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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3. Separation Anxiety Disorder: Common in Young Children

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

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

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

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

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

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

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

4. Social Anxiety Disorder: Not Just Shyness

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

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

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

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

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

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

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

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

5. Obsessive-Compulsive Disorder: Frequently Overlooked

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

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

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

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

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

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

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

Treatment for Children and Teens with Anxiety Disorders

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

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

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

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

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

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

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

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

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

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

What Makes the Shift to Middle School So Hard?

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

Small Fish in a Big Pond:

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

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

Unfamiliar Territory:

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

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

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

Fear of the Unknown

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

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

In Middle School, School and Social Life Become More Complex

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

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

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

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

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

Create a Supportive Environment for Your Middle Schooler

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

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

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

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

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

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

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

Strategies for Middle School Anxiety Management

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

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

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

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

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

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

• How likely do you think this is to happen?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When to Seek Extra Help

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

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

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

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

Good luck out there, parents—I salute you.

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

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

“Do you have kids?”

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

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

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

The Case for Therapists Who Are Parents

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

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

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

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

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

The Case for Therapists Who Are Not Parents

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

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

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

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

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

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

Parenting and Therapy Are Very Different Skillsets

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

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

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

Becoming a Parent Didn’t Make Me a Parenting Expert

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

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

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

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

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

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

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

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

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

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

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

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

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

• How Often Should a Child See a Therapist?

Child Anxiety Counseling in Charlotte, North Carolina

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

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

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

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

Signs of Panic Disorder in Children (And How You Can Help)

Learn how to help your child cope with Panic Disorder in this handy guide for parents and caregivers. Photo by Ron Lach via Pexels.

“The only thing we have to fear is fear itself.” We’ve all heard this famous quote from Franklin Roosevelt before. And it’s a great message, right? Often, our fear holds us back from doing things that really wouldn’t be so scary, if only we faced our anxiety head on. But when a child is dealing with Panic Disorder, the “fear itself” is pretty terrifying! Sweaty palms, a racing heartbeat, rapid breathing, and lightheadedness can make kids feel like the world is about to end.

Fear not! This post will take a deep dive into panic disorder, so you can feel confident navigating your child through their next wave of panic. We’ll talk about how panic disorder works, review common signs and symptoms, and discuss what parents (and professionals) can do to help.

What is Panic Disorder?

Panic Disorder is a type of anxiety disorder that can affect both kids and adults. It’s much more common in teens than in younger kids, but can strike at any age. People who have panic disorder have experienced panic attacks (also called anxiety attacks), and struggle with the fear of having another one.

Panic attacks come on suddenly, and may or may not have a clear trigger. A child may have a panic attack because they’re extremely anxious about boarding an airplane: in this case, the trigger is clear! But a child could also have a panic attack come on seemingly out of the blue, while relaxing at home or hanging out with friends. Sometimes, panic attacks can even wake a child up in the night!

Panic attacks are frightening, and it’s common for kids (and even adults) to worry they mean something’s seriously wrong. The physical symptoms can feel like you’re losing control of your body and mind. Children may worry they’re having a problem with their heart or lungs, or might even fear that they’re dying or going crazy.

Understandably, kids who’ve had a few panic attacks can get really worried about having another one. Sometimes this leads to desperate attempts to avoid things they think might trigger a panic attack, or to stay away from places where they think nobody will be able to help them. When this starts getting in the way of life, we call it Panic Disorder.

How is Panic Disorder Different Than a Regular Panic Attack?

Many people have panic attacks: up to 35% of people will have one at some point in life. They can happen as a part of other anxiety disorders, like social anxiety, generalized anxiety, phobias, or even OCD. They can also happen by themselves, without any other mental health problems.

Panic disorder, on the other hand, is much less common. It affects about 4.7% of U.S. adults and about 1-3% of kids and teens. For kids with Panic Disorder, the panic attacks are the source of anxiety. Kids are worried about having more attacks, of something bad happening during an attack, or of having a panic attack in a place where they’re not able to get help.

If a child is worried about something else—dogs, germs, other kids judging them—and they’re having panic attacks as a result, that’s not Panic Disorder. If a child is worried about the panic attacks themselves, and is trying to avoid them in unhelpful ways, that’s Panic Disorder.

What Are the Symptoms of Panic Disorder?

The symptoms of Panic Disorder include multiple bouts of extreme anxiety, as well as worries about having more attacks in the future. Photo by Shvets via Pexels.

To get a diagnosis of panic disorder, kids need to have had more than one panic attack. A panic attack is a sudden, unexpected burst of extreme anxiety or fear that only lasts a short time, usually 10-30 minutes.

They don’t always have a clear cause and may seem totally out of the blue. During a panic attack, a child may notice 4 or more of the following symptoms:

• Sweating

• Shaking

• Rapid or pounding heartbeat, or feeling like the heart is skipping a beat

• Chest pain or pressure

• Upset stomach

• Feeling short of breath or like you can’t breathe

• Strange sensations, like heat, tingling, or numbness

• Feeling dizzy or lightheaded

• Feeling detached from reality

• Feeling as though something really bad is about to happen (impending doom)

Essentially, a panic attack sends your body into full on fight-or-flight mode with no warning, which causes these intense physical symptoms. Kids with panic disorder become so afraid of these attacks that they go to great lengths to try to prevent them from happening. This means you’ll also see the following:

• Worries about having another attack

• Concern about the meaning of the panic attacks or negative consequences they could cause

• Trying to avoid or prevent attacks in ways that lead to significant behavior changes

Once these symptoms have happened for at least a month, a child can be diagnosed with Panic Disorder.

Signs of Panic Disorder in Kids

Panic attacks might be easier to spot than some other forms of anxiety, but Panic Disorder can still look different for each individual kid. If you’re beginning to suspect panic may be to blame for your child’s difficulties, here are three examples to consider.

1. Maya has had a handful of panic attacks over the past few months: her hands start to sweat, then she starts hyperventilating and crying. She was sitting in Biology class one day when she noticed her palms getting sweaty, and asked her teacher if she could leave class. Her teacher asked her to wait for another student to return from the bathroom, and Maya had a panic attack. Maya’s teacher has apologized and reassured her that this won’t happen again. However, Maya doesn’t want to go back to class for fear that she’ll have another attack.

2. Mateo has heart palpitations with his panic attacks, and gets a terrible feeling like something bad is going to happen. He’s gone to the doctor for a checkup and has a clean bill of health, but he can’t shake the feeling that his panic attack could turn into a heart attack. He worries about this possibility all the time, and asks his mom for reassurance that there’s nothing wrong with his heart. Every time he feels the slightest twinge in his body, he worries it means another panic attack is coming.

3. Ash has only had a couple panic attacks, but they really left an impression on her. Each one felt like an emergency, and luckily her mom was close by to help. Even though she hasn’t had one in a little while, Ash is really nervous about going to summer camp or sleepovers with her friends, because she’s anxious about having a panic attack away from home. She worries what her friends would think, and who would help her to calm down. Ash friends have noticed she’s turning down their invitations, but Ash is too embarrassed to tell them why.

Even though their symptoms are different, all these kids are struggling with repeated, unexpected panic attacks. As if that wasn’t enough, their anxiety about the attacks is so big that it’s getting in the way of important parts of life.

What Do I Do If I Think My Child Has Panic Disorder?

It’s important to rule out any medical problems or lifestyle issues before settling on a diagnosis of Panic Disorder for a child or teen. Photo by Liza Summer via Pexels.

If you’re concerned your child is having repeated panic attacks, it’s a good idea to check in with their pediatrician first to make sure what you’re dealing with is really anxiety-related. There are some medical conditions that can mimic panic attacks, and you’d hate to brush something off as “just anxiety” that could be made better with medical care.

Conditions like tachycardia and POTS can affect your heart rate and blood pressure, causing palpitations and dizziness. A child complaining of shortness of breath should be checked out for asthma, just in case. The cause could even be as simple as having too much caffeine: it’s hiding in all kinds of sports drinks and energy bars these days, and it’s so effective at triggering panic attacks that scientists use it when they want to research panic.

Once you’ve ruled out any underlying medical stuff, you can rest assured that as scary as your child’s panic attacks may be, they’re totally safe. Many children worry that panic attacks will cause serious harm or lasting damage. Knowing this isn’t the case can be a relief.

Next, take a look at some of the strategies below to help your child cope with panic and get back to enjoying life.

Helping a Child with Panic Disorder

You've learned the symptoms, you’ve ruled out any medical causes…now that you’re sure this is Panic Disorder, how can you help your child cope? It’s painful to watch your child go through debilitating anxiety, and emotionally exhausting for everyone involved.

Fortunately, Panic Disorder is very treatable! We have ways to help kids and teens who are dealing with panic, and we know they work. Here’s how a parent or caregiver can help a child through panic:

1. Educate Your Child About Panic Attacks

   Part of what makes panic attacks so scary is how mysterious they are. They seem to come out of nowhere, with little to no warning. Even if they aren’t dangerous, they feel like they are. It’s important for kids to know that panic attacks are not dangerous, and that they’re the result of their body doing the right thing at the wrong time. The symptoms kids feel during a panic attack are the result of their fight-or-flight response kicking in, which exists to help us escape life-threatening situations. We want to be able to feel that adrenaline rush when we really need it—just not on the school bus.

2. Practice Regular Relaxation

   It never hurts to learn new ways to calm down your body and mind, especially when you’re dealing with any form of anxiety disorder. Coping skills like deep breathing, muscle relaxation, and guided visualization really can help a lot of kids—but they work better when you practice them regularly, instead of trying them only when you’re panicked. Just like with any exercise, regular practice helps your child’s nervous system get better at coming out of fight-or-flight mode and returning to calm. Download my free guide for more ideas!

3. Use Grounding Skills When Panic Strikes

   Many kids find that typical relaxation skills don’t work super well in the midst of a panic attack: it’s hard to get all noodly when there’s adrenaline coursing through your body. Your child may find they have better luck with grounding skills. These skills give your child something to focus on outside of themselves, so they’re not just fixating on their body sensations and anxiety. Any kind of strong sensory input, like holding an ice cube, tasting a sour candy, or splashing your face with cold water can be helpful for grounding.

4. Accept That Panic Happens

   You may be surprised to learn that our goal when treating Panic Disorder is not to eliminate panic attacks from a child’s life. That’s like trying to keep yourself from ever sneezing again: it’s a bodily function that’s mostly outside of your control. The more time we spend stressing about panic attacks, the more anxious we become. Interestingly, the more kids accept that panic sometimes happens, the fewer attacks they tend to have. You can remind your child that although panic attacks stink, they’re manageable, they’re not dangerous, and they always end.

5. Approach, Don’t Avoid

   Kids with Panic Disorder are so fearful of having another attack that they change their behavior and routines to try to protect themselves. This can look like avoiding places where they’ve previously had an attack, repeatedly checking in with parents about their worries, monitoring their body for signs of panic, or saying no to activities that feel too risky. The more kids avoid these places and activities, the worse their anxiety is likely to become. Over time, the list of “dangerous” places can get longer. We can help kids overcome their anxiety by gently helping them return to these off limits places, so they can prove to themselves that they’re not so dangerous after all.

Panic Disorder Therapy for Kids

Cognitive Behavioral Therapy gives kids and parents the tools they need to deal with panic when it strikes. Photo by Any Lane via Pexels.

You don’t have to keep living in fear of your child’s next panic attack. In addition to the tips above, meeting with an anxiety therapist can help your child recover from Panic Disorder and learn skills they can use to manage anxiety as they grow. Cognitive Behavioral Therapy is often called the “gold standard” for anxious kids because we have lots of research to show how effective it is. It’s my first recommendation for families looking for help with panic.

Many “find a therapist” directories allow you to search for therapists who use specific forms of therapy, so you can specifically seek out counselors who practice CBT. This kind of therapy is very focused on education and skills. You can expect to get “homework” to practice with your child between sessions, and to be involved in your child’s therapy process. Happily, kids who learn CBT skills often move through therapy a little more quickly than kids who do not.

I love using CBT to help kids with anxiety, both in my therapy office and online. This kind of skills based counseling works great over telehealth, especially with kids ages 8 and up. If you’re located in the Charlotte area, I’d be happy to meet at my Davidson office. If you’re somewhere else in North Carolina, New York, or Florida, I offer virtual sessions using a secure platform that works just like Zoom.

Ready to get started? Send me a message. You can also download my free anxiety guide to learn more coping skills you can start using right away.

How Can I Help My Minor with OCD?

OCD symptoms often develop for minors during the tween or teen years, and most people are diagnosed before age 25.

If you’re looking for help for your minor child with OCD, you’re not alone. It’s common for OCD symptoms to first show up in childhood: two of the most common times to develop OCD are during the tween years or the late teen years. In general, most people with OCD start noticing symptoms before age 25.

Research suggests boys tend to devleop OCD at an earlier age than girls do. However, every kid is different. For example, I’m a children’s OCD therapist who was also diagnosed with OCD as a child, and my symptoms started at age 7.

Regardless of your child’s age, your support as a parent is really important. Kids—especially young ones—need their parents to be involved in the therapy process, and this is especially true when it comes to OCD therapy. The good news is that your support will have a huge, positive impact on your chid’s recovery from OCD. In this post, you’ll learn 5 simple ways you can help your minor child—and yourself—through OCD

Identifying OCD Symptoms in Minors

It’s not always easy to identify OCD symptoms in children. Kids are often aware that the worries OCD gives them are unusual, and will try to mask their symptoms as a result They may feel embarassed, ashamed, or afraid of the thoughts they’re having. They don’t want other people to know about these weird thoughts, so they cover them up instead.

Also, a child’s OCD symptoms might not fit the mold of what we expect OCD to look like. We might envision a very neat, orderly person who’s focused on avoiding germs or keeping things organized. In reality, OCD can look many different ways, and the signs are often very subtle. It’s entirely possible for a child with OCD to be messy, disorganized, or totally unworried about dirt or germs.

People with OCD have two things in common: obsessive thoughts and compulsive behavior. An obsession is an unwanted thought, worry, or mental image that pops up at unwanted times. It’s hard to get rid of, and causes a lot of anxiety or distress. In order to deal with these obsessions, OCD sufferers feel like they have to do something to alleviate their anxiety. This repeated behavior is called a compulsion.

Common obsessions for kids with OCD include:

• Worries related to getting sick, throwing up, or contracting germs

• Fear about somehow losing control and doing something bad, like hurting themselves or someone else (even though they don’t want to)

• Thoughts that if they don’t do something just right, something terrible could happen

• Worries about bad things happening to loved ones

• Doubts about whether or not they may have misbehaved or done something wrongj

• Worries about sexuality or being gay in children who aren’t otherwise questioning their identity

You may notice compulsive behaviors like these in your minor child with OCD:

• Checking and-rechecking that they’ve done something, like turned off a light switch

• Creating rituals that have to be done exactly the right way, such as a specific process for washing hands or a rigid bedtime routine

• Excessive cleaning, showering, or handwashing

• Repeatedly asking for reassurance about things, even after they’ve been given an answer

• Confessing bad thoughts or possible misbehavior to a parent

• Repeatedly touching or counting objects, or repeating actions to make them symmetrical (like tapping one leg and then the other)

The tricky thing about OCD is that compulsions never permanently get rid of an obsessive worry. This means that people get stuck in a cycle of doing their compulsive behavior over and over in order to feel some sense of relief.

Five Ways to Help Your Minor Child with OCD

As a parent, you can help your child understand their symptoms and work together as a team to combat OCD.

Now that we’ve reviewed the symptoms of OCD, let’s talk about how you can help your child to cope. OCD is a stressful diagnosis not just for the child who is suffering, but their entire family. Keep reading to learn ways to demystify OCD, reduce feelings of shame and loneliness, and start looking at OCD from a different perspective. These 5 steps will help you and your child look at OCD in a new light, so you can start working on healing together.

These techniques aren’t a replacement for therapy (more on that below), but they are tried-and-true approaches that I teach in my child therapy office. They’re also exactly the kinds of things that I think would have helped my family when I was a kid. If you’ve just noticed OCD symptoms in your minor child and you’re not sure what to do, start here.

#1: Help Your Child Understand OCD

I mentioned above that kids with OCD often know that their thoughts are unusual. That’s because OCD is ego dystonic: this means that the thoughts it causes go against a person’s temperament and values. They can feel weird, confusing, or “other,” almost like they’re not coming from you. Often, OCD preys on a child’s worst fears: peaceful kids may experience violent images, responsible children might worry about mistakes, and typically subdued kids can suddenly have thoughts about losing control and doing something inappropriate.

As you can imagine, this is really upsetting. Kids with OCD may worry they’re going crazy or that something is deeply wrong with them. They may also assume they’re the only one having these “weird” thoughts. This is especially true if their obsessions are about something embarrassing, shameful, or taboo.

You can help your child understand OCD so they feel less alone. Learning how OCD works can help kids realize that their symptoms aren’t so unusual after all, and that there is treatment that will help. Start by teaching a few important facts about OCD:

• Nothing a person does causes OCD. It’s mostly genetic, and not anybody’s fault.

• Just because you have a bad thought doesn’t mean you’ll act on it. In fact, people with OCD tend to have obsessive thoughts about things they’d never do in real life.

• OCD isn’t dangerous: it’s just a little glitch or “hiccup” that happens in the brain.

• You can fight back against OCD by not doing what it tells you to do: this is hard, but it teaches your OCD who is boss!

Reading books together is a great way to get these points across. It gives parents language they can use to explain OCD, and seeing that someone has gone through the trouble of writing a book can reassure kids that they really aren’t alone. What to Do When Your Brain Gets Stuck is a classic, and many people enjoy Up and Down the Worry Hill, too.

Your child might also appreciate taking a look at a list of celebrities who have OCD. About 1.2% of people are diagnosed with OCD. This means there are plenty of public figures who have been affected by it, including David Beckham, Daniel Radcliffe, and Camila Cabello.

#2: Be a United Team with Your Child Against OCD

Your child can separate herself from her symptoms by drawing a picture of what she imagines OCD looks like.

Battling OCD is not easy work. You have to do exactly the thing your brain is saying not to do in order to feel better! This can put parents at odds with their kids, because parents are the ones who have to hold bnoundaries and stick with the plan to overcome OCD. It’s important to remind your child (and yourself) that this fight is not you against them: it’s the two of you against OCD.

You can maintain a united front by imagining OCD as a little character or creature that is totally separate from your child. This is called “externalizing:" it’s a tool we use in therapy to help separate a problem from the person suffering from it. Externalizing OCD can help you feel like you’ve got a common enemy. It also reduces some of the shame and frustration kids feel when they experience thoughts and urges beyond their control.

Encourage your child to give their OCD a name: kids often choose something funny and nonthreatening, like “Bob” or “Dr. Annoying.” Your child might also enjoy drawing a picture of what they imagine their OCD would look like. Creating this kind of OCD character is a coping skill I use with almost all kids at the beginning of treatment (you can check out other OCD coping skills here).

Next time you notice your child saying or doing something related to their OCD, don’t blame them—blame Bob.

#3: Don’t Fall Into the Reassurance Trap

It’s only natural to want to comfort your child when they’re worried. As parents, we probably offer reassurance all day without thinking twice. Sometimes, a simple “it’s okay” or “everything will be alright” is all a child needs to hear in order to feel better.

Unfortunately, the usual rules don’t apply to OCD. Reassurance typically does more harm than good: even though it helps kids feel better in the short term, it fuels their anxiety in the long run. Reassurance-seeking is the most common OCD compulsion I see among kids in my therapy practice. Cutting back on reassurances can go a long way toward helping your child.

You might notice your child asking you the same question over and over, even after you’ve already explained that things will be fine. That’s because reassurance only quiets the OCD worries for a little bit. The OCD worries always come back, which means your child has to ask again to get relief. Over time, this pattern actually makes the symptoms worse.

One of the big goals of OCD treatment is to help parents gradually stop enabling their child’s OCD by giving into its demands. This means gradually scaling back on giving reassurance if you’ve been doing it a lot. If your child’s symptosm are mild, you may have good luck doing this on your own at home. If you’ve been stuck in this pattern for a while, a therapist can help you to gently break the cycle.

#4: Research Therapists who Treat Minors with OCD

Databases like the one provided by IOCDF can help you find therapists who specialize in treating OCD in minors.

While some minor children will recover from OCD without therapy, many will need extra help. Research has found that for about 1 in 5 kids, symptoms will resolve on their own, without treatment. For that remaining 4 out of 5, therapy will help kids get back on track and manage their symtpoms.

It might sound daunting at first to hear that most kids with OCD require therapy to recover. However, there are a couple of big silver linings here. The first bit of good news is that we have a form of therapy called ERP that’s been designed specifically for treating OCD, and it is highly effective. We also know that entering therapy early in life helps people with childhood-onset OCD make a much fuller recovery. That’s good news for your child!

Working with OCD is a specialty: not all therapists have extensive training in this area. The same is true for working with children. Finding a therapist who specializes in both OCD and working with minors might require a little extra legwork. The International OCD Foundation (IOCDF) has a searchable list of therapists who are trained in ERP, the “gold standard” treatment for OCD, including therapists who have been specifically trained to treat children. You can also run a search on Psychology Today to look for therapists in your area who offer ERP and see kids or teens.

Not all therapy therapy training programs don’t cover OCD or child therapy in tons of detail, so it can help to ask prospective therapists what their training and experience is with these two groups. Registered Play Therapists often have lots of training working with kids. ERP is the most common, best-researched therapy for OCD treatment. You can also ask more general questions, like the ones in this post, to get a sense for whether a therapist seems like the right fit for your family.

#5: Practice Self-Care So You Can Support Your Child

OCD is tough for kids, but it’s incredibly draining for their families, too. The bigger OCD symptoms grow, the more time and energy it takes to keep up with all the compulsive behaviors and rituals. Families—and parents especially—may feel like they’re bending over backwards or walking on eggshells to avoid triggering their child’s OCD. And even with all that effort, new worries pop up, seemingly out of nowhere.

It’s common for parents to feel exhausted, hopeless, or even resentful when they’ve been dealing with a child’s OCD for a long time. Kids often pick up on this tension, which adds extra stress to an already stressful situation. Gradually facing fears through OCD treatment is the most surefire way out of this vicious cycle, but it requires a lot of work, too. You’ll need a lot of patience and compassion to help your child through therapy.

Treating OCD is more of a marathon than a sprint. Resist the temptation to put yourself last on the to do list, and make sure you’re setting aside time to do whatever will help you continue to show up for your child. Date nights, exercise, time away from parenting, or watching something on TV that isn’t Bluey all count. You can also ask to speak to your child’s counselor in private or seek out your own therapist if you need to vent and get your own support.

OCD Therapy for Minors in North Carolina

You can help your child through OCD with the support of a therapist. I provide OCD treatment for kids and their families throughout North Carolina, New York, and Florida.

I hope you’ve found this article helpful, and that it gives you some options to try while you consider looking for a therapist. If you’re looking for OCD counseling for your child, I may be able to help! I’m physically located in Davidson, North Carolina, and can meet with local children in-person or online. I’m also available for virtual sessions with families in Florida and New York. You can learn more about my practice or email me to get started.

Looking for more information on how OCD affects minors? Check out some of my other posts:

Can a Child Have Mild OCD?
What Are the 4 Types of OCD?
How to Help a Child with Intrusive Thoughts
Does Childhood OCD Go Away?

Should Parents Be Involved In Their Child's Therapy?

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

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

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

You Are the Expert on Your Child’s Life

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

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

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

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

The Pros and Cons of Parent Involvement in Therapy

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

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

The Pros:

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

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

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

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

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

The Cons:

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

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

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

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

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

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

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

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

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

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

Participating in a Preschool Child’s Therapy

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

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

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

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

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

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

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

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

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

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

Including Parents in Therapy for Elementary-Aged Kids

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Therapy for Kids and Tweens in Davidson, North Carolina

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

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

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

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

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

Can a Child Have Mild OCD?

It’s bedtime, and your child’s goodnight routine is a little longer than usual. Over the past few weeks, it seems like things have gotten a little more elaborate, and the steps have to be done just right. Or, maybe you’ve noticed your child repeatdly asking if things are okay—even when they know the answer is yes.

You know kids can have quirky habits sometimes, and your child has always been prone to worrying. Is this just a passing phase, or could your child possibly have mild OCD? Is “mild OCD” even a thing?

When we see OCD portrayed on TV, it’s often easy to spot. Characters with OCD usually have easily noticeable symptoms, and they’re often pretty severe. In real life, OCD is much better at hiding: symptoms can be really subtle. What’s more, kids with OCD sometimes feel they need to hide their compulsive behavior. Children are often aware that not everybody has these “weird” thoughts and urges, and so they try not to advertise what’s going on.

The short answer is: yes, it’s very possible to have mild OCD. For the longer answer, keep reading! We’ll take a look at the different, sneaky ways that OCD can show up for kids.

First, Let’s Clarify What OCD Is

If your child’s problems are mild, it might be harder to distinguish whether or not OCD is really what you’re dealing with. Anxiety and OCD have a lot in common. And some personality traits and quirks can resemble OCD too, like perfectionism, superstitiousness, and orderliness.

People with OCD share 2 big symptoms in common:

• They have recurring unwanted thoughts, urges, or mental images. These are unwanted, tough to control, and cause the person anxiety or distress.

• The person tries to push away or “neutralize” these thoughts, usually with some kind of special thought or action.

That’s where we get the name “Obsessive Compulsive Disorder” from. The unwanted thought that shows up again and again is the obsession. The thing a person feels they have to do in order to make the uncomfortable thought go away is the compulsion. The trick is that, while compulsions make a person feel better in the short term, they actually make the thoughts and anxiety worse over time.

A child who holds herself to a high standard at school, prefers a clean room, or likes to carry a lucky charm on important days is unlikely to have OCD. However, a child whose worries seem to be stuck in a loop, or who repeatedly performs the same action might be showing OCD symptoms.

OCD Has a Range of Severities

Just like most other mental health problems, OCD can be mild, moderate, or severe. Some children might experience OCD as a minor inconvenience, while for others it can be completely debilitating. The media tends to show mental illness in its most severe forms because that’s what’s most dramatic and interesting. However, this isn’t the reality for all kids with OCD.

Many kids are able to fly under the radar for a while, without their symptoms being apparent to others. Even parents may not notice anything unusual, especially at first. By the time a child comes to treatment, they may have had OCD symptoms for quite a while.

Therapists look at a few areas to see if a child’s symptoms are mild, moderate, or severe:

• Frequency: A child whose worry shows up once a day may be on the midler end of the OCD spectrum. A child whose thought pops up many times throughout the day may have more severe OCD.

• Intensity: If a child can sometimes brush off the thought or it causes only mild anxiety, their symptoms are more mild. If a child can’t let go of a thought and it causes extreme stress, that’s severe.

• Duration: Kids with mild OCD symptoms may spend a few minutes a day doing something compulsively. Children struggling with severe OCD may spend hours.

• Functioning: Mild OCD may not really get in the way of things like school, friendships, or other everyday activities. On the other hand, severe OCD can affect relationships and keep kids from doing the things they want or need to do.

If you take your child to a therapist, they can use a special assessment to confirm an OCD diagnosis, and to see if your child’s symptoms fall into the mild, moderate, or severe range. This can be helpful to know because therapy recommendations will be different depending on where your child falls in that range.

You May Have Caught Your Child’s Symptoms Early

If you are noticing mild OCD symptoms in your child, it’s possible you’ve caught your child’s condition pretty early, while it’s still developing. As worrying as it can be to learn that a child is having these kinds of problems, discovering them early is great news.

Even though OCD is common, it can be hard to catch: one study found that it took the average OCD patient over 12 years to get a correct diagnosis! Younger people in the study had an easier time than older people when it came to getting diagnosed, but this is still a pretty long time to wait for the right help.

Research also tell us that kids who participate OCD therapy early often have better results than adults do. OCD symptoms tend to start in childhood or adolescence, so kids who are in therapy generally haven’t lived with their symptoms for as long as adults have. Quick treatment seems to make a difference: on average, they had more improvement in their symptoms than the adults in the study.

One final reason that it’s great to catch OCD symptoms early: mild OCD doesn’t always stay mild. When left untreated, kids may develop more complex and time-consuming rituals, and have more frequent and severe worries. As OCD grows, it can have more and more of an impact on a child’s quality of life. Kids who start therapy when their OCD is still mild can avoid a lot of this difficulty, and get their lives back on track sooner.

Sometimes, OCD Symptoms Are Invisible

There may be more to your child’s OCD than meets the eye. OCD involves obsessinos and compulsions that aren’t always easy to see. When we imagine a child performing OCD rituals, we might think of physical actions like handwashing or flipping light switches repeatedly. However, kids can have mental rituals as well, that don’t involve physically doing anything. Some examples are:

• Thinking a special word or thought in order to “undo” their worry.

• Praying compulsively

• Making mental lists

• Counting in their head

• Reviewing certain events over and over to double check them

Other times, compulsions involve saying something rather than doing something. These can also be a little more difficult to notice, at first. Pay attention for behaviors like:

• Asking for reassurance over and over

• Saying “I love you,” “I’m sorry”, or another phrase excessively

• Repeated confessions about things the child fears they have done wrong, such as having a bad thought, or possibly saying something unkind to someone

When parents begin to take stock of compulsions like these, what initially looked like mild OCD may look more complicated. There can be a lot happening beneath the surface, and these kinds of mental thoughts and rituals can be difficult for kids to talk about, or even put into words.

Do Kids with Mild OCD Still Need Therapy?

Even if your child’s symptoms seem mild, it’s a good idea to consult with a therapist to see if counseling could help. A therapist who specializes in OCD can complete a full assessment to see if any sneaky symptoms are going unnoticed. They can teach you and your child skills to deal with OCD worries without giving in to them all the time. Sometimes, it can be reassuring for a child just to hear from an adult who isn’t their parent that OCD worries are common, harmless, and not a sign of “going crazy.”

Occasionally, OCD symptoms may resolve on their own without therapy. Often, however, therapy is needed in order to overcome them. We know that mild symptoms tend to grow worse over time, and that younger kids do better in OCD therapy than adults. Because of all this, it’s worth talking to a counselor and considering therapy, even if your child’s symptoms aren’t getting in the way of life too much right now.

There are some great self-help resources out there for children with OCD. My favorite book for kids, What to Do When Your Brain Gets Stuck, is a great place to start. Up and Down The Worry Hill is another popular option. These books can give your family some helpful background information on OCD and how it works. You’ll also find tools you can use to take action right away.

How Can I Help My Child With Mild OCD?

There’s a lot you can do as a parent to help your child with OCD. In fact, parents are an important part of OCD therapy. A child’s symptoms tend to affect the whole family. Whether you’re waiting around for a child to complete a ritual or answering a question for the 100th time, parents ofen notice that they are changing the way they do things in order to keep the peace at home.

Unfortunately, OCD is never satisfied with what you give it. The more you give in to OCD, the bigger it grows. That’s why mild OCD often morphs over time into more moderate or severe illness.

OCD therapy helps both kids and parents to break this cycle. Using a form of therapy called Exposure and Response Prevention, a therapist can help your family learn new ways to stand up to OCD without giving in to compulsions and rituals. Kids can learn that they don’t have to listen to the thoughts and worries OCD gives them. Parents can learn how to support children without giving in to OCD’s demands.

If you’re noticing mild symptoms of OCD in your child, you can help right away by letting your child know that OCD thoughts are just random noise. The thoughts don’t mean anything, can’t hurt anyone, and everybody—even non-OCD sufferers—gets weird thoughts sometimes.

If you’re looking for help to deal with thoughts and worries right now, my free coping skills guide might help. You can download 5 Coping Skills for Anxious Tweens (That Aren’t Just Deep Breathing) right now, wherever you are.

If you’re hoping to begin therapy for OCD and you live in the states of North Carolina, New York, or FLorida, I may be able to help! I’m certified in Exposure and Response Prevention, the therapy that’s been proven most effective for OCD. As someone with a childhood OCD diagnosis, I remember how scary and overwhelming these symptoms can be. And I know that ERP therapy can really make a difference in the lives of children, whether their symptoms are mild or not.

You can learn more about ERP here, or contact me to inquire about starting therapy.

What Are the Different Types of Child Therapy?

“Play Therapy” is a catchall term to describe many different types of counseling that help children explore feelings using games, toys, and make-believe.

Considering therapy for your child but not sure where to start? This post is for you. Kids today have more options for therapy than ever before, which is definitely a good thing. However, it can also be an overwhelming thing when you turn to Google looking for a therapist only to discover a sea of jargon and acronyms. With so many types of therapy available, it can be tough to determine what’s right for your kid.

I love that families have so many different styles to choose from. No matter what your child’s concern is, there’s probably a therapy out there that’s been researched and proven to help. You can find therapists who teach practical, concrete coping skills, if that’s your thing. There are also therapists trained in forms of therapy that don’t require much language, for children who feel better expressing themselves in other ways.

There’s no one right way to do therapy, so this won’t be a ranked list. Instead, I’ll be doing a quick breakdown of 5 common types of child therapy you might encounter during your search. Even though there’s no such thing as “best’, hopefully you’ll come away with some ideas about what might be best for your child. All these types of therapy are valid, and they can all help kids and families change their lives.

Play Therapy: Exploring Feelings Without Words

Play therapy builds on a child’s natural tendency to learn about the world through play, so they can work through big feelings and difficult life changes without having to sit and talk for hours on end. Sitting on a couch across the room from a strange adult isn’t always the most natural thing for little kids. Play therapy is a wonderful way for younger children to feel safe and comfortable in the therapy room.

Play therapists like to say that “play is a child’s language, and toys are a child’s words.” With this in mind, you’ll see a wide variety of toys in a play therapists office that aim to give children a broad vocabulary to choose from. Expect to find nurturing toys, like dolls, aggressive toys, like punching bags, and creative toys, like art supplies. What you probably won’t find a lot of is electronic stuff: most play therapy toys are open-ended to encourage kids to play in avariety of ways.

So how is play in a therapy office different than play at home? Play therapists are trained to notice underlying themes that repeat themselves in a child’s play, and may give insight into how they’re thinking and feeling.

Within the umbrella of play therapy, you’ll find a variety of differen approaches. Some play therapists are child-centered, meaining they are trained to follow a child’s lead and let them set the pace for therapy. Others may incorporate education about feelings or coping strategies into play to help children learn new skills.

Cognitive Behavioral Therapy: Tools for the Here and Now

CBT differs from some other forms of therapy because it teaches children tools, like mindfulness, that they can use in the present—and continue to practice in the future.

Cognitive Behavioral Therapy, or CBT, is a form of counseling that focuses on helping people learn how to cope with strong emotions by changing their behavior or becoming more aware of their thinking patterns. It’s less focused on uncovering the past or figuring out why a problem evolved the way it did (although you might do some of this in CBT). Instead, the emphasis is on figuring out how to handle the problem now that it’s here, in the present.

One strength of CBT is that it’s an evidence-based treatment, meaning that there’s a lot of research to back it up and prove that it’s effective. Variations of CBT have been designed for pretty much every mental health concern. Exposure and Response Prevention is a specialized form of CBT for children and adults with obsessive compulsive disorder. TF-CBT, which you’ll read about below, is used for kids and teenagers who’ve survived a trauma. You’ll also see CBT used often with children dealing with anxiety, depression, or angry outbursts.

CBT gives children education to help them better understand their feelings and how they work. This can reduce fear and shame, and empower children to feel more in control of their emotions. They’ll also learn coping skills they can use during difficult moments to deal with their emotions in healthier ways. CBT skills require kids to be able to think abstractly—thinking about your own thinking is a complex skill! For this reason, it’s sometimes a better fit for older children.

TF-CBT and Trauma Therapy: Resilience and Storytelling

Children often need extra, more specialized support in order to recover from the after-effects of trauma. Highly stressful or dangerous experiences like accidents, illnesses, a death in the family, or exposure to abuse or violence can lead to long-lasting symptoms that don’t resolve on their own. You may notice a child having difficulty sleeping, experiencing big emotional outbursts, or regressing: going back to habits from earlier in childhood, such as thumb-sucking or bedwetting.

Children need to be able to share their feelings about what has happened to them in order to heal. However, traumatic memories can be very overwhelming. Trauma therapists understand how to help children gradually work through these memories in a safe way, so they don’t feel as confusing or hard to manage. This can happen through play, art, storytelling, or just by talking to a counselor.

Trauma therapy can also give kids and parents tools to deal with symptoms of PTSD, which can affect the whole family. One common form of trauma therapy for kids is Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT. This is a step-by-step approach that teaches children skills that build on each other, eventually helping a child to feel comfortable sharing their story with a parent or other supportive adult.

Parent-Child Interaction Therapy: Behavior Help for Kids and Parents

This is a special form of therapy designed for toddlers, preschoolers, and young children who are struggling with big behaviors and meltdowns. All little children tantrum, but sometimes these acting-out behaviors get so intense and difficult to manage that it puts a strain on the relationship between parent and child. This creates a vicious cycle of bad behavior, frustration, and disconnection.

Sometimes these behavior struggles are a response to trauma or stress, and other times it may just be due to temperament and sensitivity. Regardless of the reason, therapies like PCIT can help parents and children break the cycle of “bad” behavior, set appropriate limits, and enjoy more time spent together.

You can expect to spend a lot of time in the office with your child if you’re participating in PCIT. You’ll learn skills from your therapist to practice at home, and also get opportunities to use them in real time, with your therapist there to coach you through the process. The first part of PCIT is all about strengthening your relationship with your child through play and positive attention. The second is a set of discipline tools you can use to shape behavior without accidentally fueling the fire.

Expressive Arts Therapies: Use Mind and Body Together

Art materials give children a sensory experience that can help them stay grounded as they explore feelings in counseling.

Many kids (and adults) already know that the arts provide a mood boost. Mediums like dance, visual art, theater, and music can also be integrated into therapy to help children work through feelings and heal from trauma. We call this whole group of methods the expressive arts therapies, since they focus on creative expression.

Like play therapy, using art gives children a way to let out feelings they may not have words for, either because the feeling is too big or because they don’t yet have the vocabulary to do so. Music, dance, art, and drama are multi-sensory experiences, so they help kids engage their bodies and brains at the same time. This can be soothing, help children stay engaged, and even make it easier to process trauma.

Therapists can become specialists in any of the expressive arts, and use them as a way to connect with children in sessions. Your child doesn’t need to have any prior experience in a particular art form in order to do well in expressive arts therapy. All kids are creative thinkers, and therapy is focused on the process of artmaking rather than a finished product.

What’s the Next Step? Choosing the Right Type of Therapy for Your Child

Ultimately, the type of therapy you choose is going to be based on your family’s needs, and your child’s specific situation. As you’re weighing your options, you may want to ask yourself some questions, such as:

• Is my child still very interested in make-believe play?

• Are we the kind of family that does well with structure and direct advice?

• Does my child prefer to learn by doing or by talking?

• How is my child feeling about starting therapy? Are they self-motivated or a little unsure?

• Is there a specific event, like a trauma, that’s bringing us in to therapy?

• Is there a therapy option that’s tailored to my child’s specific concern?

• To what extent should I expect to be involved in this type of therapy, as a parent?

You may also want to check out my blog post on the differences between a therapist, psychologist, and psychiatrist to help you navigate those choices. Once you’ve got a list of potential helpers, this list of questions to ask your child’s therapist can help you interview them to find the right fit.

Options for Child Therapy in Davidson, North Carolina

Kids in North Carolina, New York, and Florida can participate in several forms of therapy in person or online through my Davidson, NC office.

If you’re located in the Lake Norman area of North Carolina, like I am, you may be interested in one of the different types of therapy I offer to kids in our region. At my child therapy office in Davidson, I help anxious kids and tweens through:

• Cognitive Behavioral Therapy for Anxiety

• Play Therapy

• TF-CBT

• …and one special form of expressive arts, Dungeons & Dragons Therapy

I also provide online therapy to children throughout the states of North Carolina, New York, and Florida. And if you’re further afield than that, you can check out my coping skills course, which covers my favorite strategies to help tweens with anxiety. It’s available on demand, wherever you live.

What Triggers Anxiety in a Child?

Sometimes, a child’s anxiety seems to come out of nowhere. One day, everything seems okay, and the next day, boom! You’re begging them to leave the car to go to school. Other kids may have seemed anxiety-prone since toddlerhood: they were just always more sensitive than their peers. You may even have been told that their worries were just a phase. But here you are, years later, still dealing with the same fears.

When you’re trying to tackle anxiety, it can help to know the root cause. Whether you’re dealing with an all-of-a-sudden attack or an always-been-there anxious temperament, knowing what’s triggered your child’s anxiety lets you better help them to manage it.

Genetics + Life Experiences = Your Child’s Anxiety Risk

Stress affects all of us differently. It’s not always clear why one child may struggle with anxiety after a tough experience, when another gets through the same situation seemingly no worse for wear. It’s likely that our genes and life experiences combine to give each of us a unique way of coping with anxiety and stress.

We know that anxiety runs in families. Kids who have relatives with anxiety disorders are more likely to develop one themselves. This is true even if the types of anxiety are different within the family; for example, a chid who has many family members with generalized anxiety may have a slightly higher risk of developing OCD. Depending on the genes your child inherits, they may be more or less anxiety-prone from the start.

Even if your child has inherited some anxious traits, anxiety still needs an outside event to trigger symptoms. Big events, like moves and divorces, can do this. However, more day-to-day stress plays a part, too. In general, a child who has a strong family history won’t need as big of a stress to set off anxiety. On the other hand, a child with very little family history could still become anxious after a big enough trigger.

There are plenty of things parents and families can do to support a kid with anxiety—and sometimes best intentions can accidentally cause anxiety to grow. But there are so many factors that contribute to childhood anxiety that it’s never one person’s fault.

What’s a Trigger, Exactly?

“Trigger” has become a household word…and sometimes a word used to tease people who are deemed overly sensitive. So let’s clarify what exactly we mean when we talk about anxiety triggers.

A trigger is a catchall term for anything that sets off anxiety. Triggers can be physiological, like drinking too much caffeine if you’re sensitive to it. They may be sensory, like the sound of a fire alarm going off if your child has a sensitivity to loud noises. They can also be situational, like taking a test if you struggle with perfectionism. The pandemic has served as an anxiety trigger for many kids in recent years.

Triggers are unique to an individual. What triggers one person might not be an issue for another. Sometimes it can be hard to figure out what exactly is setting off anxiety for a child. It’s helpful to discover your child’s triggers so you can figure out how to prepare for potentially difficult situations in advance. The goal isn’t to avoid triggers forever, but to find ways to gradually learn to deal with them.

Sometimes, people talk about triggers as being the thing that set off a child’s anxiety in the first place. Other times, “trigger” is used to describe the day-to-day events that cause anxiety to flare up again. We’ll talk about both types in this post.

Any Big Life Change Can Trigger Worries

Predictabilty and routine help children feel safe. Knowing what’s about to happen next gives kids a sense of control in a world that often feels big and unpredictable. Anything—good or bad—that upends routines in a major way can lead to increased anxiety for kids.

This is one reason why so many kids are struggling with anxiety after covid, even if their loved ones haven’t been seriously affected. Even without major illness, the stress of household routines collapsing in on themselves during quarantine was a lot to cope with. It’s also why starting at a new school or moving to new town can set of anxiety, even if your child is excited about the change.

Here are some big changes that can set off anxiety for kids:

• Moving to a new place

• Divorce or remarriage of a parent

• The birth of a new baby

• The death or loss of a loved one

On a more day-to-day basis, these changes in routine can cause anxiety to flare up, too:

• Unexpected changes in plans

• Changes in a parent’s work schedule that affect their time spent at home

• Vacations or travel

• New babysitters or caregivers

Family Stress Increases Anxiety Risk

Kids are really good at picking up on family stress. Sometimes, a chlid’s anxiety is almost like a release valve for pressure that’s been building up at home. If a child starts showing new symptoms of anxiety, it’s never a bad idea to do a quick assessment of how you and the rest of the family are doing managing your own stress.

If children sense that things are a little tense at home, they may respond by clinging or getting more anxious when they have to be away from a parent. Kids instinctively want to be close to a parent during uncertain times, to make sure they stay safe.

Any major stress in a family will affect children too, such as:

• Intense, frequent fights between parents

• A family member’s chronic or serious illness

• Job loss or trouble with finances

• A parent or caregiver’s own mental health struggles

• Struggles with racism or other systemic oppression

If your child is sensitive to family stress, you may notice that their anxiety gets set off by everyday scenarios such as:

• Changes in family routines or plans

• Parents leaving the house for work or date nights

• Having to separate from the family, such as for school or a sleepover

• Seemingly minor arguments, disagreements, or discipline

Friend and School Drama Are Often Triggers

The older kids get, the more important friendships become in their lives. And these friendships can be pretty turbulent! On one hand, most kids are desperate to be accepted as part of a group. On the other, they’re still figuring out the social skills they need to manage conflict without escalating disagreements into full-on drama.

Kids have to juggle all this social stuff while also dealing with academic pressure that can feel overwhelming. Homework, college admissions, and even just getting to class on time can be stressors for kids.

School and peer issues like these can contribute to the development of anxiety troubles:

• Returning to in-person school after being online during Covid

• Bullying or social isolation

• Transitioning fo a new school building, such as the move from elementary to middle shcool

• Learning difficulties, low grades, or other academic problems

Kids may notice that smaller triggers like these set off everyday anxiety at school:

• Projects that require public speaking

• Testing, especially standardized testing

• Feeling judged for their appearance, clothes, or interests

• Having to navigate a large or complicated school building

• Not sharing many classes with familiar friends

Grief: A Surprisingly Common Source of Anxiety

Grief is often associated with sadness, anger, denial, and a whole host of other feelings. But when we think of grieving children, anxiety might not be top of mind. Losing a loved one often means a loss of stability for kids. Their routines are upended, a safe person is gone, and suddenly, they’re aware of the many unexpected dangers that can happen in life.

It’s normal for grieving children to experience separation anxiety while grieving, because keeping loved ones in sight feels more safe. Health anxiety is also common, since children may worry about whether or not they or a loved one could get sick or die, too. The stress of grief can also lead to more generalized worries, trouble sleeping, and body aches and pains due to anxiety, too.

Some types of grief that can trigger anxiety include:

• The death of a family member or close friend

• Losing a loved one due to estrangement, a move, or imprisonment

• The death of a pet

• The loss of a pregnancy in the family

Triggers related to grief, death, and loss can trigger kids on a more day-to-day basis, too. Grieving kids may notice their anxiety heighten when faced with situations such as:

• Scenes of violence, illness, or death on TV or in movies

• Mentions of suicide in health class

• Assigned school readings with themes of grief and loss

• Anniversaries and holidays that remind a child of their loved one

• Being away from caregivers

Illness, Accidents, and Trauma Can Lead to Anxiety

Highly stressful and traumatic events can also shake up a child’s sense of safety. Even if nobody gets seriously hurt, the experience of an accident or a dangerous situation can leave a child with lasting worries.

At the beginning, you may notice your child is only anxious in situations that are closely linked to their stressful event. Over time, however, that anxiety can generalize. This means the anxiety pops up more often in situations that are only loosely connected to the original event. As time passes it can be harder to connect anxiety symptoms to the underlying trauma or stress that triggered them in the first place.

Traumatic or stressful events that can lead to anxiety include:

• Car accidents

• Attacks or bites from dogs or other pets

• A loved one experiencing a major illness

• Natural disasters such as fires, floods, and tornadoes

• Repeatedly hearing about crime, disasters, or other emergencies affecting people on the news

Children dealing with trauma may notice they feel nervous or overly aware of their surroundings even when there isn’t a clear trigger. They might also notice anxiety caused by:

• Sudden noises

• Sensory experiences (like sounds and smells) that remind them of their trauma

• People, places or things that are associated with the stressful event

Help Your Child Learn and Cope With Their Anxiety Triggers

Learning what triggers anxiety is the first step toward helping your child cope with worries in a healthier way. Once children know what sets their anxiety off, they can learn strategies to help them in difficult situations. They can even practice noticing their thoughts, and questioning whether the worries that bother them so much are even accurate.

These skills may seem small, but over time they add up. Coping skills can change a child’s perspective on anxiety and other big feelings. They can empower children by giving them some control when things feel totally out of hand. We can’t always change a stressful situation, but giving kids coping skills can help them deal with hard moments, both now and as they grow up.

I teach coping skills so much in my therapy practice that I’ve created an entire coping skills course for tweens on the subject. Kids ages 8-13 can learn anxiety management tools they can use right away. There’s content for parents, too, so you can learn why the skills work and how to support your child in practicing them. You’ll also learn what isn’t as helpful for anxiety, so you don’t unintentionally make worries worse.

You can learn more about the course, preview the lessons, and enroll your child here.

Do Kids Grieve Differently Than Adults?

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

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

Children’s Grief Can Be Hard to Recognize

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

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

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

Difference 1: Delayed Reactions

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

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

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

Difference 2: Grieving in Bits and Pieces

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

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

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

Difference 3: Kids Feel Grief in Their Bodies

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

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

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

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

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

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

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

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

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

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

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

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

How Do Tweens and Teens Grieve Differently?

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

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

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

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

Grief Timelines Look Different for Kids, Too

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

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

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

Grief Help Made Especially for Kids

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

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

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

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

5 Coping Skills for Kids with OCD

If your child is struggling with OCD symptoms, feel at a loss for how to help. Maybe you’ve tried using logic to help your child see how unlikely their worries are. Or, maybe you’ve been working really hard on relaxation and deep breathing techniques, but you aren’t seeing a lot of change. This is totally normal! The usual coping skills that help kids deal with anxiety and stress aren’t as helpful for OCD.

While many children with OCD benefit from counseling, there are still things you can try at home to help your child cope. You can help your child learn to understand what OCD is and how it works, and equip them with tools they can use to “fight back” against recurrent worries and rituals. Children with strong coping skills feel less alone, can manage their symptoms better, and they will likely progress through therapy more quickly, too. Let’s take a look at 5 coping skills you and your child can practice together.

Learn About How OCD Works

Obsessive-compulsive disorder, also known as OCD, is a mental health problem that is similar to anxiety, but with its own unique characteristics. It causes people to have unwanted worries or thoughts over and over again. To deal with these thoughts, people with OCD feel like they have to repeatedly do an action in order to relieve their anxiety or prevent something bad from happening. The repeated thoughts are called obsessions, and the repeated actions are called compulsions.

OCD often begins in childhood, and it can be confusing and frustrating for kids and parents alike. Kids really do not want to be thinking about the terrible things their OCD prompts them to think about. They may feel as though they’re going crazy, or worry that having bad thoughts means they are a bad person. Parents may be shocked by the seemingly out-of-the blue appearance of OCD worries. It can be tough to understand why a child is suddenly so afraid, especially when their worries do not seem logical or realistic.

The first step to coping with OCD is understanding what you’re dealing with. Books like Up and Down the Worry Hill and What to Do When Your Brain Gets Stuck teach kids that OCD is caused by a harmless “brain glitch” that keeps the brain from sorting out unhelpful thoughts. Books like these help children feel less alone, and can reduce feelings of shame and guilt that make it hard to get help. They also give kids helpful language to describe their experiences with OCD.

Cope by Focusing on Strengths, Not Worries

When your child comes to you with a problem, you naturally want to talk about it. We all want to be understanding, responsive parents, and heart-to-heart chats with our kids are part of the deal. This is a great approach for lots of childhood worries and struggles, but it doesn’t always work well for OCD.

The repeated worries that come with OCD aren’t logical. Kids with OCD often worry about events that are highly unlikely to happen, like a plane crashing into your home or contracting a rare disease. Sometimes, the worries don’t make much sense, such as being concerned that stepping on a sidewalk crack will cause something bad to happen.

Most kids know their fears aren’t realistic, but they still can’t stop thinking about them. Talking about the worries in detail and reassuring your child that nothing bad will happen is unlikely to make the worries stop. In fact, the more time we spend talking about and paying attention to OCD worries, the more likely they are to happen again.

You can help your child shift their focus away from the worry and towards something more productive: their own ability to cope. We can’t make anxiety go away, but we can help kids deal with their anxious feelings. Instead of asking lots of questions or giving lots of reassurance, praise your child for their effort to do hard things in spite of their worries. Remind them that they’re brave, strong, and capable of facing their fears…and that it will feel so amazing when they do.

Make an OCD “Worry Monster”

Parents may find themselves bending over backwards to try to soothe their child’s worries, or using tough love to try to muscle through activities that cause anxiety to flare. It’s exhausting, and can start to feel like a battle between parent and child. This leaves kids feeling frustrated or ashamed that they can’t just “get over” their symptoms.

Instead of fighting each other, parents and kids need to team up against the real enemy—OCD. We can help kids cope with their symptoms by externalizing OCD, meaning we imagine it as a force that isn’t a part of them and isn’t their fault. This helps to cut down on the shame kids feel, and can increase a child’s motivation to fight back.

A fun way to externalize OCD is by imagining it as an annoying pest, like a bug, creature, or monster. Ask your child to draw a picture that represents how they imagine their OCD. You might even give the creature a funny name. When you talk about your child’s struggles, blame them on this creature instead: “It sounds like Jim Bob is really giving you a hard time today.” It can inject some humor into a tough situation, and remind your child that they can choose whether or not to listen to what OCD is telling them to do.

Spot Unhelpful or Tricky Thoughts

Most of us go through life without questioning our own thoughts too much. We might misinterpret things at times, but it’s usually not a big deal. People with anxiety and OCD are much more prone to having overly negative, unhelpful thoughts. In particular, kids with OCD have a tough time dismissing thoughts that are upsetting or strange. Instead, these thoughts linger, and kids have to deal with the nagging, “what if?” feeling that comes with recurrent worries.

Kids with OCD can learn to notice when their thoughts are playing tricks on them. We call this skill metacognition, which means learning to think about your own thinking. Instead of just taking their thoughts at face value, kids can examine their worries like a detective. Over time, children can start to notice patterns in their own worries, which helps them not take the worries so seriously.

The book Tiger-Tiger, Is It True? is great for teaching this skill to younger children, and we cover it in depth in my online course for kids and tweens.

Practice “Talking Back” to OCD

So maybe your child has gotten very skilled at spotting their own unhelpful thoughts. What’s next? Kids with OCD have a couple options for coping with these unwanted worries: they can talk back to them, or simply ignore what OCD is telling them to do.

”Talking back” to a worry means finding something you can say to yourself instead that is more accurate or helpful. This could mean taking a huge worry and shrinking it down to a more realistic size, or reminding yourself that even when bad things happen, you can figure them out and move on. Talking back can also mean reminding yourself that you’re in charge of your thoughts, and don’t have to listen to the unhelpful ones. Here are a few examples of thoughts kids with OCD can use to “talk back:”

• “I don’t have any proof that this worry will happen.”

• “I’ve gone to school for 6 whole years, and I’ve never thrown up in class.”

• “Even if something bad does happen, I can handle it.”

• “This is just my OCD talking and I don’t have to listen.”

• “I’ve had this worry a million times and it’s never come true.”

Learning and practicing this coping skill empowers children to stop taking their worries and urges so seriously. Eventually, children may feel ready to ignore their OCD by not following through with compulsive behavior when anxiety arises. Facing scary situations and dealing with the anxiety without rituals or compulsions is the core of Exposure and Response Prevention, the most common and effective therapy treatment for OCD.

More Coping Skills for Kids with Anxiety and OCD

If you’re looking for more ways to help a child with anxiety or OCD, consider checking out my online coping skills course, Worry-Free Tweens. In the course, you’ll find child-friendly, in-depth lessons on how anxiety works, how to deal with it, and why anxiety can actually be a superpower.

You and your child will learn how to notice unhelpful thinking patterns and shift into a more realistic mindset when worries occur. Together, you can learn how and when to use coping skills most effectively. You’ll also find advice for parents on how to support and encourage an anxious child while avoiding the traps that can accidentally worsen anxiety over time.

If the course sounds like what you’re looking for, you can access Worry-Free Tweens here.

Counseling for Kids with OCD in Davidson, North Carolina

Coping skills are a great place to start when you suspect OCD. However, many kids will need the support of a mental health professional in order to overcome their symptoms. OCD often impacts the whole family: everyone has to change the way they do things in order to keep a child’s “worry monster” happy. Counseling can help both you and your child learn new ways to deal with repeated worries and urges, so you can get back to having fun together.

I’m licensed to help kids with anxiety and OCD in North Carolina, New York, and Florida. I offer face-to-face therapy in Davidson, NC, just outside of Charlotte. For families who live farther away, we meet for online therapy using a secure platform similar to Zoom. Both kinds of therapy can be effective (and sometimes even fun) for kids and tweens.

If you’re curious about therapy for OCD, check out my post on ERP. You can also check out my FAQ to learn more about what therapy with me is like. To ask other questions or inquire about setting up an appointment, send me an email. I am always happy to help.

5 Coping Strategies for Grieving Children

Grief can touch every aspect of a child’s life, from their relationships with friends to their thoughts about the future. It’s normal for kids of all ages to struggle with strong emotions after a loved one dies, but they may express their feelings differently than grieving adults. Body aches and pains are common in grieving kids, and you may also notice struggles with separation anxiety, difficulty sleeping, and trouble concentrating at school.

We can’t stop a child from feeling grief, but we can help them work through their feelings and learn to live with their loss. These 5 coping strategies can help your child to process their feelings about the death of a loved one in healthy ways.

Coping Skill #1: Reading Books About Grief and Loss

Reading a story together is a great way to gently introduce the subject of grief and loss to your child. Often, kids don’t have a strong understanding of death before it personally affects them. As hard as it is for adults to cope with a loss, it can be even tougher for children who aren’t sure what exactly is happening. Books about grief provide age-appropriate information that isn’t too overwhelming.

Young children may worry about what has happened to their loved one who died: Are they in pain? Are they scared? Older kids may worry about the thoughts and feelings they’re having in response to grief, and whether or not they’re normal. Children of any age may feel intense guilt about how they treated their loved one, and may even wonder if they somehow did something to cause the death.

When children are better informed, they’re less likely to struggle with worries like these. Seeing how characters grieve in stories give children examples of the many ways grief can look and feel. This can reassure children that no matter how they respond to grief, there is no wrong way to feel. Take a look at my recommended grief books for preschoolers as well as books for elementary-aged kids for ideas to get started.

Coping Skill #2: Scheduling Positive Activities

Sometimes, grieving people need to take a break from their grief. While it’s important to work through the feelings and pain of loss, they can become overwhelming at times. This is especially true for kids, who don’t have the capacity that adults do to handle lots of emotional pain all at once.

When a loved one dies, children may feel like nothing is fun or worth doing anymore. It’s common for kids to retreat from hobbies, extracurriculars, or social events they used to enjoy. Over time, this can lead to feelings of depression, which makes it even harder for a child to get out and enjoy life. A vicious cycle can form where the longer a child self-isolates, the worse they feel.

We can support children in taking breaks from their grief by setting aside time each week for activities that are fun, social, or creative. Tasks that give you a sense of accomplishment when you finish them are great, too. Playdates with friends, a family board game or craft night, gardening, or committing to visiting a new place in your town each week are all ways to help your child stay socially connected even when it feels hard to do.

Once you’ve chosen an activity, make sure to put it on your calendar so you can look forward to it and hold yourselves accountable. Sometimes, kids may feel reluctant to participate when the time comes. That’s okay—you can remind your child that it’s hard to get back to doing fun things after loss. Once they’re immersed in the activity, they may find it’s much easier to enjoy it.

Coping Skill #3: Letting Out Anger

There are many good reasons to be angry when a loved one dies. As a kid, it can feel so unfair to see so many other children enjoying time with their grandparents or other family members when your own time was suddenly cut short. Kids may also be angry at parents, doctors, or emergency workers who had to make medical decisions on behalf of their loved one who died.

It can be hard to figure out how to comfort an angry child, but they need support for their feelings, too. We can provide kids with safe ways to vent anger that don’t hurt people or damage belongings. Drawing a picture and ripping it up can help children release emotion. Other children may enjoy stomping on egg cartons, tearing cardboard, popping bubble wrap, or finding other materials that are safe to destroy.

Anger gives kids a lot of energy, so physical activity can be a big help, too. Any activity that increases a child’s heart rate can help them to discharge angry feelings. Jumping rope, riding a bike, or running laps are quick and easy ways to burn off some extra adrenaline.

Coping Skill #4: Examining Worries

A loved one’s death can change the way a child sees the world. This is especially true when a loved one’s death was sudden or traumatic, such as a death from an accident. Suddenly, the world no longer seems as safe as it used to. Something terrible and unexpected has happened, which makes life feel less predictable.

This can lead to a lot of worries for bereaved kids. They may worry about the health and safety of other loved ones, or about their own risk of dying. Some children may even feel less hopeful about the future, or have a sense that things just won’t turn out well for them in life. In big and small ways, their experience with grief can color a child’s thoughts.

We can help a child to pay attention to their thoughts and not take them at face value. Kids can act like detectives, gently questioning their worries to see how accurate or true they really are. Oftentimes, worries are not based on very much good evidence—they’re just guesses about what might happen in the future.

You can help your child by asking questions like “Do you have any proof that is true?” and “Even if this scary thing did happen, would it be as bad as it seems?” Remind your child of their own strengths and ability to problem-solve, as well as the network of supportive people who could help them in a true emergency.

Books like Tiger, Tiger, Is It True? help younger children to grasp the abstract concept of thinking about thoughts. Tweens can learn about how to “talk back” to worries in my coping skills course, Worry-Free Tweens.

Coping Skill # 5: Letter-Writing

There’s often a lot left unsaid when a loved one dies, especially if there wasn’t a good chance to say goodbye. Children may wish they could apologize for a past argument, share an update about their lives, or simply thank their loved one for the lasting impact they’ve left behind.

Writing a letter gives children a chance to voice all these unexpressed thoughts and feelings. Even though they can’t be directly shared with the deceased loved one, a letter can be read aloud to another supportive adult, like a parent or caregiver.

Letter writing benefits young grievers in other ways, too. Bereaved children need opportunities to tell their story to others and be heard. Repeating their story, and putting feelings into words, helps kids to make sense of what happened to them. The more children talk about their grief, the easier it becomes to discuss. We want to help children feel comfortable sharing their grief, rather than pushing it down.

You can help your child get started writing a letter in whatever format feels best to them: email, a word processor, or old-fashioned stationary can all work well. Your child can address their letter directly to their loved one. If they need help getting started, consider having your child complete a sentence such as:

• Something that reminded me of you recently was…

• I wish I could tell you…

• I want to say sorry for…

• My favorite memory of us is…

Once your child has finished the letter, listen attentively as they share it with you. They can then choose a way to “send” their letter to their loved one, such as bringing it to the gravesite or burning the paper and watching the smoke travel upwards toward the sky.

Help Your Child Cope With Grief and Loss

I hope these 5 strategies have given you ideas you can use right away to help your child cope with grief. Working through grief and loss is a long, complicated process. If you and your child could use some more support, here are some more resources for you.

My book, A Parent’s Guide to Managing Childhood Grief, is available for presale now. It includes over 100 activities you can use with your child at home to help them cope with the many feelings and struggles that accompany death and loss. You can find it at any major bookseller, including Amazon and Barnes & Noble.

If your child’s grief is mostly showing up as anxiety, they might benefit from my online coping skills course, Worry-Free Tweens. It offers a more in-depth look at how kids can spot unhelpful thinking patterns, as well as relax the body and mind and gradually face fears. The course includes a section for parents, too, so you can help your child practice new coping skills and empower them to overcome worries.

Finally, if you’re interested in counseling for your child, I may be able to help. As a children’s counselor and play therapist, I can work with families in North Carolina, New York, and Florida, either in person or online. You can reach out to me here.

What Questions Should I Ask My Child's Therapist?

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

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

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

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

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

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

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

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

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

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

5 Questions to Ask Your Child’s Therapist

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• How much is your fee per session?

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

• What insurances do you take, if any?

• What is your cancellation policy?

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

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

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

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

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

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

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

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

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

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

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

6 Helpful Books on Grief for Elementary Students

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

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

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

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

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

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

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

Recommended age range: 4-8

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

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

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

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

Recommended age range: 4-8

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

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

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

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

Recommended age range: 4-8

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

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

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

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

Recommended age range: 5-10

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

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

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

Recommended age range: 8+

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

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

Help Your Elementary Schooler Cope with Grief Through Art and Play

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

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

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

Intrusive Thoughts in Children, Explained

Every kid worries from time to time. It’s normal (and even healthy!) to wonder about fitting in before the first day of school, or to imagine the worst-case scenario before taking a big test. Usually, these worries are easy for kids to talk about, because they know other kids have felt the same way. They also tend to be time-limited: once the test or first day of school is over, the worries are over, too.

For some kids, worries aren’t so easy to talk about. A troubling thought or mental image might pop up out of nowhere, when a child isn’t expecting it. Their worries may be repetitive and feel very difficult to control. Often, these thoughts are really scary and upsetting. They can be dark, violent, or about a taboo subject. These kinds of worries are called intrusive thoughts.

Kids don’t want to be thinking these things, and know they would never act on the thoughts they’re having. So why do they keep happening? In this post, we’ll be talking about what exactly intrusive thoughts are, why they happen, and when to seek help.

What Are Intrusive Thoughts?

Take a second and imagine an intruder. What do you think of? Someone who busts down the door, unannounced, without being invited. What a scary scenario! It’s safe to assume that most of us would be pretty freaked out to discover an intruder in our home. We’d probably dread having it happen again, and try everything we could to make sure our house was secure in the future.

Intrusive thoughts are the brain equivalent of an unwanted guest. They show up to ruin the party. Intrusive thoughts tend to:

• Pop up out of the blue

• Come back repeatedly

• Feel unlike the thoughts a child usually has

• Be upsetting to the child

Intrusive thoughts are ego dystonic. This is therapy jargon that means a person doesn’t agree with the thoughts, and it may not even feel like the thoughts really belong to them. Intrusive thoughts include imagery that is violent, sexual, or feels “wrong” to a child. Other times, worries about worst-case scenarios might come up again and again. They aren’t things that kids would choose to think about, and they’re often the opposite of what a child would do or hope for.

Kids with intrusive thoughts may feel distressed, anxious, or ashamed. They may not understand why the thoughts are happening, but can guess that not everyone is bothered by their thinking in this way. Because the thoughts feel out of control, children may dread having more and try to avoid them.

At What Age Do Kids Get Intrusive Thoughts?

There is no set age at which intrusive thoughts start. However, they may be more common or noticeable in tweens and teens. Intrusive thoughts are sometimes a symptom of OCD, which can show up as early as age 7 or 8 and as late as the teens or early twenties.

In my child therapy office, it’s usually middle or high school kids who are able to put the weird experience of having unwanted thoughts into words. They are old enough to think about their own thinking and notice their thoughts as they pass by, so they know that something doesn’t feel right.

Although they may not talk about it as much, younger kids can be bothered by these thoughts, too. Because they don’t have the vocabulary to talk about what’s going on, you might see changes in their actions, instead. For example, they may ask for reassurance about the same subject again and again.

Why Do Children Have Intrusive Thoughts?

Now that we have spent the past several paragraphs talking about how difficult and upsetting intrusive thoughts can be, you’re probably wondering why kids get them in the first place. The answer may surprise you! Many people experience intrusive thoughts, and it doesn’t necessarily mean something is wrong. They may happen when a person is going through a lot of stress, or they may just happen randomly.

Having an intrusive thought every once in a while isn’t a sign of mental illness. They can be totally normal, like the brain version of a hiccup. A child with occasional intrusive thoughts can usually brush them off without taking them too seriously.

What Mental Health Problems Cause Intrusive Thoughts?

Children who are struggling with repeated, ongoing intrusive thoughts can’t brush them off so easily. In these cases, a child may be dealing with a mental health problem that needs attention. OCD and PTSD are two common mental health conditions that can cause children to have intrusive thoughts.

Kids with OCD deal with repeated thoughts, worries, or mental pictures that upset or scare them. Kids are bothered by these worries, and feel pushed to do something to make the worry go away or prevent something bad from happening. This creates a cycle of repeated worries and repeated behaviors, called obsessions and compulsions, that take up a lot of time and add even more stress.

Children who have survived extremely frightening or dangerous events may have lingering problems after the fact. While some kids will bounce back, others may be diagnosed with PTSD. Kids with PTSD will re-experience parts of their trauma in some way, often through intrusive thoughts or flashbacks. Flashbacks are vivid memories that pop up suddenly and intensely, almost as if a child is living through the event again.

What Are Some Examples of Intrusive Thoughts in Children?

Most of the intrusive thoughts children have fall into one of three broad categories: worries, flashbacks, and “inappropriate” thoughts. If you think your child may be having intrusive thoughts, keep reading to take a closer look at each category. I’ll share some examples of each intrusive thought type. It can be helpful for both kids and parents to discover that they’re not alone, and many kids (and adults) deal with these kinds of thoughts.

Worries: Children with anxiety or OCD may have repeated, unwanted worries that they cant seem to shake. These are often “what if” worries that focus on something bad that could happen in the future. Other times, these “what if” thoughts could be about something naughty a child worries they could have done. Some children with OCD may also get a nagging sense that if they don’t do something exactly right, they could cause something bad to happen. These thoughts may not always be logical, which can make them even more confusing and bothersome for kids. Here are some examples:

• “What if I throw up in public?”

• “What if I accidentally lied to the teacher?”

• “I have to step on all the sidewalk cracks or I won’t be safe.”

Flashbacks: These are most common in kids with PTSD. Flashbacks may feel like they come out of nowhere, or they can be triggered by something that reminds a child of their trauma in some way. They can include any of the 5 senses, and often activate a child’s fight-or-flight system as if the dangerous event was happening again. Examples of flashbacks include:

• Feeling as though you’re back in the place where a trauma happened

• Having an image of the trauma pop into mind

• Hearing or smelling something you associate with the trauma

“Inappropriate” Thoughts: I put inappropriate thoughts in quotes here because there’s a big difference between thinking something and acting on it. We all have weird thoughts from time to time about things we probably wouldn’t be proud to share. Sometimes, intrusive thoughts are about the exact subjects we try to push away or not think about in our day-to-day lives: things like sex, violence, and criminal behavior. These kinds of thoughts can cause a lot of shame, guilt, and distress for children, who worry these thoughts mean they are bad or naughty. They may have thoughts like:

• Imagining hurting someone else

• Picturing themselves stealing something

• Noticing other people’s bodies or imagining them naked

Are Intrusive Thoughts Normal?

The short answer: yes. Intrusive thoughts can be weird, annoying, or disturbing, but they are totally normal. In fact, most of us will probably have intrusive thoughts at some point in our lives. One recent study found that 94% of people have them, which is a surprisingly huge number.

That number is particularly surprising when you consider that most kids with intrusive thoughts feel like the odd one out. They may worry they’re the only ones who have ever had thoughts like this, and that it means they’re bad or weird. Most adults with intrusive thoughts don’t talk about them with other people, either because they quickly disregard them or because it would feel odd to mention in casual conversation. No wonder kids feel so alone.

So, intrusive thoughts are normal—but we know that they can still cause problems for kids. Those issues aren’t caused by the thoughts themselves. Problems arise when the thoughts are very frequent or intense, or when kids have a hard time dismissing them.

Children with OCD have a tougher time disregarding stray thoughts that the rest of us would shrug off. They may take these thoughts more seriously or begin to fixate on them, which causes the thought to pop up more often. Trauma-related thoughts and flashbacks may be so upsetting that they quickly overwhelm a child.

Help for Kids with Intrusive Thoughts in Charlotte, NC

If your child is complaining of an occasional intrusive thought, a little reassurance and education may be all she needs to feel better. It’s helpful for kids to hear that their thoughts are normal, and can’t hurt them or others. Armed with that knowledge, it may be easier for kids to let intrusive thoughts pass by without taking them too seriously. This reduces anxiety which, over time, can also reduce how often the thoughts happen.

On the other hand, you may be on this page because your child’s thoughts are causing larger problems. Maybe you recognized your child in the descriptions of OCD or trauma. If these thoughts have been happening for a long time, are disrupting your daily life, or are combined with other symptoms, therapy can help.

Cognitive behavioral therapy helps anxious kids learn how to catch themselves when their thoughts aren’t doing them any favors. Being able to put a name to your worries helps you to gently shift your mindset. In CBT kids learn that they have control over their thinking, and what thoughts they choose to listen to. A specialized form of CBT called Exposure and Response Prevention helps kids with OCD break the cycle of obsessive thinking and repetitive behavior.

Play therapy helps younger children work through their complicated feelings after trauma. Kids naturally make sense of the world around them through play, and this gentle, child-led approach lets kids handle scary topics in the way that feels safest to them. For kids who are ready to tell their story more directly, TF-CBT gives children a step-by-step path toward managing strong feelings, talking about their experiences, and coping with reminders of trauma.

If you are looking for therapy in North Carolina, New York, or Florida, I’d love to help. We can meet online or in-person in my counseling and play therapy offices just North of Charlotte, North Carolina. If you’ve got questions or would like to schedule an appointment, contact me here.

What to Do When Your Child Refuses Therapy

You’ve noticed a change in your kid. She’s irritable all the time, she spends most of the day in her room, and you’re worried something deeper is going on. Maybe you have a good guess about what’s to blame, like a friendship with someone who isn’t a great influence or a particularly stressful school year. Or, maybe this seems to have come out of the blue, which can feel even scarier. Either way, no matter how delicately ask whether your child wants to talk to someone, you get the same answer.

”I’m fine!”

What do you do? I know so many parents who are trying to get their kids the help they wish they’d received when they were young. When a child refuses therapy, it can be confusing or even frustrating. Let’s talk about a few ways parents can start a genuine conversation with kids who say they don’t want help.

Clear Up Any Misconceptions About Therapy

I cannot tell you how many times I’ve had a kid sit on my couch for a first session and tell me that they have no idea what’s going on. They don’t know what to expect from therapy, and they may not even know why they’re in my office in the first place!

Young children may have heard the word “therapist” or “counselor” before, but may not know what it really means. They may imagine that a therapist is someone who administers tests, prescribes medications, or even gives out shots. I’ve had a few little kids arrive at therapy in tears because they remembered a recent vaccination appointment and worried they were in for more of the same.

Older kids and teens usually have a general idea of what to expect, but their vision of therapy may be vague or stereotypical based on what they’ve seen in the media. Because older kids have the maturity to think about cause and effect, teens often worry about confidentiality in therapy. What will happen if they share what’s really going on with a therapist? Will the therapist just turn around and tell everything to their parents? Could what they say in counseling get them or someone else into trouble?

For a younger child, explain what a counselor can do (play, talk about feelings) and cannot do (give shots or medicine). It might be helpful to explain what happens in a therapy room, including that therapists keep some things private. Older kids may benefit from learning the ins and outs of confidentiality: they need to feel confident that they’ll have some privacy if they’re going to consider counseling at all. You can also share any information you have about your prospective therapist’s personality or way of working with kids.

If you’re getting ready to explain therapy to your child, I’ve gone into what to say in more depth in an earlier blog post on having the “counseling talk”.

Don’t Make Therapy Sound Like a Punishment for Bad Behavior

If your child bristles whenever you bring up the word “therapy”, be mindful about when you’re mentioning it. Are you only talking about going to counseling on the heels of a big fight, or after a bad report from school? It’s understandable that bad stuff happening would remind you of the need for therapy, but if you’re bringing up the idea in the heat of the moment it might come off as sounding like a punishment.

When an adult goes to therapy, it’s usually a decision they’ve made for themselves. It may feel scary or vulnerable to get started, but it’s also empowering and a form of self-care. On the flip side, it isn’t always a child’s idea to seek out a counselor. Kids sometimes tell me they feel they were sent to therapy for being “bad” and that the goal of therapy is to make them “good.” Instead of feeling empowered, they feel ashamed and a bit like they’ve just been sent to the principal’s office. No wonder they don’t want to come.

An honest conversation held during a calm time can go a long way toward changing a child’s opinion about therapy. It can be really helpful for your child to hear that you are struggling, too. Shifting the focus away from the child and toward a “family problem” lets your child know that you are all in this together, rather than singling out your child as the sole person in the family in need of help.

Even if you’re 99% sure of the cause of your child’s distress (a mean friend, a recent breakup, upcoming state tests) it is sometimes helpful to stick to talking about what you can see. For some kids, having an adult speculate about the cause of their troubles feels like someone is putting words into their mouth. By sticking to the facts, you may help your child feel a little less defensive. For example, saying “I notice you’ve been spending a lot more time in your room” is likely to go over better than “Ever since you made that online friend, we never see you anymore.”

Consider Alternatives to In-Person Talk Therapy

Introverted kids in particular may not be thrilled about the idea of sitting in a room with a strange adult and pouring out their deepest, darkest emotions. Even though sitting on a couch and talking face-to-face is what we consider “traditional” talk therapy, it may not feel all that traditional to a child to be alone with an adult who isn’t a relative or a teacher.

If you suspect that solo, face-to-face therapy is intimidating to your child, consider other less “traditional” alternatives. Group therapy might help some kids feel a little less on the spot, and there’s good research to show that it is just as effective as individual therapy for many problems. For others, seeing a therapist online may feel safer and more comfortable than sitting six feet away in an office.

In my own practice, I’ve noticed that tweens and teens are sometimes able to open up about difficult subjects more easily online. Maybe it’s because communicating through tech feels more natural to them, or maybe the computer screen helps them feel a bit more anonymous. Either way, it’s an option to consider if your child is refusing therapy.

Depending on your child’s interest, you might even be able to find a hyper-specific group that plays to their passions and strengths. For example, my online D&D group for middle schoolers can be a helpful first step into meeting peers and giving therapy a try.

My Child Still Refuses to Go…Is It Ever Okay to Force a Child to Attend Therapy?

It’s possible that you’ll say and do everything you can to cast therapy in a positive, non-judgmental light, and it still won’t change your child’s mind. Some kids fell so sure that therapy won’t help—or so uneasy about going—that they’ll put their foot down, no matter what.

It’s really hard to “therapize” a person who doesn’t want to be in therapy. In an ideal world, a therapist and client are equal partners in the therapy room, with both people bringing in ideas and nobody acting like the boss of anyone else. If a child is forced to attend, it immediately puts them in a low-status position and makes the therapist the boss. That makes it hard to grow.

I will sometimes ask kids and teens who are unsure about therapy if they’d be willing to give it a try for a set number of sessions, like 3 or 4. If your child is on the fence, you may want to give this approach a try—you might be pleasantly surprised! However, if after those sessions your child wants to end therapy, hold up your end of the bargain.

If a child is forced to attend therapy long-term against their will, it may give them a negative perception of therapy and keep them from seeking help in the future. I’d rather give kids a sense of agency, and let them return to therapy on their own terms when they feel ready to do the work.

There’s one big exception to this rule: if a child is self-harming or feeling suicidal, they need to be in therapy no matter what. However, these kids may need more support or a more specialized approach than once-a-week therapy can provide. If you think your child is at risk of serious harm, speak to a guidance counselor or pediatrician or, in an emergency, dial 911.

How Do You Help a Child or Teen Who Doesn’t Want Help?

So, you’ve determined your child is not going to therapy. Maybe you tried a few sessions and it didn’t work out, or the therapist you found didn’t seem to be the right fit. Now what? How do you help a child who refuses help?

If a child is absolutely dead-set on going to therapy, and there are no safety worries like self harm or suicidal thoughts, forcing a child to go to therapy can do more harm than good. It reinforces the idea that therapy isn’t really for helping, it’s a punishment for bad behavior. It will make it even harder for your child to feel safe enough to give therapy a try in the future.

On the other hand, kids are growing and changing all the time. Many Gen Z and younger kids view therapy in a positive way, so it’s likely your child will learn more positive things about mental healthcare from peers as she grows. By respecting your child’s decision and continuing to check in about therapy as an option, it’s possible she’ll come around to the idea on her own.

In the meantime, your best option is to get yourself into therapy. I know it’s a suggestion that gets recommended a lot and it may not feel great to hear. However, therapy with a counselor who specializes in working with parents can equip you with the tools you need to help your child—whether they attend with you or not. Parents have so much influence over the lives of their children and the culture they choose to create in a home. When you take the time to care for yourself, it almost can’t help but rub off on your children, too.

In-Person and Online Therapy for Kids in Charlotte, NC

I love working with tweens and teens struggling with anxiety, and have some therapy options that go beyond the usual sit-on-the-couch-and-talk to meet kids where they feel most comfortable. Even super reluctant young children are often excited to attend play therapy, which uses kids’ natural creative instincts to work through feelings using actions instead of words. Older kids and teens may prefer online therapy, which feels a little less intrusive than being face-to-face.

If your child has a passion for games or geek culture, you may also want to consider my Dungeons and Dragons-based groups for middle schoolers. They’re an introvert-friendly space to meet new people and practice social skills in an online setting that still feels meaningful.

Interested in getting started? You’re always welcome to contact me here.

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

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

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

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

What Causes Depression in Children and Teenagers?

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

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

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

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

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

• Chronic physical health problems

• Social isolation

• Poor sleep or nutrition

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

How is Depression Diagnosed in Kids and Teens?

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

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

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

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

• Decreased interest or enjoyment of activities most days

• Unintentional changes in weight or appetite

• Noticeably slower thoughts, speech, or movement

• Feeling tired or low on energy

• Feelings of guilt or worthlessness

• Difficulty thinking, concentrating, or making decisions

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

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

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

Signs of Depression in Children

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

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

• Trouble concentrating at school

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

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

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

• Difficulty handling rejection or criticism

• Low self-esteem

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

Symptoms of Depression in Teenagers

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

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

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

Depression symptoms specific to teenagers include:

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

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

• Frequently talking about death and dying

• Withdrawing from friends

• Dropping out of extracurricular activities they used to care about

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

• Cutting or other forms of self-harm

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

Counseling for Teens and Tweens with Depression in Davidson, NC

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

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

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

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

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

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

Panic Attacks and Anxiety Attacks Are Basically The Same Thing

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

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

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

What Does Anxiety Look Like in a Child?

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

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

• Frequent worries that seem like more than a phase

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

• Difficulty falling asleep, or trouble sleeping alone

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

• Clinginess and difficulty tolerating being alone

• Repeatedly asking for reassurance

• Irritability or seeming on edge

• Being easily startled by loud sounds or surprises

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

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

Signs Your Child Is Having Panic

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

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

• Shaking hands or full-body shivering

• Increased sweating

• Hot flashes or chills

• A racing, pounding heartbeat

• Hyperventilating, or feeling like it is hard to breathe

• Dizziness or weakness

• Tingling feelings in the fingers or hands

• A sense of losing control

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

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

Can a Child Have Both Anxiety and Panic?

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

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

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

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

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

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

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

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

Signs of Social Anxiety Disorder in Children

How can you tell whether your child is just shy, or if there’s something more going on? If you’ve noticed your child lingering on the edges of the playground or appearing uncomfortable during playdates, you might wonder if social anxiety is to blame. Social anxiety affects about 7% of Americans, and it often starts during late childhood or the teen years.

This post will cover the common symptoms of social anxiety and how they show up in younger kids. You’ll learn what to keep an eye out for, and how to spot the difference between true social anxiety and run-of-the-mill shyness.

How to Tell If Your Child Is Shy…

Kids who are shy have trouble meeting new people. While their shyness may pop up with close friends and family, it’s usually the most noticeable when talking to an unfamiliar person. Shy kids may have a hard time initiating conversations, or responding when an adult says hello. However, after spending some time with a new person, many shy kids are able to warm up and interact more comfortably.

Kids who are shy may appear soft-spoken or socially awkward at times, but their troubles are usually mild or fleeting. Shyness doesn’t usually cause major problems in a child’s life, or keep them from making at least a few good friends. Over time, many children may outgrow their shyness altogether.

…And How to Tell If Your Child Has Social Anxiety

On the flip side, kids who have social anxiety fear judgment from others. They worry about embarrassing themselves or making a mistake in front of friends, teachers, and even strangers. You may hear a socially anxious child worrying aloud about doing something wrong. This fear can be paralyzing, and it doesn’t usually get better on its own.

Because socially anxious kids fear judgment, they can definitely have a hard time talking to friends or meeting new people. However, they can have a hard time with other public activities, too. The “social” in social anxiety refers not just to friendships, but any activities that involve being observed by others. This can include things like reading out loud in class, participating in gym class, or even eating in restaurants or using public restrooms.

Signs and Symptoms of Social Anxiety Disorder

Therapists use a manual called the DSM-5 to diagnose children with Social Anxiety Disorder and other mental health problems. It tells us how many symptoms a child needs to have, and gives us a handy bullet point list of what exactly those symptoms are. It also tells us how long those symptoms need to last in order to be considered social anxiety.

Here are the “official” symptoms of Social Anxiety Disorder, according to the manual:

• Intense and ongoing anxiety about social situations due to a fear of being judged or humiliated

• Avoiding situations that trigger this anxiety, or tolerating them with distress

• The fear is exaggerated or out of proportion to the actual situation

• The anxiety gets in the way of completing day-to-day activities

In order to qualify as social anxiety, the symptoms need last for at least 6 months. There also can’t be a better reason for the anxiety, such as a physical problem or the side effect of a medication.

What Social Anxiety Looks Like in Kids

Okay, now that we know the “official” symptoms of social anxiety, let’s talk about how they actually show up in children. Some kids with social anxiety might be very vocal about their worries, which makes it easier to figure out what’s going on. Others might have a harder time putting feelings into words—or they may feel too embarrassed to talk about it.

Here are a few common scenarios that illustrate what Social Anxiety Disorder may look like in children:

• Your child loves school and learning, but absolutely dreads class presentations. He gets flushed and visibly anxious when he has to read aloud, and stumbles over his words. You have noticed he avoids these projects at all costs, even in classes where he excels. In fact, he always seems to get sick on presentation days.

• You’ve noticed your child is extremely worried about what others may think of her. She feels like all eyes are on her, even in situations where most of her peers probably have other things on their minds. Her thoughts tend to jump to the worst-case scenario, and assume other people are critical of how she dresses, what she says, or how she acts.

• Your child avoids trying out for sports or the school play, even though you have a feeling he’d love to join. Being “in the spotlight” is just too overwhelming for him, and he’d rather be able to participate without anybody looking at him. You’re worried he might be missing out on a lot of fun.

• It’s hard for your kid to order food at a restaurant or answer the phone. You’ve offered a lot of encouragement, but it’s still seems like it’s way harder for her than it should be. You’ve noticed other kids the same age don’t have the same struggle.

• Your younger child throws tantrums when it’s time to go to a birthday party or other social event. It’s hard for him to articulate why, but he dreads going. He complains of headaches and stomach aches, and starts feeling on edge the night before it’s time to go.

Do any of these sound like your child? If so, chatting with a children’s therapist can help you confirm whether or not your child is dealing with Social Anxiety Disorder.

Counseling for Kids with Social Anxiety

Counseling can help your child to overcome her worries, so she can participate more fully in life without a fear of being judged. Therapy approaches like cognitive behavioral therapy can help kids learn how social anxiety affects their thoughts. It can be a big relief for socially anxious kids to realize that, most of the time, other people are focused on their own lives and not thinking negatively about us at all!

Younger children with social anxiety can benefit from play therapy, too. Even if it’s too hard (or embarrassing) to talk about worries out loud, children naturally express their anxieties through their play. A play therapist can help kids work through these feelings in a non-threatening way, and even use play and storytelling to help kids learn coping skills to manage their worries.

If coping skills sound like the way to go for your child, you can also check out my online coping skills courses. My anxiety skills course, Worry-Free Kids, is a good fit for older kids with social anxiety.

I’m a CBT and play therapist in Davidson, North Carolina. I love helping kids with anxiety to learn that they don’t always have to listen to the worries that anxiety gives them. I get to see kids build their self-confidence and face their fears every day in my office, which is part of why I love my job. Even if you don’t live in the Lake Norman area, I may be able to help: I offer throughout North Carolina, New York, and Florida.

If you are ready to take the next step with counseling for childhood social anxiety, you can reach out to me here to set up an appointment.

How Do I Talk to My Child About Counseling?

You know your child better than anyone, and lately, things just don’t seem right. Maybe you have noticed your child seems to be more worried than other kids her age. Or, you’ve been waiting to see if your child’s tantrums were just a phase, but they’ve stuck around long past the toddler years. After consulting with friends, the pediatrician, or “Dr. Google”, you’ve decided that child counseling could help. How do you tell your child you’d like her to see a therapist? It’s not a conversation most families have every day, which can make it feel awkward. In this post, I’ll share some tips from my experience as a children’s therapist on how to introduce therapy to your child in a positive way.

Common Concerns When Discussing Counseling

The most common concern I hear from parents is that their child will think something is wrong with them if they see a counselor. Views on mental health are changing quickly, but there can still be a stigma attached to getting therapy. The last thing a child struggling with anxiety, depression, or low self-esteem needs is another reason to feel different or “bad”!

Parents of younger children often worry about separation anxiety during sessions, especially if this is one of the issues bringing a child to therapy in the first place. Will it be too frightening for their child to meet with a therapist alone? What be done to help soothe their child’s fears?

When the child is a preteen or teen, there’s sometimes a worry that kids will “shut down” or not be receptive to attending therapy if it wasn’t originally their idea. Any suggestions from Mom or Dad might be viewed with suspicion by a teen or tween. How can we explain therapy in a way that encourages kids to keep an open mind?

If any of these worries sound familiar to you, congratulations! Your concerns are totally normal and you’re in the right place. Keep reading for some tips on how to handle this important talk with your child.

Don’t Bring Up Therapy in the Middle of a Fight!

There isn’t one right way to bring up the subject of therapy. However, there are a few that are…not so great! This is one to avoid. As frustrating as arguments with your child can be—especially if this is your millionth meltdown this week—don’t let this be the way your child learns about therapy.

Telling your child you’re sending them to a therapist between screams or from behind a slammed door virtually guarantees they’ll view therapy as a punishment. It increases a child’s feelings of shame and embarrassment, which won’t help them get better. What’s more, it can turn children off to the whole idea of therapy. They enter their first therapy session feeling resentful and not trusting the therapist to be on their side. That is a hard place to start.

Instead, wait until everyone is feeling good to start a conversation about therapy. This way, your child won’t connect going to a therapist with bad behavior. Avoid times of the day when you know you or your child will be stressed, tired, or hungry. A quiet evening after dinner or snack time after a good day at school is a great time for this discussion.

Describe the Problem as Belonging to Everybody

It’s often easiest to start the “counseling talk” by identifying the problem at hand. Even if your child is showing the most symptoms, it helps to acknowledge that parents have a role to play in therapy, too. This way, the child doesn’t feel like she’s a problem that needs to be fixed: everyone is in this together.

Try to describe the problems you’re seeing in a matter-of-fact, non-judgmental way. It helps to empathize with the emotions your child is feeling, even if the behaviors may be tough. Avoid making assumptions about why the problem is happening, if you aren’t totally sure, and stick to the what instead. If you think a child’s struggles were set off by a particular event, you can always “wonder aloud” about the possible connection.

For example, if your child is having anxiety about going to school, you could try saying: “I have noticed you have had a lot of stomach aches and worries lately, and they usually happen right before it’s time to get on the bus for school. It must be terrible to feel so nervous every day! I wonder if starting in your new school has been scary. I don’t always know the best way to help you with your worries.”

Once you’ve outlined the problem and how it’s affecting your family, you can move on to talking about therapy itself.

Explain What a Counselor Is to Your Child

Children need to know that a counselor is someone who can help them—and you—deal with their big feelings. They need to know that therapy is common and not something to feel ashamed of. In fact, we could all use counseling at some point in our lives!

When I meet younger children, I often describe myself as a “feelings doctor” even though I don’t have a doctorate degree. Most little kids are very familiar with going to their pediatrician’s office, so it’s a good comparison to make. If you have a cold or hurt your arm, a doctor can help you feel better. If your worries, sadness, or anger are bothering you, a feelings doctor can do the same thing. It’s important to explain that feelings doctors can’t give shots!

I tell older children that a therapist is an adult whose job is to be there to listen to them. A therapist is different than a teacher or parent, because they can’t give out punishments or make the rules. They are also different from a friend, because you don’t have to worry about offending your therapist or giving them a turn to speak in conversation. Therapists also keep what you say private, which is helpful and reassuring for older kids to know.

Talk About How Child Counseling Works

When describing child therapy, it helps to keep things simple. Sometimes, over-describing the situation only adds to the anxiety. You might consider something like this: “When you see your therapist, you can talk or play about anything you want. She’ll help you with your strong feelings and will keep the things you say private. She’ll also meet with me to help me understand you better.”

You can also prepare your child for what the therapy session will look like. If you’ll be meeting the therapist in person, describe where the office is and how it looks. Young children are often excited to know that there will be a playroom filled with toys! Tell your child where you’ll be during their session, for example, that you’ll stay in the waiting room nearby.

If you’ll be meeting online, explain how that will work to your child. Most kids are intimately familiar with Zoom these days, but they may still have questions about how much privacy they’ll have or who exactly will be on the call with them. You can pick out a quiet, private location for video calls with your child, and practice logging into the therapy platform together. Younger children may want to pick out a few toys or art materials to “show” their therapist on the first day.

Looking for a Child Counselor in Davidson, NC?

I live and work in the Lake Norman area, just north of Charlotte, North Carolina. If you’re in my neck of the woods, I specialize in working with preteen anxiety and trauma at my Davidson child therapy office. If you aren’t local to Charlotte, I also work with kids throughout New York, North Carolina, and Florida using online CBT and play therapy. And no matter where you live, my coping skills courses are available to access and use at home.

Want to see if we might be a good fit? Feel free to drop me a line to ask questions about what to expect in therapy, or to schedule an intake appointment.