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:

http://www.nsvrc.org/sites/default/files/saam_2013_an-overview-of-healthy-childhood-sexual-development.pdf

http://kidshealth.org/en/parents/development.html#

http://nctsn.org/nctsn_assets/pdfs/caring/sexualdevelopmentandbehavior.pdf

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: https://en.wikipedia.org/wiki/Swear_jar

Child Restraining: https://www.k-state.edu/wwparent/courses/rd/toolbox/rdtool-37.html

Causes of Aggression:

https://childmind.org/article/aggression-in-children-causes/

Handling aggressive behavior:

https://www.empoweringparents.com/article/how-to-manage-aggressive-child-behavior/

Taming Aggression and Coping for parents:

http://www.parentingscience.com/aggression-in-children.html

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:

https://www.mayoclinic.org/diseases-conditions/encopresis/symptoms-causes/syc-20354494

http://kidshealth.org/en/parents/encopresis.html#

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.

 

Counseling

 

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

 

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.

 

Nurture

 

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 VolunteerMatch.org). 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.

 

 

Learning

 

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.  

 

Solitude

 

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?

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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

Sibling-Rivalry.jpg

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. 

Worksheet

 

Sensory or Behavior?

sensoryavoider.jpg

 

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.

Other helpful articles and information

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

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

I hate you!

yelling

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

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

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

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

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

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

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

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

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

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

Using a Fidget properly

fidgets

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

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

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

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

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

Depression in Young Children

sad child

Depression in Children
by, Patience Domowski, LCSW

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

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

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

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

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

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

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

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

Other helpful articles:

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

 

 

Panic Attack Advice

panic attack symptoms

Panic Attacks Advice
Patience Domowski, LCSW

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

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

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

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

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

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

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

Mom tribe

mom tribe

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

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

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

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

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

 

 

 

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

same page

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

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

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

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

 

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

 

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

 

 

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

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

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

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

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

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

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

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

Bullying, or not?

bullying

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

Little Tattle Tales

dam beavers tattle tale

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

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

College Choices

grad college choices

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

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

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

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

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

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

Divorced Co Parenting Tips (and Worksheet for Kids)

coparenting split child

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

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

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

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

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

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

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

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

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

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

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

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

Printable version of this article

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

Coping strategies

stress ball coping strategies

Coping skills List
by, Patience’s Behavior Therapy

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

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

      take a deep breath

      count to ten

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

      walk away from what is making you mad

      listen to music

      take a walk/exercise/dance

      pet your dog/cat

      ask for a hug

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

 

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

      think about it differently

      try to find the positive

      try to understand the other person’s perspective

      problem solve

      talk calmly with the person who is upsetting me

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

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

      try to get enough sleep and enough to eat

 

Calming strategies for Anxiety

·         deep breaths

·         try to think of the positive/realistic situation

·         use logic

·         progressive muscle relaxation

·         listen to music

·         think of a happy place/time/memory

·         draw a picture

·         talk to someone

Click here for a downloadable printable list