Tag anxiety

Parenting Through COVID-19

Many parents are confused regarding how to parent through COVID-19. This entry addresses  three qualifications, three guidelines and two common questions.

Three qualifications:

1.    Most children who were free of psychiatric problems prior to being exposed to a trauma do not develop a psychiatric condition after the exposure. Children can be surprisingly resilient.

2.    Advice from mental health professionals is most effective when it supports and informs, but does not supplant, your intuition. You are one of the world’s leading experts on your child. Suggestions from experts should be filtered through that lens.

3.    Some of the suggestions below would not apply for children who have become symptomatic; for such children it would be best to consult with a mental health professional in order to develop a tailored plan.

Three guidelines:

1.    Intermittently let your children know that you are available to talk but do not try to force a conversation. Children are like adults; sometimes we cope by trying to put something out of our mind. Assuming the topic has upset her, your child might not be in the mood to talk about such at the same time as you. Following your child’s lead can communicate that you are sensitive and respectful.

2.    Try to create a venue and manner that makes it easier for your child to communicate with you. For instance, some teens might find it easier to discuss difficult feelings and thoughts while not making eye contact (e.g., while driving) while younger children may communicate through their play. Regardless of the age range, though, it is important to not jump in too quickly with reassurances. Once we parents start self- disclosing, even if for the purpose of being reassuring, it can have a dampening effect on our child’s self-disclosure.

Once your child has finished with his or her initial statements reflect back what you’ve heard and provide empathy (e.g., “I understand why you could be african woman's half facefeeling more scared these days”). This will feel very difficult to do as your entire being wants to be reassuring, but suppress that urge initially. This may cause your child to tell you even more. When it seems that your child is finished that would be the time to offer your thoughts and feelings.

3.    Let your awareness of your child’s developmental level and/or vulnerabilities guide your self-disclosure. No matter your child’s age, it is important to not say things that you do not really believe. Doing so is often ineffective and may damage your credibility. Selective truth telling would seem to be advisable; selective based upon your child’s developmental level and vulnerabilities.

For younger or vulnerable children you may want to only share those thoughts and feelings that are positive. For older children, who are also doing well, you may choose to share some thoughts and feelings that are unpleasant. Sometimes life is painful; honestly acknowledging that, with an older child who can handle it, can be educative and facilitate a closer relationship.

Two common questions:

1. What do I say to my children about our safety?

Much of this will be determined by how you rationally answer this question for yourself. What do you believe are the odds that your family will experience significant physical or financial consequences from COVID-19? Once you have answered these questions for yourself, selective truth telling–based on the principles listed above–may be advisable.

2. Is there anything I can do to protect my children from all the fallout?

Any of the following may help:

• Aggressively pursue your own adjustment. If I am afflicted I will have a more difficult time helping my child. If I believe we are significant medical or financial risk, then it ‘s important to develop an action plan for coping with and responding to this. Consultation with a good psychologist or mental health professional can be very helpful in this regard. Many psychologists now offer video conferencing services.

line of kids• Try to maintain as many functional rituals and routines as you can. Few things give a child a clearer message that life is safe than adaptive routines and rituals (e.g., maintaining the same routines at meal time, bed time, birthdays).

• Keep your child’s developmental level and wellness in mind when deciding how much he or she should have access to ongoing developments in the news. A good guideline for anyone stressed by COVID-19 new stories is to limit the exposure to once a day or less.

• Try to turn a sense of passivity into an active plan for healing and helping. Your family may decide to pray for the suffering, make donations, write letters, create art, and join online efforts to heal and to help.

• Think of any self-quarantines as a welcomed staycation instead of an apocalyptic retreat. How many of we parents have had the thought, “when we get some extra time together we’ll…” There are so many possible ideas: have a family campout in the family room, play balloon baseball, have a bracketed gaming tournament (including making up new and fun games like who can balance a grape on their face the longest), view old family videos, have a cupcake baking contest or any one of a hundred other ideas you can get by doing an internet search for “staycation ideas.” Doing this well will cause your child or teen, 10-15 years from now, to reminisce with a warming smile, and say, “remember in 2020 when we…”

• Once every day or so do an internet search for “good news COVID-19.” In doing this I’vehappy hispanic family learned that new cases in China have dropped dramatically, that some of the first identified cases in the U.S. are now well and the early science out of China indicates that warmer weather slows the transmission of COVID-19 For teens, reviewing a graph like this may be helpful.

• Maintain a healthy lifestyle for the entire family. This would include things like maintaining good diets and schedules for physical activity and sleep. Social distancing does not require becoming shut-ins. Activities like walking in nature, biking and stargazing may be safe, practical and energizing.

• Manifest for your family the psychological truth: crisis = pain + opportunity. COVID-19, like all pain, is often akin to a dragon guarding treasure when it does not kill us. Yes, we need to experience the pain and give each other empathy for it. After all, denial can take a heavy toll when it’s the driver. But, then we can wonder where the treasure is. If your children can reach age 18 knowing this deep truth about suffering they will have a Captain America Shield against life’s slings and arrows.

• If you child seems to be having a hard time adjusting, or otherwise has changed for the worse, seek out a professional consultation. Doing so may improve your child’s adjustment. To find a psychologist click here.

 

 

“I’m stupid!” “I’m a loser!” Responding to a Kid’s Negative Thinking (Thought Testing)

“I’m stupid!” “No one likes mcharacter sitting on book overwhelmede!” “I suck at sports!” “I have no friends!” Most parents have heard lamentations like these. Our typical response is to reassure our kid and offer contradicting evidence. However, there are many occasions when that approach seems to escalate the problem. This is because if a kid is being influenced by a depressed or anxious mood, such reassurances are heard by her as “knock it off. You don’t have any reason to feel this way.” Our kid’s response is then to insist, often with more distress and an offering of data, that the negative thought is true. The technique of thought testing can be helpful in these instances.

Step #1: Get to the core thought. Our thoughts are like onions; core thoughts are the deepest layer of the onion. Sometimes our kid offers a core thought right at the start, like the ones I listed above. If so, we can skip this step. Otherwise, a kid can seem disproportionately upset about an activating event, like not getting invited to a party or making a mistake during a game. You can start by asking, “what does it mean that Monica didn’t invite you to the party?” A kid might say, “she doesn’t like me.” You can then respond with, “okay, let’s say that’s true. What would it mean about you that Monica doesn’t like you?” A kid might then say, “I have no friends.” Core thoughts are usually expressed in a few words and represent black-and-white and negative conclusions about oneself, others or the world at large. Write down the core thought at the top of a piece of paper, then draw a vertical line in the middle of the page underneath the core thought. On the left side write “facts supporting.” On the left write “facts contradicting.”

theory into practice signStep #2: Collect supporting facts. This is the step that opens up a new universe for your relationship with your kid. You say, “okay, what are the facts that support this thought? By facts, I mean things that a police officer would write down, or things that could be used in a court of law.” (You might have to do different kinds of teaching regarding what a fact is depending upon your kid’s age and intelligence.) If your kid suggests some facts in support of the thought, write it down as a valid point. The kid might say, “I didn’t get invited to Monica’s party.” You might say, “you’re right. That is a fact that suggests you have no friends so we’ll write it down on the left side. What’s next?” So, instead of arguing against the core thought, you’re asking for the data that supports it. This is what’s new. Usually a kid will have 2-4 facts, and rarely more. Just be sure you write down only facts, not what you kid imagines, guesses or implies.

Step #3: Collect contradicting facts. When your kid says she has no more supporting facts, ask if there are facts that contradict or disagree with the core thought. Usually, these start cascading from your kid (as long as you’ve done the first two steps that is). Feel free to add here-and-there but let most of the facts come from your kid. You write each one down on the right side. As you write, don’t let your kid see what you’re writing yet. It’s okay not to exhaust this side. You can stop once you have much more data on the right side.

Step #4: Give the list to your kid and ask, “Okay, you’re judge and jury. Is the thought true or false?” Your kid will usually express relief that the thought is not true. (In my parenting book I review an augmenting strategy for when a kid wants to assert that a given fact on the left side carries more weight than the facts on the right side.)

cute girl sitting white backgroundStep #5: Decide what you want to do next. Maybe you want to do “problem solving” regarding the activating event (search for that term on this blog site). Or, maybe your kid decides just to distract herself whenever she has this thought going forward, as it isn’t true.

I have two caveats. First, if the thought proves true, use it as an opportunity to do problem solving. Second, if thought testing doesn’t work for you, and your kid has a pattern of being distressed by negative thoughts, seek out a referral for a good child mental health professional. You can get a referral by clicking here.

Pay Attention to Inattention

boy head on handAn important study was recently published in April, 2015 edition of the Journal of the American Academy of Child and Adolescent Psychiatry. This study followed 11,640 kids in England from age 7 to age 16; the researchers focused on adolescent correlates of attention symptoms in childhood. These are some of their primary findings

Combating Insomnia

insomnia femaleThere are numerous causes of insomnia in youth. Stress, anxiety disorders and mood disorders can each cause this problem. However, if the problem is addressed early, or if it is mild, self-help remedies may be helpful.

A good starting point is to review the amount of sleep that kids need. Sleep is even more important to youth than it is to adults. Just one hour of deprived sleep a night can have negative impacts on cognitive, emotional and behavioral functioning the next day. Moreover, sustained problems with sleep have been shown to contribute to numerous psychological and medical problems, including obesity. These are commonly promulgated guidelines:

1-3 years old:            12-14 hours

3-5 years old:            11-13 hours

5-12 years old:          10-11 hours

Teens:                       8.5-9.25 hours

(As you look at these numbers it wouldn’t be uncommon for you, especially if you’re the parent of a teen during the school year, to think “Geez, my kid doesn’t get that much sleep.”)

What follows are behavioral, cognitive and environmental tips for combating insomnia.

Behavioral Strategies

• Try to encourage a consistent bedtime ritual that starts about an hour prior to bedtime. In this hour try to avoid activities that promote an active or a fretful reading to kid, asianmind. For younger children reading them a book can be effective. A shower or bath in this hour can also be relaxing.

• Baring unusual circumstances, consider not allowing your child to keep a cell phone in her bedroom. Likewise, try to avoid allowing your child to watch TV as s/he falls asleep. However, if you do, make sure it is not on for long and that it is turned off shortly after s/he falls asleep.

• Dim night lights are fine to use if such makes your child more comfortable, but I would try to avoid treating anxiety by laying with your child as s/he falls asleep (enter the word “anxiety” in the search bar above to find alternative approaches).

• If your child consistently fights you in getting to bed on time, consider making him or her earn access to a desired activity or object the next day by getting into bed on time (e.g., cell phone access the next day is earned by having gotten into bed on time with the lights out).  This is not punishment. (i.e., “I’m taking your cell phone away because you did not get to bed on time.”) This is reward. (i.e, “You earn your cell phone each day by having gotten to bed on time the night before.”) So, your child either earns or doesn’t earn the desired activity or access while you remain an empathic bystander.

physician and a familiy• Try to avoid caffeinated beverages and food (you might be surprised at how common caffeine is) and limit your child’s intake of sugar. (The World Health Organization’s 2014 draft guidelines recommend that no more than 5% of the daily calorie intake occur from sugar, which can be challenging given how prolific the substance is. For example, there can be a teaspoon of it in a tablespoon of ketchup.) Moreover, Ask your child’s pediatrician if natural supplements such as Omega-3 fish oil and melatonin SR might be helpful.

Cognitive Strategies

These strategies are useful when your child can’t fall asleep because his or her mind is too busy. These strategies involve redirecting his or her mind to content that promote sleep instead of interfering with it.

• At a soft volume, play an audio recording of a story with which your child is familiar. Try to avoid plots that are action packed.  Also, make sure to turn it of shortly after your child falls asleep.

• Play sounds from nature (e.g., the beach, a rainforest) or other soothing green forest roadmusic (e.g., tracks from Michael Bruce’s Insomnia Treatment that is available on iTunes). If your child has a device like an iPod, he may enjoy using one of the compatible pillows that are available.

• Encourage your child to imagine that it is the next day and s/he is in a boring class. In the class s/he is extremely tired, but s/he MUST stay awake. Encourage your child to imagine what each of her senses experience as s/he does this mental exercise.

• Encourage your child to imagine a repetitive pleasurable activity (e.g., fishing, cheerleading, pitching a ball game, dancing, etc.). Again, encourage him or her to engage all of his or her senses when imagining this activity.

Environmental Strategies

• If your child is waking up soar or stiff or if her mattress is showing signs of wear or tear, consider replacing it.

• If your child reports being too cold or too hot when trying to fall sleep, adjust accordingly.

white_noise_machine• Of course, try to ensure that your child’s environment is quiet. If you live in a busy area and outside noise is interfering, consider purchasing a noise cancelling machine.

• Some people report that the aroma of lavender can have a sedating effect. So, consider this as well.

If these strategies don’t work, and assuming physical causes have been ruled out, seriously consider seeking out the services of a qualified child mental health professional. For a referral, click here.

 

What is Cognitive-Behavioral Therapy?

stressed boyCognitive-behavioral therapy (CBT) is often the talking treatment of choice for juvenile anxiety, depression, and various kinds of problems that result from poor stress coping. The word “cognitive” refers to strategies that deal with thoughts and thinking. The word “behavior” refers to strategies that deal with behavioral choices. This blog entry will review some of the major strategies that often comprise CBT.

Externalizing the problem: kids and teens develop a name for their anxiety, depression, or the primary problem area. As Stephen King once wrote: “Monsters are real, and ghosts are real too. They live inside us, and sometimes, they win..” Youth are taught that their symptoms of anxiety and depression no more constitute their personhood than symptoms of diabetes or asthma define the personhood of someone suffering from those conditions. Moreover, youth are taught to recognize how their internal enemy attacks them and what specific and effective countermeasures they can deploy.

Behavioral activation: this strategy involves arranging to do fun things on a regular basis. When youth are depressed or stressed out they often get into a rut where they wait for a good mood to do something fun. This CBT strategy teaches a youth that s/he can manipulate his or her mood by forcing himself or herself to do something that stands to be pleasurable. Youth are also taught that fun activities that are novel, social and involve physical activity tend to be the most effective (e.g., to avoid getting into a rut with fun activities as well).

√ Physiological calming: this is a term for learning how to relax muscles in theboys praying back to back body and to belly breath. Most youth overestimate their ability to relax their bodies. In CBT they learn strategies for becoming super relaxed. Moreover, they learn that a relaxed body and anxiety are like oil and water: they just don’t mix. Some practitioners also employ methods for measuring a youth’s success (e.g., through the use of biofeedback).

√ Coping or happy thoughts: this strategy involves developing a list of true and adaptive thoughts that promote positive feelings. Kids are taught that they can swap out uncomfortable thoughts just like they can swap out uncomfortable jeans.

√ Thought testing: this is a strategy for determining whether a painful thought is true or not. Anxiety and depression attack thinking and cause a youth to believe painful thoughts that are not true. This technique is very helpful for helping youth to determine what painful thoughts are real (and which can be subject to problem solving) and which represent their internal enemy’s lie (and are to be disempowered).

Teen girl√ Problem solving: this strategy is useful when a problem is distressing a kid or teen. When suffering from anxiety or depression problems can become super magnified and overwhelming. This very powerful strategy disempowers over reactions and produces adaptive coping responses.

√ Exposures: this strategy involves having anxious youth deliberately put themselves into developmentally appropriate situations that make them anxious, in a measured and gradual way, so that they can use their CBT tools to accomplish mastery and to dominate their internal enemy.

It’s common for parents to be taught how to coach and reinforce the CBT techniques. Moreover, multiple strategies can be done together as a family (e.g., physiological calming, problem solving). The CBT might also include other techniques for specific problems affiliated with anxiety or depression (e.g., response prevention for OCD). Moreover, sets of related strategies than be imported into the CBT depending on the problem(s) the youth has. For instance, social skills training can be used for youth who struggle making and maintaining friends, behaviorally oriented family therapy can be used for defiant youth who refuse to practice their CBT techniques and strategies from positive psychology can be used to produce experiences of happiness and meaning (e.g., the use of gratitude, personal strengths, acts of kindness).

The research supporting the efficacy of CBT is well developed and suggests that mom and daughterparents would do well to consider making this treatment available for any child or teen who suffers from anxiety,  depression or an assortment of problems involving poor stress coping. To find a qualified provider near you click here.

Treating Anxiety in Youth: CBT, Medication or Both?

anxious teenAnxiety disorders in youth are common; between one fourth and one third of teens develop one by the end of adolescence. Examining treatment issues with this population, the landmark Child/Adolescent Anxiety Multimodal Study (CAMS) just published its 24 and 36 week outcomes (i.e., article dated 3/2014). This multisite study, that included 488 children aged 7 to 17 (average age of 10), compared cognitive behavioral therapy (CBT; a talking therapy) to sertraline (SRT; an SSRI medication), to both together (COMB), to pill placebo in the treatment of Generalized Anxiety Disorder, Social Phobia and Separation Anxiety Disorder. (Youth with other anxiety disorders, or with co-occurring problems such as depression or pervasive developmental disorders, were not included.) I will first review some key findings and then suggest some take home points for clinical practice.

• At 12 weeks, or the immediate conclusion of the study, this is the percentage of children who were rated to have a positive treatment response across the four conditions: COMB: 81%, CBT: 60%, SRT: 55% and pill placebo: 28%. At that point in time the combined treatment was determined to be moderately superior to the other three conditions.

• At no point in the study were there statistically significant differences between the CBT and medication treatment conditions.

• At week 24, the superiority of combined condition over medication alone and anxious childCBT shrank (COMB: 81%, CBT: 69% and SRT: 68%).

• At week 36, the superiority of the combined condition over medication alone and CBT shrank further (COMB: 83%, CBT: 72% and SRT: 70%).

• For both of the preceding two points, the magnitude of the differences at week 36 varied across the various outcome measurements.

• Quoting the authors: “…only 5% of youth receiving COMB and only 15% to 16% of those receiving monotherapy failed to achieve responder status at any point during study participation.” And, “although COMB appears best for prompt benefit, all 3 treatment conditions appear beneficial at 6 months.”

Take home points for clinical practice

therapy etchingThese results support what I, and many of my child clinician colleagues, have tended to recommend in the treatment of youth suffering from one of the aforementioned anxiety disorders. These recommendations are as follows:

• If wanting the most aggressive approach, consider medication therapy and CBT.

• If concerned about adding a psychoactive agent to a developing brain when there may be viable alternatives, consider starting with CBT alone unless the anxiety symptoms are in a severe range (e.g,, a child cannot get to school), to see if the talking treatment will be sufficiently effective.

• If a child is taking a medication, consult with the prescriber about the possibility of tapering off the medication once the CBT skills have been learned.

• It would usually not make clinical sense to treat a child with medication alone, though unusual circumstances could suggest otherwise (e.g., CBT is refused or not available).

• The CBT protocol used in this study was the “Coping Cat” program. However, other established CBT programs for children would likely also have value.

• The authors note that their results are similar to the results found in treatment therapy with teenstudies of juvenile depression. This suggests that similar clinical guidelines may also apply in the treatment of youth suffering from juvenile depression.

To read the abstract for this study, click here.

For a referral for mental health care, click here.

For an article on affording mental health care, click here.

I’d like to offer a closing thought for those parents who have a child or teen suffering from an anxiety disorder: in my clinical experience this is one of the most treatable kinds of problems that a kid can have. So, I strongly encourage you to take your child or teen to a mental health professional who can delivery quality care (for a more thorough review of what good mental health care looks like, please see Chapter 10 of my parenting book). After all, why have your baby suffer needlessly?

Tune in next week when I will post an article that describes cognitive behavioral therapy.

Reduce Separation Drama On the First Day of School

tantruming girlThe separation on the first day of school can be upsetting for kids and parents. In this entry I offer six strategies for lessening the drama.

#1: Preparation is key. For my blog entry on useful preparation strategies, click here. (Two key points I’ll re-iterate here are to avoid reassurances and the avoidance of developmentally appropriate situations.)

#2: Most kids with separation challenges have one parent, or parent-figure, that they are most attached to. Try to have that person not be the one to take your child to the bus stop or school, at least until the separation has become drama free. Separating from that person at home, while in the company of the other parent, or parent figure, allows your child to get into the separation bath more gradually instead of all at once. It’s also likely easier for your child to separate from the other person when at the bus stop or at school. (My experience is that the second parent/parent figure also tends to be the parent who is less nervous about the separation, which leads to the next point.)

#3: Be calm yourself. Our kids read us in ways that are outside even their black woman smiling backgroundawareness. As there is only so much you can fake, and your anxiety will escalate your kid’s anxiety, use your self-soothing strategies to be cool about school (e.g., thinking about something you’re looking forward to, relaxing your muscles and unobtrusively breathing into your abdomen, engaging another adult in an interesting discussion).

#4: Make the separation as cleanly and as quickly as possible. In this context, syllables synergize symptoms. “Have a great day!” “See you at X time!” “Can’t wait to hear about your day later!” are examples of simple phrases you can use to separate. Chatting your kid up suggests you’re nervous, or expect him or her to be nervous, which may start or fuel drama.

#5: Let whatever adult is taking over deal with any distress your child may be showing. Lengthening the period of separation, in an effort to calm your child, usually has the exact opposite intended effect. Rare is the child who won’t calm down on their own shortly after you leave, especially if the adults with whom you are leaving your child are baseline competent or better. If you’re concerned about this you can always arrange to call the school later to see how your child is doing.

cancel fear#6: If your child continues to struggle with separation for a period longer than two weeks, or your child displays school refusal, consider seeking out the services of a qualified mental health professional. Why have everyone suffering needlessly, right?. To get a referral, click here.

Preparing Your First Time Student for the Fall

mom and daughter2I’d like to organize this post around five Q & As:

1.  Why should parents of rising preschoolers or kindergarteners be thinking about this now?

If no child or adult in your home is experiencing anxiety about the pending school year little preparation may be needed. However, if anyone is nervous a little preparation may increase comfort and reduce drama come the big day. When in doubt, it’s usually better to prepare, when that isn’t warranted, than the other way around.

2.     What are some things parents can do in the home to help prepare their young children?

The short answer: play and read together. The playing could be things like role playing (e.g., one of my fondest parenting memories is my eldest bossing me about the classroom, as my teacher, when we would play this game). It could also be drawing about the pending school year. Kids often use play to acclimate themselves to developmental challenges.

The reading could be acquiring related books on the topic and reading them to dadandsonyour child, maybe following such up with a discussion. I find the books at magination press tend to be helpful while I like how the scaredy squirrel books treat anxiety in general.

3.     Are their any field trips that can be helpful?

Probably the most useful thing you could do would be to take a trip, with your child, to the classroom; even better yet would be to meet the teacher and to talk about what the school year will be like. Many preschool and elementary schools are willing to make such a service available in August. If not, even driving to your child’s school and walking around it, or in it, can be helpful. Also, if your child will be taking a school bus for the first time, it can be a good idea to get permission to sit in a bus for a few minutes. (Meeting his or her actually school bus driver may not be possible. But, if it is, that could be a good idea as well.)

4.     Any other preparation that can be done?

The first preparation is an anti-preparation: avoid reassurances about the school year. But, if you must reassure, try not to overdo it. A reassurance indicates that there is something potentially threatening at hand. If you came to my office and I said to you: “don’t worry about getting lice here as I keep my office very clean” can you imagine how uncomfortable you could start to feel? A well intended, but sometimes unhelpful reassurance, could be something like “Don’t worry about going to school this year. You’re going to love it.” Instead, it might be better to say something like: “Guess what, you’re going to get to make lots of new friends in a few weeks!” But, you don’t want to oversell, less you create the impression that your pushing a lemon.

character students lined up in desksIt can also be fun to collaborate on school clothes and supplies. This needn’t break your bank. Just whatever you can afford. I think it’s also good to segue to your school time sleep routine the week before. (I’ve written multiple blog entries on sleep. Just enter “sleep” in the search engine above.)

5.     Will you be offering any other advice on this topic?

Yes. In the near future I’m going to do a blog entry on how to avoid separation drama on the first day of school. So, stay tuned.

How do I get my kid to sleep in his or her own bed?!

mom frustrated by depressed daughterFirst I should state that co-sleeping, or kids sleeping in the same bed as their parents, is a culture bound phenomenon that is inherently neither healthy or dysfunctional. So, if you’re from a culture where this is common, and none of the caveats I describe below are in play, no worries. However, there are instances when co-sleeping is symptomatic of an underlying problem. In my experience, the most common of these are marital disturbance, adult loneliness, anxiety–in the child and/or the parent(s)–or some combination of the three. The purpose of this post is to suggest strategies for dealing with situations when you wish for your child to sleep in his/her own room but s/he is freaked out about that (the other problems could be addressed in counseling; you may also find articles pertaining to those topics within this blog site).

Avoidance is rarely an effective strategy for coping with fears that your child has regarding developmentally appropriate activities or situations. As none of we engaged parents are happier than our least happy child, it’s natural for us to support avoiding those (developmentally appropriate activities or situations) that distress our child. But, avoidance is a jealous strategy; the more it is used the more it pulls to be used. Plus, avoidance doesn’t deal with the underlying problem. Keeping in mind that you may need professional and tailored consultation, here are some strategies to try on your own (some of these are merely strategies for promoting sleep hygiene).

• Set up an incentive program for sleeping alone. If your child is younger, or the asian boy looking up white backgroundproblem is a mild one, a star chart may suffice (i.e., each successful night earns a star on a chart). Make it so that that your child earns something s/he desires after so many stars are on the chart. If your child is older, or the problem is more significant, it may be more effective to establish a daily incentive program (i.e., sleeping alone earns the privilege of watching TV the next day). There are multiple possible permutations of this that I review in Chapter Five of my parenting book. However, the bottom line idea is to make it in your child’s best interest, as s/he perceives such, to sleep alone.

• If your child is showing a lot of distress about this, you could use the technique of shaping. With your incentive program in place, let the first phase be a reward for something that is a small step forward from where you are at now (e.g., you lay with your child helping her/him to fall asleep in her/his bed, then leave, for a week; then progress to being in a chair in her room as s/he sleeps; then you are in the hallway, etc.).

child sleeping in bed• Install a nightlight if that comforts your child.

• Allow your child to fall asleep to soothing music or to an audio book of familiar material (you don’t want him/her trying to stay up to hear the next development in the plot line); just make sure it shuts off after a designated time. Alternatively, you could read your child a book. (You could also use shaping for both of these strategies).

• Your child may find a lavender aroma in the room to be soothing.

• A bath or shower before bed can be relaxing and prepare your child for sleep.

• Try to keep your child from consuming caffeinated beverages in the afternoon and evening. A balanced diet is also something that can make a positive contribution to most behavioral problems that kids display.

• Try to ritualize the hour before bedtime (i.e., usually the same procedures followed in the same order).happy jumping black boy, white background

• Having had at least an hour a day of physical activity (i.e., sweating and breathing hard) can facilitate a good night’s sleep.

• Try to avoid intellectually demanding or exciting activities the hour before bedtime.

If these strategies don’t resolve the problem in a short period of time, and in consultation with your child’s pediatrician, it would usually be advisable to seek out the services of a qualified mental health professional. Click here for a referral.

What Can I Do If My Kid Freaks Out About Routine Dental or Pediatric Appointments?

Trips to the pediatrician and dentist are commonly feared by kids. This fear ranges from mild discomfort to debilitating anxiety. Let me offer six strategies to help:

#1: Avoid unhelpful reassurances. As I’ve written in other entries, a reassurance is a cue that danger is approaching. While parents don’t intend for their reassurance to be heard this way, kids often hear “okay, time to start freaking out.” Think about this for a second. If you were meeting with me in my office and I told you not to be worried about the ceiling collapsing on our heads, you, of course, would start to wonder about the security of my ceiling. Wait until your child shows distress before reassuring, and then keep them brief and proportionate. If they don’t work, as they often don’t, try the other strategies listed below.

#2: Prepare. Confronting fears is like swimming in a cold lake. At the end of the day, it is sustained exposure to the feared object that calms a person down (i.e., one gets used to it).  Some people know this intuitively and are inclined to cannon ball in. But, many prefer to go in slowly, getting used to the water as they go. This is what preparing your child for the appointment is akin to. If you go to Amazon and type in search terms like “kid, dentist” under books, you’ll get a myriad of choices that will allow you to discuss what the medical appointment might be like. You can also get books that generally help with anxiety. My favorite along those lines is the Scaredy Squirrel series by Melanie Watt. (I have the entire series in my office, including a Scaredy Squirrel puppet.) A related technique is to visit the office on a day when your child doesn’t have an appointment, spending time in the waiting area while doing the next strategy.

#3: Relax your child. A relaxed body and anxiety are like oil and water: they can’t mix. So, you can try to train your child to flush anxiety out of his or her body. The three elements to this are breath, muscles and mind. I tend to focus on the first two with kids. I ask kids to pretend that their lungs are in their lower belly, instead of their chest, and to breath deeply, but comfortably, in and out from there. I also ask them to try to make all of their muscles like a cooked, rather than an uncooked, piece of pasta as I walk them through their muscle groups in a soothing voice. There are also resources you can acquire to facilitate your child’s training along these lines. One of my favorites is the relaxation CD that my friend Dr. Mary Alvord and her colleagues have created. Also, and if the cost benefit ration seems worth it, you can acquire a small, portable biofeedback device that can help your child get into a relaxed state; I like the emWave2 for this purpose.

#4: Distract. Once in the office, try to distract your child with something interesting. I was on the sidelines of a baseball game recently when a young girl, who was barefoot, stepped on a wasp. She started crying in terror and pain. I broke out a couple of magic tricks (I keep them with me) and distracted her, reducing both her pain and her anxiety (and delighting her mother). There are an endless number of ways to do this: read a story, play an electronic game, discuss the details of a fun activity coming up that weekend, and so forth. If the medical procedure your child is going to receive allows for this, distract your child during it as well; if it doesn’t, ask if he or she can listen to a portable music player that you provide.

#5: Reward. I wouldn’t do this unless you know that your child is going to struggle. But, if you’re confident that’s the case, tell your child that if he or she is brave, and doesn’t put up a fight, that you will reward him or her afterwards, specifying what the reward will be. Try to keep the reward proportionate to the level of challenge your child is experiencing. So, the reward can be as small as going to ride swings at a local park or as big as a trip to a water park. Then reward, or don’t, based upon how cooperative your child was.

#6: Get help. If these techniques fail please consider consulting with a qualified child mental health professional. Often these kinds of problems can be remedied quickly with treatments that beat having a couple of adults restrain a terrified child. To get a referral near you click here.

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