Pediatrician and our ADHD expert, Dr. Billy Levin, discusses the importance of properly understanding ADHD in children.

Children with special learning disabilities exhibit a disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language. These may be manifested in disorders of listening, thinking, reading, writing, spelling or mathematics. They include conditions, which have been referred to as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, development aphasia, hyperactivity etc. They do not include learning problems which are due primarily to visual, hearing, or motor handicaps, to mental retardation, emotional disturbance, or to environment disadvantage (Clements, 1966)".

The out-dated term, Minimal Brain Dysfunction (MBD) is no better or worse a name than the other 40 odd names suggested for this condition but it has severe shortcomings. For instance, the word "minimal" refers to the degree of cerebral damage or probably more accurately, dysfunction, which is minimal, compared to cerebral palsy or retardation, but the condition M.B.D. or the ramifications of the condition are certainly not minimal. More recently Attention Deficit Hyperactivity Disorder (A.D.H.D.) and in the teenager Residual Attentional Deficit (R.A.D.) has become acceptable.

It is the most common and largest single problem seen by psychologists and doctors working in this field. The age at which it presents itself stretches from infancy to senescence. Presentation being from Minimal Brain Dysfunction (M.B.D.) in the child to Adult Brain Dysfunction (A.B.D.), Attentional Deficit Disorder (A.D.D.) to Residual Attentional Deficit (R.A.D.) in the adolescent. As the condition becomes better known to more practitioners, more adults are going to be recognised as needing treatment.

The incidence of A.D.H.D. is about 10% of all school children and is found very much more in boys than in girls. The reason is because boys have a higher incidence of right brain dominance than girls do. The male hormone Testosterone boosts the right hemisphere and Estrogen, the female hormone, boosts the left hemisphere. It presents as either a learning problem (left brain immaturity) or behavior problem (right brain excess), or both. If seen by someone familiar with the condition it is easily diagnosed even before the child goes to school. Far too many children are only being diagnosed late, when major problems have already developed. The incidence does appear to be increasing simply because the population is increasing but also because the diagnosis is being made more frequently. This is encouraging but still not enough. A.D.H.D is still a very much under-diagnosed condition.

Diagnosis of ADD

Despite the high incidence, the devastating effects on the individual, and his family, and the prolonged morbidity of the condition, even after school going age, it is frequently misdiagnosed by unenlightened medical and paramedical personnel, or when diagnosed, poorly treated. It should be added that, even when the correct diagnosis is made and the treatment suggested facilities are too often inadequate, lacking entirely or stifled by negativism.

There is probably only one real cause, and that is a biochemical neurotransmitter deficiency in the brain, that is genetic and maturational in its nature. This predisposes the brain to an above normal susceptibility to any stress, be it physical (temperature or trauma) emotional, oxygen deficiency, nutritional depravation or bacterial invasion. Prematurity of the nervous system especially the left hemisphere of the brain also plays a part as premature infants and twins are more susceptible. The maturity lags of these children form an integral and prominent part of the diagnosis.

There are clearly psychological factors, but these are invariably secondary in nature, certainly part of the syndrome, but never the cause. With adequate treatment, most secondary emotional problems fade rapidly.

Being a syndrome all the symptoms are not required to be present to make a diagnosis. It is acceptable to confirm a diagnosis if some of the traits are present, and at that, in variable degrees from mild to severe. It needs to be understood that the milder forms should be recognised if only to receive more understanding and not necessary medication.

In infancy, colic, insomnia, excessive vomiting, feeding problems, toilet problems, restlessness and excessive crying are common. The restless baby becomes an overactive, frustrated and difficult child at nursery school. At school the learning and concentration problems develop resulting in underachievement and poor self-esteem. At first the reading problem manifests (auditory imperception) but not early maths. Later when story sums are done the maths takes a down turn. These students cope better with Geography than with History. Better at Geometry than Algebra and usually love Art and Music and especially action shows on television. All these are due to right hemisphere talent and or left hemisphere immaturity. Gradually the activity level slows down at puberty or later, but the fidgety and restless nature remains and sometimes the impulsiveness as well. The last to fade and usually the most troublesome are the frustrations and the inability to concentrate on a task for very long. Yet in certain instances they can focus their attention more easily, provided they are involved in a right brain activity such as chess.

Problems of co-ordination in the early years manifest as lags in ability to cope with the expected age related tasks but later the child is often clumsy and either poor at ball games or has an untidy handwriting or both. Yet some are highly skilled at ball games? Inco-ordination as a maturity lag and lack of inhibitory function sometimes results in enuresis (bed wetting) and encopresis (soiling pants), and is more prevalent during periods of stress but is not caused by stress.

These children have severe problems with auditory perception and verbal concentration. The inability to concentrate for any length of time on a given task, and the ability to be so easily visually distracted, makes learning a major problem. Yet learning on a computer, which is visual/mechanical is a pleasure.

With the passing of time, their developmental disability, especially in language, is now coupled with a slowly developing educational lag, to a point where they are unable to cope with the work expected of them in school. At this point, the daydreaming problem starts to show itself. (These children cease to daydream when tasks are set at their level of ability, and they can enjoy the success). The vicious cycle soon establishes itself where poor achievement leads to unfair criticism to poor self-esteem, demotivation, frustration and failure.

The aforementioned negativity is very poorly tolerated by the A.D.H.D. child who becomes supersensitive to criticism and often very aggressive and antagonistic to any form of discipline. In the teenage years depression often develops. He has constant excuses to explain inability. His impulsive nature often allows him to get into trouble before he realises what is happening to him. He will either act impulsively first, and then think about the situation afterwards. Or having erred, will explain with an untruth. Although he might even regret it, he will be too proud to admit it. These children clearly first act and then think and this often accounts for their accident proness, or getting into hot water at school or with the police. They also struggle to sequence events and organize themselves, and in so doing create even more problems for themselves.

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By the time they reach adolescence and the difficult rebellious teenage years, they are often dropouts, delinquents, anti-social and underachievers. They are also most likely to try anything to lift them out of this tragic situation including the use of habit-forming drugs and alcohol.

The diagnosis is made by correlating the findings of a specific neurological examination, and then matching these up with the detailed history taken from both parents about themselves, the child, and the rest of the family. Reviewing school reports has great diagnostic value provided that the reviewer has insight. Electroencephalograms (EEG) have no value either in diagnosis or treatment unless epilepsy is suspected. Special questionnaires (the Conners modified rating scale) completed by the teacher and the parents prior to treatment and again on a regular monthly basis have incredible vale. They can be used to confirm the diagnosis and to monitor medication.

Clearly the identification of these children requires an expansion of the traditional type of examination which is incapable of uncovering many of the subtle signs and symptoms of A.D.H.D. (The diagnostic and statistical Manual is not sufficient to base a diagnosis on)

The teacher at nursery school or at school is in a very good position to compare the child's performance with other children and will often notice discrepancies and lags, but not know their significance's. New awareness is making early diagnosis and intervention possible from as young as 3 years of age or even younger.

The sad thing is that many children are only diagnosed when they bring home unsatisfactory school reports and even then they are often labeled as lazy, naughty or lacking in concentration, and are allowed to repeat a year before someone suggests a psycho-neurological examination.

Because the parents often judge their ability to "parent" by the child's success they often feel inadequate despite there being other normal children in the family. On the other hand because of the genetic nature of this condition, one of the parents may well be immature and impulsive in his (usually "his") actions, and this leads to increased stress between parents and child, as well as increased marital problems. Actually the number of hasty, unhappy marriages ending in divorce in A.D.H.D. families is unusually but understandably high. Prior to marriage an impulsive sexual act leads to the birth of an illegitimate baby, which is then given up for adoption, and this probably explains why so many adopted babies have A.D.H.D.

Treatment of ADHD

Successful treatment of ADHD requires not only remedial work and medication, but also a very definite attempt to inform the parents fully of the implications of the total situation. They should be encouraged to continue gathering information to give them more insight and understanding, and so become an integral part of the therapeutic team.

The treatment of ADHD depends on the type of dysfunction, the severity of it, the amount of secondary emotional overlay already present, the IQ of the child, the co-operation from parents and school, and the response to medication. The overactive, high IQ behavior problem child with little or no learning problems will respond well to medication and sometimes needs very little else. The underactive (learning) perceptual problem child requires early intensive and prolonged remedial therapy after medication has been adjusted to the optimum dose. Children with learning and behavior problems will require both remedial therapy and medication and a lot more patience from everyone concerned both at home and at school.

For some very young children, but not all, a special diet that excludes artificial flavoring and colouring will improve their behavior and concentration to a point where less medication is given. It appears that diet is an aggravating factor in an already existing neurological condition, and not the cause. Older children do not respond very well to the diet.

Psychotherapy is seldom required unless there is major family psychopathology, but on-going parent counseling is vital.

For a child with a reading problem (dyslexia), there are specific reading programs (e.g. paired reading). There are also specific programs for hand writing (dysgraphia), for spelling problems (dysorthographia) and dyscalculie (maths problems). For the most difficult of all -Dysrationale, (no logic) one can not even convince them they have a problem, let alone treat it, until they reach "rock bottom". For some, a coloured lens (Urlin lens) named after Helen Urlin, a remedial teacher, can do wonders for reading. The human retina rejects black print on a white background. Far better for reading is black print on a soft yellow background.

Although Ritalin (Methylphenidate) is the most effective and frequently used medication, there is certainly place for other medication.

The medication used for A.D.H.D. is neither habit-forming nor dangerous, but requires careful selection and dosage monitoring to achieve success. Medication does not cure but allows the child to function closer to his expected age norm until he matures. The medication stimulates the formation of deficient biochemical neuro-transmitters in the brain and so normalises neuronal function. After enlightening both teachers and parents and reassuring the child, a trial of medication is started and titrated to the optimum dose and timing on an every day basis. The dose is individually tailored to suit each patient by titration, disregarding the child's age or weight. For some children the dose over weekends and holidays can be reduced or even stopped. This is done on a trial basis. Some children will need medication every day. There are also specific methods to determine when medication should be stopped. There are no long-term side effects to Ritalin what so ever. The minor short-term side effects present no problem to good management.

The time required for maturity varies from a few months to a few years, and in rare individuals medication could be a lifelong maintenance. Periodic "off medication" holidays are not essential, but may be helpful to assess the further need for medication. Weekends off medication are possible, but only when some success has been achieved and an "off medication trial" proves successful.

There are perhaps five aspects that need re-emphasizing.

FIRSTLY, the underactive (hypoactive) child who does not have a behavior problem and consequently is often overlooked because he is so quiet and loveable.

SECONDLY, the very high IQ (gifted) child who has A.D.H.D. and achieves average marks despite his high IQ, and presents a behavior problem or an under achiever.

THIRDLY, the older child (teenager), who has outgrown some of the behavior problems but is underachieving, could still benefit from treatment and must not be overlooked.

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FOURTHLY, the adult who still has a problem and has never had treatment, had inadequate treatment, or had treatment prematurely stopped, should not be over looked. They are entitled to treatment. And what is more, it is just as successful as in the child if correctly used.

FIFTHLY, many a parent cannot come to terms with the idea of medication, despite the American Surgeon- General's investigation a few years ago, indicating not only the need to medicate, but also the safety of psychostimulants. In South Africa the Health Department has come to the same conclusion. The same health department has more recently published their definite condemning of smoking as a major health hazard. Under these circumstances, it is difficult to understand the parents' reaction to medicating their children, when some of these parents condemn medication while being smokers themselves. Nevertheless a non-condemning, sympathetic attitude must be adopted towards these parents until they come to terms with their own anxieties and their children's problems.

Any attempt to explain the intricacies of the human brain to people is like a poorly sighted observer looking at a piece of complicated machinery in a darkened room through a non-strategically placed peephole, and describing it to a hard of hearing audience.

Despite this we do know that we have a right and a left cerebral hemisphere connected to each other by the corpus callosum. Each side has four lobes, each with a specific function. The "cross over" function allows the left hemisphere to team up with the right side of the body and the right hemisphere to team up with the left side of the body. The speech center is usually situated on the left side of the brain even in most left-handed people. Speech and thought are our most highly developed functions and are found only in man. The left brain is the dominant hemisphere in most people (93%) and therefore we are predominantly right handed and become aware of the "right" early on in life. There is also no confusion created by the opposition side, unless the left hemisphere is less effective or immature.

The higher cortical functions that are acquired offshoots of speech, namely reading, writing and spelling and logical maths are mainly in the left hemisphere, and they are the talents most sought after in school.

The verbal input (listening to words) and output (speech) on the left side of the brain are focally concentrated and a conscious processes, executed in an orderly, logical and sequential manner. The right brain, on the other hand, which functions in a less dominant capacity, is visio-spatially orientated. It processes information more vaguely than the left brain. It processes information simultaneously and holistically and is far more mechanically orientated than the left brain.

The left brain is clearly the thinking (inhibitory) side while the right brain is the doing (activating) side. It stands to reason, and happily so, that the dominant left-brain "thinks" first, and then allows the right brain to "do" thereafter. This maturation process occurs in a predetermined developmental pattern. This arrangement in no way implies that the right brain is inferior to the left in any way. Both sides of the brain have their own, but very different talents.

There is a maturational difference between boys and girls in that boys' right brain is often dominant and thus they tend to "do" rather than "think" while maturing. This tendency to right brain dominance is a disadvantage in boys at the age of 6 years, when we tap mainly the left brain for school readiness. Consequently six year old girls are more mature than boys are and boys have far more and behavior and learning problems than girls.

Clearly there is a maturing process that allows the left brain to become the dominant side, by the time the child has to go to school. Each side specializes in certain functions that are suited to our developmental needs.

Our genetic talents are only molded by our environment. A talent in the wrong place, such as temperament on the right side, and developing at the wrong time could well be a disadvantage. A prerequisite to understanding unusual dominance or late developing dominance is the knowledge of the developmental norms of the child.

If the left brain is more highly developed, it is also more likely to be more susceptible to insult from any cause, be it genetic inherited immaturity, trauma, anoxia (lack of oxygen) or inflammation. Any insult to the left hemisphere resulting in failure to mature, thus allowing the right hemisphere to dominate will disrupt functions.

With Cerebral Dysfunctions the tendency is for some or all of the right brain functions to gain the upper hand. This clearly explains so much of the unusual patterns of behavior (due to right brain excess) and lack of learning (due to left brain immaturity) in A.D.H.D. children. It is sometimes difficult to decide whether a particular pattern of behavior is due to increased right-sided function or decreased left-sided function or equal ability causing left-right confusion. There can be no doubt however that loss of left brain dominance is a disadvantage to learning. Equally, right brain dominance for doing first and thinking later is a built-in troublemaker, with a tendency to be left-handed.

There are a number of interesting superficial anatomical deviations (dysmorphic features) that can be seen more often in A.D.H.D. children. I refer to:

• Epicanthic folds of the eye
• Ocular hyperteleorsism (widely spaced eyes giving the appearance of a wide nasal bridge)
• Curved little finger
• Simian palmer fold (a single palmer fold)
• Webbed toes (between 2nd and 3rd toe)
• Unusually large 1st toe space
• Absent or non-dependant ear lobes
• High palate
• Facial asymmetry
• F.L.K. (Funny looking kid)

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If one recalls that the basic elements in the embryo which develop into brain come from Ectoderm, and that all skin and superficial structures also develop from Ectoderm, then any unusual cerebral development certainly could be accompanied by mild skin and superficial deviations. These unusual features could not be caused by emotions and the behavior patterns likewise are not caused by emotions, but by neurological variations.

Some time ago, in the "British Practitioner" a comment was made that there are no emotional conditions, but only emotional reactions to neurological conditions. The emotional reactions of A.D.H.D. children, whether they have a hyperactive behavior problem, a hypoactive learning problem, or a mixed type are most likely secondary to the neurological disability. The family history also suggests a genetic etiology.

Some research has shown that in some cases an irregular and unusual cellular arrangement exists on the left side of the brain as seen under a microscope. Electroencephalograms can sometimes show immature or asymmetrical brain waves but this is not diagnostic. Chromosomal studies have also been used to suggest the genetic origin as a possible causative factor.

From a biological point of view, early, yet suggestive evidence is available to suggest that a biochemical defect does exist in many children with learning disabilities in the form of a neuro-transmitter deficiency. This explains why replacing these deficient neuro-transmitters with psychostimulant medication can in some cases bring about such vast improvements so rapidly.

One cannot survive without water, a natural body requirement, never the less the drinking thereof is not an addiction. Medicating with psychostimulants is not unlike replacement therapy in a diabetic or thyroid deficient patient. Replacement therapy cannot therefore be labeled "drugging". That there are no addicts to Ritalin is therefore not surprising.

The pioneering work of the American neuro-surgeon, Roger Sperry, on the split brain, over the last few years has shed much light on the left and right hemisphere brain function and helped to dispel many old beliefs and theories. Perhaps now that Dr. Sperry has been honored by the medical fraternity for his research by bestowing on him the highly sought after Nobel Prize for medicine (1981), older psychological ideas will die gradually and make for new concepts in neuro-psychology. This would hopefully allow anxious and doubting teachers to accept the idea that the brain (while still in the head) they teach at school, is still part of the human body and the doctor's domain.

Therefore, the basic physiology, pathology, diagnosis and treatment also remain medical. The teacher does in fact become part of a new para-medical team in co-operation with speech therapists and remedial therapists. Psychotherapy is seldom required, but when necessary, essential.

The final comment must be that if the medical practitioner hopes to be elected as the co-ordinator of the diagnostic and therapeutic team, he must prove his worth by acquiring the new knowledge that is available today."

About the author: Dr. Billy Levin (MB.ChB) has spent the last 28 years treating patients with ADHD. He has researched, developed and modified a diagnostic rating scale of which he has evaluated over 250 000 in about 14 000 case studies. He has been a speaker at several national and international symposiums and has had articles published in various teaching, medical and educational journals and on the Internet. He has written a chapter in a textbook (Pharmacotherapy edited by Prof. .C.P. Venter) and received nominations by his local branch of SAMA for a National award (Excelsior award) on two occasions."

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Sooner or later just about everyone will encounter a colleague or friend with an eating disorder. Between five and 10 million people in the United States alone suffer from compulsive eating, anorexia or bulimia, and most of them are women.

It's tough sitting across the table from someone who's not eating, or someone who is eating too much. You know the problem is interfering with the person's health and general wellbeing. Should you say something, or mind your own business?

Some Advice From The Caron Foundation

"It is appropriate to express your concern, and to do so in a way that will let them hear you," says Susan Merle Gordon, director of research at the Caron Foundation, a nationally recognized addiction treatment center.

"Eating disorders aren't about food. They're about how a person feels about herself," Gordon says. People with eating disorders focus on their appearance, instead of focusing on the basis for their condition.

Gordon offers this advice on reaching out to someone with an eating disorder:

• To comment on the person's appearance, eating, or food-related behavior is to risk losing a friend, or at least shutting the door to further communication. Compulsive eaters, because they are overweight, frequently endure extraordinarily rude comments from strangers; your comments about eating may add to the pain. If you express concern to an anorexic about how thin she is, her reaction will be, "You're just jealous."
• If you comment to a bulimic on her vomiting and laxative use to control her weight, she may deny it because she is ashamed of her behavior. Express your concern without focusing on appearance or what she's eating. You can say something like, "I am concerned because you are so critical of yourself. You are a very special person, and I care about you, but I'm worried that things are not going well for you. Have you thought of getting help?"
• Steer her toward help. You can't make someone with an eating disorder eat properly, but you can show compassion and concern. You can say, "I'm not in a position to counsel you about what's going on, but I can help you find someone who can." If she works for a company with an employee assistance program (EAP), their counselors can help. Many addiction treatment centers and hospitals offer programs for people with eating disorders.
• If she refuses to acknowledge a problem or any reason for your concern, repeat the reasons for your concern, and let her know you will be there for her if things change.
• If the person's health is in imminent danger, you must intervene. People with eating disorders can die from starvation or excessive vomiting. Call a doctor or take your friend to the emergency room if you see signs of real trouble.

May Be a Link to Other Addictions

There may be a link to other addictive behaviors. Gordon says that of those being treated for drug and alcohol addiction at the Caron Foundation, 15 percent also have eating disorders.

Some have used alcohol, amphetamines, cocaine, and even heroin as appetite suppressants.

(Visit HealthyPlace.com Addictions Community for extensive information on addictions)

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Mary Mitchell brings civility to life. She established The Mitchell Organization in 1989 as a locus for her growing professional activities: columnist, author, speaker, trainer, consultant and coach. Mary is renowned for removing the starch from etiquette, a subject often perceived to be stuffy. More than 50 major corporate clients have learned and profited from her cogent observation,"Your company's competitive advantage is directly related to the social and communications skills of its employees." Her books have been translated into five languages.

next: What You Can Do to Help Prevent Eating Disorders
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Sometimes parents are afraid that educational materials about eating disorders will stimulate an eating disorder in their teenager. They also fear such material will encourage a teenager with an eating disorder to try new and different methods of acting out the illness. Sometimes loving parents are afraid to know specific information about eating disorders themselves. They think that if they ignore the subject it will keep the disorder out of their lives.

While providing information is powerful, I want to reassure parents that information about eating disorders will not cause an eating disorder to develop in their child. By the same token, such information will not cure a person, teen or any age, who is suffering from an eating disorder. Treatment consisting of compassion, understanding, and specific clinical expertise is required for recovery.

While eating disorder educational programs will not cure an existing eating disorder, such programs have many benefits for both parents and teens. Programs can:

1. alert parents and children to the nature of eating disorders;
2. show the physical and psychological risks involved in acting out an eating disorder;
3. explain how to recognize when they or someone they know needs help;
4. and most importantly describe many ways to start treatment and bring help and guidance to the individual with the eating disorder and their families.

Educational programs are needed because often early stages of an eating disorder go unrecognized by everyone, including the person with the disorder. Everyone eats. Plus, there are many ways of eating and not eating that are socially sanctioned for particular occasions. For example, it's socially acceptable to eat junk food, even large quantities of it, at parties or at the movies. It's also socially acceptable to diet and try fad diets that might include fasting. It has become acceptable to acknowledge 'comfort foods' such as chocolate or ice cream as means of coping with stress or disappointment.

It would be very difficult to distinguish a newly forming bulimic from a non-bulimic person when both are devouring lots of sweets and treats at a pajama party. It would be difficult to distinguish a newly forming anorexic teenager from her teenage friends when they are all experimenting with exotic diets and judging every aspect of their body as too fat. Plus, the anorexic and/or bulimic who is first experimenting with vomiting, rather than being worried or frightened, is usually quite happy at discovering a 'trick' to help her think she is avoiding the consequences of holding and digesting any food she eats. She doesn't know herself that she has found a dangerous activity that helps her dull her ability to feel, to be aware of her surroundings and to respond in a healthy way to stress in her life.

Parents may be reassured to know that eating disorder education might be a wake up call that jars the consciousness of young people in an early stage of an eating disorder. Through education a young girl might recognize herself as being on her way to having a serious disorder.

If she knows the symptoms, knows there is supportive and caring help available and knows how to ask for that support and help she has an opportunity to get some early healing. With encouragement and support from adults and peers in her environment, she has a chance of redirecting herself before the disorder advances to relationship destroying and life destroying levels.

Eating disorder education can help parents become less fearful and more understanding if their child does have an eating disorder. Parents can be empowered to lovingly and more confidently support the healing efforts required for their child to recover. With education and informed family support, the child may be more willing and capable of doing the necessary healing work.

Early education presented clearly and sensitively with regard to the developmental stage of the audience may provide a powerful way of waylaying an eating disorder, encouraging informed and useful family cooperation to help a child grow up healthy and free.

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Psychotherapy, light therapy, supplements and aerobic exercise work for treating mild to moderate depression.

Anti-depressants are now taken by tens of millions of Americans, and many people credit them with changing, or even saving, their lives. But they're not for everyone.

The most-prescribed medications, SSRIs (selective serotonin reuptake inhibitors) such as Paxil, Prozac and , have a host of potential side effects, including loss of libido, insomnia, restlessness, weight gain, headaches and anxiety. Little is known about the effects of long-term use. Furthermore, the drugs can be prohibitively expensive for people without health insurance. The lowest dosage of Paxil, for instance, costs about $70 for a 30-day supply.

For some people, the drugs simply don't work. Last year, 111 million prescriptions were written for them, a 14 percent increase from 2000, according to IMS Health, a market research firm. But a 2000 New England Journal of Medicine study found that the medications fail to help one-third of people suffering from mild to moderate depression and half of those suffering from chronic depression.

"The benefits of prescription drugs aren't as great as we all believed," says Dr. Daniel F. Kripke, a psychiatrist at the University of California, San Diego, who studies depression treatments.

Researchers still don't understand why the medications, which boost the production of the brain chemical serotonin, aren't effective for everyone.

But they have begun to study alternatives. Among the most promising are psychotherapy, light therapy, supplements and good old-fashioned erobic exercise. Acupuncture, >yoga, massage and relaxation techniques may also offer temporary relief, as can dietary changes, such as avoiding caffeine or loading up on fish rich in omega-3 fatty acids, which purportedly spike serotonin levels. Serotonin is a brain chemical that regulates mood.

Paul Cumming, a 46-year-old San Diego man, tried light therapy to ease his depression in 1998. "In less than a week, I felt like a major cloud had been lifted," he says.

Of course, people suffering from severe depression shouldn't experiment on their own with these techniques, caution experts. But used under the supervision of a trained professional, they can provide an alternative to medication. For people with milder symptoms, these antidotes might be all they need to banish the blues.

THE TALKING CURE

Traditional talk therapy fell out of favor in recent years because drug therapy was considered to be easier, cheaper and less time-consuming. But a form of psychotherapy, cognitive behavorial therapy could bring face-to-face treatment back into the limelight. In this form of therapy, patients learn coping strategies to counteract the obsessive thoughts of failure, inadequacy and pervasive gloom that typify depression.

"Psychotherapy has really been undersold as a treatment for depression," says Robert J. DeRubeis, chairman of the psychology department at the University of Pennsylvania in Philadelphia. "But cognitive therapy works just as well as medication, even in severely depressed people."

In a 2002 study conducted at Vanderbilt University in Nashville and the University of Pennsylvania, the most common drugs were compared with cognitive behavioral therapy in 240 patients suffering from moderate to severe depression. Although the medication group got better more quickly, after about four months, 57 percent of patients in each group had improved.

Those who showed improvement were then followed for an additional year. During the follow-up period, cognitive therapy patients fared much better: Three-quarters of them remained symptom-free, compared with 60 percent of patients on medication, and 19 percent on a placebo.

"People treated with cogitive behavioral therapy get well and are more likely to stay well because they've learned skills to deal with their depression," says DeRubeis, one of the study co-authors. "And for someone who is prone to multiple episodes of depression, this is a good alternative to SSRIs (drugs)."

Traditional therapy, in which patients rummage through the debris of their childhoods to pinpoint the source of self-destructive behaviors, doesn't appear to work as well in banishing the blues, researchers say.

LIGHT AGAINST DARKNESS

For years, light therapy has been used to treat seasonal affective disorder, a type of depression that afflicts about one in 10 people who live in places with short winter days and extended darkness. Now, growing evidence indicates that being bathed at least 30 minutes a day in bright artificial light may be as effective as an anti-depressant at any time of the year.

The therapy approximates the brightness of sunlight using a specially designed light box that emits 5,000 to 10,000 lux, which is a measure of the amount of light received in the eye. The brightness is equivalent to the intensity of sunlight about 40 minutes after sunrise.

The mood-boosting effects can kick in almost immediately, researchers say. In comparison, anti-depressants may require a month of use before their effects are felt.

Cumming, who tried the therapy as a last resort after nearly a year of severe depression, was surprised by the results -- as was his doctor. His depression had proved resistant to conventional medication.

He now periodically sits in front of a light box when he feels himself backsliding into depression.

Scientists speculate that when people's body clocks, or circadian rhythms, get out of sync, they produce too much of the hormone melotonin, creating a biochemical imbalance in the brain region that regulates mood, energy and sleep.

"Somehow, the bright light shifts the body clock," says Kripke, who has researched light therapy for more than two decades.

In a 2002 study of 16 pregnant women with major depression, an hour's exposure to a 10,000-lux light box improved their symptoms by 49 percent after three weeks, a response rate comparable to antidepressants. Scientists are gearing up for a larger, five-year test of this therapy on pregnant women.

"This is important because the use of antidepressant medication by pregnant women is not risk-free, and there is possible harm to the unborn fetus," says Michael Terman, a study co-author and psychiatry professor at Columbia University in New York. "For depression during pregnancy, if we can nip it in the bud, we may also be able to prevent postpartum depression and its often horrific effects."

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SUPPLEMENTAL REMEDIES

Perhaps the most popular alternative remedy for depression is St. John's wort. Although two recent studies found it didn't work as well as a placebo in alleviating major depression, the herb has shown promise in treating mild depression.

Side effects include nausea, heartburn, insomnia and an increased sensitivity to sunlight. It also can weaken the effect of prescription medications, such as the blood thinner warfarin, the heart medication digitalis, some AIDS drugs and oral contraceptives.

Still, "people should consider it as an option, especially if they haven't done well on other medications," says Dr. David Mischoulon, a psychiatrist at Harvard Medical School.

Another dietary supplement, SAM-e, may also help combat depression. Produced from a yeast derivative, SAM-e was introduced to the United States in 1999. Backed by 40 studies done in Europe, the over-the-counter remedy was touted as a fast-acting antidote to depression with none of conventional medication's side effects. Some depression sufferers find SAM-e (short for s-adenosylmethiodine, a substance found naturally in the body that is believed to fuel dozens of biochemical reactions) more tolerable than the usual SSRI drugs.

Timothy Dickey, a 33-year-old Los Angeles writer, took Prozac for more than a year but didn't like the numbing effect had on his emotions, or the dry mouth and mild anxiety it caused. With SAM-e, he says, his depression vanished within days.

"I feel more resilient and fortified against the daily stresses of life that in the past would have gotten me down," says Dickey, who takes a 20-milligram tablet each day.

Growing anecdotal reports about the efficacy of SAM-e, which seems to work by enhancing the action of two mood-regulating brain chemicals-serotonin and dopamine, have prompted mainstream doctors to take a look. Harvard researchers are now testing the supplement in combination with SSRIs, such as Prozac and Zoloft, on severely depressed patients whose symptoms aren't eased by conventional drugs.

SAM-e, however, may trigger episodes of mania in people with bipolar disorder. It's also difficult to know if you're getting a therapeutic dose of SAM-e in supplements sold in health food stores.

"A few brands are OK," says Dr. Richard P. Brown, a Columbia University psychiatrist who has used SAM-e successfully on several severely depressed patients who didn't respond to antidepressants. "But a lot of them are mediocre or worthless. That's why people should consult with their doctors before they use them."

ACUPUNCTURE

Acupuncture may be an effective mood enhancer. In a 1999 study conducted by University of Arizona researchers, 34 women suffering from major depression who underwent eight weeks of acupuncture treatment reported an elevation in mood similar to that provided by antidepressants. The finding reinforced earlier studies in the former Soviet Union and China. The Arizona researchers, along with scientists at Stanford University, are conducting a larger study of 150 women.

"While the initial results were encouraging," says Rachel Manber, a Stanford University psychologist and research team member, "they aren't conclusive. . . . But this might be a viable option for women who are pregnant or lactating and don't want to take medication."

RX: EXERCISE

Numerous studies have shown exercise to be an excellent antidote for mild to moderate depression. And over the long haul, researchers say, it may work better than medication in controlling symptoms.

"We still don't understand the mechanisms behind this -- whether it's a change in brain chemistry or they just feel better because they mastered something challenging," says James Blumenthal, a Duke University psychologist and co-author of a 2000 study on the long-term effects of exercise.

"But we do know it works."

Duke researchers studied the effects of exercise on 156 volunteers older than age 50 who were diagnosed with a major depressive disorder. The test subjects were given a regimen of exercise, medication or a combination of both.

After 16 weeks, all three groups' progress against depression was similar, although those who took anti-depressants got faster relief from their symptoms. But a follow-up study 10 months later found exercise groups had a significantly lower relapse rate than those on medication only. And the more participants exercised, the better they felt.

That's certainly what happened to Gary Watkins. Every winter, the 56-year-old Durham, N.C., man would lapse into an ever-deepening funk as the days got shorter. He tried medication, but it stunted his emotions so he stopped taking it. Yet he knew he had to do something.

Enrolling in the Duke University study got him started on a regular exercise regimen that he continues.

"It's hard to get yourself moving when you're depressed,' says Watkins, who still works out on the treadmill on his lunch hour and runs cross-country. "But for me, exercise is the best way to control my depression."

Source: Los Angeles Times

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"Love is the only rational act."
- Levine

Who comes first, you or your relationship? Although answering "the relationship" may sound honorable and based on a deep level of love and commitment, its an unhealthy and destructive way to live. It is only when you can honor and love yourself first, that the relationship can be a truly loving one and not one based on need, dependency, fear, or insecurities. When each partner comes to the relationship whole, the relationship becomes an enhancement of your life and not life itself.

Most of you have flown on an airplane. Have you ever wondered why they tell you to put your OWN mask on first, before you help your child? Seems kinda selfish, doesn't it? I mean, we've been taught that the ultimate in love is self sacrifice, right? Why do these airlines tell us to save ourselves first?!? There's a practical reason they instruct you to do this. Think about it. How can you help someone when you're unconscious or struggling for breath?

Love is similar to that air mask. You can't fully love another unless you love yourself FIRST. Strap that air mask on good and tight, and you can love an endless amount. If you don't love yourself first, you have no love to give. If you truly put yourself first in love, nurture yourself, honor what you want, and make YOUR happiness the number one priority, you are better equipped to love others. Love deeper. We love others to the degree we love ourselves.

And as I've said, part of loving one's self is accepting (being okay with) who we are. Consequently, we love to the degree we're happy. While we are unhappy and attending to our fears, we are not loving. The self is always crying out for acceptance. When we deny ourselves that acceptance, life gets twisted. Our attention gets sucked into a void inside ourselves, leaving nothing left to give to another.

 

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How active you are may be the key to effective treatment.

For years, parents of anorexic girls have been told to avoid arguments over food and give up their failed fight for control over their daughters' bodies. But when Claire and Bob Donovan walked through the doors of Children's Hospital of Michigan with their bone-thin daughter Megan, they were put squarely in charge.

Megan had starved herself down to 85 pounds. To save her life, therapists said, her parents would have to dispense food as if it were a prescription drug. They would gently but firmly tell her to rest in bed when she didn't eat. And they would reward her with trips to the mall when she did. Later, as Megan's health returned, they would begin to let go of their little girl and give the 17-year-old greater independence in choosing her college and spending time with friends.

Using parents as tools in treating adolescent anorexia is a radical new approach being discussed and taught this week, May 4 through 7, at the 9th International Conference on Eating Disorders in New York City. The conventional wisdom has been that family conflict sets the stage for teenage eating disorders, so therapists usually counseled parents to steer clear and allow teens to take charge of their recovery from the eating disorder. But a growing number of therapists, like Megan's, say that specially trained parents are perhaps the most effective cure -- and recent research backs them up.

Giving Food as Medicine

"These young girls are out of control when they come to see us. They are not able to take charge of anything," says Patricia T. Siegel, PhD, a pediatric psychologist at Children's Hospital in Detroit. Siegel discussed Megan's case with WebMD, but changed the family members' names to protect their privacy. "We told Megan's parents that their child was sick -- that she could not make herself better any more than if she had a cardiac problem. We put the parents in charge of giving their daughter her medicine. In this case the medicine was food."

This approach to the treatment of anorexia made headlines six months ago after Arthur L. Robin, PhD, published findings of a long-term study in the December 1999 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Robin, a professor of psychiatry and behavioral neurosciences at Wayne State University, and his colleagues followed 37 girls. Eighteen of them were treated in individual therapy sessions; their parents were counseled separately and told to give up cajoling or ordering their daughters to eat. The other 19 girls and their parents met jointly with therapists who put the parents in charge of their daughters' eating.

The majority of girls in both groups responded well to treatment: 70% reached their target weight. But the girls whose parents were trained to oversee their food gained weight faster and gained more weight. One year later, even more of those girls had reached healthy weights.

Dispelling the Toxic Family

"The older point of view was that families of anorexic girls were in some way toxic," says Robin. It's true that family problems often contribute to anorexia, Robin says, but it's also true that parents can become a therapist's best allies. Indeed, Ivan Eisler, PhD, a London University psychologist who is leading the training workshop in New York this week, says girls whose parents are directly involved in therapy "in many cases may require no more than a few sessions to achieve good results."

One reason parents can become so effective is that they're with their daughter for hours each day. When properly trained, they can monitor and guide the eating process, says Amy Baker Dennis, PhD, an assistant professor at Wayne State University Medical School, and director of training and education for the Academy for Eating Disorders. Also, parents intimately know their daughter and her social life. When a truce is called in the battle for control, they can help her solve problems and surmount the hurdles she faces. Moreover, the new style of treatment doesn't prevent a family from using therapy to work on issues that may have contributed to the eating disorder.

Dennis cautions that this approach won't work for all families. Girls whose parents have serious problems of their own -- substance abuse or mental illness -- are still best treated individually, she says.

Dinner Wins a Trip to the Mall

When Megan's family walked through the doors of Children's Hospital, Megan was a high-school senior who had lost 50 pounds in six months. Siegel first reassured the girl's parents that they were not to blame for her illness. "This approach neutralizes the parents' sense of guilt and engages them," she says.

Then Siegel placed Claire and Bob in charge of preparing meals planned by a dietitian. They never forced Megan to eat. "That was Megan's one responsibility," Siegel says. Instead, Siegel trained the Donovans in how to use behavioral incentives to subtly encourage Megan to eat. For instance, when Megan refused food, her parents required her to rest quietly to conserve her energy. When she ate, they gave her both small and large rewards. Eating a healthy dinner could earn her a trip to the mall with her friends. And when the scale showed Megan weighed 100 pounds -- a difficult mark for her to achieve -- they took her to Chicago to shop for a prom dress.

The first several months of treatment were not easy. Megan, who said she looked and felt great at 85 pounds, was often hostile and deceptive. She would hide food in a napkin to avoid eating, or put coins in her panties before she was weighed. Siegel coached the Donovans on how to hang tough. "The therapist needs to convey to the parents that he or she will see them through this and keep them in control of their daughter," Siegel says.

Parents Learn to Let Go

Once Megan had achieved her target weight of 115 pounds, the focus of therapy shifted gears. Siegel began to concentrate on family issues that would keep Megan healthy. For years an avid dancer who spent many hours each week practicing, Megan now wanted to enjoy a more relaxed teenage life. Claire, proud of her role as a "dance parent," realized that she had unconsciously pressured Megan to stick with her dancing. "Megan wanted more time with her peer group but had never known how to tell her parents that," Siegel says.

Once Megan's parents understood what she needed, they supported her moves toward independence, including her plan to go away to college the following fall. Siegel helped the Donovans balance their anxiety about letting go of their child with an enjoyment of their newfound free time for themselves and for each other. "They began golfing and traveling together," Siegel says. "A chapter needed to be closed in their lives, and they were able to close it."

Susan Chollar is a freelance writer who has written about health, behavior, and science for Woman's Day, Health, American Health, McCall's, and Redbook. She lives in Corralitos, Calif.

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Late-life depression affects about 6 million Americans age 65 and older, but only 10% receive treatment

Doctors say the typical image of the moaning old bag could be hindering attempts to deal with one of the most common ailments of old age, depression.

The elderly are the highest risk group for suicide, while health experts warn of the impact of mental illness on physical well-being.

Millions of elderly people suffer from depression - it's estimated twice the number who have dementia - yet it mostly goes undetected and untreated.

Part of the reason is ageism: people, including doctors and old people themselves, expect the elderly to feel down and do not consider this as a treatable illness.

Other likely reasons are that the elderly do not like to bother their doctors or that they fear the stigma of mental illness or that admitting a problem could lead to them losing their independence.

Assessment of Depression in Seniors

A simple questionnaire assessing depression in elderly people could tackle the problem and improve mental health and its effects on physical well-being.

The Geriatric Depression Scale (GDS) comes in a short (15 questions) and long (30 questions) form. It contains questions on physical, mental and social well-being. The GDS relies more on people's perceptions of their own well-being.

Answers to the questions may prompt further, more detailed, questions or may require a trip to the family doctor.

Complete the short form or long form and share the results with your doctor.

The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week. Or for a crisis center in your area, go here.

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UK legal resources for ADHD problems related to education, the criminal justice system, health and financial assistance.

Legal Assistance for ADHD Education Issues

Do you need help with any of the following?

The Code of Practice and how it applies to your child

Your child's Statement of Special Educational Need

Preparing for a Tribunal in order to contest what your LEA wish to do for your child

Are you having difficulties with your LEA

a. arranging specialist provision for your child?
b. refusing or delaying to take the necessary steps for your child?

If so, the following organisations may be able to help:

Organisations offering free help and advice

As far as help with a possible tribunal is concerned The Disability Law Service will offer parents free legal advice. They can be reached at Tel: 0207 7919800. Email: advice@dls.org.uk

Education Law Association: Membership of ELAS is open to anyone interested in education law and consists of legal practitioners, academic lawyers, educational establishments and others who provide educational advice. The organisation aims to promote good practice in educational advice, to develop expertise in the practice of education law and to increase co-operation between lawyers and others working on educational issues. Anyone who wants to consult a solicitor experienced in education law may contact the association at the address below.
37d Grimston Avenue, Folkstone, Kent CT20 2QD - Tel/Fax: 01303 211 570
Email: elassec@btinternet.com

IPSEA: the Independent Panel for Special Education Advice, is a registered charity providing advice on LEAs' legal duties towards children with special educational needs. It offers free second professional opinions for parents who disagree with an LEA's assessment of their child and free representation at the Special Needs tribunal when parents want to appeal against an LEA decision. All these services are provided by volunteers (who might be teachers, EPs, etc) who have undergone specialist training. The Advice Line telephone number is 0800 018 4016 or 01394 382814. For Tribunal appeals only: 01394 384711, and general enquiries 01394 380518.

ISEA (Scotland) is at 164 High Street, Dalkeith, EH22 lAY, Parents' Advice Line 0131 4540082.

IPSEA have published a book Taking Action! Your Child's Right to Special Education (Second Edition) Authors John Wright and David Ruebain. Questions Publishing Company, 1999. ISBN No 1-84190-010-9. £14.99 + p&p. Buy on-line at http://www.educationquest.com/. Credit card hotline: 0121 2120919.

The following may also have some advice or answers for you

Advisory Centre for Education (ACE) (Free Help line 0808 800 5793 open every afternoon) which also publishes many helpful handbooks including the ACE Special Educational Handbook, Tribunal Toolkit: Going to the SEN Tribunal; Appealing for a School, and various Summaries of the Law.

British Dyslexia Association 0118 9668271

National Autistic Society, Education Advocacy Help line 0800 3588667, Tribunal Support Scheme 0800 3588668

Network 81 01279 647415

Rathbone Special Education Advice (for children in mainstream schools) 0800 9176790

The amount of time and resources these organisations have to spare is limited, however.

Legal Firms

If your case is likely to need a lot of time spent on it, you may need to contact a firm of solicitors. All the legal firms will charge full professional fees for their services; so ask about their fee structure before you get too involved. Most firms, however, will offer a short consultation with you first, free of charge, so that they can gauge your needs exactly. You are no longer able to apply for legal aid for SEN Tribunal hearings; you may be able to for a case going to the High Court. Consult your adviser.

The following solicitors are experienced in dealing with issues connected with Special Needs and Statementing, Appeals and Tribunals, breaches of statutory duty and negligence, bullying and exclusions:

Ms Eleanor Wright, Maxwell Gillott (London) Tel No 0844 858 3900
Ms Angela Jackman, Maxwell Gillott (London) Tel No 0844 858 3900
Mr Robert Love, A E Smith & Son (Stroud, Glos) Tel No 01453757444
Mr David Ruebain, David Levene & Co (Haringey) Tel No 0208 8817777
Mrs Susannah Arthur, Gabb & Co (Crickhowell, Powys') Tel No 01873 810629 Also at Abergavenny, Hereford, Leominster Hay-on-Wye.
Mr Paul Conrathe, Coningsbys Solicitors (Croydon) Tel No 0208 6805575
Mr Michael Jones, Hugh James (Cardiff) Tel No 0292 0224871
Ms Elaine Maxwell, Elaine Maxwell & Co (Lancaster) Tel No 01524 8408100
Mr Felix Moss, Rust, Moss Solicitors (Accrington) Tel No 01254 390015
Ms Melinda Nettleton, SEN Legal Services (Bury St Edmunds) Tel No 01284 723952
Ms Sarah Palmer, Blake Lapthorn Solicitors (Hants) Tel No 01489 579990
Mr Jack Rabinowicz, Teacher, Stem, Selby (Holborn) Tel No 0207 2423191
Mr Phi Storey, Young & Lee (Birmingham) Tel No 0121633 3233
Ms Yvonne Spencer, Fisher Jones Greenwood Tel No 01206 578282

In addition, a barrister in independent practice who can be approached directly is:

Mr Peter Bibby,Peter Bibby Tel: 0208 693 8752

NB: Most solicitors specialising in Special Educational Needs issues will also specialise in Community Care Law relating to disabilities.

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SEN in Mainstream schools:

Rathbones has a good selection of free information sheets covering a number of problems: exclusion, how to complain, finding funding, etc. Ring them on 0800 917 6790.

The Qualifications and Curriculum Authority (QCA) is committed to building a world-class education and training framework that meets the changing needs of individuals, business and society. We lead developments in curriculum, assessments, examinations and qualifications.

Special arrangements for the National Curriculum Assessment
Further clarification and information about some changes to special arrangements for the National Curriculum Assessment Tests are included in the Assessment and Reporting Arrangements booklets which QCA sent to all schools in October. These include:
· use of prompters;
· compensatory awards in the mental maths and spelling tests for pupils with profound hearing loss;
· special consideration - allows a pupil's final level to be adjusted in very exceptional circumstances;
· dealing with disruption during the test.

Guidance has also been updated on the use of word processors, amanuenses, transcripts and readers; special arrangements for the mental maths tests, and rest breaks. There is also more detailed guidance on the use of additional time and early opening of papers.
The booklets are available from QCA publications, Tel: 01787 884444 and at: http://www.qca.org.uk/ 

Legal Help for ADHD-Related Issues in UK

www.qca.org.ukk

ADHD Adults and the Criminal Justice System:

Young adults with ADHD may find themselves in trouble with the police. A list of solicitors specialising in criminal law who also have a knowledge of Asperger Syndrome has been compiled by and is available from the Asperger Backup Campaign (01202 399208).

Levines - is a law firm who have some experience in all aspects of the legal system and awareness of ADHD and associated conditions - they have specialist advisors for SEN Tribunal, Childrens Law, Educational Law, Prison Law and most other other aspects of the Law. "I have spoken to a couple of people within this company and they have been very helpful and have said that they are happy to speak to anyone about the Law and take on cases for those who have ADHD for which they do have experience especially with education and criminal law" CH Ed
Website: Levenes

Fisher Meredith - is a law firm who have some experience in all aspects of the legal system and awareness of ADHD and associated conditions - they have specialist advisors for SEN Tribunal, Childrens Law, Educational Law, Prison Law and most other other aspects of the Law. "I have spoken to a couple of people within this company and they have been very helpful and have said that they are happy to speak to anyone about the Law and take on cases for those who have ADHD for which they do have experience especially with education and criminal law" CH Ed
Website: Fisher Meredith

Fisher Jones Greenwood LLP - is a law firm who have experience in all aspects of the legal system but especially with things like: "Education: Special educational needs, Exclusions and disciplinary matters, Children out of school, Attendance and truancy, Examination results, Choice of schools, Sick children, School transport, Human rights and judicial reviews, Disability discrimination, Education negligence. Community Rights: Access to statutory services, Community care law, Young people leaving care, Disability discrimination, Housing, Homelessness, Welfare Benefits. We are always pleased to give talks and presentations to community groups and charities on all aspects of our work at no cost. We are able to offer free specialist legal advice to those on low incomes or welfare benefits through the Legal Aid scheme."
Fisher Jones Greenwood LLP

There is also the Disability Law Service:
Disability Law Service, Ground Floor, 39-45 Cavell Street, London E1 2BP
Tel: 020 7791 9800, Fax: 020 7791 9802, Textphone: 020 7791 9801, Helpline: 020 7791 9800
Email: advice@dls.org.uk
Website: http://www.dls.org.uk/index.html
Provides free, confidential legal advice to disabled people, their families, carers and enablers throughout the UK.

Sinclairs Solicitors - Are a specialist education law practice with a legal aid franchise in the subject. They are one of the few firms that specialise in both school and Higher Education matters covering support not only for children but to adults. They also work with specialist knowledge of criminal law and medical difficulties.
Sinclairs Solicitors

Maxwell Gillott Solicitors - We are a specialist firm, working in the fields of education law, special educational needs, clinical negligence and medical law. We act for people throughout England and Wales on all aspects of education and medical law, advising them on their rights, representing them at Tribunals and panels, and bringing Court actions where necessary. Most of our work is for children with disabilities, but we will act for people of all ages who have problems in these areas
Maxwell Gillott Solicitors

OTHER HELP

Health Service Problems:

AvMA - How we can help you. AvMA has a team of medically and legally trained caseworkers who can provide free and confidential advice following a medical accident. This includes advice on your rights; medical information or explanations; help in getting the issues investigated; assessment of potential for obtaining compensation; and other sources of practical and emotional support. They have some fantastic advice online including how to complain about problems within the health service, access to medical records as well as loads of other information, help and advice on your rights and also details of solicitors who are specialised in this area. Certainly worth a visit when there are problems like this to get the best up to date information on your rights within the NHS.

Financial:

Fielding Porter Solicitors (Bolton) Tel: 01204 591123 is a legal practice whose Mental Health Department offers expertise to parents concerned about the best way to organise their own financial affairs on behalf of their child, or the child's own finances. The firm offers parents a free, brief consultation over the phone. Speak to Ms Catherine Grimshaw.

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In recovery, I am learning how to remain neutral in certain situations.

For example, the other day an acquaintance of mine (I'll call her Mary) called inquiring about mutual friends, who had recently gone through a divorce. Mary wanted to know all the details about a particular person's divorce and started making critical remarks about one of the partners.

Rather than taking sides, I remained neutral. I could easily have defended my friend or joined into the criticism. I could have given out all kinds of supporting details. But I chose not to do so. Criticism, fault-finding, and blame don't help me, my friends, or anyone involved. It just doesn't help.

When Mary started asking me about all the gory details as to the "why" of the divorce, I responded by saying (in a polite tone), "You know, there really are two sides to the story and I've heard both sides. I'm sure they (i.e., the couple) would appreciate your wanting to get the story straight from them rather than from me."

This response allowed me to remain neutral and keep myself and my opinions and judgments out of the conversation. For me, this is healthy. For me, this is also honoring my friend, because I don't want Mary going to this person and saying, "Well, you know Toma told me thus-and-so . . ."

See what I mean?

Other situations where I am learning to remain neutral are arguments between my employees; arguments between my ex-wife and my kids; and discussions with my parents about my siblings. I practice the same principle at church, and whenever I'm around my ex-wife's friends and family.

Participating in destructive, unhealthy conversations and gossip circles only promotes harm, hurt feelings, and in the end, benefits no one.

As a recovering co-dependent, I refuse to be drawn into such conversations or situations where I become a go-between or a link in a gossip chain.

There are appropriate and healthy times to discuss and/or disclose such information. But there are more inappropriate and unhealthy opportunities to do so. In recovery, I am learning to discern the difference.

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No matter how much weight is lost, or no matter how much food is thrown up, the person with anorexia, bulimia or binge eating disorder will constantly see the same overweight, vile, failure in the mirror. This typically leads to very destructive and even deadly methods of weight loss in a desperate attempt to lose the distorted perception - in this case, fat. It is very hard, though, for anyone that does not have an eating disorder to be able to understand just how someone could do this to themselves - go through hospitalizations and near death experiences even - but continually see themselves so distorted. Even though body dysmorphic disorder (BDD) isn't just shown in cases of eating disorders (someone afflicted with BDD can obsess not about weight, but instead about their hair, nose, chest, etc.), it still hurts and ruins the lives of whoever is afflicted with it.

About Body Dysmorphic Disorder

At one time or another we all worry about our appearance, but when you wake up degrading your nose, hair, chest, weight, etc. and then continuing to have these thoughts all day, that's when there is a problem. Closely linked to other disorders and psychiatric conditions, body dysmorphic disorder is a serious disorder that is growing fast. People that suffer from BDD not only dislike some aspect of how they look, they're preoccupied severely with it. Most get to the point where it is very hard to go outside or sit down comfortably, or go to work and talk to others, without thinking the self-degrading thoughts about their flaws. The thoughts soon overtake the person's mind and it is all he/she can think about.

The problem, though, is that all of these self-degrading thoughts about a perceived flaw are distorted. Many, many times the supposed flaw doesn't even exist, or an "imperfect" body part is blown entirely out of proportion. However, the person themselves cannot see that what they believe is distorted. Many hold the belief that they are seeing all of this, therefore it MUST be true. This is one of the main reasons that it is so hard for people on the "outside" to try and convince even the most severely emaciated people with anorexia that they are not fat or failures - the people with anorexia and/or bulimia themselves literally cannot look in the mirror and see the same person that everyone else sees.

Kinda like a cloud i was up way up in the sky
and i was feeling some feelings you wouldn't believe
Sometimes i don't believe them myself
and i decided i was never coming down
Just then a tiny little dot caught my eye
It was just about too small to see
but i watched it way too long
...and that dot was pulling me down-NIN

Who Body Dysmorphic Disorder Affects

It's estimated that body dysmorphic disorder affects 1 in 50 people, mostly teenagers and 20-somethings with either a gradual or abrupt onset. Often the person is a perfectionist, like most people with eating disorders. Nothing is good enough because the person cannot see that what they have done is absolutely fine, or that they are on the border of near death (in the case of anorexia and extreme weight loss). Low self-esteem is a trademark of those with BDD as they feel like colossal failures for their perceived physical flaws.

Problems Commonly Found with Body Dysmorphic Disorder

BDD can lead or take after other psychiatric problems as well. Depression, obsessive-compulsive disorder, eating disorders, anxiety issues, agoraphobia, and trichotillomania (hair pulling) are all problems that commonly follow or trigger BDD.

One person that I know that is in treatment for BDD and other issues became afflicted after a rape. Although she doesn't fit the common statistics in that she is 32 and Latino, the BDD immediately showed itself after the incident. She felt that the rapist was "inside of her" somehow and making her "ugly and disgustingly horrid from the inside out." She began to check her face and nude body in the mirror. At her worse, she was doing this about 5 hours a day. She felt degraded and disgusting from what happened to her, believing that only something that was disgusting and worthless and ugly could be raped. Eventually, the isolation and weird habits pushed her family to convince her to get help (thankfully). It took a lot of persistence, though, since she did not believe there was a problem, even in her most severely depressed times.

Body Dysmorphic Disorder Treatment

Often body dysmorphic disorder is misdiagnosed because doctors tend to have a lack of familiarity with the disorder. Many times those afflicted feel so ashamed and worthless that they downplay the problem or do not even recognize that they need help, so they end up staying in hiding. Families may even trivialize this problem, not realizing that this extreme distortion cannot be resolved through "getting over it" or calling it a "phase." However, when you or someone you know is ready to accept help and is willing to get it, there are therapists out there that specialize in treating distortion cases while new methods of treatment for Body Dysmorphic Disorder are currently being studied.

One recent study was made where 17 individuals, all diagnosed with BDD, spent 4 weeks of daily 90 minute sessions with therapists. Cognitive behavior therapy was used to treat their conditions. Further treatment for body dysmorphic disorder included having them exposed to their perceived physical defect, and they were prevented from engaging in any behaviors that increased the discomfort and triggered the BDD more. In the cognitive behavior therapy, the individuals were also taught how to resist compulsive behaviors and face avoided situations. At the end of this study, a significant decrease was found in the individuals' preoccupations and time spent engaged in destructive behaviors and thoughts.

Common anti-depressants were also used to help further the treatment. Prozac, Zoloft, Paxil, Luvox, and Anafranil are all common antidepressants that are used to treat this disorder (as well as depression), and they have all been shown to help stop the behaviors associated with body dysmorphic disorder.

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