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Brittany Schulman

Brittany Schulman, Psy.D – Consult The Expert On ADHD

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For this month’s Consult The Expert interview, I spoke with Brittany Schulman, Psy.D. She is a licensed clinical psychologist here at the Center and has a special interest in the diagnosis and treatment of Attention Deficit/Hyperactivity Disorder (ADHD).

Most of us have heard about ADHD, but may have only a vague understanding of the condition, so I asked Dr. Schulman to tell us what ADHD encompasses.

“ADHD is a neurodevelopmental disorder that first occurs in childhood,” she answered. “Research has shown that there is a difference in the brain chemistry of people with ADHD, with one of the main brain areas affected being the frontal lobe and specifically, the prefrontal cortex. The prefrontal cortex controls our executive functioning which includes impulsivity, planning, problem solving, and emotional flexibility and regulation. “

“A good analogy for understanding what happens in those with weaknesses in executive functioning is to imagine the prefrontal cortex as the conductor in an orchestra. If the conductor is off on the directions they give to the musicians, the orchestra suffers and doesn’t work in sync. In the same way, a child can have high cognitive skills, but if the prefrontal cortex isn’t regulating these other areas, the result is frustration and behavioral challenges.”

“ADHD is very genetic and we know it runs in families,” she continued. “In fact, between 20 – 35 percent of diagnosed children also have a parent with the disorder. ADHD is more common in boys and is typically first seen in elementary school, when it is often identified as inattention. Difficulty sitting still becomes less visible in ‘tweens and teens, but then we tend to see more restlessness or inability to control impulses.”

So, Is It ADD Or ADHD?

I asked if ADHD is the same as ADD and also why we don’t hear much about ADD anymore.

“Years ago, we had Attention Deficit Disorder (ADD) and there was also ADHD,” she said. “As research has evolved, the most recent version of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) categorized the two diagnoses under the same umbrella, but with different presenting characteristics. As a result, they’ve been combined and are officially recognized as ADHD today, but with three subtypes. These subtypes are ADHD with predominantly inattentive presentation, ADHD with predominantly hyperactive/impulsive presentation, and ADHD, with a combined presentation.”

Dr. Schulman acknowledges that these similar-yet-distinct terms can seem confusing at first, so she broke down the subtypes a little further. “For a child to be diagnosed with predominantly inattentive ADHD, they must meet six criteria in the inattentive category, which includes behaviors like being forgetful, losing things, or frequently wandering off-task. Maybe they fail to pay attention or to sustain it. They may have trouble organizing tasks or may avoid tasks that require a more sustained mental effort.”

“On the other hand, if a child falls into the hyperactive/impulsive category, they must meet at least six criteria from that subtype, such as being restless or squirming a lot, often leaving their seat in class, talking excessively or blurting out answers, interrupting frequently or having trouble engaging in quiet activities. Adults must meet five of the symptoms instead of six to be diagnosed, and children who are diagnosed with a combined presentation must have at least six symptoms each from both categories.”

How Is ADHD Diagnosed?

I asked her what steps are taken to make a diagnosis.

“First, the individual must have displayed some of the ADHD indicators before age 12. Symptoms typically start in the toddler years,” she explained, “but some criteria aren’t generally recognized until age 7 and above – in the early elementary school years when the child is less attentive in class.”

“To be diagnosed, the symptoms have to have lasted at least 6 months and have to have occurred in more than one setting – for example, both at home and at school. This is because being in different settings can change the child’s responses.”

As for the process of diagnosis, Dr. Schulman told me that a comprehensive evaluation is vital.

“Diagnosis is based on a thorough history and observation of the child, plus information obtained from parents, teachers, and others. We observe the child in various settings because kids can often pay better attention in a one-to-one setting or with peers or in play, but may have a hard time in school where more concentration is required. By watching how the child acts in a structured versus unstructured setting, the psychologist can see behavior differences. Another important factor in the assessment of ADHD is looking at the individual’s executive functioning skills, as those diagnosed with ADHD typically have difficulties in executive functioning.”

Is It ADHD Or Something Else?

I asked Dr. Schulman if ADHD can mimic other conditions. “On a surface level, yes,” she answered. “Bipolar disorder, for example, can have impulsive activity, as well as poor concentration and poor impulse control. So, we tend to look at the person’s mood episodes, when they occur, and how long they typically last. For the most part, we do not see the level of mood instability seen in mood disorders in young children with ADHD. Furthermore, the onset of bipolar disorders is typically later than the onset of ADHD.

“Autism is another condition that can co-occur with ADHD, however, a child on the spectrum will often have social differences, in that they may prefer to play alone or have trouble making eye contact. The child with ADHD may misbehave because of impulsivity, but an autistic child may misbehave because there were changes in the expected plan for the day, which is unrelated to an impulsive response.”

“That said, ADHD can also occur in conjunction with other disorders,” she continued. “So, when we are diagnosing a child, it’s important to be extremely thorough with our evaluations and observations to be sure that it is ADHD and not another comorbidity.”

Has Covid Affected ADHD Diagnoses?

I was surprised when Dr. Schulman mentioned that the Covid pandemic has increased the number of children who show signs of ADHD.

“We have had many, many kids come in to our clinic recently, who never had symptoms before the pandemic, but do now. In children, the symptoms of anxiety and depression can look similar to ADHD. A child may be inattentive because they are depressed or because they are worried and ruminating, so we definitely take a deep look to decide which condition is causing the problem.”

“A simplistic way of distinguishing between the two is by understanding that a child with ADHD-related inattentiveness is more easily distracted by new things. In depression, the inattentiveness shows up as having more difficulty concentrating.”

What Happens After An ADHD Diagnosis?

“Depending on what we feel will benefit the child most, they may go on medication after diagnosis. We now have not only the traditional stimulant medications, but also two non-stimulant medications for children who do not have optimal results on stimulants or for those who have side effects due to the stimulants. Medications alone don’t usually help the child entirely, though,” she said.

“Typically they must undergo some form of behavior therapy, as well. Depending on their challenge areas, the child might get executive function coaching, or behavior therapy teaching certain skills. Another important piece is implementing school interventions and putting accommodations in place so the school day is less challenging for them.”

“We will also likely recommend parent training,” Dr. Schulman said. “This is so the parent learns why the child acts the way they do, along with how to work with the child more successfully and to gain more effective ways to help the child’s behavior. For example, most kids don’t want to act defiantly, but sometimes they can only hold it together long enough to get through the school day and then lose it at home, so parent training teaches the parent how to redirect the child’s behavior.”

I asked if a child could be treated for ADHD without the use of medications. “It’s possible, depending on the case and the child,” she answered. “Some kids can possibly do better with just behavior modification. Some people can do better just by learning the skills they need to be successful.”

I had read that an ADHD diagnosis in a child is only valid for five years, so I asked Dr. Schulman why that is. “Actually, we try to have a client come back within two to three years to get an updated diagnosis for school requirements,” she answered. “Also, symptoms can manifest in different ways as a child ages and matures, so this requested intervention can help to reduce any concerns these changes bring up.”

Final Thoughts

When asked if there was one final thing she would like people to understand about ADHD, Dr. Schulman was quick to emphasize that a professional diagnosis is needed before someone labels themselves as having the disorder.

“A lot goes into an ADHD diagnosis and it’s important to have a complete evaluation. You cannot diagnose yourself!” she emphasized. “Some social media laypersons have become popular lately by taking one or two pieces or symptoms and telling you that you may have ADHD, but that is a simplistic way to see the condition. If you are concerned about the possibility of having ADHD, you owe it to yourself to go through an in-depth evaluation to be sure.”

Need More Information?

If you or someone you love has questions or would like further information about ADHD or other mental health concerns, the professionals at The Children’s Center for Psychiatry, Psychology, & Related Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-223-6568.

About Brittany Schulman, Psy.D.

Dr. Brittany Schulman is a licensed clinical psychologist who provides assessment and therapy services to children, adolescents, and adults. Although she specializes in providing evaluations for individuals presenting with an array of concerns, she has a keen interest in anxiety and anxiety-related disorders. During her clinical training, she completed a rotation providing therapy services to individuals with a variety of anxiety disorders including generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, hoarding disorder and specific phobias. Dr. Brittany is known for her ability to be personable, warm, and empathetic towards her clients while creating an environment where they feel comfortable expressing their challenges. In therapy, Dr. Brittany generally works from a cognitive behavioral approach, incorporating mindfulness and ACT techniques into her practice, but tailors each therapy session to every client’s individual needs.

Dr. Brittany completed her doctoral degree in Clinical Psychology at Nova Southeastern University in 2019. She received double bachelor’s degrees with honors in Psychology and Sociology from Florida State University. Dr. Brittany completed her doctoral internship at NSU’s Psychology Services Center specializing in school-related comprehensive psychological evaluations. During her training, Dr. Brittany provided services for individuals presenting with a variety of developmental, behavioral, and emotional challenges including attention and executive functioning, anxiety, depression, and autism spectrum disorders. She has worked in both outpatient and private practice settings. Dr. Brittany completed her post-doctoral residency at Child Provider Specialists in Weston, FL, conducting comprehensive psychoeducational and psychological evaluations.

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Post-Pandemic Social Anxiety: How To Deal With Social Anxiety After Covid

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My colleagues and I have noticed an increase in anxiety and anxiety-related disorders over the past two years. This is likely because during times of strife, people typically feel apprehensive. However, since we are returning to more normal lives, many people have been caught off-guard to realize how uncomfortable they now are in social situations – especially if they were never fearful before.

People who found it hard to socialize before Covid are now finding that they’re grateful for the time they spent alone. They were able to stay in their comfort zones and avoid difficult situations. But now that everything is changing, they’re worried about venturing out again.

Others had no social concerns before Covid came on the scene, but now find they do. Since we have been socially distant for quite awhile, it makes sense that social anxiety is now present in so many people. Strict distancing measures were necessary during the pandemic. They helped us feel protected and stay safe. But they have also made it harder to let go and start interacting socially now.

Many people experienced a lot of trauma, fear, and uncertainty during the pandemic. They learned to associate social situations with getting sick. As a result, they now feel very vulnerable around other people and those feelings will be hard to shake as the pandemic moves into the endemic stage.

Is It Normal That I Feel Anxious After The Pandemic?

Social anxiety can involve feeling that others are judging or disapproving of you. You might sweat, have a racing heart, feel difficulty concentrating, and feel sick to your stomach when you think about going out socially. For many people, any of these symptoms or a combination of them can occur even when they just think about going out.

Superficial differences also contribute to social anxiety, especially now. People who don’t do the same as others when it comes to social distancing protocols may feel judged. This is because some people have already dropped Covid protocols, but others will continue to hold tightly to safety measures.

An example of this would be if someone went to a social event without wearing a mask. They might feel anxious around people who are wearing masks. This person might become nauseous or break out in a cold sweat when interacting with a masked person – even if they are surrounded by family or friends.

They may also have problems concentrating or focusing on conversations. Feeling confident in themselves could seem next to impossible when they are convinced that everyone is staring at them.

If these reactions happen often or their anxiety is really strong, the person might start to avoid social situations altogether. This can bring short-term relief, but if they do this for a long time, they might start to feel disconnected and isolated from other people.

Simple Steps To Start Living Again After Covid

Some of us will fill our social calendars in the coming months while others will struggle emotionally with the current relaxed social standards.

If you are feeling anxious about resuming a social life, you don’t accept every invitation, especially at the beginning. Remember that this is a time of transition for everyone. Be choosy about which social gatherings you attend, limit yourself to the ones that enforce similar personal protocols, and give yourself a breather in between events.

If possible, try to take things slowly when returning to the office, as well. Perhaps you can start by going in one day a week for the first week or two, and then slowly increase your number of days from there. This will help you adjust better and not feel overwhelmed.

If you are not able to ease back into the workplace, reach out to others for support. Chances are, many people you know have been in the office for a few weeks by now. Ask them how they coped when they first went back. What did they do to make their return easier? Surely, they found each successive work day easier to manage as they got used to their old routine.

Be kind to yourself when you are transitioning back to work. Remember that the anxiety you feel before returning is usually worse than the reality. Make sure you eat well, relax, and do something you enjoy before returning. Most importantly, try to avoid anything that might stress you out and make your first few days back difficult.

It is also important to stay positive and optimistic, even when social interactions are difficult or uncomfortable. With time and patience, it is possible to manage social anxiety during this difficult period and eventually regain your normal routine.

If you are still struggling with social anxiety after trying these strategies, don’t hesitate to seek professional help. A therapist or counselor can help you explore other options and develop a treatment plan that works for you.

How To Get Help For Social Anxiety In Children

Our warm and welcoming Children’s Center offers a wide range of clinical, therapeutic, educational and supportive services specifically for children ages two through twenty two. Additionally, our facility is the South Florida regional clinic for the National Social Anxiety Center (NSAC).

For more information about how our child psychologist can help your child with their social anxiety or other mental health needs, contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

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Jamie Levine, Psy.D – Consult The Expert On Psychoeducational Evaluations For Children

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In our first Consult The Expert article for March, we had the opportunity to speak with one of our clinical psychologists, Dr. Jamie Levine. One of her areas of specialization is working with children who have school-related difficulties.

“So many components can negatively impact a child’s learning and performance in a school setting,” she explained. “These could be things like attention concerns, learning challenges, developmental difficulties, social or emotional concerns, and even challenges within the home environment. Sometimes there is an overlap of these aspects, as well.”

When working with a child who is challenged, Dr. Levine often recommends a psychoeducational evaluation. “This type of evaluation is very comprehensive,” she says. “It looks at many areas that could be affecting the child’s ability to learn.”

Indeed, an evaluation can reveal some of the challenges that can impact learning, including:

  • Cognitive (ie: what underlies the child’s learning concerns? How does the child approach new problems?)
  • IQ
  • Academic ability (reading level, math, writing)
  • Task abilities (for example: ability to focus, attention to a task, impulsivity)
  • Language skills
  • Memory

“A psychoeducational evaluation helps me understand what is at play for that particular child, so I can provide the correct support or interventions for their unique situation,” Dr. Levine said.

When Is A Psychoeducational Evaluation Done?

A psychoeducational evaluation may be requested for many reasons. An educator might ask for an evaluation if they notice the child struggling to learn or acting out in the classroom. Maybe the child’s parent wants an evaluation to find out why their child seems to be having a hard time staying focused or is resisting going to school. Perhaps the pediatrician picks up on a parent’s frustration when the child won’t sit still or seems overly anxious or fearful.

Whatever the reason for testing, Dr. Levine says the evaluation will help to identify the child’s strengths, along with the areas that are impacting their learning ability. “Once we have the evaluation results, we can make recommendations for how to work on building these strengths and providing interventions for areas of concerns within the classroom or through services outside of school.”

Who Performs A Psychoeducational Evaluation?

A psychoeducational evaluation can be conducted in a school setting or private setting, according to Dr. Levine.  “In a school setting, the testing will likely be completed by a school psychologist. Outside of school, a comprehensive evaluation should be performed by a clinical psychologist who specializes in evaluations.”

But, is there a benefit to having the child evaluated in a private setting versus a school setting?

Although a school can evaluate a child, Dr. Levine discussed the benefits of testing in a private setting. “When a teacher picks up on concerns, the school may do some testing, but it may be limited in scope,” she says. “It can take a while to start the evaluation process. Often, schools try to provide some intervention first and testing waits until they see the results of the interventions.”

She also points out that, while schools may use some similar evaluation measures to the assessments that are used in the clinic, school testing typically does not provide a specific diagnosis. “The child can be struggling academically, but a school usually won’t diagnose something like ADHD or a specific learning disorder. Because of this, they may provide accommodation and support for the child’s challenges, but not interventions or treatment. If the parent wants an understanding of the specific diagnosis, so a targeted treatment plan can be implemented, it is helpful to have the child evaluated in a private setting, such The Children’s Center.”

How Long Does A Psychoeducational Evaluation Take?

“These evaluations are extremely comprehensive,” Dr. Levine says.  “I tailor the testing to each child, based on his or her concerns. When I do an evaluation, I first meet with the parents for about 1.5 hours to get background information about the child. After I have this preliminary information, there are typically three additional appointments with the child for 2-3 hours each.”

Who Sees The Evaluation Results?

“In a private setting, the evaluation results are discussed with the parents,” Dr. Levine said. “The parents are also provided with a full write up of the results, any diagnosis, and our recommendations. We also encourage the parent to share these results with the school so the child can be supported with any accommodations and interventions that may be needed. We are always happy to collaborate with the child’s school.”

Parents may be concerned about a child being “labeled” if the results are shared with the school, but Dr. Levine says there are many benefits to doing so. “Sharing test results can help with teacher understanding of the child and empathy, as well as accommodation that can benefit the child. Also, we can recommend strategies that teachers can use to support the child in the classroom.”

A better understanding of a child’s strengths and weaknesses is also helpful for the parents and child. Children often recognize that they are facing challenges and could possibly label themselves as “stupid” or “dumb” if they don’t have an understanding of their diagnosis.

Once the child knows the reason behind their frustrations, however, it can be liberating. Instead of feeling negative about themselves, the child can address any concerns and work to improve them. “Really,” Dr. Levine pointed out, “the benefits of testing outweigh the risk of labeling by having the knowledge of what is impacting the child.”

If Your Child Is Struggling…

…the child and clinical psychologists at The Center For Anxiety Disorders can help. For more information or to inquire about a psychoeducational evaluation, contact us or call us today at 561-223-6568.

About Jamie Levine, Psy.D – Clinical Psychologist

Dr. Jamie Levine is a licensed clinical psychologist who specializes in the treatment of anxiety disorders, mood disorders, relationship difficulties, adjustment to life transitions, and ADHD. She uses a collaborative therapeutic approach to create a safe, supportive, and open environment to facilitate growth and change. She integrates a variety of therapeutic approaches, including cognitive-behavioral therapy (CBT), psychodynamic, interpersonal, and solution-focused therapy.

Dr. Levine graduated from Emory University with a bachelor’s degree in Psychology. She earned her doctorate degree in Clinical and School Psychology from Pace University in New York City. Dr. Levine received training at Columbia University Medical Center/ New York-Presbyterian Hospital where she provided evidence-based treatment and conducted neuropsychological assessments. She also provided therapy services to individuals across the lifespan at Nova Southeastern University’s Psychology Services Center and Pace University’s outpatient mental health center.

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It’s All About Trauma

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“Now is the winter of our discontent,” a speech by Shakespeare in Richard III says it all as we muddle through the beginnings of a third year of this pandemic. This horrendous experience has taken a toll on all of us. David Brooks in his op-ed in the NY Times (America Is Falling Apart at the Seams, NYT, Jan 14, 2022) comments on the current misbehavior of Americans. He describes the angry outbursts noted on commercial airline flights, in retail establishments, as reflected in highway fatalities, suicides and homicide rates or even evident in members of Congress. He identifies the usual suspects including the pandemic, politics, media, Facebook/Twitter/Instagram et al.

I think that we would all agree with his observations and many, if no most of us identify with the frustrations, irritability and general crankiness that has resulted from the Covid 19 “gift that keeps on giving”. However, I believe that there is more to the story than what is stated above. It is my contention that the entire populace has been traumatized by the unfortunate saga that we have endured. The unremitting psychological stress has resulted in anger, frustration intolerance, depression, hopelessness, out-of- character risk taking, impulsivity, substance use and a general loss of trust.

Psychotrauma had historically been defined by mental health professionals as exposure to a near death experience. The individual has had to have the intense fear of believing that they would die. Classic examples include severe car crashes, plane crashes, muggings, heart attacks and combat. It also includes abusive life experiences whether they be sexual, physical or emotional. One end of the spectrum is represented by Post Traumatic Stress Disorder (PTSD) which for a long time was what we considered the primary trauma syndrome. The criteria for PTSD had been extraordinarily specific and if one did not meet the necessary components found in column A, column B or C there was no pathological trauma condition we labeled PTSD. We now know better and have thankfully expanded the concept to include direct or indirect exposure to traumatic events. For example, the 9/11 tragedy created PTSD not only in those who fled the twin towers but individuals in the area around the twin towers who witnessed the catastrophe. Other examples include family members who watch a loved one succumb in an ICU and subsequently develop PTSD themselves.

Recent research has extended our understanding of traumatic exposure and trauma syndromes. We now understand that trauma does not have to develop in response to an identified traumatic event but that persistent exposure to a lower level of abuse can traumatize the victim. It has been my clinical experience that day after day exposure to an abusive parent whether it be emotional, sexual or physical can be more pathologic than an isolated horrendously abusive event. In addition, we now recognize that there is an entity called complex trauma. Complex trauma signifies the presence of repeated traumatic experiences over time. For example, the individual who has had a number of abusive relationships can develop a complex trauma syndrome.

So let us now return to our pandemic journey. We have all been exposed to multi-media’s painfully graphic reporting of our experiences throughout this pandemic. We have witnessed people on ventilators, grieving loved ones, heard of entire families wiped out by this virus, learned of the need for lung transplantation and observed our loved ones suffering uncertainties as to whether or not they would end up on a respirator or in an ICU. To make matters worse, the presence of a virus that none of our professionals had experience with before it infected the world led to much uncertainty, misinformation, changing recommendations from these health experts. We have observed angry politicians blaming governmental health agencies with harming the public. We even heard that Dr.Anthony Fauci had to endure credible death threats to himself and his family. All of this uncertainty and confusion naturally leads to a sense of helplessness and fear. We are human beings and as such have became a captive audience to the two plus years of stress and traumatic life experiences. Not too different from the child who has to survive an abusive family system. This person spends each day not knowing what the outcome will be or having the means to protect oneself.

So I believe it is safe to say that based on the multitude and varied pandemic-related traumatic experiences all of us have had to deal with there comes a point where the fabric of our humanity begins to shred. We need to understand this level of suffering and recognize that as this pandemic winds down we will all need time to heal. And remember, you are not alone.

Let Us Help

Trauma can be difficult to understand and even more so, to handle on your own or for your child to handle. Whether your challenges are recent or from years ago, the professionals at The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida can help. For more information, contact us or call us today at (561) 223-6568.

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Jerome Siegmeister MD

Jerome Siegmeister, MD, MaED – Consult The Expert On How Virtual Schooling Is Affecting Children

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Dr. Jerome Siegmeister, the Center’s newest clinician, is an expert on the psychiatric concerns of children and adolescents. A former high school teacher, he is in a unique position to help children through mental health resources that are tailored specifically for kids or teens in need.

Since the pandemic, parents and children have had to adapt quickly as schools shut down for periods of time. Virtual classes have become routine. An online learning environment can be difficult enough for kids, without being isolated from their peers. “Covid has really devastated these kids,” Dr. Siegmeister says. “Though some children can do well in this environment, virtual learning causes an issue for most.”

“The virtual learning modality is basically a lecture modality,” he continues. “What do you and I do when listening to a lecture? If we are honest, most of us listen to it in the background while doing other things, so we miss a lot of the information.”

“Children are no different,” he says. “From a developmental standpoint, it is clearly better for kids to attend in-person schooling, but the unfortunate reality is that we need to be worried about public health, as well. In many cases, virtual learning is all we have right now, but this isn’t workable for many kids.”

Aside from the loss of knowledge, the pandemic has affected our children’s social interactions. “Virtual classes have their place because kids need to be learning, one way or another, but it comes at a price,” he explains. “It is very obvious that our children’s socialization has been affected and will be for a long time to come.”

“At this point, we have lost at least eighteen months of socialization,” he says. “Society pushes the idea that we need others to validate us, so kids rely on social acceptance for much of their self-worth. Covid took away much of that.”

Even older teenagers are being tested by this new normal. “The pandemic has been very hard for kids who are transitioning to college,” he notes. “Life is drastically different for them, especially if they are having to do their first year of college virtually. They are missing out on the social aspects that help them adjust to college life.”

Nevertheless, Dr. Siegmeister is optimistic. For most kids who are struggling, “it isn’t too hard to stabilize them and they can do really well,” he says. “Counseling and working one on one with kids will make things better in the majority of cases.”

When it comes to mental health concerns, Dr. Siegmeister believes in treating the whole person. He often uses a team approach and commonly involves the child’s parents, teachers, or college faculty. He also may combine two or more treatment methods for children whose needs that are not being met by one single approach. For example, he may use cognitive behavior therapy along with medical treatments if the child has an underlying psychiatric concern.

And, although a pandemic silver lining would seem unlikely, Dr. Siegmester says there is one. “Mental health is often swept under the rug,” he says, “but depression is now pretty pervasive in both children and adults and people recognize this. In fact, many so called “sick days” happen because the person is depressed and really needs to take a mental health day. The positive outcome from covid is that people are now much more aware of anxiety and depression because they’ve experienced it themselves. This means it has become much more acceptable to seek help.”

About Jerome Siegmesiter, MD, MaED. (Child And Adolescent Psychiatry / General Psychiatry)

Jerome Siegmeister, MD, MaED, is a South Florida Native. He has worked with clients of all ages, and believes that the whole person needs to be treated. Consequently, he evaluates all aspects of the situation, from medical to situational, to determine the best initial course. He has a background in both individual and group therapies, employing supportive, behavioral, and insight oriented approaches, as appropriate to best fit his client’s needs, as well as comfort with medical treatment of any underlying conditions that might manifest psychiatrically. He has significant experience in all forms of psychiatric issues, including mood symptoms, thought disorders, anxiety, phobias, attention deficits, behavioral issues, insomnia, compulsive disorders, emotional lability, substance abuse, and trauma.

Dr. Siegmeister graduated with his Bachelor’s from Florida International University, after which he spent a number of years teaching, and obtained a Masters from the University of South Florida in Career and Technical Education/Adult Education. Upon deciding to pursue medicine, he initially completed a Post Baccalaureate Pre-Medical Certificate program at the University of Miami, and then obtained his MD from the University of Miami Miller School of Medicine, staying there afterwards for his specialty training in Psychiatry, followed by a fellowship in Child and Adolescent Psychiatry, where he served as Chief Fellow, and was awarded with a Research Distinction. After training, he has worked providing Emergency care, with additional work in inpatient settings, both in mental health and as a consultant to medical units at multiple hospitals. He is currently Board Certified by the American Board of Psychiatry and Neurology in both general Psychiatry, and Child and Adolescent Psychiatry, and by the National Board of Physicians and Surgeons in Psychiatry.

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Children Can Now Get The Covid Vaccine, But Some Parents Are Anxious

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As we have watched the Covid-19 pandemic unfold, the focus has been on vaccines being the key to getting us safely through the crisis and back to our normal lives. When they first came out early this year, adults were clamoring to get the jab. Since then, many parents have eagerly awaited FDA approval for their kids to be eligible as well, especially since mask-wearing is optional in some school districts.

Despite recent approval for children as young as 5, however, some parents are wary of the lack of long-term data on the vaccine, as well as some of the potential side effects. This has resulted in anxiety over whether it is better for their kids to risk getting the virus or the jab.

Why Are Parents Vaccine Hesitant?

Getting a child vaccinated against Covid-19 can be a very difficult decision for parents. Clearly, they want to protect their kids, but on the other hand, many are deeply concerned about the potential for long-term vaccine side effects. According to the Orlando Sentinel, “In a survey of 1,000 parents, 57% said they were willing to vaccinate their young kids against COVID-19, meaning more than 40% were not…”

The same referenced survey, done by the Centers for Disease Control (CDC) and their partners, “found many of those who are hesitant were worried about long- and short-term side effects, said they want to wait to see if the vaccine is safe or said they did not trust it.”

Parents are also concerned about the reports of myocarditis and pericarditis (inflammation involving parts of the heart) in teens and young adults (mostly males) who have gotten the vaccine. Johns Hopkins Medicine says, however, that “myocarditis is a much more common complication of having COVID-19 than from getting vaccinated.”

Even parents who want to vaccinate their children may be waiting until the vaccine comes to their kid’s pediatrician. They feel that putting their child through a mass vaccination setting with hundreds of people and an unfamiliar provider might be too traumatic.

 What Do The Experts Say About Covid And Children?

The American Academy of Pediatrics reports that children are at a lower risk of getting severely ill or dying of Covid, however it does also note that more than 5 million U. S. children had tested positive for the virus as of mid-September, 2021. Even though the vast majority have recovered, some of those children have become Covid long-haulers.

In addition, getting the virus naturally has been known to cause severe disease in some cases. The CDC has published information about the link between Covid and Multisystem inflammatory syndrome in children (MIS-C). They state that MIS-C “is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.”

How To Talk To Children About Getting The Covid Vaccine

If you are getting your child vaccinated against Covid, remember that kids take their cues from adults. If you are very worried about this vaccine, you will likely convey that fear to your child, unconsciously or otherwise. If you or your child are reluctant or afraid of the vaccine, talk to your child’s pediatrician for reassurance. They can provide you with statistics about the virus in kids and about the vaccine side effects, as well as give you their professional opinion about the jab.

Then, if your child is old enough, we recommend first asking them how they feel about getting the Covid vaccine. Are they scared? Eager? What are their concerns? Explain why you feel it is (or isn’t) a good idea for them to get the vaccine. You can also compare getting the Covid jab with the other vaccines they have gotten in the past, and how they have protected them from childhood diseases.

Lastly, talk to your child about the potential side effects that can be expected from getting the jab. They might run a slight fever, have a sore arm for a couple of days, or feel yucky for a day or two. But those possible side effects are small in comparison to being able to do more things, such as being able to get together with family over the holidays and enjoying a more pre-pandemic lifestyle.

Your child will also be reassured to know that you will stay with them while the get the vaccine and that you will be there for them if they don’t feel well afterwards.

Let Us Help

If you or your child are very fearful about the pandemic or are showing signs of anxiety or depression, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

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Why It Is Important To Set Limits For Children

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Parents often avoid setting limits for their kids because they think doing so will upset the child. Not setting boundaries, however, can lead to an unhappy child who doesn’t know how cope with difficult feelings, which is an essential life skill.

By setting limits on what they can and cannot do, you are giving your child a chance to practice managing their emotions. When they are sad or feel overwhelmed, allowing them to figure out how to handle the situation on their own (with limited parental intervention) helps them grow into strong people who can face the challenges of adulthood.

Why Rules Are Important For A Child

Discipline is the process of shaping a child’s behavior in order to raise emotionally mature adults. It teaches self-control, core family values, and consideration for others’ needs. It also instills assertiveness without being aggressive or hostile. Learning what is expected of them in terms of behavior gives a child an understanding that their actions have an effect on those around them. Through discipline, children become emotionally mature, considerate people who can tolerate discomfort when necessary.

Contrary to the negative connotations of discipline, such as “punishment” or “controlling” the child, boundaries and limits actually help children feel more secure. Adherence to rules, expectations, and routines make things predictable. They reduce confusion and uncertainty, which in turn decreases anxiety. If a child is able to get the parent to change their mind or relax the rules on a regular basis, it threatens their security because they learn they have more power than the adult.

How To Set Limits With Your Child

Through the years, there has been much controversy about appropriate ways to discipline children. Oftentimes, parents want to set boundaries but they have no idea how to go about it. How to do they balance the freedom to be a child with restrictions so their kids learn self-discipline?

The first step is that you, the adult, need to know what behaviors you personally value and what you believe in. Is it important to you to be respected? To be loyal? To be honest? If, for example, you value honesty and you don’t discipline your child for lying to you, then you’ve taught them it is okay to lie to get what they want.

Next, you need to decide what values you want to uphold as a family. Is it important to eat dinner together as a family? To get homework done before watching television or playing games on the computer? To have a scheduled quiet time to wind down in the evening? These values may change as your children grow and mature, but setting down family values will help your child function respectfully within the family unit.

Along the way you have to also do the things you are asking your child to do. Children learn from example and if you ask them to do one thing, but you do another, it’s confusing to them. In addition, both parents should agree as much as possible on the limits and boundaries they are setting for their children. Without this agreement, kids will quickly learn to play one parent against the other to get what they want.

Consistency is the key to discipline. Sometimes the hardest thing to do is to be consistent and keep to those limits, though. This is especially true when you are worn out from work, not feeling well, or are under pressure. If you occasionally let your child off the hook, don’t be too hard on yourself. The trick is to keep it from becoming a habit.

Setting Age Appropriate Limits For Your Child

Obviously, your child’s limits and boundaries will change as they age, but the following are our age appropriate recommendations:

  • Infants (birth to 12 months) – Limits for this age basically revolve around setting schedules. This includes setting a nap or bedtime schedule, a feeding schedule, and a playtime schedule.
  • Early toddlers (one year to two years) – Children need to explore at this age, so you need to be somewhat tolerant. Limits include keeping the child safe, limiting aggression (hitting, biting, etc), and keeping possessions safe from toddler destruction. During this age, toddlers do not understand verbal explanations, so simply say, “no” and remove or redirect the child away from what they are doing and towards a more suitable activity.
  • Late toddlers (two years to three years) – This is the time for temper tantrums as the child leans there are limits to what they can do or play with. Kids this age don’t understand how to change their behavior based on your directions or anger, so it is better to remove or redirect them. If the child throws a tantrum, remove them from the activity until they calm down.
  • School-age (eight to eleven years) – Children at this age rely on rules and order to make sense out of their environment. They think in absolutes and enjoy predictability, which means security to them. Despite what they will tell you, they want rules and need structure in their lives. Without guidance, there is uncertainty, which is very scary to children in this age group.
  • Adolescents (13 years to 18 years) – Adolescents are typically caught between the demands of their peers and parents. They may abandon family and parental values as they become more involved with friends. They may challenge limits without apology. They may also distance themselves from family members. As tough as it can be sometimes, the best thing a parent can do is to avoid lecturing or belittling an adolescent. Stay available to talk when the child needs to and continue to require them to adhere to the rules you’ve set down. Making a “contract” for behavior between you and your teen can be helpful, as well.

When you know where to draw the line, it will be easier to maintain a healthy relationship with your child. By defining what they can and cannot do, parents are able keep from disciplining emotionally, which allows their child to develop the skills they will need to be self-aware, independent and happy as they mature.

We Can Help

If you are concerned about setting and enforcing limits for your children, we can help. For more information, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

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Handling Anxiety About Going Back To School During The Pandemic – 2021

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School is starting up for the 2021 – 2022 education year and most districts are returning to in-person learning. While some kids and parents deal with anxieties during any given school year, COVID-19 and the Delta variant are still very much in the news, which has added more uncertainty for everyone.

Virtual learning took place this past school year and many kids may now find it difficult to adjust to being away from the safety of their homes. Those children who already suffered with pre-existing depression or anxiety might have an even more difficult time adjusting than normal. Even well-adjusted children may experience undue stress.

What Signs Of Stress Can Be Observed In Children During The COVID-19 Pandemic?

Generally speaking, kids are resilient. Most children will manage this transition just fine with help and support from their parents. Those who already struggled with anxiety or emotional problems before the pandemic might need additional assistance though; it’s important that you keep a watchful eye on them because they could be at risk for increased depression or anxiety.

Signs of stress to watch for include (by age group):

Preschool age – Children in this age group may be more whiny or clingy than usual. They may have problems sleeping, have nightmares, or become afraid of the dark when they weren’t before. You may also find that they withdraw or their behavior may regress. They may lose their appetite or become picky eaters.

Ages 5 – 9 – Children who are in elementary school also may be clingier. They may be angrier or more irritable and cry or otherwise resist to going to school. They might have nightmares and sleep problems, along with poor concentration. In addition, your child may stop showing interest in friends or activities they used to enjoy.

Ages 10 – 19 – Adolescent children may show everything from sleeping and eating disturbances to agitation or arguments with others. They may have physical complaints such as headaches or stomach aches. They may also exhibit poor concentration or engage in some type of delinquent behavior.

Back To School Anxiety For Parents During The Pandemic

The pandemic has made in-person schooling nerve-wracking for some parents. They are apprehensive about their child’s health and well being, but they also have to try to reassure their child that school will be safe for them. It can feel like a balancing act between supporting your kid while also telling him/her to be sure to wear their mask or stay socially distant from others. It’s all very stressful!

Dealing with stress and fear is a learned skill. Children need to learn how to react when faced with difficult situations. They benefit from having someone show them how to deal with worrisome situations without panicking and who can find positive ways of handling their fears.

To keep them safe in school, ensure your child knows how to wear a mask correctly (it should cover their nose and mouth). Teach them to carry and use hand sanitizer and how to wash their hands (wash for the time it takes to sing the birthday song). Make sure they understand how social distancing helps to reduce the spread of the virus. Teach them to cough into their elbow or a tissue and to throw a used Kleenex away immediately.

Lastly, protect your child’s health by encouraging them to eat well, get plenty of sleep and exercise daily. This will help build their immunity so they can fight off illness in the future.

Supporting Students Return To School During Covid

Going back to a physical classroom is a transition and, as with any big change, it will take time for your child to settle into a new routine. Expect there to be times of distress and upset for the first couple of weeks. This is particularly true during the pandemic when kids are having to adjust to so many new things.

Your child may be overly tired during the first few weeks of school. They might act out more often or be more emotional than usual. If there are major shifts from their normal behavior, however, such as refusing to take part in things they usually enjoy or withdrawing from friends, this could signal problems. You should consider seeking help if this behavior doesn’t go away after a couple of weeks.

Also, make the time to sit down and talk to your kids during the first few weeks of school. Encourage them to tell you what’s bothering them; acknowledge their concerns even if you don’t agree with them. When you know what is concerning your child, work with them to come up with a plan for addressing it. What can you, as the parent, do to help? Is there something the child can do? Does the school need to get involved?

Self care is vital for maintaining your own physical, emotional and mental well being. One way to do this is by engaging in calming activities such as yoga or crafting. What were some ways that made you feel better before the pandemic? Use what worked for you during previous times of stress, be it reading, exercising, listening to music, etc. Even just taking a small break can help you mentally regroup and make you feel less overwhelmed. Take a short walk around the block or indulge in some deep breathing exercises. You don’t have to take a long break – even just taking 15 minutes here and there will help.

We Are Here For You

If you are concerned that your child is struggling with anxiety or depression when they go back to school, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

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How Will The Delta Variant Affect Going Back To School?

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The coronavirus pandemic has affected our world in so many ways and we aren’t in the clear yet, despite vaccine availability. The virus continues to evolve, which is especially concerning if you’ll have children attending in-person classes this fall; as children head back to school, they do so under the specter of the Delta variant of Covid-19.

The pandemic response is deeply impacting our children. Virtual learning has become common, so kids who will be attending traditional classrooms this year may not have done so during the last school year. As a result, they may need to cope with new rules and regulations designed specifically for the safety of all students. In addition, extra-curricular programs like sports or clubs may be closed due to fears of exposure. It is also likely our children will have less of a chance to gather with friends at school as teachers and administrators attempt to maintain social distancing.

What Is The New Delta Variant Of Covid

The Delta variant, originating in India and first making news around the middle of June, has caused concern among health experts as cases become more prevalent.

The new strain is spreading more rapidly than COVID-19 strains before it. In fact, the Centers for Disease Control and Prevention reports that the Delta variant is now responsible for more than 80% of new cases in the country.

Delta is different from prior variants because it is not only much more contagious, it also grows more rapidly in the respiratory tract and is making people sicker faster.

Are Children At Lower Risk Of COVID-19 Than Adults?

Originally, Covid-19 was affecting mostly older adults. Children were less vulnerable to the virus. That is no longer the case. Because the Delta variant is so transmissible and vaccines aren’t yet available for children younger than 12, kids are now at a higher risk of contracting Covid than they have been in the past.

Research, however, has proven that vaccination is an effective way to protect against COVID-19. For this reason, it’s safest for all children 12 years of age and older to be vaccinated from the disease. However, unvaccinated children are also safe in the classroom as long as they take precautions such like masking and limiting social contact during their time at school.

Delta Variant Symptoms In Children

The symptoms of the Delta variant are basically the same as those we all know by heart now: fever, coughing, shortness of breath, headache, and the possible loss of taste and / or smell. The problem with the Delta variant is the fact that it has a greater chance of becoming serious – especially among the unvaccinated.

Delta Variant Back To School Safety Tips

After vaccination (which may be available to kids younger than 12 by the end of 2021), wearing a mask is the most important thing your children can do in the classroom. This goes for school staff and teachers, as well – regardless of vaccine status.

Although schools will try to keep kids socially distant, this can be a challenge when they are indoors. It may be hard for them to physically distance themselves from friends after possibly spending the last year separated from them through virtual learning. In addition, the fact that they have to stay socially distant can create anxiety for some kids who may fear that others will get sick and pass the virus on to them.

We know that children naturally crowd together during more social times, such as at lunchtime. While recent studies have shown that we only need to be three feet apart (instead of six), you will still want to teach your child the importance of wearing their masks at all times, except when actively eating or drinking. Also, remind your kids to wash their hands often during the school day and teach them to cover their sneezes and coughs with their elbow.

At the same time, try to avoid making your children feel overly cautious to the point that they are afraid to do anything. While it’s good to make them aware of their part in helping to stop the virus’ spread, it can be upsetting and frustrating for them to be constantly on guard and worrying about everything little thing they do.

Lastly, it’s important to make sure your child’s school has good policies in place to limit infection. Since masking provides extra protection against the virus, there should be a universal masking requirement in the school. In addition, the school should take steps to immediately quarantine students or staff who show signs of being symptomatic.

To support your child’s mental health during this school year, remember to keep to a routine. Doing so gives kids a sense that things are under control. Also be sure to foster an environment in which your children know that you are willing to discuss any worries or fears they might be facing.

We Are Here For You

If you are concerned that your child is struggling emotionally or showing signs of pandemic anxiety or depression, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

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What We Have Learned From 2021

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No one can deny that 2021 has been a momentous year. It has had a mixture of the good, the bad and the ugly for sure. It has at times been frightening, confusing, comforting and educational. We have witnessed a very unusual presidential election, a subsequent denial by some of the validity of the election and an unheard of polarization of our peers and lawmakers. Most critically, we have endured a gift that keeps on giving; the novel coronavirus that has killed countless people world-wide and more fellow Americans than we would have ever anticipated. We have had to learn the meaning of the word epidemiology as it relates to health and wellness. Unfortunately, we now know explicitly what a spike protein is and looks like. More than ever before we have been influenced (for good and bad) by the internet and social media. Although we have been witness to conspiracy theories in the past, but this year has certainly been a boon time for them.

So it is important for us to sit back and take stock of the emotional and psychological impact of these events.   A major fallout has been the confusion over what is fact and what is fiction. We have seen the major news networks disagreeing on many important issues. Who to believe? Proponents of networks that broadcast their unique take on the news may be diametrically opposite of the proponents of the “other” networks. To avoid getting into trouble I will leave the network names blank, but I am sure you know what I am talking about. There was a time in the 1950s and 1960s when veteran newscasters like Walter Cronkite, Huntley and Brinkley, Douglas Edwards educated us nightly on national and world events. Marshall McLuhan’s “the medium is the message” conveyed the power and influence of the media. Somewhere during the subsequent decades all this has changed. It became apparent to television and radio that communicating news is basically a form of entertainment. Like most popular entertainment venues it becomes essential to be able to sell the programs to the masses. Media outlets have always been for profit businesses (exceptions being Public Radio and Public Television) but it seems that profitability became linked to the entertainment value of their shows. Newscasters and news commentators became the entertainers that we see today. Walter Cronkite would not succeed as a newscaster in 2021.

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