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.

Understanding Accommodation in Child Anxiety: A Guide for Parents

Is all the comforting you’re doing backfiring? Learn about the role accommodation plays in a child’s anxiety.

As a parent, you’d probably do anything to help your child when they’re in distress. It’s kind of our main job as parents: we’re here to provide comfort, offer reassurance, and keep our kids safe. One of the trickiest things about child anxiety is that well-intentioned actions aimed at providing comfort and reassurance often backfire, making anxiety worse in the long run.

If your child has anxiety, you may have already sensed this: the more reassurance you give your child, the more reassurance they seem to need. The more you avoid feared situations, the more their anxiety seems to grow. You’ve unintentionally become the narrator of If You Give a Mouse a Cookie and your child’s anxiety is the insatiably hungry creature who somehow always craves more.

Anxiety therapists have a term for this phenomenon: accommodation. In this guide, we'll explore what accommodation entails, why it's important to address in therapy, and practical strategies for navigating accommodation as parents.

What is Accommodation in Anxiety?

In anxiety therapy, an accommodation refers to any way that you or your family alters your behavior in order to avoid triggering anxiety in your child. This might mean offering extra reassurance, changing your routines, or accompanying your child to activities they used to do alone.

If you’re like me, you are probably used to hearing the word “accomodation” used in a more positive way. Academic accommodations can be a huge help to kids in schools: a child with dyslexia might benefit from getting extra time to complete tests, for example. ADA accommodations make sure that people with disabilities are given equal opportunities in the workplace. These types of accommodations are objectively great!

In the therapy world, unfortunately, accommodation is not so great. While it might provide temporary relief for your child, it tends to make anxiety worse over time. Kids don’t get a chance to learn how to cope with their anxiety, which reinforces their belief that it’s something they can’t manage or control.

Basically, when we accommodate a child’s anxiety, we’re really just enabling the anxiety.

If you’re reading this and kicking yourself for being an anxiety enabler, please don’t. It’s human nature to want to keep someone else from feeling bad. The truth is, we all accommodate our kids sometimes. It’s usually harmless, but for kids with anxiety disorders, it can lead to larger issues.

What are the Risks of Accommodating a Child’s Anxiety?

Accommodation risks making anxiety worse over time, leading to more stress for the whole family.

When you accommodate a child’s anxiety, you risk entering a vicious cycle. By giving in to anxiety’s demands, your child misses out on a chance to test whether or not their worries are accurate. Instead, they avoid the situation entirely, which sends the message that maybe this scary thing really is worth staying away from.

This means your child is likely to be even more anxious the next time this scary situation comes up. They’ll need even more accommodation in order to cope. Before you know it, you’re bending over backwards to try to avoid anxious feelings.

An occasional accommodation here and there is a part of life. But repeated accommodation can come with the following risks for anxious kids:

• Worsening anxiety

• Lack of effective coping skills

• Increased reliance on parents to manage anxiety

• Disruption to daily routines due to avoidance of triggers

• Poor sense of self-efficacy (ability to solve problems independently)

• Increased family stress

These risks are much greater if your child suffers from an anxiety disorder, like social anxiety, generalized anxiety, or OCD. These kids’ super-sensitive brains are always looking out for danger, and they’re much more likely to fall into the trap of avoiding scary things.

Examples of Parental Accommodation

Excessive texting is a common and subtle example of accommodation.

So we know accommodation is not great. How can we tell if we’re doing it? While some accommodations are obvious, others are sneaky and subtle. It can be easy to fall into the routine of accommodating anxiety in small ways without even noticing you’re doing it.

Here are some common examples of anxiety accommodation, based on my experience as a children’s therapist:

• Allowing a child to skip activities that could trigger separation anxiety, such as field trips.

• Driving a child to school to avoid having to ride on the bus or carpool with a friend.

• Responding to text messages from the child all day (or all night!) to offer reassurance.

• Making sure to always tell you’re child where you are going or what you are doing.

• Repeatedly answering anxiety-driven questions, such as “Do you think I’m going to get sick?”

• Accompanying a child to activities that peers would attend alone.

• Helping a child stay away from triggers, such as crossing the street to avoid a barking dog.

• Participating in overly long or rigid bedtime routines.

• Changing family routines to help a child remain calm.

• Sleeping in a child’s room to avoid bedtime fears.

• Keeping special items on hand, such as Purell for a child afraid of germs or a barf bag for a child afraid of vomiting.

If any of these examples of accommodation seem familiar to you, don’t panic! As bothersome as accommodation can be, it’s also incredibly common.

Pretty much every family with an anxious child has some amount of accommodation going on. Therapy can help you scale it back, and empower your child to tackle their fears more directly.

Strategies to Reduce Anxiety Accommodation

Like gradually stepping in to a pool, reducing accommodation is a slow and steady process.

Even if the accommodating is making everyone fairly miserable, you don’t want to needlessly torture your kid. Like it or not, they’re relying on these defense mechanisms to cope. Removing them all at once would be hard on you and even harder on them. Instead, we can gradually reduce our accommodation, which gives kids a chance to adjust, face their fears, and develop healthier coping skills to manage anxiety.

If you want to start gradually reducing anxiety accommodation at home, you can try:

• Setting a limit on how many times you’ll reassure your child each day.

• Answering anxiety-driven questions only once.

• Limiting texting and communication during school hours or after bedtime.

• Encouraging your child to try new and challenging things rather than offering a way out.

• Making a plan with your child to go to scary places or try scary activities on purpose.

We want anxious kids to learn that they can do things even when they feel scared. Anxiety isn’t something to be avoided: it’s a part of life! Most of the time, their anxiety is just a false alarm, and not an indicator that a situation is really dangerous.

When kids develop this mindset, they can start facing their fears head-on, anxious or not. And, weirdly, the more this happens, the less anxious kids tend to feel. They’ve broken the anxiety-avoidance cycle and taught their brains there’s nothing to be afraid of.

Exposure Therapy for Anxious Kids and Families

Seems simple enough, right? Just…slowly stop doing the stuff you’re doing. But if you’re already way far down the accommodation rabbithole, this is easier said than done. It can feel nearly impossible to course correct if you’ve been answering a million texts a day or sleeping on the floor of your child’s bedroom for six months.

If you find you’re doing tons of accommodating, or your child’s anxiety symptoms are severe, therapy can help. A therapist can help you find creative ways to support your child in gradually facing their fears—without you doing the work for them. If things don’t go as planned, your therapist will help you problem-solve and keep you on track. Their job is to keep everyone feeling challenged, but not burned out.

This kind of therapy is called exposure therapy. In OCD treatment, you’ll also hear it called Exposure and Response Prevention. The goal is to help your child take back the parts of her life that anxiety has held hostage, whether that’s sleepovers or field trips or staying home alone. Facing your fears is hard, but a whole childhood without these kinds of activities is even harder.

Therapy for Anxiety Accommodation in North Carolina

Therapy can help anxious kids and teens learn to face their fears and live more confident, independent lives. Photo by Kindel Media via Pexels.

Wondering what could have possibly compelled me to write over 1300 fully original, non-AI-generated words about anxiety accommodation? I’m a children’s therapist specializing in anxiety and OCD. I am lucky enough to help families through exposure therapy on a regular basis, and honestly, I could talk about its benefits all day.

Exposure isn’t right for every family. But if you think it could be the answer to ending accommodation for you and your child, I would love to help! My office is in Davidson, North Carolina (North of Charlotte) but I can practice online therapy throughout the state, and in New York and Florida, as well.

If you don’t live in one of these states, you can search therapist databases for local therapists who practice CBT, exposure therapy, or ERP. These folks will be specifically trained in helping families reduce their accommodation to overcome anxiety.

To summarize, reducing anxiety acommodations helps kids build the skills they need to overcome fears, build resilience, and generally lead more confident lives. If you’re interested in taking the next step, you can contact me here.

The Most Common Types of Childhood Anxiety: Forms, Prevalence, and Symptoms

Childhood anxiety is increasingly common, but often overlooked. Learn the 5 most prevalent types of anxiety in this post.

Anxiety isn’t exclusive to adults: children can experience it, too. Childhood anxiety, while often underestimated, is a very real and prevalent concern. Research suggests that 1 in 8 American kids suffers from some form of anxiety, and that 25% of kids will have symptoms at some point during their teen years. We also know that childhood anxiety is on the rise: some studies show that anxiety rates have doubled over the last few years, possibly due to a combination of pandemic stress, social media exposure, and world events.

As a therapist, what concerns me most is that many of these children—40%—are not getting treatment for their anxiety. And as a parent, I imagine you want to make sure you’re not missing any symptoms! It’s perfectly normal for kids to experience stress and worries in the course of day to day life, and it’s not always easy to tell when those more typical worries are evolving into something more.

In this guide, I’ll cover the 5 most common anxiety disorders experienced by children. You’ll learn the basics of each anxiety type, including its prevalence, common symptoms, and examples of how these symptoms might look in kids. We’ll wrap up by talking about how you can make sure your child gets effective help if they’re struggling with anxiety.

1. Specific Phobia: Most Common Overall (and Rarely Discussed)

How Common Is It? Hands down, this is the most common anxiety disorder that affects children and teens—and yet I rarely see content about it online! Around 7-9% of children have a diagnosable phobia, and the National Institute of Mental Health says that 19.1% of teens will have a phobia at some point in their lives!

What Are the Symptoms? Children with this disorder have an overwhelming fear of a particular thing or situation—hence the “specific” part of the name. Their fear is out of proportion to the trigger: often, the thing or scenario they’re afraid of is not actually dangerous at all. Children with phobias will go out of their way to avoid being around or even thinking about the thing that scares them.

Examples of Phobias in Kids: Animals, blood, needles, clowns, and bugs are all very common phobias in kids and teens. However, any object, animal, or situation can become the source of a phobia. Here are a few examples:

• Sofia and her mother are in a standoff about scheduling her annual physical. Sofia is terrified of needles and doesn’t want to get vaccines or a blood draw during her doctor visit. Last year she was only able to cope by holding her mother’s hand, but since then she’s avoided even talking about getting a shot.

• Even though he’s never been bitten by one, Jackson is terrified of dogs. He won’t visit the houses of friends who have dogs unless they are kept outside while he’s there. If he encounters a dog while walking in the neighborhood, he makes the family turn around and take a different route.

• Cecilia has asked to stay home from an upcoming family vacation because she dreads flying on airplanes. She often has panic attacks while on the plane, and needs a lot of support from both her parents in order to get through. The trip is still weeks away, but Cecilia is already getting anxious about the flight.

Good to Know: It’s common for kids to experience temporary fears after watching a scary movie, having a negative or traumatic experience, or even after participating in Halloween events. These fears tend to resolve on their own in days or weeks, whereas phobias stick around and may even worsen over time.

2. Generalized Anxiety Disorder (GAD): Prevalent in Tweens and Teens

A child or teenager who is overwhelmed by frequent and excessive worries may be suffering from Generalized Anxiety Disorder, which is prevalent in older kids. Photo by Leah Kelley via Pexels.

How Common Is It? Generalized Anxiety Disorder (also called GAD) is one of the most common forms of childhood anxiety, especially for older kids. Estimates vary, but approximately 2.9-4.6 percent of American kids would qualify for this diagnosis.

What Are the Symptoms? Kids with GAD experience overwhelming, frequent worries about a variety of subjects, like school, health, safety, and family. The worrying occurs most days and gets in the way of a child’s life, potentially making it harder to focus at school or go to bed at night. Kids with GAD often complain of bodily symptoms like muscle tension, headaches, and stomach aches, and may feel irritable, as well.

Examples of GAD in Kids: If your child or teen is dealing with Generalized Anxiety, these examples may feel familiar to you:

• Julian has a hard time unwinding at night because he can’t seem to turn off his worried mind: each night, he vents about a variety of subjects to his mom including school shootings, homework stress, and letting down his team in basketball. He knows he worries a lot, but he’s still not sleeping well.

• Maya often stops by the school nurse’s office complaining of headaches or tummy aches, but doctors haven’t found anything wrong. At home she often seems tense—physically and emotionally—and often snaps at her mom. Things are calm in Maya’s life, but she often asks “what if” questions about worst-case scenarios.

• Lulu has always been a worrier: the topics change, but the habit of worrying remains the same. Recently, though, things have taken a turn: Lulu is worrying so much that her attention drifts from her work at school. She’s having a hard time focusing, and her grades have dropped a bit.

Good to Know: Kids with GAD often have other mental health diagnoses, too. GAD is common in children with ADHD, depression, and other types of anxiety like Separation Anxiety.

3. Separation Anxiety Disorder: Common in Young Children

How Common Is It? Separation anxiety is the most common form of anxiety in young children. About 2-5% of kids under the age of 12 experience it. Older kids can have separation anxiety, too, but it’s not quite as common.

What Are the Symptoms? Kids with separation anxiety are fearful of being away from their parent or primary caregiver. They often worry that something bad will happen to themselves or their loved one while they are apart. It’s common for kids to miss their parents, but for children with this disorder, the fear is so intense that it can cause physical symptoms or prevent them from participating in age-appropriate activities.

Examples of Separation Anxiety Disorder in Kids: The main symptom of separation anxiety is pretty clear—kids are nervous to be away from Mom or Dad! Even so, this disorder can look quite different from kid to kid. Here are a few examples:

• 12-year-old Bella is the only one of her friends who has never been on a sleepover. She hates feeling left out, but the idea of being away from her mom overnight is just too frightening. Every time she considers going, she imagines having an emergency while she’s gone, without her mom there to help.

• Oliver started preschool this year but hasn’t attended very many times. He often tells his mom he has a stomach ache in the morning, and asks to stay home. His mom has noticed these tummy aches only appear on school mornings, and never on the weekend. Oliver has a harder time at drop off than most of his friends, and takes longer to recover from his upset.

• Jaci’s mom has worked from home for years, and just started going back to the office a few days a week. Jaci has an epic tantrum every time her mom has to leave the house. When asked, Jaci said she worries her mom will get into a car accident on the way to work and won’t come back.

Good to Know: Some separation anxiety is a normal —and even healthy—part of child development. To qualify for a diagnosis of Separation Anxiety Disorder, a child’s symptoms need to be long-lasting (more than a month) and be more intense than what is expected given a child’s age.

4. Social Anxiety Disorder: Not Just Shyness

Public speaking is a comon trigger for Social Anxiety Disorder, one of the most common forms of anxiety affecting children and teens. Photo by Rica Naypa via Pexels.

How Common Is It? Most estimates agree that between 3 and 6% of kids have Social Anxiety Disorder, making it one of the most common forms of childhood anxiety. It tends to affect teens more than younger children, and may be more common in girls than in boys.

What Are the Symptoms? Children with Social Anxiety Disorder aren’t really afraid of socializing: they have an intense fear of being embarrassed, humiliated, or judged by others. They may avoid activities where they could be observed or judged, refuse to participate in class, or worry excessively about offending other people. Physical symptoms include blushing, trembling, and an increased heart rate.

Examples of Social Anxiety in Kids: A kid can be friendly and outgoing and still experience severe social anxiety in certain situations. Here are some examples of social anxiety signs to look out for:

• Jeremiah arrives home from school starving every day because he refuses to eat in the cafeteria with his peers. The idea of people watching him eat makes him anxious. Although he enjoys sports, he’s started to hang back in gym class due to concerns that his classmates will be watching him there, too.

• Natalia’s biggest worry in life is that other people are judging her or talking about her behind her back. She describes feeling like she’s being watched when she’s riding the bus or walking in the halls at school. Her worries have gotten so bad that she dreads the ride to school in the morning and class changes during the day.

• Although he’s an excellent student, Hugo asks to stay home whenever he’s due to present a project in class. As soon as he gets to the front of the room his hands become sweaty, his body shakes, and he feels so lightheaded he worries he could faint.

Good to Know: A history of being bullied, trouble with social skills, and general shyness can all contribute to developing social anxiety. However, plenty of kids with Social Anxiety Disorder don’t have any of these risk factors.

5. Obsessive-Compulsive Disorder: Frequently Overlooked

How Common Is It? Less common than others on this list, OCD is estimated to affect around 1-3 percent of children. Technically, it’s also not quite an anxiety disorder: it gets its very own category in the DSM-5, the manual therapists use to diagnose mental health conditions. Due to its sneaky symptoms, however, OCD is commonly overlooked or mistaken for other forms of anxiety.

What Are the Symptoms? OCD involves the presence of unwanted and upsetting thoughts, called obsessions, as well as repetitive behaviors, called compulsions. Kids with OCD get stuck in a vicious cycle of obsessive thoughts or worries, which they try to manage through their compulsive behavior. Common obsessions include fears of contamination, harm, or moral wrongdoing, while compulsions may manifest as repetitive hand washing, checking, or counting.

Examples of OCD in Children: OCD in real life doesn’t always look the way it does in the media. Kids and teens with OCD are no more likely to be clean or organized than anybody else! To add to the confusion, some compulsive behaviors are invisible: mental rituals like counting, checking, and praying aren’t always noticeable to others. A child with OCD may experience difficulties like these examples:

• Nina is very concerned about locking the front door whenever her family leaves the house, for fear that a robber could break in while they are away. Nina meticulously locks the door and checks it several times before heading out. Within a few minutes, though, she doubts whether she really locked the door, and often returns home to double check.

• Sasha learned about germs and handwashing during Covid, and got very worried about possibly having germs on his hands during that time. Since then, his handwashing habits have gotten more frequent and more extreme. Sasha often leaves class to wash his hands, and his skin is chapped and dry from frequent washing.

• Gracie has repeated worries that she might have said or done something during the day to offend or upset her friends. In order to help herself feel better, she confesses anything she fears might have gone wrong to her mom. Gracie’s mom wants to be supportive, but the confessing is happening more and more often, even though Gracie knows she didn’t really do anything wrong.

Good to Know: Kids with OCD are often aware that the thoughts they’re having are “weird” or unusual. This causes a lot of distress, and sometimes prompts children to avoid sharing worries or try to disguise their compulsions.

Treatment for Children and Teens with Anxiety Disorders

Treatment is readily avialable for all of the most common forms of childhood anxiety—and it can really help kids get back to enjoying their lives without worry. Photo by Jonas Mohamadi via Pexels.

The statistics around childhood anxiety are intimidating: so many kids are suffering, and relatively few are getting help! Knowledge is power, however, and being able to identify when a child’s symptoms go above and beyond “normal” worries is a great first step toward supporting an anxious child. There are many treatment options available to help kids manage anxiety and get back to living a healthier, happier life.

Cognitive Behavioral Therapy is often considered the “gold standard” for childhood anxiety treatment because it has loads of research to back up its effectiveness. CBT therapy tends to be skills focused, with an emphasis on solving problems as they exist now rather than delving into the past to figure out their origins. Kids in CBT therapy can expect to learn coping skills to relax their bodies, deal with unhelpful worries, and face the fears they may be avoiding in day-to-day life.

Play therapy is another popular treatment option, especially for younger kids who may not feel comfortable sitting still and talking to a strange adult about their problems. Young children naturally use play to work through their feelings and understand the world around them. Play therapy allows children to tap into this innate ability, rather than putting all the emphasis on verbalizing thoughts and feelings. In play therapy, you can expect your child to use make-believe, art, and imaginative play to express themeslves and work through their feelings over time, with support from a counselor who knows how to interpret their activities from a psychological perspective.

I offer both play and CBT therapy in my Davidson, NC office, and also meet virtually with clients throughout North Carolina, Florida, and New York. If you’re looking to get your child started in anxiety therapy, you can reach out to me here.

Navigating Transitions: How to Move from Elementary to Middle School (Without Losing Your Mind)

Need to help your child through the dreaded middle school transition? You’ve come to the right place.

Shifting from the safety of elementary school into the uncharted territory of middle school can be a bumpy ride for kids and parents alike. If you’re about to make this leap with your child and find yourself feeling anxious, you are not alone! So many kid clients in my practice start therapy around this transitional time, and even more opt to hold off on ending therapy until they feel settled into sixth grade. Even for kids without significant anxiety, beginning middle school can be a source of stress.

You don’t even have to take my word for it: we have reserarch to back up the idea that the middle school tranistion is hard on kids. A study from my home state of North Carolina found that sixth graders who move to a middle school building are more likely to be disciplined for behavior problems than their peers who remain in their elementary school for sixth grade. Other studies have found that students’ academic achievement drops between fifth and sixth grade, possibly due to the stress of tranisitioning to middle school. In both of these cases, the negative effects can be seen for years, even as the students enter 8th and 9th grade.

That data is a bummer, but the silver lining to all of this is that it’s not just you: the struggle for kids entering middle school is very real. In this guide, we'll explore why this transition is so nerve-wracking and share practical strategies to make the journey a little smoother.

What Makes the Shift to Middle School So Hard?

We know that the tranistion is hard, but why? For American kids, middle school is a nearly universal experience. If you’re a child of the 90s like me, you may have less-than-fond memories of your own junior high years, but ultimately, we all survived. Here are a few dynamics that make moving from elementary to middle school particularly challenging:

Small Fish in a Big Pond:

As a fifth grader, your child ruled the school. It was their home base for years—maybe as far back as Kindergarten—and they might not even remember life without it. By fifth grade, you know every nook and cranny of that school building, and it’s filled with familiar faces. Plus, your child enjoyed high status at the top of the social food chain. Fifth graders are the biggest, smartest, strongest, fastest kids in school. A Kindergartener practically looks like an infant in comparison! E ven if your child is not the competitive type, wielding this kind of power over your surroundings brings a sense of security.

Then you get to sixth grade and the whole ecosystem changes. You’re the youngest kid in the building, surrounded by teenagers who are way more physically and mentally developed than you. You’re no longer the big fish in a small pond: you’re a little fish, and the pond just got a whole lot bigger.

Unfamiliar Territory:

I’ve spoken to roughly a bajillion middle schoolers about their anxiety. Of all the fears I’ve heard about junior high, one reigns supreme: all kids worry about getting lost in their new building. In public school systems, multiple elementary schools typically feed into one middle school, so students tend to be dealing with a bigger school building.

What’s more, students face the new challenge of traveling from class to class between periods. Gone are the days of spending 7 hours in one cozy classroom: it’s not your job to get yourself to your teacher’s room on time. In most schools, you’ve got about 5 minutes between class periods, which goes by pretty quickly if you need to stop by your locker or the restroom. If I was racing against a timer 6-8 times a day, I’d be stressed out, too.

Students often worry that they’ll show up late for class and embarrass themselves in front of their new teacher and classmates. They imagine having to slink into class and sit down in their seat, humiliated, while everyone’s eyes are on them. And, honestly? Lots of kids will get turned around and end up late to a class, especially during the first week of school. It’s common, not a big deal, and definitely won’t ruin anyone’s social life. Whcih brings us to our next issue…

Fear of the Unknown

The process of starting middle school is shrouded in mystery. Most kids have not spent any meaningful time in the building. Their understanding of what middle school will be like is based on rumors passed down from older kids, as well as representations of middle school in the media. And let’s be honest, the media representations of middle school are not awesome.

With so little information to go on, kids are more likely to imagine worst case scenarios or cling to rumors that may not be rooted in fact. A child who hasn’t received their schedule yet may worry about being placed in classes without their friends or getting saddled with the teacher nobody likes. A student who hasn’t toured the building may worry about getting a locker in a bad location, or struggling to manage their combination lock. And virtually every student feels at least a little worried about the increased homework and friend drama they’ve heard comes along with life as a middle schooler.

In Middle School, School and Social Life Become More Complex

From more homework to cliques to passive aggressive bullying, there’s a lot for preteens to navigate starting aroudn sixth grade.

Middle school students are expected to do almost as much schoolwork as high schoolers, but with few of the perks. Most can expect nightly homework, more advanced subject matter, and more pressure in general to do well on tests and earn good grades.

Although they’re expected to behave like “big kids” academically, in most other respects they’re still receiving “little kid” treatment: no lunches away from campus, limited control over their class schedule, and micromanaged behavior. If I was given a heavy workload and then told by my boss that I was expected to sign out in order to use the bathroom, I’d quit immediately. Sadly, middle schoolers don’t have that option!

Things get trickier on the social front, too: friends become a primary source of support over these years. In middle school and beyond, friends are way more than just a companion on a play date: they’re confidantes, amateur therapists, and your family away from home. The older a tween or teen gets, the more central these friendships become in life.

As important as they are, we all know that navigating middle school friendships can also be fraught with drama. Everyone is figuring out their identity, and the influx of new classmates means that friend groups are frequently shaken up. Kids are dealing with issues like jealousy, gossiping, and cliques for the first time. It’s not surprising that so many kids make less-than-ideal social decisions that result in bullying or hanging out with the wrong crowd.

Create a Supportive Environment for Your Middle Schooler

Ideally, home and family life is a safe haven from the stresses we experience all day at work and school. But we don’t live in an ideal world! It’s easy for work and school stress to “bleed” into home life, or for resentment to build between parents and kids—especially during this increasingly hormonal and volatile age. Doing your best to create a supportive, consistent home environment is one of the best ways to help your middle schooler deal with the chaos of school.

Here are a few ways to emotionally support your middle schooler at home:

Take their perspective: Fumbling with a combination lock or arriving 2 minutes late to class may feel trivial to us as adults. But put yourself in your child’s shoes for a minute: in the microcosm of their middle school world, these are make-or-break issues. Keeping this in mind makes it easier to empathize with their worries, rather than brushing them off as insignificant.

Avoid toxic positivity: When a child comes to you with a worry, it’s so tempting to say something like “You’re going to have an awesome day!”, “Try to think positive,” or “You’re the best kid ever—who wouldn’t like you?!” While some kids appreciate this kind of pep talk, others find it makes them feel even more anxious, because it’s not acknowledging their concerns. Instead, try validating their fears while also focusing on their ability to overcome obstacles: “I can totally see why that would be embarrassing. I would be nervous too! But I’ve seen you handle so many awkward situations well, and I know you’d figure out this one, too.”

Normalize the struggle: Your middle schooler may feel as though they’re the only one who is having a hard time with this transition. As a parent, you can remind them that this is not the case! Let your child know that their worries are totally common and normal, and that they’re not alone.

Practice open-mindedness: If they haven’t started yet, the difficult parent-child conversations are just around the corner. You can set the stage for future conversations about hard subjects like drugs and dating by being mindful of your reactions now. Middle schoolers are highly aware of cause and effect, and if they see you’re flying off the handle about minor misbehaviors, they’ll be much less likely to approach you with the big stuff.

Avoid overscheduling: If your child is currently enrolled in 3 travel sports teams, now may be the time to consider cutting back. I’ve personally seen several anxious middle schoolers whose symptoms improved once they streamlined their after school activities. Prioritizing unstructured downtime can help ease the adjustment to the higher workload and demands of middle school.

Strategies for Middle School Anxiety Management

Anxiety about starting middle school is totally normal. There’s a lot you can do to help your kid cope.

In addition to creating a supportive home environment, there’s a lot you can do to proactively help your child navigate their middle school transition. Many of the same coping skills we use for other forms of anxiety work great for back to school anxiety, too—with a few tweaks.

Here’s how you can help your child manage their stress as they adjust to junior high life:

Be prepared: We talked earlier about how fear of the unknown can fuel worries about the middle school transition. Visiting the school, meeting teachers, exploring the school website, and speaking to rising seventh and eighth graders are all ways you can help your child prepare for their first day. This prep serves two purposes for your child: you’re helping make a strange environment feel more familiar, while also helping your child face their fears one little step at a time.

Question unhelpful assumptions: If you notice your child starting to get worked up over worst case scenarios, don’t let it slide—you can gently call out these thoughts and help your child adjust their thinking. We call this kind of worrying “catastrophizing”, and kids can expend a lot of time and energy thinking about horrible situations that are very unlikely to ever happen in real life (“I’ll arrive to class late, everyone will laugh, and the teacher will think I’m an idiot!”) You can ask your child questions like these to nudge them towards a more realistic perspective:

• Do you have any evidence this is going to happen?

• How likely do you think this is to happen?

• Can you think of some other ways that situation could go?

• Is this worry predicting something in the future that hasn’t happened yet?

• If your friend was worried about this, what would you tell them?

• Have you handled anything like this before in your life? If this happened, could you cope?

Support study skills: Executive functioning skills allow us to prioritize tasks, set and reach goals, folllow multi-step directions, and generally manage our impulses in order to get work done. It takes time to build these abilities, and a middle school workload asks a lot of kids from an executive functioning standpoint. If you suspect your child is struggling in this area, step in to support. Ask your school what they offer for kids needing study skills help, and check out the many resources available for parents of ADHDers on YouTube. Even if your child doesn’t have this diagnosis, you’ll find many helpful tips for strengthening executive functioning at home.

Don’t avoid: If your child is dreading getting to school every day, it can be tempting to let them stay home for a mental health day…and then another…and another. While everyone deserves the occasional day off, avoiding your anxiety trigger is an easy way to make anxiety grow. The more we avoid something that scares us, the bigger our fear will be when we try to return. In extreme cases, kids who frequently avoid school may become so anxious they’re unable to enter the building at all. I don’t want that for you or your kid!

It’s Not All Bad News: Make the Most of School Resources

Admittedly, this blog post has painted a pretty grim picture of middle school life so far. But it’s not all doom and gloom! I mentioned earlier that many of my preteen clients begin or continue therapy due to their nerves about starting middle school. However, once middle school actually starts, many of them return to tell me that it isn’t so bad after all.

As challenging as middle school can be, it has its upsides. Middle schoolers are some of the funniest people I know. Their imagination knows no bounds, and they’re independent enough to try out ideas on their own. This generation is so aware of social issues that, despite the usual peer drama, I find they tend to have a strong sense of morality. In short, they’re awesome.

Middle school kicks off a new developmental stage for kids. They’ve spent much of elementary school seeking praise from grownups in order to feel capable and confident. In the tween and teen years, kids are less reliant on that feedback from adults and more able to trust their own gut. Issues of identity come to the forefront: kids are figuring out who they are and what they stand for. They’re beginning to figure out what kind of adult they might like to be someday.

You can tap into this positive side of the middle school experience by making the most of what your school has to offer. Here are a few common resources that can support kids emotionally as they develop their sense of self:

• Extracurriculars: Many kids find their identity—and a group of kindred spirits—in after school clubs. Moving to middle school typically means gaining access to a much wider range of extracurriculars. Every kid needs a chance to shine and feel appreciated, and if their academics or social life are struggling, these groups can be a real safe haven.

• School counselors: These people know your particular school better than anyone! They’ve seen it all, heard it all, and probably tried it all. If you’re having a specific school-related issue, like anxiety at drop-off or loneliness at lunch time, they can likely offer strategies that have worked for others in the past. While most school counselors aren’t able to provide ongoing weekly therapy, they’re your best bet if an emergency comes up in the middle of a school day. Think of your counselor as a sort of Urgent Care for your mental health.

• Lunch Bunches and Social Skills Groups: Increasing numbers of schools offer extra support for kids looking to make friends. Lunch Bunches pull a small group of like-minded kids together during their break to get to know each other better in a structured environment, with support from a teacher. Your school’s guidance office may also run social skills groups for kids looking for more specific help. These services aren’t always widely advertised, so it doesn’t hurt to ask about them.

• Psychological and Learning Assessments: If your child is truly struggling emotionally or academically, you can request an evaluation from your school district at any time to see if they may qualify for a 504 or IEP plan. These two plans help kids with learning differences or disabilities get the support they need at school, either through changes to the learning environment or through special education. Your school district may not agree with your request, but if they do, your child can be screened for vision and hearing difficulties, autism and ADHD, learning and emotional difficulties, and sensory processing differences. These kinds of evaluations are pricy and hard to get from private psychologists, but are provided at no cost in schools.

When to Seek Extra Help

If you’ve tried to help your child through the middle school transition on your own, consider adding some extra help in the form of a counselor.

By fostering open communication, offering support, and being proactive in addressing anxiety, you can help your child navigate the transition to middle school without (we hope) losing your mind. Know that you’re not alone, and that the challenges of middle school can yield a lot of growth and personal development despite all the angst.

If you find that the stressors of middle school are becoming overwhelming for your child, or if you simply want extra guidance on supporting their emotional well-being during this time, consider reaching out to a professional therapist like me. My counseling practice specializes in helping tween clients learn effective coping skills to deal with anxiety and OCD.

For those who prefer to take a self-guided approach, I also offer an online coping skills course designed to equip middle schoolers with the tools they need to manage stress, anxiety, and the challenges of growing up.

Good luck out there, parents—I salute you.

Should Your Child's Therapist Be a Parent, Too?

Do you need to have kids of your own to be an expert on child psychology?

“Do you have kids?”

Back in the day, I kind of dreaded this question when it came up in therapy sessions. I’ve been a mom since 2021 and a counselor since 2016, which means I spent the first 5 years of my career as children’s therapist with no children of my own.

I always answered honestly, but I wondered about how my childlessness might change a client’s perspective of me. Did they think I lacked experience? Did they worry I wouldn’t be able to understand their struggles? Would they feel unfairly judged if I offered feedback on parenting strategies to try, given that I wasn’t a parent myself? Usually, families who asked this question opted to continue therapy even after hearing the answer. Sometimes it even led to fruitful discussions about subjects like infertility, the way parenthood changes you, and the high standards parents get held to by society at large.

So, do therapists need to be parents in order to provide effective therapy to kids and families? This question has been on my mind for ages, but I waited to respond until I was fully in the trenches of parenting so that I didn’t have too much bias one way or the other. We’ll take a look at factors to consider when choosing a children’s therapist, and why it may (or may not) be helpful to see someone who has kids of their own.

The Case for Therapists Who Are Parents

It can definitely be helpful to meet with a therapist who shares your lived experience. It’s common for clients to seek out therapists who share their racial or ethnic backgrounds, and queer clients may feel more comfortable meeting with queer-identified therapists. And for good reason! A therapist who shares your identity will better understand your values, your community, and the specific challenges you face.

Being a parent is a huge part of my identity, and I can see why it would be valuable to speak to a therapist who has also been through this crazy, intense life experience. It’s easy to imagine that a fellow parent will really and truly get what you are going through, and have valuable insights to share. At the very least, you know they aren’t going to judge you for feeding your child a partially defrosted Uncrustable and goldfish crackers for breakfast.

Shared experience is especially valuable when you’re looking for help with a unique parenting situation, like adoption, disability, blended families, or raising a child who is from a different race or culture than your own. Just being in a room with someone who’s in the same boat as you can be a comfort.

While I don’t think becoming a parent magically transformed me into a better therapist, it definitely given me a new level of empathy for just how hard it is to keep a kid alive on a day-to-day basis. I always intellectually understood that sleep deprivation was hard, but man, these days I feel it in my bones. If you’re the parent of a young child trying to stay awake today, I salute you.

So, yes, there’s a case to be made for seeking out a therapist who is also a parent. If finding someone with shared life experience is important to you, that’s totally valid! But there are also some potential benefits to meeting with a childfree therapist that you may not have considered.

The Case for Therapists Who Are Not Parents

A well trained therapist should be able to empathize with you and your family, whether or not they have their own children.

While researching this topic, I came across a blog post from Dr. Amy Marschall, a children’s therapist who doesn’t have kids. Like me, she says she frequently gets asked about whether or not she’s a parent. Unlike me, non-parenthood seems to be her long-term plan. Here’s what she has to say about the issue:

I don’t have kids, but at one time I was a kid who dealt with some of the same issues my clients and their families bring to me. My lived experience isn’t identical to that of my clients, but that’s true for everyone. Even if I had my client’s exact diagnosis, my experience of that diagnosis would be different. Every single person is an individual, so you will never find a therapist who completely and fully understands your experience.

Dr. Marschall makes two great points here. The first is that while not everyone has been a parent, we were all children once. Every one of us, parent or not, remembers what it feels like to be on the child side of a parent-child or caregiver-child relationship. In fact, non-parent therapists may feel a little closer to that childhood experience than the rest of us: they can still remember clearly what it was like to be a kid. They don’t have the newer memories of being a parent clouding that vision.

It’s also true that no two people are alike, so even if your therapist shares a lot of your life experiences, they still won’t have fully walked in your shoes. Think about the fellow parents in your social circle: do you agree on every issue? How much do you have in common outside of parenting? Are your values identical? Probably not. Research has shown that there’s more diversity within groups than there is between groups, meaning that two moms (or two Christians, or two Latinas, etc.) aren’t going to have identical experiences and worldviews.

All therapists, regardless of their parental status, are trained to be empathetic listeners who are curious about other people’s lives. We’re taught to view differences with respect, to not pass judgment, and to do our best not to impose our own beliefs or values on someone else’s life. Even if your therapist isn’t a parent, they should be able to understand and empathize with your feelings about parenthood. In fact, they might be able to look at your problems from a fresh perspective, since they’re not stuck in the same parenting rut every day themselves.

Parenting and Therapy Are Very Different Skillsets

Children’s therapists have a broad base of knowledge: we learn about child development, different mental health conditions, and the symptoms that commonly show up in kids and teens. Most of our training is based on research: we’re trained to look at big trends to figure out what strategies or coping skills are most likely to be effective for a given kid. Once we’re in the real world and practicing therapy, we have the privilege of meeting tons of families from all walks of life. Getting to know so many kids and parents helps you notice common struggles and see firsthand what does and doesn’t seem to be useful for the majority of families.

On the other hand, parents have a depth of knowledge: they’re the experts on their individual kid. They know the subtle signs that their child is overtired or overstimulated. They remember exactly when and how a child developed their fear of ghosts. They know what is and isn’t typical for their child, and they know how their child tends to behave in different settings. Spending 24 hours a day with a person for years, watching them grow and change, creates a kind of understanding and connection you’ll never see in therapy.

When I’m deep in the weeds with my toddler trying to figure out an issue, it is hard to take a step back and look at the bigger picture, like I can when I’m counseling. You can’t be in “parent mode” and “therapist mode” at the same time. And if you could, it probably wouldn’t be healthy! That’s part of why seeing a therapist can be so helpful. Because they don’t have the same super-close bond with your child, they can look at things with fresh eyes, and offer possible solutions that have worked for other families.

Becoming a Parent Didn’t Make Me a Parenting Expert

Does being a parent automatically make you a better therapist? It didn’t work that way for me!

I’m just being honest here. I wish I could say that the moment I became a mother, the wisdom of the ages was bestowed upon me and I knew how to respond in a perfect, emotionally attuned way to every parenting situation. But it didn’t happen! Instead I was handed a squealing newborn and told I had to keep him alive while running on 3 hours of sleep.

Before I had my son, friends would tell what a great parent I’d be someday because of my therapy background. How flattering! Now that I have a toddler, though, I know the truth. Being a therapist did not make me an expert parent. Sure, the knowledge is helpful, but I’m up at night looking for answers on Google and worrying I’ve messed up my kid just like everybody else.

Simply having a kid, in my humble opinion, does not an expert on parenting make. Maybe someday when I’ve successfully raised a child to adulthood, I’ll feel more confident claiming expertise on this topic. But even then, I’d really only be an expert on my kid, not yours.

Think about the parents in your social circle. Do they have it all figured out? Heck no. Would all of their approaches work for your kid or your family? Probably not. Are there a couple that you would never take advice from in a million years? I bet.

If your child’s therapist is a fellow parent, they may approach your situation with the kind of empathy that only comes from first hand experience. But that’s not a guarantee that they’ll know how to help. Therapy is based on more than just personal experiences, and what worked for their family might not be a great fit for yours.

In Conclusion: Finding a Therapist Who’s Right for You

Research has shown that your connection to your therapist is the single most important factor in predicting whether or not therapy will work. No matter what style of therapy you’re getting, if you trust your therapist’s ability to help you, you’re much more likely to make good progress. So if you’re searching for a children’s therapist and wondering how important it is that they’re a parent, keep that in mind.

You may decide that having that shared life experience really is crucial for you in order to feel fully comfortable. This may be particularly true if you’re trying to get help with a specific parenting issue, or if you have a unique family composition. In these cases, it might be really valuable to have guidance from someone who’s been in similar shoes.

On the other hand, you may find that parenting experience isn’t so important after all. We’ve all had the experience of being a kid, and most children’s therapists have vivid memories of their own childhoods that help them connect to their young clients. No two parents’ experiences are exactly alike, anyway, and a well trained therapist should be able to empathize with your family’s situation even if it’s not identical to their own.

For more help with getting started in therapy, check out the following blog posts:

• What Questions Should I Ask My Child’s Therapist?

• Should My Child See a Therapist, Psychologist, or Psychiatrist?

• How Often Should a Child See a Therapist?

Child Anxiety Counseling in Charlotte, North Carolina

Finding the right therapist can be tough, but CBT and play therapy can make big differences in the lives of anxious kids.

I hope you found this post helpful, and that it’s encouraged you to consider the many incredible children’s therapists we have in our midst, whether they’re parents or not. If you and your child are hoping to start anxiety therapy and live in North Carolina, New York, or Florida, maybe I’m a good fit for you!

My child therapy office is based in Davidson, North Carolina, just North of Charlotte. If you’re nearby, we can practice CBT and play therapy in person to combat anxiety and OCD symptoms. Since I’m licensed in multiple states, I’m also available for virtual appointments throughout North Carolina, New York, and Florida. About half my practice is online, and I love being able to help kids who I’d never get the chance to see in person.

Ready to get started? Check out my FAQ to learn more about my fees and services, or send me a message.

What to Do if Your Child's Therapy Isn't Working

If you’re worried your child’s therapy isn’t working, don’t despair! There’s a lot you can do to get things back on track. Photo by SHVETS via Pexels.

Therapy can be a transformative experience for kids, helping them overcome challenges, devleop essential skills, and thrive in their daily lives. If you’ve reached this page, you’re probably a believer in the many benefits therapy can provide for children. So what do you do when…it just doesn’t seem to be working?

We all know that growth isn’t linear, change takes time, and all that good stuff. But it’s still disheartening when, after all hard work finding a therapist and attending sessions, things don’t appear to be improving for you and your child. Sometimes, despite everybody’s best efforts, progress in therapy can seem slow or nonexistent. The good news is there’s a lot you can do to get things back on track.

What Should You Realistically Expect From Therapy?

No matter what kind of therapy you choose for your child, you should expect that it will likely take some time before you see major results. In my counseling practice, the average length of a child’s therapy is about six months. Of course, some kids need a lot less time, and some need a lot more.

This lines up with what the big therapy organizations say about how long therapy takes. The Association for Play Therapy estimates that kids will need an average of 20 sessions to resolve the problems that brought them to therapy. According to the American Psychological Assocation, 50% of people in therapy will be ready to go after 15 to 20 sessions, and the rest will need more time. Even “short term” forms of therapy may take longer than you might expect: TF-CBT, a short-term trauma therapy, usually requires 18 to 24 sessions.

If you’re meeting once a week, that means you’re looking at 5 months or more of therapy before your child will be fully ready to move on. Given that estimate, I think it’s safe to start questioning whether a therapy approach is effective around the two month mark.

Here are some other points to keep in mind as you evaluate whether therapy is working out:

• Early therapy sessions focus on relationship building: your child might learn about their diagnosis and feel a lot more hopeful about therapy, but you probably won’t notice huge changes during the first few weeks.

• It’s not typical to notice big, positive changes after every session. Over time, though, you should see gradual improvement.

• Sometimes, symptoms may get worse before they get better, especially if your child is in anxiety or trauma therapy that involves exposure (facing feared situations).

• Pretty much every kind of child therapy requires some level of parent involvement. Even though kids need their privacy, you should expect to be kept in the loop by their therapist about their progress and how you can help.

If your child is new to therapy, it’s possible that you’re just too early in the process to see changes. On the other hand, if you’ve been in the therapy game for a while and progress has slowed or stopped, keep reading to learn what might be getting in the way.

What Are the Signs That Your Child’s Therapy Might Not be Working?

Stalled progress, difficulty using skills in real life, feeling uncomfortable in sessions, communication struggles, and worsening sypmtoms can all be signs of problems in therapy. Photo by Monstera via Pexels.

So, let’s say you have realistic expectations for therapy: you’ve been at it for 8 sessions or so, and you know change isn’t going to happen overnight. You’re still not seeing the differences you’d hoped for. How can you tell if you’re on the right track? Here are some indicators that something about your current therapy approach isn’t working for your child:

Lack of improvement over the long term

In therapy, progress tends to happen in fits and starts. You might have a big breakthrough one session, followed by a week or two that are relatively quiet. It’s even possible that symptoms will become more intense for a little bit, if your child is confronting tough stuff in therapy that they have avoided until now. If you zoom out and look at the big picture, though, you should notice an upward trend over time.

Skills aren’t translating into real life

Many forms of child therapy, like CBT, put an emphaisis on learning coping skills and other practical strategies a child can use to manage their feelings and handle tough situations. There’s a big difference, though, between learning these skills and putting them into action. If your child is consistently unable to use what they’re learning outside of therapy, it means something is getting in the way.

Your child feels uncomfortable in therapy

It’s pretty normal for kids to be reluctant to go to therapy some of the time. This is especially true if therapy is getting into difficult subjects, like facing anxiety fears or talking about trauma experiences. This can usually be figured out with your therapist. On the other hand, if a child consistently dreads therapy and really doesn’t want attend, this might indicate a bad fit or lack of trust in the relationship.

Communication isn’t clear

Does it feel like stuff is always getting lost in translation with your child’s therapist? Maybe it feels like your child is avoiding the big issues in sessions, and you never get a chance to meet with the counselor to bring up concerns. Or, maybe you’re not sure what’s being worked on and how you can help at home. Kids need some privacy in order to make therapy work, but as a parent you should always know what the current therapy goals are, and have a way to check in with the therapist.

Things are getting worse

Okay, this one may seem a little obvious, but it’s true! If you haven’t been warned that your child’s symptoms might flare as a part of the therapy process, and things are getting worse at home, its’s time for a talk with your child’s counselor. This is especially true if you’re noticing worsening depression, thoughts of self harm, or aggressive and destructive behavior.

It’s important to note that seeing one or more of these signs doesn’t necessarily mean you have a bad therapist or that you have completely wasted your time and money. It’s absolutely a sign, though, that you need to have a conversation with your child’s therapist and figure out how to make things better, so you don’t spend additional weeks or even months doing something that’s not working.

Please, Talk to Your Child’s Therapist!

If you are feeling frustrated and don’t think your child’s therapy is working, please don’t keep this to yourself! As awkward as it might feel, telling your therapist you are concerned is a really important part of turning things around. You aren’t going to hurt your therapist’s feelings if you tell them you’re not loving how things are going!

Speaking from experience, I always want to know when something I’m trying is not landing with a client. It’s a huge bummer to hear that something wasn’t working long after the fact. We could have changed approaches so much sooner if I’d known, and saved that kid a lot of unnecessary suffering!

Pretty much every therapist out there cares more about kids getting better than they do about their own ego. Your therapist wants to hear from you. In fact, hearing feedback from parents—the good, the bad, and the ugly—makes it much easier for us to do our jobs.

When you talk to your child’s therapist, try to be as specific as you can about what you’re seeing at home and what doesn’t seem to be improving. You can mention things like:

• How often your child is struggling, and how severe or long-lasting these episodes seem to be. For example, is your child having anxiety about school 4 out of 5 nights a week? Are tantrums lasting 30 minutes or more?

• What you’ve been trying in order to help your child at home: what strategies are you using? How are you implementing them? What doesn’t seem to work out when you do?

• Any concerns you feel haven’t been addressed yet in the therapy process

• Anything you’re confused about, like how a specific strategy works or what the current therapy goals are

One final note about having this talk with your child’s therapist: please set up a time to meet with the counselor when your child isn’t present. You want to be able to speak openly about behaviors you’re seeing at home or family dynamics that might be getting in the way of completing therapy goals at home. Kids tend to personalize these conversations and may believe that it’s their fault if therapy isn’t going well.

Common Therapy Problems, and How to Handle Them

Often, an honest conversation with your child’s therapist is enough to clear up issues that are keeping you from progressing. You may need to clarify treatment goals, rethink your child’s diagnosis, figure out what’s getting in the way of using skills at home, or consider switching approaches or therapists in order to get things working again. Photo by Cottonbro via Pexels.

Hopefully, you are able to bring these concerns to your child’s therapist, along with some specifics about what doesn’t seem to be going well. Together, you can figure out what the roadblock might be that’s preventing therapy from being effective. There are all kinds of reasons therapy might not work, but here are a few common ones to consider, along with ways you can help things improve:

Unclear Treatment Plan

I often hear from parents that they’re not sure what’s going on in their child’s therapy aside from “just playing.” This should never be the case! Start off your troubleshooting process by making sure you and your therapist are on the same page regarding your child’s therapy goals.

Every therapist is required to create and maintain a document called a treatment plan. This outlines what problems brought a child to therapy in the first place, and what goals have been set in order to make those problems better. If you’ve been in therapy a while, this document has likely been updated to show how much progress your child has made toward these goals.

If you aren’t clear on your child’s treatment plan, you can:

• Ask to meet with your child’s therapist to review the treatment plan together

• Let the therapist know that you’d like to get clear on what the current goals are, and be more direct in working toward them

• Get feedback from your therapist on what they’ve observed in sessions and how they feel your child is progressing

• Ask how you can support your child in achieving treatment plan goals at home

If your child’s therapist doesn’t have a treatment plan, can’t give clear answers about goals, or isn’t able to provide specific responses to your questions, you may not be a good fit for each other.

Treating the Wrong Problem

It’s also possible that your therapist has a clear, detailed treatment plan…and you’ve been focusing on the wrong problem. Sometimes, one mental health problem masquerades as another. Girls with autism, for example, have a harder time getting diagnosed and their symptoms might be mistaken for anxiety or another disorder at first. Trauma symptoms can look an awful lot like ADHD. Children who have OCD might take a while to get the right diagnosis, as well, because the behaviors can be hidden or hard to spot.

If you’ve been diligently working on your treatment plan, trying to follow through with things at home, and nothing seems to be moving the needle, it’s worth questioning if something else might be going on.

If you’re wondering if there’s another diagnosis at play, you can:

• Ask your child’s therapist if there are any other diagnoses (sometimes called “differential diagnoses”) they have considered for your child.

• Give a thorough review of any possible symptoms, behaviors, or difficulties you’re seeing at home,

• Reflect on your child’s history: have they lived through anything that might be considered a traumatic or highly stressful event? These are good for your therapist to know about, even if they seem unrelated to the problem at hand.

• Consider getting an evaluation from a psychologist to screen for ADHD, autism, or other developmental or learning conditions

Depending on what you learn, you may find that your goals in the therapy process need to change—or you may discover that your child is a better fit for another kind of therapy altogether.

Trouble Following Through

What happens outside the therapy room matters just as much as what goes on inside of it. This is especially true if you’re in a skills-based form of therapy, like CBT, or treating a problem like anxiety or behavior difficulties where a lot of the struggles occur at home.

Kids are still in the process of learning to regulate their emotions, and need an adult’s help to do this. Even if they’re learning skills perfectly in session, they won’t be much use if there isn’t a parent or caregiver helping with follow-through in real-world situations.

Of course, this is way easier said than done. Working on therapy skills can be time-consuming and emotionally draining. It can be really hard to find the time and emotional reserves to work on therapy when you’re managing a busy and stressful life. It’s also possible that a plan that sounded really good in the office falls apart when you get home: either your child is reluctant to do it, or you encounter some kind of issue that you can’t figure out how to navigate.

If you’re having a hard time following through on therapy goals at home, try the following:

• Be honest with your therapist about what’s going on. You aren’t getting graded, so there’s no need to lie about not doing your homework!

• Make sure you feel clear and confident about what your assignment is: you should know exaclty what you’re doing, and what to say when

• Sometimes, a plan sounds okay in the office but feels difficult, uncomfortable, or scary to a child when it’s time to follow through at home. If this is the case, you may need to adjust the goal or come up with a plan to support your child through it.

• Let your therapist know about any sticking points that you’re tripping up on when you try to practice at home

If you’re in the middle of a major life transition, experiencing trauma or loss, or feeling totally overextended by work and family obligations, you may just not have the reserves to fully participate in therapy right now. It may make more sense to focus on those life stressors first, and return to therapy once things have settled down a bit.

Child Needs Higher Level of SuPport

If you aren’t seeing improvement, and especially if things are getting worse, you may simply not be getting enough help. Some issues need more attention and support to resolve than a 50-minute sit down with a therapist once a week can provide. This is kind of the “bare minimum” of therapeutic support, and there are a lot of other options to consider when it isn’t enough.

Somtimes, families opt to try therapy on an every other week or even monthly basis. This may be due to financial concerns, time constraints, or limited availability from your therapist. While this can be a good option for kids with mild symptoms, kids who are really in the thick of it will have a hard time keeping momentum up if they’re only coming every other week.

If you feel like things are steadily worsening, and particularly if your child is struggling with suicidal thougths or self-harm, it’s worth talking to your therapist about ways to increase support. Here are some possibilities to consider:

• You child may need more frequent sessions: weekly if they’re coming every other week, or twice a week if they’ve attended weekly.

• Adding group therapy, like a DBT skills group, can add another layer of support for kids struggling with suicidal thoughts or self-harm.

• Consider meeting with a psychiatrist to see if medication could help your child make more progress in therapy: you can talk this over with your therapist and pediatrician.

• If finances make it hard to attend therapy more often, ask about a sliding scale or consider making a transition to a therapist who takes your insurance or can offer a lower rate.

• If your child is not safe at home, intensive outpatient therapy (meeting daily for part of the day) or an inpatient stay might be needed before your child is ready to “step down” to weekly therapy sessions.

It might be hard to think about adding more therapy when things are already not working: it means more time, more money, and more effort. While a higher level of care isn’t the right answer for every child, it can make a world of difference for kids who really need it.

Therapist is Not the Right Fit

Sometimes, it’s just not a good match. Maybe the style of therapy your counselor offers doesn’t work for your kid: a child who’s reluctant to attend therapy might not do well in an approach that requires a lot of self-motivation, for example. Or, maybe you’re feeling a lack of clarity about what the treatment plan is, and you can’t seem to get on the same page. If your child’s diagnosis or needs have changed over time, they may need a form of help your therapist no longer specializes in.

It’s also possible that your personalities just don’t mesh well: just like you’re not going to be friends with every person you meet, you’re not going to hit it off with every therapist you meet, either. Simply not feeling comfortable with your therapist—even if they’re a nice person—can be reason enough to make a change.

If you’re just not vibing with your child’s therapist, there are a few things you can do:

• As awkward as it may seem, you can still bring this up to your therapist, as long as you don’t have any big ethical concerns about their behavior. They may sense that it’s a poor fit, too!

• Try to get specific about what you need out of therapy that you’re not getting now. Would your child respond better to a therapist who is more animated and engaging? Do you need someone who specializes in a specific diagnosis, or does more parenting work?

• Ask yourself whether a difference in culture or background might be part of the problem. It may or may not be, but sometimes finding a therapist who shares your racial or cultural heritage can help.

• Search for therapists who meet your new criteria. You can even ask your current therapist for referrals, if you’d like!

Just like doctors have no problem with patients seeking a second opinion, most therapists genuinely just want our clients to feel better, whether that happens with us or someone else. I’m always happy when a family is able to find someone who is exactly the right fit for their situation.

Should You Switch to Another Therapist?

It’s always within your rights to switch to a new therapist, and sometimes that’s exactly what you’ll need to do if your current therapy plan isn’t working. If you’ve tried talking with your therapist and things still aren’t working out, it’s perfectly okay to transition your child to a new counselor. There are so many different styles of therapy out there that you might not find the right match on your very first try.

Just like you wouldn’t fire an employee over a minor offense, I don’t recommend leaving therapy the first time something goes wrong. In fact, you should expect that things will go wrong sometimes! Your therapist won’t always get it right. They may interpret something in a way that doesn’t sit right with you. Or, they may have a policy you don’t agree with, like charging a cancellation fee.

Minor missteps and frustrations can be worked through, and will often make your relationship with your therapist stronger. If you left therapy every time something like this happened, you’d be repeatedly starting from the begining and it would be hard to make any meaningful progress. On the other hand, unethical behavior—things like making racist or sexist comments, not protecting your private information, or saying something inappropriate in session—should never be tolerated. Get out of the situation immediately if this happens to you, and consider filing a complaint with your therapist’s board.

Most of the time, there won’t be a big, dramatic reason for ending therapy: it’ll just turn out not to be a good fit. In these situations, I strongly recommend being upfront with your therapist about what’s going on. Scheduling a final “goodbye” session for your child gives them a sense of closure before moving on.

Take Care of Yourself As a Parent

Your child’s therapy process isn’t going to look like anyone else’s, so resist the temptation to compare your child or family to others. You can’t help your child through therapy if you’re completely burned out! Photo by Albert Rafael via Pexels.

It’s easy to feel burned out when therapy isn’t working for your kid. Here you are, contributing all this time, money, and emotional energy in the hopes that things will get better…and then they don’t. You might blame yourself, worry that your child’s problem is unfixable, or start to question whether therapy will ever work.

We all know the adage about the oxygen mask in the airplane: there’s no use in bending over backwards to find help for your child if you’re feeling utterly fried by the whole process, and have no time to take care of yourself. Do whatever you need to do to prioritize your own mental health during this stressful time, even if it feels a little selfish.

Your kid’s process is not going to look like any other kid’s process: they’re a unique individual. There’s no reason to beat yourself up if so-and-so’s kid had a miraculous transformation in 3 sessions of therapy and your family is still struggling 6 weeks in. Just like kids hit their developmental milestones at their own pace, you and your child will figure this out on your own timeline, too.

When you’re really feeling stuck, it can be easy to overlook the small, everyday ways that things are getting better. It sometimes helps to refocus on those small victories. Did your child encounter a triggering situation today, but not melt down? Were they able to articulate their feelings to you this week? Have some aspects of your problem gotten better, even if other parts have stayed the same? This is all growth and progress to be celebrated.

Be patient, hang in there, and don’t neglect these little wins while you figure out how to get unstuck.

Begin Child Counseling in Charlotte, NC or Online

Finding a therapist who is the right fit for your child can make therapy more effective. If you’re looking for someone who specializes in tween anxiety and OCD, I’m available to work with children throughout NY, NC, and FL. Photo by Victoria Rain via Pexels.

If you’re still looking for the right fit for therapy for your child, I might be able to help! I can see kids in person at my Davidson, North Carolina office, or online anywhere in North Carolina, Florida, or New York.

I mainly work with tweens (rougly ages 8-13) who are struggling wtih anxiety due to OCD, difficult life circumstances, or just by virtue of having an anxious temperament. We’ll work together using practical, skills-based therapy along with a healthy portion of fun and play to learn new ways to deal with difficulties in life. I’m trained in three research-based forms of therapy: CBT (great for anxiety), TF-CBT (designed for trauma), and ERP (for OCD). I’m also a drama and play therapist, so we won’t just be learning dry skills from a book, but we won’t be playing Uno all day either :-).

If you think your child could benefit from this approach, feel free to reach out! You can also join my mailing list to get my free coping skills guide, as well as monthly information on how to help kids and tweens navigate life with anxiety.

Should Parents Be Involved In Their Child's Therapy?

Since becoming a parent myself, it’s dawned on me what a leap of faith it is to send your child to therapy. Whether you’re meeting in person or online, you’re sending your child into a room with a near-stranger without knowing exactly what’s happening behind that closed door. Does this person have your child’s best interests at heart? Do they know how to help? Are you missing out on important information? Are they just playing Uno in there?

Involving parents in a child’s therapy can be a tricky business. On one hand, kids need enough privacy to trust that they can safely share difficult thoughts and feelings. On the other, it’s fair for parents to want to be kept in the loop…and research shows therapy is more effective when they are.

Being a part of your child’s therapy process benefits everybody: you, your child, and your child’s therapist. But how you get involved will depend on your child’s age, maturity level, and the reason they’re coming to therapy.

You Are the Expert on Your Child’s Life

You know how, in documentaries, there’s always a “talking head” segment where an expert drops a bunch of knowledge and historical information about the subject of the movie? If there was a documentary about your child, you’d be that expert. You have insight about your child that your therapist doesn’t.

Child therapists have broad knowledge: they have data about a large number of kids. They know what anxiety, depression, and other mental health issues tend to look like in kids. They’ve studied child development and probably attended countless lectures and trainings on specific ways to help kids with different conditions. On top of that, they’ve met with hundreds of kids for therapy. Based on what’s helped all these other kids, your therapist can make a strong educated guess about what will be helpful for your child.

Parents have deep knowledge: you know your individual child better than anyone else. You’ve spent years learning to decode your child’s tiny facial expressions or tones of voice. You know their history and you’ve seen them at their most vulnerable. You’ve likely been with your child since the day they were born and seen them grow and change. You’re the family historian, and you can remember details about your child’s life that they cannot.

Your deep knowledge is really useful in therapy. It provides background and context. You can give your therapist feedback to help them tailor their skills to work for your specific child and family. And learning those skills alongside your child will help them to get the most out of therapy.

The Pros and Cons of Parent Involvement in Therapy

Participating in your child’s therapy is a bit of a balancing act. You want to be involved enough that you know what’s going on and how to support your child, but not so involved that your child feels like they don’t have any space to do their own thing.

There are definite benefits to parent involvement, but there are also some potential drawbacks to be aware of. Let’s take a look at both.

The Pros:

• We have a lot of research that shows that being involved in your child’s therapy is linked with better outcomes: kids do better when parents actively participate.

• Participating in therapy sends a message to your child that going to therapy isn’t a punishment for bad behavior: you’re committed to growing and changing, too.

• Coping skills are great, but kids will need help from an adult to put them into practice. You can reinforce what your child is learning at home.

• You can share important information with your child’s therapist about your family history, religion, culture, or anything else that might influence your child’s experiences.

• Children of all ages need help from their parents to handle their feelings. To create lasting change, both kids and their parents need to learn new ways of dealing with anxiety and behavior struggles.

The Cons:

• If everything a child says is immediately relayed back to the parent, it’s a betrayal of trust. Children will quickly figure this out, and stop sharing important information in therapy.

• Sometimes it’s easier for children to bring up difficult, embarassing, or scary subjects for the first time with someone who isn’t a family member: it helps to protect those important relationships. If parents are in the room all of the time, it’s hard to do this.

• Older children are more aware of cause and effect, and may worry about the consequences of sharing things in therapy as a result: if I say this to my therapist, will I get in trouble at home?

• As kids become teenagers, it’s normal and natural for parts of their lives to become more private from their parents. It’s no longer age-appropriate for them to share every detail of their personal lives.

A lot of these risks can be managed by setting clear boundaries in advance: everybody, including your child, should know what gets kept private and what doesn’t. You can talk with your therapist about the best way to participate, based on your child’s age and needs.

How Involved Should I Be in My Child’s Therapy?

There’s no “right” level of involvement in a child’s therapy. Every kid is different! Your child’s age is the biggest factor to consider when trying to figure out how to participate: the younger your child is, the more present you’ll need to be.

Your child’s reason for attending therapy matters, too. Children experiencing anxiety or OCD may need a little more privacy, safe space to begin talking about their fears. A teen having relationship struggles may not want or need to talk about all the details with a parent.

On the other hand, behavior concerns like fighting, tantrums, and not following rules usually need more parent involvement. An argument takes two people, so you really need both people to figure out how to respond differently.

Finally, the severity of your child’s symptoms might also dictate how involved you need to be. A child who is feeling stressed about homework may be able to learn ways to cope with her worries fairly independently. A child who is so anxious about their work that they’ve stopped going to school most days is going to need lots of support and guidance from parents to overcome their fears.

Participating in a Preschool Child’s Therapy

Sometimes people are surprised to hear that therapy options exist for toddlers and preschoolers. They absolutely do! If your very young child is struggling emotionally, you have options. Forms of therapy have been created specifically to help preschoolers cope with trauma, manage difficult behaviors, and explore feelings through play, rather than words. Kids in this age range need a lot of parent support in order to make therapy work.

As a parent, you’re the center of your preschooler’s universe. You’re their first playmate, their protector, and the person who sets the schedule for their day. Little children look to their parents to decide how to respond in stressful situations: they’re always checking what your reaction is. When feelings get too overwhelming, it’s hard for preschoolers to self-soothe: they need your help to do this. Because preschoolers rely on their parents for so much, you can expect to be highly involved in their therapy.

Depending on your child’s needs, parent involvement in a preschooler’s therapy could look like:

• Attending sessions alongside your child, so the therapist can guide you through play-based activities together.

• Getting coaching in real time from a therapist as you interact with your child, so the therapist can “translate” the possible meaning of your child’s behavior or offer suggestions on how you can respond.

• Learning coping skills together in session that you can help your child to practice at home.

• Meeting frequently for parent sessions with your child’s therapist to discuss their progress

• Learning parenting strategies that you can try at home to support your child and the work they’re doing in therapy

To summarize, if you have a child between the ages of 2 and 5, you should expect to be a very active participant in their therapy process. Younger preschoolers will need your support in the room for the entire session: and what you learn will be just as important as what they learn.

Older preschoolers might be able to meet alone for play therapy some of the time, but you’ll still need to be involved and open to trying new things in order for therapy to work well. If your child’s therapist meets with them alone for play therapy, you should expect (and ask!) to be included on a regular basis, either for part of each session or for regularly scheduled parent-only meetings.

Including Parents in Therapy for Elementary-Aged Kids

Elementary-aged kids have mastered the art of pretend play, which makes play therapy a wonderful option for this age group! Between the ages of 5 and 10, children are also working on their ability to verbalize their thoughts and feelings. Starting school opens up a whole new world for kids: there are new important people in their lives like teachers, coaches, and friends.

All these factors mean that unlike younger children, elementary school kids can often benefit from some alone time in the therapy room. Sometimes, practicing being apart from Mom or Dad can even be a helpful goal for kids with separation anxiety!

However, it’s not realistic to expect this age group to put what they’re learning into practice by themselves: they’re going to need help and support from you. You’re still your child’s biggest teacher, and the 50 minutes they spend in therapy once a week will never have as much impact as their time with you.

If you’re participating in your elementary schooler’s therapy, you might be asked to:

• Check in about how things are going at home at the start or end of each week’s session.

• Join your child for the last part of their appointment to learn a coping skill together—or have your child teach the skill to you!

• Help your child practice simple “homework” over the course of the week.

• Meet for parent sessions to discuss your child’s progress and talk about ways you can tweak things at home (like discipline or the way the family responds to anxiety) in order to best support your child.

In general, you can expect that a child between the ages of 5 and 10 will attend therapy sessions by themselves, but that you’ll still be needed as as major source of support. Whether it’s helping your child practice relaxation skills or encouraging them to gradually face their fears, your participation makes a huge difference in the therapy process.

How to Get Involved in Your Tween or Teen’s Therapy

It’s totally normal and age-appropriate for tweens and teens to want some privacy in therapy. They’re at an age where they no longer need to share every thought that passes through their head with their parents. As kids hit adolesence, friends become a huge source of support and a helpful sounding board…but they can also be a major source of drama. It can be a relief to talk to someone like a therapist, who isn’t a close friend or family member and who is removed from a teen’s day-to-day life.

Tweens and teens are also much more capable of considering cause and effect: what will happen to me if I share this information with my therapist? Will my parents find out? Will I get in trouble? Because of this, it’s really important for these older kids to be informed about how confidentiality works in therapy. Safety concerns (like thoughts of suicide) will always be shared with a parent, but issues that aren’t urgent or dangerous (like a fight with a sibling) might not be.

Despite all this added independence, parents still need to be kept in the loop. Teenagers still need guidance from their parents, even if it looks different now than it did when they were little. It can be stressful to raise a teenager, and parents could use some support during this time, too. Participating in your teen’s therapy also sends the message that you don’t simply see them as a “problem child”: you’re willing to put in the work to make things better, too.

Participating in your tween or teenaged child’s therapy could look like:

• Having an initial session with your child’s therapist before they meet to share your perspective and fill them in on your family’s history.

• Having an open conversation in your teen’s first therapy session about how confidentiality works and what will and won’t be shared.

• Meeting periodically with your child’s therapist to discuss the progress they’ve made toward their treatment goals—but not necessarily talking about their specific worries or problems.

• If your child is in a skills-focused form of therapy, like CBT or ERP, collaborating with your child and the therapist to come up with a plan to work on skills at home.

• Getting support for yourself and learning new ways to manage your tween or teen’s strong emotions.

Until your child turns 18, you can expect—and request—to be a part of your teenager’s therapy. Once your child turns 18, however, things change. Once your teen is a legal adult, they’re entitled to total privacy in therapy, even if they’re still living in your home and you’re the one paying for their sessions.

If your child is approaching this age, you should talk with both your teen and their therapist about how to prepare for this transition. Turning 18 doesn’t necessarily mean you can never participate in your child’s thearpy again—you’ll just need their permission to get involved.

What if I Can’t Attend My Child’s Sessions?

There are many reasons why it may not be possible for you to physically attend appointments with your child’s therapist. Maybe your child is in online therapy, and meets with their therapist while you’re still at work. Or, maybe your child’s other parent is typically the one who drives them to their sessions. Divorced parents may not live in the same town or state as their child’s therapist, which can also make it more difficult to stay in touch.

Research on children’s therapy has found there’s a difference between a parent who attends a child’s therapy sessions and a parent who participates actively in the sessions. Being physically present at the appointment is a great start, but it’s not going to be very helpful unless the parent is open to sharing, listening to feedback, and following through at home. Any parent can actively participate in therapy, whether they live 1 mile or 100 miles from the office.

If you want to be involved but you can’t make your child’s regularly scheduled appointment time, you have some options:

• Ask your therapist if it’s possible to schedule a monthly “parent only” appointment at a time that works better for you.

• Online therapy is common now, which is a great option for working or out-of-town parents. See if you can schedule periodic online check-ins to avoid a long commute.

• Many children’s therapists have much more flexibility to meet while children are in school. If you can meet remotely during your lunch break at work, this can be a good option to stay involved.

• Phone calls, emails and texts can be a good way to keep in touch when video calls aren’t possible. Your therapist can keep you updated on treatment plan goals and let you know how you can help reinforce these goals at home.

• If your child is under 18, you have a right to access their medical information. Consider asking for a copy of their treatment plan, if your therapist hasn’t shared it with you.

Regardless of how you keep in contact, your participation will have a positive effect on the therapy process. Being open to change and trying new things along with your child is a huge deal!

Therapy for Kids and Tweens in Davidson, North Carolina

Ready to get started in therapy? I’d love to help you take the next step. My child therapy office is located in Davidson, North Carolina, just north of Charlotte. I also offer online therapy for kids living anywhere in North Carolina, New York, or Florida. You can reach out to me here.

If you’re searching for a local therapist, or unsure if therapy is the right step, check out my anxiety coping skills course for kids and their parents. It can give you practical, actionable skills to try at home in the meantime to deal with overwhelming worries and panic. The course includes sections for both kids and parents, so you can support your child in learning more helpful ways to cope.

If you’re looking for more information on getting started with children’s therapy, check out my other blog posts on the subject:

What Questions Should I Ask My Child’s Therapist?
Should My Child See a Therapist, Psychologist, or Psychiatrist?
What Are the Different Types of Child Therapy?

If you’re ready to get started, email me here to inquire about therapy sessions.

How to Find a BIPOC or LGBTQ+ Therapist for Your Child or Family

It can be really challenging to find a therapist of color—and even harder to find one who specializes in working with children. I hear similar struggles from families looking for therapists who are part of the LGBTQ community: it is sometimes difficult to find affirming therapists for kids.

Usually, I write in this blog about issues that I can help kids with in my therapy office, either in-person or online. This post is a little different: I’m not a BIPOC or queer therapist, but if you need one I’d love to help you find one for your child.

Below, you’ll find a list of directories designed to help match you and your child with therapists and other helpers who understand where you’re coming from. Each of these directories has an option to search specifically for children’s therapists, and also to filter the search results for therapists who share a specific identity or background.

The Benefits of a Therapist Who Shares Your Culture

In order for therapy to be effective, your child needs to feel understood. Of course, this doesn’t mean your child has to have every life experience in common with their therapist: sometimes it can be helpful to work with someone of a different gender or background. But research shows that therapy works better when a therapist understands the client’s culture, and can tailor the therapy to line up with their client’s experiences and beliefs.

Some potential benefits of working with a therapist who shares your culture include:

• Spending less time in session having to explain yourself or your experiences

• The ability to have therapy sessions in your native language

• More informed care when dealing with issues related to racism or systemic oppression

• A stronger, more trusting relationship with your therapist

For kids, having a therapist who looks like them can also be a helpful role model or racial mirror, providing another example of a helpful, caring adult in their community who looks like them.

Directories for Finding BIPOC Therapists

The following directories were created to address the challenge of finding therapists of color. While not all directories cater to children, the ones on this list do have options to search specifically for therapists who help kids.

Therapy for Black Girls was founded by a psychologist to help Black women and girls improve their mental health. They have a large database of therapists, and their search function allows you to look for therapists who accept your insurane, as well as therapists who specifically work with children or teens.

Therapy for Black Men, according to their website, was “born from the idea that Black men and boys face unique challenges, and therefore need a dedicated space for seeking and finding mental health support.” You can find Black therapists here who specialize in helping boys, and search specifically for therapists trained to help toddlers and preschoolers, elementary-aged children, tweens, or teens.

Latinx Therapy is a bilingual database that helps people find therapists who understand the Latinx experience in the U.S., as well as Spanish-speaking therapists. Their database allows you to search specifically for help with many different problems that could bring a child or family to therapy, including some specific to the Latinx community. You can also filter your search results for therapists who work with specific ages of children, from toddlers through teens.

Asians for Mental Health is a directory for AAPI therapists. All therapists list their specific ethnic backgrounds in their profiles. You can search for issues specific to the AAPI community, including transracial adoption and immigration, as well as filter the results for therapists who speak a wide range of languages. You can also run an age-specific search to find therapists who work with specific age groups, including young children.

Llapanchik Hampinakuy is a new directory for indigenous and native healers of all kinds. Founded by two Quechua therapists, its name means “we heal each other mutually” in Quechua. Expect to find indigenous and native therapists listed here, as well as other kinds of healers who take more holistic views on health and wellness.

Directories for Queer-Affirming and Culturally Competent Therapists

While the directories above are all devoted to specific racial or ethnic groups, the ones in this section are more broadly committed to inclusivity and cultural awareness. You can find therapists who have deep knowledge of specific cultures, experiences, or religions, as well as therapists who identify as LGBTQ themselves.

Inclusive Therapists is a very large database that, according to their website, “offers a safer, simpler way to find a culturally responsive, LGBTQ+ affirming, social justice-oriented therapist.” You can search for therapists with expertise in a variety of religious beliefs, racial and cultural backgrounds, and social justice issues. You can also search for therapists who self-identify as part of the LGBTQ community or as part of a specific race, culture, or group. “Children and Tweens” and “Adolescents and Tweens” are included as searchable specialties in the database.

The LGBTQ+ Healthcare Directory can help you find therapists, doctors, and other healthcare providers who are LGBTQ-affirming and who specialize in helping members of the queer community. While not specifically focused on mental heatlh, the databse includes a good number of therapists. Therapists can also be filtered based on ethnic background, languages spoken, and whether they specialize in working with youth.

TherapyDen is another large database with an emphasis on inclusivity. It allows you to search for therapists not just by cost or location, but by gender, ethnicity, and many other factors. Their “specialized experience” drop-down menu allows you to select for therapists who have described themsevles as Queer-competent, Trans-competent, Neurodiversity-affirming, and working from a racial justice framework. You can also search fror therapists specializing in child, adolescent, or family therapy.

More Mental Health Help for Kids

If you’re looking for some support while you search for the right therapist, my online coping skills course for tweens is available to download right now. My book, A Parent’s Guide to Managing Childhood Grief, might also be a helpful resource for children and families who are recovering from a loss.

I provide counseling for kids and tweens with anxiety and OCD, both in-person in my Davidson, NC therapy office and online throughout the states of North Carolina, New York, and Florida. Want to learn more about therapy with me? Check out my FAQ or contact me with questions.

5 Common Types of Intrusive Thoughts Your Child Might Have

Intrusive thoughts are freaky. Like an uninvited guest, they pop up and bother us with ideas or images we wouldn’t want to think about on our own. They can be frightening for kids to experience, because it feels like you’re losing control of your own mind. But they’re also unsettling to hear about as a parent, especially if a child’s thoughts are about something taboo, like death or violence.

The truth is, many intrusive thoughts are about taboo subjects. The more upsetting or off-limits something is to think about, the more likely it is to push back into our consciousness as an intrusive thought. It’s sort of an “opposite day” situation, where the things we find the most unpleasant—things we’d never actually want to do—pop up as thoughts or mental pictures.

Just knowing that other people have these types of thoughts can be reassuring, and a first step toward learning to manage them better. So, in this post, we’re going to go over 5 types of intrusive thoughts children commonly experience.

Content Warning: We’ll discuss specific examples of intrusive thougths in this article, which are often about upsetting or shocking subjects.

What Exactly Are Intrusive Thoughts?

An intrusive thought is any kind of idea, urge, image, or impulse that comes to mind when you don’t want it to be there. They can be about anything, but tend to be about subjects that a person finds upsetting, gross, or wrong. They usually happen repeatedly, and they can cause a lot of distress.

Intrusive thoughts are “ego dystonic”, which is a therapy jargon way of saying that they go against a person’s beliefs or don’t sync up with their personality. They can feel foreign or weird. People who have intrusive thoughts are aware that the thoughts are unusual, but can’t stop them from happening.

Intrusive thoughts are a really common symptom of OCD, which often starts in childhood. They can also happen in kids with anxiety or a history of trauma. However, that doesn’t mean every kid who has an intrusive thought has OCD! Pretty much everybody experiences a thought like this at some point. However, less-anxious people are more able to shrug them off as a weird, random event that doesn’t really mean anything. People with anxiety and OCD are more likely to hold on to these thoughts and worry that they mean something is seriously wrong.

What Are Some Characteristics of Intrusive Thoughts?

Intrusive thoughts stand out from the usual noise our brains make all day. If you’re trying to figure out whether your child is dealing with intrusive thoughts, consider the following list. Intrusive thoughts are unique because they tend to be:

• Involuntary: a person doesn’t want to have the intrusive thought, but it happens anyway.

• Repetitive: these thoughts tend to come back again and again.

• Anxiety-triggering: the thoughts can be annoying at best, and scary at worst.

• Out of character: the subject matter is something a person wouldn’t usually think about.

• Inappropriate: often, intrusive thoughts have to do with taboo subjects like sex, death, illness, violence, or bad behavior.

• Unwanted: the person has no desire to act on the thought, which is part of why it’s so upsetting. However, kids with anxiety or OCD may worry that having the thought means that someday they’ll lose control and act on it anyway—that’s not how these thoughts work.

Once you know what to look for, it gets easier to spot intrusive thoughts when they happen.

What Sorts of Intrusive Thoughts Do Kids Have?

Kids tend to have intrusive thoughts about subjects that society thinks are wrong or impolite to talk about—actually, this is true of adults with intrusive thoughts, too! Themes related to religion, sex, death, illness, or immoral behavior are all common when it comes to intrusive thoughts. Children may imagine themselves doing something they don’t really want to do, or see a mental picture of something they don’t like.

Younger children are still in the process of understanding adult concepts like sex, death, and violence, and their intrusive thoughts can reflect this. Even though the subject matter is the same, a child’s intrusive thoughts may not be the same as an adult’s. You might notice that your child’s thoughts are not realistic or logical. This can help set intrusive thougths casued by anxiety or OCD apart from the flashbacks caused by trauma or PTSD.

Next, let’s take a deeper look at 5 of the most common types of intrusive thoughts kids experience.

Type 1: “What If” Thoughts

OCD loves to make people doubt themselves. These “what if” thoughts often happen as a part of OCD, but they’re also one of the more common types of intrusive thoughts in general. A “what if” thought prompts you to question something you thought you knew for certain.

“What if” thoughts can affect people’s perceptions of their relationships, tasks they’ve completed, or even their own identity. Even if you have a clear memory of yourself doing something, the thought injects the possibility that maybe you actually forgot—and something bad might happen as a result.

Some examples of “what if” thoughts children might have include:

• A usually responsible child worrying that they somehow forgot to lock the door, and their dog will run away.

• A teenager who is secure in their sexual identity wondering if they might unknowingly be gay.

• A child who is bothered by thoughts of someone possibly hiding in their bedroom, even after checking under the bed and in the closet.

The hard thing about “what if” thoughts is that reassurance or double-checking only helps for a little while. Eventually, the doubt creeps in again and the cycle starts over.

Type 2: Thoughts About Hurting Self or Others

It can be alarming to hear your child is having repeated thoughts about hurting themselves or somebody else. Just like all other intrusive thoughts, these harm-related thoughts are unwanted and go against the personality of the child. Often, children who have these kinds of intrusive thoughts are described as being particularly kind, empathetic, and gentle.

Of course, any time you hear a child talking about harm, you can’t automatically assume it’s an intrusive thought. You need to rule out other possibilities, like suicidal ideation, which always need to be taken seriously. An intrusive thought—rather than an actual urge—might look something like:

• A child who has images pop into mind of pushing a sibling down the stairs, even though they’d never do something like that in real life.

• A usually kind child has thoughts about stabbing people that are so frightening they avoid being around knives or sharp objects.

• A teenager complains of fleeting thoughts about jumping in front of a train or running into traffic that bother him, because he really doesn’t want to die.

In all these examples, the thoughts are causing a lot of distress. Kids with this kind of intrusive thought don’t want to be thinking about violence, and may take great lengths to avoid being in situations they worry could be unsafe.

Type 3: Thoughts About Doing Something Embarrassing, Unkind or Illegal

Similar to thoughts about harm, this variety of intrusive thought is based on a fear that a child might somehow “lose control” and do something that’s socially unacceptable. Many people experience a stray thought like this, and shrug it off knowing they’d never act on it.

When children have these thoughts, they may not be so easy to shrug off. These taboo behaviors flash into a child’s mind, which makes them worry that some part of them really wants to do that bad thing. They put a lot of meaning into the experience, which leads to more anxiety.

Examples of this type of intrusive thought include:

• A child having thoughts about saying something inappropriate in a public place, like yelling “fire” in a movie theater or “bomb” in an airport.

• A student having bothersome thoughts while at school of saying insulting things to a classmate.

• A child who worries that their thoughts about shoplifting mean that they actually want to steal something.

When a child is truly having an intrusive thought, it’s extremely unlikely that they’ll ever act on it. Thinking and doing are very different things! However, the fear of possibly losing control can be very powerful, and get in the way of a child’s day-to-day life.

Type 4: Sexual Intrusive Thoughts

Even though they are common, this category of intrusive thought can cause a lot of shame and distress for kids. It can be hard enough to talk about the birds and the bees under normal circumstances, and even harder when you’re having your day interrupted by thoughts or images of upsetting sexual situations.

Because they are so taboo, children experiencing these types of thoughts may choose to keep them a secret. Even if children are open about most worries, they may fear that hearing about sexual thoughts will change a parent or therapist’s opinion of them. It can be a relief for children to know they’re not alone with these thoughts and to hear about examples of common intrusive thoughts. Some common worries in this category are:

• Worries about losing control and groping or sexually abusing someone.

• Unwanted thoughts that include family members, animals, or children.

• Fears related to unintentionally getting pregnant or getting someone else pregnant, even when this may not be logical.

There’s nothing pleasurable about these kinds of thoughts. Instead, kids experience feelings of shock, disgust, shame, and fear. Just like kids who have thoughts about harm, children with sexual intrusive thoughts may worry that having the thought means some part of them must want to act on it, and may avoid certain people, places, or activities as a result.

In reality, kids suffering from these types of intrusive thoughts are not violent or bad people: they’re just normal kids experiencing a bothersome mental heath symptom. It isn’t a reflection on their personality or character.

Type 5: Thoughts About Illness, Contamination, or Germs

Most of us have been worried about getting sick at one time or another. Health anxiety is really common, especially in the wake of the recent pandemic. Kids who struggle with intrusive thoughts may worry about sickness, too. They may worry about catching a disease, picking up germs, or spreading illness to other people. But there are some differences between their intrusive thoughts and regular health anxiety.

The thoughts children have about illness, contamination, and germs may be illogical or extreme. They may worry about catching germs from things that aren’t usually considered dirty, or about getting sick with a disease they’re highly unlikely to get. They may also worry about touching, breathing, or eating something that has somehow been contaminated. Some common fears for children with this type of intrusive thought are:

• Repeated fears that their food, drink, or utensils have been poisoned or contaminated by a chemical or cleaning supply.

• Fears that common objects or surfaces may have had germs on them.

• Thoughts about getting sick and dying from a disease such as cancer or AIDS.

• Worries about unintentionally spreading germs or serious disease to loved ones.

Children with these thoughts may avoid touching items with their bare hands, only eat “safe” foods or use “safe” utensils, or repeatedly wash their hands in an effort to avoid transmitting disease. These behaviors go above and beyond the hygiene we’d expect to see in a Covid-conscious kid, and interfere with day-to-day life.

Get Help for Kids with Intrusive Thoughts

As upsetting as they may be, intrusive thoughts are normal and common. Kids dealing with these types of worries are not alone! Sometimes, just knowing this can help soothe children’s anxiety about intrusive thoughts. When children accept these thoughts for what they are—random brain hiccups—it’s easier to just let them pass by without trying to push them down. Over time, this can help the thoughts to happen less and less often.

Other kids will need more support in dealing with their thoughts. This is especially true if the thoughts are accompanied by an urgent need to do something again and again, like washing hands or asking a parent if everything is okay. Kids whose intrusive thoughts begin after a traumatic event should also get support to help them recover.

Exposure and Response Prevention is the most effective tool therapists have to help children with compulsive thoughts and behaviors get their lives back. TF-CBT can help kids and their parents learn skills to cope with trauma symptoms and move forward in life without feeling overwhelmed by flashbacks or memories.

I offer both these therapies in my child counseling practice. I’m based in the Charlotte, NC area, but also work with kids online throughout the states of North Carolina, New York, and Florida. If you’re interested in starting therapy for intrusive thoughts, contact me here.

If you’d like to learn more about intrusive thoughts, check out my other blog posts on the subject:

Intrusive Thoughts in Children, Explained
How to Help a Child with Intrusive Thoughts
Signs of OCD in Children: What Parents Can Look For

Do Kids Grieve Differently Than Adults?

Children’s grief doesn’t always look the way we expect it to. With kids, sometimes still waters run deep. If your child has just experienced a loss and they aren’t talking about it, are they still feeling it? Should you bring it up to them, or wait until they come to you with questions? How can you tell if your child is processing their grief in the way they need to in order to move forward and heal?

All children are capable of grief: they just show their feelings differently than adults do. In this post, we’ll take a look at the key differences between child and adult grief. We’ll also go over how children of different age groups tend to grieve, so you can keep an eye out for common signs of grief in your own child.

Children’s Grief Can Be Hard to Recognize

Back in the days of Freud, experts believed young children weren’t capable of feeling grief, because they couldn’t fully understand what death meant. Today, we know that isn’t true at all: even little babies can sense when a caregiver has left. Children don’t need a complete understanding of death to mourn the loss of a loved one.

When most of us think of grief, we imagine lots of crying, maybe even depression. We might imagine grieving people talking a lot about how much they love and miss the person who died. We might assume it will be a long time before the griever starts to feel or act like themselves again.

Kids’ grief doesn’t always fit this traditional mold. While many children will cry or feel sad after a loved one dies, others may not. Their feelings and reactions to grief might change rapidly or seem short-lived. Because their grief looks so different, it’s easy to miss. Parents may notice behavior changes or physical symptoms in their children, but not recognize them as being related to grief.

Difference 1: Delayed Reactions

When a loved one dies, children have to deal with a huge shock that they don’t fully understand. In addition to dealing with the loss, kids often have to figure out what exactly death is, and what it means for them. Most children also don’t have a lot of prior experience with grief, so they may not know how they are “supposed” to react when faced with such horrible news.

Kids can grieve even if they aren’t old enough to fully conceptualize death. However, it might take them longer to process what has happened and begin showing their feelings about it. Grievers of all ages experience shock and denial after death. For children, this might include wondering if a loved one might still be alive, or wishing they could come back to visit. Little children may ask repeated questions about the death in an attempt to understand it better.

Once time has passed and children have developed an age-appropriate understanding of death, you may notice more recognizable grief symptoms begin to show up. But if a child doesn’t appear sad right away, it doesn’t mean they aren’t grieving.

Difference 2: Grieving in Bits and Pieces

Children process their feelings differently than adults do when it comes to grief. A bereaved adult is likely to feel their grief intensely for weeks, months, or even years after a loss. They may have to work hard to give themselves breaks from grieving, so it doesn’t overwhelm them. Adult grief is ever-present, and the feelings tend to exist even when the griever is focusing on other tasks.

This isn’t how grief works for most children. Kids are much more able to jump in and out of grief. It’s normal for a child to cry and have intense feelings for a short period of time, before seemingly moving on to another activity, like playing with friends or watching a show.

This kind of back-and-forth would seem weird if an adult did it, but it’s perfectly normal for kids. Adults have a much bigger emotional capacity than kids do: they can tolerate a lot more before getting overwhelmed. If you imagine that an adult’s capacity for grief is like a big empty cup, a child’s might only be a tiny thimble. Once a child’s thimble is full, they need to step away from their grief process for a while, and return when they’re ready to handle some more.

Difference 3: Kids Feel Grief in Their Bodies

Studies have shown that kids are much more likely than adults to have physical pain and other body-based symptoms as part of their grief. This may be, in part, because it’s harder for kids to put their feelings into words. Instead, they hold on to all those feelings inside, and they show up in other ways.

It’s common for kids to complain of headaches and stomach aches as a result of the stress. They may also feel fatigued, dizzy, or have trouble focusing on things. Sleep and eating habits can change, too: bereaved children may have poor appetites or trouble falling asleep at night.

It’s always a good idea to talk to a doctor if your child isn’t feeling well. However, if your child’s symptoms don’t have a clear cause, they might be an outward sign of your child’s grief.

Different Signs of Grief in Preschoolers (3-5 Years)

Little children are in the earliest stage of understanding death. They’ve probably seen movies or cartoons in which characters die, and this might be their only basis for comparison. Children may assume death means that a person has gone away, fallen asleep, or otherwise left them in a way that is not permanent. They may also worry about whether or not their loved one is afraid or feeling pain.

Any stressful event can cause regressions for preschool-aged kids, and death is no different. You may notice your 3, 4, or 5-year old returning to earlier habits, like thumb-sucking or bedwetting. Your child may be extra clingy for a while, or have trouble sleeping alone when they were once independent.

You might also notice that themes or details from your loved one’s death show up in your child’s play. While it might be a surprise to see your child having a funeral for a Barbie doll, or re-enacting an accident with toy cars, this is usually a healthy sign. Children process feelings through play, so these types of activities help kids make sense of what has just happened in their world. If the play is prolonged, rigidly repetitive, or seems to make your child upset instead of relieved, it might be worth speaking to your child’s doctor or a children’s grief counselor.

What Grief Can Look Like for Big Kids (6-10 Years)

6, 7, 8, 9, and 10-year-olds have their own unique experiences during the grieving process, including magical thinking.

Older children have a more solid understanding of death, which is both good and bad news. On one hand, it’s easier to help kids in this age range understand what’s going on when a loved one dies. On the other, kids tend to develop their intellectual ability to understand death before they build the emotional skills they need handle the strong feelings of grief. As a result, elementary-aged kids may have the hardest time coping with loss.

Big kids may be wondering why their loved one died, and searching for explanations that make sense to them. Kids in the younger end of this age range often believe that their thoughts and feelings have a direct influence on the outside world. This can lead to children worry that something they said, did, or thought might have caused their loved one’s death. It’s important for children to have a clear explanation for their loved one’s cause of death that removes any possible blame for what happened.

Children may ask repeated “why” questions at this age. It’s likely, though, that your grade schooler will show you their feelings more than they tell them. Physical complaints are common among this age group, and so are problems with sleeping and difficulty concentrating at school. Keep an eye on how your big kid handles school and friends in general: some children may throw themselves into too many activities in an attempt to cope, while others may withdraw from friends and hobbies they once enjoyed.

How Do Tweens and Teens Grieve Differently?

Tweens and teens are able to think more abstractly, which means they’re able to grasp the concept of death in ways that younger kids can’t. They understand that death is permanent, and they may wonder about their own mortality or the afterlife when a loved one dies. Even though tweens and teens think about death in similar ways to adults, they still face their own unique emotional challenges.

As kids near the teen years, their friend group becomes increasingly central to their lives. This means tweens and teens may be more likely to turn to their friends for comfort when a loved one dies. If your child is part of a healthy, mature friend group, this can be a great source of support. However, it can be hard for peers who haven’t experienced their own loss to empathize in the way that grieving teens need.

Depending on your relationship with your tween or teen, you may notice that relying more on friends for support means you hear less about your child’s grief. Changes in grades, dropping out of school activities, and self-isolating can all be ways that older kids show they’re struggling with grief. It’s also common for kids in this age range to compare their situation to non-bereaved friends, so keep an eye out for unusual arguing or difficulties with peers. Death is unfair, and it’s easy to feel jealous or angry at a friend who complains about their family when you’ve just suffered a loss in yours.

Finally, tweens and teens are more likely than younger kids to find unhealthy or harmful ways to cope with grief. They may have access to drugs or alcohol, or may use self-harm as a way to deal with strong feelings. Any signs that a child may be considering self-harm or suicide should be taken very seriously, especially when a child is grieving.

Grief Timelines Look Different for Kids, Too

Grief can be a lifelong process, and this is especially true for children. Many kids start working through their grief before they fully understand the concept of death. This doesn’t make their grief any less valid or painful, but it does mean they’re likely to revisit their grief as they age. As children mature, they may understand their loss in new ways, and more fully grasp everything they will miss out on in the future with their loved one.

Milestones like special birthdays, graduations, and other coming of age traditions can rekindle grieving feelings for kids. These events, while happy, are also a reminder that someone is missing from the family. This is especially true for children who have lost a parent or caregiver. As kids become young adults, they may be increasingly aware of how their early loss will affect their weddings, the birth of their children, and other life milestones.

If you notice your child has a hard time around the holidays, or enters a period of intense grief when a milestone occurs, it’s okay. It doesn’t mean your child’s grief is getting worse or moving backwards. They’re just looking at their grief with a new perspective and working through it in a deeper way.

Grief Help Made Especially for Kids

I hope you reached this page either out of curiosity, or to prepare for the future, just in case. If that’s not true, and you’re here because your child is grieving, I have a resource to share with you.

I wrote an activity book, A Parent’s Guide to Managing Childhood Grief, that was created to help parents understand and support the unique ways that children grieve. The book contains 100 playful and creative activities for kids ages 5-11, divided into categories to address some of the most common needs children and families face when a loved one dies.

If you’re wondering how to help your child understand what death means, or explain difficult details about a loved one’s passing, you’ll find scripts inside to help. There are also chapters devoted to safely expressing feelings like guilt, anger, fear, and sadness that tend to show up during a child’s grieving process. Finally, you’ll find activities you and your child can complete together to encourage a sense of safety, meaning, and hope after grief.

A Parent’s Guide to Managing Childhood Grief is available at all major bookstores, including Amazon, Barnes and Noble, and independent bookstores.

Grief Counseling for Children: How to Find the Right Help

While we may think of death as a grown-up topic, the truth is that many children will be touched by grief and loss at an early age. By the time they turn 18, roughly 5.8 million children will experience the death of a parent or sibling. The number of children grieving any kind of loss, including the death of a close friend or extended family member, is much higher: 1 in 3.

Some children benefit from having a person to talk to about their grief who isn’t a family member or friend. Counseling can help children to process their feelings, and make it less likely that they’ll struggle with their emotions later in life. Some forms of therapy are a more natural fit for grief counseling than others, and finding a child therapist who is experienced with grief can make a world of difference.

Do All Grieving Children Need Counseling?

If your child is reluctant to go to therapy, there’s no need to push. While grief therapy can be very helpful, it may not be necessary for every child. Grief is painful and difficult, but it’s also a natural process and the result of the close bond your child formed with their loved one. Research shows that many kids are able to adjust and cope with their loss on their own, with fewer lasting difficulties as they grow. These children might appreciate having a listening ear to talk to, but may not want or need it.

Other children have a harder time dealing with their intense feelings of grief. They may feel “stuck” in their grieving for a long time, or their emotions might be so overwhelming that they interfere with school, family, or friends. A child’s temperament, age, gender, support system, and trauma history can all influence the way they grieve. The way that a loved one died can also have a big impact.

If these more vulnerable kids don’t get help to move through their grief, their unresolved feelings put them at risk for problems later in life. These children may struggle with tantrums, problems with school or peers, and increased anxiety or depression. As adults, they may be more likely to develop mental health problems or unhealthy ways of coping with feelings.

When to Look for Help for Your Child

How can you tell if your child is coping well, or if they will need counseling to get through their grief? Your child’s feelings and behavior, as well as the circumstances surrounding their loved one’s death, can guide your decision-making.

If any of the following are true for your child, they may be more likely to need a grief counselor:

• Your child did not have many opportunities to mourn, such by attending a funeral or memorial service

• Your child struggled with anxiety, depression, or low self-esteem before the death

• Your child has a history of other traumas or losses

Some types of losses also make it harder to grieve, such as:

• The loss of a parent

• A death that was sudden, unexpected, or violent

• A death that happened when your child was very young (under age 8)

Regardless of the circumstances, if your child is showing signs of ongoing anxiety, depression, or anger following the death, they might benefit from therapy. Some of these signs include:

• Feeling guilty or believing they did something to cause their loved one’s death

• Avoiding talking about the death or doing things that could trigger memories of their loved one

• Feelings of hopelessness

• Intense feelings that get in the way of daily life

• A lack of interest in doing things, or big changes in behavior that continue after the initial wave of grief has passed

• Nightmares or trouble sleeping

• Any mention of self-harm or a wish to die: this should always be taken seriously

Sometimes, a child who is seemingly doing just fine will ask to go to therapy. It’s possible for kids to be grieving deeply on the inside but not show it on the outside. If at all possible, find a way to set your child up with a counselor for at least a few sessions to get some support and see if ongoing therapy would be a good fit.

What Types of Therapy Can Help Grieving Kids?

If you’ve decided to pursue counseling for your child, you’re faced with a ton of options. Should you look for individual therapy or a group? Does your child need a therapist, psychologist, or psychiatrist? Let’s take a look at a few options for therapy that are a good fit for grieving kids. We’ll talk about how they work and why they can help with grief. We’ll also discuss what situations these types of therapy tend to work best for.

Play Therapy: Sitting on a couch and talking about feelings works well for older kids and adults, but it’s not always the most natural thing for young children to do. If you’re seeking therapy for a child under the age of 10, I strongly recommend finding a counselor who uses play therapy in their sessions.

Children use play to learn and make sense of the world around them. It’s why we see children repeating the same situations in play over and over until they master that concept and move on. Creative play and make-believe can help children sort through their confusion and strong feelings about death. It gives young children an opportunity to express big emotions and ideas that might be too complex to put into words.

A skilled play therapist can guide this process for children and keep an eye out for signs of trauma, self-blame, or big misunderstandings about death that could be causing additional pain. Look for somebody who describes themselves as a Registered Play Therapist to find someone highly trained in this type of work.

Trauma-Focused Cognitive Behavioral Therapy: Grief is shocking and stressful for everybody, but some children may experience their loss as a traumatic event. This is especially true if a child has lost a parent, or if their loved one’s death was very sudden or due to a violent act. Children who go through these kinds of losses may experience traumatic grief, which includes symptoms of PTSD.

Children suffering from traumatic grief might struggle with frequent nightmares, or deal with unwanted memories or images of their loved one’s death that pop up during the day. Sometimes, it might even feel like they’re living through that moment in time all over again, which is called a flashback. Traumatic grief feelings are so strong that children may avoid doing anything that they associate with their loved one or the death, so they don’t have to think about it.

These children need therapy that helps them deal with both their trauma and their grief, so they can think about their loved one without getting overwhelmed or avoiding things they used to enjoy. Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT, was designed to help children learn the skills they need to manage strong feelings and gradually tell the story of what happened to them. Kids get a lot of support from their therapist and caregivers along the way.

Group Therapy and Support Groups: Many bereaved children feel isolated. Even though grief is a common experience, it’s likely they don’t have any friends who have gone through a similar loss. Peers may not know what to say to a grieving child, or how to help. Young grievers may avoid talking to their friends about what has happened for fear of upsetting them or appearing vulnerable.

It’s also common for grieving children to worry about whether or not their grief is “normal.” Grief can bring up all kinds of feelings and reactions, some of which are confusing or even contradict each other. Reading stories about grief can help children realize that these complicated emotions are normal and okay. Talking to another grieving child, however, can be even more validating.

Being around other kids who “get it” can help grieving children in a way that individual therapy can’t. Instead of learning about grief from an adult, children can hear directly from other peers about how loss has touched their lives. Children can share their stories and struggles in a safe environment where they know everyone else will understand what they are going through.

Therapy groups are led by a licensed mental health professional, while support groups usually are not. Both types can have a lot to offer grieving children. You can find a therapy or support group near you by entering your zip code into this tool from The Dougy Center.

What Do Children Do in Grief Therapy?

If you’re considering grief counseling for your child, you may be curious about what exactly happens in the therapy room. Your child might be curious, too! Every therapist is different, but here are some general ideas of activities your child’s therapist might introduce to help your child learn about and express their grief:

• Read books or play games to learn age-appropriate facts about death and grieving.

• Use art or pretend play to explore feelings of grief without having to talk about them directly.

• Draw pictures, write poetry, or use other forms of art to express feelings and memories.

• Create rituals to honor and remember your loved one’s life.

• Write a letter to your child’s loved one to express things that were left unsaid.

• Learn coping skills to manage the strong feelings of anger, sadness, and other feelings that sometimes come along with grief.

A grief therapist will never push your child to talk about things before they feel ready. While they may make suggestions, your child gets to choose the pace. It’s always okay for your child to say they aren’t ready to share.

Help Your Child While You Look for a Grief Counselor

Once you’ve decided to find a grief counselor, it may take a while before you book your first appointment. Not all children’s therapists specialize in grief, or work with every age range. The demand for children’s therapy is high in many places, which means you might need to time on a waiting list or search longer to find someone who has availability.

While you wait for your first appointment, you can help your child begin to cope with their grief at home. As a parent or caregiver, your support will be one of the most helpful resources a grieving child can have. My book, A Parent’s Guide to Managing Childhood Grief, was created to help parents and other caring adults guide children through the difficult, complex feelings that come with loss.

This book is filled with simple, easy-to-follow activities that tackle big ideas like finding meaning and imagining a hopeful future after loss. You’ll find over 100 ideas for how to use creative play, books, and games to start gentle conversations about death, express difficult emotions, and strengthen family bonds after loss.

While not a substitute for therapy, these activities are inspired by my own work as a child therapist, and borrow ideas from cognitive behavioral therapy and other approaches often used with grieving kids. The book is available for presale on Amazon, as well as other major bookstores near you.

To find a grief counselor near you, check out The Dougy Center or the National Alliance on Children’s Grief. Both have directories to help you find local children’s therapists or support groups. If you live in New York, North Carolina, or Florida and would like to learn more about counseling with me, you can contact me here.

What Questions Should I Ask My Child's Therapist?

You take a seat in the therapy office—or log on to your video conferencing platform at the appointed time—to meet your child’s new potential therapist. Maybe this isn’t your first rodeo seeking therapy your child, and you’re wondering if this counselor will have the help you need. Or, maybe it is your first visit, and you’re feeling a little overwhelmed about where to start. Either way, finding a counselor for your child is a big step, and you probably have a lot of questions to ask.

It’s really important to find a therapist who is the right fit for your child. All of us—whether we’re 9 or 99—will heal the best when we’re working with a counselor we like and trust. You don’t always have to see eye to eye, but you do need to feel safe talking to them. It also helps to find someone who truly specializes in the problems bringing you to therapy. So, how do you figure out if you’ve found a good fit? Let’s go over X questions you can bring up in your initial visit with a new therapist to learn more about what to expect.

Therapists Want Your Child to Find The Right Fit—Even if It’s With Someone Else

Sometimes, your first talk or visit with a child therapist might feel a little like a job interview. And it kind of is! You’re getting to know the therapist and how they work, and the therapist is getting to know you and your needs. It might feel awkward to ask questions about your therapist’s expertise or approach: what if you decide afterward that you need to see someone else?

Please know that we want to find the right therapist for your child almost as much as you do. We aren’t going to take it personally if you ask a hard question, or decide need to move in a different direction to find your child help. It feels amazing to be able to find someone the exact kind of help they need, even if that means they need to go elsewhere. I think I speak for most therapists when I say that working with a child I’m not equipped to help is a bummer. I don’t want that for me, and I don’t want that for you!

So, go right ahead and ask the questions you need to ask. You can even ask us to recommend other therapists to you. It’s not a weird request, and most therapists will be happy to oblige.

How Do You Interview a Child Psychologist, Counselor, or Therapist?

Reach out to the therapists who interest you, and see what their protocol is. Some may be happy to offer a consultation with you over the phone, while others may invite you into the office for a full intake session. Some therapists may charge for this service, while others don’t. Whether by phone or in person, it’s helpful to have a fairly in-depth conversation with a new therapist before your child’s first session.

While doing your research, you’ll probably find therapists with all sorts of titles beside their names, including psychologists, counselors, and psychiatrists. You might also see people who specialize in particular types of therapy, like play therapists or drama therapists. You can read more about the differences between types of therapists here to see who might be the best fit for your family. You can also check out my blogs on play therapy and drama therapy to learn more about how those approaches help kids.

If possible, set up appointments to talk to at least a couple different therapists. It’s okay to shop around a little bit before making a commitment to begin therapy. Even the most amazing therapist isn’t going to be the right fit for every child or family. Interviewing multiple people makes it more likely you’ll click with someone.

5 Questions to Ask Your Child’s Therapist

Okay, so you’ve done your research, found a few contenders, and set up some times to interview possible therapists for your child. What do you ask once you get to the appointment? I’m going to share 5 questions I think are pretty universal and would benefit any family that’s considering starting therapy. If you’ve never been in counseling before, these may not have occurred to you to ask. Hopefully they’ll be helpful to you!

Of course, every child’s situation is different and you may have more specific questions you need to ask in order to find the best fit. These questions should provide a good jumping-off point for more detailed conversations about your child, family, and needs.

Question 1: How Much Experience Do You Have Working with Children Like Mine?

No matter how skilled a therapist is, it’s impossible to be an expert in everything. You are likely to have the best experience working with a therapist who has helped children navigate similar issues. They’ll already know the ropes, and have an idea of what approaches will help.

You might want to know if your therapist has in-depth training or experience working with a specific diagnosis, like ADHD or OCD. Or, it might be helpful to hear if they specialize in helping children through certain issues, like divorce or grief. Sometimes, it can be helpful to find a therapist who shares or is very knowledgeable about your cultural, racial, or religious background.

Working with children is also very different than working with adults. Just because a therapist specializes in helping adults or teens with anxiety, for example, doesn’t mean they’ll automatically know how to adapt skills to work for kids. Ideally, you want to find a therapist who specializes not just in children, but in kids in your child’s specific age group. After all, a preschooler learns, thinks, and communicates really differently than a tween!

Question 2: How Will I Be Involved In My Child’s Therapy?

Depending on the circumstances, you may hear a lot or a little about what goes on in your child’s therapy sessions. Your child’s age, their specific concerns, and your therapist’s style will have a lot to do with what is shared and what isn’t. However, what you’re told about your child’s therapy should probably be more than nothing, and less than everything.

Ask your potential therapist if they plan to meet with your child alone, or if they’d prefer to have everyone meet together. There’s no wrong answer, but it helps to know what to expect. You should also know how you’ll be kept in the loop about how therapy is going. Some therapists may send home weekly reports, while others will schedule periodic parent sessions to talk about progress and goals.

In general, the younger your child is, the more involved you need to be in their therapy in order to see good results. Young children need their parents help to regulate their feelings, so coping skills only work if you’re there to help. On the other hand, all kids need some element of privacy in order to feel comfortable sharing in therapy. The older your child is, the more personal space they are likely to need.

No matter your child’s age, you should expect to have some information about how therapy is going, what your goals are, and what you can be doing to help. Also, you can always expect to be told if your therapist suspects that your child could be in a dangerous situation or is at risk of hurting themselves or others.

Question 3: What Are Your Fees? How Do You Handle Payment and Cancellations?

It stinks to get all the way through an interview with a new therapist, only to discover you can’t make things work financially. Hopefully, you were able to get a sense of your therapist’s fees from their website before meeting. If you aren’t clear or the information wasn’t listed, please ask! Money conversations might feel a little bit awkward, it’s so important to know up-front what you are committing to.

Therapy sessions in private practice work differently than many other medical appointments. Your therapist may or may not take insurance. If they do, your copay might be different than it is for other types of medical care. If they don’t take insurance, you may still be able to get insurance to reimburse you for some of the cost, but it may be your responsibility to contact your insurance provider. It’s likely you’ll need to be prepared to pay the full fee for your session on the day of your visit.

Also, it’s good to know that many therapists have policies about when and how clients can cancel appointments. This is excellent to talk about in advance, so you can plan ahead and not end up with a charge later that you hadn’t expected. It’s common for therapists to request either 24 or 48 hours’ notice when someone needs to cancel a session for a non-urgent reason.

You can break this big question about fees down into some smaller ones to get a detailed idea of the financial investment you’ll be making if you continue therapy:

• How much is your fee per session?

• Do you charge a different amount for intake or initial sessions?

• What insurances do you take, if any?

• What is your cancellation policy?

• How do I pay for sessions: by cash, check, card, or another way?

Question 4: Can You Estimate How Long It Takes Children to Complete Therapy?

Therapy isn’t just a financial commitment, it’s a time commitment, too. It helps if you have a ballpark idea of what to expect before you get started. That “ballpark” might still be a pretty broad estimate—it can be really hard to predict how quickly a child will move through therapy. Many things—your child’s age, the reason they’re coming to therapy, any trauma history they may have—can influence how much time they will need.

Still, your counselor should be able to talk with you about whether the type of therapy they practice is short, medium, or long-term work. There are some forms of therapy that are designed to be extremely brief, so children might complete the whole sequence in 8 to 12 sessions. That still may feel longer than what you might expect from brief therapy! Therapists who do deep trauma work or use a psychodynamic therapy approach may see clients for many months or years. Many therapy styles fall somewhere in between.

Question 5: Is There Anything I Can Do at Home to Support My Child’s Progress?

I love being asked this question, because the answer is almost always yes! You and your child’s therapist will be partners in their care. Your therapist only sees your child an hour a week, while you are with them day in and day out. Your therapist may have a broad knowledge from having worked with many children your child’s age, but nobody has a deeper knowledge of your child as an individual than you. Therapy just works better when parents are following up at home.

Your therapist may have book recommendations for you and your child, or ideas for coping skills the two of you can try together. If you continue working together, they may be able to help you figure out ways to tweak how you’re handling situations at home to help your child better manage their feelings. Asking this question during your first interview helps you get a better idea of the therapist’s style, and the sort of “homework” you may be asked to do down the road.

Begin Child Therapy in New York, North Carolina, or Florida

If you’re looking for a children’s therapist and you’re in one of these three states—New York, North Carolina, or Florida—I may be able to help! I specialize in helping anxious tweens overcome worries and cope with strong feelings using a combination of play therapy and CBT. Children are welcome to visit my Davidson, North Carolina therapy office for in-person counseling, or meet me online for virtual therapy.

I also have some mental health resources that are available to all families, regardless of location. My coping skills course, Worry-Free Tweens, helps kids and parents learn new strategies they can use at home to combat anxiety. It’s a great first step to take while you’re looking for a therapist. My book, A Parent’s Guide to Childhood Grief, helps children and caregivers reconnect and talk about their loss through play-based activities.

Now that you have your first 5 questions prepared, you’re ready to go forth and interview some therapists. I’m wishing you the best of luck on your search!

6 Helpful Books on Grief for Elementary Students

By elementary school, children have developed an awareness of death. They’ve seen characters pass away in TV shows and movies, and noticed that plants and animals die in real life, too. None of this makes it any easier, however, when a loved one dies. Death brings up many difficult questions for elementary-aged kids, and reading books about grief together can set the stage for healthy conversations about loss.

We’ve already covered picture books to help children under 5 cope with a loss. Today we’ll take a look at books geared toward slightly older kids. These 5 books can help early elementary schoolers—roughly ages 5 through 8—learn about grief, death, and serious illness.

How Stories Help 5, 6, 7, and 8-Year-Olds Through Grief

Stories and picture books give 6 through 8-year-old children accurate, age-appropriate information about death, which can help reduce anxiety. Death is a big unknown for all of us, but especially for kids. Children who don’t have enough information about death may make assumptions on their own that lead to even more worry, such as wondering whether or not they did something to cause their loved one to die.

Reading a book also helps children talk and think about death without having to share their own personal experiences. It’s easier to talk about a fictional character and their grief. Stories help elementary-aged children understand grief through another person’s perspective, and hopefully realize that the feelings they’re having are normal and healthy, too.

Time spent with a parent or loving adult is one of the most helpful experiences a grieving child can have. 5,6, 7, and 8-year-olds will still need a lot of support from you to understand their grief. Sitting down to read a book together is a wonderful way to comfort your child and let them know its okay to talk about grief.

Finding Meaning in the Life Cycle: The Fall of Freddie the Leaf, by Leo Buscaglia

Recommended age range: 4-8

At first glance, the title and plot of this book might seem a little corny—at least it did to me! The story follows a leaf through the four seasons of the year, from growth in the spring to falling off the tree and dying in the fall. It’s accompanied by nature photography that shows the beauty of each season.

While the book is recommended for kids ages 4-8, I think the length and wordiness of the story might challenge the attention spans of some younger readers. The story also raises some big philosophical questions that might be better suited to older kids, like “What’s our purpose in life?” Finding meaning in life and death is an important part of grieving, and few children’s books talk about it. If your child is starting to ask deeper questions, this book is a gentle way to think about how life and death are both natural parts of life.

One small word of caution: at the very end of the book, there’s one brief mention of death feeling like falling asleep. Younger children may take this literally and worry about falling asleep at night. I’d recommend changing the words when you get to that page!

Talking About Causes of Death: When Dinosaurs Die, by Laurie Krasny Brown and Marc Brown

Recommended age range: 4-8

Death is never easy to talk about, but it can be even harder to broach the subject when a loved one’s cause of death was difficult or sensitive. This heavily illustrated book is divided into panels, like a comic strip. The pictures are expressive, colorful, and full of small details for children to notice and study. The pictures alone can prompt a lot of discussion, but this child-friendly book also shares some hard truths about death.

When Dinosaurs Die offers brief, age-appropriate explanations of death caused by violence, racial prejudice, suicide, and substance abuse. It also helps children understand that while most people live to a very old age, it is sometimes possible for very young children and even babies to die. These specifics may be too much information for families looking for a more general introduction to the subject of death. If your little one has experienced one of these causes of death, however, reading about them in print can be extremely reassuring.

Flip through this book in advance to ensure that the content is right for your child’s needs. It’s okay to pick and choose sections to share. This is one of the books I find myself turning to again and again in my child therapy practice to help children make sense of more difficult grief experiences.

Saying Goodbye After an Illness: Ida, Always by Caron Lewis

Recommended age range: 4-8

Ida Always doesn’t feel like an educational or therapy book—it’s just a good story. Like many of my favorite books for kids, this one teaches by showing, not by telling. Readers meet Ida and Gus, two polar bears at the Central Park Zoo (who really existed!) who are best friends. One day, Ida becomes very sick and can’t get better. Over the course of the book, Ida and Gus grieve and prepare for Ida’s death together.

This book offers a child-friendly explanation of death, as well as a good example of what to expect when someone has a terminal illness. Ida sleeps more often, has good and bad days, and sometimes need a moment alone while she is sick. Gus goes through some very human feelings, too: disbelief, anger, humor, and acceptance are all a part of the story.

Gus—and readers—learn that you can continue a friendship during and after terminal illness, and that you don’t need to see someone in order to stay connected to them.

A Spiritual Look at Death: The Endless Story, by Melissa Kircher

Recommended age range: 5-10

This lesser-known book explores the entire life cycle, from birth to death as well as what might happen after. It’s great for children who are asking deeper questions about what gives life meaning, or where people go after they die. The Endless Story explores many ideas different people and cultures have about the afterlife. The book uses simple, open-minded language and doesn’t comment on whether anyone is right or wrong, which makes it appropriate for kids of all beliefs and backgrounds.

The Endless Story describes the life cycle as something universal—it happens to all of us. It’s a gentle and even beautiful way of looking at life and death that works for kids of all ages, but really lends itself to elementary-aged kids. The author, a professional artist, has added beautiful illustrations throughout that will encourage children to read this book again and again.

A Recipe for Getting Through Grief: Tear Soup, by Pat Schweibert

Recommended age range: 8+

This quirky, longer picture book uses the metaphor of creating a recipe to describe the many layered “ingredients” that make up the grieving process. Because it’s more abstract, it’s best for older kids who can easily tell the difference between fantasy and reality. Amazon recommends this book for kids 8 and up, but I think it could work for slightly younger children who are avid readers, too. It’s a little on the long side, so you may want to break the story up into a few reading sessions.

In fact, many adults who have reviewed this books say it’s been helpful for them, too. The story’s main character goes through many feelings associated with grief, including a few that are harder to talk about, like jealousy and hopelessness. Children and adults can learn about how grief isn’t a linear process, and it’s okay to focus on your grief for a little while and then take a step back when it becomes too intense. Finally, the book stresses the importance of finding supportive people who understand and can share your grief with you.

Help Your Elementary Schooler Cope with Grief Through Art and Play

These picture books are a great start to helping your young child understand grief, death, and loss. However, grief is a lifelong process: it will take more than one story to help your child work through their feelings. Losing a loved one is a huge, overwhelming experience, and it’s okay to take things one step at a time.

If you need ideas for more small steps you and your child can take to process grief, my book may be right for you. A Parent’s Guide to Managing Childhood Grief takes you step by step through activities you can use at home to help your child safely express big feelings, understand their loss, and begin to adjust to a “new normal” after a loved one has died.

All activities are geared toward children ages 5-11. You can pick and choose the ones that seem right for your child. The book is available on Amazon, Barnes & Noble, or at an independent bookstore near you.

Picture Books About Death, Grief, and Loss: Five Stories for Kids Five and Under

Preschoolers and kindergarteners are just beginning to understand the basics of what it means when a living thing dies. This makes it challenging to talk about grief and loss with little kids: even though it’s important to do, it can be hard to figure out where to begin. Picture books take these big subjects and break them down into smaller, more manageable pieces. That’s why several of the exercises for younger children in my grief activity book begin with reading a story together.

Picture books are an opportunity for you to sit down with your child and provide some much-needed one-on-one support after a loss. Stories help kids to approach grief in a gentle way, and helps kids to express their fears and feelings without having to speak directly about their own grief. Perhaps most importantly, stories reassure children that the feelings of grief are universal. Picture books take all the big, overwhelming feelings that come after loss and make them just a little bit easier to understand.

Let’s take a look at 10 picture books that can help your young child learn about grief, death, and loss. We’ll focus on stories geared toward children from preschool and kindergarten through the early elementary years.

What to Look for in a Picture Book for Kids About Grief

As a children’s therapist, I am always on the lookout for good books for my play therapy office. Something that’s important to me is that books about tough subjects don’t feel too “therapy-ish.” Really good stories for children don’t feel like after school specials or counseling in disguise, even when the topic is heavy.

Good storytelling—likable characters, strong writing, and beautiful illustrations—hold a child’s interest and help them connect emotionally with what they’re learning. I think even little children can sense the difference between a book focused on storytelling and a book that isn’t.

You may also want to pay attention to how stories describe what happens after someone dies. Some books include religious beliefs, while others don’t. None of the books on this list follow any particular belief system, so they should work for most families. Still, it’s worth paging through your picture books in advance to make sure there aren’t any messages that could be confusing to your child. Some books may use phrases like “went away” or “went to sleep” to describe death, and this kind of abstract language can be hard for young children to grasp.

A Grief Book for the Youngest Children: The Goodbye Book, by Todd Parr

Recommended age range: 3 and up

Preschoolers and kindergarteners may already be familiar with Todd Parr’s popular book series. The bright style of his illustrations is easy to recognize. The Goodbye Book is short and sweet, with basic vocabulary and only one sentence per page, making it ideal for very young readers. The language is simple, but the ideas are pretty grown-up.

Each page describes a different feeling or symptom a person may experience after a loved one dies, such as pretending the death never happened or not wanting to do fun things anymore. Young children will get reassurance that all these grief responses are normal and okay, and that they become easier to manage as time passes. The book never specifically mentions death, only goodbyes.

A Simple Story About Death: The Dead Bird, By Margaret Wise Brown

Recommended age range: 4 and up

Many children’s first encounter with death will be the death of an animal. Whether it’s a pet or simply an animal found outdoors, talking about nature and animal deaths can be a good introduction to conversations about grief and loss. The Dead Bird doesn’t go out of its way to teach young readers specifics about grief or death. It’s just a story about preschool children who discover a dead bird while outside, and hold a funeral for it.

If you’ve ever been in a similar situation with your preschooler, you might have been surprised by the seemingly morbid curiosity little kids can display when they find a dead animal. It may seem weird to adults, but it’s totally natural for children to wonder about what physically happens when a living thing dies. Similarly, this story has some descriptions of death that might seem jarring at first: it describes how the bird’s body starts off as warm, and then becomes cool and stiff. Learning this kind of information can help children begin to differentiate between living and dead, and understand that death is permanent.

This is a classic, older book that’s been updated with new illustrations showing a diverse group of kids. It’s a good option for a first conversation about death, or to help children better understand funerals and mourning.

A Children’s Book About the Death of a Grandparent: Nana Upstairs & Nana Downstairs, by Tomie dePaola

Recommended age range: 3 and up

The death of a grandparent or great-grandparent is another common way children are introduced to grief and loss. This story for young children touches on themes of aging, dementia, and the special relationship that little children and their older relatives can share. Like The Dead Bird, this book focuses more on telling a story than teaching specific concepts about death or grief. It’s an entertaining story for children in its own right that could also lead to some helpful discussions about what happens as grandparents and other loved ones grow old.

This true story, based on author Tomie dePaola’s childhood, explores the relationship between a little boy, his grandmother, and his great-grandmother, who live together in a nearby house. It gently refers to death as a part of life, and something that happens to everyone. While dementia or Alzheimer’s aren’t specifically mentioned, talking about great-grandmother’s behavior in the story might be a helpful jumping-off point for conversations about these illnesses in real life.

An Informational Book for Preschoolers and Kindergarteners: I Miss You, by Pat Thomas

Recommended age range: 4 and up

If someone in your family or circle of friends has recently died, you may need to speak a little more directly about death with your young child. The death of a loved one can bring up a lot of questions and curiosity for preschoolers and kindergarteners. Children may wonder what happens to the body when someone dies, why people die, or what happens at a funeral. It’s also common for young children to worry that they might have done something to cause their loved one’s death, or to believe that death is a punishment for being bad.

I Miss You: A First Look at Death answers these questions in a way that’s detailed but easy to understand. It’s aimed at a similar age group as The Goodbye Book, listed above, but it’s a longer and more complex read. In addition to answering common questions and dispelling misconceptions a child might have about death, it normalizes many of the complicated feelings a grieving child might have, such as guilt, regret, and anger. It also reviews a few simple beliefs different cultures have about what happens after death. There is a lot here for kids to think about and revisit over time.

Staying Connected Through Love: The Invisible String, by Patrice Karst

Recommended age range: 4 and up

Of all the books in this list, this is the one that feels the most “therapy-ish” to me. It’s a very simple, straightforward book without a lot of story to it. However, the idea of the invisible string is easy for children to understand: it’s a metaphor for the love that connects family, friends, and other special people. This image can be a big comfort when a loved one dies, leaves, or moves far away.

The book briefly mentions death and heaven, but isn’t solely focused on grief. Instead, it talks about how the bond between two people remains no matter where they are, how they’re feeling, or what they’re doing. The book points out that love doesn’t go away even when a person is angry, which can be a really important message for grieving children to hear.

Children (and adults) have to find ways to continue to love and remember the person who has died as part of the grieving process. This book can be a great opener to having conversations with very young kids about how they can continue to maintain a connection to their loved one.

A Book for Caregivers: A Parent’s Guide to Managing Childhood Grief

Caregivers need support navigating the grieving process, too. If you’re the parent of a young child who is grieving a loss, My new book, A Parent’s Guide to Managing Childhood Grief, can help you move on to deeper conversations after reading picture books like these.

The book combines guidance and grief education with hands-on activities you and your child can work on together. You’ll find ways to learn about grief and loss, express feelings, and strengthen your parent-child bond.

It’s available for on Amazon, at Barnes & Noble, and at your local independent bookstore.

Should Children Attend Funerals?

What’s the right age for a child to go to a funeral? Will an elementary-aged child get anything out of the experience, or will it just be scary? Will your tween regret not attending as they grow up? What if your child is really little—2, 3, or 4 years old. Is a funeral too much for them to tolerate?

If you’re a parent who has recently lost a loved one, you may be grappling with tough questions like these. In the midst of planning for a funeral, you’re also having to consider the wellbeing of your child. You want to help your child say a healthy goodbye, but funerals can be a lot to handle, even for adults.

Let’s take a look at the benefits and drawbacks of having your child go to their loved one’s funeral. We’ll talk about why the ritual of a funeral service can be helpful for many kids. You’ll also learn how you can set your child up to have a meaningful funeral experience if they choose to attend.

What Age is Appropriate for a Child to Attend a Funeral?

There is no right or wrong age to attend a funeral. Think about how your child handles other family or group events, like church or holiday dinners. Is your child able to sit for a period of time without melting down? Can they follow social cues like taking turns or being quiet when others are speaking? If so, they should be capable of handling the funeral—provided they want to attend.

Your child’s own wishes are your most helpful guideline when making your decision. In general, if a child is old enough to express a desire to attend, they will likely benefit from having the experience. Even really young kids can benefit from being involved in an important family ritual and getting a chance to say goodbye.

It is true that children of different ages have different needs when attending a funeral. If your child is very young, you may want to think about what a reasonable amount of time would be for your child to participate.

Many Children Benefit From Attending Funerals or Memorial Services

Children grieve differently than adults, but they still need opportunities to express their feelings, talk about their loved one, and say goodbye. Rituals help us all to move through important moments in life, and connect us to something that feels bigger than ourselves. The funeral is the biggest—and sometimes the only—ritual that happens when someone dies.

Grief experts tend to agree that funerals and memorial services are beneficial for many children. They can help bereaved children move forward in their grief process and begin to heal. When asked, adults who lost loved ones as children and weren’t allowed to attend the funeral usually say they regret not being there. As sad and difficult as funerals are, they’re an important part of mourning, and we only get one chance to attend.

Some of the benefits of attending funerals for children include:

• Coming to terms with the fact that a loved one has really died

• Seeing a loved one for the last time

• Getting a chance to say goodbye

• Receiving support from other grievers

• Observing how others grieve, which can reassure a child that their feelings are normal

• Feeling as though they’ve done something important to honor their loved one

There Can Be Drawbacks to Attending if a Child Isn’t Ready

There are a few instances when it’s not the right choice for a child to attend a funeral. If a child is not well prepared, they may leave the funeral feeling worse, instead of better. Children are more likely to have a bad experience if they’re forced to attend the funeral, pushed to do something they don’t want to do, or if they encounter something they weren’t expected to see.

Children should be allowed to take the lead in when and how they participate. If your child doesn’t want to touch their loved one’s body, for example, there’s no need to press the issue. Children who aren’t ready to attend the funeral may experience some drawbacks from attending, such as:

• Increased anxiety or fearfulness

• Distress about confusing things they saw or experienced

• Troubling memories, especially if they were pushed to do things that didn’t feel comfortable

• Feeling a lack of control, if forced to attend

Let Your Child Make an Informed Decision About What Feels Right

At the end of the day, the most important thing is not whether or not your child attends the funeral. What matters most is that your child was given a choice. So much about death is out of our control, especially for kids, who have very little say in what happens. When possible, it makes sense to give some control back to kids and allow them to make decisions for themselves.

Help your child make an informed decision by letting them know exactly what they can expect to happen at the funeral. You can talk about where the funeral will be, who will be there, and what everyone will do to commemorate your loved one. It’s also important to give your child a heads-up about how people might behave, so they’re prepared to see a wide range of emotions from attendees. Finally, talk with your child about how their loved one’s body will appear, and whether or not there will be an open casket.

If your child decides to attend, figure out a way for them to participate that honors their age and maturity level—more on that in the next section of this post. If your child opts out of attending, offer a “Plan B” that is familiar, comforting, and low-key. The plan should include staying with a person your child knows and trusts, in a place that feels safe. New experiences can be stressful for a grieving child, and big outings like special time with friends might lead a child to decline attending a funeral when they’d otherwise choose to go.

Find Age-Appropriate Ways For Your Child to Participate in the Funeral

Kids love having a job to do and feeling included in grown-up activities. This is true for funerals, too. If your child was very close to the loved one who died, finding a way for your child to participate in the funeral or memorial service can mean a lot.

Think about ways that your child might be comfortable contributing in some way to the service. Older, more extroverted children might appreciate being asked to read something aloud. Others might prefer to choose a song or poem for someone else to share. Even something as simple as picking out a bouquet of flowers or choosing a special candle to light can help younger children feel that their voices and feelings matter.

Depending on your child’s age, you may want to consider how long, and to what extent, your child participates in the funeral. Younger children may not be capable of sitting still through an entire service. Coming up with a plan in advance will make it easier for you to follow your child’s lead on the day of the funeral. It helps to select a friend or family member to be your child’s support person. This person can quietly usher your child out of the service if it becomes too much for them to handle.

It’s also worth considering if attending a virtual funeral service makes sense for your child. If your loved one’s funeral is being live streamed, this option can offer some flexibility, especially for younger kids. Your child can watch from the comfort of home and step away as needed if their attention wanes.

Questions to Ask When Deciding Whether A Child Should Attend a Funeral

If you’re on the fence about what’s the best decision for your child, here are a few points to consider. You know your child best, and can probably make good educated guesses about what your child will need in order to process their feelings about a funeral. If you’re trying to decide how to involve your child, ask yourself the following:

• Is my child able to sit still and focus during group gatherings?

• Is my child highly sensitive or prone to anxiety?

• How well does my child currently understand death?

• What was my child’s relationship to the person who died?

• How does my child feel about attending?

If your child is highly sensitive, or doesn’t currently have a strong understanding of what death means, you may need to spend some extra time preparing your child before making a decision.

If Your Child Does Not Attend, Find Another Way to Honor Your Loved One

It’s okay if your child chooses not to attend the funeral or memorial service. As long as they have been given the information they need to make a thoughtful decision, whatever choice they make is just fine. You can help your child experience some of the benefits of a funeral by creating your own rituals at home.

Help your child memorialize their loved one by setting aside time to do something together that feels special. You can think about what your child might enjoy, or consider finding something that was meaningful to your loved one. Reading a book or poem together, planting a memorial tree, cooking a loved one’s favorite meal, or visiting somewhere significant to your loved one are all ways to help your child grieve. Whatever activity you choose, be sure to offer ample opportunities to share feelings and to say goodbye to your child’s loved one.

Help Your Child Navigate Funerals, Grief, and Loss

If your child has recently lost a loved one, the funeral is just the beginning of a long process of mourning and healing. Children need ongoing support from someone they love and trust in order to recover from grief. You can help your child sort through their complicated feelings over time through repeated opportunities to remember and share memories of their loved one.

My book, A Parent’s Guide to Managing Childhood Grief, offers simple ways to support children before, during, and after a funeral. In it, you’ll find activities designed to help kids explore and learn about many facets of grief that can be tricky to talk about. From learning about death and dying to finding meaning and reflecting on growth, the activities can help your family process grief in the days immediately following a death as well as in the months or years to come.

A Parent’s Guide to Managing Childhood Grief is available on Amazon, Barnes & Noble, or through your local independent bookstore.

Talking to Kids About Death: Finding the Right Words in Difficult Conversations

You’ve probably imagined many difficult conversations you’ll need to have with your kids in the years to come: talks about bullying, puberty, and real-life issues like racism and violence. For some reason, talking to kids about death wasn’t at the top of my mind. Maybe that’s because we aren’t very comfortable talking about mortality as adults either.

Even though the subject of death may not get as much attention, it’s important to think about. Losses, both big and small, are a natural part of childhood. Many children encounter death for the first time through the loss of an animal, such as their classroom goldfish or the family dog. Kids who are fortunate enough to have close relationships with grandparents and extended family may also learn about grief as their loved ones age.

Whether you’re anticipating a loss in your child’s future, or just want to introduce the concept of death in a healthy way, it can be hard to find the right words. So, let’s talk about how we talk about death. We’ll go over how to tailor information to your child’s age, words to use (and words to avoid), and how you can make conversations about death a part of your day-to-day life.

At What Age Should You Tell a Child About Death?

Death is a huge concept, and it takes a long time for children to really understand what it means. However, even the youngest children feel grief when a loved one dies, even if they don’t grasp exactly what has happened. If you’ve recently lost a loved one, any child who is old enough to express their feelings through talking and playing is ready for a very simple explanation of death.

Usually, children begin to understand that plants, pets, and sometimes even people die by around age 4 or 5. However, it will be a long time before your child is fully aware that death is permanent and happens to every living thing. If you’re not mourning a loss and just want to broach the subject of mortality with your child, you can let their own curiosity about life and death guide your conversations.

Young children are famous for asking lots of questions—remember the “why” phase? You don’t need to volunteer lots of information about death and dying, but if your child asks you a question, it’s okay to give a short, honest answer. In general, if your child is old enough to ask, they’re developmentally ready to hear your response.

Tailor Your Talk to Your Child’s Age and Maturity Level

Talks with kids about death are not one size fits all. The information your child needs will depend on their age, where they are in their development, and your child’s individual personality. Your child is unique, so use your best judgment and your knowledge of your child when considering what to share. Let’s take a look about how kids tend to think about death, according to their age.

Preschoolers are just starting to develop a concept of death: before this age, the word doesn’t really hold any meaning at all. Little children may worry that death can be a punishment for bad behavior, or that the things they think and do might cause someone else to die. Keep your explanation of death very simple and concrete, and help your preschooler to understand that the things they do can’t make others get sick or hurt. Be prepared to answer lots of repeated questions, and to remind your child that death is permanent.

Elementary school-aged kids have a better understanding of death as a permanent event. As they realize that death happens to all living things, they may start to think about their own mortality. This can lead to worries about their own health and safety, or the safety of loved ones. It can help to remind your child that most people live to a very old age, and discuss who would take care of your child in the event of an emergency. School-aged kids are ready for a more detailed explanation of death and any religious beliefs your family holds. You can let their questions guide how deep your conversation goes.

Tweens and teens are more capable of the abstract thinking, which allows them to appreciate spirituality and the permanence of death in a deeper way. Kids this age are figuring out who they are and what they believe about life. They may enjoy reflecting on their own spirituality and what they think about religion. Teens may be ready for harder conversations about death, and may ask uncomfortable questions without simple answers. Honesty is the best policy, especially with this age group, even if the answer you have is “I don’t know.”

Simple Language Is Best for Kids

At this point, it’s common advice to use straightforward words when talking to kids about death. Euphemisms that sound comforting to us can be confusing for kids, because they’re abstract. Children may fill in the gaps in their understanding with their own assumptions, which are often scarier than the truth.

We understand what it means when someone “passes away,” but a young child doesn’t. Where did they pass to?, a child might wonder. Is it like passing out? If a family pet has been put to sleep, a child might fear going to bed at night, in case something bad happens to them, too. Even phrases like “she’s gone to a better place” can cause children to wonder if a loved one chose to leave them to go somewhere else.

Using basic language cuts down on confusion and reduces the chances that a child will experience unnecessary worries. The words “dead” and ‘died” might sound harsh to adult ears, but they’re often easier for children to hear. If your child is too young to fully understand what “dead” means, you can give simple examples of what’s physically different after someone dies. For example, the heart stops beating, the lungs stop breathing, the body stops moving, and a dead person no longer feels hunger, pain, or fear.

Build Conversations About Death Into Everyday Life

It can be intimidating to talk about death with children. It’s a sad, hard, uncomfortable thing to think about. It’s even more daunting if we envision having a serious, sit-down talk where we lay out everything our child needs to know about death and dying. Conversations about death don’t always have to be a big deal. Small events in your day-to-day life can be great learning opportunities for kids.

The natural world offers lots of chances to talk about life, aging, illness, and death. Whether you’re going on a nature walk or tending to a garden, examples of the life cycle are all around you. Talk with your kids about what you see when you’re outside. Can they notice how plants are changing when fall turns to winter? Can they spot any dead worms on the sidewalk after it rains?

Many kids are naturally curious about dead things, which can be awkward for adults. When possible, let your child express their curiosity and ask questions. If you drive by roadkill or spot a bird that has flown into a window, it’s an opportunity for you to show your child that it’s okay to talk about—and have feelings about—death.

Books can be a great starting point for conversations about death, too. The Dead Bird is a short and simple picture book for preschoolers that tells the story of a group of children who discover a dead bird outside. It’s a great way to help very young children think about death and nature. Elementary-aged kids may enjoy Lifetimes, a beautifully-illustrated book that describes the life cycles of different animals.

Leave Space for Questions and Feelings

One of the most helpful messages you can give your child is that any feelings they have about grief and loss are okay. If your child expresses sadness or worry about death, you might feel an urge to help the feel better right away. It’s tempting to rush in and fix things, but sometimes putting a name to your child’s feelings is the most helpful thing you can do. This lets your child know that it’s okay to have negative feelings, too.

It will take children a long time to work through their thoughts and feelings about death. Kids learn through repetition, and you may notice your child asking similar questions about death and dying over and over again. Sometimes, the questions might even seem a little odd! It might feel strange to wonder with your child about where dead pets go to the bathroom, or to answer the same question multiple times in a day. However, by answering honestly and consistently, you’re helping your child make sense of a big, scary topic. You’re helping your child feel more secure, and teaching them that it’s okay to ask you more questions in the future.

If your child stumps you with a question, it’s perfectly fine to say “I don’t know.” Sometimes that’s the most honest answer we can give. If you’re not sure how to respond in a child-friendly way, it’s also okay to tell your child you need to think about their question, and you’ll get back to them later with an answer.

Incorporating Religion Into Talks About Death

So far, we’ve covered the concept of death in a very practical, body-focused way. We haven’t talked about more spiritual aspects of death, like what happens to a person’s soul. If your family is religious, you may be wondering how to incorporate your beliefs into conversations with kids about death.

First, some good news: research shows that learning facts about death doesn’t get in the way of a child’s religious development. Especially as kids grow older, they can hold both the scientific and spiritual aspects of death in mind at the same time. What’s more, a basic understanding of what physically happens when somebody dies can make abstract concepts like the afterlife a little less confusing.

Find ways to tie together what happens when a person dies to your family’s beliefs about what comes after death. For younger children, its best to keep this conversation very simple. For example, “When a person dies, their body stops working and doesn’t start working again. Their body doesn’t eat, feel, think, or move. A person’s soul, which we can’t see, goes to Heaven when they die.” Because young kids are concrete thinkers, you may need to clarify that Heaven is not a place that we can visit, and that loved ones can return from in their physical form.

Older children may be ready for more in-depth conversations about your family’s belief system about death and the afterlife. It’s helpful for older kids to know that not everyone they meet will share the same ideas about what happens after we die. You can also explain to your older child that some aspects of death and what comes after are a mystery to all of us, regardless of our religion.

As always, leave space in your talks about death and religion for questions from your child. "I’m not sure,” “I don’t know,” and “Let me think about that and get back to you” are perfectly okay responses when there isn’t an easy answer.

More Ways to Help Children Understand Death and Loss

Helping a child understand death is an ongoing process. There’s no need to find the perfect words or to have one perfect conversation: you’ll have many opportunities to talk about death, grief, and loss as your child grows. Your child probably won’t remember the exact phrases you used, anyway. What they will remember is that you showed up for them, you were honest, and you cared enough to talk about difficult things.

If you’re anticipating a loss or someone you love has recently died, you may be wondering how to support your child in the weeks and months to come. How can you keep healthy conversations about death and grief flowing? How do you create a safe space for them to let out their feelings without pushing too hard?

If you’d like more step-by-step guidance, A Parents’ Guide to Managing Childhood Grief may be helpful to you. I wrote this activity book especially for parents and caregivers of school-aged kids who are going through grief. Inside, you’ll find deeper advice on how children grieve differently than adults, what to say (and avoid saying) to a bereaved child, and 10 chapters of play-based activities you and your child can try at home to explore many aspects of grief and loss.

You can order the book now on Amazon, at Barnes & Noble, or find a local Indie bookstore to support through IndieBound.

What to Say to a Grieving Child: 5 Messages Kids Need to Hear

Wondering what you should say to a child who is grieving? Your actions and words can both speak volumes.

My Child Just Lost a Loved One. What Do I Say?

It’s so hard to know what to say to someone who has just experienced a loss. Even when we’re talking to other adults, death can feel so overwhelming and huge. How do you figure out what a child needs to hear at a time like this? Go-to phrases like “I’m so sorry this happened” and “I’m here to help” fall a little flat when we are trying to support young people.

Whether you’re a parent, a caregiver, or another important adult in a grieving child’s life, this post is for you. Children understand and process death differently than adults, so the words they need to hear from people around them are a little different, too. We’ll talk about 5 messages that children need to hear from the adults in their lives as they begin to process a loss. Whether you say these phrases out loud, put them into your own words, or show them through your actions, they will help your child feel safe, loved, and understood.

First Things First: Talk Honestly About Death

Before you talk about anything else, it’s important to have an open conversation with your child about death. Younger kids need help to understand the concept of death as something that is permanent and irreversible. Kids of all ages need at least some information about what caused their loved one to die.

We’ll go into detail about how to tell a child a loved one has died in another post, but honesty is the best policy when it comes to talks about death and dying. That means avoiding euphemisms like “passed away,” and describing death as something that makes the body and brain permanently stop working. In general, if your child is old enough to ask a question, they’re old enough to hear an age-appropriate answer. It’s always okay if that answer is “I don’t know.”

Grief Message 1: “It’s Not Your Fault.”

Have you ever noticed that kids tend to believe the world revolves around them? It can be a little exasperating at times, but it’s totally normal and healthy for young children to have this mindset. Kids are the main characters in their life stories, and they’re still figuring out the impact they have on the world around them.

Up until about age 7, kids are still learning that their internal thoughts and feelings don’t affect the outside world. For example, thinking a mean thought about a sibling can’t cause them to actually get hurt in real life. Wishing a person would just go away doesn’t mean they will disappear.

When somebody dies, it’s very common for children to blame themselves. They might over-estimate the power they had to change a situation. They may also worry that their thoughts somehow caused their loved one’s death. This kind of guilt can happen even in situations where the death was nobody’s fault, such as a death from cancer or old age. As you can probably imagine, it’s a terrible feeling, and a tough one for many kids to talk about.

Make it clear to your child that nothing they said, did, thought, or felt caused their loved one to die. You can let them know that many people—adults and kids—feel guilty when someone dies. It’s a normal feeling, but it doesn’t mean the death was your fault. We can’t control another person’s life, health, or decisions, and we usually can’t prevent accidents from happening, either.

Grief Message 2: “All Your Feelings Are Okay.”

Talking about feelings can help children after someone has died. Photo via Pexels by Ketut Subuyanto.

When we think about a grieving person, we probably imagine someone who is very sad or crying. In fact, this is usually how grief is portrayed in the media, too. While it’s true that sadness is a big part of grief, there’s a whole range of other emotions involved, too.

Adults may be aware that grief is complicated, but kids usually aren’t. Most kids don’t have very much personal experience with grieving. They look to books, TV, and movies to figure out how they’re supposed to feel.

Actually, there’s one other place kids are looking to figure out how to feel: you.

Children turn to parents and caregivers to see how they are responding to grief, and to decide whether their own feelings seem “normal” or okay. You can be a role model for your child, and help them to accept and cope with the many confusing, conflicting feelings they might experience.

You can help your child understand that there’s no right or wrong way to grieve. Any feelings they have are okay. Whether those feelings are big or small, scary or sad, angry or happy, it’s all normal. It’s even alright if they aren’t feeling much of anything at all, especially right after the death when many people are still in shock.

You can affirm your child’s feelings in two ways: by talking about them directly, and by showing your own emotions in front of your child. It’s okay to share when you’re feeling sad or frustrated or worried. When your child sees you dealing with your own grief, they learn that feelings aren’t something they need to hide.

Grief Message 3: “There Will Always Be Someone to Take Care of You.”

Human brains are hardwired for survival. We’re good at looking for signs of danger—in fact, sometimes we’re a little too good at it, and we end up with anxiety. Kids understand that, in order to survive, they need to stay close to grownups who can take care of them.

The death of a loved one is a scary reminder to kids that bad things can happen to the grownups in their lives. It can leave children feeling vulnerable and unsafe. What’s more, the things that kids usually turn to for safety—routine, predictability, and time with caregivers—may all be disrupted for a while as the family deals with their loss.

Remember earlier when we talked about how kids are the main characters of their own life stories? That comes into play here, too. When children hear about a loved one’s death, they often wonder “What does this mean for me? Who will be there to take care of me?”

You can help your child feel safe by reminding them that, no matter what, there will always be someone looking out for them. Even if something unexpected happened, you have plans for who would step in to help. You can name the many adults in your child’s life who provide for them, either physically or emotionally. Keep your child in the loop about who will be taking them to school or tucking them into bed at night, so they know what to expect.

Grief Message 4: "We Can Talk About Anything, Even the Hard Stuff.”

Parents and caregivers sometimes worry that bringing up a deceased loved one in conversation could upset their child. It can be painful to bring up old memories, and the child has already suffered so much pain. If a child isn’t talking about the death, should adults around them bring it up?

We never want to force children to talk when they aren’t feeling up to it. On the other hand, if adults never talk about their grief, it can give children the mistaken idea that it’s not okay for them to talk about it, either. Kids often worry about their caregivers a lot following a death, and pay close attention to their responses to grief. They may interpret silence as a sign that you aren’t ready to talk, or that hearing about your child’s grief would be too much for you to bear.

It’s okay to take the lead on conversations about grief. It’s not too forward to ask your child how they have been feeling. If they say they’ve been fine or haven’t been thinking about their loved one lately, that’s just fine—there’s no need to push. You can always try again another time.

Sharing your own thoughts and feelings about grief can be really helpful, too. It can help make painful emotions feel less taboo to talk about. By bringing up your own positive and negative emotions, you’re letting your child know that you can handle hearing about theirs.

Grief Message 5: “I Remember Your Loved One, Too.”

Remembering a loved one is another way you can talk about grief with kids.

It’s normal for grieving people of any age to think about their loved ones more on special days. Anniversaries, milestones, and holidays can bring up difficult feelings at times of the year when we’re “supposed” to be happy. The mixed feelings can be a lot for a young person to handle.

Grieving kids have another layer of complexity to deal with, too: the older they get, the more they understand their loss. With each passing month or year, a grieving child becomes older and wiser. The realization that death is permanent really starts to sink in. Celebrations and anniversaries are a reminder of everything a child has lost: not just their loved one, but all the memories they could have made together in the future.

With your words or with your actions, you can let your child know they’re not alone in thinking about their loved one. Share a funny story about them, light a candle, or just let your child know they’ve been on your mind. There isn’t a timeline on grief, and sharing your own thoughts takes pressure off your child to just get over it and move on.

No Matter What You Say, Keep the Conversation Going

The stakes can feel really high when we’re talking to kids about grief. This sensitive, vulnerable little person is depending on us to help them figure out a life-altering event. There’s a lot of pressure to not mess up. What if you say something wrong, and end up doing more harm than good?

We’ve probably all heard the Maya Angelou quote about how people will forget what we say and do, but they’ll always remember how we made them feel. It’s a little cliché, but in this case it’s true. Children may not hang on to your every word for the rest of their lives, but they’ll remember the ways that you helped them to feel safe and supported.

It’s okay if your response to your child is honest, but awkwardly worded. It’s okay if a conversation falls a little flat. It’s even okay if you misspeak, and need to come back later and make things right. What’s most important is that you’re keeping lines of communication open with your child. If you miss an opportunity, don’t worry—you’ll get another one. You are letting your child know that you care, and that you’ll be there for them when they’re ready.

Need More Ways to Talk About Grief With Your Child?

Talking about grief with kids is an ongoing process. Children will need repeated opportunities to work through their feelings about a loved one’s death. That repetition is part of what helps children to learn and make sense of information. These conversations don’t all have to be heart-to-heart chats, although those are wonderful: playing, making art, and spending time together can all help your child grieve.

A Parent’s Guide to Managing Childhood Grief is an activity book for parents, caregivers, and any adult who wants to support a bereaved child. I wrote it with children ages 5-11 in mind. It includes 100 activities that you and your child can do together to talk about death and dying, cope with hard feelings, and honor the memory of your loved one. If you’d like more ideas and advice for helping grieving children, it’s available on Amazon, at Barnes and Noble, and in local bookstores.

Thank you for supporting your child! As always, if you have any questions or would like to learn more about children’s counseling, you’re welcome to send me a message.

How to Help a Child with Intrusive Thoughts

Dark, bad, scary, negative, weird…whatever words you or your child use to describe intrusive thoughts, the effects are the same. Intrusive thoughts are like unwanted guests in our minds, barging in without being invited to spoil the party. While any child can have intrusive thoughts, they’re more common in children with anxiety, OCD, or a history of trauma. Keep reading to learn what you can do at home to help your child with the normal, common, but still very stressful phenomenon of intrusive thoughts.

Why Does My Child Have These Negative Thoughts?

If you’re curious to learn more about intrusive thought and why they happen, check out last month’s blog post. I break down what intrusive thoughts are in detail, with real-life examples. I also talk about what mental health problems might make kids more prone to experiencing them.

If you don’t have time to read the whole post, the gist is that intrusive thoughts are normal, and not always a problem. Many people—if not most people—will have intrusive thoughts at some point in their lives. They’re just one of the many weird things our brains and bodies do in an effort to keep us safe. When most of us have these seemingly random thoughts, we can shrug them off and quickly forget about them.

However, some kids are not so lucky. It can be harder for kids to distinguish between a useful thought and a useless one. This makes it more difficult to brush the thoughts aside. Instead, children may end up focusing on the thought and worrying about it. This leads to more anxiety, which increases the likelihood that these bothersome thoughts will pop up again.

An occasional intrusive thought is no problem, but kids with anxiety or OCD may get them so often that it feels debilitating. Children also sometimes experience these thoughts after a trauma as a part of PTSD.

How Can I Help My Child With Intrusive Thoughts?

There’s a lot you can do as a parent to support a child struggling with intrusive thoughts. You hold a powerful role in your child’s life. Your child looks to you as a guide to decide how she should think and feel about things, so your responses carry a lot of weight. By responding calmly and compassionately, you can help your child self-soothe and take the power away from overly dark or negative thoughts.

We’ll go over each of these in more depth in a minute, but here are 3 ways you can help:

• Normalize intrusive thoughts for your child

• Teach the difference between thinking and doing

• Help your child name and accept intrusive thoughts

These steps can go a long way toward helping kids handle disturbing thoughts with less worry and stress. Next, let’s break down each one to see why it helps and how you can practice it at home.

Let Your Child Know Her “Bad Thoughts” Are Normal (and Not So Bad)

Intrusive thoughts can be disturbing, but they’re also really, really common. So common, in fact, that one study found that 94% of people experience them. They’re just a part of being human! As common as they are, we don’t tend to bring up intrusive thoughts during polite conversation. Because nobody ever talks about them, a child may assume she’s the only one who gets intrusive thoughts. The thoughts can become a big source of shame, especially because they might be about taboo subjects.

Things always feel scarier when we don’t understand them. Teaching children about intrusive thoughts takes away some of their power. When you tell children that many people have these bad thoughts and they aren’t alone, you alleviate their shame. Reducing fear and shame not only helps your child feel better; it can also reduce her intrusive thoughts over time.

Try explaining this to your child: “Our brains are always thinking, and always looking for ways to keep us safe.” Giving us these “bad thoughts” is sort of like the brain showing us a flashing danger sign. The only problem is, the brain isn’t always right! Sometimes, the more we try to ignore these bad thoughts, the more our brain pushes the thoughts back. These thoughts can be really weird, or scary, or even be about things we’d never want to do in real life. As weird as they seem, most people have them sometimes and they are totally normal.

Explain That Thinking Isn’t The Same as Doing

Have you ever knocked on wood to keep something bad from happening? Or worn your “lucky shirt” on game day to help your team win? If so, you’ve experienced magical thinking. Magical thinking is the belief that our private thoughts and behaviors influence what happens in the outside world.

Magical thinking is really common in children, especially younger kids. It’s usually most noticeable from the toddler years through about age 7. If you think back to your own childhood, you’ll probably discover magical thinking everywhere: cootie shots, lucky charms, and “step on a crack, break your mama’s back” are all examples of magical thinking that are fun for kids.

However, there can be a dark side to magical thinking, too. Children often believe that their thoughts can cause things to happen in the world around them. If a child worries their thoughts are responsible for something bad happening, this can cause terrible fear and guilt. It’s easy to imagine how a child who gets intrusive thoughts about violence or crime could begin to worry about accidentally hurting others.

Help your child understand that having bad thoughts does not make you a bad person. It’s our actions and choices—not our thoughts and feelings—that hep us to be “good people.” Next, reassure your child that thinking angry or scary thoughts about a person can’t hurt them or cause something bad to happen. Even if they feel bad to us, thoughts are not that powerful.

Shine Some Light on Dark Thoughts By Naming and Accepting Them

When I think about kids struggling with dark intrusive thoughts, a quote from famous psychiatrist Dan Siegel comes to mind: “Name it to tame it.” Dr. Siegel came up with this phrase, and it’s since been adopted by many therapists to describe a simple process that makes strong feelings more bearable.

“Name it to tame it” is exactly what it sounds like. Often, the simple act of labeling our thoughts and feelings as we have them can make them feel better. This is because naming something requires us to take a step back and go into observing mode, rather than being totally absorbed and overwhelmed by our feelings.

Naming intrusive thoughts as they happen can be a helpful reminder that we are not our thoughts. Thoughts come and go, but it’s up to us to decide how much attention they deserve. Calling out intrusive thoughts for what they are is also a helpful reminder that they are common and harmless: after all, they’ve happened to enough people that we’ve given them a name!

You can help your child practice saying one of these phrases (or something similar) the next time an intrusive thought strikes:

• “My brain is giving me one of those garbage thoughts again.”

• “I’m having an intrusive thought right now.”

• “This seems like one of those thoughts I don’t need to listen to.”

Once the thought has been named, don’t dwell! We can just let the thought pass by. The more a child resists having intrusive thoughts, the more likely they are to pop up again. It may sound counterintuitive, but accepting intrusive thoughts can actually reduce how often they happen. By naming the dark thought and moving on, your child is teaching herself that they’re nothing to be afraid of.

Need More Help? Begin Child Therapy for Intrusive Thoughts in North Carolina

Sometimes, a child’s intrusive thoughts grow to be so big and overwhelming that at-home strategies aren’t enough to tame them. Maybe your child’s thoughts are part of a larger problem with anxiety or OCD. Sometimes, intrusive thoughts show up after a child experiences something traumatic or highly stressful. If your child’s intrusive thoughts are very frequent or very overwhelming, therapy can help sort things out.

Cognitive-behavioral therapy teaches children that they have more power than they might think over their thoughts and actions. They can learn to spot intrusive thoughts when they happen, and dismiss them rather than worrying about what they mean. Play therapy can also help younger kids work through anxiety and other feelings that are sometimes difficult to put into words. If your child survived a trauma, TF-CBT is a special, kid-friendly form of therapy designed to help children work through their symptoms in a safe way.

I’m a play and CBT therapist who specializes in helping kids with anxiety and trauma. I can work with families in three states: North Carolina, New York, and Florida. Children who live near my Davidson, NC child therapy office are welcome to stop by in person. If that’s not possible, no worries! I really enjoy online therapy and have found it to be just as helpful for many kids.

Ready to learn more? Drop me a line here. I’m always happy to hear from you.

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

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

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

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

What Causes Depression in Children and Teenagers?

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

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

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

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

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

• Chronic physical health problems

• Social isolation

• Poor sleep or nutrition

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

How is Depression Diagnosed in Kids and Teens?

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

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

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

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

• Decreased interest or enjoyment of activities most days

• Unintentional changes in weight or appetite

• Noticeably slower thoughts, speech, or movement

• Feeling tired or low on energy

• Feelings of guilt or worthlessness

• Difficulty thinking, concentrating, or making decisions

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

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

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

Signs of Depression in Children

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

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

• Trouble concentrating at school

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

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

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

• Difficulty handling rejection or criticism

• Low self-esteem

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

Symptoms of Depression in Teenagers

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

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

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

Depression symptoms specific to teenagers include:

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

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

• Frequently talking about death and dying

• Withdrawing from friends

• Dropping out of extracurricular activities they used to care about

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

• Cutting or other forms of self-harm

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

Counseling for Teens and Tweens with Depression in Davidson, NC

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

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

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

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

Is My Child Having a Panic Attack or an Anxiety Attack?

Your child’s mind is racing. Her stomach is flip-flopping. She’s having a hard time falling asleep at night, and an even harder time getting up for school in the morning. You know something is going on, but you’re not sure what to call it when you describe it to people. Is your child having a panic attack or an anxiety attack? What’s the difference? Today I’m going to break down the difference between panic and anxiety, so you know the next steps to take to help your kiddo.

Panic Attacks and Anxiety Attacks Are Basically The Same Thing

I guess I’m giving away the big reveal in this blog post right up top, huh? Kids and parents often ask me if the symptoms they’re describing sound more like an anxiety attack or a panic attack. The truth is, most people use both terms to describe the same thing, so you can pretty much use them interchangeably. Mentioning either term to a therapist will give them a good idea of what you’re going through.

“Panic attack” is the official name for a sudden bout of intense fear, bodily reactions, and a feeling of impending doom. This is the term used by the DSM-5, the phone book-sized manual therapists use to diagnose mental health problems. The phrase “anxiety attack” isn’t usually used by therapists because it doesn’t appear in the book and isn’t “official.”

Parents might use the phrase “anxiety attack” to describe another intense emotional experience, like a tantrum or extreme worrying, but that’s rarely the case. It makes sense to describe panic as an attack of anxiety, and pretty much everyone will understand what you mean if you do.

What Does Anxiety Look Like in a Child?

The big difference between anxiety and panic is that anxiety is more general and long-lasting, while panic is specific and sudden. Anxiety can be mild or severe, and it can ebb and flow over time. Some kids may only feel nervous in specific situations, such as meeting new people or sleeping in bed alone, while others may have more generalized anxiety that happens most days.

If your child has anxiety, you might see signs like:

• Frequent worries that seem like more than a phase

• Avoiding specific people, places, or things to keep from feeling afraid

• Difficulty falling asleep, or trouble sleeping alone

• Muscle tension, headaches, and stomach aches that don’t have a clear medical cause

• Clinginess and difficulty tolerating being alone

• Repeatedly asking for reassurance

• Irritability or seeming on edge

• Being easily startled by loud sounds or surprises

• Focusing on things that went wrong in the past or that might go wrong in the future

Every child is different, but these are some of the most common signs I hear about from families in therapy.

Signs Your Child Is Having Panic

Panic comes on suddenly, and it can be debilitating. It’s possible for a child to go about her day with anxiety, but a panic attack will stop her in her tracks. While anxiety gradually waxes and wanes, panic is like a light switch flipping on and off. The good news is that although panic attacks are intense, they don’t usually last very long. If your child has a panic attack, it will most likely be over in 15 minutes.

If your child is having a panic attack, you may notice things like:

• Shaking hands or full-body shivering

• Increased sweating

• Hot flashes or chills

• A racing, pounding heartbeat

• Hyperventilating, or feeling like it is hard to breathe

• Dizziness or weakness

• Tingling feelings in the fingers or hands

• A sense of losing control

• Intense terror, as if something bad is about to happen

Your child may or may not be worried about something in particular when a panic attack occurs. Sometimes, panic attacks seem to appear out of the blue, when a child isn’t thinking about anything in particular. Over time, though, your child may start feeling worried about the panic attacks themselves. If she’s already had a few, she may dread the possibility of having another one.

Can a Child Have Both Anxiety and Panic?

Yep! A child can have both anxiety and panic attacks. In fact, it’s pretty common. Being anxiety-prone or sensitive to stress may put a child at risk for experiencing panic attacks. Sometimes, panic attacks happen on their own, and this is called Panic Disorder. It’s also very common for panic attacks to go hand-in-hand with other forms of anxiety, like Social Anxiety, Generalized Anxiety, and Agoraphobia.

If a child is struggling with both anxiety and panic attacks, she probably has lower-level anxiety on an ongoing basis that gets punctuated by brief moments of intense fear. For example, a child may struggle with perfectionism and worries about not doing a good enough job on school assignments. This could lead to problems like avoiding turning in homework, stomach aches on school days, and fitful sleep. Before a test, however, this child might experience a full-blown panic attack with rapid breathing and dizziness.

Anxiety and panic are both tough. Dealing with them both is even harder. The good news is, there are great therapy options to help kids with anxiety, panic, or a mix of both. It’s possible to get worries under control and learn to soothe panic responses in the body, so your child can get back to enjoying life.

Help For Kids With Anxiety and Panic Attacks in Davidson, NC

Anxiety doesn’t have to run your child’s life and call the shots in your house. If you feel like you’re bending over backwards to avoid things that set off your child’s worries, therapy can help. Kids can learn coping skills to feel more in control of anxiety and panic, like the ones I teach in Worry-Free Tweens, my online class for kids.

Child-friendly styles of therapy like Play Therapy and Cognitive Behavioral Therapy have been proven to help anxious kids feel better in a relatively short period of time. With a little practice, your child won’t have to dread their next panic attack, because she’ll know exactly what to do if she feels one coming on.

I love helping anxious kids and tweens in my Davidson, NC child therapy office. I also provide play therapy and CBT online to kids throughout North Carolina, New York, and Florida. I use these approaches because I’ve seen them work, and I know they’re effective. Whether you work with me or another counselor, I hope your family finds therapy helpful, too.

Questions? Ready to schedule an appointment? Reach out to me here.