Tag depression

Parenting a Depressed Teen During the Holidays

depressedThe holiday season can be harder than other times of the year for people who are depressed. When someone is struggling with depression he feels estranged from himself and the world. Then, when that world temporarily gets even more unlike him (i.e., emphasizing cheer), his sense of estrangement can worsen. For this and other reasons, parenting a teen who is depressed during the holiday season can especially challenging.

Before I offer some tips, let me offer a very important proviso. Imagine you had a kid with significant dental pain and you wondered, “what meals should I prepare that best accommodate her condition?” That seems like a useful question, but only if your daughter is receiving, or is about to receive, professional dental care. Without the dental care, cooking interventions would probably be like re-arranging deck chairs on the Titanic. It is the same thing with depression in a teenager. The tips below are best considered and rendered within a context of a kid already getting good mental health care (e.g., an evidence based talking therapy such as cognitive-behavioral therapy or interpersonal therapy).

That said, here are seven tips to consider:

• Collaborate with your teen, and ideally your teen’s treatment provider, regarding a holiday plan (e.g., which activities to do and which to set aside). Your teen’s depression would have him bail out on most, if not all, activities and that is usually a mistake. Likewise, you may be tempted to insist on 100% participation, and that can be a mistake as well. A skilled therapist’s expert assistance can increase the odds that you’ll find the adaptive middle ground.

• Do what you do for your teen without the expectation that such will cheer her african woman's half faceup. We parent-lunatics hurt when our kid hurts, and often worse. So, it’s very natural to try to cheer up a depressed teen. However, if the primary intention is to bring about a better mood it’s easy to become frustrated and worsen the stress on our teen. Better to make the effort without the expectation of an outcome.

• Accept your teen’s moods as they come. These moods can be like the weather. Sure, you’ve laid out a nice picnic and here comes a rainstorm, and that stinks. You can rage at the weather (and that can take many, many forms) or pitch a tent, realizing that the weather is outside your control, and enjoy what is possible to enjoy.

• Resist trying to reassure your teen out of a negative thought. While such encouragement can often help someone who is not depressed, to a depressed person reassurances can sound like, “you don’t have anything to feel sad about, so stop it,” which can then cause the depressed person to become even more adamant about his negative thinking. This is another instance where your teen’s therapist can be very helpful in coaching you how to respond (e.g., “I think that’s your depression convincing you of a painful lie. I believe the reality isn’t nearly as painful as your depression’s lie); the technique of thought testing can also be very helpful here (e.g., see my parenting book or search using that term above).

• Don’t allow extended family to hassle your teen regarding his depression. Loved ones can say some pretty hurtful things in their desire to be helpful. Your teen’s therapist can help you to figure out your methods for doing this in a way that respects your teen’s privacy and independence.

teen diinterested face• Regularly let your teen know, without overdoing it, that you love her, that she is not alone and you understand that it’s terrible to be feeling what she is feeling, especially during the holidays.

• If your teen is or could be suicidal, get him in front of an expert ASAP and don’t leave him alone until you do. Consider this to be a life-or-death emergency as you certainly don’t want your baby to be one of the two million U.S. teens who attempt suicide each year.

Geez. Tough stuff huh? But, hopefully there’s a helpful tip or two here for you. Regardless, I hope you and yours have a wonderful holiday season!

 

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“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.

How Can I Tell if My Kid is Depressed?

depressed stunningAccording to the National Institute of Mental Health 9% of teens suffer from depression each year while 11% of youth suffer a depressive disorder by age 18. Moreover, suicide is the third leading cause of death among those aged 15 to 24. This entry will describe common symptoms and signs of depression in youth. (Please keep in mind that depression runs on a continuum; a kid may be suffering from depression, and need treatment, but only have some of the symptoms indicated below.)

Mood disturbance: Kids who are depressed have impairing sadness and/or irritability that is persistent (i.e., two weeks or longer). When a kid’s depression is manifested as irritability, it is easy to mistakenly conclude that primary problem is defiance.

Sleep disturbance: Not being able to get enough sleep or oversleeping are both signs of depression. What can make this tricky for teens is that school and extracurricular commitments can make it so that the teen doesn’t get to bed late anyway. Moreover, parents may retire before their teen and may not realize that s/he is struggling with sleep. (For guidelines on how much sleep is recommended, across age groups, enter the word “sleep” in the search bar above).

Appetite disturbance: Like sleep disturbance, depressed kids will tend to either over or under eat. Changes in weight and waistline are common.

Poor motivation: Most kids need help learning to do things when they don’t feel like it. But, kids who are depressed experience a steeper climb up that mountain.

Anhedonia: This is the clinical word for not being able to experience joy when crying childengaging in activities that are typically pleasurable. This can be especially frustrating for parents who have endeavored to engineer a positive change in mood.

Concentration problems: Just about all kids who are depressed will experience some degree of concentration problem. (Sleep disturbance and concentration problems are to a child psychologist what fevers are to a pediatrician: there’s a problem there but it can be due to a number of different things.)

Suicidal thinking: This kind of thinking runs along a continuum. On the one end are having vague thoughts that it’d be okay to die without any specific plans or intent to take action. On the other end is generating a lethal, specific and doable suicide plan.

Here are two common myths about teen suicide: asking a kid whether s/he is having thoughts of self-harm promotes suicide (not true) and all kids who make a suicide attempt mean to die (not true also). For more information on suicide, and talking to a teen about this, use the search bar above.

Negative thinking: Youth who are depressed tend to think, “Everything sucks. It’s my fault and it can’t be changed.” This promotes what is called “learned helplessness,” meaning that a kid can become so overwhelmed that s/he won’t take obvious and straightforward steps to feel better. Feelings of hopelessness, worthlessness and guilt are also common in moderate to severe cases.

teenagainstwallVarious kinds of mental confusion: In addition to concentration problems, youth with severe depression can start confusing what is real and what is not. They can also start to form beliefs that are highly distorted.

Though not present on the diagnostic criteria there are a couple of other common indicators:

Parental burnout: Parenting a kid who is depressed can be exceptionally frustrating and difficult. Not only do intuitive interventions tend to not work (e.g., verbal reassurances), but they tend to make matters worse. This can cause a parent to feel helpless and incompetent.

Parental disputes: As most parents tend to have different parenting styles, it’s natural to believe that if only the other parent would do things differently, the kid’s depression would lift. For this reason, the youth’s depression takes a toll on the parents’ relationship. I’ve witnessed a number of marriages get better simply by effectively treating a kid’s mood disorder.

Running in the family: Depression typically results when stress activates a pre-existing genetic vulnerability. The more mood disorders run in the family, the less stress it may take to activate impairing symptoms.

Sadly, and sometimes tragically, most youth who are depressed do not get distressed teen girltreatment for it, even though effective treatments are available (e.g., cognitive-behavioral therapy). If you are in doubt about whether your child or teen is suffering from depression, by all means treat that situation as you would if you were in doubt about the presence of a cavity. For databases of treatment providers near you, click here. Also, and as is the case across all service professions, the quality of mental health care varies. Sometimes adequately credentialed therapists are not prepared to evaluate and to treat juvenile depression in a manner that is informed by contemporary research findings. For this reason, parents do well to be informed consumers. To learn more about what constitutes effective mental health care for youth, see Chapter 10 of my parenting book or search the pages of this blog.

 

 

 

 

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.

What To Do When a Crush Dumps Your Teen

We engaged parents feel like we can be no happier than our least happy child. When our kids hurt, it seems like we hurt worse. Our love is a crazy, over-the-top kind of love that makes us lunatics sometimes. While there are probably important evolutionary benefits to our experiencing love to this degree (i.e., upon reflection of the reality in which we find ourselves as a parent, we might otherwise leave our kids at the hospital ;-), there are also disadvantages, unless we are careful. One such situation is when our kids are hurting. Because of the depth of our love we sometimes try to rush in and make the pain go away in ways that either deprive our kids of important outcomes or damage our relationship with them (e.g., see my entry Failure: An Important Part of a Psychologically Healthy Childhood). This entry is designed to help you to avoid both of the latter when your teenager gets dumped by a significant other.

Tip #1: Limit your first response to listening with empathy. This is the hardest part, listening without trying to make your teen’s pain go away. To be subject to a one-way dumping hurts a lot, especially if it is unexpected, the attachment was a strong one or the relationship was your teen’s first significant romance. As you hear the story you can make empathic comments: “That’s terrible.” “You must feel like your guts are being ripped out.” “I’m so sorry that she is being so unfair.” “It must really hurt that he cheated on you.” Being empathically present as your teen cries and laments, without trying to make the pain go away, is a major gift. It may not feel like it at the time, but it is. (This is often confirmed later by your teen’s expressions of gratitude or by him or her opening up to more to you.)

Tip #2: Try to help your teen get clarity about what he or she wants to do but avoid sounding like your trying to get him or her to do this or that, with one exception. Of course, you will have opinions about best next steps. But, you want your teen to learn to thinks these things through for himself or herself now, when under your care and the stakes are lower (though important), than later, when living on his or her own and the stakes are higher (e.g., should I marry this person?). Maybe the relationship is salvageable, maybe it isn’t. Maybe it’s best to make a closing statement to the other person, maybe it isn’t. Maybe it’s best to seek out an explanation from the other person, maybe it isn’t. You can serve as a sounding board, exploring pros and cons of each choice–including pointing out risks and benefits that your teen might be missing–until clarity descends. The only time it’s usually advisable to give firm but kind directives would be in situations when your teen wants to do something that could be dangerous (e.g., going to the other person’s house at 1 AM in the morning), psychologically damaging (e.g., arranging to declare love over the loudspeaker at school) or unduly expensive (e.g., purchasing an expensive piece of jewelry). Otherwise, it’s usually best to encourage your teen to make his or her own call, even when you might wish for a different choice; in the latter scenarios I’d even say something like “Brandon, that probably would not be the way I’d do it in your shoes, but I think it’s more important that you do the thing that you think is best because you’ll be the one experiencing the consequences. Plus, who knows, I’m just an old fart and you could be right.”

Tip #3: Educate, but only once your teen’s thoughts and feelings have been vetted. Let your teen know that it may take a while to get fully over the pain (e.g., going through the holidays and changes in the seasons will bring up painful memories of closeness with the other person) and that this is okay, it is to be expected and it will pass with time. This is a wonderful time to share your stories along these lines. (Crisis = pain + opportunity. The pain you experienced from being dumped can now be an opportunity in your relationship with your teen.)

Tip #4: Help your teen to focus on maintaining good regiments for diet, sleep and physical activity. Getting dumped can cause the behaviors that support these foundations of your teen’s wellness to go into the tank. So, cheerfully supporting each of these can be very helpful. (See other blog entries for tips on maintaining each of these.)

Tip #5: Encourage pleasurable activities. Such a loss is like being in a sea of pain. Experiences of pleasure, even if muted, can be like a raft while on that sea. Try not to show frustration if your teen rejects many of your offerings but keep them coming at a pace that works for your relationship (i.e., not too often, not too infrequently but just right).

Tip #6: Encourage safe social contact. Your teen may feel like he or she is in an abyss. While that sucks it’s a better to be in the abyss with company than alone. But, the company needs to be patient, understanding and disinclined to be scornful of melancholy. Initially this contact may be best accomplished with family and close, mature friends.

Tip #7: Seek our professional help if your teen is experiencing significant impairment accomplishing primary responsibilities (e.g., academic work), is showing a serious symptom (e.g., wishing God would strike her dead), or has mild to moderate symptoms that aren’t getting better after a couple of weeks (e.g., insomnia). If you’re in doubt, go. And, don’t wait for your teen to agree. (I tell parents “it’s your job to get him into my office. It’s my job to deal with him not wanting to be there.”) For a referral, click here.

What Do I Say To My Teen When Another Teen Has Committed Suicide?

Few tragedies make us wonder more about the order of our lives than when a teenager or young adult commits suicide. Sadly, this is too common as suicide is the third leading cause of death among those aged 15-24. Moreover, a recent national survey by the Center for Disease Control indicated that 16% of U.S. high school students report that they think seriously about suicide and half of those state that they have made an attempt.

As we consider this topic we also all do well to keep in mind that there is a risk of contagion whenever a teen commits suicide (e.g., a risk of another teen committing suicide). I’ve never known an adult who intended to glorify suicide. But that can be exactly what happens when a teen suicide is sensationalized or overly memorialized.

With those comments in mind, here are a few tips for approaching your teen about this topic:

• Don’t force a conversation about the suicide, but make it clear you’re interested in discussing your teen’s thoughts and feelings about it if he or she is open to that.

• Let your teen take the lead in the discussion. Try to avoid sharing your perspective until your teen’s thoughts and feelings appear to have been fully vetted. (In my experience this is hard for many of we parents to do).

• Offer empathy in response to whatever your teen says. Empathy to a teen is like a warming sun to a spring tulip: it facilitates more opening up.

Some things to consider offering once it is your turn:

• Let your teen know (or affirm the point if your teen has already made it) that suicide constitutes the worst possible choice a person can make. There is nothing about suicide that is worthy of glory, reinforcement, romanticizing or undue attention. It is a tragic and terrible behavior engaged in by people who are experiencing overwhelming pain and/or confusion.

• Ask your teen if he or she has ever thought about hurting himself or herself. (It’s a myth that asking this question, by itself, will promote or worsen suicidal thinking or behavior.) If he or she states that he or she is thinking about committing suicide arrange for an immediate evaluation by a qualified mental health professional (you can call the emergency services unit of your local community mental health center or take your teen to your local emergency room).

• Consider asking your teen what he or she thinks it would be like for you if he or she ever committed suicide. Then, either agree with what he or she has said or share more. This would also be a good time to reaffirm your deep love for your teen and the specific things that your teen says or does that you value.

• If your child knew the teen who committed suicide let him or her know that a grieving response is normal and expected. The balance is to give those thoughts and feelings the time and space they need while also trying to live life as normally as possible.

• If your child knew the teen who committed suicide stress that there is no way to know the causes of that particular teen’s suicide. Very little insight can usually be gleaned from the circumstances of the teen’s life (e.g., the degree of academic success, how much cohesion appears to be in the family, etc.). As a psychotherapist my clients usually let me in to very private and hidden areas of their lives; however, even I do not often know every important factor that causes them to behave in a particular way.

• Let your teen know that you will arrange for him or her to speak privately with a qualified mental health professional about these issues if he or she would like that.

There are many preventative strategies Here I will share three (I am more thorough about this in my parenting book):

√ Spend at least one hour a week doing special time with your teen. A regular line of communication makes it more likely you’ll be in the loop if your teen’s mood darkens. Click here for a download on how to do this weekly exercise.

√ Do all that you can to make sure that your teen has identified his or her competencies and is manifesting them in the world.

√ Try to ensure that your teen is sleeping at least 8.5-9.5 hours a night, is eating a balanced diet that limits processed carbohydrates and sweats and breathes hard an hour 5-7 days a week.

In closing, if your teen is showing signs of mental health disturbance, please err on the side of caution and arrange for a qualified mental health professional to do an evaluation, even if your teen is opposed to the idea. For a referral, click here.

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.)

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.

Resources for Suicide Prevention

As this month is suicide prevention month, I am guest blogging at the American Psychological Association’s Blog http://www.yourmindyourbody.com. My post regards suicide prevention in youth. Click here to read it.

I also did a live radio interview, on the same topic, for the Harrisburg, PA PBS radio station. To listen to it, click here.

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