PARENT INSTRUCTIONS - the following may be useful but not replace a doctors examination and advice. Your results may vary. This is not medical advice, simply shared experience. Be skeptical about everything you read online. Some of this may apply to you and some may not. I am not responsible for what people do with this information, nor do i have infinite time to answer questions. 

FIRST INSTRUCTIONS for coping with behavioral issues of childhood, If none of these work, get professional help.

I.   Check YOUR SELF FIRST. Are you taking care of yourself? Exercising, eating well? Sleeping regularly? Learning how to relax? Children need calm and confident leader. If you are stressed out learn how to cope with stress. Kelly McGonigal, PhD has an outstanding Ted talk that you can watch to learn about coping with your own stress and becoming more resilient and capable. The unspoken example that you give is the most powerful way you can teach a child. Be sure you are doing the things you read below, then do them for your kids. 

    The reason that airlines tell you to put your oxygen mask on first, and then help your children is - they know that if you don’t do this (take care of yourself) you will be in a panic and unable to help anyone. NOT taking care of yourself is the worst selfishness.

II.   FEED YOUR CHILD

A) Regularly, they need to eat every day, several times. Find a way to sit down with them. Make a ritual of eating - set the table, put food on it, say a prayer if you have one, eat slowly (do not tell them to eat slowly), linger after eating, put away the dishes together. Make it a slow, restful, relaxing and connecting experience. Do not bring up problems or conflict - if they do it gently let them know that this is a time to rest and digest, attend and befriend. Afterwards, put things away together. That is part of the process - don’t leave it for a nanny or do it yourself. This is life, do it together.

B)  - Vegetables and fruits minimum sugar and additives. I know that this is easier said than done. Make an effort and get creative, do your best and view it not as a perfect yes or no, but a percentage game.

C) Vitamins, minerals and supplements are essential but Multi-vitamins are not recommended, according to well done studies, they don't work. Do not be impressed with the claims people make a bout expensive versions being better - those people are trying to make money. DO NOT buy vitamins from a doctor, chiropractor or any other health care provider. That is a conflict of interest. You have no way of knowing if they are telling you to take it for their sake or yours. I do not sell vitamins (or anything).  

Someday we will be able to eat a pure diet, have days with enough physical activity in the sunshine, but until then we need also may need to take the following

1 Omega–3 (Fatty Acids or Esters), these can be brought as gummy vitamins, Try different brands until you find what your kids like. (Do not get caught up in how much EPA and DHA, just get the total to be enough. It is true that EPA can be converted to DHA but pure DHA works fine too, Nordic natural has a strawberry flavored capsule that smell good. Liquid Omegas are less expensive and work fine. Cod Liver Oil works also, is cheap but sometimes smells bad.) A 150 pound adult needs 4000 milligrams of omegas per day, calculate the milligrams per kilogram or milligrams per pound and give them what they need. Two times a day or three times a day is a good way to divide up the total dose. 

2  Sublingual(Under the tongue) Folic Acid B9) 1200 µg in the morning. This is for children with normal MTHFR. If you don't know your or your children's MTHFR genes, ask the pediatrician to do this test. Information about MTHFR & Folic Acid.. If your child has one or two of the mutations, you can either order methylfolate online or have your doctor write the prescription for Deplin (methylFolate) it is a vitamin not a medication. Usually kids take half the dose of adults. Brand name Deplin costs less than the generic at pharmacies if you have your doctor call BDH at 866-331-6440. Have him or her prescribed Deplin 7.5 mg, 90 pills, Three refills. He will give them your phone number and they will call you for payment and address information. MethylFolate is more expensive than Folic acid, if you do not have the mutation (C677T) is is not any better.

3  At bedtime, magnesium and melatonin can be helpful for improving the quality of sleep. These are not sleep pills and they do not work quickly but over time they can help you create a regular sleep schedule and make sleep a better and more restful experience. I recommend avoiding magnesium capsules. This is because they often contain 400 or more milligrams each, Which is too much. They also are not able to be cut like tablets are which reduces the flexibility of your dosing. Most kids can take 250 and 50 mg tablets for a few nights(3 to 5) and then, 62 mg– 125 mg at bedtime after that. The dosing on melatonin varies greatly I usually encourage people to start at about 5 mg and then decrease to the lowest effective dose which is usually somewhere between.5 mg and 3 mg. If you talk to employees at a vitamin Shoppe they will tell you unlimited nonsense about why people should not take melatonin. Smile and thank them and leave as soon as possible.

4  Vitamin D: many people recommend this and it is said to do wonderful things. Dose which is recommended can be anywhere from 400 to 4000 (it is usually measured in international units not mg). 

5  Lithium. Beyond Cell Phone Batteries and Bipolar Disorder - Perhaps everybody should benefit from low dose lithium. Small dose, vitamin not medication. Kids 5mg capsules 2 at bedtime, Adults 20mg one capsule at bedtime. This is 100 times less than the medication dose. It does not have the same side effects. If you look up side effects for medication lithium and think it is an issue - ask yourself - are the side effects of eating one piece of pizza the same as eating 100 pieces of pizza at one sitting? please. The only problem is that at such a low dose - it may take weeks to months to fully work. That is OK. Read this before saying anything ignorant. Do not expect any health professional to know about this.

6  OTHER STUFF There is some evidence that Zinc in the morning may help with attentional problems. 5-HTP is sometimes used for anxiety. NAC can be given for twitching or impulsivity (needs to be about 13mg X pounds, divide into 3 doses per day). And some people recommend and Acetyl-L-carnitine for mood swings. Dosing and formulation can get complicated - don’t let the people who get all “into detail” intimidate you. Chelated-non chelated does not matter nor does elemental vs not or gluconate vs asporotate. These people have issues seeing the big picture. You do not have time for 8 semesters of chemistry. Get whatever is available in the store, and start with the lowest dose. Only a few of these require large doses (omega and NAC).

III. SLEEP IS IMPORTANT

A) WAKE UP At The Same Time Every Day. Wake Up At The Same Time Every Day. Wake Up At The Same Time Every Day. This is important. By waking up regularly you synchronize your neuronal and hormonal rhythms (suprachiasmatic nucleus of the hypothalamus). The more regular you are - the better your Cortisol Awakening Response (CAR). Sleeping late is not a pleasure or a luxury it is a sign of either insufficient information, self control or both. It leads to impaired attention, cognition, alertness and stimulant consumption. 

IF you have kids, first get yourself in the habit of Waking Up At The Same Time Every Day, (this may take a while), then WAKE THEM UP. The idea of letting them sleep until they wake up needs to be thought about. Are we here to let them just "obey their body" and do whatever they feel like? Take charge. Be the leader. Give them the knowledge that the beginning of each day and end of each day are book-marked by a loving relaxed parent who is present and introduces sleep and wake as acts of love.Waiting until they wake up and come to you is basically letting them enter the day alone and without love or guidance. When you wake your child up, there is a wonderful few moments of transitional confusion during which time you are there to direct their behavior before their oppositional self wakes up. If a child does not develop the ability to take direction from others, they will have problems controlling their own actions, and self discipline is very important. Wake Them Up At The Same Time Every Day and have a routine and a plan.

B) The AMOUNT OF SLEEP is important and varies with age. at the beginning of life we need 14-20 hours of sleep per day. At the end of life we need about 6-6.5 hours of sleep per day. I do not have a magic amount for each age, but I know that 8 hours is a misunderstanding. Adults probably live longest and are healthiest with 6.5-7.5 hours per day.... TOO MUCH SLEEP may cause depression, weight gain, slowed thinking, impaired memory and executive function. NOT ENOUGH SLEEP may cause irritability, impulsivity, symptoms of Bipolar Disorder and psychosis (delusions and hallucinations). The best way to know how much your child needs, is to observe carefully. Bedtime may vary but wake up time needs to be consistent. So see what happens if they go to bed earlier or later. Take notes.

C) The place to SLEEP is IN A BED, in a dark room, not too warm and not with much noise. I am not a fan of having noise or music or TV playing while one goes to sleep. I do not know if it is good or bad but my hunch is, that 1) it interferes with learning how to relax 2) information ins incorporated into the content of dreaming, which may or may not be ok. Sleep is not one thing. Each period has a purpose and different bodily function (physiology). There is an architecture of sleep. It moves from one kind to another. Initial, deep, REM dreaming etc. Let it happen.

D) STIMULANTS - There are four commonly encountered stimulants 1) Caffeine (Soda or Coffee), Theophyline (Black Tea, asthma medication), Theobromine (chocolate) and pseudephedrine (Sudafed, other nasal decongestants. The first three are a group of chemicals called methylxanthines, people often refer to all three as "Caffeine" which would be ok, but each is slightly different. The reason I mention that is, a person may have a different effect or longer effect from one than the other.  The stimulant effect can last up to 8 hours - so avoid all four of them in the late afternoon and evening. As far as over-the-counter cough and cold medication, it is generally best avoided unless your doctor recommends it.

IV PHYSICAL ACTIVITY IS IMPORTANT at all ages. Stretch, Stamina (cardio) and Strength challenge are helpful. How much, when, etc will not be discussed here. But exercise is very very important for many reasons, including BDNF.

SECOND INSTRUCTIONS - Pediatrician (a medical doctor who specializes in helping children), Psychologist (a PhD type doctor with extensive education and training in human behavior but does not prescribe medications)  or Psychiatrist (a medical doctor who specializes in behavioral problems but may be trained only for adults, some Psychiatrists treat some childhood problems especially ADHD, but other Psychiatrists refer children to a Child Psychiatrist who has extra years training specifically to diagnose and treat children)

If you have/are doing these things but there are problems, you can ask your pediatrician or other heath professional about specific issues. That provider will let you know if an evaluation by a Child Psychiatrist is a good idea.

THIRD INSTRUCTIONS

Child Psychiatrists are in short supply, but they are usually some of the best trained, compassionate, intelligent people you will meet. Please treat them with the respect that they deserve. Avoid telling them how to do their job, they already know. Instead, tell them specifics about the issues with your child especially: Exact nature of the problem. Instead of telling the doctor what the diagnosis is, r what is causing the problem, describe in detail: a. what happens, b. how long it lasts c. does it happen at one time of the day or another c. are there any things that happen right before d. are there any things that happen right after e. what makes it better f. what makes it worse. Have a list ready with all family members (Mother, Father, Sister, Brother etc) who have seen a psychiatrist, what problems they had and names of medications which helped.

Always, always, always have paper and write down what the doctor says to do. DO NOT trust your memory, it all happens fast. Take notes, review instructions before leaving. 

FOURTH INSTRUCTIONS

Beyond the Child Psychiatrist there are three options 1) another Child Psychiatrist 2) A major Medical Center 3) Brain Stimulation

Brain stimulation sounds scary, but we are not talking about shock therapy (ECT). This brain stimulation is mild, painless, and safe. One type of stimulation (VNS) was FDA cleared for seizures in 1997 and involves surgical implantation of a pacemaker, newer VNS is being developed without surgery (tVNS). Magnetic Brain stimulation (TMS) was FDA cleared in 2008 for adults. There have been many many studies in children, almost everybody is impressed with the safety. Other advantages include, few side effects, and often permanent improvement in brain function especially executive function. Long term studies have shown no long term adverse effects. Downsides include frequency of visits (TMS 5 days per week for 6 weeks) and cost ($12-15,000). TMS for children is not yet FDA cleared but many centers will consider doing it for depression, autism, ADHD and other conditions One problem with TMS for children, is, that there is a variety of approaches and each is supported by evidence but no comparison have been done. For example TMS for autism - Oberman, Casanova, Pascual-Leone and McCracken all use different methods. Nonetheless, they all seem to work well. 

In the future, I think brain stimulation will be used much much more commonly and before everything else has been tried instead of after. Cost will, hopefully come down to about $1200 per series and improved techniques will allow 2 or 3 visits per week to be as effective. Electric stimulation (tDCS, CES, tVNS and Trigeminal Nerve Stimulation) is much less expensive but has not been as well studied.

There is an FDA cleared EEG diagnostic test (NEBA) but there are few people who use it. qEEG and NeuroFeedback are advertised as wonderful, and it has probably helped some kids but I have not seen great results. HRV BiofeedBack is extremely effective for anxiety and attention problems but there are few practitioners. There are hundreds of BrainScams - programs with excellent and legit looking websites charging $2,000-$20,000 like "brain mapping", "brain exercises", "brain re-patterning", "brain balance" and others. People ask me to check out some program that is offering to help their kid with "Brain" stuff, it often takes me 30-45 minutes to figure out if it is real or a scam. These scammers are incredibly skilled at showing Books, Scientific Articles etc which look and sound real but are fake. 

FINAL INSTRUCTION

LOVE YOUR CHILD, that is what matters most. Learn how to relax and pay attention, then teach your child. Don't give up. Most kids turn out fine, and many have problems that go away on their own.

This poet said:

 

On Children

 Kahlil Gibran

 

Your children are not your children.

They are the sons and daughters of Life's longing for itself.

They come through you but not from you,

And though they are with you yet they belong not to you.

 

You may give them your love but not your thoughts, 

For they have their own thoughts.

You may house their bodies but not their souls,

For their souls dwell in the house of tomorrow, 

which you cannot visit, not even in your dreams.

You may strive to be like them, 

but seek not to make them like you.

For life goes not backward nor tarries with yesterday.

 

You are the bows from which your children

as living arrows are sent forth.

The archer sees the mark upon the path of the infinite, 

and He bends you with His might

that His arrows may go swift and far.

Let your bending in the archer's hand be for gladness;

For even as He loves the arrow that flies, 

so He loves also the bow that is stable.

 

The outcome is not in your control (sorry). You can influence but not control your children (cf Dylan "your sons and your daughters are beyond your command"). I once employed the daughter of an alcoholic gambling father and borderline-bipolar mother. The daughter was fine, stable and normal. She finished at UCSD and is now in graduate school. Her parents could not and did not ruin her. The strength and power of the human spirit can overcome obstacles. I also know many many children of high functioning and normal people who have been given everything in life but have serious problems. Take responsibility, but don't blame yourself. It is not about you. Do your best, let go of the rest. Parenting is, in my opinion, the most difficult thing of our life. It sometimes amazes me that the offspring of humans ever live old enough to reproduce. Ironically after learning all of the lessons of parenting, and becoming better people, the kids are gone. If the same person who dropped the kid off at college, had been there all along, things would have been much better. That is why there are grandparents. Hopefully you will have that joy, it makes up for all the pain of parenting.

END NOTE

Yes, i am in practice, yes I do brain stimulation, no - this is not a way for me to promote my services.

If you or your child needs brain stimulation - go somewhere close to where you live. You probably don't need me. There is a lot of driving involved and the machines all work pretty much the same. If you are thinking about asking me whether brain stimulation would be a good a good idea for you or your child - the answer is probably yes (assuming that there is no history of seizure and no metal in the head).