How Can I Help My Minor with OCD?

OCD symptoms often develop for minors during the tween or teen years, and most people are diagnosed before age 25.

If you’re looking for help for your minor child with OCD, you’re not alone. It’s common for OCD symptoms to first show up in childhood: two of the most common times to develop OCD are during the tween years or the late teen years. In general, most people with OCD start noticing symptoms before age 25.

Research suggests boys tend to devleop OCD at an earlier age than girls do. However, every kid is different. For example, I’m a children’s OCD therapist who was also diagnosed with OCD as a child, and my symptoms started at age 7.

Regardless of your child’s age, your support as a parent is really important. Kids—especially young ones—need their parents to be involved in the therapy process, and this is especially true when it comes to OCD therapy. The good news is that your support will have a huge, positive impact on your chid’s recovery from OCD. In this post, you’ll learn 5 simple ways you can help your minor child—and yourself—through OCD

Identifying OCD Symptoms in Minors

It’s not always easy to identify OCD symptoms in children. Kids are often aware that the worries OCD gives them are unusual, and will try to mask their symptoms as a result They may feel embarassed, ashamed, or afraid of the thoughts they’re having. They don’t want other people to know about these weird thoughts, so they cover them up instead.

Also, a child’s OCD symptoms might not fit the mold of what we expect OCD to look like. We might envision a very neat, orderly person who’s focused on avoiding germs or keeping things organized. In reality, OCD can look many different ways, and the signs are often very subtle. It’s entirely possible for a child with OCD to be messy, disorganized, or totally unworried about dirt or germs.

People with OCD have two things in common: obsessive thoughts and compulsive behavior. An obsession is an unwanted thought, worry, or mental image that pops up at unwanted times. It’s hard to get rid of, and causes a lot of anxiety or distress. In order to deal with these obsessions, OCD sufferers feel like they have to do something to alleviate their anxiety. This repeated behavior is called a compulsion.

Common obsessions for kids with OCD include:

• Worries related to getting sick, throwing up, or contracting germs

• Fear about somehow losing control and doing something bad, like hurting themselves or someone else (even though they don’t want to)

• Thoughts that if they don’t do something just right, something terrible could happen

• Worries about bad things happening to loved ones

• Doubts about whether or not they may have misbehaved or done something wrongj

• Worries about sexuality or being gay in children who aren’t otherwise questioning their identity

You may notice compulsive behaviors like these in your minor child with OCD:

• Checking and-rechecking that they’ve done something, like turned off a light switch

• Creating rituals that have to be done exactly the right way, such as a specific process for washing hands or a rigid bedtime routine

• Excessive cleaning, showering, or handwashing

• Repeatedly asking for reassurance about things, even after they’ve been given an answer

• Confessing bad thoughts or possible misbehavior to a parent

• Repeatedly touching or counting objects, or repeating actions to make them symmetrical (like tapping one leg and then the other)

The tricky thing about OCD is that compulsions never permanently get rid of an obsessive worry. This means that people get stuck in a cycle of doing their compulsive behavior over and over in order to feel some sense of relief.

Five Ways to Help Your Minor Child with OCD

As a parent, you can help your child understand their symptoms and work together as a team to combat OCD.

Now that we’ve reviewed the symptoms of OCD, let’s talk about how you can help your child to cope. OCD is a stressful diagnosis not just for the child who is suffering, but their entire family. Keep reading to learn ways to demystify OCD, reduce feelings of shame and loneliness, and start looking at OCD from a different perspective. These 5 steps will help you and your child look at OCD in a new light, so you can start working on healing together.

These techniques aren’t a replacement for therapy (more on that below), but they are tried-and-true approaches that I teach in my child therapy office. They’re also exactly the kinds of things that I think would have helped my family when I was a kid. If you’ve just noticed OCD symptoms in your minor child and you’re not sure what to do, start here.

#1: Help Your Child Understand OCD

I mentioned above that kids with OCD often know that their thoughts are unusual. That’s because OCD is ego dystonic: this means that the thoughts it causes go against a person’s temperament and values. They can feel weird, confusing, or “other,” almost like they’re not coming from you. Often, OCD preys on a child’s worst fears: peaceful kids may experience violent images, responsible children might worry about mistakes, and typically subdued kids can suddenly have thoughts about losing control and doing something inappropriate.

As you can imagine, this is really upsetting. Kids with OCD may worry they’re going crazy or that something is deeply wrong with them. They may also assume they’re the only one having these “weird” thoughts. This is especially true if their obsessions are about something embarrassing, shameful, or taboo.

You can help your child understand OCD so they feel less alone. Learning how OCD works can help kids realize that their symptoms aren’t so unusual after all, and that there is treatment that will help. Start by teaching a few important facts about OCD:

• Nothing a person does causes OCD. It’s mostly genetic, and not anybody’s fault.

• Just because you have a bad thought doesn’t mean you’ll act on it. In fact, people with OCD tend to have obsessive thoughts about things they’d never do in real life.

• OCD isn’t dangerous: it’s just a little glitch or “hiccup” that happens in the brain.

• You can fight back against OCD by not doing what it tells you to do: this is hard, but it teaches your OCD who is boss!

Reading books together is a great way to get these points across. It gives parents language they can use to explain OCD, and seeing that someone has gone through the trouble of writing a book can reassure kids that they really aren’t alone. What to Do When Your Brain Gets Stuck is a classic, and many people enjoy Up and Down the Worry Hill, too.

Your child might also appreciate taking a look at a list of celebrities who have OCD. About 1.2% of people are diagnosed with OCD. This means there are plenty of public figures who have been affected by it, including David Beckham, Daniel Radcliffe, and Camila Cabello.

#2: Be a United Team with Your Child Against OCD

Your child can separate herself from her symptoms by drawing a picture of what she imagines OCD looks like.

Battling OCD is not easy work. You have to do exactly the thing your brain is saying not to do in order to feel better! This can put parents at odds with their kids, because parents are the ones who have to hold bnoundaries and stick with the plan to overcome OCD. It’s important to remind your child (and yourself) that this fight is not you against them: it’s the two of you against OCD.

You can maintain a united front by imagining OCD as a little character or creature that is totally separate from your child. This is called “externalizing:" it’s a tool we use in therapy to help separate a problem from the person suffering from it. Externalizing OCD can help you feel like you’ve got a common enemy. It also reduces some of the shame and frustration kids feel when they experience thoughts and urges beyond their control.

Encourage your child to give their OCD a name: kids often choose something funny and nonthreatening, like “Bob” or “Dr. Annoying.” Your child might also enjoy drawing a picture of what they imagine their OCD would look like. Creating this kind of OCD character is a coping skill I use with almost all kids at the beginning of treatment (you can check out other OCD coping skills here).

Next time you notice your child saying or doing something related to their OCD, don’t blame them—blame Bob.

#3: Don’t Fall Into the Reassurance Trap

It’s only natural to want to comfort your child when they’re worried. As parents, we probably offer reassurance all day without thinking twice. Sometimes, a simple “it’s okay” or “everything will be alright” is all a child needs to hear in order to feel better.

Unfortunately, the usual rules don’t apply to OCD. Reassurance typically does more harm than good: even though it helps kids feel better in the short term, it fuels their anxiety in the long run. Reassurance-seeking is the most common OCD compulsion I see among kids in my therapy practice. Cutting back on reassurances can go a long way toward helping your child.

You might notice your child asking you the same question over and over, even after you’ve already explained that things will be fine. That’s because reassurance only quiets the OCD worries for a little bit. The OCD worries always come back, which means your child has to ask again to get relief. Over time, this pattern actually makes the symptoms worse.

One of the big goals of OCD treatment is to help parents gradually stop enabling their child’s OCD by giving into its demands. This means gradually scaling back on giving reassurance if you’ve been doing it a lot. If your child’s symptosm are mild, you may have good luck doing this on your own at home. If you’ve been stuck in this pattern for a while, a therapist can help you to gently break the cycle.

#4: Research Therapists who Treat Minors with OCD

Databases like the one provided by IOCDF can help you find therapists who specialize in treating OCD in minors.

While some minor children will recover from OCD without therapy, many will need extra help. Research has found that for about 1 in 5 kids, symptoms will resolve on their own, without treatment. For that remaining 4 out of 5, therapy will help kids get back on track and manage their symtpoms.

It might sound daunting at first to hear that most kids with OCD require therapy to recover. However, there are a couple of big silver linings here. The first bit of good news is that we have a form of therapy called ERP that’s been designed specifically for treating OCD, and it is highly effective. We also know that entering therapy early in life helps people with childhood-onset OCD make a much fuller recovery. That’s good news for your child!

Working with OCD is a specialty: not all therapists have extensive training in this area. The same is true for working with children. Finding a therapist who specializes in both OCD and working with minors might require a little extra legwork. The International OCD Foundation (IOCDF) has a searchable list of therapists who are trained in ERP, the “gold standard” treatment for OCD, including therapists who have been specifically trained to treat children. You can also run a search on Psychology Today to look for therapists in your area who offer ERP and see kids or teens.

Not all therapy therapy training programs don’t cover OCD or child therapy in tons of detail, so it can help to ask prospective therapists what their training and experience is with these two groups. Registered Play Therapists often have lots of training working with kids. ERP is the most common, best-researched therapy for OCD treatment. You can also ask more general questions, like the ones in this post, to get a sense for whether a therapist seems like the right fit for your family.

#5: Practice Self-Care So You Can Support Your Child

OCD is tough for kids, but it’s incredibly draining for their families, too. The bigger OCD symptoms grow, the more time and energy it takes to keep up with all the compulsive behaviors and rituals. Families—and parents especially—may feel like they’re bending over backwards or walking on eggshells to avoid triggering their child’s OCD. And even with all that effort, new worries pop up, seemingly out of nowhere.

It’s common for parents to feel exhausted, hopeless, or even resentful when they’ve been dealing with a child’s OCD for a long time. Kids often pick up on this tension, which adds extra stress to an already stressful situation. Gradually facing fears through OCD treatment is the most surefire way out of this vicious cycle, but it requires a lot of work, too. You’ll need a lot of patience and compassion to help your child through therapy.

Treating OCD is more of a marathon than a sprint. Resist the temptation to put yourself last on the to do list, and make sure you’re setting aside time to do whatever will help you continue to show up for your child. Date nights, exercise, time away from parenting, or watching something on TV that isn’t Bluey all count. You can also ask to speak to your child’s counselor in private or seek out your own therapist if you need to vent and get your own support.

OCD Therapy for Minors in North Carolina

You can help your child through OCD with the support of a therapist. I provide OCD treatment for kids and their families throughout North Carolina, New York, and Florida.

I hope you’ve found this article helpful, and that it gives you some options to try while you consider looking for a therapist. If you’re looking for OCD counseling for your child, I may be able to help! I’m physically located in Davidson, North Carolina, and can meet with local children in-person or online. I’m also available for virtual sessions with families in Florida and New York. You can learn more about my practice or email me to get started.

Looking for more information on how OCD affects minors? Check out some of my other posts:

Can a Child Have Mild OCD?
What Are the 4 Types of OCD?
How to Help a Child with Intrusive Thoughts
Does Childhood OCD Go Away?

Can a Child Have Mild OCD?

It’s bedtime, and your child’s goodnight routine is a little longer than usual. Over the past few weeks, it seems like things have gotten a little more elaborate, and the steps have to be done just right. Or, maybe you’ve noticed your child repeatdly asking if things are okay—even when they know the answer is yes.

You know kids can have quirky habits sometimes, and your child has always been prone to worrying. Is this just a passing phase, or could your child possibly have mild OCD? Is “mild OCD” even a thing?

When we see OCD portrayed on TV, it’s often easy to spot. Characters with OCD usually have easily noticeable symptoms, and they’re often pretty severe. In real life, OCD is much better at hiding: symptoms can be really subtle. What’s more, kids with OCD sometimes feel they need to hide their compulsive behavior. Children are often aware that not everybody has these “weird” thoughts and urges, and so they try not to advertise what’s going on.

The short answer is: yes, it’s very possible to have mild OCD. For the longer answer, keep reading! We’ll take a look at the different, sneaky ways that OCD can show up for kids.

First, Let’s Clarify What OCD Is

If your child’s problems are mild, it might be harder to distinguish whether or not OCD is really what you’re dealing with. Anxiety and OCD have a lot in common. And some personality traits and quirks can resemble OCD too, like perfectionism, superstitiousness, and orderliness.

People with OCD share 2 big symptoms in common:

• They have recurring unwanted thoughts, urges, or mental images. These are unwanted, tough to control, and cause the person anxiety or distress.

• The person tries to push away or “neutralize” these thoughts, usually with some kind of special thought or action.

That’s where we get the name “Obsessive Compulsive Disorder” from. The unwanted thought that shows up again and again is the obsession. The thing a person feels they have to do in order to make the uncomfortable thought go away is the compulsion. The trick is that, while compulsions make a person feel better in the short term, they actually make the thoughts and anxiety worse over time.

A child who holds herself to a high standard at school, prefers a clean room, or likes to carry a lucky charm on important days is unlikely to have OCD. However, a child whose worries seem to be stuck in a loop, or who repeatedly performs the same action might be showing OCD symptoms.

OCD Has a Range of Severities

Just like most other mental health problems, OCD can be mild, moderate, or severe. Some children might experience OCD as a minor inconvenience, while for others it can be completely debilitating. The media tends to show mental illness in its most severe forms because that’s what’s most dramatic and interesting. However, this isn’t the reality for all kids with OCD.

Many kids are able to fly under the radar for a while, without their symptoms being apparent to others. Even parents may not notice anything unusual, especially at first. By the time a child comes to treatment, they may have had OCD symptoms for quite a while.

Therapists look at a few areas to see if a child’s symptoms are mild, moderate, or severe:

• Frequency: A child whose worry shows up once a day may be on the midler end of the OCD spectrum. A child whose thought pops up many times throughout the day may have more severe OCD.

• Intensity: If a child can sometimes brush off the thought or it causes only mild anxiety, their symptoms are more mild. If a child can’t let go of a thought and it causes extreme stress, that’s severe.

• Duration: Kids with mild OCD symptoms may spend a few minutes a day doing something compulsively. Children struggling with severe OCD may spend hours.

• Functioning: Mild OCD may not really get in the way of things like school, friendships, or other everyday activities. On the other hand, severe OCD can affect relationships and keep kids from doing the things they want or need to do.

If you take your child to a therapist, they can use a special assessment to confirm an OCD diagnosis, and to see if your child’s symptoms fall into the mild, moderate, or severe range. This can be helpful to know because therapy recommendations will be different depending on where your child falls in that range.

You May Have Caught Your Child’s Symptoms Early

If you are noticing mild OCD symptoms in your child, it’s possible you’ve caught your child’s condition pretty early, while it’s still developing. As worrying as it can be to learn that a child is having these kinds of problems, discovering them early is great news.

Even though OCD is common, it can be hard to catch: one study found that it took the average OCD patient over 12 years to get a correct diagnosis! Younger people in the study had an easier time than older people when it came to getting diagnosed, but this is still a pretty long time to wait for the right help.

Research also tell us that kids who participate OCD therapy early often have better results than adults do. OCD symptoms tend to start in childhood or adolescence, so kids who are in therapy generally haven’t lived with their symptoms for as long as adults have. Quick treatment seems to make a difference: on average, they had more improvement in their symptoms than the adults in the study.

One final reason that it’s great to catch OCD symptoms early: mild OCD doesn’t always stay mild. When left untreated, kids may develop more complex and time-consuming rituals, and have more frequent and severe worries. As OCD grows, it can have more and more of an impact on a child’s quality of life. Kids who start therapy when their OCD is still mild can avoid a lot of this difficulty, and get their lives back on track sooner.

Sometimes, OCD Symptoms Are Invisible

There may be more to your child’s OCD than meets the eye. OCD involves obsessinos and compulsions that aren’t always easy to see. When we imagine a child performing OCD rituals, we might think of physical actions like handwashing or flipping light switches repeatedly. However, kids can have mental rituals as well, that don’t involve physically doing anything. Some examples are:

• Thinking a special word or thought in order to “undo” their worry.

• Praying compulsively

• Making mental lists

• Counting in their head

• Reviewing certain events over and over to double check them

Other times, compulsions involve saying something rather than doing something. These can also be a little more difficult to notice, at first. Pay attention for behaviors like:

• Asking for reassurance over and over

• Saying “I love you,” “I’m sorry”, or another phrase excessively

• Repeated confessions about things the child fears they have done wrong, such as having a bad thought, or possibly saying something unkind to someone

When parents begin to take stock of compulsions like these, what initially looked like mild OCD may look more complicated. There can be a lot happening beneath the surface, and these kinds of mental thoughts and rituals can be difficult for kids to talk about, or even put into words.

Do Kids with Mild OCD Still Need Therapy?

Even if your child’s symptoms seem mild, it’s a good idea to consult with a therapist to see if counseling could help. A therapist who specializes in OCD can complete a full assessment to see if any sneaky symptoms are going unnoticed. They can teach you and your child skills to deal with OCD worries without giving in to them all the time. Sometimes, it can be reassuring for a child just to hear from an adult who isn’t their parent that OCD worries are common, harmless, and not a sign of “going crazy.”

Occasionally, OCD symptoms may resolve on their own without therapy. Often, however, therapy is needed in order to overcome them. We know that mild symptoms tend to grow worse over time, and that younger kids do better in OCD therapy than adults. Because of all this, it’s worth talking to a counselor and considering therapy, even if your child’s symptoms aren’t getting in the way of life too much right now.

There are some great self-help resources out there for children with OCD. My favorite book for kids, What to Do When Your Brain Gets Stuck, is a great place to start. Up and Down The Worry Hill is another popular option. These books can give your family some helpful background information on OCD and how it works. You’ll also find tools you can use to take action right away.

How Can I Help My Child With Mild OCD?

There’s a lot you can do as a parent to help your child with OCD. In fact, parents are an important part of OCD therapy. A child’s symptoms tend to affect the whole family. Whether you’re waiting around for a child to complete a ritual or answering a question for the 100th time, parents ofen notice that they are changing the way they do things in order to keep the peace at home.

Unfortunately, OCD is never satisfied with what you give it. The more you give in to OCD, the bigger it grows. That’s why mild OCD often morphs over time into more moderate or severe illness.

OCD therapy helps both kids and parents to break this cycle. Using a form of therapy called Exposure and Response Prevention, a therapist can help your family learn new ways to stand up to OCD without giving in to compulsions and rituals. Kids can learn that they don’t have to listen to the thoughts and worries OCD gives them. Parents can learn how to support children without giving in to OCD’s demands.

If you’re noticing mild symptoms of OCD in your child, you can help right away by letting your child know that OCD thoughts are just random noise. The thoughts don’t mean anything, can’t hurt anyone, and everybody—even non-OCD sufferers—gets weird thoughts sometimes.

If you’re looking for help to deal with thoughts and worries right now, my free coping skills guide might help. You can download 5 Coping Skills for Anxious Tweens (That Aren’t Just Deep Breathing) right now, wherever you are.

If you’re hoping to begin therapy for OCD and you live in the states of North Carolina, New York, or FLorida, I may be able to help! I’m certified in Exposure and Response Prevention, the therapy that’s been proven most effective for OCD. As someone with a childhood OCD diagnosis, I remember how scary and overwhelming these symptoms can be. And I know that ERP therapy can really make a difference in the lives of children, whether their symptoms are mild or not.

You can learn more about ERP here, or contact me to inquire about starting therapy.

What Are the Different Types of Child Therapy?

“Play Therapy” is a catchall term to describe many different types of counseling that help children explore feelings using games, toys, and make-believe.

Considering therapy for your child but not sure where to start? This post is for you. Kids today have more options for therapy than ever before, which is definitely a good thing. However, it can also be an overwhelming thing when you turn to Google looking for a therapist only to discover a sea of jargon and acronyms. With so many types of therapy available, it can be tough to determine what’s right for your kid.

I love that families have so many different styles to choose from. No matter what your child’s concern is, there’s probably a therapy out there that’s been researched and proven to help. You can find therapists who teach practical, concrete coping skills, if that’s your thing. There are also therapists trained in forms of therapy that don’t require much language, for children who feel better expressing themselves in other ways.

There’s no one right way to do therapy, so this won’t be a ranked list. Instead, I’ll be doing a quick breakdown of 5 common types of child therapy you might encounter during your search. Even though there’s no such thing as “best’, hopefully you’ll come away with some ideas about what might be best for your child. All these types of therapy are valid, and they can all help kids and families change their lives.

Play Therapy: Exploring Feelings Without Words

Play therapy builds on a child’s natural tendency to learn about the world through play, so they can work through big feelings and difficult life changes without having to sit and talk for hours on end. Sitting on a couch across the room from a strange adult isn’t always the most natural thing for little kids. Play therapy is a wonderful way for younger children to feel safe and comfortable in the therapy room.

Play therapists like to say that “play is a child’s language, and toys are a child’s words.” With this in mind, you’ll see a wide variety of toys in a play therapists office that aim to give children a broad vocabulary to choose from. Expect to find nurturing toys, like dolls, aggressive toys, like punching bags, and creative toys, like art supplies. What you probably won’t find a lot of is electronic stuff: most play therapy toys are open-ended to encourage kids to play in avariety of ways.

So how is play in a therapy office different than play at home? Play therapists are trained to notice underlying themes that repeat themselves in a child’s play, and may give insight into how they’re thinking and feeling.

Within the umbrella of play therapy, you’ll find a variety of differen approaches. Some play therapists are child-centered, meaining they are trained to follow a child’s lead and let them set the pace for therapy. Others may incorporate education about feelings or coping strategies into play to help children learn new skills.

Cognitive Behavioral Therapy: Tools for the Here and Now

CBT differs from some other forms of therapy because it teaches children tools, like mindfulness, that they can use in the present—and continue to practice in the future.

Cognitive Behavioral Therapy, or CBT, is a form of counseling that focuses on helping people learn how to cope with strong emotions by changing their behavior or becoming more aware of their thinking patterns. It’s less focused on uncovering the past or figuring out why a problem evolved the way it did (although you might do some of this in CBT). Instead, the emphasis is on figuring out how to handle the problem now that it’s here, in the present.

One strength of CBT is that it’s an evidence-based treatment, meaning that there’s a lot of research to back it up and prove that it’s effective. Variations of CBT have been designed for pretty much every mental health concern. Exposure and Response Prevention is a specialized form of CBT for children and adults with obsessive compulsive disorder. TF-CBT, which you’ll read about below, is used for kids and teenagers who’ve survived a trauma. You’ll also see CBT used often with children dealing with anxiety, depression, or angry outbursts.

CBT gives children education to help them better understand their feelings and how they work. This can reduce fear and shame, and empower children to feel more in control of their emotions. They’ll also learn coping skills they can use during difficult moments to deal with their emotions in healthier ways. CBT skills require kids to be able to think abstractly—thinking about your own thinking is a complex skill! For this reason, it’s sometimes a better fit for older children.

TF-CBT and Trauma Therapy: Resilience and Storytelling

Children often need extra, more specialized support in order to recover from the after-effects of trauma. Highly stressful or dangerous experiences like accidents, illnesses, a death in the family, or exposure to abuse or violence can lead to long-lasting symptoms that don’t resolve on their own. You may notice a child having difficulty sleeping, experiencing big emotional outbursts, or regressing: going back to habits from earlier in childhood, such as thumb-sucking or bedwetting.

Children need to be able to share their feelings about what has happened to them in order to heal. However, traumatic memories can be very overwhelming. Trauma therapists understand how to help children gradually work through these memories in a safe way, so they don’t feel as confusing or hard to manage. This can happen through play, art, storytelling, or just by talking to a counselor.

Trauma therapy can also give kids and parents tools to deal with symptoms of PTSD, which can affect the whole family. One common form of trauma therapy for kids is Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT. This is a step-by-step approach that teaches children skills that build on each other, eventually helping a child to feel comfortable sharing their story with a parent or other supportive adult.

Parent-Child Interaction Therapy: Behavior Help for Kids and Parents

This is a special form of therapy designed for toddlers, preschoolers, and young children who are struggling with big behaviors and meltdowns. All little children tantrum, but sometimes these acting-out behaviors get so intense and difficult to manage that it puts a strain on the relationship between parent and child. This creates a vicious cycle of bad behavior, frustration, and disconnection.

Sometimes these behavior struggles are a response to trauma or stress, and other times it may just be due to temperament and sensitivity. Regardless of the reason, therapies like PCIT can help parents and children break the cycle of “bad” behavior, set appropriate limits, and enjoy more time spent together.

You can expect to spend a lot of time in the office with your child if you’re participating in PCIT. You’ll learn skills from your therapist to practice at home, and also get opportunities to use them in real time, with your therapist there to coach you through the process. The first part of PCIT is all about strengthening your relationship with your child through play and positive attention. The second is a set of discipline tools you can use to shape behavior without accidentally fueling the fire.

Expressive Arts Therapies: Use Mind and Body Together

Art materials give children a sensory experience that can help them stay grounded as they explore feelings in counseling.

Many kids (and adults) already know that the arts provide a mood boost. Mediums like dance, visual art, theater, and music can also be integrated into therapy to help children work through feelings and heal from trauma. We call this whole group of methods the expressive arts therapies, since they focus on creative expression.

Like play therapy, using art gives children a way to let out feelings they may not have words for, either because the feeling is too big or because they don’t yet have the vocabulary to do so. Music, dance, art, and drama are multi-sensory experiences, so they help kids engage their bodies and brains at the same time. This can be soothing, help children stay engaged, and even make it easier to process trauma.

Therapists can become specialists in any of the expressive arts, and use them as a way to connect with children in sessions. Your child doesn’t need to have any prior experience in a particular art form in order to do well in expressive arts therapy. All kids are creative thinkers, and therapy is focused on the process of artmaking rather than a finished product.

What’s the Next Step? Choosing the Right Type of Therapy for Your Child

Ultimately, the type of therapy you choose is going to be based on your family’s needs, and your child’s specific situation. As you’re weighing your options, you may want to ask yourself some questions, such as:

• Is my child still very interested in make-believe play?

• Are we the kind of family that does well with structure and direct advice?

• Does my child prefer to learn by doing or by talking?

• How is my child feeling about starting therapy? Are they self-motivated or a little unsure?

• Is there a specific event, like a trauma, that’s bringing us in to therapy?

• Is there a therapy option that’s tailored to my child’s specific concern?

• To what extent should I expect to be involved in this type of therapy, as a parent?

You may also want to check out my blog post on the differences between a therapist, psychologist, and psychiatrist to help you navigate those choices. Once you’ve got a list of potential helpers, this list of questions to ask your child’s therapist can help you interview them to find the right fit.

Options for Child Therapy in Davidson, North Carolina

Kids in North Carolina, New York, and Florida can participate in several forms of therapy in person or online through my Davidson, NC office.

If you’re located in the Lake Norman area of North Carolina, like I am, you may be interested in one of the different types of therapy I offer to kids in our region. At my child therapy office in Davidson, I help anxious kids and tweens through:

• Cognitive Behavioral Therapy for Anxiety

• Play Therapy

• TF-CBT

• …and one special form of expressive arts, Dungeons & Dragons Therapy

I also provide online therapy to children throughout the states of North Carolina, New York, and Florida. And if you’re further afield than that, you can check out my coping skills course, which covers my favorite strategies to help tweens with anxiety. It’s available on demand, wherever you live.

5 Coping Skills for Kids with OCD

If your child is struggling with OCD symptoms, feel at a loss for how to help. Maybe you’ve tried using logic to help your child see how unlikely their worries are. Or, maybe you’ve been working really hard on relaxation and deep breathing techniques, but you aren’t seeing a lot of change. This is totally normal! The usual coping skills that help kids deal with anxiety and stress aren’t as helpful for OCD.

While many children with OCD benefit from counseling, there are still things you can try at home to help your child cope. You can help your child learn to understand what OCD is and how it works, and equip them with tools they can use to “fight back” against recurrent worries and rituals. Children with strong coping skills feel less alone, can manage their symptoms better, and they will likely progress through therapy more quickly, too. Let’s take a look at 5 coping skills you and your child can practice together.

Learn About How OCD Works

Obsessive-compulsive disorder, also known as OCD, is a mental health problem that is similar to anxiety, but with its own unique characteristics. It causes people to have unwanted worries or thoughts over and over again. To deal with these thoughts, people with OCD feel like they have to repeatedly do an action in order to relieve their anxiety or prevent something bad from happening. The repeated thoughts are called obsessions, and the repeated actions are called compulsions.

OCD often begins in childhood, and it can be confusing and frustrating for kids and parents alike. Kids really do not want to be thinking about the terrible things their OCD prompts them to think about. They may feel as though they’re going crazy, or worry that having bad thoughts means they are a bad person. Parents may be shocked by the seemingly out-of-the blue appearance of OCD worries. It can be tough to understand why a child is suddenly so afraid, especially when their worries do not seem logical or realistic.

The first step to coping with OCD is understanding what you’re dealing with. Books like Up and Down the Worry Hill and What to Do When Your Brain Gets Stuck teach kids that OCD is caused by a harmless “brain glitch” that keeps the brain from sorting out unhelpful thoughts. Books like these help children feel less alone, and can reduce feelings of shame and guilt that make it hard to get help. They also give kids helpful language to describe their experiences with OCD.

Cope by Focusing on Strengths, Not Worries

When your child comes to you with a problem, you naturally want to talk about it. We all want to be understanding, responsive parents, and heart-to-heart chats with our kids are part of the deal. This is a great approach for lots of childhood worries and struggles, but it doesn’t always work well for OCD.

The repeated worries that come with OCD aren’t logical. Kids with OCD often worry about events that are highly unlikely to happen, like a plane crashing into your home or contracting a rare disease. Sometimes, the worries don’t make much sense, such as being concerned that stepping on a sidewalk crack will cause something bad to happen.

Most kids know their fears aren’t realistic, but they still can’t stop thinking about them. Talking about the worries in detail and reassuring your child that nothing bad will happen is unlikely to make the worries stop. In fact, the more time we spend talking about and paying attention to OCD worries, the more likely they are to happen again.

You can help your child shift their focus away from the worry and towards something more productive: their own ability to cope. We can’t make anxiety go away, but we can help kids deal with their anxious feelings. Instead of asking lots of questions or giving lots of reassurance, praise your child for their effort to do hard things in spite of their worries. Remind them that they’re brave, strong, and capable of facing their fears…and that it will feel so amazing when they do.

Make an OCD “Worry Monster”

Parents may find themselves bending over backwards to try to soothe their child’s worries, or using tough love to try to muscle through activities that cause anxiety to flare. It’s exhausting, and can start to feel like a battle between parent and child. This leaves kids feeling frustrated or ashamed that they can’t just “get over” their symptoms.

Instead of fighting each other, parents and kids need to team up against the real enemy—OCD. We can help kids cope with their symptoms by externalizing OCD, meaning we imagine it as a force that isn’t a part of them and isn’t their fault. This helps to cut down on the shame kids feel, and can increase a child’s motivation to fight back.

A fun way to externalize OCD is by imagining it as an annoying pest, like a bug, creature, or monster. Ask your child to draw a picture that represents how they imagine their OCD. You might even give the creature a funny name. When you talk about your child’s struggles, blame them on this creature instead: “It sounds like Jim Bob is really giving you a hard time today.” It can inject some humor into a tough situation, and remind your child that they can choose whether or not to listen to what OCD is telling them to do.

Spot Unhelpful or Tricky Thoughts

Most of us go through life without questioning our own thoughts too much. We might misinterpret things at times, but it’s usually not a big deal. People with anxiety and OCD are much more prone to having overly negative, unhelpful thoughts. In particular, kids with OCD have a tough time dismissing thoughts that are upsetting or strange. Instead, these thoughts linger, and kids have to deal with the nagging, “what if?” feeling that comes with recurrent worries.

Kids with OCD can learn to notice when their thoughts are playing tricks on them. We call this skill metacognition, which means learning to think about your own thinking. Instead of just taking their thoughts at face value, kids can examine their worries like a detective. Over time, children can start to notice patterns in their own worries, which helps them not take the worries so seriously.

The book Tiger-Tiger, Is It True? is great for teaching this skill to younger children, and we cover it in depth in my online course for kids and tweens.

Practice “Talking Back” to OCD

So maybe your child has gotten very skilled at spotting their own unhelpful thoughts. What’s next? Kids with OCD have a couple options for coping with these unwanted worries: they can talk back to them, or simply ignore what OCD is telling them to do.

”Talking back” to a worry means finding something you can say to yourself instead that is more accurate or helpful. This could mean taking a huge worry and shrinking it down to a more realistic size, or reminding yourself that even when bad things happen, you can figure them out and move on. Talking back can also mean reminding yourself that you’re in charge of your thoughts, and don’t have to listen to the unhelpful ones. Here are a few examples of thoughts kids with OCD can use to “talk back:”

• “I don’t have any proof that this worry will happen.”

• “I’ve gone to school for 6 whole years, and I’ve never thrown up in class.”

• “Even if something bad does happen, I can handle it.”

• “This is just my OCD talking and I don’t have to listen.”

• “I’ve had this worry a million times and it’s never come true.”

Learning and practicing this coping skill empowers children to stop taking their worries and urges so seriously. Eventually, children may feel ready to ignore their OCD by not following through with compulsive behavior when anxiety arises. Facing scary situations and dealing with the anxiety without rituals or compulsions is the core of Exposure and Response Prevention, the most common and effective therapy treatment for OCD.

More Coping Skills for Kids with Anxiety and OCD

If you’re looking for more ways to help a child with anxiety or OCD, consider checking out my online coping skills course, Worry-Free Tweens. In the course, you’ll find child-friendly, in-depth lessons on how anxiety works, how to deal with it, and why anxiety can actually be a superpower.

You and your child will learn how to notice unhelpful thinking patterns and shift into a more realistic mindset when worries occur. Together, you can learn how and when to use coping skills most effectively. You’ll also find advice for parents on how to support and encourage an anxious child while avoiding the traps that can accidentally worsen anxiety over time.

If the course sounds like what you’re looking for, you can access Worry-Free Tweens here.

Counseling for Kids with OCD in Davidson, North Carolina

Coping skills are a great place to start when you suspect OCD. However, many kids will need the support of a mental health professional in order to overcome their symptoms. OCD often impacts the whole family: everyone has to change the way they do things in order to keep a child’s “worry monster” happy. Counseling can help both you and your child learn new ways to deal with repeated worries and urges, so you can get back to having fun together.

I’m licensed to help kids with anxiety and OCD in North Carolina, New York, and Florida. I offer face-to-face therapy in Davidson, NC, just outside of Charlotte. For families who live farther away, we meet for online therapy using a secure platform similar to Zoom. Both kinds of therapy can be effective (and sometimes even fun) for kids and tweens.

If you’re curious about therapy for OCD, check out my post on ERP. You can also check out my FAQ to learn more about what therapy with me is like. To ask other questions or inquire about setting up an appointment, send me an email. I am always happy to help.

5 Coping Strategies for Grieving Children

Grief can touch every aspect of a child’s life, from their relationships with friends to their thoughts about the future. It’s normal for kids of all ages to struggle with strong emotions after a loved one dies, but they may express their feelings differently than grieving adults. Body aches and pains are common in grieving kids, and you may also notice struggles with separation anxiety, difficulty sleeping, and trouble concentrating at school.

We can’t stop a child from feeling grief, but we can help them work through their feelings and learn to live with their loss. These 5 coping strategies can help your child to process their feelings about the death of a loved one in healthy ways.

Coping Skill #1: Reading Books About Grief and Loss

Reading a story together is a great way to gently introduce the subject of grief and loss to your child. Often, kids don’t have a strong understanding of death before it personally affects them. As hard as it is for adults to cope with a loss, it can be even tougher for children who aren’t sure what exactly is happening. Books about grief provide age-appropriate information that isn’t too overwhelming.

Young children may worry about what has happened to their loved one who died: Are they in pain? Are they scared? Older kids may worry about the thoughts and feelings they’re having in response to grief, and whether or not they’re normal. Children of any age may feel intense guilt about how they treated their loved one, and may even wonder if they somehow did something to cause the death.

When children are better informed, they’re less likely to struggle with worries like these. Seeing how characters grieve in stories give children examples of the many ways grief can look and feel. This can reassure children that no matter how they respond to grief, there is no wrong way to feel. Take a look at my recommended grief books for preschoolers as well as books for elementary-aged kids for ideas to get started.

Coping Skill #2: Scheduling Positive Activities

Sometimes, grieving people need to take a break from their grief. While it’s important to work through the feelings and pain of loss, they can become overwhelming at times. This is especially true for kids, who don’t have the capacity that adults do to handle lots of emotional pain all at once.

When a loved one dies, children may feel like nothing is fun or worth doing anymore. It’s common for kids to retreat from hobbies, extracurriculars, or social events they used to enjoy. Over time, this can lead to feelings of depression, which makes it even harder for a child to get out and enjoy life. A vicious cycle can form where the longer a child self-isolates, the worse they feel.

We can support children in taking breaks from their grief by setting aside time each week for activities that are fun, social, or creative. Tasks that give you a sense of accomplishment when you finish them are great, too. Playdates with friends, a family board game or craft night, gardening, or committing to visiting a new place in your town each week are all ways to help your child stay socially connected even when it feels hard to do.

Once you’ve chosen an activity, make sure to put it on your calendar so you can look forward to it and hold yourselves accountable. Sometimes, kids may feel reluctant to participate when the time comes. That’s okay—you can remind your child that it’s hard to get back to doing fun things after loss. Once they’re immersed in the activity, they may find it’s much easier to enjoy it.

Coping Skill #3: Letting Out Anger

There are many good reasons to be angry when a loved one dies. As a kid, it can feel so unfair to see so many other children enjoying time with their grandparents or other family members when your own time was suddenly cut short. Kids may also be angry at parents, doctors, or emergency workers who had to make medical decisions on behalf of their loved one who died.

It can be hard to figure out how to comfort an angry child, but they need support for their feelings, too. We can provide kids with safe ways to vent anger that don’t hurt people or damage belongings. Drawing a picture and ripping it up can help children release emotion. Other children may enjoy stomping on egg cartons, tearing cardboard, popping bubble wrap, or finding other materials that are safe to destroy.

Anger gives kids a lot of energy, so physical activity can be a big help, too. Any activity that increases a child’s heart rate can help them to discharge angry feelings. Jumping rope, riding a bike, or running laps are quick and easy ways to burn off some extra adrenaline.

Coping Skill #4: Examining Worries

A loved one’s death can change the way a child sees the world. This is especially true when a loved one’s death was sudden or traumatic, such as a death from an accident. Suddenly, the world no longer seems as safe as it used to. Something terrible and unexpected has happened, which makes life feel less predictable.

This can lead to a lot of worries for bereaved kids. They may worry about the health and safety of other loved ones, or about their own risk of dying. Some children may even feel less hopeful about the future, or have a sense that things just won’t turn out well for them in life. In big and small ways, their experience with grief can color a child’s thoughts.

We can help a child to pay attention to their thoughts and not take them at face value. Kids can act like detectives, gently questioning their worries to see how accurate or true they really are. Oftentimes, worries are not based on very much good evidence—they’re just guesses about what might happen in the future.

You can help your child by asking questions like “Do you have any proof that is true?” and “Even if this scary thing did happen, would it be as bad as it seems?” Remind your child of their own strengths and ability to problem-solve, as well as the network of supportive people who could help them in a true emergency.

Books like Tiger, Tiger, Is It True? help younger children to grasp the abstract concept of thinking about thoughts. Tweens can learn about how to “talk back” to worries in my coping skills course, Worry-Free Tweens.

Coping Skill # 5: Letter-Writing

There’s often a lot left unsaid when a loved one dies, especially if there wasn’t a good chance to say goodbye. Children may wish they could apologize for a past argument, share an update about their lives, or simply thank their loved one for the lasting impact they’ve left behind.

Writing a letter gives children a chance to voice all these unexpressed thoughts and feelings. Even though they can’t be directly shared with the deceased loved one, a letter can be read aloud to another supportive adult, like a parent or caregiver.

Letter writing benefits young grievers in other ways, too. Bereaved children need opportunities to tell their story to others and be heard. Repeating their story, and putting feelings into words, helps kids to make sense of what happened to them. The more children talk about their grief, the easier it becomes to discuss. We want to help children feel comfortable sharing their grief, rather than pushing it down.

You can help your child get started writing a letter in whatever format feels best to them: email, a word processor, or old-fashioned stationary can all work well. Your child can address their letter directly to their loved one. If they need help getting started, consider having your child complete a sentence such as:

• Something that reminded me of you recently was…

• I wish I could tell you…

• I want to say sorry for…

• My favorite memory of us is…

Once your child has finished the letter, listen attentively as they share it with you. They can then choose a way to “send” their letter to their loved one, such as bringing it to the gravesite or burning the paper and watching the smoke travel upwards toward the sky.

Help Your Child Cope With Grief and Loss

I hope these 5 strategies have given you ideas you can use right away to help your child cope with grief. Working through grief and loss is a long, complicated process. If you and your child could use some more support, here are some more resources for you.

My book, A Parent’s Guide to Managing Childhood Grief, is available for presale now. It includes over 100 activities you can use with your child at home to help them cope with the many feelings and struggles that accompany death and loss. You can find it at any major bookseller, including Amazon and Barnes & Noble.

If your child’s grief is mostly showing up as anxiety, they might benefit from my online coping skills course, Worry-Free Tweens. It offers a more in-depth look at how kids can spot unhelpful thinking patterns, as well as relax the body and mind and gradually face fears. The course includes a section for parents, too, so you can help your child practice new coping skills and empower them to overcome worries.

Finally, if you’re interested in counseling for your child, I may be able to help. As a children’s counselor and play therapist, I can work with families in North Carolina, New York, and Florida, either in person or online. You can reach out to me here.

Does Childhood OCD Go Away?

If your child has OCD, you may worry at times about what the future holds. It seems like such an unfair burden for a young child to deal with. Maybe you’ve wondered whether your child’s OCD symptoms will eventually fade away, so she will be free to live life without constant worry. If you have, you aren’t alone.

“Does childhood OCD ever go away?” is one of the most common questions I hear from parents, especially at the beginning of therapy. And it’s totally understandable! OCD symptoms can be debilitating and time consuming. Handwashing, repeated checking, asking for reassurance, or long rituals are exhausting not just for the child, but for the whole family. Nobody wants a child be stuck with those symptoms forever!

I can’t predict what the outcome may be for your child, but I do know that therapy can lead to big, positive changes in the lives of kids with OCD. Today, I am digging into the research to see how common it is for childhood OCD symptoms to completely resolve. I’ll also take a look at what we can do to help all kids with OCD start feeling better.

How Common is Childhood OCD?

Childhood OCD is more common than you might think. While we may talk more about forms of anxiety and depression affecting kids, OCD also often starts early in life. Most studies estimate that 1-3% of kids have OCD, although their symptoms might fly under the radar for a long time. This is because because they can be hard to spot.

OCD most often starts when a person is a child or teen. Pretty much everyone with OCD starts getting symptoms before age 25. For childhood-onset OCD, the average age of onset is around 10 years old. It is common for boys to start noticing symptoms a little earlier, while girls might not develop OCD symptoms until later.

Some people may not get treatment for OCD until they reach the late teen or adult years, but their problems often began years earlier, during childhood.

You Can’t Outgrow Childhood OCD Without Help

Looking at the research, one thing that is really clear is that OCD is not likely to go away on its own. It’s not something that a child is likely to just outgrow or forget about. Kids with OCD need specialized therapy. The right counseling can help them learn how to deal with the intrusive thoughts that cause their anxiety and push them to repeat actions over and over.

OCD symptoms tend to ebb and flow over time: sometimes they’re better, sometimes they’re worse. Stress often plays a part in how bothersome OCD symptoms are. Some studies suggest that a small number of people might be able to “outgrow” their OCD without therapy: about 1 in 5. However, it can be a little tricky to tell if someone has really gotten rid of their OCD, or if they’re just in a low-stress time of life when it isn’t noticeable. It’s possible for symptoms to go away entirely when stress is low, only to return again during a more difficult time.

There’s also a risk that a child’s OCD could get worse without treatment. This can lead to small inconveniences, like chapped skin from too much handwashing, or major life impairments, like difficulty getting out of the house. Children with OCD are at an increased risk of also having other mental health problems, like anxiety and depression. Later in life, people with untreated mental health problems sometimes turn to unhealthy coping mechanisms like drugs and alcohol if they don’t have other good ways to deal with their symptoms.

The good news is that most people with OCD feel better after therapy. About 70% of people who get specialized treatment for OCD will improve, and usually they improve by a lot. The great news is that kids often get better results from OCD therapy than adults do. Catching symptoms early and getting help quickly leads to fewer symptoms later in life. Most kids will still have some leftover symptoms after therapy, but a small number of kids might see their OCD go away.

Sometimes, OCD Goes Away Completely (But Not Always)

Different experts have different opinions on whether or not it’s possible for OCD to completely go away. I don’t think I can argue with the experts! It’s not entirely clear whether people get cured of their OCD, or if they just go into remission from OCD. “Cured” means the symptoms are gone forever, while “remission” means the symptoms go away for a while, but may come back later.

Being the nerd that I am, I’ve looked over a handful of studies looking at the likelihood of OCD symptoms going away after therapy. It seems like it is possible for some people, and there are a few factors that increase a person’s odds. Kids whose symptoms start when they are young have better chances of remission than teens or adults. So do people whose symptoms are milder, and who are able to get therapy quickly. Finally, people who do not have other mental health problems alongside their OCD fare better than people who are also dealing with anxiety or other conditions.

Depending on the study you look at, you’ll see researchers estimating that anywhere from 32% to 70% of people go into remission after therapy, meaning that their symptoms are gone for a long time, or have gotten so mild that they aren’t getting in the way of things. However, this is different than being cured: there’s no guarantee that the symptoms might come back. The number of kids who are cured is much smaller and open to debate. Some experts guess that 20% of kids with childhood OCD are cured, while others think OCD never completely goes away.

You Can’t Always Cure OCD…And That’s OK!

As we just talked about in the last section, there’s a big difference between remission and cure. With good treatment, many kids with OCD will go for long stretches without problems. However, expecting your child to never have another OCD thought ever again for the rest of her life probably isn’t realistic. While some kids may fully outgrow their OCD, many won’t. Most experts consider OCD to be a chronic condition that, once you have it, sticks around for the long term.

That may be demoralizing to hear. The words “chronic illness” can sound very hopeless, especially if your child is struggling intensely right now. But just because OCD can be a lifetime diagnosis doesn’t mean it’s a life sentence. You may remember from earlier in this post that OCD affects 1-3% of people. That’s a pretty solid number! There are lots of kids and adults out there who are thriving, enjoying life, and just so happen to have OCD.

Help is Available for Childhood OCD in Charlotte, NC

OCD doesn’t have to run your child’s life. If you are tired of repeated worries and rituals taking up your family’s time, therapy can help. In counseling, kids can learn that OCD is just a way that some people’s brains think—and they have control over which thoughts they listen to and which they don’t. A skilled therapist can help a child gradually “talk back” to their worries and face their fears. Eventually, OCD stops being such an overwhelming urge and turns into background noise.

I’m a therapist based in Davidson, NC, just outside of Charlotte. I’m also someone who had childhood OCD! Everybody’s symptoms are different, but I remember what it felt like to be spending so much time every day dealing with worries I didn’t want to have. I love helping other kids manage their OCD fears so they can get back to enjoying childhood.

Cognitive Behavioral Therapy is a great option for OCD, and younger kids often benefit from play therapy, too. Is Davidson, NC a long commute for you? We can work together online if you live anywhere in North Carolina, New York, or Florida.

Want to learn more? Email me to ask a question or request an appointment.

Signs of Depression in Children and Teens: Know When to Get Help

The pandemic hasn’t been easy for any of us, but teenagers have been hit particularly hard. From the loss of highly anticipated milestones like prom and homecoming to the social isolation of ongoing lockdowns, it’s been a straight-up bummer of a year. Middle and high school aren’t usually a walk in the park under normal circumstances, so it’s understandable that many tweens and teens have felt more down than usual under these exceptional circumstances.

It’s normal (and natural and human) for any of us to feel a little down this year—kids included. But if you are like many of the parents I know, you may be trying to figure out where the line is between normal sadness and clinical depression when it comes to your child. How can you recognize when a typical reaction to a stressful situation is becoming something more?

Any childhood mental health struggle is cause for concern, but depression can feel extra scary due to the highly publicized rise in suicide rates over the last decade for young people ages 10-24. Most children and teens with depression won’t experience the serious suicidal thoughts that put them at risk. However, it’s helpful to be familiar with the signs and symptoms of depression and take them seriously when they arise. Let’s take a look at some common signs of depression in kids and teens, so you’ll know when to get help if your child is ever in need.

What Causes Depression in Children and Teenagers?

You may have heard that a chemical imbalance is to blame for depression. Many of us have heard of serotonin, and how a lack of it might lead people of all ages to feel depressed. While serotonin and other chemicals in the brain are a part of the puzzle, the causes of depression are much more complicated. Many parts of the brain are involved in depression. In fact, researchers are still trying to figure out exactly what happens in our brains and nervous systems that makes some of us more vulnerable to feeling depressed.

Outside factors like stress and trauma play a major part in depression, too. Any of the following can contribute to a child or teen’s depression:

• Genetics: having a close relative with depression puts a child at increased risk

• Trauma or ongoing stress, especially if the trauma happened early in a child’s life

• Major life changes, like an unwanted move, a breakup, or a divorce or death in the family

• Chronic physical health problems

• Social isolation

• Poor sleep or nutrition

There isn’t usually a “smoking gun” that we can point to as a cause of a child’s depression. It’s more common that several factors have built on each other over the course of months or years and eventually led to a depressed mood. This is even true for kids during the pandemic: as stressful as it has been, the pandemic itself isn’t usually enough to trigger a major depressive episode. However, if your child was already vulnerable due to genetics, stress, or other life changes, they may be having a harder time with depressive symptoms now.

How is Depression Diagnosed in Kids and Teens?

A pediatrician can be a good first stop if you’re concerned about depression symptoms in your child or teen. However, they’ll probably point you in the direction of a mental health professional to make a definitive diagnosis. Pretty much any mental health worker—a counselor, social worker, psychologist, or psychiatrist—is capable of diagnosing common issues like depression.

Therapists use a manual called the DSM-5 to help them when determining whether a child (or adult) is suffering from depression. The DSM-5 gives specific guidelines about the type and number of symptoms a person needs to have in order to qualify as having depression. This gives therapists something concrete they can turn to, rather than just using their intuition or guessing.

According to the DSM, kids and teens need to have at least 5 of these 8 symptoms in order to be diagnosed with Major Depressive Disorder:

• Depressed or irritable mood most days (this one is mandatory!)

• Decreased interest or enjoyment of activities most days

• Unintentional changes in weight or appetite

• Noticeably slower thoughts, speech, or movement

• Feeling tired or low on energy

• Feelings of guilt or worthlessness

• Difficulty thinking, concentrating, or making decisions

• Repeated thoughts about death or suicide, or making a suicide attempt

In addition to having 5 of these, a child’s symptoms have to get in the way of daily life and cause emotional distress to qualify as Major Depressive Disorder. They also can’t be due to another cause, like drug use or a medical condition.

Just because a child doesn’t fully meet criteria for MDD doesn’t mean they aren’t depressed! There are several other forms of depression that may not be as severe or dramatic as MDD, but can still really get in the way of enjoying life.

Signs of Depression in Children

It can be hard to imagine a very young child being depressed: isn’t early childhood supposed to be the most carefree time of our lives? While not as common as anxiety, about 3.2% of U.S. kids ages 3-17 have been diagnosed with depression. Interestingly, young boys (10 and under) seem to be more at risk of depression than young girls.

Little kids may show symptoms of depression differently than older children. It can be harder for them to put their feelings into words, so you may notice that young children’s signs of depression show up more in their behavior. In addition to the symptoms above, here are some signs of depression more specific to younger children to look out for:

• Trouble concentrating at school

• Frequent physical symptoms, like headaches and stomach problems, that don’t respond to treatment

• Sleep problems: either having a hard time sleeping, or sleeping way too much

• Seeming “cranky”, overly sensitive, or quick to cry

• Difficulty handling rejection or criticism

• Low self-esteem

If you’ve noticed multiple signs of depression in your child that have persisted for more than a few weeks, it’s a good idea to have a conversation with your pediatrician or a mental health professional.

Symptoms of Depression in Teenagers

It’s common for depression to begin in the teen years. Teens have to grapple with body image, sexual identity, and social issues that are different from what any other age group experiences. What’s more, teens are navigating all these challenges in a rapidly changing body, while simultaneously trying to manage intense academic pressure on the way to college or a career. It’s no wonder so many teens feel isolated, misunderstood, or suffer from low self-esteem that may pave the way for depression.

Interestingly, while depression is more common in boys in the early years, the opposite is true among teens. By adolescence, girls are significantly more likely than boys to experience depression. Regardless of gender, depressed teens may not fit our stereotypical image of a withdrawn, quiet, sad-seeming person.

Teens experience their emotions intensely, and their depression can often look like outbursts of anger rather than outbursts of tears. They are also more likely than younger children to express their feelings in impulsive and potentially harmful ways, like substance use or self-harm.

Depression symptoms specific to teenagers include:

• Dropping grades at school, especially if the drop is fairly sudden and unusual for the teen

• Feeling hopeless or disinterested about the future due to a belief that things will never get better

• Frequently talking about death and dying

• Withdrawing from friends

• Dropping out of extracurricular activities they used to care about

• Abusing drugs or alcohol as a way to cope with feelings

• Cutting or other forms of self-harm

Speaking to your child’s school counselor or doctor can help you make a plan for your teenager if you notice any of the symptoms above. Any child who talks about suicide or self-harm should be taken seriously. If you worry your teen is at risk of making a suicide attempt, call 911 or your local crisis hotline for help right away.

Counseling for Teens and Tweens with Depression in Davidson, NC

Therapy can make a big difference in a child’s life. The teen years are tough for pretty much everyone, but learning coping skills at an early age can make them a little easier to get through. One of the reasons I love working with tweens and teens is that they’re old enough to learn many of the same skills adults learn in therapy, which means they have a leg up on their current challenges as well as the ones they’ll face in their twenties and beyond.

I use the roleplaying game Dungeons and Dragons as a form of group therapy for tweens with depression. I also provide more traditional talk therapy both in-person and online for tweens and teens. Group therapy can provide kids with the social support from their peers that is so critical to good self-esteem. Individual counseling allows us to take a closer look at the thought patterns that fuel a teen’s depression, and practice coping skills to manage negative thinking.

If your child’s sadness is caused by a recent loss, you can play a big part in giving your child the coping skills to manage grief in a healthy way. My activity book for caregivers and kids is designed to help children ages 5-11 get support and process feelings of grief through simple, play-based activities you can try at home.

If you’re looking for help in the Charlotte area, you’re welcome to request a session at my Davidson, NC teen therapy office. Not local to Charlotte? I also see kids for online therapy throughout North Carolina, Florida, and New York. For more information, contact me here.

Signs of Social Anxiety Disorder in Children

How can you tell whether your child is just shy, or if there’s something more going on? If you’ve noticed your child lingering on the edges of the playground or appearing uncomfortable during playdates, you might wonder if social anxiety is to blame. Social anxiety affects about 7% of Americans, and it often starts during late childhood or the teen years.

This post will cover the common symptoms of social anxiety and how they show up in younger kids. You’ll learn what to keep an eye out for, and how to spot the difference between true social anxiety and run-of-the-mill shyness.

How to Tell If Your Child Is Shy…

Kids who are shy have trouble meeting new people. While their shyness may pop up with close friends and family, it’s usually the most noticeable when talking to an unfamiliar person. Shy kids may have a hard time initiating conversations, or responding when an adult says hello. However, after spending some time with a new person, many shy kids are able to warm up and interact more comfortably.

Kids who are shy may appear soft-spoken or socially awkward at times, but their troubles are usually mild or fleeting. Shyness doesn’t usually cause major problems in a child’s life, or keep them from making at least a few good friends. Over time, many children may outgrow their shyness altogether.

…And How to Tell If Your Child Has Social Anxiety

On the flip side, kids who have social anxiety fear judgment from others. They worry about embarrassing themselves or making a mistake in front of friends, teachers, and even strangers. You may hear a socially anxious child worrying aloud about doing something wrong. This fear can be paralyzing, and it doesn’t usually get better on its own.

Because socially anxious kids fear judgment, they can definitely have a hard time talking to friends or meeting new people. However, they can have a hard time with other public activities, too. The “social” in social anxiety refers not just to friendships, but any activities that involve being observed by others. This can include things like reading out loud in class, participating in gym class, or even eating in restaurants or using public restrooms.

Signs and Symptoms of Social Anxiety Disorder

Therapists use a manual called the DSM-5 to diagnose children with Social Anxiety Disorder and other mental health problems. It tells us how many symptoms a child needs to have, and gives us a handy bullet point list of what exactly those symptoms are. It also tells us how long those symptoms need to last in order to be considered social anxiety.

Here are the “official” symptoms of Social Anxiety Disorder, according to the manual:

• Intense and ongoing anxiety about social situations due to a fear of being judged or humiliated

• Avoiding situations that trigger this anxiety, or tolerating them with distress

• The fear is exaggerated or out of proportion to the actual situation

• The anxiety gets in the way of completing day-to-day activities

In order to qualify as social anxiety, the symptoms need last for at least 6 months. There also can’t be a better reason for the anxiety, such as a physical problem or the side effect of a medication.

What Social Anxiety Looks Like in Kids

Okay, now that we know the “official” symptoms of social anxiety, let’s talk about how they actually show up in children. Some kids with social anxiety might be very vocal about their worries, which makes it easier to figure out what’s going on. Others might have a harder time putting feelings into words—or they may feel too embarrassed to talk about it.

Here are a few common scenarios that illustrate what Social Anxiety Disorder may look like in children:

• Your child loves school and learning, but absolutely dreads class presentations. He gets flushed and visibly anxious when he has to read aloud, and stumbles over his words. You have noticed he avoids these projects at all costs, even in classes where he excels. In fact, he always seems to get sick on presentation days.

• You’ve noticed your child is extremely worried about what others may think of her. She feels like all eyes are on her, even in situations where most of her peers probably have other things on their minds. Her thoughts tend to jump to the worst-case scenario, and assume other people are critical of how she dresses, what she says, or how she acts.

• Your child avoids trying out for sports or the school play, even though you have a feeling he’d love to join. Being “in the spotlight” is just too overwhelming for him, and he’d rather be able to participate without anybody looking at him. You’re worried he might be missing out on a lot of fun.

• It’s hard for your kid to order food at a restaurant or answer the phone. You’ve offered a lot of encouragement, but it’s still seems like it’s way harder for her than it should be. You’ve noticed other kids the same age don’t have the same struggle.

• Your younger child throws tantrums when it’s time to go to a birthday party or other social event. It’s hard for him to articulate why, but he dreads going. He complains of headaches and stomach aches, and starts feeling on edge the night before it’s time to go.

Do any of these sound like your child? If so, chatting with a children’s therapist can help you confirm whether or not your child is dealing with Social Anxiety Disorder.

Counseling for Kids with Social Anxiety

Counseling can help your child to overcome her worries, so she can participate more fully in life without a fear of being judged. Therapy approaches like cognitive behavioral therapy can help kids learn how social anxiety affects their thoughts. It can be a big relief for socially anxious kids to realize that, most of the time, other people are focused on their own lives and not thinking negatively about us at all!

Younger children with social anxiety can benefit from play therapy, too. Even if it’s too hard (or embarrassing) to talk about worries out loud, children naturally express their anxieties through their play. A play therapist can help kids work through these feelings in a non-threatening way, and even use play and storytelling to help kids learn coping skills to manage their worries.

If coping skills sound like the way to go for your child, you can also check out my online coping skills courses. My anxiety skills course, Worry-Free Kids, is a good fit for older kids with social anxiety.

I’m a CBT and play therapist in Davidson, North Carolina. I love helping kids with anxiety to learn that they don’t always have to listen to the worries that anxiety gives them. I get to see kids build their self-confidence and face their fears every day in my office, which is part of why I love my job. Even if you don’t live in the Lake Norman area, I may be able to help: I offer throughout North Carolina, New York, and Florida.

If you are ready to take the next step with counseling for childhood social anxiety, you can reach out to me here to set up an appointment.

Explaining CBT to a Child: 4 Topics to Talk About

Cognitive Behavioral Therapy, also known as CBT, is one of the most effective forms of therapy for children with anxiety. There’s a mountain of research behind it to prove that it helps kids with a variety of anxiety-related problems, from tantrums and acting-out behavior to worrying and sleep difficulties. Although it’s helpful for all ages, studies show it’s especially effective for kids in the 11-13 age range. Maybe that’s why I’m such a big fan of using it in my tween therapy practice!

If you’re reading this post, maybe you are intrigued by CBT, too. It’s possible it’s been recommended to you by your pediatrician, or perhaps you’ve discovered it by Googling around for anxiety treatment for kids. However you learned about it, you might be wondering how to discuss it with your child. As helpful as CBT is, it’s also full of intimidating-sounding therapy jargon. In this post, I’ll break down some of the main concepts in a child friendly way, so your child will be ready to rock their first CBT therapy appointment!

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy is a skill-based therapy that’s used with both kids and adults. It’s a way of dealing with anxiety that’s focused on the present, rather than the past. You probably won’t spend a ton of time in CBT talking about family history and early childhood, because uncovering the root of where anxiety comes from isn’t the main goal of this style of therapy.

Regardless of where the anxiety came from, anxious kids need strategies to deal with it. That’s the main goal of CBT: learning tools to cope with anxiety when it arises, both now and in the future. Although it sounds simple, the effects of CBT can be really deep. Research shows that 70-80% of kids respond well to CBT, and they often see lasting results from short-term therapy. In my experience, learning the right coping skills often leads to an “aha” moment for kids. They start to understand how their own anxiety works, and that they have a say in how they think and feel, which is really empowering.

Common CBT Techniques

A child in CBT therapy might learn any or all of the following techniques:

• Relaxation techniques to calm the body

• Mindfulness or grounding skills to focus attention during times of stress

• Keeping a journal or written log to track worries at home

• Practicing “cognitive restructuring”, a way of transforming unhelpful worries

• Gradually exposing themselves to things that trigger anxiety

• Using roleplay to practice skills

• Doing “experiments” in real life to test if their fears really come true

Okay! Now that you’ve got an overview of what CBT is and how it works, let’s move on to talking about how to discuss it with your child. The next 4 sections cover what I think are the most helpful concepts for children to understand about CBT.

CBT Topic #1: The Cognitive Triangle

Most children view their emotions as something that come out of the blue. They come and go, sometimes without good reason, and they’re difficult or impossible to control. Heck, many adults feel this way about their feelings, too: how many times have you heard someone say that something “made them angry” or “made them anxious”? Many of us feel pretty powerless when faced with strong emotions like anxiety and anger.

However, it’s not really true that our feelings come out of nowhere. Any time something happens to us, all day long, we have a thought about it. It’s our thoughts that tell us how we should feel about what’s going on. Most of the time, this process works great and our thoughts let us make accurate judgment calls about situations. But for anxious kids, overly negative thoughts might lead them to feel anxious when they don’t really need to be.

The cognitive triangle is a map that shows how our thoughts, feelings, and behaviors are all connected to each other. Our thoughts tell us how to feel, our feelings influence how we act, and then our actions play a big role in how we see the world and future thoughts we might have. Teaching a child about the cognitive triangle is a great first step when introducing them to CBT.

You can use the cognitive triangle to show how different people can have the same experience, but end up feeling and acting different ways based on their thoughts. For example, a child who loves animals might see a dog sitting on the sidewalk and think “Cute, I love dogs!”. This would make her feel excited and happy. She might walk up to the dog and pet him. Another child who was bitten by a puppy in the past might see the same dog and think “Oh no, he could bite me!”. That would make him feel anxious and afraid. He’d probably cross to the other side of the street to avoid getting near the dog.

Learning and practicing the cognitive triangle helps kids understand that there’s no one “right” way to respond to a situation. It can also help them to notice the vicious cycles that sometimes form when a person is anxious. For example, if the boy in the story above keeps avoiding every dog he sees, he will never get the chance to learn about all the friendly dogs that exist in the world. He may just keep on fearing dogs forever.

CBT Topic #2: Thoughts or Actions Can Change Feelings

Once a child knows about the cognitive triangle, you can move on to the next step. Our thoughts, feelings, and actions are all connected, which means that changing one of those things changes the others. It’s pretty hard to change a feeling: just telling someone to stop being anxious probably isn’t going to work! It’s easier to change our thought or change our actions, and deal with the anxiety that way.

Your child can change her thoughts by learning how to spot worries and turn them into something more useful. She can change your actions by learning coping skills to relax her body and focus on something besides her worries. Either way, she’ll be helping herself to shrink her anxiety down, or turn it into a more helpful feeling to have.

CBT Topic #3: Talking Back to Worries

In CBT, kids learn a process to change their thoughts called “cognitive restructuring.” Because this is pretty much the least child-friendly term ever, I usually just refer to it as “talking back” to thoughts. To practice this technique, kids first need to get skilled at noticing when they’re having a worry. Next, they learn how to gauge whether or not their worry is realistic or not—usually, it isn’t! Finally, they come up with something that is more helpful and realistic they can say to themselves instead.

You can tell your child that in CBT, she’ll learn she doesn’t have to believe everything her worries tell her. Therapy will help her learn how to spot worries, and decide whether or not they’re worth listening to. She’ll learn how to “talk back” to the unhelpful ones, so that they won’t boss her around anymore. Tiger-Tiger, Is It True? is a great book for introducing this concept to preschoolers and early elementary-aged kids. Older kids might benefit from giving my coping skills course a try, where I cover this subject in detail and talk about how to try “talking back” to worries at home.

CBT Topic #4: The Feelings Remote Control

I often use this “remote control” analogy when I’m talking about coping and relaxation skills with kids. Activities like deep breathing, muscle relaxation, and guided visualization are one way that we can change our behavior in order to improve our mood. It can help kids understand the reason we’re always asking them to do things like “take deep breaths.”

When we’re hit with a really intense emotion, sometimes focusing on it just makes it get worse. Kids with anxiety are prone to doing something called ruminating: going over their worries again and again, which magnifies them. Coping skills work like a remote control that helps kids to “change the channel” on their feelings by shifting them into another emotional state. They can also work to “turn the volume down” on an intense emotion, to make it more manageable.

Most kids are familiar with remotes and how they work, which makes these terms helpful shorthand when you’re trying to help your anxious child. Relaxation skills like breathing and muscle relaxing can help turn down the volume, while music, exercise, and guided visualization can help to change the channel.

OK, You’ve Explained CBT to Your Child. What’s Next?

You’ve walked your child through the basics of Cognitive Behavioral Therapy. What’s the next step? If you know this is the approach for you, you can look for a therapist that specializes in CBT on therapist directories like Psychology Today.

If you live in New York, North Carolina, or Florida, I might be able to help you at my tween therapy practice. I love helping kids learn CBT, because these skills don’t have an expiration date: they can help kids manage anxiety and worries for the rest of their lives. That is pretty cool! If you’re not located in a state where I’m licensed, you might like my CBT-inspired coping skills course. It’s a self-guided class (not therapy) for parents and children that teaches my favorite techniques for managing anxiety at home.

I could chat about CBT all day, so if you are curious, feel free to reach out! You can ask a question or request an appointment here.

Can You Do Cognitive Behavioral Therapy Online?

If you or your child has struggled to get help for anxiety in the past, Cognitive Behavioral Therapy can feel like a breath of fresh air. As a children’s therapist myself, it’s so gratifying to see kids who have not seen improvements from from other forms of therapy blossom in this kind of counseling. Cognitive Behavioral Therapy is considered the “gold standard” for anxiety treatment. But what happens if you can’t meet with a therapist face-to-face? Is it possible to do Cognitive Behavioral Therapy online? Happily, the answer is yes. Let’s talk about how it works, and what you can expect from your online appointment.

What’s the Deal With Cognitive Behavioral Therapy (CBT)?

Let’s start with a basic overview of what Cognitive Behavioral Therapy is, and how it works. Cognitive Behavioral Therapy—also known as CBT for short—was developed in the 1960s by a psychologist named Aaron Beck. This makes it fairly “new” as far as therapy approaches go, but old enough that we have studies to show it’s effective. Actually, we have a ton of studies: CBT is probably the most-researched form of therapy that exists.

The core idea of CBT is that our feelings don’t just come out of the blue: they are determined by our thoughts and behavior. That might not sound like a big deal at first! However, it means that we don’t have to be at the mercy of our emotions. They don’t just happen to us: we have some power over what we feel and how we choose to express our feelings. CBT provides a toolkit to help people learn how to feel like they are in control of their emotions, instead of the other way around.

The “cognitive” part of Cognitive Behavioral Therapy refers to learning how to notice your own unhelpful thought patterns. The “behavioral” part involves noticing vicious cycles, and identifying things you can do proactively to help yourself feel better and manage strong emotions. By putting those two parts together, we can better understand and cope with our own emotional reactions. That’s CBT!

What Will I Do in Online Cognitive Behavioral Therapy?

If you’ve never done therapy online before, it can be hard to imagine. Will it feel awkward? What do you actually do in an online CBT session? I can’t guarantee what your exact therapy experience will look like, because every therapist is different. They’ll also recommend different techniques based on your particular situation. However, here are some common CBT techniques that you might encounter, and how they work in online therapy.

Relaxation and Coping Skills: Pretty much everyone is familiar with the advice to take deep breaths when you are stressed. The relaxation skills you’ll learn in CBT offer similar ways to calm down your body and brain. Your online therapist can teach skills like mindfulness, muscle relaxation, and guided visualization over video conference. It’s a very similar experience to sitting on the therapy couch.

Cognitive Restructuring: In CBT, you will learn how to catch yourself when you have a thought that is overly negative or exaggerated, and question whether or not you have evidence that it’s true. In online CBT, you’ll use a worksheet or spreadsheet to help yourself track when stress-inducing thoughts happen, and work through them step-by-step with your therapist. In my office, I ask clients to share their screen so we can both literally be on the same page. You’ll also learn how to come up with more helpful thoughts to say to yourself the next time you’re feeling worried.

Roleplay: Acting out a difficult situation in session can help you put the skills you’re learning into practice, so that it becomes easier in real life. This can be especially helpful for people with social anxiety, or for times when you need to have a hard conversation. Roleplay is great for boosting social skills and making it easier to be assertive. As long as you have a decent video connection, roleplay works great online—and sometimes feels a little less awkward from the comfort of your own home!

Thought Logs: Your therapist may ask you to keep a brief diary of events that triggered negative emotions during the week. This could include descriptions of what was happening, how you felt at the time, any thoughts you noticed, and how you dealt with the situation. You can share the results with your online counselor by email, screenshare, or using a Google Doc. This can help both of you develop more insight into common problems.

Does Online CBT Work As Well As Face-to-Face Therapy?

More people are considering online therapy now than ever before. Because it’s still a fairly new idea, you might be wondering it’s as effective as traditional, in-person counseling. Luckily, there is a lot of research on CBT we can look at for answers. Studies have shown that online CBT is just as effective at treating mental health problems like anxiety, depression, and panic attacks. People see significant mental health improvements in online CBT, and they’re able to maintain their progress over the long term.

Any form of therapy has its upsides and downsides. Even though it is equally effective overall, there are a few things to consider if you’re looking into virtual therapy. You and your therapist can only see each other from the shoulders up on a video call. This might make it harder for your therapist to read your body language. Talking to someone on video conferencing takes some getting used to, and if you are working or attending school online you might already be experiencing Zoom Fatigue.

There are some advantages to online therapy, too. It’s much more convenient to attend therapy from home. You never have to worry about traffic, and it’s a lot easier to fit your appointment into a busy schedule. It might even make it possible to see a therapist who would be too far away or hard to reach in person. Some people also prefer the anonymous feeling of meeting online, where you don’t have to sit in a waiting room with other strangers.

Does Online CBT Work With Kids?

Older children take to online therapy pretty naturally, because they’re already so comfortable with technology in their daily lives. I love using CBT in online therapy with kids ages 8 and up. It is especially helpful for kids who are struggling with anxiety or strong feelings that haven’t gotten better in other types of therapy.

Because CBT is direct and skill-based, it translates easily to an online format. Kids start learning coping skills right away, so they’re able to feel better faster. Having specific skills to learn and goals to reach helps kids stay focused and engaged, even when we aren’t sitting together in the same room. I like to spend half of each therapy session working on a specific skill or idea, and then include play therapy in the second half . This helps us make good progress while still leaving room for creativity and fun.

Online CBT for Kids in North Carolina

I’m a counselor, play therapist, and drama therapist who helps kids in North Carolina. I’m also a huge fan of Cognitive Behavioral Therapy for children with anxiety. If you’re interested in this approach, I’d love to help you get started!

My counseling office is located in Davidson, but I can work with kids throughout North Carolina, as well as in New York and Florida. You can learn more at the links above, or by checking out my other blog posts on CBT. If it seems like we could be a fit, feel free to reach out to me.

What Are Coping Skills?

Skills, strategies, tools for your emotional toolbox…coping skills go by a lot of names, and as a children’s therapist I talk about them all day, every day. But you know how sometimes if you say a word over and over, it starts to sound weird? That’s kind of how I’m starting to feel about the term “coping skill.” What even is a coping skill, exactly? I love coping skills and I sing their praises often: I have covered how to use them to manage all sorts of feelings. Today I’m going to do something a little different and talk about what coping skills are, why kids need them, and why they aren’t always healthy.

The Definition of a Coping Skill

“Coping skill” is a broad term that gets used to describe pretty much any activity that is good for a person’s mental health. Let’s take a look at a dictionary definition for “coping mechanism” to see if we can get a little more specific:

an adaptation to environmental stress that is based on conscious or unconscious choice and that enhances control over behavior or gives psychological comfort.

Technically, any healthy habit that reduces stress is a coping skill: stuff like getting good sleep, proper nutrition, and exercising regularly. But usually, when we talk about coping skills we mean something that provides more instant gratification. Coping skills are things that we can do in-the-moment, when we are feeling lousy, to help us turn down the volume of our emotions and avoid getting overwhelmed. They help us to get through stressful situations with a little more ease, and without doing something we’d regret later on.

Coping Skills Are NOT Just a Band-Aid

I sometimes hear people criticizing coping skills, claiming that they are a band-aid solution for a deeper problem. I get where they are coming from: coping skills deal with symptoms without trying to figure out where they come from. If a child uses a deep breathing technique to manage anxiety, she is soothing herself but probably isn’t going to discover that caused the anxiety to happen in the first place. Because of this, coping skills are sometimes seen as being too “surface-y” or superficial to create lasting change.

In my experience, this just isn’t the case! Coping skills provide an entry point for kids to dig deeper into the issues that are really bothering them. When a child learns and practices coping skills, she learns that her feelings don’t just “happen” to her: she has some control over them, and how she chooses to deal with them. That’s a pretty huge discovery! Once children discover they can create positive change with coping skills, it often empowers them to create change in other places in their lives. The same is true with families: trying new coping skills disrupts old patterns of behavior between parents and kids, and clears the way for something new.

…But They Probably Won’t Solve All Your Problems, Either

For kids with mild anxiety or life stress, learning a few effective coping skills may be all they need to feel better. However, most kids with a diagnoseable mental health struggle like anxiety or depression will need therapy beyond coping skills in order to heal. Finding coping skills that work well can lay a strong foundation for future therapy.

For example, children with anxiety might find relief from cognitive behavioral therapy, which can help them to face their fears without getting overwhelmed. Kids who are acting out at home can work together with their parents to break old cycles of behavior, find discipline that works, and enjoy a more positive relationship. Children who have survived a trauma will likely need a specialized therapy like TF-CBT to help them work through their feelings and memories in a safe way. For all these kids, coping skills are a great first step—they’re just not the end of the road.

Types of Coping Strategies

There are a million coping skills out there, but most of them fall into one of a few main categories. Not all coping skills work for all people, and you’ll probably need a few different options to help you navigate different situations. Here are the main types of coping skills that I help kids to learn in my therapy practice:

Relaxation: These skills help kids to soothe and relax the body, which can in turn help the mind feel more calm. Because anxiety symptoms are often felt strongly in the body, relaxation is especially helpful for anxious kids. A few common relaxation coping skills are:

• Soothing activities, like a warm bath or a cup of herbal tea

• Deep breathing exercises

• Progressive muscle relaxation

• Guided visualization

Mindfulness: Mindfulness skills help a child to stay in the here-and-now, rather than worrying about the future or thinking about the past. Mindfulness helps children to focus their attention on the present, be more aware of their feelings and surroundings, and feel more grounded during times of intense stress. These skills include:

• Meditation

• Observing and describing your surroundings

• Panic attack coping skills like the 5-4-3-2-1 technique

• Sensory play, for younger children

Safe Ways to Express Feelings: Sometimes, strong feelings just need to be let out. These skills help kids vent their feelings in a safe way that isn’t destructive or hurtful to themselves or other people. This is especially helpful for kids who experience strong anger, since uncontrolled anger might lead to hitting, breaking toys, or yelling at others. Here are some healthier ways to express emotions:

• Journaling

• Non-aggressive physical activity

• Creating art

• Assertive communication skills

Positive, Rewarding Activities: Fun is good for our mental health. Doing things that give us a sense of satisfaction and enjoyment are key to giving meaning to life and preventing depression. Kids need to be around other kids in order to grow and develop emotionally, so social opportunities are important coping skills for them, too. Here are a few examples of activities that fit the bill:

• Sports and recreational activities

• Hobbies that encourage a sense of accomplishment

• Spending time with supportive friends

• Volunteering

Can Coping Skills Ever Be Unhealthy?

The short answer: yes. Many of the things kids do that adults call “bad behavior” are actually attempts to cope with stress or strong feelings. Kids do these things to try to help themselves feel better—after all, if there was no benefit to the behavior, why bother at all? Adults don’t use perfect coping skills 100% of the time, either: who among us hasn’t turned to a bowl of ice cream or online shopping to deal with a bad day?

Coping skills can be adaptive, meaning they are healthy and helpful, or maladaptive, meaning they might help someone momentarily feel better, but they’ll do more harm than good in the long run. Some of these unhealthy coping skills are only mildly unhelpful, such as:

• Procrastination

• Numbing or ignoring feelings

• Tantrums or meltdowns

• Yelling, swearing, or name-calling

Other maladaptive coping skills are more serious, and can be dangerous or harmful. Seriously unhealthy coping skills include:

• Drug and alcohol abuse

• Self-harm

• Violence toward others

• Risky behavior, like shoplifting or dangerous driving

We all use some of these unhealthy coping skills occasionally, but it’s not good for kids—or adults—to rely on them as the main way they handle stress. Obviously, the more dangerous maladaptive coping skills are not good for anybody and need to be taken very seriously. Children using drugs, alcohol, or self-harm as a means to cope need the help of a therapist or other crisis resources.

Need Some Coping Skills Ideas for Kids?

Coping skills are a great form of self-help to try while you’re looking for a counselor, or before considering mental health treatment. My online coping skills courses teach kid-friendly strategies for dealing with strong emotions in a self-help format you can access any time. Worry-Free Tweens, designed for kids 8-12, is a great intro course for managing anxiety at home.

I have a bunch of articles on coping skills that kids and parents can use at home to deal with a variety of issues. Check out the resources below:

Coping Skills for the Pandemic
Anger Management Coping Skills
Coping Skills for Anxiety
Depression Coping Skills
Coping Skills for Panic Attacks

If you are looking for a counselor to help your child work on coping skills and you’re in North Carolina, New York, or Florida, I may be able to help. You can contact me here.

How to Explain Anxiety to Kids

It can be lonely being a kid with anxiety. Children who struggle with uncontrolled worries often think they must be the only person who feels things so strongly: after all, anxiety is invisible, and many people are really good at hiding theirs! Not understanding anxiety can lead children to feel ashamed of their emotions, and can also make them feel hopeless about it ever getting better. This is why it’s so important to explain anxiety to kids in terms they can understand, especially if you’re considering therapy for your child.

Teaching Kids About Anxiety Can Help Them Tame It

Early in therapy, many children describe their anxiety to me as something that happens to them, seemingly out of the blue. It feels almost like a force of nature: there’s no rhyme or reason behind it, and it’s impossible to control. As you can imagine, this makes the idea of managing anxiety pretty intimidating. By teaching kids about what anxiety is and why it happens, we are also letting them know that there are ways to make it better. Once you know the source of a problem, it’s much easier to find a solution.

Teaching kids about anxiety serves another important function: it normalizes what a child is going through. Many children are surprised to hear that everybody experiences anxiety from time to time, and that anxiety disorders are pretty common, too. Kids who don’t understand that anxiety is a universal experience may feel deeply ashamed or like something is seriously wrong with them. Learning that they are not alone alleviates that shame, which can improve self-esteem and put a child in a more empowered position to cope with their feelings.

Anxiety: Too Much of a Good Thing?

Is anxiety a good thing or a bad thing? I often start off first sessions with anxious kids by asking this question. 99% of the time, kids respond that anxiety is definitely bad. Most kids enter therapy with the idea that their anxiety is a problem and means something is wrong, and they have come to a counselor to get rid of it completely.

It is pretty surprising when I tell kids that I would never want to get rid of their anxiety! Anxiety feels terrible, but it serves a really important function: it helps keep us safe. What would happen if you never felt anxiety? Maybe you would cross busy streets when the light was red because you weren’t worried about being hit by a car. Maybe you would agree to do dangerous things with your friends, because there was no little voice in the back of your head saying it was a bad idea.

I like to ask kids what would happen if a giant, angry bear crashed through the window of our therapy room: would we both sit here calmly and act like nothing had happened? No! That would be weird. Our anxiety would kick into high gear, give us a burst of energy, and help us run to safety. The difference between plain old anxiety and an anxiety disorder is that, for some of us, we get anxiety when the proverbial bear is not around. Kids with anxiety disorders get anxiety in situations that aren’t really dangerous, which gets in the way of enjoying life. They just have too much of a good thing.

The Fire Alarm Analogy

I’m not the first therapist to describe anxiety as being like a fire alarm: I think a lot of us use this analogy, and for good reason. It’s super helpful! All children are familiar with fire alarms, and they have probably practiced a million school fire drills by the time they reach my office.

We have a tiny part of our brain, called the amygdala, that is sort of like our body’s fire alarm. It is constantly scanning the environment for danger, in order to keep us safe. When it detects danger—like that big angry bear, for example—it sounds the alarm! Think about how it feels when a fire alarm goes off: it’s loud, it’s jarring, it’s unsettling. It is not a nice sound to listen to. Our amygdala’s alarm is similar. It sends a burst of energy all through our bodies that makes our heart beat faster, our palms get sweaty, and allows us to move quickly to get away from the threat. It is not a comfortable feeling, but it gets the job done.

But, sometimes, fire alarms go off for no good reason. For example, if you are cooking in the kitchen and you make a lot of smoke, that might trigger your fire alarm. The sound is exactly the same, but it’s going off at the wrong time. This is what happens with anxiety: our brain is telling us there is danger, when really there isn’t any. Once children understand that the anxious thoughts and feelings they are having may not be true, they can start to take back control of their worries.

Think About Word Choice with Young Children

Anxiety has become such a household word that most older children (late elementary and up) are probably familiar with it already. I’ve noticed, though, that sometimes we get into the habit of labeling any negative feeling as “anxiety” so it may still be helpful to define the term for these older kids. Being able to put a name to their feelings can be really helpful for older children, because it means they aren’t the first or only person to have experienced this emotion.

For younger kids, however, the word “anxiety” may not be as helpful. If your child is in early elementary school or preschool, “anxiety” is probably not in her vocabulary yet. For these kids, it may not be as helpful to be able to label their feelings with such a clinical term. I have much better luck using “worry” or “nervous”—words they have likely heard before—when describing anxiety to younger children.

When to Consider Therapy for Kids with Anxiety

Not every kid with anxiety necessarily needs to see a counselor. Sometimes, a little extra support from Mom or Dad, some at-home coping skills, and a conversation about how anxiety works is all a child needs to get through a stressful time. If you’re looking to go this route, check out Worry-Free Tweens, my online coping skills class for preteens with anxiety.

Sometimes, though, counseling can help a child work through anxiety more quickly and easily than if she muddled through it alone. Hearing about how common (and sometimes helpful) anxiety is from an “expert” who isn’t a friend or family member can be meaningful for some children. Having a safe space to voice worries without judgment, and learn how to spot thoughts that are unhelpful or untrue can help children manage their anxiety in the present, as well as in the future as they grow.

I use a form of counseling called Cognitive Behavioral Therapy to help kids with anxiety learn about their symptoms, calm anxiety responses, and “talk back” to overly negative worries. Learn more about how CBT works for children, or contact me to request an appointment.

Why Do So Many Kids and Teens Have Depression During the Pandemic?

In normal times, I don’t see many kids or teens with depression coming to my office for help. It’s much more common for me to meet children who are struggling with anxiety, or who have been impacted by a recent trauma. I figured that the coronavirus pandemic would bring more of the same: lots of kids feeling super anxious about the virus, or who were experiencing the pandemic and quarantine as a traumatic event.

At first, this was true: I did see lots of anxious kids in March, April, and May. But things have changed recently. Suddenly, it seems like almost every child I meet has symptoms that warrant a diagnosis of depression. Given these new struggles, I thought it would be helpful to talk about childhood depression today: what causes it, how to spot it, and how to know when to get help.

What Causes Depression in Children and Teens?

When you imagine depression, you might picture it as the result of bad things happening in a child’s life: for example, a divorce, a serious illness, or bullying at school. Kids who experience these kinds of events can absolutely feel depressed, but for many kids, depression happens without a clear cause.

Sometimes, it isn’t negative experiences, but a lack of positive ones that leads to depression. Many psychologists believe that depression happens when we lose our ability to socialize with others, and participate in activities that are fun or rewarding. A child who is feeling isolated may begin to feel depressed, and this can set off a vicious cycle: kids who feel depressed lose interest in activities they used to enjoy, which leads to more social isolation. This can make it really hard to beat depression, and symptoms tend to get worse over time.

For other children, genetics and biology might play a part in depression. Scientists have identified at least one gene that may be linked to depression, and people who have an immediate family member with depression are up to 3 times more likely to experience depression themselves. An imbalance of chemicals in the brain, such as serotonin, might also contribute to depression for some kids.

How Quarantine Increases Depression Risks for Kids

As the pandemic wears on, many children seem to be developing depression symptoms who didn’t struggle with depression before. Even if a child doesn’t know anyone who has fallen ill, they may still notice changes in mood. Kids and teens who haven’t been directly affected by the coronavirus are still finding themselves feeling down, crying more easily and often, and losing interest in the activities that used to excite them.

When you think about depression as coming from a lack of positive experiences, rather than an excess of negative experiences, this starts to make a lot of sense. Most children have remained physically safe and unharmed during quarantine, but they’ve lost many of the activities that add joy to life. Social distancing is critically important, but it has some side effects that increase the odds of depression for kids and teens. For example:

• Many clubs, classes, and extracurriculars have been canceled or postponed.

• Online school is very structured, and kids miss out on the casual chats with friends in the halls, cafeteria, etc. that help to build friendships.

• Most children are going on fewer face-to-face hangouts and playdates with friends, and may have limited options for outings.

• Kids who have recently moved or changed schools have very few ways to meet new people.

Which Kids Are Most Affected by Pandemic Depression?

Quarantine may be especially hard on preteen and teen-aged kids, because being away from other young adults makes it harder to develop and grow. Friends play an increasingly important role during the preteen and teen years. Older children are expanding their horizons, becoming more independent, and developing their own identity, and they need their peers to accomplish these tasks.

Children of any age who already struggled with social anxiety or feeling isolated may also be at increased risk of depression. Kids who had a strong social network before the pandemic tend to be faring better right now, because it’s fairly easy for kids to maintain close friendships online. On the other hand, kids who were already lonely feel even more so right now, and they have few opportunities to meet new people or turn acquaintances into closer friends.

Signs of Depression in Children and Teens

Let’s be honest: a lot of us are feeling a little down right now, and that’s normal and okay. It can be hard to differentiate between everyday quarantine malaise and symptoms of depression that might require extra support. This can be especially true when we’re dealing with kids. Here are a few signs and symptoms of depression to keep eye out for if you are concerned about your child:

• Ongoing, prolonged feelings of sadness and hopelessness

• Pulling away from friends and activities that used to be fun

• Sleeping too much or too little

• Being irritable or extremely sensitive to criticism or rejection

• Fatigue, low energy, or low motivation

• Headaches, stomach aches, or other physical symptoms that don’t have a medical cause

• Decrease in self-esteem

• Thoughts about death or a wish to be dead

When (And How) to Get Emergency Help

Most children and teens who are depressed do not have thoughts about suicide. However, it’s important for parents who suspect their child may be depressed to be on the lookout for warning signs that could indicate a child is thinking about or seriously considering suicide:

• Isolating from family and friends

• Writing, drawing, or talking about death in a preoccupied way

• A sudden, major shift in personality

• Increasingly aggressive or risky behavior

• Giving away important belongings

• Threatening suicide

Any time a child threatens suicide, it has to be taken extremely seriously. Parents who worry their child could be at risk of seriously hurting themselves should head to the nearest emergency room, where a child can get help right away.

If your child is struggling with suicidal thoughts, there are resources to help. Parents or children can call the Suicide Prevention Lifeline for help at 1-800-273-8255. Teens can also text “home” to 741-741 to contact the Crisis Help Line, where they’ll be put in touch with a crisis counselor who is trained to work with young people. Both these services are free, and available 24/7.

Help for Kids and Teens With Depression During Quarantine

Social support systems are our best weapon to fight depression, especially during quarantine. You can help your child by encouraging her to find new ways to stay in touch with friends. I find that online socializing feels less awkward and more “real” when there is some structure to it: for example, playing a game, cooking a recipe, or even watching a movie together. Small groups or one-on-one Zoom hangouts also tend to feel more natural and less intimidating than large group calls.

Any activities that are new, different, or give a sense of accomplishment can help. You can gently encourage your child to accompany you on grocery store runs, walks, or other outings for a change of scenery. Kids with depression may be incredibly reluctant to get out of the house, but the more they do it, the easier it will become.

If you’re noticing big changes in your child’s mood, counseling can help get your child back on the right track. Cognitive behavioral therapy can help young people notice the overly negative thought patterns that fuel depression and keep them feeling down. It can also help them to learn coping skills to deal with intense sadness, and discover activities they can enjoy even in the midst of the pandemic.

Online therapy for kids is available in many communities, and some counselors have begun offering online social groups for kids, like my Dungeons and Dragons gaming group for girls. If you’d like to learn more about the group or my approach working with kids online, you can contact me here.

5 Coping Skills for Kids and Teens with Panic Attacks

They seem to come out of nowhere. One minute, your child seems just fine, and the next, it’s like a switch has flipped without a clear reason why. Kids and teens who suffer from panic attacks experience intense anxiety that seemingly pops up out of the blue, along with physical symptoms like a racing pulse, sweating, hyperventilating, shakiness, and a general sense that something terrible is about to happen.

For some kids, relaxation skills and other coping skills for anxiety aren’t super helpful when it comes to managing panic attacks. In this post I’ll be sharing a few techniques kids and teens can use to deal with panic attacks when they happen, to hopefully make them less intense and less frequent.

What Happens to the Body During a Panic Attack?

When adults have a panic attack for the first time, it’s not uncommon for them to head to an ER because the symptoms feel so intense and scary. The pounding heartbeat and other physical symptoms of panic can make people suspect a heart attack or another medical emergency is to blame, rather than anxiety. As freaky as panic attacks can feel, the good news is that they are harmless and go away on their own. Most panic attacks peak around the 10 minute mark, and fade away within 20 to 30 minutes. Almost all panic attacks are over within an hour.

We don’t really know why panic attacks happen, but we do know how they happen. When a person has a panic attack, their brain is doing exactly the right thing at exactly the wrong time. When we are in a life-threatening situation, our brains send our bodies into fight-or-flight mode, which triggers a big dump of adrenaline into the bloodstream.

This adrenaline surge gets us super amped up: suddenly, we are really energetic, our senses are heightened, and our hearts are beating quickly to empower us to make a quick escape or fight off a threat. This is helpful, but uncomfortable: we can also end up with chest pain, lightheadedness, excessive sweating, and other body sensations.

The Faulty Fire Alarm

When a child has a panic attack, it’s as if someone pulled a fire alarm in the hallway at school. Their fight-or-flight response is sounding the alarm bell for no apparent reason, giving the child a surge of adrenaline they don’t need. When a person experiences fight-or-flight symptoms out of context, they can feel extra scary: it’s as if you’re losing control of your body! This can lead people to get extremely focused on their physical sensations, and become fearful of future panic attacks. Ultimately, both of these behaviors make panic attacks worse.

Adrenaline doesn’t stay in the body for very long, which is why even the scariest panic attack will eventually get better on it’s own. Keep reading for ways your child can help make these attacks dissipate more quickly, and maybe even prevent them from happening in the first place.

Panic Coping Skill #1: Use an App to Get Grounded

Kids who are anxious often learn how to calm their symptoms by relaxing: imagining a peaceful place, taking deep belly breaths, and trying to clear the mind of worry. These techniques can work for panic attacks as well, but I often hear from kids that they are so distracted by the feeling of panic in the body that they can’t focus on anything else. They end up just sitting with their anxious feelings, which makes the anxiety spiral further and further out of control.

For these kids, grounding techniques can pull focus away from the anxiety and physical symptoms and direct it towards a focal point outside of the body. Grounding techniques help kids to stay focused on the present moment, rather than getting lost in their emotions or worried about the past or future. They usually work by helping a child to connect with their 5 senses, or by encouraging the child to observe details around them.

What’s Up? is a free app designed to help kids who are in the middle of intense anxiety or a panic attack soothe themselves. The app has all sorts of options for managing anxiety, from positive affirmations to breathing techniques. One section, titled “Get Grounded”, guides kids through simple grounding activities that can be done anywhere. Kids are prompted to name 5 items in a given category: for example, 5 things in the room that are red, or 5 foods you eat during the holidays. When the mind is engaged in this way, it’s hard to stay panicked at the same time.

Panic Coping Skill #2: Squeeze an Ice Cube or Take a Hot Shower

Engaging with any of the 5 senses can help kids feel more grounded and break the cycle of a panic attack. Many experts recommend using heat or cold sensations as a way to help kids feel more “in the moment” and to pull focus away from overwhelming emotions. I’ve personally seen many kids have success with squeezing an ice cube, jumping into a hot shower, or even stepping out into the front yard for a few minutes on a cold night.

This technique is especially helpful if your child’s panic attacks tend to happen at home. It can be a bit harder to use when you’re out and about, but a cool drink from a fountain or splashing water on your face in the restroom might be feasible when panic attacks happen in a public place. If you find that grounding skills are helpful, my online coping skills courses might benefit your child, too.

Panic Coping Skill #3: Sniff Some Lavender

Yep, this really is a thing! Lots of us have powerful emotional reactions to scent, which makes our sense of smell an especially helpful tool for grounding. There is some research to suggest that lavender is effective in soothing anxiety, and a lot of us probably associate it with relaxation, anyway. If your child isn’t a lavender fan, I think any other soothing scent, like vanilla or chamomile, would work just fine. The most important thing is to shift the brain’s focus away from the panic response onto something more pleasant.

You or your child can keep a bottle of essential oil or a rollerball container of fragrance on hand to use at the first sign of a panic attack. If a child can’t carry those objects to school, maybe a scented hand lotion could work as an alternative. I’ve even heard of children keeping a cotton ball on hand that’s been infused with a favorite scent, so that they always have a coping tool at their disposal.

Panic Coping Skill #4: Cut Caffeine

Okay, this is not really a coping skill, it’s just a thing not to do. However, it is really important, especially for preteens and teens who may have discovered the joys of Starbucks. I don’t want to forbid anyone from ever enjoying a pumpkin spice latte for the rest of time—most of us can get away with drinking coffee in moderation—but it’s important for teens and adults to understand the link between caffeinated drinks and anxiety symptoms.

Think about what happens when you drink coffee or soda: you feel more energized and alert, and if you drink too much, you might notice your heart pounding. It’s not too far off from what happens during a panic attack. Drinking caffeine isn’t likely to cause anxiety on it’s own, but it can worsen symptoms in people who are already struggling with it. In fact, high doses of caffeine have been shown to trigger panic attacks in studies.

Swearing off coffee and soda for the rest of time probably won’t cure anxiety, but it’s a smart idea to be careful about how many caffeinated drinks your child consumes. It’s also important for your child to be aware that it’s normal and okay to feel a little jittery after having a lot of caffeine. Sometimes, people who are prone to panic get so alarmed by that over-caffeinated feeling that they focus on their heartbeat or other body sensations, eventually triggering a panic attack.

Coping Skill #5: Remember This Will Pass

Sometimes, changing your mindset about panic attacks is the most effective way to make them better. Children and teens with panic need to understand what happens during a panic attack in order to feel reassured that they are safe, and that the attack will be temporary. This can cut down on the anxiety children feel anticipating future attacks, and when kids feel less anxious, they’re less likely to have panic attacks. It may seem weird, but accepting that panic attacks will happen sometimes can reduce the likelihood that the panic attacks happen at all!

When a child first starts noticing signs of a panic attack, it can help to simply put a name to it: “I’m having a panic attack.” Sometimes, even just doing this helps create some distance from the overwhelming feelings and make the panic attack less severe. Children can also remind themselves these feelings won’t last forever, or even set a timer or keep an eye on the clock to predict how long it will take for the adrenaline surge to fade away.

More Help for Children and Teens with Panic Attacks

I’ve written a few other coping skills articles on this blog, and kids and teens with panic might benefit from the 5-4-3-2-1 technique in this post on anxiety coping skills, as well as the skills listed for kids with coronavirus anxiety.

If you’re looking for more in-depth help mastering coping skills, check out Worry-Free Tweens. I designed this online course specifically for kids and young teens struggling with anxiety and panic attacks. It’s a self-guided course that includes videos for both you and your child, so you both have a road map for what to do the next time panic strikes.

Begin Child Therapy for Panic Attacks in Davidson, North Carolina

If your child or teen has been dealing with panic for a while, and coping skills like these haven’t been effective, it may be time to get extra help. Some kids with severe anxiety and panic benefit from medication which can make their panic response less intense. You can talk to your child’s pediatrician to see if this is an option for you, and they can refer you to a psychiatrist who specializes in treating children.

Counseling can also help kids with panic learn how to use coping skills more effectively, spot overly negative thinking that leads to anxiety, and gradually face their fears in a safe, supported way. I use CBT to help children with anxiety. If you’d like to learn more about the counseling services I provide, contact me here.

Preteen Girl Attitude? How to Get Along With Your Preteen Daughter

While most of us know to expect moodiness from teenagers, some parents may be surprised when the angst starts earlier than they expected with their preteen girls. Seemingly overnight, the sweet, well-behaved little girl you’ve raised has turned into a sassy, eye-rolling machine. What happened?! Is this normal? The short answer is yes, absolutely, and it’s nothing to take too personally. For the long answer, you can keep reading this post on how to manage preteen girl attitude, and keep your relationship with your daughter going strong.

Why Is My Preteen Girl Suddenly So Disrespectful?

It can be a little shocking for parents to witness a sudden transformation in their child’s behavior during the preteen years. After all, 10, 11, and 12 year old girls are still pretty young! Many girls this age still have an interest in playing with dolls and toys, and at the same time they’re starting to have decidedly grown-up reactions like sarcasm and heavy sighs.

We can thank hormones and puberty for a lot of these behavior changes. While preteen boys can certainly be moody as well, I notice that girls often start noticing this irritability sooner. This is likely because girls tend to start puberty a little bit earlier than boys, typically around age 11. Preteen girls are grappling with big changes physically, emotionally, and socially during this time.

What Causes Tween Girl Attitude? (Hint: It’s Not All Your Fault)

On one hand, girls’ bodies are maturing and their brains are going through a major restructuring. Estrogen and progesterone, the hormones responsible for puberty in girls, can also cause mood swings. Meanwhile, the brain is going through its biggest growth spurt since toddlerhood…which might be why there are some similarities between toddler and teen meltdowns.

During the preteen and teen years, the brain is adding new neural connections and eliminating ones that it no longer needs. While other parts of the brain are “under construction,” preteens and teens might be relying more on their amygdala to make decisions. This part of the brain is associated with the fight-or-flight response, aggression, and impulsive reactions.

On the other hand, increasingly complicated friendships and more demanding homework make the middle school years the most stressful years of school for many kids. In fourth grade, most girls probably weren’t worried about being kicked out of their friend group or voted off the lunch table, but by sixth grade this can be a real worry.

When you think about all these changes occurring in a short period of time, it’s no wonder we see fairly sudden changes in how many preteen girls are feeling. You didn’t suddenly become mean or uncool. This is just par for the course with growing up.

It’s Not Just You! This Is Actually Pretty Normal.

Most, if not all, of the less-than-pleasant behaviors you’re likely to seen in your tween daughter are totally normal. As difficult as they are to live with, they are also a sign that your daughter is developmentally on track. Please don’t beat yourself up worrying that you might have done something to cause this! No matter what, most preteen and teen girls are going to struggle with intense emotions and attitude at some point.

Preteen girls are beginning the difficult process of separating from their parents, and figuring out who they are as individuals. It’s a necessary step in their path to adulthood, but it can also be a bumpy ride. Here are a few behaviors that are totally normal and expected for preteen girls:

• Eye rolling

• Sarcastic tone of voice

• Overly harsh responses to criticism or being told to do something

• Crossed arms or other defiant body language

• Criticizing or nitpicking you

• Heavy sighs or other nonverbal expressions of being annoyed

When Should I Step In to Help My Tween?

Although very annoying, the behaviors listed above are not likely to be harmful, and will usually go away on their own with a little patience and understanding. On the other hand, there are some behaviors to look out for that are not as typical for the tween years, and are a sign your child needs extra help. If you notice your child struggling with one or more of the behaviors on this list, bring it up to your pediatrician or a therapist:

• Breaking or damaging things when angry

• Getting into trouble for disrespect at school

• Withdrawing from friends or losing interest in activities

• Difficulty getting along with other children

• Thinking or talking about self-harm

• Any very sudden or dramatic changes in mood or personality

How Should I Discipline A Tween for Attitude Problems?

Preteen girls often tell me that they are just as bothered by their moodiness as their parents are. The sarcastic comments fly out of their mouths before they even fully realize what they’re saying. It feels out of their control, and it’s no fun for anybody.

Because most tween attitude issues aren’t dangerous or deliberately harmful, and they are a part of normal development, the best response might be to ignore the behavior. I realize this a tall order for parents! Often, children repeat behaviors that get a lot of attention from parents. By ignoring the attitude, you may help your preteen get over this stage faster, while also saving yourself an argument. Here are a few more tips to consider:

• Watch your own tone. Think about how you tend to talk when you’re angry or stressed. If you’re using sarcasm or yelling, it’s more likely your child will copy your behavior. You can model the behavior you want to see in your child by making sure to speak respectfully around the house.

• Use natural consequences. Is your tween child refusing to do her chores? This might mean you have to do them yourself later, and won’t be free to drive her to her friend’s house this afternoon. This type of discipline is often more effective than just taking away a privilege, because it helps kids connect cause and effect.

• Offer a chance for a “do-over.” Sometimes, preteens don’t even realize that they’re not using a great tone of voice. You can help your child develop more self-awareness and practice speaking calmly by letting them “rewind” a conversation and try saying something again, minus the attitude.

• Pick your battles. It’s exhausting being a parent, and it’s doubly exhausting trying to deal with hard behaviors. Conserve your own energy by focusing on the conflicts that really matter to you, and let the rest slide. It’s okay to ignore an occasional sassy comment without making it a teaching moment every time.

How to Get Along Better With Your Tween Daughter

There is some truth to the stereotype that teen (and preteen) girls tend to butt heads more often with their moms than anyone else. If you are a mom who has enjoyed a close relationship with your daughter up until this point, it must be so disheartening to suddenly feel like everything you do drives your kid up the wall. Even though it’s a normal phase and not your fault, there are things you can do to keep your relationship with your daughter strong while you weather these preteen years together.

• Build in more positive, one-on-one time. If your daughter seems to be snapping at you every time you open your mouth, you probably aren’t feeling so thrilled about being around her right now. In fact, you might find yourself avoiding her or bracing yourself for another fight whenever you’re in her presence. Over time, this can make parent-child relationships more strained when, deep down, your daughter still wants your time and attention. Finding activities you both enjoy doing together can make arguments less likely, and give your daughter the focused attention she is craving.

• Connect with what interests her. Lots of tween girls I know are superfans of a particular TV show, anime series, or book series. They’d love nothing more than to be able to gush over their interests with an adult who is willing to listen! When you take the time to learn about the subjects your tween is geeking out about, you are showing her that you take her interests and opinions seriously.

• Teach her about her brain and emotions. Preteens are able to think more abstractly than younger kids, which means they can understand how the changes in their brains and bodies might be affecting their moods. It can be a relief for a tween to know that there is a valid reason she’s feeling so moody and vulnerable. Talking about moodiness as a brain change can also help both parents and kids to take the behavior less personally the next time it happens. If you need help with this, check out my coping skills courses which provide lots of education about how our feelings work.

More Help for Preteen Girls

If you’ve got a preteen girl who is struggling with anxiety or other big feelings, check out my coping skills course, Worry Free Tweens. This is an online, educational class (not therapy) that includes videos for both you and your child to watch at your own pace. You’ll come out of it with a set of specific tools you can use right away to deal with worries, panic, and anxiety.

I write about preteens a lot on this blog, because they’re one of my favorite age groups to work with in therapy! You can check out some of my other blog posts here:

How Preteens Are Stressed About Covid-19 (And How You Can Help)
Internet Safety for Preteens and Teens
What Causes Anxiety in Tweens?

If you’re thinking about enrolling your preteen child in counseling, my virtual door is always open. At the moment, I can work with families in New York, North Carolina, and Florida through online therapy.

Signs and Symptoms of Germaphobia in Children

After months of hearing about the dangers of catching COVID-19 and the need to sanitize everything, who among us hasn’t become a little germaphobic? Being extra wary of germs during a pandemic is a normal and healthy response. For children, however, fears about germs, catching illnesses, and needing things to stay clean might stick around long after our country reopens. Fear of germs is really common among kids with anxiety and OCD, and I suspect we’ll be seeing more kids than ever experiencing it after the pandemic. In this post, I’ll be sharing how to tell when your child’s fear of germs has become overwhelming, and how to spot common signs and symptoms of germaphobia in kids.

What’s Germaphobia, Exactly?

Simply put, germaphobia is a fear of germs: viruses, bacteria, parasites, you name it. An extreme fear of any of the creepy-crawlies that can make people sick is considered germaphobia. Although most people worry about spreading germs and catching diseases (especially right now), kids with germaphobia have fears that go above and beyond what is considered typical for most people.

Like other types of phobias, germaphobia is a response that is out of proportion to the actual threat. Even though germs can be dangerous, the lengths that germaphobic kids go to avoid contamination are extreme. In severe cases, the cleaning, avoiding, and rituals of germaphobia can start to feel like they’re taking over a child’s life.

As an example, a child with a healthy concern about germs might be diligent about washing their hands whenever they come in from outside, after they go to the bathroom, and before they eat. A child suffering from germaphobia may feel compelled to wash their hands constantly throughout the day, possibly to the point that their skin becomes chapped and dry. Most people might avoid eating meat at a restaurant that looks undercooked, but germaphobic kids might refuse to eat in restaurants at all, because they can’t control how the food is prepared.

What Makes An Intense Fear of Germs More Likely?

Phobias are more common among people who already have an anxiety disorder. Kids who are already prone to anxiety may be more likely to develop germaphobia symptoms than those who are not. In particular, many people with germaphobia are diagnosed with obsessive compulsive disorder, a form of anxiety that makes people feel like they have to perform certain actions over and over again to reduce anxiety or keep something bad from happening.

Obsessive worries about getting sick, throwing up, and contamination from germs are extremely common among kids and adults with OCD. Oftentimes, people with these types of obsessive worries feel compelled to wash their hands excessively, avoid places or objects they fear have been contaminated, or to overly clean their homes or belongings, sometimes in a ritualized way. Because these symptoms are so common in people with OCD, some experts believe that people who are truly phobic about germs can be diagnosed with OCD, as well.

Common Symptoms of Germaphobia In Children

Excessive hand washing, cleaning, and avoiding dirty places are all symptoms of germaphobia.

If you recognize your child’s behavior in one or more of the bullets below, it could mean that your child’s worries about germs and illness have gotten bigger than they need to be, and could be interfering with everyday life. Of course, mental health problems like germaphobia can’t be diagnosed over the internet, so you’ll need to follow up with your pediatrician or a children’s therapist. Here are some of the most common symptoms of germaphobia in children:

• Repeated, uncontrollable worries about getting sick or being exposed to germs

• Intense fear or terror about contamination

• Physical symptoms of anxiety, such as rapid heartbeat, stomach upset, and sweating when confronted with something that triggers the fear of germs

• Excessive cleaning or hand washing, that sometimes develops into a ritual that must be done the same way each time

• Avoiding people, places, or things that are “contaminated” with germs

Signs Your Child Has Germaphobia

Anxiety symptoms can be hard to spot: they’re felt very intensely by the child who’s experiencing them, but may not always be visible to parents or other people. Signs, on the other hand, are behaviors that are more apparent to outside observers. If you notice any of these possible signs of germaphobia in your child, it could indicate they are struggling with invisible fears about germs or disease:

• Avoiding places that your child perceives are “germy”, such as grocery stores, shopping malls, public transit, or airports

• Refusing to touch things that have been touched by other people, or requiring that things be cleaned or covered in plastic before touching

• Tantrums, crying, screaming, or clinging to a parent when in a public place that might contain germs

• Repeatedly asking for reassurance about not having germs or not getting sick

• Frequent handwashing, showering, or cleaning that seems to be more frequent than needed, especially if the cleaning has to be done in the same way each time

• Your child’s cleaning, avoiding, or worries are exaggerated and getting in the way of daily life

Cognitive Behavioral Therapy for Kids With Fears of Germs

Germaphobia can quickly become overwhelming, both for kids and families. Fortunately, therapy can help kids to feel more in control of their worries and develop a healthier level of concern about hygiene and germs. Cognitive behavioral therapy, a specialized form of therapy that helps kids to change unhelpful thoughts and behaviors, is often recommended for children with germaphobia or OCD.

Kids who participate in cognitive behavioral therapy learn to become more aware of when their worries are unrealistic, learn relaxation skills, and gradually face their fears of germs and contamination so that they can get back to their normal lifestyles. Because CBT is based on learning skills, it is a great fit for both in-person and online therapy.

If you’re located in New York or North Carolina and interested in counseling, I may be ale to help! I work with kids and tweens at my child therapy office in Davidson, North Carolina, as well as online in New York and Florida. You can send me an email to learn more. Not ready for therapy, but looking for more general help with worries? My online self-help course helps kids learn coping skills to manage anxiety at home.

Coping Skills for Kids to Manage Coronavirus Anxiety

Imagine what it must feel like to be a kid during this pandemic. You’re dealing with a dangerous event that you don’t have any frame of reference for. The adults in your life can’t tell you how long it’s going to last, or how bad it’s going to get. And to make matters worse, most of your favorite things to help yourself feel better—seeing friends, playing sports, even going to school—are now off-limits. It’s no wonder we’re seeing so many kids struggling with anxiety due to the coronavirus.

As communities begin to reopen, we may actually see kids’ anxiety increase, since they’ve been out of their routines for so long. For kids with anxiety, having to face potentially stressful situations like school or crowded grocery stores after having a long break from them can be really hard. Here are a few coping skills to help your child deal with uncertainty now, and self-soothe when it’s time to get back to daily routines.

Coronavirus Coping Skill #1: Imagine a Peaceful Place

Right now, kids’ day-to-day surroundings may not be changing very much, but they can draw on their memories and imagination to give themselves a relaxing change of scenery. I find I’ve been using this skill much more often with children during quarantine.

The idea is that by focusing all our attention on making a memory feel as real as possible, our mind and body will start to respond as if we’re actually there. If you’ve ever heard a song from your childhood and immediately felt nostalgic, or smelled perfume that reminded you of a person or place, you know how this works.

To practice this skill, have your child select a place that feels safe and relaxing to her. Ask her to close her eyes, and guide her through questions focusing on the 5 senses to help her make her image of this place as real as possible:

• What do you see around you in this place? What colors are there? Are you inside or outside?

• What do you hear in this place? Is there music? Are people talking?

• Can you reach out and touch something around you? Wiggle your toes—what are you standing on?

• Breathe in. What does this place smell like? Flowers, the ocean, food?

• Is there anything that you would eat or drink in this place? What does it taste like?

After your child has spent a couple minutes focusing on her peaceful place, you can instruct her to slowly open her eyes. You might want to ask about what place she chose, and how this exercise felt for her. Imaginative kids often really enjoy this activity, and can do it alone with some practice.

Coronavirus Coping Skill #2: Worry Breaks

Kids who are prone to anxiety are often also prone to catastrophizing: imagining the absolute worst-case scenario possible for a given situation. Catastrophizing thoughts can be like a snowball rolling down a hill: a problem starts small, but as a child continues to think about it the problem seems bigger and bigger, until suddenly it’s out of control.

There are so many unknowns about the coronavirus, and media coverage is constant and often scary. Children who are worried about the virus or its effects have a lot of fuel for their anxiety, and few distractions to pull their focus. This can get those snowballs rolling downhill pretty quickly! Worry breaks are a way to help children break the cycle of worrying over and over (called ruminating) and have a healthy outlet for their fears.

To practice this technique, pick a short amount of time—10 to 15 minutes—each day that you can be available for your child. This is a special time set aside for your child to share his worries with you, where you will be able to listen and give your undivided attention. Some children prefer to journal or write their worries down alone, and that’s okay, too! What’s most important is that the time is limited in order to prevent too much ruminating from happening. You can set a timer on your phone to help with this.

After the time is up, it’s time to stop worrying for the day. If your child starts noticing worries at other times, he can remind himself that there will be plenty of time to worry about this at his next break. He should then shift his attention to something else, like a pet, game, or TV show. By the time the next worry break comes around, your child may discover that his worry has gotten smaller, or disappeared entirely. Over time, practicing this technique helps kids learn to better control their worries and keep the snowballing from happening.

Coronavirus Coping Skill #3: Outdoor Movement

The steps we’ve been taking to protect our physical health—staying indoors and avoiding contact with other people—can also take a toll on kids’ mental health. During quarantine, many families are relying more on screen time and indoor activities to help keep kids occupied during the day. No judgment here: especially if you’re working from home, you’ve got to do whatever you need to do in order to help keep kids calm and entertained.

However, kids who are spending all their time doing sedentary activities probably aren’t getting their movement needs met, which can increase anxiety, depression, and acting-out behavior. All that energy needs to go somewhere, and if it’s not given an outlet we might see it start to show up in unhealthy ways.

If your child is starting to feel a little wobbly emotionally, it’s a smart idea to prioritize some time each day to play outdoors. Getting out in the sun and fresh air is a welcome change from sitting in the bedroom all day, and some studies suggest that sunlight activates serotonin production in the body, which could boost a child’s mood. Being more physically active during the day can help kids cope with sad and anxious feelings, and might also lead to a better (and maybe earlier) night’s sleep.

Coronavirus Coping Skill #4: Mindful Sensory Play

Okay, so what if you’re stuck in the house and you can’t go outside? Maybe it’s raining, or you’re not able to directly supervise your child’s play for the next hour. What can your child do to self-soothe indoors that doesn’t require a screen?

Sensory play is any kind of playful activity that engages kids’ 5 senses. I sing the praises of this kind of play a lot, because it has an almost magical appeal for kids: it calms super active children, helps keep easily distracted kids grounded and focused, and it’s very soothing for children with anxiety. During quarantine, I’m hearing from families that play with a sensory component can be really helpful for children who are starting to bounce off the walls due to pent-up anxious energy.

Many mindfulness techniques encourage us to put our focus on our senses, because this naturally gets us to pay attention to the present moment, rather than thinking about the past or worrying about the future. Sensory play gives kids this same mindful opportunity: they’re noticing what their body is feeling right now, which means they’re not worrying about past or future events.

Pretty much every kid I know is obsessed with slime, but it might not be the most realistic option for unsupervised play at home, especially if your child is younger. Luckily, there are plenty of sensory play alternatives that don’t require as much cleanup. Here are a few to consider:

• Coloring with scented markers, crayons, or pencils

• Rocking on a rocking horse, or bouncing on a trampoline

• Mixing washable paint colors in a sealed ziploc bag

• Playing with play-doh (bonus points for scented) or Orbeez

• Taking a bubble bath or giving toys a bath in the sink

• Putting dried rice, pasta, or beans in a container to create a sensory bin

More Resources for Kids Coping with Coronavirus Anxiety

Sometimes, adding a few more coping tools to your toolbox is all that you need to help a child with anxiety. If that’s the case, you can check out my coping skills for anger, coping skills for anxiety, and coping skills for depression posts to get more ideas.

Does your child respond better to video? If you’re looking for a more engaging, in-depth way to learn coping skills, check out Worry-Free Tweens, my video course that teaches anxiety coping skills to kids and parents. These self-help videos lead you through a sequence of kid-friendly coping skills to help kids manage anxiety, panic attacks, and excessive worrying.

If your child’s struggles are getting more intense, getting in the way of daily activities, or worsening as your area begins to reopen, short-term counseling might help your child to bounce back from this stressful experience. You can search for children’s therapists in your area on Psychology Today, or if you’re in New York or North Carolina, you can reach out to me here.

Will We See More Agoraphobia Symptoms in Children After Coronavirus?

Have you started imagining life after coronavirus? What’s our “new normal” going to look like once we’re all allowed to be together again? Even though my dreams of long-distance travel or seeing a Broadway play may still be far off, I’ve started to wonder what the near future will hold for children’s mental health. Many families that I work with are already observing big changes in their children’s behavior from being cooped up in quarantine. Oftentimes, though, we don’t really see all of the effects of a trauma experience emerge until after the stressful experience is over. As more cities start to open up, I think it’s possible we’ll be seeing more symptoms of agoraphobia in children. Here’s why.

First Of All—What Is Agoraphobia?

Agoraphobia is a type of anxiety disorder. People with agoraphobia are afraid of being in situations or places where it would be difficult to get away or get help in a crisis situation. Agoraphobia gets its name from the Greek word agora, which is a type of crowded, outdoor market often held in a town square. Many people with agoraphobia are fearful of being in this type of crowded, open space, but plenty of other situations can trigger agoraphobia fears, too. For example:

• Leaving the house

• Riding on public transportation, like a city bus

• Enclosed spaces like elevators, movie theaters, or bathroom stalls

• Anywhere with a large crowd, or where you have to wait in a line

• Big, open places, like shopping malls or parking lots.

For people with agoraphobia, these kinds of situations can set off worries such as “I won’t be able to get out of here if there’s an emergency” and “What if I get sick and nobody can come to help me?” This can lead to intense anxiety, panic attacks, and even cause people to start avoiding triggering places altogether. Agoraphobia is more common in adults, but kids can have it, too.

During Quarantine, Everyone Is a Little Agoraphobic

Big shopping malls, public transit, large crowds, movie theaters…when was the last time you were in any of these places? If you’ve been practicing social distancing, it’s probably been a while, and you might not even be leaving home as much as you used to.

Just like the new rules about handwashing have made us all a little OCD, social distancing protocols that help us keep each other safe have temporarily made us all a bit agoraphobic. We’re staying home more, and we’re naturally avoiding big crowds and public spaces that might put us in contact with others. If you have found that you start to feel nervous around crowds these days due to fears about transmitting or catching coronavirus, you’re not alone.

Many of us will gradually overcome these worries as the threat of coronavirus subsides…and it will, eventually! However, the longer we stay away from something that triggers our anxiety, the more intense our anxiety response is likely to be the next time we encounter it. For kids who may already be prone to anxiety, returning to public places and crowds might be very frightening for a while.

Returning To Our “New Normal” Could Trigger Agoraphobia Anxiety for Kids

If anxious kids have been avoiding public places for a while during quarantine, they may naturally feel some nervousness about returning to business as usual. This may be especially true if your child is fearful of catching coronavirus, or is not sure how the virus is transmitted. Worries about catching coronavirus could easily morph into worries about getting sick or being unable to get help in certain places.

It’s natural for us to want to avoid scenarios that trigger anxiety, which can set off a vicious cycle for anxious kids: they avoid a feared situation, which provides temporary relief but ensures that they will feel even more anxious the next time the scenario presents itself. This can make anxiety even worse in the long run, until some places or activities feel completely off-limits.

What’s more, it seems likely that our “new normal” may not look quite the same as our old normal. Gloves, masks, and other PPE may become more commonplace. We may have to get used to spacing ourselves further apart in lines, or acclimate to having our temperature taken before boarding an airplane. This different look and feel could be really scary for kids: even if masks keep us safe, they will take some getting used to! I can imagine that this will be an additional hurdle to overcome in helping anxious kids resume life in public places.

Is Agoraphobia Common in Children?

It’s not too common. Most often, people develop agoraphobia in their teenage or young adult years. More rarely, the symptoms can start earlier in childhood. Less than 1% of U.S. kids meet all the criteria for an agoraphobia diagnosis, but it can also be a tricky form of anxiety to diagnose. Because it can be hard for kids to put their worries into words, it might be hard to tell whether a child is reluctant to leave home due to social anxiety, separation anxiety, agoraphobia, or another type of worry.

Kids are more likely to develop agoraphobia if they have already had panic attacks in the past. They may also be at increased risk of developing agoraphobia symptoms if they’ve experienced a previous trauma, or had a loved one get hurt or ill outside of the house, for example, at a movie theater or amusement park. Past experiences and a history of anxiety can both contribute to kids developing agoraphobia.

Signs and Symptoms of Agoraphobia in Children

Children may not be totally aware of what is triggering their intense anxiety, or why. For parents, this can make spotting agoraphobia a little challenging. A child’s behavior might be confusing: for example, complaining of stomach aches before a family outing, or insisting on always taking the stairs rather than riding in an elevator. Here are a few common signs and symptoms of agoraphobia in kids to keep an eye out for if you suspect this may be an issue for your child:

• Reluctance or refusal to go out of the house, not just for school but for more “fun” activities as well.

• Panic attacks, which might include sweating, rapid breathing, a racing heartbeat, a flushed face, or stomach upset.

• A child might voice worries about getting lost and not being able to find a parent in public, getting sick or having a panic attack in a public place, or fear about something dangerous happening and not being able to escape it.

• The fears happen in multiple settings, for example, in elevators, crowded stores, and the movie theater.

Experiencing some or all of these symptoms isn’t enough to diagnose your child with agoraphobia, but it can help point you in the right direction. Knowing what the likely culprit is for your child’s anxiety is a good first step in finding the right help.

How to Help a Child With Agoraphobia

Agoraphobia is a form of anxiety, so treatment involves many of the same tools that we use for kids with other forms of worry. In particular, cognitive-behavioral therapy is commonly used to help kids with all forms of anxiety, and it can be really helpful for agoraphobia, too. A big part of therapy for many kids with agoraphobia is practicing gradual exposure. When kids avoid something that scares them, it provides a temporary relief but allows their fear to grow and worsen over time. Gradual exposure helps kids slowly work up to facing their fears, so that they can break the avoidance cycle and start to shrink their anxiety back down to a manageable level.

Working with a CBT therapist, your child might come up with a list of scary places or situations and rank them from easiest to hardest to complete. With the support of a counselor (and maybe a parent as well), your child can start making small steps towards doing scary things, starting at the bottom of the list and moving up to more and more challenging situations. Most kids find that once they start exposure, their fear drops away pretty quickly. Pretty soon, even the really frightening places or situations don’t seem so overwhelming anymore.

Kids might also learn coping skills to help with anxiety, so they can help their bodies relax more effectively when their panic gets triggered. Sometimes, just learning about how anxiety works in the body can help kids feel more in control of their panic, as well.

Does Your Child Need More Help?

If you think your child could benefit from some more personalized help, I would recommend finding a counselor who specializes in treating kids with anxiety disorders. If you’re in North Carolina or New York, I use cognitive-behavioral therapy to help kids manage anxiety through video sessions. You can contact me here.

If you aren’t local to one of those states, I’d recommend getting started with Child Mind Institute’s excellent intro to agoraphobia. You can also search for child therapists in your area on Psychology Today.

Online CBT Therapy for Kids With Anxiety

Kids weren’t meant to sit inside all day, isolated from friends while overhearing scary things on the news. Our “new normal” in quarantine may be especially tough for kids, who are so reliant on their daily routines to help them feel safe in the world. If you have noticed a spike in your child’s anxiety symptoms since the coronavirus, you’re not alone. It’s an understandable response to a very strange, stressful time in our history. Fortunately, one of the most effective treatments we have to help anxious kids—cognitive behavioral therapy—translates easily into online work with a therapist. In this post I’ll be sharing the basics of how CBT can help kids with anxiety disorders, and how it works to get CBT therapy online.

What Is CBT, and How Is It Different Than Other Forms of Therapy?

What do you imagine when you think of therapy? Maybe that stereotypical image comes to mind of a patient lying on a couch, free associating about their childhood experiences while a therapist quietly nods. While some therapists still practice this more “old school” form of therapy (and it really works for some people!) therapy doesn’t always have this look and feel. CBT is a very popular approach to therapy that offers another way to deal with stress, anxiety, and mental health struggles.

CBT stands for Cognitive Behavioral Therapy, and it’s a style of therapy that focuses on helping people learn new ways to deal with problems in the present, rather than gaining insight into the past. While you might discuss past experiences with a CBT therapist, in general the goal is finding solutions in the here-and-now. To do this, clients in CBT therapy learn how to spot the negative thinking patterns and self-talk that can lead to exaggerated worries and depression.

In CBT therapy, your child might…

• Learn coping skills to manage stress more effectively

• Gradually practice facing her fears in order to overcome them

• Learn how to identify overly-negative thinking

• Practice replacing negative self-talk with more positive, realistic self-talk

• Learn social skills to express herself confidently and assertively

What Makes CBT So Popular for Kids with Anxiety?

One big reason CBT has become so popular for treating childhood anxiety is that it can help kids feel better faster. The coping skills children learn in CBT can be used right away to start managing anxiety, panic, and stress, so many children notice some improvement in their moods early on in treatment. CBT is often a shorter form of treatment, and in general, people in CBT need fewer sessions of therapy than people who aren’t. Kids who get CBT therapy for anxiety symptoms may be able to progress through therapy more quickly, and return to their lives with skills to handle future problems.

Another reason for CBT’s popularity is that there is a ton of research to show it’s effective. As a therapist, I like knowing that the skills I’m teaching kids to manage their anxiety have been studied over and over, and have been shown to be the most helpful tools for the job. I like feeling confident that the therapy techniques I’m using are the most likely to help a particular child, and have been shown to be safe.

How Does CBT for Children Work With Telehealth?

While some forms of therapy may look and feel a little different when conducted online, in my experience CBT sessions via telehealth feel pretty similar to my in-office sessions! Because CBT is more task-oriented and involves more learning and teaching, it’s a natural fit for online therapy. While I often incorporate games, art, and play into my child therapy sessions, CBT puts an emphasis on helping kids put their thoughts and feelings into words, too. I think the fact that it’s a more verbal form of therapy helps make online sessions flow smoothly.

If your child is enrolled in online CBT therapy, she might participate in activities like these:

• Role-play difficult situations with a therapist to figure out healthier ways to respond

• Learn relaxation skills in session, like deep breathing and mindfulness techniques

• Practice turning negative self-talk into more positive or realistic self-talk

• Set goals to practice at home during the week, such as practicing a relaxation skill or raising her hand more often in class

• Learn more about how anxiety works, which can help kids feel less alone with their feelings

Online CBT therapy might use books, worksheets, and other teaching aids to help children get the most benefit from learning new skills. I sometimes email simple worksheets to parents that kids can use to track negative thoughts during the week. I sometimes assign other “homework” assignments as well, such as practicing a new skill during the week or trying to reach out to friends more during quarantine. Usually, CBT homework requires no more than 5 minutes a day of work—I know kids are overloaded with school assignments right now, and I don’t want to add to that stress!

Online CBT Therapy for Kids in North Carolina, New York, and Florida

If your child is having a hard time dealing with anxiety during quarantine, CBT can help her manage this stressful situation and equip her with tools that she can use to deal with anxiety even after quarantine ends. As a first step, you may want to consider my online course, Worry-Free Tweens, which teaches CBT-inspired coping skills to anxious kids ages 8-12.

If you’re in North Carolina, New York, or Florida and looking for online therapy for your child, my (virtual) door is always open. I love using CBT to help kids and tweens overcome anxiety and worry. You can reach out to me here to learn more.

How to Help a Child Cope with Anxiety

4 ways to take care of your child (and yourself) when stress is high

If you are the parent of an anxious child, you know how draining anxiety can be. Worries, rituals, and meltdowns can consume tons of time and energy, not just for your child but for the whole family. When a child’s anxiety is too strong to manage, the effects can ripple outward to impact siblings and parents. This is even more true during quarantine, when everyone is cooped up together and it’s harder to take time away to blow off steam. Even in unusually stressful times, kids can learn to feel more in control of their worries, and there is a lot you can do to help as a parent. Here are 4 ways to help your child learn to cope better with anxiety.

Help Your Child Understand That Anxiety Isn’t Bad

I often ask kids who are coming to my office for anxiety a trick question: is anxiety a good thing, or a bad thing? Many children assume that the goal of therapy is to totally eliminate their anxious feelings. As a parent, you can help your child understand that anxiety is an important feeling because it helps them know when something is not safe. Can you imagine what would happen if we didn’t feel at least a little anxious before crossing a busy intersection? Have you ever had a bad “gut feeling” about a person or situation that turned out to be right? Those are times when anxiety is good to have, even if it feels uncomfortable.

Because anxiety doesn’t feel good in the body, children often get anxious about being anxious: they notice their anxiety response starting to kick in, and worry that it means something is really wrong with them. In reality, their body is doing just what it is supposed to do by alerting them to danger…it just might be doing this at unhelpful times. Kids with anxiety have too much of a good thing: their “danger alarm” is going off more often than it really needs to. You can help your child understand that anxiety isn’t dangerous, it can’t hurt them, and that while you can’t eliminate anxiety (and you wouldn’t want to!) there are lots of ways to cope with the feelings to make them easier to deal with.

Practice Relaxation Every Day, Not Just When Your Child is Anxious

Helping anxious kids find ways to relax is usually one of the first goals in therapy. Many coping skills have been developed to help kids (and adults) unwind, but activities like exercise, art, and meditation can be just as helpful. In my opinion, it doesn’t really matter what coping skill you choose to use—what matters is how often you use it.

Practicing a relaxation technique is kind of like going to the gym. If you do it once, you might notice you feel a little better when you’re done. However, the boost probably won’t last very long. If you want to create lasting, positive changes, you’re going to have to do it regularly over a longer stretch of time. Deep relaxation techniques change the way our nervous system operates, helping us move out of the “fight-or-flight” mode that triggers anxiety and into the “rest-and-digest” mode that promotes calm. If a child is practicing a relaxation skill frequently, she may spend more time in this restful state and be able to access it more easily the next time she’s stressed, leading to less anxiety in the long run.

Practicing how to self-soothe daily has another benefit, as well: it helps kids master the technique before they really need it. You don’t want your child to be trying to figure out how to take deep belly breaths for the first time in the middle of a panic attack. Think of daily relaxation practice as being like a fire drill, helping your child master the coping skill while she’s calm, before she really needs it.

Focus on Your Child’s Strengths, Rather Than Worries

When a child is really anxious about something, it can be tempting to talk about it with them in detail in order to reassure them that their fears aren’t realistic. If your child is losing sleep at night due to fears of monsters in their room, for example, you may feel the urge to help them investigate in every closet and under all the furniture to prove that the room is 100% monster-free. While helping kids to spot unrealistic thoughts can be helpful, spending a lot of time talking about a fear in the moment can backfire and lead to more anxiety.

When we have a long conversation with a child about their worry, we might accidentally send them the message that it’s something worth being worried about. After all, if we’re spending all this time talking about it, it must be a possibility! Your child might wonder why you’d look under the bed in the first place if there wasn’t a chance the monster might be lurking under there. Long discussions can also encourage anxious children to ruminate, thinking about their worries again and again without coming to a resolution. This can make their anxiety increase, rather than decrease.

Instead of talking about the worry itself, focus on the positive strengths your child has that will help them deal with it. You might consider saying something like “I know you’re brave and you can do this,” “This is hard, but you’ve handled it before, and you can do it again,” or “You are so good at taking deep belly breaths!” This can help shift a child’s focus away from the problem, and toward a solution. It also sends the message that you understand how worried your child must feel, but you aren’t taking the worry itself seriously. You can be empathetic without reinforcing the fear itself.

Put the Oxygen Mask On Yourself First

You have probably heard this common advice from flight attendants applied to life outside of the airplane: put the oxygen mask on yourself first, before helping your child. It’s cliche, but it’s true! Helping a child to cope with anxiety is hard work, and it’s difficult to do if you’re feeling run-down or anxious yourself. Parents have to provide so much emotional labor for their kids every day, and they may find they’re giving and giving without getting much support back in return.

Kids are extremely attuned to how their parents are feeling. They look to the adults in their lives to determine how they should respond in a situation. During times of stress, your child is probably watching you closely, and paying attention to your facial expression and voice tones for clues to how you’re feeling. If a child senses that you’re feeling stressed, odds are good he’ll start to feel stressed out, too. This can lead to more anxiety or acting-out behaviors like tantrums and meltdowns. On the flip side, when a child sees that you’re managing your own stress, it sends the message that they can feel safe and relaxed, too.

When things are particularly stressful, a parent’s self-care might be the first activity to get crossed off the to-do list. If your child is struggling with anxiety, I’d encourage you to make your own self-care a priority. Figure out what helps you to cope emotionally, whether it’s taking an hour to exercise, going on a drive alone and listening to music, or calling a friend. Your kids will feel the effects of your improved mood, and you may find their anxiety decreases as your stress levels go down. When you practice self-care, you send the message to your children that coping with anxiety is a normal part of life. When your children see you managing your own stress, they learn that they can do it, too.

If your child’s anxiety is getting hard to handle at home, counseling can help make it more manageable, even during quarantine. You can read more about online counseling for kids here, or reach out to me to set up an appointment.