In an effort to help our NACD families and others maximize their efforts and make the most out of the time they have to work with their children, it is incredibly important to keep reminding everyone about the significance of intensity.

The foundation of what we do at NACD is designing very targeted individualized programs that are created to help provide the maximum results, relative to the time invested. The significance of being targeted is that we stimulate and change the brain when we apply specific, organized, targeted input with the necessary frequency, intensity, and duration. Random input is just noise to the brain; disorganized input is irrelevant to the brain; and any input that is not received by the brain with intensity never happened.

We understand that intensity, the most important of the Super 3 (frequency, intensity, and duration), is not entirely a reflection of how loud or strong or exciting we are when working with our kids. The big factor is what the intensity is with which they are processing the input. Have you ever seen someone fall asleep at a party or in a movie theater or sporting event? These are all intense environments; but if that person is asleep, it has zero intensity for their brains—it didn’t happen. I recall the question I heard way back when in school—“if a tree falls in the forest and there is no one there to hear it, did it make a sound?” It’s not about you, it’s about them. Back to the folks at the party-how about if they are not asleep, but just dozing? Or, they just had a fight with their significant other and are running through the last argument in their mind one more time, or have a song stuck in their head that keeps going around and around. How much did all that “intensity” that is going on impact them? Probably not much. Ultimately intensity is based on how the individual is receiving/processing the input.

I have always related intensity and impact on a scale of 1-10. If something goes into a brain with the intensity of 9 or 10, learning is virtually instantaneous. Drop it down to 7-8 and we need a fair amount of frequency and duration to change the brain. If the intensity is only a 6, we need a lot of frequency and duration—many times per day and lots of days, weeks, or months. At a 5 we are in for a very long haul. And below a 5, we are better off taking a nap.

Let’s look at some of the things that affect intensity, starting with physiological issues. Diet is one of the things we talk about with all parents. I won’t get into the specifics of diet in this article but suffice it to say that if you feed your kids pancakes with syrup for breakfast, just send them back to bed and forget about school. Sleep is another foundational issue, and doing what is needed for both you and your child to get enough sleep is very important. So before we go any further, let’s see where we are. If what you are trying to put into your child’s brain is super exciting to them and they love it, they ate some good protein, had a great night’s sleep, and feel wonderful, you might get them to an 8. Trying to input something they might like but don’t love, drop to a 7; not a wonderful breakfast, drop to a 6; and then you were up with them for half of the night, we just dropped to a 5, and perhaps you are both getting ready for a nap.

Just yesterday I had a talk with a very nice family, great, concerned parents who have a teenage son on the autism spectrum. He has had a few small seizures that did not appear to have any residual effect and is on two different anti-convulsive medications. His doctors have also put him on two additional drugs that are used for schizophrenia and irritability. When I look at this boy, he looks like he is about to fall over with his eyes open. He’s at a 2-3 for intensity, and if you work hard, you can push him briefly to a 4, and on rare occasion to a 5. Under the circumstances we hope to maintain what function he has until these medications that all slow his brain down can be altered or eliminated.

Drugs that are used for seizure control and behavior and attention control are slowing down the brain. As a side note, the neurologists and neurosurgeons that I worked with almost 50 years ago were aware that the vast majority of seizures actually caused no harm, and my clinical observations over all of these years verify it; but we still have neurologists who see their mission as stopping all seizures, regardless of the fact that they are medicating the child to the point where there can be virtually no development. I’ve been happy to hear that after 50 years, there are a few neurologists acknowledging that not all seizures spell the end of the world and are being much more conservative with the medications. And fortunately there are new very promising alternatives to the drugs.

Diet, sleep, health, exercise, or the lack of, and medications all have an effect on the brain, your child’s ability to process information, and thus to be stimulated and develop.

I have a confession to make. I do not get regular organized exercise. I played sports, and I played them hard. I have almost always lived where I had a good size piece of land and always loved working outside and work hard. I enjoy walks and hikes, but a daily exercise routine—never. It’s a good thing your child has parents and helpers to help structure their days, establish priorities for them, and to motivate them and make things fun. Perhaps if I had some great fun personal trainer who came and got me at a specific time each day and praised my success, I might exercise. I probably would also need to add a 25^th hour to every day. As adults we are responsible for ourselves. We can choose to eat well, exercise, whatever; however we are also responsible for our children, and it is our responsibility to see that our children eat well, get their sleep, and do all the other things needed to help them develop well. Even the smartest child isn’t wise. We need to make the choices for them and keep them heading in the right direction. Side note: How many of you give your pets more nutritious diets than your kids?

The younger the children, the easier it is to make things fun and increase the intensity. I constantly hear that little Johnny is bored with this or that or he doesn’t like it. The reality is that it’s not about the activity, it’s about the environment of the activity and how it is presented. Remember Tom Sawyer and how he got the kids to paint the fence for him? Create the right atmosphere, and you can get your kids to have a ball cleaning toilets. If something doesn’t hurt, you can create an atmosphere that makes whatever you are doing fun, and if something hurts, stop doing it because something is wrong. If you can’t get your intensity or their intensity above a 5, what should you do? You should go take a nap and come back to it later with good intensity.

One of the most common issues I see when watching program implementation is a lack of intensity when a child gets something right or does something well. I can observe someone working on processing, and the difference in the response when the child gets something right or wrong is almost indistinguishable. Often when reviewing program implementation videos, we have to pay close attention to see if a child got something correct or not because we can’t tell the difference from watching the reaction of the parent or caregiver.

Children of most any age will respond to your positive attitude and words of praise. If older children need something more to get their intensity up to adequate numbers, then explore some form of a positive token economy, where achievement as a reflection of their trying and doing something with sufficient intensity to impact their brains can purchase special privileges and such. But always let your child know that you are proud of them for their efforts and achievements. Don’t reward compliance that does not equate with intensity. Reward achievement even if you have to initially make it a bit easier for them so that they can experience success.

One of the most common killers of intensity is duration. Many of the activities we give children have a duration of only a minute or two, and the duration we give is a maximum. Maximum, not minimum. More often than not, more turns a positive into a negative. We encourage parents to, if at all possible, end an activity on a high note. Parents tend to continue an activity until the child has had it, and it turns negative. The result of that is the next time you go to do that activity the child recalls it as a negative, not a positive. Imagine giving your child the forbidden fruit—ice cream. You give them just a spoon or two and they love it and you stop. They want more. Now imagine that you gave your child a couple more of spoons of ice cream—still loving it—and then you gave them a small bowl. They’re still loving it, but not quite so much. Then make them eat a large bowl, having to force them to eat it over the course of an hour; and to really make it fun, make them eat more and more until they throw up. That would sure teach them to love ice cream. When should you have stopped? We have the ability to turn most anything that can be positive and fun into a negative. Remember: it’s all about intensity.

The big secret to success is intensity—the intensity with which your child takes in the input you are providing.

Intensity is not only foundational, it is mandatory: Get it?

 

Anything that adversely affects your child physiologically has a negative impact on intensity: Get it?

 

Any mediation that affects your child’s brain is likely to have a negative impact on their intensity: Get it?

 

What you do can affect your child’s intensity, but ultimately, it’s a matter of doing what works to create intensity in them: Get it?

 

Too much of a good thing is a bad thing; stop while you are ahead: Get it?

 

If your intensity or your child’s falls below a 5 and you can’t raise it, take a nap: Get it?

 

To be successful we need to provide your child with specific targeted input with sufficient frequency, intensity, and duration: Got it?

 

Good!

Reprinted by permission of The NACD Foundation, Volume 31 No. 8, 2018 ©NACD

The post Intensity: Get It – Got It – Good! appeared first on NACD International | The National Association for Child Development.

Anxiety disorders are supposedly the 
most common mental health issue 
today for adolescents, with one
 national study of more than 10,000 
adolescents finding that about 31%
 qualified for an anxiety disorder at 
least at one point in their lives 
(Merikangas et al., 2010). 
Prescriptions given to children for 
these anxiety disorders are
antidepressants that include selective
 serotonin reuptake inhibitors (SSRIs) most frequently, followed by serotonin norepinephrine reuptake inhibitors (SNRIs), and rarely benzodiazepines. In other words, we could eventually have one third of our children drugged with antidepressants for anxiety alone if all parents wanted to continuously screen their children for an anxiety disorder and get an “appropriate” prescription.

The obvious question is why is the prevalence of anxiety disorders so high? First of all, anxiety is an emotion we all occasionally experience. Infants and toddlers are commonly apprehensive of strangers, young children are commonly fearful of new situations and any adult negativity, and adolescents are anxious about rejection from friends or crushes, the test they did not adequately study for, as well as any and all issues that threaten their self-images and so on (Beesdo et al., 2009). Every child will exhibit anxiety towards certain things or will behave anxiously for periods of time, and this is normal, especially if there are new stressors in the child’s environment, such as starting a new school, conflicts at home, bullying, having a fight with a best friend, or a dreaded math test coming up. Frequently, what might occur is a teacher will notice a child has been acting anxious for a couple of weeks, the teacher will tell the parent the child has anxiety, the parent will go to doctor and tell her the teacher thought the child was showing signs of anxiety, and then the doctor will write a prescription for an anxiety disorder. This would explain the research that indicates only 20% of adolescents with a current anxiety disorder diagnosis will even retain the diagnosis (Wittchen et al., 2000). Of course, the child most likely does not have an “anxiety disorder;” and moreover, medicating the child does nothing to actually address the developmental issues or neurological disorganization or the environmental/social/academic stressors that are the source of the anxiety in the first place.

For some children, anxiety issues are the reflection of neurological disorganization. In such cases, the level of neurological organization is such that the child has not yet established a strong delineation between the two hemispheres of the brain. When there is such delineation, a dominant hemisphere is established, which assists in logical and analytical thought and helps keep emotional activity of the subdominant hemisphere in check. If a dominant hemisphere is not firmly established, then the child often functions subdominant or emotionally, such as anxiously, rather than with reason. A further aspect of neurodevelopment affecting anxiety is poor auditory working memory. If working memory is weak, the child does not have the capacity to think through and resolve issues, and therefore, tends to ruminate over issues again and again, each time heightening their level of anxiety.

Selective serotonin reuptake inhibitors given to children and adolescents with anxiety include fluoxetine, sertaline, and citalopram; and common side effects include abdominal pain, nausea, headaches, and drowsiness (Birmaher et al., 2003). Furthermore, the US Food and Drug Administration issued a black box warning on SSRIs that describes the risk of suicidal ideation for patients 25 years of age or younger (Emslie et al., 2006). Fluvoxamine, paroxetine, and escitalopram may even be less safe versions of SSRIs used to treat anxiety (Siegel & Dickstein, 2012). The serotonin-norepinephrine reuptake inhibitor known as venlafaxine is also prescribed to youth with anxiety. Side effects include asthenia (bodily weakness), pain (e.g., headache, abdominal pain), fatigue, and even anorexia (Rynn et al., 2007). Finally, benzodiazepines are sometimes prescribed, despite research that shows they are no more effective than a placebo in reducing anxiety symptoms (Simeon et al., 1992). Moreover, there is a high risk for patients to develop an addiction to benzodiazepines, and pediatric patients are especially vulnerable to disinhibition and aggression caused by benzodiazepines (Mancini et al., 2005). On the other hand, non-drug intervention has the most evidence as effective treatment for anxiety, has the most long-lasting effects, and does not have any of the side effects associated with drugs (Siegel & Dickstein, 2012).

In conclusion, it is normal for all children and adolescents to experience some level of anxiety for periods of time; and in fact, lack of anxiety may be cause for even greater concern for some. Be cautious in having your child labeled with an anxiety disorder due to anxious behavior for only a short time period. If your child does appear to be experiencing persistent and uncontrollable anxious behavior, carefully investigate any relationship or academic issues, or possible social causes, such as bullying, negative teachers, aides, therapists, and so on. Also explore neurodevelopmental issues, such as neurological disorganization or weak working memory. Whenever possible, look for and treat the cause of the anxiety and do not resort to prescription drugs until other avenues have been exhausted.

Sources

• Beesdo, K., et al. (2009). Common and distinct amygdala function perturbations in depressed vs anxious adolescents. Arch Gen Psychiatry, 66, 275-285.
• Birmaher, B., et al. (2003). Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry, 42, 415-423.
• Emslie, G., et al. (2006). Treatment for Adolescents with Depression Study (TADS): safety results. J Am Acad Child Adolesc Psychiatry, 45, 1440-1455.
• Mancini, C., et al. (2005). Emerging treatments for child and adolescent social phobia: a review. J Child Adolesc Psychopharmacol, 15, 589-607
• Merikangas, K.R., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication – Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry, 49, 980-989.
• Rynn, M.A., et al. (2007). Efficacy and safety of extended-release venlafaxine in the treatment of generalized anxiety disorder in children and adolescents: two placebo-controlled trials. Am J Psychiatry, 164, 290-300.
• Siegel, R.S., & Dickstein, D.P. (2012). Anxiety in adolescents: Update on its diagnosis and treatment for primary care providers. Adolescent Health, Medicine and Thereapeutics, 3, 1- 16.
• Simeon, J.G., et al. (1992) Clinical, cognitive, and neurophysiological effects of alprazolam in children and adolescents with overanxious and avoidant disorders. J Am Acad Child Adolesc Psychiatry, 31, 29-33.
• Wittchen, H.U., et al. (2000). The waxing and waning of mental disorders: evaluating the stability of syndromes of mental disorders in the population. Compr Psychiatry, 41, 122-132.

The post Science Corner Vol. 5 – Anxiety appeared first on NACD International | The National Association for Child Development.