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Archive for the Category Family Matters


Believe in your child – and yourself – before you believe in medications

Many parents that I work with ask the same question: “Should we medicate our boys?” Here are the basics you’ll want to consider:

  • There’s no way to predict what being on medications will be like for any particular child. There’s also no way to know ahead of time the side-effects beyond those that most of us already worry about: sleep problems, attenuated height, decreased appetite, weight loss, possibly mood swings. Some parents (and older kids) have reported to me a dampening of personality, and rarely, I’ve encountered cases where there was a cardiac concern. I don’t say this to frighten or discourage parents, but to make certain we all appreciate that these are significant medications. Always check with a pediatrician, and if possible a psycho pharmacologist. Most kids do tolerate side-effects well – or the side-effects are minimal. Go into this with your eyes wide open!
  • Keep in mind that psycho-stimulants are performance enhancing drugs. That means, they work on everyone. Kids will likely focus better and be less impulsive on these meds. We would, too, so don’t think the diagnosed of ADHD is confirmed because you see a change. Also keep aware of unanticipated problem that might come up down the road. I’ve seen many young men who started to use medication as a psychological “crutch.” That’s their word, not mine. They said they came to believe they “needed” meds to do homework, sit in class, to get themselves into college, get through college. Many have had a hard time dealing with the demands of their first job and rely on medications so much that they panic at the idea they won’t be are to face work without them. Dependence can happen on any mind altering substance.
  • This is why I recommend parents never use meds alone. People should always be working to improve themselves, identifying strengths and weaknesses, and nourishing their development – at any age! Believe in your child and believe in yourself first before you believe in medications. In fact, the treatments of choice (what is now recommended at the start of an ADHD diagnosis) are non-medical. These are behavioral training/tutoring/organizational types of interventions. All of those work better than meds for the long haul, according to research. Maybe that’s because, unlike meds, these interventions develop new skills. They change the brain for the better via learning and new ways of adapting. Pills tend to suppress the unwanted symptoms, in my experience, mainly impulsivity and motor movement. Focus improves too, but once off meds, kids fall back to where they started from.
  • If your child takes psycho-stimulants, you might very well see a sudden boost in their grades. Sounds great – but beware. Evidence shows that a boost in grades may not be about better learning – but rather – kids are performing better on tests that don’t translate to long-term gains. Also, the way in which teacher’s grade can be biased, based on behavior rather than true achievement.
  • Finally, if you try meds for ADHD, always have an exit strategy in place. Try to see this as a time-limited intervention. Try to have time off meds as well (e.g., not on weekends, not on holidays, or not during summers).

Those are my general (behavioral psychologist’s) take on the role of meds. I’ve seen some kids do better and some worse on meds, and it wasn’t entirely predictable ahead of time. I do have many other caveats I ask parents to consider. Ask if there’s anxiety at play, or some other underlying emotional issue that masks as ADHD. Is there an educational problem – bad school fit? Learning disability? Is there family conflict, parenting stress, marital stress, or is there a dietary/sleep issue which we now know have been correlated to ADHD symptoms? And always, make certain your kids are getting enough vigorous daily exercise and movement of all sorts – outdoors preferably – which have been shown to substantially lower ADHD symptoms.

Please contact Dr. Rao about reproducing any material found on these pages.

Helping Your Children Understand the Loss of Someone They Love

Losing someone – a friend or family member – is such a difficult time. It’s also an important time to think about how to talk to your kids. Foremost, be honest and direct (avoid euphemisms) with your children, but–and this is key–pitch whatever you say to the developmental level of your child. The great psychologist Piaget offers us developmental markers to guide us.

Before 7 children think more magically, more imaginatively, and often think they can cause events outside of their control. This age group gets confused or misled most by euphemisms. They can’t think abstractly. Some very young children wonder if they did something to cause a death, simply because they’d wished it during an angry moment or had a fight just before someone died, so make sure they don’t think they caused it. And, offer only as much information as a youngster can handle. Young kids often circle back and ask for more information when they need it or can tolerate it. Otherwise, don’t overload them.

Between 8 and 11 or 12, kids are more sophisticated, but concrete in their thinking. They like to connect things, appreciate how things go together, and start to think about how the bigger world works. They can handle greater complexity, so don’t sell them short. Tell older kids the truth, but it’s a good practice to ask permission – have them tell you when they feel ready to talk. They too can get easily overwhelmed by the strong emotions associated with these tragic events.

Teens possess abstract thinking skills. They can handle more information than younger sibs. They can think more critically, have opinions, and strong beliefs of their own. It’s important to respect their way of understanding things. Tell them you are available to talk when they want. Tell them you’re sad and confused as well. But reassure them that, together, you will all get through this. Know that social relationships are important in the teen years, so they may want to be with friends more than usual. Encourage this and tell them its great to have good people to help them through tough times.

Finally – here are general points that parents should keep in mind:

  • Children are thinkers and they generate lots of questions, and that’s healthy. Encourage it.
  • When parents (and other adults) don’t know the answers to difficult or complex questions, just admit it. We’re all human. It’s ok to be confused. It may take a long time to understand what happened and adjust. Sometimes there are no answers, and that’s ok too.
  • If you’re sad, be sad. Show your sadness, don’t hide it. You need to model the full range of human emotions as normal and healthy. Tell younger kids that you’re upset and sad, and that by crying or being angry, you are going to start feeling better soon.
  • Let everyone work through loss in their own way. In my experience, boys may be less emotional than girls, but not always. Teens may get more angry and irritable. In general, those of us who are more social may reach out to other people for support, but those of us who are more introverted may need time for personal reflection.
  • This isn’t a time to pressure yourself. Don’t worry about being perfect or getting everything right. It’s very human to feel your way through these hard unfamiliar events. Expect mistakes. Learn from them.
  • Finally, take care of yourself. If you’re staying healthy and emotionally supported, you can better help your kids through tough times.



Please contact Dr. Rao about reproducing any material found on these pages.

The Halloween Hangover

Tooth decay? Pediatric obesity? Sleep deprived the next morning from all night trick-or-treating?  How are you going to handle the day after Halloween? How will you deal with the sudden abundance of sweets your children will drag home?

After you inspect the candy, to insure it’s safe, and maybe claim the best treats for yourself, you need a plan. On average, kids bring home two plus pounds of sugar, cocoa butter, corn syrup, hydrogenated palm oil, and many other things few of us can pronounce or identify. Don’t get me wrong. I’m no prohibitionist. I love Halloween. I’ve been known to shake down clients for Kit Kat bars and Peanut M&M’s well into mid-November. But there have to be some guidelines to handle the confectionery loot.

Here are a few great ideas:.

Out of Sight… Out of Stomach

It’s simple, but it helps: By keeping most of the candy out of visual range, many children won’t be as tempted to dive in and overeat. I know parents who set up rules, before their kids don costumes. They establish the firm expectation that parents will be in charge of the candy once it arrives home. If kids don’t accept this, there isn’t any trick-or-treating. Tough love meets Halloween!

Treats for Track!

Walk or ride or run around the playground could earn a treat later on. Beyond the healthy, regular exercise all kids need, extra physical activity justifies being able to have an additional treat. This is a version of smart calorie counting. Children who learn to think about what they are eating each day, and how much they are burning off, will likely grow into young adults more aware of their bodies, nutrition, and more willing to engage in physical exercise.

Space It Out.

Candy has a very long shelf life. Break it up for long-term enjoyment. Spill out the contents of all those plastic pumpkins and pillowcases to visually plan what you want to do with so much candy. Maybe a few pieces at the end of the week, perhaps for getting to school on time or getting teeth brushed, for eating healthy dinner, for homework done. Maybe limit one or two a day after eating a health dinner.

Enlist your child’s help.

That may sound like asking the fox to guard the hen house, but children often come up with great solutions if you tell them they need to be in charge of their bodies and tell them they are smart enough to brainstorm solutions with you. “I need your help,” one parent I know recently said to her seven year old. “We have too much candy. I know its fun to eat, but we have to figure out a way to handle so much of it. I want you to enjoy it, but how can we keep from eating it all at once?”

Give Away and Share.

Finding people with whom to share your candy is a loving, caring act. Maybe it’s an elderly person on your block with whom your children don’t interact with very much. Maybe it’s your regular postal carrier, teachers, or a new potential friend. This is a great way to turn something often seen as frivolous, and sometimes greedy, as fueling positive social interactions.

Throw Away?

When all else fails and there’s just too much candy, it might be time to throw some of it away. Better inside the garbage pail than too much inside your child’s tummy. Yet, is this the right message to be giving to your kids? Isn’t it wasteful to throw food away? Yes. Fortunately, there’s nothing of much nutritional value inside the colorful, shiny wrappers. Sometimes, throwing things away that we don’t need teaches kids not to be wasteful in the first place. Given how much we spend on Halloween candy, upwards of two billion dollars a year, it seems better we buy and consume less to start with. If the idea of throwing it away still bothers you, some communities have candy

Buy Back Programs help reduce the amount of candy consumption. Start one in your school or town.


Please contact Dr. Rao about reproducing any material found on these pages.

Q&A: How to restore balance at home

Question and Answers on speech bubblesI love my kids, but I’m exhausted and I think they are too. Any tips for restoring some balance to our home life?

Exhausted? That means you’re expending too much energy to run your household. Maybe you’re trying too hard. Most parents I know work to be their “best” and to do everything for their kids. I think they’re putting unrealistic expectations on themselves. Rather than trying harder, try this:

  • Shift your mindset. Start thinking of yourself more as a leader (and not only as a parent). When we approach parenting as a set of leadership skills, the job becomes clearer and more gets done. First lead yourself. Get calm, collected, never yell (it only makes you look weak).
  • Avoid perfection and over-scheduling and don’t expect your kids to always be happy. That’s not possible or realistic. Good leaders are also in charge of what their environment is like.
  • Be thoughtful about what you allow into your home. Foremost, control high stimulation. Watch exposure to screens and negative news broadcasts. Set up your house to be a place where people face each other and talk.
  • Be aware of hyper-stimulation, information overload, noise, disorganization, and multitasking. These all tap your energy and rev up your nerves.

Above all, focus on the big picture – tell yourself what really matters is happening right now… right in front of you. That’s mindfulness, and it helps you appreciate precious moments. Start enjoying the time you have with your children. They won’t be young forever.

Please contact Dr. Rao about reproducing any material found on these pages.

Online “Learning Programs” – Do they work?

A mom from Arizona recently asked about a program she saw on the Internet to help her son be a better learner. He hates handwriting. It frustrates him. This program promises to retrain her son’s brain by using handwriting along with listening to music, so that his emotional systems are calmer and he can focus and write with less frustration.

On the surface, the program sounds good, and seems like it would deliver on its promise. BUT, the scientist in me isn’t buying it, for now.

Here’s what I do to be a better consumer of treatments and promises of better living that we are all barraged with daily. Be your own scientist. Think like a scientist. It’s empowering to be a critical thinker!

  1. Watch for labels like “Grounded In Science”. Grounded in science isn’t science. It’s maybe the  start of a scientific inquiry. All new treatments and ideas, no matter how good they sound, need to go the distance. They have to run their scientific course so to speak. That means they need to go through controlled, thoughtful, multiple studies. Researchers have a tough task. They set out to prove themselves wrong in hopes of showing that a pill or a clinical technique has some merit, up and beyond beyond all the other possible reasons it seems to work. Only then do they know it is worth using. This takes lots of time, years in fact.
  2. Watch for testimonials (instead of real studies). Testimonials are always positive. Those are hand-selected and intended to promote the product. They are designed to make you feel good and emotional. When emotional we’re thinking more with our hearts (emotional and irrational) and not our minds (logical).
  3. It’s worth a try… if a program is not very expensive or time-consuming, and you don’t consider it to the exclusion of all other known/tested programs. In the case of this mom from Arizona, she could sit with her son to do writing exercises (calligraphy is fun) while playing calming classical music in the background. New age music and instrumental is often better as lyrics tend to distract. If her son seems to enjoy it, if he gets calmer and seems to focus longer, that will likely help him at school (and homework) where he has to be more attentive and use handwriting.

Please contact Dr. Rao about reproducing any material found on these pages.