Good question, Chris and also a very common one. Thank you, Craig for outlining the many abbreviations that we use! There are many different types of licenses that allow for us to practice professionally in the mental health field. At minimum, a Master's degree is required in one of the following: Psychology, Social Work, Counseling ( I may even be missing a few). After that is earned, then a license is needed which are acquired through hours practiced and test (s) taken: LP (Licensed Psychologist), LICSW, LMFT, LPCC. I have many clients ask the same question and many are surprised at how many methods there are that lead to a similar place.
A lot of information, but I hope that helps.

I couldn't figure out how to edit my comment, but here is that link that explains all of the confusing letters after our names:

http://stmichael.patch.com/blog_posts/what-really-happens-in-therapy-the-mental-health-kind-part-2-of-4

A divorce is a major change in a family for children whether they are 5 or 25 so it's possible the child is feeling a range of emotions and given his age, may not have words or tools for expressing worry, fear, or anger. How much information does he know about the divorce and what that means for his time with mom or dad? Has there been a move related to the divorce? Did he just start kindergarten on top of this? A therapist who is trained in play therapy can be a great resource for a child to determine the reasons behind the behaviors. It also can be very valuable for the parents to come in together and with a therapist or parent coach, develop a parenting plan because even though they are no longer married they are still parents to the child and many decisions need to be made over the years about things like discipline and if changes occur such as remarriage by one or both parents it can be helpful to have a place to sort through those with a neutral third party.

Hi A-Town,

Yes, a 5 year old can be greatly affected by a divorce situation. The parents are the children's world at that age and when it's shaken, it causes a reaction behaviorally or emotionally.

I'll also add, that boys tend to act out (like you mentioned) and girls tend to internalize feelings. So for those kids that internalize (boys included), be sure to pay attention to increased symptoms like headaches, stomach aches, regression in milestones, etc.

Family conflict including divorce is a common reason younger children come to therapy. Because younger kids can't just talk about how they feel, look for therapists that use play techniques to help them process through this significant life change. Also, family therapy can be used to help support and guide parents through this challenging time.

Now, not everyone needs therapy. So my suggestion to the parents are to be patient, work together as co-parents whenever possible, and continue to maintain consistent consequences for inappropriate behavior.

Hi A-Town,
Thanks for the question. Just as Megan and Craig stated, divorce is quite difficult for any age, particularly a 5 year old. At 5 it is hard to express feelings appropriately, and that might be what is going on...or there may be other changes going on in the boys' life. Having a child act disrespectful is very hard for the parents and should be addressed to figure out what were the triggers and how to effectively make a change.
Some options include:

Mom and dad talking about what they are concerned about with their son and ideas on how to address them (talking with him, setting clear and consistent boundaries)

Mom and dad meet with an outside professional to discuss concerns and options. This can also be done with mom then with dad if civil conversations prove to be too difficult.

These are initial starting points for the parents...which is often a nice place to start.

a few more thoughts: some things the parents might want to track is when is the behavior the worst? After a visit with the parent in the new home? After certain foods are eaten? After watching certain TV shows or movies? If too much time passes between meals? Is the child getting less sleep? Was there and/or is there now a lot of negative talk between or about the other parent? And a very important question: When is the behavior the best and can the parents and any other adults in his life "Catch him being good"? Praise what you want more of and see if you can create the situation more often. Again, as Jenny and Craig have stated, consulting with a professional trained to work with young children specifically could be a good place to start.

There are providers called Registered Play Therapists that have an additional two years of training in play therapy. You can find a list of them at: http://www.a4pt.org/

You can also call your local mental health facility and ask about qualifications in working with younger children. Be wary about facilities that put you with the first available therapist without better understanding your needs. Ask questions and be picky!

In addition to RPTs, in our state, we also have mental health professionals that are trained in diagnosis and treatment of ages 0 - 3 (I know, it's very young!). Also, many therapists have taken additional coursework in play therapy techniques.

Don't be afraid to ask for a phone consultation with the therapist you are interested in seeing. Not everybody is going to be the right fit and a quick phone call/interview can be very helpful.

Also, never be afraid to change therapists if it is not working. Personalities and training varies and while most folks have great education and skills, they may not be a good personal fit for you and your family.

Another thing parents should consider is talking to their local school about what the kids are going through. Most should have a school counselor or social worker available that can assist the kids during the day if they are having a difficult time.

Wendy,
Some additional ones that pop up are all those holiday treats, work potlucks, etc... We all know kids and adults can be sensitive to all that extra sugar so moderation and providing outlets for that extra energy can help. There also can be a lot of activities such as holiday parades, shopping, standing in line for Santa, and the like that sound fun but can be a disaster if the kids are tired, cold, or hungry. It relates to the expectations Jenny mentioned. Often the parents are excited for the event and want it to be this fun family outing but any of the above can sabotage it. Sometimes the best solution might be to leave early or stay in for some low-key family time.

A final one can be the extra drinking that often occurs between Thanksgiving and New Years. Whether that is one too many drinks at the office holiday party or too much eggnog for Uncle Bob, excess drinking has sparked many a fight at family gatherings or led to an embarrassing Monday back at work. Designate a sober driver or have the number to a cab. Offer several non-alcoholic drink options. There are dozens of resources out there if you or a loved one struggle with substances: AA, Al-anon, AlaTeen, are just a few.

Hi MGrove Mom,
Great work in trying to get your kids more active, both then and now! Your teens sounds like many of the teens we see in our clinic as well: participating in screen time instead of face time. Setting limits for them is a great start. I often recommend this to the parents I work with. I would also suggest being very specific as far as time spent on Xbox, Smartphone, etc. It may not be realistic to cut them out entirely, as this is now their main form of communication with their friends, as you also indicated. Another recommendation I give is to let that down time guide them. Often times, when they are unable to look at their phone, watch tv, etc, they gravitate to a natural interest (reading, biking, etc). Lastly, I encourage you as a family, if you are not yet, to participate in active events, such as joining the gym, going to a community concert, attending the museum. Often times they don't know that they like it until they are exposed to it. One last thing to keep in mind is that they are teens, and they can be difficult to read when it comes to recognizing that they are actually enjoying something.

MGrove Mom,
I'm a big fan of having kids volunteer. There is a great website www.volunteermatch.org that lets you search for opportunities by age, interest, location, etc... I read a great tip awhile back that suggested to help your child pick a cause not necessarily by what they like but instead by what gets them frustrated, angry or motivated to help change a situation.

Have they tried things other than the more traditional sports? Chess, golf, science/Lego clubs? Another option that comes to mind is a part-time job. They'll earn money, get unhooked from the electronics, meet people, and learn valuable skills. A job at a movie theater or gaming store could provide an interesting environment for them at the same time.

Great suggestions from Jenny and Megan. It sounds like you want the best for your kids and would like them to find something they are good at that helps them grow and mature into happy, healthy individuals. I really like the idea of volunteering, part-time jobs (depending on age), and non-traditional events that encourage face-to-face gathering vs. screen time. I also like how Jenny put that kids have a hard time recognizing that they are actually enjoying something.

One last add, you said your kids try things for a year at time? That actually sounds like a good period of time for a child to commit to. While they may not be a four year basketball player, for example, they are at least trying different things and getting themselves exposed to different group and system dynamics that will aid them in the future. Good luck. You sound like a good parent!

I'm not completely clear on your question, Chris, but what usually happens is child protection or similar group within the county system will get involved in situations where there are child endangerment issues. Support services will be then be recommended or required by those folks or the judge. Support services could include family therapy, in-home services, parenting classes, etc.

Chris,
I can't speak directly to this but when I was living in Los Angeles part of my private practice was counseling people through the California Victims of Crime Program. There is one here in Minnesota: https://dps.mn.gov/divisions/ojp/help-for-crime-victims/Pages/crime-victims-reparations.aspx. The website list the requirements for eligibility and what is covered (it does include mental health services). I would hope that part of her journey will include counseling. Good question. Maybe Jenny or Craig know more details of the process here.

Simon,
I highly recommend the book Misdiagnosis And Dual Diagnoses Of Gifted Children and Adults by James Webb as one of the best out there. He, the members of SENG (www.senggifted.org), myself and small groups of therapists, parents and educators around the country are passionate about helping avoid this very thing. I speak to parents on the topic as it relates to teenage girls. It's a great book for educators, parents and therapists as there are many things that are misdiagnosed if other factors are not ruled out. For example, diet has a major impact on behavior; Not only what is eaten but sudden drops in blood sugar can look like ADHD. A child bored in class due to advanced academic ability may be disruptive or daydream. Some kids with high ability in one area may actually have a learning disability in another (Twice Exceptional www.2enewsletter.com) and the LD get the focus. I will refer parents to the Pediatric Integrative Medicine Clinic in Chaska led by Dr. Culbert, a pioneer in the field. The center uses "biofeedback, mind/body medicine, holistic therapies, nutrition and lifestyle approaches" as alternatives to traditional medication.

It is an on-going discussion of why the increase in bi-polar and ADHD diagnosis in children. Is it environment? Diet? Vaccines? Excess electronics? Chronic stress? misdiagnosis? I don't have an answer. I would tell people if they feel they have been given a Dx that seems wrong, always get a 2nd or 3rd opinion

Lily,
Check out www.mcgt.net. This is an invaluable group for parents who struggle with issues like you are describing. As a member you have access to an amazing listserve where people ask questions just like you did and the responses can be really helpful in navigating educational challenges. There is one woman in particular who is very knowledgeable on the issue of 504's and school's resistance to them is often discussed. My understanding is that once it is in writing they have to follow it. I would call the school today and follow up on it to get them to move faster.
Here is a site that has step by step guide about the process: http://www.help4adhd.org/en/education/rights/504 it's daunting but from the little that you shared it sounds like it's a reasonable request. Who determined he is "boarderline ADD"? A full evaluation if you haven't had one could also show other sorts of processing delays or disorders. A few I'd recommend are Dr. Teresa Boatman and Mary L. Wandrei, PhD, LP at Affiliated Counseling Center. Both specialize in working with high ability kids. I'm not sure if that would be covered under the 504 so you'd need to get more info. Best of luck on your journey. It sounds like you are both working really hard to figure this out. Ideally the 504 will help!

Hi Lily,

Has your son always had this issue? Or is this more recent?

He's 12, a 7th grader. To top it off, he also has a border line ADD diagnosis (the inattentive type), and I've got a 504 in the works, although the teachers are resisting the idea because they say we're already doing the things we'd put in a 504 (sitting in the front, giving him a test he can write out to eliminate options that can't be correct, etc) but I don't feel it's enough. His teachers are saying they tell him things, he's saying he doesn't hear them, his teachers used to say he was naughty and had to tell him many times to stop talking, but that hasn't been a problem recently. He just seems to be in the clouds at school, he writes notes in his planner but he's rarely clear on what they mean and doesn't take the time to clarify. I've asked him a million times to stay after school, meet w/teachers to clarify, ask questions, etc. he never does it.

Simon,

One of the problems is, in my humble opinion, is that the general practitioners that often do the prescribing of stimulants for ADHD do not conduct detailed assessments and interviews with school staff and both parents to determine the consistency of information that indicates problems in multiple areas of functioning for the child.

Many times those children you may be referring to in class are only medicated and not even brought to therapy to help them learn behavioral interventions in tandem with stimulant treatment.

Further, When someone presents with ADHD like symptoms in most therapist's offices, professionals that I know rarely just say this is ADHD. Like my collegues, what we often do is refer for psychological testing because it is a BIG deal to label a child and to put them on a stimulant.

Also, there are so many similar mental health issues that can look like ADHD including abuse issues, anxiety, trauma, not to mention there can be medical issues contributing to the inattention of hyperactivity. Because of this, I believe it is essential that any parent considering stimulants get through testing and evaluation from specialists preferrably a psychiatrist that only prescribes medications related to mental health disorder.

What do you folks think?

Hi Oakdale Resident,

I brought in one of my staff members, Nancy Tomanek, who is also an LMFT to respond to your question. Here's what Nancy had to say:

It's always tough to address family dilemmas especially around the holidays. It's reasonable to want an enjoyable family gathering, therefore only inviting those who are enjoyable to be around. There is also the pull of family obligations and reaching out to those who would otherwise be alone at the holidays. Is there a way to limit the visit with the Aunt? Could she be told to arrive later as a means of limiting her stay? Maybe stop by and visit with her individually instead of at a large family gathering. There are times when it is beneficial to have a heart to heart discussion as she may not be aware of the impact of her words and attitudes.It really is a tough call and not everyone will be happy with the decision.Christmas is a time for reaching out and connecting with our loved ones, sometime this means looking past indiscretions; sometimes it means setting new boundaries.

Hi Oakdale Resident,
The holidays can be such a difficult time after we lose someone. Not only are we grieving for them but we are also left with family dynamics that have a different feel now that the loved one is gone. I agree with what Nancy stated regarding boundaries and setting some new limits. Whether that means you and your husband talk with her ahead of time, plan a shortened holiday with her, or visit her outside of your home. It will be a delicate situation, however, and you may have to reevaluate what you decide, or even hold off a year to make the change. At minimum I suggest a game plan for the immediate family on how to respond to MJ if she attends, and if she is hurtful. Could you change the subject? Pull MJ aside? Let MJ know how much your MIL was loved? You do have options, so start by discussing with your husband. I do wish you a peaceful holiday.

I like what the others have said about setting boundaries. I like to explore the motto "Just because you can, doesn't mean you have to." with clients and see what the conversation brings forth. Another question: "What is the worst thing that could happen with any given choice?" You and your family can best answer those. Change can be hard for people no matter what that change relates to and so some people might be upset while others could be very happy or relieved, and I'm also hearing that not changing feels really hard too. Best of luck with whatever you and your family decides for this year.