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January 18, 2017 / 20 Tevet, 5777

Posts Tagged ‘LMSW’

Strep Throat And Anxiety: Is There A Connection?

Wednesday, May 13th, 2009

Rachel is a bubbly and adorable 8-year-old girl. From a young age, she was afraid of the dark, but after a minimal amount of coaxing, would eventually go to bed. Outside of the home, Rachel loved school, excelled in her classes, and looked forward to going to school each day. Suddenly, one night, all of this changed. Rachel would not go to bed. She claimed she was afraid of the dark. After four hours of her mother sitting beside her bed, Rachel finally fell asleep; however, she awoke an hour later screaming, “Please don’t leave me alone. I can’t be alone.” Rachel’s mother, in an effort to calm her down, spent the night on the floor beside the bed. Even so, Rachel woke about every half-hour to check that her mother was still there.

The next morning, Rachel refused to go to school and screamed, “I am afraid and I can’t leave you, Mommy.” Her mother was confused by this behavior but reluctantly brought her to school even as Rachel kicked and screamed. At school, she continued to cry all day and even fell asleep a few times. At bedtime that night, the same scenario replayed itself. At this point, Rachel’s mother knew that there was something wrong with her daughter, but she could not figure out what the problem was. Rachel seemed fine: she had no fever, no rashes, no pain that she complained of in her ears or throat.

When this strange, fearful behavior went on for a few weeks, her parents took Rachel to the pediatrician for advice. Their pediatrician examined Rachel and could not find physical symptoms, so she sent them to a psychiatrist. While the psychiatrist gave Rachel medication that somewhat eased the behavior, her mother noticed that her daughter was still not the same Rachel. Bedtime and leaving to school were still rather difficult. Her mother spent many hours on the Internet trying to figure out what was wrong with her once happy and lovable daughter. She discovered information about a syndrome called PANDAS that she believed was the cause of Rachel’s anxiety and fear.

In 1998, Dr.Susan Swedo, from the Pediatric Developmental and Neuropsychiatry branch of the National Institute of Mental Health, found a connection between strep throat and anxiety, obsessive-compulsive behavior and tics. This syndrome is called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). PANDAS often occurs when a child who has not yet reached puberty has strep throat that goes untreated or unnoticed. In every bacterial infection, the body produces antibodies to fight against the invading bacteria, and eliminate them from the body. In the case of PANDAS, the strep reacts with a part of the brain called the basal ganglia, which causes the child to act as if s/he is suffering from a mental illness. For example, a child, like Rachel, who is slightly anxious wakes up one day and is extremely anxious and has a hard time functioning. Or in other instances, a child may suddenly begin to chew on his or her collar or twirl her hair obsessively. Similar to Rachel’s mother, parents are usually able to pinpoint a certain day when their child began to exhibit these extreme symptoms.

If you feel your child’s behavior has suddenly changed and suspect that he or she has PANDAS, it is important to see a pediatrician and have a throat culture and a blood test done. Take into account, there are times that the culture may come back negative but the antibody levels in the blood may be very high. If the levels are high, the child needs to be put on antibiotics. Studies have shown that PANDAS responds to an antibiotic called Zithromax. There are various ways in which this antibiotic is used to treat the PANDAS. This needs to be discussed and administered by your pediatrician.

Once it is confirmed that it is PANDAS and the child is on antibiotics, the child should be taken for some cognitive behavioral therapy (CBT) to help eliminate the negative symptoms that have become ingrained in his or her everyday routines. CBT means that with the help of a therapist the child can teach her brain to think and act in a different way than it operated in the past. CBT is based on the idea that our thoughts cause feelings and behaviors. The benefit is that if the child can change her thoughts, she can change her behavior. While the antibiotics help to erase the exaggeration of symptoms, CBT helps to eliminate all fears, tics, behaviors and anxieties.

When Rachel’s mother read about PANDAS, she believed that her daughter was suffering from the syndrome. She was a bit confused, though, as Rachel had no strep symptoms. Regardless, she took her to the pediatrician who took a strep culture. While it came back negative her antibody levels were very high. The doctor put Rachel was put on a course of Zithromax, and with the consent of the psychiatrist weaned her off the psychiatric medication, and she then came to see me for CBT. We worked together on ways to help her conquer her anxieties and together with the antibiotics in a matter of weeks, Rachel once again became the sweet lovable girl who loved school and could sleep in her own room by herself.

Another client I worked with was an 11-year-old boy named Josh. Josh had been very social and was a straight-A student. Like Rachel, he, too, suddenly developed some rather strange behaviors. He would constantly smell his hands and explained to his father, “I think they smell. I keep checking to see if they smell.” He also acquired a tic in which he was constantly rubbing his eye and shrugging his shoulders. With this tic, Josh would also constantly bite on his shirtsleeve. Aside from his strange tics, Josh’s grades in school began to drop and his friends stayed away from him.

Josh’s parents were confused by this abrupt change in their once friendly and clever son. Eventually, they took him to the pediatrician who thought that they should test for PANDAS. While Josh had no strep symptoms, his culture came back positive and his antibody levels were very high. The pediatrician put him on a regimen of Zithromax and sent him to me for some CBT. After several months, with the help of CBT Josh was able to control the thoughts and actions that seemed to overtake him. Miraculously his tics and shirt biting all disappeared. Josh started to do well in school again and his friends began spending time with him again. His mother once told me that she feels that with the identification of PANDAS and work with CBT “a cloud has lifted from her son.”

Only recently has PANDAS become more acknowledged by pediatricians. Even today, it is still not completely understood or accepted by the medical community. Regardless, PANDAS and its devastating effects is afflicting many of the children in our community. Strep is spread easily in our highly populated schools and large families making us more susceptible to PANDAS. Those who have been treated have been able to see tremendous improvement from antibiotics and CBT. It is important for all parents to educate themselves on this topic and if they suspect their child might have PANDAS, they need to have them tested and arrange for therapy. As Rachel and Josh’s parents can attest, PANDAS is a frightening thing to watch happen to a child, however, we can all take comfort in the support available and the real possibility for recovery.

*Names and some details have been changed to protect the client’s identity.

Michal Geffner is a LMSW psychotherapist practicing in the Flatbush area sharing office space with Vicky Harari. She specializes in anxiety disorders in children and adults and has a broad spectrum of training and experience in all fields. Michal Geffner may be contacted at (718) 692-2289 ext. 2; or by e-mail at michalgeffner@gmail.com.

Michal Geffner

Helping Children Cope With Trauma

Wednesday, March 4th, 2009

Dear Rabbi Horowitz:

Our family is recovering from the terrible, unexpected loss of a loved one who passed away far too young.

My husband and I have differing views on seeking professional help to help our children cope with the tragedy. (Thankfully, at least on the surface, they all seem to be doing well.) I am strongly in favor of seeking this help, while my husband, who is an amazing father and has been our bedrock throughout this ordeal, thinks that we should leave well enough alone and not subject our children to the agony of pouring their hearts out to a stranger.

We are regular readers of your columns and recently re-read your “Open Letter to Teens Who Lost a Parent,” where you very clearly encourage them to seek help if they are having difficulty dealing with their grief. But what if they don’t seem to be exhibiting any such signs?

We would greatly appreciate your thoughts on this matter.

Respectfully, Susan

Dear Susan:

Al regel achas (literally “on one foot”), I would most certainly encourage you – in the strongest terms – to seek out the assistance of a trained, mental health professional to help your children (and their parents) cope with your grief. However, as this is a topic where input from a mental health professional is crucial, I reached out to Moshe Borowski, LMSW, ACSW, who graciously accepted my invitation to share his thoughts with our readers on the subject of grief counseling and the overall topic of helping children cope with trauma. Below, please find his slightly edited response to your letter.

For background, Moshe has spent more than two decades counseling members of our community who have suffered losses. Over the past 10 years, he has always made himself available to me, around the clock, whenever I’ve called him on behalf of individuals suffering through traumatic events who have reached out to me for guidance. I am profoundly grateful for this. On behalf of our readers, I would like to express my gratitude to Moshe for taking the time from his busy schedule to respond to these questions. Here are his comments:

At the risk of sounding self-serving, I strongly concur with Rabbi Horowitz’s advice for you to seek professional help in aiding your family members through this trying time in your lives. It is common for children and adults to “look OK” on the outside, but doing very poorly on the inside.

As a trauma therapist, I am often called upon to lend a helping ear after accidents or deaths. While situations should always be dealt with on an individualized basis, here are some general tips for helping children cope with trauma:

Explain that their feelings and reactions are normal and acceptable. Children often fear that they are weird or “going crazy” due to what they are experiencing. This additional level of distress can complicate attending to their inherent reactions to the incident.

Being reassured that their experiences are shared by many (while being careful not to minimize the uniqueness of what they are going through) is a tremendous relief. Keep in mind the incisive adage of the psychiatrist/author Dr. Viktor Frankl, a Holocaust survivor who wrote the seminal work, Man’s Search for Meaning: “An abnormal reaction to an abnormal situation is normal.” [Emphasis added]

Stress the importance of family unity. Explain that the entire family is going through this together. Children may be concerned that they are alone in their thoughts and feelings. Knowing that you are there with them – and for them – is exceptionally comforting. “Imo Anochi b’tzarah – I (God) am with a person in his troubles,” the Psalmist tells us. Hashem’s empathic caring, so to speak, is an essential trait for us to emulate.

Be an “Active Listener” – even if they have already described the incident and their responses to it. Make sure to maintain your composure and, if needed, have someone available that you can turn to for support. If you are unable to accomplish this, explain that the situation is difficult for you as well, and have your spouse or another familiar adult (family member, friend, neighbor, teacher, rabbi) “be there” for the children. Keep in mind that on some level, your child may be asking, “Will this happen to me and my family? Who would take care of me? Will I really be okay?”

Initiate hands-on projects. When trauma occurs, children feel as if their world has turned upside down. There is no longer any feeling of control, power or safety. This can be terrifying for anyone, especially children. It’s the role of adults to help restore some sense of control, at least over the “inner world” which we all carry around. Be sure to allow them input in choosing their projects. They can write stories and poems, or opt to paint and draw. They can focus on the event or express themselves in general terms. Encourage children to give tzedakah, preferably to a charity or fund where they can directly sense that they are helping people directly.

Stick to routine and be flexible. Which one is it? Actually a little of both. Routine can provide a child with structure and comfort. But be prepared for the distinct possibility that compromise and flexibility may also be needed. Schedule some extra time for them to fall asleep, read or play. If you feel that a young child needs to sleep with you for the night, or that you need to go into his or her room to facilitate sleeping, use expressions like, “Since it has been such a tough day, you can join us for tonight.” You want to avoid unwittingly fostering a situation where your child now “needs” to constantly sleep in your room.

Take care of yourself. Make sure that you have someone to vent to (spouse, sibling, neighbor, friend, rabbi/rebbetzin, therapist). Review some of the tips for children and find those that are also applicable to you. Be sure to exercise and find time for the things that give you emotional energy. Always keep in mind that the healthier you are – in body and spirit – the better positioned you will be to help your children when they need it most.

Moshe Borowski, LMSW, ACSW, is the founder and director of SSTART (School & Synagogue Trauma and Resilience Training), a non-profit organization helping children and families, schools and communities cope with various types of trauma or loss. He is also in private practice in Brooklyn and the Five Towns. He has been involved in counseling, chinuch and kiruv for over 25 years. SSTART can be reached at HealTheHurt@gmail.com or 646-673-5909.

Rabbi Yakov Horowitz

A Guide To Visiting The Sick

Wednesday, December 3rd, 2008

 They have how-to literature on just about every subject and fortunately one has come out on visiting people who need to recover from an illness. Entitled, Good Company – Facts and Fictions About Bikur Cholim, the publication is from the Rabbi Isaac N. Trainin Bikur Cholim Coordinating Council, a program of the Jewish Board of Family and Children’s Services (JBFCS).

 Utilizing a comic book format, Good Company dispenses practical information on how to make a Bikur Cholim visit effective and compassionate. Rather than just walking into a hospital room and not knowing what to say or saying too much, this publication offers the wish that “we fulfill this mitzvah with thoughtful consideration, and therefore bring light and healing to the world.”

 When I read the section that calls on visitors to “respect the dignity of the person who is ill” and to “knock before entering” and to ask permission if they want a visit, I am reminded of a time when I did none of the above. I was working in a nursing home and a colleague and I were going from room to room doing comedy routines in an attempt to cheer up the residents. We had a modicum of success doing slapstick including my colleague taking a 6-foot piece of wood and pretending to use it as a toothpick to get some salami out from between his teeth.

 One room we walked into (without a knock and without asking if our comedy was welcome) had four men lying on their respective beds. We got into our performance without much of a response from the first three patients in the room. We moved to the last bed to try and entertain the fourth man who had his back to us. Perhaps because we were being ignored, we raised our volume. I’ll never forget how the man calmly turned around and I saw an unshaven face with a look of incredulity as he squinted his eyes and tried to make some sense of what he was seeing. He said in an annoyed tone, “Do I come into your house and do this!” And then he turned his back to us again and tried to go back to sleep. Bravo to him for saying the absolute right thing.

 “Good Company” offers a lot of seemingly small, but very important practical tips. For example, it notes, “Be respectful of your body language. For example, sit at eye level if possible.”

 A few months ago I was visiting a man who cannot get out of bed. I was telling him a D’var Torah, standing over him at bedside. A friend who went with me on the visit pulled a chair over and motioned for me to sit down, indicating that the man in bed was having difficulty focusing on me in a standing position.

 There are many other food-for-thought guidelines for visiting in the publication including to “look around the room for clues for conversation,” “bring news from the outside to lessen feelings of isolation,”  “send a letter, card or call if you can’t visit in person,” “show up when you say you will” and to “thank the person for letting you visit.”

 When you can express genuine gratitude at the end of the visit, it tells the other person that being there was not a burden and was, in fact, a positive experience.

 The publication, in comic book style, insightfully describes a number of “fiction” and “fact” issues about bikur cholim visits. For example, one “fiction” listed is “Bikur cholim is only for outgoing people,” followed by the “fact” that “sometimes it’s your presence more than your words that makes you good company.”

 The Rabbi Isaac N. Trainin Bikur Cholim Coordinating Council is a year-round organization that offers an educational annual conference every November. Also offered: a short documentary film, “Turn to Me,” on bikur cholim; an interactive training video with the booklet, “The Act of Visiting;” a website with tools and tips on visiting, and on-site training workshops in the community.

 I led a workshop at the most recent November 9 Bikur Cholim annual conference on the topic of having meaningful interactions with people with Alzheimer’s, dementia and age-related memory loss.

 For more information on the Rabbi Isaac N. Trainin Bikur Cholim Coordinating Council, including information on the “Good Company” comic book, contact Robin Schoenfeld, LMSW, 212/399-2685, ext. 212 or e-mail at bikurcholimcc@jbfcs.org.

There is a bed-bound man who is not very verbal, but enjoys visitors on Shabbos and other days. He enjoys hearing a D’var Torah and visitors can read to him from seforim at his home. He is very bright and has one of the most sincere smiles of gratitude I have ever seen. He lives in Midwood, Brooklyn. If anyone wants more information on how to visit him, contact me at pr2hope@aol.com.

 A Daf Yomi shiur open to the community is given at Scharf’s Ateret Avot Senior Residence, 1410 E. 10th Street, Midwood, Brooklyn. It meets at 2:30 p.m. from Sunday to Thursday and 11:15 a.m. on Friday. Call 718/998-5400 for more information.

 There is a Mah-jongg class that meets at the Jewish Community House of Bensonhurst, 78-02 Bay Parkway, on Thursdays from Noon to 2:45 p.m. For more information on this free group for people 60 or over, call Diane or Lisa at 718/943-6311.

 Concluding thought: On days of inclement weather, before going to a food store, it’s an act of chesed to ask neighbors that have difficulty in getting out in such weather if they need juice, milk or other items.

Alan Magill

Printed from: http://www.jewishpress.com/sections/books//2008/12/03/

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