Expert Advice

What You Need to Know About Taking a Child to Therapy

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Disclosure: CHOC Children’s is a Tiny Oranges Partner

This post will hopefully explain any questions you might have about taking a child to see a therapist thanks to the expert advice of Dr. Carlos Konishi Ph.D., a pediatric psychologist at CHOC Children’s. We will cover how to find a therapist for your child, what to prepare for your first session, some questions you might want to ask and most importantly, how to know you have found a good one.

Kids’ mental health.  We need to talk about it.

But there are still stigmas and misinformation around mental health because we don’t understand mental illness like we do physical illness.

If your child was complaining about a persistent physical pain, what would you do?

Make an appointment with your doctor.

You probably wouldn’t even think twice about it, right?

What if you noticed persistent and noticeable changes in your child’s emotional or mental state or behaviors, what would you do?

The answer is not as clear as a physical ailment, is it?

But it should be.

Make an appointment with your therapist.

If you have never seen a therapist before, the idea of taking your child to one might seem daunting. But it doesn’t have to be. The first step is often the hardest but the end results will be well worth it.

Here are some of the questions I had for Dr. Konishi. If you have any to ask him, please comment below!

My child needs therapy, where do I start? How do I even find a therapist? 

“The best place to start is often with your pediatrician who can give you a referral or provide you with list of providers contracted through your insurance. When researching therapists for your child, it is extremely important to find someone who specializes in working with children, because it takes a specific skill set. It is also helpful to see if the provider has experience working with the issue you are seeking treatment for,” Dr. Konishi explained.

I made an appointment, do I need to prepare anything for our first meeting?

“Just like an initial doctor’s appointment, there will be a good amount of paperwork to complete prior to the first session. It is helpful to ask if you can get the paperwork ahead of time to allow you to arrive with everything filled out,” he suggested.

You can also bring in any information that will help the therapist learn more about your child.

“Documents like IEP’s, grades, special testing results, teacher or coach feedback, any information that will help the therapist get a more complete picture of your child is extremely helpful.”

He also recommended writing down any questions you have for the therapist before going in so you can leave with all your questions answered.

To that point, what questions are good to ask the therapist?

Along with the questions you come up with, Dr. Konishi said there are some good ones to address in the first session:

How often will we meet?

Will the sessions include both myself and my child? Or will you also want to meet with us alone?

What are the specific goals of therapy?

How are we going to be able to identify progress in a way we can objectively track?

What’s the best way to communicate with you if I have questions or concerns in-between sessions?

Which led me to my next question..

How do I explain therapy to my child?

Dr. Konishi said you can simply describe therapy as going to see a person whose job it is to help them feel better.

“Some parents have helped prepare their child for a first therapy visit by comparing a psychologist to a school counselor. Most students know who a school counselor is and usually have a positive impression of them,” he explained. ” They also understand that they are there to help, even if they have not gone and seen one themselves. Using this example can help remove the fear of the unknown.” 

For those who like books as conversation starters, he suggested a book called “Feeling Better” about therapy on Amazon (affiliate link) you can get and read together with your child.

If your child is older, like tween or teenager, “It might be a good idea to ask them what they would like to get out of therapy and what their goals are? This gives them ownership and power over the process,” he said.

What should I expect in the first session with my child?

“The first session is typically spent building rapport with the child and family while gathering information about the child’s strengths, interests and life situations.”

The therapist will also likely cover any relevant history like asking about any family history of mental illness, traumas, developmental or social delays, etc.

It might seem very personal but all of this information will help the therapist devise a plan for therapy and treatment that will be most effective for your child.

“It is important to know that everything said in a therapy session, barring any information about the child being a danger to him or herself, to others, or being the victim of acts that put the child in danger, are kept strictly confidential by HIPPA law,” Dr. Konishi stressed.

How long will it take for therapy to work?

“It is really important for parents to exercise patience when assessing the effectiveness of therapy.  The first 2 – 3 sessions are generally spent building rapport with the child and making them feel comfortable,” he expressed.

Before making any knee-jerk reactions or conclusions about therapy not working, he said to give it at least 5 sessions and sometimes it might even take up to 10 before you might start to notice any improvements.

“Change is hard for anyone, and changes do not happen overnight, so it is important to trust the process and give it some time before evaluating.”   

What if I don’t think therapy is working for my child?

The most important component of therapy is having open communication with your therapist about the things that are working but also any concerns you might have.

“Knowing this information gives the therapist insight and opportunity to tweak their approach,” he explained. 

But Dr. Konishi, isn’t it insulting to tell my therapist if I don’t think they are being effective for my child? The therapist is the expert after all, right?

“Yes, therapists are experts in how to work with certain problems and behaviors, but you are the expert when it comes to your child,” he clarified.

No one else on this planet knows your child like you do, so it is absolutely appropriate to share feedback with your therapist.

How do I know if I have found a good therapist?

Your therapist should make you and your child feel comfortable and be able to lay out specific goals for therapy so you can work together to meet these goals and help your child feel better.

“A good therapist should view therapy as a collaboration between the child, the child’s parents and the child’s medical team with the goal of treating the whole child, mind AND body. Collaboration takes communication, so it is important to communicate with both your therapist and your doctor what is going on with your child to give them better insight in treating your child most effectively,” he stressed.   

Lastly, a good therapist will also be open to hearing your honest feedback and work together with you on the best way to treat your child. 

Any final notes?

Dr. Konishi answered, “Don’t expect perfect progress. Therapy doesn’t work that way.”

It’s not like taking an antibiotic for an infection, where you take it for 10 days and you are done. Therapy is a series of progress and setbacks. You might see some steps moving forward, but then a life stressor or situation might arise, and you might see a few steps back.

“What’s important is you continue to communicate these life circumstances so your therapist can integrate proper coping tools to help get the child back moving in the right direction.”

If you would like to learn more about CHOC Children’s Mental Health services and programs please visit www.choc.org/mental-health.

6 Conversation Starters About Mental Health

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How to Talk to Your Kids About Tragic Events

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In the wake of last week’s horrific mass shooting in Las Vegas, this article on how to talk to your kids about a tragic event in the news is brought to you by CHOC Children’s

When tragic events happen in the news it is sometimes hard to know how to handle conversations about it with our children. How much information should we give? How do we answer specific questions? How does this vary with a child’s age?

Which is why I was so grateful to have the opportunity to speak with Dr. Nicole Vincent, PhD, a licensed psychologist at CHOC Children’s to get her advice to share with you today. 

 5 Key Things to Remember When Talking to Your Kids About a Tragic Event in the News

My very first question I had for her was,

“Is it better to bring up the event with your child at home first OR wait and see if they hear something from a friend or at school before discussing it?” 

1. Be Mindful of the Child’s Age

Dr. Vincent expressed how we talk to our kids about tragic events in the news will vary depending on the age of the child.

For preschoolers through about 1st grade, the chance a child would be exposed to information in the news is not as likely as it is for older children. So for young ones, a parent might consider not bringing up the event unless the child specifically asks about something they heard.  

For older elementary schoolers she suggested it might be a good idea to touch base with your child’s teacher or administrators to ask if the event has been brought up in class or if it is being talked about? Depending on the answer, this might cue you in to whether you might want to address it with your child at home. 

As kids become middle and high school age, it is very likely, especially with technology and social media exposure, to hear about tragic events and get information outside of the home. For these ages, Dr. Vincent said it is usually a good idea to take a proactive approach and start the conversation at home so you can discuss the facts and give them the opportunity to ask questions. 

Which led to my next question, how do you approach the topic about a tragic news event with your kids?

2. Consider Starting the Conversation With These Questions

The best way to start the conversation is to ask your child open-ended questions like “Have you talked about events in the news?” If yes,What have you heard about it? Tell me what you know.” 

The answers will help guide the conversation as to how much information to share.

For younger age groups, it is best to keep your responses honest and factual, but brief. Details are not totally necessary and often times these responses will be enough to satisfy their curiosity.

For older age groups, she advised to let your child take the lead with information they heard or questions they might ask. It is important to validate their concerns by letting them know they are asking great questions. It’s okay to not always have the answers, you can tell them as much, and empathize with also wanting to also know.  Being there to listen to your child is the most important. 

But regardless of age, she stressed you know your child the best and to pay attention to behavior and cues that might indicate they heard something or have questions. Even young children can pick up on information or overhear things that might surprise you.

Bottom line, take the above age suggestions as general guidelines. But again, you know your child the best.

For me personally, I was surprised my 8-year-old daughter had many more questions and wanted to talk about Las Vegas much more than my 11-year-old daughter. It also elicited more fear in her than her sister. For kids who seem to be experiencing an increase in fear as a result, I asked for suggestions on how to help.

3. Reinforce the Rarity of the Event

Tragic events often trigger fear and anxiety in people of all ages, and for children tragic events can be especially scary

Dr. Vincent suggested this could be a time to highlight the fact that a shooting like the one that occurred in Las Vegas is a rare event. And when rare tragic events happen there are many people that will work together to try to avoid it from happening in the future.

4. Teach Kids to Look for the Helpers

In times like this, I often see people quoting Mister Rodgers when he said, “When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.”

Dr. Vincent mentioned it is very helpful to highlight for your children the people that step up to help in crisis.  Teach them to look at the first responders, volunteers, or strangers helping strangers. These people show us the beauty of humanity in a crisis. 

For some kids, she suggested even possibly talking about what you can do to help as a family. Even a small act like choosing a Go Fund Me account to donate to, writing a letter to a first responder, or looking up supplies to donate can help by showing there are always things people can do to help. 

5. Keep Home Life as Normal as Possible 

One last parting piece of advice was to keep your routine at home as normal as possible.  When a child’s day to day routine is altered for whatever reason, it can cause additional anxiety to build. 

On this note, Dr. Vincent also stressed how important it is to allow yourself the time to process the events. Whether it’s talking to your partner, friends or therapist, it is important to be mindful of your own self-care so you are in the right state of mind to discuss it with your child. 

When To Seek Help

After a tragic event, it is not uncommon to experience a variety of emotions or symptoms like mood changes, difficulty with sleep, or increased headaches or stomachaches. If any of these changes persist in you or your child for more than a couple weeks, and if the symptoms are disrupting daily life, it might be a good idea to pursue help by a mental health professional. 

Get more tips from CHOC experts

For more information about CHOC Children’s and their mental health services visit www.choc.org/services/mental-health

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Getting Beyond the One Word Answer

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This article is brought to you by CHOC Children’s pediatric psychologist Dr. Carlos Konishi Ph.D on conversation starters for kids and advice on how parents can encourage communication beyond the one word answer. Getting kids to share more can be a challenge at times, especially for parents of teenagers. His information on how to get kids to open up gave me so many “AHA!” moments during my interview I actually had to apologize for saying “TOTALLY!”  so many times after he said something that struck a chord. I was like an 80’s teenager myself. Totally.

conversation starters for kids

One word answers.

Ugh.

How was your day?

Fine.

Good.

Okay.

What did you do?

Not much.

The process of trying to get more information out of your child can be painful at times, like pulling teeth. So how do you get beyond the one word answer?

Here is Dr. Konishi’s insightful advice… be ready to say TOTALLY yourself…

1. CHOOSE YOUR TIMING WISELY

Have you ever come home from a long day and had your spouse ask, “how was your day?” right when you walk in but felt too tired to even put a sentence together?

Dr. Konishi said children and teenagers are exactly the same.

Their school days and life in general require a lot of energy from them.  To have you chirp, “How was your day?” the instant you greet your child after school might not be the best timing.

If you sense your child is not in the mood to talk right away, he suggested giving them some wind down time.

You can let them know you really want to hear about their day when they are ready to talk, and then keep an ear out for other situations when conversation happens naturally. It might be in the kitchen when they are eating a snack, or in the car on the way to a sport practice, or right before bedtime.

Point being, don’t think the immediate moment you see them has to be the time to discuss all that happened in those hours when you were apart. Opportunities will arise, we might just have to exercise a little patience, and take the cues from our child as to when they are in the mood to share.

2. BE CREATIVE

“How was your day?”

Isn’t that usually the go-to question? Dr. Konishi said frankly kids might be tired of it and find it BORING which is why it doesn’t inspire more than a one word answer!

He suggested getting a little more creative in your questioning by asking different, specific questions about their day instead. More like bite size questions vs. a general one. Sometimes these types of questions are easier for kids to process and express.

For example, if you knew they had a specific project going on in one class or subject, you could ask an open-ended question about it.  Or, ask what activity they did at morning recess and who they played with?

You can also be creative in the timing of your questioning. During fun family activities like a walk, bike ride, or family game can be great times to talk.  Speaking of games, he highly recommends a game of conversation starters called TABLETOPICS which you can pick up on Amazon. There is a Family edition and Teen edition and it is a fun way to get the family talking. Not just the kids, but the parents too! (Amazon affiliate links)

tabletopics

3. BEWARE OF AUTOPILOT MODE

Many times the question, “how was your day?” simply comes from us being in autopilot mode – and it is possible that it in turn triggers an autopilot response of “good” or “fine” from our kids in return.

Dr. Konishi recommended that before starting a conversation with your kids, to first do a self-check as to whether you are able to really listen to what they have to say. Kids can sense when we are multi-tasking and not really listening. In this case, they might not want to answer because they know you aren’t listening.

Bottom line, 0ne way to improve communication with your kids is to start the conversation when you really have time to listen and be present.

4. DON’T FOCUS ON YOUR AGENDA. EXPLORE THEIR INTERESTS.

When starting conversations with our kids many times our questions come from the information we want to know. But these topics might not be super interesting to our kids.

Dr. Konishi said a powerful communication tool can be to tune into their interests and ask questions about the things that excite them. Kids are more likely to open up when it is a topic they want to talk about.

Making children feel like you share and acknowledge their passions is a great way to build better communication, because they know they can share things about it with you.

5. PICK AND CHOOSE YOUR BATTLES

Often times dialogue and conversation between parents and kids can start to go into negative spiral due to constant nit-picking from parents, which can be especially true as children become tweens and teens.  Naturally parents expect more out of older kids, but that can mean kids are constantly being told what to do, what they did wrong, or how to do something different.

If your child starts to feel like all conversations with you are negative, they can start to tune you out because they are conditioned to think you are just going to nag them again.

Dr. Konishi recommends pausing before approaching your child with something that is bothering you and ask yourself, “Is this really important?”

If it is, then by all means, start the conversation about it. But he then advises to keep your message concise and focused on the behavior – not your child’s character. When complaints are piled upon complaints the initial message can be lost. And when a child feels you are judging who they are (and not what they did), the doors will close.  

To take that one step further, he also advises parents to pause and assess whether you can approach the conversation and keep your own emotions cool.  If you can’t, your child will shut the door and go on the defensive.  This is a natural human trait when someone feels attacked. So, take a deep breath, and ask yourself if you can have the conversation without “losing it”? If the answer is no, it is probably best to wait to discuss it with your child.

 YOU ARE NOT ALONE

Dr. Konishi wants parents to realize they are NOT alone, and you don’t have to take on parenting challenges alone.

Parenting is hard. There is no instruction manual and every child is uniquely different. The truth is we don’t have all the answers, and it is OK to ask for help if you are experiencing problems with your child.  There is so much power in sharing your struggles because it encourages others to open up too, and gives us the the opportunity to learn from each other.

He wants parents to seek support…whether it’s from friends, a parenting class, or a family therapist.

One final note he also wanted to stress was that it is normal and natural for kids to go through phases where they are a little more quiet than usual, and it is normal for some kids to be innately less verbal and for some to be more talkative.

You know your child the best. What we always want to stay on the look out for are sudden changes in behavior and/or functioning. If a normally open child suddenly becomes more closed up or has challenges with daily functioning, it might be time to seek professional help. We are so blessed to have places to turn to, like the professionals at CHOC Children’s mental health services.

Get more parenting tips from CHOC experts

For more information about CHOC’s mental health services visit www.choc.org/services/mental-health

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Rising Rates of Depression Amongst Teen Girls

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This article is sponsored by CHOC Children’s Hospital

The teenage years are a time in life unlike any other marked by new, fluctuating hormones, social pressures, and school stresses. These new situations can understandably cause kids to feel down or depressed at times. But for others the feelings of sadness or hopelessness can persist in a state of depression. In fact, it is estimated that approximately 20% of teenagers experience depression before reaching adulthood.

A recent study published in the journal Pediatrics found depression rates amongst teens stayed fairly stable from the years 2005 – 2011. However from 2012 to 2014 the rates of depression were on the rise for both boys and girls, with a more pronounced increase for teenage girls.

What is causing this increase? Is the advent of social media playing a role at putting more girls at risk for depression?

I am exploring this question, along with other extremely helpful information provided by Dr. Adrianne Alpern Ph.D. a child psychologist at CHOC Children’s Hospital on warning signs of depression in teens, symptoms and how to get help if you suspect your teenager might be depressed.

depression in teens

My daughter will be eleven soon and over the past year I have seen her evolve from a little girl into a blossoming tween where friends are paramount and Music.ly’s have taken the place of pretend play. She’s growing up.

And it terrifies me.

But why is the idea of having a teenager so scary? Growing up is part of life. We all have to go through it. Logically I know this. However, as I see the years of hovering under her at the big ladder at the park and holding her hand across every street slowly come to an end I also see my ability to protect her start to fade.

At the root of the fear is the loss of control.

Up until now it’s been my job as her mom to protect her and keep her out of harms way. When our babies are close to the nest we can watch them and keep them safe. But as she spreads her wings and starts to fly into the world without me I won’t be able to protect her in the same way.

Girls will hurt her feelings, disappointments will sting on a bigger scale, and pressures at school will build. All of which will be things completely out of my control.

My role as her mother is starting to change. 

Instead of trying to protect her from these hurts, my job will be to listen, support and encourage her to dust off her wings and try again.

More damage control versus prevention.

And it is my prayer that  she will be able to work through whatever hard times the teenage years hold for her.

But what happens when your teen has difficulty getting through a hard time? What happens when hurt feelings or disappointments turn into sad moods that last for weeks?

How do you know when a teen mood swing isn’t a swing at all, but could actually be an episode of depression?

depressioninteens

This week I had the opportunity to interview pediatric psychologist Dr. Adrianne Alpern Ph.D. about depression in teens which I am happy to share with you today as I feel it is extremely important information to have as parents.

Normal Teenage Moodiness vs. Depression

My first question was, “How do you know the difference between ‘normal’ teen moodiness and clinical depression?” Dr. Alpern highlighted the fact everyone feels sad or down sometimes and being sad is a normal part of the human experience. But an episode of depression differentiates in important ways and this is a simple way to remember possible warning signs of depression.

Depression is when feeling sad or disinterested in activities you used to enjoy lasts for:

– > Most of the day

– > More days than not

– > For two weeks or more

Say it with me moms…depression is when feeling sad or disinterested in enjoyable activities lasts for most of the day, more days than not, for two weeks or more. I will remember that, won’t you?

Some Other Symptoms of Depression in Your Teenager Could Include:

– > More or less sleep

– > Changes in appetite

– > Fatigue

– > Changes in concentration

– > Thoughts of being a “bad daughter” or “bad friend”

– > Changes in movement….moving either quicker or slower than normal

– > Thoughts of not wanting to be around anymore, wanting to disappear or die

Study Finds Depression Rates Increasing in Teenage Girls

A recent study published in the journal Pediatrics found depression rates amongst teens increased from 2012 – 2014 from 8.7% to 11%, and the rise in rates of depression was more pronounced in teenage girls.

Professionals theorize the use of social media could play a role in the increase in depression. Teenage girls are more likely to engage in social media and use it as a source of their self-esteem looking to others for validation or acceptance. Social media can unfortunately also be another avenue for bullying or social shaming.

Others suggest the economic downturn could have played a role in the way teens viewed the future. Or, maybe our evolving openness in the media with celebrities sharing their mental health struggles might encourage teens to be more apt to report their depression than in years past.

But regardless of the cause, the take away for us as parents though is the same – depression amongst teens is very real, and our girls are especially vulnerable. Teen depression is increasing and we need to be aware of it.

teendepression

What To Do If You Think Your Teen is Depressed

Dr. Alpern stressed parents know their teen the best. If you notice changes in your teen’s mood or behavior, there’s no reason to panic, but it is a sign to pay attention and start some conversations.

When talking to your teen, she emphasized how the most important thing we can do as parents is to listen. Sometimes it is easy to downplay teen struggles because many parents think “life is easy” for a teen. What on earth could be so stressful? They have no mortgage, food is on the table, they have a roof over their head, etc.

However, teenagers have legitimate stressors in life, many of which they are encountering for the first time, so it’s important to empathize and validate their feelings versus discounting them.

starttheconversation

If the sad or down moods persist and start to interfere with your child’s relationships with friends or family, school work, or ability to complete daily activities (such as chores), it might be time to seek the help of trained mental health professionals.

Your child’s pediatrician could be the first place you turn to for direction on where to go to help. Many insurance plans also have lists of mental health providers.

Help is available and effective treatments exist for depression. 

How to Explain What Therapy is to Your Teen

Dr. Alpern expressed how there are so many misconceptions about therapy and we both agreed that “myths and facts about therapy” deserves its own entire blog post for this very reason! Many people think therapy is a place where you just talk about problems and vent but that is what friends and family are for. Therapy is so much more.

To break it down simply for your teen, therapy is a place to get help with the thoughts or behaviors that are causing you to be “stuck” and therapists are trained to notice these thoughts or behaviors and are able to brainstorm with you to help get you “unstuck”.

But What If My Teen Doesn’t Want to go to Therapy?

Dr. Alpern brought up the point that a lot of teens are resistant to the idea of going to therapy. However, if as a parent, you can get them in the door, the therapist can take it from there.

She suggested telling your teen how much you love them and how as their parent you want them to give it a try to see if it helps. Urge them to try it for 3 – 4 times and assure them they do not have to talk about anything they don’t want to. Tell them they can decide what they want to talk about. Giving them this sense of control can be comforting when going into an unknown situation.

There are Effective Treatments for Depression!

Dr. Alpern told me effective treatments exist for depression, and there is ALWAYS hope. With the help of a licensed trained counselor or psychologist in addition to adjunct consultation from a psychiatrist when necessary, depression can be treated.

If you are looking into help for your child, the website www.effectivechildtherapy.org can be a great place to start.  She suggests this site to many parents as a mental health resource. Click on “The Public” and you can find lists of symptoms and treatment options.

Teens Are Not Ticking Time Bombs

When I was expressing my fears about having a teenage daughter someday she told me many parents approach their teen like a ticking time bomb with gloves on, trying to diffuse whatever might come their way. I had a good laugh at this visual. So true!

She assured me that MOST teenagers do JUST FINE in the teen years. She assured me that many teens are using social media appropriately without significant harmful effects. After all, 87% of girls and 94% of boys in the study in Pediatrics did not report significant symptoms of depression within the past year. She assured me that many teens will  be able to navigate life without any major issues.

Exhale.

However, help is out there and you do not, I repeat, do NOT have to face these challenges and your child does not have to face challenges alone. Getting help for depression, anxiety or other mental health concerns is nothing to be ashamed of, it is just as important as their physical health. If your child has a broken leg, you would rush them into the doctor for treatment. If your child seems “stuck” in weeks of sadness or withdrawal from activities they used to enjoy, it’s time to take them into the doctor for treatment.

Same, same.

For more information on the CHOC Children’s pediatric mental health initiative visit:

www.choc.org/giving/mental-health/lets-talk-about-it

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Anxiety and Children

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This article is sponsored by CHOC Children’s Hospital

As a person who has struggled with anxiety for as long as I can remember, mental health is an important topic to me. Mental health needs to be talked about. Today’s article is focused on anxiety and children. Do you have an anxious child? I do. Which is why this post today on anxiety and children is particularly important to me. I had the opportunity to engage in a conversation with Dr. Christopher Min a licensed pediatric psychologist at CHOC Children’s about anxiety and children and he was so insightful.

Anxiety and Children

You know the phrase the apple doesn’t fall far from the tree? Well, my oldest daughter, is my anxious apple. It is astonishing to watch her anxious behaviors and hear her thoughts sometimes, because I GET it. I wish she didn’t have this, but it is part of who she is just like it is a part of me. What I do want is  to give her the tools to help her manage it at a young age, because it took me until age 35 to seek ongoing help.

Anxiety and Children

Here are the questions I asked Dr. Christopher Min about anxiety and children.

How do you know the difference between normal worry and anxiety in children?

He started by explaining that worry is a natural and normal physiological response built into us as human beings to help us to survive. Way back when anxiety was necessary to keep humans from getting eaten by tigers and the ‘fight or flight’ response kept us alive. Worrying is very much part of being a human. However, for children with brains more sensitive to these triggers, anxiety might be hard to control. If the anxiety is prevalent, constant and persistent, some kids might need help to re-wire or re-train their brains to diminish the response and help calm their bodies.

Anxiety Symptoms in Children

There are different ways anxiety can manifest in children. When talking about the type of anxiety that is characterized by excessive and persistent over a number of different things, it is called generalized anxiety disorder.

Symptoms of generalized anxiety disorder in children include:

– Worry which is hard to control and becomes constant and consuming
– Irritability
– Sleep onset problems
– Fidgety
– Inability to relax
– Hyper vigilant / hyper aware of surroundings
– Fatigue
– Physical symptoms like persistent stomachaches or headaches, etc. in response to worry or anxiety
– For a full list of symptoms click here

Other Anxiety Disorders in Children

Anxiety can cause other different types of anxiety disorders in children as well, issues such as:

Panic disorder: Unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress
Social anxiety disorder (common in teenagers): persistent, intense, and chronic fear of being watched and judged by others and feeling embarrassed or humiliated by their actions
Phobias: persistent fear and avoidance of a specific object or situation
Adjustment disorder: trouble adjusting as a result of a stressful event
Selective mutism: when children do not speak in certain settings

When do you know it’s time to seek help for your anxious child?

When anxiety interferes with everyday life and functioning it might be time to seek professional help from a licensed therapist. Problems with school refusal, difficulty sleeping, test anxiety, constant meltdowns, eating issues, etc. are not things to be ignored and anxiety can be treated under the care of a professional. Dr. Min stressed that a parent truly knows their child best, so if you feel in your gut that something is going on with your child, trust your instincts.

If you have concerns, schedule an appointment with a licensed professional trained with children and adolescents, preferably one that has experience with cognitive behavioral therapy (CBT).

What is CBT?

Cognitive behavioral therapy addresses the cognitive distortions or unhealthy anxious thoughts in combination with tools to help stop the dysfunctional behavior that go along with it. Cognitive therapy is an attempt to change or re-wire the anxious thoughts into more realistic and helpful ones. Behavioral therapy such as relaxation, positive reinforcement and exposure therapy work to diminish the fight or flight response. In combination, this therapy can be very effective in treating anxiety.

Anxiety and Sleep Problems in Children

I asked Dr. Min if I could ask him about something my daughter is  currently struggling with – problems going to sleep – and I am so glad I did because he had a lot of good advice.

He expressed sleep problems in children are a giant issue. Giant. In fact, CHOC Children’s even has a dedicated Pediatric Sleep Center where he is a psychologist on staff. The Sleep Disorder Center helps treat children that have problems falling asleep, staying asleep or fears of going to sleep.

Sleep Advice for Anxious Kids

  • Keep a Bedtime Journal.

Thoughts that run through the child’s mind are one of the major issues with having problems falling a sleep. If a child is able to put pen to paper before bed and get all of their worries and thoughts out before, it can help. Bringing the journal to a therapist can then help with addressing the worries.

  • Stop All Devices (Blue Light) One Hour Before Bed.

The major source of blue light is the sun and when we see the sun, are brains are cued to be awake. Electronics such as TV, tablets and phones also emit a high amount of blue light so that when looking at them, our brains are cued to think “it’s daytime” and the natural sleep hormones that kick in when it is time to sleep are halted. Removing devices one hour before sleep helps your body naturally do what it supposed to do at night – sleep!

  • Behavioral Recommendations To Help with Sleep.

– Regular bedtime and wake time each day
– No naps for older children
– Use the bed only for sleep
– Keep room on the cooler side as being too hot can inhibit sleep
– Keep a regular bedtime routine they do every night

Positive Reinforcement System for Sleep Problems in Kids

The most common (and to me, personally frustrating) behaviors that go along with sleep problems in kids have to do with seeking out interactions with parents.  You know, one more glass of water, one more kiss, one more snuggle, etc. As a parent, we want our children to be independent and able to go to sleep, or put themselves back to sleep, without needing our help.

He said what children are looking for with these behaviors is control, so he suggested a system where kids are given a certain amount of “tokens”, say 2 – 3, at the beginning of a week that they can turn in for “one more” something.  Basically, it’s a pass to get out of bed or ask for something.

If at the end of the week, if a token was not used, it can be put towards a prize or reward that is really motivating for the child.

We might be giving this a try. I will let you know how it goes.

Thank you Dr. Christopher Min for the incredible advice and for taking the time to talk to me about this important topic!

For more information on the CHOC Children’s Mental Health Initiative and programs, click here. Together, let’s talk about it.

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