Does My Child Have ADHD?

School will be starting soon and many parents will receive reports from their child's teacher that will cause them to ask, "Does my child have ADHD?"  I hear this very often and do many assessments on children to determine if a child has ADHD.  Yes ADHD is a really disorder, but too many teachers and schools rush to the conclusion that a child has ADHD and needs medication.

According to statistics by the American Psychological Association, five percent of children in the United States have ADHD.  It is also more common in males and it does tend to run in families.  However, not every child who has ADHD requires medication.  Many children can be treated with psychotherapy and behavior modification.  Therefore, if your child is diagnosed with ADHD do not rush to medicate your child.  There are different subtypes of ADHD and different severities of the diagnosis.

If you feel your child may have ADHD or their school suggests the idea, make sure you have your child appropriately assessed by a professional who specializes in ADHD.  In the past schools would often diagnosis children with ADHD.  Schools are no longer supposed to make this diagnosis.  If they feel a child might have ADHD, they are supposed to have your child evaluated.  Many parents take their child to their pediatrician, however, many pediatricians are not trained in diagnosing ADHD.  I would suggest having your child evaluated by a mental health clinician trained in working with children and in assessing for ADHD. 

As I stated above, if you are going to have your child evaluated for ADHD, make sure you take your child to a mental health clinician who specializes in children and in doing assessments.  The assessment for ADHD is not very difficult and an appropriate evaluation by an appropriate mental health clinician should cost around $250 depending on where you live.  I have seen some parents who have spent thousands of dollars getting CT scans, MRIs and PET scans.  You do not need an expensive scan of your child's brian to diagnosis ADHD.

The DSM V, the diagnostic manual that mental health clinicians use, list the criteria needed for the diagnosis.  I am including a link to the Center for Disease Control which list the criteria for the diagnosis and other information about ADHD, http://www.cdc.gov/ncbddd/adhd/diagnosis.html.  Typically the diagnosis can be made by a clinician interviewing the parents, having a play session or two with the child and observing the child at school or consulting with the teachers.  However, remember if you are going to have your child evaluated for ADHD, you want a mental health clinician who specializes in treating children and assessing children for ADHD.  Your child's pedestrian should be able to refer you to someone or if you call your insurance they will probably have referrals.

Before you rush to have your child assessed, remember some basic facts.  Most children between the ages of two to five are very active.  They also have very short attention spans.  Sometimes you need to give a child some time to mature especially if you have a boy.  Remember boys mature slower than girls and tend to be more active than girls.  It is important to keep these facts in mind when you are wondering if your child has ADHD.

Now if you child is more hyperactive than other kids his age or his attention span is shorter than most kids his age, there might be an issue.  Also if there is a strong family history of ADHD in the family such as his father had ADHD as a child and paternal and maternal uncles all had ADHD as children, there might be an issue.  Also if your child was born premature or there were complications during the pregnancy or child birth, there might be an issue.  Premature babies or babies with a difficult pregnancy or birth are more likely to have ADHD and learning disabilities.

Bottom line, if someone suggests that your child has ADHD don't rush to the pedestrian seeking medication.  Compare your child's behavior to other children and consider the risk factors. If your child doesn't have many risk factors for ADHD maybe wait six months and reassess the situation.  The most important thing to remember is if you decide to have your child assessed for ADHD, make sure you go to a mental health clinician who specializes in children and ADHD.  You want a mental health clinician who specializes in treating children with ADHD and assessing children for ADHD.  Also remember you do not need any expensive scans like a CT scan.  There are other treatment options besides medication, so do not rush to medicate your child either.  Consider all the treatment options.

Dr. Michael Rubino specializes in treating children and assessing children. He has over 20 years experience treating and assessing children and teenagers.  For more information about Dr. Michael Rubino's work visit his website at www.rcs-ca.com or his Facebook page www.Facebook.com/Drrubino3     

The Reality of Middle School in The 21st Century

As the school year is starting many parents are focused on their children’s transition into High School or Kindergarten.  However, there is another important transition for children.  Beginning Middle School is a major transition for pre-adolescents. As a psychotherapist who works with adolescents, I am very familiar with what is happening on High School and Middle School campuses and how big the transition is into Middle School.  However, some parents are not aware of what happens in Middle School today.  One example, when I mention to parents who have a child going into middle school or a child in middle school, if they have spoken to their child about drugs and alcohol, I am told no.

I hear parents say every day that they don’t need to worry about drugs or alcohol with their child in middle school because their child is too young for that right now. Well the reality is that Middle School Students are drinking, using drugs and having sex.  Many parents are unaware of what is happening in Middle Schools these days. Drugs and alcohol are just the tip of the iceberg. Children that are in the age group of middle school are now involved numerous dangerous activities such as selling drugs.

To begin with, most campuses are better pharmacies than your pharmacy. I have had middle school kids say they can get Vicodin, Concerta, Ecstasy and of course weed and alcohol on their school campus. Some kids use at school and some use after school and on the weekends.  More and more middle school kids are deciding to experiment with drugs and alcohol due to the pressure to feel successful as a teenager and so they fit in with friends.

Also many middle school kids are sexually active, but they don’t think they are sexually active. They think because they are not engaging in intercourse and they are engaging in oral sex that it doesn't count. The kids say they are just “messing around” with each other and do not consider this sex. They also have no idea about sexually transmitted diseases or how to protect themselves for STDs or getting pregnant.  However, the number of middle school kids engaging in oral sex and intercourse has increased significantly over the last few years.  The rate is now high enough that some middle schools, such as the San Francisco School District, are disrupting condoms to middle school kids.  Yes, Middle Schools are giving condoms to children in the sixth grade.  These kids are only 11 years old.

Another common issue in middle school is bullying. However, we are not just talking about one kid teasing another kid at school anymore. Today there is for a group of kids teasing one kid and it is not just at school.  Now kids are using Facebook, Twitter, Instagram, Snapchat and texting by cellphone to tease and harass other kids.  And as many of you may recall there have been a number of kids who have committed suicide due to the teasing at school.  I recently wrote an article about a middle school girl who committed suicide and in her obituary she left a note to the other students just asking them to be nice to each other.  Another issue with teasing, is that a number of middle school students have been arrested for photos they text and for harassment. Besides teasing, texting a nude photo of a student in middle school means the middle school child violated child pornography laws.  Something many parents and students are not aware of is that when a child texts a nude photo of a middle school student, who is under 18 years old, it violates child pornography laws and the child who texts it and received it can both be arrested. 

Also many kids in middle school, especially boys, don’t feel safe and are afraid of someone trying to beat them up before or afraid school. They say they have to fight because other kids are recording it and posting it on YouTube.  Boys are bragging about their fights on YouTube and comparing how many people have watched their fight with their friend’s fight.  Therefore, boys feel they must fight, otherwise if they don’t fight the other kids will think they are a “whimp” so they have to fight. Due to this fear many middle school students carry knives, metal pipes, guns or anything they can think of to protect themselves. This is very sad that kids have to live in fear for their lives and safety at school.  Also parents and students don't realize, if a student is caught with any of these items on campus they can be removed from their entire school district and required to go to continuation school.  In addition, the school can have the student arrested.  Due to terrorist activities, schools take anyone possessing items that can severely hurt someone very seriously.

These are just a few of the issues that are occurring at all middle schools and they are very serious. Your child is not going to come to you to ask about these issues or tell you about them because they feel embarrassed and they are afraid of getting in to trouble. So parents even though you may feel embarrassed or awkward discussing these issues with your 11 year-old child, please do so. If you notice anything about your child’s behavior that seems different to you and you feel a sense of concern, ask your child about what is happening at school and with friends. Mention they are getting older so are the issues in their lives and mention drinking, sex or being teased and ask if they need to talk about it. You may be saving their lives because they are dealing with things they know nothing about and these things can kill or have life long effects.

Here is a YouTube video that might help:

http://youtu.be/bK8ZPzLkxjc

Dr Michael Rubino is an expert dealing with adolescents and adolescent issues. He has over 20 years experience treating adolescents. For more information about Dr. Michael Rubino’s practice check his website www.rcs-ca.com or his Facebook page www.Facebook.com/Drrubino3.

Changes that High School Creates for Teens and Parents

Over the next few weeks, many teenagers will start High School.  There will be many changes for them and for you as a parent.  As your teen enters high school they are also starting to enter the adult world. This is now a time for them to start to take on new responsibilities and to consider the reputation they are creating for themselves.  As parents your responsibility is to help guide them, not tell them exactly what to do. It is important that the teen develop life skills on their own. You will not always be there as the parent to help.

The first step is for you to allow them to earn your respect. Explain that they are no longer little kids, that they are now young adults, and part of being an adult is earning people’s respect. You also have to be prepared to respect them and allow them to be young adults and not treat them like little children. This does not mean you are giving up control. Your teen still needs you for money, permission to do things at school and to sign the consent for the all important driver’s permit. So relax, you still have all the control you need.

The first place to start with respect is their rooms. Allow them to have their rooms as their own private space. Do not worry if it is dirty or if their are clothes all over, it is their space and they have the right to live in it how they choose. Set the limits that as long as you can close the door and there are no odors coming from their room, you will respect their privacy. If these agreements are broken, then you have the right to go in and clean as you like. You also have the right to inspect the room if there are obvious signs of drug use. As a parent you have to balance your teen’s right to privacy, but at the same time you need to ensure their health and safety.

Homework is another big area of concern.  Make your life easy. Set a minimum GPA such as 3.0 or 2.0 based on your teen’s ability and then allow your teen to manage their homework. If they ask for help, obviously help them. If they do not, let them handle their homework until progress reports and grades come out. You need to have an agreement as to what will happen if they fail to maintain the minimum GPA set and they never ask for help. If they fail to maintain the minimum GPA, then the consequences you agreed to are implemented. The consequences occur not because you are being mean, they occur because the teen failed to live up to their part of the agreement - they made the choice. This is important to reinforce so you are not labeled the bad guy and the teen learns a lesson in making choices.

Finally, you and your teen need to sit down a draw up a contract concerning the house rules, school performance and your expectations regarding their behavior in general. If you have it in black and white and there is a conflict then all you need to do is refer back to the contract and the problem is resolved. It is very important that you abide by the contract too. So you cannot increase a consequence, if you agreed to something else already with your teenager. It is essential that you honor your word. If you want your teen to be responsible, you must be responsible.

One last thing - no one is perfect. If you make a mistake, model appropriate behavior and apologize. If your teen makes a mistake and comes to you right away to apologize, thank them for their honesty and compliment them on their maturity. Remember, they want to know that they are important in the world. By treating them with respect and as maturing adults you are validating the fact that they are important and loved and you are encouraging them to keep trying.

Obviously, it is not always that easy and there are various parenting situations. The above suggestions are a guideline to get started with as your teen enters high school.

Dr Michael Rubino is an expert in providing psychotherapy to teenagers and their parents. He has over 20 years experience working with teenagers. For more information on Dr. Michael Rubino's work or private practice visit his website at www.rcs-ca.com or follow him on Twitter @RubinoTherapy.

Preparing Your Teen for High School

In about six weeks a number of students will be starting their first year in high school.   Parents this is a good time to think back to your first day of high school and how you felt and what you were expecting.  This can help you relate to some of the feelings your teenager is having and help you when you talk to them about starting high school. Hopefully this article will be able to provide some tips to make it an easy transition for your teenager and for you.

One common stressor for many teenagers are the stories they have heard about how seniors pick on and tease the freshman students. Another common fear for freshman is that they are going to get lost on the campus and not be able to find their classrooms. Your teenagers are at a point in their life where they want to make a good impression on the other students. At their age image is very important. Therefore the idea of being teased by the seniors or getting lost on the campus can be very stressful and also create a great deal of anxiety for a student starting  high school.

As parents, you can talk to your teenagers  about your first days days at high school and reassure them that the stories they hear about Freshmen being targets for the seniors are greatly exaggerated. Also you can try to go with them over to the school before it starts and walk around the campus so they can get use to where everything is at their new school. Another thing you can do is remind them that everyone makes mistakes so if they do get lost the first day it is not a big deal. Remind them there will be a lot of other kids starting their first day of school too and there will be other kids getting lost. This is also another opportunity to continue to establish an open relationship with your teenager. The more you talk with each other you increase the likelihood that they feel comfortable coming and talking to you about issues they will have while in high school.

Another issue facing some students is starting all over. In middle school may be everyone knew them and they were in the "popular group." Now no one knows them and they need to start all over. This may be frightening to them, but remind them there will be many times in life when they will need to start as the new person. Also remind them, if they were able to do it in middle school, they can do it in high school too.  However, encourage them to have faith because it won't happen over night. Now for many students middle school was a nightmare. They may be looking forward to starting over. Again remind them if they have the desire to try they can do it, but also to be patient because it may not happen as quickly as they like.

Also before school actually starts is a very good time to establish what your expectations are regarding grades and after school activities and hanging out with friends. before I school actually starts is a very good time to establish what your expectations are for your teenager regarding grades, homework, after school activities and hanging out with friends. If you establish an understanding between yourself and your teenager before these situations arise you can save yourself a lot of time arguing with your teenager. However as you establish these guidelines you want to have a conversation with your teenager about these issues. Remember your teenager is starting to enter the adult world, if you simply just tell them these are the rules no matter what they will feel that you are being unfair and they will try to find a way around your rules. If you have a discussion with them about the rules they will feel that their opinions are being respected and they are more likely to feel that the rules are fair and are more likely to follow the rules.  It is also a good idea to write a contract with all the things you agreed to.  If you write the agreements down and there is a misunderstanding you simply need to refer back to the contract.  Also this is another opportunity for you to establish a relationship with your teenager where they feel comfortable enough to come to you and discuss any problems they may be having. You are also role modeling to them how to have an adult discussion and how to negotiate fairly and respectfully with other their people.

Of course you also want to take this opportunity to discuss with your teenager the fact that they are going to be faced with making decisions about alcohol, drugs and sex. This is a good time to provide them with the education they will need in order to cope with these situations. Remind them that information they may receive from their friends may not always be accurate. Furthermore, encourage them that at any time if they have any questions or concerns regarding these matters or any other matters you are always there to listen and to talk with them.

One thing to remember is acronym HALT.  I teach this often with anger management, but it helps with communication too.

H - hunger

A - anger

L - lonely 

T - tired

If either one of you are having these feelings, it is generally not a good time to have a discussion.  Also if either one of you is feeling like this and you may not be listening to each other.  Therefore, if either one of you are having these feelings or don't feel like talking, then it's better to postpone the conversation until you are both ready to talk.

Lastly, remind them that they are starting a brand-new phase in their life and it is normal to feel anxious and stress. Also remind them that these feelings are normal in the beginning but they usually quickly disappear after they have started school.

A few things you can do on the first day of classes to help with any anxiety are you can get up in the morning with them and have breakfast with them before they go to school. You can also put a note of encouragement in their backpack that they will find when they are at school and this can help reassure them and remind them how much support they have at home. Finally, you can arrange to be at home when when they get home from their first day of high school so you can talk about it with them. Also plan to have a family dinner to discuss everyone’s first day of school and offer encouragement where needed. These are just a few ideas to help with the transition process.

Dr. Rubino has a private practice in Pleasant Hill and specializes in working with teens. To find out more about the work he has done over 20 years visit his web site at www.RubinoCounseling.com.

Why Fathers and Sons Resist Therapy

Teenage males and men hate to go to therapy.  Therefore, let's address this issue.  Here is a link for a movie, “The Mask You Live In” https://youtu.be/hc45-ptHMxo.  The above trailer contains explicit language, but it is language your third grader hears every day at school, from friends and television.  Men and teenage boys are very resistant to taking care of their physical and mental health. The question then becomes, why? If you watched the trailer, you will have a very good idea why.

In our society there is a stereotype of what it takes to be a “man.” A man is strong, healthy, and can take care of himself, knows everything about sex and is sexually active, has a lot of money and never afraid to fight and never cries. These are a just a few parts of the stereotype. Many parents may be saying, “but I don’t bring up my son like that.”   You don’t have to, but it is part of our society. If a little 5 year old boy falls down at school, the school staff picks him up and tell him shake it off, don’t cry, take it like a man. A boy playing soccer or baseball gets hurt during the game, the coach says shake it off, take it like a man. You have even saw examples of it on Dancing with The Stars.  A couple of times some of the men have started to get teary eyed and the asked for the camera to be moved because they did not want anyone seeing them cry.

Boys continue to be exposed to the stereotype in high school. There is a major focus on losing their virginity as fast as possible and sleeping with as many girls as possible. They can’t be a man if they are a virgin. Also boys are getting into fights and having a friend record it and post it on YouTube. They want everyone to see how tough they are and it makes them feel like a man. Also in High School boys stop accepting and asking for help, they are a man and they can handle life on their own. Also look at the movies and video games boys play. They have to do with fighting, killing and sex. Emotions are never mentioned and if a boy does cry he is called a “sissy, or a fag” just to list a few.

If men and boys are living with this stereotype going to a physician or a therapist is a very dangerous thing to do. They might have to confront the fact that they are not able to do everything by themselves and they might need help. This would mean they are not the tough guy. Also they know physicians and therapists have treated other men and they are afraid how they might be compared to other males. If they are not as tall or as strong or don’t measure up to the other men they are not a man.  They feel like a failure.

Going to a therapist is extremely dangerous for boys and men. Therapists ask you to deal with your feelings. What if they cry or admit they feel overwhelmed by life or inadequate to other men? If they do, they worry about their identity as a man. I have men and teenagers who cry in my office. They all get really embarrassed and beg me not to tell their family and want to know if other guys cry have ever cried in my office. They need reassurance that they are still a man. The truth is it takes more strength to cry than not to cry, but most guys don’t believe this due to the male stereotype.

We need teenage boys to focus on their emotions.  The best way for us to help boys and men is to eliminate this stereotype. Parents contact your son’s school and ask them to invite groups to the campus that are trying to eliminate this stereotype.  Challenge Day is an excellent organization which tries to help teenage males face their feelings. Also monitor what they watch and how they talk with friends. Fathers don’t be afraid to cry and go to the doctor regularly and ask for help. Look for movies that show males as men even though they don’t follow the stereotype. This is a problem in our society which leads to crime, killings and needless deaths from heart attacks and strokes. It is going to take all of us to solve the problem.

Dr. Michael Rubino is a local psychotherapist who specializes in treating children and teens.  He had over 20 years experience working with teenagers.  To find out more about Dr. Rubino and his practice or to contact him visit his website at www.RubinoCounseling.com

Honoring A Teen's Final Request

I read an article about a 15 year old girl in Pensilvania who killed herself this week.  She was the victim of bullying at school.  The family described her as a nice, care girl.  However, the bullying was severe enough to cause her to take her own life.

We need to remember that bullying is no longer just something that happens at school.  Also it is no longer just part of childhood.  With social media, bullying has become viscous.  This 15 year old girl is not the first child to commit suicide due to bullying.  It is happening very often in elementary, middle and high school.  There are also cases of suicide due to bullying in College students.  Also the children are not the only victims.

In this girls obituary, the family openly discusses how they have been torn apart by the death of their daughter.  The describe how they expect this feeling to last for a while.  They also discuss trying to come to terms with this event.  They cannot understand why kids would bully one kid so severely so the child be bullied feels that suicide is their only option.

We need to pay attention to what these parents are saying.  Bullying has reached epidemic rates and has become very vicious. Besides losing a young person too early, an entire family are victims of the bullying.  Parents lose a child, siblings lose a sibling, grandparents lose a grandchild.  The worse part is no one can make sense of the lose.  Why do we have children who feel the need to bully a child so severely that a child commits suicide?  We need to think about this issue.  I hear many children in psychotherapy reporting being bullied.  These children are being bullied at school and at home through social media.  And in my opinion, the bullying can be very vicious.  Also what makes it worse, is the child never gets a break.  They are embarrassed to tell their parents.  They feel they must have done something to deserve the bullying.  Therefore, they tend not to tell their parents because they do not want to disappoint their parents.

We can take a lesson from this girl who recently commuted suicide.  After expressing their feelings, the parents closed the obituary with a simple request.  They asked in lieu of flowers that we be kind to each other.  This is the key.  If kids who are bullying could put themselves in the shoes of the person they are bullying, they would stop.  Also we need to look at the kids doing the bullying.  What has happened to them to cause them to be so cruel to another person?  Many bullies are victims of physical or severe emotional abuse.  In order to solve the problem the person being bullied and the person bullying need to be treated.

In the mean time, we can honor the requests of this girl’s parents and be kind to each other.  If you want to read the entire obituary here is the link.  Family Of Teen Who Killed Herself Has Message For Bullies In Obituary https://patch.com/pennsylvania/northampton/obituary-pa-teen-who-killed-herself-bullies-its-not-too-late-change-your

Dr. Michael Rubino has 20 years experience treating children and adolescents.  For more information regarding Dr. Rubino’s work or his private practice visit one of his websites www.rcs-ca.com or www.RubinoCounseling.com.     

Children Are Not Mailboxes

As a child psychotherapist, I hear from many parents about their concerns for their child when there is a divorce.  A divorce is a stressful event on the entire family including the children.  However, there are ways parents can reduce the stress, but they do not.  The most common mistake I see is using the child as a messenger.

Many divorces are hostile and neither parent wants to speak to the other one.  However, when you have children, you must speak to each other.  You need to co-parent which means communicating with the other parent.  You do not have to talk about your lives or even be friends.  However, you must communicate with the other parent about issues involving your children.  You need to provide each other with information about school, your child’s health, if they have an activity coming up, etc.  Basically, anything that involves your child.

However, I see many parents choose to use the child as the message carrier.  They tell the child do not forget to tell your father to look at your homework or tell your mother to look at the note regarding your school conference.  Many of these children are 10 years old so they forget or get the message wrong and then there is a big fight.  The child blames themselves because if they did not forget, there would be no fight.

This is a great deal of responsibility to put on any child at any age.  When parents use their child as a messenger, at times children feel they have to take sides or protect a parent.  They know mom and dad do not get along and they will do anything to decrease the fighting.  So if they have a message that might upset dad, they will worry about it and try to solve the issue so they do not have to give dad the message.  The children I see in this situation are very anxious and resentful.  They are mad that mom and dad got a divorce and now they feel they have to keep the peace between their parents.

When children are older such as 12 or 13 years old, they may start to act out.  They may start using marijuana or alcohol as a way to escape.  They also may start to make parenting decisions on their own.  They feel if I have to carry the information back and forth, I might as well decide for myself.  This can really hurt the relationship that a child has with one parent or both.

What is the solution? Parents, you need to communicate with each other directly and not use your child.  The two of you divorced not your child.  No one asked them and they should not have to take responsibility for any divorce issues.  Also you really cannot get mad at the child for make parenting decisions, if you are putting them in the middle.  You can go to co-parenting classes or co-parenting therapy to help the two of you with communication issues.  You can also use email.  Many Court systems have an email service you can subscribe to so you know messages are delivered.  In Contra Costa County they call it the family wizard.

The main point is you can stop being married but you cannot stop being parents.  It is important to remember this fact and set up a co-parenting plan during the divorce process not after.  Trust me your children will thank you for it.

Dr. Michael Rubino specializes in treating children and teenagers and in high conflict divorces. He has over 20 years experience.  For more information about Dr. Rubino’s work or private practice visit his website at www.RubinoCounseling.com.