All Posts Tagged: cognitive behavioral therapy

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Social Anxiety In Toddlers

Toddlerhood is defined as the age range from 12 to 36 months. During this period, a child’s emotional and cognitive development grows by leaps and bounds, as do their social skills. This also coincides with the time when children are likely to go into a daycare environment or head off to preschool. As they engage more often with other children and adults, it may also be the stage when a toddler’s social fears begin to emerge.

Just as with adults, some children are comfortable with social interactions while others may not be. Each group of kids will have the social butterfly as well as the “shy” child who quietly observes and doesn’t interact as much. It is one thing to be shy, however, and another to be intensely fearful and anxious in a social setting. Because we know it can show up early in life, a toddler who shows such strong reactions in a social environment is often regarded as having social anxiety.

What causes social anxiety in toddlers?

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Boy with heart shaped paper

Autism Spectrum Disorder: ASD And Anxiety In Children

Autism Spectrum Disorder (ASD) comes with a variety of challenges. For many children, it can mean issues with compulsiveness and repetitive behaviors, learning and social deficits, and a resistance to change. ASD also can manifest with various emotional difficulties – although not specifically linked, we know that ASD and anxiety frequently appear together in children.

Kids with ASD and anxiety can have physical symptoms (example: racing heart or a stomach ache) or their anxiety may also show up in the form of rituals that can help calm them (for instance: shredding paper). Because many autistic children are either non-verbal or have trouble communicating, an outward display of anxiety may be their only way of telling you that they are distressed.

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Intensive Outpatient Therapy Helps Children With Depression And Anxiety

We all have our anxious moments or times when we are depressed. It’s normal to feel these emotions when we are in stressful situations. In children, anxiety and depression can manifest differently than it does in adults. We often see more dramatic signs of frustration, irritability, and even anger. Kids might be restless, withdraw socially, or lose their appetite.

Usually these conditions go away once conditions improve. For many children, however, anxiety or depression can drag on and on. It may get worse over time and might even start to interfere with their school life, social relationships, or daily activities. When it reaches this point, it is likely that the child has an anxiety or mood disorder that requires treatment from a child psychologist. Be assured that these conditions are highly treatable.

Traditionally, children who are undergoing treatment for anxiety or depression will see their therapist once or twice a week for 30-60 minute sessions. These sessions often continue for three to four months, but could go on much longer depending on the severity of the child’s disorder. However, a relatively new concept in psychotherapy, called intensive outpatient therapy, is showing promise for helping kids get better faster.

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School Violence and PTSD

School Violence and PTSD

This week marks the first anniversary of the school shootings at the Marjory Stoneman Douglas High School in Parkland, FL. On February 14, 2018, 17 students and teachers were senselessly killed and 14 more were wounded.

Reflecting on the tragedy and remembering those who lost their lives will no doubt bring up strong emotions in some children. Even those who weren’t personally connected to the event may feel sad and re-experience a sense of loss. For some kids, the anniversary may even trigger or worsen symptoms of post-traumatic stress disorder (PTSD).

Distressing events such as school shootings can affect children just like they can affect adults. In fact, it’s normal for kids to go through a range of emotions when they hear about a tragedy – they might have trouble sleeping or may express fear, sadness, anger, and grief.

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Dermatillomania (Skin Picking Disorder)

While it’s simply “being human” to occasionally pick at your skin, at calluses, or at the cuticles on your fingers, when a person obsessively self-grooms, it could be a sign of dermatillomania or excoriation disorder. In layman’s terms, this is a skin picking disorder. The condition is a form of obsessive-compulsive disorder and is one of a group of body-focused repetitive behaviors (BFRB). Dermatillomania damages skin and is characterized by compulsively picking, touching, pulling, rubbing, digging into, scratching, or even biting at one’s own skin as a way to get rid of perceived skin irregularities.

Signs of Dermatillomania

Research shows that anywhere between 2% and 5% of people compulsively pick at their skin. Females make up about 75% of those who are diagnosed with excoriation disorder. Skin picking can begin at any age, but commonly shows up in adolescence or at the onset of puberty. The condition made come and go over time, and the location the person picks at may change, but the disorder is generally chronic.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) signs and symptoms of dermatillomania include:

  • Skin picking that results in visible lesions, skin damage, scars and possibly disfigurement
  • The person has made repeated, unsuccessful attempts to stop picking at their skin
  • The symptoms cause clinically significant distress or impairment
  • The symptoms are not caused by a medical or dermatologic condition or by a substance (example: opiate withdrawal)
  • The signs and symptoms are not better explained by another psychiatric disorder

Picking at the skin can cause anxiety, depression and embarrassment in those who have dermatillomania. They may attempt to cover their skin lesions with makeup or clothing and may avoid situations in which their condition may be discovered. This can lead to isolation and emotional distress, which can increase the risk of having a mood or anxiety disorder in addition to their dermatillomania. Another complication can be the need for medical care because it isn’t uncommon for the person to get a skin infection, open wound, or scars from picking too much.

Treatment for Skin Picking Disorder

It is thought that fewer than one in five people will seek treatment for excoriation disorder, however Cognitive Behavioral Therapy (CBT) is very helpful for those who do. CBT helps patients identify the negative or inaccurate thoughts, feelings and behaviors that have become problematic and teaches them how to challenge and change their reaction to them.

While the main therapy for dermatillomania is behavioral therapy, medication is sometimes used to reduce the feelings that lead to compulsive skin picking. Although psychiatric medications have limited success, there are some people who benefit from temporary use of them, particularly if they have a concurrent condition, such as anxiety or depression. Additionally, some skin medications can help the underlying condition (such as acne) that causes the individual to pick at their skin.

As a family member, it can be difficult to be supportive of a person with dermatillomania or other BFRBs. The behavior can strain relationships with friends and family. Remember to communicate with patience and empathy and remain calm when talking to the person. If you feel overwhelmed, join a support group or explore the resources in self-help groups or in books on the subject.

Get Help for Dermatillomania

For more information about how a child psychologist at the Children’s Center can help your child overcome skin picking, 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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PANDAS Disease Following a Strep Throat Infection

PANDAS Disease Following a Strep Throat Infection

PANDAS disease (short for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) isn’t a true disease. Instead, it is a rare disorder that can occur in children following a strep throat infection. With PANDAS strep, the child’s body sets up an immune response to the invading streptococcus bacteria, but ends up attacking the child’s own tissues in addition to the strep bacteria. The result is inflammation within the brain, and the dramatic onset of OCD (obsessive-compulsive disorder), tics, intense anxiety and other debilitating symptoms.

The hallmark of PANDAS is that these new symptoms and disorders appear or worsen very suddenly. In fact, parents say they come “out of the blue” or that their child changes “overnight.” Keep in mind that children who have been previously diagnosed with OCD or tics will always have their good days and their bad days, so an upswing in symptoms does not necessarily mean the child has PANDAS disease just because they’ve had a throat infection. With PANDAS disease, however, the child’s tics or OCD would flare up dramatically and continue to stay elevated anywhere from several weeks to several months.

PANDAS Symptoms

The National Institute of Mental Health (NIMH) reports that the diagnosis of PANDAS syndrome is strictly a clinical diagnosis. There are no lab tests that can diagnose the PANDAS disorder. Additionally, the diagnosis of PANDAS is controversial, so some clinicians either don’t understand it or may overlook the syndrome.

Currently, the only way to determine whether a child has PANDAS disease is to look at the clinical features of the illness, so health care providers use diagnostic criteria to make a PANDAS diagnosis.

NIMH’s diagnostic criteria for PANDAS:

  • Presence of obsessive-compulsive disorder and/or a tic disorder
  • Pediatric onset of symptoms (age 3 years to puberty)
  • Episodic course of symptom severity (see information below)
  • Association with group A Beta-hemolytic streptococcal infection (a positive throat culture for strep or history of scarlet fever)
  • Association with neurological abnormalities (physical hyperactivity, or unusual, jerky movements that are not in the child’s control)
  • Very abrupt onset or worsening of symptoms

If the symptoms have been present for more than a week, blood tests may be done to document a preceding streptococcal infection.

Additionally, the NIMH reports that children with PANDAS often experience one or more of the following symptoms in conjunction with their OCD and/or tics:

  • ADHD symptoms (hyperactivity, inattention, fidgety)
  • Separation anxiety (child is “clingy” and has difficulty separating from his/her caregivers; for example, the child may not want to be in a different room in the house from his or her parents)
  • Mood changes, such as irritability, sadness, emotional lability (tendency to laugh or cry unexpectedly at what might seem the wrong moment)
  • Trouble sleeping, night-time bed-wetting, day-time frequent urination or both
  • Changes in motor skills (e.g. changes in handwriting)
  • Joint pains

PANDAS Disease Risk Factors

The risk factors for PANDAS syndrome are:

  • A family history of rheumatic fever
  • The child’s mother has a personal history of an autoimmune disease
  • The child has a history of recurrent group A streptococcal infections
  • PANDAS is more common in males
  • It is more common in prepubescent children

PANDAS Syndrome Treatment

Treatment for PANDAS disorder is medication to treat the strep throat infection (*Tip: Sterilize or replace toothbrushes during and following the antibiotics treatment, to make sure that the child isn’t re-infected with strep.). Treatment also includes medications to control the neuropsychological symptoms and Cognitive Behavioral Therapy (CBT) to help with the child’s OCD or ADHD symptoms.

Research does not indicate long-term penicillin use to try to prevent recurrence of PANDAS disorder. Current information suggests the syndrome is caused by the antibodies produced by the child’s body in response to the streptococcus bacteria, not by the actual bacteria itself. Research also does not support the removal of the child’s tonsils strictly to prevent recurrence of PANDAS disease.

Have Questions about PANDAS Disease?

If you are concerned your child may have PANDAS syndrome after a strep throat infection, we can help. Our Children’s Center focuses specifically on offering a variety of clinical, therapeutic, educational and supportive services to children ages two through twenty two in a warm and welcoming environment.

To learn more, 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 Does Virtual Reality Therapy Help School Anxiety?

How Does Virtual Reality Therapy Help School Anxiety?

The start of a new school year is just around the corner. While many children are happy about heading back to the classroom and seeing their friends again, for some kids, a new school year embodies fear and school anxiety. But, what if your child could go into their classroom in a non-threatening way, interact with a new teacher and classmates, and learn effective methods for coping with the anxiety-inducing situations they dread in school? With virtual reality therapy, they can do just that.

This innovative treatment is emerging as a high-tech solution that lets kids challenge their fears in a safe, realistic environment, but in a way that gives them control. VR therapy can be used across age groups and can be adjusted to the child’s developmental age as they mature.

Additionally, this therapy can be tailored to vary the complexity of school phobia scenarios. For example, one child might be apprehensive about taking exams, while another dreads interaction with their peers. Both can be helped with virtual reality therapy, which is a combination of cognitive behavioral therapy (CBT) and in-vivo exposure therapy, but with a state of the art twist.

For example, if your child has a high level of test anxiety, as studies indicate anywhere from 15% to 25% of students do, virtual reality therapy will allow them to mimic test taking in a non- or less stressful environment (just like in-vivo exposure does) in order to overcome their negative thought patterns (“I always fail tests.”) through cognitive behavioral therapy. In a test-taking scenario, the virtual reality simulated distractions and stresses of taking exams would be minimal to start with, and then slowly be increased as the child learns to process and adjust to them. At the end of the therapy, the child will be able to face an exam with reduced or minimal fear.

What Happens During Virtual Reality Therapy?

Because most kids relate so well to video games, virtual reality exposure therapy seamlessly integrates treatment with real-world interface. It helps children retrain their brain so they have a defense against problems like meeting a new peer or being bullied, which makes them feel more comfortable about situations at school. VR therapy has also been successful in teaching or improving social cognitive skills and emotion recognition in high-functioning autistic children.

When kids go through VR therapy, they first learn coping skills to help them stay calm under a stressful circumstance. Once they are comfortable with these strategies, they continue on to virtual reality therapy, where they view computer-generated environments and use an avatar to experience interactions with adults and other kids.

As you can see in this Today Show video, the teens have the freedom to pause or review and repeat their avatar’s interaction with others inside the setting until they feel confident about the situation. A therapist listens in on the virtual reality session and offers feedback and coaching to help the child navigate the difficulties that have created their school refusal.

Studies have shown that virtual reality therapy actually “rewires” the brain so that the areas relating to sociability and attention are heightened. This leads to increased awareness and understanding of social cues, enhanced perception of the give and take in conversations, and more control when faced with real-life school issues. In studies done after kids have gone through virtual reality exposure therapy, scans have shown that the regions in the brain associated with social skills and those sections that exchange information during social interactions are heightened.

This interactive and visually stimulating approach to treating school anxiety delivers a dynamic platform that can simulate an unlimited number of phobia situations. By targeting a child’s specific fears, it provides meaningful close-to-life scenarios with immediate feedback, which greatly enhances the child’s ability to cope under stress.

Did You Know?

Our Children’s Center focuses specifically on offering a variety of clinical, therapeutic, educational and supportive services to children ages two through twenty two in a warm and welcoming environment.

For more information about how our child psychologist team can use virtual reality therapy for your child’s school refusal, 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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Child Anxiety – Divorce Therapy for Children

Child Anxiety – Divorce Therapy for Children

Going through a divorce is stressful enough for the couple involved, but when children are added to the mix, it can bring a youngster’s fears to the forefront and trigger a cycle of child anxiety. The youth suddenly finds his or her world fracturing apart as the family divides into separate households. And, often the child has to adjust to living in a new home or going to a new school in addition to coping with their parent’s split.

Among other things, a divorce can increase a child’s aggression, bring up issues of separation anxiety, and negatively impact either (or both) the social and school performances of the youngster. It also increases the stress levels in children who already suffer from anxiety issues or mood disorders and can initiate anxiety-related concerns in children who do not normally have them.

Helping Children Cope with Divorce

When parents divorce, their children often react by showing:

  • Regressive behaviors (bedwetting, tantrums, thumb sucking, refusing to go to bed)
  • Rebellious behaviors (anger, disobedience, or (in an older child) disregard for the parents)
  • Increased episodes of crying or whining
  • Feel “sick” when they are healthy or becoming clingy
  • Separation anxiety
  • Blaming themselves for the divorce

The following are some ways that you, as a parent, can help diffuse some of the tension and child anxiety when going through a divorce:

  • Respect your child’s feelings and encourage them to talk to you about their fears. You may not have all the answers, but sometimes just listening and being supportive to your child can be enough.
  • Remember that your child has lost something, too. They have lost their time with one parent when they are with the other parent and, in many cases, have lost their familiar surroundings, peers, and maybe even a beloved pet or best friend.
  • Reassure your child that, no matter what, you love them now and will always love them. Be sure they understand that the divorce was not their fault and that there is nothing they could have done to prevent it.
  • Try to keep the same routines for bedtime, homework, play time, etc. New routines might need to be added (for example: going to the other parent’s house every Friday night), but keeping as close as possible to the same schedule helps children feel secure. It lets them know what to expect.
  • Rituals also create a sense of safety for your child. A family ritual such as “game night” creates an anchor for your child and gives them a sense of familiarity and a way to relate within their new world.

How Divorce Therapy for Children Can Help

Many times children will adjust to the breakup of a marriage after a “settling in” period, but in the case of youngsters who already have some anxiety, therapy might be the answer to helping children cope with divorce.

Divorce therapy for children is usually conducted through Cognitive Behavioral Therapy (CBT). This type of treatment is based on the theory that our thoughts cause our behavior and our resulting feelings – other people do not cause them. By understanding this and learning to modify our reactions, we can influence our emotions in a positive way so we can feel better about things we can not change. Becoming aware of inaccurate or negative thinking allows your child to change to a more positive way of thinking in order to decrease their anxiety.

Need More Information?

Is your child struggling with your divorce? We offer divorce therapy for children in a safe, supportive South Florida environment. For more information, contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida or call us today at 561-223-6568.

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