Sorry it took me so long to announce a winner for the recent Giveaway for Perricone MD Eye Serum with Vitamin C Ester . The lucky winner is Wanda from California! Congratulations! The prize is already on its way! Enjoy this wonderful anti-aging product from Perricone MD!
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After Gonorrhea
In case you catch Gonorrhea, don’t worry but take the following 5 steps1. Get all of the medicine your physician set down. Do not discontinue taking the medicine just for the reason that your symptoms fade away or because you feel improved. Your medical doctor might treat you for Chlamydia if you tested positive for gonorrhea for the reason that the two diseases often infect you at the similar time. Be positive to ask about any likely side effects from your medication.
2. Inform the entire group with whom you have had sex throughout the 60 days before your symptoms appeared. If you did not have symptoms, inform all of your sex partners during the 60 days prior to you were diagnosed. Partners ought to be treated the moment possible to put a stop to them from developing problems or giving the disease back to you or to further people.
3. Do not have sex until your doctor tells you its good enough again. This includes vaginal, oral and anal sex, for the reason that the disease can infect not only the sexual organs but the throat and rectum too.
4. See your doctor right away if you have any symptoms in the upcoming.
5. Once your doctor says it’s acceptable to have sex again, help out protect yourself from STDs by:
- By means of latex condoms for oral, anal or vaginal sex. Latex condoms, when used time after time and properly, can decrease the risk of transmission of gonorrhea and Chlamydia.
- Using a female condom, a polyurethane pocket that is put into the vagina. This can moreover offer protection in case a male worn condom is not obtainable.
- Use a latex condom or latex wall for oral sex on a vagina or anus.
- Showing your love without having oral, anal, or vaginal sex.
- Reducing the number of sexual partners you have.
- Having just one sexual partner who just has sex with you.
Can You Get Gonorrhea From Drinking After Someone
No, there are very less chances or almost 0% chances of this because gonorrhea can spread only with your direct contact of the infected part of the patient.It is just about impossible for the gonorrhea bacterium to survive in oxygen. Neisseria gonorrhea is very sensitive to oxygen and exposure to air, both will kill it. In fact, the single way to transfer gonorrhea is by direct contact, typically genital contact.
Be happy, it’s not a matter of trouble.
Resistant Gonorrhea in USA
3 ciprofloxacin-resistant Neisseria gonorrhoeae isolates were acknowledged in Minnesota. All these three contaminated persons were heterosexual males. One of the infections of Gonorrhea was linked to new travel to Southeast Asia. The other two infections of resistant gonorrhea may have been obtained in the vicinity.These cases, together with newly reported increases of fluoroquinolone-resistant N. gonorrhoeae in Hawaii and California, draw attention to the ongoing need for monitoring antimicrobial vulnerability of Gonococcal isolates in Minnesota.
Because the occurrence of penicillin resistant gonorrhea in Minnesota is still comparatively low, fluoroquinolones be able to carry on to be administered for treatment of simple gonococcal infections not acquired in Asia, the Pacific Islands including Hawaii, California, or other areas with greater than before prevalence of fluoroquinolone resistance. For people who might have acquired gonorrhea disease in those areas, the present CDC recommended treatment is ceftriaxone 125 mg IM.
Healthcare providers are optimistic to regularly obtain journey histories of patients suspected to have antibiotic resistant gonorrhea along with their sex partners and to be helpful for treatment failures. Clinicians and laboratories must report alleged treatment failures, resistant strains of gonorrhea and resistant gonococcal isolates at local health care.
Healthcare providers are optimistic to regularly obtain journey histories of patients suspected to have antibiotic resistant gonorrhea along with their sex partners and to be helpful for treatment failures. Clinicians and laboratories must report alleged treatment failures, resistant strains of gonorrhea and resistant gonococcal isolates at local health care.
PLEASE Participate
Please please please participate in our discussion of how to react to the boy with the cruel pictures. Remember to first answer the question: how is this behavior adaptive for Marcus? What is it accomplishing for him- what problem does it solve? Then give your opinion about what the best treatment approach is that will help Marcus change and heal. I REALLY want the opinions of everyone who is reading this. Just click "post a comment". Thank you.
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Beauty Review: Celibre Antioxidant Serum
I’ve turned 30 this month. Applying makeup on the day of my actual birthday I noticed a line in the corner of my mouth. Well, I thought to myself, it’s kind of nice to get a first line from laughing and smiling and not from frowning... On the other hand, it’s time to step up the efforts of preventing and fighting the signs of aging. Now I have graduated into the anti-age group and can test and
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Marcus and the Scary Pictures-What Would Your Team Do?
Marcus came into residential after having been ejected from a previous residential. He is adopted, and his current adoption is actually his second as he was removed from his first home because of abuse. He is small for his age and a bit strange looking. In the month he has been here he has not made any friends, in fact the other kids seem to pick on him. Several times he has said inappropriate sexual things to female clients and to female staff, which does not increase his popularity. Generally he is the kid who is always doing what you just told him not to do, then accusing you of only talking to him when he does something wrong. Staff is finding it hard to engage with Marcus.
However recently a more upsetting issue has emerged. Tony and Jarell, two of the other boys, and Amber, one of the girls, separately came to staff to complain that Marcus has been showing them some very disturbing pictures that he drew. A search of his room in fact produced many of these pictures, which are very graphic (and skillfully drawn) renditions of men torturing naked women, complete with blood and gore. Amber said to her staff that she thinks Marcus is going to grow up to be a murderer and the staff who have seen the pictures tend to be worried about the same thing.
At first when this was discovered, staff gave Marcus a sketch book and said he could draw the pictures in there, but not show them to anyone. However yesterday his roommate Tim told staff that Marcus had been showing him his latest creation. It is one of the bloodiest yet. Lisa, Marcus’s therapist, finds that the pictures make her very uneasy and she does not know what to do to help Marcus. In fact lately she has been avoiding meeting with him. In the staff meeting the most popular suggestion is that Marcus be forbidden any access to paper and writing or drawing materials in an attempt to prevent him from making these drawings.
Do you think this is the best approach? Why or why not?
How do you understand Marcus’ behavior? In what way are these pictures adaptive for him- what positive results is he getting from drawing and sharing them?
What does Marcus need? What approach would you recommend?
What should be done to support Lisa and the staff in helping Marcus to heal?
Share your answers by clicking on "post a comment" below. I strongly encourage you to participate in this discussion. Let’s generate a robust list of possible answers. I will write more about this in my next post.
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However recently a more upsetting issue has emerged. Tony and Jarell, two of the other boys, and Amber, one of the girls, separately came to staff to complain that Marcus has been showing them some very disturbing pictures that he drew. A search of his room in fact produced many of these pictures, which are very graphic (and skillfully drawn) renditions of men torturing naked women, complete with blood and gore. Amber said to her staff that she thinks Marcus is going to grow up to be a murderer and the staff who have seen the pictures tend to be worried about the same thing.
At first when this was discovered, staff gave Marcus a sketch book and said he could draw the pictures in there, but not show them to anyone. However yesterday his roommate Tim told staff that Marcus had been showing him his latest creation. It is one of the bloodiest yet. Lisa, Marcus’s therapist, finds that the pictures make her very uneasy and she does not know what to do to help Marcus. In fact lately she has been avoiding meeting with him. In the staff meeting the most popular suggestion is that Marcus be forbidden any access to paper and writing or drawing materials in an attempt to prevent him from making these drawings.
Do you think this is the best approach? Why or why not?
How do you understand Marcus’ behavior? In what way are these pictures adaptive for him- what positive results is he getting from drawing and sharing them?
What does Marcus need? What approach would you recommend?
What should be done to support Lisa and the staff in helping Marcus to heal?
Share your answers by clicking on "post a comment" below. I strongly encourage you to participate in this discussion. Let’s generate a robust list of possible answers. I will write more about this in my next post.
Treating ADHD by Floating in Salt Water?
Can Floating in Salt Water Near Body Temperature be Used as an Effective, Natural ADHD Treatment?
One of the things I enjoy most about researching and writing this blog is that I get a chance to review the literature of some pretty zany diagnostic and treatment methods for ADHD. I often wonder what is going through the minds of some of these researchers as they concoct these seemingly eccentric modes of treatment for the disorder.
This blog has covered some of these seemingly bizarre treatments, including treating ADHD with mirrors, EEG manipulated ADHD treatment, light therapy for ADHD with seasonal affective disorders, and the effectiveness of behavioral therapy measures for ADHD, and hinted at other treatments such as vestibular stimulation for ADHD.
A recent article in Cases Journal on treating a patient with ADHD and Asperger's by flotation sessions in a tank of salt water struck me as particularly bizarre, but piqued my curiosity. However, the justifications and apparent effectiveness of these measures suggests that further investigation may be warranted. Before we all decide to take a prolonged trip to the Dead Sea, we should investigate the methods of this treatment process and check for scientific evidence behind its claims. Below is a summary of the process, and some of the major points the article's authors conjured up to validate the effects of this form of ADHD treatment.
- As the name of the journal title suggests, this was a case report on a single individual, and not a controlled clinical study. However, I have repeated given my opinion on how case studies, although statistically inferior to controlled trials, should retain a place in novel medical treatments.
- The patient was a 36 year-old woman co-diagnosed with ADHD and Asperger's (although keep in mind that many diagnostic methods forbid the co-diagnosis of ADHD with anything along the Autistic Spectrum, including Asperger's. However, many clinicians often ignore this guideline and have no problem with diagnosing a person with these two comorbid disorders).
- The study authors noted that a number of the alternative treatments which previously showed promise hinged on triggering arousal levels (mirrors, EEG, etc.). It is well documented that deficiencies within arousal levels are common in the ADHD population. Hence, a sensory stimulation via flotation in a water tank may possibly show promise as an alternative ADHD treatment.
- The flotation device is essentially a covered tank (to minimize the impact of outside sources of stimulation) containing highly concentrated salt water (to enable easier floating and buoyancy) at near-body temperature (to reduce tactile stimulation due to a temperature difference between the person's body and outside environment). Keep in mind that this water is typically only 8 inches to a foot (20 to 30 centimeters) deep, and its high salt content (much higher than the ocean) allows one to float easily without touching the bottom of the tank. This method, called flotation-Restricted Environmental Stimulation Technique or flotation-REST, has been shown to be an effective stress-reliever and relaxation method. A total of 19 flotation treatment sessions were done within the span of about a year.
- The authors found five key components (arousal control, inhibition/activity regulation, sensory integration and interpretation, cognitive abilities, and emotional abilities) of ADHD behavior to be positively affected by flotation.
- Arousal control: As mentioned previously, arousal levels have been shown to be a significant component of ADHD (and it can be either over or under-arousal). The flotation-REST method apparently addresses the arousal problem and normalizes this state by providing an environment which screens out most visual and tactile environmental stimulants.
- Activity regulation/inhibitory control of physical processes: Often a hallmark characteristic of ADHD is the difficulty with inhibition control or impulsivity with regards to physical movements, especially in younger children. Impulsively grabbing at objects or persons is a common occurrence among children with the disorder (as almost any parent of and ADHD child can attest!). The salt water/ADHD treatment case study highlights that the salt water flotation/isolation therapy may alleviate some of this behavior due to it's effect on allowing the individual to "internalize" their focus on their physical movements, which may build up more regulatory ability of motor control and enhance the ability to restrict inappropriate physical impulses.
- Sensory integration: We have previously alluded to the possible connection between ADHD and sensory integration (in the context of balance impairment and inner-ear dysfunction on ADHD) disorders. Additionally, numerous studies on fine motor skill deficiencies, such as handwriting and ADHD have been covered this blog and studied in the literature. It appears (at least in theory, according to the case study and journal article) that the flotation experience in a sensory restricted environment enhances the patient's sensory integration abilities by depriving external sensory stimuli, leaving room for the person in the salt water tank more time to focus and coordinate his or her senses.
- Improvements in cognitive abilities for ADHD patients: We have discussed cognitive abilities in ADHD (as related to pharmacological treatment strategies) in previous posts, and there are numerous studies on comorbid cognitive deficits in those with ADHD. Furthermore, some posit a cognitive energy deficiency as the underlying cause to ADHD, identified as a cognitive-energetic model of the disorder. These deficiencies are believed to be at least partially remedied or improved by the flotation in salt water treatment, mainly due to the distraction-free environment being conducive to periods of prolonged concentration and enhanced thinking without interruption. According to the article, many of these benefits continue after the individual is out of the tank even for a period of a few weeks (of which these effects then begin to taper off).
- Imrovements in personal emotional abilities: Emotional abilities, especially as they relate to inter-personal interactions and relationships can also be a common deficit in individuals with ADHD. The flotation technique is believed to improve this aspect as well, as it provides an environment of personal self-acceptance which can then be transferred to improved relationships with others and their emotions.
Thus, (in this blogger's personal opinion) this flotation REST technique may be especially good for ADHD'ers who suffer from high levels or irritability or have comorbid anxiety or depressive qualities (perhaps not those with claustrophobia or hydrophobia though!). Individuals with ADHD who have responded well to Wellbutrin or other antidepressant medications may be especially good candidates for this flotation treatment, at least in theory based on our current observations at the time.
Additionally, it is worth the re-mention that the woman of the case study had co-morbid (co-existing) Asperger's and was already on an antidepressant medication throughout the whole course of the study. This may be good news for those who suffer from co-morbid disorders, as well as the fact that this flotation REST technique seems to be relatively compatible with medication treatment. Thus supplemental treatment by flotation in salt water near body temperature may be a good adjunctive measure for individuals with ADHD and a wide spectrum of comorbid disorders.
The Persistence of Punishment
Why is it that no matter how much we know, when we are concerned about a behavior our first thought about how to change it seems to always be punishment? Is it our Puritan heritage? Our religious backgrounds that emphasize Heaven and Hell? Is it that our parents used to ground us when we did something bad? Maybe our entire culture reinforces the idea that punishment solves problems. After all, we do keep building all these jails.
If you are interested in learning more about exactly how to use both reinforcement and punishment, I recommend a book called Don't Shoot the Dog! The New Art of Teaching and Training by Karen Pryor Ringpress Books Ltd; 3rd edition (March 2002). This was recommended to us in our DBT intensive training. The author states that punishment is not as powerful as reinforcement, and must be used precisely- for example, it must happen immediately after the undesirable behavior.
Let’s go back to our own upbringings. I certainly did not like it when my parents grounded me for sneaking out to see my boyfriend. However, much MUCH more difficult was when they sat me down for a talk that began: "Young lady, your mother and I are deeply disappointed in you." In other words, it was the relationship. That they loved me, and I had let them down. That is what I really wanted to avoid.
In out programs we could be much more deliberate about relational rewards and punishments, making sure to convey both our delight and our sadness about the events that take place.
But let’s remember that no matter how well done, rewards and punishments affect motivation. They make some one want to do something more, or want to stop doing it to avoid the punishment.
But if you do not know how to do anything different, it does not matter how much you want to. You need to learn the skills.
In my training I ask participants to think of a time they have tried to do something they really wanted to do, but they were not able to. The examples have included playing tennis, rollerblading, knitting, learning a language. People readily see that more punishment for not playing tennis well would not have helped- in fact it might have made the situation worse, and/or contributed to the learner giving up. If someone wants to learn to play tennis, they need lessons from a kind and patient teacher, who will teach them the many small skills that go into the game.
In some ways our punishments render our children LESS likely to achieve better behavior. They often contribute to shame and hopelessness, thus increasing the intolerable negative emotions that currently overwhelm the child’s ability to think. They accentuate passivity- I have messed up and there is nothing I can do about it. They undermine self worth.
But if not punishments, then what? We often turn to punishment when we ourselves are feeling overwhelmed and helpless.
Increase the child’s sense of safety
Build strong relationships that the child can trust so the child can ask for help
Help the child remember that people care about him even when they are not present
Teach the skills of emotion management
Increase the child’s self worth
Help the child learn to sooth her over-active danger system
Give the child opportunities for effective action and for fixing problems
Give the child opportunities to play and have fun
Create a strong community
Help the child create a positive plan for moving forward in life- create hope
These things are harder than assigning two days of room time, but they are more meaningful and they create lasting change.
Remember- children do well if they can. And remember also- children act better when they feel better.
Please let us know your thoughts by clicking on "post a comment" below and adding a comment.
If you are interested in learning more about exactly how to use both reinforcement and punishment, I recommend a book called Don't Shoot the Dog! The New Art of Teaching and Training by Karen Pryor Ringpress Books Ltd; 3rd edition (March 2002). This was recommended to us in our DBT intensive training. The author states that punishment is not as powerful as reinforcement, and must be used precisely- for example, it must happen immediately after the undesirable behavior.
Let’s go back to our own upbringings. I certainly did not like it when my parents grounded me for sneaking out to see my boyfriend. However, much MUCH more difficult was when they sat me down for a talk that began: "Young lady, your mother and I are deeply disappointed in you." In other words, it was the relationship. That they loved me, and I had let them down. That is what I really wanted to avoid.
In out programs we could be much more deliberate about relational rewards and punishments, making sure to convey both our delight and our sadness about the events that take place.
But let’s remember that no matter how well done, rewards and punishments affect motivation. They make some one want to do something more, or want to stop doing it to avoid the punishment.
But if you do not know how to do anything different, it does not matter how much you want to. You need to learn the skills.
In my training I ask participants to think of a time they have tried to do something they really wanted to do, but they were not able to. The examples have included playing tennis, rollerblading, knitting, learning a language. People readily see that more punishment for not playing tennis well would not have helped- in fact it might have made the situation worse, and/or contributed to the learner giving up. If someone wants to learn to play tennis, they need lessons from a kind and patient teacher, who will teach them the many small skills that go into the game.
In some ways our punishments render our children LESS likely to achieve better behavior. They often contribute to shame and hopelessness, thus increasing the intolerable negative emotions that currently overwhelm the child’s ability to think. They accentuate passivity- I have messed up and there is nothing I can do about it. They undermine self worth.
But if not punishments, then what? We often turn to punishment when we ourselves are feeling overwhelmed and helpless.
Increase the child’s sense of safety
Build strong relationships that the child can trust so the child can ask for help
Help the child remember that people care about him even when they are not present
Teach the skills of emotion management
Increase the child’s self worth
Help the child learn to sooth her over-active danger system
Give the child opportunities for effective action and for fixing problems
Give the child opportunities to play and have fun
Create a strong community
Help the child create a positive plan for moving forward in life- create hope
These things are harder than assigning two days of room time, but they are more meaningful and they create lasting change.
Remember- children do well if they can. And remember also- children act better when they feel better.
Please let us know your thoughts by clicking on "post a comment" below and adding a comment.
Beauty Review: Skin MD Shielding Lotion
It’s definitely getting coooold outside. Brrrr… Is your skin also feeling the change of seasons? Of course it does! The cold air outdoors and drying air from heating indoors throw it completely out of balance and weaken its protective barrier. As a result you can have dryer and more sensitive skin in autumn and winter. That is what happens to me, unless I change my moisturizer from a light summer
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Chlamydia Gonorrhea
Chlamydia is caused by Chlamydia trachomatis (CT) and Gonorrhea is caused by Neisseria gonorrhoeae (GC), and both are sexually transmitted infections (STIs). These infections may be passed on during oral, vaginal, or anal sex; they can also be conveyed from the mother to baby during childbirth and cause considerable illness in the baby.Both organisms can communicate a disease to the urethra, oropharynx, and rectum in both women and men; the epididymis in men, and the cervix, uterus, and fallopian tubes in women. Untreated CT or GC in women may lead to PVC i.e. pelvic inflammatory disease, which can cause disfigurement of the fallopian tubes and consequence in infertility or ectopic pregnancy (tubal pregnancy). The organisms can also affect other sites; N gonorrhoeae can cause dispersed infection involving the skin, joints, and other systems.
Certain strains of CT can reason lymphogranuloma venereum (LGV). This infection is widespread in parts of Africa, India, Southeast Asia, and the Caribbean. Epidemic among men who have sex with men have been reported over the precedent several years in Europe and the United States. LGV may reason genital ulcers followed by inguinal adenopathy; it can also (as in the recent cases in MSM) cause gastrointestinal symptoms, notably anorectal release and pain.
Patients with symptoms of Gonorrhea or Chlamydia are supposed to be evaluated and treated. Although CT or GC urethritis in men typically causes symptoms, urethral infection in women and oral or rectal infections in together men and women often cause no symptoms.
In actual fact, a substantial number of individuals with GC or CT infection have no symptoms. Thus, sexually active persons at risk for GC and CT should be given regular screening for these infections as well as for syphilis and other STIs. Patients are often infected with both N gonorrhoeae and C trachomatis , so they ought to be tested and treated for both.
Top 10 Beauty Foods For Autumn
Autumn is the time for a great variety of fruit and vegetables that will provide your body with the necessary vitamins and nutrients to improve your skin from the inside for its health and beauty. Below is a list of delicious fruit and vegetables that come highly recommended!Pears contain minerals such as zinc, plus Vitamins C and E, and some B Vitamins.Leeks contain a selection of nutrients,
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Drugs, Genes and ADHD
The Effects Specific "ADHD Genes" Have on Dosing ADHD Medications:
Below is a list of five of the most common medications for ADHD. In order to break down or metabolize these drugs, however, a series of steps must take place for effective absorption, delivery and clearance of these drugs. This process, however, requires a series of enzymatic steps. Generally, when a physician prescribes these drugs, he or she considers factors such as the patient's age, gender, symptom severity and past medication history. However, lost in the shuffle is a lesser-known, but often equally critical factor: the particular genes of the individual. It is these genes which play a large role as to how well these enzymes function (alongside other factors such as the person's nutritional status, as most vitamins and minerals act as chemical "helpers" to these enzymes, and deficiencies can lead to lower enzyme function and sub-optimal metabolic efficiency).
Below is a list of five of the most common medications for ADHD. In order to break down or metabolize these drugs, however, a series of steps must take place for effective absorption, delivery and clearance of these drugs. This process, however, requires a series of enzymatic steps. Generally, when a physician prescribes these drugs, he or she considers factors such as the patient's age, gender, symptom severity and past medication history. However, lost in the shuffle is a lesser-known, but often equally critical factor: the particular genes of the individual. It is these genes which play a large role as to how well these enzymes function (alongside other factors such as the person's nutritional status, as most vitamins and minerals act as chemical "helpers" to these enzymes, and deficiencies can lead to lower enzyme function and sub-optimal metabolic efficiency).
Unfortunately for prescribing physicians, the landscape of enzyme capabilities among the general population is far from uniform. Some individuals naturally possess enzymes or enzyme systems (which are coded for and dependent on the genetic makeup of the particular individual)which are more efficient than others (often by multi fold differences). If these enzymes are essential to drug metabolism (including ADHD medications), then a potentially crucial piece of information may be missing from the physician's repertoire of assessment tools for medicating at the proper dosage.
Much to the dismay of many a frustrated parent of an ADHD child, this often begins the laborious process of adjusting medication dosages through a glorified "guess and check" process. However, due to the need for a relatively small window of effective dosing (especially for psychotropic drugs such as those prescribed for ADHD and related disorders) and unforgiving margins of error in the optimization process, bits of information, such as a child's genetically-dictated levels of drug-metabolizing enzymes could be extremely useful. With the increasing efficiency, lowering costs of and wider availability of genetic screening methods, we may soon be able to predict a child's enzyme levels by their genetic makeup and facilitate the dosing of (and eliminating much of the guess-work from) their medications for ADHD or other disorders, saving both time and money while on the medication circuit.
Given the powerful role of enzymes and enzyme systems (and the specific genes which encode for them) for the delivery, metabolism and clearance of these medications, we should take a look at some of the genetic variations of these enzymes and the implications they may having in assisting the diagnosing physician in the near future for more effectively dosing ADHD medications.
Here are 5 common ADHD drugs (including one which is not prescribed but often used as a "self-medication" tool among the ADHD population), and the genetically-dictated enzymes which can play a role in their metabolism and dosing patterns and levels.
ADHD Drug #1: Strattera (Atomoxetine)
Key enzymes involved and gene of interest: SLC6A2, CYP2D6
ADHD Drug #1: Strattera (Atomoxetine)
Key enzymes involved and gene of interest: SLC6A2, CYP2D6
We have already investigated another gene believed to have an impact on dosing with Strattera, the SLC6A2 gene. However, in that earlier post, we alluded to another gene responsible for the metabolism of the non-stimulant ADHD drug Atomoxetine. This gene is called CYP2D6. The CYP2D6 gene codes for an important enzyme of the same name (which is an important enzyme produced in the liver). The gene is located on the 22nd human chromosome (the 22q13.1 genetic region to be more specific if you are familiar with genetic markers).
Approximately a dozen different genetic forms (or alleles) of this CYP2D6 gene are seen in individuals of European ancestry. These forms are often designated by a star followed by a number, such as *1 or *4. While these numbers are used for naming purposes, it is worth noting that most individuals of European descent appear to carry either the *1 (the most common), the *2 or the *4 form of this gene. Additionally, *3, *6, and *10 forms are each found in about 1-2 percent of the population.
Interestingly, the *10 form of this gene is found in higher levels in individuals of East-Asian descent. A Chinese study found that a higher frequency of this *10 form in the population (the *10 form shows up in over half of the Chinese population, about 10 times more frequently than in whites), resulted in slower rate of drug metabolism of the ADHD medication Strattera (Atomoxetine) by the CYP2D6 enzyme.
Relevance of the CYP2D6 gene to medicating ADHD with Strattera: The *10 form of the CYP2D6 produces less enzymatic activity than the most common *1 form. This can result in about a 50% increase in Atomoxetine concentration in the blood and duration before clearance, which was seen in the Chinese study. As a result, for individuals with the exclusive *10 form (such as seen in much of the East Asian population), slightly lower or less frequent dosing levels of atomoxetine might be needed to get the same therapeutic effects. This is in agreement with another study suggesting a 50 to 75% dosage reduction of Atomoxetine for those with hepatic impairment (liver dysfunction), as the CYP2D6 enzyme is produced in the liver.
Additionally, this population may be at a slightly greater risk of side effects with the drug due to a slower clearance and greater buildup of the drug. Of course other genes and additional factors in the Atomoxetine pathway certainly play a role, but these genetic variations can still play a significant role in medication dosing strategies.
ADHD drug #2: Adderall (Mixed amphetamine salts)
Approximately a dozen different genetic forms (or alleles) of this CYP2D6 gene are seen in individuals of European ancestry. These forms are often designated by a star followed by a number, such as *1 or *4. While these numbers are used for naming purposes, it is worth noting that most individuals of European descent appear to carry either the *1 (the most common), the *2 or the *4 form of this gene. Additionally, *3, *6, and *10 forms are each found in about 1-2 percent of the population.
Interestingly, the *10 form of this gene is found in higher levels in individuals of East-Asian descent. A Chinese study found that a higher frequency of this *10 form in the population (the *10 form shows up in over half of the Chinese population, about 10 times more frequently than in whites), resulted in slower rate of drug metabolism of the ADHD medication Strattera (Atomoxetine) by the CYP2D6 enzyme.
Relevance of the CYP2D6 gene to medicating ADHD with Strattera: The *10 form of the CYP2D6 produces less enzymatic activity than the most common *1 form. This can result in about a 50% increase in Atomoxetine concentration in the blood and duration before clearance, which was seen in the Chinese study. As a result, for individuals with the exclusive *10 form (such as seen in much of the East Asian population), slightly lower or less frequent dosing levels of atomoxetine might be needed to get the same therapeutic effects. This is in agreement with another study suggesting a 50 to 75% dosage reduction of Atomoxetine for those with hepatic impairment (liver dysfunction), as the CYP2D6 enzyme is produced in the liver.
Additionally, this population may be at a slightly greater risk of side effects with the drug due to a slower clearance and greater buildup of the drug. Of course other genes and additional factors in the Atomoxetine pathway certainly play a role, but these genetic variations can still play a significant role in medication dosing strategies.
ADHD drug #2: Adderall (Mixed amphetamine salts)
Genes of interest: Catechol O-Methyltransferase (COMT) gene, Dopamine Transporter Gene (DAT)
In previous posts, we have spoken extensively about a gene called COMT, short for Catechol O-Methyltransferase and its role on dosing for amphetamine-related ADHD medications such as Adderall and Vyvanse. This previous discsussion on COMT and ADHD medication dosing can be found here.
However, there are a few other genes worth noting here for their potential roles in dosing with amphetamine-based ADHD medications such as Adderall. One of these is the Dopamine Transporter gene (DAT), which is located on the 5th human chromosome. This gene also goes by other names such as DAT1 or SLC6A3. The DAT gene codes for an important protein called the Dopamine Transporter protein, which is responsible for shuttling the important brain chemical dopamine in and out of neuronal cells.
A number of stimulant drugs used to treat ADHD and related disorders work, at least in part, by interacting with this dopamine transporter (DAT) to correct a dopamine imbalance (in general, individuals with ADHD often have too little dopamine in the regions between brain cells or neurons in key regions of the brain. Many stimulant ADHD drugs remedy this by blocking the shuttling of dopamine back into the cells, keeping adequate amounts in these "gaps").
Interestingly, on a side note, the DAT gene has been implicated (in conjunction with another dopamine-related gene called DRD4) in IQ levels an behavior problems.
Like the genes mentioned above, DAT exists in a wide number of different forms across the human gene pool. Some forms appear to increase ones predisposition to ADHD and various neurophysiological or behavioral disorders and have earned the moniker "high risk alleles" (remember, an "allele" is simply a specific form of a gene which varies within the population).
A study on families of ADHD children found that a specific form of the DAT gene which included a 480 base pair repeat (simply a repeating section of DNA which is 480 DNA "letters" long) allele was associated with greater severity of ADHD symptoms, especially in the combined ADHD subtype (which includes high levels of both inattentive and hyperactive/impulsive symptoms as opposed to a predominance of one).
Potentially, individuals with ADHD who carry this "high-risk allele" of the DAT gene (which is a substantial portion of the general population) may require slightly higher levels of medication dosage with amphetamine-based stimulants than their "lower-risk" counterparts. These differences may be even more pronounced if the individual carries the "Val" form of the COMT gene, mentioned in a previous post (given the current body of research on the subject, the contributions of the COMT gene dwarf those of the DAT gene with regards to governing amphetamine dosage levels).
ADHD drug #3 Vyvanse (lisdexamfetamine dimesylate)
Gene of Interest: TrypsinogenDue to its chemical proximity to amphetamines (Vyvanse is essentially an "inactivated" form of the drug Dexedrine, which is an isolation of one of the potent components of Adderall). A special chemical "tag" is linked to the active part of the drug, which must be chemically cleaved to release the active form of Vyvanse (think of it as essentially breaking a seal to free up the drug) into its functional amphetamine-based product. Naturally, the genes listed above (and the enzymes which they encode) which metabolize amphetamines are of substantial interest for potentially influencing the effectiveness of ADHD treatment with Vyvanse as well.
However, the actual cleaving process of releasing the active component of Vyvanse is equally as important. If the drug is not freed, then it cannot be effectively metabolized.
Several enzymes which are called upon to metabolize the other ADHD drugs in this post do NOT appear to have a significant effect on Vyvanse. These include CYP2A6, CYP2B6 (both for nicotine), and CYP2D6 (for Strattera). This is good news for those who are already taking medications, as Vyvanse's relative independence of these drug-metabolizing enzymes means fewer adverse drug-drug interactions.
As far as genetics go, the genes coding for the breakage of de-activating chemical tag placed on Vyvanse may be of most importance, especially since this breakage (or "hydrolysis") is believed to be the slowest (or rate-determining) step in metabolizing Vyvanse for ADHD. The de-activating "tag" attached to Vyvanse is none other than the amino acid lysine. While the exact mechanism of cleaving this link is not fully known, one enzyme in particular may be extremely relevant to this process.
Trypsin is an extremely common digestive enzyme produced predominantly in the pancreas. It is responsible for breaking up chemical linkages much like that of the one used to de-activate Vyvanse. Thus, a genetically-governed deficiency of the trypsin enzyme could lead to a severely hampered absorption (and subsequent metabolism and clearance of the ADHD drug Vyvanse).
Trypsin is actually coded for by a series of enzymes, often referred to as Trypsinogen, which located on the 7th human chromosome (in the "q35" region of the chromosome to be more exact). Individuals with pancreatic deficiencies, including pancreatitis have been tied down to having mutations in this trypsinogen gene.
Therefore, while this genetic region on the 7th chromosome hasn't been sufficiently studied with regards to Vyvanse (at least to the best of this blogger's current knowledge), this blogger personally believes that aberrations in the region of the Trypsinogen gene on this 7th human chromosome may be a worthwhile place to look for genetic response-based differences to the ADHD medication Vyvanse.
ADHD drug #4: Concerta/Ritalin/Daytrana/Biphentin (methylphenidate)
Genes of Interest: Carboxylesterase 1 (also referred to as "CES1"), DAT (refer to ADHD drug #2: Adderall section for DAT's genetic location)Carboxylesterase 1: Although the affected form of this enzyme, which is coded for by a gene on the 16th chromosome, is relatively rare, some key studies have indicated that deficiencies in the CES1 enzyme can be coded from specific forms of this gene. These rare, low-functioning gene-mutation forms of Carboxylesterase 1 result in extremely poor methylphenidate metabolism, resulting in a buildup of abnormally high levels of the drug in individuals with this enzymatically-deficient form.
In addition to their effects on amphetamines such as Adderall or Dexedrine, variations (often referred to in the literature as "polymorphisms") in the DAT gene also play a role in the response to methylphenidate. A Korean study found that a specific allele (the 10-repeat allele, which is the same form as the "high-risk" 480 base-pair allele mentioned earlier in the amphetamines section) predicted a poor response to methylphenidate.
Interestingly, however, several Irish studies suggest the exact opposite: the "high-risk" 10-repeat 480 base pair form of the DAT gene may produce larger amounts of the DAT protein (which shuttles essential dopamine out of the gaps between the cells, the opposite effect of what one wants if they suffer from ADHD), so the higher levels of expression of this transporter may make it a better candidate for methylphenidate.
Another Irish study may help resolve some of this discrepancy. It found that individuals with the so-called "high-risk" form of the DAT gene mentioned above exhibit a more positive response to treatment with methylphenidate with regards to treating their attentional symptoms based on the left side of the brain. Left sided inattention can be a reflection of brain damage or brain asymmetry, the latter being a common trait in the ADHD population. It should be worth noting that methylphenidate has been an effective treatment method for improving cognitive processes for those suffering from traumatic brain injuries.
Given the fact that in the amphetamine section we mentioned that the DAT gene was more connected to the Combined ADHD subtype (the original article specifically stated that the association did not hold for the strictly inattentive ADHD subtype). If this holds true, then we may have discovered a potentially significant gene/medication/ADHD subtype association.
It is this blogger's current hypothesis that the "high-risk"/480 base pair/10-repeat allele form of the DAT gene might predispose one to a MORE FAVORABLE response to methylphenidate treatment if inattention is the most persistent ADHD symptom (as in the predominantly inattentive ADHD subtype). Conversely, if the hyperactive/impulsive behavior either predominates or is largely present in an individual (such as in the hyperactive/impulsive or combined ADHD subtypes, respectively), then the "high-risk" label holds for this particular gene type, and the methylphenidate response potential goes down.
In other words, if large amounts of hyperactivity are present (which is the case in most ADHD children, as the combined subtype is by far the most common form), then this "high-risk" form of the DAT gene hampers methylphenidate's effectiveness, whereas if hyperactivity is largely absent, then the response to methylphenidate is actually more favorable. If this hypothesis were to hold true, then we could screen youngsters for this form of the gene and keep them far away from methylphenidate if they were bouncing off the walls, whereas if the exhibited more of an inattentive "space cadet" type of behavior then methylphenidate might be a good first choice of pharmaceutical treatment. Of course this theory could be completely off-base, but given this blogger's current knowledge and exposure to the current literature, this may be a plausible explanation.
Another possible explanation for this discrepancy between Irish and Korean studies: We have already seen that specific forms of certain genes can be found at considerably higher levels such as the *10 form of the CYP2D6 gene mentioned above with regards to the East Asian population. Keep in mind that this gene form was associated with the metabolism of Strattera (which exhibits a significantly different mode of operation than do stimulants such as methylphenidate or mixed amphetamine salts). However, there are a number of so-called ADHD genes which have been implicated with the disorder. The current thought here is that some genes exhibit a more powerful influence on physical or behavioral traits than do others. In other words, some genes simply act more "powerfully" than others. This is known as epistasis ("Epistasis" roughly means "standing upon").
***As a side note, please don't confuse "epistasis" with the whole dominant/recessive "big A/little a" (Aa) gene thing you probably learned about in middle school biology. Dominant/recessive refers to different forms of the SAME gene, whereas epistasis refers to DIFFERENT genes. For example, let's say, hypothetically that there was a rare gene for green hair located on the 20th human chromosome. However, a more "powerful" gene, say on the 14th chromosome codes for brown hair. This brown hair gene in this case would be epistatic, meaning that it would overpower the effects of the green hair gene altogether. This phenomena is quite common in genetics.
Getting back to our discussion, this blogger hypothesizes that there may be one or more other unidentified genes in either the Korean or Irish population which are epistatic to the DAT gene with regards to the methylphenidate response. If this was true, then it's quite possible that the effects of these hypothetical yet-to-be-identified genes might "mask" or override the effects of the DAT gene, and that the association with the "high-risk allele" may be largely coincidental rather than causative. Given the state of the current research on current "heavyweight" genes such as the COMT gene mentioned earlier, it is entirely possible that the overall level of contribution among specific "high-risk" DAT alleles might be less significant than many of these studies seem to indicate.
Of course the discrepancy could just as easily be attributed to small sampling sizes, slight differences in experimental methods or uncontrolled variables in the experiment (or a complete lack of true association between methylphenidate and the DAT gene at all, although given the current body of literature, this last assertion seems highly unlikely).
ADHD drug #5: Nicotine:
ADHD drug #5: Nicotine:
Genes of interest: CYP2A6, CYP2B6
I have included this drug due to the high rates of smoking among those with ADHD. As with alcohol, nicotine is often widely used as a form of self-medication for those with ADHD. Some research even suggests that individuals with ADHD exhibit a different response to nicotine and that nicotine withdrawal may produce different patterns in certain critical brain regions between ADHD'ers and the general population. Interestingly, there are some genetic regions which may tie into this behavior.
With regards to nicotine metabolism, 2 genes appear to stand out in particular: CYP2A6 and CYP2B6 (note the similarity in nomenclature between these and the gene/enzyme mentioned above for Strattera metabolism CYP2D6. This is not an accident, as all three of these belong to the same "superfamily" of enzymes and carry many similar chemical and functional similarities). Out of these, the CYP2A6 (hereafter abbreviated as "2A6") enzyme is responsible for the lion's share of nicotine metabolism. It is coded for by by a gene of the same name, located in the "q13.2" region on the 19th human chromosome.
Like the 2D6 gene for Strattera, the 2A6 gene can exist in multiple different forms. Some 2A6 gene forms produce higher levels of the 2A6 enzyme than others. Other forms of 2A6 are less efficient, which results in a slower breakdown and clearance of nicotine. As a result, the nicotine stays in the body longer, and less of it is typically required. As a result individuals with these less efficient forms (called "slow metabolizers") of the 2A6 genes are less likely to develop nicotine addictions.
The relevance of these 2A6 genes on ADHD: The stimulating effects of nicotine are believed to be a major contributing factor to the higher prevalence of smoking among the ADHD population. If this is true, then slow metabolizers of nicotine may not derive the full effect of nicotine self-medication for attentional deficits, at least not as immediately as the fast metabolizers. On the flipside, they have lower cravings (like with virtually all stimulant drugs, the speed and rate of uptake and clearance of nicotine is a major factor in its addiction potential) and are exposed to less tobacco and often find it easier to quit smoking.
At least two alleles or forms of the 2A6 gene (using the "star/number" nomencalture us used in 2D6 for Strattera earlier in this blog), have been shown to coincide with slower rates of nicotine metabolism. They are 2A6*2 and 2A6*4 (these two forms are actually referred to as "null alleles" meaning that the 2A6 enzyme they code for has no activity).
Additionally, there are noticeable differences in the frequencies of these forms across different ethnicities among the global population. For example, these "slow metabolizing" gene/enzyme forms of are found in higher percentages in individuals of Asian ancestry (around 20%) compared to those of European descent (around 8%).
With regards to ADHD behavior, it is likely that people possessing these *2 or *4 forms of the CYP2A6 gene, may be less likely to use nicotine as a self-medication tool for their ADHD, or at least use the drug in lower doses, due to its lesser effects. On the flipside, however, there is another allele of the 2A6 gene, referred to as CYP2A6*1B. This version of the 2A6 nicotine metabolism gene actually promotes greater activity of the nicotine metabolizing enzyme, and speeds up the processing and clearance of the drug. As a result, individuals who possess this relatively rare CYP2A6 form may be more prone to more frequent use and abuse of nicotine, and individuals with ADHD who attempt to self-medicate with this drug may cycle through their nicotine more rapidly if they carry this *1B form of the gene.
Interestingly, another drug, bupropion (Wellbutrin), which is an anti-depressant often used off-label to treat more "depressive" forms of ADHD is a relatively common anti-smoking drug. Given the fact that a number of ADHD'ers who typically do not respond well to stimulants, but do respond to Wellbutrin may fall in this smoking category, it is possible that the fast metabolizers (i.e. the *1B individuals), may be good candidates for Wellbutrin, not only to stop smoking, but possibly also to treat unwanted ADHD symptoms.
Alleles of the CYP2B6 gene and enzyme with regards to nicotine and ADHD:
Shifting gears for a minute, we see that the CYP2B6 gene (as well as the enzyme which it encodes) also may also play a unique role in ADHD. The CYP2B6 gene is located on the 19th human chromosome (in the 13.2 region of the 19th, to be more specific). For individuals who lack CYP2A6 enzyme activity because of the reduced-activity or even "null" alleles, the enzyme CYP2B6 can metabolize nicotine in its place (it turns out that CYP2D6, the enzyme responsible for Strattera metabolism can also do the trick). For those who need to metabolize nicotine, but lack an effective CYP2A6 enzyme system, this is good news (however, this "B6" enzyme only functions at about 10% of the level of the "A6" enzyme, so B6 is not a very efficient "backup" for A6).
Beyond its role as a "backup" for the CYP2A6 enzyme, CYP2B6 may also be of clinical significance with regards to ADHD and similar disorders. In contrast to "A6", whose enzymes are predominantly generated in the liver, the CYP2B6 generated enzymes are expressed in brain tissue. With regards to the differences in neurochemistry and neurological functioning of the ADHD brain, the role of CYP2B6 is therefore potentially noteworthy.
Additionally, as we have discussed in earlier posts regarding ADHD and alcoholism, the 2B6 enzyme apparently also plays a role in alcoholism, and individuals who express higher levels of this genetically-encoded CYP2B6 enzyme in their brains may be more sensitive to alcohol, nicotine and other centrally acting drugs. The study even suggests that individuals with high levels of this gene-coded enzyme may be more prone to damages induced from these common chemical agents, including possible higher susceptibility to cancer.
For reference (using the "star" notation again), genetic forms of CYP2B6 which typically yield higher levels of this enzyme in the brain include the CYP2B6*4 (which shows up in about a third of the European popluation) form and the CYP2B6*9 (which is present in about a quarter of those of European descent) form. Again, don't worry too much about the specifics of these "starred" variants, just know that if you were to get a genetic screen and had one of these two enzymatic forms, you may be more sensitive to nicotine as a self-treatment ADHD "medication".
What this means is that ADHD individuals who harbor the higher-expressing "*4" and "*9" forms of the CYP2B6 enzyme in their brains may be more sensitive to chemical agents such as nicotine, and these same individuals may be more likely to suffer the toxic effects of this popular form of ADHD "self-medication".
In conclusion, we should note that some of these genes (such as DAT) have been well-studied and have repeatedly shown to be associated factor in proper dosing of ADHD medications. Others, however, such as the trypsinogen gene for Vyvanse are more at the theoretical level at the moment. However, this blogger believes that in the next couple of decades, (due in part to our expanding knowledge of the human genetic code and functional genomics), genetic screens will become foutinely more commonplace as a necessary tool for both prescribing and dosing medications. With regards to this general trend, psychotropic medications for disorders such as ADHD should be no exception.
Exercise about Taking Responsibility
I developed this training exercise to teach people how shame interferes with taking responsibility, and how a simple conversation between a Callie care worker and a client can go wrong.
I will ask for two volunteers, one reads part of Latasha, one of Callie
Latasha- Staff
Callie- Child
VERSION ONE:
Callie is sitting playing electronic game, Latasha walks into room
Latasha: Thoughts: Oh, there is Callie. I heard she had a hard time in school today; I’d better talk to her to see what happened.
Callie: Thoughts: Oh, here comes Latasha. I know she heard I screwed up AGAIN in school today. I know she’s mad at me. I hope she doesn’t see me. I’d better hide.
Latasha: Thoughts: I am really getting discouraged, Callie doesn’t seem to be changing, I wonder what I am doing wrong.
Says: Hi Callie. Let’s talk about what happened in school today. Can you tell me what went on?
Callie: Thoughts: I knew it, she hates me now, I never should have started to like her, I bet they are getting ready to kick me out; nothing is ever going to work out in my life.
Says: It’s those stupid teachers. They are no good. I want to get out of this dumb place and go to a place with a real school.
Latasha: Thoughts: This kid will never take responsibility for her own actions. If she never learns to accept what she has done she is going to end up in jail. We have to make her understand that her actions are her own choice. Maybe she is right, maybe she doesn’t belong here. We do not seem to know what to do to help her.
Says: But Callie you must have done something to get yourself into a fight. It can’t be all the teacher’s fault.
Callie: Thoughts: See I knew it she blames me for the whole thing. And she is right I will never be smart enough to learn math, I am such a loser, and when Kristi made fun of me I just could not stand it. And now (name) hates me too I have to get out of this place!!!
Says: I hate all you f...ing people and if you get any nearer to me I am going to hit you so leave me alone!!!!
Latasha: Thoughts: She is really just impossible I cannot have a simple conversation with her. She really has to learn that she cannot talk to me that way.
Says: That’s threatening. You have to go to your room now if you are going to be so disrespectful.
VERSION TWO:
Callie is sitting playing electronic game, Latasha walks into room
Latasha: Thoughts: Oh, there is Callie. I heard she had a hard time in school today; I’d better talk to her to see what happened.
Callie: Thoughts: Oh, here comes Latasha. I know she heard I screwed up AGAIN in school today. I know she’s mad at me. I hope she doesn’t see me. I’d better hide.
Latasha: Thoughts: I know Callie has so much trouble in school, especially in math. We have been working on how to ask for help when she is confused but it is so hard for her. And I know that Kristi, the girl she had a fight with, can be so mean and pick on people’s weaknesses.
Says: Hi Callie. How are you? I heard that this weekend you made that beautiful bulletin board over there, it really adds color to the unit.
Callie: Thoughts: I know she is going to talk about school and she is mad at me, but at least she noticed the bulletin board I made. Might as well get it over with.
Says: Yeah but today really sucked.
Latasha: Thoughts: I’m glad she brought up what happened. I know this kind of discussion is really hard for her because she always feels so hopeless.
Says: Yeah, I heard you had a problem with Kristi in math, that staying calm thing and asking for help thing didn’t work out as well as we hoped today, but I also heard you calmed down and did well in art afterwards.
Callie: Thoughts: Well, maybe she doesn’t hate me, but I know I screwed up big time. I wonder if they are going to kick me out of here now? I never should have trusted these people.
Says: So I suppose I’m kicked out now right and that is fine with me because I hate this f..ing place anyway and this is a stupid school that doesn’t know how to teach kids.
Latasha: Thoughts: Is that what she has been afraid of all day? It’s even more amazing she was able to calm down. Maybe she is making progress.
Says: Oh no Callie, we are not kicking you out! Far from it! We see the progress you are making. You and I just have to figure out what went wrong today and how we can come up with some better ideas for next time.
Callie: Thoughts: That’s surprising. Well, I would like to know how to keep that Kristi from aggravating me so much- I know she was glad she got me going.
Says: Well, you can start by getting rid of Kristi.
NOTE: The difference between the two versions is not just that the Latasha mentions some positives. It is that the Latasha is operating from a THEORY, and her understanding of the meaning behind Callie’s action’s enables her to approach this event differently.
As usual I am interested in your ideas and reactions. Just click "comments".
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I will ask for two volunteers, one reads part of Latasha, one of Callie
Latasha- Staff
Callie- Child
VERSION ONE:
Callie is sitting playing electronic game, Latasha walks into room
Latasha: Thoughts: Oh, there is Callie. I heard she had a hard time in school today; I’d better talk to her to see what happened.
Callie: Thoughts: Oh, here comes Latasha. I know she heard I screwed up AGAIN in school today. I know she’s mad at me. I hope she doesn’t see me. I’d better hide.
Latasha: Thoughts: I am really getting discouraged, Callie doesn’t seem to be changing, I wonder what I am doing wrong.
Says: Hi Callie. Let’s talk about what happened in school today. Can you tell me what went on?
Callie: Thoughts: I knew it, she hates me now, I never should have started to like her, I bet they are getting ready to kick me out; nothing is ever going to work out in my life.
Says: It’s those stupid teachers. They are no good. I want to get out of this dumb place and go to a place with a real school.
Latasha: Thoughts: This kid will never take responsibility for her own actions. If she never learns to accept what she has done she is going to end up in jail. We have to make her understand that her actions are her own choice. Maybe she is right, maybe she doesn’t belong here. We do not seem to know what to do to help her.
Says: But Callie you must have done something to get yourself into a fight. It can’t be all the teacher’s fault.
Callie: Thoughts: See I knew it she blames me for the whole thing. And she is right I will never be smart enough to learn math, I am such a loser, and when Kristi made fun of me I just could not stand it. And now (name) hates me too I have to get out of this place!!!
Says: I hate all you f...ing people and if you get any nearer to me I am going to hit you so leave me alone!!!!
Latasha: Thoughts: She is really just impossible I cannot have a simple conversation with her. She really has to learn that she cannot talk to me that way.
Says: That’s threatening. You have to go to your room now if you are going to be so disrespectful.
VERSION TWO:
Callie is sitting playing electronic game, Latasha walks into room
Latasha: Thoughts: Oh, there is Callie. I heard she had a hard time in school today; I’d better talk to her to see what happened.
Callie: Thoughts: Oh, here comes Latasha. I know she heard I screwed up AGAIN in school today. I know she’s mad at me. I hope she doesn’t see me. I’d better hide.
Latasha: Thoughts: I know Callie has so much trouble in school, especially in math. We have been working on how to ask for help when she is confused but it is so hard for her. And I know that Kristi, the girl she had a fight with, can be so mean and pick on people’s weaknesses.
Says: Hi Callie. How are you? I heard that this weekend you made that beautiful bulletin board over there, it really adds color to the unit.
Callie: Thoughts: I know she is going to talk about school and she is mad at me, but at least she noticed the bulletin board I made. Might as well get it over with.
Says: Yeah but today really sucked.
Latasha: Thoughts: I’m glad she brought up what happened. I know this kind of discussion is really hard for her because she always feels so hopeless.
Says: Yeah, I heard you had a problem with Kristi in math, that staying calm thing and asking for help thing didn’t work out as well as we hoped today, but I also heard you calmed down and did well in art afterwards.
Callie: Thoughts: Well, maybe she doesn’t hate me, but I know I screwed up big time. I wonder if they are going to kick me out of here now? I never should have trusted these people.
Says: So I suppose I’m kicked out now right and that is fine with me because I hate this f..ing place anyway and this is a stupid school that doesn’t know how to teach kids.
Latasha: Thoughts: Is that what she has been afraid of all day? It’s even more amazing she was able to calm down. Maybe she is making progress.
Says: Oh no Callie, we are not kicking you out! Far from it! We see the progress you are making. You and I just have to figure out what went wrong today and how we can come up with some better ideas for next time.
Callie: Thoughts: That’s surprising. Well, I would like to know how to keep that Kristi from aggravating me so much- I know she was glad she got me going.
Says: Well, you can start by getting rid of Kristi.
NOTE: The difference between the two versions is not just that the Latasha mentions some positives. It is that the Latasha is operating from a THEORY, and her understanding of the meaning behind Callie’s action’s enables her to approach this event differently.
As usual I am interested in your ideas and reactions. Just click "comments".
Beauty Shopping: Clarins Advanced Extra-Firming Neck Cream
Want to share my joy about a new beauty investment! You know what they say, dรฉcolletรฉ area is often ignored by women in their skin care routine and that's why it is often the first to show age. I did take care of my neck and chest but nevertheless there are some lines. So frustrating! That's why I need to make an extra effort and am always on the look out for an effective anti-aging product for
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Top 5 Beauty Vitamins and Minerals
I will repeat what I have said so many times before: beauty comes not only from the bottoms of expensive cream jars but from the bottoms of our dinner plates as well, i.e. from a healthy balanced diet rich in vitamins and minerals. So here is Top 5 Beauty Vitamins and Minerals you may want to look out for to include into your diet to have healthy and young looking skin as long as possible. Some
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Visit to CA LO
This past week I visited a remarkable place. It is called the Change Academy, Lake of the Ozarks, (http://caloteens.com/) and is in Missouri. CA LO is a residential treatment school formed on attachment principles. It was born two years ago from the dreams and convictions of its founder, Ken Huey, and its Clinical Director Landon Kirk. Both were working in more traditional treatment settings and felt that while good work was going on, the treatment methods did not fit their understanding of attachment and healing. So they determined to open an attachment based treatment center located in the middle of the country.
CA LO treats approximately thirty five teenagers, divided evenly between boys and girls. The youth come from all areas of the country, even Alaska. CA LO employs many creative ways to engage the families in treatment. CA LO does not use levels, points, or traditional rewards and punishments. Instead, they have developed a treatment model that describes the tasks the children must complete in order to have a life worth living, and they train staff in the empathetic responses necessary to help the children grow through these tasks. When a student does something particularly harmful, he or she is assigned a chore done with a staff, which provides reconnection with an adult and making amends to the community.
A unique feature of CA LO is their canine program. They have around 25 Golden Retriever dogs, from puppies through adults. The dogs are assigned to individual children ho provide all their care. The dogs go every where with the kids, except to meals- to school, to recreation, one free time. Youths can complete an entire process including references, a home study, etc and be approved to adopt a dog. Then they take that dog home with them when they leave! Many places have some form of pet therapy, but this is the first time I have ever seen pets so thoroughly integrated into a treatment process. The learning and love the children gain from this process is obvious.
CA LO treats approximately thirty five teenagers, divided evenly between boys and girls. The youth come from all areas of the country, even Alaska. CA LO employs many creative ways to engage the families in treatment. CA LO does not use levels, points, or traditional rewards and punishments. Instead, they have developed a treatment model that describes the tasks the children must complete in order to have a life worth living, and they train staff in the empathetic responses necessary to help the children grow through these tasks. When a student does something particularly harmful, he or she is assigned a chore done with a staff, which provides reconnection with an adult and making amends to the community.
A unique feature of CA LO is their canine program. They have around 25 Golden Retriever dogs, from puppies through adults. The dogs are assigned to individual children ho provide all their care. The dogs go every where with the kids, except to meals- to school, to recreation, one free time. Youths can complete an entire process including references, a home study, etc and be approved to adopt a dog. Then they take that dog home with them when they leave! Many places have some form of pet therapy, but this is the first time I have ever seen pets so thoroughly integrated into a treatment process. The learning and love the children gain from this process is obvious.
CA LO’s model has four components: Trust of Care, Trust of Control, Trust of Self, and Interdependence. Trust of Care teaches children that that the caregivers around them will take care of their physical needs. Food, shelter, health, wellness, and hygiene will be provided by trusted adults. Trust of Control involves believing that the adults in your life can be trusted to help and guide you. Youth who are successfully humble and vulnerable enough to accept Trust of Control allow the adults and peers in their life to teach them life lessons. When youth accept Trust of Control it provides opportunity for adults and peers to provide emotional dysregulation, coaching, guidance, and physical and emotional closeness. Trust of Self occurs when a youth moves towards independently practicing and implementing what has been modeled and taught. In Trust of Self the youth moves from doing the right thing because s/he is "supposed to" or because it has worked a few times in the past, to an inner change and commitment to live life differently. Interdependence is the ultimate goal for a youth, which means learning to live life with interdependence or the ability to maintain healthy, reciprocal relationships. Interdependence defines a successful student transition from a false and selfish independence, to experiencing the value and joy of interdependence and mutual relationships. Clearly, interdependence is neither independence nor dependence but is connected living. It is a person understanding that his/her actions affect others. Instead of just taking, the youth is now also giving. (The previous paragraph was adapted from the CA LO web site.) The youth do not move up and down between these tasks such as phases. It is understood that we all have to move around and re-work parts of each over and over again.
CA LO also includes a school with many imaginative programs, and a Therapeutic Recreation department that utilizes an indoor ropes course as well as many waterfront activities. The staff at CA LO is warm and caring. They have their struggles like everyone else. However, it is very exciting to see a program that is founded on the principles I believe in.
I particularly recommend their blog, which can be found at: http://caloteens.com/blog/
CA LO also includes a school with many imaginative programs, and a Therapeutic Recreation department that utilizes an indoor ropes course as well as many waterfront activities. The staff at CA LO is warm and caring. They have their struggles like everyone else. However, it is very exciting to see a program that is founded on the principles I believe in.
I particularly recommend their blog, which can be found at: http://caloteens.com/blog/
Beauty Talk: What You Can Do For Your Skin in Autumn
With October upon us sunny days are becoming a thing of the past and colder gloomier weeks are waiting ahead. But don’t be sad. No more sun means good for your skin! And autumn is a good time to pay some special attention to it. First of all your skin needs some help to recover from the sunny summer months. Not only did it get a dose of aging UV rays, hot sunny weather may also have caused some
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Gonorrhea in Canada
Gonorrhea is a bacterial sexually transmitted infection (STI) that affects equally men and women. Gonorrhea accustomed to be called "the clap", and it is easily treatable, frequently with a sole dose of antibiotics. Some 32 strains of the bacteria have turn out to be resistant to standard antibiotics. Treating patients with gonorrhea will turn out to be more complicated if resistant strains persist to increase. If left untreated, gonorrhea can root serious complications including pelvic inflammatory disease in women and sterility for both sexes.
In the 1980s and early 1990s, the speed of Gonorrhea in Canada went down progressively. Part of this change may have been since people changed their sexual practices because of increased awareness of the threat of HIV/AIDS.
Correct and reliable use of condoms is an effectual way of preventing both HIV and gonorrhea transmission, but persons at risk may be experiencing 'condom fatigue'. After attainment an unsurpassed low in 1997, gonorrhea rates began to go up. This reversal signals one more important shift in sexual behavior: younger people might believe that HIV is no longer the death sentence that it was in the 1980s, and are having exposed sex that raised their risk of gonorrhea and other STIs.
From 1997 to 2001, there was near 45% boost in the rate of gonorrhea in Canada. The increase has been even more vivid among men aged 30-39: in this age group, the rate went up 68% from 1997 to 2001.
Understanding who is at threat for gonorrhea is the primary step to preventing new infections. The current disease observation system does not tell enough about the risk factors amongst people who contract gonorrhea and other STIs. For the healthiness of the community, we must get ready to reach out to populations at danger using the internet and other inventive approaches.
In the 1980s and early 1990s, the speed of Gonorrhea in Canada went down progressively. Part of this change may have been since people changed their sexual practices because of increased awareness of the threat of HIV/AIDS.
Correct and reliable use of condoms is an effectual way of preventing both HIV and gonorrhea transmission, but persons at risk may be experiencing 'condom fatigue'. After attainment an unsurpassed low in 1997, gonorrhea rates began to go up. This reversal signals one more important shift in sexual behavior: younger people might believe that HIV is no longer the death sentence that it was in the 1980s, and are having exposed sex that raised their risk of gonorrhea and other STIs.
From 1997 to 2001, there was near 45% boost in the rate of gonorrhea in Canada. The increase has been even more vivid among men aged 30-39: in this age group, the rate went up 68% from 1997 to 2001.
Understanding who is at threat for gonorrhea is the primary step to preventing new infections. The current disease observation system does not tell enough about the risk factors amongst people who contract gonorrhea and other STIs. For the healthiness of the community, we must get ready to reach out to populations at danger using the internet and other inventive approaches.
Gonorrhea in Pregnancy
Gonococcal infections for the period of pregnancy pose an exceptional challenge. At the same time as in non-pregnant women, the majority of pregnant women with gonorrhea are lacking symptoms, so the infection can simply go undetected. Pregnant women have some degree of defense against the possible complications of gonorrhea. For example, the fetal membranes can help out defend the uterus and fallopian tubes from infection. However, pregnant women with gonorrhea may pass on the infection to their babies during vaginal delivery. When this happens, it is most probably because the baby comes into contact with the mother's genital secretions. Symptoms in infected infants usually come into view two to five days after delivery.
Infected infants may build up localized scalp infections, upper respiratory infections, urethritis, or vaginitis. They too may build up conjunctivitis, a serious eye infection. Less frequently, the organism may go into an infant's blood, basis general illness. As with spread infection in adults, the organism might settle in one or more joints, causing arthritis or meningitis.
Conjunctivitis in the newborn is not frequently caused by gonorrhea. When it occurs, yet, it is serious and may effect in crack of the globe of the eye and permanent blindness. Conjunctivitis caused by gonorrhea is one of the mainly common causes of preventable blindness worldwide; though, it is uncommon in the since newborns are routinely given erythromycin ophthalmic ointment to avert eye infections. The most successful means of preventing infection in neonates (infants less than 28 days old), though, is to screen and treat pregnant women previous to labor.
Infected infants may build up localized scalp infections, upper respiratory infections, urethritis, or vaginitis. They too may build up conjunctivitis, a serious eye infection. Less frequently, the organism may go into an infant's blood, basis general illness. As with spread infection in adults, the organism might settle in one or more joints, causing arthritis or meningitis.
Conjunctivitis in the newborn is not frequently caused by gonorrhea. When it occurs, yet, it is serious and may effect in crack of the globe of the eye and permanent blindness. Conjunctivitis caused by gonorrhea is one of the mainly common causes of preventable blindness worldwide; though, it is uncommon in the since newborns are routinely given erythromycin ophthalmic ointment to avert eye infections. The most successful means of preventing infection in neonates (infants less than 28 days old), though, is to screen and treat pregnant women previous to labor.
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