Resources

Looking for mental health services in Central Massachusetts? Go to:


Looking for more information? Check out these resources for more in-depth info and suggestions:
 

  • National Alliance on Mental Illness (NAMI)  has an excellent website: be sure to visit the Child and Adolescent Action Center for the NAMI Family Guide: Adolescent Depression and Treatment Options, the NAMI resource guide, and other helpful information: www.nami.org
     

  • ParentsMedGuide.org is a website that is developed and maintained by the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry to provide information for parents of children who may need medication to help with their difficulties.
     

  • Center for Mental Health Services: www.mentalhealth.org
     

  • National Institute of Mental Health: www.nimh.nih.gov
     

  • National Institute on Drug Abuse website has brief fact sheets on major drugs of abuse, as well as information about preventing and treating substance abuse: www.nida.nih.gov
     

  • Federal Drug Administration (FDA): www.fda.gov
     

  • Centers for Disease Control and Prevention: www.cdc.gov
     

  • American Academy of Child and Adolescent Psychiatry: www.aacap.org
     

  • American Academy of Pediatrics has a website with many excellent resources for parents on common questions and concerns including ADHD, parenting tips, child development, and more: www.aap.org
     

  • American Psychological Association: www.apa.org
     

  • The REACH Institute, The REsource for Advancing Children's Health: www.reachinstitute.net
     

  • Child and Adolescent Bipolar Foundation: www.bpkids.org
     

  • CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) is a website with several good resources for people who have ADHD.  Excellent resources regarding working with the school system: www.chadd.org
     

  • Depression and Bipolar Support Alliance: www.dbsalliance.org
     

  • Depression and Related Affective Disorders Association: www.drada.org
     

  • Federation of Families for Children's Mental Health: www.ffcmh.org
     

  • National Mental Health Association: www.nmha.org
     

  • Suicide Prevention Action Networks: www.spanusa.org

"Helpful Tips" by PBH Clinicians

Understanding Problem Behaviors by Dr. Damon Minow


Problem behaviors, including defiance and temper tantrums, are some of the most challenging issues that parents deal with in their children. Dealing with such difficult behaviors is extremely frustrating as a parent, and can lead to negative relationships between family members. Although it often appears that when a child is acting defiantly or engaging in a tantrum that the child is being willfully difficult, in many cases the child actually lacks the skills for engaging in appropriate behaviors and is unable to respond differently. For example, many children who demonstrate significant negative behaviors are delayed in their development of flexible thinking skills and the ability to tolerate frustration, which are critical to the ability to behave appropriately. It is important for parents and other adults involved in the lives of such children to recognize these skill deficits, so that they are able to respond to problem behaviors with empathy and skill-building, as opposed to anger and punitive measures. Some specific tips: Recognize the signs: Try to recognize if/when your child is having trouble thinking flexibly and is struggling to tolerate his/her level of frustration. Signs might include a raised voice, clenched fists, etc. Validate: When you see that your child is struggling, verbally validate his/her feelings (e.g. “I see you’re feeling frustrated”). Problem solve: Instead of responding inflexibly to your child (e.g. “Do what I say right now!), try to figure out and solve the problem together (e.g. “You want to still play with your Legos, and I want you to get dressed for school. How can we figure out a way to deal with this problem?”). This type of response not only reduces the likelihood of your child’s behaviors escalating to even more difficult ones, but helps to teach him/her the critical flexible thinking and problem solving skills that are lacking. Be empathic: Most children want to do well, and it can be very upsetting for them when they are unable to do so, and the ones they love the most (e.g. parents, siblings) are angry and aggravated with them. As difficult as it can be, try to respond with empathy and support instead of anger. Praise: Liberally praise your child for appropriate behaviors, especially when you see him/her thinking flexibly and tolerating frustration. Get help: It can be very difficult to manage a child with significant problem behaviors, and a professional may be able to provide you with support and guidance in order to do this effectively. An excellent resource on this issue for interested parents is “The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children” by Ross W. Greene, Ph.D.




How to Communicate Effectively with Your Child by Dr. Galvinhill


We all know that communication is important in creating healthy family relationships. Parents are aware of the need to communicate to their children about how to stay healthy, safe, and to develop a sense of responsibility. Just as essential, but more often neglected, is developing and practicing good listening skills as a parent. Communication is a two-way street. For children to listen to you, they must also feel heard. Being a good listener will promote your child’s ability to talk openly with you about problems and needs. It will also enhance your child’s self-esteem and build a loving feeling of connectedness between you and your child. So, how do we effectively communicate with our children?

1. Take time. Spend regular time with your child. This will emphasize your child’s importance and your availability to your child. This should not just be time running errands or taking your child to soccer practice. Your child is a priority and quiet time alone with your child is too. This will set the stage for communication.

2. Listen. When your child is upset about something, just listen. Don’t interrupt when your child is talking. Don’t try to solve problems or give advice. Your job is simply to understand what your child is saying. When your child has finished talking, you can summarize what has been said in an attempt to gain better understanding. Ask if you have understood and if there is anything more your child would like to tell you.

3. Provide support. Ask how your child is feeling about things. Emotions are never wrong. Make an attempt to understand your child’s feelings. Verify that you understand. Whether you share your child’s feelings or not, be sure to communicate that the feelings your child is having are valid.

4. Be clear and consistent. Be sure your actions match your words. Don’t give mixed signals. Don’t laugh while you tell your child “No.” Follow through on limits and consequences you have set. Otherwise, you will be teaching your child to ignore what you say.

5. Be calm. Shouting at your child says that you are out of control. It also models poor communication skills. Stay calm when talking with your child. If you feel that you are too angry to talk calmly at the moment, give yourself time to take a break and talk about it later. You will be more effective when you can think clearly.

6. Take responsibility for your feelings. Your reaction to others’ actions is just that, your reaction. Take responsibility for your own feelings by making use of the word “I”. For example, “I felt worried when you didn’t come home on time.” rather than “You are so irresponsible.” This is more likely to generate understanding from your child than defensiveness.

7. Give credit when due. When your child behaves as you would like, give positive feedback. Focus on responsible behavior and accomplishments. Your child is more likely to listen to you when negative feedback is balanced with praise.

8. Keep things in perspective. Stay focused on the big picture. No one is perfect…not you, not your child. While you want to set high goals for your child, don’t communicate expectations that are unrealistic. Success breeds further success. Be sure the goals you communicate to your child are attainable.




How to Give an Effective Time-Out by Dr. Guertin


Time out is a behavioral management tool designed to reduce problem behaviors. It is effective because during a time out, the child does not get any attention or reinforcement. Beyond teaching good behavior however, Time Out also promotes emotional maturity because it teaches children how to stop and think before they act and how to calm down when they are upset. When implemented consistently, time out is a highly effective piece of an overall behavior management plan.

  1. The Place. The place you choose for time out should be very dull. There should be no toys, no TV, no books and especially no people. Some common options are a stair, a parent's room, a bathroom, or a hallway.
  2. How Long. A good rule is 1 minute in Time Out per year of age (e.g., 4 year old = 4 minute time out).
  3. The Behavior. Choose very specific behaviors that you will give a Time Out for. Behaviors such as hitting, biting, a fresh mouth, or persistent defiant behavior are good choices.
  4. Have a family meeting where Time Out is explained in detail to the child before you start using the procedure.
  5. Every time your child engages in the problem behavior, inform him/her immediately and in a calm voice that the rule is No hitting, Time out. Then guide your child to Time Out. Set a timer for the Time Out time once the child is quiet. When the Time Out is over, ask the child why they were in Time Out. He/she should then repeat the rule No hitting. If he/she does not remember, state the rule is no hitting. What is the rule and have the child repeat the rule back to you. Time Out is then over.

Some Possible Problems

  1. Child tantrums: Remind your child only once that Time Out does not start until they are quiet.
  2. Child tries to leave the Time Out area before the Time Out starts: block their exit with your body (be sure your back is to your child so you do not give him any attention) or shut the door (if Time Out is in a room).
  3. Child leaves the Time Out area during the Time Out: Return your child to time out, remembering not to speak to him or her. Then reset the timer for the full length of Time Out again. You may need to hold him/her in a time out firmly, but gently to prevent injury if child leaves Time Out repeatedly. Be sure not to talk to your child while holding him/her.

Things to check when Time Out doesn't work.

  1. Be sure you are not warning your child more than once before sending him/her to Time Out.
  2. All adults supervising the child should know the rules and give Time Out in the same way.
  3. Once your child has completed his/her Time Out, no further discussion or punishment is needed.
  4. If your child says that Time Out doesn't bother him/her, this is a trick. Ignore it!
  5. Any misbehavior that occurs during Time Out, such as cursing, spitting or hitting, should also be ignored. Respond by restarting the child's Time Out time after he/she is quiet.
  6. Make sure the child can not see the TV, hear the radio, or interact with others (including siblings) while in time out.
  7. Give a Time Out EVERY TIME your child breaks one of the rules you are disciplining with Time Out. Be consistent.




Routines - Why Teach Them? by Dawn Hartnett


Routines help your child to gradually learn to do some things almost automatically. When daily activities such as bathing, dressing or getting packed for school are more automatic, your child can do them more easily, without as much messing up, getting distracted or sidetracked. Routines help establish expectations. Parents still have to maintain routines and watch for follow through, but they are not giving directions at every step. Consider the difference: "Now put on your left sock, now your right sock, now your pants." vs. "What is your routine? Ok, good, what do you do first? Right! Go ahead now." The responsibility for following the routine falls more on the child and the parent is freed from the role of the 'bad guy.' The child also can feel more in control of herself, which is an enormous boost to her self-esteem and sense of competence. Routines help children who have trouble remembering instructions, or who have difficulty with multistep instructions. When you leave the room and you are not available to repeat the instructions, a routine (when finally learned) can help a child remember the sequence. Repeating instructions or standing over your child becomes frustrating for both you and him. Eventually, routines can help reduce nagging and reminders. Begin by writing down the steps of the routine, for example, or having some way for you child to remember which steps to follow and in what order. Routines can reduce anxiety and stress for your child. Routines ca help to keep kids out of trouble. For example, bedtime might be a difficult time for your child, because it is hared to wind down, or let go of wanting to be with parents. In addition, your child might get ready for bed in a different order each night. Arguing or nagging might create stress and anxiety as well. Following the same routine can be relaxing, because both you and your child know the order of the steps. Routines can also help to avoid some (not all) power struggles. Some children, especially those with attention problems, receive many commands, reminders and nagging. They begin to tune out, and may be less likely to do what we want. They may even become negative, defiant, or oppositional with their parents. This creates a cycle, because parents become more likely to nag, remind, and feel critical and frustrated with their children.




Preventing Drug Abuse Among Children and Adolescents by Julie Lysiak


Parents need to educate themselves about the unique pressures that impact teenagers today. These range from such things as peer pressure, commercialism, societal messages, parental messages, and the challenges facing our nation and the world as a whole. Parents who develop strategies early on in their child’s life to communicate and support them during times of stress have the highest likelihood of having children who are able to resist the pressures involved in substance abuse.

1. Create a safe, supportive environment in which discussions regarding alcohol and drug abuse can take place. Start this when your children are young. Talking about it will not make them want to use it more. They will learn about drugs one way or the other and it will serve them much better to hear about it from you first.

2. Connect with your teen to find out what they already know, how they feel, and what pressures they are already facing. Don’t assume they already know or that they will get all of the information that they need from school or TV. The world that we live in today has raised the bar as far as the amount of stress that we are all living under. Teens aren’t immune to this. It you are worrying about something, chances are that they are worrying about it as well.

Rather than telling them to “Just Say No”, teach them about the harmful effects and the consequences that they can expect. Don’t talk down to them. Speak to them in the same manner that you would to anyone to whom it is important to get your message across. Listen to their questions, concerns, objections. If they are resistant or dismissive of the information, back it up with research.

3. Communicate clearly what your expectations are and what the consequence of use will be should this occur in your family. Evidence consistently shows that the rates of alcohol and drug use are lowest in families where parents set clear expectations and who follow through with discipline when rules are broken. Young people need guidance in setting realistic goals and expectations for themselves. If you do not share your expectations regarding substance abuse with your children, they will concoct their own.




How To Swallow Pills by Dr. Mastis


Many children and a few adults believe that they are unable to swallow pills and thereby doom themselves to bad tasting liquid medication. While no doubt there are a few people out there who really cannot swallow pills, most people can do so if they learn how. After all, most pills are much smaller than the pieces of food we swallow easily!

To learn to swallow pills, start with something that doesn't taste bad, isn't big or scary, and it's okay to take a lot of. I recommend Tic Tacs or mini M&M's.

  • First, eat one normally and notice whether or not you chew it. If you don't chew it, half the battle is over.
  • Next, eat one while trying not to chew it: just let it get nice and wet in your mouth, then give it a swallow.
  • You may have to practice a bit until you feel pretty sure you can swallow it if you've sucked on it a little.

The next step will teach you how to swallow it without sucking on it. The point is to remember that your taste buds only go halfway up your tongue. The back part of your tongue doesn't have any taste buds so NO BAD TASTE.

  • Open your mouth really wide. Put the candy on the back of your tongue as far as you can without gagging. Some people tilt their heads up and drop the pill on the back of their tongue (not down your throat: that will make you gag or choke. Just the back of your tongue)
  • Stop for a moment and notice whether you taste the candy. Mints are really good for this part.
  • Now, holding the candy on the back of your tongue, take a big gulp of water and swallow it all at once. It might take some practice to keep yourself from washing the candy back into the front of your mouth, or you might just get it right away.

Now you can swallow small candies. Try it with a full size M&M. DON'T try it with a starlight mint, that is TOO BIG.

Pills come in different forms. Tablets are the medicine mixed with a powdery filler and pressed into a hard pill. Tablets are a little bit crumbly and are most likely to melt in your mouth and leave a bad taste. Coated tablets are tablets with a coating around them to keep them from dissolving in your mouth. M&M's are just coated chocolate tablets. Capsules are little smooth containers (made usually of gelatin) that the pill manufacturer presses the medicine powder into. Capsules also keep the pill from dissolving on your tongue and leaving a bad taste. If you can swallow an M&M, you can swallow a coated tablet or a capsule, and it's okay to ask your doctor if you can have the medicine in coated tablets or capsules.

Unfortunately, not every medicine comes in a coated tablet or capsule. However, many people can swallow tablets, especially small ones, just exactly the same way that they swallow coated tablets or capsules, because there are no taste buds on the back of your tongue. If you practice with a strong flavored candy, like a mint tic tac or a Red Hot, you will soon figure out how to keep from tasting the candy while you swallow it. The trick is to be fairly quick, put the pill on the way back of your tongue, and use a lot of water.

Sometimes it will feel like the candy or pill gets stuck in your throat after you have swallowed it. Don't worry: it's not actually stuck there, and the feeling will go away in a few minutes. It means that you didn't use enough water to wash it all the way down to your stomach, so the muscles in your esophagus (the tube going to your stomach) have to work extra hard to get it there. Try drinking more water now and the next time you try, take a bigger mouthful of water to wash down the pill.

A few people still struggle, especially if they have to take big tablets. A few things may help:

  1. Use a LOT of water. Take one gulp to wash down the pill and then a few more swallows to chase it down to your stomach.
  2. Try wrapping the pill in butter or chocolate frosting to make it slide better and to hide the flavor a little. Don't use peanut butter, though, or you will have pill stuck to the roof of your mouth.
  3. Ask your doctor if you can have coated tablets, capsules, or at least smaller tablets.
  4. Some medicines can be mixed with water, juice, yogurt, apple sauce, or ice cream. Ask your doctor if yours can.
  5. Some people say that holding your nose while you eat, smelling an onion while you eat, or freezing your tongue with an ice cube first will also help you keep from tasting bad flavors.




Speaking Your Child's Language by Dr. Minow


Speak Their Language

It can be a very stressful situation when your child withdraws emotionally and isn’t interested in talking to Mom or Dad. In these situations, pressuring your son or daughter to talk will seldom help. Instead, it is often most effective when we learn to “speak their language”. In other words, stop trying to talk about the issues they are avoiding, and instead have a conversation on their terms, or about their interests. For example, if your child loves Pokemon, then let them teach you how to play Pokemon. The specific topic or activity you choose doesn’t matter, as long as its something your child truly cares about. You likely be amazed how much you learn about your child’s thoughts and feelings about school and friends while you’re just spending some “low pressure” social time with them. But there’s one more important lesson not to forget in all of this. When your child does finally open up about their thoughts and feelings, don’t question or critique what they have to say. It probably has taken some time for your child to beginning sharing, and the last thing you want to do, is frighten them off. Instead, even if it is difficult, just listen and empathize with their situation. Solving or fixing their situation is actually not critical at this time. Rather, just showing them that you care and are on their side will go a long way toward gaining their trust and most importantly – having more positive dialogues in the future.