A deep dive into a form of therapy that helps teens change unhealthy behaviors

Writer: Faith Wilkins

Clinical Expert: Christine Morrissey, LCSW, MSEd

What You'll Learn

- What are the core principles of motivational interviewing?

- How does motivational interviewing work?

- What are the benefits to using motivational interviewing as a form of treatment?

- Quick Read

- Full Article

- What are the core principles of MI?

- What is the process of treatment?

- What are the benefits of MI?

Motivational Interviewing (MI) is a form of therapy that helps patients build the confidence and self-motivation they need to change unhealthy behaviors, like substance abuse or self-harm. MI is more often used with adolescents than children, as they are more emotionally developed, and have more control over their environment.

The core principles of MI are open-ended questions, affirmations, reflections, and summarization (OARS). They’re based on the idea that clinician and patient are equal partners, and the patient should always feel like they’re in the driver’s seat. Clinicians will use open-ended questions to form a better understanding of the patient’s values and goals for treatment. During these conversations, they will offer affirmations to help teens build the confidence to change. Clinicians will also repeat, rephrase, and summarize things the teen has said, allowing them to reflect on their own values and feel heard in the process.

While the OARS are used throughout each session of MI, there is a clear set of phases that clinician and patient usually go through during treatment. In the engagement phase, therapists create a judgment-free space for teenagers to share their feelings and reservations against change. Having established trust, they move on to the focusing phase and work with teens to identify the specific behaviors they’re willing to change. This process usually takes place over many sessions, as it can involve a lot of trial and error. Clinicians will then enter the evoking phase, discussing the disadvantages of maintaining unhealthy behaviors and encouraging teens to see the benefits to change. Finally, they enter the planning phase, in which clinicians help their patients break down goals in a way that feels manageable and discuss potential barriers. This phase is optional but necessary if the patient needs more guidance.

Many therapists find MI to be beneficial because it can be tailored to the patient’s needs. For instance, if adolescents struggle with depression or anxiety, it can be hard for them to find self-motivation. They can take more intensive therapy like cognitive-behavioral therapy (CBT) along with MI.

Many of us can relate to wanting to make positive lifestyle changes and struggling to find the motivation to do so. For teenagers, it can be very difficult to make those changes, especially if their parents are pushing them to do it. The psychologists who created motivational interviewing (MI) believed that a collaborative, patient-centered approach to treatment would help people successfully commit to change. MI is a form of therapy that enables patients to gain the self-motivation they need to change unhealthy behaviors.  

The type of person who would benefit the most from MI is someone who shows resistance to therapy or change in general. They lack self-confidence, and even if they really want to change their behavior, they might not know where to start. The habit that they need to change, whether it’s drug abuse, alcoholism, or self-harm, has most likely become a coping mechanism to deal with other stressors in their everyday life. This can make it difficult for them to justify giving that behavior up, regardless of the negative consequences of continuing.

“When you think about a teenager,” says Christine Morrissey, LMSW, MSEd, a clinical social worker, “they’re undergoing a period of developing their sense of self, figuring out who they are. By the time an adolescent gets to treatment, you want to make sure that they believe they’re in the driver’s seat, which is something that doesn’t happen very often for them.”

Many teens go into therapy feeling angry or resentful, unsure why they need treatment. Therapists use MI to help teenagers overcome that ambivalence, giving them the space to explore their own goals and values and see how change can benefit them in the long run. MI is more often used with adolescents than children, as they are more emotionally developed and have more control over their environment.

What are the core principles of MI?

Motivational interviewing provides guidance for drawing out one’s own reasons and capacity for change. Clinicians are encouraged to act as an equal partner and avoid providing unsolicited advice, confrontation, or direction. To effectively guide their patients, they go by four core principles, which are known as the OARS:

- Open-ended questions

- Affirmations of strength, efforts, and past successes

- Reflections

- Summarization

“The idea of open-ended questions is that you can really get a person not only conversing with you about their life and their values and their goals, but also conversing with themselves,” Morrissey adds. 

Many topics can be covered during these sessions, such as how the adolescent’s behaviors align or conflict with their values, identifying the important people in their life, and why change would be important to them.

As an example, Morrissey describes one of her patients, whose parents and friends are concerned about their vaping habits. “In more recent sessions, we’ve been focusing on the vaping behavior, and I started by asking open-ended questions about how much they vape and really inquiring about what vaping does for them and what the drawbacks of it are, with a curious and nonjudgmental stance,” she explains. “With time to explore this, we were able to focus on what a goal might be that aligns with their long-term health goals, and also discuss ambivalence and barriers that get in the way.”

During these conversations, clinicians are careful to offer affirmations that will help build confidence in their patient. For example, if a teen describes an instance where they had to make a difficult decision, the clinician will point out the amount of strength it must have taken for them to do so. The goal is to empower the teen to use that strength in all aspects of their life.

Reflective listening is also an essential part of MI sessions, allowing clinicians to show their patients that they really care about what they have to say. Clinicians will often use this technique to repeat, rephrase, and summarize key takeaways from what has been said during each session. This is meant to get patients to really think about what they’ve just communicated and determine if that’s how they actually feel. Do their actions align with their current values and goals?

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

What is the process of treatment?

While the OARS are used by clinicians throughout each session of MI, there is a clear set of phases that clinician and patient usually go through during treatment. Depending on the needs of the patient, MI sessions can flow back and forth between phases. It’s just important that each phase is included.

Engagement: In this phase, clinicians want to get to know their patients and establish trust. It is made clear that these sessions are for them and not their parents, and anything they say will be confidential. The idea is to create a comfortable space for teenagers to share their feelings and possible ambivalence towards change. The purpose of this phase isn’t to come up with solutions quite yet, but to allow clinicians to meet their patients where they are and adjust to resistance rather than confront it head on.

Focusing: Once a solid relationship has been established between patient and clinician, they can then come up with the focus of treatment. At this stage of MI, most patients are unclear about the direction they want to take regarding recovery or making the desired lifestyle change. Still, clinicians want to make sure that this is a collaboration. They will often begin each session by discussing agenda items, making suggestions if needed, but ultimately allowing their patients to decide how to focus the sessions. Not only does this provide teenagers with the autonomy they need, but it also serves as a check-in for clinicians. They can assess whether their own goals for the sessions align with their patient’s and adjust accordingly.

This process is often gradual and can take place over several sessions, as clinicians must work with their patients to identify “change targets,” or the specific behaviors that need to change. They can draw upon the teenager’s values, which would’ve been established during the engagement phase, to identify their goals.

Morrissey explains, “The focusing is probably going to start wide and over time get narrower because over time, someone might realize that they kind of overshot their goal. If you’ve ever thought about starting a new exercise regimen and you’re like, ‘I’m going to run 10 miles every single day,’ and then over time you’re like, ‘Oh, that actually isn’t sustainable.’ Focusing would be like, ‘I want to move my body for at least 10 minutes a day.’ That can take a lot of time and trial and error.”

Evoking: The focusing phase can be difficult for teens, and they might display a great deal of resistance to setting goals. At this point, clinicians will begin the process of evoking “change talk.” This refers to any kind of statement that supports making a change. For example, a patient might say that they need to stop abusing substances, but don’t think they can do it. The change talk in that statement would be, “I need to stop abusing substances.” The clinician will keep them from going down a more negative line of thinking by asking, “What are the reasons you think you need to stop abusing substances?” With this technique, clinicians draw out the wants and needs of their patient without providing unwelcome advice.

At this stage, therapists can also work to reduce ambivalence towards change by first discussing the clear disadvantages to the patient maintaining their current unhealthy behavior. Clinicians will then use open-ended questioning and affirmations to encourage their patients to envision the benefits to change and to believe that this change is possible. Throughout these conversations, they remain optimistic and supportive while patients process their emotions towards changing their behavior.

Planning: The final phase of MI is planning. This is an optional phase but necessary when patients need more guidance on the steps that they need to take to change their behavior. It is at this point that they discuss barriers to their goals and how they might get past those barriers. Clinicians help their patients come up with a “change plan,” breaking down goals in a way that feels manageable. They also discuss what they might do if they experience setbacks.

Morrissey further explains this process when describing a session with one of her patients: “We also talked about what would happen if they ‘slipped up’ and vaped and discussed ways of using self-compassion to practice acceptance, combat all-or-nothing thinking, and get right back to goal-oriented behavior. . . there’s a lot of transitioning between stages, especially when there is ambivalence about change or slip-ups that come up that don’t align with the person’s goals.”

What are the benefits of MI?

The benefit to using motivational interviewing for teens is that it’s highly flexible and individualized. Depending on the patient’s needs, it can be used as standalone treatment, or used in tandem with other more intensive forms of treatment like cognitive-behavioral therapy (CBT). This can especially be true for adolescents who havemood disorders. For instance, if they’re struggling with depression or trauma, it could be really difficult for them to find self-motivation without the help of more comprehensive therapy.

“I really think it’s such a benefit to the client that they are the person who is the expert of their life, who knows themselves the best, who if they’re the person coming up with the solutions, they’re likely to be more realistic to their life. I think from a clinician’s perspective, it’s really fun work to do because you’re really tapping into someone’s inherent abilities. I think for the client themselves, it’s really beneficial because they get that autonomy,” says Morrissey. https://standingabovethecrowd.com/?p=16459

People opened up about the choices and moments that helped them get through their darkest periods and begin feeling like themselves again.

by Victoria Vouloumanos

BuzzFeed Contributor

Note: This post contains mentions of depression, suicidal ideation, substance use, and mental health treatment.

When things feel impossibly heavy, even small decisions can matter more than we realize. So when respondents were asked "During a very dark period, what was the best thing you ever did for your mental health?" people shared the choices, habits, and moments that helped them stay afloat — and, in many cases, slowly find their way back to themselves. From reaching out for help to making quiet, everyday changes, these are 28 things people say made a real difference when they needed it most:

1. "I acquired a cat. Somehow, 'let me ask around' was heard as 'I'll take him,' and I didn't know how to get out of it. I was in no mental state to take on a cat. But every day, I had to get up and feed him. My little accidental housemate needed me, and I couldn't bring myself to not keep going, one day at a time, to carry on taking care of him. I didn't rescue a cat. He rescued me."

2. "When I'm having a bad day, I go leave long, descriptive five-star reviews for every small shop, restaurant, etc., I've been to recently."

3. "Did the things my depression was telling me I didn't want to do. Go outside, see people, take care of myself."

4. "Get out and go for a walk. In nature. On a trail. Breathe the air. No phone."

5. "Honestly? Move across the freaking country. I went to a place where I didn't know anyone and where no one knew me. I got away from the people and the things that caused my depression. In retrospect, it was the best move I could have made. I made new friends, built a new life, and never went back. My mental health is so much better after leaving a small town with nothing but dead ends."

6. "Sounds daft, but I watched an episode of Red Dwarf to pass the time until everyone had gone to bed so they wouldn't be around when I'd take my own life. That one episode turned into a two-series binge. A week went by, and I'd finished the series. Luckily, my dad had them all on VHS. It sounds silly, too, but that first genuine laugh broke something open inside me. I was crying with laughter while trying to stay quiet. Some moments were just tears, too, but the catharsis afterward was unreal. I got myself help afterward and am here 16 years later."

7. "Quit drinking. Full stop."

8. "Anything. I was in a rut for years where I did nothing full-time and watched my life go by. I had horrible habits: not exercising, smoking a pack of cigarettes a day, and drinking four energy drinks a day. Things changed when I started participating in my own life and building better habits. You aren't going to feel much different tomorrow, but you can feel transformed in a year. So go for a walk, eat a piece of fruit, call your grandma. Do little things every day that positively benefit your life, and over time, they cascade into major changes. Whatever you need to do differs person to person, but the fundamentals are the same: you want to build better habits."

9. "I went on antidepressants, and they brought me back to who I used to be."

10. "Got my ass in the gym. I hate it when the experts are right."

11. "Asked for help, got sober."

12. "Treated myself like a plant. Mechanical self-care. As a default, I ran through a list: Have I watered and fed myself? Moved my body? Gotten sunlight? Talked with another human and attempted a connection, even briefly? Not abused my body with things that regress self-care, like overly people-pleasing or having an overly caffeinated drink that would cause a crash? As a base, I did feel better, which gave me the energy and mental power to do other good things for myself. It cycles up when you're consistent. Not everyone is great at consistency, but giving yourself grace and trying again is a skill that can be acquired, and it has helped me a lot personally."

13. "Went to see a doctor to get my mental health issues addressed."

14. "Went no contact with my entire family. Best decision I ever made for my mental health."

15. "First instance: The day I planned to complete suicide, I spent hours ruminating about it. I had the means, the time, and a plan. I called a friend instead. We went to the park. He still doesn't know he saved my life. I didn't tell him, at least, but he's very perceptive, so I wouldn't be surprised if he already knew. Second instance: I went to a psychiatrist. I still have no idea where I gathered the strength to do that. I got diagnosed with depression and got medication. Life certainly isn't breezy, but oh lord, is it better."

16. "Quit Facebook. It was the easiest and quickest substantial improvement in mental health I've ever had."

17. "Yoga. It does wonders for my anxiety."

18. "Watch stand-up comedy each night before sleep."

19. "Gaming and self-care basics: sunlight, exercise, diet, sleep, hobbies, a gratitude journal, cognitive behavioral therapy techniques, and a holiday."

20. "Called each of my closest girlfriends at 11:30 p.m. until one answered, and sobbed openly while admitting I wasn't feeling safe alone anymore. She listened and comforted me for an hour and, in her own way, helped me make a safety plan. I was at a crisis center the following day, getting my first round of antidepressants. It drastically improved my life."

21. "Did my best to get enough sleep. Walking is good, but sleep is the game changer."

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

22. "I was dealing with a sudden onset of horrific, nonstop panic attacks, probably the culmination of way too much in my life. My New Year's resolution that year was to shut down. I closed everything that wasn't essential, socially. I had trusted people that I'd see occasionally, but outside of that, I woke up, went to work, came home, and repeated. No new social interactions. Like the Moby song: 'I had to close down everything, I had to close down my mind. Too many things could cut me, too much could make me blind.' For some people, this would be bad, obviously. But for me, it was a factory reset. It helped me reframe happiness into something more achievable. The only thing I had to look forward to each day was dinner, and I learned to get excited about that. It numbed the raw nerve I felt like, so everything wasn't a trigger anymore. This isn't something I'd recommend to everyone, but it worked for me."

23. "I listened to the audiobook Spontaneous Happiness, and it changed my life. The easy steps you can implement into your daily life are ones I continue to do today, 15 years later."

24. "Taking baths, buying a full set of Sherlock Holmes audiobooks, and listening to them in the tub. Love it."

25. "I took Facebook and Instagram off my phone. I kept my accounts, but only on my laptop, and set strict limits. I got rid of TikTok altogether. It helped more than I can say."

26. "Reminding myself that hope springs eternal and that things are evolving. As the sun rises, a new day is an opportunity to change something. Reminding myself of what I can and can't control. And faking it until it works. Have the shower. Wash your face. Get fresh air. One foot in front of the other. And getting therapy. It wasn't easy, but it was worth every struggle. Change happens. Taking a tiny step and taking control, that was key."

27. "Take a shower. It was awful in the beginning, but I did feel better by the end."

28. "I stopped smoking weed. I was a daily, all-day user. My ability to make dopamine was so atrophied that nothing made me feel good, except the weed, and then only for five to 10 minutes before the negative side effects took over: paranoia, demotivation, depression. It's counterintuitive, but now that I've been clean for several months, my ability to feel good after a decent meal, a hot shower, or watching a sunset has started to return. I won't lie. None of these was easy."

If you're going through something similar, you're not alone — and you don't have to figure it out all at once. Sometimes progress looks like asking for help. Sometimes it looks like showing up for yourself in small, quiet ways. And sometimes it starts with reading a story that reminds you that change, however slow, is possible.

Dial 988 in the United States to reach the National Suicide Prevention Lifeline. The 988 Lifeline is available 24/7/365. Your conversations are free and confidential. Other international suicide helplines can be found at befrienders.org. The Trevor Project, which provides help and suicide-prevention resources for LGBTQ youth, is 1-866-488-7386.

The National Alliance on Mental Illness helpline is 1-800-950-6264 (NAMI) and provides information and referral services; GoodTherapy.org is an association of mental health professionals from more than 25 countries who support efforts to reduce harm in therapy. https://standingabovethecrowd.com/?p=16457

James Donaldson on Mental Health - Twice-Exceptional Kids: Both Gifted and Challenged

2e kids, as they’re called, have a unique set of issues that need addressing

Photo by samer daboul on Pexels.com

Writer: Beth Arky

Clinical Experts: Adam S. Zamora, PsyD , Laura Phillips, PsyD, ABPdN

What You'll Learn

- What does “2e” mean?
- How does being 2e affect kids in school?
- How can families support 2e kids?
- Quick Read
- Full Article
- Why 2e kids are overlooked
- Emotional and behavioral issues
- Giftedness can lead to misdiagnosis
- How to identify 2e children
- The challenge of educating the 2e child
- How support can help

Some children are highly gifted in areas such as math, writing, or music. Others have learning challenges like ADHD, dyslexia, dyscalculia, autism, or sensory processing issues. But there are also kids who fit into both categories. They’re called “twice-exceptional,” or 2e, which means that they have exceptional ability and disability. They are gifted but they also face learning or developmental challenges.

Children who are both gifted and challenged can be tough to understand. Gifted kids may use their strengths to cover their struggles, making learning issues harder to spot. This can also go the other way, with challenges hiding a child’s giftedness. In some cases, neither the disability nor the giftedness is recognized.

Once 2e kids are identified, it can still be difficult to get the right support. If they’re in a gifted program, they may fall short of expectations. If they’re placed in a special education program that’s not challenging enough, they can feel frustrated and restless. In either case, anxiety, depression, a lack of self-esteem, or emotional dysregulation can result, leading to behavior problems.

When a child’s giftedness or disability (or both) are missed, it can have emotional and behavioral consequences. Kids who are clearly bright but struggling to keep up might be seen as lazy. Or they might face a lot of criticism from parents and teachers for “not trying hard enough.”

Identifying 2e kids can be hard. There is no universal standard for “giftedness.” It’s often up to individual schools to decide if kids are gifted. If a child is extremely good at one or two subjects but behind in other subjects, that might be a sign that they are 2e.

The best way to see if a child is 2e is through a neuropsychological evaluation. These can help create a picture of your child’s strengths and weaknesses. The information they gather can then be used to get the child the right kind of support. When 2e kids are identified and supported, they do better in school and have higher self-esteem.

Some children are highly gifted in areas such as math, writing, or music. Then there are those with challenges that affect learning: They could have ADHD, dyslexia, or dyscalculia, or perhaps they’re autistic or have sensory processing issues. But there are also kids who fit both categories. They’re called twice-exceptional, or 2e, which means that they have exceptional ability and disability. They are gifted in some way but they also face learning or developmental challenges.

Children who are both gifted and challenged can be tough to understand. Gifted kids can use their strengths to compensate for their specific needs, and in the process mask their learning problems. Or their specific needs can mask the giftedness. In some cases, neither the disability nor the giftedness is recognized.

Once 2e kids are identified, it can still be difficult to get the supports these children need in school. If they’re in a gifted program, they may be floundering in a certain area. If they’re placed in a special-ed program, it may not challenge them, and they may be frustrated and restless. In either case, anxiety, depression, a lack of self-esteem, and emotional dysregulation can result, leading to behavior problems.

Why 2e kids are overlooked

One reason twice-exceptional kids are in danger of slipping through the cracks is that their schools are set up to help kids meet grade-level academic skills, and they may be on grade level, despite their challenges.

“Let’s take bright kids who have a reading disability,” says Adam S. Zamora, PsyD, a neuropsychologist at the Child Mind Institute. “When they’re reading, there are words that they don’t know how to decode but they use inferential reasoning and their overallcognitive capacity to kind of figure out what the missing word might be. These kids might go under the radar.”

They may eventually be diagnosed with a learning disability if they hit a wall when they reach later grades and expectations rise, or they may never receive the diagnosis and support they need.

Then there’s the case of a 2e child who may have issues that overshadow their giftedness.

This was the case at first with Jenn Choi’s son, Logan, now 14. His specific needs (ADHD and then dyslexia) were identified after he was asked to leave his first preschool for his “behaviors,” which included not being able to sit in circle time.

But it wasn’t until Logan was turning 5 and had his first neuropsychological assessment that his parents realized his potential, when he scored in a very superior range in visual-spatial thinking, including perception, analysis, and synthesis. This can translate into excellence in math, science, and engineering.

“It was a big surprise to us that he was really smart,” Choi says. And it wasn’t until first grade, when he attended an afterschool program at the Quad Mahattan, created for twice-exceptional kids, that she learned the term. Choi now offers a listserve for 2e parents in New York City.

Emotional and behavioral issues

Not having both talents and disability identified can have emotional and behavioral consequences for children.

“They know that they’re capable of more and yet something is holding them back, and they can’t really figure out why,” says Laura Phillips, PsyD, a neuropsychologist. “That’s why you often see a lot of frustration and anxiety and even behavioral dysregulation in a lot of these kids.”

They may come off as lazy because they’re clearly bright but performing poorly in some areas. They may get a lot of criticism from parents and teachers: “You’re just not trying on this math!” Their self-esteem suffers and they may experience depression.

Or they may seem oppositional to teachers and parents. “Frustrated by their difficulties, they act out in infinite ways, and they get mischaracterized or misunderstood as being oppositional,” Dr. Phillips says.

Giftedness can lead to misdiagnosis

Children who are gifted may have behaviors that look like ADHD or autism.

“One of the things we know about gifted children almost universally is that they are intense,” says psychologist James T. Webb, PhD, who specializes in them. “If they’re into dinosaurs, they eat, drink, live dinosaurs. If they’re into math and factors, they love it. If they’re into power struggles or sibling rivalry, it’s equally as intense.”

This intensity can make sitting in a regular classroom very frustrating. “The research indicates that for most gifted children, from one-fourth to one-half the regular classroom time is spent waiting for others to catch up,” Webb notes. “If you’re sitting there and your mind is intensely churning, you’re likely to be seen as being off task, fidgety, interrupting others, classic behaviors that would be ADHD-like.”

It’s also easy to misdiagnose gifted kids as being on the autism spectrum. There’s that intensity in interests. Also, “gifted children as a group just seem to be quirkier than other kids,” Dr. Webb says.

Gifted kids can also be oversensitive to stimuli, making them avoid bright lights, noise and crowds. The combination of over excitability and intellectual advancement can make them a bad match for their noisy and boisterous peers. “They just don’t play well with others,” he says. “They try to structure their world in a rigid way. They have difficulty with being redirected to new tasks. All of these are behaviors are ones you often see on the spectrum.”

Of course a child can also be 2e — both gifted and have ADHD or autism.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

How to identify 2e children

First, Dr. Webb emphasizes, parents and teachers need to be familiar with the concept of twice exceptionality. “One of the big myths about gifted children is that they will be equally gifted in all areas, or very close to that,” he says.

“There really is no universally agreed upon definition of ‘gifted’ — even with respect to general intellectual ability,” Dr. Phillips says, “as giftedness in its truest definition is not limited to intellectual potential, but instead can refer to extraordinary capabilities in creative thinking, specific academic areas, psychomotor functioning, or visual/performing arts.” She says she and most school placement decisions use a Standard Score in IQ testing of 130 as the cut-off for gifted intelligence, which would place the child in the top 2 percent of the population.

Experts suggest that when a teacher sees a child who does just okay in some areas, but in one or two areas is a prodigy — or does exceptionally well in all areas except one, where she is lagging —  the child should be referred for testing.

The optimal way to pick up on twice exceptionality is through a neuropsychological evaluation.

“Neuropsych evaluations are really the best way to understand a student’s full profile of cognitive and academic strengths and weaknesses, and to individualize a curriculum, which really is what these kids need,” Dr. Phillips explains. “They might be three grade levels ahead in math, but they might need extra support in reading.”

The challenge of educating the 2e child

According to a survey spearheaded by Choi of 503 parents with 2e kids, 254 of whom attend New York City public schools, their biggest challenge is being forced to choose between cultivating the child’s intellectual ability and helping with their special-education needs; they are not usually offered at the same time.

One way to try to get the individualized teaching 2e kids need is by being placed in an Integrated Co-Teaching (ICT) class, with one general-education teacher and one special-needs teacher. But if 2e kids are performing at grade level, it can make it difficult to persuade schools that they should provide remediation or accommodations through an Individualized Education Program or a 504 Plan.

Choi says the survey showed parents are told that children in a gifted and talented program can’t have an IEP, which is not true. The survey also showed that only 5 percent of the 2e kids had a gifted and talented placement in an ICT classroom.

Should kids be moved to older classrooms for the subjects where they excel? Dr. Phillips says it can be tricky because they don’t have the maturity level to handle the homework and social demands. In some cases, parents may opt for private schools, with smaller classes and/or curriculum tailored to a particular student’s strengths and weaknesses.

Instead of placing kids in older classes, Dr. Phillips recommends that parents provide a lot of enrichment outside school. One such resource: the Davidson Institute, including its Davidson Young Scholars Program for 2e students. Also, some museums provide weekend programming for gifted students.

How support can help

Getting support can help twice-exceptional children reach their full potential, both in terms of academics and on the emotional front.

When 2e kids are identified and supported, Dr. Zamora says, they can do better in school and have higher self-esteem. “If parents are well informed about what’s going on with the kid, if the teachers really understand that this is a bright kid who just has these one or two areas of weakness, it can affect the way the teachers talk to the kid, the way they teach the kid,” he says.

Another way to help 2e kids, adds Dr. Phillips, is to let them know it will get easier. “When I work with any sort of learning disability, I tell parents the years from kindergarten through 12th grade are going to be the hardest years in their kids’ lives” because they are required to take all the core subjects. But when they head off to college, they can select the courses in their areas of strength. “After that, they can choose careers that are suited to their strengths again and really shine there as well.”

As for Logan, he attended three private schools between kindergarten and the middle of seventh grade, partially for behavioral issues but also because the curriculum wasn’t challenging enough for him. Eventually he settled into a gifted and talented program in a public school, which has been a better fit. This month, he started at a competitive public high school.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-twice-exceptional-kids-both-gifted-and-challenged/

2e kids, as they’re called, have a unique set of issues that need addressing

Photo by samer daboul on Pexels.com

Writer: Beth Arky

Clinical Experts: Adam S. Zamora, PsyD , Laura Phillips, PsyD, ABPdN

What You'll Learn

- What does “2e” mean?

- How does being 2e affect kids in school?

- How can families support 2e kids?

- Quick Read

- Full Article

- Why 2e kids are overlooked

- Emotional and behavioral issues

- Giftedness can lead to misdiagnosis

- How to identify 2e children

- The challenge of educating the 2e child

- How support can help

Some children are highly gifted in areas such as math, writing, or music. Others have learning challenges like ADHD, dyslexia, dyscalculia, autism, or sensory processing issues. But there are also kids who fit into both categories. They’re called “twice-exceptional,” or 2e, which means that they have exceptional ability and disability. They are gifted but they also face learning or developmental challenges.

Children who are both gifted and challenged can be tough to understand. Gifted kids may use their strengths to cover their struggles, making learning issues harder to spot. This can also go the other way, with challenges hiding a child’s giftedness. In some cases, neither the disability nor the giftedness is recognized.

Once 2e kids are identified, it can still be difficult to get the right support. If they’re in a gifted program, they may fall short of expectations. If they’re placed in a special education program that’s not challenging enough, they can feel frustrated and restless. In either case, anxiety, depression, a lack of self-esteem, or emotional dysregulation can result, leading to behavior problems.

When a child’s giftedness or disability (or both) are missed, it can have emotional and behavioral consequences. Kids who are clearly bright but struggling to keep up might be seen as lazy. Or they might face a lot of criticism from parents and teachers for “not trying hard enough.”

Identifying 2e kids can be hard. There is no universal standard for “giftedness.” It’s often up to individual schools to decide if kids are gifted. If a child is extremely good at one or two subjects but behind in other subjects, that might be a sign that they are 2e.

The best way to see if a child is 2e is through a neuropsychological evaluation. These can help create a picture of your child’s strengths and weaknesses. The information they gather can then be used to get the child the right kind of support. When 2e kids are identified and supported, they do better in school and have higher self-esteem.

Some children are highly gifted in areas such as math, writing, or music. Then there are those with challenges that affect learning: They could have ADHD, dyslexia, or dyscalculia, or perhaps they’re autistic or have sensory processing issues. But there are also kids who fit both categories. They’re called twice-exceptional, or 2e, which means that they have exceptional ability and disability. They are gifted in some way but they also face learning or developmental challenges.

Children who are both gifted and challenged can be tough to understand. Gifted kids can use their strengths to compensate for their specific needs, and in the process mask their learning problems. Or their specific needs can mask the giftedness. In some cases, neither the disability nor the giftedness is recognized.

Once 2e kids are identified, it can still be difficult to get the supports these children need in school. If they’re in a gifted program, they may be floundering in a certain area. If they’re placed in a special-ed program, it may not challenge them, and they may be frustrated and restless. In either case, anxiety, depression, a lack of self-esteem, and emotional dysregulation can result, leading to behavior problems.

Why 2e kids are overlooked

One reason twice-exceptional kids are in danger of slipping through the cracks is that their schools are set up to help kids meet grade-level academic skills, and they may be on grade level, despite their challenges.

“Let’s take bright kids who have a reading disability,” says Adam S. Zamora, PsyD, a neuropsychologist at the Child Mind Institute. “When they’re reading, there are words that they don’t know how to decode but they use inferential reasoning and their overallcognitive capacity to kind of figure out what the missing word might be. These kids might go under the radar.”

They may eventually be diagnosed with a learning disability if they hit a wall when they reach later grades and expectations rise, or they may never receive the diagnosis and support they need.

Then there’s the case of a 2e child who may have issues that overshadow their giftedness.

This was the case at first with Jenn Choi’s son, Logan, now 14. His specific needs (ADHD and then dyslexia) were identified after he was asked to leave his first preschool for his “behaviors,” which included not being able to sit in circle time.

But it wasn’t until Logan was turning 5 and had his first neuropsychological assessment that his parents realized his potential, when he scored in a very superior range in visual-spatial thinking, including perception, analysis, and synthesis. This can translate into excellence in math, science, and engineering.

“It was a big surprise to us that he was really smart,” Choi says. And it wasn’t until first grade, when he attended an afterschool program at the Quad Mahattan, created for twice-exceptional kids, that she learned the term. Choi now offers a listserve for 2e parents in New York City.

Emotional and behavioral issues

Not having both talents and disability identified can have emotional and behavioral consequences for children.

“They know that they’re capable of more and yet something is holding them back, and they can’t really figure out why,” says Laura Phillips, PsyD, a neuropsychologist. “That’s why you often see a lot of frustration and anxiety and even behavioral dysregulation in a lot of these kids.”

They may come off as lazy because they’re clearly bright but performing poorly in some areas. They may get a lot of criticism from parents and teachers: “You’re just not trying on this math!” Their self-esteem suffers and they may experience depression.

Or they may seem oppositional to teachers and parents. “Frustrated by their difficulties, they act out in infinite ways, and they get mischaracterized or misunderstood as being oppositional,” Dr. Phillips says.

Giftedness can lead to misdiagnosis

Children who are gifted may have behaviors that look like ADHD or autism.

“One of the things we know about gifted children almost universally is that they are intense,” says psychologist James T. Webb, PhD, who specializes in them. “If they’re into dinosaurs, they eat, drink, live dinosaurs. If they’re into math and factors, they love it. If they’re into power struggles or sibling rivalry, it’s equally as intense.”

This intensity can make sitting in a regular classroom very frustrating. “The research indicates that for most gifted children, from one-fourth to one-half the regular classroom time is spent waiting for others to catch up,” Webb notes. “If you’re sitting there and your mind is intensely churning, you’re likely to be seen as being off task, fidgety, interrupting others, classic behaviors that would be ADHD-like.”

It’s also easy to misdiagnose gifted kids as being on the autism spectrum. There’s that intensity in interests. Also, “gifted children as a group just seem to be quirkier than other kids,” Dr. Webb says.

Gifted kids can also be oversensitive to stimuli, making them avoid bright lights, noise and crowds. The combination of over excitability and intellectual advancement can make them a bad match for their noisy and boisterous peers. “They just don’t play well with others,” he says. “They try to structure their world in a rigid way. They have difficulty with being redirected to new tasks. All of these are behaviors are ones you often see on the spectrum.”

Of course a child can also be 2e — both gifted and have ADHD or autism.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

How to identify 2e children

First, Dr. Webb emphasizes, parents and teachers need to be familiar with the concept of twice exceptionality. “One of the big myths about gifted children is that they will be equally gifted in all areas, or very close to that,” he says.

“There really is no universally agreed upon definition of ‘gifted’ — even with respect to general intellectual ability,” Dr. Phillips says, “as giftedness in its truest definition is not limited to intellectual potential, but instead can refer to extraordinary capabilities in creative thinking, specific academic areas, psychomotor functioning, or visual/performing arts.” She says she and most school placement decisions use a Standard Score in IQ testing of 130 as the cut-off for gifted intelligence, which would place the child in the top 2 percent of the population.

Experts suggest that when a teacher sees a child who does just okay in some areas, but in one or two areas is a prodigy — or does exceptionally well in all areas except one, where she is lagging —  the child should be referred for testing.

The optimal way to pick up on twice exceptionality is through a neuropsychological evaluation.

“Neuropsych evaluations are really the best way to understand a student’s full profile of cognitive and academic strengths and weaknesses, and to individualize a curriculum, which really is what these kids need,” Dr. Phillips explains. “They might be three grade levels ahead in math, but they might need extra support in reading.”

The challenge of educating the 2e child

According to a survey spearheaded by Choi of 503 parents with 2e kids, 254 of whom attend New York City public schools, their biggest challenge is being forced to choose between cultivating the child’s intellectual ability and helping with their special-education needs; they are not usually offered at the same time.

One way to try to get the individualized teaching 2e kids need is by being placed in an Integrated Co-Teaching (ICT) class, with one general-education teacher and one special-needs teacher. But if 2e kids are performing at grade level, it can make it difficult to persuade schools that they should provide remediation or accommodations through an Individualized Education Program or a 504 Plan.

Choi says the survey showed parents are told that children in a gifted and talented program can’t have an IEP, which is not true. The survey also showed that only 5 percent of the 2e kids had a gifted and talented placement in an ICT classroom.

Should kids be moved to older classrooms for the subjects where they excel? Dr. Phillips says it can be tricky because they don’t have the maturity level to handle the homework and social demands. In some cases, parents may opt for private schools, with smaller classes and/or curriculum tailored to a particular student’s strengths and weaknesses.

Instead of placing kids in older classes, Dr. Phillips recommends that parents provide a lot of enrichment outside school. One such resource: the Davidson Institute, including its Davidson Young Scholars Program for 2e students. Also, some museums provide weekend programming for gifted students.

How support can help

Getting support can help twice-exceptional children reach their full potential, both in terms of academics and on the emotional front.

When 2e kids are identified and supported, Dr. Zamora says, they can do better in school and have higher self-esteem. “If parents are well informed about what’s going on with the kid, if the teachers really understand that this is a bright kid who just has these one or two areas of weakness, it can affect the way the teachers talk to the kid, the way they teach the kid,” he says.

Another way to help 2e kids, adds Dr. Phillips, is to let them know it will get easier. “When I work with any sort of learning disability, I tell parents the years from kindergarten through 12th grade are going to be the hardest years in their kids’ lives” because they are required to take all the core subjects. But when they head off to college, they can select the courses in their areas of strength. “After that, they can choose careers that are suited to their strengths again and really shine there as well.”

As for Logan, he attended three private schools between kindergarten and the middle of seventh grade, partially for behavioral issues but also because the curriculum wasn’t challenging enough for him. Eventually he settled into a gifted and talented program in a public school, which has been a better fit. This month, he started at a competitive public high school. Even with the changes, Choi says she feels all of Logan’s needs haven’t been met. She says his gifts put him on an engineering path, something that won’t be addressed in school. Instead, she says, “We are going to have to figure it out as we go along.”

Frequently Asked Questions

What are twice exceptional, or 2e, students?

Twice-exceptional, or 2e, students are kids who are gifted in certain areas, like math or music, but who also have a learning or developmental challenge, like ADHD, dyslexia, or autism.

Photo by samer daboul on Pexels.com https://standingabovethecrowd.com/?p=16454

Harvard researchers discuss an exclusive study showing a sharp increase in NFL suicides since 2011. The findings highlight the importance of managing treatable symptoms and health disparities among Black former players.

By Tamara Brown

Former National Football League players have experienced a frightening spike in their rate of death by suicide compared with athletes in other sports, according to new data from Harvard University. The Football Players Health Study at Harvard University, a comprehensive research program that studies the health and well-being of living former National Football League players, has uncovered a stark shift in the long-term mental health of former NFL players. While professional athletes have historically shown lower suicide rates than the general public, recent data indicates that former NFL players have faced a significant increase in deaths by suicide over the last decade—a trend not observed among their counterparts in Major League Baseball or the National Basketball Association.

The research, which examined death records spanning from 1979 to 2019, found that the suicide rates among NFL, MLB, and NBA players were virtually identical for the first 30 years of the study. However, starting in 2011, a sharp divergence occurred. From 2011 to 2019, the rate of death by suicide among former NFL players rose to be 2.6 times higher than that of former MLB and NBA players.

Rachel Grashow, the director of epidemiological research initiatives for the study, expressed that the sheer scale of the increase was unexpected.

"We were surprised by the magnitude of the effect," Grashow said. "In some ways, we weren’t surprised to see that it was on par with the other sports because we knew that already. Seeing that big of a jump was a sign that more could be done to support former players.”

Researchers suggest this trend may be linked to the "pivotal year" of 2011, when public and scientific discourse surrounding Chronic Traumatic Encephalopathy (CTE) intensified, and after a series of high-profile NFL suicides. CTE is a neurodegenerative condition currently only diagnosable after death. The study offers the possibility that the widespread narrative of CTE as an incurable, progressive disease may be partially impacting the mental health and perceived hopelessness of living former players.

"CTE is a real condition that can only be identified after someone passes away," Grashow explained. "While symptoms of CTE among living former players remain incompletely understood, players experiencing trouble with memory, concentration, or mood may attribute these to CTE."

Because of the incurable nature associated with the diagnosis, players who believe they have the condition may experience a higher risk of suicidality. However, the study highlights a critical distinction: many symptoms often linked to CTE—such as irritability, memory issues, and mood swings—can stem from highly treatable medical conditions. These include sleep apnea, chronic pain, hypertension, diabetes, and low testosterone.

The research may be particularly relevant for Black former players. Alicia Whittington, who leads health equity and community-based participatory research for the study, noted that Black athletes often carry a heavier burden of mental and physical health challenges post-career.

"In the context of health equity, when you focus on those who are most affected by health issues, everyone benefits," Whittington said.

The study indicates that a career in professional football does not serve as a shield against the systemic health inequities faced by Black men in America. Despite the resources and physical fitness benefits associated with a professional football career, Black former players report poorer health across the board compared to their white peers. Whittington’s work centers the community in the research process, ensuring that the findings lead to actionable support for those most at risk.

Beyond the focus on brain health, the researchers suggested several other potential factors contributing to the rise in suicides. These include the "Werther Effect," a copycat or contagion effect following high-profile suicides, as well as broader societal changes like increased social isolation, financial stress, and the impact of social media. Changes in how medical examiners classify deaths after 2010 may also play a role in the documented increase.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

A primary goal for the Harvard team is to shift the conversation toward what can be managed in the present. While head injuries from a player’s career cannot be reversed, cardiovascular and metabolic health can be improved.

"We want former players to use our health checklist to go after what's treatable, after the things that they can change, because we think that actually can make a big difference," Grashow said.

This checklist was suggested by former players to help them advocate for themselves during medical appointments, focusing on heart, brain, and hormonal health. By treating conditions like hypertension—which Grashow calls a "silent killer" particularly prevalent in the Black community—players can protect both their heart and brain function.

The study, which has been in development for over a decade, currently follows nearly 5,000 living former players. Whittington stressed the importance of continued participation to strengthen science and provide better care for the community. Any player who signed a contract with a professional team from 1960 to the present is eligible to participate, even if they only attended training camp.

"I just hope that players will engage with our work and also remain connected to their community as best as they can," Whittington said.

For those in need of immediate support, the researchers highlighted several resources, including the NFL LifeLine, which offers confidential 24/7 consultation, and Silence The Shame, a nonprofit dedicated to mental health education and destigmatization.

Ultimately, the Harvard team hopes this research will empower former players to take proactive steps for their health while reminding them that they are not alone. As the narrative around football and brain health continues to evolve, the focus remains on supporting the men who are still here.

"Collectively, how do we better support players? How do we take care of those who are still with us, and encourage positive health activities that improve and lengthen life?" Grashow said.  https://standingabovethecrowd.com/?p=16448

James Donaldson on Mental Health - EXCLUSIVE: New Research Explores Rising Suicide Rates Among Former NFL Players

Harvard researchers discuss an exclusive study showing a sharp increase in NFL suicides since 2011. The findings highlight the importance of managing treatable symptoms and health disparities among Black former players.

By Tamara Brown

Former National Football League players have experienced a frightening spike in their rate of death by suicide compared with athletes in other sports, according to new data from Harvard University. The Football Players Health Study at Harvard University, a comprehensive research program that studies the health and well-being of living former National Football League players, has uncovered a stark shift in the long-term mental health of former NFL players. While professional athletes have historically shown lower suicide rates than the general public, recent data indicates that former NFL players have faced a significant increase in deaths by suicide over the last decade—a trend not observed among their counterparts in Major League Baseball or the National Basketball Association.

The research, which examined death records spanning from 1979 to 2019, found that the suicide rates among NFL, MLB, and NBA players were virtually identical for the first 30 years of the study. However, starting in 2011, a sharp divergence occurred. From 2011 to 2019, the rate of death by suicide among former NFL players rose to be 2.6 times higher than that of former MLB and NBA players.

Rachel Grashow, the director of epidemiological research initiatives for the study, expressed that the sheer scale of the increase was unexpected.

"We were surprised by the magnitude of the effect," Grashow said. "In some ways, we weren’t surprised to see that it was on par with the other sports because we knew that already. Seeing that big of a jump was a sign that more could be done to support former players.”

Researchers suggest this trend may be linked to the "pivotal year" of 2011, when public and scientific discourse surrounding Chronic Traumatic Encephalopathy (CTE) intensified, and after a series of high-profile NFL suicides. CTE is a neurodegenerative condition currently only diagnosable after death. The study offers the possibility that the widespread narrative of CTE as an incurable, progressive disease may be partially impacting the mental health and perceived hopelessness of living former players.

"CTE is a real condition that can only be identified after someone passes away," Grashow explained. "While symptoms of CTE among living former players remain incompletely understood, players experiencing trouble with memory, concentration, or mood may attribute these to CTE."

Because of the incurable nature associated with the diagnosis, players who believe they have the condition may experience a higher risk of suicidality. However, the study highlights a critical distinction: many symptoms often linked to CTE—such as irritability, memory issues, and mood swings—can stem from highly treatable medical conditions. These include sleep apnea, chronic pain, hypertension, diabetes, and low testosterone.

The research may be particularly relevant for Black former players. Alicia Whittington, who leads health equity and community-based participatory research for the study, noted that Black athletes often carry a heavier burden of mental and physical health challenges post-career.

"In the context of health equity, when you focus on those who are most affected by health issues, everyone benefits," Whittington said.

The study indicates that a career in professional football does not serve as a shield against the systemic health inequities faced by Black men in America. Despite the resources and physical fitness benefits associated with a professional football career, Black former players report poorer health across the board compared to their white peers. Whittington’s work centers the community in the research process, ensuring that the findings lead to actionable support for those most at risk.

Beyond the focus on brain health, the researchers suggested several other potential factors contributing to the rise in suicides. These include the "Werther Effect," a copycat or contagion effect following high-profile suicides, as well as broader societal changes like increased social isolation, financial stress, and the impact of social media. Changes in how medical examiners classify deaths after 2010 may also play a role in the documented increase.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

A primary goal for the Harvard team is to shift the conversation toward what can be managed in the present. While head injuries from a player’s career cannot be reversed, cardiovascular and metabolic health can be improved.

"We want former players to use our health checklist to go after what's treatable, after the things that they can change, because we think that actually can make a big difference," Grashow said.

This checklist was suggested by former players to help them advocate for themselves during medical appointments, focusing on heart, brain, and hormonal health. By treating conditions like hypertension—which Grashow calls a "silent killer" particularly prevalent in the Black community—players can protect both their heart and brain function.

The study, which has been in development for over a decade, currently follows nearly 5,000 living former players. Whittington stressed the importance of continued participation to strengthen science and provide better care for the community. Any player who signed a contract with a professional team from 1960 to the present is eligible to participate, even if they only attended training camp.

"I just hope that players will engage with our work and also remain connected to their community as best as they can," Whittington said.

For those in need of immediate support, the researchers highlighted several resources, including the NFL LifeLine, which offers confidential 24/7 consultation, and Silence The Shame, a nonprofit dedicated to mental health education and destigmatization.

Ultimately, the Harvard team hopes this research will empower former players to take proactive steps for their health while reminding them that they are not alone. As the narrative around football and brain health continues to evolve, the focus remains on supporting the men who are still here.

"Collectively, how do we better support players? How do we take care of those who are still with us, and encourage positive health activities that improve and lengthen life?" Grashow said. 

https://standingabovethecrowd.com/james-donaldson-on-mental-health-exclusive-new-research-explores-rising-suicide-rates-among-former-nfl-players/

James Donaldson on Mental Health - ADHD and Substance Abuse

Why teens with the disorder are at higher risk for addiction

Writer: Christina Frank

Clinical Expert: Sarper Taskiran, MD

What You'll Learn

- How are ADHD and substance abuse in teenagers connected?
- Why do teenagers with ADHD use drugs?
- Are ADHD medications connected to substance abuse?
- How can parents help teenagers with ADHD avoid substance abuse?
- Quick Read
- Full Article
- The drugs of choice
- Additional risk factors
- ADHD medications do not increase risk
- What parents can do

Research shows that teenagers with ADHD are more likely to abuse substances like drugs and alcohol. Kids with ADHD may be drawn to substances that make them feel calm. Plus, their brains might be more sensitive to drugs. That can make them feel effects more intensely and sometimes get addicted faster. 

The most common drugs used by teenagers with ADHD are marijuana, alcohol and nicotine. Often they aren’t looking to get high. Instead, they’re looking for a break from ADHD symptoms like racing thoughts and hyperactivity. 

Having another mental health disorder, like depression or anxiety, makes kids with ADHD more likely to abuse substances. Kids who are struggling in school or with friends might also end up spending time with other kids who are more likely to take risks and experiment with drugs or alcohol. 

Some people think that ADHD medication can make teenagers more likely to use other drugs, but there is no evidence of that. Most studies show that medication doesn’t either increase or reduce the risk of substance abuse. Some research even suggests that treating ADHD symptoms with medication makes young people less likely to abuse substances. 

Parents of teenagers with ADHD can help by talking to their kids early about the dangers of substance abuse. Let them know that having ADHD can make them more likely to get addicted. Parents can also help their kids learn positive coping skills instead of trying to solve problems for them. That way, kids are less likely to turn to substances when they run into challenges.  

Finally, it’s important for parents to keep positive relationships with their kids. ADHD can cause fights and frustration at home, and the conflict can cause stress that pushes kids toward substance use. Family therapy and behavioral treatment for the teen’s ADHD can help families resolve tension. 

We know that one of the long-term effects of ADHD is a heightened risk for substance abuse. In fact,  research has found that kids with ADHD are two to three times more likely to abuse substances than kids in the general population.

This association is not surprising, given that the hallmarks of ADHD include trouble focusing, curbing impulsivity and sitting still, says Jeannette Friedman, LCSW, a therapist who works with families struggling with substance use issues. “So, when kids are introduced to a substance that calms them down, it feels good to them,” she says. “Trying to engage in more productive behaviors to manage their ADHD, such as meditating or going for a walk, becomes much harder because a substance provides such a quick fix. There’s just nothing that can compete.”

And ADHD can make teenagers more vulnerable to addiction, adds Sarper Taskiran, MD, a child and adolescent psychiatrist at the Child Mind Institute. Kids with ADHD tend to experience the effects of all substances more intensely. “Their brains are hungrier for these experiences because of their wiring,” he says. Being prone to impulsivity, they may also progress to addiction faster than neurotypical teens.

The drugs of choice

Most experts agree that marijuana is the number one substance being used by teens and young adults with ADHD, with alcohol and nicotine just behind it.

Dr. Taskiran notes that kids with ADHD are not so much looking to get high as to self-medicate.

“These kids are more hyperactive, more impulsive, and their minds move at a faster pace, which is sometimes tiring for them,” he says. “They tend to gravitate to substances which decrease the pace of their thoughts. Nicotine, and in some cases cocaine, are appealing because they increase attention in the short term, while marijuana can cause mild sedation and euphoria.”

Research has also shown that kids with ADHD have a higher rate of alcohol abuse.

Additional risk factors

In addition to being predisposed to substance use because of the symptoms of ADHD itself, teenagers with the disorder have other risk factors when it comes to excessive substance use, including:

- Higher risk of a co-occurring disorder. Kids with ADHD commonly have additional mental health disorders, such as anxiety, depression and oppositional defiant disorder. Having another disorder further increases substance abuse risk, says Dr. Taskiran.
- Environmental factors. It’s common for kids with ADHD to struggle academically or with fitting in, and they may gravitate to other kids (with or without ADHD) who share these struggles. “What happens is they tend to find themselves among the risk takers in the school where substances are more available for experimentation,” says Friedman.

ADHD medications do not increase risk

There is a misconception that the stimulant medications used to treat ADHD are “gateway drugs” and can increase the likelihood of substance use, but this is not supported by the data, and in fact the opposite may be true.

A 2013 analysis of 15 long-term studies, which followed more than 2,500 children with ADHD from childhood intoadolescence and young adulthood, found that medication neither increased nor reduced the risk of substance abuse. “We found no association between the use of medication such as Ritalin and future abuse of alcohol, nicotine, marijuana and cocaine” the study’s lead author said.

But a more recent study, a 2016 analysis of Medicaid data for 150,000 young people with ADHD, found that those who took medication were 7.3% less likely to develop a substance-use disorder than their peers with ADHD who didn’t take medication. In other words, treating ADHD effectively may help protect against substance abuse.

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What parents can do

The most important thing for parents to do is to have their child evaluated — and treated — as soon as possible if they seem unusually restless, distracted and forgetful. Aside from that, parents should make sure to:

Talk to your children about substance use early

Let your child know that having ADHD makes them more vulnerable to addiction than their peers without ADHD, advises Friedman, and make sure your child understands that the best way to avoid trouble is to avoid illicit drugs altogether.

Dr. Taskiran adds that kids with ADHD struggle with planning and organization, so they tend to leave drug-related paraphernalia around more. “They can’t hide it, so their parents find out actually faster than peers who don’t have ADHD,” he says. That often gives parents an opportunity to address the topic with their child. But he urges parents not to come on too strong. “They have to take a nonjudgmental stance because having a positive relationship is even more important than trying to nip it in the bud.”

Don’t over-accommodate

Parents of kids with ADHD who are struggling may try to ease their child’s frustration by making allowances for them, says Friedman. “They’ll say, ‘Poor kid, what can we do for them? How do we rearrange things so that they’re more comfortable?’” This can backfire because it prevents kids from learning to manage their challenges. And if a teen can’t manage their challenges, they may turn to a substance to reduce their anxiety. As some experts say, notes Friedman, don’t rearrange the furniture. Teach them tools to walk around the furniture.

Maintain positive communication

Parents of children with ADHD who are struggling in school may focus so much on academic success, says Friedman, that it creates constant conflict between the parent and the child. And that conflict becomes stressful to the child, who may not have effective skills for handling uncomfortable emotions. “They can’t do conflict monitoring as efficiently as their peers, so they respond to distress with less efficient coping skills,” says Friedman. “They turn to self-medication and they turn to substances because they’re not able to self-regulate.

Friedman urges families to not only seek treatment for a child’s ADHD, but to work on maintaining a positive relationship, which can be difficult. “If they find themselves in constant conflict with their child, they also need to seek out measures to resolve that conflict, whether through family therapy or behavioral treatment strategies,” she recommends. “They need to be really mindful of their relationship with their child.”

Frequently Asked Questions

Are ADHD and addiction linked?

Do ADHD drugs cause addiction in teens?

Why are kids with ADHD more likely to abuse drugs and alcohol?

Kids with ADHD who use drugs and alcohol often aren’t looking to get high. Instead, they’re looking for a break from ADHD symptoms like racing thoughts and hyperactivity. The most common drugs used by teenagers with ADHD are marijuana, alcohol, and nicotine.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-adhd-and-substance-abuse/