ADHD: To Medicate or Not to Medicate

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ADHD: To Medicate or Not to Medicate

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My wife and I generally take a “holistic” approach to managing our family’s health. We try to prepare organic/healthy foods, encourage physical activity, and ensure a proper sleep environment free of electronic distractions. When our kids are ill, however, we go to the pediatrician and quickly consider whatever Dr. Z deems necessary.

In my psychotherapy practice I spend most of my days assessing students for ADHD. Once a child is diagnosed, most parents almost immediately ask about medication. And yes, stimulants can help one focus, but JUST giving a pill is not the proper solution to this complex situation. There is no cure for ADHD, but there are many ways to improve attention.

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Parenting: When the Going Gets Tough…

As seen in Ladue News, November 26th, 2014.

A couple of weeks ago, Ladue News editor Trish Muyco-Tobin emailed me a thought-provoking question: In today’s society, what does it mean to be tough? And, in particular, what does this mean for our children? As the father of two boys, these questions hit home. I want my children to be resilient, but I also don’t want them to be arrogant.

Teaching boys (and girls) that being tough doesn’t mean being antagonistic, belligerent or hostile can be a challenge. Violence and aggression perpetuate popular culture through movies, songs, TV, ‘celebs’ who abuse their significant others, and athletes involved in random acts of aggression. I want my boys to grow up to be good men, but the fast pace of today’s society means exposure to poor examples of masculinity constantly are on display.

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Open Their World

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As seen in Ladue News, September 25th

Last month, St. Louis and Ferguson dominated national headlines. As the story surrounding Michael Brown’s shooting grew, my 11- and 13-year-old boys had many concerns about the incident itself and their safety, but they also had more general questions about racial conflict, economic differences, and why everyone was so upset.

My wife and I were impressed by the intelligent and sensitive questions that our children were asking. But as we listened, I also started to think about how do we get our kids to a higher level of cultural understanding? How do we ensure that our kids get to know people as people and not as social stereotypes? And how do we, as parents, promote tolerance, acceptance and kindness?

According to the Journal of Marriage and Family Therapy, 75 percent of Caucasian families rarely—if ever—discuss race and cultural diversity. Many parents, at least on a subconscious level, believe that simply exposing children to different cultures is just as good as talking about it. We are happy to take our kids to an ethnic restaurant, but most are unable to speak about the cultural significance of the food or how geography impacts diet.

Becoming aware of ethnic differences is difficult because it takes effort to understand the history. It also is in our nature to talk about how people share similarities as the differences are often ‘foreign’ to us. Parents unfamiliar with Chanukah, for example, may call it the Jewish ‘Christmas’ instead of explaining the historical importance of this celebration.

Interestingly, young children are very alert to differences, albeit, on a concrete level. By the age of 6 months, babies can easily differentiate between skin color and gender. Toddlers make sense of the world by sorting things; and many will actually count or classify their schoolmates by appearance, including race, hair color or size. And by the age of 5 or 6, kids both understand and perpetuate stereotypes.

The best time to fight cultural stereotypes is before they form. For the little ones, it is easy to find toys and books that educate about intercontinental differences, and expose them to characters from different places. Ethnic street festivals also provide opportunities for young kids to try food, enjoy unfamiliar games and ask questions. Small children are unbiased, so take them to the action and open their world.

Older kids are able to think deeply, empathize and intellectualize. Ask your adolescent about how they view specific events and gently challenge with deep questions. It is one thing to know about Michael Brown, but it is another thing to understand the role of local government in law enforcement, or see all sides of the situation before forming an opinion.

Parents might also consider taking a step back to reflect on their own values. Being aware of one’s personal perceptions can be difficult, as our beliefs often exist on a subconscious level. Parents need to appreciate their own blind spots if they are to truly teach their children about diversity.

There is no recipe or instruction booklet that specifically states how to boost a family’s understanding and acceptance. Continually modeling the appropriate attitude, however, can provide a platform for a child to be inquisitive and sensitive. And most important, exercise empathy. Through empathy, we can teach how others might like to be treated.

Our world is merging; there are global economies, cross-cultural education opportunities, and the other side of the planet is just a SKYPE call away. To bring our kids to a higher level of social consciousness, parents should take initiative to both expose and teach about differences. To be successful in the 21st century, today’s youth need to learn how to be sensitive to everyone, no matter where they are from or what they look like.

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Raising Cultural Aware Kids

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St. Louis and Ferguson, Missouri have been thrust into the national limelight. Social dialogue regarding racial differences and cultural stereotypes is being discussed on TV and in the classroom. Is it, however, being discussed in your home? Dr. Hyken discusses this and, also, how to raise culturally aware kids in the Fox News Interview.

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When Mom's Away…

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Whether you have an infant, toddler or teen, most mothers—at some time—consider a return to the working world. This decision, however, often is accompanied by contradictory feelings. Guilt that you will be away from your children, relief that you will be away from your kids—or guilt that you might actually feel relieved.

While many choose to return to the nine-to-five routine, others need to work for financial reasons. No matter the cause, there are many issues to consider before making this major life decision. The first hurdle to jump is emotional readiness.

It is difficult to actually know how you will feel about being a working mom until you fully are engaged in employment. Some parents find it upsetting to miss out on a baby’s first step. And the thought of hired help developing an emotional bond with your precious offspring also can be a major source of stress. Others, however, see their career as a big part of their identity and crave the unique fulfillment that work brings to their life. There always will be moments of doubt, but most parents eventually will settle into a comfortable routine.

The next issue is finances. A long-range perspective is needed to determine if your family can prosper on one partner’s salary. Think beyond the mortgage and monthly bills, and consider other important items like health care, child activities and emergency funds. Also determine what might happen should your partner experience a reduction of income. A family should not take on excessive debt so one parent can stay at home.

The implication of an extended leave also can alter your occupational direction. A parent that steps out of career may not be able to gain re-entry. Some professions have a clear path of growth and taking a break may make it difficult to return. However, if you dislike your current work choice, being at home not only gives you the gift of time with your kids, but also allows you to explore alternative opportunities. Consider the culture of your employment field as you make this important decision.

Finally, you have decided that a return to work is eminent. A new set of nervousness makes its way through your body as you think about who will take care of the children. Would daycare make sense, could a nanny be the best option, or might grandma be willing to assist? There are positives and challenges to each consideration.

A good daycare center has a high staff-to-child ratio to ensure your child is safe and that someone always is available. Children also benefit from the company of their peers—young ones truly learn from each other. On the downside, parents must make alternative arrangements if their baby is ill, and many centers have limited ability to change routines should your child have a special need.

A nanny provides the advantage of a consistent, single caregiver for as long as you decide to employ this caring professional. Many also consider the biggest nanny benefit is the potential life-long bond they may occur between this dedicated helper and your family. One-on-one attention, however, means mom will have to coordinate socialization opportunities. Additionally, parents will need to impose rules and routines to ensure that each child is eating properly and getting the appropriate amount of activity.

A relative also can be an attractive child-care opportunity. These are trustworthy individuals who have a built-in attachment to your family and kids. There are, however, some unique issues that could make for a complicated situation. Grandmas, for example, can be notorious for providing unsolicited advice and ignoring your rules in favor of her own. Burnout and fractured relationships also can easily occur as many parents have much higher expectations of loved ones than the hired help. Set clear boundaries and define expectations should this be your best option.

Working and childcare are personal choices. Consider long-term implications and your present situation, and make the choice that is best for your family. Your children won’t care if you are a working mom, stay-at-home mom or some combination. In the end, a loving mom is all that matters to them.

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Conversations about College

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I started talking to my kids about their college education about a week after they were born. OK, that is a bit of exaggeration, but it is not too far from the truth. Education is important to any new parent, and I spent my 30s having children and pursuing graduate studies. During that decade of my life, my own education and my children’s future consumed my thoughts.


Parents have a huge influence on their kids, and children will adopt family ideals if Mom and Dad share their beliefs. Therefore, I recommend that college conversations begin when the little one enters pre-school. The purpose of these higher education dialogues, however, should not be about where to attend; rather, parents should share their college experiences, talk about the importance of education, and explain how some careers—such as being a doctor or a teacher—require many years of school. Setting the stage for lifelong learning begins in the early years.

Serious conversations about attending college should start during seventh and eighth grade. In fact, it is best to prepare for life after high school before the first high-school bell rings. Talk with your eager adolescent about choosing college preparatory classes, participating in community service and developing personal talents. With the right encouragement, a child could easily develop a passion that guides him to future educational and life goals.

In ninth grade, the college indoctrination process truly begins. Students take standardized tests, complete interest inventories, and participate in initial meetings with their guidance counselor. These exploratory steps pave the way to junior year when students and families should become motivated about researching their options.

There are more than 9,000 colleges and universities, and even the most organized student will benefit from parental assistance. Don’t, however, be the over-involved ‘helicopter’ mom who hovers over every move or the ‘talent-scout’ dad who tries to brand their teenager and broker the best deal. It’s more important to ask your maturing child the right questions, listen, and be supportive.

Size truly matters. More relationally-oriented individuals tend to prefer the intimate classroom environment of a smaller campus. These schools are more person-centered and offer better opportunities to interact with professors. On the other hand, seniors looking to break out of the high-school fish bowl or wanting to stay under the radar should consider big school opportunities. Larger institutions also offer a wider range of classes, a variety of housing options, and big-time sports.

Location is the next topic to tackle. A school’s setting can have a significant impact on the college experience. Some may want to be close to home, but others may prefer to be on a mountain, near a beach, or in a major metropolis. College is both an education and a journey; it is a great time to push beyond one’s comfort zone and live in your dream location. And no matter where the school is, a student can always pack their books and transfer credits to a new university if things don’t work out.

Some may allow their course of study to drive their college search. This is an important consideration, but the majority of college students switch degree programs multiple times prior to graduation. Also, most college-bound high school seniors don’t have enough experience or information to be absolutely positive about what they want to study. It is important a university has the proposed area of interest, but attending the most prestigious program will not ensure success or happiness.

Watching your child mature and make major decisions can be challenging for any parent. College is a huge step toward adult independence, and it can be difficult for mom or dad to recognize the line between interference and support. Trust you have a raised an intelligent individual who makes good decisions and celebrate this exciting life transition.

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No Mixed Messages

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A father makes a comment about a celebrity looking too plump in her evening gown. A mom remarks that she feels fat after eating a big meal. An older sister makes a funny observation about somebody in her class who is a ‘giant.’ While these are meant to be harmless comments, children personalize these statements and can develop a negative body image because they hear loved ones innocently criticize themselves and others.

As early as first grade, many girls become concerned with weight and appearance. Some start to restrict food intake and others begin to read food labels. By third grade, 30 percent of these young students have actively dieted. Further, body image not only is a female preoccupation. Preteen boys also experience stress as they compare their bodies to athletes and actors. Children are inundated with messages from the media, their family and their friends that lead many to think that their appearance is unacceptable.

A positive body image is one that is based in reality. The child accepts who he or she is, and generally is happy with how they look and feel. A negative image is an unrealistic perspective and the child believes they do not live up to the expectation of others, including parents and peers. Anyone—no matter their age—who continually maintains negative thoughts about their appearance is at risk for an eating disorder and/or other mental-health issues.

It is, however, part of human nature to have a personal opinion about one’s looks. It also is normal to like some parts of your body and dislike others. But how one feels often is influenced by the company they keep. Family and friends continuously convey comments about appearance from the day one is born. And parents have a bigger influence on their children’s personal perceptions than any other source.

While it may not seem like it, most kids pay attention to mom and dad. If you frequently talk about your weight, your thighs, as well as your demanding workout, your kids also will worry about their weight, their thighs and their exercise habits. If you constantly eat fat-free foods and skip meals to reduce calories, your children will develop these same unhealthy habits. Kids subconsciously mimic adult behaviors.

Fortunately, parents also can play a pivotal role in boosting self-perceptions. Emphasize to your children that there are many different body shapes and not one ideal size. Explain that weight gain, especially during the onset of adolescence, is a normal part of development.

Further, encourage health over weight worries by urging your children to actively play. The gym is great, but spending time outside with the neighborhood kids is better and more fun. Hip-hop dance class, team sports, or walking the dog gets the body moving. It does not matter what kids do, as long as they do something.

Kids receive mixed messages about what is attractive versus what is healthy. Unfortunately, no matter how much you discuss health and fitness, kids are still susceptible to outside influences, especially media messages. Teach your children to become media-savvy by discussing the images they see on the TV, in magazines, and on the Internet. It can be difficult for a maturing child to understand that their favorite Disney starlets and their thin model friends often achieve their glamorous appearance through unhealthy means or Photoshop touch-ups.

Despite a parent’s best efforts, many children, unfortunately, do worry about their body image. If your child is constantly focused on their physical appearance, excessively diets, or continually compares themselves to others, they may need professional support to understand how to live a healthy lifestyle. Sadly, a mother’s words of wisdom may not be enough to sooth a struggling child.

Research shows that active families who enjoy physical exercise raise children who have a better self-esteem than families who do not adopt this philosophy. Helping children develop healthy habits will send them down an emotionally prosperous path. Being fit does not mean being thin—and being thin does not mean being happy.

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Confessions of a Shopaholic

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What is a shopaholic? While some of us may enjoy the thrill of an occasional splurge or spending more than we bargained for during a big sale–that doesn’t make you a shopaholic. But that rush or feeling you get when you make a good purchase is what some shopaholics describe as a retail high, which in turn will lead a compulsive shopper to want to buy more.  Shopaholics are individuals who can’t control spending and have extended periods of uncontrolled spending sprees and impulse buys.


Is being a shopaholic an addiction? It is actually considered an impulse control disorder.  One purchase leads to another and the thrill of buying often outweighs consideration of the consequences that follow. And it does lead to addictive like feeling. When a shopaholic makes the purchase, the brain gets flooded with dopamine, the same chemical that the brain releases during drug use. Then, after the shopping high, the buyer crashes and feels depressed /distressed. The cycle starts all over–again.

Signs you may be a Shopaholic?

Check your closet.  Do you have many unopened items?
I am not talking about the sweater your aunt gave you last holiday season, but about items you selected on your own that are unopened or still have their tags attached. You may have even forgotten about some of these possessions – that’s a problem.

You often purchase things you don’t need or didn’t plan to buy.
You are easily tempted by items that you can do without like that tenth iPod case.  Additionally, you may be particularly vulnerable to compulsive buying if you have a specific materialistic “obsession,” like shoes or designer handbags. Just because splurges tend to stick to one category doesn’t make them any more rational.

A bad mood sparks an urge to shop.
Compulsive shopping is an attempt to fill an emotional void, like loneliness, lack of control, or lack of self-confidence. Shopaholics also report feelings of being “out of sorts” if they haven’t had their shopping fix. So, if you tend to shop after a bad day or shop to pick up your mood, you may have a problem.

Tips to avoid being a Shopaholic!

Identify triggers.

Take note of what’s likely to send you off to the nearest department store . When these feelings overcome you, resist shopping at all costs and find a healthier way to work it out. 

Carry only enough cash to buy what you need.

Leave your debit and credit cards at home. Create a shopping list with estimated costs, and stick to it when you’re at the store. And stay out of your favorite store if you can’t resist the merchandise.

Ask for help. 

If you’re still struggling with compulsive spending, don’t be afraid to ask for help. You can start with self-help books or by asking a friend or family member to help keep you in check, but it might also be wise to enlist professional help. Consider therapy, resources such as Debtors Anonymous and a therapist who specializes in OCD and addiction.

Shopaholics are all types. 

Compulsive shopping does not only affect women, but it is now believed to affect both genders almost equally. It is blind to income, race and age, and compulsive shopping negatively affects more than one out of every 20 Americans.


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Pack Some Patience

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As I write this column, it is a wintery St. Louis day. When it’s this cold, it is difficult to think about summer travel. June is still a few months away, but a sunny weather vacation free of responsibility sounds relaxing and warm.

My kids are in their preteen years. Traveling with older children provides some unique challenges, as everyone has an opinion about where to go and what to do. When a family has little ones, choosing the destination is easy. A nice place with a few kid-friendly activities is all anyone needs. It is the logistical challenges of bringing what one requires versus what one wants that is complicated.

Productive packing with small children in tow is about preemptively planning to ensure that no one has a bad time. A portable high chair may sound unnecessary, but even family-friendly places may not have one available when you need it. A new toy may appear indulgent, but can be an excellent distraction when you need a break. And cough syrup may seem excessive, but you will be glad you brought medicine if your little one has a late-night fever. To successfully travel with toddlers, plan well and pack some patience.

As your young children morph into older kids with their own thoughts, family vacations can become a complex negotiation as generations clash over what to do. To pave the way for a relaxing and rejuvenating holiday, a different type of advance planning is required. A collaborative approach that allows opinionated offspring to have a say in the stay is recommended.

Include your older children at the beginning of the vacation-planning process. Each member of the family should discuss what type of activity he or she might enjoy. With this newly learned information, parents should retreat to the Internet or to a professional travel agent, and generate a variety of options. During a family dinner, discuss each locale and let your eager adolescent guide the way to family fun.

Once the destination has been decided, let the aspiring vacationers plan a day. Encourage your teens to research activity options, follow a budget and create a schedule of events, including transportation and dining. For this to work, however, parents must commit to the plan even if it means doing something outrageously adventurous or wasting away the morning with a late sleep. Teens typically will make good choices, and allowing them to own a piece of the planning ensures minimal complaining and maximum enjoyment.

Turnabout is fair play and parents also should participate in the plan-a-day process, but with an added twist. Choose an afternoon for you and your spouse to spend one-on-one quality alone time with each of your children. This can be as simple as a hike through the hills or as exciting as mountain-biking down a steep trail. The goal is to choose something that can be enjoyed together. Mixing it up generates positive parent/child interaction, promotes family bonding, and creates great dinner conversation as each share stories from their day.

Planning in advance, however, will not guarantee a peaceful getaway unless a family conversation regarding trip rules and expectations takes place before the departure date. Remind your traveling teens that all home rules apply: no smoking, no drinking, no cursing and no hitting your sister. Emphasize the importance of time—what time they need to return in the evening, what time tired teens need to wake in the morning, and what kind of time they must spend with mom and dad. Set some basic ground rules and discuss concerns as they occur to ensure that everyone gets along.

Vacations provide some of life’s most memorable moments. And while you may return to the same destination year after year, each visit will be different as your family matures and grows. Savor the time, leave life’s worries behind and take lots of pictures. Bon voyage!

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Getting Kids to Listen

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Parents magazine polled moms and dads about their toughest discipline challenge, and the hands-down winner was “My kid doesn’t listen to me.”

Getting kids to listen…and doing so the first time…is an art. And like any art, it takes practice. We also know that learning how to listen does not happen by chance. You are your child’s best communication instructor, and it’s never too early–or too late–to improve your child’s listening habits.

First, it is important to understand that it is okay if your child does not occasionally listen. If, however, your son or daughter does not listen on a regular basis or is continually disrespectful, your approach may be an incorrect one. There are, in fact, a couple of communication processes that are best to avoid.

  • Avoid aggressive communication. As a parent it can be easy to get frustrated but a loud “attacking” tone places kids of any age on the defensive and can create an anxious child or one who thinks it is acceptable to yell.
  • Avoid a passive tone. While speaking quietly can get a child to listen, being overly passive allows your kids to walk all over you . . . which sometimes results in arguing.

For many, listening skills don’t come naturally . . . it often takes a lot of work. Here are some tips.

  1. Model good listening skills – Show your kids what you expect. Listen to your spouse, pay attention to your friend’s comments, and, most importantly listen to your children. Teach your kids to look others in the eye by asking them to do so. For the little ones, this can mean getting down to eye level when having a serious conversation.
  2. Don’t shout from across the house. When an important subject needs to be discussed or even something simple needs to be done, make sure the environment is distraction free. Ask kids to pause the TV, take a short break from their video game, look up from the homework, etc. If kids are doing something, it is natural to tune-out parents.
  3. Be reliable. “I will bring home dessert tonight”, “you can watch that show tomorrow,” or “I won’t be long” seem like innocent promises but can erode trust and the desire to listen if these expectations are unfulfilled. Say what you mean and do what you say.
  4. Tell don’t ask. If you phrase your want as a request or a question, your child can say no. Even a child that is not oppositional may respond negatively because your question has provided the opportunity to do so. Don’t ask your child to clean his room; rather, tell him to do so. And even better tie a positive outcome to the request. When your room is clean, you can play a video game.

They way you ask will greatly influence how well your child listens to you. It will not, however, produce an “overly” compliant child, but that should not be your parenting goal. Proper communication teaches your child to be reasonable, thoughtful, and well connected to the family. And if you have done all of the above and your child still NEVER listens—might be time for a hearing test.