Medication, Mental Health, and Children

medicine, children, mental health

Medication and Children’s Mental and Behavioral Health
by Patience Domowski, LCSW

Should I put my kid on medication?

Many parents wonder this when their child is struggling with mental health issues. Is this just a ‘quick fix’? Is medication going to harm the child worse than their diagnosis already affects them? It’s a difficult decision and many parents worry about side affects, addiction, and long term necessity. Many parents have heard horror stories of kids over medicated. The stories in the media are mostly negative, and most of the information about medication that is commonly known isn’t always accurate too. So how does one make that decision?

While it’s a personal decision to be made by the parent(s), and perhaps the child, (if the child is of age to make that decision, such as a teenager), here are some helpful things to consider when trying to decide what the best course of treatment is. Consider some other options for treatment before going the medicine route, except in certain situations, to be discussed below.

Treatment Options

First, try therapy. If your child is able and at least moderately willing to attend sessions, try a behavioral therapist to help with the child’s emotional or behavioral issues. Often the coping strategies taught in sessions are sufficient, and medication is not even necessary. Children with ADHD can learn some tips and tricks to help focus, kids with anxiety can learn some coping skills to calm themselves when anxious, and parents can learn some ways to better manage their child’s behavioral symptoms and emotional distress. Most child behavioral therapists will teach the parents some ways to handle the child’s behavior including ways to help calm the child when they are angry or anxious, and some behavioral strategies such as reward charts and consequences to utilize at home. There are behavioral therapists that are in offices, some that come to the homes, and some that work in the schools. Find out what is best for your child and what is available in your community, by asking your insurance agency, pediatrician, or school guidance counselor for suggestions.

If the problem occurs at school, get help from the school. If the child’s behavior is affecting their schooling whether it’s acting up in class, panic attacks that send them to guidance frequently, or the child is unable or unwilling to complete homework, ask the school for help. The school can evaluate the child to see if they qualify for an IEP for 504. If the child meets the requirements they can get extra formal and informal supports and services from the school district.

What if therapy doesn’t work?

If therapy and school supports are not sufficient, or the child is unable to even participate in therapy or school programs due to their emotional state or extreme behaviors, then it is time to consider medication. The question as to how long to wait to see if therapy and school supports are helpful enough will vary per child, however a few months is often a good time, and asking the school and therapist about this is a good option.

For example after several months of school interventions the child is still unable to focus, has frequent anger outbursts and can’t seem to control them, or other issues, it may be time to consider another path of treatment. Or after several months of therapy the anxious or depressed child is not seeing results, they are unable to do the skills at home, or the results are very minimal, they may need medication to help them achieve the ability to try the skills learned at home or school.

Do children ever absolutely have to be on medication or aren’t candidates for therapy?

Technically no, you never ‘have’ to put your child on medication, but sometimes it is strongly advised. Not every child qualifies for or would benefit from the same types of therapies. There are different options to consider to see what best fits your child’s needs. Some children need high levels of care such as hospitalization, or residential treatment, while most only need outpatient (office-based) therapy, or home based therapy.

In some cases it may be necessary to start medication immediately, prior to implementing other treatment options. If the child is extremely suicidal, has severe panic attacks on a very frequent basis, cannot focus or sit down long enough to learn in school or participate in therapy, or their behaviors are so extreme they include aggression, inability to reason (think logically), or have dangerous behaviors such as severe aggression or impulsivity, it may be imperative to start medication before, and in conjunction with, other treatment options. Sometimes children are too affected by their symptoms to even learn coping strategies in therapy or to learn and respond to school that they need something to settle them down before they can try other options.

Can my child get off their meds or are they on it for life?

Once the child, or teen, is able to settle down, because of the medication, they are better able to learn coping strategies. Often the medication takes the edge off enough that they can think more clearly, make better decisions, and use the skills and strategies that the therapist and teachers are trying to teach them. Most professional recommend a combination of both medication and therapy to best treatment.

Often kids are able to get off of medication over time, when they show progress using their strategies. Some kids are only struggling temporarily perhaps due to trauma, parent’s divorce, being bullied, or other life event, and after they have processed their feelings from these events are able to move off their medication as well. Sometimes children will be on medication for a long time however. Some children may continue to have their symptoms into adulthood. Talk to your doctor about the length and likelihood of medication for your child, as it varies per person. It may be hard for your doctor to tell you how long the child will need medication as their response to the treatment will vary.

What about side affects?

Side affects and effectiveness of medication is a real concern. Most side affects go away in a few days, and some medication works immediately (most ADHD meds) while others can take up to a month to see effectiveness (most anxiety/depression medication). If the medication is causing severe problematic side affects you should call the doctor immediately and see what they recommend. Don’t just pull your child off of certain meds that need to be tapered off, of there can be worse symptoms. If the medication isn’t working, talk to the doctor and they may increase the dose slowly, or try a different medication. They are many medications for each diagnosis, so they are several treatment options out there, not just the first one your doctor recommended. Some doctors can do genetic testing that will test the effectiveness of medication for your child and even side effects, before the child/teen even starts the medication. This may be a helpful option for some families.

Could my child become addicted to their medication?

Often parents worry about long term addiction to medication, or the child is never able to learn to live without it. While that could occur certainly, often children and teens are able to learn other coping strategies and are able to wean off the medication at some point in their lives. Also the medication should be closely monitored by the doctor to make sure no other issues are starting. People with ADHD and bipolar are far more likely to become addicted to illegal drugs than medication, as they often will ‘self medicate’ with drugs and alcohol to control their symptoms. It is much healthier to have them on legal medication that can meet their needs and is controlled by a doctor, than for them to turn to other unsafe methods to meet their needs. If the child is extremely suicidal, aggressive, or impulsive the risks of medication may outweigh the risks of non-medication due to the child’s likelihood of harming themselves or others from their symptoms.

How does medication help?

How does medication help? It fills in the chemicals in the brain that are ‘missing’ or reduced in the brain that are causing the child’s symptoms.  Often behavioral problems and mental health disorders are genetic, in that they are passed down biologically, or occur randomly in the child’s brain. It is not the parent’s fault, or the child’s fault. It just happens. Sometimes however problems can occur from environmental issues such as the child being raised in a stressful or difficult family situation, significant issues at school, a traumatic event, or significant loss. Then these situations ‘cause’ the diagnosis to some degree. Often there is a both a genetic and environmental factor that combine to cause the disorder, and fixing the brain chemicals can be done by treating with medication, and also by changing brain pathways in therapy in learning new ways to re-train or think about things differently and therefore respond, cope, in a better way.

Is there a medication for behavioral issues like ODD?

Oppositional Defiant Disorder is one diagnosis where there is not a specific medication or even category of medication for it specifically. While ADHD has a variety of meds to choose from, including stimulants, and nonstimulants, and there are numerous meds for anxiety and depression, and antipsychotics and other types of medication for certain disorders, there is not really anything specific for ODD. ODD is best treated with behavioral interventions. However if the child is experiencing depression symptoms along with their oppositional behavior, such as chronic sadness, frequent and prolonged anger outbursts, or aggression, there are medications that can address some of these issues. Medication for depression can help with these other symptoms to help the child be able to think more positively, be more flexible in thinking which can then help behavior. There are also medications for aggression and impulsivity that calm the body down to help the child stop and think and slows their impulses. If you aren’t sure if your child can be helped by medication for their behavioral issues, ask their doctor.

Who should I have prescribe the medication?

For children, often their primary care doctors, such as family doctors or pediatricians, will prescribe medications. Sometimes they will only prescribe something initially to start with and then refer you to a psychiatrist, other times they will handle the medication long term. Some pediatricians specialize or have a lot of experience handling emotional issues, or ADHD for example, and have no problem managing the medication, however others are reluctant to do so. Some children respond to the first medication and others need to have it figured out. If its more complex than just trying one medication, often pediatricians recommend to see a psychiatrist. A child psychiatrist specializes in handling medication for children and knows much more about these issues than a general physician would. They are the best option most of the time. Sometimes neurologists will handle medication for children with ADHD, and sometimes other diagnoses too.

What if my child refuses to take their medication?

Often children will refuse to take medication. Sometimes it’s just that they don’t like how it tastes or feels in their mouth, other times its because they are being teased about it from siblings or peers, or they aren’t sure it will help them. Making it easier for them to swallow by putting the medication into food can help, as well as providing them education on how it can help them. Often children report they feel much better on their medication and look forward to taking it. If they are refusing to take it because they don’t think they need it, have them talk directly to their prescribing doctor and/or therapist to discuss these issues. If they are not taking it because of behavioral reasons, a simple reward system for taking their pill daily can often be the best solution.

My child’s other parent refuses to allow them to take medication

This is a common problem, especially in divorced families. Often one parent doesn’t see, or believe, the same behaviors and symptoms that the other parent witnesses. Sometimes parents have personal reasons, have heard horror stories, or have bad experiences with medication themselves that they are not open to this type of treatment. It can be helpful for that parent to participate more in the child’s therapy, school support meetings, and attend the doctor’s appointments so that parent can discuss their concerns with the doctor and others involved in the child’s treatment. It may be helpful for the child to communicate directly to the other parent if they want to take medication (often teens ask for anti-depressants for example), so it’s not just coming from the other parent. In the end however if the child is underage both parents have to agree and sign off on medication. Perhaps asking the other parent to just allow it for a trial period to see if anything improves may be a good resort. Have them take data of the behaviors or feelings before and after the medication to see the results themselves.

Personal Note

Personally, as a behavioral therapist, I often do not recommend medication right away, because most children respond pretty well to behavioral therapy, and having parents involved in therapy and willing to take the therapist’s suggestions and try them at home, is often sufficient. However sometimes there are times, as mentioned above, where medication is necessary. I recommend medication sometimes after trying therapy for a little while without a lot of progress, or in some extreme situations where it is necessary to go ahead with it sooner rather than later. I support parents’ desires to make informed decisions regarding their child’s treatment while also encouraging an open mind to other forms of treatment available. Parents are often surprised to learn that there are many other children already on medication and it makes a huge different in their child’s life. Some parents are so happy to finally see progress from something that is very simple to implement. Often the information parents have on medication is outdated, as things have changed since the ‘ritalin age’ where kids were over-diagnosed with ADHD and over-medicated with Ritalin for example. Now there are more options out there and more information. I encourage parents to research and ask questions and find a doctor that can help.

Other helpful articles and information

 http://www.aacap.org/aacap/families_and_youth/facts_for_families/FFF-Guide/Psychiatric-Medication-For-Children-And-Adolescents-Part-I-How-Medications-Are-Used-021.aspx

http://kidshealth.org/en/kids/ritalin.html?ref=search&WT.ac=msh-p-dtop-en-search-clk
http://www.specialneeds.com/children-and-parents/general-special-needs/behavioral-problems-and-medication-kids

I hate you!

yelling

When your kid says “I hate you!”
by, Patience Domowski, LCSW

When your kid says “I hate you!” and how to handle it…

1)      Remember you’re not alone. Many kids say this at some point to their parents.

2)      Recognize they usually don’t mean it. Knowing they don’t mean it and it’s not personal can help parents feel better about themselves and also not overreact. Instead of getting hurt or angry, recognize that your child is really trying to communicate something.

3)      Realize it’s a lack of skill. They don’t know how to express their frustration properly. Teach them by modeling the correct feelings words, giving them space to calm down and later discussing with them how they could’ve handled that situation differently.

Usually when kids say “I hate you” or similar mean things like “I want a different family!”, “You’re the worst parent”, etc… they are really trying to say “I don’t like the answer you gave me”, “I’m upset I'm not getting what I want”, or “I’m mad/frustrated/etc”.

Instead of saying “We don’t say Hate” or “You don’t mean that” or “You’re hurting my feelings” etc try saying this instead: “Sounds like you’re frustrated. Can you say “I’m really mad!” or “I don’t like that!” Model it for your child and hopefully they will copy you in the moment and then remember next time how to handle it.

4)      Teach empathy. Talk to them later about how they would feel if someone said “I hate you” to them when they really didn’t mean it. Even if they apologized later. Explain how it makes parents feel. Talk to the child about their feelings and teach them to identify some better coping strategies.

5)      Train kids to change their thoughts from Negative to Positive. Instead of seeing the bad sides to situations, help the child identify the positive sides of the situation. Over time they will better be able to handle disappointments.

Here's a link to a list of great responses!

Using a Fidget properly

fidgets

How to use a fidget toy properly
by, Patience Domowski, LCSW

Fidgets can be really helpful for kids with ADHD, Anxiety, Sensory issues, etc, however they MUST be used properly to help you stay Focused or else they will just distract you further. Here are the Fidget Rules: 

1)      It should be kept in your lap or inside your desk.

2)      You should be looking at the teacher, or focusing on your work on your desk, not looking at the fidget.

If you start to look at the fidget, are thinking about the toy instead of your class, or if the fidget becomes distracting to others around you- it is NOT being used properly and becomes a distracter instead of a helper. If that happens the teacher may take it away for a little while and then give you another chance later.

Depression in Young Children

sad child

Depression in Children
by, Patience Domowski, LCSW

            Depression is often characterized by symptoms such as severe chronic sadness; frequent crying, difficulty or resistance in doing regular activities like going to school or work, not interested or motivated to interact with others like hanging out with friends or going to social events. Sometimes there are also suicidal thoughts or actions as well. However in young children the symptoms for depression can look a bit different. Often parents are looking for the symptoms listed above in their child to identify them as “depressed” and are surprised or confused when their young child is identified with depression or a mood disorder when they really don’t seem sad.

            Children with depression may have the above listed symptoms, however oftentimes children present with symptoms of anger or rage outbursts, often very cranky or irritable, easily frustrated or upset, and overreaction or extreme aggression outbursts (often over small problems). Aggression can be physical- like hitting, kicking, throwing objects, or verbal- screaming, saying mean things.

            Sometimes depression comes from a specific event such as someone dying, parents divorce, being bullied at school, or a traumatic event. Other times it comes from “nowhere”- it could be genetic, or just something is off in the person’s brain chemicals. Often depression and mood issues are genetic and run in families. Sometimes symptoms only occur in one setting- such as just at home, or only at school. Sometimes they are worse or more prevalent in one place than another (more at mom’s house than dad’s house, for example in divorced families).

            It’s helpful to be aware of what depression can look like in young children because it differs from the typical symptoms we think of that are more easily seen in adults and teens. By being more aware we can help get children and families help sooner. If you see these symptoms or have concerns about a child, please have them see their pediatrician, school psychologist, or a behavioral therapist/mental health clinician. The clinician or doctor can help figure out what the problem is and how to fix it so the child is feeling better and behaving better at home and school.

There are a few different diagnoses that may be considered. Here are some general ideas of what each disorder means. They must be diagnosed by a licensed therapist or doctor however. This is not an exhaustive list or inclusive of all the symptoms, but just a very brief overview/explanation.

Depressive disorder – depression symptoms, as listed above
Mood disorder - mood issues, doesn’t fit exact definition of another disorder
Disruptive Mood Dysregulation Disorder (DMDD)- depression symptoms such as frequent irritability with oppositional defiant disorder (ODD) symptoms
Childhood emotional disorder- other emotional issues related to children
Adjustment disorder with depression- patient is adjusting to a trauma or life event that is causing the depression symptoms

            Prognosis is usually pretty good for young children who are identified and treated early. Some children will just “grow out” of their symptoms, while other children may need treatment. Sometimes the symptoms occur at different times and go away and then return in a different form. Children with depression/mood disorder don’t necessarily have a diagnosis for a lifetime. Children often may only have depression symptoms for a short period of time, or they may occur cyclically, while some may suffer for a longer period of time, even into adulthood. Usually with treatment children can learn to manage or overcome their symptoms. Parents can also learn how to better support and help their children going through this as well.

            Treatment for children usually involves first identifying the need such as noticing the symptoms, and reaching out to a child specialist to help. Getting your child diagnosed may also be the first step. Pediatricians, psychiatrists, school psychologists, mental health therapists and clinicians can diagnose, treat, or refer to someone who can help. Sometimes there is just an initial discussion with a therapist or doctor about the symptoms and other times there is a more formal assessment (including observations, testing, etc) for diagnosis. Treatment can include cognitive behavioral therapy with a child behavioral therapist, social worker, school counselor, or psychologist. A psychiatrist or pediatrician may recommend medication to help improve mood, which affects behavior. Sometimes if there are behaviors at school that are causing a problem there may be a need for a formal school evaluation and services provided via a 504 or IEP plan. Often a mix of treatment modalities such as medication, therapy, and school supports are the most effective.

Other helpful articles:

http://www.webmd.com/depression/guide/depression-children
http://kidshealth.org/en/parents/understanding-depression.html
http://www.nytimes.com/2010/08/29/magazine/29preschool-t.html
http://www.wingofmadness.com/depression-in-children/
https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Childhood-Depression-What-Parents-Can-Do-To-Help.aspx
http://www.medicinenet.com/depression_in_children/article.htm

 

 

Panic Attack Advice

panic attack symptoms

Panic Attacks Advice
Patience Domowski, LCSW

Panic attacks usually include difficulty breathing, hyperventilating (short, shallow breaths), trouble controlling your breathing, feeling overwhelmed, severely anxious, sometimes racing thoughts, pounding heartbeat, and other symptoms.

Panic attacks usually occur when in an anxiety-producing situation like a large crowd, feeling confused and overwhelmed over school or work assignments, or other environments or thoughts that cause anxiety. Sometimes panic attacks come out of nowhere too for no specific reason.

Here are some ways to calm down during a panic attack:

If possible, Go to quiet space away from crowds and people (At school go to the hallway, bathroom, nurse’s office, guidance office. Don’t stay in a crowded hallway or classroom, if possible). If you feel the panic attack is going to start soon, try to preemptively leave the area.

Focus on breathing. Try to take Deep Slow Breaths from your stomach, not from your chest. You can try breathing into a paper lunch bag too, if available.

Don't think about why you are panicking, or what is causing the attack. Try not to think about anything anxiety related, or trying to figure out why you are panicking. Focus on calming. Think about a happy place or memory. Say in your head a calming word over and over like “Peace”, “Calm”, “Chocolate”, or the name of your pet, for example. Pick a calming word in advance to use for when you’re having a hard time.

If your panic attacks are happening several days a week and  also affecting  your life – such as interrupting school day, causing you to not be able to go to school or work, etc, consider medication and therapy. Therapy can help you discuss what makes you anxious and come up with some coping strategies. Medication can help calm your anxiety in general, and a rescue medication you can take when you’re panicking that can calm your body down immediately.

Mom tribe

mom tribe

Why you need a “tribe”: for moms
Patience Domowski, LCSW

Women are social creatures. We need friends to talk to, significant others to vent to, grandparents to support us, and therapists to guide us. We need people. Moms, especially new mothers, and mothers of children with special needs, often struggle to make friends. They are so caught up in caring for their new child/children, organizing their children’s activities and appointments, keeping their spouse (moderately) happy, and (maybe) keeping the house clean, that they don’t have time or don’t focus on making other mom friends. But it’s really necessary!

Moms need someone they can  go to to ask those questions like “am I crazy or…” as well as “is my kid normal, he does…” and get some feedback from other women in the trenches as well. Moms need someone to hang out with, call to chat, and someone to help out when you just need a break.

Whether your social supports are your family, your spouse’s family, your neighborhood group, friends, or people in your church program, you need supports, you need friendship, you need a “Tribe”. Other women who can help you, listen to you, laugh with you, cry with you, and just be there for you.

Ways to find mom friends could be connecting with others via online forums like Facebook, blogs, etc, meeting moms at the local playground, parents of your children’s friends at school or daycare, coworkers, others in your church group, etc. Try to think of where you could be more intentional, what you could get more involved in, or whom you could try to start up a conversation with. The other person doesn’t have to be a mom. The other person doesn’t have to be a woman (though that might make your husband jealous!). The other person just has to be someone who cares, someone who is there, someone you can call and talk to, hang out with (virtually or in real life!), and is supportive of you and your family.

 

 

 

Getting on the Same Page, even if you're not in the same book!

same page

The Same Page: Helping Parents Agree on Discipline
by Patience Domowski, LCSW

Many parents struggle to be on the “same page” with parenting. This is totally normal because both mom and dad have their own different personalities, upbringing, thoughts, and ideas that they bring into the relationship. But it can be so frustrating when the parents cannot agree on the same strategies or level of enforcement for discipline at home. Some parents are not only not on the same page, they aren’t even in the same book! Mom might be really strict with the kids because she’s home all day and needs them to listen to her, and dad feels bad he’s not around much so gives in all the time. Or maybe mom’s the nice soft pushover and dad’s the strict one the kids know they can’t get away with anything around him. There does not have to be a “strict parent” and a “fun parent” or a “good cop”/”bad cop” in a parenting couple- there can be the a balance for each parent. It’s really important to try to figure this out so that there is less arguing between the parents, a more cohesive family, and the children aren’t playing parents against each other.

Here are some ways to try to get on the same page with your spouse or co-parent.

1)     Agree on something!  Try to find even something small you agree on – even if it’s just the outcome like you want your children to be “good people” for example. (Then later define what that means and how to get there!)

 

2)      Decide on an outcome. Do we want our children to be happy, balanced, independent, highly educated, etc. Then work on what’s the most important to focus on for our family (Such as school/education, life skills (like learning how to cook, do chores, etc), sports/activities , being social, being creative, future independence, just being “happy”, spiritual/faith based, being healthy, etc) Do the kids need to work on improving their grades? Or are we worried they will live with parents forever because they won’t do chores and get a job? Do we just want them to be happy, we don’t care what they do for the most part?

 

Parents should decide what they’d like to see in the future so they know what they are working towards. It doesn’t have to be super specific like “my child will be a doctor” or “my kid will never eat red meat” or “I really want them to be married or they won’t be happy”. Outcomes can be more general like “I want my child to be independent” or “I want my child to be as healthy as possible” (if child has health concerns, this might be a goal, for example).

 

 

3)     Discuss both parents’ backgrounds and where they come from. Where her parents strict and his super passive? Was she a “child of the ‘60s”, and he from a super conservative family? Discuss child rearing of the parents, how did the grandparents discipline them, what do you want to do the same and what do you want to do differently. Even discuss where they grew up (urban, rural), cultural backgrounds, even socioeconomic status, etc. (Especially if you don’t already know this, or it wasn’t covered in your pre-marital counseling- for married parents).

4)     Try to find a compromise somewhere. The plan doesn’t have to be all mom’s way or all dad’s way. In fact- it really shouldn’t be that one sided. (Because then the other parent will be upset, or one will undermine the other).

5)     Eachparent make a list of what is important to you- then compare and see which things are the same/almost the same.

6)     Decide which behaviors we’re going to “let go” and which we will make a big deal about. Not everyone will agree on what needs to be focused on and that’s okay. [If you can’t decide, see my other article on hierarchy of behavior for my suggestions.]

7)     Even if parents are split and kids go between homes it would be better to still be on same page at both homes for consistency for the children (if this is possible).

8)     Make a plan! Specific behaviors to target, discipline techniques, etc. Write it down and even post it in the house so everyone knows and remembers what to follow. Look online for templates or ideas for making House Rules, chore charts, behavior charts, etc.

9)     Consult with a therapist if needed. A couples/marriage counselor can help get parents to be on the same page, and a child behavioral therapist can help parents come up with specific behavior interventions for their children.

10)Try to get grandparents, babysitters, etc on the same page with the parents for consistency. If the kids know grandma will say yes if mom says no, or the babysitter allows kid to do this and dad would not, it’s going to be difficult to maintain the level of control and discipline you may want in the home. So try to get everyone on board, if possible.

Bullying, or not?

bullying

Bullying is a hot term these days with "Zero Tolerance" school policies, etc. However sometimes kids get confused if someone is just 'being mean' or really 'bullying' them. Also some kids tattle on anything mean that is done, and other kids are afraid its not worth telling on even when they are being really bullied. So to figure out if your child is being bullied or not have them answer these questions on the Bullying Vs Meanness worksheet. Also if they are having difficulty figuring out when to tell or tattle see that decision worksheet and blog post on that topic.

Little Tattle Tales

dam beavers tattle tale

If your kid likes to tattle on classmates at school or siblings at home, it might help to have a conversation about "tattling" versus "telling" on someone, when its necessary.

Use this Decision Worksheet to figure out if you should tell an adult about something or not. 

College Choices

grad college choices

When your kid picks a college/career choice you don’t approve of…
by Patience Domowski, LCSW

So your kiddo is all grown up. And now they are ready to spread their wings. But you aren’t quite ready to let them leave the nest yet. You’re really struggling to accept their choices perhaps, or you just want to slam down the hammer and tell them they have to listen to you. You want to protect them, you want the best for them, and you know more than they do too. But it often causes a lot of arguing and upset between parents and emerging young adult and makes the distance between you even farther apart.

Let’s think about their point of view. We all value our freedom and ability to make choices. Children have very limited choices and very limited freedom. Most kids can’t pick their school, teacher, class, etc as a child…until college. Now they suddenly have a lot of choices and a lot more freedom. They can pick their major, future career choice, college location, etc. They want to make their own choices, and parents also want to help them make their best choices too.

Often parents will be firm and tell their kids which college they have to attend or just give them a short list to pick from whether its about where the college is located (close/far from home, suburbs or urban), type of school (private, religious, public, etc), as well as what to major in, where to live (on campus/dorm, in an apartment, or at home with family), etc.

The problem is when your child disagrees and parent stands firm opposite them it will just drive a large wedge between you and really mess up the relationship. In order to continue to have a good relationship with your child you should try to hear their side/viewpoint, don’t just argue but really listen. You should present your reasons factually, not emotionally. And in the end let your young adult child make their own choice, because now they are becoming an adult and need to make their own choices and learn from them.

Maybe they will fail and come back to you crying that they learned their lesson. Maybe they will do great and surprise you. Either way it’s a good learning experience. While college and major is important it’s not going to ‘ruin’ their life to pick the ‘wrong’ one. Sometimes kids have to come home or switch schools after first semester/freshman year. And that’s okay. Try not to gloat if you were right, but lovingly welcome them back and help them figure out what to do next. 

Divorced Co Parenting Tips (and Worksheet for Kids)

coparenting split child

Divorce tips to co-parent better - because it’s really all about the kids
by Patience Domowski, LCSW

1)Don’t try to ‘get back’ at your ex via the kids such as trying to take the kids away, limit visits, get the kids to not like them, etc

2) Try not to always have your way or the control. It’s about what’s best for the kids, not you. If you and your ex both think your opposing ways are the best for the child and you can’t agree- meet with a mediator or therapist.

3) Don’t use your kids as “spies” asking what their other parent is doing or who they are dating (there’s social media for that)

4) Don’t let your kids get stuck in the middle. They shouldn’t have to hear both sides and make a choice whom to believe. Don’t make them feel like they have to take sides.

5) Don’t bad mouth your ex to the children. Even if its completely true. Try to find something nice to say or don’t say anything.

6) Don’t try to get your child to not like your ex or their new stepparent (if applicable). It’s okay for them to love mom, dad, stepmom, stepdad, new sibs, etc all at once.

7) If the kids ask why the divorce occurred and it’s a complicated or “adult” reason, don’t tell the children exactly what happened, instead explain that ‘mom and dad just couldn’t work things out’ reassure the child you still love them and that won’t change and that the child is not at fault at all. Be careful about saying you don’t love the ex anymore because sometimes children worry that because parents don’t love each other anymore they might not love their children anymore at some point too.

8) If you have to argue with your ex, try not to let the children hear. Use a professional or unofficial mediator if needed. Try not to respond in anger to texts, emails, etc. Wait until you’ve cooled off before replying.

9) Spend quality time together, especially if you don’t have a lot of time together. Do fun things together, talk, bond. Sometimes do things one on one with the kids (without your new spouse or other children if possible) so they get some alone time. Encourage them to talk by being open and not judging or criticizing.

10) Allow your child to take favorite toys and comforting transitional objects, and call their other parent if they miss them. It doesn’t mean they don’t like you because they miss their other parent or ask for them. Try to help ease the transitions.

11) If your child seems distressed about the divorce, arrangement, etc have them go to therapy. If parents aren’t handling it well go to therapy and handle your stress yourself, don’t dump/vent to the kids. 

Printable version of this article

Worksheet for your child to fill out to see how they feel about the divorce

Coping strategies

stress ball coping strategies

Coping skills List
by, Patience’s Behavior Therapy

It’s good for kids to have their own list of coping strategies hung up in the home or within easy access, for anxiety and anger. Here are some examplesand ideas for your list.

Here’s a list of things that can help calm you down when angry:

      take a deep breath

      count to ten

      go to a quiet space (like your room) to calm down

      walk away from what is making you mad

      listen to music

      take a walk/exercise/dance

      pet your dog/cat

      ask for a hug

      draw/writewhat you’re mad about and then rip it up and throw it away

 

Here’s a list of ways to fix anger problems:

      think about it differently

      try to find the positive

      try to understand the other person’s perspective

      problem solve

      talk calmly with the person who is upsetting me

      remember “if I’m nice, than people are more likely to give me what I want”

      If I do what I’m told quickly I have more fun free time and won’t be as grumpy

      try to get enough sleep and enough to eat

 

Calming strategies for Anxiety

·         deep breaths

·         try to think of the positive/realistic situation

·         use logic

·         progressive muscle relaxation

·         listen to music

·         think of a happy place/time/memory

·         draw a picture

·         talk to someone

Click here for a downloadable printable list

Bored List

bored kid

If you're tired of hearing "I'm bored" especially around the school break days have your kids make a "Bored List"- basically a list of everything they can do around the house and when bored they can pick something from the list. Here's a sample one or make your own! 

Bored List Example

When your child hates writing

frustrated child writing

I hate writing! and how to fix it
by Patience Domowski, LCSW

If you child says they hate writing and its causing an issue (at school, during homework time, etc) then figure out which aspect of writing is the problem and then you can work on the solution. You child may never love writing, and that’s okay, but they need to be able to write without a full tantrum, on a regular basis, to survive at school and there’s always going to be something to write in the future in their career and in daily life.

What do they hate the most? … and how to solve it!

1)     Physical aspect of writing- the moving of the pencil across the page. Maybe it hurts their hand or its difficult to hold the pencil

Solution: Try a pen or marker because it’s easier to write with (don’t have to push hard to get a result like with a pencil or crayon). Warm up their hands with some putty, playdough. Try a pencil grip squishy. Let them type instead.

If they really struggle with the handwriting aspect get an OT eval at school.

2)     Ideas – can’t think of what to write (for open ended assignments)

Solution: Give them ideas – two or three to pick from, or write a bunch of topics on strips of paper and put in a box and they can pick from the box.

3)     Time- takes a long time to write out answers.

Solution: Reduce the amount they have to write (If needs to be 5 sentences, settle for 3 or 4, for example). Have them type it or write with a different medium to go faster. Take a break between working.

4)     Bored – writing is too boring

Solution: Find topics that are interesting to the student. Make it a game. Listen to music while writing.

5)     Behavior- they just don’t want to.

Solution: Set up a reward system. They get a reward or fun activity after writing. At school- free time after finishing writing. Homework time at home- maybe get video game or TV time after finishing.

Some kids may struggle with writing for more than one reason. If you’re not sure just try a variety of solutions and see what works. Some ideas that work across problems include let them type instead of hand write, setting up a reward system where student earns a reward for doing their writing (without a fuss), and also having them write about something that interests them, and maybe even draw a corresponding picture (if they enjoy drawing/coloring). 

For some ideas for your stuck student see my Writing Prompts  download.

Communication with children and teens

talk to the hand teen

Communication between parents and children/teens

by, Patience Domowski, LCSW

Isn’t it so frustrating when your child/teen won’t talk to you? Especially if they seem to talk better to their other parent, stepparent, friends, teachers, etc. Communication with your child/teen is so important as it builds your relationship together, and prevents some risk factors as well (like drug abuse, for example). Here are some ways to work on this.

 

If your child won’t talk to you…

·         Initiate/ask about their day. Don’t accept shrugs/”fine” answers, press a little more and then back off a little and wait for them to answer. (Riding in the car is the best time to talk usually).

·         Try being more approachable- Don’t expect your child to talk to you every time you try to initiate a conversation but be open and ready when they bring something up/start to talk. If it’s really not a good time tell them that what they have to say is really important to you and tell them when a better time is- and then stick to that time/make sure to come back and discuss it later.  

·         Don’t overreact- Even if your child tells you some shocking things- please act cool or he/she will automatically shut down and refuse to tell you what’s going on. It’s better to know what they are thinking and doing than not so be open minded to hearing what they have to say.

·         Don’t respond with shut downs like “you shouldn’t feel that way” or “don’t do that!” or “you have to do…” but instead just listen to their feelings and give advice if they want it without telling them no or shutting them down.

·         Be nice- don’t make fun of them or say something demeaning or insulting, try not to yell, don’t make a big deal about small things, don’t punish constantly for small problems, try to listen and not just talk. Compliment them when they make good choices or you are proud of them. Tell them specifically what you liked about their behavior/choices/etc.

·         Ask your child how to make things better and try to take their suggestion if possible- If you realize there is a problem but don’t know what it is exactly that is causing your child to pull away or not want to be around you, ask them what the problem is and then try to take their input and see if its fixable.

·         Try to fix the problem – If your child says what the problem is or you realize what it is try to fix it! Be open to changing and don’t just expect your child to change but parents to adjust too. Be willing to compromise.

·         Do fun things together- Find something you have in common to do together or at least something your child enjoys even if you don’t. Go out to eat, go shopping, mini golf, bowling, make crafts/build something together at home

Some writing prompts could work really well as conversation prompts. Check these out. 

Bedwetting

bed wetting

There are several different reasons children struggle with bedwetting past the age of 4. It’s normal for a child to be unable to hold their bladder all night up to age 4 and sometimes even up to age 7. However after age 7 its considered diagnosable (nocturnal enuresis). If child was nighttime trained and then regressed it could also be a diagnosable problem. See reasons below.

Note: If children are wetting during the daytime past the potty training stage, that is likely a medical problem or trauma related. Seek a doctor’s recommendation.

1)     Medical/Health problem

The child could have a bladder problem, Urinary tract infection (UTI), immature bladder (not ready to be able to hold it all night), some other health issue. It could be genetic too.

Solution: To rule this out see your child’s pediatrician and/or an urologist.

2)     Heavy sleeper

Some kids sleep too heavily at night and are unaware when their bodies need to go. Their body doesn’t automatically wake them up at night to go. 

Solution: Limit fluids a few hours before bedtime, wake them during the night to use the bathroom, try a ‘Bell Pad technique’ device that vibrates or rings when child starts to wet and it wakes them to finish peeing in the bathroom. Try a reward system for a dry bed. If these don’t work there are medications that can help. See urologist for options.

3)     Trauma

If a child has been through a traumatic experience, especially sexual abuse, it can cause bedwetting. The child may be sleeping fitfully, having nightmares, or their body is unconsciously trying to fend off people by wetting self to push people away.

Solution: Seek a child therapist. If you’re not sure if your child has been through a trauma or been abused but you see some signs, have them evaluated by a doctor or therapist.

4)     Behavioral

If the child is refusing to get up during the night or wetting the bed in the morning, it could be because they are lazy and don’t want to get out of bed to use the bathroom. If the other reasons above have been ruled out this might be the problem.

Solution: Provide reward/sticker chart for using bathroom and dry bed. Have child strip sheets off bed and wash them themselves or bring to laundry area for parents. Have child make their own bed with clean sheets (or help make the bed). Have child wash their body themselves in the morning. If problem continues see a therapist. 

OCD... or not!

OCD list

“You’re so OCD!” and other myths of OCD - by Patience Domowski, LCSW

“OCD” stands for “Obsessive Compulsive Disorder.” It’s a real anxiety disorder that is often misrepresented. Many people think they know someone with this disorder but it’s really not this.

What it is:

A person with OCD has to do specific behaviors in order to counter upsetting thoughts or to keep something ‘bad’ from happening. They may have a specific bad thing they think will happen or just a general anxious feeling.

Often these thoughts revolve around germs, dirt, needing things organized or a certain way, counting steps or other things. Sometimes they can’t remember if they completed a certain action. Their brain doesn’t say ‘it’s done’ but has to be done over and over or worries that they didn’t do something.

Sometimes the action they feel they have to complete isn’t related to the anxiety they are trying to avoid.

The behaviors are compulsory and ritualistic. They usually realize what they are doing isn’t ‘normal’ but don’t seem to be able to stop it.

Examples: The person has to wear red socks to school in order to not get a bad grade. The person has to tap the door 3 times or something terrible will happen that day. The person has to check that they turned the stove off over and over or close a door 5 times because their brain says it wasn’t completed.

What it is NOT:

Often people say they think they have OCD or someone they know has OCD because they are a perfectionist, very neat, like things a certain way, enjoy routines and desire order, especially with items in their home. However this is not ‘OCD” unless those behaviors are to counteract negative thoughts. Also some behaviors that someone does over and over like their brain gets stuck on one thought or action is more perseverating or idiosyncratic behaviors that aren’t necessary OCD. So if they say the same phrase over and over or turn their hands a certain way constantly it’s not necessarily OCD unless they are trying to counteract anxious thoughts and these behaviors are relieving that feeling of something bad happening.

OCPD is Obsessive Compulsive Personality Disorder.

OCPD varies from OCD in it’s a personality disorder and affects several domains of their life but they don’t think it’s a problem usually. The person has a very specific “right way” to do things, very rigid with rules and order, they are more about concerned with following the itinerary than having fun, they are very stuck on doing regular things a certain way all the time. Examples of someone with OCPD on TV includes: Danny Turner from Full House, and Sheldon Cooper on Big Bang Theory (in my opinion). [Sheldon also has Aspergers]. 

Attention Seeking Behaviors

attention seeking behavior

Attention Seeking Behaviors ~ by Patience Domowski, LCSW

If your child is a little “Attention Whore” constantly craving attention and trying to get attention even if they are given plenty of positive attention from parents, etc, parents might need to try some strategies to teach appropriate attention seeking behavior.

·        Teach your child it’s okay to play alone

-have them go play for a few minutes at a time, slowly increasing the time spent alone, and then give them a lot of one on one attention after those few successful minutes

-give your child some toys they can only play with/have when mom/dad is too busy to engage with them (like while driving, on the phone, in a conversation, etc).

·        Make a list with your child of things they can do alone, such as

-play with toys

-color/draw

-read a book

·        Teach your child how to ask for attention appropriately

[instead of hitting/yelling/etc]

-such as by saying “excuse me” and waiting until good time to talk

-start a conversation

-asking a question

-ask someone to play nicely

-ask for a hug

-ask for attention “Mom, can I have some attention!”

·        Ignore your child if they are asking for attention at the wrong time or in the wrong way.

-Remind them to ask appropriately and wait for them to do so.

- Then immediately provide social reinforcement such as praise when they do so appropriately.

-Provide attention when it’s appropriate time and they ask correctly

[Note: If you are giving your child attention such as answering their questions/doing what they request/ etc when they are asking for attention inappropriately (such as hitting/interrupting/etc) then they will continue that behavior. Instead have them wait or ask appropriately for what they need and then parent should give attention at that time. ]

Sibling Squabbles

sibling fights and mom referee

Sibling Rivalry ~ by, Patience Domowski, LCSW

Siblings love to fight. It’s typical for brothers and sisters to not get along at times. However they should love each other at other times and often get along together. If siblings are constantly fighting and never getting along that’s not typical and it needs work. If the sibs are rarely getting along, don’t like each other, and not engaging together positively, that is a problem.

Try these activities (besides seeking therapy) if these issues are severe.

Work Together Activities

Have the siblings work together to create or make something together. For example:

·         craft project

·         make something out of recycling items (water bottles/cardboard boxes, etc)

·         make a puzzle out of cardboard/cardstock paper

·         cook/bake something together- a cake, brownies, cupcakes, etc

·         science experiment

[Look at Pinterest or DLTK and other mom blog websites for ideas!]

Positive Reinforcement

If siblings are constantly fighting with each other try to stop it with this simple behavior chart strategy. Have them each draw about 20 circles on their own paper/poster (more if they fight very often!). Then whoever starts a fight, or whoever continues a fight get an X on their circle (per parents, not kids!). Whoever has the least amount of X’s and the most leftover circles earns a prize at end of the week (example- go out for ice cream as a treat!). This teaches healthy competition and reduces fighting.

Conflict Resolution

Teach the children to solve their own problems (instead of mom/dad having to solve it all the time). Try to have them come up with some creative solutions themselves. If they can’t or refuse to do so then take away the toy/activity they are fighting over or send them to time out to think about a solution and then return and try a new strategy.

Some suggestions for solving conflicts:

·         Compromise

·         Take turns/share

·         Find something to do separately if can’t get along

·         Take a break

Circles template

 

Homework organizer

homework list

I made a homework organizer worksheet for all those kids who are having trouble keeping track of their homework, turning in assignments, etc. Having things organized is a huge stress reducer for kids with anxiety and depression, and very helpful for kids with ADHD who are struggling with organization. Now just make sure they bring this paper back and forth to school! 

Download Homework Organizer Worksheet here!