Tag Parenting

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Strategies if Your Child or Teen is Being Bullied

Nov 7, 11 12:40 PM

Your child reporting that he or she is being bullied can be very upsetting. According to the Center for Disease Control, 19% of kids are victims of bulling on school grounds. Bullying can include physical and/or verbal confrontation, social exclusion and spreading harsh rumors; it can also occur through electronic and online technologies. Available evidence suggests that those who experience a pattern of being bullied experience significant mental health challenges (the same is often true among those who engage in a pattern of bullying). Among the children who are bullied low self-esteem and under socialization are common. In the animal kingdom predators prey on vulnerable members of the herd who can be found on the fringes or in isolation. This is often the case for children who are repeatedly bullied as well. If your child is experiencing a pattern of being bullied, or if any incidents of bullying are causing him or her distress, consider the following:

  1. Get expert assistance. An evaluation by a well qualified child mental health professional is usually a good idea, even if you are able to get the bullying to stop by other means. It is much better to understand any contributing problems, and to develop a plan for managing or fixing them, than it is to let a child or teen languish. To find a qualified professional near you click here.
  2. Consult with the school about the bullying. I’ve never met a teacher or school administrator who is willing to tolerate bullying. It is ideal to have this consultation with a child mental health professional at your side. The consultation can be used to reach a clear understanding about what has happened and to develop a plan for fixing things.
  3. Encourage your child or teen to travel with at least one friend as she or he travels from one location to another at school. As I implied above, bullying is much more likely to occur when a child or teen iis traveling solo. This step might involve inviting prospective friends over to your house in order to develop or to create friendships. If your child or teen cannot, or will not, name friend candidates her or his teacher(s) may be willing to do so.
  4. If your child or teen is a victim of cyber bullying consider first whether his or her online life is adaptive (please see my blog entries that cover monitoring online activity and internet addiction to help in this determination).
  5. If you know the parents of the alleged bully, and you have no clear reason to believe that they would be hostile, consider arranging to have them over to your home to discuss what everyone can to do garner wellness and peace. (In many instances it may be better to do #1 before this one so that a qualified mental health professional can help you to think through the issues, including how you want to manage the meeting.)
  6. If your child has not discovered things that he or she is good at, or does not have regular access to activities that put such talents on display, I would make changing this a top priority. Please see Chapter Two of my book Working Parents, Thriving Families, to read about specific strategies for pulling this off.

Here also are three strategies that often are not advisable. Keep in mind that even a broken clock is right twice a day. So, just about any strategy has some chance of working. But, I am suggesting that the odds of the following working, independent of significant negative side effects, are probably low:

  1. Encouraging a child to be physically aggressive. Yes, there is reason to believe that assaulting a bully might cause him or her to retreat. But this teaches all sorts of unsavory lessons, risks school disciplinary action and can be excruciatingly difficulty for a child or teen to pull off.
  2. Succumbing to your child’s or teen’s plea for you to do nothing. If your child told you that mold was growing in his or her locker at school and you could tell that this was making him or her sick, would you adhere to his or her begging to not take action? Keep in mind that any number of different kinds of action may be in order (see above). What I believe is generally more advisable is to find out what your child or teen reasonably fears could happen if you initiated a plan for fixing the problem (e.g., retaliation by the bully, someone finding out that he or she is in counseling). You might then take steps to make the odds of such happening remote. (A consultation with a mental health professional is especially advisable if your child is insistent along these lines.)
  3. To view the problem as completely resolved if the only change the occurs is that a pattern of bullying stops. I think it is very important to a child’s or teen’s wellness to take steps to understand and to resolve the underlying issues that caused such a painful cycle to begin.
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Mental Health Concerns Are Nearly Universal By Age 21

Oct 28, 11 7:09 PM

Earlier this year a landmark study on the prevalence of psychological disorders in youth was published in the Journal of the American Academy of Child and Adolescent Psychiatry. Examining youth living in 11 counties in the southeastern US, it is the first to track kids’ mental health status from ages as young as 9 through age 21 (a total sample size of 1,420). The authors–Drs. William Copeland, Lilly Shanahan and E. Jane Costello and Ms. Adrian Angold–note some key findings in their report:

• Assuming that there was no incident of psychiatric disorders among the missing cases (an unlikely event), 70% of the sample met criteria for a mental health disorder, at some point, by age 21. (This is referred to as the unimputed number.)

• If one were to assume that the rates of psychiatric disturbance are the same among the missing cases, the frequency of a mental health disorder by age 21 rose to 82.5%. (This is referred to as the imputed number.)

• Child participants entered the study at one of three different ages: 9, 11 and 13. Among the youngest cohort (i.e., entered the study at age 9), the rates of having a diagnosable mental health problem by age 21 was “higher than 90%.” The authors note “This suggests that the experience of psychiatric illness is not merely common but nearly universal.”

• When examining the imputed analyses, these were the most common disorders: substance abuse–42%, behavioral disorders (e.g., ADHD, Oppositional Defiant Disorder)–23.5%, anxiety disorders–20.9% and mood disorders–14.8%.

While all research studies have their flaws, and this one is no exception (e.g., an under representation of African-American and Hispanic children), this study numbers among those contributing to the notion that mental health disorders and physical disorders, as they manifest in youth, have many similar characteristics:

• The odds of having at least one by adulthood are nearly universal.

• Most are not chronic or severe.

• Most can be cured or effectively managed through evidence-based interventions.

• Most will either worsen, or promote needless suffering, when they go unrecognized or untreated.

However, there is a key way that mental health and physical disorders in youth are substantively different. As the authors indicate: “Only about one in three individuals with a well-specified psychiatric disorder received any treatment at all, and even when treatment was obtained, it rarely conformed to best practice recommendations.” I find myself wondering when we will grow weary and intolerant of this needless suffering that our babies endure.

If you, as parent or caregiver, would like to find an ally in your neighborhood to help you to understand whether a child or teen under your charge could use help along these lines, click here. To read a consumer guide for child mental health services, see Chapter 10 in my book Working Parents, Thriving Families: 10 Strategies That Make a Difference.

You may also find value in reviewing posts I’ve written on related topics:

• Affording Mental Health Care

• Signs that a Kid Needs Mental Health Services

• Seven Common Myths About Counseling

• Millions of Teens are Suffering Needlessly

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10 Tips for Parenting Your Progeny’s Online Life

Oct 7, 11 12:56 PM

When considered from the lens of parenting, I liken Facebook, and services of its ilk, to dust mites. It’d be awesome if I could eradicate them, but that’s not realistic. Instead, I try to look upon online services that are available to my kids as offering opportunities to further realize my parenting agenda. This post offers my top 10 tips for tapping this opportunity.

#1. Maintain a weekly dialogue with your child. Having weekly one-on-one time to discuss how your child’s life is going is an essential foundation for just about any parenting agenda. “What are the best thing and the worst things that happened today, even if they were minor?” “Who are your top three friends these days and what do you like about them?” “What’s it like to be in 7th grade these days?” (Click here for a blog entry that lists other potential conversation starters. Please also see Chapter One in my parenting book Working Parents, Thriving Families, for detailed coverage.)

#2. Limit sedentary electronic pleasures to two hours a day. This is the recommendation of several authoritative bodies. If a kid is plugged in more than this he may be missing out on other important activities (e.g., being physically active, doing academic work, engaging in extracurriculars, socializing face-to-face).

#3. Use the social networking mediums that your kid is using and link to your child. If your child uses Twitter discover what it can do for you and be sure to follow each other. If your child uses Facebook use it as well and friend each other.  You also want to make sure your child doesn’t have two social networking accounts: the one you’re connected to and the one on which he goes rogue.

#4. Monitor your kid’s computer use. We want to strive for the middle ground. Over monitoring a successful and responsible child dampens the development of independence and can unduly tax a parent-child relationship. Under monitoring a child who is struggling, or who is putting herself into harmful situations, is obviously not a good idea either. This is where your world’s leading expertise of your child is essential to inform your steps. Regardless of the dosage of monitoring that you decide is advisable, programs that allow you to track your child’s computer use can be very helpful (e.g., www.spector.com/spectorpro.html, www.webwatchernow.com).

#5. Network with other parents and use parenting resources. Whenever you’re hanging out with other parents (e.g., on the sidelines of games, before a parent meeting starts) ask them what strategies they use. While you may hear from parents who seem misguided in their approach (e.g., washing their hands of a monitoring responsibility), others may have clever insights and ideas to share. There are also an abundance of online resources available for parents. (e.g. www.wiredkids.org, www.familyinternet.about.com, www.familysafemedia.com).

#6. Set up rules. Here are some I’d suggest:

√ No swearing.

√ No discussions of sexual or illegal activity.

√ No threatening others.

√ No “friending” people above the age of              (i.e., your 11 year old child’s 19 year old cousin may be super nice to her and a great person, but friending her on Facebook may afford your child access to inappropriate adult material, either on her cousin’s page or on the page of someone in her cousin’s network).

√ Under the “How You Connect” portion under “Privacy Settings,” make sure they are all set to “Friends.”

√ Public searches should be disabled on Facebook. This means that people cannot find your child’s page through internet searches. Under “Privacy Settings” click on “Apps and Websites,” then click on “Edit Settings”  that is next to “Public Search.” Then uncheck the “Enable Public Search” box.

√ You must get others’ permission before posting his or her picture online. Depending on the age and maturity of your child you may also decide that you must also approve all pictures before they are posted; this would also allow you to determine if your child’s friend’s parents’ approval should be garnered.

#7. Role-play scenarios. This is an excerpt from a 2008 national study of the online experiences of kids aged 10-15, authored by Drs. Michele Ybarra and Kimberly Mitchell, that appeared in Pediatrics: “Fifteen percent of all of the youth reported an unwanted sexual solicitation online in the last year; 4% reported an incident on a social networking site specifically. Thirty-three percent reported an online harassment in the last year; 9% reported an incident on a social networking site specifically. Among targeted youth, solicitations were more commonly reported via instant messaging (43%) and in chat rooms (32%), and harassment was more commonly reported in instant messaging (55%) than through social networking sites (27% and 28%, respectively).” Given how common such experiences are we do well to train our kids how to respond. “Hunter what would you do if someone put on their Facebook page a hurtful lie about you?” “Aiden what would you say if someone asked you for your address?”

#8. Set up parental controls on computers that your child uses. This would include things like using browsers designed to block explicit content from kids (e.g., bumpercar,  www.cybersitter.com), not allowing your child to covertly install software (i.e., through settings within the system software), and making sure that there are sufficient parental controls on your child’s other gear that can go online (e.g., cell phone, video game console, portable gaming unit). After you set up your controls offer a tech savvy 20-something person a gift card if he can try to circumvent your controls; offer a higher value gift card if he is successful and can show you how to install effective countermeasures.

#9. Make sure your child understands the limits of privacy on the internet. Colleges search Facebook pages for information, as do employers, volunteer organizations and other people who might be a gatekeeper for some experience, membership or standing that your child may desire in the future (e.g., I recently heard of a coach of a travel baseball team who rejected a kids application to play on the team because of what he found at that kids Facebook page). A good rule of thumb: if you wouldn’t want the world to see it, think four times about posting it.

#10. Consider what you might do to promote the privacy of your family’s online experience. Each computer has an IP address that tells internet sites you visit where you’re located. However, there are services available that make it more challenging to do this (e.g., www.hidemyass.com, www.anonymizer.com). As a start you might read up on IPs and privacy (e.g., http://www.livinginternet.com/i/iw_ip.htm). Moreover, many websites will, without you knowing it, collect information from your computer. However, there is software available that allows you to approve or disapprove this activity (e.g., for Macs: www.littlesnitch.com; for Windows: www.zonealarm.com).  Keep in mind that some have argued that Facebook’s true customers are not its users but the corporations to which it sells information about its users.

For other websites and resources please also see the “Further Reading and Viewing section of Chapter Three in Working Parents, Thriving Families, or the Chapter Three section at www.resilientyouth.com. You may also enjoy reading 10 Strategies If Your Child is Addicted to World of Warcraft (WOW).

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Six Tips For When You Lose It With Your Kid

Sep 10, 11 3:24 PM

All of we parents say and do things with our kids that we regret. These are not knowledge deficits (i.e., we know we’ve erred) but are performance deficits, the causes of which are as varied as the number of stars in the sky. (Most of the time these lapses would not cause the staff at a state’s welfare department to become alarmed, and this entry is not meant to address such instances.) These are moments when our personal reservoir of resources has been depleted by stress and we snap, issuing forth with harsh invectives. This post is meant to give you some strategies to try once you’re back on your game and parenting with intention.

#1: Be kind with yourself in how you think about your lapse. Such moments are as universal to family life as dust mites. Sure, it’d be nice to be rid of them, and we strive for that as best as we can but, at the end of the day, we’re only human. Moreover, research suggests that our kids, assuming our family life is generally healthy, make less of these skirmishes than we do.

#2: Do a psychological autopsy with your child after you both have calmed down. In other words, have a calm discussion about what happened. During this conversation own your lapse without qualification. “John, it was wrong of me to call you lazy and slow witted. Neither of those things are true. I was having a bad day and over reacted to your complaints about doing your homework. That was wrong of me and I apologize son.” Let your kid respond and reinforce that with which you agree. Then, if your child misbehaved in some fashion, try to raise his or her awareness. This is done independent of the apology. That is, I don’t want to sound like I’m trying to place responsibility for my behavior onto my child. “John, thinking more about this, is there anyway you can think of that you could have acted better?” If your child comes up with a reasonable answer you can salute his or her growing maturity. If not, you can suggest what you have in mind. “Well, I think it would have been better for you to do your homework, without complaint, after being warned that I had had enough complaining for one day.”

#3: Consider what you can do to keep yourself from turning this type of intermittent lapse into a regular pattern. Some useful questions to consider: is your self-care sound (e.g., getting sufficient doses of sleep, healthy foods, physical activity, fun, interpersonal connections, and calm)? Is there a pressing stress on you that may need more focused attention? Could you use more help or support and, if yes, how might you get it?

#4: Assuming your child’s behavior prior to your lapse was problematic, consider what you can do to keep such from becoming a dysfunctional pattern. Some questions to consider: could the behavior your child is demonstrating be signally the presence of an underlying problem that needs attention? Are your child’s health habits in need of adjustment? (As much as we adults can be adversely affected by poor health habits, this is even more the case with our kids.) Does your child have any insights into what might be driving the behavior?

#5: Spend one hour a week one-on-one with your child doing nothing but paying attention to him or her and offering positive thoughts and feelings. (Please note that this is different from quality time–a valuable activity to be sure– but which usually involves my dividing my attention with the thing we are doing together.). This dosage of weekly attention is to a child psychologist what an apple a day is to a pediatrician.

#6: If the trigger for your lapse is your child resisting doing a chore or some other obligation, consider setting up a behavioral contract to make it in your child’s best interest, as he or she looks at things, to comply. This switch can turn you from acting like a harsh warden to a benevolent bystander. Click here to read a blog post that covers this method a bit more. Click here to learn more about my book, which covers all the issues in this post in depth.

In closing remember that there is a small army of highly trained mental health professionals available that is willing and able to be of help. To access one data base of such mean-lean-healing machines, click here.

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51 Truths (as I see things anyway)

Aug 22, 11 2:57 PM

I recently saw a blogger use the occasion of his birthday to write a list of tips that equaled his years. I thought that such a good idea that I didn’t want to wait until my birthday to do something similar. So, this is my top 51 truths. One caveat–which I feel somewhat apologetic for and which will be obvious as you read on: while the large majority of these statements are supported by research findings, others are merely personal beliefs that are not testable by science.

1. Self-care is an act of love towards one’s children.

2. Effective discipline = effective teaching.

3. Self-entitlement has many faces, but two common ones are expecting others to protect one from the consequences of one’s choices and expecting that others, if they are fair, will give one the outcome that one wants because one is a good person who tried hard.

4. Behind just about any action of abuse or neglect is pain.

5. At the end of everything, how well we love is what matters the most.

6. Avoiding avoidance is generally advisable when the avoided thing, person or situation is not truly dangerous.

7. More determinative of mood is what we think about what has happened, not what has actually happened.

8. Being kind to others is a great mood enhancer.

9. We loose IQ points when we get angry.

10. Show me someone who is not engaged in an internal battle and I will show you someone whose life is in shambles.

11. Being in a successful long-term marriage is one of the most difficult things a human can try to do.

12. The greatest pain is having one’s child die.

13. The opposite of love is not hate, it’s fear.

14. We get use to just about anything. One of the many things this teaches us is that we need to mix things up lest our sex life become mundane.

15. Single parenting in a two-parent household is a symptom.

16. Becoming physiologically and psychologically calm on a daily basis promotes many health and psychological benefits.

17. “Physical activity” is a much more effective term than “exercise.”

18. Fast food is generally poisonous, though it may take a long time for the effects to become obvious.

19. We are suffering from an epidemic of sleep deprivation, across the lifespan.

20. The large majority of kids, teens and adults who could benefit from evidence-based mental health services do not get it. This truth is even harsher for minorities and the poor.

21. We parents love our kids so much it makes us lunatics some of the time.

22. The practice of a spirituality correlates strongly (and positively) with multiple physical and psychological benefits.

23. If Heaven exists (and I believe it does), there are no institutions there.

24. When we don’t know what is motivating another person’s irritating behavior, our own mental health is nurtured when we assume she or he has good cause.

25. Adaptive rituals produce positive illusions.

26. Men are generally simpler creatures than women.

27. There are many more ways to promote misery than there are to promote happiness.

28. Corporal punishment can usually be aptly labelled “undisciplined discipline.”

29. Willpower, when used in isolation, is not a very reliable tool for changing harmful habits.

30. The more we learn the more nuanced we become.

31. Understanding how well a person can do things when he or she doesn’t feel like it can tell you a great deal about his or her success in both vocational and personal arenas. This is why teaching such skills to our children is a top parenting activity.

32. Heaven exists outside of space and time, which makes it very difficult for us to think and talk about what it is like.

33. Crisis = (pain/2) + (≥ opportunity/2).

34. Using addiction to deal with pain is like drinking ocean water when on a life raft: certainly understandable but it makes things worse.

35. We parents are shepherds, not sculptors.

36. Having kids quadruples the importance of having a good maintenance schedule for a committed relationship. (I’d write something higher than quadruples but I had a hard enough time spelling quadruples.)

37. If swimming is the activity that uses the most physical muscles forgiveness is the activity that uses the most psychological muscles.

38. What an apple is to a pediatrician, positive one-on-one attention is to a child psychologist.

39. Simultaneously pursuing self-interest and effective political service is like trying to iron clothing underwater.

40. Addiction is a jealous, cunning and harsh mistress that isn’t satisfied until its victim is left with nothing else.

41. An important mistake we make in thinking about race is to suppose that being impacted by someone’s race is the same thing as being racist.

42. Show me someone who is critical and unloving towards others and I will show you someone who is critical and unloving towards himself or herself.

43. Though they vary, we all have our limitations and when we exceed them we break.

44. No engaged parent can be generally happier than his or her least happy child.

45. Improving someone else’s life, without them knowing one did so, is glorious.

46. Well-conceived mission statements can help one to make many decisions about how to spend one’s time and resources.

47. Considering a difficult decision from the context of one’s deathbed can promote clarity.

48. That which is loving is of God. That which is not loving is not of God.

49. Empathy tends to soften anger.

50. Going through an effective psychotherapy is like being reborn.

51. Show me a spiritual person who is generally physically active, getting enough sleep, eating a good diet, executing his or her top talents in service to others, and being loving in his or her personal relationships and I will show you someone who is wise.

I enjoy receiving all comments, but would especially  welcome others sharing truths I have left out. Also, if anyone would like me to do a subsequent blog post on any of these assertions, I’d enjoy hearing about that as well.

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Failure: An Important Part of a Psychologically Healthy Childhood

Jun 22, 11 8:38 AM

Recently I was on a sports field and overheard heard this conversation between a mom and a coach:

Mom: “Coach Jim didn’t make the all star team. Did they tend to pick older boys?”

Coach: “Ahhh, not really. Older boys are often more skilled, and so more of them were chosen, but some younger talented boys were picked too.”

Mom: “What do I say to him? I don’t want him to be crushed. I think I’ll just say that they were choosing older boys this year”

Coach: “Whatever you think is best.”

On this same ball field, as is the case all across America, children are routinely praised for poor outcomes. A kid grounds out weakly without advancing a runner and hears “good hit Colin!” A girl pitches ball four to load the bases and is told: “good pitch Sarah!” Moreover, kids receive positive feedback on a very high proportion of plays (in my neighborhood, well over 90%).

Is it easy to understand why this happens. No engaged parent is more happy than her least happy child. When one of our kids hurts we hurt worse, so it’s natural to try to avoid the pain that failure brings. Moreover, we are very interested in making sure that our kids have a solid self-esteem and are concerned that failures, or an absence of consistent positive feedback, may leave our child falling short of developing well.

However, what we sometimes fail to realize two things: (1) failure is a critically important part of a psychologically healthy childhood and (2) too much praise dulls it. I once asked a panel of child mental health experts on a TV program I host. “If it were possible to raise a child into adulthood and make sure that she never failed at anything would you want to do it?” Everyone on the panel instantly declared “no” as such an adult would be handicapped when inevitable failures come along. Moreover, praise that is vague, inaccurate, overdone or overstated loses its impact and can actually have detrimental effects.

Let me focus a little bit on failure and review some of the benefits it offers:

√ Failure helps a kid to understand what her true talents are (i.e., if one is praised for every outcome, even the bad ones, it is more complicated to discern one’s true capacities).

√ Failure provides the opportunity to learn how to think adaptively about failing and how to respond effectively to it. Sure, I might be able to protect my child from the notion that he has failed (e.g., by stating falsehoods) for much of his childhood, but at some point the world will visit failure upon him. Better for him to learn how to think about it and respond to it early on, before dysfunctional attitudes and coping styles might develop, and when I can have a greater impact on how he responds to failure. Moreover, I certainly don’t want to condition my child to believe that she is owed a good outcome simply because she is a good person who means well and tries hard.

√ Failing offers the opportunity to learn a very important psychological formula: crisis = pain + opportunity. None of us likes pain, of course. But is it not woven into the fabric of all of our lives? Part of being resilient is to recognize that pain, to paraphrase a poet, is like a dragon guarding treasure; and, the fiercer the dragon the more valuable the treasure. However, the dragon must have its way before the treasure can be accessed. Time after time I’ve seen examples of resilient kids and families taking the hit and, because of the hit, coming out on the other side stronger, wiser, more effective and happier.

A few suggestions for those moments when your child produces a poor outcome:

√ Sometimes no comment is the best comment. For some kids striking out can be as upsetting as having a fly land on their nose. It may not need to be remarked upon.

√ If a comment is needed, sometimes waiting is advisable (e.g., for my child to become more responsive, so that it is less public)

√ Don’t lie or exaggerate. This is not the same thing as saying everything on my mind. But, when I do speak I want it to be truthful. This strengthens my long-term credibility and models virtuous behavior.

√ Provide empathy when your child is hurting without qualification. “That hurts doesn’t it.” “I could see why you’d be upset over that happening.” “It hurts to not be able to come through for your team.” Keep the butts off it initially (e.g., “…but you’ll get ‘em next time”). This can be especially difficult for we lunatic-parents to endure (i.e., we love our kids so much it makes us crazy), especially when our empathy leads to more opening up about the pain. But, tolerating this is a gift we give our children.

√ After feelings and thoughts have been vetted consider whether a plan of action is warranted: drilling, studying, problem solving, etc. If the failing represents a painful pattern think of it as a problem to be solved.

√ Value things like effort (e.g., your child hustles even when a losing outcome seems inevitable) and character (e.g., you child congratulates an opponent for a good play, lifts up a team mate who was feeling down) making sure that such comments are tied to specific examples.

√ Keep praise for effective performance proportionate, especially when around others from outside of the family.

I realize I’m hitting only some high points here. A much more complete accounting of these issues, together with stories that illustrate the points, can be found in my parenting book Working Parents, Thriving Families. I’ve also written a blog entry titled Five Questions for Effectively Parenting Kids in Sports. Finally, if your child has a pattern of responding to failure that is consistently impairing (e.g., public displays of anger, inconsolable and persistent sadness) consider seeking out the services of a qualified mental health professional.

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

Jun 10, 11 1:56 PM

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

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Seven Tips for When Your Child Refuses to Do a Chore

May 18, 11 9:15 AM

What’s a parent to do when a child resists doing a chore? In this post I offer seven tips for dealing with such a situation. These tips are premised on three assumptions:

  1. The chore is age appropriate and skill appropriate for your child. Said another way, the task is within your child’s reach to complete.
  2. Your child is not suffering from an untreated psychiatric problem. If a child suffers from depression, anxiety, bipolar disorder, or another diagnosable mental health disorder he or she may need interventions that are more sophisticated than what’s indicated below.
  3. Your child’s resistance to the chore is not in response to someone else’s psychiatric problem (e.g., someone acting in an abusive fashion, someone abusing alcohol, etc.).

Tip #1: Make it clear what you expect. Your idea of a clean room and your child’s idea of a clean room may be very different. One way to avoid this problem is to write down on an index card what effective task completion looks like. For instance, a clean room = bed made, all clothes put in their place and all food particles/dishes out of the room and either in the trash or the dishwasher (for pre-readers this can be indicated with pictures). It’s also a good idea to put down how long you expect it to take for your child to complete the task.

Tip #2: Don’t make it sound like you’re asking for a favor. “Colin would you Puhleezzee take out the trash just once this week without a hassle?! Puhleezzee!” sounds like I’m asking for a favor, and we all get to say no to favors.

Tip #3: When giving a command make eye contact and use as few words as possible. If my child is watching TV, or I’m issuing a command from another room, the odds of compliance go down. Moreover I facilitate the escalation of anger and resistance if I start lecturing in these moments.

Tip #3: Establish a reward.  In the mildest cases of non-compliance your praise for a job well done may be sufficient. If that doesn’t work you can make your child’s access to a privilege contingent upon having done the chore properly. “Jaden from now on you earn the privilege of watching TV by doing kitchen duty.” After having done the chore multiple times in a row a bonus can be offered (e.g., a game rental, a trip to an ice cream shop, etc.).

Tip #4: Give your child the opportunity to control aspects of the task. “Peter which day of the week would you like to pick up the dog’s poop off the lawn?” “Brooke do you want to take your shower right after dinner or right before bed?” “Claire do you want to rub my shoulders before or after you rub my feet?” (Just kidding on that last one…or am I?)

Tip #5: Give a warning that the task is about to be due. “DJ I know you’re into your video game but in 15 minutes I’m going to need you to stop and pick up your toys and put them in their place.”

Tip #6: Use time out if the reward is not sufficient. If your child resists doing the chore after you’ve given three commands to do it (issue the threat of time out when giving the command the second time), have her sit in a hard chair for a minimum sentence of one minute for each year she has lived outside the womb (don’t let your child know what the minimum sentence is). After the minimum sentence has elapsed your child can get out if she is sitting there quietly and she agrees to do the chore. If either or both conditions haven’t been met, and without announcing that you are doing so, cylce through new periods of minimum sentences until your child is sitting there quietly and agrees to go do the chore.

Tip #7:, Seek out help if your child has a persistent patter of non-compliance, that is not responding to your best efforts. For a referral for a provider near you click here.

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Communicating with Teens about STDs

May 11, 11 7:44 AM

My various jobs call for me to read on a regular basis. However, there is only one book I’ve read that felt so important to my parenting mission that I interrupted my own reading of it and asked for my two teenagers to read the first chapter. That book is Seductive Delusions: How Everyday People Catch STDs by family practitioner Jill Grimes, M.D.

The national survey data on youth sexual behaviors indicate that teens frequently have sex, and in ways that put themselves and their partners at risk. For instance, the CDC’s most recent edition of the Youth Risk Behavior Survey, indicates that 46% of high school students have had sexual intercourse (African-American youths reported the highest rates at 65%), with 34% reporting that they are sexually active and 14% indicating that they have had sexual intercourse with four or more different partners. Moreover, 39% of teens reported that they did not use a condom the last time they had intercourse, though 22% did use drugs or alcohol.

The results of these behaviors can range from unwanted pregnancies (e.g., according to the CDC there were 409,840 infants born to girls ages 14-19 in 2009) to the contraction of a (sometimes life-long) sexually transmitted disease (e.g., quoting from Dr. Grimes’ book: “Estimates vary, but between 50 and 90% of adults have oral herpes by age 50…25% of adults have genital herpes, but up to 90% of them are unaware of it.”) I do my teen no favor if I think that she or he could never be one of these statistics.

Giving teens real life stories of peers and young adults suffering from STDs can be one effective way of reaching them about these matters, especially when those stories poignantly review the long term, embarrassing and inconvenient realities that can follow from even a brief lapse. That is what makes this book so important. The stories are effectively organized by type of STD and include facts about each disease at the end of each chapter; the reviews of the book have also been stellar (e.g., see amazon.com). I encourage you to review it yourself and see whether you might want to recommend it for your teen (or older) child. (Please also stay tuned to this blog as Dr. Grimes will be doing a guest entry for us sometime later this month or early next month.)

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A Chronic Health Problem in Teens: a Lack of Sleep

Mar 9, 11 10:03 AM

The National Sleep Foundation does an annual Sleep in America Poll. Their 2011 edition, which has the theme of “Communication Technology in the Bedroom” was just published. In this blog I’m going to summarize the findings as they regard teenagers, which the poll refers to as Generation Z’ers.

Almost three out of four teens report bringing their cell phones into their bedrooms at night, with 56% texting every night/almost every night in the hour before bedtime. This is concerning as those who text in this hour are less likely to say they got a good night’s sleep, less likely to wake up feeling rested, more likely to be characterized as sleepy the next day and more likely to drive drowsy.  Moreover, 28% percent of teens leave their cell phone ringers on at night and 18 percent report being awakened by incoming transmissions. Finally, when they wake up at night 35% of teens report that they will text.

The poll also found, as has been the case with previous editions of this survey, that our teens are not getting enough sleep.  This year 4 out of 10 teens reported getting less than the minimal recommended dose of sleep each night with 60% stating that they wake up feeling like they had not gotten enough sleep (46% indicated that they rarely/never get a good night’s sleep on weekdays and only 6% endorsed getting a good night’s sleep every school night).  Moreover, among those that drive, 40% indicated that they have driven drowsy.  In total 77% of teenagers reported having sleep problems at least a few nights/days a week (e.g., 34% of teens report taking more than 30 minutes to fall asleep at night).  Despite these problems teens seem to be aware of how many hours a night they need to be rested (i.e., 61% indicated that they need 8-9 hours, or more, to be rested).

The poll also asked the teens what areas are negatively affected the next day when they are tired. These are the areas they indicated become problematic (the percentage endorsing the problem is in parentheses): mood (87%), schoolwork (84%), family life or home responsibilities (73%), and social life or leisure activities (68%). (Please see my previous blog entry that reviews both the negative next-day consequences, for youth, of being deprived of just one hour of sleep as well as the National Sleep Foundation’s recommendations for how much sleep kids should get each night.)

Other findings:

√ More than three out of four teens use their laptops in their bedrooms in the hour before going to sleep. Most of the poor sleep outcomes that are associated with texting in this hour are also associated with this kind of activity.

√ Sixty percent of teens drink caffeinated beverages each day, with one out of four drinking four or more.

√One percent of teens report using an e-book reader in the hour before bedtime.

To review strategies for promoting a good night’s sleep in your child click here. For now the obvious thing to say is that we parents do well to be mindful of how much sleep our teens need as well as what the likely consequences will be if they are deprived of such.

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