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Ask the Expert

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An Interview with Andrew Rosen, PhD, ABPP, FAACP & Ryan Seidman, PsyD

Q. There is new information and data regarding a rise in psychiatric problems in children and adolescents, especially anxiety issues. Why is there such an increase in the last 1ti years?

A. Several issues have impacted children’s mental health over the last decade. While Covid has been

linked to the rise in anxiety and depression in kids, other societal issues, including increased screen time and social media, academic pressure and success, changes in family dynamics and the social stigma

related to mental health, have also contributed to what many call a mental health crisis in our youth.

Q. Can we tie this growing anxiety back to Covid and the resulting effects of not being in school?

A. Covid has changed the learning and social paradigm for children because it was sudden and drastic

and long term. It was also associated with danger and death. So, anxiety was injected into everyone and

especially children. It made the unthinkable very possible and took away the feeling of safety in our children. In addition, the lack of face-to-face socialization changed the scope of how our youth interact and communicate with one another. Upon returning to an in-person learning environment, anxiety around peer socialization and communication significantly increased.

Q. Would you say that screens are addicting?

A. Screens are clearly addicting. Just look at the stats and you can see an exponential increase in the

number of hours that children spend on screens. No other activity triggers such compulsive behavior. In

addition, there is ample evidence that the game makers and social media developers have inserted ways to make continuation of screen time almost impossible to stop. Screens have also provided an

environment where those with social anxiety no longer need to communicate face to face.

Q. What is the cause of this reliance on electronics instead of human interaction?

A. Reliance on electronics is easy, readily available, and less complicated than the challenges that can

come with face-to-face human interaction. Rejection, embarrassment, and social humiliation can be

avoided when communicating behind a screen rather than in person. The challenge becomes that

children then lack the appropriate social skills taught through real-life interaction with peers and caregivers. The ability to understand and read non-verbal cues such as body language and facial expressions has become significantly reduced as a result of the reliance on technology.

Q. What can we do about the growing addiction to screens?

A. It will be necessary for parents of children of all ages to set firm limits on the number of hours spent

as well as the types of screens that are accessible. Children are not capable or exerting self-control and cannot be blamed for their addiction. Caregivers need to better understand the consequences of screens and electronics. In addition, education around ways to safeguard our technology for our children is key. Access needs to be limited in terms of what they are able to view and who they are able to interact with while using their devices.

Q. What is the parents’ responsibility in this rise of anxiety?

A. Parents need to examine their own usage of electronics and confront their own denial about it. It has

been all too easy to encourage children to use electronics to babysit them. The lack of real family

interaction as well as peer interaction has led to an actual defect in children’s capacity to tolerate various aspects of life. As a result, anxiety becomes a symptom. Adults and caregivers now spend so much of their lives, both personal and professional, utilizing technology and screens. Modeling realistic ways to use technology for our youth is key. Setting up “screen free” times throughout the day, setting time limits on usage, and promoting social opportunities outside of the home are important ways for caregivers to support a decrease in anxiety related to technology.

Q. Are kids safer being at home (and therefore with potentially more access to electronics)?

A. The paradox is that parents have mistakenly thought that if children are home they are safer. However, they may be safer in terms of reality dangers, but the dangers of virtual reality are much greater and much more common and likely.

Q. Is it okay to have kids look at a screen while in a restaurant?

A. It is really not okay. Children need this time to be with their parents and siblings even if they resist

interaction or seem bored. Modeling appropriate conversation, practicing social skills and

communication, and picking up on nonverbal cues, are extremely important elements that children can

practice when in a restaurant. If parents feel they need to use technology as a babysitter when out then

children are better off staying home.

Q. How can parents better strategize and control screentime?

A. Depending on the age, screen time should be dependent on completion of other activities beforehand. School work, family time, exercise, meals, and hygiene have to occur first. Electronics should not be available after bedtime either. Using electronics as an incentive for completing necessary tasks

throughout the day is often helpful. Creating a schedule of when electronics can be used and for how long is key.

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The Uses of Virtual Reality in Social Anxiety Treatment

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Dr. Rosen and Dr. Spinner recently presented a session on The Uses of Virtual Reality in Social Anxiety Treatment for the National Social Anxiety Center.

View the presentation on The Uses of Virtual Reality in Social Anxiety Treatment.

We Can Help

If you are worried about your child’s social anxiety, discuss your concerns with our clinicians, who specializes in childhood anxiety. For more information, contact us or call us today at 561-223-6568.

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The Mounting Crisis of Childhood Obesity

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Growing up in the United States, we remember our childhoods as filled with fun and games – tag on the playground, sports competitions with friends – a seemingly endless well of energy. Unfortunately, too many kids today are facing a different reality; they’re falling victim to a crisis that’s been mounting for years – childhood obesity.

It’s no secret that junk food and technology are taking over our kid’s lives. At the same time, physical activity has become a thing of the past, leading to a public health crisis that is only getting worse as each year passes. If we don’t take action now, future generations will be faced with even more detrimental effects from the growing childhood obesity epidemic. We can’t afford to wait any longer – it’s time to step up and make a change!

Childhood Obesity Statistics

2022 was the final year of available statistics related to childhood obesity, and the numbers are staggering – it’s a crisis that needs attention. This crisis affects children all around the world, and it’s clear that we need to do something to stop this problem before it gets any worse.

  1. According to the World Health Organization (WHO), a staggering 39 million children under 5 were overweight or obese in 2020. This issue is no longer limited to higher-income countries; it’s now affecting middle and lower-income nations too. Even more concerning is that being overweight or obese is now linked to more deaths across the world than being underweight!
  2. The prevalence of obesity among preschoolers has grown nearly three-fold since 1975, jumping from 5% up to more than 18%.
  3. The Centers For Disease Control And Prevention (CDC) reported that, in the United from 2017 to 2020, an estimated 14.7 million American children – nearly one-fifth of our nation’s kids – between the ages of 2 and 19 were classified as obese.
  4. Obese children are at a significantly higher risk of developing medical issues related to their weight than those who have a healthy weight. In fact, they may be up to five times more likely to have at least one significant health issue by the time they reach 12 years old.
  5. Studies show that obese children often face increased risks for cardiovascular diseases, type 2 diabetes and certain types of cancer into adulthood. There are also psychological effects associated with being overweight, such as depression, anxiety and lower self-esteem.
  6. Additionally, obese children are more likely to become obese adults, which can lead to even more serious medical conditions, like stroke, heart disease, fractures, and other chronic diseases later in life.
  7. It is projected that there will be over 70 million obese children worldwide by the end of 2023, if current trends continue unchecked. This number would represent a 70% increase since 2012.

One of the most important ways parents and caregivers can help children stay at a healthy weight is by teaching them good habits early on. It’s also beneficial if healthcare providers give kids and their parents support and guidance.

Why Is Childhood Obesity Becoming A Crisis?

As with anything, there isn’t just one answer for today’s childhood obesity crisis. Among the contributing factors are:

Unhealthy Eating Habits: Poor eating habits, such as not eating breakfast, skipping meals, consuming too much sugar, and snacking on unhealthy foods throughout the day can all cause weight gain in children.

Lack Of Exercise: Today’s kids are much more sedentary than a generation ago. This is due to increased technology use and it means that children often miss out on important physical activity opportunities that help keep them fit and healthy. If calorie intake isn’t balanced with physical activity, it can lead to weight gain and a higher chance of developing chronic health problems.

Stress: Stressful life situations can cause children to overeat or engage in other unhealthy behaviors that lead to weight gain. They can also create other physical and mental health issues. Without healthy coping strategies, kids may manage their stress by resorting to unhealthy behaviors.

Genetics: Due to genetics, some young people may be more prone to storing more fat than the average person, leading to an increased risk of being overweight or obese.

Not Enough Sleep: Some studies have shown that not getting enough sleep might make kids more likely to be obese.

Medications: Certain medications have been linked to weight gain in children. Be sure to speak with your child’s doctor or a pharmacist about any potential side effects of any prescribed medications and ask whether any lifestyle changes may be necessary while the child is taking them.

How Can We Prevent Childhood Obesity?

Fortunately, it’s not too late to take steps to reverse the obesity trend. To be sure, preventing childhood obesity is a group effort, but it starts in the home.

To reduce the chances of their children becoming obese, parents can take the following steps. They should also check in with their pediatrician regularly to make sure their child’s weight is healthy.

These steps include:

  • Reducing and limiting screen time
  • Regular physical activity, ideally modeled by physically active parents
  • Encouraging the child to drink more water instead of fruit juices and sugary drinks
  • Healthy snack and food choices at home, such as fresh fruits and vegetables
  • Limiting access to unhealthy food options, like high-fat or sugary foods and beverages
  • Creating a positive environment where children feel supported and encouraged to make good nutritional choices
  • Setting bedtime schedules so the child gets enough sleep
  • Talking to kids about nutrition and weight issues in a way that fosters body confidence and self-esteem instead of reinforcing negative attitudes toward weight or size

Pediatricians should screen their patients for risk factors for obesity and provide nutrition education to parents. They should also refer to community resources as needed. In addition, pediatric doctors must counsel parents on creating a supportive home environment and encouraging healthy behaviors in their children.

Schools can also help kids stay healthy by creating and enforcing policies promoting physical activity and healthy eating habits. Nutrition education programs can teach their students the importance of making nutritious food choices and maintaining a healthy weight.

The key to reversing childhood obesity is to get kids involved in their own health from an early age and empower them with knowledge about the benefits of good nutrition and regular physical activity.

If we make small changes in our lifestyles and provide proper guidance and tools at home and in the schools, we can break the cycle of childhood obesity and our children can grow into happy, healthy adults.

We Can Help

If you are worried about your child’s weight and health, discuss your concerns with our pediatric psychologist, who specializes in childhood obesity. For more information, contact us or call us today at 561-223-6568.

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Darbi Miller, MS, LMFT – Consult The Expert About Increasing Relational Self-Awareness

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In this month’s Consult The Expert interview, we spoke with Darbi Miller, MS, LMFT. She is one of the marriage and family therapists here at The Center For Treatment Of Mood And Anxiety Disorders. Although she likes working with all ages, she enjoys the dynamic surrounding family and relationships.

“One of my favorite things to work with is increasing clients’ relational self-awareness,” she said. “I also enjoy exploring peoples’ Families of Origin, which is connected to self-awareness from my perspective.”

What Is Relational Self-Awareness?

What does she mean by “relational self-awareness”? “Family of Origin and self-awareness are related,” she answered. “In any experience with another person, relational self-awareness can look like asking ourselves, “What is mine? What is yours? What is ours?”

“We each have our own stories, beliefs, and experiences,” she said. “Relational self-awareness looks at what each person brings to the table and how this affects the interaction between us. If we are self-aware, we have a compass for ourselves which translates into tolerance. We are able to share our personal values and beliefs and hear the other person’s.”

“If we are not self-aware, our interactions are based in fear. We begin looking for approval or we get defensive because we may feel we will “lose” in some way if we are vulnerable with the other person. When you have self-awareness, however, you can be vulnerable and can create more intimacy in all of your relationships.”

Ms. Miller talked about a Harvard study that has been following certain individuals over an 80-year period. One of the surprising things it has found is that the quality of our relationships has a higher impact on our health than even our cholesterol levels. “It turns out that surrounding ourselves with positive, close relationships creates a better sense of community within ourselves, which in turn, has a better health impact,” she reported.

So, how does relational self-awareness help with anxiety treatment? “With anxiety, behind that is usually fear on a basic level. Our thoughts are powerful. If you can get to the core and understand the fear (how can I feel more connection with myself?), connecting to your body and grounding yourself, allows this to be part of the healing process.”

How Does Family Of Origin Fit Into Mood Disorder Therapy?

Ms. Miller explained how Family of Origin can impact the treatment of anxiety and other mood disorders. “We come from our own system that was learned in childhood. This is the Family of Origin,” she explained. “This system has patterns, beliefs, and values that we can sometimes see, but sometimes aren’t aware of. We all have a family role – maybe we’re the funny one, the responsible one, or the nurturing one. This role can carry into our adult lives and play out between couples.”

“Sometimes people go into a relationship expecting it to heal their Family of Origin wounds,” she said. “Although it can happen that a new relationship can be good and healing, if we enter it expecting our partner to instinctively know what we need to heal, that may not be the case and we’re disappointed. If you are expecting your partner to heal you, where is this coming from? The answer leads back to relational self-awareness.”

How Can We Use These Concepts To Improve Mood Disorders?

We discussed how knowing what we bring with us from our Family of Origin can be used to help when dealing with mood disorders.

“Knowing what you have “inherited” and what you can change can be very empowering,” Ms. Miller told me. “You don’t have to operate out of same system you inherited. You have control. The realization that you don’t have to follow the same patterns – and you get to decide – can help with anxiety and trauma.”

“I mainly use this work for people who feel stuck in their life, work, and relationships,” she continued. “During therapy, my approach is always to start at the top. We begin with something action-focused, like behavior organization, and getting back into routines that can have a positive effect on the person’s mood and decrease anxiety.”

“I also use cognitive behavioral therapy to challenge negative thoughts. Taken together, these give people some relief. But if they are still looking for more, this is when we explore other things like Family of Origin and relational self-awareness.”

“When we look into Family of Origin, we can choose to do the work for ourselves and also within the family roles, with siblings and parents,” she said. “I typically go three levels up within the family to look at the generational dynamic. Doing this work can uncover patterns that influence a person’s mood, narratives, and the core beliefs that influence mood, which can be healing.”

“People want to explore these concepts, but in a safe space,” Ms. Miller said. “So, we balance a safe space with these tools, allowing them to go deeper to uncover the aspects that may be underlying their anxiety, depression, or trauma.”

We Are Here For You

If you are concerned that your child is struggling emotionally or 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.

About Darbi Miller, MS, LMFT

Darbi Miller is a Licensed registered Marriage and Family Therapist. She has extensive training in Integrative Systemic Therapy however, does not believe one model fits all. Her approach is strength-based, collaborative, holistic, and geared to meet her client’s specific needs and goals. She works to truly understand each client and the systems that surround them. She believes therapy is a courageous step and feels privileged to bear witness to their journey. Through her authenticity, empathy, and compassion, she provides a safe space for exploration. Darbi works to integrate her knowledge into meaningful and collaborative sessions with individuals, couples, and families. Her areas of interest include walk/talk therapy, the mind/body connection, increasing relational self-awareness, high-conflict couples, and full family work. 

She holds a Bachelor of Arts in Psychology from Michigan State University and a Master of Science in Marriage and Family Therapy from Northwestern University, where she received academic distinction. She is also certified as an Eating Psychology Coach and a Prepare/Enrich Facilitator. Darbi has worked in a variety of settings including schools, hospitals, university clinics, and in-home. She also published an article in the Encyclopedia of Couple and Family Therapy on conjoint sex therapy.

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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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Lonette Belizaire

Lonette Belizaire, Ph.D. – Consult The Expert On Cognitive Behavioral Therapy (CBT) And Self-Care

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Dr. Lonette Belizaire works with children, teens, and young adults in our Children’s Center. Her primary treatment approach utilizes cognitive behavioral therapy (CBT), a modality which helps people recognize and change their negative thoughts and behaviors. CBT has been shown to be effective in treating many mental health conditions, including anxiety and depression.

How do negative thoughts and behaviors contribute to anxiety? “The brain has plasticity,” Dr. Belizaire explains. “Anxiety, trauma, and distressing life experiences actually create structural changes within the brain.”

When we encounter something that scares us, worries us, or puts us on guard, the amygdala – a small structure within the brain – responds with a nearly instant message to our hypothalamus. The result is the activation of stress hormones and heightened physical responses, along with the building of new neural pathways.

This is designed to keep us safe by getting us out of imminent danger, such as out of the path of a speeding car. “The fight or flight response is protective and good,” Dr. Belizaire says, “but at times we apply this response when we’re not in danger.”

“For example, someone who is anxious and facing an exam in school may have the thought “I’m going to fail this test,” she explains. “The distress response from this negative thought can lead to the person avoiding the test altogether. However, with cognitive behavioral therapy, this person would learn how to challenge their negative thought and replace it with a more positive one, such as “I can study for the test and do my best.”

Exploring Thinking Patterns

The longer we focus on and worry about a stressor, the more robust those neural pathways become and the stronger we respond. This is involuntary on our part, but it means the key to calming anxiety is breaking those pathways and building more positive channels. In turn, the positive emotions support the building of new neural responses that suppress the old, negative responses.

“I begin by having my clients look at their thinking patterns. I want them to explore how they see themselves, others, and how they operate within the world,” Dr. Belizaire says. “Part of our work together involves identifying these patterns and working to challenge those distortions.”

“When working with adults, we may explore how early childhood responses to early attachment figures may still be operating in adult relationships,” she explains. “Are those messages still in place? How do these responses show up across relationships, in both the past and present?”

The answers to these questions can be enlightening. “Sometimes this is the first time the person has thought of it this way,” she says.

Incorporating Self-Care

Along with traditional CBT, Dr. Belizaire often integrates self-care into her therapy sessions. Mindfulness exercises and grounding techniques help to refocus anxious responses and build positive brain pathways. “These techniques are aimed at the amygdala,” she explains.

“We know that self-care and self-regulating activities engage the physical to help the mental and emotional responses, so I try to find out what the client likes to do. What are their interests? Once I know, we incorporate regular self-care strategies in our work.”

For example, Dr. Belizaire may encourage yoga, diaphragmatic breathing exercises, meditation, or progressive muscle-relaxing exercises. When using visual imagery, “I may incorporate breathing exercises with visual imagery and have the client visualize breathing in calming white light or a calming word, phrase, or memory filling their body, and then exhaling black smoke, for example…or stress, anxiety and visualize it escaping their body with every breath.”

At times, she also gives “homework,” but it’s the kind that clients want to complete. “I’m not giving out actual homework,” she chuckles. “Along with self-care homework, I may ask them to monitor their cognitive distortions between now and our next session, or implement a new sleep hygiene, or reward themselves after achieving a step towards their treatment goal.”

This homework doesn’t have to be time-consuming either. “Something as simple as a gratitude journal can help reframe your thinking more positively,” she says.

Just as with school-based homework or working out at the gym, Dr. Belizaire says that engaging in daily self-care exercises brings results. “If you can learn to do them when you aren’t anxious, the habit kicks in when you are fearful, which helps ease your stress response. After all, when you are in those anxious moments, you are in fight or flight activated mode and you may not readily recall the strategies that will help reduce your stress response.”

In addition, a big step in reducing stress comes from being prepared for it. “If you can anticipate a trigger, such as an upcoming anniversary, exam, or anxiety-producing situation, you can prepare for it in advance, which can help reduce the stress during the actual event.”

We Are Here For You

Dr. Belizaire is primarily seeing clients through teletherapy right now. “There are advantages to telehealth, which includes scheduling,” she says.

One caveat: “Teletherapy may not be appropriate for everyone and for every presenting concern,” she cautions, “but many people do benefit. Young children tend to do better with in-person interaction, but tweens, teens, and adults all do well with teletherapy.”

If you are concerned that your child or teen is struggling emotionally or showing signs of anxiety or depression, we can help. To schedule an appointment with Dr. Belizaire or our other clinical team members, contact The Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

About Dr. Lonette Belizaire, Ph.D.

Dr. Lonette Belizaire is a licensed psychologist with over 15 years of clinical experience working in a variety of treatment settings. She has worked with the gifted and talented child and adolescent school population, in college counseling centers, city hospitals and in private practice. She specializes in the treatment of anxiety, adjustment issues, interpersonal concerns, stress management, and bicultural identity. Dr. Belizaire’s approach is grounded in evidence-based treatment. She utilizes an integrative model that draws upon cognitive behavioral therapy and mindfulness-based interventions tailored to meet the client’s needs. She has found that building an awareness of the neurological basis of anxiety, how it is created and maintained in the brain, has also been particularly transformative for clients.

Dr. Belizaire earned her doctoral degree in Counseling Psychology from Fordham University, Master’s Degree in Mental Health Counseling from the University of Miami, and her Bachelor’s degree in Psychology from Stony Brook University. She has worked in some of the top institutions in the New York area including the Hunter College Campus Schools, Cornell University, and Pratt Institute. She is licensed in both Florida and New York.

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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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How Pandemic Stress Is Affecting Society: A Psychologist’s Observations

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As a psychologist who treats anxiety daily, I’ve been in a distinctive position during the pandemic. I can very clearly see the difference the last two years have had on individuals, families, and society, as a whole. Right now, our Children’s Center is overflowing with kids. They’ve been struggling through losing personal time with friends and peers. They have had to adapt to online learning and the disruption of their routines – and it shows. We are also seeing many more adults in our Anxiety Center. The family/children aspect is a big concern for parents right now. They are very worried about their kids (the schools are, too). Adults are not only trying to help their children, they are also juggling lost incomes, supporting kids who are learning virtually, and coming to terms with relationship challenges, not to mention the illness or loss of loved ones. When the pandemic started, I told colleagues that this virus would have two parts to it. The first and most apparent part would be the medical aspect, since we knew some people would get sick from it. The second part, however, was the mental aspect. There was no doubt that every one of us would be affected by the pandemic in some way. Maybe we would personally contract the virus. Maybe we’d lose a job or a loved one. We had the stress of shut downs and the upending of our normal lives. Even if we have somehow managed to escape the virus’ direct impact, we have become aware of this bigger force looming over and all around us, over which we have no control.

Pandemic Trauma Effects

The pandemic is malignant. It is malicious, evil, and malevolent. The virus infects without regard. It sickens or kills the old, the young, the rich, and the poor. Knowing this does not sit well with us. Humans have an inherent coping mechanism that helps us distance ourselves from a traumatic event. We may feel sad or upset about a tragedy, but we can still go on with our day-to-day lives. But, this pandemic is so big and so menacing, we find it impossible to ignore. In my opinion, one of the best stories ever written about life and how we ultimately deal with tragedy’s fallout is the Wizard of Oz. In the story, the malignant force is the wicked witch. Dorothy can’t defeat her on her own. She needs the wizard to protect her from the witch and send her back to her normal world. After many challenges, she learns there is no all-powerful wizard. He’s simply a man hiding behind a curtain. All seems lost. She has to manage on her own. Like Dorothy, we are on our own as we try to cope with the mayhem brought by the pandemic, both as individuals and as a society. When we entered this crisis, we were relying on authority figures (our governmental leaders, the CDC, the World Health Organization, etc.) to help get us through a new unknown, but this hasn’t turned out as well as we’d hoped. The problem is that humans have dependency needs. As children, we relied on our parents to keep us safe. Today, our needs are not being met by those in authority.

No Escape From Covid Stress

We don’t feel safe. We are fearful, so some have begun to lash out at other targets. Often, they find them in fellow sufferers. Here’s why. If you were lost in the forest, you wouldn’t want to be alone. You’d want to be with others. But if you were in a group that couldn’t find their way out of the woods within a reasonable time, the members would start turning on one another. “It’s your fault we didn’t turn left, instead of right,” someone might accuse. It wouldn’t take long for the group to begin fighting amongst themselves. People would start doing their own thing in an effort to gain a measure of control of the situation. This analogy is being reflected in the infighting we’re seeing amongst ourselves lately. Sadly, this will likely continue to be a long term situation as we emerge from the pandemic. We won’t suffer as much from the medical aspect of the virus anymore, but we will continue to feel the effects of the societal and psychological factors that have resulted from it. I can’t stress enough how essential it is to stop watching and reading the news. These reports are almost always shocking, negative, and upsetting. This is not good for your emotional health. Dealing with so much trauma in the news and in our personal lives creates chronic stress and disillusionment. This is very much like the battle fatigue that military personnel encounter during a war. It wears you down. In this case, however, we have no battlefield to come off of. We literally have no escape. Knowing this only adds to the anxiety, mental fatigue, apathy, and depression the world is dealing with. As in my forest analogy, since it seems that no authority figure can make things better, some people become defiant. As a result, we hear about fights on airplanes, trucker blockades, protests against vaccine mandates, and mask and vaccine refusals.

Resiliency And Moving Forward

There is no easy answer for managing the emotional stress of the past two years. As the pandemic recedes and we move forward, however, our built-in resiliency will help us bounce back. People can basically recover from anything. I have seen them do so over and over during my past three decades as a practicing psychologist. That doesn’t mean there won’t be long term negatives from the pandemic or that we’ll develop amnesia about what happened. Without a doubt, some people will come out of this feeling kinder towards each other, while some will feel more selfish, entitled, and rebellious. Nature has a way of correcting itself, however. Just as a pendulum swings back and forth, the anger will swing back to the gentler side. I believe that our innate nature to help each other will help all of us cope as we move forward. We must take care of ourselves as the pandemic drags on. Already, many people have begun to reevaulate their priorities. This has led to The Great Reset we’ve been hearing about. We’re deciding what is important to us. We yearn for something meaningful in our lives, something better – whether it is a new career, a new relationship, or a new hobby. So, I encourage you to take the time to do the things that make you happy. Spend time with family. Take a deep look inside yourself to figure out what you want going forward. Take what has happened and learn from it. Become more spiritual in a way that is meaningful to you. Be more aware of time and how quickly it passes: use your time well. Go out and live, but don’t be irresponsible. Instead, use this experience to make your life meaningful. Remember that the Japanese symbol for “crisis” is the same as the symbol for “opportunity.” So, find your opportunity and turn this crisis into something positive!

If You Are Struggling…

We can help. Whatever the difficulties you are facing, we are here to listen and offer effective solutions. For more information, contact us or call the Children’s Center today at 561-223-6568.

About Andrew Rosen PH.D., ABPP, FAACP

Dr. Andrew Rosen received his doctoral degree in clinical psychology from Hofstra University in New York in 1975 and completed an additional six years of psychotherapeutic and psychoanalytic training at the Gordon Derner Institute in New York, where he earned his certification as a psychoanalyst in 1983. In 1984, Dr. Rosen founded the Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, where he continues to serve as Director and to work as a board-certified, licensed psychologist providing in-person and telehealth treatment options. Dr. Rosen is Board Certified by the American Board of Professional Psychology (ABPP). He is also a Clinical Fellow of the Anxiety and Depression Association of America (ADAA) and a Diplomate and Fellow in the American Academy of Clinical Psychology (FAACP). He is an active member of the American Psychological Association (APA), the National Register of Health Service Providers in Psychology, the Florida Psychological Association (FPA), and the Adelphi Society for Psychoanalysis and Psychotherapy. Dr. Rosen was appointed a Clinical Affiliate Assistant Professor at the FAU College of Medicine in November, 2021. He is a Board Member of the National Social Anxiety Center. He has previously served as president of both the Palm Beach County Psychological Society and the Anxiety Disorders Association of Florida.
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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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