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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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Social Skills Training can help children and young adults connect with other.

Social Anxiety In Toddlers

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

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

What causes social anxiety in toddlers?

We aren’t really sure what causes social anxiety in toddlers. Genetics likely plays a role, since it contributes to a child’s temperament and personality. We also know that some genetic traits can influence certain mental health conditions.

A toddler’s environment could also predispose them to social anxiety. For a young child who already has a higher genetic risk, living with trauma or a severe parenting style may be enough to initiate social anxiety.

Social anxiety may also be learned from a parent, according to a 2006 study by de Rosnay, et al. Their research focused on indirect expressions of a mother’s social anxiety on their infant. The results showed that, “compared to their responses following their mothers interacting normally with a stranger, following a socially anxious mother-stranger interaction, infants were significantly more fearful and avoidant with the stranger. Infant-stranger avoidance was further modified by infant temperament; high fear infants were more avoidant in the socially anxious condition than low-fear infants.”

Is Social Anxiety a form of autism?

Studies have shown that social anxiety is not a form of autism, although the two have overlapping indicators, such as separation anxiety and avoiding eye contact. In fact, not only are they two distinct disorders, but the symptoms and diagnostic criteria for each are vastly different.

As the name implies, social anxiety is driven by anxiety. A child who has social anxiety will function within the parameters of their level of unease. For instance, they may simply keep to themselves, avoid other children, or might talk too quietly. Some kids may not talk at all.

On the other hand, a child with autism spectrum disorder doesn’t behave based on their anxiety level. Instead, this child has trouble understanding social cues and the nuances of communication. They might speak too loudly, may push their way into a group of children, or might misinterpret facial expressions or gestures.

Does my kid have social anxiety?

Children who have social anxiety may be branded as difficult kids because their anxiety can show up in forms other than just in social interactions.

Toddlers with social anxiety often show certain signs, such as:

  • Being a picky eater
  • Easily startled by noises
  • Not adapting well to new situations
  • May have a higher sensitivity to tactile sensations
  • Acting shy around new people and fearing strangers
  • Disliking being separated from their parents (separation anxiety) and distraction doesn’t calm them
  • Having strong emotional reactions and difficulty self-soothing
  • Might have sleep issues
  • Seems afraid to interact with peers, both individually or in a group setting
  • Often has other phobias or fears

Therapists who specialize in treating children’s mental health concerns can do an assessment, however a definitive diagnosis in a toddler with social anxiety may not be feasible due to their young age. The results should highlight challenging areas, though. It may also reveal the basis of the child’s social anxiety, which allows for early intervention.

How to help a child with social anxiety

At home, parents can demonstrate healthy social interactions when their child is with them, so the toddler learns not to be so fearful.

They can also rehearse a new situation with their child before it comes up. For example, a toddler who will be going to daycare for the first time might role-play some of the things they’ll do while they are there. Practicing certain aspects of the day or even dropping by the daycare a couple of times before officially attending can ease fears because the daycare will already be familiar. It would also be helpful to let the teachers or caregivers know about your child’s fears, so they can help build confidence.

Other supportive methods include:

  • Encouraging your toddler, but not forcing them into social interactions.
  • Using praise when the child successfully navigates a scary situation.
  • Not criticizing them for their fears.
  • Being calm and showing the toddler that you are confident.
  • Not being overprotective, which only reinforces the idea that the toddler has something to be afraid of.
  • Reading books or watching videos that show confident children.

Get Help for Social Anxiety in Toddlers

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.

References

  1. de Rosnay, M., Cooper, P. J., Tsigaras, N., & Murray, L., (2006). Transmission of social anxiety from mother to infant: An experimental study using a social referencing paradigm. Behaviour Research and Therapy, 8(44), 1165-1175. Doi: https://doi.org/10.1016/j.brat.2005.09.003
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Autism Spectrum Disorder: ASD And Anxiety In Children

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

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

Autism And Anxiety Comorbidity

“40% of young people with ASD have clinically elevated levels of anxiety or at least one anxiety disorder, including obsessive compulsive disorder”, according to an article by Dr. Elisabetta Burchi and Dr. Eric Hollander of the Autism and Obsessive Compulsive Spectrum Program at Montefiore Medical Center and the Albert Einstein College of Medicine.

They stress the importance of anxiety treatment for children with autism spectrum disorder. “While untreated comorbid anxiety has been associated with the development of depression, aggression, and self-injury in ASD, an early recognition and treatment may convey better prognosis for these patients“.

Some studies have shown that high-functioning children suffer from more anxiety disorders than do lower functioning children on the spectrum. Additionally, other research reports that adolescents and teens with ASD may be more challenged by anxiety than their younger peers.

How To Recognize Anxiety In Asperger’s and ASD

It can be difficult to spot the signs of anxiety in a child who has ASD for a couple of reasons: kids who are verbal may not be able to recognize and express their emotions, while children who are nonverbal can’t tell you that they are afraid or worried.

Also, children with ASD often display common behaviors that can look similar to those found in anxiety disorders. For example, the compulsions that are carried out in obsessive compulsive disorder can look much like the repetitive behaviors that a child with ASD will use, however the autistic child may not actually be anxious.

Although there are no specifics to watch for, anxiety often presents in the form of physical or behavioral issues. The signs may not be apparent in a younger child, but may show up in later years as they mature and their world expands to include school and other settings.

  • Social anxiety may show up in the form of avoidance of social situations. This keeps the child from experiencing interaction with peers and the opportunity to practice social skills.
  • Separation anxiety may be present if the child acts out when being parted from their parent, such as when a babysitter comes to the home or when the child goes off to school for the first time.
  • Phobias are anxiety responses to specific fears (i.e. fear of insects or acting out after being startled by a loud noise).
  • Distress about changes in routine can show up in the form of physical rituals or repetitive behaviors that the child uses to soothe themselves until they can calm down.
  • Controlling behavior or threats to hurt themselves or someone else are often a sign of high levels of emotional distress.
  • In adolescents and teens, alcohol and drug abuse are destructive coping methods that may be used to mask anxiety.

Treatment For Autism And Anxiety

Research has shown that behavioral interventions are helpful for many ASD children who have anxiety. One of the most effect therapies for treating autism and anxiety is cognitive behavioral therapy (CBT). This therapy is best for a child who has some verbal abilities.

CBT teaches kids how to uncover the fear beneath their anxiety so they can challenge their negative or inaccurate thoughts. For instance, if a child has anxiety about going to school, they may actually be afraid of getting lost and not being able to find their parents again.

Once the fear has been identified, the therapist can use small doses of exposure therapy to provide the child with evidence that they are safe. In the case of school anxiety and the resulting fears surrounding being separated from a parent, exposure therapy might involve having the child spend a minute or two in a room without their parent. When mom or dad come back in, the child feels safe. As the length of time apart from their parent increases with an end result of the parents returning, the child’s anxiety level can begin to decrease when they are away from the parent in other situations.

Depending on the child, an anxiety medication, such as a selective serotonin reuptake inhibitor (SSRI) like Prozac, may also be used in combination with behavioral therapy.

Need More Information About ASD And 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.

For more information about how our child psychologist can help your child with their ASD and anxiety, 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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7 Tips for Overcoming Back to School Anxiety

Another school year has come around and with it, the possibility of extreme fear and separation anxiety for some children. Although it’s normal for any kid to have a certain degree of back to school anxiety, there is a huge difference between a child who is nervous about the new school year and one whose anxiety is severe enough to seek professional care.

Kids often worry about things like fitting in or whether the teacher will pick on them, which increases their stress. In the week leading up to the beginning of the school year or in the last few days before the end of a school break, younger kids may show some separation anxiety by crying frequently, throwing temper tantrums, or being more clingy than usual. Older children’s school anxiety symptoms can include being moody or irritable, complaining of headaches or stomach aches, or withdrawing into themselves.  So how can a parent tell if their child just has school jitters or if they truly have back to school anxiety?

Fears about new teachers, harder school work, and being away from their parents are common for kids and usually stop within a couple of weeks once the child settles into the routine of the new school year. For those children whose anxiety symptoms continue beyond the first four or five weeks of school or seem extreme or inappropriate for their developmental level, a consultation with a therapist may be in order.

Tips to Ease School Fears

If your child is worried about the new school year, these back to school anxiety tips can help

  • Help you child identify what it is they are worrying about. Assure them that it’s normal to have fears. Give them your full attention and be sure to set a regular time and place to talk to them about their concerns. For example, bath time might be a good time to talk to a younger child, while a teen might be more receptive later in the evening.
  • Focus on the positives: In order to redirect your child’s attention from their worries, ask them to tell you a couple of things that are positive about school. Generally, even the most nervous child can think of something they like about it. Maybe they have a new friend or enjoy a certain subject or look forward to working on an art project. Looking for the positives can make the negatives seem a little less overwhelming.
  • Don’t pacify the child, instead coach them to come up with ways to solve their problem. Telling your child that “things will be okay” doesn’t help them get past their fears. What does is giving them some control. Encourage the child to give you some ideas of ways they can deal with what’s concerning them. This type of problem-solving helps them learn coping skills and teaches them critical thinking so they can develop a plan instead of simply reacting negatively.
  • Try role-playing. Going through a particular scenario can often help your child feel confident. Let the child be the “bad guy” teacher or scary bully, while you play the part of the child. Your responses can help them learn how to deal with the situation appropriately and allow them to respond with less fear.
  • Reinforce positive behaviors and reward their successes and their bravery in facing what they fear.
  • Be supportive, but don’t allow them to stay home from school. Even though it is normal for your child to worry about going to school, it is crucial that they attend. Allowing them to avoid school only increases and reinforces their fears. The longer they stay out of school the harder it can be for them to go back.
  • Seek professional help for back to school anxiety that gets worse or lasts more than about four weeks. Additionally, medication is sometimes appropriate in severe cases of separation anxiety.

Help Your Child Overcome Back to School Anxiety

If your child is struggling with back to school anxiety, it may be time to seek help from 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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Does Rapid Onset Gender Dysphoria Exist?

When a person feels strongly that they don’t identify with the biological gender they were born with, the American Psychiatric Association terms them as having gender dysphoria. Although children as young as age four may express gender nonconformity, many times gender dysphoria doesn’t become evident to the person until they reach puberty and realize they are not comfortable with the changes going on in their bodies. For a gender dysphoria diagnosis, the person must feel these symptoms for at least six months. Recently, however, some researchers have been exploring a new development in gender dysphoria that seems to occur very suddenly and without the child having expressed any prior distress with their physical gender. This is called Rapid Onset Gender Dysphoria (ROGD).

What is Rapid Onset Gender Dysphoria?

Rapid Onset Gender Dysphoria is a term that has sprung up within the past couple of years. It is important to note that ROGD has not been established as a distinct syndrome. This dysphoria has been casually (not scientifically) observed.

In ROGD, an adolescent or young adult who has always identified as their physical (birth) gender suddenly starts to identify as another gender. Prior to this, the child would not have met the criteria for gender dysphoria nor would they have displayed any discomfort with their gender. Additionally, often multiple friends within the same peer group simultaneously identify with another gender and become gender dysphoric around the same time.

Why is ROGD Controversial?

Recently a Brown University researcher published a study “to empirically describe teens and young adults who did not have symptoms of gender dysphoria during childhood but who were observed by their parents to rapidly develop gender dysphoria symptoms over days, weeks or months during or after puberty.” The study author was Lisa Littman, an assistant professor of the practice of behavioral and social sciences at Brown’s School of Public Health.

Littman surveyed over 250 parents whose children had suddenly developed gender dysphoria symptoms. Of the parents who answered the survey, about 45 percent reported that their child had increased their social media use and that the child had one or more friends who became transgender-identified around the same time as their child.

This led to Littman’s hypothesis that gender dysphoria could be at least partially spread by social contagion. She proposed that social media and a child’s peers could cause the child to embrace certain beliefs, such as the idea that feeling uneasy with the gender you were born with meant you were gender dysphoric. Because many RODG teens also push for medical transition to another gender, Littman suggested that this could actually be a harmful coping tool in the same way that drugs, alcohol or substance abuse are negative coping mechanisms.

Transgender advocates fiercely criticized Littman’s study, saying it was methodologically flawed because Littman only interviewed parents and not the transgender-identifying children themselves. They also called the study “antitransgender” and a denial of transgender affirmation while citing the fact that a person who is questioning their gender and seeking answers would naturally read up on the subject and spend time with supportive friends who may have similar thoughts and feelings. Advocates pointed out that a true gender dysphoria diagnosis requires evaluation by specialists, while Rapid Onset Gender Dysphoria only required the parent’s perspective.

As a result of the criticism, Brown withdrew its press release about the study and wrote a statement explaining its decision to conduct a post-publication re-review. They worried that the study “could be used to discredit efforts to support transgender youth and invalidate the perspectives of members of the transgender community.”

Gender Dysphoria Treatment

Clearly, more research is needed in order to settle the question of whether Rapid Onset Gender Dysphoria is real, however we know that gender dysphoria exists. Early diagnosis, gender-affirming approaches by parents, and individual and family counseling can help the transgender person and their loved ones deal with the emotional challenges of gender transition.

Many transgender people take action to be more in alignment with who they feel they are. They might change their name to one more suited to the gender they express or dress as that gender. Other options include taking puberty blockers, hormones to develop physical traits for the gender they identify with, or sex-reassignment surgery.

We know that people with gender dysphoria have higher rates of mental health conditions like depersonalization disorder, anxiety, depression and mood disorders, and increased substance abuse. They also experience higher suicide rates, therefore it is important for them to seek mental health treatment. The goal of treatment is not to change the person’s feelings about their gender, rather it is to give them a way to deal with the emotional issues that come with gender dysphoria.

Get Answers about Gender Dysphoria and ROGD

If you or a loved one are distressed, anxious, or depressed about your gender identity, we can help. Contact the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida for more information or call us today at (561) 223-6568.

 

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Bullying Kids With Food Allergies

Bullying Kids With Food Allergies

Imagine being a child who lives with severe food allergies. Ingesting even the tiniest amount of the allergen (or having it touch your skin) can be enough to trigger anaphylaxis, which can kill you. Your condition is so severe that you must extremely vigilant about your food and you carry an epinephrine injector everywhere you go in case your inadvertently miss something and begin having trouble breathing or your throat starts to close. Now imagine fellow students bullying you because of your life-threatening allergies or having a fellow student force you to touch or eat the food that might kill you. It sounds far-fetched in view of the danger, but that’s a real life scenario for approximately 31.5% of children with food allergies, according to a 2013 study reported in Pediatrics.

These children are being singled out for harassment and are more than twice as likely to be bullied specifically because their food allergies.

Food Intolerance or Food Allergy?

5.9 million kids in the U. S. have food allergies. In fact, the Centers for Disease Control and Prevention (CDC) reports that “among children aged 0–17 years, the prevalence of food allergies increased from 3.4% in 1997–1999 to 5.1% in 2009–2011”. That means about 1 child out of every 13 in a given classroom has a food allergy.

According to the American College of Allergy, Asthma & Immunology, food allergies occur “when your body’s natural defenses overreact to exposure to a particular substance, treating it as an invader and sending out chemicals to defend against it.”

A true food allergy isn’t the same as the more common food intolerances we think of when we avoid a certain food because it will negatively affect our body (for example: lactose intolerance). Instead, food allergies trigger a person’s immune system, sending it into overdrive. This overreaction can bring on symptoms ranging from mild (like hives, itchiness, or gastric problems) all the way up to anaphylaxis, which can be life-threatening.

Food allergy reactions can start in as little as two minutes and as long as two hours after eating or touching the food. The Mayo Clinic reports that the most common food allergy signs and symptoms include:

  • Tingling or itching in the mouth
  • Hives, itching or eczema
  • Swelling of the lips, face, tongue and throat or other parts of the body
  • Wheezing, nasal congestion or trouble breathing
  • Abdominal pain, diarrhea, nausea or vomiting
  • Dizziness, lightheadedness or fainting

Anaphylaxis

In some people, a food allergy can trigger a severe allergic reaction called anaphylaxis. This can cause life-threatening signs and symptoms, including:

  • Constriction and tightening of the airways
  • A swollen throat or the sensation of a lump in your throat that makes it difficult to breathe
  • Shock with a severe drop in blood pressure
  • Rapid pulse
  • Dizziness, lightheadedness or loss of consciousness

Emergency treatment is critical for anaphylaxis. Untreated, anaphylaxis can cause a coma or even death.

Impact of Food Allergy Bullying

Often, kids think it is funny to tease and bully kids who have food allergies. This may be because they don’t really understand what can happen to children who have severe food allergies, although older kids and teens clearly have an idea. A 2018 New York Times article reported that a parent stated on Twitter that his son was “taunted by ‘friends’ with a PB & J sandwich,” who said, “‘let’s see if he dies.’” In other cases, “children with food allergies have had milk poured over them, peanuts waved in their faces, cake thrown at them, and peanut butter smeared on them.”

This harassment and stress can cause allergic children to fear school, leading to school refusal, and can make them depressed or cause them to isolate themselves socially. Parental involvement can help keep down the attacks, but children only report the harassment to their parents about 52.1% of the time. Additionally, teachers often make insensitive remarks or single-out and exclude children with food allergies from certain activities or school functions, further contributing to the child’s feelings of isolation and anxiety.

Increasingly, there have been legal consequences for food allergy bullying. In 2017, a 13 year-old U. K. boy was arrested for attempted murder after flicking a piece of cheese into a fellow student’s mouth, causing an anaphylactic reaction that led to the victim’s death. That same year in the U. S., a Michigan student with a peanut allergy (who was unconscious due to a hazing incident) was smeared in the face with peanut butter, resulting in an anaphylactic reaction. Thankfully, he later recovered, but the perpetrator pleaded guilty to assault and battery charges.

What Should Parents Do?

  • Know what’s going on by staying involved at your child’s school.
  • Know the signs of bullying: your child refuses to go to school, has stomach aches, stops talking about peers or friends, their grades may drop, or their sleep patterns may change.
  • Teach your child what to do if they are being bullied – make sure they know they should tell the school nurse or their teacher. Also teach them to tell you. Studies show that children experience a reduction or cessation in bullying if a parent knows they are being bullied.
  • Discuss your child’s allergies and their severity with the school principal and with your child’s teacher before your child starts the school year. Find out about the school’s anti-bullying policies and the procedures for handling an incident.
  • Seek help from your child’s friends and classmates. They will often see things a teacher may not and can report any threats to your child’s teacher or warn your child of impending danger.
  • Teach your children compassion and caring so they learn it’s not funny to bully others and that people can be hurt or can die from what might seem like a harmless prank.

Get Help for Bullying

It’s important to seek help as soon as possible if your child becomes the target of food allergy bullying. For more information about how a child psychologist at the Children’s Center can help your child stand up to bullying, contact the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

 

Article Resources

https://www.allergicliving.com/2017/09/06/michigan-student-pleads-guilty-in-peanut-butter-face-smearing-case/

https://www.nytimes.com/2018/02/15/well/family/in-allergy-bullying-food-can-hurt.html

https://snacksafely.com/2017/07/food-allergy-bullying-leads-to-death-of-13-year-old-boy-arrest-of-another/

 

 

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