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pink ribbon for breast cancer

Supporting A Child Whose Parent Has Cancer

It is October – a time for pumpkins, Halloween…and breast cancer awareness. The numerous pink ribbons we’ll see this month focus attention on the many women (and men) who are facing a breast cancer diagnosis and treatment. But what about the kids who have a parent or primary caretaker with cancer? For a child, coping with a loved one’s diagnosis can be particularly traumatic.

In this article, we’ll answer your questions about the best ways to discuss a parent’s cancer diagnosis and give you some ideas for supporting a child whose parent has cancer.

Should I Use The Word “Cancer” When Talking To My Kids?

Absolutely – and this applies even to young children. Although your first instinct is to shield your child from a harsh reality, kids need to have open, honest conversations with their parents – no matter the prognosis. Imagine how much more upsetting it could be to know there is something wrong, but not knowing what it is.

When you first talk to your child about a cancer diagnosis, do it privately and be sure to set aside enough time to answer their questions. If you don’t know the answers, let them know that you will do some research and get back to them.

“The most important thing is to communicate openly, honestly and frequently,” say social workers, Wendy Griffith and April Greene, with the M. D. Anderson Cancer Center. “Children tend to think in very concrete terms and like to know what’s going on and what to expect.”

Keep in mind, too, that many people’s first reaction to a cancer diagnosis is the fear that the person will die. Children who are old enough to understand the concept of death will understandably be concerned about that possibility as well, even if they don’t ask.

Ms. Griffith and Ms. Greene recommend using “the 5 C’s” when you discuss a cancer diagnosis with your kids:

  • Say that it’s cancer.
  • Tell your kids, “You didn’t cause it. You can’t catch it. You can’t control it.”
  • Also, tell your kids that you can still spend quality time together, participate in care, still be a kid, have fun, etc.”

How To Talk To Kids About Cancer

When talking to children about cancer, consider the age of the child and keep it simple, but informative. Just lay out the facts:

  • Cancer affects cells – the tiny units that make up all living things. Each person has billions of cells in their body.
  • Usually, cells grow and divide. They are programmed to stop growing after a certain point and to eventually die.
  • In cancer cells, this normal progression gets interrupted and the cells do not stop growing and dividing. They also do not die.
  • These abnormal cells clump together to form a tumor. Tumors can kill the healthy cells around them, which makes the person sick.
  • Doctors aren’t sure why some people get cancer, although some unhealthy habits can make it easier for someone to get cancer. These include things like smoking or using tobacco products and drinking too much alcohol daily.
  • Cancer is not caused by germs and it isn’t contagious. It is okay to hug or kiss someone with cancer.

How To Explain Cancer Treatments To Children

When discussing cancer treatments with a child, gear your explanation to the child’s age level. Young children need to know the basics, while teens and tweens will likely want a more in-depth explanation:

  • Many cancers are treated with surgery. The surgeon will try to remove as much of the cancer as possible and the person will need some time to heal afterward. Let your child know that you can still hug and kiss them, and even play with them, but that they will have to be gentle around the surgery site and you may be limited in what you can do while you are recovering.
  • Often, chemotherapy (chemo) is used for cancer treatment. Chemo is specialized medicine that attacks and kills the cancer cells. Sometimes people take a chemotherapy pill, sometimes the chemo is given intravenously through an IV. Some people have a port put in under their skin to make it easier to get the IV form of chemo. A port is a small device that inserts into a large blood vessel in the chest – it will look like a big “bump” on the chest after it is implanted. The person will need to be careful and protect the port site. The port will be removed after chemo is finished.
  • Some people may get radiation treatment for their cancer. Radiation uses something like an xray to kill the cancer cells.
  • All of these treatments can make the cancer patient very tired and they may have trouble eating, might lose their hair, and may experience nausea and vomiting. This is all temporary and goes away after the treatment is finished.
  • During treatment, the person’s immune system will be very low, so they should stay away from the child if the child has a cold. If the person does get sick, reassure the child that it isn’t their fault – it happened because the cancer treatment has weakened their body’s immune system.
  • After the cancer treatment is finished, the goal is to be in remission, which means there are no signs left of the cancer. The oncologist (cancer doctor) will do tests to see if the cancer is gone. If there is still some remaining, which sometimes happens, the doctor may give the person more chemo or radiation.

The National Cancer Institute has a free, comprehensive guide for teens whose parent or loved one is facing cancer. It is available in a PDF, a Kindle version, and ePub form and the information can be scaled down to help younger kids.

Coping When A Parent Has Cancer

Children will worry about their parent’s health and will also likely feel some resentment that life has upended for everyone. They may also feel guilty, sad, and angry.

To help your child cope:

  • Try to continue as normal a routine as possible while going through treatment.
  • Let them know that it is okay for them to talk to you and tell you about their feelings – both positive and negative.
  • Asking questions can help calm fears because, just like with adults, imaginations can sometimes get the best of us. Connecting with the parent through questions and discussions can help the child feel less alone.
  • For older children and teens, journaling can be a great outlet for their thoughts and feelings.
  • Getting together with friends and being active can help relieve stress. Encourage your child to continue doing the things they enjoy so they don’t feel guilty about having fun.
  • Let them know it is okay to talk to others about your diagnosis and treatment. They may feel more comfortable about sharing their fears and concerns with a close relative or friend.
  • Support groups can be very helpful for kids. They can share their feelings with peers and learn from those who are going through the same experience. There are online support groups or in-person groups. Often, the oncologist or the oncology social worker will have recommendations for local support groups.
  • Sometimes it isn’t enough for a child to talk to a parent, relative, or their peers. In this case, it may help to talk to a neutral person such as a guidance counselor, school nurse, or clergy person.
  • Watch for your teen’s risky behavior (smoking, drinking alcohol, sex or drugs). Sometimes teens turn to these activities in order to cope and you may need to seek outside help if it continues.
  • In some cases, psychosocial support may be needed from a mental health therapist, child psychologist, or other professional counselor.

Find Support At Our Children’s Center

If your child is struggling with the cancer diagnosis of a loved one, talk with a compassionate child psychologist at Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us for more information at (561) 223-6568.

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child crying

Hurricane Anxiety

This summer’s hurricane season was fairly quiet until Hurricane Dorian blew through offshore earlier this month. Then, Humberto threatened the South Florida area last week, putting everyone on high alert for the second time in less than a month. For some children, hearing about the devastation in the Bahamas, watching parents make storm preparations and evacuation plans, or knowing that there are other menacing storms out there can bring up hurricane anxiety.

Symptoms Of Hurricane Anxiety

While you are listening to updates and getting ready for an impending tropical storm or hurricane, don’t forget to talk with your child about their fears. If a storm is coming, they will likely be worried about their friends, their home and school, their pets, and all the disruption that a major storm can bring.

In addition, if they have ever been through a hurricane, they will remember the fear they felt while sitting in the dark, listening to the wind howl and feeling the house shake. After a terrifying experience like that, even hearing the pounding rain of a normal storm could bring up some post-traumatic stress for the child. This can be magnified by the act of going through preparations for another hurricane.

Children who have hurricane anxiety might show their fears in the form of physical or emotional symptoms, or both.

Physical symptoms include thing like:

  • Trembling
  • Having headaches
  • Saying that they feel dizzy or lightheaded
  • Stomach aches, vomiting, nausea
  • Experiencing nightmares, having trouble sleeping, or being afraid of the dark

Emotional symptoms can show up in the form of:

  • Being clingy or wanting to keep you or another caregiver in sight at all times
  • Crying or being overly whiny
  • Talking incessantly about what they experienced in a past storm
  • Being jumpy and on edge
  • Getting physically ill or acting distressed if they are being separated from their loved ones for any reason
  • Expressing fears about them or someone they love possible being harmed because of the storm
  • Being afraid to be in a room by themselves
  • Refusing to participate or avoiding taking part in activities that will keep them away from their parents or caregivers, even briefly

How To Help A Child Who Has Hurricane Anxiety

If your child shows a heightened level of concern or fear about storms, our child psychologist recommends that you:

  • Talk to your child about their fears and let them know that it is okay to be worried.
  • Talk positively about the preparations you will be making to keep them safe and where you all will go if you have to evacuate. If the child knows they will be in a safe place, it can help to reduce their anxiety.
  • Assist them in soothing their fears by letting them sleep with a favored stuffed animal or allowing them to keep a nightlight or hallway light on at night during a storm.
  • Help your child choose something to take with them just in case you do have to go to an evacuation shelter. For example, they can pack a backpack with toys, books and games, then keep it nearby so they feel more prepared for the storm.
  • Remind your child that hurricanes can and do routinely change course. Many times, the storm won’t impact your area, despite the warnings. We saw this when Hurricane Dorian skirted the shore of Florida instead of hitting the state directly as forecasters first thought would happen.
  • This should go without saying, but do not tell your child about any bad experiences you might have had during a hurricane or bad storm! There is no need to add to their fears.

Even though you talk to your child about the steps you are taking to keep them protected, their hurricane anxiety may still continue. If their stress level seems too high for the current situation, it is best to seek the help of a child psychologist.

These experts can help your child identify and change their anxious thoughts. Through role-play and modeling of positive behaviors, your child will learn coping strategies to lessen their fearful response to an approaching hurricane or other storm.

Talk With A Child Psychologist At Our Children’s Center

If your child seems unduly worried about storms or overly fearful when there is talk of a possible hurricane, it may be time to speak with a child psychologist. 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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First Day Jitters and Back To School Anxiety

For many kids, the end of summer and the beginning of school is something to look forward to, but for some, it can trigger a case of school anxiety. Children may be unwilling to get on the bus for the first day of classes or might cry when they talk about starting school.

There can be many reasons for this separation anxiety and the resulting back to school fears: a move to a new house, an attachment figure’s illness, or a friend who has moved away. Kids may also worry over how they will do in school or if they will make new friends.

School Anxiety Causes

One of the most common triggers for back to school anxiety is starting school for the first time. First of all, any separation from a parent can be scary, especially if the child is used to being at home all day with them. In addition, school days are very organized – the child has to adhere to a schedule and do tasks and lessons at prescribed times, and these set routines can add stress.

For teens and older children who have been in school before, back to school anxiety is often directly related to their worries about how well they will do in the upcoming school year. They may be concerned about having to answer questions in class or might fear being asked to read aloud in front of their peers. In some cases, a child may have been made fun of at school or might have been the target of a bully the previous year, so they feel anxious about the possibility of this happening again in the new school year.

Even teens who are starting college may have some school anxiety, despite the fact they want you to think they are above something so “childish”. Leaving home for the first time, not having their parent around to fall back on, and having to adjust to a new world can all be nerve-wracking for a teen.

Back To School Anxiety Symptoms

If your child is apprehensive the start of classes, they will show pretty obvious symptoms. Back to school anxiety is likely present if they have:

  • Nausea or stomachaches
  • Trembling
  • Fatigue
  • Headaches
  • A racing heartbeat
  • Need to use the bathroom more frequently

Some of the things you can do to help your child with school anxiety include:

  • Telling them you love them and that you will see them after school each day.
  • Role playing situations they may encounter so that they will be better able to deal with it if something happens.
  • Letting them know they are brave for going to school despite their fears. Tell them you are proud of them.
  • Reassuring the child that the first couple of days will be hard, but that things will be okay once they get settled in.
  • Visiting the new school with your child a few days before the start of classes, so they are somewhat acquainted with the building and their teacher.
  • Sticking to a familiar routine to make the child less anxious.
  • Talking about things that they can look forward to, both within and outside of school.

Coping With Parental Anxiety About A Child Starting School

We think of children as being the only ones who suffer from first day jitters, but many parents also have anxiety over the start of school. They’ve been their child’s protector, entertainer, and advocate all summer, so you would think these parents would be looking forward to getting a break.

Many parents actually dread seeing their kids head back to class, though, particularly those who have children starting kindergarten or whose teens are going off to college. Their worry over sending their “baby’ off to the unknown kicks in, leaving them with their own version of separation anxiety.

If this sounds like you, don’t feel alone. It is perfectly natural to be distressed over this milestone. Even so, here are some of the most common parental fears, along with ideas that can help reassure you that everything will be fine:

  • Fearing that the child will be scared. Sure, your child may be nervous, but seeing that you are worried can make them wonder if there is something to be afraid of. Instead, show your child that you are calm and excited for them to take this new step. Try to keep in mind that they will be so busy learning new things and making new friends that they will be distracted and less likely to be afraid once they get to school and begin their day.
  • Worrying that the child will get lost. After all, your kid is going off into to what seems like a huge building – how will they ever find their way around? Remember that schools deal with this all the time. They have teachers in place (especially during the first few days of school) to direct students to classrooms and to help them find the correct bus at the end of the day. For added reassurance, you can visit the school with your child a couple of days before classes start, when the teachers are getting their rooms ready. You both can meet their new teacher, plus you can tour the school to find their classroom, the bathroom, the lunch room, etc.
  • Fearing that the child will be bullied. Let’s face it, kids can be cruel, even starting at a young age. The best way to address your concerns to have a serious talk with your child. Let them know that it is not okay for someone to be mean. Try some role playing with your child so they can learn how to respond if another child isn’t nice to them. Teach them to walk away from the bully. Practice how they should tell a teacher or another adult about the situation.

If School Anxiety Symptoms Don’t Resolve

For most kids, the uncertainties surrounding the start of classes will fade away as they get used to the routine of a new school year. If these fears don’t go away within four weeks, however, or if your child has school anxiety that is inappropriate to their developmental level or age, they may really have school refusal.

School refusal is not an “actual” diagnosis, instead it is a result of the child or teen having a deeper issue, such as a separation anxiety disorder, panic disorder, post-traumatic stress disorder, or a social phobia.

If you think your child has developed a school phobia, it’s important to seek treatment as soon as possible. The longer their school refusal continues, the harder it can be to treat.

We Can Help

To get help for your child’s school anxiety or school refusal, talk with a compassionate child psychologist at Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us for more information at (561) 223-6568.

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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.

What Is Intensive Outpatient Therapy?

Intensive outpatient therapy is focused therapy that is given over longer treatment sessions. For example, intensive treatment might be concentrated into daily, three-hour sessions given five days in a row over a two to four week period.

Just as with a regular psychotherapy session, intensive treatment uses methods like cognitive behavior therapy CBT, mindfulness, and exposure response and prevention (ERP). The idea behind the intensive sessions is to teach strategies to decrease the child’s symptoms and provide support, but to do it within a framework that allows them to live at home and continue school and family activities.

An intensive outpatient therapy program includes:

  • Comprehensive treatment planning
  • Learning to recognize unhealthy behaviors
  • Building successful problem solving abilities
  • Learning coping strategies and skills
  • Methods and practice to aid in asking for and getting support
  • Follow up sessions to reinforce these new skills

Although intensive therapy is fairly new, research is showing that it is just as beneficial as long term therapy or in-patient centered therapy. A 2012 study of adults by Ritschel, Cheavens, and Nelson at the Emory University School of Medicine reported that, “Depression and anxiety scores decreased significantly and hope scores increased significantly over the course of treatment.“

Children who have anxiety and depression make similar advances when they undergo intensive outpatient therapy. These gains are long-lasting, just as they are for traditional treatment.

Intensive therapy involves parents as well as children. During treatment, family meetings are held so that parents can better understand the therapy process and learn how to best support their child.

Additionally, children may interact with other kids so they can see that others are going through similar challenges. This is also an opportunity for them to relate to children their own age in a way they may not be able to with their peers or siblings who don’t face the same concerns.

If you are looking for an intensive program for your child, be sure that whichever one you choose utilizes therapists who have been highly trained in treating anxiety and depression in children and teens.

Also, you want the program to be individualized to your child. They should feel a connection with the therapist. The therapist should work with your child to develop a plan specifically for their needs in order to maximize the outcome of their treatment.

Who Would Benefit From Intensive Outpatient Therapy?

Sometimes a child struggles with depression or anxiety symptoms while still being able to function in their daily life. At other times, they may need more focused therapy and support. Intensive outpatient treatment would work for both children. Intensive therapy can also provide rapid and effective management in someone with severe symptoms who has taken time away from school for their recovery.

To be most effective, children who participate in intensive therapy should:

  • Attend every session. This can be difficult if they are having bad days, but they will get the most benefit by coming to every appointment.
  • Allow themselves time to process what they are learning.
  • Treat themselves gently while they learn that it’s okay to make mistakes
  • Trust in the therapy and therapist.

Learning coping skills and effective management of symptoms may continue on and off during a child’s life. Sometimes kids need a “booster” even after intensive therapy, but trusting that the psychotherapists and treatment will help can aid in quickly reducing and managing moderate to severe anxiety and depression.

Learn More About Our Upcoming Intensive Outpatient Therapy Sessions For Children – Starting Soon!

For more information about our upcoming intensive outpatient therapy sessions for children and teens, talk to the professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.

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The Connection Between Diet And Mental Health

Food And Mental Health – Is There A Connection?

If your child is hungry, be wary of letting them reach for the chips or soda – junk foods could affect their mood. In fact, recent studies are showing that food and mental health are more closely linked than we realize.

Felice Jacka, president of the International Society for Nutritional Psychiatry Research reports that, “a very large body of evidence now exists that suggests diet is as important to mental health as it is to physical health. A healthy diet is protective and an unhealthy diet is a risk factor for depression and anxiety.”

Nutrition Psychiatry

In the U. S., mental health conditions are more common than you might think.The Centers for Disease Control and Prevention (CDC) estimates that around 50 percent of Americans will be diagnosed with a mental health condition some time during their lives. They report that, as of 2018, “mental illnesses, such as depression, are the third most common cause of hospitalization in the United States for those aged 18-44 years old.”

These alarming statistics, coupled with the fact that the Western diet is often filled with junk food, made scientists wonder if there was a connection between the two. Could it be that nutrition affects the brain as much as it does the body? To find out, researchers began to look into the relationship between food and mental health about a decade ago.

Drew Ramsey, MD, an assistant clinical professor at Columbia University reports that the last ten years of study has shown that, “the risk of depression increases about 80% when you compare teens with the lowest-quality diet, or what we call the Western diet, to those who eat a higher-quality, whole-foods diet.” He also points out that, “the risk of attention-deficit disorder (ADD) doubles.”

Because they are seeing that nutrition can play a role in mental health, researchers are now even thinking that food allergies might affect bipolar disorder and schizophrenia.

Food and Mental Health

Most of the recent studies have revolved around the connection between a healthy diet and anxiety and depression. Although direct evidence linking food and mental health has not been found yet, there are trials in progress to prove it.

Meanwhile, we do know that a healthy diet affects brain health by:

  • Changing brain proteins and enzymes to increase neural transmitters, which are the connections between brain cells.
  • Boosting brain development.
  • Raising serotonin levels through various food enzymes, which improves mood.
  • Increasing good gut bacteria. This promotes a healthy gut biome, which decreases inflammation. Inflammation is known to affect both cognition and mood.

We now know that a nutrient-rich diet creates changes in brain proteins that improves the connections between brain cells. But diets that are high in refined sugars and saturated fats have been shown to have a “very potent negative impact on brain proteins,” Jacka says.

Moreover, we know that a high sugar, high fat diet decreases the healthy bacteria in the gut. Some studies have shown that a diet that is high in sugar may worsen the symptoms of schizophrenia. And, a 2017 study of the sugar intake of 23,000 people by Knuppel, et al., “confirms an adverse effect of sugar intake from sweet food/beverage on long-term psychological health and suggests that lower intake of sugar may be associated with better psychological health.”

Foods For Brain Health

It’s logical that the foods that are best for the body should also be the foods that promote brain health. This theory is supported by the results from a large European study that shows that nutrient-dense foods like the ones found on the Mediterranean diet may actually help prevent depression.

The nutrients that may help brain health include:

  • Zinc – low levels of zinc can cause depression.
  • B12 – A 2013 report by Ramsey and Muskin that was published in Current Psychiatry, noted that “low B12 levels and elevated homocysteine increase the risk of cognitive decline and Alzheimer’s disease and are linked to a 5-fold increase in the rate of brain atrophy.”
  • Omega 3s – may improve mood and do help improve memory and thinking.
  • Vitamin C – The report by Ramsey and Muskin also noted that, “Vitamin C intake is significantly lower in older adults (age ≥60) with depression.”
  • Iron – iron-deficiency anemia plays a part in depression.

Eating nutrient-dense foods like whole grains, leafy greens, colorful vegetables, beans and legumes, seafood, and fruits will boost the body’s overall health – including brain health. Both the Mediterranean diet and the DASH diet, which eliminates sugar, were found to significantly improve symptoms in the patients who took part in one study.

Adding fermented foods like sauerkraut, miso, kimchi, pickles, or kombucha, to your diet can improve gut health and increase serotonin levels. Serotonin is a neurotransmitter that helps to regulate sleep and stabilize mood. About 95% of serotonin is produced in the gut, so it is understandable that eating these foods can make you feel more emotionally healthy.  The next time your child reaches for the chips and soda, ask yourself if those empty calories are benefiting their developing brains. Since they probably aren’t, hand them some cultured yogurt or an apple instead. Remember – every bite counts!

Note: Dietary changes shouldn’t substitute for treatment. If your child is on medications for a mental health disorder, don’t replace or reduce them with food on your own. Speak with their pediatrician or mental health professional about what they should eat, as well as what they shouldn’t. Medications will work better in a healthy body than an unhealthy one.

Questions? We Can Help

For more information about how your child’s diet could be affecting their mental health, talk to the professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.

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Suicide Contagion And The Parkland Tragedy

It’s just one month past the first anniversary of the massacre at Marjorie Stoneman Douglas High School and we have all been saddened to hear that two students who survived the attack recently took their lives within days of each other. Also, the father of a child who was killed in the 2012 Sandy Hook school shootings died this week in an apparent suicide. Now experts are concerned that these deaths may be the result of suicide contagion.

What Is Suicide Contagion?

There is strong evidence to suggest that suicides can occur in groups. When the media reports that someone famous has died by suicide, it seems that other, similar deaths quickly follow. It is almost as if suicide somehow becomes “contagious.”

We saw this happen last summer when Anthony Bourdain took his own life within days of Kate Spade’s death. Now we have this most recent suicide cluster involving the Parkland students and the Sandy Hook father. Were they due to suicide contagion?

Suicide contagion is also known as the Werther Effect – a phrase coined in the 1970s by suicide researcher, David Phillips. The name refers to a character called Werther from a 1774 novel by Johann Wolfgang von Goethe. In the book, Werther takes his life when he learns that the woman he loves has married another man.

After its release, Goethe’s novel was blamed for numerous copycat suicides across Europe. In this early example of suicide contagion, many of the victims died in a similar manner to the way the Werther character killed himself in the book. Some people used the same type of gun and some dressed in the style of clothing that Werther wore. Some were even found with a copy of the novel on or near their bodies.

The News Media’s Connection To Suicide Contagion

Phillips’ research into suicide clusters led him to conclude that copycat suicides rise when there is excessive news coverage of the suicide of famous figures. In addition to Phillips’ investigations, several other studies have found that suicide rates go up after media coverage of a notable death. These rates also fall when the media coverage stops.

“The way suicide is reported is a significant factor in media-related suicide contagion, with more dramatic headlines and more prominently placed (i.e., front page) stories associated with greater increases in subsequent suicide rates,” says Dr. Madelyn Gould, a suicide researcher from Columbia University.

As with Goethe’s book, suicide clusters also occur when fictional characters die by their own hand. Dr. Gould has reported that, “Research into the impact of media stories about suicide has demonstrated an increase in suicide rates after both nonfictional and fictional stories about suicide.”

There is an ongoing debate among experts about why suicide contagion follows these reports. Is it that the news coverage itself causes someone else to take their own life or do they do it because they are already in a vulnerable state?

Regardless of the reason, media guidelines for reporting a death by suicide have been in place in many parts of the world since the end of the twentieth century. Both the Centers for Disease Controls and Prevention (CDC) and the World Health Organization (WHO) have issued policies for how news reports should cover notable and celebrity suicides.

Today, however, we have a new concern. In the twenty-first century, we rely less on standard media reporting and depend more on online sources to find out what is going on in the world. In particular, young people get their news from social media and the internet. These methods can spread a topic far more quickly than a news broadcast and – unfortunately – will do so with no filtering.

Suicide Risk Factors

In the case of the Parkland tragedy, we know that the first student to take her life was struggling with post-traumatic stress disorder (PTSD). She also suffered with survivor’s guilt, as do many of the teens who were at the school that day.

Suicide is already the second leading cause of death for young people between the ages of 10 and 24 and this is without factoring in the trauma of a massacre like the one in Parkland. Clearly, we need to talk more openly with young people about suicide prevention.

We all can help avert this type of suicide by watching for youth suicide signs and risk factors and by asking direct questions.

A risk factor can’t predict if someone will take their own life, but having one or more of them makes it more likely the person will either consider or attempt suicide. These risk factors are:

  • Talking a lot about the suicide of someone important (or having recently lost someone close to them)
  • Making jokes about dying or about suicide
  • Losing interest in activities or relationships they used to enjoy
  • Sharing feelings of self-contempt or worthlessness, or talking about feeling hopeless and unsure if they will ever being happy again
  • Giving away possessions they used to care a lot about, such as favorite clothes or mementos
  • Isolating themselves
  • May exhibit extreme mood swings or have violent outbursts of grief or anger
  • Might have insomnia or may over-sleep or be lethargic
  • Indulging in risky behavior, especially if this is not characteristic of the person

Asking Questions That Can Help

The first step in preventing a suicide is the awareness that someone is considering ending their life. The next step is determining whether immediate intervention is needed.

If you think someone you know may be at risk, you can help them by using the Columbia Protocol suicide risk assessment. The Columbia Protocol was developed jointly by researchers from Columbia University, the University of Pennsylvania, and the University of Pittsburgh, along with the National Institute of Mental Health (NIMH). It was adopted by the CDC in 2011 and today it is used worldwide to assess at-risk individuals.

The Columbia Protocol is a series of three to six direct questions that you ask the person you are worried about. Their answers will provide enough information to know if they need help and if urgent action is necessary (click here to download the free Columbia Protocol toolkit now).

If your child or someone you know tells you they are considering suicide, don’t judge them. Instead, show empathy for their feelings and let them know you care about them. Next, get help from a mental health professional or a suicide crisis hotline. A crisis hotline is especially critical if the person is in immediate danger of attempting suicide.

Never leave someone alone if they are threatening suicide. If you believe they are in immediate danger, call 911 or the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) in the United States. The line is open 24/7.

Talk To Us

If you are worried about your child or a loved one who may be at risk for suicide, talk to the specially trained mental health professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.

References

Forum on Global Violence Prevention; Board on Global Health; Institute of Medicine; National Research Council. Contagion of Violence: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Feb 6. II.4, THE CONTAGION OF SUICIDAL BEHAVIOR.Available from: https://www.ncbi.nlm.nih.gov/books/NBK207262/

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Protecting Kids From The Momo Challenge

Protecting Kids From The Momo Challenge

Recently, the media has been reporting that 2018’s online Momo challenge has resurfaced. They talk about children encountering it in seemingly innocent YouTube videos. Originating on WhatsApp, the reemergence of the scary social media game has prompted schools and police stations to issue warnings about the challenge so that parents can discuss it with their kids.

What Is The Momo Challenge?

The Momo figure was actually a sculpture called “Mother Bird”. It was created by Japanese artist, Keisuke Aisawa. The sculpture featured a wraith-like figure with bulging eyes and long, stringy hair. To date, no evidence suggests that the artist or his special effects company had anything to do with the Momo challenge and the sculpture has since been destroyed.

Reports say that when the game first started, children were contacted to participate in the Momo challenge through their interaction with WhatsApp. More recently, however, the media is warning that the figure has apparently been popping up in Peppa Pig or Fortnight YouTube videos.

When a child participates in the game, they are actually interacting with someone who tells them to perform certain tasks to avoid being “cursed.” Reportedly, these assignments often require the child to do something harmful to themselves or others. They might be told to take pills or stab or otherwise hurt someone. The tasks even go as far as telling the child to take their own life.

The Momo figure asks the child to prove they have completed a task by providing a photograph of themselves while engaged in the assignment. To advance through the game, the child must show this proof. At the end of the game, the child’s final assignment is to commit suicide while recording it for social media.

Is The Momo Challenge A Hoax Or A Real Thing?

When the Momo game initially came out on social media, critics were quick to dismiss it as a hoax. While there have been a few child suicides that were thought to have been a result of the challenge, there has never been any definitive proof linking them to the game.

Additionally, it is difficult to find online images of kids participating in the game. Doubters think that if the challenge was real, there would be many more social media pictures of Momo collaborations.

ReignBot, a YouTuber who is famous for videos that explore creepy things on the Internet says, “Finding screenshots of interactions with Momo is nearly impossible and you’d think there’d be more for such a supposedly widespread thing.”

Often, the warnings about dangerous online challenges spread farther and faster than the actual game. That said, it is potentially dangerous for a child who is vulnerable to self-esteem and other psychological issues to be exposed to something that could be harmful.

Talking To Your Kids About Momo

Regardless of whether the game is real, experts agree that parents need to address the topic with their children preemptively. Dr. Ryan Seidman, a child and adolescent psychologist and the Clinical Director at our Children’s Center, says parents should warn their kids about these online challenges.

“Discuss with younger children what to do if they see the face,” she advises. You might start by asking the child if they have heard of Momo, then tell them to get a parent or other adult if something scary or threatening ever pops up on an app or video.

For teens and adolescents who want more independence, it’s good to have periodic discussions about online encounters, as well as anything in their lives that is frightening or threatening to them.

Encourage your kids to tell you if they are being bullied (by the way, Momo is a form of cyber-bullying). Be sure they understand that you are trusting them to let you know.

Self Harm And Suicide – Who Is At Risk From The Momo Challenge?

It’s unlikely that an online challenge would affect a psychologically healthy child, but it could push kids who self harm or who are contemplating suicide to act on their thoughts.

Self Harm

Self harm isn’t restricted to a certain age group or race, or to someone with a certain socioeconomic or educational background. Anyone may engage in self harm, but the behavior happens most often in teens and young adults.

Self harm happens most frequently in:

  • People who have difficulty expressing their emotions
  • Those individuals who have a background of childhood trauma, such as physical, verbal, or sexual abuse
  • People who don’t have a strong social support network. Conversely, we know it happens more often in those who have friends who also self harm
  • Those who also have post traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), borderline personality disorder, eating disorders, or in those who engage in substance abuse

Suicide

Keep in mind that suicide is the result of a mental illness. People who are vulnerable to online cyber-bullying and content like the Momo challenge are often already suffering from mental health issues, such as low self esteem, anxiety, or depression.

As mentioned above, the Momo game is thought to have led to several teen suicides last year, although the link hasn’t been proven.

Suicide is the second leading cause of teen deaths, but could a dangerous challenge increase risky behavior in an susceptible teen?

Madelyn S. Gould, Ph.D., a psychiatrist at Columbia University, thinks so. She says, “The magnitude of the increase [in the number of suicides] is proportional to the amount, duration, and prominence of media coverage. We know from a number of studies that the celebrity status of a suicide victim increases the impact of the suicide.”

Add to that the feeling of being alone in their pain and it’s possible a challenge could push a distressed teen over the edge.

Adolescents and teens who are considering suicide usually give unmistakable warning signs:

  • Making jokes about dying or about suicide
  • Sharing feelings of self-contempt or worthlessness, or talk about feeling hopeless and unsure they will ever being happy again
  • Giving away possessions they used to care a lot about, such as favorite clothes or  mementos
  • Losing interest in activities or relationships they used to enjoy
  • Talking a lot about the suicide of someone important (or may have recently lost someone close to them)
  • Isolating themselves
  • Might have insomnia or may over-sleep, may be lethargic
  • May exhibit extreme mood swings or have violent outbursts of grief or anger
  • An increase in drug or alcohol use
  • Indulging in risky behavior, especially if this is not characteristic of the person

Your child needs to know you are taking them seriously and that you care about them. If you are concerned that they are exhibiting some of these signs, ask the child directly if they are considering suicide (or have someone else they trust ask them). Be assured that it is okay to use the word “suicide” – saying the word will not raise the chance that they will act on the idea.

If your child admits that they are considering suicide, be empathetic about their feelings – don’t judge them. Seek help from a mental health professional such as those at our Children’s Center, from your child’s pediatrician, or from a suicide crisis hotline. The crisis hotline is especially critical if you think your child is in imminent danger of attempting suicide.

Worried about the Momo challenge’s influence on your child? Talk with a Child Psychologist at our Children’s Center

For more information about our children’s mental health services,  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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Destigmatizing Mental Health Services For Youth

Studies have shown that children in the United States have many mental health needs that remain unidentified. In 2015, the Centers for Disease Control and Prevention (CDC) reported that about 20% of the nation’s youth have or will have an emotional, mental, or behavioral disorder. Only about 7.4% of these children report having received any type of mental health services, however.

A 2014 National Center for Biotechnology Information (NCBI) study by Jane Burns and Emma Birrell noted that many mental health problems escalate in adolescence and young adulthood. The effects of these under treated childhood mental health issues can be higher rates of substance abuse, anxiety, and depression, as well as suicidal ideation and self harm.

There is a stigma surrounding mental illness and its treatment. This disapproval is a barrier that keeps young people from seeking assistance. The consequence is that they are not receiving appropriate care, which translates to an increased chance of dropping out of school, employment or relationship problems, future incarceration, or even suicide.

Impact of Childhood Mental Disorders

The most prevalent mental disorder in children is attention deficit hyperactive disorder (ADHD). Other common conditions are:

  • Depression
  • Anxiety
  • Autism spectrum disorders
  • Substance abuse
  • Learning disorders
  • Eating disorders

A 2013 study by Khong, et. al. stated that “The highest-ranking top 25 causes of disability include anxiety disorders, drug and alcohol problems, schizophrenia, and bipolar effect disorders. By age 5, mental health and behavioral problems become an important and soon dominant cause of years lost to disability, peaking between ages 20–29.”

There is often a gap of up to 15 years between the onset of symptoms and the person getting the appropriate care. Because behavioral and mental health concerns are not being addressed early enough, they become issues down the road – major depression is one of the top four causes of disability in adulthood.

As the study noted, mental health conditions can begin to emerge as early as 5 or 6 years old. Symptoms of anxiety disorders often include:

  • trouble sleeping
  • trouble concentrating
  • fatigue,
  • irritability
  • restlessness
  • numerous, lingering, or intense periods of stress, anxiety, or fear that seem out of proportion to the triggering event and which affects the child’s daily life

Ways to Destigmatize Mental Health Services

Children with mental health challenges are often marginalized or bullied by their peers. This social exclusion keeps them suffering in silence, discouraging the majority of adolescents and teens from seeking help.

To destigmatize mental health in general, we need to:

  • Equate mental illness with physical illness. Mental illness is a disease, just the same as physical illnesses like diabetes or cancer, but mental health conditions are often thought of as something the person could overcome if they just “tried harder.” They are disorders of brain function, however, which means they are based in the physical body in much the same way as something like a heart condition or high blood pressure. We certainly wouldn’t expect a heart patient to just “try harder” to get their blood pressure or irregular heartbeat under control.
  • Show compassion to those with mental illness and don’t treat them differently. People with mental health conditions live meaningful lives, but they often have to fight to keep from being judged.
  • Watch what you say. Don’t use words like “freak” or “crazy” because this type of language continues the negativity against mental illness.
  • Change the culture by taking a good look at children who are acting out. Try to figure out why they are behaving in certain ways, instead of writing them off as bad kids.
  • Don’t judge yourself if you are struggling with mental health issues. Your condition is out of your control. Being ashamed only adds to the burden and can keep you from seeking help.
  • Encourage family members or friends to seek help if they are facing mental health challenges.
  • Familiarize your child with mental health concerns like anxiety and depression from a young age. For example, help them understand that everyone has days when they are sad or angry or feel stressed, but if they can’t shake those feelings, it is okay to ask for help.

People who are challenged with mental health issues often feel alone. The reality is that the majority of us have some type of mental health condition. Great examples include the new mother with postpartum depression, the college student with ADHD, and the coworker who has post-traumatic stress disorder from their military service.

By destigmatizing mental health problems and services from a young age, we can teach children to challenge negative attitudes so they are more comfortable asking for help.

Connect with a Child Psychologist at our Children’s Center

For more information about our services to treat mental disorders in children, contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

References

Monshat K, Khong B, Hassed C, et al. “A conscious control over life and my emotions:” mindfulness practice and healthy young people. A qualitative study. J Adolesc Health. 2013;52(5):572–577.

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Self Harm – Is Your Child Engaging in it?

Self harm or self-injury is the intentional wounding of one’s own body. Most often, people who self harm will cut themselves with a sharp object.

Self harming may also include:

  • severely scratching areas of their body with a fingernail or sharpened object
  • carving words or patterns into their skin
  • burning or branding themselves using lighters, cigarettes, lit matches, or other hot objects
  • biting themselves
  • excessively picking at their skin (dermatillomania) or wounds
  • hair pulling (trichotillomania)
  • head banging
  • punching or hitting themselves
  • excessive skin-piercing or tattooing may also be indicators of self harm

Generally, people who self-harm do so in private. Often, they follow a ritual. For example, they might have a favorite object that they use to cut themselves or they may listen to certain music while they self injure.

Self harmers will target any area of the body, but the legs, arms, or front of the body are the most commonly selected. These areas are not only easy to reach, they are also easy to cover up, allowing the person to hide their wounds away from judgmental eyes.

Additionally, self harm can include actions that don’t seem so obvious to others. Activities like excessive substance abuse or binge drinking, driving recklessly or having unsafe sex can all be signs of self harm.

Causes of Self Harm

There are many reasons that people engage in the unhealthy coping mechanism of self-injury.

Oftentimes, a self-mutilator may have trouble understanding or expressing their emotions. Those who self harm report feelings of worthlessness and rejection, loneliness or isolation, guilt, self-hatred, and anger.

When a self harmer attacks their own body, they are really seeking:

  • distraction from painful emotions
  • to release intolerable mental anguish
  • a sense of control over their feelings, their body, or their lives
  • a physical distraction from emotional pain or emotional “numbness”
  • to punish themselves for supposed faults

People who self injure often feel an intense yearning to injure themselves. Even though they know it’s destructive, this feeling grows stronger until they complete the act of mutilation.  Feeling the resulting pain releases their distress and anxiety. This relief is only temporary, though, until their shame, guilt, and emotional pain triggers them to injure themselves again.

Who is At Risk for Self Harm?

Self injury happens in all walks of life. It is not restricted to a certain race or age group, nor to a particular educational or socioeconomic background.

It does happen more often in:

  • people with a background of childhood trauma, such as verbal, physical, or sexual abuse
  • those who have difficulty expressing their emotions
  • those without a strong social support network or, conversely, in those who have friends who also self harm
  • people who also have obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), eating disorders, borderline personality disorder, or those who engage in substance abuse

Although anyone may self harm, the behavior occurs most frequently in teens and young adults. Females tend to engage in cutting and other forms of self-mutilation at an earlier age than males, but adolescent boys have the highest incidence of non-suicidal self injury.

Self-Harming Symptoms

Physical signs of self harm may include:

  • unexplained scars, often on wrists, arms, chest, or thighs
  • covering up arms or legs with long pants or long-sleeved shirts, even in very hot weather
  • fresh bruises, scratches or cuts
  • telling others they are clumsy and have frequent “accidents” as a way to explain their injuries
  • keeping sharp objects (knives, razors, needles) either on their person or nearby
  • blood stains on tissues, towels, or bed sheets

Emotional signs of self harm may include:

  • making statements of feeling hopeless, worthless, or helpless
  • isolation and withdrawal
  • impulsivity
  • emotional unpredictability
  • problems with personal relationships

Help for Self Harm

The first step in getting help for self harm is to tell someone that you are injuring yourself. Make sure the person is someone you trust, like a parent, your significant other, or a close friend. If you feel uncomfortable telling someone close to you, tell a teacher, counselor, religious or spiritual advisor, or a mental health professional.

Professional treatment for self injury depends on the specific case and whether or not there are any related mental health concerns. For example, if the person is self harming but also has depression, treatment with address the underlying mood disorder as well.

Most commonly, self harm is treated with a psychotherapy modality, such as:

  • Cognitive behavioral therapy (CBT), which helps the person identify negative beliefs and inaccurate thoughts, so they can challenge them and learn to react more positively.
  • Psychodynamic psychotherapy, which helps identify the issues that trigger their self-harming impulses. This therapy will develop skills to better manage stress and regulate emotions.
  • Dialectical behavior therapy (DBT), which helps the person learn better ways to tolerate distress. They’ll also learn coping skills so they can control the urge to self harm.
  • Mindfulness-based therapies, which can teach them skills to effectively cope with the myriad of issues that cause distress on a regular basis.

Treatment for self injury may include group therapy or family therapy in addition to individual therapy.

Self care for self-harming includes:

  • Asking for help from someone whom you can call immediately if you feel the need to self injure.
  • Following your treatment plan by keeping your therapy appointments.
  • Taking any prescribed medicines as directed, for underlying mental health conditions.
  • Identifying the feelings or situations that trigger your need to self harm. When you feel an urge, document what happened before it started. What were you doing? Who was with you? What was said? How did you feel? After a while, you’ll see a pattern, which will help you avoid the trigger. This also allows you to make a plan for ways to soothe or distract yourself when it comes up.
  • Being kind to yourself – eat healthy foods, learn relaxation techniques, and become more physically active.
  • Avoiding websites that idealize self harm.

 If your loved one self-injures:

  • Offer support and don’t criticize or judge. Yelling and arguments may increase the risk that they will self harm.
  • Praise their efforts as they work toward healthier emotional expression.
  • Learn more about self-injuring so you can understand the behavior and be compassionate towards your loved one.
  • Know the plan that the person and their therapist made for preventing relapse, then help them follow these coping strategies if they encounter a trigger.
  • Find support for yourself by joining a local or online support group for those affected by self-injuring behaviors.
  • Let the person know they’re not alone and that you care.

Need More Information?

Are you concerned that your child is engaging in self harm? Don’t wait to seek help – speak to a compassionate child psychologist at The Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us for more information or call us at (561) 223-6568.

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Signs Your Child May be a Hypochondriac

Signs Your Child May be a Hypochondriac

A hypochondriac is someone who lives with the fear that they have a serious, but undiagnosed medical condition, even though diagnostic tests show there is nothing wrong with them. Hypochondriacs experience extreme anxiety from the bodily responses most people take for granted. For example, they may be convinced that something as simple as a sneeze is the sign they have a horrible disease.

Hypochondria accounts for about five percent of outpatient medical care annually. More than 200,000 people are diagnosed with hypochondria (also known as health anxiety or illness anxiety disorder) each year. While health anxiety generally begins in early adulthood, children can also experience hypochondria.

Hypochondriac Symptoms

True hypochondria is a mental health disorder. Hypochondria may show up in a child after they or someone they know has gone through an illness or a serious medical condition. Its symptoms can vary, depending on factors such as stress, age, and whether the person is already an extreme worrier.

In children, hypochondriac symptoms may include:

·         Regularly checking themselves for any sign of illness

·         Telling you about a new physical complaint almost every day

·         Fearing that anything from a runny nose to a gurgle in their gut is the sign of a serious illness

·         Frequently asking their parent to take them to the doctor

·         Asking to have their temperature taken daily (or more than once per day)

·         Talking excessively about their health

·         Happily wearing bandages like badges of honor, has one on almost constantly

·         May focus excessively on things most children typically don’t: a certain disease (example: cancer) or a certain body part (example: worrying about a brain tumor if they have a headache)

·         Having frequent pains or finds lumps that no one else can feel

·         Fearing being around people who are sick

Health anxiety can actually have its own symptoms because it’s possible for the child to have stomachaches, dizziness, or pain as a result of their overwhelming anxiety. In fact, illness anxiety can take over a hypochondriac’s life to the point that worrying and living in fear are so stressful, the child refuses to go to school or participate in outside activities.

You may be wondering what triggers hypochondria. Although there really isn’t an exact cause, we do know that people with illness anxiety are more likely to have a family member who is also a hypochondriac. The child with health anxiety may have gone through a serious illness and fear that their bad experience may be repeated. Or, they may already be suffering from a mental health condition and their hypochondria may be part of it.

Hypochondriac Treatment

Self-help for child hypochondria can include:

  • Letting your child know that sometimes focusing too much on being sick can cause anxiety that makes their bodily sensation worse
  • Trying to not talk about your own aches or pains in front of your child
  • Helping your child learn stress management and relaxation techniques
  • Encouraging older children to avoid online searches for the possible meanings behind their symptoms
  • Focusing on outside activities such as a hobby they enjoy
  • Working to help your child recognize that the physical signs they experience are not a symptom of something ominous, but are actually normal bodily sensations

Professional treatments for hypochondria include:

  • Cognitive Behavioral Therapy (CBT), which is very helpful for reducing patient fears. In this type of therapy, the child learns to recognize and understand the false beliefs that set off their anxiety. Research has shown that CBT successfully teaches hypochondriacs to identify what triggers their behavior and gives them coping skills to help them manage it.
  • Behavioral stress management or exposure therapy may be helpful
  • Psychotropic medications, such as anti-depressants, are sometimes used to treat health anxiety disorder

Get Help for Hypochondria and Health Anxiety Disorder

Being a hypochondriac negatively affects the lives of the child who suffers from it.  The child psychologists at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida are experienced in helping those with illness anxiety. For more information, contact us or call us today at (561) 223-6568.

Reference: https://jamanetwork.com/journals/jama/fullarticle/198437

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