August-September 2025

Back-to-School Tips for Kids Who Are Struggling

How resetting expectations and planning ahead can help children with learning challenges

Writer: Rae Jacobson

Clinical Expert: Karol Espejo, LCSW

The first day of a new school year always feels like a new start. New school supplies, new classes, new teachers, new hopes and, if you’re anything like I was, a brand new chance to screw up.

I haveADHD, and in high school I was undiagnosed and barely scraping by academically. Every semester I’d start off full of optimism and big hopes for academic success. This, I’d tell myself, was going to be “The One.” The One where everything changes, when I turn my act around, when I  start — and stay — on the right foot. The. One.

If you’re the parent of a child with ADHD or a learning disability you can probably guess what happened next.

When you’ve got high hopes but no plan for how to achieve them, things tend to go off the rails pretty quickly. It never took long for The One to become just another one. Another year of barely keeping my head above water.

It wasn’t until after I was diagnosed that things began to change. Once I understood why I was struggling, I was able to start creating strategies to address my problems — instead of just hoping that wanting things to change really badly would somehow be enough. Turning things around took a lot of hard work, understanding my strengths and weaknesses, learning how to ask for (and accept) support, facing difficulties instead of avoiding them, and learning how to be a little less hard on myself. It’s not easy but it is doable, and the rewards last long after school’s out.

Here are some steps you can take to help your child lay the groundwork for an (actually) good start this year.

Be specific about learning challenges

When you have ADHD or a learning disability, the difficulties it causes often feel baffling, unmanageable and inevitable: The teacher has been talking for an hour and I have no idea what they said. How does everyone else know!? Or: All the other kids are already done with the quiz! Why is this taking me so long?  

Without understanding it can be easy for kids to disappear down a rabbit-hole of self-loathing: I’m such a screw-up. Or simply write the subject off: I’ll never get it anyway, so why bother?

When it comes to learning disorders, knowledge is power. Helping your child understand their learning difference — not just what it is, but the specific ways it affects them both in and out of school — is the bedrock of success. For example:

• If your child gets off track easily or has problems with impulsivity, “studying” with friends might not be the best way for them to prepare for tests. Agree that this year they’ll study in a dedicated quiet place at home and see their buddies afterwards.

• If your child is easily overwhelmed by large projects, look at their syllabus together and make a plan to break daunting assignments down into smaller, more manageable pieces.

• If they’re struggled with a particular subject, add support and planning from the start, rather than waiting until they’re falling behind.

Make organization a priority

Disorganization and poor time management: twin agents of chaos and destruction. Nothing pushes a new semester off course faster than lost assignments, forgotten backpacks and late arrivals. If your child struggles with organization, help them be proactive. Discuss their organizational challenges and choose some realistic strategies for tackling them. Here are some tips to help you get started.

Talk about what to do when things don’t go as planned

“Everything is going to be perfect this year,” I’d tell myself. “Perfect.” Unfortunately, in real life things are very rarely perfect, and as soon as I inevitably fell short of the impossible goal I’d set, I gave up. Being able to recover and move forward from a mistake is one of the most important skills kids can learn.

• Discuss what they’ll do if they miss an assignment or start to fall behind. This could include staying behind to talk to their teacher about extra credit, reaching out to the school’s resource center, or agreeing to refocus their efforts on getting a good grade on a major test or project that can pull their grade back up.

• Address avoidance. When and if things do start to slide, many kids fall back on the time-honored strategy of “If-I-ignore-it-maybe-it’ll-just-go-away.” Of course, avoiding scary assignments or the gut-punch of a bad grade may feel better in the moment, but in the end it leads to disaster. Help your child face their fears in a healthy way by setting up regular check-ins and giving them positive feedback for being honest and proactive. “I’m so glad you told me your paper is late! I know you were worried about it. Let me help you get it done.”

• Turning something in is always better than nothing. Kids are often embarrassed to turn in assignments that are late, unfinished or just not that great. But a zero (or many zeros) in the grade book is far, far more damaging than a C. Make an agreement at the start of the year that your child will turn in their assignments no matter what. For younger kids, or those that need a little extra incentive, you could add a reward: “If you get all your assignments in this semester, you can get the Mario game once school ends.”

• Help them learn to manage mistakes in a healthy way. Slipping up is upsetting, especially when a kid’s confidence is already shaky. It can be easy to slide into self-recrimination, or feel like it’s not worth it to keep trying. Take care to validate their feelings — they may be frustrated, sad or worried about disappointing you — and let them know you appreciate them telling you about the problem. Then quickly change the focus to how they’ll move forward and what they’ll do to avoid similar problems in the future.

Set up morale boosters

Figuring out how to achieve and sustain academic success is a long process, and there are bound to be moments when your child’s self-esteem takes a beating. Creating some things to look forward to can help bolster a kid’s self-image and take some of the pressure off when things get rough.

• Make sure your child has time to just relax. Don’t go overboard on extracurriculars.

• When they do participate in extracurriculars, encourage them to find activities where they have the chance to excel. A little success can go a long way towards building (and protecting) confidence.

• Plan a few specific events your child can look forward to that have nothing to do with school: Sleeping over at a friend’s house, going on a trip, getting a brand-new video game and having a day to just play. Having something good on the horizon can help make rough patches feel less consuming.

Don’t surprise kids with questions about school

When kids have a history of failure, conversations about school can be fraught. Questions like “Did you turn in your report?” or “How did the math test go?” may read as criticism or leave kids feeling upset and rattled. Avoid ambushing kids with questions about school when they’ve just gotten off the bus. Instead, agree on times when you’ll talk about what’s going on and what they need to do.

• Validate your child’s feelings by acknowledging that school is a hard topic for everyone. “I know this isn’t easy to talk about — how can I help?”

• Keeping conversations regular and predictable will help normalize them and make them more productive. And by setting boundaries around school discussions, you’ll be able to preserve peace and positive family time even when things aren’t going great academically.

Give kids space to try, and fail, and try again

Whenever you can, try to empower your child to take charge of their own needs. Whether that’s setting up their backpack for school the night before, arranging a study-session or asking a teacher for help when they’re struggling with an assignment, giving them the reins (within reason) will communicate your confidence in their abilities and enable them to practice being independent.

That said, some kids need more scaffolding than others. Some, especially those who struggle with mental health conditions like depression or anxiety, may benefit from greater parental oversight. Assess where your child is realistically and move forward in the way that makes the most sense for your family.

Finally, after all these years what I’ve learned is that there’s no cheat code, no “perfect” way to do better. It’s hard work, but work that pays off, both at school and long after.

Go to https://childmind.org/article/back-to-school-tips-for-kids-who-are-struggling/?utm_medium=email&utm_source=newsletter&utm_campaign=pub-ed-nl-2025-08-19&utm_content=back-to-school-tips-for-kids-who-are-struggling-read-more for more information.

Summer 2025

How Anxiety Affects Teenagers

Signs of anxiety in adolescents, and how they're different from anxious children

Writer: Caroline Miller

Clinical Experts: Jerry Bubrick, PhD , Dave Anderson, PhD

Anxiety in adolescents is on the rise. Why? Lingering effects of the pandemic? Experts cite increased pressure to succeed in school, a world that feels scarier and the toll social media can take on self-esteem. But nobody really understands it. It’s important to recognize the signs of anxiety, and get kids who are struggling help.

How is anxiety different in teenagers?

Anxious teenagers are different from anxious children. At each stage of development, kids have different worries and vulnerabilities.

Younger children are prone to be anxious about external things — like animals or insects, the dark, monsters under the bed, or something bad happening to mom and dad. But teenagers are more likely to be worried about themselves — their performance in school or sports, how they are perceived by others, the changes in their bodies.

Some anxious teenagers have been anxious for many years by the time they reach adolescence. Maybe parents have been aware of it, but the child functioned well despite their distress, so nothing was done about it. Or the child was treated, and things got better. But as more is expected of them, in middle and high school, and as they develop more focus on their peers, the anxiety can resurface and become more severe. And some teens who weren’t anxious children develop adolescent-onset kinds of anxiety, including social anxiety and panic attacks.

What are teenagers anxious about?

Their performance. “We see a lot of fear of not doing well,” explains Jerry Bubrick, PhD, a clinical psychologist who treated many children with anxiety andOCD at the Child Mind Institute. “A lot of anxiety is geared towards perfectionism, or needing to do their absolute best in school, beyond an intense work ethic.” Even when parents report that they urge kids not to stress over college admissions, teenagers say they feel intense pressure to get those straight A’s.

How they’re perceived. “Every teenager is going to have an awareness of and a certain vigilance about how they’re being perceived,” Dr. Bubrick notes. “That’s just part of the adolescent process, but some kids have that on steroids.” The result can be debilitating social anxiety. “They’re going to be really excessively worrying about whether they might be seen as incompetent or stupid, or they’re really worried about doing something embarrassing.”

Their bodies. Physical changes of adolescence are a cause of discomfort for many teenagers. Developing either before most of your peers, or after them, can make kids feel different and out of step.  “For girls, if you’re on the early side in development, it’s going to affect you more negatively than if you were on time with development or even late,” notes Dr. Bubrick. Boys, he adds, are especially sensitive to height. “So if a 15-year-old hasn’t gone through puberty yet, and they’re looking like they’re 12 and their peers are looking like they’re 19, that can have a pretty profound impact on self-esteem and confidence.” Some kids develop a form of extreme anxiety called body dysmorphic disorder, becoming so obsessed with a perceived physical flaw (real or imagined) that it causes great distress and interferes with their functioning.

Symptoms of anxiety in teenagers

Symptoms of anxiety vary widely, from withdrawal and avoidance to irritability and lashing out. Anxiety is often overlooked because teenagers are good at hiding their thoughts and feelings. But these are some of the behaviors that might be a sign that a teenager is anxious.

• Recurring fears and worries about routine parts of everyday life

• Irritability

• Trouble concentrating

• Extreme self-consciousness or sensitivity to criticism

• Withdrawal from social activity

• Avoidance of difficult or new situations

• Chronic complaints about stomachaches or headaches

• Drop in grades or school refusal

• Repeated reassurance-seeking

• Sleep problems

• Substance use

Anxiety and school refusal

Since so much of what adolescents are focused on is connected with school — think academics, sports, other activities and social life — school can be the setting of a lot of things a teenager might be anxious about. Hence when kids resist going to school, it’s not necessarily about school itself.

Dr. Bubrick notes that what we call school refusal used to be called school phobia, but that implied that school is the source of their anxiety. Instead, in dealing with kids who find frequent excuses to stay home, or flat-out refuse to go, the focus isn’t on that decision to not go to school. “We’re more focused on why they’re making that decision to not go to school.”

The problem could be worry about being called on randomly by a teacher and making a mistake. Or having apanic attack in class. Or worry that they look wrong, and people will make fun of them. “You could interview a hundred kids refusing to go to school,” adds Dr. Bubrick, “and get a hundred different reasons why.”

Anxiety and substance use

Teenagers who are anxious (not unlike adults who are anxious) may use recreational drugs, especially marijuana, as a way of coping with their discomfort. It’s self-medication, notes Dr. Bubrick, and the reality is, in the short term, it works. “It does alleviate anxiety and stress. It numbs it. It does shut off the worry part of your brain.” But it’s a poor coping mechanism in the longer term, because the anxiety persists and the teenager becomes dependent on the substance.

Dr. Bubrick says what he hears about most from teenagers is that marijuana is healthier than alcohol. And now that marijuana is legal in many places (for those over 21) and vaping is an option, it’s easier than ever to smoke — on the street, at home or at school — without adults being aware of it.

But he notes that neither is a healthy way to manage anxiety, and he urges kids not to use recreational drugs as medicine. “If you have a joint in your pocket all the time and you’re smoking during the day, to get through your day at school, that’s no different from having a bottle of vodka in your desk drawer at work.” You’re still relying on a substance to get through the day — and the more you use it, the more dependent on it you’ll be.

Anxiety and depression

It’s common in teenagers to find that they are depressed as well as anxious. That is in part because an anxious lifestyle can be so distressing, or so limiting, that it leads to depression.

Dr. Bubrick recalls treating a young woman whose move to a new high school triggered intense social anxiety. She was so worried about failing in a more competitive atmosphere that she began to withdraw from activities. Then she had a panic attack, and began to withdraw from friends because she was afraid of having another panic attack in front of them. Eventually she was so isolated she became severely depressed.

This kind of layering of anxiety and depression is both common and commonly missed, Dr. Bubrick notes. If a clinician just treats the presenting symptoms of depression, and misses the anxiety, the result won’t be effective.

But it’s also possible that anxiety and depression are two separate co-occurring disorders.

Dr. Bubrick explains: “The question I ask kids is ‘If I was able to go into your brain and just remove your anxiety, would you still be depressed?’ If they say ‘Yes, I would still be depressed,’ that would suggest it might be a co-occurring depression. If the answer is, ‘No, I would feel amazing if you took the anxiety away,’ then I would think the anxiety is causing the depression.”

Dr. Bubrick notes that among the various kinds of anxiety, generalized anxiety disorder, commonly calledGAD, is particularly linked to depression later in life — so much so that it’s also thought of as a precursor for depression. GAD is anxiety that’s not triggered by a particular thing (that’s called specific phobia) but by persistent and excessive worry about a variety of everyday things.

What’s the link between anxiety and depression? Dr. Bubrick thinks anxiety undermines well-being. If you can’t trust yourself and you can’t trust that you’re going to make good decisions and you live defensively, then you’re especially at risk for depression.

“If you’re walking around always worrying and always doubting, and everything in life is ‘what if?’ that’s going to start to have a pretty profound effect on how you see yourself and your confidence and your self-esteem,” he explains. It’s not surprising, he adds, that if you’ve been living defensively, with a steady diet of fear, it could lead to depression.

Treatment for anxiety

The most effective treatment for anxiety in teenagers is cognitive behavioral therapy (CBT), combined, if needed, withantidepressant medication. And the good news is that it’s very effective.

CBT teaches anxious kids strategies for thinking differently about anxiety and responding to it differently when it occurs. By tolerating anxiety rather than avoiding things that trigger it, they learn that it diminishes over time. And by gradually increasing exposure to feared objects or activities (a type of CBT called exposure therapy), the anxious response itself is reduced or eliminated.

Antidepressants called SSRIs (selective serotonin reuptake inhibitors) ― are the medications recommended for treating anxiety disorders in children. They are combined with CBT in kids whose anxiety is too great to enable them to participate in CBT alone.

March 2025

What Is an Eating Disorder and When to Worry

https://childmind.org/article/when-to-worry-about-an-eating-disorder/ 

Writer:  Rachel Ehmke

Clinical Expert:  Allison Dubinski, LCSW

All teenagers worry about their appearance. Self-esteem can be precarious duringadolescence, and body consciousness comes with the territory. But if you’ve noticed that your child is fixated on weight, you’re probably worried. So what is the difference between normal behavior and behavior that might indicate an eating disorder? 

• Distorted Body Image: While other people see a normal (or painfully skinny) kid, teenagers witheating disorders look into the mirror and see a different person entirely. They have a distorted perception of their own appearance, and no amount of reassurance from family and friends—all of them saying, “You’re not fat”—will change that conviction. 

• Fixated on Appearance: Young people who develop eating disorders are extraordinarily focused on their appearance as a measure of self-worth. While other kids tend to stake their identities on their interests and accomplishments, these teenagers have their emotions, and their lives, wrapped up in thoughts of food and appearance. 

• Extreme Dieting: Anorexia nervosa, the most common eating disorder, is self-imposed starvation, usually by a young woman who is otherwise high-functioning. Personality types more likely to develop the disorder include athletes, perfectionists, and over-achievers. They are driven to maintain a dangerously low body weight because of a distorted self-image. Detecting anorexia can be very difficult because it typically affects high-performing kids. 

• Overeating: Kids with bulimia nervosa, the other most common eating disorder, indulge in periodic and usually secretive binges. Many kids with bulimia say they feel out of control during their binges and describe them as “out of body experiences.” To compensate, many will purge afterward or diet strenuously. Teenagers with the disorder may be very influenced by body ideals perpetuated in media and popular culture. It can be difficult to diagnose the disorder because people with bulimia can have a normal body weight or may even be overweight. 

What signs to look for 

Kids with eating disorders often try to keep their unhealthy eating habits and behaviors a secret, but there are still some signs that parents might notice. 

Signs of anorexia 

• Losing weight unexpectedly and/or being dangerously thin (Despite their extreme thinness, kids with anorexia usually don’t think that they are unhealthy and actually want to lose even more weight.) 

• Obsessing over calorie counts, nutritional facts, and diets 

• Spending many hours exercising to burn off calories 

• Skipping meals 

• Avoiding eating socially 

• Irregular periods, thinning hair, and constant exhaustion 

Signs of bulimia

•  Exercising excessively or using diet pills or laxatives 

• Going to the bathroom immediately after meals

•  Spending a lot of time in the bathroom 

• Having a sore throat, sore knuckles, discolored teeth, and poor enamel

•  Hoarding food in her room 

• Having large amounts of food that go missing at home 

Preventing Eating Disorders 

Eating disorders can affect all kinds of kids for all kinds of reasons. Still, there things you can do to help your child build a healthy relationship with food and eating and reduce the risk that they might develop an eating disorder. 

• Try to establish healthy eating habits. Make a routine of eating healthy, balanced meals as a family. 

• Discuss foods in terms of how healthy they are, not how “good” or “bad” they are. 

• Don’t criticize your child’s weight or appearance. Adolescence is a difficult time for most kids, and it’s essential to provide them with a nurturing and supportive environment. 

• Some kids are more likely than others to develop eating disorders. Be extra vigilant if you have a family history of eating disorders or if you know that your child is under extreme pressure to look a certain way. 

Treating Eating Disorders 

Eating disorders in children are very serious and can be deadly, but they’re also treatable. If you think your child has an eating disorder, you should contact a doctor for help immediately. 

Hospitalization is sometimes necessary, but for many kids with eating disorders, the recommended treatment involves staying at home and recovering under their family’s care. Family-based treatment (FBT) coaches parents on guiding their child’s recovery and evidence shows that it helps kids return to a healthy weight more quickly than other treatments. Enhancedcognitive behavioral therapy (called CBT-E) and adolescent-focused therapy (called AFT) have also been shown to be effective in many cases, though they generally work more slowly than FBT. This article was last reviewed or updated on October 23, 2023. 

February 2025

What to Do if You Think Your Teenager Is Depressed

Writer: Stephanie Dowd, PsyD

Clinical Experts: Stephanie Dowd, PsyD , David Friedlander, PsyD

When kids are young, parents are used to swooping in and rescuing them whenever they need help. As your kids get older and their problems become more complex, you have to transition into more of a supporting role, and that can be difficult. This is especially true with teens who are struggling with depression. They need help to get better, but first they have to want that help.

Signs your child is depressed:

• Have they been sad or irritable most of the day, most days in a week for at least two weeks?

• Have they lost interest in things that they used to really enjoy?

• Have their eating or sleeping habits changed?

• Do they have very little energy, very little motivation to do much of anything?

• Are they feeling worthless, hopeless about their future, or guilty about things that aren’t their fault?

• Have their grades dropped, or are they finding it difficult to concentrate?

• Have they had thoughts of suicide? If so it’s crucial you have them evaluated by a mental health professional immediately. If the thoughts are really serious and there is imminent threat, you will need to take them to an ER.

If your teen shows more than a few of these signs they may have depression that warrants professional attention. While you can’t make them want to get better, there are some things that you as their parent can do. And it starts with simply being there for them.

Be supportive

One of the most important things you can do for your teen is to work on strengthening your relationship. Try to build empathy and understanding by putting yourself in their shoes. You might be frustrated that they seem down and irritable a lot of the time and don’t seem to be doing much of anything to help themselves. But if there isn’t much in their life that is making them happy, or something intensely disappointing has happened to them, it’s understandable that they might avoid things they used to enjoy and retreat to their room. Depression makes even doing the smallest things more difficult.

Try to validate their emotions, not their unhealthy behavior. For example, you could say, “It seems as though you’ve been really down lately. Is that true?” Make it clear that you want to try to understand what’s troubling them without trying to problem solve.

Be compassionately curious. Ask them questions about their mood gently, without being emotional. Even parents with the best intentions often don’t realize that their concern can come across as critical rather than loving. Do not be judgmental or try to solve their problems, even if you disagree with their point of view. Listening to them talk about their problems might seem as though you’re highlighting the negative, but in fact, you’re letting them know that you hear them, you see them, and you’re trying to understand — not fix them. People don’t like to be fixed. Listening without judgment will actually make them more likely to view you as an ally and someone they can turn to when they’re ready to talk.

Try also to give them opportunities to do things without being critical of them. Instead of saying, “Honey, you should really get up and do something. How about calling an old friend?” you might say, “I’m going to the mall to do an errand. Let me know if you want to come with me, and maybe we can get lunch together.”

For some parents, this can feel passive, as though you’re not doing enough. But being there for them and communicating your acceptance is exactly what they needs from you right now. It’s actually a very active way to strengthen your relationship.

Accentuate the positive

Make sure you’re noticing the positive things your teen does, too. Going to school, holding down a part-time job, doing the dishes or picking up their brother from soccer practice: These are all good things they’re doing, and it’s important to recognize them rather than thinking, “This is what they should be doing.” We all like to be appreciated and recognized for doing a good job even when it’s expected of us.

Ask yourself how many positive things have you said to them today? How many negative things have you said? How many times have you highlighted their problems or tried to fix them? The positive should outweigh the negative. Let them know that you’re proud of them, that they’re doing a good job if you see them taking care of themselves, doing homework, interacting with the family, or doing other things that take effort. They’ll likely appreciate that you noticed.

Likewise, you don’t need to mention that you’re disappointed they aren’t hanging out with friends as much or taking the interest they used to in guitar, for example. They probably feel disappointed, too, and don’t need to be reminded of what’s not going well in their life. They don’t want to feel this way. If they could snap their fingers and feel better, they would.

Helping kids with depression get treatment

Some teens will want to go to therapy when you ask them and some won’t. For those who are resistant, know that they aren’t going to suddenly open up to the idea of therapy (or to you) quickly, but you can help guide them towards treatment by opening the door and then waiting patiently for them to walk through it.

Try saying, “I know you’re having a hard time, and I have some ideas of things that could help. If you’d like to talk with me about them, let me know. I’m here for you.” It’s also a good idea to ask them if they has any suggestions on how you might be able to help. You might be surprised with what they have to say.

Be aware that your teen might tell you to back off. That’s fine; it’s their way — albeit a slightly irritable one — of telling you that they need space. It’s normal for teenagers to want independence, and it’s important for you to respect that. You can respond by saying, “I’ll give you more space, but know that I’m here for you if you ever want to talk or hear my suggestions.”

If they do come to you wanting help, be prepared. Do your research. Find two or three therapists they can interview and tell them that they can choose the one that they feel most comfortable with, and think will help the most. Finding a therapist who is a good fit is extremely important, and making the choice theirs will help them feel ownership over their own treatment, which is extremely important to teens and sets the stage for effective therapy.

It’s also important to know that there are several different kinds of therapy that might be helpful for your teen, including some well-studied behavioral therapies. Interpersonal therapy (IPT),cognitive behavioral therapy (CBT), and dialectical behavioral therapy (DBT) have all been shown to be helpful for teenagers with depression. Make sure that your child has had a thorough evaluation that includes treatment recommendations to help guide you.

Many teens with depression benefit from medication, such as an anti-depressant. While therapy alone may be effective with mild to moderate depression, the best results are usually gained with a combination of medication and therapy. If depression medication is a consideration, it is strongly recommended that you make an appointment with a board certified child and adolescentpsychiatrist (rather than a general physician) for a consultation.

Why depression treatment might not be working

If your child already is in treatment but it isn’t helping, ask them why they think that is. What isn’t helpful or what don’t they like about therapy? Are there things about therapy they do like? Maybe you can work together to find a therapist who does more of the things they like. If you do consider changing therapists, it’s important to discuss this with their current therapist before the decision to change is made. Many times, the therapy and/or the therapeutic relationship can be improved.

Keep in mind that therapy usually isn’t effective if the person in treatment isn’t committed to it, or is doing it to please someone else. Your child should want to get better for themselves. Unfortunately, sometimes people have to get worse before they want help. But the good news is that if you lay the groundwork by strengthening your connection now, they’ll be more likely to turn to you for support when they’re finally ready.

Taking care of yourself

Lastly, it’s important to make sure that you’re taking care of yourself. It can be emotionally and physically exhausting to be a parent of someone who is struggling with depression. Know that you are not alone, and get support for yourself. Make sure that you make time to do things you enjoy and go out with friends. The phrase: happy mommy (or daddy) = happy baby (read: teenager) still applies!

December 2024-January 2025

How to Talk to Kids About Starting Therapy

Preparing kids and teens for that first appointment

Writer: Stephanie Cornwell

Clinical Expert: Karol Espejo, LCSW

Starting therapy can be scary and uncomfortable, especially if your child isn’t used to talking about their emotions or if they don’t think they need help in the first place.

How you talk to your children about starting therapy can make them feel more comfortable, open, and prepared to go into the first session.

Normalizing therapy

Getting kids accustomed to talking about feelings is important to set the stage for what goes on in therapy. “If we’re going to normalize talking about emotions and mental health conditions, notes Karol Espejo, LCSW, a clinical social worker at the Child Mind Institute, “we need to have open conversations.”

Talk about therapy as something that will help the child rather than making them feel like something is wrong. By talking openly about some of the concerning behaviors that you see, you are modeling that it’s not something to be embarrassed about. Espejo compares this to a toothache — if your tooth hurts, you go to a dentist. Likewise, if a child is having issues regulating their emotions, a therapist can teach them how to do so more effectively. In both cases, the goal is to feel better.

Therapy, especially for children, is about learning new skills to help them throughout their lifetime. The therapist is like a coach — their job is to teach, support, and help your child be the best version of themselves.

Timing matters

Timing for bringing up therapy is not one-size-fits-all, but Karol says a meal with the child, a drive in the car, or during the weekend when things are less busy are all good times to begin the conversation about going to therapy.

How far in advance the child should know about the session depends on how they will handle it. While every kid deserves a heads-up, kids with anxiety may worry themselves sick leading up to the appointment. “I would suggest about a week in advance for most children, but for anxious kids, the timeline should be shorter — about two days before the first session.”

There are also specific times when bringing up therapy could do more harm than good. “I would avoid talking about it at bedtime as increased anxiety can impact sleep or lead to rumination ahead of sleeping,” Karol says. Another big thing is to never bring it up during an emotional conflict or argument or use therapy as a punishment — “See, this is why you’re going to therapy!” The role of therapy is not to punish or shame.

How to talk to young children

Using developmentally appropriate language that connects to something your child is already familiar with is important in preparing them for therapy. Espejo advises being honest, direct, and simple for toddlers and preschool-aged children. Parents can say things like, “We’re going to see a doctor,” or “A support person who talks about feelings and emotions.” It’s important to clarify that this isn’t the kind of doctor who will give them a shot; this is a doctor who’s more interested in talking, possibly playing a game, or doing something fun together.

Also, try to avoid over-promising. Rather than saying, “We are going to meet a new friend today,” try, “We are going to see somebody who helps with emotions, and they will ask you some questions.”

Young kids also benefit from repetition and reminders to help them internalize their understanding of what’s happening. So, if you have the initial conversation a week before their first session, you might remind them a few times throughout the week leading up to the appointment. For example: “Remember, on Wednesday after school, I’m going to pick you up, and we’re going to see that adult I told you about. The one who helps us with our feelings.”

How to talk to school-aged children

For elementary-aged kids, comparing a therapist to their school counselor can be helpful. Even if they don’t see the counselor regularly, they likely know who the person is. And they’re familiar with the idea of kids speaking with that adult about feelings and behaviors. You can say something along the lines of, “You know how Ms. so-and-so in your school talks about feelings? We’re going to see someone like that who has their own office and will talk to you about the emotions that have been coming up for you.”

If your child seems reluctant or nervous about the appointment, you might say, “We’re going to meet someone new, and I know it can be scary. I know sometimes you feel nervous. But I’ve spoken to Ms. Espejo, and she told me I could be in the room with you initially. And I won’t leave until you’re ready for me to leave.”

It can also be comforting to let your child know that the whole family wants to support them through whatever is going on and that they aren’t alone.

There are things you can do before the appointment to help your child feel prepared. The therapist will likely send several questionnaires for both the parent and child to fill out before the first session. This can be a good segue into therapy, as the child can see what questions the therapist might ask.

“We want to lessen any anticipatory anxiety,” Espejo says, “so if your therapist has a website with pictures or videos of themselves, that can help make the child feel comfortable.”

How to talk to tweens and teens

Tweens and teenagers are generally much more aware of what’s happening and might be more resistant to therapy. Whereas younger children may not understand why their parents are seeking treatment, older kids have their own opinions and often object to outside intervention in their lives. So, what if your teen doesn’t want to go to therapy?

“We need to normalize therapy as a safe place to talk about emotions and feel better,” Espejo says. “I think sometimes parents approach the conversation from a problem. ‘There is this problem; let’s go to therapy to fix it.’ That can make kids defensive and feel targeted.” It’s important to talk about the therapist as an expert who teaches us how to process emotions to, for example, communicate better or not feel so nervous. In other words, focus on how therapy can help them.

No one wants to start therapy feeling blindsided by the process, especially not a teenager, who typically is starting to feel a little more control over their life. As with younger children, it’s important to be direct and honest with your teen about why you’re seeking treatment and how it can help them. If parents can get their children to try therapy, it will likely be more effective. You can say, “Let’s explore the possibility of therapy because I noticed that you’ve been sad more days than not,” or, “I noticed that you’re not interested in some of the things you were interested in before.” These conversations allow parents to model emotional recognition, and rather than blaming the teen — “you need therapy because we’re always fighting” — it shows an awareness that the child is struggling.

First and foremost, you can assure your child that whatever is said in therapy is confidential, and they can feel comfortable sharing information with their therapist. The therapist will not share any of what is said in the session with their parents. However, therapists must break confidentiality if the child is in danger of harming themselves or another.

What if your child had a negative experience in therapy in the past?

Therapy success depends on the relationship and rapport between therapist and child. And every therapist isn’t going to be the right match for every kid. If your child didn’t connect with a particular therapist in the past, it can be difficult to convince them to try again. Espejo suggests reassuring them that they just haven’t found the right match and encouraging them to try this new person. You can also urge them to be patient and give the new therapist a few sessions before judging the connection. Parents can say, “If after a few sessions, you still feel like this is not going to work with this person, we will find somebody you will connect with.”

Is it OK to tell people that your child is in therapy?

Some kids are open and comfortable about seeing a therapist, while others may want to keep it private. Kids may feel uneasy about explaining why they go to therapy, whether it’s to friends, extended family, or siblings. So, it should be up to them if and how their siblings or other kids in their social circle are told. Espejo suggests asking the child in therapy what language makes them comfortable — therapist, counselor, feelings doctor, etc.

When explaining to a child that their sibling is in therapy for anxiety, for example, you could say, “Your brother gets really nervous every day, so we’re going to see somebody that helps reduce some of the nerves.”

How to talk about medication

If you and your child’s therapist think your child will benefit from medication, you will need to see a psychiatrist or other medical doctor. Ask the person prescribing medication any questions, and ensure you and any other parents are comfortable with the medication route before presenting it to the child. Medication may seem frightening to a child, and hearing conflicting opinions between caregivers will add to their confusion.

When discussing medication with your child, the goal is to emphasize that medication can make learning new skills easier. Espejo uses anxiety as an example: Sometimes, we are so anxious and constantly uncomfortable that we can’t practice the coping skills we’re trying to learn in therapy, like deep breathing.

It’s important that the child knows this isn’t their fault; instead, something is going on in their brain that they can’t control. Espejo does a lot of psychoeducation with the kids she sees so they understand that medication is there to help reduce the symptoms of their condition. If they are anxious, for example, medication may be used to help reduce panic attacks and extreme worry.

October/November 2024

How Are Self-Injury and Suicide Related? 

The intent is different, though one can lead to the other 

Clinical Expert: Janis Whitlock, PhD, and Elizabeth Lloyd-Richardson, PhD 

This is an excerpt from Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones, by Janis Whitlock, PhD, and Elizabeth Lloyd-Richardson, PhD. It’s not unusual for young people who are struggling with painful feelings to engage in self-injury — things such as cutting, burning or scratching themselves until they bleed. Knowing that a child is intent on harming themselves is very upsetting to parents, and many worry that self-injury is a sign that their child is suicidal. 

Self-injury and suicidal behaviors — imagining, planning or attempting suicide — are related, but the relationship between the two is confusing. Because they can look similar, it can be very difficult to tell the difference between them. But there are important differences in the intention as well as the danger: Selfinjury is virtually always used to feel better rather than to end one’s life. Indeed, some people who selfinjure are clear that it helps them to avoid suicide. In fact, the technical term for self-injury is non-suicidal self-injury, or NSSI. 

Differences

Self-injury and suicide differ in multiple ways, including: 

• The intent: The intent of self-injury is almost always to feel better, whereas for suicide it is to end feeling (and, hence, life) altogether. 

• The method used: Methods for self-injury typically cause damage to the surface of the body only. Suicide-related behaviors are much more lethal. Notably, it is very uncommon for individuals who practice self-injury and who are also suicidal to identify the same methods for each purpose. 

• Level of damage and lethality: Self-injury is often carried out using methods designed to damage the body but not to injure the body badly enough to require treatment or to end life. Suicide attempts are typically more lethal than standard NSSI methods.

• Frequency: Self-injury is often used regularly or off-and-on to manage stress and other emotions. Suiciderelated behaviors are much more rare. 

• Level of psychological pain: The level of psychological distress experienced in self-injury is often significantly lower than that which gives rise to suicidal thoughts and behaviors. Moreover, self-injury tends to reduce arousal for many of those who use it and, for many individuals who have considered suicide, is used as a way to avoid attempting suicide. 

Presence of cognitive constriction: Cognitive constriction is black-and-white thinking — seeing things as all or nothing, good or bad, one way or the other. It allows for very little ambiguity. Individuals who are suicidal often experience high cognitive constriction. The intensity of cognitive constriction is less severe in individuals who use self-injury as a coping mechanism. 

Aftermath: Although unintentional death does occur with self-injury, it is not common. The aftermath of a typical self-injury incident is short-term improvement in sense of well-being and functioning. The aftermath of a suicide-related gesture or attempt is precisely the opposite. 

Common risk factors 

• Despite differences and intention, suicidal thoughts and behaviors and self-injury do share common risk factors. Some of these include: 

• High emotional sensitivity 

• A history of trauma, abuse, or chronic stress 

• Extreme emotion or lack of emotion 

• A tendency to suppress emotions coupled with few effective mechanisms for dealing with emotional stress

• Feelings of isolation (this can be invisible in people who seem to have many friends/connections) 

• A history of alcohol or substance abuse. 

Because of these common risk factors, it is important for you to know that youth who self-injure are also at increased risk for suicidality. Our work shows that about 65 percent of youth who self-injure will also be suicidal at some point (though many will not go beyond having suicidal thoughts). For many, self-injury is used alone or in combination with other behaviors as a way to keep emotional distress or disconnectedness at a manageable level. 

Although suicidal thoughts and behaviors can occur before self-injury is used, in most cases, suicidal thoughts and behaviors coincide with or come after self-injury starts. It is also important to note that only 36 percent of adults who self-injure in the United States reported having ever felt suicidal while engaging in self-injury, meaning that the majority of individuals who injure have never felt suicidal while engaging in self-injury. 

Reducing inhibition to suicidal behavior 

Although self-injury does not cause suicide, the other important thing to know about the relationship between self-injury and suicide is that the very act of engaging in self-injury reduces inhibition to suicidal behavior if someone becomes suicidal. In other words, having “practiced” injuring the body repeatedly makes it easier to actually injure the body with suicidal intent. 

 Other factors that can place someone at greater risk of moving from self-injury to suicide include: 

• Greater family conflict and poor relationship with parents 

• More than 20 lifetime NSSI incidents 

• Psychological distress in the past 30 days 

• A history of emotional or sexual trauma 

• Greater feelings of hopelessness

•  Identifying self-hatred, wanting to feel something, practicing or avoiding suicide as reasons for self injury 

• High impulsivity and engagement in risky behaviors 

• Substance use 

• A diagnosis of major depressive disorder (MDD) or PTSD 

These risk factors may be present individually or in clusters. The more of these your child has, the higher their risk is of at least having suicidal thoughts (this is called “suicidal ideation”). 

August/September 2024

School Mornings Without the Stress

How to get your child up and out the door with the least amount of conflict

Writer: Beth Arky

Clinical Expert: Dave Anderson, PhD

During the school year, a cry is heard from parents across the land: Getting kids out the door Monday through Friday is a killer.

What makes school mornings so hard? “They’re kind of like a perfect storm,” says David Anderson, PhD, a clinical psychologist at the Child Mind Institute.

“You have a number of things that have to get done,” he explains, “and there’s also a time limit.” Add to this the fact that parents sometimes feel their kids don’t appreciate the ticking clock while they’re trying to get everyone to school and work and you’ve got a pressure cooker that can, at its worst, lead to yelling, tears, and forgotten lunches.

Dr. Anderson says one colleague calls times like school mornings—along with homework, transitioning from dinner and shower time to bedtime, and then actually getting kids to sleep—”frequent flyer situations,” when stress levels regularly reach their peak. He says mornings are “definitely tough for most families we talk to,” whether the child has a psychiatricdiagnosis or not.

However, the stress quotient can rise among families with a child who has special needs. “Kids with ADHD or behavioral issues may be much less likely to be able to maintain their focus on what they need to get done, remember what they need to get done, or may actually be defiant about getting things done like getting dressed, making their bed, taking a shower, brushing their teeth, or eating breakfast,” Dr. Anderson says.

Meanwhile, kids who are depressed may have difficulty getting out of bed, while those who are very anxious may refuse to do what’s required because they are avoiding something that is happening at school or even school itself.

Dr. Anderson adds that if a child is on the autism spectrum, mornings might be tougher because of a rigid adherence to rituals. If his parent needs him to be flexible and do the tasks out of order, that could lead to a lot of conflict.

Also, many kids have difficulty with transitions, whether they have diagnoses likeADHD and autism or not, and the morning is all about transitions done under a hard and fast deadline.

While parents can be more flexible about things like bedtime—perhaps they’ll let a child stay up reading until he falls asleep—morning doesn’t afford the same luxury.

If a child leaves the house in the morning without the right shoes, or sports gear, or homework, or without eating breakfast, it can contribute to problems during school.

And if a child ends up being late to school, the parent is often late to work, too.

So what’s a parent to do to both get out the door on time and with as little conflict as possible? Dr. Anderson recommends several things.

Plan ahead

First, regardless of a child’s age, think about what can be done the night before such as making lunches, taking showers, organizing backpacks, and laying out clothes. Talk with your kids as to what needs to get done in the morning. “It’s great to have these discussions when cooler heads are prevailing and we can really problem solve about how to get things done in an efficient way,” Dr. Anderson says.

Parents of younger kids need to focus on being clear about what needs to get done, helping them develop this list into good habits. This can be accomplished by noticing when a child is successful, then praising him for those successes. It’s also helpful to break tasks down into very small steps and then noting how well the child is trying to comply or do things independently.

Those with older kids could help them develop an organizational plan—a list they could check back on to make sure each step is completed. “We’re all more effective when we’re very clear with ourselves about what steps we might need to take and realistic about what we actually have time to get done,” he says.

Temper expectations

Dr. Anderson also says it’s a good idea for parents to prioritize the essential steps—what must get done—vs. the “icing on the cake” steps, at least at first.

Exactly what is essential? “The reality is often that the child at least has all of his clothes on, has something in his stomach, and has brushed his teeth,” he says. “If we can get those three things done somehow, either before the child leaves or on the way to school, and reinforce the child’s progress, then we can start to build those habits and make it so that mornings are easier in the future.”

Once the essential steps become habit, parents can focus on the “icing,” which can include things like a child keeping his hands to himself around a sibling, making his bed and organizing his things.  

Use visual prompts

Dr. Anderson says that especially for younger kids who are on the autism spectrum or have ADHD, “we absolutely want to make it so that any behaviors we’ve defined as target behaviors are also prompted visually so that they can remember and, over time, start to independently do them.” Visual prompts might include posted schedules and photos of targeted behaviors, such as a picture of a child brushing her teeth near the sink.

With typically developing children and teens, the amount of visualization needed varies: “There are kids who only need their parents to give instructions verbally and then they can usually remember them and follow through. Certain kids need either more reminders or time to form these habits,” notes Dr. Anderson. 

Create incentives

When it comes to making mornings better, rewards are also key. They can be either short term, involving some kind of immediate treat or, because of the time crunch, earned privileges to be enjoyed later.

Dr. Anderson offers one of his favorite examples of a short-term reward, involving a teenager and her mother. “They talked about what specific behaviors they were going to focus on,” he says. “The idea was she gets up by a certain time, gets all of her things together and leaves by a certain time for school. If those three things happened without too many prompts, then they would stop for a special breakfast like Starbucks and walk rather than take the subway.” Not only did this motivate the teen, it improved the mother-daughter relationship, since they had more time to talk.

Younger kids can be motivated by a more defined behavioral plan with meaningful rewards. Dr. Anderson cites the example of a fourth grader: As long as he gets up, eats a breakfast from among a few healthy choices, gets dressed quickly, and brushes his teeth without too many parental prompts, he earns points for each of those behaviors. These points translate into 30 minutes of screen time that evening.

Stay calm

When parents hit bumps in the road and tempers are flaring, they need to think about ways to deescalate the situation, since arguing is a distraction and can damage their relationship with their kids, as well as slow things down even more. There are several ways parents can try to deescalate a situation, such as:

• Speaking in a calm tone

• Being clear about expectations

• Continuing to praise even small efforts rather than focusing on what the child might not be doing

• Focusing on the next step in the process

• Keeping one’s eye on the prize, both in the short and long terms.

It also helps to accept that in least in the short term, things might not be perfect but that by sticking to behavioral strategies, they can improve.

If all else fails, seek professional help.

In situations where kids have difficulty “even getting out of bed or where there’s conflict every morning with screaming fights,” to the point that family function is impaired or there are mental health concerns for either child or parent, Dr. Anderson recommends professional counseling. This could involve behavioral parent training, where caregivers learn to use effective behavior management strategies; coaching the parent and child together for more successful interactions; or working individually with the child on cognitive behavioral therapy to build coping skills and better emotion regulation.

March -April 2024

What Is Bulimia Nervosa?

How bulimia, the bingeing-and-purging disorder, affects adolescents, and how it is best treated

Writer: Caroline Miller

Clinical Expert: Daniel Le Grange, PhD

Bulimia nervosa is an eating disorder that involves a pattern of frequent binge eating and then purging to avoid gaining weight. Binge eating is when a person consumes an unusually large amount of food in a short period of time, often feeling out of control or unable to stop while doing so. They will thenpurge, which is usually done by throwing up, but can also include misuse of laxatives, diuretics, or extreme exercise.  

Bulimia nervosa generally starts inadolescence, and in this age group it’s actually thought to be more common — by one estimate more than twice as common — thananorexia nervosa. And like anorexia, it’s treated most effectively with family-based treatment (FBT).

But bulimia is harder to spot than anorexia. Kids with bulimia usually are not underweight and they may appear to eat a healthy amount at family meals. Bingeing and purging are most often done in secret. When kids go into treatment, many parents are shocked to find out how often they’ve been vomiting after meals, notes Daniel Le Grange, PhD, director of the Eating Disorders Program at the University of California, San Francisco.

Despite its prevalence, far fewer teenagers get treatment for bulimia than anorexia. That may be because bulimia is easier to hide from parents, Dr. Le Grange explains, and because kids are often embarrassed to admit that they have it.

But bulimia is just as life-threatening as anorexia, though the causes of death are perhaps different in the two disorders.

Symptoms of bulimia nervosa

The key symptoms of bulimia are recurring episodes of binge eating, followed by purging, at least once a week for no less than three months at a time. As is the case in anorexia, young people with bulimia also have an intense focus on body weight as the basis for self-esteem.

Binge eating is defined as eating an amount of food that’s larger than what most individuals would eat in a similar period of time under similar circumstances. Dr. Le Grange notes that what’s considered an unusually large amount is relative to the person’s culture. The eating episode is accompanied by a feeling of loss of control over eating. It’s common for teens with bulimia to binge on calorie-rich foods they would otherwise avoid and consume only low-calorie foods between episodes.

Purging involves the use of compensatory behaviors to prevent weight gain, such as self-induced vomiting, fasting, excessive exercise, or the misuse of laxatives or diuretics.

Accompanying the bingeing and purging is an intense focus on weight and body shape as the basis for the teenager’s self-esteem. Like those with anorexia, kids with bulimia are obsessed with their appearance and very worried about gaining weight. Bulimia is 10 times more prevalent in girls than it is in boys.

Warning signs of bulimia

While kids often hide symptoms of this disorder, there are behaviors that can be signs of bulimia that parents might notice, especially if they occur frequently. These behaviors include:

• Worrying or complaining about being fat

• Having a distorted, negative body image

• Eating large quantities of food in one sitting, including foods they usually avoid

• Strict dieting or fasting

• Being secretive about eating

• Going to the bathroom right after eating

• Disappearance of large amounts of food

• Drinking excessive amounts of water or beverages  

• Using excessive amounts of mouthwash, mints, and gum  

• Exercising too much

• Having sores, scars, or calluses on their knuckles or hands

• Having damaged teeth and gums

Bulimia and shame

One important difference between anorexia and bulimia is how kids feel about what they are doing to avoid weight. Anorexia is what Dr. Le Grange calls “ego syntonic,” meaning that it is aligned with the person’s values and self-image. As a result, kids with anorexia don’t think there’s anything wrong with them, and they often resist treatment.

Bulimia, by contrast, is by and large “ego dystonic,” meaning that behaviors such as bingeing and purging conflict with the person’s values and sense of self. “Most young people withbulimia nervosa, ” Dr. Le Grange notes, “do not like the fact that they have bingeing episodes and then compensatory behaviors like self-induced vomiting that are unpleasant ways of getting rid of excess calories. Such episodes are often followed by guilt, disgust, and/or self-loathing.”

While kids with anorexia may be proud of their ability to resist eating and even be admired by other kids, those who binge and purge often see it as a sign of weakness and feel ashamed of these behaviors. It’s common for kids in treatment for bulimia to say they started out meeting criteria for anorexia and then resorted to binge eating because they found restricting calories too difficult. Some of these young people, Dr. Le Grange adds, even describe themselves as “having failed at anorexia.”

Health consequences of bulimia

Due to the many dangerous health risks associated with this disorder, bulimia is associated with an increased likelihood of an early death. Unfortunately, these medical risks are often underestimated because they’re not visible, and at least half of the young people with the disorder are at a healthy-looking weight.

But frequent purging, whether by vomiting, laxatives, or enemas, can damage multiple organs in the body and cause electrolyte imbalances and other health risks. This can lead to irregular heartbeats and possibly heart failure, which is one of the main causes of death in people with bulimia. Repeated vomiting can cause a sore throat and chest pain from esophagus burns, and in some instances even esophageal tears. It can also lead to tooth decay, gum disease, and damage to the salivary glands. A weakened gut lining can make it hard for the body to absorb nutrients, causing one’s bones to become brittle and weak, resulting in higher risk for osteoporosis. Digestive disruption can cause stomach pressure and nausea. Abuse of laxatives can irritate the bowels and lead to constipation and diarrhea. Additionally, dehydration from purging can result in kidney stones and infections.

To prevent or reduce long-term damage from this disorder, it’s important to seek treatment as soon as possible.

Treatment for bulimia

Family-based treatment (FBT) has been shown in studies to be the most effective treatment for adolescents with bulimia, and is recommended by the American Psychiatric Association. In the case of bulimia, the main goal is usually not gaining weight but helping the patient eliminate the bingeing and purging episodes and maintain healthy eating habits.

The parents’ role is to supervise the child carefully enough to inhibit bingeing and purging behaviors. That might mean, for instance, sitting with the child after meals to prevent purging, monitoring trips to the bathroom, and being the one to flush the toilet.

“These are all very intrusive steps,” Dr. Le Grange admits. “But without that level of vigilance, there’s no way you’re going to get a handle on the behaviors. So, we say to the parents, ‘This is what would happen if Amanda was in an inpatient unit. Do you think that you could adopt some of those levels of supervision? This may be what’s necessary to help her overcome these urges and these behaviors that are not just unpleasant, but life-threatening.’ And so parents will usually agree.”

Parents also support their child by what experts call “externalizing the disorder”— identifying the bulimia as separate from the child. “Young people do not choose to develop these illnesses, and illness-related behaviors are not willfully engaged in, even if it seems so at times,” notes Dr. Le Grange.

To avoid being critical or angry, parents are encouraged to keep in mind that the child is in the grip of a powerful disorder that is influencing their thoughts, feelings, and behaviors. They are coached on how best to support their child through this ordeal. “The parents’ task is to battle the bulimia,“ notes Dr. Le Grange, “not their healthy child, who is still there but may be overshadowed by the disorder.”

Challenges in treating bulimia

One challenge in FBT for bulimia is that progress is more difficult to track than with anorexia, because it depends on reports from the patient regarding binge eating and purging episodes, corroborated by their parents, rather than a scale that reports weight gain. The therapist depends on the patient accurately reporting the weekly count of binging and purging.

Sometimes the young person feels so embarrassed that they won’t acknowledge the true extent of their binging and purging. “When that happens, the clinician needs to help parents share the real frequency of these behaviors without being critical,” notes Dr. Le Grange. “They need language that they can use to express sympathy that the illness has gotten the hold of the young person in this way, rather than saying, ‘Oh, no, that is just blatantly untrue. She vomited at least six times,’ and you can just hear the criticism rolling from the parents’ tongue.”

Positive factors in treating bulimia

What works in the favor of FBT for bulimia is that kids with the disorder tend to be less resistant to participation in treatment than those with anorexia. In part, Dr. Le Grange says, that’s because kids may actually want help to stop these behaviors that they find embarrassing and distressing. This can give parents some leverage in the treatment process, and the child can help articulate how they think parents can best support their changing these behaviors.

But Dr. Le Grange also notes that, for the most part, kids with bulimia tend not to be as emotionally impacted as those with anorexia. For instance, “You don’t typically see someone with bulimia nervosa declining time with their friends or not wanting to go out anymore, isolating themselves. They would still find a way to really be out there in the world with their friends.”

“At least eighty plus percent of young people with bulimia can and should be treated as outpatients,” notes Dr. Le Grange. “If they really have to be admitted to a hospital, then it’s because the degree of engagement in binging and purging is such that parental effort has not made any impact on these behaviors.”

January -February 2024

When Are Kids Ready for Social Media?

And how to monitor social media use when kids are starting out

Writer: Caroline Miller

Clinical Experts: Dave Anderson, PhD , Jerry Bubrick, PhD , Max Stossel

Since kids are so quick to pick up on digital technology, it can be a big job for parents to keep up with them — monitoring what they’re accessing in the way of games, music, videos, photos, and websites. But for many, the biggest challenge is when to let kids have access to social media. And how much access?

Kids crave contact with their friends and peers, and social media has become an important way for them to interact. For children who are isolated, it can be a lifeline. But it also has the potential to become addictive, to get them into trouble, and to harm fragile self-esteem.

Pressure on parents

Kids often start pushing for access to social media in late elementary and early middle school, and parents feel pressured to allow it because they don’t want their children to feel left out. But delaying social media immersion helps insure that they will be more mature about what they post, more able to resist its addictive appeal, and less vulnerable to emotional harm.

Max Stossel, the founder and CEO of Social Awakening, a group that promotes healthy use of social media, has talked to groups of parents, students, and educators about the impact of technology on kids for more than 10 years. Stossel says he always asks parents to raise their hands if they wish they had given their kids access to social media sooner. “I am still waiting for the first parent to tell me they wish they had given it sooner, he says. “And that’s thousands of parents. But many, many say they’re glad they waited.”

Stossel notes that social media algorithms are designed to maximize profits, not to benefit kids. “Eleven-year-old kids are just too young to have these super computers pointed at their brains, often preying on their self-image, or their hormones, to keep their attention.”

Stossel endorses a parent movement called Wait Until 8th that advocates delaying exposure to social media until kids are in eighth grade. “And eighth grade is the minimum, I would say. Research shows that 10 -to 14-year-old girls are hit hardest by this. I would wait until 15, 16, but that has just seemed less and less realistic for a lot of parents’ lives and kids’ lives.”

Choosing the right time

The best timing for each child depends not just on their age but their maturity, and kids develop at different rates. “I could introduce you to a really mature 13-year-old and a really immature 17-year-old,” notes Jerry Bubrick, PhD, a clinical psychologist at the Child Mind Institute.

When they are ready will depend on things like their ability to read social cues, their impulse control, and their vulnerability to criticism or rejection. If a tween has a particularly hard time disengaging from continuously stimulating things like video games, they might have trouble resisting the rabbit hole of social media.

Dave Anderson, PhD, a clinical psychologist at the Child Mind Institute, suggests that introducing social media in middle school gives parents the opportunity to supervise their initial exposure as a condition for the privilege of using the app. “If you wait until high school to give permission, they’re not likely to let you monitor their social life. You will never know what their online world looks like. And you will never be able to kind of navigate that with them.”

Monitoring kids on social media

Experts agree that parental oversight is crucial when kids are starting to use social media.

“Initial access should come with a lot of talk beforehand and a parent saying, ‘Here’s what I consider to be acceptable and unacceptable behavior,’” Dr. Anderson explains. “And also ‘I want to go on Instagram with you, look at some of your friends’ accounts, and we’ll talk about what is acceptable or unacceptable about what they’re doing with their accounts.’ “

Dr. Bubrick encourages families to go one platform at a time, and monitor what kids are posting. “So parents are really kind of helping their kids learn the do’s and don’ts rather than parents just hoping they’ll figure it out.”

Parental oversight should also pay attention to the balance in the child’s life, Dr. Bubrick adds. “There’s a dedicated time for social media. But it’s only part of your day because you also have to be out face-to-face with friends, and you have to be exercising, and you have to do homework. So really teaching our kids how to have balance with social media is just as important in my point of view as helping them learn what’s appropriate and inappropriate to post.”

Rules for social media access

Families vary about what they want kids to be allowed to do on social media, but parents can make it clear to kids that access is contingent on following rules. Some parents set rules limiting who their kids can interact with, some on what kinds of things they can post.

For many, the cardinal rule is not to post anything they wouldn’t say to a person face-to-face, or want adults in their lives to see.  “Tell kids they should act as if their parents are reading almost everything they post,” says Dr. Anderson. “And if that’s not enough of a deterrent to oversharing or acting impulsively, explain that they shouldn’t post anything they wouldn’t be comfortable having their grandparents read.”

Dr Anderson notes that some parents are drawing the line on posting selfies. “A lot of families are making that decision because selfies invite judgment of just you and how you look, and that can be damaging to kids’ self-esteem” he explains. “If you post pictures of you and your friends hanging out by the lake, you get comments like, ‘Wish I was there. Oh my gosh, you guys are looking like you’re having so much fun.’ But if you post a selfie in a bikini, you’re asking followers to decide whether or not they like your clothing or your appearance.”

Likewise, he adds, it’s important to have well-defined consequences for not following the rules, for example, “As long as you’re ok with the no-selfie rule, we can keep Instagram, but if you break it we’ll have to delete the app.”

Dr. Bubrick recommends prompting kids to think through who they are sharing with as well as what’s appropriate to share. “How are you defining who’s a friend online and what are you willing to share with them.”

Parental controls

Major social media platforms like TikTok, Instagram, and Snapchat have rolled out a series of parental control settings as an answer to parents’ concerns about their kids’ exposure. Not only has TikTok launched a new dashboard where users can now monitor and set limits on their screen time, but they’ve also added a Family Pairing setting. Once parents link their account to their child’s, they can control all privacy settings for their child’s account. Parents can also restrict the types of videos that can come up on their feed, limit screen time, limit or turn off comments and likes, and turn off direct message (this is automatically disabled for kids ages 13 to 15).

The Family Pairing setting is password protected and even if the child manages to disable it, parents will be sent a notification.

While TikTok’s settings appear to be the most expansive in their restriction abilities, Instagram and Snapchat have launched similar settings. Instagram has also separately given the option of limiting or completely turning off comments and likes.

Alternatively, if parents aren’t comfortable with their child having their own account but still want to give them the freedom to express themselves online, they can create a joint account and engage in the content with them. On TikTok and Instagram, there are several family accounts in which the parents create, control, and appear in the videos or photos alongside their children. Often the comments on these accounts are limited or even shut off to shield children from unwanted scrutiny. There are also more kid-friendly apps such as Funimate and Triller that allows users to create and edit fun videos without the immediate option of sharing their content with an outside audience.

Stossel recommends the parental control tool Bark, which monitors a child’s activity on social networks, as well as YouTube, email and text messages. It filters for the signs of harmful content, including sexual material, threats of violence, depression,suicidal ideation, and bullying. Parents get email and text alerts if there is something concerning in the child’s online activity. It can also be used to limit screen time and to block individual websites.

Screen Time is another tool that allows you to set time limits on daily screen time, block out periods when screens are not to be used, and includes categories of sites and individual URLS.

Kids who are vulnerable

For kids who are struggling with emotional issues, parents need to be aware that the algorithms in social media apps can read their mood and reinforce it.

“Social media is built to feed you content you’re more and more interested in,” says Dr. Anderson. “If you have a kid who’s depressed, the algorithm will feed them content that aligns with their mood. If you’ve got a kid who’s anxious, the algorithm will feed them the content that aligns with their dominant emotional state. And if you’ve got a kid who hasADHD and is looking to be distracted, the algorithm will feed them distraction.”

While the majority of kids are not necessarily harmed by what they see on social media, it’s not always clear to parents if a child is depressed or anxious, so Dr. Anderson recommends careful monitoring and use of guardrails. “The reality is that for kids who are already in a vulnerable mental health population, consuming social media alone is a real risk factor. It can really affect them.”

December  2023

 How to Change Negative Thinking Patterns

Recognizing unhealthy thinking errors called 'cognitive distortions'

Writer: Juliann Garey

Clinical Expert: Jeff DeRoche, LCSW

Children can be their own worst critics. This is particularly true for kids with mental health disorders, who may be especially down on themselves. They can get stuck in negative thinking patterns that contribute to depression, amp up their anxiety, or make painful emotions feel overwhelming.

If your daughter wasn’t invited to a birthday party, for example, she may decide that everyone who went to the party hates her. If she forgets a line in a school play, she may insist that she ruined the whole performance.

These negative thinking patterns are often unrealistic, but they can have significant impacts on our emotions, behaviors, and world views. Mental health experts call them cognitive distortions — they’re also sometimes referred to as cognitive errors, thinking mistakes, or thinking errors.

“Some amount of cognitive distortion is normal,” says Jeff DeRoche, LCSW, a clinical social worker. “We all make thinking mistakes. It’s when that kind of thinking is chronic and entrenched that the thoughts are likely doing a number on a child’s emotional life. I’ve never seen someone suffering under the weight of any kind of behavioral health problem who isn’t making cognitive errors quite regularly.”

In cognitive behavioral therapy (CBT), kids are taught to recognize common cognitive distortions that may be making them feel bad. But whether or not your child is in therapy, it can help to recognize and identify them when you see them. Here they are distilled into 11 common categories. DeRoche emphasizes that there’s a lot of overlap among them.

1. All-or-Nothing Thinking (also referred to as Black-and-White Thinking or Dichotomous Thinking)

What it is: Seeing things in only two categories, so they’re either good or bad, black or white, with no shades of grey. A common distortion that makes you think — and therefore feel — that if something is not all of what you want then it’s none of what you want. It’s also thinking that you have to perform well on everything — perfectionism — or you’ve totally failed.

For example: I didn’t get into my first choice school so my hopes for high school are totally dashed. Or: If I didn’t get that A+ then I’m a failure.

2. Emotional Reasoning

What it is: Believing that because you feel something it must be true, even when there’s no evidence other than the feeling.

For example: I feel lonely, therefore no one likes me. Or: I feel afraid to go in an elevator, therefore elevators are dangerous places.

3. Overgeneralization

What it is: Taking one negative event or detail about a situation and making it a universal pattern that is a truth about your whole life.

For example: This person didn’t want to hang out with me. No one ever wants to hang out with me! Or: I messed up my chemistry experiment today. I never do anything right!

4. Labeling

What it is: Putting a negative label on yourself – or someone else – so that you no longer see the person behind the label. When you lock someone in place like that, your understanding becomes so rigid that there’s no wiggle room to see yourself or another person differently.

For example: I fell down trying to score that goal in soccer today. I’m a horrible klutz. I didn’t have anything to say in that conversation. I’m totally uninteresting!

5. Fortune-Telling

What it is: Predicting something is going to turn out in a negative way. This can become a pessimistic way of viewing the future, and it can impact your behavior, making the event you’re fortune-telling more likely to turn out badly.

For example: I know that I’m going to do horribly on that test (so you panic and perform less effectively on it). Or: If I reach out to this person, they’re not going to want to talk to me or accept me (so you don’t reach out and take a chance on connecting with someone you want to know better or get help from).

6. Mind Reading

What it is: Assuming that you know and understand what another person is thinking, and typically being sure it reflects poorly on you.

For example: I’m talking, and the person I’m talking to doesn’t seem to be paying attention. I’m sure they don’t like me. (In fact it might be that they’re just distracted, or stressed about something unrelated to you and are having a hard time focusing.)

7. Catastrophizing (also called Magnification)

What it is: Taking a problem or something negative and blowing it up out of proportion.

For example: This party is going to be the worst experience ever! Or: If I don’t get a base hit I’ll die of embarrassment.

8.Discounting the Positive (also called Minimizing)

What it is: Taking something positive that happened and minimizing it so that it doesn’t “count” as a good thing in your life or experience. It discounts any evidence against our negative view of ourselves or our situation.

For example: I did well on that one quiz, but I just got lucky. Or: This person said, ‘I love hanging out with you,’ but she’s just being nice. She doesn’t really mean it.

9. Mental Filter (also called Selective Abstraction)

What it is: Seeing only the negative instead of looking at all the positive or neutral aspects of an experience.

For example: You write a paper for a teacher and they give you plenty of positive feedback on it, but you spelled someone’s name wrong. All you can think about is the misspelling. Or you have many positive conversations in a day, and one in which you say something embarrassing. You focus with total horror only on the embarrassing statement you made, forgetting all your other social interactions.

10. Personalization

What it is: Making things about you when they are not. This includes blaming yourself for what is beyond your control and also taking things personally when they are not  intended to be harmful to you.

For example: If I hadn’t demanded so much of my parents, maybe they wouldn’t be getting a divorce. Or: How dare that person walk in front of me – that was so disrespectful! (When the person just didn’t notice you and cutting you off was an honest mistake.)

11. Imperatives

What it is: Thinking in “shoulds” and “musts” (and the inverse, “should nots” and must nots”).

For example: I should be able to give presentations in class without feeling any anxiety. What’s wrong with me? (Of course, thinking this way, on top of feeling nervous, makes you even more nervous about speaking!)

How parents can help kids

CBT helps kids identify, challenge, and ultimately restructure their thinking so that they can live healthier, better adjusted lives.  Taking a cue from CBT, parents, too, can help kids recognize cognitive distortions, and reduce their intensity.

The best way to start is with your own cognitive distortions, says DeRoche. Once you’ve learned the different types, try recognizing them in your own patterns of thought. For example, if your child has anxiety, you might personalize this, assuming it’s your fault, and then label yourself a “terrible parent.”

“I can’t stress enough how important it is to notice cognitive distortions in a way that’s not judgmental,” says DeRoche. “When you get skillful at noticing distortions in your own thinking, you are in a much better place to help someone else notice theirs. And be humble about noticing your own – call them out in a playful way when you make them, and let your kids call yours out, too.”

The goal is to model for your children that we all make thinking mistakes, he adds, and “the act of noticing them and making corrections with levity and self-compassion is usually the best medicine.”

To learn the cognitive distortions, you can help your children make flash cards so you can quiz each other. The Internet is full of colorful posters of the various distortions as well, and CBT phone apps often ask the user to label the distortions in their thinking from menus of choices.

“Keep this work together light,” DeRoche advises. “Even very experienced therapists have to work hard to safeguard against inadvertently invalidating children by telling them their thinking is ‘in error’ or ‘illogical.’ Even when it is, we can’t assume they are always going to be ready or willing to see it that way. Sometimes we get stuck on how we feel and it’s tough to rationally evaluate how we’re thinking.”

Most importantly, if your child is making many cognitive distortions – if their thinking is very rigid, their expectations are chronically negative, or their feelings are too strong for them to be reflective about their thinking mistakes, it’s time to ask for help from experts. It’s great to collaborate with your child in learning and identifying cognitive distortions – especially as a supplement to good therapy – but a child who is seriously struggling may need treatment from a mental health professional.

October - November 2023

Does Social Media Use Cause Depression?

How heavy Instagram and Facebook use may be affecting kids negatively

Writer: Caroline Miller

Clinical Experts: Jerry Bubrick, PhD , Alexandra Hamlet, PsyD

Is using social media making our kids unhappy? Evidence is mounting that there is a link between social media and depression. In several studies, teenage and young adult users who spend the most time on Instagram, Facebook and other platforms were shown to have a substantially (from 13 to 66 percent) higher rate of reported depression than those who spent the least time.

Does that mean that Instagram and TikTok are actually causing depression? These studies show a correlation, not causation. But it’s worth a serious look at how social media could be affecting teenagers and young adults negatively.

One reason the correlation seems more than coincidental is that an increase in depression occurred in tandem with the rise in smartphone use.

A 2017 study of over half a million eighth through 12th graders found that the number exhibiting high levels of depressive symptoms increased by 33 percent between 2010 and 2015. In the same period, the suicide rate for girls in that age group increased by 65 percent.

Smartphones were introduced in 2007, and by 2015 fully 92 percent of teens and young adults owned a smartphone. The rise in depressive symptoms correlates with smartphone adoption during that period, even when matched year by year, observes the study’s lead author, San Diego State University psychologist Jean Twenge, PhD.

Over that same time period there was a sharp spike in reports of students seeking help at college and university counseling centers, principally for depression and anxiety. Visits jumped 30 percent between 2010 and 2015, and they’ve continued to rise since the pandemic.

Social media and depression

One of the biggest differences in the lives of current teenagers and young adults, compared to earlier generations, is that they spend much less time connecting with their peers in person and more time connecting electronically, principally through social media.

Some experts see the rise in depression as evidence that the connections social media users form electronically are less emotionally satisfying, leaving them feeling socially isolated.

“The less you are connected with human beings in a deep, empathic way, the less you’re really getting the benefits of a social interaction,” points out Alexandra Hamlet, PsyD, a clinical psychologist. “The more superficial it is, the less likely it’s going to cause you to feel connected, which is something we all need.”

Indeed, one exception to the depression correlation is girls who are high users of social media but also keep up a high level of face-to-face social interaction. The Twenge study showed that those girls who interact intensely offline as well as through social media don’t show the increase in depressive symptoms that those who interact less in person do.

And there are some teenagers who aren’t successful in connecting with peers offline, because they are isolated geographically or don’t feel accepted in their schools and local communities. For those kids, electronic connection can be lifesaving.

Social media and perceived isolation

Another study of a national sample of young adults (age 19-32) showed correlation between the time spent on social media and perceived social isolation (PSI). The authors noted that directionality can’t be determined. That is, “Do people feeling socially isolated spend more time on social media, or do more intense users develop PSI?”

If it’s the latter, they noted, “Is it because the individual is spending less time on more authentic social experiences that would decrease PSI? Or is it the nature of observing highly curated social feeds that they make you feel more excluded?”

Which brings us what we now call FOMO, or fear of missing out.

Jerry Bubrick, PhD, a clinical psychologist at the Child Mind Institute, observes that “FOMO is really the fear of not being connected to our social world, and that need to feel connected sometimes trumps whatever’s going on in the actual situation we’re in. The more we use social media, the less we think about being present in the moment.”

Instead we might be occupied with worrying why we weren’t invited to a party we’re seeing on Instagram, or making sure we don’t miss a single post from a friend. But if we’re always playing catch-up to endless online updates, we’re prioritizing social interactions that aren’t as emotionally rewarding and can actually make us feel more isolated.

Social media and self-esteem

Another theory about the increase in depression is the loss of self-esteem, especially in teenage girls, when they compare themselves negatively with artfully curated images of those who appear to be prettier, thinner, more popular and richer.

“Many girls are bombarded with their friends posting the most perfect pictures of themselves, or they’re following celebrities and influencers who do a lot of Photoshopping and have makeup and hair teams,” explains Dr. Hamlet. “If that’s their model for what is normal, it can be very hard on their self-confidence.”

Indeed, image-driven Instagram shows up in surveys as the platform that most leads young people to report feeling anxiety, depression and worries about body image.

Curation of a perfect image may not only make others feel inadequate, it’s unhealthy even for those who appear to be successful at it, notes Dr. Bubrick. “Kids spend so much time on social media trying to post what they think the world will think is a perfect life. Look at how happy I am! Look how beautiful I am! Without that they’re worried that their friends won’t accept them. They’re afraid of being rejected.” And if they are getting positive feedback from their social media accounts, they might worry that what their friends like isn’t the “real” them.

Less healthy activity

Another possible source of depression may be what teenagers are not doing during while they’re spending time on social media, including physical activity and things that generate a sense of accomplishment, like learning new skills and developing talents.

“If you’re spending a lot of time on your phone, you have less time for activities that can build confidence, a sense of achievement and connectedness,” explains Dr. Hamlet.

Kids who are spending a lot of time on devices are not getting much in return to make them feel good about themselves, she adds. “Yes, you get a little dopamine burst whenever you get a notification, or a like on a picture, or a follow request. But those things are addicting without being satisfying.”

Disrupted concentration

Another thing disrupted by social media is the process of doing homework and other tasks that require concentration. It’s become common for teenagers to engage with friends on social media at the same time they are studying. They take pride in being able to multi-task, but evidence shows that it cuts down on learning and performance.

“Basically, multitasking isn’t possible,” Dr. Hamlet notes. “What you end up doing is really just switching back and forth between two tasks rather quickly. There is a cost to the brain.” And with poorer concentration and constant interruption, homework takes substantially longer than it should, cutting into free time and adding to stress.

Sleep deprivation and depression

Some of the ways in which social media use impacts mood may be indirect. For instance, one of the most common contributors to depression in teenagers is sleep deprivation, which can be caused, or exacerbated, by social media.

Research shows that 60 percent of adolescents are looking at their phones in the last hour before sleep, and that they get on average an hour less sleep than their peers who don’t use their phones before bed. Blue light from electronic screens interferes with falling asleep; on top of that, checking social media is not necessarily a relaxing or sleep-inducing activity. Scrolling on social media, notes Dr. Hamlet, can easily end up causing stress.

“Social media can have a profound effect on sleep,” adds Dr. Bubrick. “You have the intention to check Instagram or watch TikTok videos for 5 minutes, and the next thing you know 50 minutes are gone. You’re an hour behind in sleep, and more tired the next day. You find it harder to focus. You’re off your game, and it spirals from there.”

How to minimize negative effects of social media use

While we don’t yet have conclusive evidence that social media use actually causes depression, we do have plenty of warning signs that it may be affecting our kids negatively. So it’s smart for parents to check in regularly with kids about their social media use, to make sure it’s positive and healthy, and guide them towards ways to change it, if you think it’s not.

Also, be alert for symptoms of depression.  If you notice signs that your child might be depressed, take them seriously. Ask your child how they are doing, and don’t hesitate to set up an appointment with a mental health provider.

Steps you can take to ensure healthy social media use:

• Focus on balance: Make sure your kids are also engaging in social interaction offline, and have time for activities that help build identity and self-confidence.

• Turn off notifications: App developers are getting more and more aggressive with notifications to lure users to interrupt whatever they’re doing to engage constantly with their phones. Don’t let them.

• Look out for girls at higher risk of depression: Monitor girls who are going through a particularly tough time or are under unusual stress. Negative effects of social media can have more impact when confidence is down.

• Teach mindful use of social media: Encourage teenagers to be honest with themselves about how time spent on social media makes them feel, and disengage from interactions that increase stress or unhappiness.

• Model restraint and balance in your own media diet: Set an example by disengaging from media to spend quality family time together, including phone-free dinners and other activities. Kids may resist, but they’ll feel the benefits.

• Phone-free time before sleep: Enforce a policy of no smartphones in the bedroom after a specific time and overnight. Use an old-fashioned alarm clock to wake up.

August-September 2023

Back to School Dos and Don'ts

Tips on navigating summer's end, especially for kids who are anxious

Writer: Jerry Bubrick, PhD

Clinical Expert: Jerry Bubrick, PhD

The end of summer is in sight, and parents everywhere are feeling that inevitable anxiety over how to make the most of the upcoming school year. In my experience, anticipating the hurdles of reentry and carefully structuring the first few weeks of school goes a long way to setting the stage for a successful year, particularly if your child has an anxiety disorder or another psychiatric condition. With that in mind, here are some dos and don’ts for families who want to start the school year right.

DO get back into the routine

There are many positive things about summer, like more time to spend with your family and novel opportunities for your children. But summer is also a disrupting time for kids, who can easily forget that they were ever in school at all. So I strongly suggest that you start making the necessary readjustment to school life before the first day. There is no use denying that school is coming, and getting prepared earlier can get them off to a better start.

First, we want kids to start (and they’re going to resist) having more school-like hours. Even just a few days before school begins, bedtime should go back from 11:00 to 9:00, for example, or whatever is appropriate. Additionally, kids should be waking up around the time they’d have to wake up for school and performing the normal routine: shower, breakfast, getting dressed, and so forth.

We also suggest that you limit “screen time”—whether it’s a computer, the TV, or a handheld device-and make sure they are off at least an hour before bed. Kids sometimes have a hard time separating from their virtual world, and if they don’t have some “downtime” they’ll still be engaged and it will affect their ability to fall asleep on their own.

You can also shop for school supplies earlier rather than later. The selection at stores is better, which is no small matter when you’re trying to make the transition as easy as possible, and the activity primes kids for their eventual return to the classroom.

DON’T forget to refuel

When kids are with you, when you’re both on vacation, you know what and when they’re eating, and if they’re staying up late, it’s likely to be watching a movie with you. When school starts again, you lose some control, even if you don’t realize it. You may assume that certain things are happening at school-or in your child’s bedroom-and then wonder what in the world has gotten into your suddenly surly, under-performing kid. Well, if they’re not eating until they’re starved, and they’re on Facebook until midnight…

I encourage all my families to be particularly aware of meals. Most kids wake up at 6:30 or 7:00am and may or may not have breakfast. For younger grades, lunch could be anywhere from 10:30 to 1:00. Do we know what they’re eating for lunch? Do they pack lunch or buy hot lunch? How much are they eating? Are they trading their sandwiches for cookies? Are they having a snack during afterschool activities? If they’re not having a snack, they could be coming home ravenous at 5:00pm, not be able to focus on homework for an hour, then get all of the days calories and nourishment at dinner and feel exhausted and have little mental energy for work. Then they get a second wind and are online into the wee hours.

The fact is that a well-fed, good sleeper is going to have a better school day and be more efficient with homework than a kid who’s over-tired and starving.

DO talk about changing friendships

Summer can be a volatile time for young friendships, and talking about what to expect when school starts is a good way to ease kids into the idea that social relationships change. Sometimes your BFF one year may seem a little distant the next year, and letting kids know this sort of thing happens can help them weather these often-painful changes. Being able to share friends with other children, and to have friends overlap, is a skill that’s important to learn, which is why it’s something that warrants discussion. Not all problems need fixing; sometimes kids just want to be able to talk about these upsets without expecting you to fix them; sometimes kids just want parents to validate their feelings and say, “I know that’s hard.”

DON’T share your anxieties

Parents are often very caught up in their children’s social lives because they want them to make good friends, be happy, and learn social skills that will help them be successful adults. These are all great reasons to be engaged, but kids don’t always understand the interest that way. This is particularly true of anxious kids.

For instance, it’s very easy for parents to get into the habit of asking, “Did you make any friends?” when kids come home from school. But that can be shaming for kids who are struggling or still figuring out where they fit in. Better questions would be, “How was your day?” or “Tell me three things you liked about your day,” or “Tell me three things you didn’t like about your day.” Neutral questions are better than ones that a child might interpret as, “If you didn’t make friends, then I’m going to be disappointed in you.”

DO have a trial run

One way to help kids get off on the right foot—or at least a better foot—is to give kids with anxiety problems, and certainly kids who have refused to go to school in the past, a “dry run” or two before school starts. Driving by the building, walking in the building, getting reacquainted with the smells, sights, and sounds; this can be necessary to make day one happen at all.

Trial runs are also really good for kids transitioning to a new school. Kids who are going from elementary to middle, or middle to upper, have an orientation, but it usually takes place at the end of the previous year. So it’s good to go and take a dry run and map out your classes, know where your locker is and that kind of thing. And if a kid puts up a fight and refuses to do that, it could be a red flag that this year will be problematic. But at least you’ve figured this out before school starts.

DON’T be afraid of setbacks

If you have a child who had some real trouble the year before—like a mood or anxiety problem—and may have made real gains over the summer, you might be tempted to anticipate an easy return to school. But it’s good for parents to temper expectations. Too often we think our children have learned all these new skills and so day one, two, and three should be stellar days. If not, then something’s wrong. But that’s not how it works. We have to let kids ease into it, and allow for ups and downs. If you are a dedicated parent and your child is receiving proper care, they’ll improve—but it’s not always a straight line going up. If you can accept that, then your child will have more confidence and be able to accept setbacks.

DO help kids manage their commitments

The tricky part of coming back to school is that the first week or two are usually pretty exciting but slow weeks in terms of work, so it’s easy to get caught up in a false sense of, “Oh, this is easy, and I can take on this, this, and that extracurricular.” Then, October comes along and a kid can think, “Holy crap, I have a lot of work in front of me and where am I going to find the time?” So it might be a good idea to wait on new activities until mid-October and leave enough time for adjustment.

The fact is that these days kids tend to get over-involved in clubs, sports, student government, and by the time they get home, they’re exhausted. Maybe by the time they start homework, it’s nine o’clock, only two hours before bedtime at 11:00. I’ve worked with many kids who get overwhelmed by their activities, and then they get further and further behind in their work, which makes them depressed and prone to procrastinate. It just becomes too much for them to handle. We want parents to temper their expectations for kids, so that kids can practice balance in their own lives; modeling this in your own life can be helpful. For example, you could explain to your child that you were asked to join a fundraising committee but you said no because you realized that you would be overcommitted. Practicing what you preach, and letting your kids see, can be worth a thousand stern reminders.

DON’T ignore problems

To flog this point one more time: Many schools are fantastic, with talented and caring teachers and administrators. But you can’t expect the school to have your insight into your child, or to automatically have the same concerns and knowledge about them. Sometimes the school’s point of view is, “We’re not going to do anything until we see a reason to do something.” That’s why we’d like parents to be more proactive. You need to be your child’s advocate, and if you see them struggling, or you’re worried about them struggling, it’s better to say something sooner rather than later.

Summer 2023

Anxious Stomach Aches and Headaches

Physical symptoms are often the way children experience anxiety

Writer: Caroline Miller

Clinical Experts: Amanda Greenspan, LCSW , Janine Domingues, PhD

All kids get an occasional headache or stomach ache — think not enough sleep or too much Halloween candy. But when children get them often, they may be signs of anxiety.

Stomach aches in the morning before school. Headaches when there’s a math test on the schedule. Butterflies before a birthday party. Throwing up before a soccer game. These physical symptoms may be the first evidence a parent has that a child is anxious. In fact, the child may not even know they are anxious.

“Especially with kids who may not be able to verbalize what they’re feeling anxious about, the way their anxiety manifests can be through physical symptoms,” explains Amanda Greenspan, LCSW, a clinical social worker at the Child Mind Institute.

Physical symptoms of anxiety

In fact anxiety is associated with a host of physical symptoms, including headaches, nausea, vomiting and diarrhea, along with a racing heart, shakiness or sweating — symptoms older people experience when they’re having apanic attack.

All these physical symptoms are related to the fight-or-flight response triggered when the brain detects danger. All of them have a purpose, notes Janine Domingues, PhD, a clinical psychologist at the Child Mind Institute. When she talks to kids about anxious headaches or stomach aches, she explains the role of each. For instance, she says, “your stomach hurts because your digestive system is shutting down to send blood to other areas of your body. You don’t want to be digesting food at that moment because you’re trying to either flee danger or fight danger.”

Dr. Domingues assures children that these symptoms are not harmful — they’re just their emergency system responding to a false alarm. But it’s important to understand that kids aren’t necessarily inventing their symptoms, and the danger may feel very real to them. Don’t assume a child who spends a lot of time in the nurse’s office at school is doing it intentionally to get out of class. Their acute anxiety may be causing them pain.

“Headaches and stomach aches related to anxiety are still real feelings, and we want to take them seriously,” says Ms. Greenspan.

Check with your pediatrician

When a child develops a pattern of physical symptoms before school, or other potentially stressful moments, experts recommend that you visit your doctor to rule out medical concerns. But if the child gets a clean bill of health, the next step is to help the child make the connection between their worries and their physical symptoms.

“We help them understand in a very child-friendly way that sometimes our body can actually give us clues into what we’re feeling,” explains Ms. Greenspan.

Parents can start by validating their child’s experience and reframing it in a more helpful way. Instead of telling kids there’s nothing wrong with them, the goal is to tell them that what they’re feeling is worry.

“We give it a name,” adds Dr. Domingues. “We help them connect it to an emotion and label it. And after some practice kids are able to identify it,” she adds. ” ‘Yes, my stomach hurts and, oh yeah, I remember that’s because I’m feeling worried.’ And after learning some skills to help them calm down, I think they feel a sense of control. And that helps.”

What can parents do to help?

The first thing our experts suggest is something parents should not do, or at least try not to do: Let kids avoid things they are afraid of. It can be very tempting when children are complaining of a headache or stomach ache to let them stay home from school, or skip the party or the game they’re worried about. But avoidance actually reinforces the anxiety.

“If we’re allowing them to avoid it,” says Ms. Greenspan, “then they’re not able to learn that they can tolerate it.” The message needs to be: “I know it hurts, I know it’s uncomfortable, but I know you can do it.”

Another things parents should not do is ask children leading questions like “Are you worried about the math test?” Questions should be open ended, to avoid suggesting that you expect them to be anxious: “How are you feeling about the math test?”

If the problems your child is having are disrupting their ability to go to school consistently — or concentrate at school, participate in activities, socialize with peers — they might have developed an anxiety disorder that should be treated by a mental health professional. The treatment favored by most clinicians foranxiety disorders iscognitive behavioral therapy (CBT). CBT helps kids — as young as 5 years old — identify their anxiety and learn skills to reduce it.

The techniques clinicians teach children to calm down body and mind can also be deployed by parents, for children with less impairing symptoms.

Techniques for calming down

Here are some of the techniques clinicians teach anxious children, adapted from CBT and mindfulness training:

Deep breathing: Drawing in air by expanding the belly, sometimes called belly breathing, helps kids relax by slowing breathing, and reducing the heart rate, blood pressure and stress hormones. It can also help relax tense stomach muscles.
Mindfulness exercises: Techniques such as focusing on what’s around them, what they see and hear, can help pull children away from the anxiety and ground them in the moment.
Coping statements: Children are taught to “talk back to their worries,” Ms. Greenspan explains. “They can say, ‘I’m feeling scared and I can handle it.’ Or something along the lines of, ‘I’m bigger than my anxiety.’”
Coping ahead: Children are taught that when you have to do something that makes you nervous, it helps to anticipate that you might have some discomfort, and plan what you can do to counteract it, knowing that if you can push through it, it will get easier.
Acceptance: This involves acknowledging the discomfort without fighting it. “Instead of trying to push the feeling away and get rid of it,” Dr. Domingues explains, “we ask you to hold onto it and tolerate it and get through it.”

The parents’ role is key

It’s only natural that parents don’t want to see their kids in distress or make them go to school when they’re worried that they’ll throw up. That puts parents in a difficult spot. “What we hear from parents is, ‘We just let them stay home one day — and one day led to three months,’ ” says Dr. Domingues. It’s a slippery slope — the child may ask to stay home more and more.

“So we work with parents a lot around how to find that balance between enabling anxiety and meeting a child where they are,” she adds. “And we also give them statements that they can use to be empathic and encouraging at the same time. For instance: ‘I know that this is really hard and you feel like you’re sick. But we also know that this is anxiety, and you can get through it.’ ”

Sometimes setting up a reward system can help by giving a lot of positive reinforcement for kids pushing through their anxiety.

Parents also face the challenge of tolerating their own anxiety about pushing a child who says they are ill or worried about vomiting. “If your kid is in distress and talking about not wanting to go to school or feeling sick or thinking they might throw up,” says Dr. Domingues, “then you’re, as a parent, also anxious that that might happen.”

Working with the school

The school plays an important role when kids develop physical symptoms of anxiety. Clinicians work with the school nurse — and sometimes the psychologist or school counselor — to set up a protocol for keeping the child’s absences from class as short as possible. For instance, the recommended amount of time to wait before encouraging the child to go back to class might be as short as five minutes.

“As much as we can, we urge them not to contact the parent or send the child home if they’re saying that they’re nauseous,” adds Dr. Domingues, “if we know that they are feeling this way because they’re anxious.” The shorter the break can be, the better it is, because the longer they’re out of the thing that’s making them feel anxious, she says, the harder it will be to get them back in.

This sort of symptoms can appear in a wide-range of children, but they’re most common in the grade-school years, notes Ms. Greenspan. “As kids get older and transition into adolescence and adulthood, they are more likely to manifest their anxiety symptoms in other ways.”

Retrieved from:  https://childmind.org/article/anxious-stomach-aches-and-headaches/?utm_medium=email&utm_source=newsletter&utm_campaign=pub_ed_nl_2023-04-04&utm_content=anxious-stomach-aches-and-headaches

April 2023

What to Do (and Not Do) When Children Are Anxious

How to respect feelings without empowering fears

Writer: Clark Goldstein, PhD

Clinical Expert: Clark Goldstein, PhD

When children are chronically anxious, even the most well-meaning parents, not wanting a child to suffer, can actually make the youngster’s anxiety worse. It happens when parents try to protect kids from their fears. Here are pointers for helping children escape the cycle of anxiety.

1. The goal isn’t to eliminate anxiety, but to help a child manage it.

None of us wants to see a child unhappy, but the best way to help kids overcome anxiety isn’t to try to remove stressors that trigger it. It’s to help them learn to tolerate their anxiety and function as well as they can, even when they’re anxious. And as a byproduct of that, the anxiety will decrease over time.

2. Don’t avoid things just because they make a child anxious.

Helping children avoid the things they are afraid of will make them feel better in the short term, but it reinforces the anxiety over the long run. Let’s say a child in an uncomfortable situation gets upset and starts to cry — not to be manipulative, but just because that’s how they feel. If their parents whisk them out of there, or remove the thing they’re afraid of, the child has learned that coping mechanism. And that cycle has the potential to repeat itself.

3. Express positive — but realistic — expectations.

You can’t promise a child that their fears are unrealistic—that they won’t fail a test, that they’ll have fun ice skating, or that another child won’t laugh at them during show & tell. But you can express confidence that they’re going to be okay, that they will be able to manage it. And you can let them know that as they face those fears, the anxiety level will drop over time. This gives them confidence that your expectations are realistic, and that you’re not going to ask them to do something they can’t handle.

4. Respect their feelings, but don’t empower them.

It’s important to understand that validation doesn’t always mean agreement. So if a child is terrified about going to the doctor because they’re due for a shot, you don’t want to belittle those fears, but you also don’t want to amplify them. You want to listen and be empathetic, help them understand what they’re anxious about, and encourage them to feel that they can face their fears. The message you want to send is, “I know you’re scared, and that’s okay, and I’m here, and I’m going to help you get through this.”

5. Don’t ask leading questions.

Encourage your child to talk about their feelings, but try not to ask leading questions— “Are you anxious about the big test? Are you worried about the science fair?” To avoid feeding the cycle of anxiety, just ask open-ended questions: “How are you feeling about the science fair?”

6. Don’t reinforce the child’s fears.

What you don’t want to do is be saying, with your tone of voice or body language: “Maybe this is something that you should be afraid of.” Let’s say a child has had a negative experience with a dog. Next time they’re around a dog, you might be anxious about how they will respond, and you might unintentionally send a message that they should, indeed, be worried.

7. Encourage the child to tolerate their anxiety.

Let your child know that you appreciate the work it takes to tolerate anxiety in order to do what they want or need to do. It’s really encouraging them to engage in life and to let the anxiety take its natural curve. We call it the “habituation curve.” That means that it will drop over time as he continues to have contact with the stressor. It might not drop to zero, it might not drop as quickly as you would like, but that’s how we get over our fears.

8. Try to keep the anticipatory period short.

When we’re afraid of something, the hardest time is really before we do it. So another rule of thumb for parents is to really try to eliminate or reduce the anticipatory period. If a child is nervous about going to a doctor’s appointment, you don’t want to launch into a discussion about it two hours before you go; that’s likely to get your child more keyed up. So just try to shorten that period to a minimum.

9. Think things through with the child.

Sometimes it helps to talk through what would happen if a child’s fear came true—how would they handle it? A child who’s anxious about separating from their parents might worry about what would happen if a parent didn’t come to pick them up. So we talk about that. If your mom doesn’t come at the end of soccer practice, what would you do? “Well I would tell the coach my mom’s not here.” And what do you think the coach would do? “Well he would call my mom. Or he would wait with me.” A child who’s afraid that a stranger might be sent to pick them up can have a code word from their parents that anyone they sent would know. For some kids, having a plan can reduce the uncertainty in a healthy, effective way.

10. Try to model healthy ways of handling anxiety.

There are multiple ways you can help kids handle anxiety by letting them see how you cope with anxiety yourself. Kids are perceptive, and they’re going to take it in if you keep complaining on the phone to a friend that you can’t handle the stress or the anxiety. I’m not saying to pretend that you don’t have stress and anxiety, but let kids hear or see you managing it calmly, tolerating it, feeling good about getting through it.

March 2023

ADHD in Teenagers

How to help kids handle the new challenges and expectations of high school

Writer: Mary Rooney, PhD

Clinical Expert: Mary Rooney, PhD

There is no typical teenager with ADHD. Symptoms and impairments vary by gender, by what type of ADHD they have, by the environment they’re in, and by their individual strengths and any other disorder they might have.

Overall, teens with ADHD tend to display fewer of the hyperactivity symptoms we associate with ADHD in children. That’s the good news.

But once kids get to high school, the expectations for them, both academically and socially, are greatly increased, and that can be tough on teenagers with ADHD.

Developmentally, teenagers are expected to be able to handle more autonomy: less structure in their school and home lives and less teacher and parental oversight.

Think of it as a chart with the line for structure and supervision heading down, and the line for demands and expectation going up. The lines cross inadolescence, and as the gap widens, the challenges for kids with ADHD mount. In addition, adolescents are more susceptible to peer group influence, which becomes more powerful in the teenage years, as kids gradually separate from their parents and other authority figures.

If your child has ADHD, it’s important to be alert for struggles in many areas, not just their functioning in school. You also want to keep an eye open for difficulties in relationships with friends, emotional functioning, driving, and risky behaviors. We’ll take these areas one at a time.

Academics

Without support, teenagers with ADHD tend to have lower grade point averages and scores on standardized achievement tests, and higher rates of school failure and suspension for problem behavior. Even if hyperactivity and impulsivity are not significant issues for your teen, symptoms associated with inattention and difficulty with organization can take a big toll once academic expectations are ramped up.

How you can help: Make sure your teenager has access to accommodations in school and in testing if they need them. Tutors or homework helpers can help them if they are struggling with particular academic material, or just with the self-discipline to apply themselves to homework. Helping them get (and stay) organized can be critical, whether you do it by creating structure for working at home, or get them an organizational coach, whose mission is to help them learn to organize themselves.

Above all, teenagers with ADHD need parents to stay in the picture and know what they need to do and when they’re doing it, rather than assuming they are handling the work independently.

Peer Relationships

About half of adolescents with ADHD have serious problems with peer relationships. Research shows that they tend to have fewer reciprocal friendships, and are more likely to be ignored or rejected by peers. They’re also more likely to be the victim of bullying, or to bully others. It may be due to impaired social and communication skills—they may not listen to friends, fail to pick up on important social cues, or act impulsively or intrusively.

How you can help: The most important thing you can do is know who your teen is spending time with, and try to encourage them to discuss friendship and relationship difficulties with you or another trusted adult. It’s also important to encourage participation in extracurricular activities, which offer social opportunities in a structured environment. If you see them seriously struggling to make, and keep, friends, you might want to find a therapist who teaches social skills.

Emotional functioning

The teenage years tend to be an emotional rollercoaster for all kids, but those with ADHD are prone to poor emotion-regulation, which may result in greater highs and lows. Their emotional impulsivity can make it especially difficult for them to cope with frustration. It can be tough on them, and those around them.

How you can help: One thing you can do is to help your teen practice cool down strategies and develop coping tools. You can also talk to them about the value of apologizing after they have lost their temper. For kids with ADHD who are having serious problems with volatility, cognitive behavioral therapy can be effective.

Risky behavior

Research shows that teenagers with ADHD tend to start using cigarettes, alcohol and illicit drugs earlier than typical kids. Later, they tend to have higher rates of smoking and substance use, and higher rates of alcohol-related problems. They also tend to become sexually active earlier, be more likely to have unsafe sex, and have higher rates of sexually transmitted disease.

How you can help: It’s especially important for parents to know where your teen is and who they are with at all times. Encourage participation in extracurricular activities to minimize unstructured and unsupervised free time. Teach your teen about the risks associated with substance use and sexual activity, and encourage them to have an open dialogue with you about these issues. You want them to know what your rules and expectations are, but you also want them to feel comfortable coming to you with questions or calling you if they find themselves in a problematic situation.

Driving

Teenagers with ADHD may have challenges behind the wheel because of inattention or impulsivity. Research shows that they have higher rates of traffic tickets and accidents, and the accidents they have tend to be more serious than average.

How you can help: 

It’s very important to take extra care in teaching teenagers with ADHD to drive. In some cases it may be wise to consider delaying the age when your teen beings driving, and to limit how and when they can drive (and who can be in the car with them) until you are confident that their skill and judgment are sufficiently mature. If your child takes medication for ADHD, it may be important to make sure they are taking medication when they’re behind the wheel. You should make sure they’re aware of the difficulties associated with driving and ADHD, and recognizes the importance of monitoring their own behavior to make sure they’re a safe driver.

February 2023

How Does Anxiety Affect Kids in School?

What it looks like, and why it's often mistaken for something else

Writer: Rachel Ehmke

Sometimes anxiety is easy to identify — like when a child is feeling nervous before a test at school. Other times anxiety in the classroom can look like something else entirely — an upset stomach, disruptive or angry behavior, ADHD, or even a learning disorder.

There are many different kinds of anxiety, which is one of the reasons it can be hard to detect in the classroom. What they all have in common, says neurologist and former teacher Ken Schuster, PsyD, is that anxiety “tends to lock up the brain,” making school hard for anxious kids.

Children can struggle with:

• Separation anxiety: When children are worried about being separated from caregivers. These kids can have a hard time at school drop-offs and throughout the day.

• Social anxiety: When children are excessively self-conscious, making it difficult for them to participate in class and socialize with peers.

• Selective mutism: When children have a hard time speaking in some settings, like at school around the teacher.

• Generalized anxiety: When children worry about a wide variety of everyday things. Kids with generalized anxiety often worry particularly about school performance and can struggle with perfectionism.

• Obsessive-compulsive disorder: When children’s minds are filled with unwanted and stressful thoughts. Kids with OCD try to alleviate their anxiety by performing compulsive rituals like counting or washing their hands.

• Specific phobias: When children have an excessive and irrational fear of particular things, like being afraid of animals or storms.

Here are some tips for recognizing anxiety in kids at school, and what might be causing it.

Inattention and restlessness

When a child is squirming in his seat and not paying attention, we tend to think of ADHD, but anxiety could also be the cause. When kids are anxious in the classroom, they might have a hard time focusing on the lesson and ignoring the worried thoughts overtaking their brains. “Some kids might appear really ‘on’ at one point but then they can suddenly drift away, depending on what they’re feeling anxious about,” says Dr. Schuster. “That looks like inattention, and it is, but it’s triggered by anxiety.”

Attendance problems and clingy kids

It might look like truancy, but for kids for whom school is a big source of anxiety, refusing to go to school is also pretty common. School refusal rates tend to be higher after vacations or sick days, because kids have a harder time coming back after a few days away.

Going to school can also be a problem for kids who have trouble separating from their parents. Some amount of separation anxiety is normal, but when kids don’t adjust to separation over time and their anxiety makes going to school difficult or even impossible, it becomes a real problem. Kids with separation anxiety may also feel compelled to use their phones throughout the day to check in with their parents.

Disruptive behavior

Acting out is another thing we might not associate with anxiety. But when a student is compulsively kicking the chair of the kid in front of him, or throws a tantrum whenever the schedule is ignored or a classmate isn’t following the rules, anxiety may well be the cause. Similarly, kids who are feeling anxious might ask a lot of questions, including repetitive ones, because they are feeling worried and want reassurance.

Anxiety can also make kids aggressive. When children are feeling upset or threatened and don’t know how to handle their feelings, their fight or flight response to protect themselves can kick in — and some kids are more likely to fight. They might attack another child or a teacher, throw things, or push over a desk because they’re feeling out of control.

Trouble answering questions in class

Sometimes kids will do perfectly well on tests and homework, but when they’re called on in class teachers hit a wall. There are several different reasons why this might happen.

“Back when I was teaching, I would notice that when I had to call on someone, or had to figure out who’s turn it was to speak, it was like the anxious kid always tended to disappear,” says Dr. Schuster. “The eager child is making eye contact, they’re giving you some kind of physical presence in the room like ‘Call on me, call on me!’ ” But when kids are anxious about answering questions in class, “they’re going to break eye contact, they might look down, they might start writing something even though they’re not really writing something. They’re trying to break the connection with the teacher in order to avoid what’s making them feel anxious.”

If they do get called on, sometimes kids get so anxious that they freeze. They might have been paying attention to the lesson and they might even know the answer, but when they’re called on their anxiety level becomes so heightened that they can’t respond.

Frequent trips to the nurse

Anxiety can manifest in physical complaints, too. If a student is having unexplained headaches, nausea, stomachaches, or even vomiting, those could be symptoms of anxiety. So can a racing heart, sweaty palms, tense muscles, and being out of breath.

Problems in certain subjects

When a child starts doubting her abilities in a subject, anxiety can become a factor that gets in the way of her learning or showing what she knows. Sometimes this can be mistaken for a learning disorder when it’s really just anxiety.

However anxiety can also go hand in hand with learning disorders. When kids start noticing that something is harder for them than the other kids, and that they are falling behind, they can understandably get anxious. The period before a learning disorder is diagnosed can be particularly stressful for kids.

Not turning in homework

When a student doesn’t turn in her homework, it could be because she didn’t do it, but it could also be because she is worried that it isn’t good enough. Likewise, anxiety can lead to second guessing — an anxious child might erase his work over and over until there’s a hole in the paper — and spending so much time on something that it never gets finished. We tend to think of perfectionism as a good thing, but when children are overly self-critical it can sabotage even the things they are trying their hardest at, like school work.

You might also notice that some anxious kids will start worrying about tests much earlier than their classmates and may begin dreading certain assignments, subjects, or even school itself.

Avoiding socializing or group work

Some kids will avoid or even refuse to participate in the things that make them anxious. This includes obvious anxiety triggers like giving presentations, but also things like gym class, eating in the cafeteria, and doing group work.

When kids start skipping things it might look to their teachers and peers like they are uninterested or underachieving, but the opposite might be true. Sometimes kids avoid things because they are afraid of making a mistake or being judged.

Dr. Schuster notes that when kids get anxious in social situations, sometimes they have a much easier time showing what they know when teachers engage them one-to-one, away from the group.

January 2023

Teens and Anger

How parents can model healthy coping skills

Writer: Rae Jacobson

Clinical Expert: Lauren Allerhand, PsyD

Teenage anger is a thing of legend. The stereotype of the eye-rolling, door slamming rebellious adolescent is often played for laughs, but for parents dealing with the real thing, it’s anything but funny. Bitter outbursts, unpredictable mood swings, and frequent battles about everything from school to friends to clothes to who’s going to set the table can leave parents feeling like they’re walking on eggshells.

And teenage anger is having a moment. Because, if we’re honest, there’s a lot for teenagers to feel angry about right now. The pandemic has caused a year of frustration and disruption. No school (well sure, the work part but none of the socializing), no hang outs, no parties, no dating. Endless time spent on screens and cooped up with family. Stress about getting into college. Add to that the greater issues adolescents are facing: The ongoing fight against racial injustice, fears about climate change, and uncertainty about what the future holds.

It’s okay to be angry

Anger, says Lauren Allerhand, PsyD, a clinical psychologist at the Child Mind Institute, isn’t necessarily a bad thing. “Anger is an important part of our emotional lives,” she says. “But anger gets a bad rap because the urges that come with it — yelling, fighting, being unkind to others — can be destructive and upsetting.”

Parents should strive to see teenage anger not as something to be dispelled or overcome but as a normal part of being a person. “Our job is to help kids understand that it’s okay to feel angry,” she says. In the right circumstances, like when it drives us to strive for social change, anger can be motivating. “Being angry doesn’t mean there’s something wrong with you, it just means you have to find a way to deal with those feelings.” The goal, she says, shouldn’t be to stop teens from feeling anger, but to help them find safer, less harmful, and even productive ways of expressing it.

Finding healthy ways to process anger can be a challenge even for the most mature of adults, but for teenagers biology creates an extra layer of difficulty.  Though on the outside teens may basically seem like (and insist they are) grownups, their brains and bodies are still growing. “The prefrontal cortex, which is the part of our brains involved in problem solving and impulse control, isn’t fully developed until your mid-to-late twenties,” says Dr. Allerhand. Adolescents are also flush with hormones like testosterone and estrogen, which can have a significant impact on mood. When kids make impulsive decisions or seem like they’re overreacting to small provocations it can be helpful to remember that they’re biologically less equipped to manage overwhelming feelings — like anger — than adults.

Decoding anger

Helping kids learn to talk about what’s causing their anger can be hugely important. True, some teenage snippiness can be chalked up to the developmentally appropriate (if annoying for parents) task of separating from parents (You like that? I hate it!).

But anger can also belie serious problems. Irritability, mood swings, or outbursts may be symptoms of disorders like anxiety and depression. Reactions to trauma or negative experiences with which kids feel unable to cope can also surface as bursts of temper. Even less significant struggles, like trouble at school, or problems with friends or relationships can masquerade as anger, especially if kids lack the tools to investigate and articulate their feelings.

So what should parents do?

Reach out

If you notice your teenager has been angrier or more irritable than usual, don’t skirt the issue. Instead, let them know you’ve noticed something is wrong and invite them to talk when they’re ready. “I can tell you’re feeling upset. I’d really like to help. Can we make time to talk?” If your child seems resistant, take a step back and wait, says Colin De Miranda, ACSW, a clinical social worker. “Leave the door open but don’t force it. Instead I’d recommend saying something like, “I can see you’re really angry right now and it doesn’t look like you want to talk. I’ll be in the other room when you’re ready.”

Validate and show respect

When your child is ready to talk let them know you take their feelings seriously. “The absolute number one thing is validation,” says Dr. Allerhand. “Our emotions are a communication tool. They let the other people know how we feel and help us get our needs met.” Teenage problems can seem silly or overdramatic to adults, but to your child, the feelings they cause are real and  painful. When your child expresses anger about something, be careful not to minimize or dismiss it. Instead, acknowledge how they’re feeling — “That sounds so upsetting”— and do your best to ask questions and listen without passing judgement or trying to “solve” the problem.

It can also be hard not to feel frustrated when your teenager’s anger, as it may often be, is directed at you. But even when kids are being incredibly difficult, they’re still relying on you to be the calmer influence and to let them know that how they’re feeling matters to you. Taking a moment to really acknowledge their emotional experience can also help defuse the situation says Dr. Allerhand. “It’s hard to stay mad when someone really sincerely says, ‘I understand how you’re feeling. I’m here to help.’ ”

Check in with yourself

But let’s be real. It is hard to be your best self under pressure.  Nobody likes being yelled at or having a door slammed in their face. Parents are only human and teenagers can be infuriating. It’s normal to feel frustrated, confused or, you know, furious. But kids (yes, even teenagers) look to parents for cues on how to behave. And as with so much of parenting, helping kids learn the skills they need to cope with anger, is more about showing, not telling.

“One thing that’s often really hard for parents to recognize when they’re trying to manage their kids’ anger is the role their own emotions play,” says De Miranda. This doesn’t mean parents can’t, or shouldn’t, get angry, he says. “But it does mean that how you handle it when you do get mad is a huge part of the message you’re sending.”

Checking in with yourself is key to responding effectively, especially when you’re already feeling frustrated.

• Be conscious of your body language and tone. How you say things can matter just as much as what you’re saying. For example, “I’m sorry you’re feeling so frustrated” sounds good on paper, but if you’re saying it through gritted teeth you’re unlikely to get a good response.

• Practice mindfulness skills, like deep breathing, counting to ten, or taking a walk to clear your head. And let your teenager see you doing it.

Take a break

It can be tempting to charge headlong into an argument, but realistically, no one is at their best when they’re angry. If you or your teen are struggling to keep your temper during an exchange, don’t press it. Instead, model healthy coping skills by choosing to take a break until you’ve cooled off. Be open and clear about your reason for pausing the conversation. For example, “You know, I really want to talk this through with you, but I can tell I’m just too frustrated for it to be productive right now. Let’s both take some time to cool down and we’ll come back to it when we’re feeling calmer.”

Come back to the conversation when you’re both feeling less upset. You’ll not only be giving yourself, and your teenager, a better chance at saying what you really mean, you’ll also be demonstrating the value of learning how to deescalate.

When to seek help

Anger, frustration, irritation, even rage are all a normal part of being a person. And teenagers are prone to intense feelings, but if your teen’s anger is having an outsized, negative impact on their life, it may be time to seek some help.

“Anytime that there’s consistent violence or consistent aggression that just can’t be stifled or doesn’t really necessarily correlate with the stimulus — for example if the explosions are really out of proportion for what’s going on — those are red flags,” says De Miranda. Likewise, anger that seems to come out of nowhere or is persistent, regardless of what’s going on may be a sign of something more serious.

“Everyone’s threshold is going to be different,” says Dr. Allerhand. “But if a child’s anger is impacting their ability to function, or having a serious impact on the family at large, or there’s concern about physical harm, like getting into fights or hurting themselves or others, that’s when it’s time to seek outside help.”

Remember the good

That said, our clinicians caution parents to remember that this past year has been unusually difficult for teenagers (and everyone else) and that our collective ability to cope with stress has been taxed to breaking point.

“We could all benefit from practicing a little acceptance,” says De Miranda. “This has been such a hard time, especially for teenagers. I think it is really important that parents recognize that even though it may not look like it, their kids are trying. And that while they may blow up, it has more to do with their brain development and their ability to control chemical signals and the extraordinary amount of stress we’ve all been facing than anything else.”

It can be easy, he says, for parents to become over-focused on the bad and the mad, and forget to honor the good moments. Dr. Allerhand agrees. “Something simple we can do is to remember that we’re all doing the best we can given the current situation and our skillset.”

Finding ways to give a little space and a little grace, and being intentional about acknowledging and enjoying good moments with your teenager will help you both feel more connected and give you both something to come back to when blowups inevitably do happen.

November/December 2022

Saying thank you is one of the first social rules many parents teach their children, and for good reason. We want our kids to be appreciative and not take things for granted, and learning to be grateful can improve kids’ relationships, ability to empathize, and overall happiness. If you are looking for ways to reinforce the importance of gratitude or would like to find other meaningful ways your kids can show appreciation, here are some tips:

1. Set an example

Kids learn a lot from watching their parents. Show them what it means to be grateful by offering a genuine “thank you!” to a waitress who serves your food, a helpful neighbor, someone who holds the door open for you. But don’t stop there — include your kids, too. Thanking children for doing things that are helpful, even when they are chores like putting away toys, reinforces the behavior and lets them know they’re appreciated.

2. Point out generosity

Call attention to it when people (including your kids!) do things that go beyond what’s expected — helping without being asked, being especially thoughtful, or taking extra time to do something because it’s important to someone else. Send the message that you will notice if they knock themselves out for you, or for someone else.

3. Have a talk

For some kids, especially young children or those who have trouble understanding emotions, it can help to have a talk about how showing appreciation makes other people feel. Try asking your child how they feel when people say thank you to them for doing something nice, and then how they feel when they don’t. Going over his own feelings will help them understand how his behavior affects others and make it easier for them to understand the emotional benefits of being grateful.

4. Find fun ways to say thanks

There are lots of ways to show gratitude. If your child isn’t comfortable talking to strangers or has a hard time expressing themself in writing, work together to come up with a different way for them to show their appreciation. They could try giving a smile or a thumbs up if someone holds the door, or show grandma how much they love their new coat by drawing a thank you picture (or taking a smiling selfie!) instead of writing a card.

5. Share the love

Encourage kids to think of people who help them, from coaches to neighbors to the local firemen, and say thanks with cookies or cupcakes. Making them and giving them are fun, and they help kids see how connected we all are.

6. Put things in perspective

Talk to your kids about those who are less fortunate. Don’t scare them, but don’t keep them in the dark either. Understanding that not everyone has the same advantages will help them develop compassion for others and gratitude for their own privileges.

7. Let kids choose

Encourage kids to turn their interests into action. Whether it’s a fundraising drive at school, a bake sale, or a run for charity, expressing their interests and using their skills for a good cause is a great way to boost their confidence and give them a chance to give back at the same time.

8. Get involved

If kids are too young to go alone or aren’t comfortable dealing with strangers solo, make giving back a family affair. Find places where you can volunteer together or let your child choose a charity to donate to. Giving and gratitude go hand in hand, and doing it as a family will bring everyone closer and help you make some great memories.

9. Make gratitude part of bedtime

When you tuck them in at night, ask your child to tell you three things they’re grateful for. Even if they’ve had a bad day it will help them—and you—end each day on a positive note.

10. Give kids credit

Be mindful of the fact that your child may have their own way of expressing gratitude, even if it doesn’t fit your expectations. Different kids communicate in different ways. For example, your child may be more comfortable giving a hug than a verbal thank you, or might show their appreciation by helping out around the house or drawing you a picture. Tuning in to your child’s unique way of being thankful will let them know that even as they’re learning new ways to give back, you see and appreciate the thoughtful person they already are.

March/April 2022

Coping with Current Events

With the ongoing Covid-19 pandemic and the unrest in the Ukraine it is no surprise that many are noticing feelings of anxiety and distress. The increased stress can begin to take a toll mentally and physically making it imperative to prioritize self-care. Here are some tips on how to effectively cope with emotions related to current events:

Limit news/social media exposure.

Setting boundaries around media exposure helps in reducing stress levels and prevents us from being consumed by the difficult situations occurring throughout the world. Consider limiting exposure to news and/or social media platforms to once or twice throughout the day. It is especially important to avoid exposing yourself to media before bedtime, as it activates your body’s natural stress response.

Acknowledge your feelings. 

There is no right or wrong way to feel regarding current events. Some common feelings you might notice are frustration, sadness, anxiety, helplessness, and anger. Feeling distress is a normal reaction to negative events and avoiding those feelings would cause them to persist for longer. Take notice of what you are feeling, label the emotions, and acknowledge that those feelings are valid and deserving of expression. Helpful ways to express feelings can be through communication with a trusted source, journaling, expression through art, and/or speaking with a professional.

Focus on the present. 

Often when things are out of our control our brain’s natural response can be to try to predict what the future holds. The issue with this is that as humans we have a negativity bias that can cause us to predict the worst case scenarios (catastrophizing) or take in more negative than positive information. Acknowledge when you may be catastrophizing and allow yourself to bring your brain back to the present by utilizing mindfulness. Try utilizing mindfulness by bringing attention to your five senses, taking note of what you can feel, see, touch, hear, and taste in the present moment. Research has shown that utilizing a meditation practice has been found to reduce stress and symptoms of anxiety/depression. Lighthouse

Find a way to contribute. 

Feelings of helplessness can arise when we see injustice occurring in which we have little to no power over. It is helpful to focus on what you can control and ways you can contribute, such as donating to causes you believe in or volunteering your time.

Look for the good. 

When negative events are taking place, that negativity can skew our perspective and cause assumptions that everything is bad. Intentionally keep an eye out for what you personally feel grateful for and the positive things still occurring throughout the world. Keep in mind this quote from Mr. Rogers, “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’”

Engage in activities you enjoy. 

Finding pleasurable activities you can engage in can help reduce your stress levels. Consider taking a walk in nature, reading a book, listening to music, or watching a comedic movie. 

Stay connected with others. 

Rather than isolating when difficult emotions arise, do your best to connect with others in your life to create positive experiences. Consider meeting a friend out for coffee or planning a game night.

December 2021/January 2022

Know! Healthy Ways to Handle Holiday Stress

Ready or not, the holiday season is here, along with all the festivities and fun that go along with it: family gatherings, shared meals, gift-giving, party planning, special school and church events, hosting out-of-town family stays, and on and on. It’s enough to make your head spin just thinking about it.

The question is, how do you plan to handle the extra stress that accompanies this time of year?

If your route to relieve stress includes pouring a glass of wine or grabbing a cold beer, you’re certainly not alone. Many adults reach for alcohol to relax and destress. While an occasional drink is ok for most people, depending on alcohol to lift your mood can be problematic, both emotionally and physically, for yourself and your children.

While alcohol is a sedative, and can help ease nerves momentarily, it is a short-term fix to what can become a long-term problem. It is an unhealthy coping strategy that can increase a person’s anxiety and depression, and lead to addiction.

We also must remember that our children are always observing our behavior, whether we recognize it or not. If they learn from us that it is ok to reach for alcohol when we are stressed, worried or feeling down – that is a problem.

Instead, we can teach by example healthy ways to handle stress, that do not involve the use of substances.

The Mayo Clinic offers a stress-reducing strategy called the 4 A’s, that we can put into practice for ourselves and role model for our children: avoid, alter, accept, or adapt. The way it works is that with any given situation that increases our stress, we look for ways to apply one or more of these concepts.

Avoid: Believe it or not, a lot of stress can simply be avoided. Plan ahead, learn to say no, and ditch parts of your to-do list (low priority items).

Alter: Take inventory of whatever stressful situation you find yourself in, then consider ways you change or modify it for the better.

Accept: Sometimes we have no other option than to accept things the way they are. When this is the case, it is important to talk to someone, to forgive, to practice positive self-talk, and to learn from our mistakes.

Adapt: There are times when we need to adjust or revise the standards and expectations we set upon ourselves, which many times are unreasonable. What can help to change one’s perspective is to ask yourself, “Will this matter in a year or in five years?”

Just because you’ve traditionally hosted Thanksgiving doesn’t mean someone else can’t take a turn. If your holiday to-do list becomes overwhelming, look it over and see what you can cut out. If you’re tired of being the punchline of your cousin’s jokes at family gatherings, ask him or her to leave you out of the comedy routine. Give yourself and others grace and do your best to put a stressful situation in perspective.

In addition to a well-balanced diet, exercise, social connectedness, and quality sleep, the Mayo Clinic’s 4 A’s technique can help you balance the stress equation for a more peaceful, enjoyable holiday season for yourself and your children.

Tips For Mentors and Adult Allies

Help young people avoid turning to substances for stress relief by sharing healthy coping strategies:

Maintain a well-balanced diet

• Get daily exercise – outside when possible

• Stay connected to friends and family

• Get good quality sleep

• Put the 4 A’s – as shared in this tip

November 2021

Know! About the TikTok Bathroom Challenge

The latest TikTok trend sweeping the nation and wreaking havoc in schools is called the “Bathroom Challenge.” It’s where middle and high school students record themselves stealing and vandalizing school property, then post their videos on social media. It’s called the Bathroom Challenge because of what many students refer to as “devious licks” takes place in school bathrooms. As part of this challenge, soap dispensers and sinks are being ripped from the walls, mirrors and floor tiles are being smashed, and toilets are being overfilled with rolls of paper towels or pulled out of place completely.

After having experienced instances of this “challenge” in his school building, Central Ohio Middle School Principal Scott Gaddis reached out to his network of parents and guardians urging them to have a strong conversation with their children to discourage them from participating in this destructive trend. “We have already made a school-wide announcement informing them (students) that anyone caught stealing or damaging school property will receive appropriate discipline,” Gaddis said.

Appropriate discipling might include a theft or institutional vandalism charge on their record, as well as school suspension. 

“The bottom line is that these actions amount to theft and destruction of property,” said Gaddis. “In addition to school discipline, students also will likely face criminal charges. Families will be held responsible for the cost of repairs or replacement of any property that is damaged or stolen.”

Many schools have been forced to close bathrooms for a portion of the day or altogether. In addition to the obvious, limiting access to restrooms is not ideal at a time when handwashing is more critical than ever.

TikTok responded quickly to demands made to remove all content related to this challenge; however, youth are savvy and have found ways around it. These videos can still be found on TikTok and other social media.

The key to discouraging such behavior is to talk with your child about this and other social media “challenges.” As you do, here are some points to keep in mind: 

• Don’t assume your child won’t try it: Remember, a teen’s brain is not fully developed. Impulsivity, peer pressure and competitive desire to one-up a peer are all-powerful influencers.

• Set clear boundaries: Share your expectations and what you consider to be acceptable and unacceptable behavior. What your child thinks is okay, may not be okay with you.

• State (and restate) the obvious: Stealing and destroying school property is wrong. Explain that fellow students may do it to fit in, or because they think it’s funny, but it’s no joke, and the punishments can be harsh.

• Prompt critical thinking: Ask your child, “What do you think would happen if you do this?” Help your child learn to step back for a moment and apply basic logic and reason before making a decision that could impact his/her/their future, as well as your trust.

• Keep it positive: Though you may be tempted to focus solely on the negative consequences, remember that youth are hardwired to defend against negative messages or scare tactics. It’s important to educate them on the risks; however, you must also emphasize what they should do, like resisting peer pressure, making good decisions for themselves, and never encouraging others to put themselves at risk.

• In reading this tip, you are already taking a step in the right direction. But you must also be aware that as this internet challenge fades out, another is sure to follow, which is why it’s so important to talk with our teens about the risks of this and other online challenges.

Tips for Adult Allies

Share the consequences of the bathroom challenge with youth.

In addition to consequences set forth by parents/guardians, you’re looking at the potential of:

• School suspension.

• Loss of sports/band/other school-related extracurriculars.

• Theft or institutional vandalism charges on your record.

• Your family being responsible for repairs or replacement of property.

Sources

CNN, Megan Marples: The ‘devious licks’ TikTok challenge has students stealing toilets and vandalizing bathrooms. Sept. 18, 2021.

McAfee, Toni Birdsong: Digital Dares - Dumb Kids with Smart Phones. Sept. 23, 2014. 

Know! The TikTok Challenges Continue On 

The Bathroom Challenge is just one of many challenges on a long list that encourages students to behave badly. In fact, a school-year schedule is (and has been) circulating with a new TikTok challenge for each month.

Once again, parents and other adult allies are being asked to talk with their students to discourage them from participating in these destructive acts and warn them of the consequences should they choose to take part.

“Not only will a student’s participation in any of these activities result in school discipline, but they will also face the potential legal consequences of their actions. For those that entail the theft and destruction of property, families will be held responsible for the cost of repairs or replacement of any property that is damaged or stolen,” said Westerville (Ohio) City Schools Superintendent John R. Kellogg.

School officials are also asking for parents and caregivers to encourage their students to do the right thing by notifying school officials if they learn of anyone who has participated or is planning to participate in any of these challenges.

For key information on what to share with your children, please refer to our previous tip.

Even when we know what to say, it isn’t always easy to get young people to listen or to engage in conversation with us. So here are a few additional tips to help open the lines of communication with youth and keep them talking. (Adapted from the Child Mind Institute.)

• Pose an open-ended question, then listen carefully: Regarding this topic, you can start by asking what your child knows about the year-long list of “devious lick challenges,” then sit back and listen. Keep in mind that you’re likely to hear far more if you show that you’re open and interested but not prying for answers.
  
  

• Keep your cool: While you don’t have to be void of emotion, it’s important you keep your cool even if you don’t completely agree with what your child is saying. If you get too worked up, or your child feels like they are being harshly judged, they will either sensor their comments or simply shut down altogether.
  
  

• Don’t be a dictator: Young people need to know what is expected of them with clarity; however, they do not need a dictator to get the point across. Remember, the way you say it can be just as important as what you say.
  
  

• Give praise: Let them know that you appreciate them talking to you and maybe even educating YOU on the topic.

Once again, awareness and conversation are key. It would be naive for us to think we can stay a step ahead of all the internet challenges or other opportunities that encourage risky choices for our youth. Instead, we can set clear expectations for their behavior, encourage healthy, positive choices

and keep the conversation ongoing.

Sources:

Child Mind Institute, Rachel Ehmke - Tips for Communicating With Your Teen.

Westerville City School District, Superintendent John R. Kellogg, Letter to CSD Families, Sept. 30, 2021.

Tips For School Personnel and Adult Allies

The key to discouraging such behavior is to talk with your student about this and other social media “challenges.” As you do, here are some points to keep in mind:

• Don’t assume a youth won’t try it.

• Set clear boundaries.

• State (and restate) the obvious.

• Prompt critical thinking.

• Keep it positive.

October 2021

Know! To Balance Work and Play

The lazy days of summer have come and gone, and the school year is full steam ahead. But with our children’s school day followed by homework, sports, music lessons, dance classes, and them wanting to spend time with friends, it’s no wonder many of them are feeling overwhelmed and stressed out. While we want to enrich our children’s lives through a wide variety of fun and enjoyable activities, helping them become well-rounded people, we also must help them find balance in their lives and minimize stress. Sometimes this means cutting back on the “extra stuff.”

It's challenging because there are many benefits to the extra stuff, like building self-esteem, discovering self-interests, teaching responsibility, helping to grow friendships, etc. The extra stuff can be good for them, so knowing when it’s too much may not always be that simple.

In an article shared by Synergy Academics, Dr. Jerry Bubrick, a clinical psychologist at the Child Mind Institute, encourages parents to ask ourselves the following questions to determine if our children are overscheduled:

• Are your children getting quality homework done?

• Are they getting the recommended amount of quality sleep each night?

• Are they able to take part in family activities?

• Are they able to hang out with their friends?

Dr. Bubrick says that if the answer is ‘no’ to one or more of these questions, then it’s time to cut back. He also says that while it’s tempting to allow our kids to sign up for all the different activities or programs they are interested in, the risks can sometimes outweigh the rewards.

Those risks include our children:

• Feeling too much pressure.

• Developing issues related to stress and anxiety.

• Experiencing disrupted or not enough sleep.

• Not getting enough free or “down” time.

• Feeling isolated and not spending time with friends.

• Getting poor grades and decreased academic performance.

In helping our children find balance, they must first be clearly aware that their number one priority is school. If grades begin to decline or they are falling behind in their schoolwork, then that means something else must go. And that something else is the extra stuff.

Figure out how much time your child needs on average, to complete daily and weekend homework. This will vary for every child and planning is key. From there you will know how much time is left in your child’s schedule to dedicate to extracurricular activities, knowing that time may need slight adjustments around school testing, big projects, etc.

To help minimize the stress that surrounds homework, and help your child make the most of their study time, encourage them to follow these simple tips:

• Select a well-lit, comfortable, quiet place to study, free from distractions.

• Keep extra pencils, pens, paper, etc., in your dedicated study space.

• Keep your space clean and organized.

• Use a daily planner for assignments and check them off as you go.

• Don't wait until the last minute to complete assignments. Create timelines for long-term projects and stick to them.

• Dedicate space for every class in your book bag.

• Make study guides and/or study cards to help break down important information.

• Talk about assignments with friends.

• If you are struggling, ask for help.

Young people are much less likely to feel overwhelmed with school and homework when they’ve taken steps to be prepared, organized, and focused. These steps will also help to free up time to then put toward the extra stuff, like spending much-needed time with their friends, participating in their favorite sports, playing an instrument, taking a dance class, etc.

Of course, there are additional stressors that come with school, as well as extracurriculars, which can overwhelm and exhaust our children. In the tip to follow, we will look at ways to help our children unwind and destress on a regular basis to maintain healthy minds and bodies.

Sources

Synergy Academics: Balancing School and Extracurricular Activities. Oct. 16, 2019.

Eli Terry Jr. Middle School (Terryville, CT): Study and Homework Tips for Middle School Students.

September 2021

Know!  Better Sleep=Better School Performance

Heading back to school is a transition that impacts many aspects of life, including our tweens’ and teens’ sleep schedules. Sleep, as we know, is fuel for the brain and getting the right amount of quality sleep is essential to their health.

A good night’s sleep is important for everyone but especially our growing and developing children. According to Johns Hopkins All Children’s Hospital, children who regularly get an adequate amount of sleep have improved attention, behavior, learning, memory, and overall mental and physical health. On the flip side, inadequate sleep can lead to high blood pressure, obesity and even depression.

So how much sleep do our tweens and teens need?

• Children 6 to 12 years old: nine to 12 hours.

• Teenagers 13 to 18 years old: eight to 10 hours.

It’s not just about hitting the numbers though, it’s important our children get high-quality sleep. Experts agree there are certain steps we can all take to promote more restful sleep. The Sleep Foundation has broken it down into the following four categories:

Create a Sleep-Inducing Bedroom: This is about a comfortable sleep environment with minimal distractions.

• If financially possible, invest in a quality mattress and pillow along with comfortable bedding for your child.

• Help them avoid light disruptions with blackout curtains or a sleep mask.

• They can use a fan or white noise machine to drown out abrasive background sounds.

• Find an agreeable sleep temperature for your household. Typically, a cooler room is more suitable for restful sleep.

• Lavender, among other essentials oils, is known to help calm, soothe, and ease one into sleep.
  
  

Improve Their Sleep Schedule: Helping them take control of their sleep schedule is a big step in acquiring quality sleep.

• While most young people look forward to sleeping in on the weekends, experts agree that sticking to regular wake times is essential in establishing and maintaining a healthy sleep routine.

• When thinking about your child’s targeted bedtime, include enough time for them to relax and unwind before preparing for sleep.

• Caution them on napping, as it can interfere with nighttime sleep.
  
  

Craft a Pre-Bedtime Routine: Bedtime routines aren’t just for little ones.

• Encourage them to wind down for at least a half-hour before bed with soothing music, quiet reading, or low impact stretching.

• They should avoid bright lights that stimulate the brain and should disconnect from devices up to an hour before bedtime.
  
  

Foster Pro-Sleep Habits During the Day: Pave the way for quality sleep at night by keeping these tips in mind during the day.

• They should throw open those blinds and get a dose of daylight shortly after waking, as our internal clocks are regulated by light exposure. 

• Encourage exercise during the day to promote solid sleep at night. 

• It’s tempting for teens to reach for a soda or energy drink if they are feeling sleepy during the day, but health experts say that approach isn’t sustainable and can cause long-term sleep deprivation. 

• While schedules can get hectic during the school year, it’s important to avoid heavy meals too late in the evening, which makes it harder to fall asleep. 

• Their bed should be reserved for sleep only. If possible, homework and hanging out should be done elsewhere, so that their mind develops a strong association between their bed and sleep.
  
  

When young people have trouble falling asleep, it’s common to think the problem begins once they lie down. However, the time leading up to bedtime is vital to their good night’s sleep. Acquiring both quantity and quality sleep promotes improved attention, behavior, learning, memory and overall mental and physical health. While all this can seem overwhelming, it’s not an all-or-nothing approach. Every positive action step you take from above, no matter how small, will be making a difference towards improving your child’s sleep and overall health

Tips for School Personnel

QUALITY SLEEP+SLEEP QUANTITY=IMPROVED CLASSROOM PERFORMANCE

Encourage your students to achieve optimal sleep with these tips:

• Children up to age 12 should get nine to 12 hours of sleep. 

• Teens 13 to 18 should get eight to 10 hours of sleep.

• Give yourself at least 30 minutes to wind down before bedtime without electronics.

• Wind down with soothing music or relaxing reading.

• Work to create a comfy bed and bedroom environment.

• Try to wake at the same time each day. 

If students frequently are sleepy in class, talk about this issue with them and their parents. Ask how long they are spending on homework. If this causes concern, then discuss beneficial homework management strategies.

Sources

Johns Hopkins All Children’s Hospital, Rachel Dawkins: The Importance of Sleep for Kids. March 12, 2018.

Sleep Foundation, Eric Suni; Healthy Sleep Tips. July 30, 2020.

Homework vs. Sleep: A Cause of Stress in Teens (And Younger Kids), Dr. Craig Canapari, Aug. 31, 2015.