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

“Use your words.”

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

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

Make it a Game

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

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

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

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

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

TV and Books as Learning Opportunities

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

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

• What kind of face is this character making?

• What feeling is the character’s body showing?

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

Help Your Child Label Emotions

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

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

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

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

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

Use Visual Aids

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

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

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

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

4 Coping Skills to Help Children with Depression

If your child is experiencing severe depression symptoms or is feeling suicidal, please contact 911, the National Suicide Hotline, or the Crisis Text Line.

As anyone who has experienced anxiety symptoms knows, anxiety and depression often go hand-in-hand. People who have survived a trauma also often have symptoms of depression, including hopelessness, numbness, or lack of interest in activities. Because of this, I often see children struggling with depression in my therapy office, even though I specialize in PTSD and anxiety disorders.

There are lots of coping skills for anxiety that can offer some quick relief, either by distracting a child from worries or by helping the body to relax. I think it’s a little trickier to find skills that provide “quick wins” for kids with depression. Maybe this is because anxiety often has a more sudden, intense onset, and depression tends to be a consistent feeling for a longer period of time. In this post, I’ve compiled a few simple ways to help a child cope with depression that are supported by research. While some of these may not be as simple or quick as a breathing exercise, building these habits over time can help boost a child’s mood and encourage positive thinking.

Depression Coping Skill #1: Schedule Positive Activities (Even if They Don’t Sound Fun)

Many people assume that depression is caused by a negative event in life: for kids, maybe this is a move, a divorce, or an experience being bullied. While it’s true that tough life situations can trigger depression, researchers who studied depression found that a lack of positive experiences can also lead to low mood. Kids struggling from depression often withdraw: an elementary schooler might prefer staying home to going on play dates, or a preteen might drop out of her extracurriculars. This can create a vicious cycle where the lack of positive, rewarding activities in a child’s life make the depression worse, which in turn makes it harder to get out of the house.

You can help your child by encouraging activities that are social, fun, or provide a sense of accomplishment. Therapists call this technique behavioral activation, and it’s a treatment for depression in adults, as well as kids. Even if a child is reluctant, scheduling these kinds of activities and sticking to them can have a positive snowball effect. Think of it like going to the gym: you might really dread going the first time, but once you try it, you’ll realize it wasn’t so bad. In fact, you might feel so energized that you get motivated to go back the next day. The same thing can happen for children: the first outing might be really hard, but they may surprise themselves, and have more fun than they expected, which can make the next activity easier and more fun.

Here are a few positive, rewarding activities to consider:

• Making a meal or a snack together

• Trying an art class, or another class related to a child’s interests

• Taking the dog for a walk

• Re-arranging a child’s bedroom

• A movie night with a friend
  

Depression Coping Skill #2: Talk Back to Negative Thoughts

Kids with depression are prone to ruminating: mulling over their negative thoughts over and over again, which makes their sad feelings more intense. Depression often exaggerates and distorts our thinking, making our thoughts too negative to be true. Kids can stop the cycle of ruminating by spotting these overly-negative thoughts, questioning them, and coming up with a more helpful and realistic alternative. This is called cognitive restructuring and it’s an important part of cognitive-behavioral therapy, an approach that helps people learn how their thoughts and behavior influence their feelings.

This skill is best for kids who are elementary-aged or older. Sometimes it is hard for kids to learn this skill on their own, because it requires them to think about thinking, which is an abstract concept. A child counselor can teach children how to master this idea and practice “talking back” to negative thoughts. I often use the picture book Tiger Tiger, Is It True? to help kids understand how changing their thoughts can change their feelings.

You can help your child catch himself when he’s thinking something too negative to be true, and encourage him to ask himself questions like:

• Do I have any proof this is true?

• What would I tell a friend who had this thought?

• Is there another way of looking at this?

• OK, it if really is true, would it be the end of the world?

If your child benefits from this form of thinking, CBT might be a great option to help them cope with feelings of depression, and learn to change the thinking patterns that can trigger sadness and low mood.

Depression Coping Skill #3: Add More Sunshine

Many people notice that their depression is worse in the winter, when there is less access to sunlight. Seasonal Affective Disorder, a form of depression that often starts in the fall and ends in the spring, can occur in kids as well as adults. There is a theory that sunlight might encourage the body to produce serotonin, a chemical that influences many processes in the body including our sleep, digestion, and mood.

For kids, outdoor play is a great way to improve mood and cope with depression. Children who play outdoors get more sunlight, but this kind of play offers all kinds of other benefits, too. A study by the American Medical Association found that “children will be smarter, better able to get along with others, healthier and happier, when they have regular opportunities for free and unstructured play in the outdoors.” Being more connected to nature can also be a mood booster for both children and adults. Interestingly, spending more time in nature has been shown to help kids with ADHD feel more relaxed and focused, as well.

You don’t have to go on a big camping trip or expensive vacation to get the benefits of playing outdoors: a trip to the park, playing catch in the backyard, or a walk on a local nature trail can be just as helpful.

Depression Coping Skill #4: Practice Good Sleep Hygiene

Therapists like to say that sleep, exercise, and nutrition are all important for treating and preventing depression. If your child is feeling down, it’s worth looking into all 3. I have personally noticed that many of the children I meet who are feeling depressed are also really struggling with their sleeping patterns. Often, these children are staying up late, having a hard time falling asleep, and as a result have really shifted their sleep cycle to start and end later than is typical. These kids often have to operate at school on very few hours of sleep, or end up sleeping all day and missing out on the daylight hours they could be spending with friends.

Insomnia is a common symptom of depression, so it’s totally understandable that depressed children often have such a hard time falling asleep. What makes this situation so tricky is that sleep deprivation can also make people more vulnerable to anxiety an depression, so disturbed sleep can create a vicious cycle that ultimately makes depressed feelings more intense. In addition, if a child is losing a lot of their daytime hours to sleep, it cuts back on their opportunities to socialize or get involved in other positive activities that can reduce and prevent depression.

Sleep hygiene is a term to describe many habits that can encourage people to fall asleep and stay asleep, leading to a better night of rest. These habits on their own may not be enough to completely resolve sleep problems for a child, especially if she is also struggling with bedtime anxiety, but they’re a great place to start. Here are a few things to consider if you think your child’s sleep patterns might contribute to depression:

• Stop using any electronics (phones, computers, TV) for at least 30 minutes to an hour before bedtime.

• Finish any soda or other caffeinated drinks 4-6 hours before it’s time to sleep.

• If your child is struggling to fall asleep, encourage him to read a book or try another quiet activity for a few minutes. This can help kids feel tired faster, whereas tossing and turning in bed can make children more angry or anxious, and less likely to sleep.

• Create a routine for your child that is consistent each night and can help her unwind, such as reading a book together and practicing a relaxation technique.

• Checking the time repeatedly at night can lead to more worry and less sleep. If this is the case for your child, put the clock or phone in a position in the bedroom where she can hear the alarm but can’t see the face or screen.

• Make sure your child gets enough physical activity during the day, so that they are ready to relax by bedtime.

Begin Therapy for Kids with Depression in Davidson, North Carolina

Depression is tough, but kids can and do bounce back from their low moods. Trying these coping skills at home can be a great first step in fighting back against depressive symptoms. Looking for a way to go deeper with coping skills? Check out my online courses, which teach coping skills to kids and tweens in a self-study format. You and your child will learn specific skills you can start using right away, and get tips on how to practice them effectively.

If your child is dealing with depression after a loss, my activity book for bereaved children helps caregivers support children as they work through their grieving process. It’s available on Amazon, Barnes & Noble, and at local bookshops near you.

If you try these techniques and find your child is still struggling, a counselor can provide in-depth help and support. If you live in the Davidson, NC area and would like to learn more about how therapy can benefit children with depression, anxiety, and trauma, contact me here.

How to Help a Child with Separation Anxiety

The first time your child told you they didn’t want you to leave, it might have been a sweet moment. Being sad to see someone go is a sign of a close, loving relationship. Maybe you offered a little reassurance and a few extra hugs, and sent your kiddo on his or her way. Lots of kids have worries about a parent going away every once in a while, but for some kids, these worries quickly snowball into larger fears that need extra help to resolve. When a child suffers from separation anxiety, it can get in the way of day-to-day activities and cause stress and frustration for the whole family.

If your child is struggling with separation anxiety, there is some good news: it’s totally normal and natural for children to want to stay with their parents. Children are hardwired for survival, and they know that their parents are the safe people in their lives who will protect them from harm. Almost all children go through a period of separation anxiety as infants and toddlers, and a lot of the time, the worries resolve by themselves once children learn that when Mom and Dad leave, they always come back.

Signs and Symptoms of Separation Anxiety

How can you tell if your child is experiencing a passing worry, or is struggling with anxiety that might need extra help? Here are a few signs that might indicate your child needs some extra support to move past their worries:

• You notice that your child appears much more clingy than other children his or her age

• The anxiety is keeping your child from participating in activities they want or need to do, such as school, birthday parties, or sleepovers with friends

• Your child’s worry seems to be getting more intense over time, or you are noticing more worries about other issues coming up

• Your child’s anxiety includes body symptoms, like headaches or stomach aches

If any of these bullet points sounds familiar to you, you might benefit from the ideas below.

How Parents Can Help Kids with Separation Anxiety

Stay calm: It can be nerve-wracking wondering if today is a ay your child is going to panic at school drop-off. Kids are really tuned into their parents emotions, and can often sense a parent’s anxiety. If a child sees that a parent is feeling nervous about separation, it can heighten the child’s anxiety, too.

Highlight your child’s strengths: It’s helpful to take focus away from a child’s worries, and put the focus on how capable the child is of handling a difficult situation. Rather than trying to talk your child out of her fears in the moment, tell her you know she’s a strong, brave person, and she can do this!

Practice deep breathing: Learning coping skills, like taking deep, belly breaths, can help kids to calm their bodies and minds. This can help children deal with their stress, and might cut down on body-based symptoms like stomach aches, as well.

Don’t prolong the separation: Sometimes, the longer a parent stays around, the more a child’s anxiety rises. It can be really hard to make a quick exit and not stay to give extra hugs and kisses when a child is feeling nervous, but a brief and loving goodbye helps a child transition faster into his next activity.

Child Therapy for Separation Anxiety in Davidson, North Carolina

Need more help with separation anxiety? Whether you live local to me in the Lake Norman area of North Carolina or far away, there are options to help. My educational course for kids teaches coping skills to deal with anxiety and life stress, and you can stream it immediately so your child can start learning right away.

If you’ve tried these techniques, and are still having a hard time helping your child get separation anxiety under control, it might be time to contact a child counselor for some extra support. Therapy can be a big help for children with anxiety, helping them to strengthen their coping skills, express feelings through play, and gradually learn how to separate from their parents or loved ones without fear.

If your family is in the Lake Norman area of North Carolina, please feel free to reach out to learn more about how counseling can help kids work through separation anxiety. I can also provide online therapy to kids in other parts of the state, as well as in New York and Florida. With some help and support, kids can feel more confident at school drop-off, sleepovers, and other independent activities.

Anger Management: 3 Coping Skills for Kids

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

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

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

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

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

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

Anger management Coping Skill #2: Journaling

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

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

Anger Management Coping Skill #3: Positive Self-Talk

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

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

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

More Coping Skills Help for Anger Management

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

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

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

PANS and PANDAS: A Cause of Sudden OCD in Kids?

I have a confession: I have been a child counselor for a while now, and I had never heard of PANS or PANDAS until fairly recently. It wasn’t covered in my graduate school program, or in my postgrad training. As far I was concerned PANS and PANDAS were kitchen implements and cute fuzzy bears from China.

All of a sudden, this year I began receiving many calls from parents looking for help for their kids who had been diagnosed with one of these two conditions. In this post, I’ll share what I’ve learned about PANS and PANDAS as a possible cause of sudden-onset OCD symptoms in kids. I’ll also let you know how therapy can help.

What Are PANS and PANDAS?

PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. In a child with PANS, anxiety and OCD-type symptoms develop very suddenly and severely due to an infection that has affected the child’s neurological system. Many types of infections are linked to PANS, including some fairly common ones like mononucleosis and Lyme disease.

PANDAS, or Pediatric Autoimmune Neuropsychiatric Syndrome Associated with Streptococcus, is a form of PANS. In PANDAS patients, the child’s rapid-onset symptoms are believed to be caused by the Strep A bacteria. Some researchers believe that PANDAS and is an autoimmune condition, in which the child’s body is attacking the brain instead of the bacteria causing the infection.

PANDAS was first identified in 1998, making it a relatively new condition. Because it’s so new, doctors and therapists are still learning about the causes of PANDAS and how best to help affected children.

What Are the Symptoms of PANS and PANDAS?

The most important detail to remember about PANDAS and PANS is that the symptoms come on very quickly. Usually, OCD and anxiety disorder symptoms develop gradually, over the course of months or years. Parents of children with PANDAS and PANS often describe the symptoms as almost coming out of the blue, developing over a weekend or a few days. These symptoms can quickly become so severe that they start to interfere with the child’s day-to-day life.

According to the International OCD Foundation, symptoms of PANS and PANDAS can include:

• Symptoms of OCD, like ritualized behavior or repeated worries

• Anxiety symptoms, like sudden separation anxiety

• Tics and other unusual movements, or problems with coordinated movement like handwriting

• Changes in eating and bathroom habits

• A recent strep infection (or other infection, in the case of PANS)

How are PANDAS and PANS Diagnosed and Treated?

PANDAS and PANS are diagnosed by a medical doctor. If the doctor thinks a child’s symptoms sound like they could be PANDAS, they will order tests like a throat culture or blood test that can detect a recent strep infection. If these tests come back positive, a doctor may choose to prescribe antibiotics to treat the infection. If child’s symptoms are due to PANDAS, they should subside along with the strep. PANS is diagnosed in a similar fashion, with tests and medications prescribed according to the infection that is suspected to be causing problems. Sometimes, when a child’s symptoms aren’t responding well to other medicines, doctors will use a more in-depth treatment called intravenous immunoglobulin (IVIG).

Doctors also often recommend therapy for PANS and PANDAS patients to treat the symptoms of anxiety and OCD caused by the illness. Although PANS and PANDAS may have a different cause than other anxiety disorders, kids with these conditions can still get relief from their symptoms with counseling.

Controversies: Are PANS and PANDAS Real Illnesses?

Because PANDAS and PANS are so new, doctors and researchers still are not in total agreement about what causes them. Some doctors are very convinced that strep and other infectious illnesses are the cause of PANS and PANDAS, while others feel there isn’t enough evidence yet to be certain. Some doctors feel more comfortable than others prescribing antibiotics to treat PANS and PANDAS symptoms, especially if the testing shows that the infection wasn’t extremely recent.

I’m not a medical doctor so I can’t speak to what really causes PANDAS and PANS or the best way to medically treat it. I do know that many children have had these symptoms since doctors first identified PANDAS in 1998, so whatever the cause, the problems children are suffering from are real. I also know that counseling, especially cognitive behavioral therapy, can be really helpful for these children.

Can PANS and PANDAS be Cured?

PANS and PANDAS are believed to be curable. Usually, if the symptoms are being caused by an infection, they get a lot better when the infection is treated. Counseling can also support kids in recovering from PANS and PANDAS and help them resolve any remaining anxiety after their medical treatment is done.

CBT for Children with PANS and PANDAS

Therapy can be helpful for kids with PANDAS and PANS for a few reasons:

• Learning coping skills to deal with anxiety might help symptoms resolve more quickly.

• Sometimes, even after medical treatment a child still shows signs of separation anxiety or OCD-type worrying. For these kids, the anxiety might have become a habit. They may have avoided the things causing their anxiety for so long, that now it is difficult to get back into their normal routine.

• PANS and PANDAS can be really frightening for kids. Children sometimes describe feeling out of control of their bodies. Having some support to work through the experience of suddenly getting sick can also help children to feel better.
  

Cognitive behavioral therapy, or CBT, is often recommended for kids with PANDAS and PANS. This kind of therapy helps children to notice when they’re having unhelpful thoughts that lead to worrying, and learn how to face their fears rather than avoiding them. It’s more goal-oriented and structured than some other forms of child therapy, so kids can really focus on the triggers for their anxiety.

ERP for Kids with OCD Symptoms Due to PANS and PANDAS

For children who have sudden-onset OCD symptoms, a special kind of CBT called Exposure and Response Prevention, or ERP, is often the best fit. This kind of therapy helps children to gradually face the fears that set off OCD worries and behavior. Children learn how to handle triggering situations without resorting to rituals or repeated behavior to help calm them down. Over time, kids feel more in control of their thoughts and less bothered by worries.

Help for PANS and PANDAS in Davidson, North Carolina

I’m a counselor who practices in Davidson, North Carolina, where I specialize in using CBT to help children combat anxiety. If you’d like to hear more about how I might be able to help your child with PANS or PANDAS, reach out to me here.

Not located near Davidson? I can provide online therapy throughout North Carolina, New York, and Florida. I also have an online coping skills course for kids with anxiety called Worry-Free Tweens. Because it’s education-based and not therapy, it’s available everywhere.

You can also get more in-depth information by checking out the references below.

International OCD Foundation’s PANDAS Page
Parents.com’s feature on PANDAS
PANDAS Physicians Network on how CBT helps PANDAS

3 Quick and Easy Coping Skills for Kids with Anxiety

In therapy as in life, there’s no such thing as a quick fix. Helping a child work through anxiety or trauma is a gradual process, and a child often needs lots of time to grow, learn new ways of thinking about things, and make sense of experiences. When working with kids, it helps to be patient.

But what about the times when patience isn’t going to cut it? What if your child is in the middle of a panic attack, and you need help right now? Or you’ve only recently started therapy, nut there’s an event looming in the near future that you know is likely to trigger anxiety? These situations are what coping skills are made for. Read on to learn 3 easy coping skills for kids with anxiety that can be used any time, anywhere.

What’s a Coping Skill, Exactly?

“Coping skill” is a broad term for any healthy habit or activity a person uses to manage strong feelings. They turn down the volume on anxious thoughts, so a child can carry on with her day. They are used deliberately when a person is feeling anxious, stressed, or angry as a way to cool off their feelings, so the person can think more clearly or get through a difficult situation. Coping skills can also be an alternative to unhealthy or even harmful behavior that some people resort to when feeling overwhelmed.

Meditation, mindfulness, physical activity, and creative arts activities all fall under the umbrella of coping skills kids with anxiety or other mental health concerns might use to manage their emotions. Lots of coping strategies help kids to focus on their breath or objects around them to help them take their attention off their anxious feelings, and focus them on something else.

Teaching a child coping skills won’t address the underlying cause of anxiety or trauma symptoms. However, helping a child learn to relax, self-soothe, and focus their attention elsewhere is a critical skill. . Over time, coping skills can build resilience and keep kids from having strong reactions when they feel stressed.

Why Do Kids with Anxiety Need Coping Skills?

When a child is very anxious, her brain and body are in fight-or-flight mode. Fight-or-flight is a natural response that is hardwired in all of us to help keep us safe from danger, giving us a big surge of adrenaline and other hormones that quickly get us ready to fight off an attacker or run for our lives. Fight-or-flight affects many systems in the body, including heart rate, sweating, breath, and digestion.

An anxious kid’s fight-or-flight response isn’t working quite the way it should. It’s going off at the wrong times, putting him in this physically uncomfortable state when he doesn’t need to be there. While coping skills can’t change the circumstances making a child anxious, they can help to change the fight-or-flight response.

Coping skills help anxious children to relax in both the short- and long-term. They help the child to calm down right away, lessening the anxiety and panic so that the child can decide how to handle a situation. They can also help in the long run: the more a child practices a coping skill, the more effective it becomes. Some children with anxiety find that when they practice coping skills regularly, their fight-or-flight response becomes less sensitive.

How Coping Skills Work for Anxious Children

Coping skills can work in a few ways:

• They can help kids to relax: coping skills are a great way for kids with anxiety to calm their fight-or-flight response.

• They buy kids time: they give children an opportunity to pause and consider all their options before making a decision.

• They shift a child’s focus: coping skills often help a child put his attention on something outside of himself, which can help to reduce worries.

Coping Skill for Anxiety #1: Breathing in a Box

Breathing in a box is a simple way to teach children how to breathe slowly and mindfully. Draw a square on a piece of paper, and have your child trace their finger around the shape.

As your child moves his finger up one side of the square, he can breathe in on a count of 4. Next, hold the breath for a count of four as his finger moves along the top of the square. As his finger moves down the side, breathe out on a count of 4. Finally, rest for a count of 4 as his finger moves along the bottom of the box, before starting the breath cycle again.

The full cycle would look like this: Breathe in 1-2-3-4, Hold 1-2-3-4, Breathe out 1-2-3-4, Rest 1-2-3-4.

Coping Skill for Anxiety #2: Squeeze and Relax

Progressive Muscle Relaxation, or “squeeze and relax”, is a popular coping skill used to help kids struggling with anxiety, trauma, and insomnia. When a child is anxious or afraid, the muscles of the body tense up, which can lead to headaches, stomach aches, and other bodily symptoms of stress. Squeezing and releasing each muscle group in a sequence sends a message to the brain and body that it’s safe to relax right now.

To practice this, your child can start by squeezing the hands tightly (but not painfully) for a few seconds, and then relaxing. With just one squeeze there should be a noticeable difference in how the hands feel. Try the squeeze again, and then move to other muscle groups, like the arms, shoulders, stomach, and legs. Start at the top of the body and move down to the feet, before ending with one big, full-body squeeze.

Coping Skill for Anxiety #3: 5-4-3-2-1

This simple tool is particularly good for combating panic attacks as well as trauma symptoms like flashbacks. Grounding skills like this one pull a child’s focus away from the worries in her head and back to the world around her. Here’s how to try this coping skill:

Name 5 things you can see in the room or place around you
Name 4 things you can touch around you
Name 3 things you can hear (you may need to really pay attention)
Name 2 things you can smell: if you can’t smell anything after really trying, name your favorite smells
Name 1 thing you can taste: if you can’t taste anything, imagine what the last thing you ate tasted like

This quick skill can be used almost anywhere, since all it requires is use of the 5 senses.

More Coping Skills Resources for Anxious Kids in North Carolina

If these coping skills seem like a step in the right direction for your child, there are many more options to try. My educational course for anxious kids, Worry Free Tweens, covers these coping skills and other tools for managing anxiety in more depth. You’ll also find tips for parents so you can help your child to practice at home, and manage your own stress, too.

If you feel like your child needs more support, or other issues insomnia or back-to-school anxiety are making life complicated, therapy can help. I love helping anxious kids learn strategies to handle their worries. If you’re in the Lake Norman area of North Carolina, I’d love to help at my child therapy office. You’re always welcome to reach out to me, or to inquire about online counseling, which is available to kids in North Carolina, New York, and Florida.

ERP Therapy for Children

How Exposure and Response Prevention Helps OCD

When I first meet a child with OCD, they often tell me they feel hopeless. Kids with OCD are usually aware something is wrong: the worries that bother them feel foreign, and they wish they could just make the thoughts go away. When a child isn’t able to control his thoughts on his own, it can be a powerless and scary feeling.

The compulsive behaviors and rituals that come along with OCD can quickly become all-consuming, taking kids away from fun activities they love and leaving them feeling frustrated and embarrassed. Even though OCD can feel hopeless, the truth is that there’s a therapy approach out there that is really effective for treating obsessions and compulsions. ERP therapy for children can help kids deal with the overwhelming worries of OCD, and the way that it works might surprise you.

What is ERP Therapy?

ERP stands for Exposure and Response Prevention. It is a form of therapy that has been specifically designed and studied to treat OCD symptoms in adults, teens, and children, and it is often considered a “gold standard” for OCD treatment. ERP is a form of cognitive behavioral therapy, meaning that it’s based on the belief that changing a person’s thinking patterns and actions can also affect their emotions. Although some kids with OCD might also benefit from medication, ERP therapy does not involve medication. You can find ERP being practiced in big mental health centers as well as in private practice by psychologists, counselors, social workers, and other mental health professionals.

The main goal of ERP is to help children gradually face the frightening or difficult situations that set off their OCD worries (called exposure) without having to do their OCD behavior or ritual (response prevention). This is done in a safe, controlled way, usually in the therapy office, to keep children from feeling too overwhelmed. Children are taught about how OCD thoughts work to make them less mysterious and scary, and are given tools to fight back when their OCD thoughts arise.

Can Young Children Have OCD?

OCD can start at any age. Although most people with OCD aren’t correctly diagnosed until adulthood, two thirds of adults with OCD say their symptoms began before the age of 18. OCD can be diagnosed in children as early as age 6, and the time frame between 6 and 15 years of age is a common time for children to develop symptoms.

Here are some possible signs of childhood OCD to look out for:

• Recurring fears, worries, or thoughts that the child doesn’t want to have, but can’t stop thinking about

• Fears about hygiene (like handwashing), morality (like telling the truth), illness (like vomiting), or violent or upsetting thoughts

• Needing to sort, count, or perform an action an excessive number of times, or in a certain sequence

• The repeated worries and tasks are getting in the way of your child’s day-to-day life

How Does ERP Therapy Work with Children?

ERP therapy for children is based on the same tools and ideas as ERP for adults, but adapted to be more kid-friendly. OCD can feel disorienting and even embarrassing to children, who are often aware something is wrong but feel powerless to stop it. The first step in ERP with kids is to help children understand what OCD is, how it works, and that they are not alone. Explaining OCD using metaphors, reading age-appropriate books about ODC, and art and play therapy techniques can all help demystify OCD and help children understand that they’re experiencing something common and manageable.

Once kids have a better understanding of OCD, we can start teaching children tools to stop the cycle of OCD worries, and get control over their compulsive behavior.

“Bossing Back” OCD Thoughts with ERP

ERP therapy for children is a cognitive-behavioral approach, meaning that it focuses on a child’s thoughts and behavior to help shift their mood. Usually, ERP starts by helping a child learn to manage the repeated worries and unwanted thoughts that arise over and over with OCD. Sometimes these are described as “intrusive thoughts” because the thoughts can be upsetting ones that a child would never choose to have, but they pop into the child’s brain anyway.

In ERP a child learns that, like a glitch or a hiccup, these intrusive thoughts can be bothersome, but they’re not dangerous or a sign that something is seriously wrong. Kids learn how these OCD thoughts are different and less realistic than everyday thoughts, and practice spotting them when they pop up. Once a child can identify her OCD thoughts, she can learn tools to be the boss of them, instead of getting bossed around by the unhelpful worries.

Children might learn ways to use logic to prove that worries aren’t accurate, which can help take some of their power away. Children can also learn how to talk back to their fears, coming up with more helpful and empowering statements to say to themselves when an OCD thought is bothering them. Rather than being bossed around by OCD worries, children learn how to “boss back” and challenge their thoughts to regain control over them.

Doing the Opposite

The behavior-based part of ERP therapy for children is the one that might surprise you. After children tackle the thoughts and worries of OCD, they are asked to do the exact thing their OCD tells them not to do. For example, a child with a fear of getting germs on their hands might be encouraged to play in the mud…without washing her hands right away. A kid who worries about throwing up might be asked to talk about vomiting and make barf jokes in therapy sessions.

This might seem counterintuitive: if a child is feeling really anxious about a certain activity, won’t doing it make him feel worse? When a person is anxious, it’s really tempting to avoid anything that triggers anxiety. Each time we do this, however, we are “feeding” the anxiety and making it stronger in the long run. Although our anxiety might go away when we avoid a scary thing, the next time we encounter the same situation it will come back even stronger.

Kids are never asked to face their fears all at once—this would be way too scary and overwhelming! Instead, a therapist helps a child to work up to the scariest situations, bit by bit, usually over the course of many weeks. This is done in a safe setting like a therapy office, where the therapist can control the situation and make sure the child is not feeling too overwhelmed. Each time the child faces a part of their fear, they re-train the brain that this situation is not something worth getting so anxious over. Children are also encouraged not to practice their OCD behavior during this time, even if it feels like it would help them to reduce their anxiety. By ignoring the urge to complete a compulsive behavior, we can diminish its strength over time, and eventually children may not feel the need to do it at all.

More Resources on ERP Therapy for Children

If you suspect a child in your life has OCD, and wonder if ERP therapy for children could be helpful, there are a few next steps you can take. My blog post on child OCD symptoms can help you learn more about how OCD can manifest in kids, or you can check out my homepage on childhood anxiety to get advice about how to help kids soothe anxiety at home. You can also visit the International OCD Foundation’s website, which has excellent resources for families and can help you find a therapist who specializes in OCD in your area.

If you’re in the Lake Norman or Charlotte, NC areas, I’m always happy to talk about local resources and how I might be able to help support your child with OCD. You can reach out to me here.

TF-CBT for Preschoolers: Therapy for Early Childhood Trauma

TF-CBT is designed to help preschool children as young as 3 and 4 years old after a trauma.

Preschool Trauma is Common

Trauma is one of the leading causes of mental health problems in children, and TF-CBT for preschoolers can help support the many young children who find themselves affected by trauma each year. Learning that a preschooler has experienced a trauma is terrible news for any parent. As caregivers for children, we do everything possible to shield the young people in our lives from danger. Despite our best efforts, sometimes life happens in ways we didn’t expect or hope for: accidents, violent situations, grief, and loss are not always preventable, and can affect people of any age—including preschool children. Statistically, 26% of kids in the United States will witness or experience a trauma before the age of 4.

Some common causes of childhood trauma among preschoolers are:

• Prolonged separation from a parent due to illness, incarceration, or foster care placement

• A severe accident or illness, such as a car accident or cancer

• Physical, verbal, or sexual abuse

• Witnessing physical or verbally abusive arguments between parents

It’s important to know that preschoolers can be just as affected by witnessing a parent’s trauma as they would be if the trauma happened to them directly. Very young children are so connected to their parents that their own sense of self and safety is wrapped up with their parents’ well-being. Seeing a parent in trouble can be intensely frightening and painful for a preschool-aged child, and can be just as likely to result in trauma symptoms.

How PTSD Affects Preschoolers

While some preschool children will “bounce back” fairly easily from their trauma experience, others might show lingering problems long after the initial event has passed. Trauma symptoms can impact any child’s life, but younger children may especially vulnerable to developing symptoms. Other factors that make trauma symptoms more likely include having special needs or sensory sensitivities, experiencing other life stresses, and having a previous history of trauma or loss.

How can you tell if a preschooler in your life has trauma-related symptoms? Very young kids may not be able to tell us in words what they are going through, but will communicate their trauma through tantrums or crying, difficulty sleeping, frequent nightmares, or problems paying attention or following directions. Parents often observe that their child seems to “regress” to an earlier developmental stage after a trauma, and may suddenly struggle with problems they had previously grown out of, such as potty training or sleeping through the night.

Lots of research has been done on the subject of early childhood trauma. We’re learning that even the youngest children can be just as deeply affected by trauma as older children and adults. Fortunately, we’ve also discovered that preschool-aged children can benefit greatly from age-appropriate trauma therapy tailored to their developmental level. One of the best-researched forms of therapy for preschool survivors of trauma is Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT.

What is TF-CBT, and How Can it Help Preschool Children?

TF-CBT is a form of therapy designed specifically to help children ages 3-18 following a traumatic event, and it can be an especially big help for children in the preschool and early elementary age range. It is an evidence-based form of therapy, meaning that it has been proven effective by research to help children with these symptoms. Through TF-CBT, preschoolers and their parents learn skills to cope with trauma symptoms, helping the child to alleviate anxiety, manage worries, and cope with strong feelings. The parent and therapist gradually assist the child in expressing their thoughts and feelings about the traumatic event and make sense of what happened, so that it no longer feels like an overwhelming experience.

TF-CBT tailored for preschoolers puts a strong emphasis on educating both children and parents about how trauma can cause problems problems with their bodies as well as their feelings. This can be extremely helpful for young children, who may feel quite confused by their symptoms and alone in their experience. Educating children about trauma in an age-appropriate way helps children understand that they are not alone—many other young children have walked in their shoes, and have recovered from trauma to live happy and fulfilling lives.

How does TF-CBT for Preschoolers Work?

During treatment with TF-CBT, preschoolers are taught how to use relaxation and mindfulness techniques to reduce anxiety and mood swings during the day and promote restful sleep at night. While these relaxation skills are used initially to reduce symptoms of trauma, they are also a great life skill that can grow with the child, helping them to manage other stressful situations as they arise.

Since younger children may have more difficulty putting feelings into words and making connections between past and present experiences, TF-CBT for preschoolers relies more on art and play-based activities to help children identify important feelings and develop a better understanding of their experiences. Through art and play activities facilitated by a therapist, the child can work through any misconceptions about their trauma experience, alleviate feelings of guilt or self-blame, and find a sense of closure.

Helping Preschoolers Move Beyond Trauma with TF-CBT

While therapy cannot make a young child forget what has happened to him, it can take some of the power away from a traumatic experience. It can help a child move past this difficult time in their lives and toward other, more hopeful chapters. Many parents and children find that after working through a traumatic event in therapy, children develop more resilience and empathy for others. Children and parents complete the TF-CBT process together by reviewing the child’s growth and learning strategies to help the child stay safe and avoid dangerous situations in the future.

If you’d like to learn more about how to support your preschooler with trauma through TF-CBT, my door is always open. You can also learn more by visiting the official website for TF-CBT.

Signs of OCD in Children: What Parents Can Look For

Obsessive-compulsive disorder, or OCD, is a common form of anxiety that affects up to 3% of kids in the U.S. Parents can play a big role in spotting early signs and symptoms of OCD in children, especially since the problems kids experience can be subtle at first. In this post, I’ll debunk some of the common myths and misconceptions about OCD, highlight some common symptoms to look for, and share how to get the best help for your child if you’re concerned about OCD.

Obsessive-Compulsive Disorder: Stereotypes vs. Reality

“I like to make sure all my papers and pencils are organized…I’m a little OCD.”
“I’m super OCD about my house being clean.”
“I have such OCD about getting my books back to the library on time.”

Have you ever heard anyone talk like this? Over the last decade or so, “OCD” has become a household word. Often used as a slang term to describe someone who is very organized or strict about something, the way we use “OCD” in casual conversations is not a very accurate description of what life is like for people who have this disorder. More people are aware of OCD than ever before, which is great! On the other hand, the stereotype of an “OCD” person as always being extremely neat and tidy might make it harder for parents to spot true signs of OCD in children. Not all kids (or adults) with OCD are particularly clean or organized!

Obsessive-compulsive disorder, or OCD, is a form of anxiety that affects both children and adults, but often begins in childhood. The American Psychiatric Association defines OCD as “an anxiety disorder in which time people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions).”

Common OCD Symptoms in Children

OCD has two main symptoms: obsessions and compulsions. Obsessions are repeated, bothersome thoughts that are different from the worries most of us experience occasionally. They pop up again and again, even when the person does not want to be thinking about them. Often, the thoughts are very unrealistic, frightening, or illogical. People who suffer from OCD may know that their worries are not logical, but continue to be bothered by them.

To stop their obsession from bothering them, people with OCD feel compelled to do something to relieve anxiety or to prevent something bad from happening. This might be a common behavior that has been taken to an extreme and repeated too much, like handwashing or asking for reassurance. Sometimes, the behavior may not be tied logically to their worry. For example, kids with OCD may need to a certain number of items perform tasks in a certain order.

Kids with OCD sometimes describe an “itch” or “not right” feeling that they have until their compulsion is completed. While performing a compulsive behavior helps the person to feel better for a little while, the OCD thought always recurs again, leading the person to have to perform the compulsion over and over.

Everybody has worries or feels the need to do something to prevent bad luck from time to time, but for children and adults with OCD, these repetitive behaviors take up a ton of time—even many hours a day. The obsessions and compulsions of OCD get in the way of a person’s day-to-day life. If your child’s repetitive behavior or worries are beginning to interfere with their daily activities, it’s a sign that OCD symptoms may be to blame.

What Are the Most Common Signs of OCD in Children?

Often, children feel very confused or even ashamed of OCD symptoms. They may not be able to verbalize exactly what they’re going through to their parents, but they can probably tell something is not right. A child with OCD may bring up repeated worries, even after being reassured about it multiple times, or appear repeatedly anxious in situations that may not seem entirely logical. Some common fears and obsessions for children with OCD are:

• Fear of dirt, germs, or items becoming “contaminated”

• Worries related to religion or morality, such a truthful child being afraid of possibly lying

•  A need for things to be symmetrical, in a certain order, or done a certain number of times

• Worries about getting sick, others getting sick, or throwing up

• Thoughts about violent or upsetting things happening that feel intrusive (unwanted by the child)

In addition to these worries, children with OCD usually feel the need to repeat a certain behavior over and over again. These repeated actions, called compulsions, are also commons sign of OCD in children:

• Repeatedly checking things, such as light switches, the oven, or reviewing homework

• Rituals that must be performed exactly the same way each time, such as an elaborate bedtime routine

• Hand-washing, showering, or brushing teeth more often than necessary

• Counting or arranging items in a specific way

• Repeatedly asking for reassurance from parents or friends

What’s the Best Treatment for OCD Symptoms in Kids?

OCD can impact many areas of a child’s life, including their ability to focus on schoolwork, their sleep and eating habits, and their ability to fit in with friends. Treatment for OCD supports a child in all these domains, as well as helping the child to break the cycle of obsessions and compulsions. Research suggests that Exposure and Response Prevention, also known as ERP, is the most effective form of therapy for OCD.

ERP helps children to notice when their worries become obsessive, and empowers them with specific strategies to reduce their need to follow through with compulsive behavior. Over time, the urge to complete the compulsion gets weaker and weaker, and children are better able to identify and ignore any “OCD worries”.

Get Help for OCD and Childhood Anxiety in Charlotte, North Carolina

If you’re interested in learning more about how therapy could help your child with the signs and symptoms of OCD, feel free to reach out to me here. I’m available to help kids in North Carolina, New York, and Florida using online therapy. Not in one of those states, or not ready for therapy? Learning coping skills such as relaxation techniques and how to spot unhelpful thinking patterns can benefit kids with any form of anxiety. My educational course, Worry-Free Tweens, is not a replacement for therapy but may be a helpful first step for you and your child to learn skills together.

You can also find more helpful information at the sources below:
Nationwide Children’s Guide to OCD
The CDC’s Children’s Mental Health OCD Information Page

Therapy for Toddlers with PTSD: Child-Parent Psychotherapy

A Special Therapy for Toddlers with Trauma Symptoms

Can Toddlers Have PTSD?

Trauma has become a buzzword among people who care for children. In the past, the word “trauma” was usually reserved for experiences most common among adults, like war and violent crime. Now, mental health professionals understand that many other frightening experiences, such as abuse, medical emergencies, and witnessing accidents or violent arguments can lead to trauma in people of all ages. In this post, I’ll be discussing how therapy can help toddlers with trauma symptoms and PTSD following one of these experiences.

Doctors, teachers, counselors, and parents are becoming increasingly aware of the ways that traumatic experiences like these can affect children's physical and emotional health. Even children's television programs like Sesame Street have recognized the impact of trauma on young children, and have started to address difficult experiences like grief, foster care, and incarceration in episodes. As hard as it might be to imagine, trauma and PTSD can affect even very young children—including toddlers.

How Trauma Affects Toddlers

Studies have shown that exposure to extremely frightening or violent events impacts a child's ability to learn, form close relationships with family and friends, and can even make kids more susceptible to chronic illnesses later in life. Separation from a parent, even when it isn’t due to a violent or scary cause, can also have similar effects on a child. We also know now that these effects last for a long time: even if a toddler is too young to remember the traumatic event, he may suffer from trauma symptoms like tantrums, anxiety, difficulty bonding with parents, or problems with sleep for years to come if he does not receive the help he needs to move forward.

Therapy for Toddlers with PTSD

While there are quite a few forms of therapy to help older children cope after a trauma, it can be hard to find therapy that is a good fit for very young children. Toddlers often have a hard time putting their feelings into words, and need specialized therapy that incorporates play and nonverbal techniques to help make sense of traumatic experiences, as well as coping skills to manage strong emotions. Child-Parent Psychotherapy is one of the only forms of therapy specially designed for the youngest kids--children under the age of five--who have survived a trauma or loss.

Child-Parent Psychotherapy, or CPP, is a form of play and talk therapy for children ages 0-5 and a parent or caregiver. It is a dyadic therapy, which means that typically the child and parent participate together with support from a therapist. CPP aims to strengthen the bond between parent and child after a frightening event. Because parents are so central to young children's lives, they are especially equipped to help a child return to healthy growth and development.

How Child-Parent Psychotherapy Works

Through CPP, toddlers with PTSD symptoms rediscover how to feel safe and protected after a trauma, and make sense of what has happened to them in an age-appropriate way. Learning coping skills to help the child relax and manage emotional outbursts is another important goal of CPP. Parents can also get support for themselves through caregiver coaching sessions, where they have the opportunity to cope with their own feelings about what happened and receive tips from the therapist on how to handle behavior problems related to trauma.

CPP is an evidence-based therapy, which means that it has been proven effective by scientific research. While not every form of therapy works for every person, CPP has been used successfully with kids from many different cultural backgrounds, and to help with a variety of traumatic events including domestic violence, grief, abuse or neglect, parental separation, and serious accidents. It can be a helpful therapy for children with biological, foster, or adoptive parents, and even a caring relative can serve as a support system in CPP sessions.

Therapy for Young Children After Trauma in Davidson, NC

Coping with a trauma or loss can be an extremely challenging situation for people of any age, but parents with toddlers don't have to struggle with this alone. If you think your young child might benefit from therapy for toddlers with trauma symptoms, please don't hesitate to reach out to me and learn more about this approach. You can also learn more about the impact of trauma on children and how therapy can help here.