What to Do When Your Child Refuses Therapy

You’ve noticed a change in your kid. She’s irritable all the time, she spends most of the day in her room, and you’re worried something deeper is going on. Maybe you have a good guess about what’s to blame, like a friendship with someone who isn’t a great influence or a particularly stressful school year. Or, maybe this seems to have come out of the blue, which can feel even scarier. Either way, no matter how delicately ask whether your child wants to talk to someone, you get the same answer.

”I’m fine!”

What do you do? I know so many parents who are trying to get their kids the help they wish they’d received when they were young. When a child refuses therapy, it can be confusing or even frustrating. Let’s talk about a few ways parents can start a genuine conversation with kids who say they don’t want help.

Clear Up Any Misconceptions About Therapy

I cannot tell you how many times I’ve had a kid sit on my couch for a first session and tell me that they have no idea what’s going on. They don’t know what to expect from therapy, and they may not even know why they’re in my office in the first place!

Young children may have heard the word “therapist” or “counselor” before, but may not know what it really means. They may imagine that a therapist is someone who administers tests, prescribes medications, or even gives out shots. I’ve had a few little kids arrive at therapy in tears because they remembered a recent vaccination appointment and worried they were in for more of the same.

Older kids and teens usually have a general idea of what to expect, but their vision of therapy may be vague or stereotypical based on what they’ve seen in the media. Because older kids have the maturity to think about cause and effect, teens often worry about confidentiality in therapy. What will happen if they share what’s really going on with a therapist? Will the therapist just turn around and tell everything to their parents? Could what they say in counseling get them or someone else into trouble?

For a younger child, explain what a counselor can do (play, talk about feelings) and cannot do (give shots or medicine). It might be helpful to explain what happens in a therapy room, including that therapists keep some things private. Older kids may benefit from learning the ins and outs of confidentiality: they need to feel confident that they’ll have some privacy if they’re going to consider counseling at all. You can also share any information you have about your prospective therapist’s personality or way of working with kids.

If you’re getting ready to explain therapy to your child, I’ve gone into what to say in more depth in an earlier blog post on having the “counseling talk”.

Don’t Make Therapy Sound Like a Punishment for Bad Behavior

If your child bristles whenever you bring up the word “therapy”, be mindful about when you’re mentioning it. Are you only talking about going to counseling on the heels of a big fight, or after a bad report from school? It’s understandable that bad stuff happening would remind you of the need for therapy, but if you’re bringing up the idea in the heat of the moment it might come off as sounding like a punishment.

When an adult goes to therapy, it’s usually a decision they’ve made for themselves. It may feel scary or vulnerable to get started, but it’s also empowering and a form of self-care. On the flip side, it isn’t always a child’s idea to seek out a counselor. Kids sometimes tell me they feel they were sent to therapy for being “bad” and that the goal of therapy is to make them “good.” Instead of feeling empowered, they feel ashamed and a bit like they’ve just been sent to the principal’s office. No wonder they don’t want to come.

An honest conversation held during a calm time can go a long way toward changing a child’s opinion about therapy. It can be really helpful for your child to hear that you are struggling, too. Shifting the focus away from the child and toward a “family problem” lets your child know that you are all in this together, rather than singling out your child as the sole person in the family in need of help.

Even if you’re 99% sure of the cause of your child’s distress (a mean friend, a recent breakup, upcoming state tests) it is sometimes helpful to stick to talking about what you can see. For some kids, having an adult speculate about the cause of their troubles feels like someone is putting words into their mouth. By sticking to the facts, you may help your child feel a little less defensive. For example, saying “I notice you’ve been spending a lot more time in your room” is likely to go over better than “Ever since you made that online friend, we never see you anymore.”

Consider Alternatives to In-Person Talk Therapy

Introverted kids in particular may not be thrilled about the idea of sitting in a room with a strange adult and pouring out their deepest, darkest emotions. Even though sitting on a couch and talking face-to-face is what we consider “traditional” talk therapy, it may not feel all that traditional to a child to be alone with an adult who isn’t a relative or a teacher.

If you suspect that solo, face-to-face therapy is intimidating to your child, consider other less “traditional” alternatives. Group therapy might help some kids feel a little less on the spot, and there’s good research to show that it is just as effective as individual therapy for many problems. For others, seeing a therapist online may feel safer and more comfortable than sitting six feet away in an office.

In my own practice, I’ve noticed that tweens and teens are sometimes able to open up about difficult subjects more easily online. Maybe it’s because communicating through tech feels more natural to them, or maybe the computer screen helps them feel a bit more anonymous. Either way, it’s an option to consider if your child is refusing therapy.

Depending on your child’s interest, you might even be able to find a hyper-specific group that plays to their passions and strengths. For example, my online D&D groups for middle and high schoolers can be a helpful first step into meeting peers, exploring emotions, and practicing social skills.

My Child Still Refuses to Go…Is It Ever Okay to Force a Child to Attend Therapy?

It’s possible that you’ll say and do everything you can to cast therapy in a positive, non-judgmental light, and it still won’t change your child’s mind. Some kids fell so sure that therapy won’t help—or so uneasy about going—that they’ll put their foot down, no matter what.

It’s really hard to “therapize” a person who doesn’t want to be in therapy. In an ideal world, a therapist and client are equal partners in the therapy room, with both people bringing in ideas and nobody acting like the boss of anyone else. If a child is forced to attend, it immediately puts them in a low-status position and makes the therapist the boss. That makes it hard to grow.

I will sometimes ask kids and teens who are unsure about therapy if they’d be willing to give it a try for a set number of sessions, like 3 or 4. If your child is on the fence, you may want to give this approach a try—you might be pleasantly surprised! However, if after those sessions your child wants to end therapy, hold up your end of the bargain.

If a child is forced to attend therapy long-term against their will, it may give them a negative perception of therapy and keep them from seeking help in the future. I’d rather give kids a sense of agency, and let them return to therapy on their own terms when they feel ready to do the work.

There’s one big exception to this rule: if a child is self-harming or feeling suicidal, they need to be in therapy no matter what. However, these kids may need more support or a more specialized approach than once-a-week therapy can provide. If you think your child is at risk of serious harm, speak to a guidance counselor or pediatrician or, in an emergency, dial 911.

How Do You Help a Child or Teen Who Doesn’t Want Help?

So, you’ve determined your child is not going to therapy. Maybe you tried a few sessions and it didn’t work out, or the therapist you found didn’t seem to be the right fit. Now what? How do you help a child who refuses help?

If a child is absolutely dead-set on going to therapy, and there are no safety worries like self harm or suicidal thoughts, forcing a child to go to therapy can do more harm than good. It reinforces the idea that therapy isn’t really for helping, it’s a punishment for bad behavior. It will make it even harder for your child to feel safe enough to give therapy a try in the future.

On the other hand, kids are growing and changing all the time. Many Gen Z and younger kids view therapy in a positive way, so it’s likely your child will learn more positive things about mental healthcare from peers as she grows. By respecting your child’s decision and continuing to check in about therapy as an option, it’s possible she’ll come around to the idea on her own.

In the meantime, your best option is to get yourself into therapy. I know it’s a suggestion that gets recommended a lot and it may not feel great to hear. However, therapy with a counselor who specializes in working with parents can equip you with the tools you need to help your child—whether they attend with you or not. Parents have so much influence over the lives of their children and the culture they choose to create in a home. When you take the time to care for yourself, it almost can’t help but rub off on your children, too.

In-Person and Online Therapy for Kids in Charlotte, NC

I love working with tweens and teens struggling with anxiety, and have some therapy options that go beyond the usual sit-on-the-couch-and-talk to meet kids where they feel most comfortable. Even super reluctant young children are often excited to attend play therapy, which uses kids’ natural creative instincts to work through feelings using actions instead of words. Older kids and teens may prefer online therapy, which feels a little less intrusive than being face-to-face.

If your child has a passion for games or geek culture, you may also want to consider my Dungeons and Dragons-based groups for tweens and teens. They’re an introvert-friendly space to meet new people and practice social skills in an online setting that still feels meaningful.

Interested in getting started? You’re always welcome to contact me here.

Is Your Child a Highly Sensitive Person?

Have you noticed that your child is deeply affected by things that don’t seem to faze other kids? Maybe your son is ultra-sensitive to the way clothing fits, and absolutely can’t stand seams in his socks. Or, your daughter always seems to melt down after spending a day in a loud or crowded place. Many of the children I work with in my child counseling practice fit this description: they’re very perceptive, emotional, and respond strongly to changes or sensory input. They might be Highly Sensitive People, a term used by some therapists and parenting experts to describe kids who have big responses and strong feelings.

What Is a Highly Sensitive Person?

“Highly Sensitive Person” is a term coined by the psychologist Dr. Elaine Aron in the 1990s. According to Dr. Aron, Highly Sensitive People (or HSPs) are neurologically wired in a way that makes them more sensitive to the world around them. This means they respond more strongly to sensory stimuli, like loud sounds, strong smells, and bright lights. They also react with bigger, stronger emotions as a result. HSPs tend to feel things very deeply, and may need a longer time to emotionally recover when upset.

Being “Highly Sensitive” Is Not a Diagnosis

Being highly sensitive isn’t a disorder or mental health problem, it’s just a personality trait. It’s also more common than you might think! Dr. Aron estimates that around 15-20% of people qualify as highly sensitive. In fact, she considers herself to be a Highly Sensitive Person. Just like a person might be introverted or extroverted, they can also be more or less sensitive.

A therapist can diagnose a child with anxiety or depression, but they can’t diagnose a child as being an HSP. There is no in-depth test that can “prove” how sensitive a person is. What’s more, being highly sensitive isn’t a problem to be solved. Just like any personality style, it has its pros and cons. On one hand, the strong reactions and emotions HSPs experience can be hard to manage. On the other, they tend to be incredibly empathetic, creative, and perceptive.

Ultimately, calling someone (or yourself) a “Highly Sensitive Person” can help put a name to experiences that otherwise might feel lonely or “weird”. It can be helpful shorthand to describe your child, and might help you find coping strategies to help with strong feelings. On the other hand, it’s just a label. You only have to use it if it’s helpful to you.

Signs Your Child May Be Highly Sensitive

Wondering if your child might be a Highly Sensitive Person? Here are a few of the most common signs of high sensitivity that I see in my child therapy office:

• Difficulty With Change: Pretty much every child struggles with transitions sometimes, but HSPs are really affected when their routines are thrown off. This can look like an inconsolable tantrum if a playdate is canceled, anxiety about going on an unexpected errand, or discomfort with their room being rearranged at home.

• Empathy and Intuition: Because highly sensitive kids are so attuned to subtle changes, they’re great at spotting other people’s emotions. These kids are often the ones who can read their parents like a book and pick up on everyone’s nonverbal cues. They can easily feel what others are feeling, which often makes them compassionate young people.

• Easily Overwhelmed: Sensory input that wouldn’t bother other people can overwhelm a sensitive kid. They may not be able to tolerate loud parties or music as well as other children. Certain textures or foods might bother them. Busy places can be visually overstimulating and lead to fatigue or a grouchy mood. I also often hear about HSP kids being particular about their clothing having the right fit or texture.

• Strong Emotions: These kids might get labeled as “dramatic” or “fussy” by others. They feel things deeply, and their emotions tend to be bigger and last longer than you might expect. Being highly emotional often means HSPs are creative and funny. However, without adequate coping skills they can be overwhelmed by their feelings.

No formal test exists that can “diagnose” someone as being a Highly Sensitive Person. However, if you’re curious, you can take this self-test on Dr. Aron’s website to see if your child fits many of the HSP traits.

How to Help a Highly Sensitive Child

It can be tough growing up as a highly sensitive kid. Adults may not always understand why a child feels things so deeply. Meanwhile, a child may have a hard time putting her big feelings into words. If your child is struggling with sensory overload or emotional overwhelm, there are things you can do to help.

• Remember the Positives: If you’ve been dealing with the harder parts of this personality style, it can be easy to forget that being highly sensitive is a gift. I’d be willing to bet that many artists and people in creative professions are HSPs. You can’t have all that empathy and intuition without also having the sensitivity and anxiety—they’re two sides of the same coin. You can help your child to reframe her way of seeing the world as a strength, rather than a weakness.

• Practice Coping Skills: A highly sensitive child’s powerful emotions can easily lead to overwhelm. These kids need to learn healthy ways to channel their strong feelings, so they don’t turn into panic or tantrums. You can support your child by practicing mindfulness or relaxation skills at home to soothe anxiety. Physical activity, art, and journaling are other helpful outlets for strong emotions.

• Provide Structure: Many sensitive kids fare better when they have a predictable schedule. Children feel safe when they know what’s coming next, so a set routine can calm your sensitive child’s nerves. Consistent boundaries can also help children with strong feelings to better regulate their feelings. This doesn’t mean you have to be harsh or strict—just that you generally stick to your word. Just like a predictable routine, predictable rules help children feel more secure.

Considering Child Counseling in North Carolina?

Sometimes, despite everyone’s best efforts, kids need a little extra help. I tell families that a child doesn’t need to have a serious problem in order to benefit from counseling. There’s probably a time in every person’s life when having somebody to talk to can make a difficult phase pass by a little more easily.

If your sensitive kiddo could use some strategies for dealing with strong emotions, check out my online coping skills courses for kids. They’re available at-home, on demand, wherever you live. Worry-Free Tweens, my course for kids ages 8-12, could be a good bet if your child’s sensitivity leads to anxiety.

A child counselor can help your child better understand her strong feelings. In therapy, highly sensitive kids can learn how to cope with the day-to-day situations that lead to stress. They can also learn ways to self-soothe and deal with overpowering feelings when they happen. My hope is that kids and parents leave my office recognizing how cool it is to have strong feelings.

I love working with highly sensitive kids and preteens in my Lake Norman counseling office. If you aren’t nearby, I also see children for online therapy throughout North Carolina, New York, and Florida. Ready to get started? You can get more information or request an appointment here.

What Age Can A Child Start Therapy?

How young is too young to see a counselor? Every week, I talk to parents on the phone who are trying to figure this out. Starting therapy can feel like a big step, and nobody wants to jump the gun. On one hand, a child may be passing through a phase that will resolve on its own. On the other, behavior struggles are tough for the whole family even if it is “just a phase.” In this post, I’ll unpack how old a child needs to be to benefit from therapy. I’ll also share tips on what to expect in counseling according to age, and signs that you should consider getting help.

The Younger the Child, The More Involved You’ll Be in Therapy

When you imagine what therapy looks like, you probably envision the patient sitting alone in a room with their counselor. Individual therapy is the most common form of therapy in the U.S., especially for adults. Things look a little different for kids in therapy. Depending on their age and developmental level, kids don’t always get the most benefit from working 1-on-1 with their therapist. As a rule of thumb, the younger your child is, the more time you can expect to spend in the room with your child’s counselor.

Parents are the center of a young child’s life. Little kids look to their caregivers to decide how they should think, feel, and act. Their connection with their parent is what helps them feel safe. Because your young child takes so many cues from you, it’s hard to create any lasting change in therapy if you aren’t kept in the loop.

Can Really Little Kids Benefit From Counseling?

You might be surprised to learn that special forms of therapy exist to help babies and toddlers with emotional problems. This type of therapy always includes the parent and child together, and helps the parent learn new ways to soothe their baby and deal with hard behavior. This can be especially helpful for young children who have survived trauma.

When I see preschoolers in therapy, I try to have parents join for about half the session. That way, we have a chance to learn coping skills together and problem-solve anything new that’s come up during the week. Most preschoolers are able to meet alone for part of their therapy session. However, they’ll need their parents’ help to practice the new things they’re learning in therapy at home.

For elementary-aged kids, it’s still helpful to have a quick check-in at the beginning of the therapy hour. Kids this age usually meet alone most of the time, but will still need reminders and support from parents in between sessions. I like to meet with parents periodically to talk about our progress in therapy, and discuss skills they can use to at home to help their child.

When Can Children Go to Therapy By Themselves?

Many preschoolers can benefit from individual play therapy. In my therapy office, I usually meet with 3-, 4-, and 5-year-old kids alone for half of each session. Preschoolers make sense of their world through play, and can’t always put their feelings into words. This makes play therapy a fantastic option for this age group, since it builds on a young child’s natural strengths.

I usually start seeing children for therapy by themselves around ages 7-9. By this age, kids have gotten used to separating from their parents each day for school. They are more independent, and much more able to verbalize their thoughts and feelings. Elementary school kids are also starting to develop more advanced thinking skills. This makes them a great fit for cognitive behavioral therapy, or CBT, which helps kids learn how to deal with overly negative thoughts and feelings. Parents of elementary school kids should still plan on meeting with their child’s therapist on at least an occasional basis.

By middle and high school, most kids are able to manage therapy almost entirely by themselves. Tweens and teens crave independence and have started forming an identity away from the family unit. Having an unbiased listener to vent feelings to in confidence can be really helpful at this age. While I still work closely with parents of tweens and teens, they don’t usually need to meet with me as frequently.

How to Tell if Your Child Is Old Enough for Therapy

Age isn’t the only thing to consider when deciding whether your child is ready for therapy. Every child is unique and develops at their own pace, so there’s no one-size-fits-all answer. Keep an eye out for these signs to decide whether your child will benefit from one-on-one time with a therapist:

• Your child has started make-believe play: for example, they can use an object to represent something else while playing.

• Your child can communicate her needs to other people if you aren’t around.

• With help, your child can focus on an activity for more than a few minutes.

• Your child has started verbalizing thoughts and feelings.

Every child’s situation is different. If your child is meeting milestones at a different pace due to a health condition or developmental delay, they can still benefit from counseling. Look for a therapist who has training in helping children with special needs to make sure you have the best possible fit.

Signs That Therapy Could Help Your Child

It’s totally normal for young children to throw tantrums, fear monsters under the bed, or enjoy using the word “No” whenever possible. So how do you figure out when a problem has gotten big enough to consider therapy? In my experience, the fact that a parent is considering therapy at all is usually a sign that things have gotten too hard to manage.

You don’t have to wait for a crisis to call a therapist. In fact, sometimes it’s nice to get an outside perspective on the typical, every day problems of growing up. Even if you can muddle through a situation on your own, a therapist can help make things easier and less painful for everyone involved.

Here are a few indicators that therapy could help your child:

• Your child is struggling with her feelings more than other kids her age

• The problems are getting in the way of daily activities like eating, sleeping, play dates, or school

• Your child is having difficulty making or keeping friends, or getting along with siblings

• The problems started after a stressful event

• You’ve noticed that things are getting worse, not better

After you have thought about your child, take a minute to check in with yourself, too. How is your stress level about this issue? Are you feeling so overwhelmed by your child’s emotions that you’re not sure how to help her manage them anymore? Feeling pushed beyond your own limits as a parent is a totally valid reason to look into counseling.

Begin Child Therapy in Charlotte, North Carolina

If you are looking for a child therapist in the Charlotte area, I can help. I’m a children’s counselor and Registered Play Therapist who loves working with kids from preschool through the preteen years. You can meet me for individual or parent-child therapy at my office in Davidson, or join me online from anywhere in North Carolina, New York, or Florida.

Not in one of those states? I can’t provide counseling, but you may be interested in my coping skills class for tweens. It’s an online video course that includes step-by-step help for both kids and parents to better manage anxiety at home.

Have questions about getting started? Learn more about me here, or reach out by phone or email.

Help! My Child Won't Stop Interrupting Conversations!

It's normal for young kids to blurt things out sometimes, but parents can help make it easier to hold that thought.

Remember “BBC Dad”? The guy who was giving an interview with the BBC about South Korea when his 4-year-old toddled through the door behind him on camera, followed shortly by his adorable baby in a bouncer? I’ve been thinking a lot about poor, flustered BBC Dad lately in this age of Zoom calls, and how tough can be when kids continuously interrupt conversations, whether they are virtual or face-to-face. In this post I’ll be unpacking a few reasons why kids may struggle with interrupting, and what parents can do to help.

Why Does My Child Interrupt?

It’s normal, common, and even developmentally appropriate for young kids to interrupt conversations sometimes. From roughly age 2 to age 7, children are naturally egocentric, meaning that it’s hard for them to think about points of view different from their own, or to separate their thoughts and feelings from other people’s. Kids this age tend to assume that everyone is thinking and feeling the same way that they are. This can make it hard for young children to realize that other people have important thoughts to share, too, and may not be ready to hear what a child has to say.

Here are a few other factors that can contribute to frequent interrupting behavior in kids:

• Difficulty with impulse control

• Boredom

• Trouble with social skills, such as recognizing natural give-and-take in conversations

• Desire for attention from a parent or other adult

• Stalling to avoid an unwanted activity

Has Zoom Made Kids’ Interrupting Worse?

I accidentally interrupt people on Zoom calls all the time. The few seconds of lag time between when someone speaks and when you hear their voice makes it easy to assume someone is done talking when they really aren’t. It’s pretty easy for adults to navigate this with minimal awkwardness, but for kids, it might be much harder to do.

In addition to the slight sound delay, there are fewer opportunities to pick up on nonverbal communication in video conferencing calls, especially if there are many participants. We can’t really read body language when we’re only seeing people from the shoulders up, and people’s faces are pretty tiny when the whole class is on the call together! This could make it even harder for kids to know when it’s a good time to talk.

Finally, I know that some kids feel quite anxious about online school. While Zoom calls are a big relief for many children with social anxiety, for others, it can be overstimulating. Kids who are feeling a little uneasy about being on camera or who worry they may be overlooked by their teacher due to the large number of kids on the call will be much more likely to interrupt.

Give Visual and Physical Cues To Let Your Child Know You’ve Heard Them

Kids who interrupt are trying to connect with people around them, which is awesome! They may just need a gentle acknowledgement that we’ve seen their request to speak and haven’t forgotten about them. A hand gesture can let your child know you’ve seen them and will be with them shortly, without you having to break the flow of your current conversation.

Ariadne Brill from Positive Parenting Connection describes how she used to gently hold her child’s hand when he interrupted her on the phone, to let him know that they were still connected and he’d have her attention soon. For older kids, try holding up 2 or 5 fingers to let them know how many minutes you need, or coming up with a funny secret code together that you can use to gently make them aware of their interrupting when it happens.

Boost 1-on-1 Time Together

When kids are craving attention, they’re more likely to rely on difficult behaviors like interrupting to try to get their needs met. If your child has been going through a particularly stressful time, she may need a little more attention than normal to feel secure. Similarly, kids who have had to share a parent’s attention with a sibling may be feeling a little lacking in individual support.

Setting aside a few minutes a day of individual, focused playtime with your child can help them get their need for attention met in a more positive way. Kids who get this 1-on-1 time often feel more secure in their connection with their parent, which can make it easier to tolerate time apart. This can help cut down on interrupting in the long run.

Practice Social Skills at Home to Interrupt Politely

Some kids may just need the right language to interrupt politely. You can teach your child to say “excuse me” or “may I please interrupt” when they have something important to say, and praise them when you hear these words. It’s also helpful for kids to learn the times when it is good to interrupt, such as in an emergency or when someone has been injured.

The picture book “My Mouth Is a Volcano!” is a children’s therapy go-to for young kids who are struggling with interrupting. The story, told from the point of view of an elementary school-aged boy, can be validating for kids who interrupt. It highlights the positive intentions that sometimes motivate kids to interrupt: for example, being really eager to share information that feels important with your friends and family. At the end of the story, children learn a simple coping skill to help them self-soothe and hold on to important thoughts until there’s an appropriate time to share them.

Model the Behavior You’d Like to See

Kids learn how they should behave from the adults in their lives, so any time a child is struggling with a behavioral issue, it really helps them to see the grownups around them practicing what they preach. Do you come from an outspoken family where people tend to talk over each other? Have you been a little lax in your own manners when you need to interrupt your child in conversation? I know this is something I could be more mindful of in therapy sessions, myself!

Nobody is perfect, but really accentuating the behaviors you’d like to see more of can help your child pick up on them, too. Make a point of saying “excuse me” or apologizing to your child for interrupting when it’s really necessary to do so. When you notice your child using good manners, heap on the praise! Children tend to repeat the behaviors that we pay a lot of positive attention to, so showing your enthusiasm for their newfound manners is a good way to encourage a repeat performance.

More Ways to Help a Child Who Constantly Interrupts

I’ve written a few other blog posts that might be of interest if you’re struggling with a tiny interrupter. If your child is really struggling to stay on task during online school, these tips to help combat Zoom fatigue may help improve his focus and comfort during class.

Online social groups are an excellent resource for kids looking to brush up on their social skills while still practicing social distancing. I’ve rounded up a few suggestions for online groups here, as well as outlined the benefits of these kinds of group activities for kids.

If your child is having a hard time picking up on social cues and collaborating with others, counseling that incorporates drama therapy might be a fun, low-pressure way to practice teamwork, nonverbal communication, and the other “soft skills” that help children communicate effectively and make friends.

I run an online group that helps middle schoolers brush up on social skills through game play—if that sounds appealing for your preteen, you can read more about my Dungeons & Dragons Social Support Group here.

All About PCIT: How Parent Child Counseling Helps Strong-Willed Kids

Imagine this: your kids are sitting quietly on the couch, watching a show together. It’s seemingly the first time all day that they haven’t been bugging each other about something. You breathe a sigh of relief: you can finally finish the coffee that’s been sitting on the counter all morning. You sneak off wordlessly to the kitchen to finish your cold coffee and scroll through Instagram. You’ve only been gone a few minutes when you hear a yell, and you have to drag yourself back to the living room for yet another 15-mintue lecture to your oldest about not hitting her sister.

Those lectures are not fun for anybody, and it seems like they never work. Your child may smile and nod, but in a half hour the whole cycle is going to repeat itself again. PCIT, or Parent-Child Interaction Therapy, is a therapy for kids and parents designed to break this cycle. Read on to learn more about how this parent child counseling approach can help strong-willed kids to get attention from good behavior, rather than bad behavior.

How Parent Child Counseling Breaks the Bad Behavior Cycle

Many parent child counseling strategies are based on the idea that children will repeat the behaviors we pay attention to. It’s a simple concept, but it can be really difficult to put in to practice, especially when you consider that both positive and negative attention can make a behavior more likely to happen again. PCIT helps parents to “feed” the good behaviors they want to see more of by heaping on positive attention and praise, while “starving” unhelpful behaviors by depriving them of attention.

Often, we ignore kids when they are doing the right thing. Think of the scenario above with the siblings sitting quietly on the couch: it’s only natural to want to slip away unnoticed for a few minutes, especially if your kids have been bickering all day. But by ignoring this good behavior and only coming back into the room when the children start fighting, the parent has accidentally heaped a big dose of attention onto that bad behavior. The child who hit has learned that nobody notices when she’s being good, but that hitting her sister is a great way to get mom’s attention.

What Is Parent-Child Interaction Therapy?

Parent-Child Interaction Therapy, or PCIT, is a form of counseling for young kids who have problems with acting out. It’s an evidence-based treatment, meaning that it’s been heavily researched to make sure it’s as effective as possible for the largest number of families. In PCIT, a counselor acts like a coach for parents, giving them new discipline tools to try with their child and helping them to implement them successfully.

The goal of PCIT isn’t to simply punish a child for being “bad”: it also helps a family create more fun experiences together that provide a child with opportunities to do the right thing. Often, by the time a family tries PCIT, parents may feel exhausted and exasperated by their child’s behavior, which makes it hard to enjoy time spent together. Children may sense their parents pulling back, which can lead them to act out even more in order to keep their parents close.

The Two Phases of Parent-Child Interaction Therapy

PCIT is divided into 2 stages: in Phase 1, parents learn play therapy skills that they can use at home with their child on a daily basis. By setting aside a small amount of time each day for “special playtime”, parents give kids the focused, individual attention they are craving so intensely at a time when they’re behaving well. This helps kids to see that they can get more (and better) attention from parents by doing the right thing, and can help parents to reconnect with their kids and enjoy time spent together.

In Phase 2, parents learn a set of simple discipline strategies to help change difficult behaviors. Consistent, effective, and non-physical discipline helps put parents back in the driver’s seat and gives kids the consistent boundaries they need to feel secure. Over time, kids learn that their old acting-out behaviors like negotiating, tantrums, and whining don’t work anymore: the rules are the rules, and they don’t change. Once that happens, negative behaviors tend to fade away.

What Kids Benefit from Parent Child Counseling Like PCIT?

PCIT was designed to be used with kids ages 2-7 who have disruptive behaviors at home, school, or with others. It’s been used with children who are very strong-willed and have a hard time following rules, as well as children whose behavior problems stem from traumatic experiences. Because PCIT strategies are gentle and based on common sense and logic, I have found these skills can be modified to work well with older kids, too.

Here are a few signs your young child could benefit from parent child counseling such as PCIT:

• Frequent tantrums that are longer and more intense than other children her age

• Deliberately annoying behavior, like whining, pouting, stomping feet, or calling people names

• Breaking things on purpose when angry

• Difficulty following directions or being told “no”

• Negotiating, stalling, or ignoring you when you give an important instruction

How to Find a Parent Child Counselor

PCIT uses a “bug in the ear” approach in counseling sessions: your therapist teaches you the skills, and then observes you playing with your child and gives you real-time feedback through a microphone device in your ear. This unique setup means that “pure” PCIT usually occurs in a big therapy office or agency that has equipment like a two-way mirror or a special observation room.

Here’s a list of therapists who are certified to practice PCIT in the US as well as worldwide. I have completed a certificate course in PCIT from UC Davis, and although I don’t practice “pure” PCIT, I borrow many of the skills in my work with children and preteens. You can learn more about my therapy practice here.

Looking to get started in therapy? Reach out to me to learn more about my approach, and how to help break the cycle of bad behavior with strong-willed kids.

How Do I Know if My Child Has Sensory Issues or Emotional Problems?

“It is a daily struggle to get my son to brush his teeth.”

”My daughter has a huge meltdown any time we go to a crowded place.”

”My child plays too rough with other kids, and can’t seem to get out of their personal space.”

”We spend forever trying to find clothes my child is willing to wear, because nothing feels ‘right’ to him.”

Do any of these sound familiar to you? Concerns like these bring many families to a child counselor’s office, because they can really get in the way of a child’s life and cause stress for the whole family. But how can you know if your child’s behavior are caused by emotional struggles like anxiety, or by sensory issues? In this post, I’ll be talking about common signs of sensory processing difficulties that might show up as behavioral or emotional problems.

What Are Sensory Processing Issues, Exactly?

“Sensory processing” describes the way that our brain and nervous system deals with the information we receive through our senses. We take in sensory information all day long through our eyes, ears, noses, mouths and hands, and special receptors pass along this information to the brain, which interprets the information and decides how important it is. For most of us, this all happens pretty easily: our brains can manage the amount of sensory information they’re receiving, and know just how to handle the information when it arrives.

For some people, though, this process isn’t quite so easy. They may be easily overwhelmed by the sensory information they’re receiving, which is called hypersensitivity. They may crave more sensory information and not be getting enough, called hyposensitivity. Or, they may have a hard time organizing information from different senses and keeping it all in sync, a process called sensory integration. This kind of trouble with sensory information is more common than you might think: it likely affects between 5 and 15% of kids.

How do Sensory Processing Issues Affect Kids?

Sensory processing issues can affect any of the 5 senses we are all familiar with—sight, hearing, sound, taste, and smell—but it can also have an impact on 3 additional senses you may not have heard of before. These senses are:

Proprioception: Our sense of where our body is in space, and what our body is doing.
Vestibular: Our sense of balance and movement, which is controlled by the inner ear.
Interoception: Our awareness of sensations inside our bodies, like heartbeat and hunger.

We may not always be totally aware of these senses: for example, proprioception helps us to move around easily while we focus on other things, and our vestibular system keeps us balanced as we go about our day. When one of these senses is not being processed well, it can cause problems for a child.

When Sensory Hypersensitivity Looks Like Emotional Problems

Children who are hypersensitive are more easily affected by information from at least one of the senses. This means they can get easily overwhelmed by sensory experiences that might not seem like a big deal to others, which can lead to outbursts, meltdowns, or avoidance of certain tasks that might look a lot like anxiety or behavior problems. Here are a few ways hypersensitivity commonly shows up that might look like an emotional issue:

• Extremely picky eating

• Tantrums and meltdowns that seem to come out of nowhere, but mainly happen in loud or overstimulating places

• Abruptly running away from caregivers, which can be a safety risk

• Being very sensitive to the fit and texture of clothing, for example, refusing to wear anything with a tag or anything that feels “wrong”

• Refusing to brush their teeth or hair, or avoiding other activities that involve the senses, like haircuts

• Not enjoying cuddles or touch, especially when it’s unexpected

• Fear of swings, slides, or other activities that involve movement

When Sensory Hyposensitivity Looks Like Behavioral Problems

Kids who are hyposensitive react less strongly to sensory input than other people, meaning they often feel understimulated and crave more sensory input. These children often engage in “sensory seeking” behavior, meaning they deliberately try to get more of the sensory experiences they lack. Sensory seeking can look a lot like aggression or hyperactivity, and it may be hard to figure out the root cause of a child’s behavior at first glance. Here are a few examples of hyposensitivity that might resemble emotional symptoms:

• Speaking too loudly, or craving loud music or TV

• Not giving people enough personal space

• Seemingly in constant motion, with difficulty sitting still

• Lack of awareness of their own strength, which leads to being too rough with others

• Touching people (hugging, holding hands, sitting in laps) even when it isn’t socially appropriate

• Very drawn to rough-and-tumble play, like crashing into furniture and jumping off things

• Doesn’t appear sensitive to pain

• Frequent chewing on objects, thumb-sucking, or nail-biting

How to Get Help for a Child with Sensory Issues

If you suspect your child has issues with sensory processing, it’s worth bringing up with your child’s pediatrician and school. Often, schools can help children to get evaluated for sensory processing issues for free. Teachers might also have good insight into your child’s behavior at school, and your pediatrician may recommend skills to try at home before reaching out to another professional for help.

If you do decide to get professional help for sensory issues, an occupational therapist can help. Occupational therapists use an activity-based approach to help children better process sensory information and practice life skills. Kids often participate in occupational therapy in a “sensory gym”, and the process is a bit like play therapy in that it non-invasive and often fun for children. Through OT, kids learn exercises they can practice at home to get used to different sensory experiences.

Sometimes children with sensory difficulties benefit from counseling, as well. Many (but not all) kids with sensory processing difficulties also have anxiety, ADHD, or fall somewhere on the autism spectrum. You can learn more about my online therapy with children by contacting me here.

Common Preteen Behaviors, Explained

It can be tough to be a tween. Things that felt easy in elementary school can suddenly get complicated as middle school approaches. How do you make new friends when you can’t just run up to someone on the playground and say hi? How can you manage the increase in expectations and homework at school? How do you respond if your peers start trying things you feel uncomfortable with—do you speak up, or just play along?

The complexities of a preteen’s social life, along with the surge of hormones as puberty approaches, can lead to behaviors that are challenging for kids and their parents to deal with. I’ll be unpacking a few of those common preteen behaviors in this post, explaining why they happen, and sharing some tips on how to manage them.

Preteen Behavior #1: Super Focused On Body Image

What it looks like: Preteens who are struggling with body image issues may unfairly compare themselves to celebrities, social media influencers, or their peers. They may make self-deprecating comments about their appearance, body shape, or weight. They may appear self-conscious or have a hard time accepting compliments about their looks. For some kids, this can progress into restricting food or over-exercising, and the beginning of disordered eating.

Why it happens: Sadly, poor body image is extremely common in preteens and tweens: studies show that 40% of 9 and 10-year-old girls have already tried to lose weight, and by age 13, 53% of girls report they’re unhappy with their bodies. Many tweens are experiencing physical changes of puberty, and at the same moment that they may be feeling awkward about their own bodies, they’re introduced to a flood of unrealistic portrayals of teenage bodies on Instagram, TikTok, and TV.

Preteen kids are old enough take these images to heart and be affected by them, but not old enough yet to think critically about what they’re being shown. A preteen’s self-esteem often comes from external things, like clothes, belongings, or their looks. When you pair that focus on superficial items with movies, TV, and social media that emphasize the importance of being attractive, it’s understandable why poor body image becomes a struggle for so many young people.

How to help: Preteens, and girls in particular, need support to learn that their bodies aren’t decorative objects: they have important jobs to do beyond just looking attractive for other people. This becomes even more important as kids approach puberty, and dating and sexuality take center stage. Here are a few things to consider:

• Teach your child about how images are manipulated in the media to sell things or influence people.

• Limit time spent on social media or screens in favor of “real life” interactions with peers: this has been shown to improve self-esteem and body image.

• Get your child involved in activities that help her show her talents, learn new skills, and develop a sense of pride in herself not based on physical appearance.

• Praise your child for things other than looks.

• If you’re worried about changes in your child’s eating or exercise patterns, consult with their pediatrician.

Preteen Behavior #2: Sassy, Snarky, Sarcasm

What it looks like: Even a gentle comment or request can be met with an annoyed response from your preteen. It doesn’t take much anymore for them to snap at someone, and that “someone” is usually a parent. Sarcasm, insulting comments, eye rolling, and general disrespect are all common at this age.

Why it happens: On average, girls start puberty at age 11 and boys at age 12. The surge of hormones associated with puberty can also lead to mood swings, and make kids feel extra irritable. At the same time, kids’ brains are going through a growth spurt, too. The prefrontal cortex, which is responsible for things like impulse control, regulating emotions, and social skills, gets a complete overhaul during puberty to prepare teens for adulthood. However, while it’s under construction, preteens and teens may have more difficulty in those areas.

How to help: Although not all preteens struggle in this area, sassy comments are so common that they’re considered a normal part of preteen life. You may not be able to entirely avoid the snark, but you can find ways to make it more manageable—for both you and your kid. Here are a few tips to help tone down sarcasm:

• Avoid name-calling or using sarcasm with your child, so you can show them what respectful language looks like.

• If your preteen has blurted out something rude without thinking, offer a chance for a do-over.

• Ignore the small stuff: sometimes paying attention to these annoying behaviors make them worse.

• Help your child understand the brain changes that go along with puberty: she might be as distressed by her mood swings as you are!

Preteen Behavior #3: Craving More Privacy

What it looks like: Suddenly, everything you do embarrasses your kid! Your child might be asking to do more things independently, like walking into school alone without a big fuss at drop-off. You might also notice your child spending more time alone, or involved with friends, rather than spending time with the family. Your preteen may share less about her life with you, too, compared to when she was younger.

Why it happens: Children have both physical and psychological milestones they have to meet during adolescence. A major psychological milestone for preteens and teens is figuring out who they are as an individual, away from their parents. After all, in a few short years your preteen will be a young adult living alone for the first time, needing to make choices without you. This process of individuating can feel rocky and off-putting, but it’s totally normal and won’t last forever.

Preteens approaching puberty may also be dealing with body changes and feelings they don’t feel totally comfortable with. Puberty can be really awkward to talk about, especially with a mom or dad! Preteens may feel more comfortable talking to their peers about this stuff, but it’s important to make sure they’re getting the right education from you, rather than misinformation from friends or the internet.

How to help: Know that this isn’t going to last forever, and you won’t always be the World’s Most Embarrassing Person in your child’s eyes. As tough as this phase can be, it’s a sign your child is growing and maturing the way they need to in order to be a successful adult someday. Here are a few ways to support your child’s need for privacy while also staying connected:

• Get to know your child’s interests. Is there a manga he’s obsessed with, or a TV show she loves? Showing an interest in the things your preteen likes can keep conversation flowing, and help you continue to keep an eye on how he spends his time.

• Find one-on-one activities to do with your child. Preteens still need (and want) attention from parents, and sometimes this is easier away from friends.

• Make sure your child has age-appropriate education about sexuality and puberty.

• Remind your child that if you’re there if he ever needs you, and there’s no subject of conversation too bad or uncomfortable to be discussed.

Preteen Behavior #4: Following Trends

What it looks like: Your kid’s interests are shifting from “kid stuff” to “teen stuff.” They’re devoted followers of YouTube personalities and influencers, and are suddenly fluent in memes you’ve never even heard of. You might also notice your child seems more susceptible to peer pressure than she did before, and have more of a desire to fit in. Similarly, you may observe that your preteen’s taste in music, personal style, and friend groups change rapidly.

Why it happens: Trends and fads are another way that preteens start to practice individuation: the process of developing an identity separate from parents that helps turn children into adults. The rapid shifts in interests and style may seem random, but they serve an important purpose. Preteens are starting to try on different identities for size to see what fits them and what doesn’t. As children become more independent, friends take on an increasingly important role, and acceptance from friends and peers feels crucial. This can sometimes make preteens more easily swayed by peer pressure, especially if they don’t feel comfortable being assertive.

How to help: Honestly, there’s not a lot of helping to be done with this one! Provided that your preteen is staying safe, experimenting with fads, trends, and identities is a sign that their development is right on track. Here are a few ways you can support your preteen as they learn about themselves:

• Roll with the changes in clothing and style without making a big deal about them.

• Provide your child with age-appropriate education about topics that might lead them to feel pressure from peers, like vaping and adult internet content.

• Get to know your child’s friend group, and ask questions about what her friends are up to. This lets your child know that their friends are important to you, too, and helps you keep an eye out for unsafe situations.

• Praise your child and highlight her personal qualities that you enjoy and make you proud.

For More Info On Preteen Mental Health…

Preteens are one of my favorite groups to work with in therapy, so I write about them quite a bit these days! If you’ve got a tween at home, you might want to check out my posts on tweens and internet safety, preteen anxiety, and preteen girl drama.

Most preteens I meet could use some solid coping skills, which is why I created my online course, Worry Free Tweens. If your preteen child is struggling with anxiety, it may be worth a look. This self-help course includes instructional videos for both you and your child to deal with strong feelings and take control of worries.

If you’re looking for counseling for a preteen, I see this age group for online therapy in New York, North Carolina, and Florida. I offer individual therapy, as well as online game-based social groups for preteens. You can learn more about my practice here, or check out how to make an appointment.

Choosing a Child Therapist, Psychologist, or Psychiatrist

Once you have made the decision to get outside help for your child’s mental health, you’re faced with an array of choices to navigate. There are all sorts of other mental health professionals standing by to help your child manage anxiety, depression, or other big feelings. How can you sort through these different labels to find the professional who can best help your child? Today, I’ll be focusing on the differences between therapists, psychiatrists, and psychologists, and the different problems that they can help children and families to overcome. By the end of this post, I hope you’ll feel more confident choosing a therapist, psychiatrist, or psychologist for your child and family.

How Can I Tell If My Child Needs Therapy?

As a parent, it can be tough to decide when exactly it’s time to reach out for help for your child. Other people might reassure you that your child’s problems are just a phase, or you may worry that seeing a therapist might make your child feel singled-out or different. I wish there were a magic checklist I could give to parents to help them decide when to contact a therapist, but it’s really a personal decision.

I believe that most of us could use someone to talk to about our problems at some point in life. Even if a problem is just temporary or a phase, therapy can help make a really difficult time in life easier and less painful to deal with—for both kids and their parents.

Here are a few general things to consider that can help you decide if and when your child could benefit from therapy:

• Your child is dealing with a stressful situation in life, such as bullying, a health problem, divorce, a new sibling, or a move to a new city or school.

• Your child’s problems seem to be getting worse with age, instead of better.

• Tantrums last longer than you’d expect, or your child gets destructive or hits people when angry.

• The emotional problems started after a trauma in the family, such as a death, accident, or abuse.

• You notice big personality changes in your child: for example, your child spends most of the day in her room and has dropped out of school activities.

• Your child’s anxiety seems bigger and different than other kids his own age, and it is interfering with activities like school, homework, meals, or bedtime.

• It is harder for your child to make and keep friends.

• Your child’s grades are dropping, or she is frequently having trouble with her behavior or paying attention in class.

If any of these things are true for your child, and your gut is telling you that a therapist could help, it’s worth making a call or sending an email to a children’s therapist. Keep reading to see what kind of mental health professional might be the best fit for your child’s needs.

When to See a Child Therapist

“Therapist” is an umbrella term for several types of mental health professionals. Most often, people who refer to themselves as children’s therapists have a Master’s degree in a mental health field like social work, marriage and family therapy, or mental health counseling. These therapists have attended a specialized 2 or 3 year graduate school program after college, as well as some time (usually 2 years) being supervised by another professional before they are allowed to practice therapy on their own.

A therapist can help a child to work through difficult situations, learn coping skills to manage strong feelings like anxiety and depression, and help families to communicate and get along better. Most therapists work directly with clients in an office setting, and they are less likely to be researchers or teachers. Therapists usually have an approach that is more practical and focused on problem-solving.

While a therapist can diagnose you and help you treat emotional or mental health problems, they can’t prescribe medication. They may also not be the best bet if you need a diagnosis for an IEP or other school accommodations: often, schools prefer to hear from a psychologist for this.

Your child might benefit from seeing a therapist if:

• They need emotional support and someone to talk to about their feelings

• They’re struggling with anxiety, depression, anger, or big life changes

• You’d like help figuring out how to get along better with your child, and improve tough behavior

• You’d like to meet with someone on a regular basis, and you’re not looking for help with medication

When to See a Child Psychologist

A child psychologist has a doctoral degree, which means they have spent about 5-6 years studying different aspects of psychology. Most psychologists also have to work under another doctor’s supervision for about a year before working on their own. Psychologists learn about human behavior, how to help clients in therapy, and also conduct research as part of their training. Because their training is more broad, psychologists can work as researchers, professors, or teachers in addition to seeing clients in an office for therapy.

If a child needs emotional support, a listening ear, and help managing big feelings, a therapist or psychologist might be equally good choices. Both therapists and psychologists have similar training in how to provide this kind of counseling.

However, psychologists are able to conduct many tests that therapists can’t, in order to help diagnose mental health and learning problems such as ADHD, autism, and learning disabilities. This can make them extremely helpful when you need more information about the source of a child’s difficulties, or if your child needs accommodations to succeed at school. Psychologists are not medical doctors, which means that they can’t prescribe medication for your child.

Your child might benefit from seeing a psychologist if:

• You think your child might have a condition that affects his learning or neurology, such as ADHD, a learning disorder, or autism spectrum disorder.

• Your child needs support to manage emotional or behavior problems.

• You would like a more detailed diagnosis for your child, and a full picture of all the factors that might influence your child’s mental health.

• One of your goals for therapy is to determine what changes your school can make to better support your child.

When to See a Child Psychiatrist

Psychiatrists are mental health providers who have a medical degree. Like other medical doctors, they attend school for 7 or more years, where they are trained in biology and chemistry as well as psychology in order to understand how different medications affect the brain. After graduation, they participate in a residency, where they work under supervision for several more years before becoming fully licensed.

Psychiatrists are the only mental health professionals who can prescribe medication. In some situations, a nurse practitioner or family doctor may be able to write prescriptions for your child, but usually, this is a child psychiatrist’s job. Because so much training is required in order to safely prescribe medication, psychiatrists—and especially child psychiatrists—are in very high demand. Child psychiatrists can see patients to help them manage medication, and they can also sometimes work as researchers or professors.

These days, most child psychiatrists see children on an occasional basis, and only manage the medication portion of a child’s treatment. While some psychiatrists also provide therapy, this is less common. Usually, a child will need to see a different professional, like a therapist or psychologist, for weekly therapy in addition to their visits with a psychiatrist.

Your child might benefit from seeing a psychiatrist if:

• Your child has been in therapy for a while and is still struggling to manage their symptoms, and you wonder if medication could help them make more progress.

• You need someone to help you select the right medication and dosage for your child, and keep an eye out for side effects.

• Your child’s pediatrician, therapist, or another professional in your child’s life has suggested that medication might be helpful.

• You aren’t sure if medication is right for your child, and you’d like to talk about your options with someone knowledgeable.

Therapists, Psychologists, and Psychiatrists:The Bottom Line

Finding someone who you and your child like, trust, and feel comfortable with is the most important part of looking for a mental health worker. The relationship you create with your therapist, psychologist, or psychiatrist is more powerful than any degree or label, and it’s the biggest factor in whether or not therapy will be helpful to your child.

One you’ve decided what type or types of professional might be a good fit for your family, look for clinicians who specialize in the difficulties your child is going through. Someone who really knows your child’s struggles inside and out is more likely to understand what your child needs in order to feel better. Trust your gut, and find a professional who helps you and your child feel comfortable, safe, and free from judgment.

If you’re looking for next steps to take, you can read more about child counseling here, or reach out to me if you’re interested in scheduling an appointment with a therapist for child counseling. Not ready for therapy? My educational course, Worry Free Tweens, can help your child learn coping skills to manage anxiety at home.

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.

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.

Why is My Child More Clingy During Quarantine, And How Can I Help?

You deserve to be able to go to the bathroom in peace! If your Self-Isolation is feeling a little crowded due to clinging, there are ways to help your child relax and adjust.

Kids react in all sorts of ways to stress, from anxiety and fearfulness to anger and irritability. If you’re a parent who is self-quarantining with children, you may be starting to see this wide array of stress responses at home. I have noticed that, among the kids in my practice, the past week or so has been a turning point for many children. While the first week off from school might have felt fun and novel, like a snow day, the second week of school feels more like the beginning of a new normal. The serious change of pace is bringing up anxiety for many kids, and one form you may notice it coming out in is increased clinginess to parents. If you expected your self-isolation to include a little more alone time, read on to learn why kids get clingy when stressed and how we as caregivers can help them adjust.

Why Do Kids Get Clingy During Stressful Times?

Children see their parents as their “safe base.” Mom or Dad is the person who is always predictable, will always protect them, and knows how to keep them safe. Usually, the older kids get, the more comfortable they feel straying farther and farther from their safe person, knowing that their parent will always be there for support if needed. During times of stress, like quarantine, the distance from parents that feels safe may shrink. This is especially true if there has been a loss of predictability due to changes in routine: if a child is no longer able to predict what happens next each day, a parent’s continued presence may feel less predictable, too.

It is also common for children’s behavior to regress during a period of trauma or stress. While it’s normal and common for infants and toddlers to have separation anxiety, preschoolers and older children who have move past this stage might revert back to it if they’re feeling vulnerable. This is usually a temporary phase, and kids will shift back to more age-appropriate behavior once the stress has resolved, especially if they have support in managing their anxious feelings.

How Can I Tell If My Child’s Clinginess Is Normal?

Separation anxiety and clinginess are a normal (and stressful!) part of child development for babies and toddlers, especially from the age of seven months old to about two and a half. Around this age, kids are learning that even when they can’t see a person, they still exist in the world and can still be relied upon to come back again. This is a concept called object permanence.

While some clinging is normal, it’s also possible for toddlers and older children to develop separation anxiety that is outside of the norm and cause added distress for everyone. Here are a few signs that a child may need help overcoming their clinginess:

• Your child can’t tolerate even brief separations from you: for example, a trip to the bathroom or to go outside to get the mail.

• Your child’s anxiety when away from you is so intense that they can’t cope.

• The clinginess is getting more intense with time, rather than less.

• The anxiety and clinging are more than you’d expect from a child of this age, and it’s interfering with daily activities.

It’s possible to reassure kids that they are safe and loved and help them to gradually increase their independence. You deserve to be able to go to the bathroom in peace, especially during these stressful times!

Make Your Child’s Routine Predictable

If you think your child’s clinging might be a response to their routine being thrown off, adding some structure to the day can be extremely helpful. For young children, predictability equals safety. Being able to anticipate what will happen each day and when allows them to trust that they’ll be taken care of and transition between activities more smoothly. When that predictability goes away, it can make children feel out of control and unsafe.

You don’t need to create an elaborate, Montessori-inspired routine in order to increase your child’s sense of safety. Simply setting established times for meals and snacks, playtime, and bedtime can go a long way in helping a child feel like their life is more in control. For bonus points, you can create a visual schedule of your day so that your child can follow along and know what to expect next.

Build Some Individual Playtime Into Your Day

A predictable routine is extra effective if your child knows they can rely on getting some individual, face-to-face time with you every day. I know this can be a tall order when everyone is working from home and cooped up with family 24/7. However, I have found that even 10 or 15 minutes of individual playtime with a parent is a huge help for kids with behavioral problems. Children crave focused attention from parents, and when they’re feeling insecure they often seek it out in unhelpful ways, like clinging and tantrums.

If you’d like to try this approach at home, find a time each day when you know you’re consistently available to spend time with your child. Right after dinner, after bathtime, or before bed might be good opportunities to sneak in a few minutes of togetherness. Make sure your child knows this is part of the routine, and if they start to cling to you at other times of the day, remind them that you’ll have special time to spend with them later on.

Praise or Reward Your Child For Being Independent

Most of us feel moved to speak out when someone around us isn’t doing the right thing, and this is especially true with kids. Good behavior, however, often goes unrecognized. Adults may be used to not getting praised every time they do what they’re supposed to do, but for kids, not getting praise for good behavior can accidentally reinforce behavior issues.

Kids crave attention from parents because it makes them feel safe. If a parent’s eyes are on you, it means they can look after you if something dangerous happens. As a result, children tend to repeat behaviors that have gotten them attention—positive or negative—in the past. If we get into the habit of ignoring good behavior, it’s less likely to happen again!

If your child has been struggling to separate from you at home, make sure you enthusiastically call out the times they succeed. If your child is playing independently, praise them for it! Kids who are really struggling to separate from a parent for any period of time often benefit from a reward chart. The positive reinforcement of earning a “prize” can motivate children to do the hard, scary work of separating.

Address Your Child’s Fears About The Coronavirus

Even young children are likely picking up more information about the coronavirus pandemic than you might expect. Lots of children I speak to understand that the virus is more serious for adults than for kids, and this has led to worry for some children that their parents might fall ill and not be able to care for them. This can lead to more anxiety about being away from a parent, and more clinging.

If you think this might be the case for your child, make sure they understand all the ways you’re keeping them and the family safe. For example, maybe your family is practicing social distancing, washing hands, getting groceries delivered, or even eating extra healthy during this time. It might also be reassuring for children to hear that there are lots of other caring adults in their extended family or neighborhood who will be ready and willing to help if the child ever needs them.

A child getting clingy during quarantine can be an added stress on parents during an already challenging time. Adding some structure and predictable opportunities to play each day can help your child adjust to their new normal feeling safe and secure. If you find that your child is still struggling even after trying these ideas, online child counseling or online parenting support can help you get back on track. Hang in there, parents! This phase won’t last forever.

Emotion Identification Activities for Preschoolers: 4 Ways to Practice Naming Feelings

“Use your words.”

Have you ever asked a young child to do this? Me too! Preschoolers and toddlers are notorious for acting out their feelings through tantrums, whining, hitting, and countless other behaviors that can be stressful for everyone involved. One of the reasons why preschoolers often resort to physical displays of emotion is that it’s hard for them to put their feelings and needs into words. When you aren’t able to tell people around you that something makes you angry, it’s easy to understand why you might resort to showing your feelings instead! When children can say “I’m mad”, it' makes them less likely to show their anger in other ways, like hitting.

I wish I could say that helping your preschooler name feelings would magically resolve all tantrums and naughty behavior. That’s not the case. I do notice, though, that young children in my office are often familiar with feelings words, but have a hard time applying those words to themselves or other people. Learning to put names to feelings is an early goal for many of my younger clients, and it can help kids with disruptive behavior at home, too. Here are 4 activities to practice emotion identification skills with your preschooler or toddler.

Make it a Game

Lots of children’s games can be modified to incorporate education about feelings. In my office, I have a wooden toy fishing set (this one) with photos of different emotions taped to the bottom of each fish. Whenever someone catches a fish, they have to name the feeling and mimic the facial expression shown. Kids really have fun with this, and I’ve found that after repeating the game a few times, it’s easier for them to correctly name the feelings.

You can apply this idea to all sorts of games. Here’s a few others to consider:

• Memory game: print 2 pairs of each facial expression and lay the images face-down.

• Charades: take turns portraying different emotions with your child, and guess what feeling the other is trying to communicate.

• Simple games like Candy Land and Jenga that require drawing or collecting blocks or cards can be tweaked to include emotion identification. Add an emoji sticker to each block or card, or use color coding to prompt children to identify or talk about a specific feeling whenever a card of that color is drawn.

TV and Books as Learning Opportunities

Any children’s story has lots of opportunities to prompt kids to reflect about feelings. When watching TV or reading a book with your child, you can model how to think about other peoples’ emotions. This can make it easier for your child to identify feelings in themselves and others, and also helps to develop empathy. You might want to pause stories to ask questions like:

• How do you think the character feels when someone is not nice to them?

• What kind of face is this character making?

• What feeling is the character’s body showing?

You can also select books to read at home that specifically introduce the subject of naming emotions. One book that I particularly like is The Color Monster by Anna Llenas. It’s a pop-up book that is bright and engaging enough to hold the attention of preschool children. It helps kids understand emotions by linking each feeling to a different color.

Help Your Child Label Emotions

Young children aren’t always aware of how they are feeling in the moment: their feelings may be intense and sudden, but hard to express in words. You can help your child develop their ability to connect her emotions to the physical sensations she feels in her body by calling out feelings when you see them. It’s also useful to practice naming your own feelings for kids, and guessing about the feelings of family members. Comments like these can help children feel more understood, and make it easier to name feelings:

• “Wow, your baby sister smiled and laughed when you did that! It made her feel really happy.”

• “I can see that your hands are making fists and you are feeling angry right now.”

• “It must be scary to see those monsters on TV.”

When labeling feelings for young children, stick to simple emotions: happy, mad, sad, and scared are a great place to start. As children get older, they will be ready to talk about more nuanced and complex feelings like surprise, frustration, and jealousy.

Use Visual Aids

Before children master the vocabulary to name feelings, they can often point to how they’re feeling if shown some options in pictures. If you went to school in the 90s, you might remember that ubiquitous “How Are You Feeling Today?” poster that had a ton of cartoon faces showing complex feelings like “lovestruck” and “ecstatic.” A large number of choices and advanced vocabulary are not super helpful for preschoolers, but lots of options exist for simpler, less busy feelings charts.

You can find tons of examples of feelings charts online, or make your own at home by gluing feelings faces to a piece of paper, or tacking them on to a bulletin board. Consider adding the basic emotions (happy, sad, angry, scared) and perhaps a few others your child might be working on mastering, such as surprised, tired, nervous, or excited. Ask your child each day to point to how he is feeling, and follow up by naming the feeling he selected and talking about why he feels that way today.

I often use a strip of cartoon or emoji faces that looks like the pain scale used in doctor’s offices to help children rate how intense their anxiety or anger is at a given moment. This can help children to understand that emotions don’t always have to be the same strength, and that using coping skills can reduce the intensity of a feeling.

I hope this list has given you some inspiration to start talking about feelings with your preschooler in a more deliberate way. While a good emotional vocabulary can’t solve every preschool problem, it can definitely help. If you think your preschooler could use some more help expressing feelings in a healthy way, reach out to learn more about play therapy and child counseling.

Internet Safety for Preteens and Teens

This is my second post in a series on internet safety. For part one, click here.

It’s rare to see a tween or teenage kid today without a smartphone. They can be an essential part of everyday life, allowing kids to share music and messages with friends, as well as giving them a way to reach out to parents in an emergency. However, access to a smartphone comes with serious risks for teens and tweens: research shows that half of teens are cyber bullied and one third of teen girls are sexually harassed online. The addictive nature of cell phones and the dangers children are exposed to on the internet have led some experts to recommend waiting until 8th grade to give a child a phone. Regardless of when you choose to let your child have a phone, here are some steps you can take to help your tween or teenage child stay safe online.

How Can Smartphones Cause Emotional Problems?

Too much time in front of a smartphone screen can lead to problems with emotional health, relationships, and safety. While some risks, like the risk of predators online seeking out children, are well-known, other risks are more subtle and less easy to recognize. Here are some points to consider when thinking about smartphone and internet safety for your preteen or teen:

• Many apps and social media platforms are designed to be addictive, making it difficult for teens to stop using them once they’ve started.

• Screen time cuts down on the face-to-face interaction a teen has with other people. Over time, this can lead to reduced empathy and a harder time recognizing other peoples’ emotions.

• Influencers on social media may lead teens to be more materialistic and competitive.

• Teens whose phone use isn’t monitored are at risk for being bullied by peers, which can contribute to anxiety and depression. This kind of harassment is surprisingly common, with at least half of teens reporting they’ve experienced it.

How Can Smartphones Be Dangerous for Teens?

Totally unsupervised smart phone use can expose teens and preteens to adult situations that put them at risk of being manipulated or abused. While many teens will never cone into contact with a predator online, for those who do the affects can be very damaging. Here are a few statistics about teens and crime on the internet:

• According to the FBI, more than 50% of sexual exploitation victims are kids between the ages of 12 and 15.

• The majority of attempts to make inappropriate advances on children happen in chatrooms or on platforms where users can direct message each other.

• 1 in 5 teens in the U.S. say they’ve received an unwanted sexual comment or advance online.

Given these stats, what can parents do to parents do to protect preteen and teenage kids from harm online without smothering them? Keep reading for some tips on how to keep preteens and teens safe online while still allowing them some freedom.

Internet Safety for Preteens

Preteens (ages 11-13) are often eager to imitate older teenage kids, including by getting on to social media platforms like TikTok, Snapchat and Instagram. Many preteens chat with their friends by text or through apps, and online friends are increasingly common for this age group. This can put preteens at risk, because it’s impossible to know exactly who your’e speaking to online, and preteens are still very susceptible to being manipulated or scammed by adults.

You can support your preteen by keeping their computer in a public area of the house, rather than their bedroom, and by filtering and monitoring their activities using parental control software. Children this age don’t need to be on social media platforms intended for adults, even though they are tempting. Although kids this age no longer need an adult constantly supervising their activity online, preteen kids should not have any email or social media accounts that parents do not have passwords or access to. At this age, parents should also be reviewing safety skills with kids, including the danger of speaking to strangers online, giving out personal information, or agreeing to meet an unknown person in real life.

Internet Safety for Teens

Teenagers (14-18) are getting ready to live their lives independently, but they still haven’t developed all the problem-solving skills they’ll need to navigate the adult situations that can arise online. It’s normal for teenagers to push the envelope by seeking out edgy or inappropriate content online, but searches for adult content can increase the risk of a teen being exposed to danger. Teenagers lack the life experience and history that adults have, which can make it harder to make informed decisions when it comes to issues like cyberbullying, sexting, communicating with strangers, and making online friends.

Many experts recommend that a teen’s online activities should still have an age-appropriate level of filtering and monitoring from parental control software. Similarly, it’s still recommended that a teenager use a computer in a public area of the house, as opposed to a private bedroom where there is no supervision at all. Parents should educate teens on how to be safe and responsible online, and the risks involved with sending people bullying or explicit messages. Many teenagers develop online friendships, and they may be eager to meet their friends in real life. Parents need to stay in touch with their teen children about their social lives online, and it is up to parents to decide whether an (accompanied) meetup with a new friend seems safe or not. Finally, any purchases that a teen makes online should be reviewed and monitored by parents to prevent illegal activity, identity theft, or overspending.

For More Information

I frequently recommend Internet Safety 101 as a resource for parents who are deciding on age-appropriate internet rules for their kids. You can also read more about the Wait Until 8th campaign, which advocates waiting until 8th grade to give children a smartphone. If your child has been affected by online bullying or harassment, my resource pages on anxiety and trauma may give you ideas on how to support your child through the experience. If you’re in the Davidson, NC area and interested in counseling for your child, you can contact me here.

Internet Safety for Children: An Age-By-Age Guide

When I was three, my Dad brought home our first computer. It was an enormous, boxy thing that ran on MS-DOS and made screeching noises for about 5 minutes as it booted up. I was thrilled! Having access to games and limitless information was magical. Today, children are growing up in a world where they are inundated by internet access, and that access carries many more risks than it did when I was a kid in the ‘80s and ‘90s. I often hear that parents are questioning whether or not their child is old enough to go online, or how they can make sure their child is getting safe, age-appropriate experiences on the internet. Read on for tips on how to keep kids safe online, according to age.

Kids and Tech: The Pros and Cons

It can be tempting to try to keep kids off the internet entirely, to minimize the risk of them being exposed to dangerous or inappropriate situations. As scary as these risks can be at times, I think most children benefit from age-appropriate access to the internet. The internet has become most peoples’ primary source of information, and it can connect kids with tons of free resources to complete school assignments and generally learn about the world.

Lots of kids’ culture is now based online, and a child with no access to the internet is likely to feel left out of conversation with peers. I often hear from children that their desire to fit in with their classmates is their number one reason for wanting to go online or play a particular game. It’s important for children to feel like they’re a part of their peer group, and I think this is a valid reason to give kids exposure to at least some pop culture online.

On the other hand, there are very real dangers to unrestricted internet access. We’ve all heard horror stories about internet predators actively targeting children, sometimes with devastating results. Even if kids aren’t able to directly chat with anyone online, it’s very easy for children to come across violent material, hate speech, sexually inappropriate material, or even plain old fake news that can cause confusion. Often, children aren’t even seeking out this material but may stumble upon it anyway: for example, YouTube automatically queues videos to play, and has a bad track record of accidentally allowing disturbing videos into child-friendly feeds.

The internet is so pervasive now that it’s almost impossible to fully block a child’s access. Even if kids don’t have access at home, it is easy for them to sneak onto a friend’s smartphone at school, or get access in a public place. When internet access is completely forbidden, it can become “forbidden fruit” that is even more appealing to children. Providing structured, supervised access to the internet at a young age can help kids feel connected to their friends, while also teaching them safety skills that will help them navigate the internet more responsibly as they grow up.

Internet Safety for Preschoolers

Preschool-aged children have vivid imaginations, and it’s difficult for them to differentiate between what is real and what is pretend. Characters from TV, movies, and the internet can easily be frightening to young kids, and lead to nightmares and other anxiety-related problems. Preschoolers also don’t have the problem-solving skills yet to keep themselves safe online. For these reasons, it’s a good idea to put strict limits on screen time, and only allow preschoolers to use a computer if you’re sitting right beside them. Children at this age don’t need to be online, but Internet Safety 101 recommends that if you’d like to start teaching computer skills to your child, you can introduce them to age-appropriate educational games.

Internet Safety for Early Elementary Students

Kids in the early elementary school range (ages 5-7) are still working on separating what’s real from what’s pretend, and can still be prone to nightmares and anxiety from cartoon characters and other media. Most kids this age can already easily navigate a phone, type things into Google, and may even figure out how to make online purchases. For this reason, kids this age should always be supervised online. You might want to consider investing in parental control software to limit the places your child can go online, or limit them to a handful of websites you’ve already checked out and know are safe. Elementary school kids should never be able to chat with other people online, or give out any real information about themselves.

Internet Safety for Late Elementary Students

Older elementary school kids (ages 8-10) are maturing and crave more independence. Some kids this age may already have their own phone or tablet. Games like Minecraft and YouTube channels for kids are a huge part of popular culture for kids this age, but children this age are trusting and can still be easily tricked or scammed by adults online. Experts recommend keeping a family computer in a public area of the house, rather than in a child’s bedroom, and continuing to filter their internet access. Some kids may be ready to chat with friends on child-friendly platforms but shouldn’t be allowed to comment on sites with adults. Parents should still be supervising internet use, and can begin to teach kids about online safety.

More Resources for Kids and Parents

Internet Safety 101 is a fantastic resource for families that goes into more depth on how to help kids of all ages use technology in a safe way. I also recommend exploring options for parental control software to filter inappropriate websites, as well as apps like Bark that monitor kids’ computer and phone use for keywords that might signal a problem with bullying or other issues. If you’d like more guidance on this or other parenting concerns, and would like to hear about how counseling can help, reach out to me here.

Are Imaginary Friends Normal?

Your child is excitedly telling you about her new best friend. They seem to be inseparable! You’re hearing all kinds of stories about their adventures, and even a few of their arguments. There’s only one problem… your kid’s friend has superpowers, has a strange name, is invisible, and is totally made up.

It can be jarring for parents when a child has an imaginary friend, especially if the child has gotten deeply invested in the friendship. Parents may wonder if their child is lonely, or if the friend is a sign their child can’t tell the difference between reality and pretend. In this post, I’ll talk more about the interesting phenomenon of imaginary friends, and why it’s totally normal if your child has one.

How common are imaginary friends?

Research on imaginary friends has found that about 65% of kids will have an imaginary friend at some point during childhood. So, if your child has dreamed up a new companion for himself, he’s in good company. Firstborn and only children are more likely than other kids to create an invisible friend, possibly because they are spending more time playing independently.

At what age do imaginary friends start?

Invisible friends are an extension of a child’s normal make-believe play. Kids usually start this kind of play in the late toddler or early preschool years, so imaginary friends can develop as early as two-and-a-half or three years of age. Studies have shown that kids between the ages of 3 and 5 are the most likely age group to have an imaginary friend.

How long do imaginary friends last?

An imaginary friend can be present in a child’s live for anywhere from a few months to a few years. For most children, imaginary friends taper off by late elementary school—around age 8 or 9. For a few kids, though, invisible friends can last much longer, even into the teen years. As long as an older child’s imaginary friend isn’t getting in the way of his or her social life, this can still be a healthy expression of imagination.

Imaginary friends are a sign of creativity, not loneliness

Kids with invisible friends are no more likely to be lonely than any other child. Although an imaginary friend may be a convenient form of entertainment on days that a playmate can’t come over, they don’t necessarily mean a child is unhappy or doesn’t have real-life friends. In fact, the more researchers learn about imaginary friends, the more benefits they find to having one. Children who have imaginary friends are often highly creative, and can easily lose themselves in stories. This trait can last a lifetime, leading kids to artistic pursuits later in life.

Because an imaginary friend is a heightened form of make-believe, it can offer children the same benefits as imaginary play. Children with a pretend friend are practicing social skills through role play, which can strengthen their real-life socializing with peers. An imagined friend can also be a source of support for children during stressful times, helping them to make sense of the world around them.

Also, in my own experience, kids are almost always aware that their imaginary friend is not real. If you ask about the difference between real and pretend, the child can easily differentiate between the two, and might even share with you that their friend is make-believe. Imaginary friends are real for a child in the same way that a doll or stuffed animal are “real”: the emotions feel genuine to the child, but she knows the difference between play and reality.

How to support your child’s (totally normal) imaginary friend

If your child has an imaginary friend, congratulations! Here are a few suggestions for how to navigate issues that can come up with a make-believe companion:

• If your child is blaming bad behavior on an imaginary friend, you don’t have to play along! It’s fine to tell your child this is not something that their imaginary friend could have done and to offer consequences as usual.

• It’s okay to have discussions with your child about the difference between real life and pretend. Kids with vivid imaginations can be prone to fear and nightmares from scary movies and stories, so reinforcing that scary characters don’t exist in real life can be reassuring.

• Try not to tell your child how their imaginary friend behaves. Invisible friends are ghly personal—they’re an extension of the child’s own imagination—so this can feel confusing or upsetting for kids. Instead, ask them questions about what their friend is up to, and follow along with your child’s stories about their friend.

Can an invisible friend ever be a problem?

An imaginary friend is almost always a normal, healthy part of child development. Rarely, it can be a sign of a deeper problem that needs to be looked into. Sometimes, children who experience trauma develop imaginary friends as part of dissociation—a way of distancing or disconnecting from reality during a stressful time. If a child’s imaginary friend says cruel or hateful things to the child, or encourages them to behave badly, this could also be a cause for concern. Finally, if a child’s imaginary friend is getting in the way of socializing with real-life kids, especially at an older age, it is no longer helpful to the child.

The overwhelming majority of kids with invisible friends will never encounter these kinds of problems. However, if you notice these traits in your child, it’s a good idea to review them with your child’s pediatrician. They may benefit from counseling or other assistance to help get back on track.

If you’re located in the Lake Norman area of North Carolina and you’d like to learn more about how to support highly imaginative kids through counseling, feel free to reach out to me.

Anger Management: 3 Coping Skills for Kids

There’s a trick question that I love to ask kids who visit my office struggling with anger: Do you think anger is good or bad? If someone is looking for coping skills to help with anger management, it must be a bad thing to have, right?

I really believe that anger is a good thing for a person to have. It may not be comfortable to feel, but it serves an important purpose. Anger lets us know when something is unfair or unjust. It gives us the energy to persevere at something, even when the task is challenging. It can help us defend ourselves during an emergency. If someone never experienced anger, they’d probably be in trouble.

On the other hand, anger can come out in all kinds of unhelpful ways. When children express anger through destructive behavior or by hurting others, it can damage their relationships as well as their self-esteem. In this post, I’ll share 3 coping skills for anger management that children can use to channel their angry powers for good, instead of getting in trouble.

Anger Management Coping Skill #1: Non-Angry Physical Activity

It’s not a big surprise that exercise can help get angry feelings out. Sometimes, kids are encouraged to do something like punch a pillow or rip up paper when they’re mad. While this works just fine for some kids, it’s not the best option for others. Some kids with really intense anger find that these kinds of activities actually fuel their anger. Because punching and ripping are angry gestures, it can create a kind of feedback loop that keeps the anger going.

For these kids, physical activity that has nothing to do with anger is a better bet. Simple physical movement like jumping jacks, running in place, or hopping onto a bike can all be good options for burning off anger. It can also be helpful to encourage kids to be mindful while they are moving: if a child is running in place while thinking about how angry she is at her sister, it’s less likely to help. If the child really focuses on the task of running, her anger might burn off more quickly.

Anger management Coping Skill #2: Journaling

Writing down feelings instead of saying them aloud can be a great option for kids who tend to blurt things when angry that they’ll regret later. Writing these angry thoughts down helps “get them out” without necessarily having to share them with someone else. I think this type of journaling is best done by hand, because handwriting helps connect the person to what they are writing and slows down a person’s thought process.

Once a child has cooled off, he can reread his thoughts and decide if there’s anything in them worth bringing up in a conversation. Recording angry thoughts can also be a great way to spot the exaggerations and distorted thinking that leads to intense anger in the first place. Children can use journaling both to cope with angry feelings, and to learn more about the way the brain can play tricks on us when we’re angry.

Anger Management Coping Skill #3: Positive Self-Talk

A short, simple phrase can put a more realistic spin on situations that trigger anger. Often, when a child is angry, her thoughts exaggerate how bad a situation really is. Kids may find themselves thinking things like “I never get what I want”, “I hate this”, or “This is no fair.” Thoughts like this are usually too negative to be entirely true, and they can intensify anger.

Kids can come up with a statement to say to themselves to help them cope with these angry thoughts. Something like “I can handle this”, “It’s not a big deal”, or “This isn’t worth getting in trouble for” can help a child to self-soothe, and remind her that she doesn’t have to believe everything she thinks.

This is a technique that is borrowed (and slightly tweaked) from the book What to Do When Your Temper Flares, a self-help book to help children deal with anger. I love this book, and if this technique works well for your child, it’s worth checking out.

More Coping Skills Help for Anger Management

If you are looking for more anger management coping skills for kids, you may want to also check out my previous blog post on coping skills for anxiety. Most coping skills are versatile, and can help kids manage pretty much any strong emotion.

Looking for more tools for your child’s toolbox? My online coping skills self-help courses help kids learn strategies they can use to self-soothe when anger or strong feelings strike. These skills grow with your child, equipping them with skills to handle difficult situations both now and in the future.

If you’re looking for help for a child with anger in Davidson, NC, feel free to reach out to me here. I love meeting with kids in my counseling office, and also see kids throughout North Carolina, New York, and Florida for online therapy.

How Do I Teach My Toddler Gratitude?

4 Tips from Cognitive Behavioral Therapy to Help Your Toddler Learn About Gratitude

This is the second in a 2-part series on gratitude. For Part 1, click here.

Toddlers aren’t exactly known for their gratitude. 2-, 3-, and 4-year-olds are naturally egocentric: they are really focused on their own feelings, and aren’t aware that other people might have a different point of view. When we describe an adult as being egocentric, it’s usually an insult, but for toddlers and preschoolers, egocentrism is a totally normal and healthy part of child development. Not being able to take another person’s perspective makes it hard for toddlers to really appreciate what others do for them. However, there are things that parents can do to help plant the seeds of gratitude for very young children. In this post, I’ll share 4 tips inspired by cognitive behavioral therapy to teach your toddler or preschooler about manners and gratitude.

Be a Good Role Model

Little kids learn by observing the grown-ups around them. Whenever we’re playing or interacting with a toddler or preschooler, they’re watching us intently to see what we do and how we react to things. If you have a toddler or preschooler in your house, you know that they love to mimic what their mom or dad does. Toddlers love their parents, and want to be just like them! You can use this power for good by making sure that you consistently model the grateful, polite behavior you’d like to see in your toddler or preschool child.

Make sure you’re demonstrating how to use polite words like “please” and “thank you” to encourage your child to do the same. When you ask your child to do something, phrasing it in a polite way makes it more likely your child will listen, and also models for them how to ask you questions in the future. During play, show your child how to treat toys gently and respectfully, which includes picking up at the end of playtime.

You can also teach your toddler gratitude by making sure you voice your own appreciation out loud, letting your child know the things you are grateful for. If you’ve received a gift, describe what makes it so thoughtful. If your child has done something kind, be enthusiastic in showing your appreciation. Pointing out everyday moments that you feel grateful gives your children a model for how to do it, too.

Catch Your Toddler Being Good to Encourage Gratitude

In cognitive behavioral therapy, we sometimes talk about “catching a child being good.” Nobody would ever compliment an adult for sitting patiently, saying “please”, or using good manners: good behavior is expected as par for the course with adults. It’s easy to forget that young children are still figuring out what good behavior is, and by taking their good behavior for granted, we aren’t helping them learn what kind of behavior we want to see.

Whenever you see your toddler or preschooler saying “thank you”, treating toys respectfully, or showing appreciation, make sure to praise them! Calling out good behavior, rather than simply reprimanding bad behavior, helps kids learn what we want them to do, as opposed to simply what we don’t want. Praise makes kids feel good about themselves and more connected to the adults around them, which means they’ll be more likely to repeat the behavior that was just praised. Catching toddlers being good not only teaches them about good behavior, it makes it more likely that the good behavior will occur again.

Encourage Your Child to “Help”

Since we know toddlers and preschoolers love to mimic their parents, recruiting young children to help out with household chores can also help lay the groundwork for developing gratitude. Young children are often eager to “help” their parents with chores like sweeping, cooking, and feeding pets. Even though their efforts to help may make the task take a little longer, it’s a good idea to let them try. Encouraging young children to pitch in with a task gives them a sense of responsibility. Children learn to understand the time and effort it takes to do everyday tasks like prepare a meal, which eventually leads to more appreciation and gratitude.

Read Books to Teach Toddlers About Gratitude

Reading books together can be a great way to introduce young children to big ideas like gratitude. A good picture book helps get a child’s gears turning about the subject in a fun, engaging way, without feeling too lecture-y. Learning about behavior through stories about another child or character gives the child some distance from the subject, and makes it less threatening to talk about. Here are a few books on gratitude for toddlers and preschoolers that get great reviews on Amazon:

• Bear Says Thanks is a picture book for children ages 3-8. The illustrations have a Thanksgiving tone to them, but there are no direct references to the holiday, which makes this book useful for reading year-round.

• The Thankful Book is part of a very popular book series for preschoolers by author Todd Parr. This simple and brightly colored book gives great examples of simple things children might be thankful for in their daily lives.

• Thank You and Good Night introduces children to the idea of practicing gratitude at the end of the day, through the eyes of a group of animals having a sleepover.

I hope you’ve found some helpful tips here on how to teach your toddler about gratitude. If you’d like to learn more about how cognitive behavioral therapy can help young children with behavior problems, you’re always welcome to reach out to me here.

What to Do When Your Child Won't Eat Anything

Help for Picky Eaters

It can be frustrating for both parents and kids when a child refuses to eat anything you cook. Lots of kids go through a picky eating phase at some time in their lives. You can probably think of a child in your life who can’t stand when his foods touch on the plate, or who refuses to eat anything green, or who insists that the crusts be cut off his sandwich…but tomorrow might insist that the now-cut-off crust be placed back ON the sandwich…

The majority of children pass through this stage easily and grow up to enjoy a wide variety of foods. For some kids, though, picky eating is more than just a phase and can develop into a bigger problem. These children may have become so selective about food that they are left with a very short list of foods they can tolerate, or they may be extremely reluctant to eat more than a few bites at mealtimes.

Food issues can be particularly stressful for both kids and parents. There’s no avoiding mealtimes, so parents of picky eaters have to go through this struggle at least three times a day. For many families, food is love. When a child rejects food, it can be frustrating and even hurtful to the parent who is working so hard to feed the child. Many parents also fear that their child isn’t getting the nutrition she needs to grow. Parents may find themselves resorting to bribing their child, cooking special meals the child is likely to eat, or getting into power struggles with their child over food.

Does this sound like your family? If so, don’t despair! When kids are having these kinds of problems with eating, therapy can be an effective way to break the power struggle cycle and make mealtimes a more enjoyable experience for everyone.

Is picky eating ever a serious problem?

Plenty of picky eaters will grow out of it on their own without additional help. Their picky eating may be a minor annoyance, but it’s not likely to interfere with their relationships or activities. Other children may need some extra help to expand the repertoire of foods they can eat. Here are some indicators that children’s picky eating may be causing bigger problems that need extra assistance:

• The child frequently tantrums at mealtimes, or cries when an unfamiliar or disliked food appears at the table.

• The child has a very small list of foods they like to eat…and the list may be getting smaller.

• Parents find themselves pleading, bargaining, or getting upset at mealtimes when the child won’t eat anything.

• Parents are making extra accommodations for the child, like cooking special meals or allowing TV at the dinner table.

What causes picky eating in children?

Figuring out the source of a child’s difficulties with food is an important first step. For some kids, sensory sensitivities are an underlying cause of picky eating. These kids may find certain smells, flavors, tastes or temperatures of foods off-putting or overwhelming, even when the rest of the family has no problem with the meal. If your picky eater only eats foods with a certain texture, avoids very mushy or crunchy foods, or has difficulty with foods touching or mixing, they might fit in this category.

For other children, avoiding eating can be a way of gaining control. Because nutrition is so important for growing children, parents and kids often get locked in a power struggle over food. Sometimes, the more a parent insists that a child eat, the more the child refuses, which worsens the cycle. These children may be feeling a bit “out of control” in other aspects of their lives, and mealtimes may be one of the few places that a child can call the shots.

How can I help my child who won’t eat anything?

Helping children develop healthy eating habits takes time, but it can be done… if you are very patient. Studies on children’s eating habits suggest that kids need to be exposed to a new food up to 15-20 times before they accept it as a regular part of their diet. Continuing to offer a variety of foods, even if a child seems disinterested in them, can be helpful in the long run. Here are a few other tips to try:

Model healthy eating for your child: Children decide how to behave by observing the grownups in their lives. Show your child that you enjoy lots of different foods (including fruits and veggies), and let them see you eating when you are hungry and stopping when you are full. Seeing that you are enjoying a “gross” food might make a child more curious to try it himself!

Schedule (screen-free) family mealtimes: Whenever possible, try to eat dinner as a family without distraction from phones or TV. Eating together encourages healthy eating habits and helps the family stay connected. It can also take some of the pressure off a picky eater who gets stressed at mealtimes, since the focus won’t be entirely on the child and her eating. While screen time might distract kids from fussing about their food in the short term, it can worsen eating habits over time. Screen-free meals encourage mindful eating and help kids pay attention to their own hunger and fullness cues.

Encourage sensory play: Kids who avoid certain textures in food sometimes benefit from having more opportunities for messy play. Slime, play-doh, orbeez, and other sensory-rich activities can help kids acclimate to the types of textures they might be avoiding, so that they are not so overwhelmed the next time a mushy or sticky food arrives at the dinner table.

More help for kids who won’t eat anything

If you’ve tried these tips at home without much success and you live in the Charlotte, North Carolina area, please reach out to me to learn how I might be able to help! Play therapy can help children reduce sensory sensitivities, work through their feelings, and expand the variety of foods in their diet. Parents can also learn ways to make mealtime a less stressful experience, and encourage lifelong healthy eating habits.

Back-to-School Anxiety: 3 Ways to Handle Monday Morning Jitters

Depending on where you live, school has been back in session now for a month or two. Maybe it already seems like ages ago that you snapped that cute photo of your child holding a sign announcing their new grade and teacher’s name.

By this point in the year, many children are already fully immersed in standardized testing practice, project deadlines, extracurricular activities, and other school happenings that can be both exciting and stressful. Ok…maybe more stressful, and less exciting. Possibly very stressful. Today, let’s talk about what you can do when Monday mornings have become a source of dread. Here are 3 ways to help your child manage school anxiety!

Anxiety About Going to School…In October?

I see many kids begin to struggle with school anxiety in late fall. By this point in the year, the novelty of being back at school has worn off, and the daily routine has fully set in. Big class projects and tests are in full swing. Even kids who were a little excited to return to school in September may be dreading it by October or November.

While it’s normal for most children to feel hesitant to get on the school bus occasionally, or to have a tough time waking up in the morning, some children’s worries about going back to school become so overwhelming that it interferes with their attendance in class. If you’re wondering whether your child’s anxiety about school has reached a level where therapy might be helpful, here are a few questions to consider:

• How often is the anxiety happening? For example, is it just on Monday mornings following a weekend away, or is it becoming an everyday occurrence?

• Is your child complaining of physical symptoms, like headaches, stomach aches, or vomiting, that only seem to occur on school days?

• Is your child’s anxiety response getting stronger or weaker as the school year progresses?

• Have your child’s worries escalated to the point that tantrums or intense fearfulness are keeping him from being able to attend class?

If you found yourself answering “yes” to a couple of these questions, you are not alone! School is an extremely important, formative part of a child’s life, but the day-to-day experience of attending school can be stressful even for bright, resilient children. The increased focus on standardized testing and the added peer pressure of social media don’t make the experience any easier. Keep reading for a few tips on how to handle school anxiety.

School Anxiety Tip #1: Teach Relaxation Skills for Back-to-School Stress

Simple techniques that use the breath or senses to soothe anxiety can be used almost anywhere, and are easy enough that even young children can master them. Teaching your child to take slow, deep belly breaths (called diaphragmatic breathing) can be helpful, as well as helping your child to practice tensing and relaxing the muscles of the body, starting at the head and moving down toward the feet (called progressive muscle relaxation). It’s best to practice these skills repeatedly while the child is feeling calm. That way, the next time she is feeling anxious or panicked, she knows just what to do.

If these relaxation techniques work well for your child and you’d like to learn more of them, check out my coping skills courses for kids. These educational courses give kids tools they can use right away to manage big feelings like anxiety, anger, and stress. They also include a guide for parents, so you can help your child make the most of their coping skills at home.

School Anxiety Tip #2: Read Books that Tackle School-Related Worries

In therapy-speak, we refer to using books in the counseling process as bibliotherapy. Reading a book with your child can be a great way to gently open up a conversation about a topic. Children may feel less nervous or threatened talking about their school worries when the conversation is focused on a fictional character, rather than themselves. A good story can add some much-needed humor to a scary situation, while also helping children feel less alone with their fears.

Two of my favorite books about school for young children are School’s First Day of School by Adam Rex, which tells the story of a first day in Kindergarten from the perspective of a school building, and The Pigeon HAS to Go to School, from Mo Willem’s popular series for kids. Neither one feels overly “therapy-y”, but the plotlines are reassuring and empowering. They’re interesting enough stories that kids stay emotionally invested throughout.

School Anxiety Tip #3: Keep Class Attendance Consistent (Even When It’s Hard)

This is the hardest advice to follow, but it might be the most important! When a child is in extreme distress about attending school, it is very tempting to diffuse the situation by allowing her to stay home and relax. Taking an occasional mental health day is not likely to cause problems for most children. However, for kids with severe school anxiety, taking days off is virtually guaranteed to make anxiety worse over time.

By avoiding the anxiety-provoking situation, we are alleviating a child’s fears for the moment, but also sending a message to the child’s anxiety response that school is worth being afraid of. The next day, the child may find it is even more difficult to get back to class. Helping children face their fears is the best way to combat anxiety about going back to school.

Middle School Is Tough, But Your Child Is Tougher. Therapy Can Help With Back-to-School Anxiety!

If you’d like more information on how to support a child struggling with back-to-school anxiety, feel free to reach out to me. Counseling that utilizes play therapy and cognitive-behavioral techniques can be a big help in reducing anxiety about school for children who are really struggling. You can reach me directly by filling out this form to inquire about how therapy might be helpful for your child. I can help families living in North Carolina, New York, or Florida through online therapy.

Not living in one of those states, or not ready for counseling? For some kids, learning effective and easy-to-use coping skills can be enough to break the cycle of back-to-school anxiety. My educational course, Worry Free Tweens, is designed especially to help middle school or late elementary-aged kids learn how to overcome anxiety. Kids walk away from the course with a better understanding of how anxiety works, and how they can control their worries—both now and as they grow up.

Good luck, and may this school year be your best one yet!

Help! My Child Won’t Sleep Through the Night!

It’s 9pm. The homework is done, the dishes are washed, and your kiddo is bathed and tucked into bed. Stories have been read! Cuddles have been given! You’ve made it to the end of the day! Time for a celebratory Netflix episode, or a chapter in that book you keep telling yourself you’re going to finish…and then you hear the pitter patter of little feet in the hallway, and your door creaks open.

Does this sound familiar to you? If so, you are not alone! In this post, I’ll be sharing suggestions to help a child who can’t sleep through the night.

When Your Child Can’t Sleep Alone, Bedtime Becomes a Problem

Insomnia is one of the most common concerns I hear about in my child therapy office. This can mean a child is having trouble going to bed, falling asleep, or staying asleep. Sometimes, a child is able to fall asleep with no problem—as long as a parent stays in the room all night long.

Insomnia is a frequent complaint for both kids and adults, but children’s sleep problems can be especially tough on a family. When a child isn’t sleeping well, it weighs on everybody in the household. Not only is the child not getting enough sleep to function, but parents and siblings may also be getting their rest interrupted by the child’s frequent waking,. This maked things harder for everyone the following morning.

The Insomnia Vicious Cycle

Many of us will have trouble sleeping at some point in life, especially when we’re stressed. Sometimes, a child’s sleepless nights resolve by themselves once the stress is gone. For other children, sleep problems are not so easily solved. The insomnia can go on for weeks, months, or longer.

Sleep is important to a child’s emotional well-being, children who have trouble sleeping for prolonged periods often enter a vicious cycle. The lack of sleep leads to increased anxiety and difficulty concentrating, which in turn makes it even harder to sleep the following night. With help from parents, and sometimes with extra support from a child counselor, children and families can break this cycle, and help everyone to get a better night’s sleep.

Sleeping Through The Night Helps Children’s Physical and Mental Growth

Good quality sleep is especially important children who are still growing. It has a direct impact on their ability to grow physically, mentally and emotionally. During sleep, kids release growth hormones that they need to develop and mature. Sleep is also critical for learning. It helps children to retain and store information they’ve learned, and makes them more able to focus and learn at school the next day.

Sleep is really important for kids’ emotional health, too. Sleep problems can contribute to anxiety, depression, and ADHD. In fact, poor sleep can even trigger emotional problems, and make it more difficult for people to cope. Studies have shown that disturbed sleep can lead to symptoms of depression, and that depressed people who aren’t sleeping well are less likely to respond to treatment than those who are getting a good night’s rest.

How Much Sleep Do Kids Need Each Night?

More than you might think! No two kids are exactly alike, and different kids may be able to get by with different amounts of sleep. The National Sleep Foundation has set guidelines to help make sure your child’s sleep time is in the right ballpark.

For toddlers between ages 1 and 2, the Foundation recommends 11-14 hours of sleep per day, which usually includes a daytime nap. Preschoolers (age 3 to 5) generally need 10-13 hours a day, and may still nap.

By elementary and middle school (age 6 to 13), it is recommended that children sleep between 9 and 11 hours a night. You know your child’s rhythms best. Helping him to establish a healthy sleep schedule within these guidelines will ensure that he’s getting the rest he needs to grow, both physically and emotionally.

What Causes Childhood Insomnia and Sleep Problems?

Many children have difficulty falling or staying asleep at some time in their lives—this is a really typical problem! Here are a few common reasons children can’t (or won’t) sleep through the night:

Anxiety: Many children appear nervous or downright fearful as bedtime approaches. Separation anxiety, a fear of being away from parents or loved ones, is common in younger children. It can sometimes manifest as reluctance to go to bed, a fear of being alone, or a fear that something bad will happen if the child is out of sight of the parent.

Other forms of anxiety, like generalized anxiety and OCD, can also make it harder for children to sleep. If a child seems nervous or afraid at bedtime, is bothered by lots of worries at night, or needs to complete a long or elaborate bedtime ritual in order to feel comfortable going to bed, anxiety might the source of their difficulties.

Media: Kids often have vivid imaginations, which is a great strength. Sometimes, though, a very active imagination can make children more prone to sleep problems. For children with rich fantasy lives, the lines between reality and pretend are easily blurred. These kids may be more sensitive to the effects of scary movies, violent video games, and stories shared by children at school. Their fears of scary characters may last long after the movie ends, and often intensify at bedtime.

Behavioral Causes: Sometimes, without meaning to, children and parents fall into a nightly routine that has to be repeated in order for the child to feel ready to sleep. For example, a child whose mother lies in bed each night until she falls asleep may start to link mom’s presence in bed to the idea of sleep, and soon this becomes a requirement for bedtime every night. Once the child has unconsciously connected this behavior with falling asleep, she won’t be able to drift off until it’s been done.

Physical Causes: Just like adults, some kids are naturally night owls while others are morning people, and this can impact sleep habits. According to this article from Today’s Parent, a small minority of children with sleep problems may have an underlying medical reason, such as sleep apnea or restless leg syndrome. If sleep problems persist for a long time, or you notice any physical symptoms such as difficulty breathing, it’s a good idea to schedule a checkup with your pediatrician to rule these conditions out.

Trauma: Rarely, a traumatic event can be the cause of disturbed sleep. Children who have experienced a trauma often become fearful at bedtime, have trouble falling asleep, and are bothered by night terrors or other bad dreams that may or may not have anything to do with what they’ve experienced. If the sleep problems are accompanied by other symptoms, such as bedwetting, tantrums, or anxiety, trauma should be ruled out as a possible cause. You can read more about the impact of trauma on children here.

How Can I Help My Child Sleep Better at Night?

Sleep problems take time to develop, and so they also take some time and patience to resolve. Anxious children benefit from a bedtime routine that is consistent, predictable, and includes opportunities to soothe and relax before bed. Creating a visual chart of the bedtime routine can also be a good way to help kids shift gears and get ready for sleep.

For imaginative children with fears about monsters or other “bad guys”, it can be a big help to talk about the difference between “real” and “pretend” and offer reassurance that scary events from TV will not happen in real life. Some children are also very motivated by reward charts. Children may “buy in” to the idea of sleeping alone more readily if they are able to set a goal for themselves to sleep independently for a certain number of nights in order to earn a prize.

If you have tried these tips and your child still can’t unwind at bedtime, she may need more effective coping skills. My coping skills course for kids helps kids and tweens learn how to relax their body, manage panic attacks, and learn how to deal with unrealistic worries that aren’t likely to ever happen (like that monster showing up in the night).

Begin Therapy for Kids With Insomnia in Davidson, North Carolina

Sleep problems can be exhausting for all involved, but patience and persistence can often turn even the most nocturnal of night owls into a more peaceful sleeper. However, some kids need more than a few coping skills and a consistent routine to resolve long-standing sleep issues. If you’ve been trying tips like the ones in this post for a while with no luck, counseling can help.

Therapy can help your child work through any underlying worries, and increase her sense of felt safety so she can sleep more soundly. I use cognitive behavioral therapy to help kids with bedtime anxiety at my Davidson, North Carolina child therapy office. If you aren’t local, I see kids online throughout North Carolina, as well as in New York and Florida. I also have an educational class called Worry Free Tweens, which can teach coping skills to kids regardless of where you live.

Interested in therapy? You can contact me to request an appointment or get more information.