Making Friends at a New School

Making Friends at a New School

By Patience Domowski, LCSW



Starting at a new school can be so hard for kids! Whether it’s the start of a normal school transition like Kindergarten, or beginning of middle or high school, or starting in the middle somewhere because you moved to a new district, it’s really difficult. It’s normal to be nervous and not happy about it.

You’re the ‘new kid’ like it or not, and everyone already has friends and a group, so you automatically feel left out. While some kids can be welcoming and friendly it can still be difficult or take a while to find your niche. Here are some helpful tips:

  • Be friendly, even if you’re naturally shy, and introduce yourself to people. Smile and look happy, even if you don’t really feel that way. People are automatically attracted to happy and friendly looking people.

  • Try to sit with others and interact with them. Acknowledge you are new and ask for insight and help (even if you don’t really need it). You can start with ‘Hey, I’m new here, can you tell me about this teacher?’, or ‘What do you think of the cafeteria food here?’, or ‘How do I find the library?’. Often people appreciate being asked for help and will engage with you.

  • Ask for someone to show you around the school. The principal may have already set this up. Maybe the person who shows you around may become a friend, if not they can at least introduce you to other people. If they don’t automatically do so you can ask them to introduce you.

  • Join any clubs, activities, programs, sports you may be interested in. If you aren’t sure what you’d like to participate in, try a few out and see what you like. Finding others with similar interests is a great way to make new friends.

  • If you find someone you think would make a great friend try inviting them to come see your new house, or hang out sometime. If they say they are busy ask when is a good time. If they keep putting you off, move on to someone else.

  • If you make one friend, try to meet their already existing friends and connect with them too.

  • If your parents allow have a party at your house and invite everyone. Whomever comes, try to talk to them and secure future plans.

  • In some elementary schools there is a ‘buddy bench’ to sit on at recess if you need a friend. If you sit there other kids will come around and ask you to play.

  • If the school is really cliquey recognize it’s not your fault, and keep trying. Remember it can take a while sometimes, but you’ll get there.

  • Be okay with just one or two friends. Your friend group will slowly grow if you want it to, but it doesn't have to be the same amount as at your previous school.

  • If it’s not going well, ask the teacher or school counselor for help.


Helpful Book for Elementary and Middle school age children for making and keeping friends:

Lily Makes Friends, by Patience Domowski. Available on Amazon.

Helpful tips for anxiety when starting at a new school.

Screen Time: How much is too much?

Screen Time: How much is too much?

By Patience Domowski, LCSW

“Screen Time”- how much is too much? Is it affecting our children? Parents want to know!

According to the AAP (the American Academy of Pediatricians) children under age 1 should not have screen time, ages 2-5 should have about 1 hour and be on it with their parents, and over age 6 should set ‘consistent limits’ to make sure they have time for other important things. *

So what should those ‘consistent limits’ be? And how much time do they need for other important things? Unfortunately there is no clear cut amount of hours to recommend because each child and family varies.

What’s important to look at is what types of screen use is the child accessing and are they spending time doing things other than look at screens. Watching TV, or even Youtube videos is more mindless than playing a challenging or educational strategy game on a device. It’s important for parents to be aware of what their child is doing on their devices. Are they accessing videos that are inappropriate or adult-rated websites or violent games? Are they getting into cyber bullying and social media problems? These are things to be aware of and monitor. Check your child’s browser history, phone use, etc, periodically.

It’s important for good brain development and social skills for kids to spend time interacting ‘in real life’ not just virtually so make sure they are spending several hours playing outside, interacting with friends and siblings, and creating something - whether building with blocks or making crafts, or cooking. Being creative is helpful for teaching many important life lessons. Interacting with others provides opportunities for social skills development and promotes happiness. Make sure there is some family time where all devices are down (you too, mom and dad!) and you’re talking and playing together. Daily, if possible!

Is electronic usage affecting your child? Several parents have told me they noticed a big difference in their child’s mood and behavior when the child was on punishment and restricted from electronic usage. The child seemed happier and less difficult when not on their games, after being off for some time. Often children get overly frustrated with games, get upset when it doesn’t work out their way, get addicted to the immediate satisfaction of the game ‘reading’ them with points or level ups. If they aren't progressing in the game they get angry and irritable. If they are playing violent games they start acting out those behaviors on siblings, sometimes.  They are also not spending enough time doing other things if on their screens all the time, so they are getting bored (though they won’t admit it!) and lack of exercise may be affecting them too.

Many children are getting addicted to gaming. Signs and symptoms include:

  • Constantly talking about the game, and no other subject, thinking only of the game all the time

  • Has this drive or need to be on the game at all times, including not wanting to do other activities so can be on the game (wants to avoid school, sports activities, even seeing friends so has time to play games)

  • Cannot go more than a few minutes without being on a device

  • Has no other interests besides games

  • Gets very upset if cannot be on the game or told to get off it

  • Not getting up to use the bathroom, eat, or other important things while gaming

  • Hours spent on the game without any other activity or interruption (often child won’t be aware of how many hours they have spent)

Take a quiz online to see if your child may be addicted.** (Link to quiz in references below). If your child seems to be suffering from this, there are resources out there such as therapists specializing in addiction, support groups, and other tips you can find on reducing gaming time and enjoying more of time outside of gaming. If you are concerned then there probably needs to be some intervention whether its as simple as parents limiting online time, to more intensive options such as contacting a therapist or support group for help.

Getting your child to do more activities may be helpful such as encouraging them to play outside, have real-life playdates, take up a club at school or other program, play a sport, or be involved in some other activity. For teens maybe volunteering, or getting a job can get them doing other things. If the child resists, you can still set limits on the time and type of screen time they are allowed and insist they cannot be on the games for x amount of time or during this time period even if they refuse to participate in another activity. Remember it’s okay for kids to be bored as that bored feeling can foster creativity. Have them come up with some other activities they can do instead of screen time. Maybe even reward them with a certain amount of screen time per other time spent (such as if play outside for 1 hour= can be on the ipad for 30 minutes later).

Important things to think about:

  • Be aware of what your child is doing on their devices, including what websites, what games they play. Are they appropriate, etc. Look at the ratings on games, look online to check what professionals say about them. Plugged in, and Common Sense Media rate movies, games, TV shows, etc for parents so you don’t have to do the research yourself. (See links below). ***

  • Recognize any differences in child’s emotions and behavior when on and off the games- are they more depressed, angry because of the games or when told to get off the games?

  • How much time are they spending on games? Is it all their free time? Do they ever play outside or with other children in real life, or only online? Do they spend time doing anything else? Set limits and parental controls. Use the Media Time calculator, and Net Nanny controls if needed. ****

  • Does your child have other interests besides video games, TV, or social media? Do they spend any time doing other activities? If not- encourage and insist on other activities in and outside of the home.

  • Are their school grades suffering because they are only gaming and not doing homework? Have child finish their homework and parents check it before they can get on any devices.

  • Are they showing signs of addiction? Can they go some time without reaching for a device? If they are showing some concerning signs look into getting some help and support.


*AAP Guidelines:

**Video Game Addiction test and resources

Internet addiction

Types of treatment for Video Game Addiction

***Plugged in Magazine, and Common Sense Media- Reviews of movies, TV shows, Video games, including rating their age appropriateness and other content.

****Media use calculator:

Net Nanny- sets up parental controls on devices and provides helpful blog articles


Bullying- Signs of bullying and tips on how to help the victim and the bully



By Patience Domowski, LCSW

Bullying is such as big issue. It can cause anxiety, depression, eating disorders, even suicide. We’ve heard of school shootings as a result of bullying. Kids who are being bullied shouldn’t be told not to worry about it, or it’s just normal, because it's really affecting them in a negative way. Kids who are bullies shouldn't just be ignored, or just told to stop and not actually be disciplined for it. Most often bullying occurs at school, however it can occur in the neighborhood, in the community, on the playground, at summer camp, anywhere. Adults can even be bullied in the workplace. Sadly, sometimes children are even bullied by adults like parents and teachers.


Signs your child is being bullied:

-They suddenly don’t want to go to school

-They act anxious around other children or want to avoid the bus or school

-They regress in any way like reduced speech, potty accidents, less social, avoiding others

-They start acting angry for no apparent reason

-They talk about kids being ‘mean’, or call a sibling or someone else something you haven’t heard them say before (may have learned it from others)

-Being afraid or not wanting to go to certain places like camp, sports, etc (where the bullying may have occurred)


If your child is being bullied:

-Ask them if they are being bullied, and describe what bullying means (not just someone being mean occasionally, but constant put-down negative words, or physical aggression)

-Let them know it’s not their fault

-Tell them you will help them figure it out/make things better

-Try to build their self-esteem with some positive encouragement and affirmation

-Encourage child to tell the bully to please stop, say ‘that’s not nice’ or ‘I don't like that’.

-Suggest the child try to befriend the bully- sometimes bully children are just poor at knowing how to make friends and just want attention. If your child is nice to them sometimes the behavior will change.

-Otherwise suggest the child avoid the bully as much as possible, ask to not sit near them in class.

-Encourage the child to report the incident to the teacher or school counselor, if at school. (Some schools have a ‘Bully Box’ where you can put notes about incidents in them for the counselor to review).

-If child is too afraid to talk to school staff themselves, ask if they want mom/dad to step in and contact them. If the child says no- assess if the incidents seem severe enough the parents should step in regardless. Try to find out why the child doesn't want to tell on the bully- of they are worried the bullying will get worse or kids will tease them for being a ‘snitch’. If the parents tell, however, usually other students wouldn’t know.

-If the teacher or counselor fails to respond or doesn't do anything, follow up and go up to higher admin if the bullying is continuing and child is very affected. Recommend counselor talk to the bully child and the victim separately to work on the issue. Sometimes principals have to be involved. In some severe cases children need to change classes or schools.

-If incident is happening in the neighborhood or community- try to avoid the bully child if possible, parents can try to talk to the bully’s parents, if they are amenable to that. If severe- contact the police (such as physical assault for example).

-If child is very affected- severe anxiety, depression, suicidal statements, etc- have them talk to a crisis counselor or therapist as soon as possible.


If your child is the bully:

-Talk to them about how it makes the other person feel, and how they would feel it if was happening to them

-If they can articulate it try to have them say why they are doing this (to join in with others, because they think it's cool, they don't like a certain type of people, etc)

-Teach understanding and respect. Even if they dont like someone it doesn't mean they have to be mean about it.

-Provide discipline and consequences for bully behavior

-Work with the school counselor on addressing the issue, if it’s happening at school

-Encourage your child to make friends with others, especially if they are different to help them to be more inclusive

-Make sure as a parent you are modeling good behavior and not making comments about others that are rude or disrespectful that your child might pick up on. Again- even if you don't like a certain person or type of person it doesn't mean you have to be mean! Best to just do nothing if you can’t accept them.

-Have your child talk to a therapist if they continue to struggle. There could be more issues going on with them and they are taking it out on others.

To help your child decide if they are being bullied or not use this worksheet.

To help your child decide when to 'tell' on someone or not, use this decision worksheet.


Teaching kids to be grateful/Have a gratitude attitude!


Teaching Kids Gratitude

By Patience Domowski, LCSW

In today’s day and age it's hard to raise grateful kids because they are used to getting everything they want and right away. We live in an instant coffee and on demand world. Also the parenting culture today is to provide everything for the kids as soon as possible to make them be happy. As nice as it is to get things right away and provide things for your kids that they want, the problem is that they can get too used to it and not really appreciate what they are given. My advice would be to sometimes give them things they want- like birthday presents, and vacations, but not giving them things constantly or as soon as they ask for it. Have them work for things they want instead- doing extra chores at home or for neighbors to earn money to buy something they want to save up for can teach them the value of things and they will appreciate the things they worked for much more. Encouraging kids to say ‘Thank you’ regularly to everyone even for small things like the waitress handing you a drink, or a cashier giving you a sticker, or even thanking a doctor after a visit. Having kids involved in some volunteer work can be extremely helpful as well- not only do they get a sense of others in need out there but they get a nice feeling of helping others which can help instill some gratitude for what they already have.


Here’s a list of some practical suggestions for teaching kids to be grateful.

  • Don’t give them everything they want! It's okay to say ‘No’ or ‘Wait’, or ‘Work for it’.

  • Have them work for some things/earn money to buy things they want (it’s okay if it takes a long time to save up for something big!)

  • Model gratitude and saying thank you yourself as a parent

  • Occasionally go around the dinner table and say something you are grateful for- if creative, make a poster list and keep adding to it so kids can see all the things they have and should be grateful for on a regular basis

  • Volunteer- find a program in the community or at church that allows children to help, or start your own project collecting winter coats, school backpacks, or food to donate

  • Go to a third world country- doing missions/volunteering, not tourism to see how others without live

  • Make them say ‘Thank you’ to others, soon it will become ingrained in their heads

  • Have them send ‘Thank you’ notes/cards for gifts they received for birthdays, holidays,

  • Have the children help go through old items in the home like clothes or toys they don’t need anymore and give to a charity- have the kids be a part of this. A good time is before Christmas or before a season change.

Don't touch that! It's Mine! Sibling issues

Don’t touch that! That’s mine!

Dealing with siblings messing with each other’s things

By Patience Domowski, LCSW


Do your kiddos fight over who is allowed to touch what item and what toy belongs to which kid? Do your kids get super upset and overprotective of their stuff to the point of fighting frequently over it? Do you have a younger child who loves to torment their older sibling just for the fun of it? Well, here’s some help!

Let’s look at the Why this happens, What to do about it, and How to prevent it strategies.

First, Why does this happen? Why are siblings always getting into each other’s rooms, toys, clothes, etc? Often it's for a reaction or attention. So when Sibling A touches Sibling B’s toy and Sibling B gets mad, Sibling A loves to see that reaction! Sometimes it's because they want to play with the toy or are jealous they don’t have the same item. Some kids want to play with it just because it's not theirs even if they have the same thing! Often younger kids want to be like their older siblings and want to do what they do, so they get into things because of that. Some kids are just curious and get into things out of curiosity and exploration. If you can figure out WHY it will help. Often it can be a combination of these reasons.

  • To get a reaction/make sibling mad/get adult’s attention

  • For attention/wants to play with the sibling

  • Wants to play with the toy because don't have one, or because they just want to play with something different, jealous they don’t have the same thing

  • Want to be like an older sibling

  • Out of curiosity/exploring (usually very young kids)

  • Other reasons...

Next, What can we do about it? We want to look at how to shape the behavior of both the sibling that’s getting into things and the sibling that owns the things because both reactions and behaviors are important to address.

Let’s call the sibling that’s getting into the things “JJ”, and assume he’s younger, and the sibling that owns the things “Johnny”, and he’s a little older than JJ.

Here’s the scenario: JJ sneaks into Johnny’s room and starts messing with his lego creations. Johnny comes home and goes in his room and discovers this. He screams and yells and maybe even hits JJ. Mom comes in and finds everyone is crying. Now what? Let’s assume the reason JJ did this is just out of curiosity and wanting to play with Johnny’s toys, not that he was trying to infuriate him.

My suggestion: Talk to both about their behaviors.

-First try to calm everyone down. If they are out of control, send to separate rooms for some alone time until everyone is calm.

-Then talk to JJ about how he needs to ask before going into brother’s room, and also touching his things. He needs to respect Johnny’s space and toys. He should ask Johnny first if he can touch and play with his legos.

-Talk to Johnny about his reaction. Explain that JJ was just curious and wanting to check the toys out because he’s too little to build things that cool, so he likes to look at them. Suggest that next time Johnny ask JJ nicely to not touch his toys, and suggest another activity or toy that JJ can play with instead, or show him nicely how to build things with some other legos, possibly. If JJ doesn't listen, then ask mom or dad to step in.

-If possible have the siblings act this out again. Have JJ pretend to go into Johnny’s room, Johnny comes in, and practices saying nicely “Please don't touch my legos. Let’s play with your blocks downstairs”. Have JJ ask “Can I please see your airplane you built? It’s so cool!” etc… Praise the children for acting this out appropriately.

(Acting out/role-playing appropriate behavior is a more effective way of teaching good behavior, than just talking/discussing what to do next time, as the act of doing the right behavior builds ‘muscle memory’ instead of just a lecture).

Another situation. Let’s say little brother Bobby loves to make older sister Haley mad. Here’s the scenario: Haley is playing nicely with her dolls in the living room. Bobby runs in, snatches the doll and pulls its hair, throws it down, and runs out of the room. Haley starts screaming and crying. Bobby laughs. Haley chases him down, intent on bodily damage. Mom/Dad comes in and starts yelling at everyone to stop.

Suggestion: Ask everyone to calm down. Have them sit down to discuss when calm. Address Bobby first. Ask what did he do wrong and what would’ve been a better idea. Bobby: “I grabbed her doll. I probably shouldn't touch it”. If he’s able to discuss why see if he can explain (some young children are unable to answer Why questions just yet). Bobby: “ I wanted to make her upset.” Or “Dolls are stupid.” Mom can say something like “Okay, that’s not very nice, let’s think of a better way to interact with your sister”. Bobby: “I could ask her to play with me.” “I could ignore her”. Parents may need to prompt some appropriate responses, such as suggest if he wants a reaction maybe tell her a funny joke, or story, or ask her to play something together. Then talk to Haley. What could she have done differently or better? Haley: “I should’ve told mom/dad instead of chasing him and screaming”. Parents; “Right, when you scream and chase him- that’s what he wants! He’s trying to make you upset. While it's not right what he’s doing, a good way to make him stop is to just ignore him, ask him nicely to please stop, and then tell mom/dad if he isn't listening/continuing. If you keep screaming when he does these things, it makes him happy, which makes him keep doing that. I know it's really hard, because its infuriating when someone hurts your toys or grabs something from you, but if you are calm, he won’t get the reaction he wants.” Haley: “He should be grounded for a year!” …

Then have kids re-do the scenario in a better way. Haley pretends to play with doll. Bobby comes in, thinks ‘I want attention!’. He can say ‘Hey Haley, did you hear this funny joke?’ Haley can say ‘What joke?’. Then have Bobby touch her doll. Haley can say ‘Please don’t touch my doll, Bobby. It makes me upset when you touch my things.’ Praise the kids for making better choices.

Key strategies:

-Teach the one that is messing with the things to ask and respect property and space

-Teach the over-reactor child to ask the sibling to please not touch, ask first, and react calmly. Get parents to help if sibling isn't listening

-Role-play/Act out how to make better choices next time

-If behaviors continue- give out consequences to the child who touches the stuff, and if needed, the child who overreacted (if severe reaction like hitting/etc)

How to prevent this: Talk to all the children about the importance of respecting each other’s space and stuff. Gather them all together and ask them why they don’t want people touching their things, and how they feel when someone messes up their toys. Have them share with each other why it bothers them and what they would prefer. If the children are struggling to share, discuss how this makes others feel, and emphasize why it's important to share sometimes, and sometimes it's okay to keep things to yourself. Ask them how they feel when they are getting into someone’s things, and why they do it. Have the children calmly tell each other why it’s not a good idea and why it upsets them. Have the children figure out what toys/spaces are shareable- maybe the playroom and the blocks are for everyone, but the bedrooms and stuffed animals are individually owned, for example.

Remember- its okay for kids to have some items or space that is just theirs. It is good for them to have some ownership over things and it helps them feel secure to know “this is mine”. However it's just as important to learn to share spaces and toys and knowing which is which and how to respect boundaries is important for children to learn as they are growing up.

Key points: If someone asks you to stop or not touch, you need to listen. If it doesn't belong to you you need to ask for permission before touching or using it.

Don’t Lose your Temper when You Lose a Game!

Don’t Lose your Temper when You Lose a Game!

By Patience Domowski, LCSW


No one likes to lose, but why do some people have such a hard time with it? We’ve all seen (adult) sports fans freaking out when their team loses, but often adults handle it fine. Children, however, are a different story. While most adults can process that while it's disappointing to lose, they know it's a part of life and maybe they will win the next time. Children, though often don’t think about the broader picture or the future impact and cannot accept defeat.

Does your child ‘lose it’ when they lose? Throwing their gaming controller/sports equipment, screaming, stomping their feet, having a full tantrum when they lose a game? Are they unable to accept defeat or disappointment and overreact in anger? Do the blame the opponent and declare they must have cheated because they cannot take responsibility themselves for the loss? Do you worry taking your child to their sports events that they will lose their temper if they don’t win and it will embarrass you in front of the other team members and parents? If yes to any of these, keep reading!

Here are some reasons children struggle to accept loss in games (“games” refers to video games, board games, and sports games):

  • Child puts a lot of pressure on themselves to do well, often due to anxiety, and sees losing as “failure”.

  • Parents, coaches, others put a lot of pressure on child to win all the time, instead of just ‘do your best and have fun’.

  • Child has low self-esteem and losing confirms their negative view of themselves which is already low.

  • They are teased because of their performance by siblings, peers, friends, bullies, etc

  • Parents, coaches get upset and overreact when their child’s team doesn’t win

  • Child doesn't have the coping skills or emotional maturity to handle disappointment

  • Child/team hasn't been taught good sportsmanship skills.

  • There certainly can be other reasons too.


Some strategies to teach your child to handle losing a game better:

  • Remind child that just because they lost doesn't mean they did anything wrong or are a bad person/team because of it

  • Build child’s self-esteem in other ways, if games/sports are not helping or child is just not good at these activities, such as finding other things the child is good at like building, or art for example.

  • Encourage child to do their best, regardless of outcome, and don’t make them feel bad for missing a shot or making a mistake

  • Remind child that everyone wins some and loses some, and they need to just try their best, and it’s okay (if they can’t handle constructive feedback, say nothing, or just point out the positives, until they are more able to handle suggestions for improvement)

  • Model good sportsmanship by handling it well when adult’s preferred professional sports teams lose or do poorly. “We’ll get them next year”.

  • Praise the good as much as possible and focus on that: “You made a good pass” or “You got one goal!”

  • Teach child that if they handle losing well, the opponent/friend is likely to want to play with them again, however if they throw a fit the other person is likely to not want to play with them anymore.

  • Role-play/practice with child on how to react if they win or lose. Have child act out saying “Good Game” at end of game regardless of the results.

  • Try not to focus or mention the score in a game, or even saying who won or lost, but just on how individual did in some moves/plays

  • Also make sure to teach children to be good winners- not bragging, or teasing the other team, but just graciously accepting the result without over-doing their reaction (no show-boating). Make sure they say ‘good game’ regardless, and shake the other team’s hands (if appropriate).

  • Point out how professionals handle loss (look up some good examples online of professional sports players) and point out how professional coaches look for good sportsmanship and want to see that behavior in pros.

  • Teach child emotional regulation skills of recognizing their own emotions and how to handle anger and disappointment (like taking a deep breath, walking away for a minute to collect themselves, thinking about the problem differently) and have child practice and act out these behaviors

  • Purposefully play a game with child where the point is for child to handle losing graciously- tell the child this is the plan. (Adult should try hard to win). Praise the child for handling it well, if they do, or have them try again if they get upset. (May need to remind child how to respond towards end of the game.) If needed, add in an incentive like a small reward if they handle losing without getting upset.

Excellent book resources to read  and discuss with your child:

  • “If Winning isn’t Everything, Why do I hate to Lose?” by Bryan Smith (available on Amazon)

  • “Bubble Gum Brain” by Julia Cook (addresses thinking flexibly, not giving up even if something is hard, handling mistakes, and growing)

  • Search on Amazon for other books on this subject.



If you’ve had a good time playing the game, you’re a winner even if you lose
— Malcolm Forbes
It is not up to me whether I win or lose. Ultimately, this might not be my day. And it is that philosophy towards sports, something that I really truly live by. I am emotional. I want to win. I am hungry. I am a competitor. I have that fire. But deep down, I truly enjoy the art of competing so much more than the result.
— Apolo Ohno
First, accept sadness. Realize that without losing, winning isn’t so great.
— Alyssa Milano
There are more important things in life than winning or losing a game.
— Lionel Messi
You learn more from losing than winning. You learn how to keep going.
— Morgan Wooten
Losing a basketball game hurts but when you see what you’ve been through, you look on it and say well if this is the worst thing that can happen to me, then I’m okay.
— LeBron James
I’ve missed more than 9000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.
— Michael Jordan
You can’t win unless you learn how to lose.
— Kareen Abdul-Jabbar
We didn’t lose the game, we just ran out of time
— Vince Lombardi
Success comes from knowing that you did your best to become the best that you are capable of becoming
— John Wooden

Shy/Anxious, and Sensory-Avoidant Children and Overwhelming Social Scenarios

Shy/Anxious/ Sensory kids getting overwhelmed in social settings

By Patience Domowski, LCSW

If you have a shy kid or a kid with sensory issues that is easily overwhelmed in large group settings it can be rough to attend a birthday party, or even a crowded grocery store. You probably find yourselves avoiding large concerts or parades and cringing when taking your child to church or other types of social events. Anxious kids struggle in large social settings and may shut down and refuse to speak, may cry, or even have a full meltdown. Sensory kids may also have a meltdown or tantrum behaviors due to the overdose of noise and light and people. Avoiding these situations may seem best but not always. If the child never learns to cope they will always struggle and it’s not always possible or even prudent to always stay away from large social gatherings. Here are some strategies to try to help your child manage these overwhelming situations.

Some simple strategies to try:

  • If the child is sensitive to sound let them wear headphones, if light- sunglasses. They might look a little different but they will be at least able to attend, and over time they will often adapt and be able to take those things off. Just like when you enter a room that is too cold or hot, often your body will adapt after a few minutes.

  • Practice going into loud and crowded areas for very short time, slowly increasing to help desensitize your child to the sensory stimulation. For example go to the grocery store for a few minutes and buy one thing, or go to church and sit in the back and go to the foyer when its too much, go to parties for just 15 minutes perhaps to start. When your child is doing well, then increase the time. (This may take several attempts and last a few weeks or months).

  • Rehearse ahead of time. Do some role-playing with your child ahead of time such as pretending to be a new person you might meet and have your child practice what they will say if the other person says hello for example or asks them questions. You can switch it up and parent pretends to be the kid and the child gets to be the new person you are meeting.

  • Prep the child for the event in advance (if possible) such as talking through who they will see, what will happen, what is expected etc. If possible look online to see what the place looks like so the child can see it so it doesn't feel so new and scary. If its a birthday party at someone’s house maybe try to do a playdate in advance so the child is comfortable with the home and the child and family before the party (if possible).

  • Try to have your child identify in advance what is bothering him or her and see if you can help them work through it. For example if they are scared no one will play with them at a party, give them some suggestions on how to engage with other children. If they are worried that it will be too loud, suggest they bring headphones, and if they can’t handle it they can take a break outside perhaps. Try to help the child problem-solve the situation themselves, if they are old enough and willing, as they are more likely to use their own suggestions. If they need help, parents can give some suggestions too.

  • If the anxiety is pretty severe and seems unresolvable, seek out help from your child’s pediatrician, school guidance counselor, or a child behavioral therapist. If the issue is more sensory related (sensitive to stimulation like sounds, light, etc) seek out help from an Occupational Therapist (OT) or your child’s special education teacher (they have one).


Books flyer

Feelings by Age

Feelings by Age

What your child should be able to understand and express, by age

By Patience Domowski, LCSW


Age 0-1: Baby can express sadness by crying, anger by screaming, and happiness by smiling and laughing. Some babies can express surprise too with a facial expression, often following by happy smile or crying depending on how they feel about the surprise. Babies usually respond to their parents and other caregivers emotions and reactions such as being more fussy if they sense mom is upset, or laughing when big sister makes a funny face at them. [Known emotions: Happy, Sad, Angry, sometimes Surprise]

Age 2-4: These little ones are just learning how to talk to express their feelings. Parents can teach them to name their feelings such as saying “I’m Happy!” or “I’m Mad!” when they are acting like they feel that way with their behaviors or facial expressions. Often these kids have very strong opinions and feelings and may show big emotions like anger and disappointment in the form of tantrums and meltdowns and excitement or anger in screaming. Parents can try to have their child say how they feel. Parents can also model this by naming their own feelings so the child learns which emotion goes with which term. For example “Daddy is sad right now because you aren’t listening and putting on your shoes.” “Mommy is so happy to see you after a long day at preschool!”

Some strategies for calming child is to teach them to take deep breaths, give themselves a hug or ask for a hug, and taking a break (such as child going to a private area to calm down, or parents and older siblings leaving them alone in one area until they are calm). Teaching these skills when the child is not upset is helpful so they are ready to use the skill when needed. Parents can also model these strategies themselves by doing and naming them. For example “Mommy is angry right now because you made a big mess when I asked you not to. I’m going to take a break and calm down. I’ll be right back.” or “Daddy is really disappointed you didn't make a good choice and hit your brother. I’m going to take a deep breath.”

Also if the child resists using a strategy to calm down, parents can offer an incentive such as use of a toy or a treat for calming quickly. Often it’s best to ignore screaming and tantrum behaviors until the child calms (if they are too upset to reason with) and then praise them when they are calm and divert to something else. At the preschool age some children are more verbal and understanding than others so it will vary based on your child’s language ability to be able to talk out the feelings and handle them appropriately. [Known emotions: Happy, Sad, Anger, Surprise, Excited, Love, Scared, sometimes Disappointed, Frustrated]

Age 5-7: These early school agers should know the names of most common emotions by now and be able to do some calming strategies. Parents should continue to encourage them to name their feelings and model handling their feelings too. These children may also be recognizing how their actions affect others’ feelings too. Some kids are very sensitive to recognizing others feelings while others are more oblivious. Helping them be aware of how their behaviors and feelings impact others is important. For example if they are mad and hit their sister, it can make their sister feel sad. Or if they are jealous and take their friends toy, the friend may be angry. Expanding their understanding of emotions can grow beyond the basic feelings to more specifics like Happy vs Proud specifically, or Angry broken down into disappointment, frustration, or fear. There are many games and flashcards/posters to use to teach the various emotions. Having children learn what each feeling is called, what it looks like on someone’s face and body, as well as what can cause that feeling is really important for them to grow in emotional intelligence. [Known feelings: Happy, Sad, Scared, Mad, Nervous, Surprised, Excited, Proud, Loved, Disappointed, Frustrated. Maybe: Jealous, Anxious]

Ages 8-10: These kids should be pretty familiar with most emotions. They may continue to express their feelings in acting out ways, but should know some strategies for coping and calming down. If they still struggle they may need to see a specialist to help. They should be more aware of other people’s feelings and be able to offer comfort to others if needed. They should be able to name an experience that would cause a feeling. For example “If my brother messes up my lego creation, I would be mad” or “If my friend got a new toy and I didn't, I would be jealous”. [Known feelings: Happy, Sad, Mad, Scared, Surprised, Anxious, Excited, Proud, Disappointed, Frustrated, Jealous, Loved, Uneasy, Annoyed, Nervous]

Ages 11-13: Preteens are hitting that hormonal puberty stage where their feelings may be all over the place. They may be getting upset and angry for no clear reason and acting out more than usual. Helping them realize its their hormones that are out of whack, not that the world is against them may be helpful in helping them calm their reactions. They may need more space and understanding as they navigate this difficult time. Parents should be understanding but also not allow them to be disrespectful either. Often preteens need time and space to calm down and think through their feelings and when they are in a better mood often talking about it can help. [Known emotions: at this age they should know most if not all the emotions, but may struggle to differentiate specific breakdowns of feelings such as anxious versus scared].

Ages 14-18: Teens should be able to name and know all the emotions and may admit to struggling with certain ones specifically- like anxiety or anger. They should know some coping strategies to calm down and be able to manage their extreme feelings. If they are extremely up and down with mood it can be a sign of a problem and they may need expert help (ask your doctor or therapist). While it’s normal to feel all the emotions at some point the teen should likely not be all over the place severely such as excitement to furious in a few minutes, for example. As they mature they should be better handling their emotions and learning how to regulate their responses. [Known emotions: All of them. They may have slang terms for some feelings].

Overall it's important to teach children of any age the names of feelings as well as how to recognize them (by facial expression and body language) in themselves and in others. It’s also important for children to learn what causes what feelings. After they learn those basic skills then they can learn calming and coping strategies to feel better such as taking a deep breath when angry or anxious (it tells your brain and body to relax), taking a break (such as walk away, go to room to calm down ,etc). After the child is calm then they can work on a strategy to solve the problem! Even positive emotions like excitement can cause problem behaviors if the child gets too silly, or screams, gets super energetic, etc and may need to calm down. Learning when and where to act appropriately is helpful too. Such as its okay to be silly when playing, or loud when outside, but not during library time at school, for example. There are many books, games, flashcards, posters, etc available for teaching these skills. Look online for ideas. Also realize that if your child has any developmental delays or autism than often these skills will be very delayed and may not come naturally- they may have to be specifically and deliberately taught. For example most children can recognize when their parents are angry, or their friend is upset, but a child with a delay or autism may be completely clueless.

If your child is struggling beyond reasonable expectation seek out help from their pediatrician, school guidance counselor, or a child behavioral therapist.

Some online printable resources: 
Free Download of Various Feelings Activities

More Fun Feelings Crafts and Activities

These are for learning ESL but can be used by native English speakers too!

There are plenty more! Just do a search on Google or Pinterest for free printable emotions activities. 

I have some books on these topics as well. "Violet" discusses Anxiety, "Brianna" discusses Depression (deep long lasting sadness), "Julian" learns about Anger, and "Lily" learns about making friends/social skills (which is related to recognizing others' feelings). They are all for sale on Amazon

No Social Media? What to do when you feel left out.

No Social Media? When you Feel Left Out

By, Patience Domowski, LCSW



When all your friends are talking about ‘Insta’ and Tweeting and ‘Snapping’ and you’re not… you’re likely feeling left out. So what do you do if all your friends are on Social Media and you’re not?

Maybe you’re not on social media because you’re parents won’t let you, you’ve lost the privilege because you got in trouble for making a poor choice online, or you’re just too young but your older siblings and friends are on there (legal age is 13+). Maybe you just don’t really want to get sucked into Instagram or your parents won’t let you have a smartphone, or they let you do some social media but not others.

Regardless of why you can’t be on it, what do you do about it?

1)Realize it's okay to not be doing something just because ‘everyone else’ is. It’s certainly hard, and you may feel left out, but realize there’s a reason you aren’t on it, and it’s okay.

2) Find other ways to connect with your friends- texting, talking in person, emails, etc

3)Remember not everything on social media is real. For example often people only present their ‘best selves’ and will only show pictures of them looking their best, or pictures that look like they’re having fun, when that might not be the reality of their life.

4)Try to cultivate other aspects of your social life that is offline such as joining clubs, activities, gatherings, and other events. Try to take up hobbies and find other interests. Kids are often happier interacting in person and having hobbies and interests than just perusing their friend’s profiles online.

Being on social media can cause some depression too. Seeing all the ‘perfect’ lives of your friends, realizing you’re not invited to parties that everyone else enjoyed, or even being a target of cyber bullying, can all cause feelings of sadness and loneliness. Remember that it's not about how many online friends or followers you have, or how many ‘likes’ on your photos you get, but it's about the real-life connections and friendships you make that will last and be more meaningful and real for you now and in the future.

Its okay to remind your friends ‘Hey, I'm not on facebook, so if you throw a birthday party, make sure to personally invite me!’ If you feel like you’re not being invited or included in activities, maybe set up an event or party yourself. Invite everyone with text or email, or be super old school and send print invitations in the mail. Then the people who come are people you can be friends with. You can still take pictures and enjoy the event, even if its not online.

As you get older your parents may allow you a presence online, or as you learn to make more mature decisions they may loosen the rules. Or even not, when you’re an adult you can decide these things for yourself. But make sure you’re not getting sucked into doing anything just because ‘everyone else is doing it’ and that you’re still grounded in ‘Real Life’ friendships and social connections, not just online ones.


Cold Weather Brings More than Winter Woes, by guest writer Caleb Anderson

Cold Weather Brings More Than Winter Woes - by Caleb Anderson -


It’s not uncommon to get a little down in the dumps when winter weather arrives. Most of us get over it pretty quickly and actually start to look forward to crisp temperatures, hot cocoa and snow days. But for the millions of Americans who suffer with Seasonal Affective Disorder (SAD), cold weather means crippling depression that doesn’t go away until spring.

If you or someone you love shows signs of depression that occur only in the winter months, SAD may be the culprit. Here are a few tips on how to manage seasonal sadness:


  • Go outside. One of the most effective ways to put SAD on hiatus is to simply go outside when the sun is shining. The Mayo Clinic lists reduced exposure to sunlight as a potential trigger for SAD and reports that more nighttime hours can disrupt your circadian rhythm and reduce your body’s level of serotonin.


  • Look to the light. If getting outside is not an option, there are ways to see the light from behind closed shutters. Your doctor may recommend a light therapy box. These are available without a prescription. However, these bright light therapy devices, which range in price from $25 to several hundred dollars, are not regulated by the FDA and may increase your risk for overexposure to UV rays.


  • Talk about it. Similar to traditional depression, those who suffer with Seasonal Affective Disorder may benefit from speaking with a cognitive behavioral therapist. Therapy, when used alongside other treatment methods, may reduce your risk of experiencing a recurrent bout of SAD in subsequent years.


  • Get creative. Using art to get in touch with your feelings may help you overcome depression, seasonal or otherwise. The American Art Therapy Association was founded in 1969 and advocates the use of artistic endeavors to help patients come to term with everything from posttraumatic stress disorder to OCD. Even if you cannot afford this integrated therapy, the simple act of drawing, painting, writing or playing music may help you relax long enough to see the world outside of your depression.


  • Take your vitamins. Vitamin D deficiency has been linked to Seasonal Affective Disorder, along with cancer, asthma and numerous other health conditions. Consider investing in a high-quality vitamin D supplement, which may reduce or alleviate some symptoms of SAD.


  • Stay in motion. Taking care of your physical health does more than just make your body strong. Exercise triggers chemicals in your brain that can help counter depression. When you stay in motion, your body feels better. This can make it easier for you to cope with stress and other issues that can exacerbate negative feelings.

  • Do something you love. Perhaps the most important thing you can do while fighting depression is to simply do something you enjoy. Give yourself a quick mental health boost by participating in activities that make you happy. This could be reading, which can give you a timeout in the midst of a hectic day; taking a walk in the park, which will help you clear your mind; or volunteering, which will help you put your life into perspective. Behavioral Wellness & Recovery also suggest spending time with animals and considering a service dog to help you cope with anxiety.

Even though SAD is a temporary, it can have long-lasting effects on your self-esteem as well as your relationships. It’s a debilitating mental health condition that you must actively work to overcome, and you can overcome it. So get outside, enjoy the light and make your physical and mental health a priority today and every day. Soon, the sun will return, and you will feel better and be better prepared for next year’s winter woes.

Gift Ideas for Mental Health

10 Holiday Gift Ideas for Merrier Mental Health

by Jennifer Scott, Spiritfinder

If you have a friend or loved one who needs a little extra mental health boost this holiday season, we have the perfect gift ideas for you. Whether they live with depression, anxiety, bipolar disorder, or just the regular holiday blues, we’ve carefully selected a list of gifts that won’t just be something new to wear, a household appliance or tool, but a gift that can truly change their life.


Here are our top 10 picks for gifts that make for merrier mental health.

●        Shiatsu Pillow Massager with Heat for Back, Neck, Shoulders Muscle tension is an ugly side effect of many anxiety disorders, and can lead to agonizing muscle pains in the neck and shoulder area. This powerful deep-kneading massager works to relax tight muscles similar to a visit to a local masseur. Programmed with a 20-minute auto shut-off, this heated massager costs $39.95, and is designed to fit perfectly behind the neck or in other body contours of the lower back, calf and thigh areas.

●        A Massage Gift Certificate Who doesn’t like a trip to the masseur for a luxurious hour of pampering? A new study shows that beyond the pleasure, massage actually helps to treat anxiety and other mental health disorders like depression by reducing cortisol levels, which decreases anxiety symptoms.

●        Relaxation CD In just about any store that sells CDs, you can pick up a relaxation playlist. These CDs can be used in the car during rush hour or at home before bedtime to lower the heart rate and reduce stress.

●        Online Guitar Lessons According to Neuropsychologist Daniel Levitin, PhD, there’s “strong evidence” that music can affect our heart rate and our mood, and even improve our immune systems. The gift of music provides a healthy outlet and the opportunity for positive changes for your special someone. Online guitar lessons provide a more cost-effective way to take private lessons, and you get to do it from the comfort of your own home for around $20/month.

●        13 Things Mentally Strong People Don't Do: Take Back Your Power, Embrace Change, Face Your Fears, and Train Your Brain for Happiness and Success Psychotherapist Amy Morin shares her poignant story of becoming a widow at age 26, and how she developed the mental strength to move on. Through “powerful lessons,” Morin encourages readers to overcome life’s challenges by developing healthy habits, exercise and hard work.

●        BioSense Pillow from Brookstone Some mental health disorders, like anxiety and depression, can be caused by sleep deprivation, so a good night’s sleep is important. The BioSense Pillow uses memory foam that helps relieve pressure, and includes three natural ingredients to help soothe and neutralize odors: green tea, seed oil, and charcoal.

●        Soundspa Machines These sound-making devices, often kept bedside, provide a variety of natural sounds, such as rain, thunder, ocean, babbling brook and white noise, to soothe.

●        Heartmath Biofeedback Devices Biofeedback is a mind-body technique that works to help patients influence their autonomic nervous systems. More than 11,000 Heartmath users reported the following mental health benefits: a 50% drop in fatigue, a 46% drop in anxiety, a 60% drop in depression, a 24% improvement in ability to focus, and a 30% improvement in sleep. Heartmath comes in three models, ranging from $129 for the iPad and iPhone app to $299 for a computer-based, multi-user system.

●        Yoga DVD Yoga has many mental health benefits, but most notably, it changes your body’s nervous system from a fight-or-flight anxiety response to a rest-and-digest calm response. Yoga’s deep breathing, combined with its stretching movements, takes your body into a more relaxed state. Yoga DVDs cost around $15.

●        Weighted Blanket These provide comfort and security for people with PTSD, depression, anxiety and related disorders.

A gift that benefits one’s mental health can have a lasting impact. So as you prepare to share the holiday with your loved ones, show them how much you support their mental health condition with a gift that improves their quality of life. Share it with the gift of your time, and it will be extra special.


Appropriate Sexual Development and Behavior in Children

Appropriate Sexual Development in Children

Patience Domowski, LCSW


Often parents wonder if their child’s curiosity about their body parts, or other people’s body parts is normal or a concern. What sexual exploration is normal, and what is a major red flag? Certainly some curiosity and comparison is normal in young children, but how much is too far? Also what should parents do about it? Sexual development occurs from infancy on up, however what is normal or appropriate varies by age.

It is normal for toddlers and preschoolers (ages 2-5) to want to be naked, check their genitals out, and ask about them. They may be curious about their parents body parts and want to touch their mother’s breasts, or check out their sibling’s different genitals. It is typical for children at this age to explore their bodies and want to see others, or play ‘doctor’ and examine each other. It is not normal or okay for any aggressiveness in this play, or having toys act out sexual acts at this age. It would not be normal for them to want to show their body parts to a much older peer, or talk about sex specifically.

At this age parents should teach the proper body parts names- slang terms are fine but it’s also good for the child to know the real names for their body parts. Teaching children when it’s okay to be naked (bath time) and when not (in public) is a good idea at this age. Teaching appropriate personal space as well and proper boundaries is important. Parents should point out that it’s not polite to grab someone’s bottom, or put their hand up someone’s shirt for example. Parents shouldn't try to shame or upset their children as they are naturally exploring and testing boundaries. Parents should just teach appropriate touching and boundaries calmly. Teaching children that hugs and kisses are for close family, and if they don't want to, that’s okay. It's not usually a good idea to force a child to hug or kiss anyone (such as an extended relative they don't know).

By elementary school age (ages 6-10) however children should be aware it's not okay to be naked publicly, they usually have some sense of wanting privacy when using the bathroom and changing. At this age they may want to touch and explore their own body parts. Boys are more likely to fondle their genitals than girls. It should be taught to children at this age that if they want to touch themselves to do so in the bathroom, or the privacy of their bedroom. Children should not have their hands down their pants in public, and it's not okay to be scratching body parts very visibly. Parents should respect and encourage privacy of children and start to have different gendered siblings dress in separate spaces. Children may be curious and want to peek at people changing or see naked pictures and think its funny.

At this age children can be taught “Good touch/Bad touch” and that no one should touch their private area unless helping them stay safe or healthy. For example ‘staying safe and healthy’ means that parents may need to help them bathe, (though at this age they should be starting to be able to bathe themselves with some minor supervision), and doctors may need to check out their bodies to make sure they are healthy, or an emergency responder may have to touch them in certain cases (car accident, for example) to help them if they are hurt. However no one else should be touching you anywhere on your body that a bathing suit covers. Children should be taught that if anyone tries to touch them in a way that make them uncomfortable they should tell their parents right away.

Children should also be taught at this age that is not typically appropriate to hug and kiss peers at school. They may hug close friends and family, but should not be holding hands or hugging all their classmates, and should not be kissing anyone outside the family at this age (some exceptions may apply). Parents should answer any questions children have about sex and body development as age appropriately as possible giving some a basic understanding but not too many details.

Many parents teach their children about ‘stranger danger’, however statistically children are more likely to be abused by someone they know, so it’s important to teach appropriate boundaries for themselves regardless if they know the person or not. Just because someone is a close adult friend, neighbor, uncle, or staff at their daycare, doesn't mean they should allow the person to touch them in a way that is uncomfortable or in the ‘bathing suit zone’. Children can be told to tell the person who tries to touch them to please stop they don't like that, and then try to get away from the person immediately, and tell their parents or a trusted person at their school. It is usually not recommended for children to sleep in same bed with an opposite gendered person, especially if they are much older.

It would be a cause for concern, and not normal if an elementary school child was touching peer’s genitals at school, or showing off their body to someone much older than them (if it occurs normally it would be same age), or showing fear and excessive shyness around their genitals during bath and changing. It would not be normal for sexual acting out or language, or to be caught watching porn at this age.

In the middle school/preteen years (ages 9-13) children will likely want to know more about sex and their bodies. At this age parents should teach their kids about puberty and more about their body. Both boys and girls can be given information on periods, sex, and healthy relationships. It is important to teach children the family’s values and beliefs around sexual expression. Preteens may be interested in dating and relationships. Parents should set up what is expected for appropriate boundaries- though these boundaries and relationship values vary widely between families. Some parents are open to their child having sexual relationships at this age, though most are not. Some parents are fine with their child dating at a young age, but some would rather them wait. It is important to discuss values and the pros/cons of sexual involvement at this age, and not just rely on the school to provide the basics in sexual education.

Generally children at this age should be taught not to masturbate in public, not to touch anyone in a private area on their body, and not to allow anyone to touch them in a private area. They should learn ways to resist peer pressure and decide in advance how to handle any sexual advances by peers. Sex should be discussed such as how far to go (hand holding, hugging, kissing, touching, etc…) and when to give oneself sexually to someone else and how to make that decision. Parents should also teach some basics of contraception information, even if they are encouraging abstinence.

Sexual development and changes in genitalia usually occurs during preteen and teen years during puberty. Some children will develop earlier or faster than others and some children will be more interested in it than others. Encourage children to talk to parents or a trusted teacher about their questions and concerns. Keep the conversation dialog open throughout the teen years to help them navigate through difficult decision making and peer pressures and desires as they grow older.

At any age children will ask questions and be curious. It is helpful to answer questions as truthfully but appropriately as possible. While you probably don’t want to explain exactly where babies come from to your 5 yr old you can say that babies grow in mommy’s tummy for example, which is truthful versus ‘you came from the hospital’ or a ‘stork delivers babies’, or even brushing it off ‘I’ll tell you when you’re older’, ‘Ask your mother’, etc. There are plenty of books available written for children, especially preteens, to explain puberty, sex, and other questions that parents can provide to their child to read and discuss. Parents may feel uncomfortable answering questions but it is better for children to find out the truth from their parents than to get an incorrect answer from their peers on the school bus.

To keep children safe go over how to establish boundaries (not allowing others to touch them in their private areas) and avoid dangerous situations (don’t walk alone at night, for one example). It’s okay to ask your child if they have ever been touched in a way that was not comfortable or appropriate. To keep your child safe have child abuse clearances run on any babysitters, review appropriate boundaries before child has a sleepover, meet the families of children your child is friends with, don’t allow sleepovers without supervision, don’t allow children in the bathroom with other people that you don’t know and trust, and rely on your gut if anything seems off with the other person or your child’s reaction to others has changed. If your child is suddenly upset and afraid to visit someone that they normally love to see, that is something to explore. If a toddler/preschooler doesn't let mom help him wash in the bathtub, not due to being independent but is afraid and upset to have someone touch them, or seems fearful when diaper changed, that is a cause for concern.

If a child shows any inappropriate sexual behaviors ask your child about it in a calm way such as where they learned about that, and what they are doing. Sometimes it's a misunderstanding (example: they drew a large walking stick, not a penis, in front of grandpa, or: they meant to grab their friend’s leg to stop them from running and they pulled off thier pants by accident), and sometimes it’s a cause for alarm. Try to be calm so the child opens up and doesn't shut down or feel ashamed.

If parents have any concerns about their child’s behavior not seeming to be developmentally appropriate, the child has more knowledge of sexual things than what parents have taught them, or any changes in child's behavior that seems to indicate something suspicious having happened, parents should have their child evaluated by a professional such as the child’s doctor, a therapist, or guidance counselor. If the child has been sexually abused, or even if there is suspicion parents should report it to the appropriate authorities to investigate.

Other helpful resources:

Aggression in Children and How to Handle it

Aggression- how to decrease behaviors

By Patience Domowski, LCSW

Aggression in children is really difficult. From yelling to hitting, its very disruptive and sometimes even dangerous. Especially as the child gets older it becomes more of a safety concern. A 3 yr old hitting a parent is not that big of a problem, but a 13 yr old could really hurt someone.

To solve this problem we need to figure out why it is happening. Here are some possible causes:

-Child cannot manage their emotions (needs coping strategies), gets easily angry, anxious, frustrated, etc

-Child cannot effectively communicate (hasn't developed full speech due to age or speech delay, or autism)

-Child has a mental health diagnosis (autism, bipolar, ODD, …)

-Child has observed and copied aggression from older siblings, parents, violent TV

-Child is very impulsive (can’t stop and control themselves)

-Child has discovered that this gets them what they want from others  (example: if they hit then people leave them alone, if they yell then dad gives in, etc)

-Child gets attention from their behavior (even though it is negative, some children still want this attention).

-Other reasons…

For some children there may be a combination of reasons. Sometimes the reason is easy to discover but other times it may be more complicated. Collecting data (writing down the behaviors and what happened before and after) and doing an FBA (Functional Behavior Analysis) can be helpful. Ask your child’s teacher or behavioral therapist about how to do one if it is difficult to figure out the ‘why’ for the behaviors.

To correct the behavior we want to teach the child a combination of better coping strategies and a more effective way to get what they want.

For example: if they get angry easily when their sibling takes their toy we want to teach them to calm down, and also the skill of asking for the toy nicely, or asking a parent for help. If the child wants attention then teaching the child a more appropriate way such as saying “Mom, play with me!” instead of hitting would be helpful. Also the parent should ignore the inappropriate behavior until the child does the expected response.

If the child is copying others aggressive behavior- whether in person or on TV shows/games/ etc it is important to limit this exposure. If the parents are showing aggression such as yelling and hitting children, then it's likely the child will copy this as well. If the parents can try to be more patient and handle their frustrations in a more appropriate coping way, this can greatly help the child. Parents may want to seek therapy on their own, or try anger management groups, or even medication to help, if they are really struggling with depression for example. If older siblings are exhibiting aggression it is helpful to try to get them some more help and teaching the younger child to not copy those behaviors. If the child is watching violent TV shows, movies, video games, eliminate or at least reduce the frequency the child is exposed to that. If the child resists, explain that if they reduce their aggression they can slowly return to those games/shows etc. Pay attention to the ratings on games and shows however and the child’s age.

For cursing- if it’s in conjunction with anger and aggression, use same strategies already listed to teaching better coping behaviors, but besides that mostly ignore it, or teach a silly replacement word “peanut butter jelly sticks!” The more attention you give the curse word, the more powerful they become. You can tell them not to say that word and maybe even why, and if necessary punish for it, but if you make a huge deal about it (such as yelling and lecturing) it will likely make it worse. Also make sure parents and older siblings are refraining from using those words completely. Even if parents tell child not to say a word, if they are saying it themselves, the child will still learn it and repeat it. With any behavior, parents need to model good behavior and not to do anything they would not want their child to do (for the most part). Sometimes an old fashioned ‘swear jar’ is helpful. The person that says the bad word is ‘fined’ and has to pay real money into the jar.When the jar is full some families will use it for a fun activity, sometimes the money would go to the non-swearing person, or maybe the family would donate it to a charity.

Make sure the child’s aggressive behavior is not getting them what they want. If they are hitting their sibling to get them to leave them alone, and its effective, that is going to maintain the behavior. Try to teach the sibling to respond better and quicker and teach the aggressive child to request space in a better way. If the aggressive behavior is getting them the attention or item they want from parents, parents need to try hard to not give in. Even though it makes the screaming stop now, it will just make the behavior worse the next time if you give in.

If the child has not developed appropriate speech, due to age or delays, it maybe be helpful to teach a simple hand gesture/sign language to use to communicate. Maybe a clap means ‘Can I have it?’ or a hand tap means ‘I need help’. Ask your child’s speech therapist for some ideas to figure out what will work best for your child’s speech needs.

For kids who don’t have good coping strategies have them write up a list (or draw) several things they can do when they are angry and then hang the list in a well-trafficked area in the home (living room or kitchen is usually good). The list should be visible because when someone is angry they are not going to go searching for a paper in a drawer to figure out what to do. The strategies can include deep breathing, walking away/ignoring, asking parents for help, doing something fun to distract yourself, and remembering to ask nicely for things. There are many coping strategy lists that can be found online. The key is to find which ones work best for your child and to have your child identify these as well. The more the child is involved in identifying the strategies the more likely the child will use them.  Also have the child act out the appropriate coping strategy when they are in a good mood, as a role play, or after they made a poor choice to reenact making a better choice.

Try giving a reward to the child for using a strategy. For example if the child takes a deep breath instead of hitting mom, or stops screaming by deciding to go chill out in their room, give them a piece of candy, access to a special toy, or extra ipad time for making a good choice. Praise your child for calming down, whether it took 10 seconds or 1 hour, immediately praise them when they are calm so they associate positive attention with calming down.

Try behavioral charts. Children are often not motivated to make a better choice internally - it’s easier for them, or not big deal for them to yell and hit versus breathe and ask nicely. But if you sweeten the deal by offering candy, toys, extra time, other privileges then they are more likely to make the better choice. Some kids will need the reinforcement reward immediately and some can wait until the end of the day or week. Think about your child’s needs and personality to figure out the immediacy of rewards. If you aren't sure how to do this seek out a behavioral therapist who is experienced in this and can help you. Once your child learns the strategies to handle their feelings more appropriately they are likely to reduce aggression and you can fade out the behavior chart, or use the rewards to target another behavior.

Sometimes if the child is so out of control and aggressive they have to be restrained. Parents can learn appropriate ways to restrain their children (ask the school, doctor, or a therapist). If the child is in danger to themselves or others it is okay to restrain them until they are calm and in control again. The police and mental health crisis workers can also be helpful in these situations. If aggression is a regular occurrence, behavioral interventions are not effective, and the behaviors are fairly severe, medication may be necessary. Talk to your child’s doctor or seek a child psychiatrist for help.

Helpful Links:

Swear Jar:

Child Restraining:

Causes of Aggression:

Handling aggressive behavior:

Taming Aggression and Coping for parents:

Anger Strategies (Other helpful blog articles)

Encopresis (soiling) and Behavior

Encopresis and behavior

By Patience Domowski, LCSW


Encopresis is the term for when a child past toilet training age (around age 4) is still soiling (pooping) in their clothes, and not properly eliminating in the toilet.

This issue occurs often in conjunction with enuresis (night and day wetting their clothes/bed after potty training age), but not always.

Sometimes the soiling is on purpose, but often it is not. Usually children with this problem have constipation issues and cannot feel or control their bowel movements. They often need extra fiber diet, to drink alot of water, and to take laxatives. It can take a while for this problem to clear up. Sometimes this problem occurs from a problem during potty training or just a GI physical issue where their colon gets stretched out and they can’t feel their bowel movements. However, sometimes this is a behavioral issue. In many cases it's a mix of medical and behavioral problem.

When the problem is behavioral, the child may be holding their stool in, or refusing to use the toilet for several reasons. Sometimes the child doesn't plan or mean to do this, it just happens for various reasons. Common reasons include fear of phobia of the toilet/flush (especially public toilets with the auto-flush), past trauma (doesn't have to be related to bathroom issues, but any kind of abuse, especially sexual abuse), child wants to have some control in their life (maybe some external stressors are causing child to feel out of control), they are afraid of the pain of passing hard stool, they don't want to interrupt play time to use the bathroom, they refuse to drink enough water so their stool hardens, diet issues (refuse to eat vegetables, eat only constipating foods like grains and cheese for example) or they are under some sort of stress (such as parents divorce, major move, bullied at school, new sibling, etc). The child may be unaware of why/the reason for this behavior problem. They often are not doing it intentionally.

To address this issue first try to figure out the cause. Rule out medical reasons first.  Is the child diagnosed with constipation or other GI issues, any food sensitivities that cause diarrhea perhaps? Did they have a difficult time being potty trained? Were they taught to ‘hold it’ instead of ‘go’ perhaps at school or daycare? Constipation can be diagnosed via xray by a GI doctor. If this is the problem try laxatives, high fiber diet, drinking alot of water, and anything else the doctor recommends. Using a small stool for the child to prop their feet while using the toilet may help in pushing it out easier.

If the issue is behavioral (or a mix of both) try scheduling mandatory bathroom use. If the child is emptying themselves on a regular schedule it is less likely they will have anything in them to come out at an unplanned time. There are potty watches you can buy or just set a timer and have child use the bathroom every 1-2 hours. Make sure the school is on board. If they are resistant to letting the child use the bathroom that often, have the doctor write a note, or get a 504 plan. Also offering child a reward for using the toilet can be very helpful. They get a small treat (toy, candy, ipad time) for using the toilet at their scheduled time, and maybe additional treat (more of it) if they actually eliminate in the toilet during that attempt. If they go a whole day without accidents maybe they get another reward.

Do not punish for soiling. Often children cannot help it so this will not help. Even if they have some control, if they feel shame about it and have someone upset with them over it they will likely shut down further and it will make the problem worsen. You can, however, give a natural consequence such as they have to help with the clean up after an accident, they have to put their clothes and sheets, etc in the washing machine and help do the laundry. This is not a punishment but it is a consequence. The consequence can help the child think about if it’s easier to eliminate in the potty versus all the work of a clean up from pooping elsewhere. This is often effective if the problem is strictly from the behavioral issue of not wanting to interrupt play or to get up to use bathroom (sometimes called laziness in using the toilet).

Try to have both parents and any other caregivers (grandparents, babysitters, teachers) get on the same page with the toilet scheduling and rewards system. If one main caregiver is handling the problem differently it can impact the effectiveness of the intervention across settings.

If the problems continue, or if the reason is from a past abuse or trauma, it is a good idea to seek out help from a professional child therapist who can help the child work through those issues. Sometimes just having another person talking to the child about the interventions, instead of just the parents, is effective. If the child is experiencing any emotional stress it may be helpful for them to talk to a therapist about the stress and by airing the stress and learning some coping strategies the toileting issues may just go away.


Some additional helpful resources:

Tips on bedwetting.

Helpful tips for getting a 504 at school.

Where to buy a potty watch.

Book for children explaining this problem: “Bedwetting and Accidents aren’t your fault. Why potty accidents happen and how to make them stop.” by By Dr Steve Hodges “Dr Pooper” and Suzanne Schlosberg (Available on Amazon)

PA Outlets for Anxiety, by Guest Writer Jennifer Scott.

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Pennsylvania Residents Have Many Outlets for Anxiety

by Jennifer Scott

If you’re suffering with anxiety, depression, substance abuse disorders, or other mental health conditions, take heart knowing that your home state can help you heal.




There is no shame in seeking help for issues that consume you. Depression and anxiety are difficult to overcome on your own. Thankfully, there are many qualified clinical counselors from Pittsburg to Philadelphia and everywhere in between. Counseling isn’t simply “getting things off your chest,” although having a nonjudgmental listener is extremely therapeutic. Counselling is more about self-discovery and self-reflection. It is a tool you can use to get yourself unstuck and gain a better understanding of your actions. Getting help is one good choice you can make for your mental health and overall well being.




Nature. It’s all around you all the time. All you have to do is step outside. And, at least according to Jo Barton and Jules N. Pretty, researchers from the University of Essex, a dose of the outdoors can improve your mental health. The Keystone State offers ample opportunities to mix and mingle with Mother Nature. Skiing at Laurel Mountain State Park is a family-friendly activity that will not only help your recovery from depression, but can forge stronger bonds between you and your children/spouse. There are countless trails and mountains throughout the state, too, so you can choose to take a stroll on a paved walkway or gear up for a grander expedition.




Did you know that giving your time to a cause near and dear to your heart could actually stave off depression? Well, it can, says Harvard Women’s Health Watch Editor Stephanie Watson. Volunteering may even lower your blood pressure and help you live longer. And since a healthy body directly correlates to a healthy mind, don’t be afraid to roll up your sleeves and make a difference in the world around you. There are more than 250 volunteer opportunities in the Johnstown area alone (for a listing, check out You can give your time to your children’s school, a local animal shelter, delivering meals to the elderly, or virtually any cause that makes you feel good about your time on this earth.





Give your brain a boost by filling it with more information. Studies suggest that education can protect your brain from the effects of anxiety and depression but to what degree remains unclear. However, digesting new information is never a bad thing and especially when combined with learning something new and fun, such as painting, clay art, or jewelry making. Learning a new hobby (even if you aren’t great at it) can keep your days interesting and help you find control and better manage stress, regardless of age. Check out the Community Arts Center of Cambria County for adult classes on everything from knitting to acrylic painting.  




If you are suicidal or fear that being alone would trigger a relapse, please seek help immediately. However, if you feel you need to get away and have some time for yourself, PA has plenty of places for that. Sometimes, just a night or two without someone asking for your help with homework, needing you to fix a problem at the office, or looking to you for dinner can really make a big difference in your health and well being. A weekend alone at one of the area’s many bed and breakfasts can open your eyes to a whole new world and give you the time you need to relax and recover from the stresses of everyday life.


No matter where you live, there are resources to help you overcome mental health disorders. Thankfully, you live in one of the most beautiful states in the nation and never have far to go to find an outlet for what ails you.


My Child Can Talk, But Won't, Why?


My Child CAN Talk, But Won’t, Why?
Selective Mutism/Social Anxiety

By Patience Domowski, LCSW

Assuming your child is able to talk, and not dealing with a speech delay or autism, but the child sometimes, or often, refuses to talk, usually in certain situations,you may be quite confused why this happens, and what to do about it.

Usually the reason is excessive anxiety. The child could have social anxiety, social phobias, or be diagnosed with ‘Selective Mutism’ (an anxiety disorder where the child will not speak at all in certain settings).

Children can get anxiety from genetics (anxiety ‘runs in the family’, so to speak), from a traumatic event (the child considers it traumatic, even if others might disagree), or sometimes anxiety seems to come out of nowhere (likely to be biological). Social Anxiety or Social Phobia is a fear of others judging or looking at them. Often children, and adults, know that know one is technically watching them but they feel like they are being watched. It's like paranoia, but may not be quite that severe. The affected person may feel like if they speak others will think bad thoughts about them. Maybe they are worried they will be bullied, or taunted. Maybe they get so anxious they can’t say what they want to say so they clam up. Maybe in the past they were actually bullied, or ridiculed or yelled at by peers or adults, or maybe nothing ever bad happened, they just worry it will happen.

If the child has become mute from a traumatic event, it is likely they will not speak across many settings, not just some. They may show signs of fear and other issues like bed wetting. Usually the mutism occurs right after the trauma.

Sometimes children refuse to talk because they don’t know what to say, they want control, they want to  frustrate their parents, or for behavior issues. However if the child is showing other signs of anxiety like acting nervous, only refusing to talk in certain situations of high anxiety (like at school, in the community, around strangers), trying to avoid social situations, and even other symptoms like panic attacks, headaches, stomachaches, throwing up, etc it is likely to be for anxiety reasons.

So what do we do about it? One major way is to not pressure the child to speak. Instead of saying ‘You HAVE to say Hi to Grandma!’ you can prompt gently ‘Would you like to say HI? Or you can just wave, if that’s easier’. And then don’t expect any response and be okay with that.  Don’t punish the child or yell at them for not speaking. This will make the anxiety much worse and not help at all. If the child is already afraid to speak, then by being yelled at or punished, they will become even more fearful of speaking. They should be encouraged to speak, but then let it go, not pushing it, just telling them they can speak when they are ready. Maybe the child can learn a simple sign/gesture that is acceptable such as a wave, high five, or fist bump for greetings. If that is too much for them, it’s okay.

To help the child become more comfortable, praise them (if they like praise) when they do speak in more relaxed settings. Remind them of the good job they did when in another situation “Remember when you were so brave and said Hi to Uncle John? You did a great job! It went great, didn’t it?  You can try to say hello to Uncle George today!”  Have them warm up to others by watching before approaching, and visiting places in advance before an event (if possible). For example starting at a new school- have them visit the school a few times when no one is there, or meet the teacher one on one, before the first day, or orientation day.

Try to make meeting new people or new situations relaxed and friendly and not expect or make a big deal about the child talking,  just let the child warm up slowly on their own time and at their own pace.  Example: “Sweetie, you can join the other kids on the playground if you want, or it’s okay to just stand by me if you prefer.” or “Let’s just watch the other kids play this game and when you’re ready, if you want, you can join in. Wow, that looks like fun!”

It may be helpful to tell others, especially adults, that the child is anxious and not speaking, so the other adult doesn't try to force the interaction and make the child more anxious. Sometimes other children may not even notice, if they are very young, as a lot of play is nonverbal, or the other child will just do all the talking. Often adults may get upset and confused however so it may be helpful to calmly say ‘She might not respond, but don’t take it personally. We’re working on anxiety’ or ‘Don’t worry if she doesn't respond, she will warm up eventually.’

For the socially anxious child they may do great with one on one playdates but be a mess at parties and larger gatherings. Encourage the small group settings to start with, and don’t force larger parties too soon. If possible, just have them observe from a distance, and not expect them to join in the activities.  For older children giving them a script of something to say may help if they aren't sure how to start a conversation. “Ask them about their favorite TV show” may be more helpful than “Just try to talk to him!”

Seeking out professional help may be needed if the child isn't making progress after a few weeks. Often children may adjust to a new school after a month or so, or get used to a new group of friends, but if they are still quite mute even after a typical adjustment period, it may be time to ask for some more help. A Behavioral Therapist may be more effective than a speech therapist, find out what their approach would be when selecting someone. Make sure the therapist works with kids with anxiety, not just behavioral disorders, as the approach should be from an anxiety point of view, not a oppositional defiant type approach. The strategies are likely to include acceptance, not forcing, relaxing the environment if possible, preparing child for new and scary situations, telling people not to expect a response, allowing the child to slowly warm up, but not avoiding all scary anxiety situations, and slowly building child’s confidence and reducing fear in being able to speak to others.

Try to remember as a parent, it’s probably not your fault, and it’s not the child’s fault either! Being calm and accepting will help a lot even though it’s very frustrating and of course you want your little darling to speak up. If you as the parent also struggle with anxiety getting some help for that can be useful. Or if you are just so frustrated to the point that you are getting angry with your child about this, it might be helpful to seek out a therapist as well to help you cope. If you aren't feeling so upset about it it may help your child feel less anxious about the situation too. Try not to take the problem personally or that it reflects badly on you as a parent, and that can help you feel better about it as well.

Some kids may grow out of this problem, but likely it will worsen if not treated. Getting some help for anxiety such as coping strategies, learning how to change negative thinking, and sometimes even medicine can go a long way to making things get a lot better. If your child won’t talk to the therapist or doctor, see if the therapist will work with you as a parent to handle the child and teach them the strategies indirectly and that may be sufficient. Also don’t give up too easily. Often children warm up to therapists after a few visits, but not always the first or second meeting. Giving the child an incentive or special reward may be helpful like getting to go out to eat before the session, or can bring a favorite toy with them may help. Even telling the child they don't have to talk about their anxiety, but about anything they want can help a lot (even though of course you want them to talk about the problem!).  A good therapist will go along with what the child wants to discuss first and bring it around to the topic they need to work on at some point (may be after a few sessions so the child can warm up). Child therapists also should have some toys, books, coloring, something to do besides just talking which may help the child feel more comfortable. Even if the child isn't talking in therapy, if they are listening to a story, or coloring a picture, it can still be really helpful. Try not to get too frustrated if the therapy isn't working right away, it often takes a while for kids who are slow to warm up. Some kids may even surprise you and talk immediately to the therapist, when they normally wouldn't talk to a strange adult at all.

Remember your child can learn how to speak in social settings with some help. It gets better. Hang in there.

Sibling of a Child with Special Needs


If you have a 'typical' child that is struggling to handle having a sibling with behavioral issues/disability/special needs, I made a worksheet to help them process their feelings and thoughts about this. If it seems to be a major concern for the child, they may need some therapy to handle their siblings issues. Its hard to notice the other children as needing therapy versus the one with the special needs, who is likely already getting alot of attention and services, but sometimes siblings feel forgotten or resentful and may need some extra support. 



Sensory or Behavior?



Sensory vs Behavior
By Patience Domowski, LCSW

How do I know if my child’s behavior is sensory-related or a behavioral problem? Parents wonder this all the time. The simple answer is that it's often hard to tell and sometimes the reasons overlap. Often the issues can be both.

Sensory issues are sensitivities related to the senses- see, hear, feel, taste, smell. People can be over-sensitive or under-sensitive to senses. Children can be sensory- seeking: they do certain things to get certain sensory stimulation, such as excessively rubbing a soft blanket, or sensory-avoidant: they do things to avoid sensations they cannot handle, such as covering their ears for loud sounds. Some behaviors that are sensory related can also be behaviors for other reasons, which makes this so difficult to figure out. Some children are both sensory seeking and sensory avoidant for different senses.

Some behaviors you might see in a sensory-seeking child: running around and crashing into furniture/items, desires tight hugs and squeezes often, chews/sucks on toys/fingers/etc, bites/scratches/squeezes  people or furniture, likes to feel various items and objects, fabrics, textures. These behaviors are  not to get something they want from another person, like a toy, or attention, but for sensory input into their body.

Some behaviors you might see in a sensory-avoidant child include: won’t touch or eat certain textures- wet or soft items often like pudding or yogurt, screams and covers ears/eyes in certain bright lights or loud noises (may seem normal lighting or sound to a non-sensory person however, but to a sensory kid it’s overwhelming), avoids certain fabrics/clothing.

If a child is screaming or running around, those are not obviously sensory related behaviors, so how do you know the difference? The way to figure it out is to try to figure out the function, or the WHY, of the behavior. Is the child running around because they are trying to get your attention? (Behavioral) Do they seem to be very hyper and struggle to sit still? (Could be Sensory) Is the child screaming to get what they want, get attention, or because other people are doing it? (Behavior) Or are they upset with no clear reason why? (Could be sensory) Would the child do the behavior if no one was in the room with them? One of the simpler ways to figure out if a behavior is for sensory purposes is if the behavior would occur without any other interaction from another person. If the child was alone in a room and would still do that behavior, it is likely sensory- because they are not trying to avoid something they don’t want to do, get attention, or get something from someone else (the other functions of behavior). [For more info on functions of behavior see my other article on this topic].

Many children do sensory-seeking behaviors that are not a major problem as most children like to run in circles, dance around, touch soft items, etc. because it feels good to them. It's only a sensory problem when the behaviors are disrupting the family or school setting, or causing distress or interference in the child’s life. To have your child diagnosed with a sensory disorder please seek an evaluation from an occupational Therapist (OT). OTs are available through Early Intervention (if your child is under age 5), the school system, or private agencies.

If the behavior is for any other reason than sensory-stimulation it's a behavioral issue, not a sensory issue. If a child is throwing a tantrum because they didn't get candy, that’s behavior. If they are melting down because the lights are too bright- that’s sensory. Sometimes it's hard to know why so trying to figure out when the behaviors occur, what set it off, and the environment is very helpful. If your child is verbal, ask them what the problem is if they can verbalize it. Sometimes taking data is helpful to see patterns and figure out what settings the behavior seems to occur in most often.

So what do we do about it? We want to treat the behavior differently based on the function (or WHY) of the behavior. If a child is screaming for attention purposes, we would likely want to ignore them and teach them a better way to get attention. But if the child is screaming to avoid a loud sound, we would want to help them protect their ears- such as providing headphones in noisy environments. If the child doesn't want to wear underwear to be difficult or in control that is much different than a child who is complaining the underwear is itchy. So once we figure out WHY the behavior is occurring, then we come up with a solution.

OTs help kids de-sensitize and meet their sensory needs in more appropriate ways. So a kid who cannot tolerate certain clothing would probably be brushed until they could tolerate it. They would have the child do sensory activities like jumping on a trampoline or crashing into cushions to meet those needs instead of grabbing people or running into walls. Behaviorally the child can be given rewards for making good choices- like using a sensory toy or strategy, such as biting a chew toy instead of mom’s arm.  We want the child to meet their needs in an appropriate way or get them to a point that they don't need that problematic behavior anymore.

Often the behaviors are both sensory and behavioral and they can feed each other, so sometimes a combined approach to treatment is helpful. Many children with ADHD, autism, and anxiety also have sensory issues. However a child can have sensory issues without a mental health diagnosis as well. Try to have your child evaluated by both a behavioral/mental health therapist and an OT to figure out the right diagnosis as that will be very helpful in coming up with a treatment plan.

Because sensory and behavior needs vary so much per child, and figuring out the function can be difficult sometimes, it is important to meet with an experienced professional to help figure out a plan specifically for your child. OTs and Behavioral Specialists/Therapists are the best professionals for this. Some Physical Therapists (PTs) can be helpful as well. Not all child therapists are familiar with sensory issues however, so find someone who knows something about sensory concerns and behavior.

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.

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