How to Talk to Your Child About Disasters & When to Seek Help

Recent disasters, such as the wildfires in California, the Thousand Oaks shooting, and the shooting at a Pittsburgh Synagogue, can be very frightening for children.  Since children often see or hear about these events either through the different news outlets that are accessible to them or through their interactions outside the home, it can be helpful to talk about the event with them in language they can understand.

The following guidelines can be useful when having these conversations:

  • Try to set aside adequate time and a quiet space.
  • Use a tone that’s calm and language that’s not overwhelming.
  • Ask the child what he/she already knows and what questions he/she has.
  • Be honest as children are very aware of their parents’ concerns and know more than we think.
  • Talk about your worries as well as your abilities to keep your child safe.

In addition to having these conversations, it is also important to look for signs that your child might be struggling after a disaster.  There are different factors that can affect a child’s response to a disaster that can include:

  • The way they experience their parents’ response.
  • How close they are to the disaster/whether there was direct involvement
  • Whether they know anyone that was directly affected.
  • The child’s age.

Behavioral changes that might indicate your child is struggling and may benefit from being evaluated by a mental health professional include:

  • Acting out or misbehaving in school or at home that is atypical for the child.
  • Refusing to go to school or other places the child typically attended without a parent.
  • Fears that persist long after the disaster, jumpiness, nervousness, and a much heightened sensitivity or alertness to danger.
  • Avoidance of people, places, and things that remind the child of the incident.
  • Sleep disturbances or changes that were not occurring prior to the disaster, such as nightmares or bed-wetting.
  • Depressive symptoms that can include low or irritable mood, appetite changes, fatigue, withdrawal from friends and family, decreased interest in activities, feelings of hopelessness, and in some cases suicidal thoughts.
  • Physical symptoms in the absence of a physical injury or illness, such as headaches and stomachaches.

How to Talk to Your Child About Suicide

Recent celebrity suicides have shed more media light on the issue of depression and suicide. Any time someone commits suicide, family, friends and acquaintances are left in shock and sadness. There is often an overwhelming question of why and why didn’t we know? These questions are also followed by feelings of guilt and regret for not having known how badly a loved one was suffering.

It can be a difficult and awkward topic for parents to discuss with their children, however it’s important to be direct and as honest as possible when speaking to children about depression and thoughts of self-harm.

Be direct and provide age appropriate information. Provide an explanation of mental illness that makes sense for your child’s age, maturity and level of understanding. For example, for a younger child you may say that ‘people’s thoughts and feeling are controlled by their brain and sometimes their brain gets sick the same way a body can get sick. When someone’s brain gets very sick, it sometimes makes them want to stop their body from working. For an adolescent or teenager, you may use more direct language.

Encourage your child to ask questions. Providing the opportunity to have a conversation about mental health opens the doors to further conversations and it also normalizes discussion about mental health in general. While it may be uncomfortable, try to remain present and listen to your child as much as possible. Practice reflective listening and ask open ended questions such as, ‘How do you feel about what happened?’ ‘What are your thoughts about what happened?’ ‘What questions do you have?’

Talk about the signs and symptoms of depression. If your child is a young adolescent or teenager, it’s a good opportunity to talk about how anxiety and depression affect someone’s behavior. This is the age where kids start sharing less with their parents and more with their peer group, so give your child helpful information so that if they or a friend is feeling depressed, they know what to do.

Finally, emphasize the importance of maintaining good mental health. Just as going to the gym regularly can help keep your body healthy, talking to a licensed therapist or counselor helps keep our minds healthy. Encourage your child to speak and use outlets for their feelings. Let them know who the counselor is in their school, discuss the value of therapy. Consider making an appointment for your child with a therapist if you have any concerns that they may be depressed or anxious.

*If you or your child is feeling suicidal, call 911 or go to your nearest emergency room or contact the National Suicide Prevention Lifeline at 1-800-273-8255 or https://suicidepreventionlifeline.org/. *

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Summer Social Skills Group Starting on Saturdays at 9am

We are excited to start offering a social skills group for children in grades 1-3 starting Saturday June 23 at 9am. This group will be run by Olga DaSilva, LCSW and will focus on different aspects of social skills including the stages of friendship, social problem solving, conflict resolution, communication skills and more.

Please call the front desk at (973) 605-5000 to secure a spot or with any questions.

Brand new patients will be required to do an intake session before beginning group.

Group rates are $65 per session.

What to Do if Your Child is Being Bullied

It can be very difficult as a parent to watch your child come home from school in tears, withdrawn, or moody only to find out that they are being teased or bullied at school.  Here are some key tips to support your child and help resolve the situation as effectively as possible.

  1. Listen to your child without judgement. Allow your child to tell you the full story in their own words without interruptions and minimal reactions.  It is already difficult for a child to recount what has happened so they may minimize what happened if they feel you are getting upset.  Use open ended questions and phrases such as:  tell more about that, how so?
  2. Find out the facts. When appropriate make sure you get the  who, what, when, and where of what occurred so that you can record it and let your child’s teacher know. Keep a record of an future incidents.
  3. Problem solve. Engage in problem solving with your child so that they know how to self-advocate if the situation occurs again.  Come up with several strategies (including finding a safe teacher or administrator that your child can go to) with whom your child feels comfortable.  Practice using the strategies with role play.
  4. Reach out. Talk to your child’s teacher as soon as possible.  Keep in mind that teachers don’t always and can’t always know when bullying occurs.  Kids are smart and know when to tease/make cruel remarks when the teacher is occupied or out of earshot.
  5. Ask for a copy of your school district’s bullying policy. This will send the message that you know how to advocate for your child. Also, every school should make this available to parents upon request by law.
  6. Take your concerns up the chain of command. If the problem persists, meet with your child’s school principal and ask for documentation of how the problem will be resolved.  Familiarize yourself with the state law and pursue that the school do a full investigation and document a case of HIB (Harrassment, Intimidation, or Bullying) if you feel like you are not getting results.

Find out more here:

http://www.nj.gov/education/students/safety/behavior/hib/ParentGuide.pdf

 

http://www.stompoutbullying.org/information-and-resources/parents-page/what-do-if-your-child-being-bullied-and-resources/

 

  1. Watch for signs of serious stress, anxiety or depression.  Having your child talk to a professional can be particularly helpful especially if you see emotional or behavioral signs of stress such as social withdrawal, sleep issues, changes in appetite, or mood swings.

The Video Game Dilemma and the ADHD Child

Do you sometimes wonder if your child is addicted to video games?  Is getting off or ending video game sessions often the cause of fights or meltdowns for your child?

In an increasingly digital world, children are spending more time in front of screens and parents are left  to negotiate the muddy waters of figuring out how much screen time/video game time is healthy for their child.  This can be particularly difficult for a child with ADHD as video games lend themselves to being ‘time sucks’ and can often distort a child’s temporal awareness.  Here are some tips for setting and maintaining healthy boundaries for video games and screen time.

  1. Communicate clearly with your child about the amount of screen time that is allowed

During a calm period of the day, sit down with your child and discuss your concerns about screen time and present your concerns.  Make sure to listen to your child and reflect their concerns.

  1. Consider the time of day when you agree to schedule gaming/screen time.

Scheduling screen time right before homework or bedtime can be a recipe for disaster especially for children who have very difficult moments detaching.  Try to involve your child in problem solving and ask for ideas of when you can best schedule screen time so that it is not disruptive when it must come to an end.  Be flexible.

  1. Always monitor and preview content before your child views it.

Some games and videos can have violence or sexual content that may be inappropriate or overwhelming for your child.  Always check the suggested ages and consider watching the video game first before you purchase or rent it for your child.

  1. Consider what your child is getting out of screen time.

Playing a video game or watching a youtube video may provide much needed zone out time for the ADHD brain.  Make sure to expose your child to a range of other activities that may also provide relaxation and self-soothing feelings such as yoga, meditation, music lessons etc.

  1. Practice what you preach.

Modeling is one of the most powerful tools of influence that parents possess.  Practice your own healthy boundaries with your cell phone and screen time.  Schedule regular family media -free times or zones, such as meal times, bedtime or family outings.

  1. Use Screen time to build on your child’s strengths

Not all screen time is unhealthy. There are amazing tools available that can help support learning.   Research some great new learning sites or games that support your child’s reading or math and spend some time with your child exploring their interest in art or science by checking out online museums.  Speak to your child’s teacher or the school librarian for recommendations.

 

 

How to Talk to Your Child About School Shootings

Sadly school shootings have become normative in our culture and parents are faced with the question of how and when to talk to their kids about being safe in school. Here are a few tips and resources to help parents navigate these discussions:
1. Keep discussions age appropriate. Younger children need more reassurance and less specific information. They may have questions about active shooter drills or why there was a school walkout. Keep information short and age appropriate and reassure your child that adults are always taking measures to keep students safe. Older kids and teenagers will want to talk more and may want to get more involved in advocacy efforts. Make sure to make time to talk and practice reflective listening. Echo back their concerns and ideas.
2. Limit exposure to the news. News tends to refresh and replay the same upsetting images and soundbytes. Exposure to these stories via television or on the radio can be upsetting and confusing for children. Also, keep an eye out for newsfeeds that come up as ads or pop-ups on social media. Your child may be watching news footage unbeknownst to you.
3. Pay attention. Know the signs of stress or anxiety in your child. Pay attention to changes in behavior such as excessive worry, nightmares or sleep disruptions. Consider reaching out to a qualified child mental health professional if you see any of these symptoms for an extended period.
4. Stay on top of what is happening locally. Follow and attend school board meetings, talk to your child’s school principal or administrator. In the wake of the latest shooting at Parkland, many school districts have made changes to their safety policy. Share this information with your child as well as with other caregivers so that they can be prepared for changes in school visitation or pickup policies.
5. Stay connected. Encouraging regular communication with your child is the best way to know what’s going on in your child’s school . Consider scheduling a regular time to meet with your child to discuss any concerns they may have. Creating an environment of open communication will beget open communication.

Resources for parents:

Check out this recent piece which was featured in Time magazine by Dr. Ross Greene:
https://www.livesinthebalance.org/Nineteen-years-tragedy

ADHD: Myths vs. Reality

 

Attention difficulties commonly occur in children and adults for various reasons. Sometimes they can be related to mood issues, motivational issues, environmental challenges or physical health issues. But, when there are significant and persistent difficulties, with a combination of inattention, overactivity, impulsivity, and distractibility that impairs functioning or development in multiple settings, this can be attributed to Attention Deficit Hyperactivity Disorder in children and/or adults.

Of children aged 4-17 years of age in the United States, 5.1 million or 8.8%, have a current diagnosis of ADHD, with boys (12.1%) more than twice as likely as girls (5.5%) to have ADHD. Approximately half of children with ADHD continue to have symptoms into adulthood, or 4.4% of adults overall.

The exact cause of the disorder is unknown but research shows that areas of the brain are affected and there is a family/genetic connection. The impact of the disorder includes lower academic performance, increased risk of injury, increased risk of traffic accidents, increased likelihood of smoking, poorer social function and lower self esteem. Treatment can reduce the symptoms of ADHD, but it does not completely eliminate the impact of these complications.

When it comes to ADHD, it’s important to separate the myths vs. the facts. Here are some important considerations to keep in mind when thinking about an evaluation, diagnosis and treatment.

Myth


Fact


“ADHD isn’t a real disorder”

  • It is a recognized medical condition
  • ADD = ADHD
  • Exact cause unknown
    • Multiple factors have been implicated in the development of ADHD – family history/genetics, certain environmental factors, problems with the central nervous system /an imbalance of chemical messengers, or neurotransmitters, within the brain.
  • Research has shown that certain brain regions don’t synchronize properly and overall brain architecture is different.

“ADHD is overdiagnosed”

  • Studies show that ADHD is underdiagnosed in minority populations
  • Awareness of the disorder has been growing since the 1990s when it became recognized under special education law as a condition that affects learning.

“ADHD only occurs in childhood”

  • The symptoms of ADHD can occur as early as the preschool years. The intensity of the behaviors and how they are affecting a preschooler’s life, development, self-esteem, and general functioning is considered.
  • Some children with ADHD continue to have symptoms during their teen years and about 50 out of 100 have symptoms into adulthood.
  • Symptoms in adults look different.
  • Hyperactivity tends to diminish
  • Inattentive symptoms become more troublesome
  • Sense of “inner restlessness”

“Children outgrow ADHD”

  • ADHD is a lifelong condition
  • Some children do outgrow their symptoms
  • Most children carry the disorder into adolescence and adulthood
  • Symptoms change as a child gets older and learns ways to manage them

“My child is just lazy or dumb or unmotivated”

  • ADHD has nothing to do with a person’s intellectual ability.
  • A child who finds it nearly impossible to stay focused in class, or to complete a lengthy task may try to “save face” by acting as though he/she does not want to do it or is too lazy to finish.
  • This behavior stems from real difficulty in functioning and possible frustration.
  • They simply work differently.

“My child is a handful or is a daydreamer – but that’s normal”

  • There are variations of “normal”
  • How much behaviors consistently impede a child and their ability to succeed at school, fit into family routines, follow household rules, maintain friendships, interact positively with family members, avoid injury or otherwise manage in his/her environment should be considered

“My child focuses on video games for hours. He/she cannot have ADHD”

  • ADHD poses problems with tasks that require focused attention over long periods of time, not so much for activities that are highly engaging or stimulating
  • Less or unstructured time can be difficult to manage
  • Social situations can also be problematic due to the constant, subtle exchange of social and emotional information

“ADHD is caused by poor parental discipline”

  • ADHD is not caused by bad parenting.
  • Parenting techniques can affect symptoms.
  • Try to stay positive
  • Establish structure and stick to it
  • Set clear expectations and rules
  • Encourage healthy lifestyles – eating, exercise, sleep
  • Teach how to make friends
  • Learn to anticipate potentially explosive situations
  • Be a good role model

“If after an evaluation, a child does not receive the ADHD diagnosis, he/she doesn’t need help”

  • ADHD is diagnosed on a continuum
  • A child may not always show symptoms of ADHD, especially in an unfamiliar setting
  • Monitoring symptoms and behaviors in multiple settings is critical
  • Counseling, home management tools, school behavior management recommendations, social skills interventions, and help with managing homework flow, organization and planning can be helpful

“All you need are medications to treat ADHD”

  • Medications often curb symptoms
    • They help children focus and be less hyperactive
  • Typically a combination of treatments are the most effective way to treat ADHD
    • Behavioral therapy
    • Notes/reminders to prevent self from forgetting tasks
    • Academic help

“Medicine for ADHD will make a person seem drugged”

  • Properly adjusted medicine for ADHD sharpens a person’s focus and increases his or her ability to control behavior
  • Sedation or personality changes are not side effects of the medication

“ADHD stimulant medication leads to addiction”

  • No evidence
  • Research has shown that people with ADHD who take medication tend to have lower rates of substance abuse than people with ADHD who don’t take the medication
  • A long-term study looked at childhood & early teen use of stimulants and early adulthood use of drugs/alcohol/nicotine in males with ADHD and showed no increase or decrease in substance use.

“Treatment for ADHD will cure it. The goal is to get off medication as soon as possible”

  • ADHD is a chronic condition that changes over time
  • Depending on the circumstances and demands as a person matures, the need for continuing medication or other treatments varies
  • TRUE GOAL = function well at stage of development in all environments

Teen Stress: On the Rise, But So Are Their Remedies

Teenagers are experiencing stress like never before. Their stress tends to be over many things, including schoolwork, parents, relationships and friends. Often, it feels overwhelming, even paralyzing, and it can lead to isolation, withdrawal, academic decline, aggression and depression.

Perhaps our competitive and technologically advanced society is a part of the problem. The pressure applied by educators, and the message transmitted to students, as well as to their parents, that they must perform to ever rising levels of excellence in order to get into that mythical “good school” following graduation, leaves them in a state of fear, or even panic, that anything less will assure a life of failure and lost opportunity.

Today’s world of social media is another source of stress. Peer acceptance is incredibly important in the teenager’s life. To fit in is everything. But, with Facebook, Instagram, Twitter and other forms of social media, a teen’s personal information, reputation and social valuation can be tossed to and fro, at internet speed, by anyone with an electronic device and an opinion.

Teens are dealing with increasing responsibilities and heightened expectations, but have not learned how to cope with the stress that accompanies them. Teens learn Algebra and trigonometry, but they do not learn coping strategies. They learn Language Arts and European History, but they don’t know how to deal with their emotions or to problem solve in stressful situations.

As a result, some schools around the country are beginning to realize there is a real need for stress reduction training to be offered in the school setting. In these schools, teens are being taught various tools to help them deal better with stress. Studies show that the practice of meditation, yoga and mindfulness can be quite effective in treating stress. CBT and DBT therapies are specific forms of psychotherapy that teach the re-assessment of one’s thoughts about a stressful situation, about one’s self and one’s life, which in turn changes one’s feelings and emotional state, to that of greater calm, hope and optimism, and allows for more effective problem solving.

Our challenge is to help our teens to deal better with the stresses in their lives. Stress reduction begins with a healthy lifestyle, with adequate sleep and healthy nutrition. It also requires a balance of relaxation and fun to offset the rigors of school and social pressures. But, if they also learn some stress reduction tools that they can apply when life begins to feel a bit overwhelming, these tools will serve them well, through their teenage years and well beyond.

Children Who Can’t Pay Attention/ADHD

Parents are distressed when they receive a note from school saying that their child won’t listen to the teacher or causes trouble in class. One possible reason for this kind of behavior is Attention Deficit/Hyperactivity Disorder (ADHD).

Even though the child with ADHD often wants to be a good student, the impulsive behavior and difficulty paying attention in class frequently interferes and causes problems. Teachers, parents, and friends know that the child is misbehaving or different but they may not be able to tell exactly what is wrong.

Any child may show inattention, distractibility, impulsivity, or hyperactivity at times, but the child with ADHD shows these symptoms and behaviors more frequently and severely than other children of the same age or developmental level. ADHD occurs in 3-5% of school age children. ADHD must begin before the age of seven and it can continue into adulthood. ADHD runs in families with about 25% of biological parents also having this medical condition.

A child with ADHD often shows some of the following:

  • trouble paying attention
  • inattention to details and makes careless mistakes
  • easily distracted
  • loses school supplies, forgets to turn in homework
  • trouble finishing class work and homework
  • trouble listening
  • trouble following multiple adult commands
  • blurts out answers
  • impatience
  • fidgets or squirms
  • leaves seat and runs about or climbs excessively
  • seems “on the go”
  • talks too much and has difficulty playing quietly
  • interrupts or intrudes on others

A child presenting with ADHD symptoms should have a comprehensive evaluation. Parents should ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist, who can diagnose and treat this medical condition. A child with ADHD may also have other psychiatric disorders such as conduct disorder, anxiety disorder, depressive disorder, or bipolar disorder. These children may also have learning disabilities.

Without proper treatment, the child may fall behind in schoolwork, and friendships may suffer. The child experiences more failure than success and is criticized by teachers and family who do not recognize a health problem.

Research clearly demonstrates that medication can help improve attention, focus, goal directed behavior, and organizational skills. Medications most likely to be helpful include the stimulants (various methylphenidate and amphetamine preparations) and the non-stimulant, atomoxetine. Other medications such as guanfacine, clonidine, and some antidepressants may also be helpful.

Other treatment approaches may include cognitive-behavioral therapy, social skills training, parent education, and modifications to the child’s education program. Behavioral therapy can help a child control aggression, modulate social behavior, and be more productive. Cognitive therapy can help a child build self-esteem, reduce negative thoughts, and improve problem-solving skills. Parents can learn management skills such as issuing instructions one-step at a time rather than issuing multiple requests at once. Education modifications can address ADHD symptoms along with any coexisting learning disabilities.

A child who is diagnosed with ADHD and treated appropriately can have a productive and successful life.

Re-printed with Permission from American Academy of Child & Adolesccent Psychiatry