Tag anxiety

Ten Steps to Take if Your Child is Exposed to a Traumatic Event

What it means to be exposed to a traumatic event varies greatly. The exposure can be direct (it happened to your child) or indirect (it happened to someone your child cares about). It can be a single event or repeated over time. Vulnerable children might also experience traumatic reactions when learning about something terrible that happened to strangers. Moreover, traumatic experiences themselves vary greatly (e.g., watching dad physically abuse mom and witnessing mom get hit and killed by a car are both traumatic, but one more than the other). For this reason, what follows can only be considered general advice that may need adaptation across a range of traumatic experiences and reactions.
#1. Try to keep adaptive rituals in place. Rituals are islands of stability in the torrential currents of our culture. Rituals promote a sense of stability and safety in a child’s life. One of the ways in which traumatic events are most damaging is in how they fracture a child’s basic assumptions about stability and safety. So, try to maintain as many of your usual daily, weekly, seasonal and special occasion rituals as you can. (See Chapter Four of my parenting book for an expanded discussion and a list of methods for pulling this off.)
#2. Monitor your child’s health habits. When excessively stressed our children may start to suffer impairing changes in their sleep, diet and level of physical activity. A brief period of these kinds of reactions is typical. However, if such persists for weeks it is a good idea to get assistance (see tip #9).
#3. Give your child the opportunity to discuss the trauma but do not force the issue. It’s important for kids to know that you, or others who are available (e.g., therapists, school personnel), are interested and willing to discuss the trauma whenever your child likes. However, sometimes kids cope by not talking about what is bothering them. Also keep in mind that younger children may deal best with these kinds of feelings by drawing or playing.
#4. If your child is traumatized by misfortune that has befallen someone else, engage him or her in a plan for making a contribution to reparative efforts. Perhaps your child might draw a picture of support, or help with some volunteer project (e.g., making food, conducting drives), or offer prayers. Making an active contribution can combat a feeling of powerlessness.
#5. If your child is traumatized by something that happened to him or her be careful to not give her or him the idea that it’s not okay to hurt around you. We parents hurt when our kids hurt, and often worse. So, it is natural for us to try to convince our kids, and ourselves, that they are not really in pain or that they are over their pain, when that isn’t the case. It’s very tough to provide empathy for the pain our kids experience, and to stay with them in that experience until they are ready to move on, but doing so is a major gift.
#6. Try to avoid blaming yourself. “If only I had…” is a very normative reaction for we parents when our kid has suffered a trauma. However, it’s rarely helpful as the resulting guilt and shame can have the paradoxical effect of making us less available for the kinds of responses that promote healing and resolution. (Of course, if poor choices or poor judgment on your part has caused the trauma, that is much trickier and would make #9 an even more important step to take.)
#7. Once your child’s pain has been given it’s due (and judging that point in time is an art form unto itself), help him or her to look for the opportunity imbued within all crises. That is, crisis = (pain/2) + (opportunity/2). As one poet put it, the pain is like a dragon guarding treasure. Or like Khalil Gibran put it “your pain is the breaking of the shell that encloses your understanding.” Teaching our children to think about trauma in this way is a major way to promote resilience.
#8. Be on the watch for signs of depression (e.g., persisting depressed and/or irritable mood, diminished concentration, not taking pleasure in activities that used to be fun, appetite and/or sleep disturbance, self-blame, hopelessness, harmful thinking) and Post Traumatic Stress Disorder (e.g., avoiding situations, things or people that remind your child of the trauma, experiencing withdrawal from others or life in general, reliving the trauma in dreams or flashbacks, doing psychological back flips to avoid being reminded of the trauma).
#9. If you see signs of mental illness, or if the trauma is severe, please do not go at it alone. This is complicated business. So, for your child’s sake, your family’s sake and your sake, seek out the services of a qualified child psychologist or mental health professional. (See Chapter Ten of my parenting book for detailed guidance along these lines.)
#10. Don’t forget about self-care. Our self-care can be one of the first things we jettison off a ship that feels like it’s sinking. However, doing so is like throwing the life jackets overboard first. What good am I for my child if I’m breaking down? (Please see Chapter Seven of my parenting book for a detailed review of issues and methods.)

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My Child Gets Afraid A Lot. What Can I Do?

Our science tells us that some children are born with an anxious temperament. These temperaments can often be identified by the toddler years, and sometimes sooner. Kids with such personalities may cling excessively to their parents (or other attachment figures) and respond to novel situations, people or things with hesitation and/or fear. Moreover, about one third of such children may go on to develop an anxiety disorder (compared to eight to twelve percent of the general population). All this said, there are at least nine things parents can do, and not do, to help.

#1: Try to reduce parental anxiety. If I have unrealistic fears about the person, thing or situation under consideration I may be facilitating my child’s anxiety without even realizing it.

#2: Avoid avoidance. If the person, thing or situation your child is fearing is developmentally appropriate for him to be exposed to (e.g., going to the first soccer practice of a new team), it is often a good idea to not avoid it just because he is afraid of it. None of we engaged parents are happier than our least happy child. So, when our kids hurt we hurt, and often worse. Hence it can be an understandable knee-jerk reaction to allow our child to avoid those people, things and situations that distress him without considering whether doing so is helpful or not. However, what we often find is that avoiding developmentally appropriate experiences that are distressing can facilitate more and more avoidance and more and more anxiety.

#3: Avoid preemptive reassurances. I suggest to the parents in my practice: “Imagine I said to you as you sat down. ‘Listen, don’t worry about the ceiling collapsing on your head while we meet. It’s quite secure.’ Of course, your attention would be drawn to the ceiling and you could not help but wonder what danger I’m referring to.” A pre-emptive reassurance states that there is something worthy of being reassured about and can be like saying to a kid (unintentionally of course): “Go ahead and freak out now.”

#4: Avoid excessive reassurances. This is similar to the previous suggestion. Imagine a friend said she was nervous about a job interview and you responded by hugging her and kissing her and suggesting she’ll be fine regardless of what happens. A peer might just find it odd. A kid, who often looks to her parent to decide what to make of her world, might imagine that maybe she has underestimated the gravity of the situation.

#5: Remember that most anxiety passes once a kid is in the situation. Assuming the situation is developmentally appropriate and a child does not suffer from an untreated mental health disorder (e.g., Panic Disorder) and assuming adults are not throwing gas (excessive reassurances) on the fire, a child with an anxious temperament will usually show some initial distress but then be fine.

#6: Preemptive exposures to the situation can be helpful. Doing a dry run to the new classroom before school starts, going to the soccer field before the first practice, meeting the new coach before hand, and other preliminary exposures to what is feared can sometimes soften the initial distress, especially if such is practical and not accompanied by preemptive or excessive reassurances.

#7: Having your child breathe into his belly and try to make his muscles as soft as a cooked piece of pasta can help just before facing the feared person, thing or event. It is very difficult, and maybe even impossible, to be anxious and to have a relaxed body. In doing this, work on muscles in groups. That is, first relax the hands and arms, then the shoulders, neck and head, then the chest and belly and then the legs and feet, all while pretending that the lungs are in the lower belly instead of the chest cavity.


#8: If part of your child’s avoidance strategy is to cling to you, consider leaving the premises once you’ve dropped your child off. Of course, this assumes that you’ve determined that a responsible adult is in charge and that the situation is developmentally appropriate for your child. You can always leave your cell phone number with the adult in charge in case something surprising happens and you need to return. (It would generally not be advisable to tell your child that he may call you if he gets upset.)

#9: Consider consulting with a mental health professional if these strategies do not resolve the problem. To obtain a referral click here.

Mom Arrested for Giving Her Daughter Xanax: CBT Can Help to Avoid Such Sad Stories

According to a story this week in the North Platte Telegraph, a mother in Nebraska was arrested for intent to deliver a controlled substance after she gave Xanax to her 15 year-old daughter (the story indicates that daughter later gave it to a friend). I know no more about this story than what is contained in the above link. But I find myself wondering how much each of the following factors contributed to this unfortunate arrest:

√ The pharmaceutical industry markets directly to the public. The marketing budget of this industry far exceeds the public education budget of any mental health association that tries to teach the public about how psychological pain can be understood and relieved.

√ Studies vary but between one in ten and one in four youth suffer from an anxiety disorder (e.g., this graph, from the National Institute of Mental Health, demonstrates the high rates in teenagers).

√ Between 2/3rds and 90% of these kids receive no care. And, even when they do receive care they’ve often been suffering for years first and/or the care is truncated (my blog post discussing some of these issues regarding teens can be found here).

√ Many people, including primary care physicians and teachers, do not know what cognitive behavior therapy (CBT) is or that it is the number one researched talking therapy for relieving anxiety in children and teenagers.

This author knows of not one authoritative association or legitimately published researcher who recommends that anxiety disorders be treated by medication alone, in any human, at least when the afflicted person is able and willing to take part in talking therapy. Moreover, many kids successfully treated with CBT do not need medication to help manage their anxiety-based symptoms.

Cognitive behavioral therapy, which is a time-limited intervention, involves learning a collection of strategies for manipulating emotions and thoughts. Some of these strategies involve recognizing and adjusting thoughts (i.e., the “cognitive” part of the term), while others involve adjusting behaviors (the “behavioral” part of the term). In the case of anxiety treatments there are often two phases. In the first phase the child or teen learns the cognitive and behavioral strategies for defeating anxiety. (In my practice I’ll teach anywhere between five and ten strategies depending on the youth’s problems and situation.) In the second phase the youth then deliberately puts herself or himself into those developmentally appropriate situations that tend to evoke anxiety (e.g., getting on a school bus instead of being transported to school) and uses the techniques to conquer the anxiety. The work is finished once the youth is able to defeat all such fears. Often at termination both the youth and her or his parent(s) cannot believe how far she or he has improved in a relatively short period of time.

These treatments can be delivered to a child by himself or herself (with intermittent parent sessions so that the parent(s) are in a position to coach the strategies once the treatment is over), in groups of youth or together with family members. To identify a mental health professional who might be available to deliver this treatment in your area, click here. Below I have also listed links to three related blog entries.

Affording Mental Health Care

Signs that a Kid Needs Mental Health Services

Seven Common Myths About Counseling

Helping Children Cope with Scary News

Many parents are confused about what to say to their children after scary news stories appear in the media (e.g., acts of terrorisms, school shootings, hurricanes, etc.). 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 news story 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 older children might find it easier to discuss difficult feelings and thoughts while not making eye contact (e.g., while driving or waiting for a movie to start) 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 feeling more scared these days”). 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 a similar trauma? 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.

• Try to maintain functional rituals and routines. Few things give a child a clearer message that life is safe than adaptive routines and rituals (e.g., maintaining the same adaptive routines at meal time, bed time, holidays, birthdays, etc.).

• 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.

• 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, join community efforts to heal and to help, etc.

• Maintain a healthy lifestyle for the entire family. This would include things like spending time having fun together each week and maintaining good diets and schedules for physical activity and sleep.

• 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.

Signs that a Kid Needs Mental Health Services.

About 14-22% of children in the United States suffer from a diagnosable psychological disorder. Add 20% to that number if you include youth who suffer at sub clinical levels. However, only about 20% of these children get effective care. And, even when they get it they’ve often had to suffer for years first. This occurs even though the research on the effectiveness of child psychotherapies is very positive. What would we conclude about our culture if this were true of our childrens’ dental health instead of their mental health?

I’m writing this blog entry to try to review key indicators of when a child might benefit from mental health services. There are four primary areas of functioning that one can consider: relationships with adults, relationships with peers, academics and mood.

Relationships with adults: The key issue is whether the youth gets along reasonably well with adults. Of course this includes parents/parent-figures and teachers. But it also includes coaches, extended family, bosses, etc. If the youth is frequently in conflict or frequently avoidant or detached from any significant type of relationship with adults, an evaluation may be warranted.

Relationships with peers: Kids need to be able to form friendships, and get along effectively, with other kids who are doing well. For example, if a teen’s close friendships are primarily with those who often get into trouble, abuse substances, or are significantly symptomatic, a significant problem may be present. Likewise, if a child or teen is avoidant, aggressive, controlling or otherwise routinely rejected or ignored by most other youth, this is of concern.

Academics: This is one of the trickier areas to describe tightly. The central issue here is not grades, though grades consistently falling in the C and lower range would generally indicate that a problem exists (assuming that the teaching and curriculum are appropriate). The central issue here is the youth applying herself or himself when she or he does not feel like it.  Developing this psychological muscle (i.e., task persistence when internal motivation is required) is one of the most important developmental tasks of childhood. So if a child is not applying herself or himself, or experiencing significant turmoil or failure in academic pursuits, an evaluation is likely warranted.

Mood: The key issue is whether or not the youth is content. Happiness is great. Contentment is the bar however. If the child is consistently sad, angry or anxious for a significant portion of his or her waking day, this is signaling a need for professional attention. It is often the case that a parent may be confused regarding what a child or teen is thinking or feeling. Thus, problems with sleep, appetite, concentration, connectedness with the world or physical activity can be signs of a problem. (There may also be absences of experiences of joy, but more for kids with depressive disorders than anxiety disorders. )

As I write this blog, there are 42 ways that youth can be diagnosed with a mental health disorder. So, this is hardly a comprehensive post. However, if a child is getting along well with others, is doing well in school and seems content, that child may be fine. The only significant area I’ve left out is experiencing success in one or more extracurricular pursuits. While a lack of positive experiences in the latter area is not, by itself, necessarily indicative of a problem, a child who lacks for such experiences may be more vulnerable to attacks on self-esteem.

I hope you will share this blog post with those who could use it. If you would like to read about common myths about mental health services, click here. For ideas on how to afford care click here. And, finally, to find a lean-mean-healing machine in your neck of the woods, click here.

Coping with School Anxiety

The start of the school year often brings worry and anxiety for both kids and parents. The following tips are designed to help parents ease the transition for a child who may be prone to separation anxiety.

Avoid reassurances at the point of separation as such often has the opposite intended effect

A reassurance suggests, to an anxious child, that there is something threatening about to happen. Imagine I said to my clients  “Please don’t worry about the ceiling crashing down on us. I’ve made sure that we are in a safe environment.” Would their anxiety not be heightened as their eyes darted upwards and they wondered why the heck would I say that?

Try to calm any of your own anxiety as our kids often take their cues from us.

If I’m anxious about my son going to school–which is certainly an understandable thing to feel for that first-time departure–he is more likely to feel anxious as well. I do well to try to try to calm myself first and then imply that his going to school is as dramatic as a trip to the grocery store.

If your child is vulnerable to anxious reactions, try to familiarize her with the new setting as much as you can.

Familiarity can soften anxiety. Hence, see if you can arrange for a trip to your child’s classroom in advance. (Actually, the school may have already initiated an invitation along these lines.) It is difficult to imagine that competent school personnel would experience this as an intrusion or an odd request. Should you be unable to reach them take your child for a few dry runs up to the point of the hand off. Moreover, the Scaredy Squirrel books by Melanie Watt can be very helpful to read together.

Teach your child muscle relaxation and belly breathing.

Muscle relaxation and anxiety mix about as well as oil and water. Suggest to your child, if she is vulnerable to separation anxiety, that she is less likely to be afraid if her muscles are like a cooked piece of pasta instead of the uncooked variety. Moreover, she is less likely to experience fear if she breathes into her belly instead of her chest.

Consider arranging for someone less engaged with your child’s anxiety to manage the first few days.

If you anticipate that your child will do a white-knuckled clutch of your leg at the bus stop or at school, try to arrange for another caring and responsible adult to take him from your home to the separation point. By itself, this can reduce your child’s distress as (1) he has accomplished separation from you in a familiar setting (i.e., your home) and (2) he will be accomplishing the separation from someone less engaged with his anxiety.

Make the separation clean and quick.

If there is a significant chance that your child will be distressed at the point of separation arrange for a particular adult to take her hand from yours (or whoever else might be bringing her). Then, make this exchange efficiently. Try to avoid offering reassurances or waiting until your child seems calm. Actually, you might do well to expect some crying/screaming and to steel yourself to leave anyway. You could always call the school later to see how she’s doing; if your experience is typical, you’ll likely be told that she cried for a few minutes after you left and then was fine.

Please also see my post “My Child Gets Afraid A Lot. What Can I Do?

If the above strategies fail, or are otherwise not indicated, please consider consulting with an experienced child psychologist or like professional.

For a referral in your area, click here.

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