Mirrors and Windows: Why All Kids Need Racially Diverse Books

As I write this, we are right in the middle of Black History Month, and I’ve been thinking a lot recently about how I can be a better ally to my clients of color. What can I do as a white therapist, living and working in a town that is not very diverse, to better support these kids and families? One small step I’ve taken is to select images for my website, therapy office, and playroom that represent many races and ethnicities. My hope is that children who visit me in the office will feel that it is a place for them, regardless of whether or not they look like me.

Working toward this goal, I’m making sure that new toys and books that I add to the playroom reflect the children who are going to be using them. I believe this is helpful to all my clients—regardless of their background—because everyone benefits from better representation. Kids of all races need opportunities to see themselves in stories, as well as chances to see the world through other peoples’ eyes. In this post, I’ll be sharing 5 books that provide racial mirrors and windows for kids of many backgrounds, while also giving parents opportunities to introduce conversations about race.

What Are Racial Mirrors and Windows?

“Racial mirror” is a term that may be familiar to you if you’re in the adoption community, particularly if you’ve adopted a child whose race is different than your own. A racial mirror is a person whose identity matches yours, and who can reflect your own experiences back to you. Racial mirrors can help a child feel seen and validated, and also help them to imagine a place for themselves in their community and the world at large. White people have lots of opportunities for racial mirrors, usually in their own neighborhoods as well as in their schools, in politics, and on TV.

For children of color, racial mirrors can be harder to come by, especially if a child is being raised in a family of a different race or in a largely white community. While it’s important for all kids to understand prejudice, it’s just as important for all children to be able to see positive role models who resemble them. Studies show that students do better in school when they have teachers who are racial mirrors. For Black children, having at least one Black teacher in elementary school reduces the likelihood of dropping out of high school by 39%.

A racial window, on the other hand, offers children an opportunity to see into someone else’s experience of life. Children begin to learn empathy by putting themselves in someone else’s shoes, so getting lots of opportunities to see life from another perspective can help kids grow into more empathetic, caring adults. Having many racial mirrors might also help make us more skilled at solving problems creatively. Researchers have found that diverse groups of people are better at coming up with new and innovative ideas, because the individuals have gotten smarter about considering a problem from many points of view.

Why Kids Need Diverse Books

I often use books in the therapy room to gently introduce topics that might otherwise feel too overwhelming for kids to talk about. Books can make heavy subjects like trauma, grief and loss feel more manageable. They can provide kids with language to describe their feelings when faced with unfamiliar situations, like a new sibling or the first day at a new school. Most importantly, books help children know that they aren’t alone with their thoughts and feelings: other people have been where they are now, and have felt these things before.

Books aren’t a replacement for real-life role models as racial mirrors and windows. However, children learn through stories, and easily identify with characters in books. Reading stories together can be a meaningful and child-friendly way to give children more reflections of themselves, as well as glimpses into the lives of others. Because race is a taboo subject for many families, books can provide a good jumping-off point for conversations with children. Fictional stories give kids a safe remove from serious or real-life topics, which can make them less threatening to talk about. I often find that, after reading a book together, kids share takeaways that I would have never expected.

5 Books With Racial Mirrors and Windows

The following books are ones that I like, because they feature ethnically diverse children and also address themes common to children in therapy, like self esteem, friendship, and empathy:

The Day You Begin by Jacqueline Woodson

I’m obsessed with this book, and so is the rest of the internet. Maybe you’ve already heard of it! This story, written in verse like a poem, describes a girl’s insecurity about returning to a school where she feels singled out for being different. Along the way, we’re introduced to other children who also have reasons to feel left out. I love this book because children of all backgrounds can see themselves in it: white kids, Black kids, kids living with a disability, and kids of various economic backgrounds. The story is open-ended enough that it allows children to put themselves into the narrative, while also making it easy to discuss race and other differences. The text and illustrations are both beautiful, and make this book feel really special.

Even Superheroes Have Bad Days, by Shelly Becker

This cute, brightly-illustrated book uses a cast of superheroes to teach kids about how to handle strong emotions. If your child is into superheroes, this could be a great way to start talking about coping skills and healthy ways to burn off anger. The gang of superheroes as well as the people they rescue are a pretty diverse group, which makes this a nice option if you’re looking for books about feelings. Other books in this series have the superheroes tackling the issues of sleep and making mistakes, so if this is popular with your child, you have more books to explore.

Lovely by Jess Hong

I just added this one to my own shopping cart. The illustrations are, well, really lovely, and I can imagine this art style appealing to lots of little girls in my practice. I love that the author of this book is an Asian-American woman. Aimed at younger children, this book is light on text and heavy on illustrations, and uses contrasting words to show how all different ages, body types, hair colors, and skin tones are worthy of being celebrated. The only downside is this appears to be out of print, and is a little hard to find.

Sulwe by Lupita Nyong’o and Vashti Harrison

A beautifully illustrated and popular book co-written by actress Lupita Nyong’o, this book addresses colorism from the point of view of a young girl who feels ashamed by the darkness of her skin. This book has a fairytale quality and incorporates fantasy elements that help children connect with the story and elevate the message of the book. This book won a Coretta Scott King award for its illustrations, and is a New York Times bestseller.

All the Colors We Are by Katie Kissinger

This bilingual, photo-rich picture book gives young children language to understand the concept of race. I like that it discusses that our skin color comes from melanin and our ancestors, and acknowledges that members of a family can have different shades of skin. This seems like a great way to explore the subject of race and ethnicity that doesn’t split people into a binary of “White” and “not White”. I can imagine that children appreciate being able to see real photos of other children, and to get a chance to see themselves and lots of other kids reflected in this book.

More Resources for Racially Diverse Books

If you are specifically looking for books with racial mirrors for Black children, or books that celebrate the Black experience, you can’t go wrong with Coretta Scott King Award-winning books. This award is given each year to an African-American authors and illustrators of children’s books that “demonstrate an appreciation of African American culture and universal human values.” These books are intended for many different age ranges, so you’ll find picture books as well as longer chapter books and YA novels.

This list of 21 Multicultural Books About Feelings was a great resource for this post and has many more options for books with a therapeutic bent that also happen to feature a diverse cast of kids.

I hope this post gave you some ideas about how you can use books to help your child see themselves and others through stories. You can always reach out to me here with questions about how counseling can help children dealing with anxiety, trauma experiences, and other life stresses.

4 Coping Skills to Help Children with Depression

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

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

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

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

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

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

Here are a few positive, rewarding activities to consider:

• Making a meal or a snack together

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

• Taking the dog for a walk

• Re-arranging a child’s bedroom

• A movie night with a friend
  

Depression Coping Skill #2: Talk Back to Negative Thoughts

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

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

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

• Do I have any proof this is true?

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

• Is there another way of looking at this?

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

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

Depression Coping Skill #3: Add More Sunshine

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

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

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

Depression Coping Skill #4: Practice Good Sleep Hygiene

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

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

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

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

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

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

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

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

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

Begin Therapy for Kids with Depression in Davidson, North Carolina

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

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

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

Internet Safety for Children: An Age-By-Age Guide

When I was three, my Dad brought home our first computer. It was an enormous, boxy thing that ran on MS-DOS and made screeching noises for about 5 minutes as it booted up. I was thrilled! Having access to games and limitless information was magical. Today, children are growing up in a world where they are inundated by internet access, and that access carries many more risks than it did when I was a kid in the ‘80s and ‘90s. I often hear that parents are questioning whether or not their child is old enough to go online, or how they can make sure their child is getting safe, age-appropriate experiences on the internet. Read on for tips on how to keep kids safe online, according to age.

Kids and Tech: The Pros and Cons

It can be tempting to try to keep kids off the internet entirely, to minimize the risk of them being exposed to dangerous or inappropriate situations. As scary as these risks can be at times, I think most children benefit from age-appropriate access to the internet. The internet has become most peoples’ primary source of information, and it can connect kids with tons of free resources to complete school assignments and generally learn about the world.

Lots of kids’ culture is now based online, and a child with no access to the internet is likely to feel left out of conversation with peers. I often hear from children that their desire to fit in with their classmates is their number one reason for wanting to go online or play a particular game. It’s important for children to feel like they’re a part of their peer group, and I think this is a valid reason to give kids exposure to at least some pop culture online.

On the other hand, there are very real dangers to unrestricted internet access. We’ve all heard horror stories about internet predators actively targeting children, sometimes with devastating results. Even if kids aren’t able to directly chat with anyone online, it’s very easy for children to come across violent material, hate speech, sexually inappropriate material, or even plain old fake news that can cause confusion. Often, children aren’t even seeking out this material but may stumble upon it anyway: for example, YouTube automatically queues videos to play, and has a bad track record of accidentally allowing disturbing videos into child-friendly feeds.

The internet is so pervasive now that it’s almost impossible to fully block a child’s access. Even if kids don’t have access at home, it is easy for them to sneak onto a friend’s smartphone at school, or get access in a public place. When internet access is completely forbidden, it can become “forbidden fruit” that is even more appealing to children. Providing structured, supervised access to the internet at a young age can help kids feel connected to their friends, while also teaching them safety skills that will help them navigate the internet more responsibly as they grow up.

Internet Safety for Preschoolers

Preschool-aged children have vivid imaginations, and it’s difficult for them to differentiate between what is real and what is pretend. Characters from TV, movies, and the internet can easily be frightening to young kids, and lead to nightmares and other anxiety-related problems. Preschoolers also don’t have the problem-solving skills yet to keep themselves safe online. For these reasons, it’s a good idea to put strict limits on screen time, and only allow preschoolers to use a computer if you’re sitting right beside them. Children at this age don’t need to be online, but Internet Safety 101 recommends that if you’d like to start teaching computer skills to your child, you can introduce them to age-appropriate educational games.

Internet Safety for Early Elementary Students

Kids in the early elementary school range (ages 5-7) are still working on separating what’s real from what’s pretend, and can still be prone to nightmares and anxiety from cartoon characters and other media. Most kids this age can already easily navigate a phone, type things into Google, and may even figure out how to make online purchases. For this reason, kids this age should always be supervised online. You might want to consider investing in parental control software to limit the places your child can go online, or limit them to a handful of websites you’ve already checked out and know are safe. Elementary school kids should never be able to chat with other people online, or give out any real information about themselves.

Internet Safety for Late Elementary Students

Older elementary school kids (ages 8-10) are maturing and crave more independence. Some kids this age may already have their own phone or tablet. Games like Minecraft and YouTube channels for kids are a huge part of popular culture for kids this age, but children this age are trusting and can still be easily tricked or scammed by adults online. Experts recommend keeping a family computer in a public area of the house, rather than in a child’s bedroom, and continuing to filter their internet access. Some kids may be ready to chat with friends on child-friendly platforms but shouldn’t be allowed to comment on sites with adults. Parents should still be supervising internet use, and can begin to teach kids about online safety.

More Resources for Kids and Parents

Internet Safety 101 is a fantastic resource for families that goes into more depth on how to help kids of all ages use technology in a safe way. I also recommend exploring options for parental control software to filter inappropriate websites, as well as apps like Bark that monitor kids’ computer and phone use for keywords that might signal a problem with bullying or other issues. If you’d like more guidance on this or other parenting concerns, and would like to hear about how counseling can help, reach out to me here.

Slimed Out? 3 Sensory Play Alternatives to Making Slime

I am fully on board with the slime trend. Slime is an easy way to add more sensory play to a child’s life. Sensory play—any kind of playful activity that engages the 5 senses—can be emotionally soothing and also helps children to develop and learn. I have to confess, though, that sometimes I get tired of slime. It is messy. It can be expensive. Sometimes you’ve got to take a break from burning through that much Elmer’s glue. If you (like me) occasionally feel a little “slimed out,” I hope some of these sensory play activities will be good alternatives to making slime.

Slime Alternative #1: Orbeez

What it is: Have you ever seen those little plastic pellets in potting soil? That’s what Orbeez are. These tiny spheres are made out of a plastic-like substance that absorbs many times its weight in water, turning into a squishy, jelly-like ball when hydrated. If you’ve ever had bubble tea, they look and feel similar to boba. They also remind me a little of fish eggs, which is kind of icky.

How to play with it: Kids love the squishy, wet texture of Orbeez, which have a similar sensory quality to slime. You can pour Orbeez into a big bin and play with them like you would a sandbox, using shovels, funnels, or other sand/water toys to move them around. Some kids love to submerge their hands or even their feet in Orbeez. We’ve also experimented in the play therapy office with making stress balls by funneling Orbeez into a balloon.

The pros: Unlike some slime recipes, Orbeez are nontoxic and biodegradable…but please do not test this by eating them! Because Orbeez are solid, they’re easier to clean up than slime, and less likely to get stuck on carpets or furniture.

The cons: Orbeez take a while to hydrate, so you can’t use them right away. Orbeez can be reused, but eventually they may stop rehydrating or become moldy, so eventually they need to be replaced.

Slime Alternative #2: Shaving Cream “Snow”

This “snow” is made by combining shaving cream with either baking soda or cornstarch to create a light, fluffy, snow-like mixture. It naturally feels cool to the touch, and can be packed and molded like the real thing. You can find a recipe here.

How to play with it: Kids may enjoy packing their “snow” into snowballs or making snowmen, especially if they live in a place where snow isn’t common. Children can also use miniatures in the snow for imaginative play. Sand and water tools could also be useful to dig and sift through the snow.

The pros: With only 2 ingredients, this is a much simpler recipe than slime. Because there’s no Borax, it’s less likely to irritate sensitive skin. Also, this white snow doesn’t require any food coloring, so there’s less risk of staining skin or clothing. I have found shaving cream is much easier to clean up than slime.

The cons: Not everyone is crazy about the scent of shaving cream. Although less likely to stain, you may still have some mess to deal with after playtime is over.

Slime Alternative #3: Dry beans, pasta, or rice

This one is an old favorite of occupational therapists, who often use play activities like this to help children with sensory processing issues. Dried beans, pasta, and rice can be a fun indoor alternative to a sandbox, particularly for younger children. You can buy these in bulk, and different types of beans will provide different color and textures, changing the sensory experience.

How to play: You can create a sort of indoor sandbox by pouring the dried item(s) of your choice into a large Tupperware container. Be sure to put a blanket or tarp underneath to catch any spills! Some kids enjoy hunting for “buried treasure” in the box, searching for small toys or plastic coins. Others might prefer to sort the items by color, which can also be a soothing activity. I’ve seen many kids try to climb in the box, which is a great sensory experience but has a higher risk for mess!

The pros: Because these items can be bought in bulk and last a long time, this is a cheap and effective option for sensory play. The dry ingredients won’t stain, but may need to be swept or vacuumed when playtime is over. Since all these items are food items, they aren’t likely to cause a problem if someone nibbles on one.

The cons: While they won’t mess up clothing or fabric, you probably will be left with some stray pieces to pick up or vacuum. This is a very different texture to slime, so it may not be quite as satisfying as a slime alternative for kids who want that squishy feeling.

More Sensory Play Alternatives to Slime

If you’re needing more ideas for slime alternatives, there are tons of sensory play suggestions online. Check out this site for more ideas for how to make a simple “bean box” fun and exciting for younger kids. This seasonal Christmas play-doh recipe is a little more labor-intensive, but also looks really fun for winter. To learn more about how play helps kids to develop learning and emotional skills, check out my play therapy page.

If you’re in the Davidson area, I’m always happy to chat more about the benefits of play therapy for kids. You can reach out to me here.

Are Imaginary Friends Normal?

Your child is excitedly telling you about her new best friend. They seem to be inseparable! You’re hearing all kinds of stories about their adventures, and even a few of their arguments. There’s only one problem… your kid’s friend has superpowers, has a strange name, is invisible, and is totally made up.

It can be jarring for parents when a child has an imaginary friend, especially if the child has gotten deeply invested in the friendship. Parents may wonder if their child is lonely, or if the friend is a sign their child can’t tell the difference between reality and pretend. In this post, I’ll talk more about the interesting phenomenon of imaginary friends, and why it’s totally normal if your child has one.

How common are imaginary friends?

Research on imaginary friends has found that about 65% of kids will have an imaginary friend at some point during childhood. So, if your child has dreamed up a new companion for himself, he’s in good company. Firstborn and only children are more likely than other kids to create an invisible friend, possibly because they are spending more time playing independently.

At what age do imaginary friends start?

Invisible friends are an extension of a child’s normal make-believe play. Kids usually start this kind of play in the late toddler or early preschool years, so imaginary friends can develop as early as two-and-a-half or three years of age. Studies have shown that kids between the ages of 3 and 5 are the most likely age group to have an imaginary friend.

How long do imaginary friends last?

An imaginary friend can be present in a child’s live for anywhere from a few months to a few years. For most children, imaginary friends taper off by late elementary school—around age 8 or 9. For a few kids, though, invisible friends can last much longer, even into the teen years. As long as an older child’s imaginary friend isn’t getting in the way of his or her social life, this can still be a healthy expression of imagination.

Imaginary friends are a sign of creativity, not loneliness

Kids with invisible friends are no more likely to be lonely than any other child. Although an imaginary friend may be a convenient form of entertainment on days that a playmate can’t come over, they don’t necessarily mean a child is unhappy or doesn’t have real-life friends. In fact, the more researchers learn about imaginary friends, the more benefits they find to having one. Children who have imaginary friends are often highly creative, and can easily lose themselves in stories. This trait can last a lifetime, leading kids to artistic pursuits later in life.

Because an imaginary friend is a heightened form of make-believe, it can offer children the same benefits as imaginary play. Children with a pretend friend are practicing social skills through role play, which can strengthen their real-life socializing with peers. An imagined friend can also be a source of support for children during stressful times, helping them to make sense of the world around them.

Also, in my own experience, kids are almost always aware that their imaginary friend is not real. If you ask about the difference between real and pretend, the child can easily differentiate between the two, and might even share with you that their friend is make-believe. Imaginary friends are real for a child in the same way that a doll or stuffed animal are “real”: the emotions feel genuine to the child, but she knows the difference between play and reality.

How to support your child’s (totally normal) imaginary friend

If your child has an imaginary friend, congratulations! Here are a few suggestions for how to navigate issues that can come up with a make-believe companion:

• If your child is blaming bad behavior on an imaginary friend, you don’t have to play along! It’s fine to tell your child this is not something that their imaginary friend could have done and to offer consequences as usual.

• It’s okay to have discussions with your child about the difference between real life and pretend. Kids with vivid imaginations can be prone to fear and nightmares from scary movies and stories, so reinforcing that scary characters don’t exist in real life can be reassuring.

• Try not to tell your child how their imaginary friend behaves. Invisible friends are ghly personal—they’re an extension of the child’s own imagination—so this can feel confusing or upsetting for kids. Instead, ask them questions about what their friend is up to, and follow along with your child’s stories about their friend.

Can an invisible friend ever be a problem?

An imaginary friend is almost always a normal, healthy part of child development. Rarely, it can be a sign of a deeper problem that needs to be looked into. Sometimes, children who experience trauma develop imaginary friends as part of dissociation—a way of distancing or disconnecting from reality during a stressful time. If a child’s imaginary friend says cruel or hateful things to the child, or encourages them to behave badly, this could also be a cause for concern. Finally, if a child’s imaginary friend is getting in the way of socializing with real-life kids, especially at an older age, it is no longer helpful to the child.

The overwhelming majority of kids with invisible friends will never encounter these kinds of problems. However, if you notice these traits in your child, it’s a good idea to review them with your child’s pediatrician. They may benefit from counseling or other assistance to help get back on track.

If you’re located in the Lake Norman area of North Carolina and you’d like to learn more about how to support highly imaginative kids through counseling, feel free to reach out to me.

How to Help a Child with Separation Anxiety

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

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

Signs and Symptoms of Separation Anxiety

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

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

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

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

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

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

How Parents Can Help Kids with Separation Anxiety

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

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

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

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

Child Therapy for Separation Anxiety in Davidson, North Carolina

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

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

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

Anger Management: 3 Coping Skills for Kids

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

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

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

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

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

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

Anger management Coping Skill #2: Journaling

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

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

Anger Management Coping Skill #3: Positive Self-Talk

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

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

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

More Coping Skills Help for Anger Management

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

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

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

Why is my kid obsessed with slime?

If you are a millennial like me, you might remember Gak. It was a toy sold by Nickelodeon in the 1990s, and came packaged in brightly colored plastic containers. It was more goopy than play-dough, more stretchy than silly putty, and if you squeezed it…it made rude-sounding noises. Old TV ads for Gak show a dowdy old teacher recoiling in disgust as kids stretch and squeeze their slimy toy.

I was OBSESSED WITH GAK. And so were a lot of other kids! If only I had known that you can make this squishy product at home with Elmer’s glue and Borax. I would have been swimming in it. Like so many other things from the 90s, Gak is cool again. Kids today are obsessed with slime: they make it at home using household ingredients like contact solution and shaving cream. They buy it from the store in a rainbow of colors and textures. There are even Etsy shops dedicated to selling artisanal slime.

Slime is messy. It can dry up and get stuck on carpets and furniture. It can stain fabric and skin. It uses up lots of ingredients and can get expensive to make. Have we all become the Nickelodeon teacher, turning our nose up at slime? Why are kids of all ages so fascinated by this gooey stuff? In this post, I’ll be looking into why kids are so obsessed with slime, and how it could actually help their mental health.

What are the benefits of slime?

It is true that slime has some downsides: it’s messy, it can be expensive, and it can get tiring to keep sacrificing bowls and utensils to a child’s slime-making pursuits. On the other hand, making and playing with slime can have some real benefits for kids, including the following:

• Manipulating slime and measuring ingredients can strengthen fine motor skills.

• Experimenting with slime recipes helps kids learn about cause and effect, and how to deal with failure. If a child doubles the glue or adds extra glitter, it could result in a “slime fail”, but the child has learned something about trying new things.

• It’s an appealing alternative to screen time. Many kids are so interested in slime that they’ll happily give up some TV or video game time to make it.

• Many kids say that slime has a calming, focusing quality. Slime is a form of sensory play, meaning it stimulates the senses. Sensory play can be soothing for kids, and is often used in play therapy for this reason.

Kids need sensory play

Today’s children have less time to play outside, shorter school recess, and more screen-based time than the generations before them. All of this equates to fewer opportunities to be messy. When was the last time you saw a child make a mud pie? “Messy” play experiences, like slime, are a form of sensory play that enriches a child’s awareness of their bodies and senses. Kids need this kind of play to grow and develop, and many children aren’t getting enough.

Slime helps kids get in touch with almost all the senses: they focus on how it feels, sounds, looks, and smells. This can lead to more self-awareness, as well as awareness about the world around them. Sensory play also helps children to develop: it’s been shown to boost language skills, problem solving skills, and cognitive abilities. The unmet need kids have for this kind of healthy play may explain the current obsession with slime.

Slime promotes mindfulness and grounding

When a child is focused on the tactile experience of playing with slime, they aren’t focused on their thoughts. Getting immersed in a sensory activity, like slime, can help kids focus on their experience in the present moment, rather than worrying about the future or replaying the past events of their day.

Mindfulness is the practice of being aware and accepting of what is happening in the present. It’s a simple concept, but it can be difficult to do. Mindfulness is often taught to adults and children as a way to handle overwhelming feelings like anxiety, and to help people feel more relaxed and focused in daily life. Focusing on body sensations is one way of practicing mindfulness, and so slime play can be a mindful experience for kids.

Grounding skills are anything that a person can do to help them feel more “rooted” or “grounded’ in the present, rather than allowing their mind to drift elsewhere. Grounding skills are often used with people following a trauma, to help them feel more secure and manage flashbacks. Sometimes, people are coached to give themselves a strong sensory experience, like a hot shower or holding a cold ice cube, as a form of grounding. Although it’s not exactly a grounding technique, I think slime provides a similar sensation that could have a grounding effect for kids.

At what age do kids become obsessed with slime?

As far as I can tell, kids of almost every age are interested in slime. It’s one of the only activities in my office that appeals to preschoolers as well as preteens. Slime is so much a part of kid culture right now that children of all ages know what it is. I have even had older teens request to go to the playroom to try out making slime. Interestingly, slime is becoming increasingly popular with adults, too: a pop-up shop just opened in New York City targeting grown-up fans of slime. It seems like everyone could use more sensory play in their lives, regardless of age.

Can slime ever be dangerous?

Some slime recipes include ingredients like Borax, which are not safe to eat and can cause irritation to the skin in large quantities. I recommend that young children should always be supervised when playing with slime, and it should be stored safely away from toddlers and young children who might be tempted to eat it. For most people, the small amount of Borax in slime is not likely to cause irritation, but I always wash my hands (and children’s hands) when finished playing, just in case.

Slime in play therapy

I always keep slime ingredients on hand in my therapy playroom. It’s a great way to break the ice when welcoming a new child into play therapy. Because the sensory element of slime is relaxing, it can help kids relax and feel more comfortable in a new situation. Slime can also help kids to self-soothe after a session that has been “deep” or difficult. It can give children a sense of control over their environment, since they get to control what goes into the mix. Finally, it’s just plain fun for kids, and fun in itself can be therapeutic. I find that many kids really enjoy slime for the first few sessions in therapy, and then are ready to move on to other things.

If you’re curious about how sensory play and play therapy can help kids become more mindful, you may want to check out my page on play therapy. This list of 31 activities is also a great jumping-off point for sensory play at home. If you’re located in the Lake Norman area in North Carolina and would like to talk more about how play therapy could help your child, you’re welcome to contact me.

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

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

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

What Are PANS and PANDAS?

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

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

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

What Are the Symptoms of PANS and PANDAS?

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

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

• Symptoms of OCD, like ritualized behavior or repeated worries

• Anxiety symptoms, like sudden separation anxiety

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

• Changes in eating and bathroom habits

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

How are PANDAS and PANS Diagnosed and Treated?

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

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

Controversies: Are PANS and PANDAS Real Illnesses?

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

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

Can PANS and PANDAS be Cured?

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

CBT for Children with PANS and PANDAS

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

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

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

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

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

ERP for Kids with OCD Symptoms Due to PANS and PANDAS

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

Help for PANS and PANDAS in Davidson, North Carolina

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

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

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

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

3 Quick and Easy Coping Skills for Kids with Anxiety

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

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

What’s a Coping Skill, Exactly?

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

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

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

Why Do Kids with Anxiety Need Coping Skills?

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

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

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

How Coping Skills Work for Anxious Children

Coping skills can work in a few ways:

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

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

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

Coping Skill for Anxiety #1: Breathing in a Box

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

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

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

Coping Skill for Anxiety #2: Squeeze and Relax

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

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

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

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

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

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

More Coping Skills Resources for Anxious Kids in North Carolina

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

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

How to Help Grieving Children Through Christmas

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

Involve Your Child in Holiday Planning

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

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

However Your Child Feels About Christmas is Okay

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

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

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

Tell Stories About Your Loved One

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

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

Read Children’s Books About Grief

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

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

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

Take Care of Yourself During the Holidays

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

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

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

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

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

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

How Do I Teach My Toddler Gratitude?

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

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

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

Be a Good Role Model

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

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

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

Catch Your Toddler Being Good to Encourage Gratitude

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

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

Encourage Your Child to “Help”

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

Read Books to Teach Toddlers About Gratitude

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

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

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

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

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

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

2 Play Therapy Techniques to Encourage a More Thankful Mindset

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

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

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

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

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

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

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

Give Them Responsibility

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

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

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

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

Less is More

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

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

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

ERP Therapy for Children

How Exposure and Response Prevention Helps OCD

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

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

What is ERP Therapy?

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

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

Can Young Children Have OCD?

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

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

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

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

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

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

How Does ERP Therapy Work with Children?

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

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

“Bossing Back” OCD Thoughts with ERP

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

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

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

Doing the Opposite

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

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

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

More Resources on ERP Therapy for Children

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

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

TF-CBT for Preschoolers: Therapy for Early Childhood Trauma

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

Preschool Trauma is Common

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

Some common causes of childhood trauma among preschoolers are:

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

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

• Physical, verbal, or sexual abuse

• Witnessing physical or verbally abusive arguments between parents

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

How PTSD Affects Preschoolers

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

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

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

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

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

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

How does TF-CBT for Preschoolers Work?

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

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

Helping Preschoolers Move Beyond Trauma with TF-CBT

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

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

Signs of OCD in Children: What Parents Can Look For

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

Obsessive-Compulsive Disorder: Stereotypes vs. Reality

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

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

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

Common OCD Symptoms in Children

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

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

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

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

What Are the Most Common Signs of OCD in Children?

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

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

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

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

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

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

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

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

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

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

• Counting or arranging items in a specific way

• Repeatedly asking for reassurance from parents or friends

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

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

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

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

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

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

Drama Therapy for Children: Express Yourself Through Theater

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

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

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

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

Drama Therapy for Children: No Theater Experience Required

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

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

Why Drama Therapy is a Natural Fit for Children

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

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

What Kinds of Children Benefit from Drama Therapy?

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

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

• Children on the autism spectrum

• Children who are acting out behaviorally

• Children who are recovering from a serious injury or illness

• Children who have experienced trauma or loss

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

Benefits of Drama Therapy for Kids

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

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

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

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

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

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

Learn More about Drama Therapy for Children

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

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

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

What to Do When Your Child Won't Eat Anything

Help for Picky Eaters

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

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

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

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

Is picky eating ever a serious problem?

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

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

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

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

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

What causes picky eating in children?

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

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

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

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

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

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

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

More help for kids who won’t eat anything

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

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

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

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

Anxiety About Going to School…In October?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What's a Registered Play Therapist?

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

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

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

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

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

What is a Registered Play Therapist?

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

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

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

Who Should See a Registered Play Therapist?

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

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

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

• Anxiety and phobias

• Tantrums or behavior problems

• Grief and loss

• Trauma

• Social skills difficulties

• Problems in family relationships

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

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

How Are RPTs Different Than Other Therapists?

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

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

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

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

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

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

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

Find a Registered Play Therapist in Davidson, North Carolina

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

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

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

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