MENTAL HEALTH CHALLENGES IN NEUROLOGICAL DISORDER

MENTAL HEALTH CHALLENGES IN NEUROLOGICAL DISORDER

 

Having a neurological disorder can present many welcome abilities. However, they can also present many challenges. Many neurological disorders increase the likelihood that a person will suffer from a mental health disorders. Some of these disorders can lead to intense feelings of anxiety and depression.

Stress and Mental Health

Stress (good or bad) can exacerbate symptoms and lead to “overload”. Because some people who have neurological disorders are poorly equipped to self-regulate themselves, they can unknowingly exhaust themselves physically as well as mentally. In such a case, poor mental health may come upon them slowly, without detection. Or, a sudden stressful situation may occur, and it may “tip” a person into a state of poor mental health very quickly. Regardless of the cause, judgment will be impaired and a sufferer may feel overwhelmed and unable to cope. In extreme cases, a sufferer may make harmful decisions (to themselves or others) in a failed attempt to cope with their situation, symptoms or fears. As someone with neurological disorders, I know I must be aware that my neurological disorders can pose challenges to my mental health and have the potential to lead to a state of mental ill-health. It’s a reality that I must be aware of and vigilance is required in order to reduce the risks. I know that the times of greatest risk to me often occur when I am subjected to external pressure. Pressure is perceived differently by each person, based on their personal strengths and weaknesses. Stress can come from work, family or stressful events such as having an ill friend or family member. To preserve my healthy mental health state, it is vital that I know what my weaknesses and my “triggers” are. Knowing what “stresses you out” will allow you to plan to avoid (if possible) the trigger or minimize its effect on your mental well-being.

Reactions to Stress

NeurologicallyGifted.com Mental Health shutting downNeurologicallyGifted.com Mental Health anger expression Contemplate how you naturally react to stressors. Do you “shut down” and become reclusive? Do you lash out in anger? Everyone reacts differently to stress. You must first identify and accept these reactions before you can make healthy changes.  Knowing your reaction to stress makes situations more predictable and thus more manageable through self-awareness.

Coping Mechanisms

After identifying your weaknesses, triggers and natural responses, you must then determine appropriate responses that will counteract or eliminate those triggers or have strategies to deal with their repercussions and your natural responses. Consider the things that help you cope with stress. Create a list of these strategies and keep it handy for times of stress. They could include outlets such as jogging, knitting, reading or whatever you truly enjoy and from which you obtain relief.   In my case, I discovered at an early age that running and weight training helped my get rid of ADHD and Tourette Syndrome energy. As a result, I was calmer. When I knew I was approaching a stressful time (university exams or giving a presentation), I would ensure I proactively went for a run to reduce my stress levels, in anticipation of the stress that I was about to experience. In effect, I was increasing my capacity to take on more stress than the regular daily amount.

I often share this analogy:

I think of myself as a clear glass bottle.

As stressful events occur, the bottle fills.  Highly stressful situations and events cause it to fill quickly.  Daily work and family stress fill it more slowly, over days and weeks.  Left unchecked the bottle will keep filling and eventually it eventually overflow.   By participating in stress reducing activities, I empty the bottle of some of the accumulated stress and I create more empty space in my bottle (body).  When I know I am heading into a stressful time or event, I make sure to first reduce my internal stress so I have more room for adding stress to the bottle, so it doesn’t overflow.  I can predict stressful triggers and my responses and also prepare myself to manage the pressures that follow.

In times when you are caught “off-guard” by a stressful situation and are unable to initiate your safe responses to counter a stressor, being aware of how your body reacts is critical. Being aware allows you to self-monitor and regulate your behaviour in challenging situations. With self-awareness and practice, you can become better able to control how stress affects you and reduce its impact on you (and your mental health). It is critical that you are aware of your strengths and weaknesses. Understand and anticipate situations that can “mess you up”, and prepare a plan to deal with challenges in a healthy way.

 

 

Why Is My Child Mean?!?

Why Is My Child Mean?!?

There have been many parent posts online regarding the general and persistent negative behaviour patterns of their children.  “Why is my child mean?”  They describe their children as being “mean” on a regular basis.  It’s not uncommon to see this default behaviour in children who have neurological challenges.   In my presentations, I call this the “Awfulizer Syndrome“.  To these children, everything is awful.  They always seem annoyed or angry.  They are routinely mean or insulting.  They often engage in name calling and typically communicate in an unkind or angry tone of voice.  Generally negative in most aspects of their daily life, they are most often disagreeable.  Without intervention and support, it is difficult to correct these behaviours.  From personal experience, as a person who has overcome this challenge and a parent who has dealt with it, I can tell you it takes a great deal of effort to overcome this neurological affect.

Step One:  Identify your child’s behaviours and the responses of your family members

Identify and address when your child is mean through his/her words, voice or actions.  Be sure to do this when your child is in a calm and receptive state of mind.  Session need to be frequent and on-going.  Share your feelings with your child.  Explain how their words/tone/behaviours make you feel, and how it affects your thinking about them (e.g. “Although I love you, your tone of voice makes me feel mad and I don’t want to be around you when you are mean to me”).  This response is a natural consequence – people don’t want to be around people who are mean or unkind.

You need to make your child recognize and understand their behaviours before you can begin to change them. At times, it may be necessary to actually reflect behaviours back to your child by demonstrating them in a kind way.  There was a time in my stepsons “awareness training” where I actually showed him what he looked like by putting him in front of a mirror to show him how threatening he looked.  I showed him his angry face and clenched fists, and clearly stated that he was not allowed to be near us when he presented in this threatening way.  Prior to this moment, he had no idea how he looked or sounded.  It was not an easy process to embark.  He was enraged by us showing him what he looked like.  In the end, it was worth it.  We convinced him that showing him explicitly how he appeared was something we were doing for him and not to him.  It was not punishment but a step necessary for self-insight.  I am not sure he could have learned as much about himself and how he appears to others without this step.

Step Two:  Show and Teach

Do not assume your child knows how to be kind, even though you are kind in all you do to model appropriately for your child.  Many children with these disorders do not learn by watching.  They miss most body language and social cues (facial expressions and tone of voice).  As a result, they must be explicitly taught.  You will need to teach them appropriate words and actions, and explain when and how to use them (e.g. “When you upset someone, you must say “I’m sorry I hurt your feelings.  I didn’t mean to”).

As a parent of neurologically challenged children, I admit it’s not always easy to for me to maintain my composure.  In times such as this, it is also important to apologize to your child.  As the grown-up it is our responsibility to model how to demonstrate how to keep calm and be in control.  In addition to repairing any possible damage to your relationship with your child, you will be also teaching your child how to apologize.

Step Three:  In the moment

When my stepson engages in mean behaviour, we politely remind him with positive language, “You need to use a friendly and caring tone of voice”, “Please use kind words” , “You need to try again, with a friendly (or caring) face”.

(See Neurologically Gifted’s article:  Using Positive Language for Success)

If he continues with unkind behaviour we then issue a choice for him to self-correct, “You need to use a friendly voice”, or “You need to go somewhere else (give a choice) because we don’t like your behaviour right now and don’t want to be around you”.  (such feelings are normal, and are the result of the child’s behaviour.  This is a true-life natural consequence that your child needs to be aware of for understanding social norms.  If he can’t make a positive choice independently then we would help by making the decision for him

(see Neurologically Gifted’s article Taking On Rage 4: Prepare a Plan)

While teaching my stepson, there were good days and bad days.  I was not disheartened when he seemed to “slip back” a few steps.  We focused on his progress, when he applied his new learning, and we built on those moments.  Always quick to give him praise for making a good choice, we built his confidence and his emotional investment in the members of our family.  Once distant and unconnected to his family, he now knows he is loved, and he not only cares about us, he is quick to admit when he has made a mistake, and asks for help when he needs it.

We all do, in our family.

RAGE 4 TAKING ON RAGE: PREPARE A PLAN

Rage/Neurologicallygifted.com

RAGE 4 TAKING ON RAGE: PREPARE A PLAN

Rage/Neurologicallygifted.com

Rage tends to make family members feel hopeless and out of control.  We began our discussion in Neurologically Gifted’s article, Rage 1:  About Rage.  Preparing a plan to deal with rage in the home puts an end to those feelings of hopelessness.  With a predetermined plan, you will have responses and strategies that you and your family can rely on.  You will now have something you can do about it.

When preparing to take on rage in our home, we stepped back to observe carefully what was happening.  We watched for triggers for our son’s rage, how it occurred, and how we responded.  In doing so, we were able to uncover our own (ineffective) default behaviours.  (See Neurologically Gifted’s Article:  Rage 2:  Look, Listen and Focus)  Once we had identified the behaviours in our family (rage, triggers and responses), we sat down with our son to discuss those patterns.  We openly and honestly discussed our feelings.  With care and support, we helped our son explore what he felt before, during and after a rage episode.  We made it clear to him that this was a family problem and that as a family we could find solutions and improve our situation.  (See Neurologically Gifted’s Article:  Rage 3:  Talk About Rage)  With this critical step completed, it was time to for us to make a family plan to get control over rage in our home.

Make House Rules

Make rules with your child.  Ask them what rules they think should be included.  Prompt them by letting them know that the rules will apply to everyone in the family.  Ask them how they would NOT want to be treated by others.  Ask if there are things they would like to change by making a rule.  Discuss with your child why the rule is important and the natural consequences of non-compliance to the rule.

Guide your child through the rule making process.  Keep rules simple and concise for easy recall.

Do not over-burden the process with too many rules.  Choose your battles, picking only rules that apply to your greatest challenges. Over time, your child will become better able to self-regulate their emotions and responses.  As your family begins to experience progress, you will be able to change your focus and rules to address other priorities.

Keep rules obtainable and focus on safety.  For example, a rule prohibiting swearing is not realistic for a child with coprolalia.  A rule prohibiting anger or frustration isn’t appropriate either as we all have feelings.  In such a case, the family rule could outline acceptable ways (and places) to express anger and frustration.   You want your child to be successful, gain confidence and learn to apply skills for managing their emotions throughout this process.

Keep copies close by for quick reference.  Having the rules posted in their personal space will allow the child time to review expected behaviours and natural consequences of prior behaviours.  In our home, we placed a copy in our son’s bedroom, and referred to them at bedtime when we debriefed the day’s successes and challenges.

When referring to the rules:  Give kind and gentle reminders.  Reminders could include what the family (including the child) agreed would promote a safer and more peaceful environment.  Referencing the rules on paper takes the blame/authority away from the offender/enforcer and places it on the family rules.  A child is less likely to express anger towards a predetermined rule, rather than to being told to stop what they are doing by a parent.   Avoid trying to catch your child breaking the rules or to use the rules in a punitive manner.  You are attempting to use the rules to guide them in a predetermined way to modify/control their rage, not to punish them.

RAGE 4 TAKING ON RAGE: PREPARE A PLAN

The Plan

Make a plan for what will happen when the child (or any other family member), is unable to comply with the rules.  The rules clearly set out the expectations for behaviour and the plan will clearly state the consequences that will follow non-compliance.  Consequences must be consistent, fair, logical and natural.  For example, if a child is acting in a threatening manner, they must go to their room, (or other predetermined safe area) so the family members will be kept safe.

Again, involve your child in this discussion and try to have them help to come up with ideas for helping them regulate their own behaviour.  We found that our son had great ideas for how we could help him regain control, or how we could take control for him when he was unable.  When you are making the plan with your child, try to put yourselves in the moment.  Ask your child,  “What would you do if this happened?”  “What do you think you would do next?”  “How could we help you in this step of the rage?”  Our son was excellent at imagining the scenarios for us.

The plan should consist of step-by-step interventions with increasing increments of taking control for your child.  Each step will provide your child with an opportunity to succeed in regaining control.  For example, our first step was a friendly reminder about the undesired behaviour using positive language.  (see Neurologically Gifted’s article:  Using Positive Language for Success)  “You need to speak in a calm and kind way to everyone in our family.”  If the child cannot regain control with the reminder, then the next step of the plan would be used and so on.  Our next step was to ask our son to remove himself from the situation.  This allowed him an opportunity to be successful by being able to continue his behaviour but doing it someplace else.  The final step of the plan would be used only if the child, given each opportunity, could not regain control by themselves.  In the last step the parent would take control for the child. “Nathan, if you cannot take yourself to your room to calm down (and be safe), I will need to take you there.” Remember:  This is for helping, not punishing.  It is done with care not anger.

Our Plan for Rage

With our help, our son guided us through what the steps of the plan would be. First we would give a friendly warning using positive language.  Next, we offered a suggestion to leave the room and take some space.  If necessary, the next step would be the instruction to go to his room.  The toughest part of our original plan would be getting him to his room.  At this point he told us we would need to take him to his room if he didn’t go on his own.  I’m fortunate that as a special education teacher who specializes in challenging behaviours, I have training in using physical restraint.  I DO NOT recommend anyone restrain a child without training.  The training not only teaches you to calm your child (to prevent the need for restraint), it also teaches you to stay calm in the face of calamity as well.  It’s important to understand how and when to restrain someone who is in a fit of rage.  In addition, it teaches you how to safely restrain without causing injury to the child.  It is far too easy for a grown up to use their strength advantage over a child, and injure them.  It also helps you stay in emotional control, preventing you from acting out of anger. So, in our case, I would physically take him to his room.  We also discussed a plan for when only his mom was home and he needed to be physically taken to his room.  In this case, we made it clear that for safety, mom would need to call for help – even if that meant calling 911.  He also suggested that he might not stay in his room, so we problem solved for a lock on his door to keep him inside.  Together we made a trip to the police station to discuss our plan of helping our son regain control, to stay safe, and to keep our family safe.  Involving him in every part of the plan was essential.  Together we set his room up so that upon entering the room, there were comforting items within his sight.  We removed everything that could be dangerous.  We provided soft balls for throwing and devoted a drawer in his dresser for calming stress-reducing toys.  With those calming toys, we discussed how Nathan could use these things to redirect his anger (like punching his pillow or mattress and hugging his stuffed toys).

By the end of making the plan, our son knew exactly what would be happening if he lost control to rage and that knowledge made him feel safe.  Having a clear understanding of our process eliminated unpredictability, and made our son feel safer.  We signed, witnessed and distributed copies throughout the house.  Signing the rules together, we reinforced the commitment to a family effort to help keep our home safe.

For more on rage from Neurologically Gifted:

Rage 1:  About Rage

Rage 2:  Look, Listen and Focus

Rage 3:  Talk About Rage