How to Help Grieving Children Through Christmas

Whether your child has lost a loved one recently or long ago, Christmas can rekindle feelings of grief for children. Happy memories of past Christmases with a parent or family member who has died makes their absence during the holidays even more apparent. Christmas is often described as the “most wonderful time of the year” for children, and the movies, songs, and advertisements targeted at kids can trigger complicated feelings as the holiday approaches. Here are some ways to support a child in your life who is grieving over Christmas.

Involve Your Child in Holiday Planning

The Dougy Center is one of my favorite resources for bereaved children and their families. Their tip sheet for getting through the holidays is an excellent guide for how to discuss an upcoming holiday with bereaved kids. Asking your child how they feel about continuing with holiday traditions helps you to gauge what could be comforting to them, and what might be too painful to handle this year.

Many children benefit from predictable routines, especially after trauma or loss. Participating in Christmas traditions as they have always been done might be just the thing to help some kids. These holiday rituals can help restore a sense of normalcy for children, and give them an opportunity to feel close to family after the loss. On the other hand, some holiday traditions may feel so closely connected to the lost loved one that they are too overwhelming to practice. Asking your child about his or her preferences gives them some control in a tumultuous time. It’s okay to keep some things the same, modify others, and leave some traditions for another year.

However Your Child Feels About Christmas is Okay

Children grieve deeply, but the way they show their grief can be different than adults. Adults can remain in mourning for a long time. Even as they get back to their daily lives, they are aware of their grief. Children, by contrast, often grieve in bursts. This may be because they don’t have the same capacity to handle deeply painful emotions as adults do.

It’s common to see an intense outpourings of emotion from bereaved children, interspersed with periods that are relatively calm. It doesn’t mean the child has forgotten about their grief: they just need to take a break. The child will “pick up” their grief again when they are ready to keep processing it.

Because kids sometimes grieve in bursts, any reaction to Christmas is normal, okay, and healthy. Children need permission to feel mad, sad, guilty, or frightened about celebrating holidays without their loved one. They should also be allowed to feel excited, to enjoy holiday traditions with family, or to anticipate receiving gifts from Santa. Letting a child feel whatever feelings come up for her supports her in working through her grief. You can help support your grieving child by letting her know that her feelings about Christmas are normal, even if they change day to day.

Tell Stories About Your Loved One

Because Christmas is loaded with family memories for most people, it can be a good opportunity to tell stories about a family member who has died. Many children have a strong desire to share stories about a loved one following a death in the family. Sharing these stories can help a child feel connected to their deceased family member, and help them to heal.

If your grieving child is interested in telling stories about her lost loved one, you can support her by talking about favorite holiday traditions. What was the family member’s favorite food? What was a memorable gift the family member gave or received? It can also be helpful to remember less happy memories involving a deceased family member. This shows children that negative feelings are okay to share, too.

Read Children’s Books About Grief

The holidays may be a good time to share a book about death, loss, and bereavement with your child. Children’s books can approach grief in a more general way, which can be less threatening for kids. Books can also normalize the feelings that children have after a death, reassuring them that their reactions are normal and they aren’t alone.

The Invisible String is a classic book for children that doesn’t directly address the topic of death, but talks about how love between a parent and child never goes away. It can be a helpful book for children who are grieving the loss of a family member, as well as children who are anxious or sad about separation from a loved one for any reason.

When Dinosaurs Die is a more educational book that speaks directly about death, and addresses questions children may ask after a loved one dies. Instead of reading this book cover-to-cover, it might be more helpful to pick sections to read based on an individual child’s experience and the nature of their loved one’s death. The illustrated dinosaurs in this book help keep the book feeling safely removed from everyday life, which helps the book feel more reassuring for kids.

Take Care of Yourself During the Holidays

Therapists often use an airplane analogy when talking to parents about self-care. When you’re in an airplane, the flight attendants tell you that, in case of emergency, you need to put on your own oxygen mask before helping a child. The same can be true during grief.

Children rely on their caregivers heavily after a death. They may become more clingy, and need more individual attention, as they heal from their loss. Kids also look to their parents to learn how they should be feeling, and to get reassurance that they will still be safe. Caregivers need to take care of themselves, physically and emotionally, so they can have the strength to take care of their grieving kids.

It’s okay to say no to holiday events, if you don’t feel up to the task. Practicing self-care, especially around Christmas, is really important for a mourning parent. It is okay to let your child see how you’re feeling, even if you’re feeling sad or angry. Parents can show children that it is okay to cry, and also model the ways that both adults and children can care for themselves during grief. It’s also always okay to step away from holiday celebrations and take a break, if things become too overwhelming.

Help Your Child Cope With Grief During Christmas and All Year Long

If your family is grieving this season, you’re not alone. We can’t take a child’s grief away, but parents and caregivers can give children the tools they need to cope with their loss in a healthy way. My activity book for bereaved kids and caregivers is available on Amazon, Barnes & Noble, as well as through small booksellers near you. Inside, you’ll learn how children grieve differently than adults, and get over 100 ideas for hands-on activities you and your child can try together to manage the difficult feelings of grief.

Children may have symptoms of trauma after a death, especially if the loss was sudden or violent. You can learn more about symptoms and help for trauma here. If you’re in the Lake Norman area in North Carolina, my door is always open if you’d like to reach out.

How Do I Teach My Toddler Gratitude?

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

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

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

Be a Good Role Model

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

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

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

Catch Your Toddler Being Good to Encourage Gratitude

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

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

Encourage Your Child to “Help”

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

Read Books to Teach Toddlers About Gratitude

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

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

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

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

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

How to Teach Children Gratitude Through Play: 2 Tips from a Play Therapist

2 Play Therapy Techniques to Encourage a More Thankful Mindset

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

Happy Thanksgiving! This week, I’ve been thinking a lot about the theme of gratitude, and how it impacts the children I see in my playroom. Our culture pays a lot of lip service to gratitude. We have an entire national holiday dedicated to the concept of being grateful for what we have. Interestingly, right after Thanksgiving, we are catapulted into the most materialistic season of the year. In this post, I’ll be talking about how to navigate this with children, using play therapy skills to teach children gratitude through play.

The day after Thanksgiving, Black Friday sales will immediately start peddling the hottest new products to both adults and children. In fact, lots of kids’ culture is based on needing the hottest new toy, from unboxing videos on YouTube to TV commercials targeted directly at children to videogames that constantly push in-game purchases. In a world where Thanksgiving and Christmas are so loaded with messages about needing more, how can we help teach children gratitude and help them to be thankful for what they already have?

I came across this 2014 article from the Atlantic by Jenn Choi recently, and I think it’s fantastic. It’s advice from a parent’s point of view on how to effectively teach gratitude to kids without preaching or lecturing. The author, a mom and journalist, feels torn: she wants to provide her kids with the material things her own family couldn’t afford as a child, but also worries about spoiling them. She decides to appeal to her kids’ interests and speak their language—toys and play—in order to instill the value of gratitude:

Kids do not know how big or little your paycheck is. Kids do not understand what income tax or health insurance deductibles are either. However, they do know how much a Nintendo DS game cartridge costs. They know how much a Wii costs. Or a slice of pizza or a bottle of Gatorade. This is their vocabulary—their understanding of values in our material world. We can work with that. And to get our kids to understand the meaning of gratitude, we must.

The entire article is worth a read, and it’s a good reminder that adult worries about finances are just not good motivators to help kids learn to be more grateful. They’re too abstract for children to understand, and hearing about financial difficulties might make children feel guilty or anxious, rather than grateful. It got me thinking about how play therapy can help parents to teach the concept of gratitude at home without resorting to lecturing.

Lots of the skills that are “bread and butter” for play therapists can be used by parents at home to promote gratitude in a fun, engaging way. Here are some play and activity-based tips to consider if you’d like to encourage your children to develop a more thankful mindset.

Give Them Responsibility

In play therapy, we talk a lot about “returning responsibility” to a child, which simply means encouraging children to do things by themselves whenever possible. Rather than jumping in immediately to help if a child is working hard to open a jar lid or balance a tower of blocks, a play therapist allows the child to struggle a bit and try to achieve the task alone. With a little patience, the child can usually do the task all by herself, and feels proud of herself for doing it.

Being responsible for an activity can also help children be more grateful for the end result, because they appreciate the effort that went into it. When children are given a job to do during family chores, cooking, and cleaning, they feel more thankful and take less for granted. Here’s two ways to promote gratitude by giving kids responsibility:

• Get kids involved with their own meal prep: even toddlers can help with tasks like mixing, dumping ingredients, and washing produce. Older children can cut food with child-safe kitchen knives, measure ingredients, grease baking pans, and rinse dishes. Involving children in the kitchen is a common recommendation for helping picky eaters, because children are more likely to appreciate and enjoy food they have helped to cook themselves. Similarly, kids who took part in cooking their own food take pride in their accomplishment, and are more aware of the work it takes to put food on the table each day.

• Let kids assemble their own toys: Did your child just come home with a massive Lego set or playhouse requiring an elaborate set-up? While it may not be realistic for your child to put everything together themselves, encouraging the child to put their new toy together with you can help them to grasp the work and effort that goes into building their new plaything. This might help your child to feel more thankful for his new toy and treat it with more care.

Less is More

Play therapists work with toys for a living, and yet if you peek into a play therapist’s office, you’ll likely find a small collection of traditional and fairly “basic” items. Having a mountain of toys in the office can overwhelm children, making them feel more anxious and unfocused, so many play therapists take a “less is more” approach and carefully curate their playrooms to include classic toys rather than the latest “it” item of the season.

Research now shows that kids with fewer toys focus for longer and play more creatively than children with more. A study published in Infant and Child Development showed that toddlers in a room with only 4 toys showed more imaginative and advanced play than children in a room with 16 toys. The kids in the 4-toy room were also able to play with their toys for longer periods of time, without becoming distracted. Children don’t need every hot new toy advertised on TV, or 100 presents under the Christmas tree. In fact, teaching kids how to make do with less might lead to happier, more grateful kids.

You can read more about play therapy and its benefits for children by clicking here. I’ll be back next week to share some more tips about teaching gratitude to kids during the holiday season and year-round.

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

Drama Therapy for Children: Express Yourself Through Theater

Drama Therapy uses storytelling and make-believe to help children work through feelings

This is the second blog post in my series on drama therapy. Click here to read part one!

Drama therapy is a form of mental healthcare that uses theater techniques to improve the mind-body connection, encourage emotional growth, and provide symptom relief. When drama therapy is used with kids, storytelling, imaginative play, props such as dolls and puppets, as well as theater techniques like improvisation and performance help children to explore their feelings, connect with others, and problem-solve difficult situations.

Drama therapy can be used in both group and individual therapy sessions. Because it helps participants express themselves nonverbally, it works well for people of all ages and abilities, as well as across cultures or when there may be a language barrier within a group. Today, I’d like to talk about how Drama Therapy can be an especially powerful tool for kids in counseling.

Drama Therapy for Children: No Theater Experience Required

Parents might wonder if their child has to have a flair for the dramatic in order to benefit from Drama therapy. Is this a form of counseling just for "theater kids?" Not at all! Kids who are natural performers or have theater experience are a great fit for a drama therapy group, since they’ll be building on their strengths and connecting with other children who may share their interests.

However, I believe that more introverted kids can benefit just as much—if not more—from therapy that uses theater techniques. There’s a lot more to Drama therapy than just performing on stage, and the skills can be modified to meet any child’s needs and comfort level with performing.

Why Drama Therapy is a Natural Fit for Children

If you have a young child in your life, you have probably seen her pretend to be a superhero, or act out scenes from a favorite movie or story using her friends or toys. Children are natural storytellers, and they love to take on the roles of their favorite characters and heroes. This type of play is the foundation of drama therapy!

Kids are naturally inclined to work out their feelings and learn through play. Child therapists like to say that "play is the child's language,” and research has shown that imaginative, make-believe play is a critical part of healthy child development. Even when children are exploring pretend scenarios in play, they are learning important lessons about real life. Drama therapy builds on this natural capacity for imaginative play to help children work through feelings and events that might be too big to describe with words. 

What Kinds of Children Benefit from Drama Therapy?

Drama Therapy has been used to help children with a wide variety of problems. Some of these include:

• Children having problems with relationships, or who need to practice social skills

• Children on the autism spectrum

• Children who are acting out behaviorally

• Children who are recovering from a serious injury or illness

• Children who have experienced trauma or loss

In general, drama therapy can be an asset for any child who has a hard time verbalizing his feelings. Even bright and talkative kids often have a hard time articulating deep, underlying worries or emotions. Even if they can verbalize them, many kids are hesitant to share these deep-down feelings out of a fear that they may become too overwhelming for themselves or others to handle. For these kids, traditional talk therapy alone may not be the most helpful option. Drama Therapy can help children begin to access and explore their emotions in a less threatening, more playful environment.

Benefits of Drama Therapy for Kids

Drama therapy has some unique benefits for children when compared to other forms of therapy. Here are a few of the common positive outcomes for children who participate in drama therapy:

Reduced Social Isolation: Drama Therapy is a community-building activity that helps children build empathy and social skills. Young people have the opportunity to walk in another person’s shoes and may discover that their peers not only understand their worries and problems, but share them.

Increased Self-esteem: Children can experience the confidence that comes from learning a new skill, whether performing for a full house, a group of peers, or an audience of one. Theater performance celebrates the uniqueness of each individual and can help young people to identify their own strengths.

Practicing New Skills: Roleplaying allows kids to try out new coping and social skills in a safe, low-risk environment. The role-player is free to experiment and make mistakes, and discover how different approaches to a problem have different outcomes.

Creative Problem-Solving: Drama therapy increases children’s creativity and spontaneity, encouraging young people to trust their instincts and come up with new, out-of-the-box ways to approach life's challenges.

Improved Emotional Expression: Drama therapy is a great way to more deeply explore feelings that may not be accessible with verbal therapy alone. It can also be a safe way to explore feelings that are too big or scary to talk about directly.

Learn More about Drama Therapy for Children

Drama Therapists are increasingly employed in settings that work with children, such as schools, early intervention programs, recreational facilities, and hospitals. Drama therapy for kids can also sometimes be found in therapy practices specializing in children, such as my own.

To find out more about how Drama therapy can benefit young children, check out the North American Drama Therapy Association’s website here.

If you’re in the Davidson area, I’m a Registered Drama Therapist and would be happy to talk more with you about this unique form of child therapy. You can contact me here.

What to Do When Your Child Won't Eat Anything

Help for Picky Eaters

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

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

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

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

Is picky eating ever a serious problem?

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

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

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

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

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

What causes picky eating in children?

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

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

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

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

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

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

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

More help for kids who won’t eat anything

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

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

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

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

Anxiety About Going to School…In October?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What's a Registered Play Therapist?

An RPT is a therapist who specializes in play therapy with children.

If your younger child is struggling but has a hard time talking about her feelings, keep reading: this post is for you.

Any parent who has searched for a child counselor is probably familiar with the string of letters that follow every therapist’s name. This “alphabet soup” of acronyms demonstrate that a therapist has specialized training to help with a particular problem.

More specialties are becoming avialable all the time, which is a great thing! No matter your concern or your stage in life, there is likely a therapist in your area who has been specially trained to be the best help to you. But if you’re not familiar with every acronym, it can be hard to tell exactly what you’re looking at.

There’s one set of letters that’s particularly important to know if you’re searching for a counselor for a young child: RPT. Today, we’re going to talk about Registered Play Therapists—also called RPTs—and learn why this special type of therapy can be so helpful for kids.

What is a Registered Play Therapist?

A Registered Play Therapist, or RPT, is a counselor, psychologist, or other mental health professional who has received additional training in helping people heal through play. RPTs use play activities in a strategic way to help young people express feelings, work through problems, and practice new ways of interacting with others.

More traditional talk therapy techniques often work great for adults, but they’re not always so effective for children. Kids are much more likely to show their feelings, rather than tell about them. They don’t process their experiences through language as easily as adults do.

A Registered Play Therapist uses familliar toys like dolls, stuffed animals, art supplies, and even slime to help kids learn, discover, and process information in the way that’s most comfortable to them. You may find that your child can make more progress and express deeper feelings in play therapy, because they’re in a more age-appropriate environment.

Who Should See a Registered Play Therapist?

Preschool and elementary-aged kids who still use imaginative play to learn and express themselves are great candidates for play therapy with a Registered Play Therapist.

People of all ages benefit from play, but most participants in play therapy are children or teens. The majority of children in play therapy in are between 2 and 12 years of age. If a child has an interest in toys, make-believe, and imaginative play, it’s a good indicator that they could benefit from (and enjoy!) play therapy.

Some of the concerns that bring children to a play therapist’s office include:

• Anxiety and phobias

• Tantrums or behavior problems

• Grief and loss

• Trauma

• Social skills difficulties

• Problems in family relationships

• Coping with big life changes, like divorce or a recent move

Play therapy can be especially helpful for children who are working through experiences that are too big to easily put into words. The birth of a new sibling, overwhelming fear or anger, or experiences with trauma and loss can all be difficult to talk about. Play offers kids another way to express their feelings that isn’t as intimidating. A play therapist can guide a child as they work through their feelings and deepen their understanding of what happened.

How Are RPTs Different Than Other Therapists?

While many therapists may incorporate toys into their therapy sessions to help children feel more at ease and facilitate conversation, Registered Play Therapists are trained to work with children through play at a deeper level. Using the metaphors of play and storytelling, an RPT can help a child to communicate and explore feelings and subjects that she may not be able to put into words. An RPT’s work with children is rooted in play therapy theory, as well as knowledge of child development.

This means that when your child meets with a play therapist, they’re doing more than “just playing” with toys, the way they might at home. The therapist is responding and guiding the play with a plan in mind to help your child work toward the goals you’ve set. This might mean helping a child express their feelings about a situation, safely express anger, use coping skills, or strengthen self-esteem through play.

What Training Do You Need to Become a Registered Play Therapist?

All Registered Play Therapists hold a Master’s degree or higher in a field of mental health, like counseling, psychology, or social work. They also have to pass an exam to be licensed to practice therapy in their state, just like other therapists. But RPTs complete additional coursework during or after graduation to deepen their knowledge of children, development, and play therapy.

To become a Registered Play Therapist, you must complete a minimum of 150 hours of additional training on different subjects related to play therapy. During this time, you also consult with a more senior therapist who is an expert in play therapy, so they can give you feedback on your work and help you become a stronger therapist.

By the time an RPT starts conducting play therapy sessions with kids, they’ve received additional training in child development that goes beyond what most therapists were taught in their grad school programs. They’ve also learned how play can help children with specific problems, including behavioral difficulties, grief and loss, ADHD, social skills difficulties, anxiety, and depression.

This helps play therapists use toys and games intentionally when they meet with kids, keeping their specific needs and goals in mind.

Find a Registered Play Therapist in Davidson, North Carolina

I’m a Registered Play Therapist based in Davidson, North Carolina. I’m avialable to meet with families both in the Charlotte area and throughout New York, North Carolina, and Florida.

The Association for Play Therapy maintains a database of all Registered Play Therapists, both in the U.S. and globally. Families looking for a play therapist can run a search for therapists working near their zip code who have completed formal play therapy training.

Are you in the Charlotte area? I am a Davidson-based Registered Play Therapist who specializes in helping tweens (ages 8 to 13) through anxiety, OCD, and trauma. Keeping sessions playful makes it a lot easier for kids to learn coping skills and face their fears. I also love using games (like Dungeons & Dragons!) to help kids socialize and meet like-minded peers.

My Davidson, NC play therapy office is accessible to Charlotte and Lake Norman-area families. If that commute doesn’t work for you, fear not! If you’re anywhere in North Carolina, New York, or Florida, we can also meet online. Reach out here to learn more, and see if we might be a good fit.

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.

All About Drama Therapy (and Why It’s Not Just for Extroverts)

Find out how drama therapy might help your child, even if she’s not a “theater kid”

When you hear the words “drama therapy”, what do you think of? Maybe you imagine standing on stage, performing a play in front of an audience. If you’re super extroverted (like me!) this might appeal to you, but if you are someone who is not so jazzed about public speaking, this might sound like a nightmare. How could performing a play be therapeutic?

I had some of these same thoughts before I became a Registered Drama Therapist. I knew that I loved theater, and I knew that creating and performing art was an inherently healing activity, but I wasn’t entirely sure how theater could be used to help heal mental health problems. Here’s a little bit of what I have learned about the field of drama therapy, and why it might be a great fit for you or your child…even if you aren’t an extrovert.

Therapy That Uses Theater

While some drama therapists do help their clients to perform plays, there are many other ways to practice drama therapy that don’t involve getting up on a stage in front of lots of people. Most Drama Therapists incorporate theater techniques, like improvisation, roleplay, and storytelling, into group or individual therapy sessions where there is a greater sense of privacy. Sometimes, Drama Therapy is a standalone form of therapy treatment, but it can also be blended with other, more familiar forms of therapy that a client may already be using, such as CBT, trauma-focused therapy, or play therapy.

The North American Drama Therapy Association defines drama therapy as "the intentional use of theater techniques to achieve symptom relief, emotional growth, and mind-body integration." It’s an experiential form of therapy, which means participants learn by doing, rather than simply sitting and talking about their feelings and problems. This full-body approach can be a great fit for clients who have a hard time feeling grounded and focused in traditional therapy, or who need to access bigger, deeper feelings that are difficult to put into words.

What Are the Benefits of Drama Therapy?

Although acting is a form of make-believe, drama therapy explores real-life issues. Through an imagined character or an improvised scenario, we get the opportunity to try out new ways of interacting with other people, and can come up with more creative solutions to problems than we might think of in our everyday lives. Because Drama Therapy is based in play, it’s often a less intimidating, more enjoyable way to explore heavy subjects. The safe remove of make-believe can also make it easier to share experiences or feelings that might be too overwhelming to talk about right away in traditional talk therapy.

Theater is one of the oldest art forms on earth, and it can be found in cultures all over the world. By participating in a Drama Therapy group, people can develop a sense of community, create new friendships, boost empathy, and strengthen self-esteem. For people who have experienced trauma, Drama Therapy can be especially helpful because it engages the entire body, which helps to fully process traumatic memory and relieves trauma-related symptoms, like flashbacks. Drama Therapy is also an excellent option for people interested in improving their social skills, because it emphasizes nonverbal communication and team-building.

Finding a Registered Drama Therapist

Many Drama Therapists enter the field after professional careers in theater, where they may have noticed the healing effect that drama can have on both the audience and the performers. Therapists who are certified in Drama Therapy are called Registered Drama Therapists. This is a specialized, Master’s-level credential that requires the same coursework as a mental health counselor, as well as extensive training in several forms of Drama Therapy, professional theater, and completion of a supervised internship that is equivalent to a second Master’s degree. Like other mental health professionals, Drama Therapists are board certified and adhere to a code of ethics.

Because it doesn’t rely solely on verbal communication, drama therapy has been used across many cultures, and adapted to meet the needs of people of all ages, abilities, and needs. Drama Therapists can be found working in a wide variety of settings, including inpatient and outpatient mental health facilities, schools, shelters, Early Intervention programs, wellness centers, and in private practice. If you’d like to learn more about Drama Therapy, please feel free to reach out to me (I’m a Registered Drama Therapist myself!), or check out the North American Drama Therapy Association’s website.

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

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

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

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

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

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

The Insomnia Vicious Cycle

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

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

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

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

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

How Much Sleep Do Kids Need Each Night?

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

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

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

What Causes Childhood Insomnia and Sleep Problems?

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

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

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

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

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

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

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

How Can I Help My Child Sleep Better at Night?

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

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

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

Begin Therapy for Kids With Insomnia in Davidson, North Carolina

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

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

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