Reflections on my Journey

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It’s been 2 years that I have been self-employed as a therapist in private practice.  After 30 years in education, as a teacher (5 yrs.) and school psychologist (25 yrs.), I took the leap from public school retiree to opening my own practice. Before I jumped head first into the business world, I took one year off for reflection, rest, obtaining licensure as a professional counselor, and setting up my business.

I feel this is an apt time to reflect on my first two years post “retirement.”  Following are my thoughts, both good and bad, on how I’m doing. Maybe someone on a similar path can glean some useful information from my travels.

  • Retiring from my “profession” was both positive and negative. The first year was the most difficult. Some days I awoke with the feeling of total glee, and others were met with the troubling thought – what am I going to do today? It can get lonely when the nest is empty and the spouse works all day. I found the quietude refreshing at times, and at other times, difficult to tolerate.
  • I am a very social individual, so it became important to connect with people on a daily basis. At times I was so desperate, I would go to the grocery store just to talk to someone in line. My family laughs at me because they say I’ll talk to anyone for a connection!!
  • Studying for my licensing exam at age 50+ was challenging. I bought a study guide that was my bible for months, and studied, studied, studied. It became my goal for the first summer post retirement – get the license by September.  Setting a goal always helps!
  • Starting a business was exciting, risky, uncomfortable, challenging, and worth it! When service in public education is your career, business knowledge is as far away from your mindset as the Himalayas. Ask for help from anyone with business knowledge, even your son who has a degree in finance. Take a course, seek information, and get busy.
  • Finding an office was an adventure. I looked at various locations for months and nothing seemed to connect with me. Too small, too large, rent too high, building too old, etc. When my friend found the perfect office, I knew it right away (and so did she-thank you Kerry). I decided to work only part time, which enabled me to sublease to another therapist twice per week. (Hint, Hint – financially a good move since building a practice takes time). Part time hours also allows me to travel as the desire hits, which has proven to be an asset as a new addition was added to the family right before I retired.
  • It is very important to keep your skills and be a life-long learner. I personally love to learn new strategies, techniques, a different way of thinking about things, etc.  Continuing education is a necessity for my profession, so I’m constantly on my toes learning new things. In addition to seeing children and teens, I’ve also added adults to my clientele, which keeps me on the learning curve. When I need assistance professionally, I seek supervision from a certified supervisor who I’ve added to my resources.
  • Finally, I have to say that I love my “new” profession.  I decided to focus on counseling and reduce the psychological evaluations that had been a large part of my duties as a school psychologist. This was a good decision. My knowledge of public schools and special education is utilized frequently; I am grateful for my 30 years of experience.

My new path has brought me much satisfaction and joy. Although being a solo practitioner can be more isolating than working in schools, I enjoy my clientele and feel challenged when I am in the office. Maybe I’ll have to update this again in 2 years to see where my journey takes me then!

To Spank or Not to Spank? That is the Question!

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As my private practice continues to grow, I find it has become more difficult to keep up with blogging. My new goal is to try to complete a new entry at least once per month. Here we go:

Parents often ask me about spanking: Is it o.k. to spank? Should I try another type of discipline? My child doesn’t respond to timeout—what should I do? And on and on…. It is a controversial topic and one on which many parents disagree.

After 30 years in public education and 1 ½ in private practice, I have never waivered in regards to my feelings about spanking. I don’t believe any type of physical hitting or violence is ever justified. Although my own children will tell you that I have raised my voice on more than one occasion when feeling an urgent amount of stress, I never resorted to hitting, spanking or any physical violence as they grew up. I think it’s fair to say that all parents want to raise kind, motivated, responsible, non-violent and confident children. It is my personal and professional belief that hitting and/or spanking actually undermines these goals.

Just this week, an article in the journal Pediatrics outlined the results of a study titled Spanking and Child Development Across the First Decade of Life, in which researchers examined the relationship between spanking and children’s behavior and vocabulary through age 9. Parental reports of spanking were assessed at ages 3 and 5, along with instances of aggressive behavior.

Overall, 57% of mothers and 40% of fathers engaged in spanking when children were age 3, and 52% of mothers and 33% of fathers engaged in spanking with children at age 5. Maternal spanking at age 5, even at low levels, was associated with levels of child aggressive behavior at age 9. Fathers’ high-frequency spanking of children at age 5 was associated with lower child receptive vocabulary scores at age 9.

The authors concluded that not only is spanking still used as a typical form of discipline by many American parents, but also that spanking has proven to have negative effects on both the behavior and cognitive development of young children.

I found this study to be interesting for several reasons: 1) The actual percentage of “spankers” was a bit higher than I realized; 2) Throughout my career, I have consistently counseled/educated/voiced my opinion to parents about the importance of NOT spanking, hitting or perpetrating any form of violence on their children, thus this study validated my beliefs; and 3) the study is current, had a large sample, and used a control population, deeming is scientifically sound.

Like many things, it’s easy to tell parents NOT to spank, but that’s just not enough—we must provide them education about other more healthy techniques for managing their children’s behavior (see my earlier posts about time-out, for example).

More emphasis needs to be placed on providing children the tools necessary to resolve conflicts without hitting, to manage stress in their lives, to learn empathy for others and to communicate and interact with others respectfully. Spanking is a short-term response that ultimately fails to teach children what we want them to learn over a long period of time.

So, if To Spank or Not to Spank is the question, the outcome of this study suggests that Not to Spank is most definitely the answer.

Please tell me how you feel about this topic by leaving a response above.  If you feel that you need to speak to a helping professional, contact me, your child’s teacher/school, or seek counseling from a reliable therapist. As always, thank you kindly for reading.

Woo Hoo! Back To School! (Part 2)

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Part 1 of my back-to-school blog covered basics of ensuring a smooth transition for you and your child(ren) as a new school year begins. This post focuses on the back-to-school “jitters” and those children who truly get anxious.

Not only do students encounter beginning-of-school jitters, but teachers and school staff also feel the emotions of a new year, a new beginning.  I worked in schools for 30 years and can safely affirm that I rarely had a good night’s sleep the night before school started.  It’s a natural phenomenon to get excited, scared, eager, or overwhelmed at the start of something new. Although some accept change with ease and slip into new experiences with little fanfare, others just – well – worry, stress, and get anxious.

The following tips (extrapolated from NASP “Back to School Transitions: Tips for Parents”) are to help those of you with children who are beginning school soon and tend to get anxious.

  • The first few days may be rough; try not to overreact. Particularly the younger student may suffer separation anxiety after a summer with parents and loose schedules. School personnel are trained to deal with children who may have a hard time adjusting.  Best advice:  Drop off your child without lingering, say “I love you and will be back at the end of the day,” then leave.
  • Talk to your child and let them know that you care. Model optimism and confidence and reinforce your belief in their ability to cope. Tell them that it’s o.k. to be nervous about starting something new, but he/she will be fine once they become more familiar with their new surroundings. Best advice:  Send positive, short notes in their lunch box or backpack and listen to any concerns when they arrive home. Reinforce positives as they discuss their school day.
  • Try to remain calm and positive about any bad experiences from the previous year. Those who had a difficult school year may have more anxiety about their return to school. Children who were teased or bullied, those encountering academic problems or any other difficulties may be reluctant to start another year with a positive attitude. Best advice: Talk to school personnel before school begins about this and then reassure your child that this is a new year and a fresh start. Reinforce that you will be working with the school to ensure a smooth school year and prevention of further issues.
  • Give your child strategies to cope if they are feeling anxious. Be open with the school and keep open communication with your child’s teachers. Encourage your child to tell you or the teacher if problems continue.  Best advice: Maintain open communication with your child and your child’s teacher.
  • Try to allow your child to meet with other students and school friends before the first day to ease your child into the new academic year. Best advice: Encourage your older child to contact friends, or if your child is younger, call the parents yourself to schedule play dates.
  • Plan to volunteer in your child’s classroom periodically throughout the year. This reinforces to your child that you are interested in their learning and that school and family are communicating. Additionally, you are building relationships with teachers, classmates, and other school personnel, as well as learning about classroom routines and atmosphere. Best advice: Even if you can’t regularly volunteer, periodic parent help is often welcomed and only benefits your child.

If your child’s anxiety becomes problematic, extreme in nature, or lasts for an extended period, make an appointment to speak with the teacher or school psychologist. More in-school support may be indicated or other resources in the school or community may be suggested. Remember: most children are very resilient and with support, encouragement, and communication will be able to have a successful school year.

Leave me a comment if you liked this entry.  I’d love to hear from you!  Any suggestions for future entries?  Let me know.

Woo Hoo! Back to School! (Part 1)

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It’s August already and it’s time to think—Back to School. With most schools across the country starting their school year before Labor Day, now is a great time to begin preparations.

Of course, each developmental/grade level may bring different challenges or expectations.  But there are a few general guidelines for ALL children that I’ve highlighted below:

  • Schedule all doctor and dental visits before the start of the school year.  Be sure to mention to your child’s doctor any concerns about their emotional or psychological development.  Your physician is able to determine the difference between age-appropriate issues or those that require further assessment.  Be prepared before school begins to notify school staff of any problems so they may be addressed early in the school year, if possible.
  • Start re-setting routines, such as mealtimes and bedtimes.  In the week or two before school starts, begin to talk to your child about the need for routines.  If you discontinued certain routines for summer, such as reading with your child before bed, then reestablish this. Stress the importance of a good breakfast, and start this every morning, as well.
  • Turn off the TV.  Emphasize quiet activities in the morning, such as games, reading, or coloring rather than turning on the TV. This will help your child ease into the school year. Try to maintain this throughout the school year; watching too much TV can be distracting before school.
  • Get rid of the TV in your child’s bedroom!  While I am on the topic of TV, I want to emphasize there is NO reason to have a TV in your child’s bedroom.  It has the potential to keep your child awake until late hours. Also, it’s impossible to monitor your child’s viewing. Even if you believe they will listen to you, they might turn it on before school (see above), and TV’s are not babysitters. Make TV viewing a family activity, or set guidelines for a certain amount of TV viewing during the school week.
  • Make copies of important school documents.  Keep a folder(s) handy of important documents, such as health and emergency information. Health records are often acceptable for over a year and can be used for other activities, such as extracurriculars, sports teams, or clubs.  Also keep important school records in a folder, including reports from teachers, report cards, special commendations, etc.
  • Homework areas.  Children should have a designated homework space in their house.  Older children should be allowed to complete homework or study in their rooms or other quiet areas of the home.  Younger children should be in an area of the house where they can be monitored by an adult, such as the kitchen, dining area, or family room.
  • Designate an area of the house for backpacks.  All children should be responsible for emptying backpacks every day and placing important notices and notes in a designated area for parents to read/sign/return. The backpack should be put in that specific area at night and repacked so as to be ready for a quick departure in the morning.
  • If your child is going to a new school.  Visit the new school with your child, once or several times depending on the age of the child. Designate meeting zones for after school pickups, visit the teacher, locate the classroom, etc. to ease anxiety.  Always call ahead to make sure the specific school personnel will be available for introductions.
  • Mark important dates.  As soon as you receive the school year calendar (and all schools distribute these), mark your calendar for important events, such as conferences, back to school night, concerts, etc. This is especially important if you have children in different schools and will also aid in arranging for babysitters when needed for those who must stay home.
  • Clothes.  Buy early and check your school to see if they require uniforms of a specific color or style. Schools often have rules about length of skirts or shorts, bare midriffs, halter-tops, flip-flops, tee shirts with inappropriate messages, etc. Specific guidelines will be available at the school; avoid conflict with your child by reading the guidelines before school starts.

My next blog entry will deal with the first week of school, and how to cope with the anxious child (and parents) as the new school year begins.

*These tips were extrapolated from NASP “Back to School Transitions:  Tips for Parents” at www.nasponline.org

Teenagers and Being Mindful: A Contradiction?

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Hi again.  I’ve been on a blog hiatus, but happily, I’m baaaaaaack!  Hope your summer is continuing to be relaxing and enjoyable.

If you haven’t noticed, I see many children and adolescents in my private practice. I also see many of their parents or speak to them on the phone. I’ve also worked in public schools for 30 years and have had contact with my share of young people, teachers, and parents. Perhaps the most troubling aspect of this age group for teachers and parents is understanding their pre-teens and teenagers.

What is it about this population that is so puzzling? Perhaps it is their tendency toward moodiness. Or….. the constant challenging of your authority? Throw in their past adorable-ness and how they soooo needed you, but now want only to avoid your very presence. Sometimes there is the mix of  “I need you” and then, “I don’t need you,” all in the course of half an hour! Absolutely, I’m sure there are “perfect” teens out there (I haven’t seen one, but perhaps you have), but inevitably most experience changes at this juncture, including social, academic, hormonal, and emotional. A mindfulness practice can help.

What is mindfulness? It is the deliberate practice of paying attention to whatever you are doing, right now.  It is learning to be aware, or mindful, during difficult times in life. We become aware of our thoughts, feelings, behaviors, and physiological changes. We don’t try to change things; just become aware, fully focused. Breathing in and out helps us to stay in touch with this moment. Mindfulness requires practice on a consistent basis.  Perhaps parent and teen can learn this together!

That is exactly why I have become very interested in Mindfulness for teenagers. Recent research published in the British Journal of Psychiatry (June, 2013) revealed that mindfulness could reduce stress and lessen symptoms of depression among high school age students and increase their well-being.

Uh oh—another study. Just what we need!!!  But I liked this one A-Lot. The Universities of Exeter and Cambridge in England enrolled 522 students between the ages of 12 and 16 during their summer exam period. 256 of the students completed a 9-week introductory mindfulness course; the others did not participate in that specific training. It was found that the ones who completed the course reported lower stress levels, less depression, and overall greater well-being.

Over the nine weeks, the students enrolled in the mindfulness course learned a different mindfulness skill each week including: recognizing worry, harnessing the power of attention, dealing with unpleasant feelings, and distancing from thoughts and emotions.

One of the interesting findings was that mindfulness training can help with the psychological well being of all students, not just those who have symptoms associated with mental health problems.  Mindfulness practiced by adults has been more widely researched and has shown to have the effects of lowering stress levels, enhancing sleep, increasing compassion and self-knowledge, and other health benefits. Fewer studies have focused solely on children and adolescents.

I believe a large part of teenage “angst” can be approached with mindfulness techniques.  I have incorporated them into my therapy practice, even with some of the children I see.  The practice of breathing, being in the here and now, focusing, attending, and learning are all part of teaching children and teens to be okay with themselves, become grounded, and self-aware. Not bad stuff to learn on the road to a healthy life.

If you have any questions about mindfulness or any other topic, please contact me.  I am always eager to respond to any inquiries!  Happy day and BREATHE.

ADHD–Part II

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ADHD, as stated in my last post, is one of the most common chronic health conditions for children.  Those with this condition have difficulty regulating their behaviors, attention, and/or impulsivity.  ADHD presents itself in school, home, and the community and can present challenges in each environment.

ASSESSMENT

A comprehensive assessment involving multiple methods conducted by multiple professionals within different settings is important for arriving at a diagnosis of this disorder. Too often the diagnosis of ADHD is made too quickly or by observation alone.  The assessment should consist of communication with the child’s medical professional, and other sources, including a psychologist, educational personnel, and family. A direct assessment of the child is also recommended. The assessment should address the age of onset of the symptoms, the degree that it impairs the child, and any other features.

How do we obtain information from different sources?  First, I believe a good history is essential, one involving the child’s health, family background, and when the child’s developmental milestones were reached. A thorough history is also ascertained from information provided by school records, the child’s physician, and family members, as well as any others who might be familiar with the child.

Secondly, a physical evaluation is essential (and oftentimes, a neurological evaluation is also indicated) to rule out other causes of the disorder.

Next, information obtained from family should address different settings and include ADHD parent and child rating scales or checklists, including the assessment of inattention, hyperactivity, and impulsivity. The family assessment should also include structured and unstructured interviews.

School/classroom assessments are teacher-reported and can provide information including teacher rating scales and checklists of inattention, hyperactivity, and impulsivity, teacher narratives and reports, schoolwork, grades, and work samples, as well as specific data regarding the child’s behaviors in the classroom.

Finally, an assessment of coexisting conditions should take place that rule in or out other disorders that may include depression, learning disabilities, and anxiety, to name a few.

TREATMENT

There is no cure for ADHD at this time, but many treatments exist which are effective in the management of the disorder. When speaking of any treatment, most important is the education of the family and school staff about the nature of the disorder and its management for children. But among all of the treatments available, which ones are most effective?

The treatment that results in the greatest degree of improvement in the symptoms of ADHD is stimulant and nonstimulant medications.  Before medications are considered, though, academic and behavioral interventions and accommodations should be implemented for a reasonable time. Sometimes these interventions are effective alone.  According to the American Academy of Pediatrics (AAP), 80 percent of the children who use stimulant medications, either alone or with behavior therapy, show increased focus and decreased impulsivity. The most common stimulant medication, Ritalin, has been used for over 40 years in children and has shown to be safe. Strattera is a nonstimulant medication that is frequently used with children, as well. Antidepressants seem to be less effective, but are often used with those who have coexisting symptoms of mood disorders.  Some children may need a combination of medications depending on if they have other disorders along with their ADHD. There are side effects to these medications and they should be discussed with the physician who is in charge of prescribing them.

The decision to use medications can be a difficult one for parents, and rightly so!  If you do decide to try medication for your child’s ADHD, there must be close monitoring and frequent reassessment to decide if the treatment is working. Each decision about whether to try or not try medication should be based on what is best for the child as an individual.  There is a great deal of information available on the pros and cons of starting your child on ADHD medications.

Psychological treatments, such as behavior modification in school, social skills training, and parent training in child behavior management techniques have shown to have short- term effects.  Some studies suggest that once treatments end, so do the gains obtained (as with medication treatment, as well). Therefore, ADHD should be seen as a chronic condition that requires ongoing treatment for good, long-term management of the symptoms. Counseling can help parents and children understand the disorder, improve social skills, assist with behavioral interventions, and help those who are having difficulty coping.

Some children with ADHD may be eligible for special education services in the public schools under the Individual with Disabilities in Education Act – IDEA- and/or Section 504 of the Rehabilitation Act of 1973. To qualify for these services, the symptoms of the ADHD must be interfering with the child’s ability to learn in school. Thus, the comprehensive evaluation is important to ascertain whether the school services are warranted.

In summary, the treatment of ADHD requires a comprehensive behavioral, psychological, educational, and sometimes medical evaluation, along with the education of family members as to what this disorder is and the methods proven to assist with its management. Once the ADHD condition is managed, those with this disorder can usually lead adjusted and productive lives.

Please feel free to comment about this topic.  I welcome your feedback!

ADHD–Part I

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ADHD (Attention Deficit/Hyperactivity Disorder) often comes to my attention in my private practice; it’s frequently the reason that parents call me for help with their child. I worked in the school system for many years and ADHD was the most frequent reason that children were referred to me for assessment, counseling, or parent and teacher consultation.  What exactly is ADHD and how can I manage my child, both at home and at school?

ADHD is one of the most common chronic health conditions affecting school-age children.  It is a specific developmental disorder with respect to controlling and/or regulating behaviors, impulses, and/or attention, and is observed in both children and adults.  About  5-8% of the childhood population and 4-5% of the adult population meets the criteria for ADHD that has been established and researched by the medical field.  The latest research now points to ADHD as a disorder of inhibition and self-regulation.  Although their have been many names for this disorder, it is now referred to as ADHD.

What causes ADHD? There is a very strong biological contribution to its occurrence although specific causes have not yet been determined. Several genes associated with the disorder have been identified, however, it is such a complex disorder, it’s almost certain that more genes will likely be identified. Given that ADHD represents a set of complex behavioral traits, a single gene is unlikely to account fully for this disorder.  The popular notions that excessive sugar, food additives, excessive TV viewing, or poor behavioral management by parents contribute in some way to ADHD have not been supported by research. Factors that MAY contribute outside heredity include difficulties during pregnancy, prenatal exposure to tobacco and alcohol, prematurity or low birth weight, excessive lead levels in the body, as well as postnatal injury to the prefrontal area of the brain.

ADHD presents with both core and peripheral, or related, symptoms that tend to occur together to spell this diagnosis. The core symptoms are related to inattention, hyperactivity, and impulsivity. Peripheral symptoms include academic problems, social skills deficits, behavioral problems, and other disorders such as anxiety or depression.  The expression of ADHD is highly variable so that all children won’t likely have all of the core and peripheral symptoms. Individuals with ADHD demonstrate vast differences from each other within the ADHD diagnosis.

Given the above, there are specific diagnostic criteria for ADHD, too numerous to mention here. To reach a diagnosis of ADHD, symptoms must cause impairment in school, social, or work settings and signs of this must present before age 7.  Some impairment must be present in two or more settings (such as school AND home). The symptoms must not be better accounted for by other mental disorders, such as anxiety disorder, mood disorder, dissociative disorder, or a personality disorder, nor can it be explained by a different diagnosis, a stressful experience, or any other factor within the child’s environment.  Finally, the child’s symptoms must create dysfunction for the child in areas such as academic performance and interpersonal relationships.

There are three types of ADHD based on specific diagnostic criteria:

  • ADHD, predominantly inattentive type:  This is identified if criteria for inattention are met, but criteria for hyperactivity/impulsivity are not met for the past 6 months.
  • ADHD, predominantly hyperactive/impulsive type:  Identified if criteria for hyperactivity/impulsivity are met but criteria for inattention are not met for the past 6 months.
  • ADHD, combined type:  If both criteria for inattention and hyperactivity/impulsivity are met for the past 6 months.

There is NO treatment that has been found to cure this disorder, but many treatments exist to help manage the symptoms.  Next time, I will write about assessment and treatment options for ADHD.  If you have any specific questions, please address them to me at rtlapidus@gmail.com or respond via this blog in the upper right corner’s speech balloon.

Can I Advocate for My Child’s Mental Health Needs? (*Of course, you can!!)

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Since 1949, May has been declared National Mental Health Awareness Month to draw attention to mental health issues that affect many Americans. As part of this effort, the first week in May is National Children’s Mental Health Week, which raises awareness about the importance of children’s mental health to their overall healthy development.  Today’s blog will focus on advocacy for your child regarding their mental health.

According to the U.S. Surgeon General, 1 child in 5 experiences significant problems with a psychiatric disorder. Sadly, only less than 1 in 3 is receiving the treatment that they need. This issue has come to the forefront due to several recent tragedies and the realization that mental health treatment is so often not available for those children who need it. Early detection and screening of children is also hotly debated around the country as to its effectiveness in the prevention of violence.

NAMI (National Alliance on Mental Illness) recently shared an article on tips for parents to advocate for their child regarding their child’s mental health. As written by Dr. David Fassler, Child and Adolescent Psychiatrist, I found these tips to be quite informative and helpful for individual advocacy. I hope many of you will find these tips useful, as well:

  • Get a comprehensive evaluation for your child to address your concerns. This may include several visits to a mental health professional. A careful and accurate diagnosis will yield effective treatment.
  • Look for the best clinician in your area pertaining to your child’s condition.  Check their credentials carefully: Are they appropriately licensed or certified in your state? If he/she is a physician, are they board certified? Push schools, insurance companies and state agencies to provide the most appropriate and best possible services, not merely those that are deemed adequate or sufficient.
  • Ask lots of questions about any diagnosis or proposed treatment, and enlist your child’s questions, as well. Child disorders may be very complex and simple solutions usually don’t exist. Most, if not all treatments have both risks and benefits.
  • Seek family centered treatment that builds on your child’s strengths. Ask about goals and objectives of treatment and how you will know if the treatment is helping. If treatment does not work, ask about options or alternatives.
  • Remember to keep all copies of consultations, treatment reports, and assessments in an organized place. Ask and insist on your own copies of all evaluations and maintain your own file on your child. This avoids unnecessary duplication of previous treatment efforts and future unnecessary testing.
  • Feel free to seek a second opinion. Any mental health professional should be happy to help with referrals and sharing information for the benefit of your child.  If you question a diagnosis or a treatment for your child, absolutely arrange an independent consultation with another clinician.
  • Help your child learn about their specific condition in an age appropriate fashion.  Use books, pamphlets, or the Internet to access information that your specific aged child can understand. Remember not to overload your child with more detail than they want or need.
  • Work with your child’s school. Be included in all school meetings held to discuss your child. Request school records and keep them at home in your organized file.  Make sure their educational program is meeting their specific needs.
  • Know the details about your insurance policy and how it affects your access to mental health care. Know their coverage of “specialists.”
  • Learn about your state’s reimbursement and funding systems. How does Medicaid work? Which services are covered and which are excluded? What other sources of funding is available for your child.
  • Seek out support from other parents by joining a local parent support group.  If none exists, think about starting one in your area.
  • Attend local and national conferences of parent and advocacy organizations where information is shared, ideas are offered, support is given and camaraderie is available.

Advocacy is hard work; there is no right or wrong way to be an advocate for your child.  It takes a lot of time and energy to advocate for better mental health access, but in the end you will help not only your own child, but also others who deserve access to appropriate and effective mental health treatment.

How do you advocate for your child or children in general?  I’d love to hear your stories and as always, thank you for sharing.

How Can I Help My Child When Terror Strikes?

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My first blog post was dedicated to Mary Sherlach, the school psychologist who was violently gunned down at Sandy Hook Elementary School. The death of 20 innocent children and 5 additional staff members profoundly affected me, mainly because I spent 30 years working in public schools.  It’s hard to wrap your hands around such violence and tragedy when those images hit so close to home and when the ability to visualize the scenario seems so real.

Now, once again, the frightening news of the Boston Marathon bombings surrounds us. Thinking of all the injured and uninjured athletes who only wanted to compete and enjoy this sporting event, along with the onlookers who experienced the terror around them, has once again scarred Americans and people from around the globe. The availability of instant media access, Internet, and social media has allowed horrific images and constant news coverage to inundate our society.

But what about the children? As a parent, therapist, citizen, and educator, the death of an 8 year-old and the injuries suffered by several other children breaks my heart. Although we as adults try to process our own grief, we also need to help our children process theirs. How do we help our children understand terrorist attacks, frightening news, and their emotions surrounding these events?

These events are frightening. These events are upsetting. Children look to the reactions of their parents and other adults to figure out their own reactions. Parents can help their children by giving them a sense of security and safety. The National Association of School Psychologists (NASP) offers the following suggestions for all adults when helping children cope with these events and working through their emotions:

  • Model calm and control. Children take cues from adults in their lives.  Avoid appearing anxious and frightened.
  • Reassure children that they are safe. Help point out factors that ensure their safety.
  • Remind children that trustworthy people are in charge.  Explain that first responders and the government are working to ensure that no further tragedies will occur.
  • Let children know that it is ok to feel upset and frightened.  Explain that when a tragedy occurs, it is ok to feel upset and that talking about their feelings helps.  Adults may need to help children express feelings appropriately.
  • Tell children the truth.  Don’t pretend that the event has not occurred or is not serious. They may be more afraid if they think you are not telling them what is happening.
  • Stick to the facts. Don’t embellish the event or who might be responsible. With younger children, don’t dwell on the scale or scope of the tragedy.
  • Be careful to not stereotype people or countries that might be associated with the violence.  Children model parent’s negativity and develop prejudice. Talk tolerance and justice.  Stop any bullying or teasing immediately.
  • Explanations should be kept developmentally appropriate. Be a good listener to all children and allow them to verbalize their thoughts and feelings
    • Early Elementary children need brief, simple information balanced with reassurances that their daily structure will not change.
    • Upper Elementary and early middle school children will tend to ask more questions about whether they are really safe. Separation of reality from fantasy is important.
    • Upper Middle School and high school students will have strong and varying opinions about the causes of violence and threats to safety in school and society. They will share suggestions about how to prevent tragedies in society. They may become more committed to action to help the victims and affected community.
  • Maintain normal routines.
  • Monitor and/or restrict viewing repeated scenes of the event as well as the aftermath.  For older children, encourage accessing coverage from multiple news sources.
  • Observe children’s emotional states.  Many children will not verbally express their concerns. Look for changes in behavior, appetite, and sleep patterns.  There is no right or wrong way to express fear or grief.
  • Be aware of children who are of greater risk.  This includes those who have experienced a past trauma, personal loss, suffer from depression or other mental illness, or those with special needs. Be observant of those who may be at risk for suicide. Seek professional help if you are concerned about your child.
  • Provide an appropriate outlet for children who desire to help.  Examples include cards, letters to families or survivors, thank you letters to doctors, first responders, nurses, etc.
  • Monitor your own stress level.  Don’t ignore your own feelings of anxiety, grief, and anger. Talk to friends, family, religious leader, and mental health workers.  Get appropriate sleep, exercise, and nutrition. It is ok to let your children know that you are sad, but you believe things will improve.
  • Keep communication open between home and school.  School is where children can experience normalcy. Schools can inform families of additional resources. Also let your child’s teacher know if he/she is having particular difficulty with the present situation.

I hope these tips from NASP were helpful.  Please contact me with comments or suggestions for future topics.

Bedtime Blues or Bliss–II

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My last post provided guidelines for establishing bedtime routines for your children, with an emphasis on consistency. Consistency is the key to helping ensure that everyone gets a good night’s sleep. When your child gets into a consistent sleep routine, he or she will be at less risk for emotional, behavioral, and learning problems. Additionally, you – the parent – will feel more refreshed during the day and enjoy a better overall family life.

What if my child has more serious sleep problems? Some children and teenagers suffer from sleep disruptions and have difficulty following a good sleep diet. These disorders may include:

  • Insomnia
  • Nightmares
  • Sleepwalking
  • Night Terrors
  • Other sleep disturbances caused by hormonal changes and stress in adolescence

Let’s explore these more serious sleep problems in greater detail.

Primary insomnia occurs when your child has difficulty falling or staying asleep without any known underlying medical condition. This may be due to poor sleep patterns or erratic sleep schedules. Usually the establishment of a good sleep routine is sufficient to reduce or eliminate primary insomnia. Emphasize calming activities in the hour or so before bedtime, avoid giving your child caffeinated food or drinks before bedtime, and provide for plenty of exercise during the day. If these techniques do not help, consult your child’s pediatrician to rule out any underlying medical conditions that my interfere with sleep. A mental health professional may be sought out as well.

Nightmares are disturbing and/or frightening dreams. As many as half of all children may suffer from nightmares; however, they are most common in preschool and elementary grade children and tend to lessen over time. Nightmares may begin around age 2, peak in the 4 to 6-age range, and then slowly diminish, although they can occur in all ages. What causes nightmares? Stress, traumatic events, scary TV programs, violent video games or movies, vivid imaginations, fear (such as fear of the dark), and even some medications can all trigger nightmares. When your child experiences a nightmare, calm her down and repeat a shortened version of her bedtime routine to help her back to sleep. A nightlight in the bedroom may help a frightened child, or a shared storybook for those who have frequent nightmares.

Sleepwalking occurs during deep sleep, often 1 to 2 hours after initially falling asleep. Episodes can range from simply sitting up in bed to actually getting up and walking around the house, down stairs, or even outside. It can be very difficult to wake a sleepwalking child. When awakened, he may seem confused and usually will have no memory of the event. Comfort your child after an episode of sleepwalking and then return him to his bed. Sleepwalking usually stops in late childhood, although a few continue to sleepwalk into adulthood.

Night Terrors are episodes during which the child screams, seems disoriented and anxious, does not recognize parents, but at the same time appears wide awake. They usually occur between ages 3 and 8, and often 3 hours into the sleep period. Night terrors typically end by age 12. I often refer to them as “Parent Terrors” because it can be very scary to be awakened by a screaming, anxious child who may not recognize you. While children who have night terrors seem to be awake, they are not consciously awake, and may fight the parent who is trying to calm them. When the night terror eventually ends, often after 10-15 minutes, the child will return to sleep and have no memory of this terrifying event. Although parents are usually frightened (and I have personally experienced this!), there is little or no impact on the child. Hold your child gently until the episode ends and then return him/her to bed. Night terrors are NOT a sign that your child is troubled or emotionally disturbed.

Teenagers usually outgrow nightmares, sleepwalking, and night terrors; however, other sleep disturbances caused by hormonal changes and stress in adolescence may crop up.  Changes in sleep cycles can be triggered by puberty, hormonal fluctuations typical to adolescents, and the stresses of growing up in a complex society. Most teens do NOT get enough sleep at night, nor do they fall asleep quickly when they lie down for the night. Teens begin their days with school early in the morning. Extracurricular activities, such as jobs, homework, athletics and other social events often work against teens, preventing them from getting an adequate number of hours of sleep. Parents can intervene by reducing stress, encouraging adequate exercise, eliminating caffeine and energy drinks in the evening and removing distractions from their bedrooms.

If you believe your child has any of these serious sleep issues, a sleep diary may be helpful. Record the number of hours your child sleeps, how many times he/she wakes during the night, what happened before the child fell asleep, and any parental intervention taken during the disruption. Your child’s pediatrician should be consulted for serious sleep problems. The sleep diary information will be a useful tool to determine if your child has a sleep disorder.

Does your child or teen have sleep disturbances?  Please share your interventions or frustrations. I’d love to hear from you.