Guest Post: Sleep Apnea and "ADHD"

By Kim Bureros

It’s truly shocking how many kids today are diagnosed with attention deficit hyperactivity disorder (ADHD). At one point, the United States almost acknowledged the condition as an epidemic. However recent studies have shown that the problem in some cases may be centered on parents, who believe the child to be suffering from ADHD, when, in actuality, they’re suffering from a sleeping disorder or sleep deprivation.

In the National Survey of Children’s Health (NSCH) from 2007, they interviewed over 91,000 parents about their children and asked various questions about ADHD. From this survey, it was determined that parents assumed that 1 in every 10 kids has ADHD, making for about 5.4 million kids in the United States alone! If the parents’ diagnoses were accurate, then there has been a stark 22% increase in ADHD diagnoses since 2003.

These statistics would be more horrifying, however, if each of these parents were an ADHD expert. Nowadays, an energetic child or kinesthetic learner seems to be labeled ADHD—almost as if it’s the brand everyone turns to. However, there are many other possibilities for what’s really going on.

First of all, are parents letting their kids get enough sleep? Children respond differently to sleep deprivation than adults. Rather than become fatigued, many actually become more rambunctious if they haven’t received enough sleep, putting them in a state of delirium. This delirium can easily be misread as hyperactivity, and the sleep deprivation consequence is the inability to focus.

A lot of the recent diagnoses of ADHD in children are simply due to parents not providing strict bedtimes due to ineffective discipline, or even neglect, and letting kids stay up as late as they please. However, even if a child is sent to bed at a proper time, if they’ve been playing on their phones, with video games, or in front of the computer, they’ll actually be in a heightened state of excitement, making it more difficult for them to fall asleep at night. 

Additionally, letting a child fall asleep in front of artificial light—as from a TV screen—can actually inhibit a child’s sleep cycle because their body will have difficulty differentiating between day and night. All these factors and bad habits are training the child’s body to be confused about when to be awake and when to sleep.

Of course, the worst - and not uncommon - scenario is prescribing a child with ADHD medication (Ritalin, Adderall, etc.) when they don’t actually suffer from the condition. Ritalin and Adderall for instance, are stimulants, and if a child is unable to fall asleep this will grievously affect their sleeping ability. 

It’s also not unheard of for kids to suffer sleep disorders, and a child may not understand that they are not getting enough sleep —which is more common than you think. If a child is suffering from insomnia, then the added ADHD stimulant medication will only worsen the child’s condition—sadly, most parents then decide to “up” the prescription.

This is increasingly dangerous as studies and reports are showing that ADHD medication can actually have adverse effects on boys and girls entering puberty.

Another common cause of sleep deprivation is sleep apnea. Sleep apnea is the result of the tissue at the back of the throat relaxing too much, and thus constricting breathing. This can result in snoring, but often does not. People suffering from sleep apnea are not getting enough oxygen and have brief periods where they stop breathing altogether. 

Although the sudden halts in breathing only happen for 3-5 seconds, these may happen hundreds of times throughout the night. The result is the brain and body cannot regenerate cells, and people never achieve the most restorative part of sleep: their REM cycle. This results in excessive sleep deprivation, which makes a child unable to focus, be hyperactive, and unresponsive—also key determinants for an ADHD diagnosis.

Sleep specialists determined that 90% of people suffering from sleep apnea go undiagnosed. Since most people are not aware that they have it, key indicators they should look for are: family history of hypertension or heart disease, snoring, drowsiness during the day, obesity, or depression and anxiety (for more information visit sleepdisorders.com for details). Most parents, however, would rather prescribe medication than spend one night in a sleep lab. And many pediatricians and doctors are only recently asking about sleeping habits as a factor in health.

ADHD should not be the go-to problem for parents. If your child is acting up, take a step back and see if you’re allowing them to stay up too late or stay up in front of a television. If they’re getting enough sleep, make sure its quality sleep. It is better to spend one night monitoring your child than having them spend a lifetime on “corrective” pills. 

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The author: Kim Bureros is a Copywriter for sleepdisorders.com. She has extensive experience with writing, blogging, and internet marketing and has concentrated on medical copywriting for the past few years. She firmly believes that “building relationships is the key to success.”

Freddie the Freeloader and Minnie the Moocher Update

In my post of August 10, 2012, Freddie the Freeloader and Minnie the Moocher, I described how family members often enable other family members – usually adult children but any family member really – to be deadbeat no-accounts who refuse to grow up, get jobs, and move out on their own. The Freddies and Minnies continue to mooch off of the enabling family member with that family member’s almost compulsive and enthusiastic cooperation - in many cases while simultaneously being criticized unmercifully by them all the while they are being enabled by them.

Well, if letters to advice columnists are any indication, this problem continues to expand in a variety of interesting ways. 2012 seems, in fact, to have been a banner year for Freddies and Minnies. Below are some examples of letters by concerned outsiders, and sometimes from the clueless enablers themselves, from the advice columns Dear Abby, Carolyn Hax, Ask Amy, and Annies’ Mailbox.

The root cause of this enabling in a majority of cases of such enabling is, IMO, parental guilt over having their own lives separate from their children in situations in which the enablers' own families of origin frown on individualistic pursuits.

I considered turning this post into a game of Are the Freddies/Minnies just doing what is expected of them by their enablers, or are they in fact mentally ill? That issue came up in some of the letters. I decided against doing this because it would not be much of a game. None of the Freddies and Minnies described in these letters is bipolar!!

I apologize in advance for the length of the post. I like to illustrate all the different ways a phenomenon I discuss can present itself (and also illustrate how common it is), but they all do kinda boil down to the same thing. Read as few or as many of these 35 [!] letters as hold your interest.

1.      1/19/12.  Dear Annie: I am in a relationship with a widower. He is a thoughtful person and works two jobs. His two adult sons live in his home with their girlfriends. Neither of the boys pays rent. Nor do they buy groceries or cleaning supplies. They never offer to take their father out to dinner or do anything special for him. Their father buys their vehicles and pays their insurance. The house is in shambles. The boys' only responsibility is to take the trash to the dump and mow the yard in the summer. They do this grudgingly and not very well. The boys show little respect for their father. They leave beer bottles and dirty dishes all over the kitchen and their shoes, dirty clothes and trash all over the house. No one cleans a bathroom or vacuums a floor. They are busy working out, doing what they want with their friends or going out drinking. One of the girlfriends is always broke and looking for a handout, but she has money to get hammered every weekend. She doesn't lift a finger around the house and has the nerve to tell my boyfriend what he needs to buy to make her more comfortable.  My boyfriend thinks that this is normal behavior and that I am the one with the problem. He believes it is his responsibility to take care of them, because they don't have "good" jobs that pay a lot of money. He would never kick them out.  We don't live together and never will under these circumstances. My boyfriend reads your column every day. Will you tell him I'm not the only one who thinks this situation stinks? — Kick 'Em Out!

2.      1/25/12.  Dear Annie: I have two sisters. They never have been financially savvy, especially when it comes to saving money. They start and then decide it's a waste of time and end up spending everything they set aside. I'm the opposite. I have always saved for whatever I needed or wanted. My grandfather got me into the habit when I was 10, and I kept it up long after he passed away. Over the past 15 years, I managed to save quite a bit. But when my parents saw what I had, they demanded that I share it with my sisters. I absolutely refuse. This is my money. I earned it. I saved it. And I told them that. Since then, I've been receiving messages from my parents that "families help each other out" and "families share." My parents have always given my sisters money whenever they needed it. When I was in high school, I would always give them money when they needed it. Now that the folks are retired, they say it's my job to help my sisters. I say it's not. Why should I give them my hard-earned income because they can't be frugal? I feel as though I am being punished for being financially responsible. My sisters haven't saved a dime toward their own retirements, so this is only going to get worse. What can I do? — Stuck in the Middle

3.      2/7/12.  Dear Annie: After 40 years of marriage, my wife came home from work one day and said she was leaving. I decided then that I would never marry again. Four years ago, I met "Lynn." Now, of course, I am madly in love with her. She never ceases to amaze me with her big heart and infectious smile. She accepts that I don't want to marry, but I have noticed that when someone gets engaged, her mood changes dramatically. She becomes depressed and cries, and I can see the hurt in her face. I've decided I do want to marry Lynn, but the problem is her 20-year-old son, "Mike." He is bipolar and uses that as an excuse to sleep all day and play video games all night. He once said he can't get the mail because he is bipolar. He lives with multiple friends, each of whom eventually kicks him out because he won't help out and he steals from them. When Mike lived with Lynn, he stole from her, screamed at her, snuck out at night and got into legal trouble. They went to counseling together, and Lynn was on serious depression medicines until Mike moved out. When Mike calls, Lynn breaks out in a nervous rash. Mike stayed here for two weeks last year and hacked my computer, watched porn all night and stole from us. Lynn and I are scared to death that he will run out of housing options and she will have to take him in. My heart says to marry Lynn, but my head doesn't want to take on the issues with Mike. What do I do? — Confused

4.      2/28/12.  Dear Annie: My wife and I have been married for 20 years. She has a grown daughter from her first marriage. I watched "Lori" grow up and love her as my own. My wife always has been fiercely defensive of Lori. I can't say anything remotely negative or critical about her without risking a big argument. Even the suggestion of having Lori help around the house or clean up her room would cause a fight. Lori is a good kid, but she has never wanted for anything. My wife makes no secret of the fact that Lori comes first in her life. Lori is now in her early 20s and is a senior in college. Even though she is taking only two classes a week, she doesn't have a job and is unmotivated to get one. My wife makes all kinds of excuses for her. Meanwhile, we pay all of her expenses, including her rent. I'm disabled and on a small fixed income, and my wife is self-employed. We struggle with our finances while Lori lives a carefree life. It is causing friction in our marriage. We tried counseling, but my wife refused to discuss anything related to Lori and quit going. Lori calls her mother every hour, and my wife encourages it. Lori has no other friends, and all of my wife's attentions are focused on her daughter. I get very little. Is this normal behavior? — Concerned for Our Future

5.      3/18/12. Dear Annie: When I married my wife last summer, her son was living in the basement with no intention of getting a job. "Terence" is 23 and not exactly bright. We tried offering advice to help him move forward with his life, but he likes things his way. My wife excuses this, saying it's his generation's lifestyle. She told me her co-worker's daughter moved back home with her husband and baby, and they accept it. I know there are a lot of parents in the same situation. Terence has decided he wants to move back to a town where he used to have friends, but my wife still wants to support him. So she is willing to continue paying for his car insurance, rent, spending money and trips to fast-food restaurants. He doesn't save a nickel. As soon as he gets money, he spends it. I get the impression that my wife doesn't want to cut the apron strings. Terence likes having his mother support him. Money isn't the issue. It's that we won't be around forever, and at this rate, I don't see him ever growing up. He'll be the same when he's 50. Counseling seems useless. I've been married with stepkids before. They didn't want me in their lives and acted as if they knew everything. Am I wrong to expect young adults to be independent? I love my wife, but she wants me to be quiet and not say anything. — Perplexed and Stifled

6.      3/19/2012.  Dear Abby: My brother has systematically taken over my parents' lives for the past 20 years. He uses his depression and agoraphobia as an excuse not to lead his own life. He lives on government disability payments, and the majority of his support comes from my parents, whom he lives with and mooches off of. He doesn't help them around the house or contribute in any way. He refuses to get treatment for his disorders. How can I help my parents finally be free of him? They are fast approaching 70 years old. Talking to my brother is useless, as he becomes extremely hostile and threatens to kill himself. My parents deserve some rest at their age. -- Anonymous in NYC.

7.      3/31/12.   Dear Abby: My cousin "Carla" just had a baby. She's in her early 20s, unemployed and living in a condo her parents bought her so she won't be homeless. Her deadbeat boyfriend lives with her. They smoke pot and love to party, although Carla has abstained since she got pregnant.  When I received an invitation to her baby shower, I declined. I don't think her having a baby is a good thing, and I didn't feel comfortable celebrating this "good" news. I have not offered my opinion on the subject, but when my sister asked me why and I told her, she called me selfish. Do you think she is right? -- Principled cousin

8.      4/6/12.  Dear Amy: I have been married to a wonderful man for the last four years. We are both in our 60s. Recently, his 23-year-old son moved back into the house we share. He has a part-time job and goes to school two days a week. His dad is putting him through school and spends money on groceries. My problem is that my husband is lenient with him and is letting him get away with things. I wrote down a few house rules that needed to be followed. Since he has moved in with us, he hasn't done things his dad has asked him to do. He comes up with a lot of excuses, but he spends time with his friends. On one occasion, he spent three days not leaving his bedroom because he didn't want to do what we asked. I have asked my husband to be firm dealing with him. My husband keeps ignoring my pleas, and the sad thing is that he wants me to get some help because I am bothered by his son's behavior. How can I encourage him to be firm with his son?! I don't want him to grow up to be irresponsible. -  Desperate

9.      4/23/12.  Dear Abby: My wife and I are 50-year-old professionals who have paid every penny of the cost for our two daughters' four-year college educations. Our oldest, "Lana," went on to law school and has incurred well in excess of $100,000 in law school loan debt. She has struggled to find a job as an attorney, and I'm no longer sure she still wants to practice law. Lana is married to a medical student who also has significant student loan debt. Two nights ago I made the mistake of telling Lana that her mother and I would help her pay off her student loans. I regret having opened my mouth. She and her husband spend their money on frivolous luxuries and are not responsible financially.  My wife and I live frugally. We withdrew money from our retirement accounts to help fund our daughters' college educations. We now need to increase our retirement contributions and pay for maintenance and repairs to our home that we delayed while paying for their tuition. Although we have always helped our children financially, we can no longer afford to trade our future financial security and our present standard of living to support them. I would appreciate some advice. This may be an issue affecting a lot of parents at this time. -- Spoke too soon

10.  4/24/12. Dear Annie: "At the End of Our Rope" described a common problem: having a young adult child who does drugs, still lives at home and doesn't work. A friend dealt with this well. When their son was 19, they refused to let him live at home unless he found a job or went back to school and took a drug test once a week. He refused and was ousted, although he was allowed to come home to eat, shower and do laundry. After a year of sleeping on friends' couches and in his car, he was arrested for DUI. It took several more months before he finally agreed to the drug testing and found a job. This young man now rides his bike to work, tests clean and is building his life again. — It Can Work

11.  5/10/12.  Dear Annie: My 25-year marriage is falling apart. My husband's 40-year-old daughter, "Sally," has been living with us for eight months. She occasionally buys a few groceries, but otherwise pays nothing. She does no work around the house. I've asked her to help clean the shared bathroom. She says she doesn't think she should have to do any cleaning because she doesn't mess anything up. She uses the bathtub more than we do and has all kinds of junk in there. She says her father also has stuff in there, so it's my job to clean it. I refuse.  Meanwhile, my husband says Sally is right. He agrees that she shouldn't have to do any work around the house because she has a full-time job. (We are retired.) She also never cleans up after herself in the kitchen and doesn't help with the dishes after eating the dinner I cook. This is causing major problems between my husband and me. He isn't interested in counseling. What can I do about Sally? — A Sad Marriage

12.  5/16/12.  Dear Carolyn: My 46-year-old, divorced son is working full time and lives within walking distance of me in his own apartment. To compare, his 50-year-old, divorced sister who works full-time also lives within walking distance in her own apartment. She is independent and lives responsibly. We all three get along quite well about most things, but my son has shown limited financial responsibility. He plays the slot machines at a local casino and spends extra money on social drinking and in pursuit of women. He spends the money to show off as if he actually had the money to spare.My sole income is Social Security, and I have to pay my normal monthly living expenses. My son, who earns twice what I do, has no money left over nearly every payday. He then goes without decent food and other necessities. Too many paydays he asks if I can buy him some food and has even borrowed money for his rent. I’ve always told him he needs to be responsible, but he just gets defensive and confrontational. How can I tell him that I cannot afford to bail him out anymore and that he has to start right now taking ownership of his finances? As his mother, I just can’t let my son go hungry — he’s still my “little boy.” - Exasperated Mom

13.  5/21/12. Dear Annie: My brother and sister and I had an amazing childhood. Our parents stressed the importance of hard work and education. The three of us got advanced degrees, and my sister and I entered the workforce after graduation. Our brother, "Dennis," however, seems content to live with my parents, working a seasonal minimum-wage job. He was unable to find employment when he graduated and has not bothered to look since. That was seven years ago. My parents do not charge him rent. They cook for him and take him on weekend excursions. They pay a portion of his student loan bills. Dennis doesn't seem to have any ambition to move forward. It has created a lot of resentment. The last time I saw Dennis, he made a snarky comment when I revealed that I was a month behind in my mortgage payment. I was amazed at his nerve, and it resulted in no contact between us for almost a year. Resentment is also building toward my parents for continuing to allow him to mooch off of them. They are now in their 60s and nearing retirement. They deserve better. And I admit that I'm a bit jealous that Dennis gets handed to him the same things my sister and I have to work so hard for. I will be bringing my fiance to visit my parents for the first time, and we will be staying with them. I'm already dreading it. My fiance says to bite my tongue, that it's my parents' decision. But every time I see them, I notice how they have aged. Any suggestions? — Frustrated in Ft. Worth

14.  June 21, 2012.  Dear Annie: I am engaged to a man who was divorced 20 years ago. He has three grown sons. The first two are doing well, but the third is still not financially responsible at the age of 30. His father has to pay off his automobile and credit cards. My fiance also helps out his siblings, who seem to be quite irresponsible and alcoholic. I come from a large family, and we each were told that at age 21, we were on our own. We all obtained professional degrees and now help our parents. At what age does a parent allow a child to grow up and become responsible? It appears to me that my future will be forever intertwined with relatives who are begging us for money. My fiance won't discuss this matter with me. What should I do? — Engaged but Having Second Thoughts

15.  6/22/12.  Dear Abby  My husband and I separated two years ago. For the past year, I have been dating one man exclusively. We have a wonderful relationship that has great potential. Never have there been two people with more in common. There is one problem. I have no children and he has three. Two are adults -- responsible, good people. The youngest, "Erik," is 18, and he's the problem. He dropped out of school, doesn't work, refuses to even try to find a job and doesn't have a driver's license. Erik has stolen money from me and also from his father to buy drugs and alcohol. Basically, the kid is good for nothing. He doesn't even have any friends left. My boyfriend realizes his son's problems, but has essentially given up on him. I can't blame him. It has reached the point where I can't even stand to be around the kid. It doesn't look like he'll ever get a life and move on. Please tell me what to do. -- At a loss in Nova Scotia

16.  6/24/12.  DEAR ABBY: My mother-in-law, "Lisa," is 50 and married to husband No. 5. I'll call him "Steve." He is 38. (Lisa's son is 31.) The problem isn't the age difference. It's the fact that her husband refuses to hold a steady job. Steve is often "between jobs" for six to eight months at a crack. Lisa had a job with the same company for 28 years and has a very nice income. My husband and I are sick of seeing Steve mooching off his mom. He drives around in a new truck, dresses well, has a nice place to live and anything else he wants -- all at my mother-in-law's expense. Abby, she retired recently, and Steve is spending her retirement money faster than it's coming in. What can we do to get rid of this bum? -- Bummed out in Georgia

17.  6/29/12. Dear Annie: I have been with "Jim" for eight years. We are in our 40s and have been through a lot together. When I moved in with him three years ago, two of his kids lived with their mother, and the older boy was in prison. I was supportive of Jim's visits to "Lloyd" and also wrote letters myself. Lloyd got out of prison 18 months ago and was paroled to our home. He is not supposed to frequent bars, but his drinking has increased, and he constantly violates the terms of his parole. Two months ago, he was arrested for public intoxication and spent the weekend in jail. He had to wear an ankle monitor for 30 days. Lloyd refuses to abide by our curfew. He wakes us up when he strolls in drunk at 3 a.m. Twice he left the refrigerator open and let the food spoil. He has kicked in our front door and broken numerous things, and now items have been disappearing. We've given Lloyd chance after chance. We pay all of his bills, including the one for his cellphone service. I've told Jim that Lloyd needs to respect our rules or find somewhere else to live. Jim keeps telling Lloyd to straighten up, but there are never any repercussions, so it never happens. I'm exhausted and can't take much more. I don't want to ruin my relationship with Jim. How do I proceed from here? — Lost in Love

18.  7/13/12. Dear Amy: Our adult son has a drug problem. Family and friends are aware of this because he has been in rehab and has had long periods of sobriety. He is a good person when he is not using drugs. But like all addicts, he will do what he needs to do to get drugs when he is using.  He has stolen from us, and we have responded by not allowing him into our home. We have not allowed him to live here for years, but when he is doing well, we allow him to visit and begin to trust him. Recently, he stole from us again. We are coping with it, but I am wondering what to say to family and close friends who inquire about him. I don't really want to tell truthful details, because I am embarrassed and I still have hope that someday he will be clean for good. I don't want people to remember this about him. What could one say to be truthful but not share details? Are we enabling? — Distressed Mother

19.  7/18/12.  Dear Annie: My husband's 35-year-old daughter, "Effie," has a college degree, but has never held a job. My husband sends Effie most of his Social Security check each month and also pays her credit card bills, which means he is now in debt to the tune of $10,000. When Effie visits, she makes a mess of the house and is disrespectful to me. She somehow manages to take several vacations a year. Now she wants my husband to foot the bill for an expensive wedding, and he's agreed. He also agreed to continue supporting her after she marries. Because the wedding is in our state, Effie wants to stay in our house for several weeks before the wedding. I don't think I can take it. My husband is entirely in her corner and believes his relationship with her is perfectly normal. He's been unwell, and I hate making things worse for him, but I can't hold in this anger and disappointment much longer. I keep asking myself whether I'd be better off without him, but I don't know the answer. — Torn in Tallahassee

20.  7/20/12.  Dear Amy: I have a friend who is 72 years old with three grown children. Two of her children constantly ask her for money to make mortgage payments, buy cars, furniture, pay for their vacations, pay for their children's birthday parties and even to send their children to expensive private schools. These two adult children do not have full-time jobs, are lazy, selfish and take advantage of their mother. I see the pain on my friend's face when she tells me about a phone call from one of them asking for more money. I would like to suggest that she say "no" to them, knowing that it would be for their own good to start being more independent and knowing that she is depleting the money that her late husband left her. I would like to suggest tough love. Should I? — Sad for my Friend

21.  8/6/12.  Dear Abby  I need some advice about my girlfriend "Vivian's" son. "Kirk" is 22 and very immature. I love Vivian with all my heart, and I get upset when Kirk verbally abuses her. I try not to say anything because I feel it's not my place because he's not my son. Kirk hasn't worked in two years. He walks into his mother's house and takes whatever he wants -- food, toothpaste, rolls of toilet paper, etc. He won't help her around the house, mow the lawn or wash a dirty dish he has used. And he lives rent-free in one of the duplexes his mother bought for additional income.  Vivian is a wonderful woman who is hard-working and self-supporting. She's also tired of her son's lack of motivation and how he takes her for granted. I know a mother doesn't want to see her child go hungry, but where do you draw the line? -- Fed up in TX

22.  8/18/12. Dear Annie: What do you do with a sibling who has been enabled all of his life when Mom is no longer around to provide for him?  My brother has had a house to live in, a car to drive, insurance, etc., for the past 25 years. He is an alcoholic and a drug user. He doesn't work because he doesn't want to. He has an all-expenses-paid life. When my mother dies, how do we settle the estate? If the house is given to my brother, he would lose it because he has no concept of paying bills. My sister thinks we should sell the place, give my brother his share and move on. My mother is 82 years old and in poor health. She will be leaving us a huge mess when she passes, but she refuses to discuss it now. — Help Me Plan

23.  9/7/12. Dear Annie: My older sister, "Susie," is 33 and has been receiving financial support from my parents for more than a decade. They give her money outright and also pay her car insurance, health insurance and other bills. Susie does not work. She's in a master's program, but it is unclear whether she will finish. My mother believes she needs to help Susie, as she has had mental illness issues throughout her adulthood. I am not upset that Susie is receiving money from my parents. It also doesn't bother me that I am not likely to receive similar assistance. But I worry that my parents are giving Susie no reason to finish her degree or pursue a job. I consider it enabling. On several occasions, Susie has maxed out her credit cards, and my mother paid those off. My parents do not have the money to continue doing this. Is it appropriate to speak with them about this? - What To Do?

24.  9/15/12.  Dear Annie: When can we stop giving our children money? When is enough enough? My daughter and her husband are in their mid-30s. They bought a house they could not afford. On top of that, they are in the middle of filing for bankruptcy, as they have been overspending for years. My daughter works two jobs that provide neither a consistent paycheck nor benefits. Her husband's job is more stable, but his salary is low. At one point, we gave her one of our used cars, which she was able to keep running for a couple of years. When that car died, I took money out of my retirement fund to buy her a used car. My son-in-law's mother just bought them a new oven. My question is: When does all this stop? I worked for 30 years and never once asked my mother for money. I'm tired of doing and doing for them. At what point can a parent stop taking on the problems of their children? — Resenting Parent

25.  9/18/12.  Dear Annie: I am engaged to an intelligent, beautiful, loving woman. We both work full time and see eye-to-eye on just about everything. However, we are becoming increasingly frustrated with her four kids when it comes to doing their laundry, putting dirty dishes in the dishwasher, walking the dog, etc. If a trashcan is overflowing, they simply pile more on top of it instead of taking it outside. These kids are between 13 and 21. We want them to take responsibility for their actions and take pride in their home. We have tried making lists and assigning tasks, punishments and rewards, to no avail. During our most recent conversation with the kids, one said, "It's too difficult to remember." Another said, "You can't make us do it." Two of these kids are working. Any suggestions? — Frustrated in the Midwest

26.  9/28/12.  DEAR ABBY: I recently married a wonderful man, and I like my in-laws very much. They're nice, welcoming people and we get along well. There's just one problem: They are the biggest enablers I have ever met! With my husband it isn't a big deal because he's very self-sufficient. On the other hand, his 30-year-old brother has lived with them for three years. He is jobless and has a drinking problem. His parents don't encourage him to look for work. They give him an allowance, pay all his court costs and drive him around because he got a DUI. They even pay his cellphone bill. What is my place in all of this? Should I say anything? My fear is that when my husband's parents die, his brother will become our problem. -- Looking ahead in Colo.

27.  10/15/12. Dear Amy: My daughter seems upset with me because she perceives that I give my other daughter (her sister) too much help. She does not want to discuss it, so at this point her feelings and concerns are unknown. The first daughter is married, with a home and a full-time job with health benefits and a retirement plan. She has two children who are also married. They have jobs and are self-supporting. The second daughter is divorced, rents and is unemployed. She also has two children, but neither is married or employed. Her children use drugs and have leeched every available cent from their mother. Over the past few years I have helped the second daughter with apartment rental guarantees (she has always paid all the rent). I bought her several cars averaging $3,000 a piece. I helped her children (before drugs) with cars that the first daughter's children have not needed. I think the first daughter should be thankful she has a strong financial future and does not need help, rather than be enraged with sibling jealousy. When the conversation finally comes up, what could I say to the "prodigal daughter's" sister? — Upset Mother

28.  10/16/12. Dear Annie: Our son graduated from college more than two years ago. He has not looked for a job, nor does he have a resume. He claims that he can't put a resume together because he didn't participate in any school activities and has no job experience, although he has done quite a bit of volunteer work at his church. He spends much of his time playing video games. Currently, he plays all night. He goes to bed when other people are just waking up and then sleeps until late afternoon.  We have never pushed him hard. He helps some around the house, but my wife and I like to do things ourselves. Our son is intelligent and moral, does not drink or smoke, and is well liked. But I worry about his lack of ambition. He refuses to talk to a counselor to determine whether something is holding him back. I've told him that unless he shows some initiative, he eventually will be too old for anyone to want to hire him. He doesn't want any of the part-time jobs that are easily available, because he says he cannot learn anything from them. I've said he should at least show he is willing to work. Do you have any suggestions? — Frustrated Dad

29.  10/21/12.  Dear Carolyn: After graduating from art school in 2008, my daughter, now 26, worked an assortment of odd jobs before landing a job at an art gallery late last year. I’ve been giving her $2,500 a month to help cover her living expenses but I feel like she should be able to shoulder more of her own expenses, given what she earns. There always seems to be some unexpected expense that crops up, though, preventing me from cutting back my support. To make matters worse, she and a co-worker are fed up with the boss and now want to quit and open up their own art gallery. The co-worker apparently would be able to secure financial backing. My daughter would work as director. I want to retire, but my retirement income would not be enough to support both me and my daughter. Meanwhile, I feel that after a lifetime of support, including college costs and a new car, I’ve done enough. But if she fails, then she might have to move back in with me, which would be an intolerable situation. So I feel stuck. Any suggestions? — Sad Dad

30.  11/10/12.  Dear Amy: Many times you have advised engaged couples who are facing possible deal-breaking issues (usually involving other family members) that unless they are both prepared to put their marriage at the center of their lives, they should not tie the knot. How about married couples who are faced with issues later during their marriage?  I am 66 and 12 years into my second marriage. The past six years have revolved around my 25-year-old stepson’s heroin addiction, related felony convictions, sex-offender conviction, prison sentences and parole violations. My wife has centered our life on her son and in my opinion is his greatest enabler, with no signs of change in the future. I love this woman and want to spend the rest of my life with her. Before marrying, I agreed that she and her son were a package deal. That was when he was a child (his father had died). Who could have seen this coming? However, I am done with the daily drama. I feel he is long overdue to take responsibility for his choices and actions. I want to feel our marriage is at the center of our lives. I have not felt this in six years. I feel I’m being selfish in wanting my life back. We have been to numerous counselors only to end the sessions at the slightest hint that the marriage should be of prime importance. We’ve talked of divorce, and I guess that’s where we are heading. Do you have any wisdom? -- Sad Stepdad

31.  11/18/12. Dear Abby: My parents are in their 80s. I have two brothers. "Pete," the oldest, is in his 50s and lives with them. "Dave" lives next door. My parents support them both financially. Neither one works or even tries to find a job. Both of them are addicted to meth, and one is hooked on prescription pills as well. My parents know it but enable them by paying their bills. Pete and Dave steal and blame each other or any innocent family member who comes to visit. My parents are in total denial. There is major drug use going on every day, as well as potential violence. Pete and Dave threaten to shoot people all the time. Part of me understands it's none of my business, and I have no desire to be around such dysfunction. The other part of me is furious and wants to put a stop to them using my parents. If I offer suggestions to my parents -- such as cutting off Pete and Dave -- they get mad at me! I'm ready to sever all ties because there's no stopping this train wreck. I think my parents actually enjoy paying for my two 50-something brothers so they can stay high, never grow up and always be dependent. Any advice? -- No name in the Southwest

32.  11/25/12.  Dear Amy: We are retired and have a very small home. Our child, who is close to 50, went through a divorce and told us she was moving back home. She has been with us for almost six months. She does nothing except sit with her laptop all day, every day. She has no job or means of transportation. She refuses to take the bus, taxi or anything but our auto. She has doctors, dental and other medical appointments that we take her to. We are tired of being a chauffeur, cook, house cleaner, etc. When we try to talk to her about a job or plans to find her own living space, she starts shouting, shedding tears, bullying and arguing. What would be your suggestion to help us? We can get nowhere and could use some help. Help us get our home back! — Upset Parents

33.  12/2/12. Dear Amy: I have a sister I love dearly, except for one thing: She is a total pushover when it comes to her kids. Her oldest son is 38 years old, lives at home, has no job, runs all night and sleeps all day. He has three children by two women that he is not supporting in any way. Lately, he has brought a new girlfriend into the mix, her new baby (by another man) and her dog that pees all over the house. My sister has a daughter (32 years old) who also lives there with her daughter and her dog as well. And my sister has a dog. None of these ingrates contributes to the household expenses. We have the same conversation over and over again, and I just can’t do it anymore. She refuses to throw anybody out, especially now with the weather getting cold. I say make them responsible for themselves. I have tried all the avenues I can think of to help. I just hate how they take advantage of her, but I hate even more how she lets them. Any advice? -- Disappointed Sister

34.  12/28/12.  Dear Annie: I can relate to "S.W. in California," the father who had a falling out with his daughter and she cut off contact. In response, he took her out of his will.  My husband and I have traveled this road with our adult children. Some young adults are simply selfish and ungrateful. They expect their parents to tolerate everything they do (even drugs), allow their friends into the home (even drug pushers and felons), give them money at the drop of a hat (even when the parents are struggling financially), and allow them to use their home as a hotel or storage facility. If the parents don't cooperate, the kids punish them by being abusive or keeping the grandkids away. I am tired of being treated so poorly. I have loved unconditionally, and in return, I've received disrespect and a broken heart. My job is done. — Indiana Mom

35.  1/1/13.  Dear Amy: I have a 22-year-old stepson who is immature and irresponsible. He has been attending classes at a community college for four years and has yet to earn a degree! He spent some of his financial aid money last year to buy his girlfriend an engagement ring. (His fiance's mother has now let him move into her home.) He needed $500 worth of repairs for his car, and instead of fixing it he went out and bought a $3,000 car with financial aid money. That car broke down in a week. He took out a student loan for $8,000 because he needed money to pay off his credit cards. After all this, he borrowed $600 from his grandma for school supplies and she called my husband saying she needed her $600 back, so my husband paid her back, but did not require his son to repay us! What should we do? My husband states we should do nothing because his son is grown and can make his own decisions. He says he has talked with his son and he won't listen, so he has to suffer the consequences of his decisions and actions. I think he needs some tough love and I have told my husband that the only times his son should be given money from us is for his birthday. — Shaking My Head

The (Sometimes) Myth of The Wicked Stepmother

In my post of 4/12/2012, Your Spouse's Secret Mission, I described how the spouses of people who are not getting along with their family of origin often make it look as if they were villainous meanies who are poisoning the mind of the innocent husband or wife against his or her family members. That way, the parents in said family of origin do not get angry at their own progeny, but blame any and all problems on the nasty spouse.

These family of origin members seem to ignore the fact that their darling son or daughter is going along with the spouse's supposed "program." Maybe they are just weak-minded souls who are easily led by the nose?  Not!

This is an example of how what Freud called "defense mechanisms," which he thought of as existing solely within an individual's mind may, in fact, be interpersonal strategies. In this case, the defense mechanism in question is displacement. You know, how you come home and kick the dog when you are really mad at your boss? In this case, the spouses are allowing their in-laws to displace any anger that exists in the in-laws' family of origin onto them. This way, the person who is actually angry at his or her parents gets off scott free and appears utterly blameless for any emotional cut off.

Yet another example of how one family member can volunteer to take the heat for a spouse involves some divorced parents of young children. For various reason, many of which I will not get into here, one parent abandons these children, runs off to marry someone else, has more children, and then lavishes all their money and attention on the new family. In the process, they completely ignore, in many cases, their children from their first marriage. This seems to happen more often with men than with women, although women are certainly known to abandon their children in this same manner.

Men, at least until recently, were often screwed in divorce proceedings in regards to child custody arrangements. Usually, the ex-wife would get prime custody of the kids, and the ex-husband would just get the right to pay child support. In other words, the ex-husband got the bills for the cost of raising the children, while getting little say in how they were raised. To add insult to injury, if there was any remaining tension within the couple because of their divorce, which there often was, the husband had to go through the disagreeable ex-wife to even get to see his kids. Some ex-wives went out of their way to make that as difficult and/or unpleasant as possible. 

Having more access to the kids than their dad, these ex-wives might also attempt to alienate the children from him by constantly saying terrible things about him (parental alienation syndrome). I have seen cases in which an ex-spouse does not even give the kids letters and birthday cards from Dad written to them - or even acknowledge their existence - and won't let the kids see their dads while lying and telling them that it is Dad who does not want to see them.

Now, before anyone gets their panties in a bunch, let me be quick to add that it is also a frequent occurrence that a divorced mom really does want the dad to be involved in the kids' lives, and he for whatever reason still avoids them. He may say he is coming to pick them up and then not show, making them feel very disappointed. And of course controlling Dads can also alienate their kids from their mothers.

Which takes us to the actual topic of this post. I bet you thought I was never getting around to wicked stepmothers, didn't you? I know, I have a nasty habit of writing long expositional prologues before I get to the main subject of a post.

Anyway, for many of those dads who seem to want to avoid the kids from their "first" family, their new wife volunteers to be the villainess, just as she might have done with dad's estranged parents. She makes it look like Dad's avoidance of the children is entirely her doing. This way, the abandoned kids get to feel better about their dads by blaming his absences on his mean and nasty new wife.

In a way, she is actually trying to protect the abandoned children from the pain of being seemingly rejected by their own fathers.

In these cases, the "wicked" stepmother is often accused, rather, of keeping dad away from said kids because, for example, she wants all of his money to go to her children, either from their marriage or those kids from her former marriage or marriages. The poor guy doesn't have a chance against such a monstrously powerful little witch, does he? So he is forced to go along with her wicked plot against his better judgment.  

Yeah, right.

Is Your Psychiatrist Paying Attention?

In my post of 2/24/2010, Counting Symptoms that Don't Count, I discussed how many psychiatrists these days are taking huge shortcuts in order to squeeze as many patients into an hour as they possibly can. I described how they are focusing just on symptom counts without trying making the slightest effort to ascertain whether or not the symptoms in question are clinically significant for a particular diagnosis, or whether they might require psychotherapy rather than drug treatment.

As I have pointed out many times in this blog, in order to make such a determination, the doctor has to take into account the timing, pervasiveness, persistance, and subjective quality of a symptom. The psychiatrist has to know what other symptoms are present at the same time and at different times. Most importantly, the doctor has to know something about the psychosocial context of a symptom.

One of my partners reported a particular glaring example of what can happen when this is not done: A patient with no previous psychiatric history became depressed right after finding her husband in bed with another woman.  Her "depression" was characterized, not surprisingly, mostly by anger and preoccupation with the discovered affair.  Nevertheless, when she came to the attention of a psychiatrist, he diagnosed her with "major depressive disorder."  Really?  I mean, really???

Another time saving "convenience" is for the doctor to write down the information that the patient is relaying during an interview on the patient's chart, using either pen and paper or a computer, as the patients speaks. This not only saves time, but solves a second problem: Some insurance companies do not want to pay for a doctor's time unless it is spent face to face with the patient. Even time spend reviewing the patient's record and writing down all the information that insurance companies demand in order to pay the doctor is supposed to be donated, I guess. So instead of writing a progress note after the patient leaves, it is written with the patient still in the room!

So, aside from wasting the patient's time while the doctor does that, what's wrong with that?

Well, I'll tell you.  When a doctor is writing or typing away on a computer, his or her attention is split between doing that and observing the patient. Often a patient's body language or facial expression can give a doctor a clue that what the patient is saying may not be completely accurate or may not be the whole story, so that the doctor then needs to ask for clarification with follow-up questions. When the doctor is staring at a chart instead of the patient, that is probably just not going to happen.

Even more important, patients will often mutter vitally important information quickly and in passing, or even under their breath. This is particularly likely to happen if the information patients are relaying is troublesome to them in one way or another, such as reporting things they are ashamed of. If the doctor is not paying close attention, he or she will literally not hear it!

In my book, How Dysfunctional Families Spur Mental Disorders, I describe in detail a videotape of a psychiatry trainee doing a diagnostic interview in front of two senior faculty members in order to practice for her upcoming oral boards. In the videotape, a real patient was used. During the interview, the patient stated in passing that she had been repeatedly molested by a close relative. In fact, the matter even ended up in court. After the interview, the examiners both said that they "suspected" that a trauma history was "likely" in the patient.

There were three doctors in the room, all of them preoccupied with the trainee's performance.  All three of them either missed or forgot that abuse was not only likely, but had actually been mentioned!