What happens to anorexic teenagers when they become anorexic young women?

In their twenties many fall in love, get married and try to build a life with their husbands just like other young women. The difference is that the anorexic young woman has anorexic thinking and feeling influencing every decision and action in her life. She is often very afraid.

Most people in their mid-twenties go through a kind of developmental shock as they are confronted by new and different kinds of personal challenges in their lives. The woman is only recently no longer a young girl. There are new responsibilities to understand and shoulder. She discovers that she and others people are placing new and often quite reasonable expectations on her.

Whether she accepts those expectations or not, she still has to deal with them. This is a stressful time for any young woman, but particularly so for an anorexic young woman. She can feel angry, frightened and overwhelmed.

An anorexic who for years has been doing a 'good job' at being anorexic is hiding in plain sight all the time. She's thin, but not skeletal. According to fashion dictates, she is elegantly lean in a most feminine way.

When friends and family see her, they often see an attractive, dainty and feminine young woman who, in their eyes, might be a lovely model. She is a bit on the nervous side and does overreact to a few things, they think, but, they continue to themselves, she's still young. She'll outgrow it soon.

However, she knows she has begun to build an adult life based precariously on an image of herself that is unsupported by her inner world.

Inside, the anorexic young woman is wracked with anxiety. Because her outer appearance is so different from her inner experience she has problems expressing her fears. If she makes a reference to her anxieties she is often ignored or discounted. She may even be accused of being stupid for being nervous because she appears to have a good life. She may have what appears to others to be a better life than they, and so her pain is even more difficult to accept or understand.

This makes her, already an isolated person, even more isolated. Grief, despair and anxiety become her constant companions.

If someone does see a bit through her facade, suggests that she has a mental problem and that it might be a good idea to seek psychotherapy she will often panic. The classic paradoxical thought comes through. "I don't need a psychotherapist. I just need someone to talk to honestly who will listen to me."

She yearns for genuine understanding, but that means she would have to reveal herself. This would, in her perception, destroy the adult life she is attempting to build. She knows her foundations for that life are flimsy. She is so good at creating a correct and lovely appearances that few people appreciate just how flimsy her foundations are. And, in keeping with her isolationist beliefs, she can think of no one who could listen to her. She is trapped in a bind created by her own mind.

Because she needs desperately to have people think well of her and because she thinks her appearance is the way to control other people's perceptions she strives valiantly to maintain a specific look and image.

If she publicly acknowledges her tormented inner world, she is terrified of what people will think of her. Her fear drives her to create an image of even greater perfection as she withholds her real feelings from others. She draws the anorexic trap tighter around herself.

Often, she knows she is doing this and her terror terrifies her as well. Her intelligence may tell her that this kind of thinking and behavior doesn't make sense, but it seems more powerful than any healing action she might dare.

Many anorexic women find benefits to being riddled with anxiety. Anxiety can be a powerful experience that overwhelms the possibility of feeling anything else. In the anorexic anxiety can eliminate any recognition of hunger for food. It's easier to starve. But then they can panic over that too. Too much starvation might affect their appearance so that others know something is wrong.

An anorexic can feel hunger. But her anxiety is greater than her hunger. Her fear is that is she eats a tiny bit or eats the wrong thing her hunger will overwhelm her and she won't be able to stop eating. That fear creates an overwhelming state of anxiety that floods her inner world. The flood of anxiety overwhelms her need to nourish herself and she continues living in starvation mode.

Often the anorexic woman knows she is in some kind of cycle where she recognizes a pattern to her feelings of weakness and flooding anxiety. She doesn't know what is causing it. She can't tell if it's coming from the outside world or from her inner life. If she gets more close to exploring her inner life than she can bear, she often will feel a strong burning sensation in her abdomen.

This is like a danger signal, a warning not to know more about herself. Also, since that burning sensation will prevent her from eating food, she may experience that pain as a kind of familiar protection. She may also experience it as a betrayal and become even more frightened.

The anorexic young woman wants relief from this anguish. She says she wants a normal life, but she doesn't really know what that is. She hopes there is help, but she can't imagine it. Help involves moving into exactly what she fears most, letting someone see her real inner life. It means experiencing exactly what she wants to avoid.

She is not a teenager now. She is a young woman attempting to build a life. She may have made promises to her husband, made commitments to an advanced educational program, be on a career track where others depend on her. After all, she looks good and knows how to control her appearance and what others perceive at least for a while longer.

Healing may mean that her flimsy structure will collapse. She cannot imagine the life that would remain in the debris. Despite her fear and pain she is clutching to the life she has. She tries to keep her fear and pain away from her awareness through starving, controlling her appearance and trying to control other people's behavior and perceptions. She is certain that if she surrenders control she is doomed to unimaginable horrors.

It's difficult to convey to a woman who is anorexic that the healing process does not have to be dramatic and extreme. Healing is a gradual process where each level of experience unfolds when the person is ready for it. That's one of the many reasons a mental health professional who understands eating disorders is so helpful. Healing is painful. So is being anorexic and living with hidden pain.

One kind of pain is endless. The other is in the service of healing and living that healthy life she so years for.

The biggest and most important step in healing is that first step...making the commitment to your own healing regardless of fear and regardless of what people think. The young adult anorexic woman knows that building a life on false appearances with no solid base just makes the structure she is creating more apt to topple on its own. The consequences will impact her and people who depend on her presence.

This adds to her anxiety. But this thought can also lead her to make a decisive move toward genuine healing and a genuine life.

There are ways to recover and people to help.

U.S. Sources of Help

More help is available in urban areas than rural areas, but more resources are continually developing around the country. Specific, personal, in depth and confidential attention is available through private practice licensed psychotherapists. This is often more costly than what is available through clinics which often offer treatment at low fee by therapists in training who are supervised by licensed professionals or by HMO programs which limit number of sessions and access to psychotherapy. Some hospitals have excellent in patient and out patient treatment programs for people with eating disorders.

Twelve step programs can be a great support. Plus the people you meet at local meetings may be able to provide good local referrals to public and private resources that may be helpful to you.

Referrals are available online for therapists, out patient and residential programs around the world.

See:

EDAP (Eating Disorder Awareness and Prevention)

The Something Fishy website offers a treatment finder section.

next: Eating Disorder Education: Benefits for Parents and Teens
~ all triumphant journey articles
~ eating disorders library
~ all articles on eating disorders

sexual problems

Almost everyone, at one time in their lives, will have been attracted to a person of the same gender, but not necessarily felt sexual attraction. We all have idols, heroes or heroines during our growing years, and for many, that is where it ends. But for about 10-15% of the adult population, the feelings of attraction to a person of the same gender persist.

Trying to identify your true sexual orientation may be difficult for some, who might be distressed at the feelings of sexual attraction, and experience behavioral changes, like withdrawal, unwillingness to go out socially, mood swings, eating difficulties, and problems with concentration.

The question 'Am I gay or lesbian?' can be a cause of great pain and turmoil to many women and men alike. In particular, those who have had a strict religious upbringing can suffer very much if they find themselves attracted to a person of the same gender.

Many people suppress their true feelings and form heterosexual relationships, leading to marriage or longterm partnerships in an attempt to be 'normal' or acceptable to family, friends and society. Others suppress their feelings with alcohol, drugs, or even overwork. Sadly, a number of gifted, talented people have committed suicide, rather than face the disapproval or judgment of family members. People do not choose to be gay, they either are or are not, although to date there is no proof that it is either 'in the genes' or determined by experiences in early life.

It can be very helpful to openly discuss these feelings and attractions with someone non-judgmental and supportive, who can help you to discover who you really are.

next: Male Erection: Penis Erection Problems

sexual problems

Men don't like to admit to sexual problems, especially their own.

Women are much more ready to admit ignorance, to find fault with their own behavior, and to look for ways of making things better. Compare women's magazines with men's. The women's magazines have articles on improving sex and fixing problems in virtually every issue. Playboy and Penthouse almost never have such articles. Since so much rides on a man's being good, or at least adequate, in sex, it's very difficult for men to hear they have a problem in this area.

A lot of these differences are things that both sexes have taken heat about. Women are often criticized by partners for their relative lack of interest, not initiating enough, wanting too much foreplay, and taking too long to get aroused or to orgasm. Men have been scolded for every single item on the list. I think the criticism is unfortunate and gets us nowhere. In a sense, everyone is doing what comes naturally, whether naturally be defined as what's built in or what's been learned over the years.

While it is true that we have to learn to accommodate to each other, I don't think blame and accusations or feeling guilty is going to help. We have to feel good about ourselves to have decent relationships and sex. A man should not have to feel guilty for looking at or fantasizing about younger women, for desiring sex without love, or anything else that he is or feels. But neither, on the other hand, should he denigrate his partner. It's fine if you have fantasies about the college girl next door, but it's something else if you make comments about her in front of your lover that imply your lover is inadequate. It's fine if you sometimes want a quickie -- perhaps you can arrange it with your partner -- but it is not fair to complain that you can't have them all the time or that she takes too long to turn on.

The male ways of expressing love and sex are really OK. And so are the female ways. The better we understand and feel about ourselves and each other, the more likely we will be able to make the changes we desire in our sex lives and elsewhere.

From "The New Male Sexuality" by Bernie Zilbergeld, PhD. Copyright © 1992 by Bernie Zilbergeld.

next: Four Perspectives on Sex Problems

men and sex

Not many people talk about male rape and sexual assault. However, I discovered that outside of child abuse and the prison population, the gay community deals with that a lot. I would imagine that men, like women who are sexually victimized, wonder whether what happened was rape and whether they were to blame.

Rape and sexual assault can happen to anyone, including men, regardless of their race, class, age, size, appearance, or sexual orientation.

"I picked up this guy at a bar and took him home with me. He made me have a kind of sex that I didn't want. I was too scared to fight back or refuse. Is that sexual assault?"

Yes. Rape and sexual assault include any unwanted sexual acts. Even if you agree to have sex with someone, you have the right to say "no" at any time, and to say "no" to any sex acts. Rapists sometimes use threats or weapons to force a person to cooperate. It is important to remember that cooperation does not mean consent. Sometimes cooperating with a rapist is necessary to survive the situation. If you are sexually assaulted or raped, it is never your fault - you are not responsible for the actions of others.

What are rape and sexual assault?

A sexual assault is any time either a stranger, or someone you know, touches any parts of your body in a sexual way, directly or through clothing, when you do not want it. Sexual assault includes situations when you cannot say no because you are drunk, high, unconscious, or have a disability.

Rape is any kind of sexual assault that involves the forced penetration of the anus or mouth, by a penis or other object.

Rape and sexual assault are not sex, they are violent crimes. Rape and sexual assault, like any other forms of violence, are used to exert power and control over another person.

Can men be sexually assaulted or raped by other men?

Yes. Rape and sexual assault can happen to anyone, including men. Thousands of men are sexually assaulted and raped every year, and it has nothing to do with their race, class, age, religion, sexual orientation, size, appearance, or strength. A man can be sexually assaulted by a stranger, a family member, or someone he knows and trusts. Experts estimate that 1 in 6 men are sexually assaulted during their lifetime. Even though male sexual assault remains vastly underreported, the united States Department of Justice documents more than 13,000 cases of male rape every year.

"I was walking down the street late one night and three guys jumped me and dragged me into an alley. They called me a "faggot" and a "bitch", threatened to beat me up, and forced me to give them all blow jobs. It this what I get for being gay?"

No. What you experienced was a sexual assault, a crime of violence, not sex. Attackers frequently use verbal harassment and name-calling during a sexual assault. Sexual assault has nothing to do with the sexual orientation of the attacker or the survivor. While rapists can be bisexual or gay, most of the men who rape and sexually assault other men are heterosexual. Sometimes heterosexual men use rape and sexual assault to target, humiliate, and hurt other men for being gay. A sexual assault does not make you gay, bisexual, or heterosexual.

What are typical reactions during or after a rape or sexual assault?

Sexual assault or rape is almost always a traumatic experience. Sometimes a man who is sexually assaulted or raped has an involuntary or forced erection or ejaculation. Also, muscles in the anus often relax when a man is raped. This does not mean that the survivor wanted to be raped or sexually assaulted. Involuntary erections and ejaculations are normal reactions to trauma.

Although, everyone reacts differently to surviving such an assault, there are some common symptoms and reactions.

Common Physical Symptoms:

• tears in the lining of the rectum
• swelling and abrasion of the anus
• anal warts or lesions
• stiff or sore limbs
• loss of memory and/or concentration
• loss of appetite
• nausea
• changes in sleep patterns
• stomachaches
• and headaches

Sometimes a survivor can contract a sexually transmitted disease during the assault, but not have symptoms until months later.

Common Psychological Reactions:

• denial
• shame
• humiliation
• feeling of loss of control
• fear
• mood swings
• flashbacks to the attack
• depression
• loss of self-respect
• anger
• anxiety
• guilt
• retaliation fantasies
• nervous or compulsive habits
• change in sexual activity
• suicidal thoughts and behavior
• withdrawal from relationships or support networks.

"My boyfriend and I were having lots of problems. He was going out a lot and having sex and not using a condom. One night he got angry, hit me, stormed out of the house, and came back hours later, stinking drunk. He forced me into bed, fucked me, and refused to wear a condom. I was always careful about having safe sex, now I'm afraid of getting HIV."

Many people are concerned about HIV infection after surviving a sexual assault, and it is important to know the facts. Any contact between your bodily fluids (including blood and semen) and the bodily fluids of an HIV-positive person puts you at risk of contracting HIV. However, repeated contact with HIV is usually necessary for infection.

What should I do if I am raped or sexually assaulted?

Get medical attention as soon as possible.

Go to the nearest hospital emergency room that has a rape crisis program. Although you may feel embarrassed about your injuries, it is important to receive medical assistance. Hospital staff frequently see such injuries to the penis, anus and other body parts, not all caused by rape or sexual assault.

Even if you do not seem to be injured, it is important to get medical attention. Sometimes injuries that seem minor at first can get worse. Also you may have been infected with a sexually transmitted disease, which may take weeks or months to appear, but may be easily treated with an early diagnosis.

If you are living with HIV/AIDS, especially if you are symptomatic, medical attention is particularly important. Exposure to another persons bodily fluids can further compromise your immune system, or trigger an opportunistic infection.

Going to the hospital can be frightening, especially after surviving a traumatic experience. Ask a friend to go with you, or call the Anti-Violence Project.

Consider talking to a sexual assault/rape crisis counselor.

Counseling is an important way to regain a sense of control over your life after surviving a rape or sexual assault. Counseling can help you cope with both the physical and emotional reactions to the sexual assault and any previous sexual assaults, as well as provide you with the information about hospital and criminal justice system procedures. A counselor can provide you with information and support necessary to help you decide whether or not you want to tell friends and family members about the assault, or report the assault to the police.

Consider reporting to the police and/or pursuing a criminal case.

Sexual assault is a serious crime. As a sexual assault survivor, you have the right to report the crime to the police. If you think you can identify the perpetrator, you have the right to look at mug shots and ride in a patrol car to look for the perpetrator.

Because police are not always sensitive to male sexual assault survivors, it is important to have a friend or advocate accompany you to the precinct to report the crime.

If you are concerned about HIV infection, it is important to talk to a counselor about the possibility of exposure and the need for testing.

next: The Basics of Sex Therapy Homepage

Discover how to deal with the pressure to have sex and why many teens are choosing abstinence.

More and more teenagers are choosing abstinence now because they want to be 100% sure of avoiding STD's (sexually transmitted diseases) and pregnancy. Even teens who have had sex before are making a commitment to be abstinent. Read on to find out more about how to deal with the pressure of having sex, whether it's still possible to get STD's, and why many teens are choosing abstinence over sex.

What exactly is abstinence anyway?

Abstinence means that you are not having sexual intercourse. Sexual intercourse means that you are having "sex" with a partner. Sex can be vaginal, oral or anal. So if someone is abstinent, it means they are not having sexual relations with anyone.

Why are teens choosing to be abstinent?

Many teens choose abstinence because they know that it is the best protection against STD's, and it is 100% effective in preventing pregnancy. Others choose abstinence because of religious beliefs or because of their own values.

Do most teens who have had sex wish they waited?

Yes! In fact 3 out of 4 girls who have had sex wish they had waited longer before having sexual intercourse.

What should I say if I feel pressured to have sex?

A good relationship is about good communication. Talk to the person you're dating and be clear about your values and what you really want. Don't be shy about what you don't feel comfortable doing. The fact is you don't really need to tell anyone why you don't want to have sex. It's good to be honest with the person you are dating early on that you plan to be abstinent. This way there will be no expectations and you both can avoid situations that could make abstinence difficult, such as going to a party where there's alcohol or being alone in an empty house.

My partner keeps telling me. "If you love me, you'd have sex with me."

Don't be fooled by this line! Loving someone doesn't just give them permission for sex. Changing your mind and having sex when you really don't want to is letting yourself down, and it doesn't guarantee that your partner will stay with you either. In the long run, if someone wants to break up with you just because you won't have sex, they really are not worth it.

How can I talk to my parents about sex?

You may think that your parents would be last on your list of people that you would talk to about sex but remember they were teenagers once too and probably faced a lot of similar issues that you are facing now. In fact, your values are based on your parent's attitude about things. Talking to a parent may help you understand your feelings. You might want to start a conversation with your parent(s) about peer pressure. You could mention that you think there's a lot of pressure on teens to have sex. Then you might ask them their feelings about sex before marriage. Parents know that growing up isn't easy. If given the chance, parents can be very helpful and supportive. The important thing to remember is to talk about your feelings with an adult or friend you feel comfortable with—someone you can trust.

Is it possible to get and STD or become pregnant without vaginal intercourse?

It is possible to get pregnant without having sexual intercourse if a male ejaculates near your vagina, since sperm can still get inside of you. If you don't have vaginal, anal, or oral sex, you can't get and STD. You should know that some STD's are spread from oral sex.

Are there any other risks involved with having sex?

Yes. Besides running the risk of getting an STD or becoming pregnant, having sex when you're not ready can cause you to feel bad about yourself and also make you question your relationship.

How will I be able to tell if I'm ready to have sex?

Knowing when you are ready to have sex can be tricky because your body may feel like you are ready. You may feel very romantic with your partner and have the urge to have sex. This is perfectly normal but you should also listen to your thoughts and beliefs to help you decide when the time is right. If you're nervous or not sure, wait until you can make a choice that you are sure of. Remind yourself that abstinence is the only 100% way to avoid pregnancy and STD's. One thing for sure to remember is: "you should never feel pressured or pushed into having sex."

Most teenagers will agree that saying "no" to sex can be hard but having sex is a serious decision that has consequences. You can make a choice to say "no" to sex and still be close with your partner. When you choose to be abstinent, it means you want to wait to have sex until the time is right for you! Talking with someone you trust will help you follow your feelings and values and stick to your decision.

South Korea Women Starving, Victims of Fashion

Thirty miles south of the border with starving North Korea, young women in the South Korean capital are starving themselves, victims not of famine but of fashion.

Dr. Si Hyung Lee has seen this dark side of affluence and modernity. He remembers best the patient who died of respiratory failure: "She was a pediatrician's daughter," said Lee, director of the Korea Institute of Social Psychiatry at Koryo General Hospital in Seoul. "Her father and mother were both doctors."

But her parents failed to realize that their teen-ager suffered from anorexia nervosa -- a disease almost unheard of in Korea a decade ago -- until it was too late to save her.

If Asia is a reliable indicator, eating disorders are going global.

Anorexia -- a psychiatric disorder once known as "Golden Girl syndrome" because it struck primarily rich, white, well-educated young Western women -- was first documented in Japan in the 1960s. Eating disorders are now estimated to afflict one in 100 young Japanese women, almost the same incidence as in the United States, according to retired Tokyo University epidemiologist Hiroyuki Suematsu.

Over the past five years, the self-starvation syndrome has spread to women of all socioeconomic and ethnic backgrounds in Seoul, Hong Kong and Singapore, Asian psychiatrists say. Cases also have been reported -- though at much lower rates -- in Taipei, Beijing and Shanghai. Anorexia has even surfaced among the affluent elite in countries where hunger remains a problem, including the Philippines, India and Pakistan.

Doctors in Japan and South Korea say they also have noticed a marked increase in bulimia, the "binge-purge syndrome" in which patients gorge themselves, then vomit or use laxatives to try to keep from gaining weight, sometimes with lethal consequences.

Experts debate whether these problems are caused by Western pathologies that have infected their cultures via the globalized fashion, music and entertainment media, or are a generic ailment of affluence, modernization and the conflicting demands now placed on young women. Either way, the effects are unmistakable.

"Appearance and figure has become very important in the minds of young people," said Dr. Ken Ung of National University Hospital in Singapore. "Thin is in, fat is out. This is interesting, because Asians are usually thinner and smaller-framed than Caucasians, but their aim now is to become even thinner."

A weight-loss craze has swept the developed countries of Asia, sending women of all ages -- as well as some men -- scurrying to exercise studios and slimming salons.

Liposuction surgeons have popped up in Seoul, as have diet powders and pills, cellulite creams, weight-loss teas and other herbal concoctions "guaranteed" to melt away the pounds.

In Hong Kong, 20 to 30 types of diet pills are in common use, including variations on the "fen-phen" combination of fenfluramine and phentermine that was banned in the United States last month for causing heart damage, said Dr. Sing Lee, a psychiatrist at the Chinese University of Hong Kong who has written extensively on eating disorders. Though the Health Ministry has asked pharmaceutical companies to withdraw the offending drugs, "I'm sure new ones will be coming out right away," Lee said.

In Singapore, where the anorexia death of a 21-year-old, 70-pound student at the prestigious National University made headlines last year, dieting itself has become a fashion statement. On Orchard Road, the city's toniest shopping district, a hot-selling T-shirt designed by "essence" bears this stream-of- consciousness essay on modern female angst:

"I've got to get into that dress. It's easy. Don't eat ... I'm hungry. Can't eat breakfast. But I ought to ... I like breakfast. I like that dress ... Still too big for that dress. Hmm. Life can be cruel."

In Japan, where dieting is less a trend than a way of life for many young women, the principle that thinner is better is now being applied to facial beauty. A recent subway flier for a young women's magazine pictured an attractive model complaining, "My face is too fat!"

Drugstores and beauty salons offer face-reducing seaweed creams, massage, steam and vibration treatments and even Darth Vader-like facial masks designed to promote sweating.

The Takano Yuri Beauty Clinic chain, for example, now offers a 70-minute 'facial slimming treatment course' for $157 at 160 salons across Japan, and reports business is booming.

South Korea is perhaps the most interesting case study since, until the 1970s, full-figured women were seen as more sexually attractive -- and more likely to produce healthy sons, said Lee. "When I was a kid, plumper-than-average women were considered more desirable, they could be a first son's wife in a good house," he said.

But standards of beauty have changed dramatically in the 1990s with democratization, as South Korea's government decontrolled TV and newspapers, allowing in a flood of foreign and foreign-influenced programming, information and advertising.

"The 'be slim' trend starts earlier now, even in elementary school," said the institute's Dr. Kim Cho Il. "They shun overweight boys and girls -- especially girls -- as their friends."

Dieting by growing teen-agers often leads to inadequate calcium intake and weaker bones. Kim is worried about an increase in osteoporosis cases when this generation of girls reaches menopause.

"The dieting will also result in weaker physiques and lessened resistance against disease," she said.

South Korean psychiatrist Dr. Kim Joon Ki, who spent a year in Japan studying eating disorders, said the increase in eating pathologies over the past few years has been phenomenal. "Before I went to Japan in 1991, I had seen only one anorexia patient," Kim said. "In Japan they told me, 'Korea will be next, so you should study this now.' And sure enough, they were right."

Kim said he has seen more than 200 patients, about half of whom were anorexic and half bulimic, in the 2 years since he opened a private eating-disorder treatment clinic. "Lately I have so many calls that I can't even give them all appointments," he said.

But Kim said his new book on eating problems, "I Want to Eat But I Want to Lose Weight," is selling poorly. "Readers' attention is still focused on dieting, not on eating disorders," he said.

Dieting is not only trendy, it's a necessity for many South Korean women who want to fit into the most fashionable clothes _ some of which are only made in one small size which is the equivalent of an American size 4, said Park Sung Hye, 27, a fashion editor at Ceci, a popular monthly style magazine for 18- to 25-year-old women.

"They make just one size so only skinny girls will wear it and it will look good," Park said. "They think, 'We don't want fatty girls wearing our clothes because it will look bad and our image will go down."'

As a result, "If you're a little bit fatty girl, you cannot buy clothes," she said. "All of society pushes women to be thin. America and Korea and Japan all emphasize dieting."

Park said eating disorders are increasing but still are relatively rare. "If, say, 100 people are dieting, maybe two or three have bulimia or anorexia so it's not enough to worry about," she said. But in the articles she writes on how to diet, she cautions readers against excess, warning, "A model's body is abnormal, not normal."

Park said young Koreans' attitudes toward food differ from those of their elders, who remember hunger after World War II and the old greeting, "Have you eaten?" and fat as a sign of prosperity. "Now skinny (means you are) more wealthy, since everyone can eat three times a day," Park said.

Young women interviewed in Seoul's swanky Lotte department store said dieting was a necessary evil.

"Boys don't like plump girls," said Chung Sung Hee, 19, who at 5 feet and 95 pounds considers herself overweight. "I don't know whether they are serious or not but sometimes they say I'm plump.... So I try to lose weight. I go without food, and my friends use milk diets or juice diets, but we don't last that long."

Han Soon Nam, 29, an advertising company employee, said of dieting: "I don't think it's good but it is the fashion. Everything has a price. You lose your health to get skinnier."

next: Eating Disorders: The Cultural Idea of Thinness
~ eating disorders library
~ all articles on eating disorders

The stress of raising a child with ADHD can be tremendous. Families with an ADHD child have higher incidences of verbal and physical abuse, along with substance abuse.

The Stress of Raising an ADHD Child

Living in families, and raising children can be difficult under the best of circumstances. Many of us had a hard time living in the families that we grew up in. It may be difficult today, living together in the families that we have created. We may feel guilty for not giving our children or partner what we feel they deserve. We may feel painfully aware of how we are not taking care of our own needs. This is especially true if a member, or several members of our family have Attention Deficit Disorder.

As our knowledge of Attention Deficit Disorder grows, we are learning that ADD is not simply a disorder of childhood. ADD is life long condition. Children with ADD grow up to be adults with ADD. People with ADD do not live and grow in a vacuum. They have relationships, children, and create families with people who may or may not have ADD. Therefore, it is essential to help not only the person directly affected by ADD, but the entire family. Attention Deficit Disorder, similar to addictions affects every member in the family. Families do not cause ADD, and yet families need help to live and thrive in spite of the impact of ADD.

We now know that ADD runs in families. It has been estimated that there is a 30% chance that a child with ADD has at least one parent who has ADD. It has also been estimate that there is a 30% chance that that same child will have a sibling with ADD. I frequently work with families where one or both parents have ADD, and one or two of their children also have the condition. Living in a family with ADD can be like living in a five ring circus. There is always someone or something that demands attention.

As parents we want the best for our children, and are often willing to sacrifice our needs for theirs. But what is the impact on the family if one of the parents has untreated Attention Deficit Disorder? Too many times, I hear caring parents say, "Please help my son or daughter. I've dealt with this all my life and can continue to." The problem with this is that it can be incredibly difficult to provide consistent parenting for any child, let alone a child with ADD, if you as the parent have untreated ADD. There is a reason why the airlines request that adults put their oxygen mask on first, so that they are then able to help the children.

Families with ADD have higher incidents of physical, and verbal abuse. Substances such as alcohol, food and drugs are often used to self-medicate the pain and frustration of family ADD. Some parents of children with ADD suffer from Post-traumatic Stress Disorder (PTSD). PTSD is a condition that occurs when people are subjected to extreme, ongoing stress that is beyond the realm of normal experience. PTSD symptoms include depression, anxiety, sleep disturbances, hyper-vigilance, and re-experiencing of the trauma.

For the for mention reasons, it is imperative that ADD is viewed in the context of the family, or persons environment. Relationship therapy that is specific to addressing the impact of ADD is essential. Family therapy which includes parents and siblings with and without ADD is critical. So often the non-ADD siblings are left out, or feel that they have to somehow make up for the difficulties that their ADD sibling(s) are causing. Educating and treating all members of the family system promotes family wellness.

We have learned from the evolution of the chemical dependency field over that past two decades that treating alcoholics and addicts outside of the context of their relationships is less than helpful. We have also learned that family members of the chemically dependent person also need treatment, so that they too can recover. The same is true with Attention Deficit Disorder. Let us continue to be quick learners as our knowledge of ADD expands. ADD is not caused by poor parenting, or dysfunctional families, and yet the entire family deserves treatment. No one in the family is immune from the impact of Attention Deficit Disorder.

About the author: Wendy Richardson M.A., LMFCC specializes in the treatment of ADD and co-related substance abuse. She provides education and therapy for couples and families where ADD is present. She is a writer who speaks nationally and provides workshops and trainings on Attention Deficit Disorder.

next: An Introduction to ADHD Coaching
~ back to adders.org homepage
~ adhd library articles
~ all add/adhd articles

Analysis of benefits and risks of ADHD medications plus side-effects of medications for ADHD. And why using medications to treat ADHD is controversial.

Important Points

• Medications are NOT the only treatment for ADHD.
• The decision to use medications for treatment of ADHD requires knowledge and consideration.
• Other interventions (such as psychotherapy, educational accommodations, etc.) should always accompany the use of medications for ADHD.
• Periodic re-evaluation of ADHD medication use is essential, as a person's response and need can change over time.

What is ADD / ADHD?

Attention-Deficit/Hyperactivity Disorder (AD/HD, or ADHD) is characterized by two or more of the following:

• poor attention
• impulsivity
• hyperactivity.

The condition may take different forms: either inattentive or hyperactive/impulsive. Children are more often the ones diagnosed with ADHD, but many adults also maintain the attention impairments (ADD).

It is currently believed that ADHD is a neurobiological condition caused by genetics, conditions in utero, or possibly by relational trauma.

Why are medications often used for the treatment of ADHD?

Although the causes of ADHD are somewhat speculative, the source is generally believed to be a problem with either the structure or functioning of the brain. The most common view is that ADHD is a biochemical problem, related to an imbalance of the neurotransmitters in the brain. Thus, the use of medications is to regulate this presumed imbalance. Stimulants are the most frequently utilized type of medications for ADHD. Gabor Maté, M.D., author of Scattered: How Attention Deficit Disorder Originates and What You Can Do About It, offers this explanation and analogy:

• Even though ADHD individuals are generally hyperactive, their brain waves are slower at a time when they would be expected to be faster (when reading or other tasks are attempted).
• The brain's prefrontal cortex is supposed to sort out and organize sensations and impulses coming from the body and the environment, and to inhibit those that are not useful in a given situation. When this task is successful, there is order, as with a policeman directing traffic at a busy intersection.
• In an ADHD person, the prefrontal cortex is underactive, like a policeman asleep on the job, thus not prioritizing and selecting or inhibiting input. The result is a flood of data bits that keep the mind and body unfocused and in turmoil. Traffic is gridlocked.
• Stimulant medications wake the policeman and allow the prefrontal cortex to perform traffic direction more efficiently.

What are the medications for treating ADHD?

Stimulants

The most common medications for treating ADHD are stimulants. Stimulants have been the longest in use for treatment of ADHD, and have the most research studies on their effects. Although some have been used on children as young as age 3, most are recommended for age 6 or older. Long-term studies on the use of stimulants for the treatment of ADHD lean toward the discontinuation during adolescence, due to possible growth inhibition.

Stimulants for the treatment of ADHD may be shorter or longer acting formulations. Short/intermediate acting stimulants require dosages 2-3 times a day, while long acting stimulants last 8-12 hours, and can be taken once a day, thus not requiring a dose at school.

There are four main types of stimulants used for treatment of ADHD:

• amphetamines (Adderall)
• methylphenidate (Ritalin, Concerta, Metadate)
• dextroamphetamine (Dexedrine, Dextrostat)
• pemoline (Cylert - less commonly prescribed because can cause liver damage)

Non-stimulant

The newest medication for treatment of ADHD is Strattera. This medication is a reuptake inhibitor that acts on the neurotransmitter norepinephrine (which affects blood pressure and blood flow) in the same way that antidepressants act on the neurotransmitter seratonin, allowing the natural chemical to remain longer in the brain before being drawn back up. Because it is a non-stimulant, it may be less objectionable to some families. Nevertheless, it has similar side effects as other medications used for ADHD.

Antidepressants and anti-anxiety medications

In some cases, Antidepressants or anti-anxiety medications may be prescribed either in addition to or instead of stimulants for the treatment of ADHD. Most often, this determination is based on other symptoms, beyond those typical of ADHD alone. Antidepressants most commonly affect the neurotransmitters seratonin or norepinephrine. (the FDA advises that anyone on antidepressants should be watched for increases in suicidal thoughts and behaviors. Monitoring is especially important if this is the child or adult's first time on depression medication or if the dose has recently been changed. If the depression appears to be getting worse, an evaluation by a mental health professional should be scheduled as soon as possible).

Antipsychotic or mood-stabilizing medications

For certain conditions that include symptoms of ADHD, other medications may be prescribed. With a few exceptions for seizure disorders, antipsychotic medications are not prescribed for children and most mood stabilizers are not recommended for children or adolescents.

What are the side effects of medications for ADHD?

Persistent and negative side effects of stimulants have been documented, including sleep disturbances, reduced appetite, and suppressed growth, which might have important health implications for the millions of children who are currently taking medication for ADHD. Source: Centers for Disease Control and Prevention

Side effects most commonly include:

• decreased appetite or weight loss
• headaches
• upset stomach, nausea or vomiting
• insomnia or sleep difficulties
• jitteriness, nervousness, or irritability
• lethargy, dizziness, or drowsiness
• social withdrawal

All medications have side effects, and sometimes a change in dosage, brand or type of medication will allow for the usefulness of the medication while reducing the side effects. One problem with medications for ADHD is that they are most often prescribed for young children, who usually will not be able to accurately report side effects. This is one of the concerns about prescribing any medications for children.

Why is the use of medications for ADHD controversial?

The introduction of medications for the treatment of ADHD initially seemed like a miracle cure. Many believe that the benefits in terms of academic achievement and social behavior warrant the possible risks. However, there are also many concerns about the use of medications for ADHD, and as studies continue to monitor their effects, the controversy grows. Some of the most often-expressed concerns are:

Overuse

As cultures become more fast-paced with increasing time pressures on parents, children, and teachers, the use of ADHD medications seems a fast fix for a complex problem. Long-range effects on the developing brain are not known. Even when medications are advised, they should never be used as the exclusive treatment for ADHD. Additional interventions (such as behavior management, parenting skills, and classroom accommodations) must also be incorporated.

Age of children

Originally, ADHD medications were prescribed for school-age children, and use was generally discontinued at adolescence. In recent years, these medications have been prescribed at younger ages, and have been extended through adolescence and into adulthood. In some cases, doctors are diagnosing ADHD and prescribing medications for children as young as age 2, even though the controlled studies on these medications were not done on pre-school children. Understanding of normal child development and family behavioral management skills might be a more appropriate intervention for such young children.

Misdiagnosis of ADHD

ADHD is defined by behavioral symptoms. There is no specific test for ADHD. Behaviors that are common to ADHD may be caused by a variety of other sources, such as domestic violence, alcoholism in the family, inadequate parenting, ineffective behavior management, poor attachment to a stable caregiver, or a number of other medical conditions. The symptoms of ADHD are on a continuum that could be interpreted differently by any particular parent, teacher or physician. What one person would consider normally active for a child might be seen by someone else as hyperactive. What one adult can tolerate or handle might be seen by another adult as impossible behavior.

Sources:

• DSM-IV-TR, The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.
• ADHD, Wikipedia
• Attention Deficit Hyperactivity Disorder publication by NIMH, June 2006.
• FDA Warning on Antidepressants
• The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (ADHD). Archives of General Psychiatry, 1999;56:1073-1086.

next: Guidelines for Use of ADHD Medication For Children
~ adhd library articles
~ all add/adhd articles

Many women complain of unwanted advances driven by a partner's need to get his money's worth from Viagra, the $10 little blue pill.

Millions of men have been able to enjoy sex again thanks to the famous . For years it was assumed that a man's rejuvenated sex life would be happily shared by his partner. But in a series of recent studies, researchers are noticing that the passionate romance with anti-impotence drugs does not always cut both ways.

Dr. Annie Potts, a psychologist at the University of Canterbury in New Zealand, began interviewing couples to determine if there are any downsides to treating erectile problems. She has heard from women who say that Viagra (sildenafil citrate) provides a renewed sex life, but at an unexpected cost. Many complain of unwanted advances driven by a partner's need to "get his money's worth on the $10 pill," with little input on their feelings. Some even feel that the men in their lives are more attracted to Viagra (sildenafil citrate) than to them.

"The thought of that little blue pill seems to get them very excited," explained one 60-year-old woman to Potts. "It's almost like they've fallen in love with Viagra (sildenafil citrate)."

"We won't have sex unless he's had the pill," said another woman who thinks her husband is addicted to the drug. The woman said that erectile dysfunction had certainly caused problems for her marriage before, but after treating it with Viagra (sildenafil citrate), the problems became much worse.

More Fans Than Critics

The recent findings are but a minor blemish to some of the top selling drugs of all time. Critics concede that Viagra (sildenafil citrate), as well as two related drugs, and Cialis (tadalafil), have helped rekindle old romances and are a major reason why once taboo sexual problems are so openly discussed. But the research highlights what some say is a long neglected issue in treating erectile problems: how do women regard their sex lives now that Viagra (sildenafil citrate) is a major part of it?

Compared to the large number of studies that have documented the sexual benefits to the Viagra (sildenafil citrate) user, only a handful looked at the attitudes of partners. Overall, research suggests that women generally enjoy the sexual attention.

A survey done in Japan showed that two-thirds of women rated their sex as satisfying after their partners took Viagra (sildenafil citrate), compared to 20 percent who said they were disappointed. Another study, led by Dr. Markus Muller in Germany, found more tenderness and less quarreling between couples when men were successfully treated for erectile problems.

"There are obviously some women who are relieved when a man is no longer interested in sex," says Dr. Stanley Althof, who directs the Center for Marital and Sexual Health of South Florida. "But the majority of women are eager to renew their sexual intimacy."

Many of the problems, such as wives feeling that husbands like anti-impotence drugs more than them, are probably the result of tensions already present in a relationship, he says. "That's their insecurities speaking."

Yet Potts contends that Viagra (sildenafil citrate) has some potentially negative effects as well, even in women who are supportive of their husbands or boyfriends taking anti-impotence drugs. Potts says that men should not assume that their desires are automatically shared by their partners.

"Viagra (sildenafil citrate) is not simply and only men's business," she says.

Potts interviewed 27 women and 33 men in New Zealand as part of her research, which was published in Sociology of Health & Illness and more recently, Social Science & Medicine. She presented her findings at a female sexual dysfunction conference in Montreal, Canada in mid-July. A recurring complaint, Potts found, is that some women said that men felt entitled to have sex after taking Viagra (sildenafil citrate).

One 48-year-old woman summed up her husband's discussion of sex. "He would be, 'I've taken the pill, OK, let's go." The man also expected to have intercourse for as long the drug would last, but with little time for foreplay or romantic spontaneity. "You like to think it's an act of love, rather than just lust," the woman said.

Making Viagra (sildenafil citrate) a Couple's Business

Dr. Leonore Tiefer, an expert on female sexuality who teaches at New York University School of Medicine, says that she has heard similar concerns. "It's called the 'I spent the money, let's have sex' talk." She says that such one-way discussions do not make for healthy relationships.

Indeed, researchers have found that as much as Viagra (sildenafil citrate) can make for a happy love life, it can also cause some men to take their new found sex drive too far. One man admitted to Potts that Viagra (sildenafil citrate) played a crucial part in going from a monogamous relationship with his wife to 18 different affairs, including some with men, in the space of one year.

"You could be completely unemotionally involved and yet still [be physically ready]," he said. Viagra (sildenafil citrate) also helped him, as he characterized it, "endure" sex with his wife.

Although sex is something that men are thought to want most, more than 75 percent of women in one large survey said this was moderately to extremely important to them as well. So far, however, there is no female equivalent of Viagra (sildenafil citrate).

A recent study in the Archives of Internal Medicine found that a testosterone patch could improve sexual interest and activity in women who had low sexual desire after having their ovaries removed. But the dangers of taking steroids has led many to question the safety of the approach, prompting the Food and Drug Administration to turn down a request to make the testosterone treatment available for women.

Regardless of what is used in the bedroom, experts say that the key to good sex begins with discussion.

"If Viagra (sildenafil citrate) or anything else is going to be put in a relationship, it has to be collaborative," Tiefer says.

next: Sex and Your Body Image

Reproduced by kind permission of Jenny Lyon - International Psychology Services
Jenny Lyon, Cert.Ed., B.A.(Hons.), M.Sc., C.Psychol.

Introduction

It is unfortunate that the majority of recent publicity about AD/HD, in the UK, has focused almost entirely upon examples of bad practice: short and inadequate assessment procedures, the use of medication in the absence of other forms of support, the use of medication with very young children, the failure of private clinics to liaise with schools, etc. While I am not disparaging the importance of these issues, I was concerned at a recent training day to find a group of professionals so concerned with bad practice that they were unreceptive to talking about good practice.

Good practice regarding the treatment of AD/HD depends upon the initial diagnosis being correct, and for the following reasons AD/HD is not an easy disorder to identify. Firstly, a child can be inattentive, impulsive and hyperactive for many reasons other than AD/HD. Secondly, AD/HD is a continuum disorder, which is to say that we all suffer from the defining symptoms to some extent, and it is only when those symptoms persist over time and across situations in a severe form that an AD/HD diagnosis is appropriate. Thirdly, many children who suffer from AD/HD also suffer from other childhood disorders, all of which interact upon one another. Lastly, AD/HD itself can lead to secondary problems which are more damaging than the initial problems.

We cannot X-ray a child to find out if s/he is AD/HD, and even if we could this would only provide a starting point. The purpose of a psychological assessment is to establish what problems a child is experiencing and generating, and how these can be alleviated. A child's problems exist within the context of his/her home and school, and it is inevitable that some families and teachers will cope better than others with an AD/HD child. Furthermore, it is perhaps wrong of us to use the term "AD/HD child", as this describes only one part of the whole child. Some of the children I see have excellent social skills, while others have problems relating to adults or peers. Some are articulate, while others have problems with speech and/or language. Every human is an individual, and the term "AD/HD child" can be misleading in terms of differential diagnosis and treatment.

As a result, the assessment of childhood problems is often a complex, lengthy, multi-professional process, and one which should be properly explained to parents. Where parents understand the nature of an assessment, it will follow that they understand the diagnosis and the recommendations that follow. It is hoped that the following "good-practice guidelines" will help parents in this process.

The Basic Principles of Assessment

The psychologist who assesses your child will not start from the premise that his or her problems are due to AD/HD. S/he will want to gather as much information as possible, and then "identify and define symptoms and problems which differentiate the target child from those in a similar population", i.e. from his/her peers (Goldstein, 1994). As Goldstein points out, this means that a specialist clinic will not differ, in principle, from a general clinic. The psychologist will want to learn as much as possible about the child's behaviour, and any preconceptions would only cloud his/her judgement. However convinced parents feel that their child is AD/HD, they should approach a psychologist with a careful and accurate description of the child's behaviours rather than a diagnosis.

Gathering Information

As an Educational Psychologist I am committed to the principle of observing a child at home and at school. As noted above, problems do not exist in a vacuum, and it is important to see how "within child" factors interact with the environment. Questionnaires and rating scales can assist this process, and if it is difficult to observe the child directly the psychologist may depend upon this information. I use the Achenbach parent, teacher and child questionnaires. Results are computer analysed on 8 scales, and the 3 forms are compared to see how well they correlate. I also use the ACTeRS questionnaire, which differentiates between hyperactivity and attention problems. In addition, many psychologists use a comprehensive developmental history form (I have designed my own, as there was no British version available, and this is an up-dated version of the one I originally designed for my work at the Learning Assessment Centre in West Sussex). A developmental history form is an efficient way of gathering important information about the child and family prior to meeting. I often ask teachers to compare the referred child to his/her peers using a simple observation schedule such as the TOAD (an acronym for "Talking", "Out of Seat", "Attention" and "Disruption").

Parent/Child Interview

It is essential that the meeting between psychologist, parent and child should be non-judgmental. The aim is to identify and solve the child's problems, and all concerned will need to work in close co-operation if this process is to be successful. Part of the problem-solving is to see how parents and children relate to one another, remembering that the interaction between parents and child is complex and two-way: thus bad parenting can lead to childhood problems, and a difficult child can cause parents to lose their confidence and thus become less able in managing the child. This downward spiral of events can place tremendous stress upon a family, which is exacerbated by the fact that parents almost invariably blame themselves for their children's problems. Learning that the boot can be on the other foot can relieve guilt and anger, and set the scene to move forward. I frequently marvel at how well parents cope with immensely demanding children, and feel saddened that they have received criticism rather than support. The psychologist should be providing this support: educating parents and teachers regarding the management of AD/HD, offering on-going advice and acting as an advocate for the child and family.

Assessing the Child

Many psychologists start an assessment with a clinical interview, but I prefer to begin with an assessment of overall ability, using the Wechsler Intelligence Scales for Children III UK (WISC III UK). Different versions of the WISC exist for very young and older children. While this sounds rather daunting, most children enjoy the games and puzzles, and success is built into the system: when the child begins to fail on any test the examiner moves to the next test. This part of the assessment allows me to establish a rapport with the child, and by when the battery of tests has been completed most children feel fairly relaxed.

The WISC III UK serves several purposes. Firstly, it establishes the child's IQ, or overall level of intellectual ability. Secondly, it allows me to examine the child's individual profile of results on 13 tests (6 verbal, and 7 non-verbal). For example, dyslexic and language-disordered children tend to do less well on verbal than on non-verbal tests, while AD/HD children are likely to have depressed scores on the "Freedom from Distractibility" and "Processing Speed" indices. Lastly, and most importantly, it enables me observe the child on a battery of tests with which I am very familiar: any unusual behaviours or responses are immediately apparent. AD/HD children typically lose marks because of impulsive responding, slow processing and erratic attention.

The next part of the assessment involves testing the child's levels of attainment in basic skill areas (reading, spelling, writing, oral language and maths), and seeing whether or not s/he is achieving appropriate scores for his/her age and ability. These tests also provide a wealth of information regarding the child's learning style ( impulsive, careful, determined, confident, easily discouraged etc.), processing skills (memory, attention, speed) and literacy skills such as handwriting and phonic awareness.

My findings from the WISC III UK and attainment tests determine what follows. For example, if I think the child is dyslexic, further assessment of phonic skills, memory skills and processing speed will be on the agenda. If the child has had problems with attention and/or impulsive responding, both computerised and manual tests of these skills will be administered.

Lastly, and only if I feel it is appropriate and useful, I may ask a child to complete one or more questionnaires which focus on such areas as anger, depression and self-esteem, or I may use other assessment tools such as a sentence completion test or personal construct therapy. The approach a psychologist takes will vary from child to child, and will also reflect the psychologist's views regarding the assessment of personality.

The initial assessment usually lasts around a half-day, and at the conclusion I need time to score results before I talk to the parents and child. A family should expect to devote a day to visiting a psychologist.

Feedback

Feedback should always start and end on a positive note. I have never assessed a child where this is not possible, as there are always some aspects of a child's personality and behaviour which are likeable and praise-worthy.

Feedback consists of explaining what has taken place in the assessment process, what conclusions I have reached and why I have reached them. It is very important, at this point, for parents and child to feel free to ask questions, and add information.

I always write a report, detailing the feedback I have given, on the day after I have seen the child while s/he is fresh in my mind. This provides the parents with a comprehensive account of my findings and recommendations. The report belongs to the parents, although I provide spare copies for them to distribute to school and any other professionals involved. I ask parents to contact me if they have any concerns or questions, or if they require any further explanation.

Ways Forward

The most important part of the feedback session lies in talking about ways forward. It is important for the family to leave on a positive note, and with a very clear understanding of the recommendations I am making. I try to be as specific as I can be, for example: "We have agreed that Stan has problems with sustained concentration, impulsivity and hyperactivity, and that he is a classically AD/HD child. These problems are affecting his learning, social skills and behaviour. In addition, and separately from AD/HD, Stan has the phonic difficulties associated with dyslexia. These two problems are acting adversely upon one another: children who find learning difficult will find it hard to attend, and children who find it hard to attend will find learning difficult. Poor Stan has 'double trouble', and it is not surprising that he also has very low self-esteem. This is how we can try to help Stan."

How we can help Stan is the subject of another article, which would include the controversial topic of medication. In conclusion to this article, I would emphasise only the following points:

• every child is an individual who needs an individual management plan
• most children require multi-modal intervention, involving parents, teachers, a psychologist, psychiatrist or paediatrician, and possibly other professionals, for example, a speech and language, or occupational therapist
• plans only succeed if they are regularly monitored and revised
• older children must play a central role in the formation, monitoring and revision of their management plan
• parents and teachers should try to adopt a problem-solving approach to dealing with behaviour problems, and avoid being judgmental, angry or guilty. This will help the child to acknowledge, and take responsibility, for his/her problems, rather than denying that s/he has a problem or blaming others
• children, parents and teachers require ongoing support: an assessment is only the first stop towards solving a child's problems.

© Jenny Lyon 1995 Goldstein, S. (1994) Understanding and Assessing AD/HD and Related Educational and Emotional Disorders Therapeutic Care and Education Vol. 3 (2) pp. 111-125