3 Signs Your Child is Ready for Social Media

Figuring out when to cave to your child’s pleas for a social media account is easier said than done. With more and more of life happening online, having Instagram or Snapchat can feel like a lifeline to kids. On the other hand, parents are right to be concerned about the (very real) dangers that children can be exposed to on social media, even if your child is only intending to talk to other kids. The stakes are really high!

Pretty much all the major social media apps set an age minimum of 13 for kids, but many experts agree that parents should base their decisions about social media on a child’s development and maturity, rather than just their numeric age. After checking in with some of the big organizations that speak out about children and social media, I’ve come up with a short list of signs that your child may have the maturity needed to stay safe online.

Readiness Sign #1: Your Child Can Think About Cause and Effect

As adults, we are painfully aware that anything we put on the internet is pretty much there forever. Even if we try to delete it, there’s no guarantee it’s been completely wiped from the record. When we interact with other people, we have a little running commentary in the back of our head that guides what we say and do. We’re aware that our actions have consequences. Embarrassing selfies or flame wars with strangers in a Facebook group doesn’t just exist in a vacuum: they could come back to haunt us in a job interview someday.

Adults are able to think abstractly and play out different possibilities in our heads. This helps us to make guesses about other people’s motivations and how they could affect us. It also (hopefully, at least most of the time) keeps us from saying or doing things online that we might really regret later on.

Kids are often concrete thinkers up until about age 11, but this can vary. Younger children tend to live in the here-and-now, and use the information they have in a given moment to make decisions. It is harder for them to play out hypothetical situations in their minds, especially when those things could occur far off in the future. It’s totally normal and healthy for kids to think this way, but it makes it harder to appreciate some of the risks of social media.

Some kids develop their abstract thinking abilities earlier than others. If your child is able to consider problems from different angles, plan ahead for different scenarios, and improvise solutions to problems, she’s likely reached this point in her development. If you are considering allowing your child to get on social media, check in about her ability to visualize different situations she might encounter online. If she’s able to understand cause and effect and anticipate possible issues, it will be easier to make safe choices.

Readiness Sign #2: Your Child Has Healthy Body Image

Honestly, even as I’m typing this I am asking myself how many tweens I know who fit this description. I can name maybe a small handful of tweens and early teens whose self-esteem about body shape, weight, and appearance seems pretty unshakeable. Many more kids share that they feel extremely vulnerable and open to criticism about the way that they look. While we may think of poor body image as a problem that mainly affects girls, boys can be impacted, too.

Researchers have started looking at possible links between social media use and poor body image and disordered eating in young girls. Although nothing has been proven for sure, studies suggest that photo-based social media apps, like Instagram, make girls feel worse about their bodies. Tweens on social media are inundated with images that are designed to look candid and casual—the “woke up like this” shots. In reality, though, these pictures have been heavily edited and posed by a team of professionals. The standard of beauty keeps getting more extreme and hard to attain as our ability to filter images becomes more commonplace.

In my own child and tween therapy office, young people tell me that they can’t help but compare themselves to others on social media. They scrutinize the likes their classmates have received, and question why they can’t look like the influencers they follow. I don’t think social media is solely to blame for the body image issues teens and tweens have to deal with, but it doesn’t make things any easier.

Before moving ahead with a social media account for your child, you might want to think about how you’ve seen your child respond to criticism or bullying from peers. Does she crumble when someone says something mean to her, or is she able to let it roll off her back? Does she celebrate the way she looks, or do you see her frequently comparing herself to others? How media literate is she—can she recognize an airbrushed or unrealistic photo when she sees one? If the answer to most of these questions is “yes”, she may be ready to brave the world of Instagram.

Readiness Sign #3: Your Lines of Communication Are Open

Chris McKenna at WaitUntil8th.com wisely points out that you should make sure you’ve had “the talk” and all other potentially awkward conversations with your child before letting them loose on social media. Even kids who are not looking for trouble are likely to stumble across explicit material on any of the major platforms. You want your child to be prepared when that happens, and not confused about what they have come across.

Being on social media also makes your child more vulnerable to sexual predators, which means you need to talk about safety and go beyond simple stranger danger. Your child should know how to recognize signs of grooming, and have a plan for what to do if someone makes them feel uncomfortable. You’ll also want to talk about what to do if that uncomfortable pressure is coming from someone your child knows—for example, a friend or classmate asking for inappropriate photos.

Social media opens up a new, private world for your child where they might encounter all kinds of uncomfortable stuff. It requires a certain level of mutual trust between parents and kids. As a parent, you’ll want to know that your child is responsible and makes good decisions. However, your child also needs to trust that they can come to you with problems, and you won’t immediately panic or ground them for the rest of time. If something inappropriate happens online, your child should feel safe coming to you for help. This will go a long way toward keeping them out of harm’s way.

More Help for Tweens and Teens

Tweens are stuck dealing with many of the pressures of teen life, like social media, demanding homework, and friend drama. But, they have to do it without enjoying a lot of the same freedoms that the older kids have. It doesn’t always seem fair, and it’s hard for both parents and kids to figure out.

In my Davidson, North Carolina therapy office, I help tweens learn skills to manage anxiety and recover after stressful or traumatic events. If you and your tween are having a hard time navigating this exciting, challenging, and sometimes awkward phase of life, counseling can help you both get through things a little more smoothly. Even the seemingly small stuff—like deciding when to get a social media account—can cause a lot of unnecessary stress, and it can be nice to have a neutral party around to help sort out everyone’s feelings.

If you’d like to get started in counseling, I’m available to help kids in North Carolina, New York, and Florida. You can learn more or schedule an initial appointment by phone or email.

Should My Child Have Social Media?

Depending on who you ask, social media is either the best or worst thing to ever happen to kids. Is it the way of the future, giving kids endless entertainment and a connection to peers all over the world? Or is it an unsupervised no-man’s-land that exposes children to danger and risks their mental health? I’m not here to tell you what to do—every kid and family is different. But, as a children’s counselor, I can go over the pros and cons of social media for children from an emotional perspective. Hopefully, this post gives you a more balanced perspective so you can make the right choice for your child.

What’s The Right Age to Get Instagram, TikTok, or Other Social Media?

If you ask pretty much any social media company, the answer is easy: 13. Instagram, TikTok, Discord, Snapchat, YouTube, and Facebook all require users to be 13 or older to join. This seems straightforward enough—end of blog post, right? If only life were so simple. Sure, Instagram says you have to be 13 to join, but Instagram doesn’t have a tween daughter begging for an account, claiming she’s the last person in her class who is without one.

As far as I can tell, the 13 year old age limit has very little to do with kids’ readiness to be on social media. Nobody consulted with a child psychologist or child development expert to come up with this magic number. Instead, it has more to do with big media companies not being allowed to collect data on little kids. One of the reasons social media apps remain free is because they’re collecting data on us all the time, so that they can target advertisements to us. I guess that, somehow, it’s deemed okay to do this once a child turns 13.

What does this mean for parents? I think we should all be taking this age guideline with a grain of salt, because it’s a little bit arbitrary. Depending on their maturity level, some kids may be ready for social media at 13. Many others may need to hold off until they are older, or have a lot of parental supervision to make sure they stay safe. Personally, I would not feel comfortable with any child age 13 or under having an unsupervised social media account of any kind.

How Social Media Hurts Kids’ Mental Health

Have you seen The Social Dilemma yet? If not, go watch it and come back…I’ll wait. It does a much better job than I could possibly do of explaining how social media puts children at risk of developing anxiety and depression. Imagine your 13-year-old past self for a moment. Think about how important your friends’ approval was to you. Remember how awful it felt when someone made a snarky comment about you? Multiply that by ten, one hundred, even a thousand, and that’s what tweens and teens are exposed to on social media.

Our brains were not designed to deal with social acceptance or rejection on such a large scale. Getting “likes” activates the pleasure centers of the brain and can become addictive. Kids on social media aren’t just comparing themselves to other students at school, but to professionally styled, heavily filtered influencers on TikTok and Instagram. This can really do a number on a child’s self-esteem. Research shows that depression, anxiety, and suicidal thoughts are all more common among teens who frequently use social media.

The Safety Risks of Social Media for Children

We have all heard horror stories about internet predators at this point. Fear-mongering news stories aside, it’s absolutely true that there are people out there who try to victimize kids online. Even if you’re in a “child-friendly” corner of the internet, or talking to someone who appears to be a fellow teen, you never really know who you’re dealing with.

Even though most kids are very aware of “stranger danger”, predators know what to say and do to earn trust. This is called “grooming”, and it lowers a child’s defenses and makes them more vulnerable to being financially or sexually exploited. Because being online feels so anonymous, it’s really easy to accidentally overshare personal information. Younger children tend to be impulsive, and they have a hard time considering the long-term consequences of their decisions. This can (incorrectly) make it feel less dangerous to send photos through apps like Snapchat, where they’re seemingly only available for a short period of time.

Are There Any Benefits to Social Media For Kids? (Actually, Yes)

Okay, so this all sounds pretty grim. Even though it’s super common, it’s undeniably risky for kids’ mental health and safety to have unrestricted social media access. But here I am, the children’s therapist, writing this blog post with Instagram pulled up on my phone and Facebook in the next tab on my browser. You may be surprised to learn that I think social media—when used in moderation—can be beneficial to kids’ mental health.

Social Media Is a Child-Friendly Creative Outlet

Social media can be an amazing creative outlet for kids. Many of my child clients primarily use social media to share fanfiction and fan art that they’ve created based on their favorite TV shows. Aspiring makeup artists, photographers, and fashion designers can also find an outlet for their passion online. I could write a whole blog post on the possible mental health benefits of this kind of creative expression. It’s meaningful, positive social interaction that helps kids build real-life skills. Especially during times when kids are stuck at home, positive and creative experiences like these can reduce their risk of depression.

Social Media Encourages Diversity

I also think social media can open a child’s eyes to a bigger, more diverse world. If you live in an area where everybody looks the same, this is an opportunity to provide racial windows for your child that give her a peek into another culture or way of life. Did you know there’s a big Indigenous and Native American community on TikTok performing dances and teaching about their culture? I didn’t until this year, and now I love watching their content.

I also think social media is a godsend for anyone living with a disability or chronic illness. A child who lives with a medical condition may be the only person at their school with that diagnosis. However, social media can connect him to tons of other people who get exactly what he’s going through. It can be a source of moral support, positive role models, and even advice. Being different can be isolating, and social media can make a child feel less alone.

Need More Help? Try These Resources for Tweens and Teens

It’s tough to figure out how to navigate the internet when you have young children. Unless you are planning to move off the grid, internet access is a necessary evil for today’s kids. My age-by-age guide to internet safety can help you figure out what activities are appropriate for kids from preschool through late elementary school.

If you have older children, my guide on internet and phone safety for preteens and teens may help. It talks about the specific risks older kids face online. You’ll also find advice to consider if you’re deciding whether your tween is ready for their own phone.

As you may have gleaned from this post, I’m a children’s counselor in Davidson, North Carolina. I especially love working with preteens who are dealing with anxiety and trauma symptoms. I’m able to work with families in North Carolina, New York, and Florida thanks to online counseling. If you’re in one of those states and would like to learn more about starting therapy, you can reach out to me here.

5 Books on Transracial Adoption for White Parents of Black Children

If you’re a parent considering transracial adoption, you’re probably experiencing a whirlwind of emotions. On one hand, there’s the joy of growing your family—possibly after struggling with infertility or other setbacks. Expecting a child is hopeful and exciting! On the other hand, you may be feeling sorrow for your child’s first family and anxiety about how to effectively parent a child of another race. How can you help your child navigate a racist world? How can you teach your child about a culture that isn’t yours?

One benefit of adoption is that adoptive parents often have a lot of time to prepare for parenthood. It can be a long wait! If you’re waiting to meet your child, you can use that time to read up on the subject of transracial adoption. Today, I’ll be sharing 5 books that I’ve personally read and enjoyed as I learn more about adopting a baby of another race.

Who is This Book Recommendation List For?

This list focuses on books for white parents adopting Black infants or children. Most of the adoptions described are domestic infant adoptions, although a few books touch upon international or older child adoption. Although most books are geared toward adoptive parents, grandparents, relatives, and interested friends will find something of value in them, too.

I’ll share the pros and cons of each book (from my perspective) as well as who might benefit from giving it a try. I’ll also present these books in the order that I wish I’d read them—if you’re interested in learning more about transracial adoption, you can start with my first recommendation and move your way down the list.

#1. So You Want to Talk About Race, by Ijeoma Oluo

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Although not an adoption book, this is a great start for any white person wanting to learn the stuff about race and racism that wasn’t covered in school. Ijeoma Oluo, a Nigerian-American author, talks about her experiences as a Black woman in a way that sounds almost as casual as a friend talking over coffee. Each chapter of the book is devoted to exploring a different issue, such as white privilege, cultural appropriation, or affirmative action.

The Pros: I wish this book were taught in schools. It’s a great introduction to concepts that might feel overwhelming or intimidating to talk about. Whereas other books about race and racism can feel very dry and academic, this one is easy to read. Oluo shares personal stories that bring the concepts to life, and there’s a lot of humor despite the heavy subject matter. One big takeaway of this book is to expect to make mistakes: trying to speak up and putting your foot in your mouth is better than never speaking up at all.

The Cons: If you have already done some work learning about race and racism, this book may be too introductory for you. I was hoping for a little more depth. Most of the discussions of race focus on interactions between white and Black people, which may not be as helpful if you’re wanting to learn about the experiences of other races. I would also have loved some more actionable advice on how to start conversations with my family, friends, and acquaintances.

#2. In Their Own Voices: Transracial Adoptees Tell Their Stories, by Rita J. Simon and Rhonda M. Roorda

If you are a hopeful adoptive parent, start here. This isn’t so much a book as it is a collection of interviews with adult transracial adoptees. If you don’t know adoptees in your personal life, it can be hard to find these kinds of first-hand experiences, which makes the book really valuable. The young adults interviewed for the book were also part of a study on what it’s like for kids to grow up with a family of a different race. The results of that study are shared and unpacked in the book. The book includes an even number of male and female interviewees, all of whom are Black or biracial and grew up with white parents.

The Pros: There are a lot of transracial adoption books out there, but most of them are written by white adoptive moms. It’s harder to find books that share other perspectives. Rhonda Roorda is a transracial adoptee herself. She writes not just as a researcher but as someone who personally knows what it’s like to grow up as a Black child in a white family. The adoptees she interviews come from all different types of families, so their experiences are different and interesting to read.

The Cons: This is not the most reader-friendly book. It has an academic writing style that makes it feel like a book you’d be assigned in a college class. The interviews were all conducted in the mid-90s, and the book hasn’t been updated since. The book shows its age in some places: all the adoptees were in closed adoptions, which is no longer the norm, and there’s a lot of ‘90s slang. I’d love to see a follow-up with more modern adoption stories!

#3. Dim Sum, Bagels, and Grits: A Sourcebook for Multicultural Families, by Myra Alperson

This is a good book for adoptive parents, but I think it might be an even better fit for grandparents or other family members who may not be doing as much research as a new mom or dad. Myra Alperson is a white, single mom to a daughter adopted from China. She shares stories from her own family’s experience trying to blend multiple cultures under one roof, and brings in quotes from other families, as well. There’s a lot of direct advice about how to honor a child’s birth culture in your day-to-day life.

The Pros: This is a quick and easy read, which is one reason why I think it’s a great option for non-parents who are curious about someone else’s adoption. I really enjoyed the passages from other adoptive families and adult adoptees. It was helpful to learn that adoptees may have different levels of interest in their birth culture throughout their lives, and that’s ok! There’s no need to force a child into cultural activities just because that’s what adoptive parents “should” do.

The Cons: Because the author adopted her daughter from China, this book isn’t quite as relevant for white families adopting Black children in the U.S. This book could also really benefit from an updated second edition. There are some really impressive, very detailed resource lists at the back for stores, websites, and book series that look amazing—but many of them no longer exist.

#4. Secret Thoughts of an Adoptive Mother, by Jana Wolff

As you can guess by the title, this is a memoir that offers a peek into the private thoughts of a transracial adoptive mom. I think this is most helpful for people considering transracial adoption and wondering what the emotional experience will be like for them. Very close friends or relatives might also enjoy it. Jana Wolff is the mother of a biracial son, and details her adoption process from infertility through her son’s early childhood. She also touches on some of the discoveries she made about subtle racism after her son was born.

The Pros: This book does a good job of covering the full range of emotions a person might feel when considering adoption: both the good and the not-so-good. If you’ve had any worries about bonding with your baby or any other aspect of adoption, you’ll probably feel validated by this story. It’s a quick read—I finished it in an afternoon. Moms may find this book especially helpful, because Wolff talks about the pressure society puts on women to get pregnant.

The Cons: I’ve seen some controversial reviews of this book online. Some people feel that Wolff is too cynical or harsh in the way she describes her adoption experience. I’ve even seen a few concerns that her son might read this someday, and feel uncomfortable with his mom’s less positive thoughts. Ultimately, this is one person’s very personal and individual story. You might see parts of yourself in it, but you probably won’t connect with the whole thing.

#5. In Their Voices: Black Americans on Transracial Adoption, by Rhonda M. Roorda

This is another book by Rhonda Roorda with a very similar title to book #2 on this list, so don’t get them confused! In this later book, Roorda interviews Black Americans who are somehow involved with or touched by transracial adoption. They aren’t adoptees, but they may be lawyers, social workers, teachers, or the adoptive parents or siblings of a Black child who was adopted by white parents. The interviews are organized based on age, and gives a lot of context for what was happening in Civil Rights as these interviewees grew up. Because it’s more in-depth, I’d recommend it for parents as opposed to other family.

The Pros: This might be the most informative book on this list. It manages to teach about racism, give perspective on the positives and negatives of adoption, and provide concrete “to-dos” for adoptive parents all in one book. Even though Roorda doesn’t shy away from the hard parts of adoption, she’s advocating for you, too. The final chapter of the book includes specific tips to connect your child to his or her culture, plus a list of further reading. Honestly, that last chapter is worth buying the book all by itself!

The Cons: Like the other books in this series, In Their Voices is very dry and a slow read. It’s written like an academic textbook, and not the kind of book you’ll breeze through in one sitting. Because this book isn’t from the perspective of an adoptee or a parent, it might feel a little less relevant if you’re just starting off in your adoption journey. But come back to it later—it’s worth it!

Mental Health Resources for Kids and Parents

No matter how your children join your family, sometimes kids need emotional support. There’s some research to suggest that adopted kids are more at risk for certain kinds of mental health struggles. If your child is dealing with anxiety or trauma symptoms, counseling can help both of you to navigate your child’s big feelings with less stress.

I’m a children’s therapist who works with children and tweens in the states of North Carolina, New York, and Florida. If you’re close to Davidson, North Carolina, you can stop by my office for a face-to-face session. Otherwise, I’m available for online therapy using a video conferencing platform.

Have any questions? Did you read one of the books on this list? I’d love to hear your thoughts. You can always reach out to me here, either to schedule an appointment or let me know what’s on your mind.

Explaining CBT to a Child: 4 Topics to Talk About

Cognitive Behavioral Therapy, also known as CBT, is one of the most effective forms of therapy for children with anxiety. There’s a mountain of research behind it to prove that it helps kids with a variety of anxiety-related problems, from tantrums and acting-out behavior to worrying and sleep difficulties. Although it’s helpful for all ages, studies show it’s especially effective for kids in the 11-13 age range. Maybe that’s why I’m such a big fan of using it in my tween therapy practice!

If you’re reading this post, maybe you are intrigued by CBT, too. It’s possible it’s been recommended to you by your pediatrician, or perhaps you’ve discovered it by Googling around for anxiety treatment for kids. However you learned about it, you might be wondering how to discuss it with your child. As helpful as CBT is, it’s also full of intimidating-sounding therapy jargon. In this post, I’ll break down some of the main concepts in a child friendly way, so your child will be ready to rock their first CBT therapy appointment!

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy is a skill-based therapy that’s used with both kids and adults. It’s a way of dealing with anxiety that’s focused on the present, rather than the past. You probably won’t spend a ton of time in CBT talking about family history and early childhood, because uncovering the root of where anxiety comes from isn’t the main goal of this style of therapy.

Regardless of where the anxiety came from, anxious kids need strategies to deal with it. That’s the main goal of CBT: learning tools to cope with anxiety when it arises, both now and in the future. Although it sounds simple, the effects of CBT can be really deep. Research shows that 70-80% of kids respond well to CBT, and they often see lasting results from short-term therapy. In my experience, learning the right coping skills often leads to an “aha” moment for kids. They start to understand how their own anxiety works, and that they have a say in how they think and feel, which is really empowering.

Common CBT Techniques

A child in CBT therapy might learn any or all of the following techniques:

• Relaxation techniques to calm the body

• Mindfulness or grounding skills to focus attention during times of stress

• Keeping a journal or written log to track worries at home

• Practicing “cognitive restructuring”, a way of transforming unhelpful worries

• Gradually exposing themselves to things that trigger anxiety

• Using roleplay to practice skills

• Doing “experiments” in real life to test if their fears really come true

Okay! Now that you’ve got an overview of what CBT is and how it works, let’s move on to talking about how to discuss it with your child. The next 4 sections cover what I think are the most helpful concepts for children to understand about CBT.

CBT Topic #1: The Cognitive Triangle

Most children view their emotions as something that come out of the blue. They come and go, sometimes without good reason, and they’re difficult or impossible to control. Heck, many adults feel this way about their feelings, too: how many times have you heard someone say that something “made them angry” or “made them anxious”? Many of us feel pretty powerless when faced with strong emotions like anxiety and anger.

However, it’s not really true that our feelings come out of nowhere. Any time something happens to us, all day long, we have a thought about it. It’s our thoughts that tell us how we should feel about what’s going on. Most of the time, this process works great and our thoughts let us make accurate judgment calls about situations. But for anxious kids, overly negative thoughts might lead them to feel anxious when they don’t really need to be.

The cognitive triangle is a map that shows how our thoughts, feelings, and behaviors are all connected to each other. Our thoughts tell us how to feel, our feelings influence how we act, and then our actions play a big role in how we see the world and future thoughts we might have. Teaching a child about the cognitive triangle is a great first step when introducing them to CBT.

You can use the cognitive triangle to show how different people can have the same experience, but end up feeling and acting different ways based on their thoughts. For example, a child who loves animals might see a dog sitting on the sidewalk and think “Cute, I love dogs!”. This would make her feel excited and happy. She might walk up to the dog and pet him. Another child who was bitten by a puppy in the past might see the same dog and think “Oh no, he could bite me!”. That would make him feel anxious and afraid. He’d probably cross to the other side of the street to avoid getting near the dog.

Learning and practicing the cognitive triangle helps kids understand that there’s no one “right” way to respond to a situation. It can also help them to notice the vicious cycles that sometimes form when a person is anxious. For example, if the boy in the story above keeps avoiding every dog he sees, he will never get the chance to learn about all the friendly dogs that exist in the world. He may just keep on fearing dogs forever.

CBT Topic #2: Thoughts or Actions Can Change Feelings

Once a child knows about the cognitive triangle, you can move on to the next step. Our thoughts, feelings, and actions are all connected, which means that changing one of those things changes the others. It’s pretty hard to change a feeling: just telling someone to stop being anxious probably isn’t going to work! It’s easier to change our thought or change our actions, and deal with the anxiety that way.

Your child can change her thoughts by learning how to spot worries and turn them into something more useful. She can change your actions by learning coping skills to relax her body and focus on something besides her worries. Either way, she’ll be helping herself to shrink her anxiety down, or turn it into a more helpful feeling to have.

CBT Topic #3: Talking Back to Worries

In CBT, kids learn a process to change their thoughts called “cognitive restructuring.” Because this is pretty much the least child-friendly term ever, I usually just refer to it as “talking back” to thoughts. To practice this technique, kids first need to get skilled at noticing when they’re having a worry. Next, they learn how to gauge whether or not their worry is realistic or not—usually, it isn’t! Finally, they come up with something that is more helpful and realistic they can say to themselves instead.

You can tell your child that in CBT, she’ll learn she doesn’t have to believe everything her worries tell her. Therapy will help her learn how to spot worries, and decide whether or not they’re worth listening to. She’ll learn how to “talk back” to the unhelpful ones, so that they won’t boss her around anymore. Tiger-Tiger, Is It True? is a great book for introducing this concept to preschoolers and early elementary-aged kids. Older kids might benefit from giving my coping skills course a try, where I cover this subject in detail and talk about how to try “talking back” to worries at home.

CBT Topic #4: The Feelings Remote Control

I often use this “remote control” analogy when I’m talking about coping and relaxation skills with kids. Activities like deep breathing, muscle relaxation, and guided visualization are one way that we can change our behavior in order to improve our mood. It can help kids understand the reason we’re always asking them to do things like “take deep breaths.”

When we’re hit with a really intense emotion, sometimes focusing on it just makes it get worse. Kids with anxiety are prone to doing something called ruminating: going over their worries again and again, which magnifies them. Coping skills work like a remote control that helps kids to “change the channel” on their feelings by shifting them into another emotional state. They can also work to “turn the volume down” on an intense emotion, to make it more manageable.

Most kids are familiar with remotes and how they work, which makes these terms helpful shorthand when you’re trying to help your anxious child. Relaxation skills like breathing and muscle relaxing can help turn down the volume, while music, exercise, and guided visualization can help to change the channel.

OK, You’ve Explained CBT to Your Child. What’s Next?

You’ve walked your child through the basics of Cognitive Behavioral Therapy. What’s the next step? If you know this is the approach for you, you can look for a therapist that specializes in CBT on therapist directories like Psychology Today.

If you live in New York, North Carolina, or Florida, I might be able to help you at my tween therapy practice. I love helping kids learn CBT, because these skills don’t have an expiration date: they can help kids manage anxiety and worries for the rest of their lives. That is pretty cool! If you’re not located in a state where I’m licensed, you might like my CBT-inspired coping skills course. It’s a self-guided class (not therapy) for parents and children that teaches my favorite techniques for managing anxiety at home.

I could chat about CBT all day, so if you are curious, feel free to reach out! You can ask a question or request an appointment here.

Signs of Separation Anxiety in Older Kids and Teens

The term “separation anxiety” might conjure up images of a toddler crying in the window as you pull out of the driveway. While it’s true that separation anxiety is super common in preschool kids, older children and even teenagers can be affected by it, too. As I’m writing this post, we are (still) in the middle of the COVID pandemic, which has kept kids of all ages at home with their parents for most of each day. I’ve noticed more older kids and teens coming into my virtual office these days with separation anxiety struggles. In this post, I’ll share some signs to look out for if you suspect that Separation Anxiety Disorder is the cause of your older child’s worries.

How Common is Separation Anxiety in Kids and Teens?

Separation anxiety is so common in young children that it’s considered a normal part of child development. In fact, it can be seen as a positive sign: it means that a child feels attached to his caregiver, which is always a good thing.

Historically, little children have needed to stay in close proximity to their parents in order to survive. Feeling anxious about being far away from a parent makes sense! This is why we often talk about separation anxiety in little kids, but don’t usually start referring to it as Separation Anxiety Disorder until about age 6.

Separation Anxiety Disorder is pretty common among older children. It affects roughly 4-5% of American kids between the ages of 7 and 11. If your tween child is struggling to leave home and do things away from the family, she’s not alone.

The older kids get, the less common Separation Anxiety Disorder seems to be. About 3.9% of young teenagers (12-14) are dealing with separation anxiety symptoms. The numbers go down even further for older teenagers, to about 1.3% for teenagers ages 14-16. Although it used to be considered a children’s condition, some research suggests that a small percentage of adults continue to struggle with Separation Anxiety Disorder into adulthood.

What Causes Separation Anxiety In Older Kids?

There’s no single cause for separation anxiety in older kids. As is the case with many mental health problems, a combination of genetics and life events seem to make some children more vulnerable to it than others.

Some children may simply be born with more anxious temperaments than others, kids can inherit these anxious traits from their parents. Kids with Separation Anxiety Disorder are more likely to have other types of anxiety disorders as well, like Obsessive Compulsive Disorder, Agoraphobia, and panic attacks. IF a child is naturally worry-prone because of their biology, they’ll be more predisposed to all these forms of anxiety.

Children who have been through stressful situations are also more likely to develop separation anxiety. Trauma experiences—especially ones that involved a child being separated or removed from a parent—can make it much harder for a child to be away from parents in the future. The loss of a loved one can also prompt children to cling more closely to surviving family members. Sometimes, less serious changes can also trigger separation anxiety, such as a big move or switch to a new school.

Both genetics and environment are usually to blame for separation anxiety. If your child has a naturally anxious temperament, they may be able to cope just fine as long as life remains calm. However, a big disruption can really activate their anxiety, and sensitive kids may have a harder time bouncing back. These kids may try to cope with their overwhelming anxiety by staying close to a parent, which can sometimes get in the way of day-to-day life.

What Are the Symptoms of Teen Separation Anxiety?

We all know that the major symptom of separation anxiety is fear of being away from a parent, and this is true for all kids from toddler age through the teens. However, all kids are different, and separation anxiety can manifest in various ways based on age.

Older children and teens may be less likely to voice their worries about being away from parents. This might be due to embarrassment or shame about struggling with something seen as babyish. Parents may need to look to their child’s behavior for clues that Separation Anxiety Disorder is behind their teen’s struggles.

Here are the symptoms that therapists use to diagnose Separation Anxiety Disorder in kids and teens:

• Anxiety about being away from an important caregiver that is excessive and not typical for the child’s age. This can lead kids or teens to avoid separating from parents altogether.

• The anxiety or avoidance is persistent and lasts at least 4 weeks.

• The child or teen suffers negative consequences due to their anxiety, and it may interfere with school, work, or friends.

• The problems aren’t better explained by another reason or another form of anxiety.

Now that we know the symptoms to look for, let’s see how these problems might look in teenagers or older kids.

Signs of Separation Anxiety to Look Out For

Here are a few signs of teen separation anxiety to look out for:

• Refusing to go to school: this is a big one. Plenty of teenagers are reluctant to go to school for all kinds of reasons. If your child’s dread about school looks more like anxiety or sheer panic, without a clear reason, social anxiety could be an underlying cause.

• Worrying about the health or safety of family members: many kids with separation anxiety fear that something terrible will happen to their caregivers if they let them out of their sight. This can be true for teens, as well. Teens are more able to imagine worst-case scenarios than younger children. They may be especially prone to these worries if they’ve survived a trauma or experienced the serious illness or injury of a family member.

• Fears about kidnapping or getting lost: teens are very aware of stranger danger and other safety risks. If their anxiety levels are high, they may be overly worried about their safety when they are away from home. The fear is out of proportion to the situation, and might hold them back from going on outings alone.

• Body symptoms: for some people, anxiety mainly shows up as physical illness rather than emotional upset. If that’s the case for your teen, you’ll likely notice that the symptoms start shortly before a separation and resolve once the threat of being away from parents has passed. Of course, it’s always a good idea to rule out medical causes before assuming this is a sign of anxiety.

• Avoiding outings with friends: difficulty being away from home might lead teens to turn down social invites they would otherwise be interested in. It may be too anxiety-provoking to participate in activities if you aren’t there, too. This can negatively impact a teen’s social life.

• Meltdowns: you may notice your teen having meltdowns when it’s time to leave the house. They may seem unexpected for your child’s age, and even resemble the tantrum of a younger child. It’s a sign your child is so overwhelmed with anxiety that she’s moved past her ability to cope.

Begin Counseling For Teens With Separation Anxiety in North Carolina

Whether it’s due to an anxious temperament, life stress, or the pandemic, counseling can help anxious kids and teens get back on track. It’s really satisfying to watch teens master their separation anxiety through cognitive behavioral therapy. Sometimes, the process is surprisingly quick once teens feel empowered and they have the right tools!

If you are looking for therapy for a preteen or young teenager, I may be able to help at my Davidson, North Carolina counseling office. If your family lives anywhere else in North Carolina, New York, or Florida, we can meet virtually in my secure telehealth platform. If you’d like to learn more, contact me here. I’m always happy to answer questions!

5 Things I've Learned From Playing DnD With Middle Schoolers

If you’d told me in 2019 that I’d spend 2020 hosting Dungeons & Dragons groups for middle schoolers, I would have been…very surprised, to say the least. But 2020 was a weird year! As the pandemic and quarantine moved our social lives online, my therapy practice moved online, too. Online D&D groups are a big part of my life now—and, honestly, a highlight of my week.

When I first moved to North Carolina from New York, I joined a “DnD” group on a whim as a way to make friends. I learned that DnD is perfect for this: it’s an easy, low-stress way to socialize, especially if you are someone who doesn’t love small talk. There’s enough structure to the game that you aren’t left staring at someone, wondering what to say next. It’s creative, a little goofy, and sometimes surprisingly heartfelt. Because you are playing as a character, it’s hard to feel like you’re making a fool of yourself: any mistakes are the character’s fault, not yours.

When quarantine started, I realized that so many of the tweens I knew could use a structured, creative outlet like DnD to help them feel connected while social distancing. It’s been so fun to watch kids who have never played before take to the game easily, and use it as a way to support each other through a tough time.

Playing DnD with middle schoolers has taught me a lot about the game, the value of online friendships, and it’s even debunked some myths about middle school. Here’s what I’ve learned after 6 months of DnD with tweens.

“Mean Girls” Are a Myth

I have to admit that as a tween therapist I have perpetuated the myth of the “Mean Girl” many times. I grew up with the movie, and I remember how miserable 6th grade was for many of us. You couldn’t pay me to go back to 6th grade! While it’s true that middle school friendships can be filled with drama, there’s nothing inherently “mean” about girls this age. In fact, middle school girls really want to support each other.

It can be hard to be kind and supportive 100% of the time in a stressful school environment, where everyone is competing with each other and you’re worried about grabbing a spot at the “good” lunch table. In our groups, though, players know they are working toward a common goal: they’re here to make friends, and they take that responsibility seriously.

Far from “mean girls”, tween girls are some of the most welcoming and inclusive people I know. We’ve had girls from all walks of life join these groups, and their differences have not just been accepted, but celebrated. When they are set up for success, middle schoolers are an accepting bunch. Adults could learn a thing or two from watching them play.

Having Fun is Good Therapy

It’s easy to get hung up on the serious side of therapy—making sure you are working in a way that’s effective, and backed by solid research. I can geek out on this stuff all day: I love approaches like Cognitive-Behavioral Therapy that use scientifically proven techniques to help kids cope with anxiety and trauma.

Creativity, joy, and fun are as important for our mental health as any coping skill. In fact, it’s pretty hard to do any kind of therapy with kids if it’s not fun. Children learn through play. We can talk about social skills until I’m blue in the face, but talking will never be as effective for learning as playing is.

For kids who are struggling with depression, fun may be just what the doctor ordered. Depression is caused not just by the presence of bad things in life, but an absence of good things. We all need opportunities to learn new skills, flex our creative muscles, and just plain enjoy life. We call these opportunities “positively reinforcing activities” in therapy, because they leave us with a sense of accomplishment or fulfillment.

In quarantine, kids are getting fewer positively reinforcing activities than they should. DnD is an opportunity to be playful, make a terrible pun or inside joke reference, and generally act like a goofball for 90 minutes with a circle of friends. That’s good therapy in and of itself.

“Online” Doesn’t Have to Mean “Impersonal”

I worried a little about getting girls together across multiple states for these groups. They’d never met in person: heck, I had not met a lot of them in person. How would the group gel, having only met online? I think adults from my generation (elder millennials) and up still think of online hangouts as being more distant and removed from the real thing.

Gen Z doesn’t have the same feelings about online friendships. They’re digital natives; video chatting is just a part of daily life. It was a little humbling the first time a tween girl taught me something about how to use the Zoom platform, but I’ve embraced it now. Having structure to follow and a clear reason for meeting together online helps the sessions feel very personal and “real”.

…In Fact, It Can Help Anxious Kids Connect

Online school has been a dream come true for some of my tween clients with social anxiety. At last, they can learn without feeling like all eyes are on them! While I want my anxious clients to learn how to face their fears and handle face-to-face school with confidence, online hangouts are a great way to practice socializing with less fear.

Meeting online means we can gradually ease anxious kids into socializing without feeling put on the spot. Not ready to turn your camera on? That’s okay, this isn’t school. Nervous about talking on mic because your voice is shaky? No problem, lean on the chat function until you’re feeling more comfortable. While I always want players participating as fully as possible, tech gives us an option to turn down the intensity while new players build up confidence.

You’re Not Alone (Even If It Feels Like You Are)

At least once a week, a tween client tells me through tears that they feel totally alone. Nobody likes the stuff they do, nobody listens to their music or watches their favorite anime. Everybody has already found their clique, and nobody’s looking for new friends. It’s terrible to feel like you’re missing out, and even worse to feel like you’re the only person who is so isolated.

If these groups have taught me anything, it’s that you’re never alone. There’s somebody out there who is passionate about the same things you are. Somewhere, somebody is staring at their phone, too, wishing it would light up. In fact, there are probably multiple somebodies, and they’re probably closer to you than you think. Kids who attend the same schools or who live in the same towns have “discovered” each other through DnD groups, never knowing they had so much in common.

This has to be true for adults, too, right? Online groups mean that we can all find the people who like the same weird, goofy stuff we do—even something as weird and goofy as DnD.

Interested In DnD For Your Tween?

I’ve got you covered! As I write this, we’re about to embark on a new group adventure, and we have additional 6-week sessions starting periodically. We have groups available specifically for middle school girls, as well as groups that are open to all genders. Games are currently open to kids in New York, North Carolina, and Florida.

You can learn more about the groups I currently offer, fees, and other FAQs on my Dungeons & Dragons Therapy page. If you’d like to chat more or ask about enrolling your child, email me here.

Looking for something a little different? Consider joining us at Young Dragonslayers, which uses D&D for fun and friendship-building rather than counseling. These games are not facilitated by therapists, and are open to kids in all 50 states.

Signs of Perfectionism in Children (And How Parents Can Help)

When you think of a child who is a perfectionist, what do you envision? Most of us probably think of the stereotypical straight-A student who is enrolled in 5 extracurriculars and still somehow finds time to volunteer on the weekends. Even though we all know perfectionism is a “problem”, it tends to be seen as a good problem to have—the kind of thing it’s okay to mention on job interviews when you’re asked to describe your weaknesses.

Although it’s not officially a diagnosis, perfectionism is often misunderstood when we talk about kids’ mental health. Just like we casually say “I’m so OCD” and mean we are super clean or organized, we tend to call anyone who is a high achiever a perfectionist. But perfectionism isn’t always something that pushes kids to succeed: it can also hold kids back, and put them at risk for anxiety and depression. Keep reading to learn about the common signs and symptoms of perfectionism in kids, and how you can help your child who has a perfectionistic streak.

Perfectionism Can Hold Kids Back

A lot of us—myself included, sometimes—think about perfectionism as something that drives children to succeed. After all, holding yourself to a high standard challenges you to work harder and not give up. True perfectionism doesn’t always work this way. Perfectionist kids are so terrified of failure that they may limit themselves to activities that come easily to them.

They might avoid new sports or extracurriculars where they would risk making mistakes. They may also stick to familiar school subjects and interests rather than stretching themselves in new, less certain directions. Over time, this can limit a child’s growth. Mistakes are a crucial part of learning, so avoiding them means a child is missing out on learning opportunities in the long run. These children also run the risk of missing out on opportunities for fun, too: maybe some of those unfamiliar activities they passed up would have been really fun, if only they’d given them a shot.

What Are the Symptoms of Perfectionism in Children?

Perfectionism is a personality trait, not a mental health diagnosis. This means there isn’t an official list of signs and symptoms we can use to determine if someone is a perfectionist. However, it can be good to know if your child tends to think in a perfectionistic way, because it can sometimes lead to bigger problems with anxiety over time. Some children with perfectionistic traits may also have diagnoses of social anxiety, generalized anxiety, or OCD.

If you’re wondering whether your child might be a perfectionist, here are some symptoms to look out for:

• Unrealistically high expectations for themselves or other people: more than just a high standard, these expectations are overly tough.

• Easily frustrated by mistakes on homework or during other activities, to the point that the child might abandon the whole project.

• Avoiding or putting off activities that the child fears may be difficult.

• Worries about failing that are out of proportion to the actual situation.

• Taking a long time to finish assignments or repeatedly re-starting them due to anxiety about not getting things exactly right.

• Self-consciousness, low self-esteem, or lots of negative self-talk about the child’s own achievements.

• Meltdowns when a child feels they have been criticized or not done well enough on their work.

Perfectionism goes beyond just a desire to succeed: the standards kids impose on themselves are unrealistic and exaggerated. Children may fear that their teachers will be extremely disappointed with them, or imagine their work is extremely sub-par, when in reality the situation is not so serious. Even small tasks can become a big deal when a child is struggling with perfectionism.

Can Perfectionism Cause Low Grades?

Not all perfectionistic kids are straight A students! While some perfectionistic kids are driven to excel in school, others have the opposite experience. Some children actually see their grades suffer as a result of perfectionism that’s gotten out of hand.

These children earn grades that are below their ability level because they are not handing in work they deem “not good enough.” Sadly, this often happens after hours of agonizing and working on an assignment—only to get no credit for it.

Even when a child with perfectionism is successful in school, it comes at an emotional cost. Although they may seem happy and accomplished on the outside, these children are often insecure and unhappy on the inside. It’s hard to feel satisfied with your achievements when it always feels like you could have done more.

How to Help a Child With Perfectionism

Parents can do a lot to support children who are prone to perfectionism. Many schools are starting to recognize the importance of developing a growth mindset, which encourages kids to focus on their effort instead of simply the end result. Fostering a growth mindset is one of the best things you can do to combat perfectionism. Here are a few things you can try at home to get started.

• Focus on the process, rather than the product. Instead of just praising your child’s amazing drawing or their high score on a test, let them know you are proud of the work it took to get to that point. You can compliment your child on all the research they did, how careful they were in drawing their picture, or how much time they put into learning a new skill. Even if the end result isn’t perfect, the effort is still worthy of praise.

• Make the connection between accidents and growth. Older kids might like to hear stories about some famous mistakes that led people to unexpected success. For example, penicillin was discovered accidentally when mold grew on a petri dish the scientist was trying to use for something else. Potato chips are the result of somebody cutting French fries way too thin. Penicillin saves lives, and who doesn’t love a potato chip?

• Read books that celebrate mistakes. Younger children might enjoy Beautiful Oops!, a pop-up book that shows how mistakes in art can be turned into something beautiful. I use this book a lot in my therapy practice. Although it’s intended for young readers, older children like it too. It can open up great conversations about creative problem solving.

• Be a good role model. Whether it’s because of genetics or just learned behavior, perfectionism can run in families. Kids study their parents closely to decide how they should deal with things, so even day-to-day setbacks can be a casual learning opportunity. Pay attention to how you talk about your own mistakes, especially if you tend to be hard on yourself, too. If you can reframe them as something that isn’t a big deal, your child may follow suit, too.

When Perfectionism Turns Into Anxiety, Child Therapy Can Help

Perhaps unsurprisingly, perfectionist kids are prone to developing anxiety and depression. Sometimes, perfectionism can be the first sign of a mental health disorder like OCD, which can involve repeating things, checking work, and recurring worries about mistakes. It can be really isolating to struggle with perfectionism, and children may feel like they’re the only people on earth dealing with these feelings.

If you’ve tried self-help coping skills and they aren’t enough to overcome your child’s worries, counseling can help your child approach school in a more balanced way. Approaches like cognitive behavioral therapy help notice when their thoughts are unrealistically focused on failure. Over time, kids can learn to think more flexibly and take mistakes in stride. Almost as importantly, therapy reassures kids that they’re not alone: plenty of kids (and adults) have felt this way, and overcome their worries.

If you’d like to learn more about counseling, you can check out my page on child therapy here. I am available to help kids in the states of North Carolina, New York, and Florida from my online and in-person therapy office in Davidson, North Carolina. If you’d like to talk more about therapy with me, you can drop me a line here.

Helping a Teenage Girl With Anxiety: What to Say, and How to Say It

Did you know that teen girls struggle with anxiety at higher rates than teen boys? During the elementary school years, about 5% of girls and boys will be diagnosed with depression. As puberty approaches, those numbers shift: by the teen years, as many as 20% of teen girls have symptoms of an anxiety disorder. If your teenage daughter is struggling with anxiety, she isn’t alone.

It can be easy as an adult to look back at the high school years through rose-colored glasses. As exciting as the teen years can be, they also come with a lot of stress. Teenage girls have to tolerate all kinds of uncertainty: a changing body due to puberty, shifting friendships and social groups, and unknowns about life after graduation. Social media pushes an impossible standard of beauty on teen girls. Meanwhile, standardized testing and resume-building activities are putting more pressure on today’s teens at school than ever before. It’s no wonder so many young women are feeling stressed.

Some of this stress is inevitable, but parents and caregivers can do a lot to make life easier for teen girls. Here are a few ways you can help your anxious teen to cope with stress in a healthy way.

Don’t Try to Solve Your Teen’s Problem—Validate It

If someone is venting to you, it’s tempting to start offering advice right away. This is especially true with teenagers, who are going through problems that might sound all too familiar to us from our own teen years. I struggle with this same advice-giving impulse sometimes in my therapy office: therapists were teenagers once, too! Unless you’re directly asked to give advice by your teen, it might be more wise to validate their feelings rather than jumping straight to a solution.

When a teen vents her worries or frustrations, she’s not necessarily asking you to “fix” anything. She’s looking to connect with you and feel heard. That may be all the comfort she needs to self-soothe and figure out the solution to her issue on her own. You can let your teen know that you empathize with her and that what she’s feeling is totally normal and understandable. If you’re feeling the pull to give advice, consider a short, sweet validating statement instead:

• “Ugh, that sounds awful.”

• “That would upset me, too.”

• “I can see why this is so important to you.”

• “What a rough day.”

Highlight Your Teen Girl’s Strengths, Rather Than Her Anxiety

Sometimes, talking about anxiety actually makes it worse. While some venting and validating can help (see above!), continuing to rehash the same information tends to intensify anxious feelings. Have you ever found yourself in a conversation where you’re hitting the same points over and over again, and it kind of feels like you’re circling the drain? You keep analyzing and re-analyzing, but there’s no resolution.

This kind of circular thinking pattern is called ruminating, and it’s common in both teens and adults who struggle with anxiety. Just like water circling a drain speeds up and gets faster, ruminating tends to amplify our worries. Rather than falling into the trap of ruminating, redirect your conversation to focus on your teen girl’s strengths. After you validate her feelings, you can show her you’re confident that she can overcome whatever situation she’s facing. Consider saying something like:

• “This sounds so hard, but I know you can handle it.”

• “You are so brave.”

• “You’ve done this before, and you can do it again.”

• “You’ve got this!”

Practice Coping Skills to Relax and Manage Worries

We all know we need to relax when anxious, but it’s easier said than done. Well-meaning friends might suggest that we “just breathe” or “just relax”, which might work fine for someone who has a lot of practice using coping skills. For many teens, though, this advice isn’t specific enough. They need to learn what relaxation feels like, and find the coping skills that work best for them.

Learning how to take deep belly breaths, rather than shallow breaths, can help teens learn how to use the breath to soothe anxiety. For some teens, body-based techniques like progressive muscle relaxation work better than breathing. Mental health apps designed for teens, like What’sUp?, give teens portable tools to stay grounded during panic attacks. I also have an online course, Worry-Free Tweens, that teaches my favorite coping skills for anxiety to both kids and their parents.

Although teen girls are more likely to struggle with anxiety than younger children, they also have more options when it comes to dealing with their worries. Teens have the advanced verbal and cognitive skills needed to start noticing their own thoughts. Rather than accepting their worries at face value, teen girls can double-check to see if they are worth listening to. Cognitive Behavioral Therapy can teach teens and young adults how to “think about thinking” and manage worries more easily.

Cognitive Behavioral Therapy for Teen Girls With Anxiety

If supportive conversations and coping skills don’t seem to be enough, counseling can help teens girls overcome anxiety. You don’t need to be in a full-in crisis situation in order to benefit from therapy. Normal life transitions like starting at a new school, managing homework stress, or dealing with friend drama are common and valid reasons to seek out a counselor. Sometimes, it’s just nice to have an unbiased person to work through all this stuff with who isn’t a friend or a parent.

In particular, Cognitive Behavioral Therapy can be a great option for teen girls with anxiety. It goes beyond just talking about worries—teens walk out the door with tools they can use right away to start coping with life stress. It’s really empowering to get a handle on strong feelings like anxiety. Teens can take the newly learned self-confidence and coping skills they learn in CBT with them into young adulthood.

If you’re in North Carolina, New York, or Florida and looking for a CBT therapist for your teen girl, I’d love to help! I’m local to the Davidson, North Carolina area, but I can see teens from all three of these states online. You can learn more about me and my approach, or shoot me an email if you’d like to set up a first appointment.

Is Your Child a Highly Sensitive Person?

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

What Is a Highly Sensitive Person?

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

Being “Highly Sensitive” Is Not a Diagnosis

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

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

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

Signs Your Child May Be Highly Sensitive

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

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

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

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

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

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

How to Help a Highly Sensitive Child

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

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

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

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

Considering Child Counseling in North Carolina?

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

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

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

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

5 Things Your Child Learns When You Play Together

“Mom! Dad! Play with me!” If you are the parent of a young child, you’re familiar with this plea. Kids crave individual playtime with a parent more than pretty much anything else on the planet. We all know that “quality time” is important for families. And, if you’ve ever visited a children’s counselor, you’ve probably heard all about the importance of parent-child playtime from them, too. What exactly makes this play so special? When you play together with your child, you’re teaching them important lessons about themselves and the world.

Children Learn Through Play

Have you ever watched your child repeat an activity over and over again? Maybe your preschooler watched the same movie every day, or loved to repeat the same game for what seemed like forever. Kids repeat things in their play because they are using play to figure out something new. Play is one of the main ways the children learn. Even when it looks like they’re just goofing off and having fun, they’re also doing serious work that helps them grow and develop.

Social skills, fine and gross motor skills, and creative problem-solving are all learned or practiced through play. You are nurturing life skills when you play with your child, but you’re also nurturing your relationship. Play can help you and your child to bond. It can also teach your child important lessons about herself, and how you see her.

Play Lesson #1: “I Am Important”

Some parents are surprised to learn that setting aside time for individual play is so helpful to kids. After all, many children are with at least one parent all day long! Sometimes, it can even feel like there’s a little too much togetherness when everyone is cooped up at home.

Even if you and your child are together a lot, much of that time is spent multitasking. We have all “uh-huh-ed” our way through a conversation with a child while replying to a text, or half-watched a movie while trying to finish some work. That’s life! Nobody is perfect.

During playtime, however, all of your focus is on your child. You are totally present. Ideally, this means no phones or screens. When you do this, you are letting your child know that they matter to you. Their interests and feelings are important, and worthy of your undivided attention. This kind of attention strengthens your child’s self-esteem. It may also make it easier to handle not being the center of attention at other times of day.

Play Lesson #2: “My Parents Listen to Me”

As a play therapist, I help parents learn how to play with their kids as part of my work. Sometimes parents tell me they aren’t sure what to say while playing. How do you respond when your child is telling you about an elaborate Star Wars Lego adventure or dollhouse family saga?

When in doubt, you can always reflect what your child says back to them. When you paraphrase or repeat back what your child just said, it shows you are listening. Kids love to feel heard, and they don’t always feel like grown-ups pay attention to what they say. It is empowering to know that what you say is important enough to be listened to, even if the topic is Star Wars Legos.

Children learn social skills through play. When you listen to your child, you are teaching them to be a good listener by example. Over time, it can help them to be a better listener when you’re speaking, too.

Play Lesson #3: “This is What Good Behavior Feels Like”

Kids are usually on their best behavior when playing. And why wouldn’t they be? It’s fun, it helps burn off energy, and it gives children a chance to feel like they’re in charge for a little while. Whining, tantrums, and other forms of negative attention-seeking often seem to melt away. This is especially true when a parent is following the child’s lead during play.

Children are more likely to repeat behaviors that we pay attention to. All too often, good behavior gets ignored due to the business of everyday life. We might only stop to reprimand a child for negative behavior, and take advantage of quiet “good behavior” times to get other work done. This can mistakenly lead a child to believe that the only way to get our attention is by acting out.

Playing with your child gives you the chance to point out good behavior and reward it with a heaping helping of positive attention. Your smiles, praise, and focus lets your child know that you like what they are doing. That feels great! Kids can then mentally “flag” that behavior as something that got a positive reaction from you. This means they’ll be more likely to show that good behavior again in the future.

Play Lesson #4: “I Can Be Mindful”

Another trick I teach parents in my office is to verbally track what their child is doing during play. This is something that play therapists do all the time. “Tracking” means simply describing the actions you see your child doing. If you imagine a sports commentator talking about a game, it’s a similar idea.

Children are still learning to be self-aware. A lot of the time, they’re acting on their impulses and are not really conscious of what they’re doing, or why they are doing it. This can make it hard to be “well behaved”—after all, how can you change your behavior if you’re not aware that it’s happening?

Describing your child’s play increases their self-awareness, and helps them to be more mindful of their actions. We know that mindfulness is an important skill for helping children (and adults) to manage strong feelings without becoming overwhelmed. Being more mindful during play also helps active or distractible children to focus on an activity. You may notice your child sticks with an activity longer if you are narrating while they play.

Play Lesson #5: “I Am Loved”

The activity you choose for playtime doesn’t really matter. The warmth exchanged between you and your child is what’s most important. A lot of nonverbal communication happens during play: smiles, laughter, hugs, or pats on the back are common. Play makes it easy to feel and show affection, which brings up warm, fuzzy feelings for kids and parents alike.

Playing together strengthens your parent-child bond. It helps children to feel safe in their knowledge that you love them unconditionally. Feeling loved increases a child’s emotional resilience. It can make it easier for them to cope during periods of stress.

All this bonding has a benefit for parents, too. If your child has been challenging you with difficult behavior, it might be hard to summon up those warm, fuzzy feelings all the time. During stressful times, positive experiences with a child can feel few and far between. Setting aside time to play makes sure that those positive experiences keep happening even during hard times. Playtime can help you feel closer to your child, and make parenting feel more rewarding.

Are You Considering Play Therapy in North Carolina?

Individual playtime with a parent can work wonders for children. It can improve relationships, increase resilience during times of stress, and even improve tough behaviors. Sometimes, though, children need more help. A specially trained play therapist can work with you and your child to help you get through stressful times more easily.

Play therapy is a great fit for younger kids, because they still do most of their learning through actions rather than words. It can help kids with anxiety, trauma, and general life stress. If you’re looking for a play therapist and you live in North Carolina, New York, or Florida, I may be able to help. My play therapy office is located in the Charlotte area, and I also provide online counseling to kids in all three of these states.

You are always welcome to call or email me to learn more about how play therapy can help your child. If you’d like to go ahead and request an appointment, you can do that too!

Can You Do Cognitive Behavioral Therapy Online?

If you or your child has struggled to get help for anxiety in the past, Cognitive Behavioral Therapy can feel like a breath of fresh air. As a children’s therapist myself, it’s so gratifying to see kids who have not seen improvements from from other forms of therapy blossom in this kind of counseling. Cognitive Behavioral Therapy is considered the “gold standard” for anxiety treatment. But what happens if you can’t meet with a therapist face-to-face? Is it possible to do Cognitive Behavioral Therapy online? Happily, the answer is yes. Let’s talk about how it works, and what you can expect from your online appointment.

What’s the Deal With Cognitive Behavioral Therapy (CBT)?

Let’s start with a basic overview of what Cognitive Behavioral Therapy is, and how it works. Cognitive Behavioral Therapy—also known as CBT for short—was developed in the 1960s by a psychologist named Aaron Beck. This makes it fairly “new” as far as therapy approaches go, but old enough that we have studies to show it’s effective. Actually, we have a ton of studies: CBT is probably the most-researched form of therapy that exists.

The core idea of CBT is that our feelings don’t just come out of the blue: they are determined by our thoughts and behavior. That might not sound like a big deal at first! However, it means that we don’t have to be at the mercy of our emotions. They don’t just happen to us: we have some power over what we feel and how we choose to express our feelings. CBT provides a toolkit to help people learn how to feel like they are in control of their emotions, instead of the other way around.

The “cognitive” part of Cognitive Behavioral Therapy refers to learning how to notice your own unhelpful thought patterns. The “behavioral” part involves noticing vicious cycles, and identifying things you can do proactively to help yourself feel better and manage strong emotions. By putting those two parts together, we can better understand and cope with our own emotional reactions. That’s CBT!

What Will I Do in Online Cognitive Behavioral Therapy?

If you’ve never done therapy online before, it can be hard to imagine. Will it feel awkward? What do you actually do in an online CBT session? I can’t guarantee what your exact therapy experience will look like, because every therapist is different. They’ll also recommend different techniques based on your particular situation. However, here are some common CBT techniques that you might encounter, and how they work in online therapy.

Relaxation and Coping Skills: Pretty much everyone is familiar with the advice to take deep breaths when you are stressed. The relaxation skills you’ll learn in CBT offer similar ways to calm down your body and brain. Your online therapist can teach skills like mindfulness, muscle relaxation, and guided visualization over video conference. It’s a very similar experience to sitting on the therapy couch.

Cognitive Restructuring: In CBT, you will learn how to catch yourself when you have a thought that is overly negative or exaggerated, and question whether or not you have evidence that it’s true. In online CBT, you’ll use a worksheet or spreadsheet to help yourself track when stress-inducing thoughts happen, and work through them step-by-step with your therapist. In my office, I ask clients to share their screen so we can both literally be on the same page. You’ll also learn how to come up with more helpful thoughts to say to yourself the next time you’re feeling worried.

Roleplay: Acting out a difficult situation in session can help you put the skills you’re learning into practice, so that it becomes easier in real life. This can be especially helpful for people with social anxiety, or for times when you need to have a hard conversation. Roleplay is great for boosting social skills and making it easier to be assertive. As long as you have a decent video connection, roleplay works great online—and sometimes feels a little less awkward from the comfort of your own home!

Thought Logs: Your therapist may ask you to keep a brief diary of events that triggered negative emotions during the week. This could include descriptions of what was happening, how you felt at the time, any thoughts you noticed, and how you dealt with the situation. You can share the results with your online counselor by email, screenshare, or using a Google Doc. This can help both of you develop more insight into common problems.

Does Online CBT Work As Well As Face-to-Face Therapy?

More people are considering online therapy now than ever before. Because it’s still a fairly new idea, you might be wondering it’s as effective as traditional, in-person counseling. Luckily, there is a lot of research on CBT we can look at for answers. Studies have shown that online CBT is just as effective at treating mental health problems like anxiety, depression, and panic attacks. People see significant mental health improvements in online CBT, and they’re able to maintain their progress over the long term.

Any form of therapy has its upsides and downsides. Even though it is equally effective overall, there are a few things to consider if you’re looking into virtual therapy. You and your therapist can only see each other from the shoulders up on a video call. This might make it harder for your therapist to read your body language. Talking to someone on video conferencing takes some getting used to, and if you are working or attending school online you might already be experiencing Zoom Fatigue.

There are some advantages to online therapy, too. It’s much more convenient to attend therapy from home. You never have to worry about traffic, and it’s a lot easier to fit your appointment into a busy schedule. It might even make it possible to see a therapist who would be too far away or hard to reach in person. Some people also prefer the anonymous feeling of meeting online, where you don’t have to sit in a waiting room with other strangers.

Does Online CBT Work With Kids?

Older children take to online therapy pretty naturally, because they’re already so comfortable with technology in their daily lives. I love using CBT in online therapy with kids ages 8 and up. It is especially helpful for kids who are struggling with anxiety or strong feelings that haven’t gotten better in other types of therapy.

Because CBT is direct and skill-based, it translates easily to an online format. Kids start learning coping skills right away, so they’re able to feel better faster. Having specific skills to learn and goals to reach helps kids stay focused and engaged, even when we aren’t sitting together in the same room. I like to spend half of each therapy session working on a specific skill or idea, and then include play therapy in the second half . This helps us make good progress while still leaving room for creativity and fun.

Online CBT for Kids in North Carolina

I’m a counselor, play therapist, and drama therapist who helps kids in North Carolina. I’m also a huge fan of Cognitive Behavioral Therapy for children with anxiety. If you’re interested in this approach, I’d love to help you get started!

My counseling office is located in Davidson, but I can work with kids throughout North Carolina, as well as in New York and Florida. You can learn more at the links above, or by checking out my other blog posts on CBT. If it seems like we could be a fit, feel free to reach out to me.

What Age Can A Child Start Therapy?

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

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

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

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

Can Really Little Kids Benefit From Counseling?

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

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

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

When Can Children Go to Therapy By Themselves?

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

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

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

How to Tell if Your Child Is Old Enough for Therapy

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

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

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

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

• Your child has started verbalizing thoughts and feelings.

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

Signs That Therapy Could Help Your Child

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

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

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

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

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

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

• The problems started after a stressful event

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

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

Begin Child Therapy in Charlotte, North Carolina

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

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

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

Online Trauma Therapy: How TF-CBT Helps Kids Heal At Home

2020 has been a weird year. The pandemic has been a trauma event for the whole world: we are all going through it together. As Covid continues on and case counts rise and fall, regular life carries on, too. Kids are experiencing traumas like accidents, illnesses, and violence just like they were before the pandemic began. How do you get your child the trauma therapy they need while staying at home? In this post, I want to talk about online TF-CBT, and why it’s a great option for kids’ trauma therapy both now and in the future.

Why Consider Online Trauma Therapy?

Families may consider online trauma therapy for a variety of reasons, some of which are not unique to 2020. Depending on where you live, it might be hard to find a counselor who knows how to treat childhood PTSD. Other life circumstances can make it hard to find time to drive to a counselor’s office in the middle of a 9-5 work day. Health conditions might also prevent a child or parent from easily being able to travel. Here are a few situations where online trauma therapy can help:

• You really connect with a therapist who lives in your state, but not your town

• You live in a rural area where it’s hard to find a trauma specialist

• You or your child is living with a chronic illness or disability

• You and your ex-spouse have joint custody, so your child travels between two far-apart homes

• Your child’s schedule is extremely busy, and it’s hard to squeeze in another appointment

Doing therapy online means you can see therapists all over your state. You have way more options! If you’re looking for someone who specializes with a specific age group or a particular problem, online therapy broadens your horizons.

What is TF-CBT?

TF-CBT stands for Trauma-Focused Cognitive Behavioral Therapy. It’s a form of therapy that was created to help kids with PTSD symptoms following a trauma. If you imagine a stereotypical therapy session, what comes to mind? Do you picture going into a room and talking about your earliest childhood memories while a therapist nods and says “How does that make you feel?” If so, that’s not what happens in online TF-CBT.

This style of therapy is skill-based, meaning kids learn coping tools they can use in the here-and-now to get some relief quickly. It is also fairly short-term, meaning that children will usually attend therapy for a matter of months. TF-CBT is designed for children from age 3 to age 18. Any child who can put their trauma experience into words is likely to be a good fit for this therapy approach.

How Does TF-CBT Work Online?

TF-CBT is divided into three parts. Here’s how each of them works online:

In the first phase of TF-CBT, kids learn about trauma symptoms and practice coping skills to manage them. Children learn that many other kids have gone through similar experiences, and felt the same way they do now. They rediscover how to soothe their body and mind when trauma symptoms send them into high alert. A TF-CBT counselor can model how to practice relaxation skills on video chat, email handouts to families to practice at home, and share educational books and videos online.

In the second phase of TF-CBT, children gradually begin to face their fears. Many children are bothered by upsetting memories or flashbacks after a trauma. They may also be fearful of situations or people that remind them in some way of what happened. In this middle part of the therapy process, the therapist helps the child gradually expose themselves to scary situations or memories in a careful way. Children can use their new coping skills to manage strong feelings as they arise.

An important way children face their fears is by creating a trauma narrative: a story about their trauma experience from their own point of view. This can be done online using a shared Google Doc for older kids, or by using online comic strip or art programs for younger children. Either way, the therapist is there at all times to make sure the child isn’t overwhelmed.

Finally, children and parents meet together. Kids have an opportunity to share their story with their parents. Meanwhile, parents have the change to show children that nothing they think or feel is too scary to be mentioned. This helps children and parents strengthen their bond after trauma, and paves the way for the child to graduate from therapy. I really enjoy seeing families curled up together on the couch to read their child’s story: it’s much more comfortable than being in my office!

The Benefits Of At-Home Therapy for Trauma

While I love seeing children for face-to-face therapy, online counseling has a few distinct benefits to offer. Until I started practicing online, I’d never considered its hidden perks! Here are a few advantages to consider if you’re considering at-home trauma therapy for your child:

• Online therapy can feel less overwhelming than being face-to-face. This can be especially helpful for shy children who are nervous about talking to a strange adult. When kids are in my office, they’re very aware that I’m close by and looking at them. Online, though, I seem a bit more removed. This makes it easier for some children to open up.

• Being at home means being close to comfort objects. If a child gets overwhelmed during a home session, they are already in a place that likely feels safe and comfortable to them. Pets, stuffed animals, siblings, and photos of loved ones can all be brought into sessions for emotional support.

• As a therapist, I’m able to watch children write and create their stories in real-time. A shared Google Document allows me to observe a child’s thought process as they’re writing, without having to awkwardly peek over anyone’s shoulder. This can be really helpful when children are sharing memories of trauma, because I can spot important details quickly.

Looking for an Online Child Trauma Therapist in North Carolina, New York, or Florida?

I’m a Davidson-based children’s counselor who specializes in childhood trauma and anxiety treatment. I’m also a big proponent of online therapy for kids! I love online counseling because it gets rid of many barriers that make it hard for kids to get good quality therapy. If you’re not local to the Charlotte area, I offer online TF-CBT throughout North Carolina, New York, and Florida.

If you’re looking for an online trauma counselor for your child, you can learn more about me or reach out to schedule an appointment. I’m always happy to chat and answer questions before scheduling.

You can also learn more about TF-CBT and trauma here or by checking out my blog posts on the subject.

How Often Should a Child See a Therapist?

For most kinds of healthcare, we don’t have to worry about when or how often to show up. We go for an annual check-up or drop by the doctor’s office if we feel sick. Dentists send reminders for six month cleanings, and pediatricians have a set schedule of appointments to keep babies and children healthy. Therapy is a little different: we need to attend on a regular basis in order to see results, but what “regular basis” really means isn’t always clear. This can be especially true for kids in therapy. In this post, let’s unpack how often children should be seeing a therapist in order to see positive changes in their mental health.

Kids Need to Attend Therapy Regularly to See Change

Children thrive on predictability and repetition. They need time to absorb new ideas and put them into action. The fact that therapy happens on a regular, predictable basis is part of what makes it so effective. Kids know they can count on their counselor to be at the office each week for their scheduled appointment, and that they have a special time set aside to work through their feelings. This helps to reduce anxiety about the therapy process, and builds trust in the therapist-client relationship.

The positive changes that happen in therapy don’t happen all at once: they are usually gradual and incremental. Each session builds upon the next one. This is why it’s extremely difficult for kids who only attend therapy occasionally to make any meaningful progress. With these kids, so much time has to be spent reviewing old skills and getting caught up on current events that there isn’t much time left for “deeper” work. It’s also hard to establish trust and feel comfortable with your therapist when you only see them once in a blue moon.

Weekly Therapy Sessions Work Best for Most Children

In my own child counseling practice, I recommend that nearly all kids start therapy with weekly appointments. This how often most experts recommend that you see a therapist, and for good reason. Making therapy part of a child’s weekly routine helps them to mentally plan ahead and look forward to appointments. It means that kids and parents are setting aside time for regular self-care, just like they set aside time for piano lessons, sports practice, or any other activity in a child’s life.

I use cognitive behavioral therapy with children, and meeting weekly gives kids a chance to practice coping skills between appointments, without forgetting what we talked about last session. This gives us plenty to talk about the following week! For most kids, weekly CBT is a good balance between feeling supported and having enough free time to participate in the extracurriculars that keep life fun.

Younger Children Need More Frequent Therapy

Meeting weekly is especially important for younger kids. Preschoolers and early elementary-aged children can’t retain information over long periods of time the same way that older kids can, so repetition is key. This is especially true for young children who have separation anxiety about leaving Mom or Dad in the waiting room when they come to therapy. Getting regular opportunities to practice separating makes it much easier, and it’s common for young children to feel a bit nervous about coming to therapy if they have been away for a while.

In general, I still think most little kids do just fine with weekly appointments, and it’s rare they need to meet more often. However, if you’re having a parent session with the therapist one week, consider scheduling an additional appointment for your child in order to keep the momentum going.

Older Kids Can Sometimes Be Seen Less Often

Every once in a while, I will suggest that a kid who is 12 years or older can start therapy on an every-other-week basis. As kids approach the teen years, their ability to retain information and practice skills independently increases. Kids in this age range also face more demands on their time from school, sports, and other extracurriculars, which can make it a little more difficult (and stressful) to schedule regular therapy sessions.

While it’s still usually best (and fastest) to meet weekly, every-other-week sessions can sometimes be a good compromise for busy kids. However, there are a few times when this might not be a good idea. Kids who are experiencing severe symptoms of anxiety or depression really need more consistent therapy in order to feel better. This is also the case for children who have survived a trauma or stressful event. Finally, preteens or teens who have thoughts of suicide or self-harm absolutely need to be seen more frequently until they’re in a safer, more stable place.

Do Kids Ever Need Therapy More Than Once a Week?

There are some situations where kids really need to be seen two or more times a week for therapy sessions. Often, this is a short-term plan designed to help kids get through an extremely difficult time. The goal is always to help children strengthen their coping skills enough that they can function independently for longer, and come to therapy less often.

Here are a few circumstances that could affect how often a child needs to be seen, and require more visits:

• A child has just experienced a new trauma or loss, such as a death in the family

• Severe anxiety or depression prevents a child from doing important daily activities, like attending school

• A child or teenager has expressed serious thoughts of suicide, or has made a suicide attempt

• A child is “stepping down” from more intensive therapy, like inpatient therapy at a hospital

Going More Often Might Mean Fewer Sessions Overall

This is purely based on my own experience as a child therapist, although I’m sure there’s research out there to back me up. I have noticed that my clients who come to therapy on a weekly basis usually end up needing fewer sessions than those who come less often. Weird, but true!

Sometimes, parents request every-other-week or even monthly therapy sessions due to financial concerns. I totally get it—therapy can be a big investment of both time and money. However, I’ve noticed that kids who come to therapy every other week often need to stay in therapy much longer, because we have to spend more time playing catch-up. In the long run, this makes therapy more expensive: more sessions are needed to achieve the same result.

Are You Considering Child Therapy in Charlotte, NC?

Now that you know how often you can expect your child to go to therapy, maybe you’re thinking about next steps. If your child is struggling with anxiety, my online course can help her learn coping skills as you consider your options. You can check out Worry-Free Tweens here.

If you live in the Charlotte, NC area and have a child struggling with anxiety or stress, I’d love to help at my Lake Norman office. You can learn more general information about child counseling here, learn more about me, or contact me to book an appointment. I can also see kids for online therapy throughout the states of New York, North Carolina, and Florida.

5 Classic Toys with Mental Health Benefits for Children

I am an easy mark for any toy that’s advertised as being educational or good for a child’s development. I’m a sucker for toy delivery services that promise to teach Montessori at home, or for dolls and toys that introduce a child to another culture in an accurate, respectful way. As I’m writing this, we’re about to enter the time of year when everyone gets inundated with ads for the latest, greatest new toys.

But here’s the thing: if you take a peek into any play therapist’s office, you’re probably not going to see any of these hot new toys, no matter how wholesome or beneficial they claim to be. What you’ll see are classic toys you probably remember from your own childhood: no frills, no bells and whistles, and probably no batteries required. If you’re looking to stock your child’s home playroom, here are 5 classic toys that encourage emotional growth and promote good mental health.

Baby Dolls Help Children Learn to Nurture

Rocking, feeding, dressing, bathing…baby dolls teach children how to empathize and care for others. Parents have to learn how to respond to their babies’ cues in order to give them what they need. When children play make-believe with dolls, they’re using their imaginations to practice this same important social skill.

Interestingly, when kids pretend soothe and nurture a baby doll, they’re also soothing and nurturing themselves. In play therapy, kids who have had difficult experiences in early life can use baby dolls to reconnect with a feeling of being cared for and loved. This probably goes without saying, but kids of all genders can benefit from playing with baby dolls: if we want all our kids to be loving parents and empathetic people, they need practice to develop these skills!

Play-Doh Encourages Sensory Awareness

I’ve written a lot in this blog about the not-so-hidden mental health benefits of the slime craze…I am all in on slime and it’s a staple in my play therapy room. But if you aren’t as thrilled by the idea of dried glue on every upholstered surface of your home, maybe Play-doh—slime’s older, less trendy cousin—is more your speed. Play-doh and other similar products, like modeling clay or kinetic sand, provide kids with a great opportunity to engage in sensory play.

Sensory play activities help kids get in touch with their 5 senses: scented markers, musical toys, and water tables are all great examples of toys that give kids interesting sensory experiences that go beyond sight. This type of play has been shown to help with motor and language development, but it offers benefits for emotional health, too. Focusing on sensory input is a form of mindfulness, similar to paying attention to the breath while meditating. Kids tend to get very absorbed in sensory play because they’re super aware of what’s happening in the present moment, rather than multitasking or letting their minds wander to other thoughts. This can have a soothing and focusing effect for kids who are feeling anxious scattered.

Dress-Up Clothes Let Kids Try Out New Possibilities

Playing dress-up is more than just make-believe fun. Putting on a costume allows kids to test-drive new ways of thinking, behaving, and interacting with others. Playing dress-up is a form of roleplay, which drama therapists often use as a mental health tool with both children and adults. Drama therapists believe that we all have roles we play in life that dictate our behavior: we probably behave pretty differently at school, at work, with our families, and when out with friends, for example. Children are still learning the social and emotional skills they need to operate in all these different settings, and dress-up gives them a chance to practice.

Thinking about the kinds of costumes kids choose for Halloween can provide good insight into the types of dress-up clothes that can be helpful for emotional growth. “Real life” costumes like doctor and firefighter outfits help kids to emulate adults in their life, explore their interests, and develop a sense of responsibility. Superhero costumes are awesome for building self-esteem and self-confidence: who doesn’t want to feel like Superman or Wonder Woman for a day? Even villain costumes have a function for kids, allowing them to experience feeling powerful and letting out aggressive energy in a safe and playful way. Consider stocking up on at least one costume in each of these three categories if you’re building a dress-up area for your child at home.

Toy Weapons Help Kids Vent Anger Safely

Whether or not kids should be allowed to have toy guns is a pretty fraught subject, and may schools, daycares, and parents have decided to ban them. It’s a complicated issue, and these days there are a lot of reasons why it may not be a good idea for kids to have toy weapons in public places. Nevertheless, I think there are some good reasons why toy weapons can actually be beneficial for mental health when used in a therapy playroom or at home.

Many parents are worried that playing with toy guns will encourage violent tendencies in children. I used to wonder about this, too! However, the research shows this isn’t the case: kids who play with toy guns do not grow up to be more aggressive than kids who don’t. In fact, playing out war or fight scenes may help children learn how to better understand and control their own anger. Children play things out in order to better understand them, and to develop a sense of control over their surroundings. When kids act out angry scenes, they are learning how to handle their own anger and safely express it in ways that don’t hurt people in real life.

Play therapists often say that “toys are a child’s words”, because kids often use play, rather than language, to work through their thoughts and feelings. Sadly, many kids enter play therapy after witnessing violence, and they often need toy weapons available to give them the “vocabulary” they need to express themselves. If toy guns feel too risky to have at home, consider getting a very childish, non-realistic nerf gun or another play weapon such as a sword, instead.

Play Kitchens Strengthen Parent-Child Bonds

Almost every child I’ve ever worked with in play therapy has enjoyed making pretend food to serve their parents in the play kitchen. Children imitate their parents as a sign of affection: they want to be just like you! Many kids see their parents preparing food all day long, and play kitchens give kids a chance to step into that grown-up role for themselves.

Similar to the baby dolls I mentioned earlier in this post, play kitchens give kids a chance to practice nurturing and caring behavior. Plenty of kids use the play kitchen to make meals for their dolls and toys, but play kitchens also get kids interacting more with parents or other adults in the playroom. In many families, food is love. Even though play kitchen food is pretend, serving food to parents or other special people gives kids a chance to express their own love and care. In play therapy, this kind of interactive, open-ended play is wonderful for helping kids and parents reconnect and increase feelings of attachment.

Learn More About the Emotional Benefits of Toys and Play

Children naturally use their play to explore their feelings and figure out the world around them. If you are looking for mental health support for a child in your life, play therapy is an option to consider. I provide play therapy to children in and around Charlotte, NC, and work with kids across North Carolina, New York, and Florida in my online child therapy practice.

If you’d like to learn more about play therapy or set up an initial appointment, contact me here.

What Are Coping Skills?

Skills, strategies, tools for your emotional toolbox…coping skills go by a lot of names, and as a children’s therapist I talk about them all day, every day. But you know how sometimes if you say a word over and over, it starts to sound weird? That’s kind of how I’m starting to feel about the term “coping skill.” What even is a coping skill, exactly? I love coping skills and I sing their praises often: I have covered how to use them to manage all sorts of feelings. Today I’m going to do something a little different and talk about what coping skills are, why kids need them, and why they aren’t always healthy.

The Definition of a Coping Skill

“Coping skill” is a broad term that gets used to describe pretty much any activity that is good for a person’s mental health. Let’s take a look at a dictionary definition for “coping mechanism” to see if we can get a little more specific:

an adaptation to environmental stress that is based on conscious or unconscious choice and that enhances control over behavior or gives psychological comfort.

Technically, any healthy habit that reduces stress is a coping skill: stuff like getting good sleep, proper nutrition, and exercising regularly. But usually, when we talk about coping skills we mean something that provides more instant gratification. Coping skills are things that we can do in-the-moment, when we are feeling lousy, to help us turn down the volume of our emotions and avoid getting overwhelmed. They help us to get through stressful situations with a little more ease, and without doing something we’d regret later on.

Coping Skills Are NOT Just a Band-Aid

I sometimes hear people criticizing coping skills, claiming that they are a band-aid solution for a deeper problem. I get where they are coming from: coping skills deal with symptoms without trying to figure out where they come from. If a child uses a deep breathing technique to manage anxiety, she is soothing herself but probably isn’t going to discover that caused the anxiety to happen in the first place. Because of this, coping skills are sometimes seen as being too “surface-y” or superficial to create lasting change.

In my experience, this just isn’t the case! Coping skills provide an entry point for kids to dig deeper into the issues that are really bothering them. When a child learns and practices coping skills, she learns that her feelings don’t just “happen” to her: she has some control over them, and how she chooses to deal with them. That’s a pretty huge discovery! Once children discover they can create positive change with coping skills, it often empowers them to create change in other places in their lives. The same is true with families: trying new coping skills disrupts old patterns of behavior between parents and kids, and clears the way for something new.

…But They Probably Won’t Solve All Your Problems, Either

For kids with mild anxiety or life stress, learning a few effective coping skills may be all they need to feel better. However, most kids with a diagnoseable mental health struggle like anxiety or depression will need therapy beyond coping skills in order to heal. Finding coping skills that work well can lay a strong foundation for future therapy.

For example, children with anxiety might find relief from cognitive behavioral therapy, which can help them to face their fears without getting overwhelmed. Kids who are acting out at home can work together with their parents to break old cycles of behavior, find discipline that works, and enjoy a more positive relationship. Children who have survived a trauma will likely need a specialized therapy like TF-CBT to help them work through their feelings and memories in a safe way. For all these kids, coping skills are a great first step—they’re just not the end of the road.

Types of Coping Strategies

There are a million coping skills out there, but most of them fall into one of a few main categories. Not all coping skills work for all people, and you’ll probably need a few different options to help you navigate different situations. Here are the main types of coping skills that I help kids to learn in my therapy practice:

Relaxation: These skills help kids to soothe and relax the body, which can in turn help the mind feel more calm. Because anxiety symptoms are often felt strongly in the body, relaxation is especially helpful for anxious kids. A few common relaxation coping skills are:

• Soothing activities, like a warm bath or a cup of herbal tea

• Deep breathing exercises

• Progressive muscle relaxation

• Guided visualization

Mindfulness: Mindfulness skills help a child to stay in the here-and-now, rather than worrying about the future or thinking about the past. Mindfulness helps children to focus their attention on the present, be more aware of their feelings and surroundings, and feel more grounded during times of intense stress. These skills include:

• Meditation

• Observing and describing your surroundings

• Panic attack coping skills like the 5-4-3-2-1 technique

• Sensory play, for younger children

Safe Ways to Express Feelings: Sometimes, strong feelings just need to be let out. These skills help kids vent their feelings in a safe way that isn’t destructive or hurtful to themselves or other people. This is especially helpful for kids who experience strong anger, since uncontrolled anger might lead to hitting, breaking toys, or yelling at others. Here are some healthier ways to express emotions:

• Journaling

• Non-aggressive physical activity

• Creating art

• Assertive communication skills

Positive, Rewarding Activities: Fun is good for our mental health. Doing things that give us a sense of satisfaction and enjoyment are key to giving meaning to life and preventing depression. Kids need to be around other kids in order to grow and develop emotionally, so social opportunities are important coping skills for them, too. Here are a few examples of activities that fit the bill:

• Sports and recreational activities

• Hobbies that encourage a sense of accomplishment

• Spending time with supportive friends

• Volunteering

Can Coping Skills Ever Be Unhealthy?

The short answer: yes. Many of the things kids do that adults call “bad behavior” are actually attempts to cope with stress or strong feelings. Kids do these things to try to help themselves feel better—after all, if there was no benefit to the behavior, why bother at all? Adults don’t use perfect coping skills 100% of the time, either: who among us hasn’t turned to a bowl of ice cream or online shopping to deal with a bad day?

Coping skills can be adaptive, meaning they are healthy and helpful, or maladaptive, meaning they might help someone momentarily feel better, but they’ll do more harm than good in the long run. Some of these unhealthy coping skills are only mildly unhelpful, such as:

• Procrastination

• Numbing or ignoring feelings

• Tantrums or meltdowns

• Yelling, swearing, or name-calling

Other maladaptive coping skills are more serious, and can be dangerous or harmful. Seriously unhealthy coping skills include:

• Drug and alcohol abuse

• Self-harm

• Violence toward others

• Risky behavior, like shoplifting or dangerous driving

We all use some of these unhealthy coping skills occasionally, but it’s not good for kids—or adults—to rely on them as the main way they handle stress. Obviously, the more dangerous maladaptive coping skills are not good for anybody and need to be taken very seriously. Children using drugs, alcohol, or self-harm as a means to cope need the help of a therapist or other crisis resources.

Need Some Coping Skills Ideas for Kids?

Coping skills are a great form of self-help to try while you’re looking for a counselor, or before considering mental health treatment. My online coping skills courses teach kid-friendly strategies for dealing with strong emotions in a self-help format you can access any time. Worry-Free Tweens, designed for kids 8-12, is a great intro course for managing anxiety at home.

I have a bunch of articles on coping skills that kids and parents can use at home to deal with a variety of issues. Check out the resources below:

Coping Skills for the Pandemic
Anger Management Coping Skills
Coping Skills for Anxiety
Depression Coping Skills
Coping Skills for Panic Attacks

If you are looking for a counselor to help your child work on coping skills and you’re in North Carolina, New York, or Florida, I may be able to help. You can contact me here.

Online Therapy for 11-Year-Olds? 5 Ways Preteens Benefit from Virtual Counseling

I love working with kids online. While there are a few things that just can’t be done virtually (it’s pretty hard to make slime on a video call), this form of therapy has so many hidden perks that I hadn’t considered before diving headfirst into the online world. In particular, online sessions have proven to be an awesome fit for my preteen clients. 10, 11, and 12-year-olds are at a great age for this style of work, due to their maturity level, the reasons they commonly come to therapy, and the way they naturally communicate. In this post I’ll be unpacking the 5 reasons preteens and online counseling are a match made in virtual heaven.

11-Year-Olds Are Digital Natives

By the time today’s 11-year-olds were born, Facebook, Twitter, and Amazon were already a thing. They’ve never known a world without an iPhone, and they’ve probably been using it to FaceTime with grandma and grandpa since they were toddlers. Video conferencing feels natural to most tweens, because it’s been the norm their entire lives. While the technology may feel cold or impersonal to us, it’s the primary way most tweens connect with their friends.

The technical difficulties that could easily fluster an adult are no big deal for most tweens. They know their way around a computer, and they can figure out many minor issues alone without missing a beat. I have been consistently amazed by how easy it is for my preteen clients to navigate our online sessions.

Preteens Crave Privacy and Independence

Around age 11 or 12, many parents notice their children start to crave their own personal space. They may spend more time tucked away in their room, or prioritize social events over family activities that they used to enjoy. While the change can be unsettling, it’s a totally normal part of growing up. As children become teens, they start a process called separation-individuation: they are learning to think and do things for themselves, without their parents help, as they prepare for adulthood.

Online therapy sessions give preteens more agency over the therapy process. They can log on and off by themselves, and don’t need to catch a ride from a parent. They can chat with their therapist from the comfort of their own room, knowing that there aren’t other kids, therapists, or parents sitting in a waiting room just outside their door. Headphones or text chatting can ensure conversations are kept private from siblings’ ears. When tweens are empowered in this way, they may feel more invested in their own therapy.

It’s Easier to Talk About Touchy Subjects

Have you ever tried to bring up one of those “after school special” subjects with your preteen kid? Drug use, peer pressure, puberty…the stuff nobody really feels super comfortable talking about? Eye rolls, exasperated sighs, or indifferent shrugs often ensue. It’s not always the easiest thing for tweens to talk about these subjects in therapy, either. Sitting on a couch in a random lady’s office while she perches on a chair 3 feet away from you making direct eye contact can feel…weird.

Online therapy gives kids some physical and emotional distance that can make easier to open up about this stuff. It can feel safer and a little more anonymous behind a screen, and typing is sometimes easier than talking out loud. I have had so many surprising conversations with my tween clients using the chat feature that I’m not sure would ever have happened in face-to-face therapy. From boy drama to moral dilemmas to painful past experiences, we have chatted (and typed) about it all.

Preteens Have Packed Schedules

I swear that nearly every preteen on my caseload is in a traveling sports league that meets approximately 25 times a week. Plus music lessons. Plus girl scouts. Plus school. Academic demands get way more intense in middle school, and so do extracurriculars. Coping with a full schedule and commuting from activity and activity can be stressful, and might even contribute to anxiety for some kids.

From a practical standpoint, online sessions ease stress because it’s one less thing that kids (and parents) have to drive to. Sessions are easier to schedule, because there’s no risk of getting stuck in traffic. Online therapy has allowed me to work with kids who might otherwise not have been able to attend therapy due to their parents’ work hours or their own after school activities. In the middle of a busy school week, there’s something kind of nice about being able to take a breather at home, and show up for therapy in your house slippers with a favorite drink or snack on hand.

Online Therapy Offers New Ways to Be Creative

I know I mentioned earlier that you can’t make slime in online therapy, and that is true: I really miss slime! While some play therapy standbys don’t translate quite so well into the online world, virtual therapy has opened up a world of new opportunities to get creative in therapy sessions. It’s not better or worse than in-person counseling, just different—but cool!

Tween clients can collaborate on Google Docs with me to write stories together in real time. They can show me content from Instagram influencers they look up to, and give me a glimpse into their inner world that I wouldn’t otherwise see. I don’t think I ever would have considered running online Dungeons & Dragons groups for middle schoolers before starting virtual therapy, and now they are a highlight of my week!

Looking for Online Therapy for Your 11-Year-Old?

Preteens are my favorite age group to work with in therapy. You can learn more about my online therapy practice here, or contact me to schedule an appointment. I’m able to work with clients online in North Carolina, New York, and Florida. My (virtual) door is always open!

I love working with this age group so much, that I created an online course just for them. Worry-Free Tweens is a self-help video class that teaches anxiety coping skills to kids ages 8-12. You can access it right away to start learning new strategies for you and your child.

How to Explain Anxiety to Kids

It can be lonely being a kid with anxiety. Children who struggle with uncontrolled worries often think they must be the only person who feels things so strongly: after all, anxiety is invisible, and many people are really good at hiding theirs! Not understanding anxiety can lead children to feel ashamed of their emotions, and can also make them feel hopeless about it ever getting better. This is why it’s so important to explain anxiety to kids in terms they can understand, especially if you’re considering therapy for your child.

Teaching Kids About Anxiety Can Help Them Tame It

Early in therapy, many children describe their anxiety to me as something that happens to them, seemingly out of the blue. It feels almost like a force of nature: there’s no rhyme or reason behind it, and it’s impossible to control. As you can imagine, this makes the idea of managing anxiety pretty intimidating. By teaching kids about what anxiety is and why it happens, we are also letting them know that there are ways to make it better. Once you know the source of a problem, it’s much easier to find a solution.

Teaching kids about anxiety serves another important function: it normalizes what a child is going through. Many children are surprised to hear that everybody experiences anxiety from time to time, and that anxiety disorders are pretty common, too. Kids who don’t understand that anxiety is a universal experience may feel deeply ashamed or like something is seriously wrong with them. Learning that they are not alone alleviates that shame, which can improve self-esteem and put a child in a more empowered position to cope with their feelings.

Anxiety: Too Much of a Good Thing?

Is anxiety a good thing or a bad thing? I often start off first sessions with anxious kids by asking this question. 99% of the time, kids respond that anxiety is definitely bad. Most kids enter therapy with the idea that their anxiety is a problem and means something is wrong, and they have come to a counselor to get rid of it completely.

It is pretty surprising when I tell kids that I would never want to get rid of their anxiety! Anxiety feels terrible, but it serves a really important function: it helps keep us safe. What would happen if you never felt anxiety? Maybe you would cross busy streets when the light was red because you weren’t worried about being hit by a car. Maybe you would agree to do dangerous things with your friends, because there was no little voice in the back of your head saying it was a bad idea.

I like to ask kids what would happen if a giant, angry bear crashed through the window of our therapy room: would we both sit here calmly and act like nothing had happened? No! That would be weird. Our anxiety would kick into high gear, give us a burst of energy, and help us run to safety. The difference between plain old anxiety and an anxiety disorder is that, for some of us, we get anxiety when the proverbial bear is not around. Kids with anxiety disorders get anxiety in situations that aren’t really dangerous, which gets in the way of enjoying life. They just have too much of a good thing.

The Fire Alarm Analogy

I’m not the first therapist to describe anxiety as being like a fire alarm: I think a lot of us use this analogy, and for good reason. It’s super helpful! All children are familiar with fire alarms, and they have probably practiced a million school fire drills by the time they reach my office.

We have a tiny part of our brain, called the amygdala, that is sort of like our body’s fire alarm. It is constantly scanning the environment for danger, in order to keep us safe. When it detects danger—like that big angry bear, for example—it sounds the alarm! Think about how it feels when a fire alarm goes off: it’s loud, it’s jarring, it’s unsettling. It is not a nice sound to listen to. Our amygdala’s alarm is similar. It sends a burst of energy all through our bodies that makes our heart beat faster, our palms get sweaty, and allows us to move quickly to get away from the threat. It is not a comfortable feeling, but it gets the job done.

But, sometimes, fire alarms go off for no good reason. For example, if you are cooking in the kitchen and you make a lot of smoke, that might trigger your fire alarm. The sound is exactly the same, but it’s going off at the wrong time. This is what happens with anxiety: our brain is telling us there is danger, when really there isn’t any. Once children understand that the anxious thoughts and feelings they are having may not be true, they can start to take back control of their worries.

Think About Word Choice with Young Children

Anxiety has become such a household word that most older children (late elementary and up) are probably familiar with it already. I’ve noticed, though, that sometimes we get into the habit of labeling any negative feeling as “anxiety” so it may still be helpful to define the term for these older kids. Being able to put a name to their feelings can be really helpful for older children, because it means they aren’t the first or only person to have experienced this emotion.

For younger kids, however, the word “anxiety” may not be as helpful. If your child is in early elementary school or preschool, “anxiety” is probably not in her vocabulary yet. For these kids, it may not be as helpful to be able to label their feelings with such a clinical term. I have much better luck using “worry” or “nervous”—words they have likely heard before—when describing anxiety to younger children.

When to Consider Therapy for Kids with Anxiety

Not every kid with anxiety necessarily needs to see a counselor. Sometimes, a little extra support from Mom or Dad, some at-home coping skills, and a conversation about how anxiety works is all a child needs to get through a stressful time. If you’re looking to go this route, check out Worry-Free Tweens, my online coping skills class for preteens with anxiety.

Sometimes, though, counseling can help a child work through anxiety more quickly and easily than if she muddled through it alone. Hearing about how common (and sometimes helpful) anxiety is from an “expert” who isn’t a friend or family member can be meaningful for some children. Having a safe space to voice worries without judgment, and learn how to spot thoughts that are unhelpful or untrue can help children manage their anxiety in the present, as well as in the future as they grow.

I use a form of counseling called Cognitive Behavioral Therapy to help kids with anxiety learn about their symptoms, calm anxiety responses, and “talk back” to overly negative worries. Learn more about how CBT works for children, or contact me to request an appointment.

PTSD in Teens: Signs and Symptoms to Look For

This is the second post in a series about trauma symptoms. For information on PTSD in children, click here.

Trauma doesn’t discriminate based on age, race, or gender. Most teens—as many as two thirds—will experience at least one traumatic event before the age of 17. While not all of these young people will suffer long-term effects from their trauma, some research suggests teens may be more vulnerable to developing PTSD than adults. Teenagers don’t always show their trauma symptoms in the same ways that adults do, and they may need special therapy techniques that are meant just for them. In this post, I’ll be sharing how trauma commonly affects teens, signs and symptoms to look out for, and how to get help.

What Causes PTSD in Teens?

Any time a teenager is at risk of serious harm, or witnesses a loved one being put at risk, they are likely to experience a traumatic event. Trauma experiences are so intense that they overwhelm our brain and body’s ability to cope in the moment. Some trauma experiences are common for people across all ages, such as:

• Natural disasters, such as hurricanes, fires, and earthquakes

• Serious accidents, such as car accidents

• Medical emergencies

• Violence and crime

Other trauma experiences, however, more frequently affect teenagers than other age groups. These include:

• Abuse or neglect from a parent or caregiver

• Sexual assault

• Witnessing domestic violence against a parent

• School or community violence

Some traumatic events are more likely to lead to PTSD than others. Interpersonal trauma—trauma that was inflicted on one person by another—is more likely to cause lingering symptoms. Trauma also has a cumulative effect, and the more traumatic experiences a teen has survived, the more likely they may be to develop PTSD.

Can a Teenager Develop PTSD?

Yes, people of any age can and do develop PTSD. There is even some evidence that teenagers are more likely than adults to develop PTSD following a trauma. Research from the National Institute of Mental Health has shown that about 5% of American teenagers have PTSD, and about 1.5% of those teens are severely affected and impaired by their trauma symptoms. This is higher than the 3.5% of American adults who are diagnosed with PTSD each year.

It is important to know that teen girls are more at risk of PTSD than teen boys, with up to 8% of girls being affected. To me, this seems like an incredibly high number! Amazingly, though, many more young people undergo trauma every year but do not go on to struggle with long-term PTSD symptoms. Nearly half of all U.S. teens will have experienced at least one traumatic event by the time they reach 18.

What are the Symptoms of PTSD in Teens?

PTSD symptoms fall into 4 major categories that are the same for people of all ages:

Intrusion symptoms are unwanted thoughts or feelings that come up unexpectedly, such as flashbacks, recurrent nightmares, and dissociating, which happens when a person detaches from their surroundings due to overwhelming emotions.

Avoidance of people, places, and things that remind a person of the trauma, or not wanting to talk or even think about what happened.

Negative changes in the way a persons thinks and feels, such as feeling depressed, hopeless, or ashamed.

Arousal symptoms, which amp up a person’s fight-or-flight response and leads to increased anxiety and anger.

Common Signs of Teen Trauma to Look For

Some signs of trauma may be more common among teenagers than others. Here are a few signs specific to teenagers that parents can look out for following a trauma if they’re worried about PTSD:

Feeling numb: I hear this one so often from teenagers with PTSD. Teens often tell me that the absence of any emotions is harder for them to deal with than anxiety or depression (although many teens feel these, as well). Teens may also have a hard time feeling connected or close to other people after a trauma.

Low self-esteem: The persistent low mood and negative outlook on life that comes with PTSD can lead to teenagers feeling bad, worthless, or guilty. Perhaps because teens are vulnerable to low self-esteem anyway, this symptom seems to be common amongst adolescents.

Extreme irritability: All teens get angry and mouth off to their parents, but teens with PTSD may have outbursts that are on a whole other level. This is because PTSD causes hyperarousal, meaning a teen’s nervous system is very sensitive and quickly shifts into fight-or-flight mode, which can prompt intense anxiety or anger as well as aggression.

Dropping grades: People with PTSD have a hard time focusing, absorbing information, and remembering things. It’s hard to learn when you’re constantly on edge. This can result in a sudden, unexplained drop in grades for teenagers following a trauma, and school difficulties that might resemble ADHD.

Drug and alcohol abuse: Many people turn to drugs and alcohol to cope with the overwhelming symptoms of trauma, and this may be especially true for teens. A study of teens with substance use disorder found that 70% had previously experienced a trauma. Using drugs and alcohol might also make teens more vulnerable to trauma in the first place, since they may be more prone to taking risks while under the influence.

Suicidal thoughts: Teenagers with PTSD have higher rates of suicide than other young people. The prolonged depression, low self-esteem, and hopelessness of PTSD, paired with increased impulsive behavior, puts teenagers at risk. Many teenagers with PTSD describe having suicidal thoughts or impulses to hurt themselves. While not all of these teens will go on to actually attempt suicide, any thoughts or suicidal behaviors should be taken extremely seriously.

How Can I Help a Teen with PTSD?

Teens with PTSD may feel very hopeless about ever recovering, but PTSD is not a life sentence. People can and do recover from trauma, and our understanding of how to help people with trauma gets better all the time. Today, several therapies exist specifically to help teenagers who are struggling with PTSD.

TF-CBT is a form of cognitive-behavioral therapy that was designed for people with PTSD ages 3-18. It helps teenagers to understand their symptoms, learn ways to cope with strong feelings, and feel more comfortable telling their own story without being bothered by flashbacks or memories.

DBT helps teenagers who are dealing with rapidly shifting moods, urges to self-harm, difficulty with family and friends, and risky or impulsive behavior like drug use or disordered eating. Many people who struggle with these kinds of symptoms are trauma survivors. DBT can help teens learn coping skills, keep themselves safe from self-harm, and learn to tolerate strong negative emotions without losing control or becoming overwhelmed.

I work with preteens and young teenagers with trauma using TF-CBT. If you’re located in North Carolina, New York, or Florida, and you’re looking for counseling, please don’t hesitate to contact me.

What are the Symptoms of PTSD in Children?

Kids are incredibly resilient. One of the things I love about being a children’s therapist is that children are growing and developing every day—they can’t help but grow! This often means that they can progress through therapy at a surprisingly quick pace. Sometimes, however, children can have an experience that is so stressful that it overwhelms their capacity to cope. Parents of children who have endured a trauma often ask whether their child has been seriously affected, or if they may be suffering from PTSD. Keep reading to learn about the signs and symptoms of PTSD, and how these symptoms commonly show up in children.

Categories of PTSD Symptoms

In order to receive a diagnosis of PTSD, a child must have witnessed or directly experienced something that put themselves or a loved one at risk of serious harm. They must also have a number of symptoms in each of 4 identified categories: intrusion, avoidance, negative changes in mood or cognition (thoughts), and changes in arousal or reactivity. These categories are the same for kids as they are for adults, but children often express their symptoms a little differently than their older counterparts.

Intrusive Symptoms in Children

Intrusive symptoms are negative thoughts, memories, or feelings that pop up uncontrollably even though they are not wanted. Many people know that flashbacks can be a part of PTSD, and these are a common intrusive symptom. A child who is experiencing intrusive symptoms may feel like they are right back at the scene of their trauma, and living through it again. These symptoms aren’t under the child’s control, and they may be triggered by people, places, or situations that remind the child in some way of their trauma experience.

Flashbacks, recurring dreams, and strong physical or emotional reactions when reminded of a trauma are all examples of intrusive symptoms. Here’s a few ways they can manifest in children:

• Frequent, recurring nightmares which may or may not resemble some part of the trauma experience: even if your child’s dreams are about something seemingly unrelated, they may be a symptom of trauma if they’re new and/or unusual for your child

• Meltdowns, fear, or anger when your child encounters something reminiscent of the trauma

• Repeatedly acting out scenes through play that are similar in some way to the trauma: this type of play is often very rigid, repetitive, and it may be hard for the child to shift focus to another activity once the play has started

• “Spacing out” when something stressful happens

Avoidance Symptoms in Children

As you can imagine, it feels terrible to have intrusive symptoms that show up when you don’t want them. Children with PTSD begin to avoid people, places, or situations that remind them of their trauma as a way to protect themselves from distressing and overwhelming feelings. They may do this by avoiding external reminders (people and places), internal reminders (their own memories), or both.

In children, avoidance symptoms may look like:

• Refusing to talk about the trauma, or insisting that they are not bothered by it

• Avoiding people who resemble their abuser in some way

• Reluctance to go near the place where the traumatic event occurred

Sometimes, the things a child avoids become more generalized over time: for example, a child whose mother had a heart attack may be afraid of driving by the emergency room where her mother was treated, but may also begin to avoid any doctor’s office.

Negative Changes in Mood or Thoughts in Children

Traumatic events can color a child’s entire worldview. People with PTSD experience changes in the way that they think, feel, and remember things. PTSD can make it very hard to trust other people, especially if your trauma was deliberately caused by another person. Many people with PTSD feel depressed, and they may unfairly blame themselves for what has happened. Some people find they can’t remember parts of their trauma experience.

Adults with PTSD are often able to put these negative beliefs into words: for example, “The world is a dangerous place” or “I’m just waiting for the rug to be pulled out from under me again.” For kids with PTSD, however, these feelings are harder to verbalize. Here are a few ways you might see negative changes in thinking and mood show up in children:

• Low self-esteem

• Lack of interest in seeing friends, or doing things they used to enjoy

• Difficulty with attachment or bonding

• A belief that they caused the trauma, or it was somehow their fault

Increased Arousal and Reactivity in Children

When a person is in danger, the brain and body go into fight-or-flight mode: a surge of adrenaline is triggered in the body, giving the person the energy they’ll need to either physically defend themselves or run to safety. For children with PTSD, their fight-or-flight response may have been activated so much that it now remains “switched on” a lot of the time. Increased arousal, also called hyperarousal, means that the brain is on high alert at times that it doesn’t really need to be, causing that surge of energy and adrenaline in the body. Reactivity means that a person with PTSD has very strong, fast emotional and physical responses to stressful situations.

Hyperarousal and reactivity can look a lot like ADHD in children. I have met a good number of kids who were diagnosed with ADHD before the adults in their lives became aware of their trauma history. Of course, it is possible for kids to have both ADHD and PTSD, but if a child’s symptoms came on very suddenly, it is worth ruling out any possible trauma. Here are a few other ways these symptoms can show up for kids:

• Difficulty concentrating or learning

• Sudden, severe tantrums that seem to escalate from “zero to sixty” very quickly

• Being very sensitive to sounds or small movements

• An exaggerated startle response

• Having trouble falling or staying asleep

• Aggression towards others, risky behavior, or self-harming behavior

How Long Do a Child’s Symptoms Have to Last to Be Considered PTSD?

It is normal and common for many children to experience at least a few of these symptoms in the days and weeks immediately following a trauma. It’s also common for a child to be in a state of shock, and have a hard time processing their feelings about what has happened at first. If your child’s trauma is very recent and they are struggling, it doesn’t necessarily mean they will go on to develop PTSD.

A child’s symptoms need to be happening for over a month in order for PTSD to be considered as a possibility. It’s also good to know that trauma symptoms may not show up right away: a child may not start showing signs of PTSD for weeks or months after a trauma.

Does Every Kid Who Experiences Trauma Develop All These Symptoms?

Not every child who survives a trauma event will develop PTSD. As many as 43% of American boys and girls experience at least one trauma event every year, and many of these resilient kids will be able to “bounce back” from the experience without developing PTSD. Nobody knows exactly why some children develop PTSD while other’s don’t, but we do know that children are more likely to be affected if their abuse happened as a result of violence or abuse, or if they have had repeated trauma experiences throughout their lives.

It’s also possible for children to experience a few of the symptoms listed above, without fully meeting the criteria for PTSD. PTSD is a label that can help us give a name to a child’s experiences and figure out what treatments will work best for them, but many kids have trauma-related symptoms that don’t exactly fit this mold. Trauma-focused therapy can be helpful for these children, as well, if they are bothered by their symptoms but don’t fully meet the criteria for PTSD.

I Think My Child May Have PTSD. How Do I Get Help?

If you suspect your child may have been abused, contacting a Child Advocacy Center near you is a good first step. Your local Child Advocacy Center can give you advice on what to do next, and they have trained professionals who can help determine whether a child has been abused in a way that minimizes a child’s stress and protects their emotions. The CAC may also be able to refer you to local therapists in your area who are trained in PTSD.

If you are looking for a children’s therapist for a child with trauma symptoms, I’d recommend seeking out someone with specialized training in a form of trauma-focused therapy, such as TF-CBT for older children, CPP for toddlers, or TBRI for children who survived long-term abuse or neglect.

Sometimes, grieving children can suffer trauma symptoms due to the nature of their loss. If you’re wondering what’s “typical” for grief and what might be a sign of something more serious, my book for grieving kids and caregivers might be a good place to start. Inside, you’ll find over 100 activities for caregivers and kids to do together to manage grief symptoms.

If you’re looking for more information on childhood trauma, check out my Help for Trauma page for more information and resources.