Help! My Child Won't Stop Interrupting Conversations!

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

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

Why Does My Child Interrupt?

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

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

• Difficulty with impulse control

• Boredom

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

• Desire for attention from a parent or other adult

• Stalling to avoid an unwanted activity

Has Zoom Made Kids’ Interrupting Worse?

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

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

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

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

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

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

Boost 1-on-1 Time Together

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

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

Practice Social Skills at Home to Interrupt Politely

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

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

Model the Behavior You’d Like to See

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

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

More Ways to Help a Child Who Constantly Interrupts

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

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

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

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

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

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

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

How Parent Child Counseling Breaks the Bad Behavior Cycle

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

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

What Is Parent-Child Interaction Therapy?

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

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

The Two Phases of Parent-Child Interaction Therapy

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

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

What Kids Benefit from Parent Child Counseling Like PCIT?

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

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

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

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

• Breaking things on purpose when angry

• Difficulty following directions or being told “no”

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

How to Find a Parent Child Counselor

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

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

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

Online Social Groups for Kids Can Help Beat the Pandemic Blues

2020 is a weird year for pretty much everyone, but it might be especially tough for kids. Children need to be around other children in order to grow and learn, and the pandemic has made this hard to do. Preteens and teens, who are in a developmental stage where friendships become central to life, might be hit especially hard by social distancing. If your child is struggling with depression or loneliness, online social groups can be a great way to reconnect with old friends or meet new people. Here are a few things to consider if your child is considering joining a group!

The Benefits of Online Groups for Kids

If you’ve noticed signs of depression or anxiety in your child, your first thought might be to seek out a counselor. One-on-one therapy can be a great option for many kids, giving them new coping skills and a chance to work through their feelings with an adult who isn’t a friend or family member. However, if a child is feeling lonely or struggling socially, there are some things that individual therapy just can’t provide as well as a group.

Any time a child has the opportunity to socialize with peers, it benefits her emotional wellbeing. Here are a few ways that extracurriculars, clubs, and online group classes of any kind can benefit kids’ social and emotional growth:

• Group activities give kids a real-life opportunity to practice social skills like turn-taking, compromise, and starting and maintaining conversations.

• Learning and mastering a new activity helps kids feel more confident and boosts self-esteem.

• Group activities provide a chance to meet like-minded kids who might become good friends.

• Socializing with others can help treat and prevent depression.

The Benefits of Therapy Groups for Kids

In addition to the benefits listed above, therapy groups have a few extra perks that can make them particularly effective for kids struggling with anxiety, depression, or social skills difficulties:

• Being in a therapy group helps kids realize they are not alone with their feelings: they’re in a room with other kids who share their experience and get what it’s like.

• Children in therapy groups have the opportunity to help and support each other, which is empowering.

• Being in a group more closely mimics the “real world” experiences kids are likely to have once they leave the therapy office: if they can use their coping skills in group, they can use them outside of group, too!

Small Online Classes Encourage Kids’ Interests

No matter what your child’s interest, there’s probably a group out there to learn about it. Outschool offers small group online classes for kids on pretty much every subject under the sun, from video game design to cupcake baking to how to draw Baby Yoda. I find that smaller groups tend to feel less awkward for kids (and adults!) than big ones, which might make it easier to socialize in classes like Outschool’s. Class lengths vary, too, from multi-week courses to one-off classes, so it’s not a big commitment to give it a try.

Online Communities Connect Tweens and Teens (Without Roblox or TikTok)

While not exactly a group activity, kid-friendly online communities can be valuable for preteens and teens because they’re budget-friendly and available 24/7. If you’re looking for an alternative to social media or the typical Minecraft and Roblox fare, check out this awesome list of age-appropriate online communities from Commonsense.org. I’m particularly intrigued by the Harry Potter Alliance, an online club for kids that uses the Harry Potter series to encourage social activism. Am I too old to join?!

Online Gaming Groups Help Children Practice Social Skills

Often, kids who are struggling to make or keep friendships could benefit from brushing up on their social skills: things like how to keep conversations going, deal with conflict, and speak up for themselves assertively. But what kid really wants to go to a place where they feel like their social awkwardness is under a microscope? Not only is learning social skills through play less uncomfortable for kids, it’s also likely to be more effective: role playing conversations with an adult is never going to be exactly the same as talking to another kid.

Game-based groups offer kids an opportunity to socialize and practice skills in a low-pressure environment, and these types of groups often translate easily into online sessions. I am currently running Dungeons & Dragons-based therapy groups for kids in my own practice, and I’ve found that the game gives kids some structure that makes getting to know each other online feel less awkward, while still giving plenty of opportunities to be creative.

Need More Help Finding an Online Social Group?

The resources I’ve listed here are available to kids throughout the US, but ongoing social distancing means local opportunities are likely popping up in your community, as well. Many dance, art, and music studios are offering distant group learning options for kids, and your local library may be able to give you information about other nearby programs. Older kids might be interested in online foreign language classes offered by local chapters of language and culture societies like the Alliance Française, which are often available online and reasonably priced.

If you’re local to North Carolina, New York, or Florida, my D&D therapy groups might be a good option. Not local to one of these states? Consider my sister site, Young Dragonslayers, where we run non-therapeutic D&D groups for kids focused on friendship-building and fun. I also offer an online coping skills class for tweens, which can help your child learn to manage worries from home.

If you’d like more information on these online social groups or other counseling services, you are always welcome to contact me.

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

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

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

What Causes Depression in Children and Teens?

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

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

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

How Quarantine Increases Depression Risks for Kids

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

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

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

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

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

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

Which Kids Are Most Affected by Pandemic Depression?

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

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

Signs of Depression in Children and Teens

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

• Ongoing, prolonged feelings of sadness and hopelessness

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

• Sleeping too much or too little

• Being irritable or extremely sensitive to criticism or rejection

• Fatigue, low energy, or low motivation

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

• Decrease in self-esteem

• Thoughts about death or a wish to be dead

When (And How) to Get Emergency Help

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

• Isolating from family and friends

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

• A sudden, major shift in personality

• Increasingly aggressive or risky behavior

• Giving away important belongings

• Threatening suicide

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

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

Help for Kids and Teens With Depression During Quarantine

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

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

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

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

5 Coping Skills for Kids and Teens with Panic Attacks

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

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

What Happens to the Body During a Panic Attack?

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

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

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

The Faulty Fire Alarm

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

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

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

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

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

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

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

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

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

Panic Coping Skill #3: Sniff Some Lavender

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

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

Panic Coping Skill #4: Cut Caffeine

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

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

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

Coping Skill #5: Remember This Will Pass

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

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

More Help for Children and Teens with Panic Attacks

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

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

Begin Child Therapy for Panic Attacks in Davidson, North Carolina

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

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

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

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

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

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

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

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

What Are Sensory Processing Issues, Exactly?

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

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

How do Sensory Processing Issues Affect Kids?

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

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

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

When Sensory Hypersensitivity Looks Like Emotional Problems

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

• Extremely picky eating

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

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

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

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

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

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

When Sensory Hyposensitivity Looks Like Behavioral Problems

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

• Speaking too loudly, or craving loud music or TV

• Not giving people enough personal space

• Seemingly in constant motion, with difficulty sitting still

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

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

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

• Doesn’t appear sensitive to pain

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

How to Get Help for a Child with Sensory Issues

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

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

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

4 Ways to Keep Kids Engaged on Zoom (and Avoid Zoom Fatigue)

Remember when unlimited screen time was a child’s dream come true? I’ve been joking with my kid clients that the pandemic is teaching all of us to be careful what we wish for: maybe being on screens all day isn’t as much fun as we imagined it would be! As schools reopen and many students find themselves gearing up for another semester online, I thought might be helpful to discuss the phenomenon of Zoom fatigue: what it is, why it happens, and how we can help keep kids engaged and having fun on their school calls.

What’s Zoom Fatigue, and How Does It Affect Kids?

Have you ever finished a long day of back-to-back video conference calls and found yourself feeling surprisingly drained, even though you’ve been sitting still all day? That’s Zoom fatigue, a pandemic-era term for the physically and emotionally sluggish feeling some people describe after spending lots of time on video conference calls. Depending on your workload and how easily affected you are, you might feel a little irritable or flat-out tired.

Kids can be affected by Zoom fatigue, too, and I find that large group calls are often the hardest for them to manage. Older children can make the connection between their low energy and Zoom calls, but younger children may not be able to articulate what is hard for them about Zoom meetings. Here are a few signs and behavior changes to look out for that might mean Zoom fatigue is setting in for your child:

• Reluctance or tearfulness when it’s time to join a call, even when it’s a social or fun meeting

• Irritability or meltdowns that immediately follow Zoom calls

• Fidgeting, difficulty sitting still, and trouble focusing

• Unusual frustration or arguments with peers during meetings

• Headaches, eye strain, or other physical complaints

If you’re noticing some of the symptoms above in your child, keep reading: there are ways adults can help make this temporary new normal easier for kids to manage.

But Wait! Zoom Isn’t All Bad News

Even though this post is about how to handle Zoom fatigue, I don’t want to leave you with the impression that all online activities are horrible. I’m a firm believer that online meetings aren’t necessarily better or worse than face-to-face. Zoom meetings are just different, with their own pros and cons, and we are still figuring out how to do them well.

For some kids, online sessions have some major advantages over meeting in person. Research shows that people who struggle with social anxiety feel more at ease online, which can make interacting over Zoom a more positive, less intimidating experience. Children with social anxiety may find it’s easier to make the first steps towards speaking up in class or talking to peers when there’s no pressure to immediately meet face-to-face.

There’s also a thought that meeting online equalizes some of the factors that could lead to bullying and teasing in person. For example, differences in height and other physical traits are less noticeable in Zoom meetings, where everyone is seated and your whole body isn’t on display. I wonder if online classes have also reduced teasing about the clothing children wear, since it’s hard to pass much judgment on an outfit when it’s mostly out of frame.

Zoom Engagement Tip #1: Add More Movement

It’s challenging enough for many kids to remain seated at a desk all day, but classes used to be broken up by recess, as well as trips to the bathroom and water fountain, gym class, and walks between classrooms. All those little breaks added up to a decent amount of movement throughout the day. In online meetings, kids aren’t getting any of those opportunities to move. Being sedentary all day long can drain energy, lower mood, and make it more difficult for kids to focus.

You can help your child minimize the drain of sitting down all day on calls by intentionally building more movement into your day. Use 20 minutes of your child’s lunch break to take a walk outside, or try out a yoga video on YouTube. Encourage your child to get out of her chair and stretch between calls, rather than simply waiting for the next one to begin. Hopefully, teachers are finding ways to incorporate movement in to their lesson plans, but any added opportunities to move can combat fatigue.

Another way to add more movement is by giving your child a fidget toy to use while seated. Kids aren’t getting the same sensory-rich experience on Zoom calls that they’d be getting in person, which can make sitting still in front of a screen even harder. A quiet, non-distracting fidget toy such as a Tangle or a Boink can help children keep their bodies engaged without pulling focus from the teacher.

Zoom Engagement Tip #2: Create the Right Space

When the pandemic first started, I assumed I’d be working from home for a matter of weeks. I grabbed a hard plastic folding chair, propped it awkwardly in the corner of a spare room, and figured I’d be good to go. Two weeks later, I was getting tension headaches, my energy was low, and I was starting to feel the drag of Zoom fatigue. Setting up a designated office space with a comfortable chair has made a big difference in my stamina for doing online conference calls.

One benefit of virtual meetings is that we get to control our own environment. We control the temperature of the room, we can sit in a way that feels comfortable, and our favorite drinks or snacks are available to us pretty much any time. When I see children for online therapy, they often have their favorite toys, blankets, and even pets on hand to help them feel comforted and grounded during session.

If you started off online school the way I started online therapy—preparing for weeks, not months, of working remotely—the new school year is a good time to reassess where and how your child is taking Zoom calls. You don’t need a Pinterest-worthy home office setup, but giving a child a designated, comfortable place to work can make it easier to stay focused as well as a more enjoyable experience. Here are a few tips to consider if you’re creating a “Zoom space” for your child this fall:

• If your child will be joining calls from his bedroom, encourage him to sit at a table or desk rather than lying in bed. I’ve found when kids are joining calls from under the covers it leads to low energy, poor focus, and a general desire to go back to sleep!

• The larger the screen, the easier it is for children to stay focused. Phones are not great for virtual calls, tablets are better, and a laptop or desktop computer is your best bet, if one is available.

• Position your child’s computer at eye level to reduce strain and simulate “real” eye contact. All you need is a stack of books under your computer, and this can make a world of difference on Zoom calls.

• It can be really tempting to pull up a second window to start a game or chat with friends during online calls: we’re all used to multitasking on computers, and it’s harder to get caught! Consider helping your child reduce distractions during school time by installing an app that blocks social media or other websites during study time.

• Adding some sensory elements to your child’s work area can help offset the lack of sensory stimulation they’re getting from Zoom calls, which don’t often engage the full body the way in-person learning does. Weighted blankets, textured pillows, fidget toys, or scents that calm or energize your child can be helpful grounding tools as well as a way to make work time feel more fun and special.

Zoom Engagement Tip #3: Shift Your Schedule

Many schools are including more asynchronous learning this year, meaning that classes will be pre-recorded and available for children to watch at any time. This gives parents (and kids) a lot more freedom in figuring out a learning schedule that works for them and reduces Zoom fatigue. I think this is another silver lining of online learning: if your child is not a morning person, or learns better when they can have frequent breaks, they no longer have to conform to the typical 8-to-3 school day schedule.

On a personal note, adjusting my own schedule was the most helpful thing I have done to combat Zoom fatigue. Even though you’re sitting still, virtual calls can take a lot out of you! Communicating with other people online sometimes takes a little extra effort, especially when you’re still adjusting to the format. Working longer hours over 4 days worked well for me doing in-office work, but ended up being too much screen time for online calls. Spreading my sessions out over 5 days gives me more breathing room, and I’m much more energized for my meetings.

If you have some flexibility with your child’s school schedule this year, here are a few points to consider that may help combat Zoom fatigue:

• If possible, give your child some control over her own schedule. Many children have felt very powerless during the pandemic, and being able to choose when to do school work can be empowering.

• Consider breaking up the school day into smaller chunks, or spacing out the work over a longer span of days in order to reduce the consecutive hours spent in front of a screen each day.

• Keep your schedule consistent whenever possible. Encourage your child to go to bed and wake up at the same time each day to promote healthy sleep. Maintaining predictable times for meals, study time, and play time can be reassuring for kids and reduces anxiety. It can also help kids maintain the habits and structure they’ll need when in-person school resumes.

Zoom Engagement Tip #4: Be Picky!

At the beginning of quarantine, many of us experienced a tidal wave of social Zoom calls. While we are all craving connection and looking for ways to spend our newfound free time, it’s okay to be selective, too. This is especially true for children, who may have a hard time staying engaged on social calls after a long day of school.

Just like any other activity, Zoom calls can become too much of a good thing. Be picky about what social calls you and your child agree to, and prioritize the meetings that are most important. If you notice your child is already feeling worn out from school calls, it’s totally fine to turn down the optional class check-in or book club chat. This allows your child to conserve his time and energy for the stuff that really matters.

In general, smaller calls cause less fatigue than larger group calls. Conversation flows much easier and feels more natural when you aren’t accidentally interrupting 10 other children. If you have an option for your child to meet with peers individually or in small groups, give this format a try. It’s likely to be a more fun experience for all involved, and you may find your child connects more easily with friends when there are fewer kids on the call.

I hope this post has been helpful to you as you navigate another highly unusual school year. Please drop me a line if you have questions or found this article helpful—I’d love to hear how you are managing online school! If you are looking for online counseling for your child, my (virtual) door is always open. I’m able to offer therapy to children and families in New York, North Carolina, and Florida.

If you’re looking for non-therapy resources, my online courses teach coping skills to kids to manage anxiety and stress. Check out Worry Free Tweens, which helps kids ages 8-12 learn how to cope with panic, anxiety, and worries.

Common Preteen Behaviors, Explained

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

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

Preteen Behavior #1: Super Focused On Body Image

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

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

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

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

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

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

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

• Praise your child for things other than looks.

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

Preteen Behavior #2: Sassy, Snarky, Sarcasm

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

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

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

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

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

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

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

Preteen Behavior #3: Craving More Privacy

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

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

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

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

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

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

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

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

Preteen Behavior #4: Following Trends

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

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

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

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

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

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

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

For More Info On Preteen Mental Health…

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

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

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

How Drama Therapy Helps Kids Build Social Skills

Imagine you’re a sixth-grader on your first day of school. You walk into your classroom, and realize you don’t know many other students. How do you strike up a conversation with the stranger sitting next to you? Will you be able to tell when they’re getting bored, and you need to change topics? What if the teacher gives everyone a dreaded group assignment—how will you negotiate who does what work on the project? What if somebody disagrees with you?

In order to thrive in school, children have to learn more than just academics. There’s a whole host of social and emotional skills that kids need in order to start conversations, make friends, and generally get along with other people. For kids who struggle with social anxiety or nonverbal learning, these skills may not come quite as easily or feel as natural as they do to other people. Sometimes kids I speak to feel hopeless about their ability to socialize: they think that social skills are either something you’re born with or you’re not.

The truth is, nobody is born with perfect social skills: we all have to learn them, and we can all get better with practice. Keep reading this post to learn how drama therapy can help kids boost their social skills in a fun, supportive environment.

How Drama Therapy for Kids Works

Drama Therapy uses theater-based activities to help kids learn empathy, explore feelings, and work together as a team. Any activity that involves imagination and play can be fair game for a drama therapy session: children may write scripts, improvise scenes, or even play games like Dungeons and Dragons that are based on roleplay.

Drama Therapy helps a child get both their brain and body involved in the learning process. This can be especially helpful when it comes to learning social skills, since body language is such an important part of how we communicate with other people. It’s one thing to sit with a therapist and talk about social skills, or to fill out a worksheet about how to make conversation. It’s another thing to practice those skills in real-time, with other kids.

Drama Therapy allows children to experiment with eye contact, body language, and tone of voice and get immediate feedback about how others perceive them. It also gives kids practice in reading other people’s tone, which is so important for building social skills. Most importantly, all this learning happens in a setting that is playful and fun, so mistakes don’t feel as personal or overwhelming.

Drama Therapy Helps Kids Recognize Tone

Have you ever had the feeling that you’re not in on a joke? It feels terrible. Some children need extra practice in order to understand other people’s tone, pick up on sarcasm, and understand not just the words being said, but the feelings behind them. A lot of times, these tones are subtle and never put into words, but drama therapy makes them explicit and easier to understand.

In order to successfully perform a scene, children need to be really attuned to the emotions their scene partner is trying to convey: what are they saying with their body language? How does their voice sound? Kids also have to think critically about their own body language and tone of voice in order to play a character: a friendly nurse, for example, is going to carry herself and speak very differently than an angry giant.

The awareness of tone and body language that kids develop through Drama Therapy can be carried with them back into the “real world.” Understanding tone allows children to detect sarcastic comments, notice when they may be coming off as braggy, and pick up on subtle cues that someone might be ready to end a conversation or move on to another topic.

Drama Therapy Encourages Teamwork

Anyone who has taken an improv class has learned the number one rule of improvisation: “Yes, and…”

When you are acting out a scene with an improvised partner, you have to work together and roll with whatever the other person says or does. For example, if your partner says “Wow, I can’t believe it’s been raining all day” and you reply with “What are you talking about? It’s sunny!” the scene falls apart.

Good improv requires that you say “yes” to whatever your partner gives you, and then build on it by adding something of your own—that’s the “and” part. Responding to your scene partner’s comment about the rain with “Good thing I brought the world’s largest umbrella” keeps the scene moving, and makes it funnier, too.

In Drama Therapy, kids practice taking turns, making compromises, and sharing ideas. Everyone gets a chance to be in the spotlight, and children learn how to accept this positive attention as well as when it’s time to step aside and give another person a chance to shine. Improvisation helps children to think more flexibly, deal with different points of view, and discover how combining many points of view can lead to something unexpected and better than what any one person could have dreamed up alone.

Drama Therapy Turns Strangers Into Friends

Theater brings people closer together. One of the reasons that “theater kids” love drama club is that creating a play together also creates friendships. It’s pretty hard to work together on a theater piece week after week and not come away from the experience with more understanding and appreciation of your castmates. Drama Therapy can have the same effect for children whose goal is to improve their friendships.

Performing with other people builds empathy: it requires you to imagine putting yourself in someone else’s shoes, and imagining how they would feel in a given situation. Performing also allows children to share parts of themselves that might not always come out at school. Kids who may feel shy or withdrawn at school have a chance to share their goofy, silly side, their assertive and confident side, or their supportive side that is a cheerleader for other children.

You learn so much about other participants in Drama Therapy that it’s hard not to become friends. It’s a good reminder to not judge a book by its cover, and to look for the surprising things you might have in common with other people who seem different at first glance. The acceptance and belonging that kids feel through their friendships in a Drama Therapy group can help them feel more confident the next time they need to make friends in a new situation.

Learn More About Social Skills And Drama Therapy

Want to learn more about Drama Therapy and how it can help kids with social skills? The Family Compass website was a great source for this post, and goes into more detail about the neuroscience behind Drama Therapy. You can also get good general information from the North American Drama Therapy Association. I’m a Registered Drama Therapist helping kids in the Charlotte, North Carolina area, as well as working with children online in North Carolina, New York, and Florida. You can reach out to me here.

Choosing a Child Therapist, Psychologist, or Psychiatrist

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

How Can I Tell If My Child Needs Therapy?

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

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

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

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

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

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

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

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

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

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

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

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

When to See a Child Therapist

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

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

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

Your child might benefit from seeing a therapist if:

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

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

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

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

When to See a Child Psychologist

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

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

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

Your child might benefit from seeing a psychologist if:

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

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

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

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

When to See a Child Psychiatrist

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

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

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

Your child might benefit from seeing a psychiatrist if:

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

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

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

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

Therapists, Psychologists, and Psychiatrists:The Bottom Line

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

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

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

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

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

Why Is My Preteen Girl Suddenly So Disrespectful?

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

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

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

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

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

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

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

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

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

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

• Eye rolling

• Sarcastic tone of voice

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

• Crossed arms or other defiant body language

• Criticizing or nitpicking you

• Heavy sighs or other nonverbal expressions of being annoyed

When Should I Step In to Help My Tween?

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

• Breaking or damaging things when angry

• Getting into trouble for disrespect at school

• Withdrawing from friends or losing interest in activities

• Difficulty getting along with other children

• Thinking or talking about self-harm

• Any very sudden or dramatic changes in mood or personality

How Should I Discipline A Tween for Attitude Problems?

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

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

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

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

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

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

How to Get Along Better With Your Tween Daughter

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

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

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

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

More Help for Preteen Girls

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

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

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

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

Anxiety About Returning to School After Covid? Here's How to Help.

Even kids who are usually eager to attend class may be feeling nervous this back-to-school season. The pandemic threw a wrench in many children’s daily routines, leaving them with tons of unstructured time and few opportunities to hang out with other kids. Combine that with the uncertainty in many school districts about what the new school year will look like, and you’ve got a recipe for school anxiety. Today, I’m sharing some advice about back-to-school anxiety, and how to help your child feel confident and prepared for an unusual school year.

My Child Loves School. Why Is This Year So Much Harder?

We are going to be seeing the after-effects of the coronavirus pandemic on children for a while. As daycares, schools, and extracurricular activities reopen for business, many kids find themselves feeling more anxious, rather than less. Back-to-school jitters are common for all kids, but there are a few good reasons why this year’s return to school may be especially challenging:

• Kids have been out of school much longer than a normal summer vacation, which makes returning harder

• It’s tough to transition back into the strict routines of school after lots of unstructured time at home

• Not having chances to socialize with other kids can increase social anxiety

• Some children are very worried about the coronavirus, and how they’ll stay safe at school

• New safety measures, like masks and social distancing, might trigger anxiety for kids

• Uncertainty about the school’s reopening plans can make anxiety worse

What Are The Signs and Symptoms of School Anxiety?

Chances are, if your child is nervous or reluctant to go back to school, you are hearing a lot about it already! However, sometimes it’s hard to distinguish between run-of-the-mill worries about the first day of school and stronger anxiety that might need some extra help to overcome. In addition, some kids are not as vocal about their anxiety, and their symptoms may be more body-based. Here are a few clues to look out for if you think your child might be struggling with school anxiety:

• Headaches, upset stomach, or complaints of other physical problems on school mornings

• Frequent trips to the school nurse during the school day, without a clear illness

• Repeated worries about bad things that could happen while at school, such as getting sick

• Tantrums, anger, or outright refusal to go to school

• Panic attacks, which may seem to come out of the blue

• Anxiety that seems to be more intense or long-lasting than what is usual for the child’s age

One or more of these symptoms might indicate that your child’s worries about school are stronger than they need to be, and they could use some help to move past them.

How Can I Help My Child Get Ready to Go Back to School After Coronavirus?

Right now is a great time to help your child combat anxiety and prepare to go back to school. There is no getting around it—this school year is likely to be a weird one, and it’s understandable that kids are feeling nervous! Even so, there are steps that parents can take to help kids soothe their worries and feel more ready to deal with the changes this year might bring.

If your child has been spending tons of time isolated at home, now is a great time to (safely) help them get used to being back in public. You don’t want your child’s first venture back out into the “real world” to be on the first day of school! If you are safely able to do so where you live, let your child accompany you on grocery store runs or other errands. Try some outdoor activities that allow for social distancing while still letting your child be around other people.

This can help your child re-build their tolerance for transitions between activities and get used to socializing again. It’s also a great opportunity to practice wearing masks and using good hygiene, which might be needed for in-person school.

School Hasn’t Started Yet. What Can I Do Now to Reduce My Child’s Coronavirus Anxiety?

The summer weeks leading up to the start of school are also a great time to prepare your child for what changes to expect when school reopens. Are they likely to be online, in-person, or a mix of the two? Will children be expected to wear masks? Will their desks be spaced further apart, or will children be attending school in smaller groups? Younger children can benefit from acting out these changes through play, while older kids can handle a simple conversation.

Even if you’ve done it before, this is also a great time to review facts about coronavirus with your child and check for any misinformation that is causing anxiety. Make sure your child knows how coronavirus is and isn’t spread, and emphasize what measures their school will be taking to keep students and teachers safe. Many children I work with are very fearful about catching coronavirus through food, or simply by being outside of the house. Accurate knowledge about how the germs spread can reduce anxiety.

School Has Started For My Child, And The Anxiety Hasn’t Gone Away. How Can I Help?

For some kids, anxiety about school might subside once they’re settled into their new routine. For others, anxiety symptoms may stick around and continue to cause problems. This year, parents may be put in the difficult position of having to make decisions about whether or not to allow their child to return to in-person classes. Parents might also find themselves worried about or not in agreement with school policies, but needing to send their child to school, anyway.

Whatever choice you make, it’s a good idea to avoid speaking negatively about the school’s decisions in front of your child. Kids will take your opinions to heart, and they’re looking to you to help form their own beliefs about school. You can help to set a tone in your household that is both optimistic and realistic. If you need to vent about the impossible situation you’re being put in as a parent, find a friend to talk to away from your child’s listening ears.

My Child Won’t Be With Friends This Year. How Can I Make It Easier?

Some children may struggle from being separated from their friends at school this year. Whether it’s due to social distancing in the classroom, attending school on alternate days, or friends changing schools or switching to homeschooling, this can have a big impact on a child’s attitude about school. Help your child find ways to keep in touch with friends, whether through group zoom chats, after-school activities, or an old fashioned phone call. Games or structured activities might make staying connected with friends feel easier and less awkward.

The usual, non-pandemic advice for how to help kids with school anxiety still applies, too. Practicing relaxation skills at home, encouraging consistent attendance, and reading books to children about school stress can help ease the transition back to the classroom. You can check out my earlier post on back-to-school anxiety for more detailed advice.

More Help for Returning to School After Covid

Unicef has a great mental health guide for helping kids re-adjust to school this year. I also really like healthychildren.org’s practical advice about how students can stay safe at school, as well as how to address bullying and other issues that might be more intense as this school year begins.

My favorite tools for helping children practice relaxation skills are Headspace and Insight Timer for guided visualizations, and the app What’s Up? to help kids struggling with panic attacks feel more grounded.

If you’re looking for counseling for your child with school anxiety, my virtual door is open, and I’d love to hear from you. I can see clients in New York, North Carolina, and Florida for online therapy.

Online Therapy for Minors: What You Need to Know

Telehealth is more popular than ever before. By now, many of us are probably used to consulting with doctors, physical therapists, and counselors online. Given the current stresses in the world, there are many children and teens who could really benefit from having an understanding person to talk to.

However, many of the “big name” companies for online therapy primarily cater to adults. In this post I’ll go over what you need to know about online therapy for minors. This information should be helpful whether you’re a parent looking for therapy on behalf of a child, or a young person seeking therapy for yourself.

What’s Online Therapy, and Who Uses It?

Online therapy goes by a lot of names: teletherapy, telehealth, virtual therapy, video therapy…ultimately, all these terms describe the same idea. Online therapy is mental health treatment that is done over the internet, using a video conferencing platform. Sometimes when people hear “telehealth”, they think of “telephone”, but online therapy almost always includes both sound and video. Most therapy sessions take place using programs that are very similar to Zoom or Google Meet, but with more security in place to make sure the conversation stays private.

Some reasons a young person might choose online therapy are:

• They have chronic health or mobility problems that make it hard to meet in person

• Their family is taking precautions because of the coronavirus

• They live in a rural area where it’s hard to find a local therapist

• They or their parents have busy schedules that make it hard to drive to an office

• They just feel more comfortable doing therapy from home

How Do I Find an Online Therapist Who Works With Kids Under 18?

Some of the large, national companies who provide online and text therapy only serve adults. The ones that do see minors typically only see teenagers ages 13 and up. In general, I think your best bet is to find a therapist who is licensed in your state and specializes in kids or teens. This is especially true if you are looking for therapy for a younger child. When you’re selecting a therapist this way, you are able to learn more about them and their approach, and ultimately have more control in choosing a therapist whom seems like a good fit for you and your family.

You can use therapist directories like Psychology Today to search for counselors in your area who work with minor clients in your city or state. TherapyDen is another great option for searches: it’s a smaller directory, but gives you lots more information about each individual therapist, including their commitment to social justice and inclusivity. If your finances are limited, Open Path Collective is an awesome resource that may be able to help you connect with a private practice therapist who can offer you a reduced fee for appointments.

Will a Minor Child’s Therapist Talk to Their Parents, Too?

Most people under the age of 18 don’t have the legal right to keep their therapy sessions 100% private, because they have a parent or guardian who is legally in charge of their care. A parent or legal guardian can access a child’s medical records at any time. On the other hand, can you imagine going to a therapist knowing that everything you say is going to be shared with your Mom or Dad? It makes it very hard to open up, and almost guarantees that therapy won’t be effective.

It can be a little bit of a balancing act to respect a minor’s need for privacy while also making sure parents feel included and have the information they need to help their child. Even though parents have a legal right to know everything, most therapists who work with minor children will ask that a parent allow treatment to remain mostly private.

When I work with young people, I usually share what I am doing with parents—for example, what coping skills I’m teaching or what our therapy goals are—but I don’t share personal things that a child has told me without permission from that child. That way, kids can feel secure in knowing that I’m not going to tattle on them to their parents, but parents can also feel secure in knowing what is happening in treatment.

How Does Confidentiality Work Online for Kids Under Age 18?

Even for therapists who keep sessions with minor children private, there are a few situations in which a parent must be told what is going on. All therapists have to follow a code of ethics which includes a promise to always inform a parent or caregiver if a child is in a very dangerous situation. This is called mandated reporting. The three major reasons that a therapist might need to break confidentiality with a minor client are:

• The therapist suspects that a child is being physically or sexually abused

• A child is at risk of self-harm, or of hurting someone else

• The therapist hears about an elderly person or a person with a disability being abused

If a therapist has to report one of these events, only the information needed in order to keep everyone safe will be shared. For example, if a child is feeling suicidal, a therapist will share this with parents and, if needed, other professionals who can help. The therapist wouldn’t share unrelated information with those people, like how a child feels about family or friends.

Therapists can share this kind of information with parents in emergency situations, but in general, therapists can’t share information about a minor client with anyone else unless they have specific permission to do so. Teachers, employers, extended family, or other people in a child’s life won’t be told anything about therapy without written permission.

Can a Minor Seek Out Therapy Without a Parent’s Consent?

The short answer is: it depends on where you live. I wish young people never found themselves in this position, but I know that sometimes teens feel unsafe telling their parents about their need for therapy. Each state has its own rules about whether or not minors can be in therapy without a parent knowing, and in most states, the rule is that anyone under 18 needs written permission from their parent or guardian.

This article from Teen Vogue has some helpful information and advice if you are a minor looking for therapy and find yourself in this difficult situation. Another good suggestion I’ve heard is to reach out to your school’s counselor: they can help you right away, it’s confidential, and they will know about your state’s rules and resources you might have in your neighborhood.

If you are in an urgent situation and you need help right now, here are some crisis hotlines that are open to teens:

Crisis Text Line
Suicide Prevention Lifeline & Chat
The Trevor Project (LGBTQ Friendly)

Online Therapy for Minors in North Carolina, New York, and Florida

If you are looking for therapy for your minor child, or if you’re a young person doing your own research, I offer online therapy for children and preteens. Most of my clients are between the ages of 9 and 13. I’m licensed in New York, North Carolina, and Florida, so I can see kids for online therapy in any of these states. If you’d like to learn more about online counseling or make an appointment, you are welcome to contact me.

If you’re the parent of a child or tween looking for online help, my coping skills course might be a good support as you consider your therapy options. Worry-Free Tweens is an educational class for kids and parents, and teaches some of my favorite anxiety management skills for this age group.

Dungeons and Dragons as Therapy? How This Popular Game Helps Mental Health

During quarantine, many of us have been looking for activities to fill our stay-at-home time that feel more rewarding and productive than endless Netflix streaming. Many people are craving an escape from real-life stress and looking for ways to connect with friends that feel more personal than texting. Maybe it’s not surprising, then, that Dungeons and Dragons experienced a revival during the pandemic.

Although it may seem surprising at first, it makes sense that people are turning to D&D during stressful times. Dungeons and Dragons and other roleplaying games are increasingly popular tools in group therapy can help players improve their emotional and social well-being. In this post I’ll unpack how D&D is used in group therapy, and why it can be a benefit for mental health.

What Is Dungeons and Dragons?

Dungeons and Dragons, also known as D&D, is the most popular tabletop roleplaying game on the planet. It was invented by Gary Gygax and Dave Arneson in 1974, so it’s been around for a while and has built up a large following of devoted players. Players in D&D take on the role of a character in a fantasy world, and they collaborate with other players to pursue a goal, collect treasure, or defeat bad guys. Unlike most other games, there is no set path to take, and characters don’t just progress along spaces on a board. What makes D&D and other roleplaying games unique is that the players improvise to create a story together, and their choices affect what happens next.

The game is facilitated by a lead player, called the Dungeon Master, who describes situations for the players and asks them how they’d like to proceed. Then, it’s up to the players to decide how their character would act in a given situation. To add an element of chance to the game, players then have to roll a die to see how well their plan works. It’s not competitive, and there are no winners or losers: everyone works together toward a common goal. This can lead to surprising, funny, and even touching moments during game play that could never have been planed in advance.

Why is D&D Having a Moment Right Now?

Although D&D has always been popular in geek culture, it’s enjoying a moment right now due to the popularity of Netflix’s hit show, Stranger Things. Although the show is set in the 80s, the teen characters’ obsession with D&D has piqued the interest of 2020’s kids. Although it isn’t D&D specific, TV shows like Game of Thrones have also made fantasy stories cool, and helped to bring previously “nerdy” interests into the mainstream. Finally, podcasts like The Adventure Zone and Critical Role are bringing younger, more diverse people into a game that might have formerly been associated with older guys playing in a basement. Thanks to pop culture, D&D is cool again, and being played by more young people than ever.

What Are the Mental Health Benefits of D&D?

Play of all kinds has mental health benefits—it’s why play therapy has been used to help kids since the days of Freud, back when psychology was a new and emerging field. Play helps us to assimilate information we’ve learned, test new ways of behaving before using them in real life, hone our social skills, and boost our creative problem-solving abilities.

Although we might think of play as something reserved for little kids, the truth is that older children, teens, and even adults benefit from having playful experiences in life. Unfortunately, the older we get, the harder it is to find socially acceptable ways to play. D&D is an awesome, age-appropriate way for older kids and adults to recapture that playful childhood feeling and reap some of the same benefits that play has for younger kids.

Some of the possible mental health benefits of D&D are:

• Improved social skills with peers

• Increased self-esteem and self-confidence

• Ability to express yourself and your needs assertively

• Improved impulse control and practice with turn-taking

• Stronger creative thinking and problem-solving skills

What Makes D&D Work So Well in Therapy?

Although there are plenty of games in the world that aren’t just designed for little kids, D&D has a few unique characteristics that sets it apart from the rest when it comes to improving mental well-being. Here are a few reasons why D&D is so great when used in therapy:

• D&D is collaborative. Rather than competing against each other, players must find a way to get along and work together.

• Playing as a character who is different from yourself allows you to literally see the world through someone else’s eyes, which can build empathy.

• Because the game is based in role-playing, it’s a great way to try out new ways of interacting with other people in a low-stakes, fun environment.

• Playing the game tends to help people bond and build friendships. D&D provides a structured way to get to know new people that might feel less awkward than making small talk with a stranger.

• D&D players have almost unlimited creative freedom, which can be liberating. Do you want to be a 1,000 year old elf sorcerer with purple hair and a pet mongoose? You can do it in D&D.

How Does a D&D Therapy Session Work?

Usually, D&D therapy is group therapy: you need a team of at least 3 or 4 people to get the game going. Unlike other forms of group therapy, D&D groups tend to be pretty intimate, which makes it easier for players to get to know each other. It’s most common for therapy groups to meet on a weekly basis, but this can vary.

Typically, groups begin with a check-in for participants to talk out of character and connect with each other. This is a great time to share about how the week has gone, and share anything that has happened that might be relevant to the group’s goals. Once everyone is settled in, the actual game-play portion of the session begins, facilitated by at least one therapist who can keep an eye on everyone’s progress and make sure that everyone is having fun. After playing, the group ends with a wrap-up conversation, which can be a great time to connect what is happening in the game to the particular goals of the therapy group.

The actual time spent playing D&D can vary a lot: based on the age and attention span of the players, a session could be as short as 1 hour or as long as several hours! It’s safe to assume that most therapy groups will be on the shorter side.

More Info On D&D As Therapy

For more info on the mental health benefits of D&D, check out one of the following resources. Geek and Sundry has an awesome, in-depth look at how D&D can help kids with social anxiety get excited about going to group therapy. If you’re more of a video person, check out this interview with a D&D therapist to hear more about her work.

If you’re local to North Carolina, New York, or Florida, I may be able to help you get started with D&D Therapy! I co-facilitate a few groups for middle and high school students, and they’re a highlight of my week.

If you’re not looking for therapy, but interested in the social-emotional benefits of roleplaying, check out Young Dragonslayers, where my geeky colleagues offer online friendship-building D&D games for kids all over the U.S.

6 LGBTQ Kids Books I Love

Amidst everything else going on right now, June is Pride Month, when we celebrate the impact LGBTQ people have made on our country and the world. Recently, I have been on the hunt for children’s books that address social issues while also being a genuinely good, fun read for kids. I’ve been looking forward to sharing a handful of books about LGBTQ topics that I’ve found over the past year that I think fit the bill. Whether you have a family member who is part of the LGBTQ community or you’re simply wanting to expand your child’s worldview, the books below can help open up a conversation and give kids positive examples of all kinds of families.

Benefits of LGBTQ Books for Kids

Reading a book together can be a great way to introduce complicated subjects to kids in a nonthreatening way that allows children to learn at their own pace. All kids benefit from having toys and stories around them that reflect their own identity, as well as give them a peek into someone else’s worldview. Books about the LGBT community can be extremely affirming for kids growing up in families with 2 moms or 2 dads, but they can also help all children to better understand their classmates, neighbors, and friends.

When a child reads a story, they’re putting themselves in someone else’s shoes. It’s an exercise in building empathy that can have long-lasting benefits. By reading stories about different types of families, kids learn to celebrate diversity and look past superficial differences to see that all families are really the same, and connected by love.

Why I Picked These Books

I love reading books with children that talk about social issues or help them to understand mental health concepts like anxiety, depression, and trauma. Reading a book together can let children know that their feelings are normal and they’re not alone. What I don’t love so much is that, a lot of the time, these books provide great information to kids but are not particularly engaging reads. It’s easy for these types of books to start to feel overly teach-y or preach-y, which I think can lead kids to check out of the story.

I love these books because, aside from representing diverse families and explaining LGBTQ issues to kids, they’re just genuinely good books. The illustrations are beautiful, the characters are likable and believable, and the plots help pull kids into the story and give them a different perspective on the world. I also looked for books that touch on multiple aspects of the LGBTQ experience (same sex parents, gender nonconformity, feeling accepted and celebrated) and books that go into more or less depth on the subjects depending on a child’s age. Finally, I tried to find books that had other kinds of diversity, too, including families from different races and cultures.

6 Picture Books to Check Out During Pride Month

Click on the titles to read a full review of each book!

Julián is a Mermaid by Jessica Love

I found this in a local bookstore earlier this year, and was drawn to it because of its beautiful watercolor illustrations. Julián is an Afro-Latinx kid living with his grandmother in a New York City neighborhood, where he becomes fascinated with the annual mermaid parade. Julián imagines himself as a mermaid, and dresses up in secret in the family’s home… until his grandmother catches him in costume. The story has a happy ending, and gently explores what life might be like for gender-nonconforming kids without directly talking about it. I think any child would enjoy this book, and would find a message to take away from it about being seen and accepted for who you really are. Recommended for ages 3-8.

It Feels Good to Be Yourself by Theresa Thorn

Unlike the other books on my list, this one is very direct in discussing sex and gender, and definitely a little bit “teach-y”. However, if you need to talk about gender identity with a child, this book is for you. It Feels Good to Be Yourself gives parents and kids simple, straightforward, and child-friendly language to talk about sex and gender, gender nonconformity, and people who are cis, trans, and non-binary. I appreciate that this book is positive and hopeful, and uses vocabulary that any child can understand. The illustrations, drawn by a nonbinary artist, are beautiful and feature diverse kids and families. Recommended for ages 3-9.

Love Makes a Family by Sophie Beer

This is a board book with a sweet, simple story geared for younger children who may not be ready for the other books on this list. Love Makes A Family emphasizes and celebrates how families of all shapes and sizes show their love for each other. Although not mentioned in the text, the bright, modern illustrations show families with 2 moms and 2 dads, multiracial families, children raised by grandparents, and single-parent families. Recommended for toddlers and preschoolers.

Stella Brings the Family by Miriam B. Schiffer, Illustrated by Holly Clifton-Brown

For older kids who have outgrown board books, Stella Brings the Family offers a more direct, thoughtful look at one child’s experience of being in a family with two dads. Stella has to decide who to bring with her to school for her class’s Mother’s Day celebration, since there is no mom in her family. When other children ask her who performs all the motherly tasks in her life, like reading bedtime stories and packing her lunch, Stella is able to name all the important family members who fill the “mom role” for her. This is an inclusive book that gets great reviews, and is recommended for ages 4-8.

Not Quite Narwhal by Jessie Sima

Okay, so this one isn’t exactly an LGBTQ-specific book, but I had to include it anyway because it is such a helpful story to have around. Kelp, the story’s hero, grows up believing he’s a narwhal and living with a family of narwhals, even though he sometimes feels out of place and struggles to do typical narwhal things. When a strong current sweeps him onto land, Kelp learns that his identity isn’t quite what he thought, and he’s been a unicorn all along. Kelp learns that he doesn’t have to belong to any particular group, because all his friends accept him for who he is. The art style makes this book really popular with little kids in my office, and the story is open-ended enough that pretty much all children can find meaning in it. Recommended for ages 4-7, but even preteens sometimes enjoy this one.

Mommy, Mama, and Me by Leslea Newman, Illustrated by Carol Thompson

Another board book for younger kids, this is a sweet and simple story in rhyming verse that describes the loving, daily activities of a family and their toddler, who just happens to have two moms. The illustrations are sweet and look like real people, and the toddler’s gender isn’t made clear, so all children can see themselves in this book. Reviews I’ve read from parents say that their children want this read over and over. A second book in the series, Daddy, Papa, and Me, covers a toddler with two dads. Recommended for ages 1-3.

More Resources for LGBTQ Books

If you’re looking for more LGBTQ books for kids, check out this big list of books featuring LGBT characters or this list of LGBT books for young readers.

If you’re looking for LGBTQ-affirming counseling, databases like Psychology Today and TherapyDen allow you to search for therapists who are allies or who have specialized experience helping LGBTQ families.

Signs and Symptoms of Germaphobia in Children

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

What’s Germaphobia, Exactly?

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

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

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

What Makes An Intense Fear of Germs More Likely?

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

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

Common Symptoms of Germaphobia In Children

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

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

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

• Intense fear or terror about contamination

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

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

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

Signs Your Child Has Germaphobia

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

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

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

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

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

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

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

Cognitive Behavioral Therapy for Kids With Fears of Germs

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

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

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

How to Talk to White Children About Racism and Protests (and Why You Should)

In the week since my last blog post, round-the-clock media coverage of the coronavirus pandemic has given way to round-the-clock coverage of nationwide protests following the death of George Floyd due to police brutality. The footage of the protests can be scary: just a few nights ago, protesters in Charlotte, North Carolina (where I live) had a frightening conflict with police. I can’t imagine how overwhelming it must be for parents and families to be thrust directly from one crisis into another: how can we possibly begin to explain this to children who have been through so much already?

I have been looking for resources to help my White families discuss the protests and racism with their children, and have been coming up short. There are plenty of articles on how to have “the talk” with Black children to help them understand how to stay safe around police as they grow up, but not as many on how to help White kids become better allies. If you’re living in a mostly White community, like I am, it’s easy to avoid having uncomfortable discussions like this because we don’t see or feel the impacts of racism on a daily basis.

Even if you’re living in an area where there aren’t protesters nearby, I think it will benefit your child’s mental health to make them aware, in an age-appropriate way, of what is going on in our country. Let’s talk about how to talk about race.

Why Is It Important to Talk to White Children About Race?

I grew up a in a White family, living in a mostly White neighborhood, attending a mostly White school. It was a friendly community where nobody made overtly racist comments, and the school system encouraged tolerance and kindness. Each February, for Black History Month, we read books about Martin Luther King, Jr. and Rosa Parks and talked about how we used to discriminate against Black people in our country.

Since we only ever talked about racism as something that happened during slavery or in the protests of the 1960s, I assumed racism was a thing of the past. Looking around my classroom of kids who all looked like me, there was nobody to help me think otherwise. If I had never left my small town, would I have learned this wasn’t true?

We all want our children to grow up to be empathetic, moral, and accepting of others. In order to achieve this goal, White kids need to understand the real struggles that others go through on a daily basis. While it’s important for children to learn that everyone is equal, it’s just as important for them to learn that some people aren’t treated equally by our society. It can feel really uncomfortable to talk about racism as a here-and-now event. However, if kids grow up believing that racism is a solved problem, they may have a hard time believing their Black friends when they encounter discrimination.

At What Age Can We Start Talking About Race?

Children are able to notice differences in skin tone and hair color at an early age: one study found that babies as young as 3 months old already show a preference for looking at faces of their own race. Toddlers are often quick to point out differences in people around them (whether it’s polite to do so or not) and this is a great time to help give them the vocabulary to talk about race in a respectful way.

By openly talking about race with children as they grow, we’re showing them that it’s okay to do it. Race is an uncomfortable subject for many adults, and children pick up on this and avoid bringing up the topic as they get older. For kids who are too young to have a conversation about race, you can teach your child through your own actions. Here are a few suggestions for how to introduce the subject of race to young kids:

• Do your best to let your child see you interacting with people who don’t look like your family

• Give your child dolls and toys that represent other races, and use playtime to discuss differences in people’s skin, hair, and language

• Read picture books together that have non-White main characters

What Should I Say to Kids About the Protests?

Just like we have tried to shield children from alarmist coverage about the coronavirus pandemic, it’s also a good idea to protect young kids from media about the George Floyd protests that is not appropriate for them. Repeatedly seeing violence on TV can be scary, anxiety-provoking, and even traumatic for both children and adults. Kids do not need to see the George Floyd video or other violent acts firsthand in order to understand the injustice that caused them to happen.

Elementary school-aged kids are usually very interested in rules, right and wrong, and the idea of things being fair or unfair. This can be a great way to frame conversations about racism that uses language children already understand. You can ask your child to think of a time when they were treated unfairly, and discuss what they did to make things right. Author Jennifer Harvey told NPR she is using this technique to help her White children understand why the protests are happening now:

I [talked with my children about] how they might respond when they have been harmed or an injustice or an unfairness has happened to them and they aren't heard. Because we've been having these conversations, my kids understand that peaceful protest has not yielded justice for black and brown people in this country.

We're wrestling with it as a family and acknowledging that it's really unsettling, but also appreciating that people are really hurt and really angry. 

Kids know how it feels to be really angry, and helping them to understand the protests as an expression of pain and anger can help them connect with what is happening in an age-appropriate way.

Should I Wait for My Child to Bring up the Subject?

Talking about race feels so taboo for many children that they may not bring up this subject on their own. By initiating a conversation about racism and the protests with your child, you’re communicating that it’s an okay, safe thing to talk about. This might make it more likely that they bring up the subject on their own next time.

You can always let your child lead the discussion after you bring up the topic, and use their questions as a gauge for how deep the talk needs to go. It might be helpful to ask your child what they have already heard about the protests: given the constant media coverage, it’s possible your child has already heard a lot about what is going on. Learning what your child has already heard in their own words can also help you to correct any rumors or misinformation, and to identify worries your child might be having about the protests and other current events.

Resources for Talking About Racism and Protests with Kids

If you’re ready to start having this conversation but you’re looking for a guide, here are a few resources that I have found and liked:

Beyond the Golden Rule is a free downloadable ebook from Teaching Tolerance that has tips, child development information, and interviews with experts to help parents talk about prejudice with kids from preschool through the teen years.

Parents also has an age-by-age guide for talking to kids about race that is a shorter read and has concrete action items for kids up to age 8. This one might be especially helpful if you’ve ever heard your child say something judgmental or unkind about someone else’s race or appearance.

I found this article about how to discuss the current protests with White children very helpful. The author interviewed for the article also has a book, Raising White Kids, to help parents talk about race and teach anti-racism to their children.

If you can’t make it to a bookstore right away, you can find read-alouds of many children’s books that discuss race and diversity on YouTube. Check out Sankofa Read Aloud’s channel for a few options, including this reading of The Day You Begin.

If you are more of a podcast person, check out the 20-minute podcast “Talking Race with Young Children” to get advice from experts on how to have helpful conversations that are age-appropriate for little kids.

Coping Skills for Kids to Manage Coronavirus Anxiety

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

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

Coronavirus Coping Skill #1: Imagine a Peaceful Place

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

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

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

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

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

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

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

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

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

Coronavirus Coping Skill #2: Worry Breaks

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

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

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

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

Coronavirus Coping Skill #3: Outdoor Movement

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

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

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

Coronavirus Coping Skill #4: Mindful Sensory Play

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

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

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

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

• Coloring with scented markers, crayons, or pencils

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

• Mixing washable paint colors in a sealed ziploc bag

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

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

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

More Resources for Kids Coping with Coronavirus Anxiety

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

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

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

What Causes Anxiety in Tweens?

I see tons of preteens with anxiety in my practice. While anxiety is common at any age, there seem to be some unique challenges to preteen life that can make worries more intense. We tend to think of the teen years as a time of major physical, emotional, and social upheaval, but those changes are already beginning for lots of tweens. This may be especially true for girls, for whom puberty often starts between the ages of 10 and 14. There can be many reasons for anxiety, including genetics, but in this post I’ll be sharing 3 of the top issues I hear about from my preteen clients that trigger their anxiety.

Tween Anxiety Cause #1: The Middle School Transition Is Rough

Do you ever feel nostalgic or daydream about going back to middle school? I don’t. I don’t know anyone who does. Middle school is really rough! The academics get a lot harder, but without any of the fun freedoms that high school students enjoy to reward them for their efforts. Students may be switching classrooms throughout the day for the first time, all while trying to navigate a new school building, without the opportunity to blow off steam at recess like they were able to a few years ago. Add the shifting social world of preteens and the awkwardness of puberty into the mix, and it’s pretty much a recipe for anxiety.

I hear from tweens that 4th and 5th grade feel like a big step up in terms of what kind of work their teachers expect, maybe in preparation for this shift to middle school. Bright kids who find learning comes easy to them may be able to sail through the lower grades without great study skills, but things start to get more real around this time. This can result in disorganization, trouble finishing homework in a reasonable amount of time, and missing work.

Research backs up the idea that the shift to middle school is really hard on kids. A study of middle schoolers compared the grades of kids who had to switch to a new school for 6th-8th grade to kids who stayed in a K-8 school. The study found that kids who had to change schools experienced a drop in academic performance that didn’t let up until 10th grade! The researchers think that staying in the K-8 school allows kids to be the “top dogs” in school for longer, which tends to make kids more relaxed and reduces bullying. By comparison, moving to middle school suddenly puts kids in the “underdog” position again as the youngest kids in school, leading to more anxiety and social troubles. Speaking of social issues…

Tween Anxiety Cause #2: Preteen Bullying Is The Worst

While the high school bully who pushes kids into their lockers is a familiar cliche, the truth is that bullying is at its peak during the tween years. Research on bullying has shown that it’s most common between ages 10 and 13, and that kids who are bullied during this age range may feel the effects more strongly than an older teen. That’s because preteen kids are starting to form the identities and friend groups that will carry them through to the end of high school. Being ostracized or feeling like an outcast in middle school can set the stage for a tougher social experience in the teen years.

Interestingly, the research also showed that preteen bullying doesn’t usually look like that shoved-into-a-locker cliche. Tween bullying is often more subtle and focused on relationships: for example, spreading gossip, making passive-aggressive “jokes”, or excluding someone from the lunch table. This kind of bullying can be harder for adults to recognize and punish, which makes it harder to stop. Even though “drama” like this is common among preteens, it can be really agonizing for kids, especially those who are being excluded on a regular basis. When the bullying is more than occasional, it can become a source of anxiety and low self-esteem.

Tween Anxiety Cause #3: Body Image Awkwardness

Many kids start puberty in the tween years: for girls, this usually happens between ages 10 and 14, and for boys, between ages 12 and 16. Preteens find themselves suddenly looking more like adults, and having to manage their hygiene like an adult, too. This is a big adjustment! Even when kids have gotten good education about what to expect in puberty, they may wonder about whether their experience is “normal” or feel really embarrassed about body odor, body hair, and other signs that they’re growing up.

I often hear from tween girls in particular that they feel super self-conscious about their bodies. We all know that girls are under a lot of pressure from pop culture to look a certain way, which can lead even young tweens to question whether their body type is measuring up to the ideal. This can create unrealistic expectations, lower self-esteem, and prompt anxiety about looking “good enough” in front of peers.

I also hear, though, that this body anxiety can come out in more subtle ways. Sometimes, well-meaning remarks from family members or friends about how a preteen is “growing up” can spark anxiety and make young people feel like they’re under a microscope. After all, nobody was commenting on their body shape at family functions a few years ago! These offhanded compliments heighten a preteen’s sense that their looks are being evaluated by everyone around them—the last thing most tweens want.

Therapy Can Help Preteens Manage Their Anxiety

Do you see your preteen kid struggling with any of these issues? Tween-aged kids are often at a great stage in life to benefit from counseling: they have the cognitive skills to learn more advanced ways to manage worries, but still have a playful attitude that can make the therapy process creative and fun. Not every tween who struggles with anxiety will need therapy to feel better. However, having someone to talk to who isn’t a friend, parent, or teacher can be really valuable to a preteen who feels alone with anxiety, and can make this phase of life move by a little more smoothly.

If you’re looking for some extra support for a preteen in North Carolina or New York, you can contact me here.

Will We See More Agoraphobia Symptoms in Children After Coronavirus?

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

First Of All—What Is Agoraphobia?

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

• Leaving the house

• Riding on public transportation, like a city bus

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

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

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

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

During Quarantine, Everyone Is a Little Agoraphobic

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

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

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

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

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

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

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

Is Agoraphobia Common in Children?

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

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

Signs and Symptoms of Agoraphobia in Children

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

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

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

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

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

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

How to Help a Child With Agoraphobia

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

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

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

Does Your Child Need More Help?

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

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