Food Allergies and Anxiety

Food Allergies and Anxiety

By Patience Domowski, LCSW

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More and more children seem to be developing food allergies these days. Kids with severe reactions often are very anxious about their allergies because they don’t want the consequences of a reaction (such as trouble breathing), and can be worried that other people won’t be understanding of their allergy. For example a child who had to be hospitalized for going into anaphylactic shock from peanut butter on someone’s fingers at a birthday party  is naturally going to be little more wary and even nervous to attend another birthday party. They don’t want to end up in the hospital again! Or another child who tells their friend’s mom they can’t have seafood and the mom serves shrimp for dinner anyway might be concerned that people don’t understand them or care. Sometimes kids even get teased about their allergies or told they aren’t real. This is very upsetting for the allergic child and can make them quite frightened as some kids’ allergic reactions are life -threatening.

 

Ways to help your food-allergic child feel less anxious:

-Teach them nice ways to explain to others about their allergies, maybe even give them little business cards with information on it to pass out to friends and friend’s parents so they understand a little better.

-Teach them how to check food labels so they can be confident what they eat won’t make them react, and ask grown-ups present to help them double-check as well

-Remind them that just because they had an allergic reaction in a certain situation before (like at a party, or school), doesn't mean it will happen again- child and family will be more careful next time

-Remind them of the protocol of what to do if they think they are having an allergic reaction and who to ask for help, carry epi-pen if needed or other medications

-Teach some coping strategies for anxiety such as deep breathing, thinking happy/calm thoughts, and making a plan to handle problems that arise

-Joining a food allergy support group can be helpful for parents and children

-If they continue to show excessive anxiety, have them see a child behavioral therapist

 

Ways to help others understand your child’s allergies:

-Provide some basic education, nicely, to other parents, friends, teachers, etc on how the food allergy affects your child and what they need to avoid and how (can they just not ingest a food, or not even be near it?)

-Remind friend’s parents before a playdate or party and also pack safe foods for your child so the other parent doesn't have to worry about what to feed your child at their house

-Even if your child has a 504 for allergies at school, inform any new teachers or lunch aides about the allergies, and ask teachers to tell other parents coming into the classroom with food for parties about the concerns. Suggest other options that won’t affect your child like toys, stickers, or other foods that are safe and yummy to bring in to the class, or say you will provide all treats for your child at these events.

-If your child is being teased or bullied about allergies, provide some education to the other person about the seriousness of the reaction and why its not cool to be mean about it. Report the bullying incidents to the authorities such as school staff or adults in charge at the event.

-Tell teachers and other adults involved with your child some ways you are working on teaching coping strategies to your child to handle their anxieties like ‘remind them to take deep breaths’ or ‘please tell my child I packed his lunch so he doesn't need to worry’, etc.

-Give everyone written and verbal information on how to handle allergic reactions, symptoms and how to dispense medication in case something does happen. For example while the school nurse is trained to use an epi-pen, the chaperone on a field trip might not be trained, so they would need that information in advance

Other tips:

Connect with other parents dealing with same situation for more ideas and supports. Make sure your child is getting support as well if they are emotionally affected by their allergies.

Positive Self Talk

Positive Self-Talk

By Patience Domowski, LCSW

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Did you know that talking positively to yourself can change how you feel and behave? It’s amazing how much our minds and thoughts can affect our feelings and behaviors. This is the basis theory for Cognitive Behavioral Therapy, known commonly as ‘CBT’. CBT teaches that changing your thoughts (often through a strategy or coping skill called ‘Self Talk’) changes your feelings, which then changes your behavior.

For example: You see someone you know at the store or a restaurant and they don’t talk to you at all. If you think “That girl didn't talk to me because she doesn't like me”, you might feel sad, annoyed, jealous, etc. Your behavior may be to snub her, not talk to her, or be rude. However if you change your thoughts to “That girl didn't talk to me today; maybe she’s having a rough day, or she didn't see me. Or she was busy/some other reason,” then your feelings change to more neutral/content feeling, not caring about it, or even feeling bad for the girl. Then maybe your behavior might be to go talk to her yourself or just let it go. The situation didn't change- the girl still didn't talk to you, however by changing thoughts from negative (‘she doesn't like me’) to positive (‘maybe she is having a bad day or didn't see me’, or some reason not related to feeling badly about me) then your feelings become more positive and your behavior improves as well.

‘Positive self-talk’ is also used to help you feel better about yourself when you have negative thoughts about yourself. So if your thoughts are ‘I’m a terrible person’, ‘No one likes me’, ‘I’m so stupid’, which makes you feel sad, disappointed, like a failure and leads to behaviors of withdrawal, avoidance, etc you can work on changing those thoughts to ‘Well, I did the best I could’, ‘Not everyone likes me, but my friends do’, ‘I’m still learning and everyone makes mistakes’, then your feelings become more positive such as feeling hopeful, happier, etc and your behavior likely would be to try harder, not continue to think harshly on yourself, maybe be more active or social.

Just going into a situation thinking positively about the possible outcomes will help you notice more positive aspects of situations and likely you will have a better experience than going in with a negative viewpoint. For example maybe you’re dreading a family party because you don’t know a lot of extended relatives that are attending, or there are often family arguments. You head into the party dreading these awkward moments that may arise. Instead you can change the thought to ‘I’m going to enjoy myself, regardless of others’, and instead maybe focus on the food, plan to talk to the one or two people you like/get along with, or anything else that may not be too bad about the event. Then after the party you may realize that it wasn’t so bad because you were focused on the good parts, and even if you didn't know some people, or someone started a fight, at least you were focused on the people you did know, and you stayed out of the drama.

Although thoughts won’t affect what happens- you can’t magically think away something bad happening, but if you focus on the positives/good things, you will feel better than if you are focusing on or looking for the bad things.

The situation may remain the same, but the outlook is different. For example let’s say you and your friend have a day off school or work due to the weather. One person is happy because they don’t have to go to school/work, and can hang out at home doing something they’d rather do for fun. The other person is upset because they either don’t get paid for not working, or they have to make up a school day later, and they are thinking they will be bored while home and really wanted to see their friends that day. The situation is still the same- school/work is closed due to weather, however the positive person will enjoy their day, despite the consequences of lost wages or having to make up the day later, while the negative person will be miserable thinking of what they would’ve rather had happen that day.

Common positive self-talk phrases include self-esteem affirmations such as ‘I’m a good person’, ‘Others like me’, ‘I am smart’, ‘I am loveable’, as well as motivating statements such as:  ‘I can do it’, ‘I can think positively about this’, ‘It will get better’, ‘I just have to try’, etc.

If positive statements do not automatically come to your mind spend a few minutes trying to think of something positive about a situation or thought that you have, and if you get stuck, think what would you tell your friend if they were struggling with the same thought. It might be hard to think positively for yourself, but it may be easier to think of something helpful to tell a friend. If you are still stuck, ask a friend or family member for some help coming up with some positive thoughts and phrases. Write them down so you don’t forget them. If you usually think negatively, it will be very hard to remember the positives, and even harder to believe them! So have them written down so you can go to them and use them when needed.

As you work on thinking more positively, just like physical exercise, it will become easier over time. At first it will be super hard, but then your brain will help you think of them faster. The more you try it the easier it eventually becomes. The more you focus on the positives, the better you will feel. So when you catch yourself thinking negatively about something, try to change that thought right away or focus on another positive aspect of the situation, in order to think and behave better.

People with anxiety and depression mostly need to work on postive self-talk, but all of us have times of feeling down or negative and can use this coping strategy so start stretching the positive 'muscles' of your brain now so you can be ready for when you are having a negative day. 

An old quote from Henry Ford (inventor of the Ford automobile) says “If you think you can, or you think you can’t: you’re right!”

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Making Friends at a New School

Making Friends at a New School

By Patience Domowski, LCSW

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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.

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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.

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

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Bullying

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.

 

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).

 

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.

 

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.

Sensory or Behavior?

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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

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.

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.

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

OCD... or not!

OCD list

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

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

What it is:

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

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

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

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

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

What it is NOT:

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

OCPD is Obsessive Compulsive Personality Disorder.

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

Breathing exercises to help calm kids down

belly breathing

Taking DEEP SLOW breaths are important to help teach your brain and body to relax. These breathing exercises are great for kids with anxiety as well as anger or any strong emotion. 

benefits of breathing

Download this list of breathing exercises! Print out and hang up in your child's calm down spot to help them remember how to relax! 

Breathing exercises for Anxiety or Anger to help kids calm down. 

Anxiety

anxious child

Anxiety

For kids with severe anxiety I recommend therapy and possibly medication if they can’t get through the day or are having many panic attacks.

While the child might ask you multiple times about various anxious scenarios I would suggest not constantly talking about their sources of anxiety and constantly reassuring them, but instead refer them to a professional therapist. They often may only need a few sessions to start feeling better. They need some reassurances from parents that they are safe/okay, but constantly talking about it can lead to them thinking more about their worries instead of getting them to think about other relaxing thoughts. Don’t tell your child not to worry about things or make them feel bad for having anxiety- it’s not their fault and saying this will just make them feel worse. Help them examine evidence if their fears are irrational to challenge their anxious thoughts. Also ask them how to make them feel better and teach them how to solve their problems. Also help them develop some coping strategies.

Coping strategy suggestions:

·         Take deep breaths from stomach (instead of chest)

·         Picture a relaxing scene/favorite place (often kids pick a vacation, or thinking about their pet)

·         Progressive musical relaxation (tighten and then relax your muscles)

·         Try to change your thoughts by questioning your fears if they are really likely to happen. [For example- if you worry your parents will die, then think- is it really likely? Probably not if you examine the evidence- that they aren’t sick and have never died before. Then you can try to challenge your thought and remember they will likely be fine and you can try to relax].

·         Problem solve:  If your child is asking “What if” this or that happens, ask them to try to think of logical solutions.

Anxiety about going somewhere new

Some kids have a lot of anxiety about going somewhere new (or somewhere they haven't been in a while) or visiting/meeting new people. Some kids may not show their anxiety, but rather internalize it (may be worried but not express it) and other kids express it in different ways. Some kids show this anxiety in the typical way: clinging to mom/dad, crying, refusing to go.  Other kids show this anxiety by throwing a fit or a tantrum. Sometimes parents don't recognize the reason for the tantrum- the child doesn't or can't appropriately express his feelings so they throw a fit.

Tip: Review and prepare. Show the child the website of where you are going (all attractions like museums, zoos, etc have websites with pictures), or show your child pictures of who you are visiting (grandparents for example). Discuss what you will do, what you will see, etc. Explain to the child it’s okay and normal to be a little anxious about doing something new or going somewhere new. Tell the child what the OK reaction should be. Also remind them how they can cope (hug parents, hold their hand, bring their favorite toy). Finally make sure you emphasize the fun part! Remind kids it will be fine.


Some kids do great with "Social Stories" where a story is written with the child in the story and it explains what will happen, what the expected behavior is, and reminds the child they are doing a great job learning whatever the skill is you want them to learn. (Search online for some free available social stories, or you can make one up yourself!)


Here's an example of something you can say to your anxious child before you go, and maybe during the car ride too.  "I know sometimes you (or use "kids" in general if the child gets upset if you specifically focus on them) get a little worried or anxious when going somewhere new. It’s okay, and normal. Even mommies and daddies get anxious sometimes. (You can say if it’s true that you feel a little nervous too).  Remember you can tell me "I feel worried" or "I'm scared" (use whatever feeling word you think your child is most familiar with and would understand) and come give me a hug, or you can hold my hand until you feel comfortable. We're going to do and see lots of fun things (give specific examples, if you can).  I'm sure you will have lots of fun!”

  (If you are leaving the child with a new babysitter for example, explain you will be back very soon and will give lots of hugs and kisses when you return, and you will miss them too.)

[see articles on breathing, preparing for a new school, separation anxiety and depression]

You're not a bad mom

busy mom

You’re not a “Bad Mom” ~ by, Patience Domowski, LCSW

You’re not a bad mom if…

·       you can’t breastfeed/choose not to

·       your baby/kids aren’t on a perfect sleep schedule

·       you want a break from your kids sometimes

·       you don’t want to be a stay-at-home-mom (or can’t)

·       you don’t’ do “Pinterest” crafts

·       your home doesn’t look like a catalog/clean and decorated

·       you have to ask for help in caring for yourself/your family

·       you aren’t up with all the current trends in parenting

·       sometimes you don’t like your children

·       you have to put your kids in daycare/hire a sitter

You’re a good mom if…

·       you love your kids with all your heart

·       you try to do everything you can to care for your family

·       you admit when you need help (and ask for help!)

·       you play with your kids

·       you let the kids make messes sometimes

·       you teach your children to love others and care about people

·       you take a break when you need to in order to save your sanity

·       you try to have a good marriage/get along with your child’s father as best as possible for sake of the children

What if the baby isn't healthy?

What if the baby isn’t healthy?

new baby

By Patience Domowski, LCSW

 

When you find out you’re having a baby, you are usually scared and excited all at once! Whether the baby is expected or not it’s scary but exciting to become a new mom/dad. You start to think about what that child will be like as a baby, growing up, and even what their future might be like when they are an adult. Sometimes you really want a girl or a boy but often people say “I don’t care if it’s a boy or a girl, I just want it to be healthy!” Sometimes they are lying- they secretly want a boy. Or a girl. But usually they really do mean they want the baby to be healthy. No one wants an unhealthy child. But what if the child is “unhealthy”? What if the child is not “normal”? Then what?

Often parents don’t find out their child has special needs until months or year after he or she is born. Sometimes parents find out while pregnant, however, such as if the baby’s condition shows up on a test or ultrasound. Sometime parents find out when the baby is born with some defect right away. Whenever you find out about a “difference” about your child you were probably not expecting it. Whether you find out there is something “different” about your child sooner rather than later, it’s still usually surprising, and often devastating. New parents aren’t expecting any problems usually, and when they find out their precious new baby is going to not be healthy or normal, they are usually very disappointed. Which makes sense, considering it’s not the ideal and it’s usually quite unexpected.

However, many people might not expect to go through all the stages of grief and loss like you would if you lost a baby to miscarriage or stillbirth, or infant due to SIDS, etc, however often the reactions and feelings are quite similar to someone’s who lost a child. Parents might be shocked and confused why they are feeling such loss when their baby didn’t pass away, and they might feel bad knowing other people have lost their children but they at least have one even if the child has special needs. You might feel guilty because you know you love your child, yet by being upset about their condition you feel like you are denying him/her to an extent. Parents go through grief because the loss is not of a child, but of an expectation. They feel their child may never live up to the parent’s expectation of their potential that they had hoped for, and that is why they must grieve. Grieving is important, so we can get to Acceptance and Hope.

The Kubler-Ross stages of grief and loss, so often noted for bereavement, can be applied to this situation as well. The stages include Denial and Isolation, Anger, Bargaining, Depression, and finally Acceptance. Often parents don’t believe the child’s condition- whether it be mental health, cognitive, developmental delays, medical fragility, sickness, deformity, genetic conditions, etc to be real at first. They might want to see several doctors, they might try to get all the information they can online or from specialists to try to explain it away or find a way to change the situation. Parents often isolate themselves, feeling no one understands my child or what I’m going through, or it’s too hard to explain why my child looks or acts different. They might feel shame that their baby is not “beautiful” in the expected ways of the world or that their child is not “normal”. Parents might feel jealous and upset seeing everyone else’s “perfect” children and so keep themselves isolated so as not to feel that way by seeing other babies. Often parents will be angry- perhaps at God- why did you do this to me?, to my baby? Or at the doctors- why didn’t they tell me? Or why didn’t they do anything? Or even at themselves- I should’ve taken more prenatal vitamins, I shouldn’t’ve rode that roller coaster while pregnant, etc.

The Bargaining stage might look like parents going after every kind of intervention and help their child can get such as taking the child to every doctor, specialist, early interventionist, treatment clinic, etc to try to make whatever is “abnormal” about the child go away.

Parents are often grieving which can cause some depression, and postpartum depression can play into this as well, and when they feel they should NOT be grieving, or that they are “bad parents” in some way, or blame themselves for situation, it just causes depression to worsen.

What we want is to get to Acceptance. And Hope. Whether child lives or dies, is healthy or unhealthy, is not up to the parents for most part. Parents can, and should, get as much help as possible for themselves such as mental health therapy, support groups, reaching out to family and friends. Parents should get help for their child as well such as Doctors, Early intervention, etc. too, however it’s important to not worry so much about getting that child to “normal” in comparison to peers, but rather to get that child to be as healthy or as functional as possible for him or her. Develop a “New Normal” or Adapted Expectations. What that will be for your baby will vary greatly from child to child. Everyone is different and everyone develops in their own pace. Some people develop faster and further than others. Children, especially babies, have so many milestones to reach, but instead of focusing on what they “should” be doing or what their peers are doing, if you have a special needs baby, just focus on being happy that you have that child, that you were blessed with someone who needs some extra love and help from you, and embrace the special needs parents identity and community that comes along with it. You will find that you will feel less grief and depression, but rather much hope and acceptance, and even get to the point where you will celebrate difference perhaps. Your child will be happier for it, and you will too. 

[this article was written for MainLineDoulas. Patience provides some postpartum doula services through Main Line Doulas]

Breathing Exercises for strong emotions

deep breathing child

Breathing Exercises for Children ~ Compiled by Patience Domowski, LCSW

Kids and other professionals have given me many ideas for breathing exercises!

Deep breathing is so important for kids to learn because they can use it to calm their body down when stressed, anxious, angry, or other strong emotions. Children should try to breathe all the way from their stomach and as slow and deep as possible. Deep breathing tells your body and brain to relax.

Blow out candles

(pretend to blow out candles, pretend fingers are candles. blow out all 10!)'

Smell the flowers

(pretend you have a flower in your hand and inhale deeply)

Snake breath

(slow hiss to let your breath out)

 

Blow fish breathing

(pretend you’re a blow fish and fill up with air)

 

Square breathing

(hold and release breath for 4 seconds each)

7-11 Breaths

(count to 7 breathing out, count to 11 breathing out) 

Belly breath

(put hand on your stomach and breathe from belly, not just from chest)

Butterfly hug

(cross arms across chest and tap your shoulders)

Starting at a new school

starting school

Anxiety about starting at a new school

Tips ~ by, Patience Domowski, LCSW

1)   Tour the school alone (or with friends/family) [call office and ask]

 

2)   Attend orientation/group tour events – meet teachers and classmates

 

 

3)   Ask school if can come visit when no one is around during summer


Teens:

-get class schedule early

-chart route for classes

-practice walking the route

Kids:
                   -find out who teacher is
                   -check out the classroom
                   -play on the playground during summer

4)   Try to meet the guidance counselor over the summer [or beginning of school year. The school counselor is a great resource to go to when anxious at school]

 

5)   Try to make a friend before school starts- meet people at orientation, find out who in your neighborhood attends your school, or ask counselor to pair you up with someone

 

6)   Remember it will be fine. It will be fun. Try to look on the positive side. 

Sleep problems

cant sleep child

Sleep Strategies~ when your child has trouble sleeping~ Patience Domowski, LCSW

Falling asleep/bedtime routine

·         Turn off screens at least half hour before bed [Don’t let kids keep their ipads and phones in their rooms at night. Parents can charge them in their own bedroom or elsewhere in the house.]

·         Use a bedtime routine including reading books before bed. Sometimes a calming bath is helpful.

·         Sleepytime tea or warm milk can help

·         Listening to music while falling asleep can be helpful for some kids (check with your child if they think this would be helpful or too distracting)

·         Noise machine // fan// sound machine

·         Melatonin (natural vitamin that helps you fall/stay asleep) can buy over the counter at pharmacy

·         Progressive muscle relaxation (can find many scripts for this online)

·         Remind yourself everything will be okay

·         For racing thoughts: write down what need to do tomorrow// or what you’re thinking about to get it out of your head

·         Talk to doctor about medication if necessary

For nightmares:

·         Think happy thoughts / make a “happy things to think about before bed” Sweet Dreams box and have your child draw pictures of things he likes and pick out what he wants to dream about before bed

·         Use a Dream Catcher (can make one easily- look online for craft ideas)

·          Prayers

·         Assure them they will be okay

·         Watch a funny show or funny podcast before bed so thinking happy thoughts

Won’t sleep on their own

·         Parent stay with child until they fall asleep in their own room

·         Let child sleep on floor in parents room getting closer to door until can be in their own room

·         Let pets sleep with child or share bedroom with sibling

·         Give reward in morningif child stays in room all night or falls asleep on their own