Do you remember when your child was born? We have all dreamed about how our children will be - how we will treat them, what kind of adults we want them to be. When we have a child who has more problems than most children, we have certain feelings. When we have a child with a chronic physical or mental illness, we go through a cycle of grief over the loss of the child we dreamed of.

An understanding of grief may not eliminate the pain, but the pain can be handled better. When we go through grief, we often have physical symptoms that may include shortness of breath, loss of appetite or eating too much; problems in sleeping; sick feelings in the stomach; feeling exhausted, irritable, angry, weak, restless, helpless. We burst into tears, unable to hold them back.

Families can continue for some time, even years, denying that there is a real problem with their child. We cannot believe our child has a serious problem. This is denial. If we don’t think about it, the problem will go away.

As the behavior and attitudes of the child become worse, we feel resentful and angry toward the child. "After all I have done for you, why are you acting this way?" We feel anxious and confused as we look for help. We get conflicting opinions and advice from professionals.

Parents often disagree about how to handle a difficult child. One parent will give in to the child while the other parent wants to punish the child. Tension in the household increases.

Parents have moments of intense guilt, especially after becoming angry with their child. We agonize over what we might have done to cause the child to behave this way. Doubts and anxiety lead to a frightening distrust of the family’s instincts, perceptions, and judgments. Parents think, "How much more can I take?" We are in grief over the loss of the child we had dreamed of.

Most people go through these stages:

1. The beginning uneasiness. Is this behavior normal?
2. Doubts - talking with family, friends, minister, doctor.
3. Searching for explanations.
4. The need for professional help that confirms family’s sense of failure.
5. Denial - if we don’t think about it, it will go away.
6. Anger toward the child, family members, the school, mental health system.
7. Guilt - what did we do or not do to cause this?
8. Shame about the child’s behavior.
9. Isolation - We can’t take the child anywhere and friends won’t visit us because of the child’s behavior. We can’t find anyone to take care of him.
10. Depression and hopelessness - We realize this won’t go away.
11. Constant crises keep the family in an uproar and in a state of anxiety.
12. Loss of faith in the mental health system.
13. Acceptance - coming to terms with a mental illness or behavior disorder is a long rocky road.
14. Chronic sorrow and pain - we function with a heavy heart.

Not every family member feels grief in the same way or at the same pace. One parent may be stuck in denial, guilt, or depression. This causes conflict within the family. One parent may not be available or able to support the other. If you are a single parent, you may really feel alone.

Acceptance without loss of hope is the stage most families reach after a long time. We learn to control our reactions to our child. We learn about medications and treatments, about educational programs, about new ways to help the child control his behavior. We learn to live without feeling anger and resentment, to take care of ourselves, to find a support group, to find some joy in life, and to relieve stress in positive ways.

By Marcia Garatt, NAMI Cabarrus County

ADHD (Attention Deficit/Hyperactivity Disorder) affects three to five percent of the population making it one of the most common childhood disorders. These children exhibit symptoms that disrupt classroom activities and impede their education. Our focus here is on specific behaviors which teachers can target and replace with approved behaviors. The idea is to set the ADHD student up for success, to reinforce students for doing what we want them to do, not punish them for undesirable behavior.

• Task duration – ADHD students have short attention spans. Assignments should be brief and feedback immediate. Break up larger projects into smaller, manageable parts.

• Direct instruction – Teacher-directed as opposed to independent seatwork. Teach note-taking strategies to increase benefit.

• Peer tutoring – Provides immediate and frequent feedback and can lead to dramatic academic gains.

• Scheduling – Instruction time scheduled in the morning is a plus.

• Novelty – Attention to task improves with more novel, stimulating material such as the use of color, texture, various shapes.

• Structure and organization – Use carefully structured lessons with important points clearly identified. Provide a lecture outline to help with note taking. Rule reminders should be clear, well defined, and frequently reinforced visually. Consequences should be clear as well. Review rules before change of activity and after breaks.

• Pacing of work – When possible, let ADHD students set their own pace. This lowers the intensity of problem behaviors.

• Instructions – Need to be short, specific, direct. It is helpful to ask students to rephrase them to teacher. Teachers need to be prepared to repeat directions often.

• Physical movement – Students with ADHD have difficulty sitting still and need productive opportunities for movement. Examples include standing at desk, sharpening pencils, tending to class pet, assisting teacher with audio-visual aids, and writing on blackboard.

• Distractions – Keep distracting materials to a minimum and located away from student’s field of vision.

• External reinforcement – Students with ADHD need external criteria for success and a pay-off for increased performance. Intangible awards alone do not work. Rewards need to be changed often. Students need a lot of praise and encouragement.

• Time out – Can be effective in reducing aggressive, disruptive activity, particularly when behavior is reinforced by attention of peers. Use only with the most disruptive behaviors and only with trained staff. Time out should be followed by a discussion about what happened and how to prevent a recurrence. Time out period should be brief and in a pleasant environment.

• Token economy systems – Involves giving the students tokens when they exhibit acceptable behaviors. Tokens are later exchanged for tangible rewards or privileges.

• Response-cost programs – A program found to be effective with impulsivity is based on giving the students a certain number of tokens at the beginning of the day. When rules are broken, tokens are taken away. A tangible award or privilege is awarded at the end of the school day.

• Anticipation – Teachers need to anticipate difficult situations for children with ADHD. They can reduce the length of an assignment, focus on quality instead of quantity, when presenting a task that might be more difficult for students with ADHD.

• Encouragement – Teachers should seek to reinforce desired behaviors and discourage undesirable behaviors. It is important to have alternate plans available.

(Source: Strategies for Teachers by Stephen Brock, National Association of School Psychologists, Communique Vol. 26, No. 5 February 1998)

With the new school year approaching it is time for us to schedule our school presentations. NAMI NC has a well-documented two-hour presentation entitled "Emotional, Behavioral, and Mental Disorders in Children and Adolescents." Topics include warning signs, medications, the needs of families, and classroom interventions. The presentation was piloted last year to over 300 school professionals. Their response was overwhelmingly positive. They greatly appreciated the information and helpful handouts. We even donate a selection of five books that are excellent references for teachers and school nurses. I will soon be getting information out to the schools that have shown an interest in scheduling a presentation. Please call if you would like me to contact a school or group of school nurses about scheduling a time for the presentation. This presentation is made possible by NAMI NC’s contract with the Division of Mental Health, Child and Family Services Section.

Attending a school for the first time can be a scary time. There are a lot of new teachers, administrators, and students to get to know. For children who have emotional, behavioral, or mental disorders this can be overwhelming. Here are a few ways parents and teachers can ease the move to a new school.

• Take the student on a tour of the school. Help him or her get oriented to these new surroundings.

• Introduce the student to key people (e.g., counselor, school nurse, office staff). This way the student feels there are people there who know him or her and the student can put a face with a name.

• Make sure the student has support when classes change. Students need help surviving the rush in the hall as students go to their next class.

• Make sure the student understands the lunchroom procedure – where to sit, how much time is allowed, what menu choices are to be made. It might help to get a copy of the menu in advance so the student can make a selection. Local newspapers often print this.

• Once school begins, it is helpful if the student has a teacher to whom he can relate, someone who can offer a "safe place" for the student to go to when feeling anxious and in need of timeout. This "safe place" also gives teachers an out when they feel frustrated and need to get the student away from their classroom.

• Encourage the student to talk to counselors and staff about clubs or groups the student can participate in through the year. This is a great way to meet other kids.

• If a student is not having a good day, it may be helpful for him to let the teacher know at the beginning of class. That way the teacher can avoid calling on him.

• Other tidbits of advice to students include: follow yourself, not the crowd; seek advice from someone you trust to tell you the truth; learn to ignore people who may only want to get you in trouble; and seek support from friends and family.

(Adapted from "How to Keep Your Cool in School" by Kenny Rogers in "Claiming Children," the Federation of Families for Children’s Mental Health, fall issue 1999.)