Couples Communication - Sylvia's Story

A couple of years ago, as part of my Family and Marriage studies, we did some assignments dealing with couples communication. Psychologists have come up with a couple of models of what effective communication looks like for couples, calling them the Awareness Wheel and Listening Cycle.The previous links go to a couple of pages at Momentum Counseling Services that do a good job of explaining what those are, so I won't go into detail, here. What I do want to share is a portion of an interview I did for that class. It was as a way to practice using the principles behind the Awareness Wheel and Listening Cycle, and to demonstrate some competence. It was with a young woman I will call Sylvia. Her name was changed to protect her anonymity.

Just so you know, I think the principles involved go well beyond just couples. I think they are appropriate for any situation where more than casual communication is desired. Not all communications need to be deep. Some kinds of communications work best when superficial. This just doesn't apply as well to them, as it does more intimate sharing.

Awareness Wheel and Listening Cycle - Sylvia

Sylvia was concerned about her future. As an 18-year-old young woman, living in a rural area, she had been unable to find a regular job. She had done the occasional baby-sitting job for neighbors, but nothing regular, and nothing that paid well. The prospect of graduating from high school and attending college excited her, she wanted to study illustration, but not being able to get a job meant that she wouldn’t be able to pay for college or basic living expenses without taking out grants and costly loans.

Sylvia had learned from her teachers that, in the future, there will be less available jobs that didn’t need a college degree. She had also been warned against going into debt by various adults in her life. Her parent’s income was modest, bordering on the poverty level. She had seen them struggle to pay off their own debts, and pay the bills in general. She had also seen her older friends, who had moved away from home, struggle financially. Many of them had low paying jobs and some has lost their jobs.

Because of her own experience in trying to secure work, and the experiences of others in her life, she decided that she must start gaining work experience while still in high school, or she would be unable to secure a job as a college student. This would severely compromise her plans to study illustration. School costs money. While her parents had promised to help her in any way they could, paying her application fees and other fees as much as possible, they would be unable to pay her tuition costs.

The problem, she thought, was creating a reason for people to hire her. Her grades were good and she had basic skills most jobs require. She even had a food handlers permit, required for most work in the food service industry. What she lacked was the work experience that many employers were asking for. How could she get experience if she couldn’t get a job to get the experience with?

Sylvia was beginning to feel desperate. It made her frightened to think that she may have to give up her plans to go to school and get a degree. This compounded her fear and frustration because she knew that, as an adult, not having a degree would compromise her ability to make money as an adult. She was afraid of moving out on her own, and becoming a functioning adult, if she couldn’t find financial security.

Financial security and independence were important to Sylvia. She knew that she may qualify for various grants and scholarships, but she was afraid she would likely have to take out large student loans if she couldn’t find gainful employment while in college. She didn’t want to use her parents as a crutch in life, burdening them with undo costs. Living in poverty was unacceptable, as well. Instead, wanted a comfortable home, filled with the things she loved.

In spite of her previous failures at securing employment, to achieve her goals, Sylvia would continue to apply for work, even tasks that she wouldn’t normally enjoy doing, like working in fast food restaurants or housekeeping or cleaning jobs. She would also seek out and apply for grants and scholarships for school that she would not be required to pay back, both public and private. As a high school senior she had taken some classes in cosmetology and may take her first year in college to finish a cosmetology license. This would allow her to work as a cosmetologist while she pursues her studies in art. Because struggling as an artist did not appeal to her, she has decided to take a minor in business. This way, she will be able to better address the business side of art, increasing her chances of being more successful, financially.

Conducting the Interview

In conducting the interview with Sylvia (not her real name), I used a combination of explorative listening and attentive listening styles. I tried to use mostly open-ended questions, inviting her to give me details. Questions such as: “How are you feeling about moving away from home?” and “Where did you learn that you needed a degree to get a job?” helped her open up to me and think about details that went beyond her surface thoughts. I also used questions such as, “What do you think about that problem?,” “What do you want to get out of school?” and “What will you do about getting a job?” In some cases I simply said, “Tell me more about that.”

In order to make sure I was referencing all aspects of the awareness wheel, I kept a text document open on my computer with the different areas of the awareness wheel listed as headings. I was then able to keep track of her answers and direct my questions to make sure I was getting a full picture of the issue. She knew I was doing this for an assignment, and we had talked about this issue in more casual styles in the past, she said she was comfortable with me taking notes in this way.

As she would give me answers to my questions, adding details to her original answers, I would switch to an attentive listening style. I would summarize what she had said and ask her if that was what she meant. I also kept watch on her body language, tension in her eyes, shifts in her position or gaze. I would often ask a follow-up question about those shifts related to her feelings: “Does that make you feel scared?” She would often open up more as I acknowledged her emotional states and experience, showing her that I respected her and would not judge her actions or feelings about the issue. I never interrupted her.

My Own Experience

While I was certainly assigned to do this interview, Sylvia is someone I care deeply about. We had spoken before about her current problems surrounding her transition from high-school to college, and from late childhood to emerging adulthood. My goal, then, besides finishing the assignment, was to better understand her and what she was going through, as well as help her understand her problem better, herself. I believe that talking through a problem in this non-judgment way with someone you trust will often help you see he problem in a different light, and reveal solutions that you hadn’t previously thought of. Indeed, it may show that what you thought was the original issue, may not have been the source of anxiety at all, but a deeper desire for something else entirely. She was very willing to speak to me, and chose the subject herself, without any prompting on my behalf.

Because I wanted to help her find a solution, as well, it was difficult to not “butt in” with my own ideas. The point was to draw us closer together and increase understanding, not impose my own thoughts or desires for her into the mix. To my pleasant surprise, she brought up a few things I had thought about on her own. Although I have my own feelings of what should be a priority for these actions, I left it alone in favor of letting her solve the problem herself. She may decide to ask me about them later, she may not. I practiced holding my tongue and I hope it will get easier the more I do it. We both expressed thoughts and feelings of being happy about the way the interview went and I made sure to thank her for talking with me in such an open way, as well as helping me with my assignment.

As I practice these methods of communication, I hope they will become second nature to me. That way, my conversations will naturally be more effective, and more fulfilling.

ADHD: Developmental Challenges and Treatments

This was my final paper for Human Development Across the Lifespan. It deals with the developmental challenges facing children with ADHD, specifically, but I believe it may be beneficial for understanding many children with special needs, similar to ADHD. To be honest, I was was surprised where the research took me, in some cases. It was enlightening for me so, I thought it might be useful for others, as well.

Be warned. This is a research paper, so it is kind of long. References are included at the bottom.

ADHD: Developmental Challenges and Treatments

Attention Deficit Hyperactivity Disorder, or ADHD, afflicts approximately three to five percent of children in the United States. With a child population of approximately 2 million, an average sized classroom of 30 children will have at least one ADHD child in it. It is difficult for ADHD children to control their behavior, creating challenges for teachers to educate them along side other children in their classrooms. It also increases the normal challenges faced by parents raising them at home.

Although we may see ADHD as something new, knowledge of this as a disorder has been around for over a century. It was first described by Doctor Heinrich Hoffman in 1845. A poet, as well as a doctor, he wrote a book called “The Story of Fidgety Phillip,” containing an accurate description of a child with ADHD. In 1902, Sir George F. Still published a series of lectures at the Royal College of Physicians in England describing a group of children with significant impulse and behavioral problems. He attributed the cause in the group to genetic dysfunctions, not poor upbringing on the part of the parent. Today, these children would easily be identified as having ADHD.

Causes of ADHD

While the cause of ADHD remains unknown, research has shown it is likely genetic and may be linked to exposure to toxic substances. Positive correlations have been found between the use of cigarettes and alcohol during pregnancy as well as lead exposure. (Mick E, Biederman J, Faraone SV, Sayer J, Kleinman S. 2002)

Studies involving brain injury have shown that some children with brain damage exhibit ADHD like symptom, but only a small number of children with ADHD have suffered traumatic brain injuries. Likewise, studies involving diet, especially sugar, have shown no correlations. In one study, where half the children were given aspartame and half sugar, the only behavioral differences found were in the perceptions of their mothers. The mothers who thought their kids were being given sugar were more critical of their child’s behavior, whether the child had actually received sugar or not. (Wolraich M, Milich R, Stumbo P, Schultz F. 1985)

The most positive correlations seem to be genetic. 25 percent of close relatives in families with ADHD children also have ADHD. The ratio in the general population is only five percent. Many studies with twins show that both twins will likely have ADHD. Each of these factors suggests a strong genetic influence. PET scans have shown a marked difference in brain functioning between a normal child and a child with ADHD, suggesting a neurological dysfunction, not just a psychological one. (Faraone SV, et. al. 2005)

Delayed Brain Development

Recent studies conducted by the National Institute of Health suggest a delay in brain development of children with ADHD, not a total dysfunction. An earlier study found that thickening of the cerebral cortex was delayed in ADHD, specifically those sections dealing with functions such as attention, cognition, language, and sensory processing. This study tracked children over a period of seven years, scanning their brains and regular intervals between age 10 and 17, and measuring both cortical thickness and cortical surface area, both of which mature during childhood. These scans showed a marked delay in the development of these areas. For example, a typical developing child attains 50 percent peak area in the right prefrontal cortex at an age of 12.7 years, on average. ADHD children didn’t reach this peak until an average age of 14.6 years. (Elsevier 2012, July)

Psychosocial Stage 3, the Preschool Years and ADHD

Because of this delay in brain development, children with ADHD will, like other special needs children, be behind their peers in some areas and may experience problems in school, socially and academically. When we consider Erik Erikson’s stages of psychosocial development, ADHD symptoms typically begin manifesting during stage 3, the preschool years. This is a time when children being to exert more control over their environment through directing play and other social interactions. Lacking self-control, such children will try to exert too much influence, meeting resistance from their peers, teachers, parents, and siblings. Lacking impulse control, this frustration is more likely to manifest as aggressive behaviors such as yelling, hitting, or throwing objects.

At this stage, children also begin to physically explore their world, taking on activities by themselves, and developing a sense of independence. Lacking impulse control, ADHD children are more likely to take on activities that are beyond their capabilities and engage in risky behaviors such as crossing the street alone or riding a bike without a helmet. They may also attempt activities that interfere with other people’s plans and activities. Adults who are supportive of the child’s attempts, and try to guide them to make more realistic choices, help the child develop initiative: independence in planning and undertaking activities. Adults who dismiss the child’s attempts as silly or bothersome contribute to the child developing feelings of guilt about their needs and desires. Adults who are frustrated by the ADHD child’s proclivity to respond in aggressive ways may be more likely to resist the child’s efforts at independence, putting ADHD children at greater risk for failure during this stage. (Berk 2010)

Psychosocial Stage 4, Early Childhood and ADHD

As children enter early childhood, they learn to cope with greater academic and social demands. Ideally this is a time to learn more complex tasks such as reading, writing, and telling time. They may also express their independence by talking back, being disobedient and rebellious. It is also at this stage that children develop a sense of morality, recognize cultural and individual differences, and can manage most of their personal needs, such as grooming and hygiene, with minimal assistance.

Because of the delay in development in areas of the brain crucial to this stage, children with ADHD are more likely to have difficulties in the early years. Children who are encouraged to make and do things, and then praised for their accomplishments, will develop diligence and perseverance in completing tasks. They will learn to delay gratification. If they are ridiculed or punished when they are incapable of meeting adult expectations, they will develop feelings of inferiority about their abilities. It should be noted, however, that because development is these crucial brain areas are delayed, the development of diligence and delay of gratification are likely to be delayed, as well.(Berk 2010)

Psychosocial Stage 5, Adolescence and ADHD

During adolescence, children explore their independence and develop a sense of self or personal identity. This transition is marked by a need to re-establish boundaries for themselves in a potentially hostile world. No matter how the child has been raised, this is the time they will choose a personal ideology for themselves. This often leads to conflicts between adults and the developing child, especially over religious, political, and sexual orientations.

Because of the developmental delays of children with ADHD, this stage is often prolonged, well into early adulthood. It is of note that this Erikson noted this same delay in person’s of particular genius. This delay can also be prolonged by the demands of taking a longer time to master certain skills within our highly technological society. It is, perhaps, because of this natural delay, that many ADHD children grow into very intelligent and technically skilled adults. The psychosocial demand for prolonging this stage may coincide with their biological delays.

Because of this natural delay, there can still be problems. Early in this stage, peers and adults may see the child as acting “like a child” and react negatively. If adults are too insistent in choosing an identity, “acting their age,” and force closure of the normal identity moratorium early, the child may give up and take on an less health identity foreclosure status. They will be less likely to integrate their sense of self within a diverse society as they enter adulthood. (Berk 2010)

Modern Treatment Modalities

Current ADHD treatments focus on reducing symptoms and improving functioning. They include medications, various forms of psychotherapy, and education. One size does not fit all. The best results seem to be from a combination of therapies. (National Institute of Mental Health 2008)

The Risks of ADHD Medications

Stimulants are the most common type of medications prescribed for ADHD ,and are by far the most controversial. The exact medication and dosage must be individualized, and it is common to try several out before finding one that seems to work, best for that patient. As with all medications, stimulants come with a wide range of side-effects, however. These side-effects, and a general misunderstanding of the causes of ADHD, create additional stresses for parents seeking to help their children, as well as the children themselves.

The most common side-effects of stimulant medications are decreased appetite and sleep problems. Some children experience upset stomach and headaches. A few children may experience slight “tics” or personality changes such as appearing to be without emotion. These side-effects are often mitigated by changing the dosage or using a different medication.

Many people are concerned that using stimulants in this way to treat ADHD may lead to substance abuse and addiction later in life. There is little evidence to support such a claim, and far more that suggests they do not. Children who take these medications do not “get high,” although some report feeling slightly different or “funny.”

In spite of being generally considered safe, there are some rare side-effects that must be noted. Patients with existing cardiovascular disease or psychological problems may have their symptoms exacerbated by stimulants, leading to stroke, heart-attack, or sudden death. A few patients report hearing voices, hallucinations, experience mania, or paranoia even when they do not have existing psychological conditions.

Non-stimulant medications also pose risks, especially in teens. Children and teens who take medications such as atoxometine more often report thoughts of suicide than their peers who do not take such medication.

The long term effects of ADHD medication on development are not known. Some researchers are concerned that administering stimulants to children will have an adverse effect on brain development. (NIMH 2008)

The Benefits of Treatment

Because a combination of therapies seems to be the best approach, removing medication as an option seems counterproductive. The question becomes do the benefits of medications outweigh the risks? There seems to be no consensus within the medical community on this. My own research has shown that many scientists cherry pick the data to support their own theories, while ignoring the rest of the data. In some cases, medication seems to have been the key element that allowed the child to participate in other forms of therapy as well as educational activities.

When a developmental perspective is taken, it seems clear that, untreated, ADHD poses severe and known risks in the long term. Failing to achieve the developmental milestones, as given in the previous examples, creates greater risk for not developing the coping and life skills required by modern living as adults, as well as greater risk for psychological disorders that may lead to physical problems, as well. They may have lower self-esteem and be unable to cope with stress, develop expertise in vocational and leisure pursuits, have healthy intimate relationships.

References

Berk, Laura E. (2010) Development Through the Lifespan (5th ed.). Boston, MA. Pearson Education, Inc.

Elsevier (2012, July). Brain development delayed in ADHD, study shows. ScienceDaily. Retrieved December 11, 2012, from http://www.sciencedaily.com/releases/2012/07/120730094822.html

Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P. (2005). Molecular genetics of attention-deficit/hyperactivity disorder. Biological Psychiatry, 57, 1313-1323.

Mick E, Biederman J, Faraone SV, Sayer J, Kleinman S. (2002). Case-control study of attention-deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. Journal of the American Academy of Child and Adolescent Psychiatry 41 (4) 378-385.

National Institute of Mental Health (2008). Attention-deficit Hyperactivity Disorder (ADHD) (No. 08-3572). U.S. Department of Health and Human Services; Author.

Wolraich M, Milich R, Stumbo P, Schultz F. (1985) The effects of sucrose ingestion on the behavior of hyperactive boys. Pediatrics, 106 (4):657-682.