard approach to continue treatment in patients who are dependent on a typical high-potency antipsychotic, such as haloperidol, fluphenazine hydrochloride (Prolixin, Permitil), or trifluoperazine (Stelazine), or a midpotency antipsychotic," he said in an interview. "We avoid using low-potency antipsychotics, such as chlorpromazine, because of side effects, such as hypotension, and a suggestion that they might be associated with a slightly increased risk for malformations."

There are only sparse data on the reproductive safety of the currently available newer compounds, clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). "So we typically suggest that pregnant women who require treatment with antipsychotics and are on an atypical agent should switch to one of the older drugs," he said. He and his associates also recommend that they not breast-feed while on an atypical agent until better safety data become available.

Some patients do not respond to treatment with typical antipsychotics but respond only to an atypical agent. "We have followed a small number of such patients who have stayed on the atypical antipsychotic drug during pregnancy and so far have not observed any unexpected problems," Dr. Cohen said. The manufacturer of olanzapine has developed a registry of fewer than 100 women exposed to this drug during pregnancy. To date, there's been no evidence of an increased risk for congenital malformations or other treatment-emergent difficulties, he said. Typical agents are increasingly being used for psychiatric disorders in women who may be more likely to bear children, such as those with anxiety or mood disorders, compared with those with schizophrenia. As a result, "we may be seeing more women on these drugs becoming pregnant, because they have less of an impact on fertility than the older drugs, which increase prolactin secretion," he pointed out. With the exception of risperidone, which causes relatively high rates of hyperprolactinemia, ziprasidone, quetiapine, olanzapine, and clozapine are prolactin-sparing compounds.

An option for a woman with bipolar disease who is taking an atypical antipsychotic is to switch her to lithium during pregnancy. "We know that the absolute risk of having a child with Ebstein's anomaly after first-trimester exposure is about 1 in 1,000 to 1 in 2,000," Dr. Cohen observed. "And since we basically know nothing about the reproductive safety of atypical antipsychotics, I would rather see a woman who has been on a drug like olanzapine (Zyprexa) or quetiapine (Seroquel) for bipolar disease switched to lithium during pregnancy since it has a known teratogenic potential," he said.

Source: This article originally appeared in ObGyn News.

Home Study

• Don't Panic,
  Chapter 3. Panic within Psychological Disorders

A person who suffers from generalized anxiety tends to worry about big and little issues and feels uncomfortable physical symptoms throughout most of the day.

This site will teach you ways to manage many of the symptoms of anxiety, including handling your worries, learning relaxation and breathing skills and the option of using medications. I will not, however, explore the issues in your life that might be causing or increasing your anxiety. Be careful not to simply treat the symptoms and neglect to address some of the stressors that might be influencing them. Talk to friend, family members, your minister or rabbi, or a trained mental health professional, if need be.

The most common worries are the small day-to-day concerns, like arriving on time or completing enough projects during the day. Other prominent concerns are health and illness, work or school performance, money and family.

The physical symptoms can include any of those on the chart below.

POSSIBLE PHYSICAL SYMPTOMS DURING ANXIETY

Cardiovascular System

• tachycardia (rapid heartbeat)
• palpitations (uncomfortable awareness of the heart rate)
• headaches
• cold fingers

Musculoskeletal System

• muscles tense
• involuntary trembling of the body
• tension headaches
• other aches and pains

Central Nervous System

• apprehensive, aroused and vigilant
• feeling "on edge," impatient, or irritable
• insomnia
• fatigue
• poor concentration

Genitourinary System

• need for frequent urination
• difficulty becoming sexually aroused or achieving orgasm (women)
• difficulty maintaining an erection

Gastrointestinal System

• dry mouth
• difficulty swallowing
• "butterflies" in the stomach
• the gurgling sounds of gas in the intestines
• colon spasms
• diarrhea and/or constipation
• cramp-like pains in the upper stomach

Respiratory System

• hyperventilation symptoms

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male sexual problems

Although doctors are able to give men their erections back, they and their partners may not regain full enjoyment of their sexual experience. I think the psychological side of impotence is frequently inadequately addressed.

I realize that although in many cases there is a clear physical reason for a man's erection problem, their psychological reactions to these male sexual problems often compound them.

Through the months or years of difficulty achieving or maintaining your erection, you probably have developed a series of negative emotional reactions associated with the sexual experience.

1. Tension, anxiety - developed through the frustration and disappointment of not experiencing a completely satisfying sexual experience.

2. Worry about failure - thoughts focused on the possibility of things not going well: not maintaining your erection, not ejaculating, not pleasing your partner.

3. Rushing - for guys who could get a partial or temporary erection, a tendency to rush to penetrate, and possibly to ejaculate before the erection is lost.

4. Not psychologically close to your partner - as a reaction to your failure experiences, you have focused your attention less on being close to your partner and more on your performance.

5. Not attending to the sensual, sexual aspects of the experience - as you focused more and more on your physical performance you became less and less aware of the touch, sight, sounds and smells of the experience.

6. A feeling of tension has arisen between you and your partner when sexual matters are broached as you both react to the series of frustrating experiences you have both experienced with the other in recent times.

These reactions will not necessarily change by themselves when your erection is restored. That's the reason for individual and/or couple's counseling.

You may find here information for your wife or partner.

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Complaints of difficult, labored, or uncomfortable breathing (called dyspnea) can be a signal of a serious emergency or of a mysterious medical puzzle. Seek immediate professional evaluation if this problem has never been diagnosed. Most often a person will describe it as "not being able to catch my breath," or "not getting enough air," even while appearing to breathe normally. Certainly the inability to breathe properly can be alarming, and many persons will immediately react with anxiety, fear, or panic.

Physical Causes of Difficult Breathing (Dypsnea)

• bronchitis
• pneumothorax
• emphysema
• hemothorax
• asthma
• pulmonary edema
• pneumoconiosis
• mitral stenosis
• collagen disease
• left ventricular failure
• pulmonary fibrosis
• aortic insufficiency
• myasthenia gravis
• pericardial effusion
• Guillain Barre syndrome
• cardiac arrhythmia
• pleural effusion

Under normal circumstances, difficult breathing comes after any strenuous activity. If the degree of the problem seems out of proportion to the amount of exertion, concern is appropriate. Troubled breathing is sometimes experienced in pregnancy, since the uterus expands upward, reducing the possibility of a full inhalation. Severe obesity can also reduce the capacity of the lungs to inhale fully.

Most physical causes of dyspnea are associated with disorders of the respiratory and cardiac systems. Acute and chronic diseases of the lungs are the most common physical causes. Within the respiratory system, the problem usually stems from an obstruction of air flow (obstructive disorders) or the inability of the chest wall or lungs to expand freely (restrictive disorders). Each of these disorders makes the patient work harder to take each breath and decreases the amount of oxygen that he can absorb with inhalation. The three major obstructive disorders are bronchitis, emphysema, and asthma. In these problems a second common symptom is "chest tightness" upon awakening, shortly after sitting up, or after physical exertion.

The primary symptom of bronchitis is a deep cough that brings up yellowish or grayish phlegm from the lungs. With emphysema, the shortness of breath gradually becomes worse over the years. The distinct symptoms of bronchitis and the gradual onset of emphysema will usually prevent these disorders from being misdiagnosed as severe anxiety or panic.

Those suffering from asthma will complain of difficult breathing, a painless tightness in the chest, and periodic attacks of wheezing. Severe cases can cause sweating, increased pulse rate, and severe anxiety. The primary trigger of an asthma attack is an allergy to such things as pollen, dust, or the dander of cats or dogs. Attacks can also be caused by infections, exercise, psychological stress, or for no apparent reason. Some asthma sufferers anxiously anticipate the next attack, since an acute attack of asthma can come suddenly "out of the blue" and last for an uncomfortably long time. This fear of an impending attack can actually increase the likelihood of the next attack and can extend the length of each attack. Asthma is a good example of a physical disorder that can increase in severity because of anxiety or panic.

Chapter 6 of the self-help book Don't Panic will describe the manner in which panic can contribute to difficulties in patients with chronic obstructive pulmonary disease. Special attention is given to chronic bronchitis, emphysema, and asthma.

There are a number of restrictive disorders of the respiratory system that cause difficult breathing. Some produce a rigidity of the lungs (pneumoconiosis, collagen disease, pulmonary fibrosis); other involve the interactions of muscles and nerves (myasthenia gravis, Guillain Barre syndrome); and still others prevent the lungs from expanding to full volume (pleural effusion, pneumothorax, hemothorax). A restrictive deficit in pulmonary function can also be caused by pulmonary edema, which usually stems from heart failure or occasionally from toxic inhalants.

Dyspnea may occur in any of the various diseases of the heart and lungs, but it is more prominent in those associated with lung congestion. For example, mitral stenosis occurs when a small valve between the left upper chamber and left lower chamber of the heart (the left atrium and left ventricle) becomes abnormally narrow. As blood is forced through the heart, pressure backs up into the lungs and produces congestion. It is this congestion that causes breathlessness.

Other possible cardiovascular problems that can lead to difficulty breathing include left ventricular failure, aortic insufficiency, pericardial effusion, and cardiac arrhythmia.

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Articles and research on Internet addiction: what makes the internet addictive, cybersex and infidelity online, online gambling addiction and more.

Articles on Treatment of Internet Addiction

Internet Addiction: The Emergence of a New Disorder
by Dr. Kimberly S. Young

This article attempts to differentiate addictive from normal use of the Internet. The paper also documents significant behavioral and functional differences between those subjects classified as addicts and non-addicts. On-line addicts in this study spent an average of 38 hours per week on-line, mostly used interactive applications such as chat rooms and MUDs, and were unable to control their Internet usage which resulted in significant marital, academic, and job related problems.

The Relationship between Internet Addiction and Depression
by Dr. Kimberly S. Young and Robert C. Rodgers

This study showed that levels of depression as measured by the Beck Depression Inventory (BDI) correlated with pathological Internet use. This article discusses implications for assessment and treatment planning in cases where a primary psychiatric condition is related to a subsequent impulse control problem such as pathological Internet use.

What Makes the Internet Addictive: Potential Explanations for Pathological Internet Use
by Dr. Kimberly S. Young

This article discusses the psychological reinforcement of increased social support, engagement in unforbidden sexual fantasies through cybersex, and the ability to reinvent oneself through on-line personas that provide potential explanations for addictive Internet use.

Cyber-Disorders: The Mental Health Concern for the New Millennium
by Kimberly Young, Molly Pistner, James O'Mara, and Jennifer Buchanan

This study surveyed therapists who have treated clients suffering from cyber-related problems to gather outcome information on incidence rates and treatment. Five general subtypes of Internet addiction were categorized that include addictions to Cybersex, Cyber-relationships, online stock trading or gambling, information surfing, and computer games. Treatment strategies included cognitive-behavioral approaches, sexual offender therapy, marital and family therapy, social skills training, and pharmacological interventions. Finally, this paper examines the impact of cyber-disorders on future research, treatment, and public policy issues for the new millennium.

Cybersex and Infidelity Online: Implications for Evaluation and Treatment
by Dr. Kimberly Young, Jame O'Mara, & Jennifer Buchanan

This paper outlines warning signs of a cyberaffairs and shows their dramatic impact on marital separation and divorce. The ACE Model (Anonymity, Convenience, Escape) of Cybersexual Addiction provides a workable framework to explain the underlying cyber-cultural issues that increase the risk of virtual adultery. Finally, the paper outlines specific treatment interventions.

Internet Addiction: Symptoms, Evaluation, and Treatment
by Dr. Kimberly S. Young

This paper is geared towards mental health practitioners who have dealt with cases of Internet addiction in their clinical practice. This article outlines the complications to diagnosis of Internet addiction, a comprehensive evaluation procedure to assess for this disorder, and several treatment strategies for recovery.

Legal Articles

Interventions for Pathological and Deviant Behavior Within an Online Community
by Dr. Kimberly S. Young

This paper investigates the potential of using on-line interventions including e-mail consultation and real-time chat for addictive and deviant behavior. Preliminary findings are presented and treatment implications are discussed.

The Legal Ramifications of Internet Addiction
by Dr. Kimberly Young

The credibility of Internet addiction has become a legal issue in both civil and criminal courts coming up in divorce cases and custody hearings as well as child pornography.

General Interest Articles

Internet Addiction: Personality Traits Associated with Its Development
by Dr. Kimberly S. Young and Robert C. Rodgers

This paper utilizes the 16PF to measure potential personality traits using associated with compulsive Internet use. Preliminary findings are presented and treatment implications are discussed.

Addictive Use of the Internet: A Case That Breaks the Stereotype
by Dr. Kimberly S. Young

This paper dispels the popular stereotype of the young, computer-savvy male as the prototypical Internet addict by outlining a case study of a 43 year old woman addicted to chat rooms which eventually destroys her 17 year marriage.

Is the Internet Addictive, or Are Addicts Using the Internet?
by Storm A. King

This paper is an overview of current research findings and an attempt to explore some of the possible explanations for this phenomena. Factors related to what makes the Internet attractive and who is most at risk for becoming addicted are discussed.

Women's Growing Addiction to the Internet

People who are addicted to the Internet are more likely to be thirty-something women than the stereotyped shy, male teenagers.

Why is This Thing Eating My Life? Computer and Cyberspace Addiction
by Dr. John Suler

Dr. Suler examines the Palace, a forum which provides graphical interface where participants create personal avatars (cartoon like characters ) which interact among other avatars in a visually rich environment. His paper examines why some people might become addicted to that type of environment in terms of how this activity fulfills all of Maslow's hierarchy of needs.

Computer and Cyberspace Addiction
by Dr. John Suler

This article examines the multiple definitions and clarifies several common warning signs of computer/Internet addiction.

Computer Addictions Entangle Students
by Bridget Murray

This article appeared in the American Psychological Association's trade newspaper, The APA Monitor and focuses on college students who suffer from academic failure and poor social relationships due to Internet misuse.

Hooked on the Net
by Debbie Seaman

A Time Magazine article outlining the problems with Internet misuse in the workplace and among families.

Researchers Find Sad, Lonely People on the Internet
by Amy Harmon.

A New York Times article about surprising results of the Carnagie Mellon Study that found increased levels of depression and loneliness after a two-year study of Internet users. Related links are provided.

Sex, Lies, and Techno Escapes
by Ej Gong

ABCNEWS story why people can't stay offline.

Gambling Online? You Bet!

As famous names and established companies get involved, opposition to Internet gambling is appealing to crumble.

Sex on the Net

News story that reviews the results of a survey of over 9,000 MSNBC.com readers published in a journal of the American Psychological Association.

Internet Addiction: Is it just this month's hang-wringer for worryworts, or a genuine problem?
By R.W. Greene

A Computerworld Magazine article that examines the symptoms and existence of Internet addiction. The article contains extensive quotes from leaders in the field.

Dealing with Online Auction Addiction and Obsessive Online Trading

February 11, 1999 - New York Times - Buying is only a click (oops!) away February 3 - MSNBC - Bidding til your broke

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Uncomfortable changes in heart rate are the most frequently reported symptoms of panic attacks. Over 80% of those experiencing panic list a rapid or irregular heart rate as a symptom.

Three complaints are common among patients who seek a doctor's advice about their heart: "My heart feels like it's pounding violently in my chest," "My heart is racing, " and "My heart feels like it skips a beat." An arrhythmia is any irregularity in the heart's rhythm. If the heart beats more rapidly than normal, this arrhythmia is called tachycardia. An unpleasant sensation in the heart, whether rapid or slow, regular or irregular, and of which one is consciously aware, is called a palpitation.

Physical Causes of Rapid or Irregular Heart Rate

• arrhythmia
• postmyocardial infarction
• tachycardia
• organic heart disease
• palpitation
• heart failure
• extrasystole
• infections
• coronary artery disease

Heart palpitation is typically an expected sensation when the force and rate of the heartbeat are considerably elevated. After strenuous exercise we are apt to notice the thumping of our heart against the chest wall. As we begin resting, that sensation may continue briefly until we recover from our exertion.

People who are prone to anxiety may have palpitations more frequently when they find themselves in psychologically uncomfortable situations. In fact, the great majority of complaints about the heart presented to physicians indicate a psychological rather than a physical problem. An anxious person may turn his attention to his physical symptoms instead of learning to cope with the situation causing the symptoms. After several episodes in which he experiences his heart "pounding" or "beating too fast," he fears it is a sign of heart disease or some other physical disorder.

It is possible to consciously notice a few minor disturbances of the heart rhythm. For instance, some people describe sensations such as a "flop" of the heart, the heart "skipping a beat" or "turning a somersault." We call this sudden forceful beat of the heart followed by a longer than usual pause an extrasystole. These premature contractions of the heart are usually of no serious significance and occur in many healthy individuals.

In fact, because of several research findings, we now know that arrhythmias of all kinds are common in normal, healthy individuals. In one recent study published in the New England Journal of Medicine, Dr. Harold Kennedy found that healthy subjects with frequent and complex irregular heartbeats seem to be at no more risk of physical problems than is the normal population. In general, researchers are finding that the majority of even the healthiest people have some kind of rhythm disturbance such as skipped beats, palpitations, or pounding in the chest.

Tachycardia, or rapid heartbeat, is the most common complaint associated with the heart and one of the typical reasons that patients seek medical attention. For many normal healthy individuals it is a daily occurrence in response to physical exercise or intense emotion. Any kind of excitement or trauma, even fatigue or exhaustion, can accelerate the action of the heart, especially in overly anxious individuals. Too many cigarettes, too much alcohol, and in particular, excessive amounts of caffeine can cause tachycardia on occasion. Infections such as pneumonia, as well as acute inflammatory diseases such as rheumatic fever, may also produce a rapid heartbeat.

Although most complaints of palpitation reflect a minor cardiac problem or a sign of anxiety, it is possible that they involve some kind of coronary artery disease. A narrowing of the arteries to the heart causes such diseases.

Recovery and rehabilitation after a heart attack can be a difficult psychological problem. Many people become afraid that too much activity or excitement might produce a second attack. It is no wonder then, that postmyocardial infarction patients become fearfully preoccupied with the sensations of their heart. Many will return to their doctor's office or hospital emergency room with complaints of palpitations. Fourteen percent of cardiac patients later suffer from panic disorder, which is the worried anticipation of having an anxiety attack or heart attack. Chapter 6 of the self-help book Don't Panic describes the way in which panic complicates recovery from a myocardial infarction.

Complaints of a "racing" heart can signal certain kinds of organic heart disease and heart failure. More often, however, the symptom of these ailments will be breathlessness. Infections, such as pneumonia and rheumatic fever, may also produce a rapid heartbeat.

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