child anxiety

Are You Unaware or in Denial of Your Child’s Anxiety?

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Childhood Anxiety

Does your child sometimes feel anxious? The reality is that childhood is quite an anxious process. Kids are regularly being tasked with learning and developing new skills, being faced with new challenges, confronted with overcoming their fears and being asked to navigate a world that many times doesn’t make a whole lot of sense.

At times these stressors and fears are manageable, and at other times they could bring your child to overload. The loving attempts to comfort your child and prod her along are no longer doing the trick. In such situations, it may be that your child is suffering from anxiety or an anxiety disorder.

It is well known that anxiety disorders are at the top of the list of mental illnesses in the United States. Unfortunately, children are no exception. Approximately 12% of children in this country may be suffering from an anxiety disorder. And many aren’t receiving the necessary treatment. Anxiety left untreated puts a child at risk for poor school performance, inferior social skills, and prone to dangerous behaviors such as addiction.

So, is there a way to know when your child’s anxiousness is anxiety?

Symptoms

Some physical clues of anxiety

  1. Regular complaints of headaches or stomach aches without a medical reason
  2. Very reluctant to use a bathroom anywhere but home
  3. Lacking an ADHD diagnosis is still generally distracted, “hyper” or fidgety
  4. Having difficulty either falling or remaining asleep
  5. Intimidating situations cause the child to sweat abnormally or shake

Some emotional clues of anxiety

  1. Crying or displaying sensitivity too often
  2. Prone to anger or grouchiness for no apparent reason
  3. Fearful of committing even minor mistakes
  4. Experiencing panic attacks or expressing fear of having them
  5. Excessive worrying about things that will happen far into the future

Some behavioral clues of anxiety

  1. Incessantly asking “what if something terrible will happen?”
  2. Refuses to join in class activities or to go to daycare or school
  3. Doesn’t interact with others even playing or working together
  4. Approval seeking from friends, teachers or parents constantly
  5. Consistently having tantrums or meltdowns

Anxiety Disorders in Children

Sometimes the child’s anxiety is not only anxiety but something more serious- an anxiety disorder. It happens to be that anxiety disorders are the most common psychiatric disorders in children, even more than depression or ADHD.

Types of Childhood Anxiety Disorders

Although there are numerous anxiety disorders, these are these disorders are the most common found in children.

1. Generalized Anxiety Disorder  

A child who presents any of the following symptoms over six months will probably be diagnosed with a generalized anxiety disorder. They include irritability, sleep disturbances, problems focusing and concentrating, fatigue, or difficulty concentrating.

Children with generalized anxiety disorder may present somatic symptoms as well, such as pains, muscle aches, headaches, or abdominal pain.

2. Specific Phobia

Sometimes a child may show anxiety or excessive fear about a particular situation or object. When this fear doesn’t subside over time but rather becomes calcified in the child’s psyche, there is a reason for concern as it may indicate a phobia. Confronted with the object or situation that is causing the phobia will often cause the child to freeze, cling to an adult, or cry, sometimes uncontrollably.

3. Selective Mutism  

More than any other anxiety disorder in children, selective mutism is often the most frequently overlooked. Such a child is mistakenly viewed as extremely shy. However, a child’s adamant refusal to speak or make eye contact in a social situation, when at the same time that same child is very comfortable speaking at home is usually a red flag.

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4. Separation Anxiety Disorder

For children between 1-3 years old, it is perfectly normal and well within what is considered developmentally appropriate to be anxious about being separated from a parent or caregiver. However, once the child reaches age 4, anxiety or excessive fear of that separation may indicate a separation anxiety disorder.

Children suffering from this disorder often worry quite frequently about the parent separating from them or even dying. This anxiety may cause nightmares about separation, reluctance, refusal to go to school, or even adverse physical symptoms such as nausea or stomach aches.

5. Social Anxiety Disorder

Children who exhibit an excessive fear of interacting with other children or participating in school may be suffering from a social anxiety disorder. This fear may present in any number of ways from clinging to an adult, crying, throwing a tantrum, or just going into a freeze. Withdrawal from other children to the safety of solitude is often an indicator.

6. Panic Disorder

Although it is more common for teenagers to suffer panic attacks than children, occasionally a young child may have a panic disorder. Symptoms may include the sensation of choking, dizziness, getting the chills, shortness of breath, or the impression of a heart attack. Some children report that they feel like they are dying.  

How To Help

Unfortunately, many parents feel helpless when they observe their child suffering from excessive worry or fear. There is a reflexive inclination to remove the child from any and every situation that seems to trigger the child’s anxiety.

But the unwitting parent doesn’t realize that such a strategy often boomerangs, leaving the child even more sensitive and vulnerable to these environments and situations.

The goal of the parent shouldn’t be to eliminate anxiety triggers from the child’s life, which is, of course, unrealistic. Instead, the parent should strive to effectively manage anxiety until the child can be led to professional help to discover and confront the source of anxiety.

Your pediatrician may recommend that the child receive mental health therapy, either face to face or via teletherapy.  An experienced child psychologist can often be very helpful in alleviating the symptoms of anxiety and perhaps uncover the source of the anxiety itself.

Children with anxiety disorders are typically treated with talk therapy either face to face or via teletherapy, medication, or a combination of the two. Often through cognitive behavioral therapy (CBT), a child can learn the difference between real and unreal thoughts, which is often the key to healing the child.

kids and cell phone use

7 Reasons to Get Your Kid to Put Down the Smartphone (If You Can)

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Brave New World

The meteoric rise of the smartphone is radically changing our kids' lives by the day in every arena of life, from how they interact socially to their emotional well being. Wherever you can find a cell tower, you will find an ever-increasing number of children and teens whose lives are being impacted and sometimes defined by their smartphone.

As incredible as it may seem, children as young as two years can show signs of mental health problems due to using smartphones and tablets. It doesn't take much. Even an hour a day, staring at the screen is enough to increase a child's anxiety and vulnerability to depression. Staring at the screen reduces their curiosity self-control and, emotional stability.

The Multiple Problems

1. Distorted Communication

Children who spend time on social media and smartphones learn and practice what social-psychologists call deindividuated communication. In other words, communication through social media or smartphone texting gives children a sense of being absent, anonymous, and faceless, virtually unaccountable for what they are saying.

This lack of accountability leads to an increased preponderance to be extreme and aggressive in the verbal sense. The children’s shaming, mocking, and bullying is far more devastating than anything they would ever do face-to-face.

2. Parental Detachment

When technology use is not controlled, the relationship between parent and child suffers. Children and teens who average hours a day alone in their rooms obsessed with their devices are not present to interact with their parents. And even when parent and child are physically occupying the same space, the child is often unavailable.

As if that weren't enough, the degree of trust between parent and child is often defined by how the parent controls social media and phone usage. But parents shouldn't dupe themselves into believing that their perceived control is real. The digital landscape is replete with apps that allow teens to hide their true digital life from their parents.

3. Social Handicapping

Childhood and adolescence provide critical opportunities for developing lifelong social skills. But as the smartphone becomes the replacement for spending face time with friends, there are fewer and fewer opportunities to learn and hone those vital skills. This creates a vicious downward spiral that makes communicating via text or emoji more comfortable than face-to-face interaction further diminishing genuine social interaction.

Some experts have asserted that it's not that the smartphone creates a nonverbal learning disability, but instead, it places everyone involved in a nonverbal disabled context. The critical dimensions of communication such as facial expression, body language, and vocal tone become invisible and hence irrelevant.

4. Creeping Loneliness

Social networking sites such as Facebook promise to be a conduit facilitating connecting with friends. But study after study has shown conclusively that social networking is producing a dislocated and lonely generation. Children and teens who visit their social-networking sites religiously but interact less frequently with their friends are unwittingly creating a detached and lonely existence for themselves.

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Ironically, all of this connecting through social media is exacerbating the sense of being left out or "fomo" as it is fondly known. The sad fact is that children and teens spend less time together, and even when they do meet the activity invariably centers around their social media activities. Without posting pictures to Instagram, it's considered as if their time spent together didn't even happen.

5. Chronic Insomnia

Experts claim that a teen who sleeps less than seven hours at night is a teen that is sleep deprived. Recently two independent national surveys showed that if a teen is on his digital device three hours a day, he is 28 percent less likely to get seven hours sleep. Sadly these studies showed that more than twice as many teens were sleep deprived in 2015 than in 1991.

The consequences of sleep deprivation can be devastating. Without enough sleep, it is difficult to focus on school. Consequently, grades will suffer and motivation will tank along with it. Not enough sleep means slower reaction time, which increases the likeliness of being in a car accident. And when tiredness compounds with social pressure, the child or teen is more prone to depression.

6. Increasing Depression

A recent survey involving thousands of 12th graders found that teens who spend more of their time on non-screen activities are found to be happier. And the opposite was also found to be true. Those who spend more of their time on their smartphones and tablets are likelier to be lonely, anxious, and depressed.

And it has been found in recent studies that struggling with depression as a teen is generally a recipe for suffering depression as an adult. Hard to believe that the smartphone is such a critical factor in the increasing rates of depression all around us.

7. Rising Suicides

Indeed, one advantage of teens being more socially isolated and not spending as much time together is that it is less likely that they will kill someone else. However, the converse is true as well; they are more likely to kill themselves. In 2011 for the first time in quarter century suicide rates for teens surpassed homicide rates.

Girls who are more prone to depression than boys are especially vulnerable. Whereas boys gravitate more to face to face bullying, cyber-bullying is more the bullying of choice for girls. This distinction may account for the statistic that shows that from 2012 to 2015, depression for girls increased at a 250 percent greater rate than boys over that same period.

How Can You Help Your Child?

With all this heartbreaking news, it would be understandable for parents to feel helpless and hopeless, but they need not. Implement these suggestions to begin to gain control of your children's digital lives.

  1. You need to model cell phone control: Set an example for your children of how to use and limit the use of smartphones and social media in your life.
  2. Establish digital family curfews: Ban the use of phones during the dinner hour. Designate the parents' bedroom into the overnight charging station.
  3. Transform the discussion: Instead of instilling within your children a fear of getting caught being digitally inappropriate, focus on the benefits of online safety and healthy social life.
speech delay

Your Child is a Late Talker: When Should You Start Worrying?

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Do You Have a Late Bloomer or a Problem?

As a parent, you know your child. You understand what your child means when she points to the door or waves. You listen to your toddler babbling and watch her play. You remember what your older children said and did when they were the same age. Just like it is reasonable to compare your toddler to the other children so too, it is reasonable to worry when this child isn't keeping up.

If you detect even the most subtle of a communication problem, invariably you will ask your friends, relatives or even the pediatrician for an unofficial evaluation. And you may get answers like, "My son was slow, too. Now he won't shut up," or "Don't worry; she'll outgrow it." The doctor may tell you to relax, not to be concerned until the child is ready for school. And the doctor may be correct.

But that nagging feeling won't go away. What if they aren't right? No parent wants just to relax only to find out later that something could have done, and now it may be too late!

While all children go through practically identical stages as their speech and language develop, it is often difficult to gauge the precise point that your child will arrive at any particular stage. The breadth of what is considered normal is quite extensive and can vary a lot.  

The primary variables in your child's speech and language development are:

  1. Her innate capacity to learn the language
  2. Other seemingly unrelated skills that are being learned concurrently
  3. How much talking she hears around her during the day
  4. What type of response is elicited from those who are watching her

What Are You Looking For?

If your child is anywhere between 18 and 30 months old and not talking as well as you think he should, you should be aware of some of the factors that put your child at higher risk of developing speech or language problems.  Having a problem with anything on this list doesn't guarantee a problem, but it may cause for concern.

Understanding - Generally, a child understands what he hears before becoming verbal. This is known as receptive language. Although your child may not be talking like others his age, he may be able to follow simple directions or point to the object when you name it. If the understanding is there even though the language 'isn't, it's highly likely that his language will catch up. If not, this may signal a language delay.

Gestures - Children often gesture to communicate before they begin to use many words. Gestures can include anything from waving "hi" or "bye" to pointing, to putting out her arms signalling that she wants to be picked up. As a rule of thumb, the more your child communicates through gestures, the more likely she will catch up to others her age.

Learning new words - Even children who begin talking slower should be experimenting with new words every month. If she does this, there is less likely to be a language delay. If you aren't hearing many new words, there may be a problem.

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What Causes a Speech Delay?

1. General Speech-Language Delay - Perhaps the most common and most natural problem to solve, this delay is temporary and can be remedied with a combination of speech therapy, be it face-to-face or via teletherapy, combined with reinforcement from home. These children catch up to the others in a relatively short time.

2. Expressive Language Problems - This is when a child can think and understand clearly and develop healthy relationships. While the 'child's talking is "normal," he is unable to transform talking into expressive language. The delay in speech is grounded in the child's struggle to be an effective communicator.

3. Receptive Language Problems - This condition is somewhat the converse of an expressive language problem. Here, the child's comprehension is compromised, so consequently, the child speaks unclearly manifesting the inability to connect words with concepts, instructions, or even objects. While speech therapy, be it onsite or via teletherapy, will help it will often take considerable time to see significant results.  

4. Autism - Children who are on the spectrum often display multiple developmental problems, including speech delay and the inability to communicate clearly. Repetitive activity is also common. In such situations, professional evaluation and treatment are necessary to arrive at an accurate diagnosis..

5. Childhood Apraxia of Speech - This problem is reflective of the child lacking the capacity to enunciate the proper sounds for the chosen word. The result is a speech impairment and difficulty for the listener to understand what the child is trying to say. This condition often requires a multi-pronged approach to resolve.

6. Hearing Loss - Sometimes hearing loss, even temporarily from chronic ear infections, can wreak havoc on a child's speech.  Both the clarity and quality of the child's speech may deteriorate as the hearing loss continues. The child is essentially becoming disconnected from the "speaking world" at a vulnerable juncture in his life.

What Can You Do About It?

It is relatively easy to take the guesswork out of the entire situation. If you think there may be a problem, get your child evaluated and have your child seen by a speech therapist, either face-to-face or via teletherapy. After the SLP meets with your child, she is sure to have ideas to implement immediately. Alternatively, she may suggest meeting with your child regularly for a period of time if your child's condition seems to warrant such intervention.

But often the work of the SLP needs to be supplemented by the child's parents.

handling divorce

The Therapist’s Critical Role in Helping Children Cope With Divorce

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The Pain of Divorce

Divorce is neither rare, occurring in 50% of all marriages, nor easy for anyone involved be it the parents or the kids. The entire family feels a tremendous sense of anxiety and loss. Everyone knows that life will never again be the same.

Divorce may be one of the worst moments in the child's life, and it will impact everything happening in that child's life. The experience will likely involve pain, frustration, stress, and sometimes an overwhelming sense of loss.  While most kids are resilient, they need help adjusting to their new reality, which they don't yet quite understand.

How Children React

The first thing to recognize is that children experience significant anxiety when they live with persistent parental discord. For younger children below the age of ten, this parental discord and tension often create a deeply felt sense of instability and insecurity.

If that discord morphs into separation and then divorce, that instability and insecurity will only become exacerbated. Generally speaking, divorce tends to intensify a younger child's dependence, and it tends to accelerate the adolescent's independence.

Children and adolescents are grieving the loss of their family, nothing less than their emotional foundation in this world. Although technically speaking, this isn't grief; nonetheless, grief is probably the best way to understand the child's experience and emotional journey.

Typically the stages of grief include anger, depression, denial, bargaining, and acceptance. While every child is different with some experiencing certain stages of grief and not others, or not in this specific order, it is helpful to be aware of the classic stages of grief to help identify the child's reality.

Since for younger children, the trauma of divorce occurs when the line between reality and fantasy is still blurred, some children wonder if their mommy and daddy will continue to love them. Or they may take personal responsibility for their parent's broken relationship by attributing the divorce to their bad behavior.

It is critical for both the parents and the therapist to be accepting of any feelings that the child expresses. Allowing the child the ability to maintain and communicate feelings is critical to the child's healing, avoiding perhaps permanent emotional scarring from the experience, and facilitating a "smoother' transition into the new reality.

The Important Role of the therapist

At times the child of a couple who is going through a divorce may already be seeing a therapist, and at other times the impending divorce may be the trigger for the child to enter therapy. Either way, the therapist must be prepared to become as involved as necessary to provide the support and help the child so desperately needs.  

The importance of a sensitive and compassionate therapist at this most vulnerable time in a child's life cannot be overstated. Aside from insights that the therapist can share, children need a neutral, supportive space to share their sadness, confusion, and anger they are feeling, and to find constructive ways to deal with these painful emotions.

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Therapeutical Strategies

1. Clarification

If the parents have been able to do so thus far due to the charged emotional atmosphere, the therapist will need to explain the divorce to the child in a simple, straightforward way. Often the emotions and incriminations that the child is being subjected to will confuse the child as to what is happening and why.

Sugar-coating the situation will not only be unhelpful but will prove detrimental. Children and adolescents need to be made aware of how their life will change. The more that children know of the practicalities of their new reality, and the quicker they can resume their routine, the better chance they have of succeeding in this challenging situation.

2. Reassurance

It is difficult to stress enough the importance of impressing upon the child that the divorce isn't the kid's fault. Children, by nature, are "egocentric" and live with the belief that they have the power to control events through their thoughts and behavior. They need to be able to grasp and internalize that their parents' decision to end the marriage has nothing to do with them.

A corollary to this is that a child must know that he/she still has the love of both of parents and that this parental love is non-negotiable (unlike the financial arrangement). Unfortunately, the child may logically presume that since my parents don't love each other anymore, maybe I'm next on the chopping block!

3. Feelings

Many children bury their emotions during this difficult time. They figure that if they can ignore their feelings that their pain will somehow subside or go away completely. As a therapist, you need to draw those feelings out delicately. You might begin by telling the child, "It is perfectly normal to feel sad and even angry about the divorce."

Encourage the child to maintain an ongoing dialogue by creating a safe emotional environment, accepting any feeling. Don't be afraid if the child expresses something that seems terrible or even violent. Keep in mind that the expression isn't the problem and that the only way for the child to begin to cope and heal is to share what’s inside.

4. Expectations

It is to be expected that when a child is going through the divorce that invariably the child will tend to withdraw, regress either socially or academically, and even act up. These are normal reactions. This is why communication, especially with the therapist, is so crucial. The parents are often too obsessed with their problems to "hear" their child.  

Know as well that often boys and girls react differently to divorce. Studies have shown that boys show their distress in more noticeable ways, such as acting out in school or social situations. Girls, on the other hand, seem to be "alright" at the moment. However, it is often the case that later, when they become involved in a close relationship, they are gripped with a sense of suspicion or fear of abandonment.

Bottom Line

If possible, the therapist should convey to the parents that children who survive divorce the best are those children whose parents put their children's needs above their own needs wherever possible. Frequently when working with a child of divorce, the role of the therapist extends beyond the clinical session and migrates into the position of being the child's advocate.