October is ADHD Awareness Month

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children (8.4 percent), though it also affects many adults (2.5 percent). General or common symptoms of ADHD include: 

  • Inability to stay focused, which can lead to not paying attention
  • Hyperactivity, which means the person is moving their body too much and/or inappropriately for their setting (for example, bouncing up and down during quiet reading time in school)
  • Acting on impulse in any given moment without thought 

ADHD is most often initially identified in school-aged children because the symptoms lead to disruption in the classroom or problems performing schoolwork. ADHD is more common among boys than girls, though the cause of that factor is unknown.

No specific causes of ADHD have been identified, though some evidence suggests that genetics contribute to ADHD. In approximately 75 percent of cases, a relative of someone with ADHD also has the disorder. Other factors that may be linked to ADHD include premature birth; brain injury; or the mother smoking, drinking alcohol or experiencing extreme stress during pregnancy.

What are ADHD symptoms?

Many ADHD symptoms, such as short attention spans, sitting still for extended periods and high activity levels, are common in most younger children. In children with ADHD, though, their heightened activity level and inability to focus are much more noticeable and greater than expected for their age. Their symptoms also cause distress and problems with daily functioning, whether at home, school or with friends.

ADHD symptoms are not due to the child being defiant or hostile or unable to understand and follow instructions or complete a task.

A diagnosis is typically based on symptoms experienced during the previous six months. ADHD is diagnosed as one of three types: 

  1. Inattentive: six (or five for people >17 years old) of these symptoms occur often:
    • Has a hard time staying focused with activities or tasks, such as listening to lectures, participating in conversations or completing long reading
    • May start tasks, but does not follow through or quickly loses focus
    • Seems to not be listening when spoken to (inattentive)
    • Doesn’t pay close attention to details; makes seemingly careless mistakes in school or at work
    • Is easily distracted
    • Difficulty with organizing and managing time; may miss deadlines and turn in messy work
    • Forgets to do regular daily tasks, such as chores or errands; for older teens and adults, examples include grocery shopping, returning phone calls, going to appointments, paying bills
    • Often loses commonly needed daily items or tools, such as a cell phone, car keys, wallet, schoolbooks
    • Avoids or dislikes (more than average) anything requiring a sustained mental effort
  2. Hyperactive/impulsive type – six (or five for people >17 years) of the following symptoms occur often:
    • Always go, go, go
    • Fidgets, taps hands or feet, squirms in a seat
    • Unable to stay seated in the classroom or at work
    • Runs around or even climbs when and where it is inappropriate
    • Has difficulty waiting for their turn
    • Unable to play or do leisure activities quietly
    • Talks too much (others may not get a word in)
    • Interrupts conversations or in class; may not wait to answer before a question has been finished or is not directed at them; may finish other’s sentences
    • Intrudes into other’s activities without being invited; may even take over a task (a symptom more of older teens and adults)
    • Uses other people’s things without asking permission
  3. Combined type

How is ADHD Diagnosed?

No laboratory tests can diagnose ADHD. Diagnosis involves a medical evaluation to rule out other possible medical problems. Information is gathered from parents, teachers, the patient and possibly others. Checklists also help make a diagnosis. 

What do I do if I notice symptoms in my child?

Though teachers and school staff can provide information about resources or tools to help evaluate behavior and learning problems, they cannot diagnose ADHD or make decisions about treatment or administer medication at school without an official diagnosis. If you are noticing symptoms and/or your child’s teacher brings up behavioral issues, you should start with making an appointment with your child’s pediatrician.

Students diagnosed with ADHD that impairs their learning may qualify for special education under the Individuals with Disabilities Education Act or for a Section 504 plan (for children who do not require special education) under the Rehabilitation Act of 1973. These benefits allow children with ADHD to receive instruction on study skills, behavioral modification techniques, changes to their classroom setup (for example, a yoga ball “chair” they can bounce on), alternative teaching techniques and a modified curriculum.

What should I do if I notice symptoms in myself or my adult partner?

Many adults with ADHD are unaware they have the disorder. Often, an adult partner or other close person who starts to recognize symptoms. If you recognize symptoms in either yourself or your partner, make an appointment with your primary care physician. They will be able to help begin the diagnosis process and provide you with referrals and resources. 

The diagnosis procedure is the same as for children, but with the use of adult rating scales or checklists. Adults with ADHD are typically treated with medication, psychotherapy or a combination of both. Behavioral modification strategies can also help, such as finding ways to minimize distractions and increase your daily structure and organizational skills. Involving immediate family members can also be helpful.

What can I do to raise awareness about ADHD?

The Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) organization recommends the following to raise awareness. 

  • Print out the NRC fact sheets on ADHD and share them with your friends and community.
  • Find additional resources on how you can increase awareness about ADHD and share them with others.
  • Host an event promoting ADHD Awareness Month or local resources for ADHD and mental health. You may want to partner with a local organization. During the COVID-19 pandemic, a virtual event is the safest choice.
  • Use your social media platforms to help dispel myths about ADHD and provide facts and other helpful information.
  • Speak out. Whether commenting on a social media post, having a conversation with family or friends, volunteering at your child’s school, contacting your local news media, or even your elected officials—use your voice to foster positive education and change. Let everyone know what it is like to live with ADHD and refer them to evidence-based information they can use to help spread awareness. 

Awareness is education. The more you educate others, the more benefit you promote to those living with ADHD, especially for those who are unaware they or their child might have the disorder.

ADHD is a serious health condition that can create much adversity in a person’s life. With identification, proper treatment and support, they can be successful and have fulfilling lives. The ADHD, Mood & Behavior Center is always available to help you, whether providing resources or telepsychiatry visits with an online psychiatrist or online therapist. Contact us with questions and concerns or to make an appointment.

How to Prepare Your Child to Go Back to School Online

As the COVID-19 pandemic continues to spread, many schools have opted to function completely online or in a hybrid format, with some days of in-person learning and the rest online. This format is new to most schools, parents and children. This new way of educating children is daunting enough for parents, but especially challenging for parents of children with attention-deficit/hyperactivity disorder (ADHD).

Now, children must face an extended period of no socialization with their friends and peers, canceled sports, clubs and other activities, and being stuck at home for months without any assurance of a date that they can get back to “normal.” They may be having to face a new normal that looks different than the comfort of their past routines, except that no vision of what this new normal will be is available.

 

Impact of COVID-19 on Children’s Lives

Having our regular routine disrupted unsettles all of us. Anxiety, mood, ability to learn and more are all affected. When a scary pandemic is the cause, our emotional and mental reactions are even more heightened. Frustration and confusion are common. Just having the news on can cause anxiety in an adult, but for children, it may cause even more confusion and fear. 

Take care of your family and your community. Stopping the spread of COVID-19 is the bottom line. Follow whatever guidelines are being made, from reputable sources like the American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC). In those areas of COVID-19 “hot spots,” stay home if you can and keep your children at home unless necessary to leave. If you have to go out, wear a mask, be sure your children properly wear a mask, and stay at least six feet away from other people. For most kids, unfortunately, that means not getting together in person with friends for now as well as canceled sports, clubs and other social activities.

 

Challenges of Uncertainty for Children, Especially Children with ADHD

Children mentally process things differently than adults. Uncertainty is abstract for kids. Be realistic but also reassuring about the pandemic and how it personally affects them and your family. Encourage discussion often and questions. Children often need straightforward answers to their questions first. Avoid oversharing and flooding with facts. Then wait and see what further questions your responses elicit. Answer those in the same way—brief and to the point, honest, and reassuring.

 

Using Mindfulness to Normalize Mood

Though you can’t change the pandemic and school situation, you can work on keeping your children mentally settled. Trying mindfulness may help normalize their daily lives. Mindfulness builds resilience during stressful and difficult times by giving deliberate attention to how we relate to what is happening in our lives each moment. 

The level to which you can employ mindfulness with children depends on age. Teenagers are likely to be able to fully grasp the concept and practice on their own. Younger children may need more planting of seeds of mindfulness, where you normalize the experience of awareness. Then the practice of mindfulness grows over time. 

If your child is receptive to the idea, set aside a few minutes a day to start for a mindfulness practice. Don’t force it as this may make your child resist the idea completely. Find a guided practice online if needed, or a book or app. Make it a family activity and schedule mindfulness “breaks” during the day and evening.

For kids (and parents), focus on keeping mood or emotions close to neutral. Think of mood on a scale of one to 10. A settled, calm, “normalized” mood is a five. You and your child will slide a bit over and a bit under and that’s normal. What you want to avoid is a huge swing one way or the other, closer or at a one or a 10. Big swings can lead to heightened emotions and distraction.

There is nothing you need to expect to happen. The purpose is to gently guide children back to their present awareness when they get distracted. Keep mindfulness breaks unforced and fun, and let the practice develop at its own pace. 

 

Schedule, Schedule, Schedule

Create structure and routine. Both adults and children are happier with a daily schedule. For families, post it somewhere for everyone to see, whether on a piece of paper or using an online family calendar. Posting a hard copy will be easier for younger children who do not have access to an online calendar or know how to use one.

  1. Exercise. Our mental health is connected to our physical routines. Exercise daily, even if your children complain. Regular exercise has a positive outcome on mood, energy level, learning and more. 
  2. Sleep. A consistent routine of wake up and bedtimes encourages better sleep.
  3. Eat healthy. Don’t use food as bribes or to keep kids happy. Stick with a balanced diet. 
  4. Limit screen time. The more screen time kids have the more wound up and agitated children get. No limits lead to arguing with you over putting a device away. Set a total amount of time or a set time period during the day and stick to it. 
  5. Keep up with relationships. One place screen time is very useful and helpful is in sustaining relationships with friends and family. Support is there for you and children when you reach out regularly during this challenging time.
  6. Create a chore schedule to keep to reduce the stress of a messy home, keep a routine and teach responsibility.
  7. Schedule and prioritize everything else if you wish, like family time, outdoor time, hobbies, art, etc.

 

Adjusting to Virtual School 

Almost all kids can get off-track or miss details without strong adult supervision and guidance. Expect your child will need additional home supervision and guidance while working online. The success of online learning in previously in-person learning environments is unknown, and some to many teachers have little experience in this area. There will be a learning curve for students, parents and teachers. Try not to form preconceived ideas of how much progress will be made during this initial learning curve. 

If your child has ADHD, remember he or she has difficulty with self-management and lag behind the non-ADHD norm. Children with ADHD need more structure and direct involvement than their peers to complete online work. Inform your child’s teacher and work with your child’s teachers and administrators and counselors to keep an open line of communication. Your child may have an Individual Education Plan (IEP). Contact the school to see how this will impact your child with online learning. Ask for support early and often, and if your child is still struggling, ask your school’s counselor or administrator for advice on what to try next or additional resources.

Your school will likely send out a supply list. If you don’t receive one, ask the teacher. Even though they are learning at home, your child will need many items for the virtual learning to support his or her learning and classroom lessons.

Find out what virtual classroom platform your school will be using. Get comfortable with using it so you can help your child when needed. If your school is not offering tutorials and your child needs one, you can find many online. Many schools are using Zoom, which can record class sessions for students who are unable to attend due to family obligations or other scheduling conflicts or who wish or need to review the material again at a later time.

Ideally, students should have access to learning anytime, anywhere. Teachers of younger students may also work with families to determine the specific needs of their children, including built-in time for completing assignments away from the computer that may differ from what is given in the daily schedules.

 

Synchronous and Asynchronous Learning

Synchronous learning takes place in real-time with a group and the teacher either live in person or live via videoconferencing, such as Zoom meetings.

Positives:

  • Frequent live interaction with teachers and peers
  • Questions can be answered quickly
  • Feedback is immediate
  • Closest format achievable in a virtual setting to replicate in-person learning

Challenges:

  • Less flexible schedule; students need to be online at specific times to learn
  • Feedback given in a large group setting may not be specific to each child

Asynchronous learning is anytime, anywhere learning that provides students with structured and engaging independent practice and possibly pre-recorded lessons. Examples include independent reading, video lessons, online assignments and discussion boards.

Positives:

  • Students choose the time and place that they learn
  • Students have more time to review and reflect on their learning
  • Students can follow the learning pathway in whatever way meets their personal learning needs
  • Many traditional learning strategies such as group discussions, individual student conferences and assessments are accessible in an online format 

Challenges:

  • Students need a degree of self-motivation or adult support to stay on task
  • Presents additional challenges for ADHD children and their parents
  • Lack of live interaction with others

 

Setting up Your Home School Environment

  • Set aside a time for school. This may be dictated by your school except for offline learning activities (asynchronous learning), which you will have to schedule.
  • Create a dedicated school work area for your child with a minimum of distraction. Take away phones, turn off TVs and music and shut down anything else that is distracting. 
  • At the start of the day, check school assignments posted online. Make a to-do list from it. Play time must wait until that list is complete.
  • Supervise schoolwork. You are a parent, not a teacher, but most kids need an adult around to stay efficient. Kids have immature self-management skills by definition and ADHD kids have even less self-management skills and computers are distracting to even adults.
  • Use timers if necessary. Children may find it easier to focus and behave if they know when a break is due. If not already defined by the teacher, define for your child what he or she is to do at the start of each work period. For example, for the next 20 minutes, do only this math sheet. Make the timer visible to them.
  • End each school day by having your child clean and organize his or her work space, just as it would be in school. 
  • Emphasize “recess” daily. Remember the benefits of exercise, as this will help your child learn.
  • Encourage reading to promote academic success. Read with your kids and have them read alone. They can even read aloud to pets. Schedule it each day. 
  • Limit non-school screen time, as mentioned earlier.

 

For middle school and high school students:

  • Focus on behavior management instead of “brain breaks.” When it comes to middle and high schoolers with ADHD, they need help sustaining their motivation and attention versus preventing learning burnout (which is where “brain breaks” come into play in the classroom or live online environment). Getting these students engaged to start with may be the most challenging aspect at home.
  • Choose the best time and place to remove distractions from their environment. Though having a dedicated work space is very helpful, a change of scenery may be useful if they are having trouble staying focused. If it’s nice outside, perhaps a school day outside in fresh air is an option.
  • Allow teens to use electronics (usually their phone) for fun only if they have completed all of their academic tasks for the day. Parents will need to develop a strategy of how they can monitor student performance consistently. Some schools have academic parent “portals” and even text and email reminders of assignments that are due, what is outstanding, what has been turned in and grades. Check if your school uses this extremely helpful tool and sign up.
  • Help your teens plan out their work in advance and use time management strategies. 
  • Dividing their work into smaller chunks is helpful while being sure they are aware of expectations. Then monitor whether it’s completed.
  • Recognize and praise your teens for staying on-task and getting work done. 
  • Refrain from micromanaging or taking over for them. This behavior is tempting for many parents, especially when they become impatient and have their own work to get done. 
  • Do not give in to attempts to get out of work.

 

This school year is going to be challenging for everyone, with extra challenges for children with ADHD and their parents. The ADHD, Mood & Behavior Center is always available to help you, whether providing resources or visits with an online psychiatrist or online therapist. Contact us with questions and concerns or to make an appointment.

Productivity versus Procrastination in the Remote Work Environment

Working from Home

Working from home sounded great at first. The idea of not having to get up early (in theory), wear uncomfortable clothes and shoes, and drink horrible breakroom coffee all day sounded appealing to many former office workers. Now that some – or a lot – of weeks have passed, it hasn’t turned out to be the pajama party you thought it would be. With those perks come distractions: television, your personal phone, social media, kids, errands that are easier to run during the day, household chores to get done. And let’s not forget that fridge and pantry full of snacks. 

If you are struggling to maintain productivity while working remotely, you are not alone. These easy, but effective tips may help:

  • Make a list. Start your day by making a to-do list. Write down everything you need to get done each day or use an electronic list or app. Put everything in order from most important to least important. Checking them off as you finish will also provide you with a sense of accomplishment, which helps fuel motivation to keep working.
  • Reward yourself. Sometimes it helps to keep yourself accountable by putting a reward system in place for yourself. For example, after you complete five tasks from your list, you get to treat yourself to a snack break, one (short) episode of your favorite show on Netflix, reading a chapter of a book, taking a quick power nap, or anything that will keep you motivated to keep going. 
  • Switch it up. Many people recommend having one designated space for your home office. You’ve probably heard not to work in the same room you sleep or watch TV. However, sometimes switching to a more comfortable chair with your laptop and getting a change of scenery is just what your brain needs to stay productive. Weather permitting, take that laptop outside for a bit while you soak up some energy boosting Vitamin D.
  • Get dressed. It doesn’t have to be a suit and tie or a skirt and heels. It doesn’t even necessarily need to be jeans. Just don’t wear what you wore to bed last night when you work. The routine of grooming and getting out of sleepwear is needed to switch your brain from sleep mode to work productivity mode.
  • Take breaks. It’s important to get up and stretch your legs every once in a while. Stand up, drink some water, walk around, grab a snack. It can even be helpful to go outside for a couple minutes and get some fresh air. While there may not be time to take a walk around the whole block, exercise is very beneficial to a brain with ADHD. Also, sitting for extended periods is harmful to your health in many ways.
  • Take your medication. Adult ADHD medication works best when taken regularly. Just because you’re working from home in a familiar and comfortable environment does not mean you can skip a day of taking your medication. 
  • Stick to a routine. Set your alarm and get up at the same time each day and go to bed at the same time each night. Set your work hours. Eat meals and snacks at roughly the same times. Do not perform any chores or errands you would not be able to perform if you were working in an office, which will throw off your entire work routine.

Learning from Home

Online learning for children is another big adjustment many people have had to make. It can seem overwhelming to parents who had to transition from working in an office, uninterrupted by the needs of school and childcare, to working at home while facilitating a learning environment and being constantly interrupted for snack demands to needing help getting back on Zoom. 

To help lighten the load, many of the steps listed above for working from home also apply to learning from home. Also, remember that even though your child is usually spending around seven to eight hours at school, they really don’t need to spend that much time hitting the books at home. They had lots of breaks at school, too. These guidelines can help provide a structure for your day:

  • Kindergarten through second grade only need a maximum of 90 minutes of active curriculum learning per day
  • Grades three through five only need a maximum of 120 minutes per day
  • Grades six through eight need a maximum of 180 minutes per day (30 minutes per class)
  • Grades nine through 12 need a maximum of 270 minutes per day (45 minutes per class)

These timeframes can even be broken down into smaller chunks throughout the day. 

Getting your child involved by giving them new age-appropriate responsibilities will help both you and your child. Some ideas include:

  • On the weekend, make up breakfasts and lunches together for the week and refrigerate or freeze them
  • Teach your child how to safely use the microwave
  • Keep healthy snacks within their reach in the pantry or fridge and set a timer for snack times or limits on the number of snacks
  • Set a reading time for each day. Have your child read out loud to you or a pet if they are younger and need supervision.
  • Plan physical activities in advance and offer a choice to your child to avoid them sitting in front of a screen all day.
  • Keep art supplies on hand and an area set up where your child can get their art on. 
  • Give them an age-appropriate chore list. When they are bored, have them pick a chore. This won’t be their favorite activity, but it will help you keep them occupied while getting housework done. Chores also teach responsibility, even though their standards are likely going to be a lot lower than yours.
  • Bless the mess. Most children are messy. Art is messy. Snacks are messy. Having them dance in the background of your work Zoom meeting is messy. As you watch the mess expand like the blob throughout the day, your frustration level will likely rise in accordance. Instead of yelling, ask your children to behave as if they were at school – would their teacher allow them to leave a mess? Learning to accept some degree of messiness is also key. You’ll need to find the balance that works for your home. Just remember to keep your expectations reasonable for your child’s age and development level.
  • Set boundaries (like no dancing during meetings), but remember kids aren’t always going to follow the rules. They don’t at school either. Talk with your pediatrician or look online for ways to keep them engaged so they have less of a chance to break the rules, and a discipline structure for when they do.

If you are still feeling overwhelmed and having difficulty coping with the new arrangements, schedule a session with a therapist here. Online psychiatrists are also available when needed for your convenience. We are here to help.

Daily Life and Coping with Coronavirus

Life has drastically changed for all of us as a result of the outbreak of coronavirus disease 2019 (COVID-19). At times, all of these changes can result in overwhelming feelings of fear, anxiety, sadness, and also grief. Many of us have experienced many losses over these past four weeks – from the loss of our ability to see our loved ones whenever we wish and the loss of seeing our co-workers in person, to the loss of jobs and the loss of loved ones. Some of us are struggling with the fear of having to go to work at grocery stores, pharmacies, gas stations, hospitals, banks, post offices, etc etc. Those of us who are not essential workers might be struggling with feelings of guilt – of feeling like we’re not doing enough. For parents working from home, it can also be very difficult having to balance your own work responsibilities with your child’s/children’s teaching responsibilities. IT’S A LOT. We, at the ADHD, Mood, & Behavior Center, would like to provide our patients, and anyone else looking for some guidance at this difficult time, with some tips on how to cope with these feelings and how to differentiate between a normal stress response and a response that may require professional help. We are currently offering video appointments with our psychiatrists and therapists for our current patients, as well as anyone else who is looking to initiate care at this time. Please do not hesitate to reach out for help if you need it.

Ways for adults to cope:
• Make sure to take breaks from COVID-19 related news stories or social media stories.
• Try to maintain a daily schedule if your day is now significantly less structured. Have a consistent bedtime and waking time. Have well-balanced and regularly scheduled meals. Exercise regularly.
• Make time to relax and engage in activities you enjoy. Try to get some fresh air when you can, while maintaining social distancing practices.
• Try to maintain social connections using video chats and phone calls. There are many apps now that allow you to have group video chats with friends and family.
• Take space when you feel you need it. Sheltering in place could sometimes result in some of us feeling overstimulated by always having to be around those in our household. It’s important that we all take breaks and get space when we need it.
• Avoid unhelpful coping strategies, like substance use and high-risk behaviors.
• Seek out help from a professional if you are struggling.

Ways for parents to help their children cope:
• Limit the amount of television or news children watch as the news can be frightening and disturbing to them. Instead, find accurate and age-appropriate information and have an honest discussion with them using language they can understand. Answer any of their questions honestly.
• Try to maintain a regular routine, as children feel more secure when there is structure to their day.
• Help facilitate video chats and/or phone calls with their friends and family.
• Make sure children get some fresh air whenever they can, while maintaining social distancing practices. Try to implement some sort of daily physical activity.
• It can be very difficult for children to be stuck inside, especially when the weather is beginning to get nicer. Try to come up with fun activities for the family to engage in. Have game nights. Have children help in meal preparation or menu planning. Encourage them to learn a new skill. There are many free online classes available now.
• Give children choices when possible, as this will give them a sense of control during a time when there is little they can control.
• Give them space when they need it. Sheltering in place could sometimes result in some of us feeling overstimulated by always having to be around those in our household. It’s important that we all take a break and get space when we need it.

Common stress responses in adults:
• Changes in sleep or eating patterns
• Difficulty concentrating
• Changes in energy levels
• Avoidance of activities previously enjoyed

Common stress responses in children and teens:
• Excessive crying, irritability, or acting out
• Regressive behaviors or returning to behaviors they have outgrown such as bedwetting
• Changes in sleep or eating habits
• Poor school performance or avoidance of school related tasks
• Difficulty concentrating
• Avoidance of activities previously enjoyed

When to seek out help:
• If any of these responses persist for longer than 1-2 weeks and/or start to get in the way of an individual’s function, it is likely time to seek out professional help from a psychiatrist or therapist.
• If you or your child becomes preoccupied with or has intrusive thoughts or worries surrounding COVID-19 or death.

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/. *

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