Are You Divorcing?

Woman reflecting on divorce options after therapy, illustrating 'Are You Divorcing' decision-making in online therapy in Maryland and DC.

Are You Divorcing? Choose the Right Path

Understanding Pro Se, Litigation, Mediation, and Collaborative in online therapy Maryland and DC

Are You Divorcing and unsure of where to start? It’s common to think of lawyers and court battles first—but there are more considered paths forward. As an online therapist serving families in Maryland and DC, I encourage clients to research options like Pro Se, Litigation, Mediation, and Collaborative Divorce before taking action. For an expert comparison of mediation versus collaborative divorce, see this helpful overview from Jackman Law Firm. To learn how online therapy in Maryland and DC can support you emotionally during separation, check out that resource as well.

Your marriage is in trouble and you want out. The first thing that you think about is finding a lawyer and battling your way through the process. Don’t be so quick to open the Yellow Pages. First, do some research. Divorce can be done in at least 4 ways: Pro Se, Litigation, Mediation or Collaboration.

Pro Se means that you and your spouse sit at the kitchen table and work through all of the issues of sharing custody, changing living arrangements, dividing property, setting up two new households and sharing time with the children. Once you have decisions on all of these issues, you can write down your plans, research the law in your area and petition the court for a divorce decree. The kitchen table has the advantage of keeping things low key, working cooperatively and maintaining a good relationship with the other person as you reconfigure your lives. The disadvantages of this method are that a power imbalance could put one party at a disadvantage, unfamiliarity with the law could result in some poor choices for the future, and incomplete processes could lead to litigation in the future.

Litigation is the most familiar and probably the most contentious method of divorce. Each party hires a lawyer to advise them and represent their interests. Most litigated cases end of settling without going to court; however, the process leading up to that point is generally one of battle, hostility and acrimony. Many times the family, extended family and even friends are injured in the battle. Often there is little or no recovery from the process. When a case does go to court, the decision making power is ceded to the judge and both parties may end of very unhappy with the outcome.

Mediation is a more civil process of using one trained mediator to help you work through all of the issues and develop a settlement agreement. This agreement is then taken to a lawyer for review prior to signing and filing for divorce. A skilled mediator can keep you focused on the issues at hand and reduce emotional conflicts in the room. However, the mediator is there to work toward resolution of the issues and is not trained in facilitating a change in the emotional dynamics. Because of this, mediation can feel more like the kitchen table with a guide.

Collaborative is a transformative process whereby a team of professionals assists in working through the practical and emotional issues. The team generally consists of a lawyer for each person and a coach for each person. The lawyer advises on aspects of the law as you consider different options and solutions. The coach addresses the emotional dynamics and assists in learning new ways to communicate your needs and resolve issues with the other person. For custody issues and shared parenting, an expert in child development acts as a neutral advisor to the entire team so that the children’s needs are presented objectively for everyone to consider as they problem solve. For financial issues, an expert in financial planning can develop projections and plans as a neutral advisor to the team. The collaborative process is focused on transforming the historical model of divorce as a battleground to a more realistic model of divorce as a reconfiguration of the family where relationships will continue in a new form. The couple retains control of all decision making and decisions are based on mutual interests and common goals and not on power dynamics.

By now my bias toward the Collaborative Divorce should be obvious. Reshaping the family is a difficult process. Even the most mature individual will report that during their divorce they were a bit insane at times. The stress of ending a marriage and making dramatic changes in the life style of your children and yourself is a major emotional event. The team approach can give you the best opportunity to make choices that are legally sound, financially wise and emotionally healthy. For more information on Collaborative Divorce visit the web site of the International Academy of Collaborative Professionals: www.collaborativepractice.com

Deciding Are You Divorcing? means choosing the process that best suits your needs, goals, and emotional wellbeing. Whether you lean toward a collaborative approach or mediation, I offer online therapy in Maryland and DC to guide you and your family through the transition. For deeper insight into the benefits of collaborative divorce, take a look at the differences outlined. Let’s work together to keep your emotional health a priority through this change.

VOTE ‘TIL THE COWS COME HOME

Man and wife reflecting during online therapy in Maryland and DC, discussing the Vote ‘Til the Cows Come Home process.

Vote ‘Til the Cows Come Home: Family Decision-Making Tools

How Vote ‘Til the Cows Come Home frames family mission setting in online therapy Maryland and DC

In today’s fast-paced world, the classic phrase Vote ‘Til the Cows Come Home still rings true when setting family boundaries and roles. As a Maryland and DC online therapist specializing in family dynamics, I guide parents in using techniques like family meetings and mission statements to foster unity and authority. For a deeper dive into family communication strategies, see this article on the benefits of family therapy or learn more about online therapy in Maryland and DC.

In the 1960’s family meetings were the latest technique for including the children in the process of family decision making. I remember the experience in my own family with some fondness. Four children, two parents and the occasional “live in” school friend would participate in planning weekend activities and the family vacation with some parameters determined by the family budget. At times we were even privy to some budget discussions in an effort to get all of us to care about turning off the lights as we left the room. The promised savings were to be used for the ice cream truck when it came through the neighborhood. During one of our family meetings, the discussion was getting lively and we decided that this democratic process should be used to determine what we would have for dinner. As steak and veal were being bandied about, my mother rose from her chair with, “You can vote ‘til the cows come home, we are having meatloaf for dinner!”

Mother was a farm girl. Most contemporary families have not seen a cow except for the Turkey Hill ads and have no idea of the work involved in milking them. Mother knew when to take charge and assert her authority as the parent doing the work. Today’s families face social pressure to not just share authority but to often times abdicate to their children. Modern social pressures can be disorienting. When the sexual experimentation comes home at 10 years of age and the marijuana experiment begins at 12, the family meeting to empower the children is way out of its league. The modern family may require very different tools to stop the onslaught of contemporary life from undermining the family completely. The psychologist working with today’s family is also working with a very different configuration. The two parent household can easily be two moms or two dads. Many families are headed by single adults or singles with non-parenting live-ins.

The first part of treatment with families today requires gaining a sense of the goals and priorities of these families. To accomplish this task, I like to borrow a process from the collaborative law model whereby the parents develop a mission statement. The mission statement enables the parents and the therapist to clarify what this family is all about. Some simple questions (1) to answer are listed below:
What is the purpose of our family?
What are we all about in life?
What kind of family do we want?
What is our identity as a family?
What are the things that are truly important to us as a family?
What are our unique talents, gifts, and abilities?
What are our responsibilities in caring for one another?
How do we want to make a difference to our community?

As the adults are addressing these questions, the children may be working on their responses to the following questions:
What kind of home do you want to invite friends to?
What is embarrassing to you?
What makes you feel comfortable at home?
What makes you want to come home?
What qualities in your parent(s) are important to you? And cause you to be open to my/our influence?
How can your parent(s) improve?

The mission statement developed by the parents serves to anchor the family and leads to the development of an active and positive parenting plan. As situations arise in the family, the mission statement becomes a practical tool for decision making. With the mission statement clearly in hand, the children can see that their parent’s are thoughtful and not capricious. The mission statement also serves as an anchor that enables the parents to provide guidance and make decisions with confidence and without guilt.

In the course of designing a mission statement, the parents examine their social, moral, ethical and religious positions in order to develop succinct, measurable criteria for tracking their parenting. While this process would be valuable for any family, the ADHD family benefits in particular ways. The mission statement gives the parent who tends to be impulsive a place to check their impulse and the ADHD child benefits from the consistency and care that follows as Mom or Dad go back to the mission statement for clarity and support. The following case will illustrate the process of forming a mission statement and the value of it in the ADHD family.

Carol and Dennis came to therapy when their son Derrick was in second grade. Derrick had been diagnosed with ADHD at the beginning of first grade and was currently being treated with time release Ritalin. The parents had become comfortable with the medication regimen but also tended to give weekend and summer medication holidays. They had one other child, a girl, who was in kindergarten and did not have any of the signs of ADHD. The mother reported that she saw herself as having ADHD as well but had never been formally diagnosed or treated. As the family went through the process of assessing Derrick, the mother’s history and current behavior emerged as very similar to Derrick’s. The father did not seem to have any of these characteristics though he reported that his mother would probably fit the diagnosis. He remembered growing up in a pretty disorganized household and was hoping to spare Derrick some of his early experiences.

Derrick had a love/hate relationship with his sister. They could play together for brief periods of time before the play deteriorated into shouting matches or tears. Derrick’s school performance was generally above average though he tended to lose materials and misplace completed assignments. Derrick seemed to be in constant need of stimulation even with the medication. He moved quickly from one activity to the next without finishing anything. In the classroom, he tended to get into the space of others, often called out in class, and had designated himself as the playground monitor for directing all forms of play and settling disputes between players. Of course, much of this self proclaimed oversight was not welcomed by his peers.

The parents were overwhelmed and sought therapy to try to gain some control over the household and hoped to provide better guidance for Derrick in school.

Carol and Dennis spent about 6 therapy hours developing their mission statement. In the course of those sessions, Carol decided to educate herself on her own ADHD and began to read Understanding Women with ADHD by Kathleen Nadeau, Ph.D. and Patricia Quinn, M.D. (2) Dennis identified his negative judgmental attitude as harmful to the family. Since he lived with two people with ADHD, he decided to reframe his experience and learn more positive language for relating to his wife and son. He found The Gift of ADHD by Lara Honos-Webb, Ph.D. (3) to be a valuable resource as he practiced more reframing. Dennis’s negativity is a fairly common problem. Most of us have trouble using positive language and doing the work of looking for the positive aspect of a difficult situation.

As Carol and Dennis began to come together with a vision for their family, they were struck by the power that they had ceded to current social pressures and dynamics. Video games, television, reality shows, rap music, even clothing had more sway over their children than they did. This realization led to one of the most powerful parts of their mission statement. They wanted to be the primary influences in the lives of their children before any contemporary social or cultural entities including the school. Their commitment to that vision led them to think more clearly about how to order their home life.

Their mission statement is as follows:

Recognizing the power of modern culture to undermine family connections and the tendency of ADHD to welcome this rapid paced stimulation, we purpose to strengthen our individual and joint connection to each of our children such that they will experience us as their primary relationship and seek out our counsel frequently and consistently. We desire to encourage thoughtful, compassionate characteristics in our children and to nurture the creative, inspirational aspects of our son’s ADHD. To accomplish these goals we commit to the following:
Daily individual time with each child of at least 30 minutes face to face.
Daily meal time with no TV, Radio or media devices of any kind and we purpose to use table time to share positive character qualities in our children and learn more about how they think and view the world.
Weekly family time of at least 2 hours of face to face activity in a noncompetitive format that enhances the quality of life for one of us or others that we may choose.
A monthly focus on a creative project generated by Derrick or his sister.

Once the mission statement was clarified, Carol and Dennis saw how afraid they had been to lead their family. This realization energized them to implement their mission and actually enjoy their role as parents. They were excited about their focus on relationship but knew that they had to confront old habits and routines that had been undermining their family. They decided to try some family meetings. Carol and Dennis needed to take back their position of influence in their family and not be afraid to confront the pull of the media culture that had taken their place. They had to stop being afraid of the cultural influences that were more lively, more exciting and more rapid paced than they could ever be. Their decision to not compete was critical to regaining parental authority and being able to nurture healthy relationships with their children.

Step 1. Carol and Dennis set aside 10 minutes each morning to read their mission statement out loud to each other. This focus on their positive goal strengthened their bond with each other and energized them for the parenting challenges of the day. They used this time to plan their daily “face time” with each child.

Step 2. Carol and Dennis used break time at work to write down the positive character qualities of each child with specifics that were relevant to the past few days and imaginings that could be applied to the next few days ahead. This prepared them for meal time. They brought their notes to the table to show their children that they were seriously working on rebuilding relationship and authority through respect.

Step 3. After dinner they required Derrick and his sister to spend 10 minutes together to read the family mission statement and to plan their monthly creative project. Carol and Dennis accepted that for the first few weeks their children would probably just argue with each other. However, they trusted Derrick’s creative side and their daughter’s emerging compassion to eventually help them to design a project.

Step 4. At the beginning of each week Carol and Dennis called a family meeting to discuss possible activities for the 2 hour non-competitive family time. They were pleasantly surprised by how their children responded and they allowed wild and zany ideas to morph into more practical possibilities. Derrick’s initial trial balloon of “let’s save an endangered species” evolved into exploring the neighborhood creek and bringing home some weird water creatures to identify.

Carol and Dennis have redefined the family meeting. Instead of the 1960’s notion of empowering the children, their family meetings have become a means of restoring their authority and influence as parents. They are no longer afraid of coming home to chaos. The old tool has become a new resource to help families reorder their lives. My mother would be proud of them even though they don’t own any cows.

References

Tamara Rounds, L.C.S.W. Creating the Mission Statement, Collaborative Divorce Team Trainings, 2008.
Kathleen Nadeau, Ph.D. & Patricia Quinn, M.D., Understanding Women with AD/HD. Advantage Books, 2002.
Lara Honos-Webb, Ph.D. The Gift of ADHD. New Harbinger Publications, Inc. 2005.

 

With Vote ‘Til the Cows Come Home at your center, family decision-making becomes deliberate and empowering. Whether you’re in Bethesda or Silver Spring, I offer online therapy in Maryland and DC to help families craft mission statements, set healthy boundaries, and build consistency. Learn more about the benefits of family therapy and how it can restore your authority and connection at home.

Educating the Child about his Brain – Understanding is the first step in taking charge

Child and mother engaging in brain-based activities during online therapy, illustrating neurocognitive psychotherapy for ADHD in Maryland and DC.

Neurocognitive Psychotherapy for ADHD Treatment

How neurocognitive psychotherapy supports children with ADHD through online therapy in Maryland and DC

Neurocognitive psychotherapy is a powerful, brain‑based approach to ADHD that blends cognitive‑behavioral therapy with cognitive rehabilitation. As an Maryland and DC online therapist for children and families, I use neurocognitive psychotherapy to help kids understand and harness their own brain strengths. Beginning with a comprehensive neuropsychological evaluation, we map executive function, memory, processing, and emotional coping skills. This personalized approach aligns with current research into the brain’s executive function deficits in ADHD. If you’d like to learn how online therapy can integrate these assessments remotely, check out online therapy in Maryland and DC or explore strategies from Verywell Mind on types of therapy for ADHD.

Neurocognitive Psychotherapy is a brain-based treatment approach that is a unique blend of cognitive-behavioral therapy and cognitive rehabilitation. This approach is a team approach based in the most recent research on brain functioning and ADHD. This article is the first in a series that will illustrate how neurocognitive psychotherapy is applied in treating children with ADHD.
The key to building a treatment plan is to understand how the brain works in general and to discover how the brain of a particular child is functioning specifically. This brain based approach starts with a neuropsychological evaluation that enables us to measure various aspects of executive function, memory function, and processing abilities. This evaluation may also examine emotional strengths and resources that the child has been using to cope with the stress of learning and living.
Once a diagnosis of ADHD has been made, educating the child about the specific strengths and weaknesses in their brain is the next step. I will use a variety of techniques to help the child see and understand how his or her brain is functioning. Pictures of brains from web sites showing fMRIs have been very helpful. With the fMRI, we can see different areas of the brain light up as one thinks and problem solves. You may want to log on to www.amenclinic.com to take your own tour of different brain images. We may also use brain models, or build our own using found objects in the office. Sometimes we will make drawings or abstract art that represents the various functions of the brain and how they interact with each other.
As a child comes to understand how his own brain is working, he is encouraged to present his understanding in a family session as a means of educating others in the family. In this way, the child is given power over the ADHD. The stigma that has been associated with inattentive or hyperactive behavior is replaced by knowledge that empowers the child to take more control over his life. The earlier this empowering process can begin, the more opportunity the child has to build compensating strategies, make changes in his environment and develop supportive relationships. Educating the child about his own brain, how it works, and how he can help make it work best is a central part of neurocognitive psychotherapy – de-stigmatizing the brain patterns we refer to as ADHD and giving the child a sense of understanding and control.

Understanding how a child’s brain functions empowers the whole family toward targeted interventions. If you’re in Silver Spring, Bethesda, or anywhere in Maryland or Washington, DC, I offer neurocognitive psychotherapy via online therapy throughout MD and DC. This brain‑based treatment helps reduce stigma, build coping strategies, and reinforce emotional resilience. For more ideas on ADHD treatment options, check out Verywell Health’s take on untreated ADHD in adults or insights into neurofeedback treatment for ADHD, which can complement a neurocognitive approach.

ARE YOU A “DADDY”

Woman reflecting on a father-child book, highlighting father engagement and emotional connection in online therapy in Maryland and DC.

How Online Therapy in Maryland and DC Supports Father-Child Connection

My dad always kept his old baseball glove in the trunk—ready for a catch anytime, anywhere. As a Maryland and DC online therapist focusing on family and adult therapy, I’ve seen how small, consistent moments like these shape children’s growth and emotional security. Studies show that even brief quality time with dads boosts academic success and reduces risky behavior. If you’d like to see how online therapy can support father engagement, check out online therapy in Maryland and DC or explore this research on the science behind fatherhood benefits.

My Dad carries his baseball glove in the trunk of his car. It is very old and battered. The padding has become thin with age. The fingers are short and stubby, not long and laced as in today’s gloves. Today’s gloves are made to reach above the fence and snatch a home run away from the batter. Dad’s glove was made for catch and from the trunk of his car, it was always at the ready. He tore his rotator cuff about a year ago, swinging an ax. So, I doubt that he could toss a ball anymore, but the glove still travels. The potential is there.
The research on fatherhood shows that children listen more easily to the voice of father than they do to mother. Something about the tone or quality of the voice communicates a seriousness that is easily processed by even the youngest child. The research also shows that girls who spend more time with their father are brighter in school and more successful in math and science. Fathers are designed to have a powerful impact. Think of the wisdom to be imparted or the fun to be had. Yet, on the average, fathers spend only minutes with their children each day. Father’s rarely say “I love you” to their children, especially after the child becomes school age.
Inside of each of us is the desire for a Daddy. “Daddy” is someone who will be there all the time, someone who will know what we should do in this difficult situation someone who will support us and love us. We look for him first in our own fathers and if we don’t find him there we look in one relationship after another, in search of the strength and acceptance that we need.
We formulate our idea about a supreme being based on our earthly experience with father. That is a heavy burden for any Daddy.

TOSS A BALL
Sometimes on long car trips we would stop at a roadside park for a break and Dad would break out the glove. We would toss the baseball to him, chase after high flies and dive for grounders. The energy and relaxation in those brief moments was exciting. That glove represented the potential for relationship, any time and any place. He was always ready.
As we got older and moved away from home, the relationship did not change. Daddy was always there to listen and to guide.

TAKE A FALL
Dad’s are more likely to act out their feelings of love than they are to say it. Something about the words causes their tongues to get stuck or twisted. When they do fall out, they often get embedded in sentences like, “you know that your mother and I, we love you, don’t you son?” If he was familiar with that concept, why would you have to ask such a stupid question? When will they fall out in simple, direct form and just say “I love you”. Daddy must have practiced in the mirror or something. It always sounded so right.

ACCEPT THE CALL
Dad’s are special. They have a big responsibility. Their voice is often the one that we carry in our heads when big decisions are to be made. Fulfilling that responsibility takes a plan. One cannot be a Daddy without planning and setting the time aside to be in relationship. Too often, men are caught up in building castles for their families or inheritances for their children, rather than in building relationship. Being a Daddy takes a vision. What is your picture? How are you doing? When you review the year, can you list the times that you connected with your children? And a year from now, what will the picture include? Do they still call you Daddy?

Daddies leave lasting impressions through both actions and words. Whether you’re in Bethesda, Rockville, or Silver Spring, I offer online therapy throughout Maryland and Washington, DC to help fathers deepen relationship, build routines, and foster emotional connection. For practical tips and research on father engagement and child well-being, see this helpful article from Science Times on the “father effect” or visit my therapy resources in Maryland and DC.

A QUESTION OF MENTAL HEALTH: Are You a Bad Egg?

Man and wife reflecting during online therapy in Maryland and DC, discussing the Vote ‘Til the Cows Come Home process.

Effective Online Therapy Strategies in Maryland and DC for Family Conflict and Boundaries

Every family has that prickly relative who tests our patience. As a Maryland and DC online therapist specializing in family and adult therapy, I support clients in navigating challenging relationships with empathy and healthy boundaries. In this post, we explore how to stay calm, curious, and firm with difficult family members. For more on setting emotional boundaries, check out this article on how to set boundaries with relatives or learn how online counseling in Maryland can support your mental health and relationships.

Every family seems to have that one relative that is difficult to approach or be with and seems to have very hard edges. Of course, that person is never you! She could be your sister: the one who never calls unless she wants something or wants to let you know that you have really made her mad. It could be your brother who seems to know all of the vulnerable spots and takes advantage of this knowledge to hit you when you’re down. Sometimes it is the busy body aunt who seems so sympathetic and really understands what you’re going through, but next week when you hear your story coming back around through the grapevine, you realize that she was just out to grind the gossip mill.
So, just what is a body to do when the bad egg is on you?

DON’T BOIL OVER
My husband tells me that if I want to boil an egg, I should let it warm up a bit before immersing it in the water. I have never had the patience to watch an egg warm up. I plunk that sucker into the pot, cover it with water and turn the flame up to just below ‘trigger the smoke detector’. Then my usual routine is to go get into something else and forget about the 3 minute rule. Maybe Mr. Perdue will one day invent an egg with an alarm built in. By the time that I return to the pot, a white stringy scum indicates that the shell has cracked allowing the white insides to leak out into the boiling water. The chemistry here invariably causes the pot to boil over creating a gooey mess on the spill tray under the burner. Suddenly my three minute egg has turned into a half hour scouring project. Eggs are like toasted cheese. Yes, I manage to burn those all the time too!
The mess created by the rapid boil takes more time to clean up than watching the egg warm. Maybe I could learn to warm up to that prickly relative too.

DON’T CRACK UP
Do you check the egg carton before you leave the refrigerated case? Turning each egg to be sure that none are stuck to the carton because of a hair line fracture? Not me. Oh, I flip the lid alright to be sure no oozing mass is in there, but jiggling each egg seems to be a bit much. It’s not the time that it would take that gets to me, its more the looks from the other cart drivers.
Sometimes I care too much about what someone else might think. The prickly relative brings out the same dynamic. If I talk to her for too long at the reunion, someone will think that I like her or that I might be on her side in the next dispute. Truth is that I need to spend that time with her to learn what it is really like for her. Underneath all of the difficulty, she is fragile just like me. I could gently check out how she thinks or feels rather than slamming the lid shut with my assumptions.

DON’T TURN GREEN
Remember the Dr. Zeus book about green eggs? What a disgusting thought. Same feeling waves over me when that prickly person is on the phone or looking to visit. A green sickness comes over me and inside of 3 seconds, I have run a complete video of how this weekend will go. It’s the Titanic in fast forward. That rush to disaster makes it hard to come back to the present and prepare for the visit.
Have I ever been curious about this person’s history or hopes or needs or longings? If I can stop feeling sick and start being curious, this visit can help me see her as a complex person rather than a vile entre’.

 

When you find yourself dealing with a “bad egg,” remember that compassion, curiosity, and clear boundaries go a long way. Whether you’re in Silver Spring, Bethesda, or DC, I offer online therapy throughout Maryland and Washington, DC to help individuals and families improve communication, resolve conflict, and restore emotional safety. For practical strategies to strengthen your relationships, you might also consider family therapy techniques or consultation. Together, we’ll support you in creating healthier dynamics and peace of mind.

A QUESTION OF MENTAL HEALTH: Are There Really Witches in the Basement?

Person quietly reflecting while reading, symbolizing school anxiety and the need for emotional support through therapy in Maryland and DC.

Helping Kids With School Anxiety

Starting school is a major milestone, but for many children, it’s also filled with invisible fears. As a Maryland and DC-based online therapist for families and children, I often help parents decode their child’s anxiety through stories and drawings. This post shares one mother’s experience navigating her daughter’s school fears and offers guidance on how to handle anxiety before the first day. For more information on how online counseling works, you can also visit this helpful guide or learn more about school anxiety and mental health from the Child Mind Institute.

A mother’s story:
She is 5 years old going on 6 and first grade is just around the corner. The summer will soon end and the serious business of school will begin. She knows where she will be going because we drive past the building regularly. Each time, I cheerfully point to the sprawling brick façade announcing that she will soon be in first grade. I describe my first grade teacher with fondness in hopes that her fears will be calmed. She usually sits quietly in the seat next to me staring straight ahead. Occasionally she will boldly announce that she is not going to school. She sees no need for the exercise. She is perfectly content learning at home from her siblings or neighbors. She already knows how to read and assures me that she can learn anything that she needs on her own. I sigh and steel myself for the battle that I know will ensue in the fall.
Lately, she has been drawing pictures of the school building. It is usually quite large on the page and the basement windows are particularly menacing. The latest version has a black figure oozing between the bars on the windows. The fingers are pointed, the mouth is full of teeth. This is the witch that lives in the basement of the school. I try to explain the modern construction technique of slab building that eliminates the need for a basement. I know that the building has no basement, but my arguments are to no avail. Someone has convinced her that a witch lives under the classrooms. I go looking for her brother.
At first he pleads innocent then admits that it was a great tease. He knows that she is afraid of beginning first grade and he just couldn’t resist the story about a witch living in the basement. He defends himself by saying that a few of his elementary teachers were witches so it is not really an exaggeration. This is going to be a long year.

DRAW ON YOUR OWN EXPERIENCE
Reflect on your own experience of elementary school. Tell the stories that you haven’t thought of for years. My second grade teacher put a large wire cage in one corner of the room. In that cage we watched “Bitty Hen” live and lay eggs and hatch baby chicks. It was marvelous! Looking back, I do not know how “Bitty” survived the stress of all of those voices, and noses pressed against the wire each morning. For all I know, the teacher may have gone through numerous chickens without our knowing. “Bitty” was the center of attention and our class was the talk of the school.
Even if your stories are tragic, they are worth telling. Your child will take comfort from knowing that they are not the only one who has ever been afraid of school.

DRAW OUT THE FEAR
The witch in the basement is more than a brother’s tease. The child who is afraid of separating from mother or afraid of performing in school is trying to communicate that fear. Your child’s fear should be taken seriously. Listen to the fear and draw out more information by saying “tell me more”, ” tell what will happen next”. Using these specific phrases will encourage your child to explore the fear and help your child to feel secure because you are taking the fear seriously. Leave questions behind. They demand rational and specific answers. Fears are usually not rational or specific. You will learn more with the “tell me” approach.

DRAW A BOUNDARY
Once you know more of the nature of the fear, you can draw protective fences to create a sense of safety and comfort for your child. You may want to consult with the school psychologist before school opens to get more ideas of how to create a sense of comfort that your child can carry from home to school. The child who is afraid of leaving mother behind, can be comforted by taking some specific token or symbol of Mom to school. These treasures can help to calm a child’s fears and refocus the child on the task at hand. The child with learning problems or fears of performance can be comforted by clear expectations that are easily attained. Do not be afraid to set lower expectations at first and gradually raise the bar as your child’s comfort increases. Stay away from asking your child to do his or her best. Make the expectation specific and concrete. At the end of the day, you should both be able to easily see that the child has been successful. Even the simple task of bringing your lunch box home can be a mark of success for the first week.
If the fear persists beyond week 2, consult a professional. Early intervention will save a lot of heartache for you and your child.

If your child is expressing fear about school, take it seriously and respond with patience, structure, and empathy. Whether you’re in Silver Spring, Bethesda, or Washington, DC, I provide online therapy throughout Maryland and DC to help families manage anxiety, transitions, and emotional challenges. For more tips on how to approach emotional readiness, check out my therapy resources or explore this article on how to support children with anxiety.

ADHD The Price We All Pay

ADHD comorbidity circle diagram

Understanding ADHD’s Impact on Society: Why Early Identification Matters


In Maryland, Washington, DC, and across the country, the emotional and financial toll of undiagnosed ADHD is far-reaching. As a licensed psychologist specializing in online therapy for adults and families in DC, I often see the long-term effects of delayed diagnosis. In this post, I examine the societal cost of untreated ADHD, the barriers to early intervention, and why timely support is essential not just for individuals but for our communities at large. If you’re wondering whether therapy might be the right step, I invite you to explore my therapy FAQ for Maryland and DC or review this summary from the CDC about ADHD in children and adults.

Gloria Kay Vanderhorst, Ph.D.ADHD is a life long condition. Like other chronic conditions, interventions lead to improvements and early interventions are beneficial. Edward Hallowell, M.D., a leading expert in ADHD, is a strong advocate for early identification because he recognizes the emotional damage caused by the child’s experience of frustration and failure and the pain of being labeled as ‘stupid’ or ‘difficult’. When identification is delayed, emotional costs easily translate into higher social costs. The price we all pay can be examined by looking at four areas of social significance: work force productivity costs, direct and indirect medical costs, auto accident related costs, and incarceration costs.
Work force productivity can be examined by looking at educational success and household income figures. According to studies conducted by Joseph Bierderman, M.D., professor of psychiatry at Harvard Medical School, ADHD is present in over 8 million adults or 4.3% of the adult population in the United States. These adults tend to be undereducated with fewer graduating from high school. Those who do graduate are less likely to finish college or go on to complete graduate degrees. Therefore, they end up under-employed and more frequently experience periods of unemployment throughout their working years, resulting in a dramatic loss of household income. A 2003 survey estimated that the annual loss of household income attributable to ADHD ranged from $67 billion to $116 billion. For an impact comparison, consider that the medical cost associated with cigarette smoking in the United States in 1998 was approximately this same amount when the country began to declare legal warfare on the tobacco industry.
The direct and indirect medical costs associated with ADHD are related to work force productivity and comorbid conditions. Workers Compensation claims are higher among adults with ADHD and unofficial absences from work are four times more prevalent in this population. A 2000 study extrapolated to the national level from data for a large corporation indicated that employers spend $13.7 billion for medical costs related to employees with ADHD. When you add in the cost of comorbid disorders, the price nearly triples. Adults with ADHD are more often diagnosed with asthma, anxiety, bipolar disorder, depression, drug or alcohol abuse, antisocial or oppositional behavior. The medical impact of these comorbidities costs an employer three times more medical dollars than they would spend on an employee without ADHD. The estimated total cost for employers in the United States for the year 2000 was $31.6 billion.
The social impact of lost work productivity and associated medical costs should cause us to mobilize our resources to intervene earlier. However, neither of these has the life threatening impact that has been associated with auto accidents. Automobile accidents are the leading cause of death among teens between the ages of 15 and 20. This statistic has resulted in some states increasing the legal age for obtaining a driver’s license. According to a study at the University of Virginia, teens with ADHD are two to eight times more likely to have an auto accident and four times more likely to be at fault for the accident. When teenage passengers are in the car, the likelihood of an accident increases along with the fatality rate. According to Russell Barkley, Ph.D. teens with untreated ADHD have a higher incidence of traffic violations than their peers, especially speeding. In 2005, the Insurance Information Institute noted the average cost of an auto accident involving bodily injury was more than $10,000. Jury awards in auto liability cases are also a factor in the social cost of auto accidents. According to Jury Verdict Research in 2003, which is the most recent year for complete data, the average jury award in personal injury auto accident cases was $261,000. The insurance industry spent over $4.1 billion defending their policy holders in liability cases in 2004 and that cost has continued to rise in 2005 and 2006. For insurance premiums that translates into about 60% of the cost. None of these surveys can calculate the social cost of the lives lost.
Lost lives are also visible in the justice system where people with ADHD comprise almost 40% of the population. A recent study by Dr. Paul H. Wender in the state of Utah prison system indicated that inmates with ADHD are often misdiagnosed with bipolar disorder or depression. The total prison population across ages and types of incarceration in the United States today is approximately 1.71 million people. This is the highest rate of incarceration for any industrialized nation in the world today. The only nation to remotely approach this rate was South Africa during apartheid. In fiscal year 2005, maintaining one inmate in a Federal Bureau of Prisons facility cost $23,431.92 and $20,843.78 to keep a Federal inmate incarcerated in a community correction center. That means that the country was spending over $40 trillion to house Federal prisoners in 2005 and if 40% of those have ADHD, we are spending over $16 trillion on that population alone.
Each of these social costs is significant by themselves: lost income of $67 billion to $116 billion, corporate medical costs of $31.6 billion, incarceration costs of $16 trillion and uncountable loss of life due to auto accidents. Where is the outcry for early identification and intervention to aid us in reducing these costs? Most children are not identified until they attend elementary school at age six and here the identification favors boys who are physically acting out or have difficulty following the rules. Often children are not identified until the 4th grade when the child’s performance is no longer heavily dependent on memorization, repetition and basic skills. This pattern of later identification still neglects the needs of most girls as well as boys who are academically gifted and more inattentive than hyperactive. Many girls go undiagnosed until late high school or college.
Why don’t we require screening for ADHD at the preschool level? A major deterrent for early identification has been fueled by parents, teachers and pediatricians who see the symptoms of ADHD as too close to the developmental characteristics of the typical preschool child: high energy, impulsivity, and a short attention span. The lack of knowledge about the life long cost of ADHD also contributes to this failure of early identification and intervention. Multiple research studies clearly point out that early experience is critical in brain development and shaping later behavior; therefore, early assessment for ADHD is critical for later success. A thorough physical examination, neuropsychological battery, full family history and clinical observation of the child can discern between the normal exuberance of a preschooler and the processing difficulties of an ADHD child. The cost of delaying assessment is too high a price for the individual and for our society.REFERENCES:
Lenard A. Adler, Thomas Spencer, StephenV. Faraone, Ronald C. Kessler, Mary J. Howes, Joseph Biderman, Kristina Secnik. Validy of Pilot Adult ADHD Selp-Report Scale ( ASRS) to Rate Adult ADHD Symptoms, Annals of Clinical Psychiatry, Volume 18, Number 3/July-September 2006. pp 145-148.
Edward M. Hallowell, M.D. Young Children with Challenging Behavior: What to know-What to do. Institute #2. The Learning Lab @ Lesley and The Early Childhood Institute, January 2004.
Colorado Department of Corrections, FY 1980 to FY 2004, Operating Budget, Joint Budget Committee, Appropriations Report (FY 1983 throug FY 2004)
Marcotte, D.E.; Wilcox-Gok, V. Estimating Earnings Losses Due to Mental Illness: A Quantile Regression Approach. Journal of Mental Health Policy Economics, 2003; 6(3): 123-124.
M. Rösler, W. Retz, P. Retz-Junginger, G. Hengesch, M. Schneider, T. Supprian, P. Schwitzgebel, K. Pinhard, N. Dovi–Akue, P. Wender and J. Thome. Prevalence of attention deficit–/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates. European Archives of Psychiatry and Clinical Neuroscience. Volume 254, Number 6, December, 2004, pages 365-371.
National Highway Taffic Safety Administration. Traffic Tech. Technology Transfer Series, Number 131, July, 1996.
National Center for Statistic and Analysis of the National Highway Traffic Safety Administration. Traffic Safety Facts 2004. Available at: www.nhtsa.dot.gov. Accessed June 22, 2006
Gary Kay, Ph.D., Washington Neuropsychological Institute, USPMHC Poster #241, Tuesday, November 8, 2005, 6:45 PM EDT. “The Effect of MAS XR on Continuous Performance Testing in Young Adults with ADHD.”
Barkley RA, Murphy KR, DuPaul GH, Bush T. Driving in young adults with ADHD: Knowledge, performance, adverse outcomes, and the role of executive functioning. J of International Neuropsychological Society. 2002, Volume,8, pages 655-672.

If you or someone you care about is struggling with attention, focus, or impulsivity, early evaluation and support can make all the difference. I offer secure, confidential online therapy throughout Maryland and Washington, DC for individuals and families facing challenges like ADHD, anxiety, and trauma. To learn more about how I work, visit my therapy for anxiety and trauma in DC page or schedule a consultation today. If you’d like to better understand how ADHD manifests in adults, I also recommend this article from CHADD (Children and Adults with ADHD). Together, we can reduce the emotional burden and improve long-term outcomes—starting with a conversation.