Brought to you by Harriet Kohen, MSW, LICSW

Routines are soothing. Think about babies and how they are wired for feeding and sleeping routines.  Routines can allow the scariness and separation of bedtime to be absorbed by predicable schedules and activities for most toddlers and school age children. Routines and rituals can mean the difference between healing sleep and hours of wakefulness.

Routines decrease anxiety and lowers resistance to regular tasks, according to Dr. Howard. Tooth brushing and taking out the trash become expected. Routines also send important messages to children and reinforce a sense of belonging. When a family experiences major stress such as a job loss or chronic illness, routines provide stability.

Family without routines tends to be chaotic. Perhaps this is due to high levels of parental stress pr depression or anxiety in a parent.

Family meals, consistent homework times, and rules about curfews tend to promote academic success and lessen behavioral problems for adolescents.

Routines also help children stay organized so they can fit in exercise, socializing and faith-based programs. They protect children feel more confident about their daily life.

Routines convey value or meaning and help to communicate to children what’s important to the family. Parents are encouraged to explain routines in a clear way especially to children who are anxious. For example, instead of saying you’ll “try” to do something, just do it or explain why it can’t be done and make alternate plans.

Routines can be simple so they can be easily repeated. If your child becomes rigid about routines, this could be a coping strategy, especially if your child is 2-7 years old. You can always visit with your pediatrician if you’re concerned.

Although rituals and routines overlap, a routine is something done the same way over and over and a ritual is a routine with symbolic value.

If you would like to consult about ways to introduce or streamline routines and rituals in your family, consider a consult with Harriet Kohen, LICSW or Anne Ford, LICSW at Partners in Healing at 763-546-5797. WE CAN HELP.

*Pediatric News, November 2011.

Did you know that children’s and adolescent’s behaviors can talk? 

• “I hate school!”

• “I forgot my homework—again.”

• “My stomach hurts; do I have to go to school?”

At the Institute for Brain Behavior Integration (IBBI) we believe that children and adolescents often use their behaviors to tell us that something is not quite right. Our brains are made up of a series of interacting modules:

• auditory and visual processing
• attention and memory
• complex problem solving
• reading and language
• motor skills

Learning requires these modules to work in concert in order to produce a written, oral, or behavioral response.  A breakdown in one of these areas can interfere with your child’s ability to learn and achieve academic success.  And, since children and many adolescents are not aware of how their brains work, they use their behaviors to communicate with their parents. Most often, defiance and noncompliance regarding homework can be ‘tip-off’s’ that they have an undiagnosed learning disability that can give rise to depression if not recognized.

How Can You Tell if Your Child or Adolescent May have a Learning Disability

Here are some simple clues:

• Poor Handwriting
• Tends to be clumsy
• Meltdowns while doing homework
• Reads in a slow and choppy manner
• Difficulty sounding out and spelling words
• Delays in fine and gross motor skills
• Family history of learning disabilities
• Speaks and/or writes in short, choppy sentences
• Homework is returned with many comments from the teacher

Substance Abuse, Depression & Learning

It is well documented that learning disabilities and substance abuse go hand-in-hand. Adolescents with an undiagnosed learning disability tend to personalize their academic underachievement rather than attribute it to how their brain processes information. They may develop depression-generating thoughts such as:

What’s wrong with ME? How could I be so stupid? I am such a loser.

When thoughts such as these go unchecked, they begin to take on a life of their own and can negatively shape a child’s self-perception. By adolescence, negative thoughts and habits may have become ingrained, affecting friend choices as well as their relationship with their parents. Adolescents with undiagnosed learning disabilities not only have higher rates of depression, their rate of substance abuse is also much higher than that of their peers.

How a Neuropsychological Evaluation Can Help

An evaluation at the Institute for Brain-Behavior Integration can be an important step in putting your child or adolescent back on a path to success.  IBBI evaluations focus on the pathways between brain functioning and daily behavioral functioning. We work to identify resources that help clients improve day-to-day functioning by improving the integrative functions of the brain through various therapy tools we utilize. This can result in positive changes to school performance, relationship health in families and with peers, and benefit social relating skills. 

By Nancy Foster, PhD

We are very happy to welcome Anne J. Ford, MSW, LICSW, to Partners in Healing of Minneapolis.  Anne brings over 15 years of therapeutic experience working with children, teenagers, parents, adults, couples and groups.  She specializes in ADHD, High Functioning Autism and Asperger's syndrome.  To schedule with Anne J. Ford, please contact us at 763-546-5797 or info@pih-mpls.com. 

by Deborah Simmons, PhD, LMFT

As Fall approaches, some households will see the youngest in the family leave for college or for independent living.  For parents who have enjoyed the chaotic pleasure of raising children, the transition to an Empty Nest can bring many emotions and reflection.  Grief, pride, fear, and relief can sit right next to each other. For some marriages, the needs or stresses of parenting have overshadowed the marital relationship.  The transition to the Empty Nest can raise questions and even concerns about what comes next.  Just as young adults have many new experiences in their exploration away from the nest, parents and marriages can find new areas of exploration. 

Here is a list of questions that our team at Partners in Healing have developed to help guide reflection and awaken curiosity about this transition to the next phase of life.  We wish you a smooth transition.  If you find that you have deeper concerns or need more guidance, come see us here at Partners in Healing.  Contact us at 763-546-5797 or info@pih-mpls.com.

• Who am I now at this stage of my life?  
• Where have I/we just been?
• What has parenting been like for you/me/us?
• What did I/you miss for all these years?
• What has been joyful or enjoyable in those years?
• How are I/you different now than before having children?
• What are I/you/me looking forward to now?
• What are I/you/we passionate about now?
• What has not been said in our relationship?  
• How do I/we find passion again?  
• What are our expectations of ourselves and each other now?  
• What are my/your/our dreams now?  
• What are my/our life goals now?  

As Fall begins, families gear up for many transitions that traditionally happen at this time of year. Some children will begin school for the first time, some will start or transfer to a new school, which can mean leaving old friends, and some children begin junior or senior high.  The lazy days of summer are over. There are new schedules to follow, an increased pace of life with sports, clubs, socializing and homework.  How can parents support their children during these times when stress and worry can develop and before new routines are created? 

To help ease these transitions:

• Review all the information the school sends about special dates, bus schedules, after school activities, emergency forms and class room assignments.
• Record important dates on the family calendar so that you can juggle your schedule, especially if you have children in more than one school.
• Re-establish bedtime and meal routines and stress the importance of getting adequate rest.
• Reduce TV and non-homework electronic time to 2 hours or less per week.
• Support your child’s visit to their new school and visit it with them if possible.
• Help your child organize their workspace for homework.
• And if your child is stressed, use your best listening skills. Do not overreact. Remain calm and positive. Reinforce your child’s ability to cope.

How parents can help when problems arise.
If your child demonstrates problems that seem extreme in nature or go on for an extended period, you may want to contact the school to set up an appointment to meet with your child’s teachers and school counselor. They may be able to offer direct or indirect support that will help identify and reduce the presenting problem. They may also suggest other resources within the school and the community to help you address the situation.
While children can display a variety of behaviors, it is generally wise not to over-interpret those behaviors. More often than not, time and a few intervention strategies will remedy the problem. Most children are wonderfully resilient and, with your support and encouragement, will thrive throughout their school experience.

However, when these problems persist and solutions seem unavailable, know that our knowledgeable staff of child, adolescent and family therapists are available to meet your needs.  Give us a call so we can extend our help to you.

By Harriet Kohen, MA, LICSW

Resources
Clark, L. (1996). SOS: Help for parents (2nd ed.). Berkley, CA: Parents’ Press. ISBN: 0935111204.
Dawson, M. P. (2004). Homework: A guide for parents. In A. Canter, L. Paige, M. Roth, I. Romero, & S. Carroll (Eds.), Helping children at home and school II: Handouts for families and educators. Bethesda, MD: National Association of School Psychologists.
Rimm, S. (1996). Dr. Sylvia Rimm’s smart parenting: How to raise a happy, achieving child. New York: Crown. ASIN: 0517700638.
Some of this material was reprinted from Back-to School Transitions: Tips for Parents,             
by Ted Feinberg, EdD, NCSP, & Katherine C. Cowan National Association of School Psychologists

(Brought to you by Harriet Kohen, MSW, LICSW)

Parents, are you wondering how to foster greater self regulation skills in your children? David Walsh, founder of the National Institute on the Media and the Family, addresses this question in a recent article in the Star Tribune. I found it helpful for thinking about ways to coach parents to develop strategies to encourage more resilient children by understanding their developmental needs.  Who's in charge in your family?

Need more guidance with your kids?  Schedule an appointment with Harriet Kohen at 763-546-5797 or info@pih-mpls.com. 

HARNESS KIDS' BRAIN POWER

Julie Pfitziner, Star Tribune
David Walsh studies the brains of today's kids, a task their own parents might be reluctant to do.  Walsh, founder of the National Institute on Media and the Family and author of several books, has become an internationally known family-life expert and a go-to source for parents looking to better understand their children throughout their various ages and stages, from newborn to teenager.

Walsh, who lives in Minneapolis, has a new book called Smart Parenting, Smarter Kids: The One Brain Book You Need to Help Your Child Grow Brighter, Healthier and Happier (Free Press, 292 pages, $25), which tackles the subject of brain development as it relates to topics including intelligence, memory, connection, exercise and the impact of technology.

We asked Walsh to comment on a few of many key messages in his book on how, by acquiring greater understanding of the many facets of their child's brain, parents can enhance their parenting skills.

"A constant drumbeat of 'more, fast, easy and fun' undermines 21st-century parents' attempts to foster self-discipline in their children."

Walsh: The unintended consequence of the self-esteem movement, launched by the publication of "The Psychology of Self-Esteem" by Nathaniel Branden in 1969, is that parents started to develop an allergic reaction to kids feeling bad. This has led to an epidemic of what I call discipline deficit disorder in kids: distraction, disrespect, impatience, need for instant gratification, sense of entitlement, unrealistic expectations and self-centeredness.

If we constantly praise our kids, it can make them risk-averse. For example, if children are repeatedly told how smart they are, they want to maintain their identity as being smart. They won't want to risk doing something they might not be good at for fear of losing that identity. Kids can't control their innate ability, but they do have control over their efforts. And if we praise them for their efforts, they will work harder.

"The key to a child's language success is conversation. Social interaction with a child is critical for any number of reasons, and language is an essential ingredient."

Walsh: There are so many opportunities for parents to engage their child in conversation, and it is especially important for kids to learn how to express themselves, to spend time talking face-to-face and to learn how to read nonverbal cues and tone of voice. We need practice developing these skills and the time to do it is when you are growing up.

None of these skills are activated when we're doing online communication, which is one of the reasons it is so easy for kids to say mean things to each other online. I'm not against technology, but for some kids, technology is taking over their lives. I have an example in the book of a 12-year-old girl named Meaghan who got to the point where she was sending 1,000 texts per day.

Be clear with kids that technology can have a place in the world, but there have to be tech-free zones imposed around the dinner table and during family activities.

"Whatever the brain does a lot of is what the brain gets good at."

Walsh: There are two types of attention: reactive, which is an automatic response to a situation, and focused, which is important for critical thinking. There are so many triggers for reactive thinking. That is why I encourage parents to limit the distractions of media and technology.

Some of the classic games such as "I Spy" or "Where's Waldo" can really help kids develop focused attention. Any kind of sustained concentration helps build memory -- it's like building scaffolds and the more elaborate the scaffolding is, the more places the child has to build upon.

"While we've known for a long time that exercise builds strong muscles and a healthy heart, neuroscientists have found that moving and exercising our muscles directly builds better brains."

Walsh: Our brains -- which are the master control for our entire bodies -- don't do well with all the sedentary activity we have in our lives. When we exercise, our brains are energized. Recent research reveals the brain-derived neurotrophic factor, a chemical which is likened to "Miracle-Gro for the brain," is transported when our hearts are beating vigorously during physical activity, which can then strengthen the neurons in our brains. If we get kids moving, we are helping them to improve their brain function.

(Brought to you by Dr. David Alter)

 Spring is coming.  It is a season of renewal, of new  beginnings that restore hope and offer to give us a fresh start.  So, how do we get a fresh start when we so often drag the past around with us?  What are the steps we can take that really make a difference in how the sense of connection we feel to others and to ourselves?  In this inspiring 20-minute talk, Dr. Brene Brown gives us a simple but powerful answer that can not only give us a fresh start this coming spring season, but opens the doors to a life transformed!  Enjoy! 560x349]

Brought to you by Harriet Kohen, LICSW

I have learned over the years that kids have plenty to say.  I thought you would enjoy this article by Jeff Opdyke in the Wall Street Journal.

By JEFF D. OPDYKE

Wall Street Journal  November 28, 2010I picked up my 14-year-old son from school two weeks ago. I smiled at him. He laughed...and then he got mad.
That morning, an orthodontist had slapped braces on my teeth. I smiled to show my son, who is just weeks away from getting his braces off. While at first he thought it was funny that Dad had braces too, he quickly realized I'd gotten the clear braces; his are full-metal jacket.

"How much extra was that?" he asked. I told him $500. "Why didn't I get those? Why do I have to get the ugly braces and you get the ones that don't look as bad?" He was miffed, and raised the topic again with his mom that night.

Later, as I thought more about it, I started to realize that something is wrong with this picture. Why does my son believe -- no, assume -- that he and I should spend the same amount of money on our respective braces.

The answer, I also realized, is because of the way I've raised him, and it was yet another illustration of something I (and readers) have mentioned before: the blurring of the lines between so many parents and children. Many kids these days see themselves as fully empowered members of the family, with opinions that carry just as much weight as their parents' opinions do.

That's not always bad. But we parents today have gone overboard. We have inadvertently created kids who think they have the power to dictate what happens in the family -- from where we go to eat to where we vacation to the kinds of braces we each deserve.  It's time, I would argue, to take back control.
Most parents my age -- I'll be 45 in January -- grew up in a time when our choices were limited to one: Whatever Mom and Dad said you were doing, you did.                                                                If my grandparents, who raised me in South Louisiana, said that we were going to visit my uncle in Mississippi over the weekend, I had no other option but to go to Mississippi, no matter how much I didn't want to. If they said Friday night dinner was at the Piccadilly restaurant, I couldn't counter with some other restaurant I might want to eat at instead. It wouldn't have dawned on me to even try.
 
But that's not how it always goes today.

Moms and dads today often play the role of friend instead of parent. Many of us, no doubt, want to avoid giving our kids the sense of powerlessness, and the distance, we might have felt with our own parents. But in doing so, we've inadvertently given our kids a sense of power that we may one day come to rue.

A friend of mine, for example, says that his teenage daughter thinks it is "monumentally unfair that her computer isn't quite as powerful as the one I have for work." And like me, he realizes he brought this on himself.

"Too many times I've asked her for input in decisions she should have no say in," he says. "I should just get her a computer rather than ask, 'Is this one good enough?' There is a line between getting input and letting her dictate, and at times, I've not drawn that line sharply enough."

To be clear, this isn't about kids who are bratty, obnoxious or harbor a sense of entitlement. These aren't bad kids. It's just that many of today's generation of youngsters have grown up in a world where their opinions matter. A lot.

The question now is what do we do with the power-hungry monsters we have created? How do we fix them?

Many parents, I know, will fume about this column. They will insist that kids should never be allowed to define expectations -- particularly when it comes to how the family spends money. Mom and Dad make those decisions, no questions asked. The problem isn't one of balance, they'll say. Kids are kids and parents are parents, and you shouldn't mix the two.

I agree...up to a point. Despite my lamenting in this column, I don't think we parents should impose every one of our choices on our children without their input. Kids need to feel like they have a voice, and that the voice is heard. Eventually, it will help them learn how to make smart decisions -- and the consequences of making not-so-smart ones.

At the same time, it isn't good for them to feel in control, either. They don't want all that power, even if they think they do. They want the security of somebody else making decisions. They need to know that parents make the rules.

That's the balance I need to find, and that has too often been lacking in my house. To offer a simple example: If I'm craving Greek for dinner and my son or daughter isn't, I want them to express that; it's a lesson in learning to defend your desires and not to accept what everyone else around you is pushing.

That doesn't mean I'll change my mind. And it doesn't mean we won't eat Greek that night. But, then again, I might say to one of my kids, "OK; your call tonight. You get to choose."

For those of us who have gone too far, it's important to scale back the authority we've given our children. But not all the way.

The decisions kids make, for instance, might be relatively rare events that they come to see as "special." Maybe it's the opportunity once a month to have complete control over the family's Friday night plans -- the restaurant you go to, the movie you see. Maybe it's giving your kids three vacation options to choose from. Maybe it's regularly letting them voice their opinions about anything they want, with no guarantees that Mom and Dad will agree with them. But we'll listen.

That's what I have started to do. Before it's too late, I am determined to revoke the authority I have too often ceded to my kids. If I want to spend $500 extra on clear braces that my son didn't get...hey, it's my money and my choice.

Not his.

Dr. Deborah Simmons will be speaking on "Lessons in Love" with the St. Paul Mothers of Multiples club on February 10, 2011 at 8 pm.  Anyone with lovely lessons to share is welcome to email at Dr. Simmons at info@pih-mpls.com or share them on Facebook at "Partners in Healing of Minneapolis." 

Brought to you by Dr. Deborah Simmons

A good percentage of my practice is spent working with people with reproductive problems.  This article in Science Daily offers guidance on reproductive treatment between family members.  

Intrafamilial Medically Assisted Reproduction

ScienceDaily (Jan. 22, 2011) — The European Society of Human Reproduction and Embryology (ESHRE) has published on January 20, 2011 a position paper related to intrafamilial medically assisted reproduction (IMAR).This particular type of assisted reproduction can raise various ethical and controversial issues, due to the involvement of a family member as a third party.

The ESHRE Task Force on Ethics and Law acknowledges the benefits that IMAR may bring to those choosing this approach and concludes that certain forms of IMAR are morally acceptable under certain conditions. The group advises to evaluate each request for IMAR individually, based on four ethical principles in health care: the respect for autonomy, beneficence and non-maleficence and justice.

The Task Force explains that the right for individual autonomy is elementary: any individual should have the principle of choice with whom to reproduce. It is understandable that couples wish to preserve some sort of genetic identity with the child, and hence may wish to choose a donor in the family. IMAR may facilitate a child's access to its biological roots and enable it to have contact with the donor or the surrogate mother. Often faced with no realistic alternatives due to long waiting times or lack of donors, IMAR may also be the only option available to these patients. The ESHRE group recommends that fertility doctors should take into account the relevant regulations in their country when they assist a couple with IMAR. In some countries IMAR is illegal and the relevant laws against incest and consanguinity apply to protect the offspring from genetic risks and to avoid possible social disruptions and conflicts. "Doctors should assess any possible psychosocial and medical risks related to the treatment," says Dr. Wybo Dondorp, deputy coordinator of the Task Force. "Doctors must therefore consider the principles of beneficence and non-maleficence together and aim at producing net benefit over harm for all parties involved."

Potential risks may affect several parties, including the future child. These risks can arise from intrafamilial conflict if parents feel threatened in their parental role or if they have different views from the collaborators on how the child should be informed of its genetic origins. Especially in cases of intergenerational IMAR, there are concerns that the child may be confused about his role in the family. The possible pressure on the donor or surrogate to collaborate can also lead to psychological problems. Adequate information on possible risks should be given to all parties. This includes both combined and separate counseling of recipients and collaborators to assess the voluntariness of the donation and to reduce potential conflict situations. According to the principle of justice, doctors should treat similar cases in the same way. So if sister-to-sister oocyte donation is accepted so should brother-to-brother sperm donation. The justice principle also applies where IMAR may circumvent unjust exclusion if waiting times for donors are long or the treatment costs are too high without intrafamilial donors.

It is of paramount importance that recipients and collaborators give their informed consent. The ESHRE group is in favour of disclosure of information to the child if other relatives are aware of the familial collaboration. The counselor should offer support in any case and various strategies may be equally justified; while some would give priority to the child's right to know, others would be more concerned about the risk of confusion and accept a parental preference for secrecy.

Doctors should not accept a minor relative as a gamete donor or a surrogate. In the case of intended surrogacy the Task Force considers parenthood by the surrogate to be a precondition in order to collaborate in IMAR. The paper gives special attention to (rare) cases of consanguineous IMAR, involving the mixing of gametes of persons that are genetically closely related. "The Task Force considers consanguineous IMAR between up to third degree relatives as acceptable in principle, subject to additional counseling and risk-reduction," says Professor Guido de Wert, coordinator of the ESHRE Task Force. "Here, genetic counseling is appropriate to assess the increased risk of conceiving a child affected by a serious recessive disease."

Part of adequate genetic counseling and good clinical practice in such cases is to offer carrier screening for those disorders that are more prevalent in the particular ethnic group. Given that fertility specialists have a co-responsibility for the welfare of the child, it may be morally justified to offer such genetic testing as a condition for access to assisted reproduction.

The group concludes that in some situations IMAR is morally acceptable as long as counseling of recipients and collaborators is applied in order to reduce potential psychosocial and medical risks. First-degree intergenerational IMAR needs special scrutiny, also in view of the increased risk of undermining autonomous choice. First- and second degree consanguineous IMAR is at odds with the spirit of anti-consanguinity and anti-incest legislation in most countries and should not be offered. The group encourages more research into the psychosocial implications of IMAR to contribute to adequate and moral guidance.

Background Depending on the degree of familial closeness, there can be different types of IMAR.  The relationship between donor and acceptor can be either:

(1) first degree such as between siblings or parents and children,
(2) second degree such as for example between uncle and niece and
(3) third degree such as between cousins.

The collaboration between the different parties (those providing donor gametes, a surrogate uterus or both, and the acceptor) can be in the same generation (such as for example sisters) or between generations (for example mother and daughter). IMAR can involve different scenarios such as sperm, egg or embryo donation by a family member and/or surrogacy which can be full surrogacy (surrogate provides the eggs) or partial surrogacy (surrogate carries the IVF embryo). In practice, a common form of IMAR is sister-to-sister oocyte donation. Most cases of IMAR are non-consanguineous. Consanguinity, which is defined as reproduction using gametes (eggs and sperm) from individuals that are closely related genetically, may lead to an increased genetic risk for the future child. The magnitude of this risk depends on the degree of consanguinity. In any general population the risk of having a child with a handicap or a major disease is 3%. In third degree consanguinity, the risk is estimated to be around 5-6%. If the applicant and the intended collaborator carry the same disease, there is a 25% risk of conceiving a child affected with that particular condition.