Can You Do Cognitive Behavioral Therapy Online?

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

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

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

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

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

What Will I Do in Online Cognitive Behavioral Therapy?

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

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

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

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

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

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

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

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

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

Does Online CBT Work With Kids?

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

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

Online CBT for Kids in North Carolina

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

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

What Age Can A Child Start Therapy?

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

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

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

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

Can Really Little Kids Benefit From Counseling?

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

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

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

When Can Children Go to Therapy By Themselves?

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

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

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

How to Tell if Your Child Is Old Enough for Therapy

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

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

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

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

• Your child has started verbalizing thoughts and feelings.

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

Signs That Therapy Could Help Your Child

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

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

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

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

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

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

• The problems started after a stressful event

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

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

Begin Child Therapy in Charlotte, North Carolina

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

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

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

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

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

Why Consider Online Trauma Therapy?

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

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

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

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

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

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

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

What is TF-CBT?

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

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

How Does TF-CBT Work Online?

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

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

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

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

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

The Benefits Of At-Home Therapy for Trauma

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

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

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

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

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

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

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

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

How Often Should a Child See a Therapist?

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

Kids Need to Attend Therapy Regularly to See Change

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

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

Weekly Therapy Sessions Work Best for Most Children

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

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

Younger Children Need More Frequent Therapy

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

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

Older Kids Can Sometimes Be Seen Less Often

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

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

Do Kids Ever Need Therapy More Than Once a Week?

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

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

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

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

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

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

Going More Often Might Mean Fewer Sessions Overall

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

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

Are You Considering Child Therapy in Charlotte, NC?

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

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

5 Classic Toys with Mental Health Benefits for Children

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

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

Baby Dolls Help Children Learn to Nurture

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

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

Play-Doh Encourages Sensory Awareness

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

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

Dress-Up Clothes Let Kids Try Out New Possibilities

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

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

Toy Weapons Help Kids Vent Anger Safely

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

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

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

Play Kitchens Strengthen Parent-Child Bonds

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

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

Learn More About the Emotional Benefits of Toys and Play

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

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

What Are Coping Skills?

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

The Definition of a Coping Skill

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

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

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

Coping Skills Are NOT Just a Band-Aid

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

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

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

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

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

Types of Coping Strategies

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

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

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

• Deep breathing exercises

• Progressive muscle relaxation

• Guided visualization

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

• Meditation

• Observing and describing your surroundings

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

• Sensory play, for younger children

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

• Journaling

• Non-aggressive physical activity

• Creating art

• Assertive communication skills

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

• Sports and recreational activities

• Hobbies that encourage a sense of accomplishment

• Spending time with supportive friends

• Volunteering

Can Coping Skills Ever Be Unhealthy?

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

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

• Procrastination

• Numbing or ignoring feelings

• Tantrums or meltdowns

• Yelling, swearing, or name-calling

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

• Drug and alcohol abuse

• Self-harm

• Violence toward others

• Risky behavior, like shoplifting or dangerous driving

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

Need Some Coping Skills Ideas for Kids?

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

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

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

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

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

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

11-Year-Olds Are Digital Natives

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

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

Preteens Crave Privacy and Independence

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

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

It’s Easier to Talk About Touchy Subjects

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

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

Preteens Have Packed Schedules

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

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

Online Therapy Offers New Ways to Be Creative

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

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

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

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

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

How to Explain Anxiety to Kids

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

Teaching Kids About Anxiety Can Help Them Tame It

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

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

Anxiety: Too Much of a Good Thing?

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

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

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

The Fire Alarm Analogy

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

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

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

Think About Word Choice with Young Children

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

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

When to Consider Therapy for Kids with Anxiety

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

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

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

PTSD in Teens: Signs and Symptoms to Look For

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

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

What Causes PTSD in Teens?

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

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

• Serious accidents, such as car accidents

• Medical emergencies

• Violence and crime

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

• Abuse or neglect from a parent or caregiver

• Sexual assault

• Witnessing domestic violence against a parent

• School or community violence

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

Can a Teenager Develop PTSD?

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

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

What are the Symptoms of PTSD in Teens?

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

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

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

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

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

Common Signs of Teen Trauma to Look For

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

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

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

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

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

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

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

How Can I Help a Teen with PTSD?

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

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

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

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

What are the Symptoms of PTSD in Children?

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

Categories of PTSD Symptoms

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

Intrusive Symptoms in Children

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

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

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

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

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

• “Spacing out” when something stressful happens

Avoidance Symptoms in Children

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

In children, avoidance symptoms may look like:

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

• Avoiding people who resemble their abuser in some way

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

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

Negative Changes in Mood or Thoughts in Children

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

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

• Low self-esteem

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

• Difficulty with attachment or bonding

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

Increased Arousal and Reactivity in Children

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

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

• Difficulty concentrating or learning

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

• Being very sensitive to sounds or small movements

• An exaggerated startle response

• Having trouble falling or staying asleep

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

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

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

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

Does Every Kid Who Experiences Trauma Develop All These Symptoms?

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

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

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

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

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

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

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

Help! My Child Won't Stop Interrupting Conversations!

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

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

Why Does My Child Interrupt?

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

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

• Difficulty with impulse control

• Boredom

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

• Desire for attention from a parent or other adult

• Stalling to avoid an unwanted activity

Has Zoom Made Kids’ Interrupting Worse?

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

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

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

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

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

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

Boost 1-on-1 Time Together

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

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

Practice Social Skills at Home to Interrupt Politely

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

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

Model the Behavior You’d Like to See

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

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

More Ways to Help a Child Who Constantly Interrupts

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

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

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

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

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

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

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

How Parent Child Counseling Breaks the Bad Behavior Cycle

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

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

What Is Parent-Child Interaction Therapy?

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

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

The Two Phases of Parent-Child Interaction Therapy

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

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

What Kids Benefit from Parent Child Counseling Like PCIT?

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

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

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

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

• Breaking things on purpose when angry

• Difficulty following directions or being told “no”

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

How to Find a Parent Child Counselor

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

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

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

Online Social Groups for Kids Can Help Beat the Pandemic Blues

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

The Benefits of Online Groups for Kids

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

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

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

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

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

• Socializing with others can help treat and prevent depression.

The Benefits of Therapy Groups for Kids

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

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

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

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

Small Online Classes Encourage Kids’ Interests

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

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

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

Online Gaming Groups Help Children Practice Social Skills

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

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

Need More Help Finding an Online Social Group?

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

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

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

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

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

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

What Causes Depression in Children and Teens?

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

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

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

How Quarantine Increases Depression Risks for Kids

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

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

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

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

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

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

Which Kids Are Most Affected by Pandemic Depression?

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

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

Signs of Depression in Children and Teens

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

• Ongoing, prolonged feelings of sadness and hopelessness

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

• Sleeping too much or too little

• Being irritable or extremely sensitive to criticism or rejection

• Fatigue, low energy, or low motivation

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

• Decrease in self-esteem

• Thoughts about death or a wish to be dead

When (And How) to Get Emergency Help

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

• Isolating from family and friends

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

• A sudden, major shift in personality

• Increasingly aggressive or risky behavior

• Giving away important belongings

• Threatening suicide

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

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

Help for Kids and Teens With Depression During Quarantine

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

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

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

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

5 Coping Skills for Kids and Teens with Panic Attacks

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

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

What Happens to the Body During a Panic Attack?

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

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

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

The Faulty Fire Alarm

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

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

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

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

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

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

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

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

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

Panic Coping Skill #3: Sniff Some Lavender

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

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

Panic Coping Skill #4: Cut Caffeine

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

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

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

Coping Skill #5: Remember This Will Pass

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

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

More Help for Children and Teens with Panic Attacks

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

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

Begin Child Therapy for Panic Attacks in Davidson, North Carolina

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

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

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

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

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

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

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

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

What Are Sensory Processing Issues, Exactly?

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

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

How do Sensory Processing Issues Affect Kids?

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

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

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

When Sensory Hypersensitivity Looks Like Emotional Problems

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

• Extremely picky eating

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

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

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

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

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

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

When Sensory Hyposensitivity Looks Like Behavioral Problems

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

• Speaking too loudly, or craving loud music or TV

• Not giving people enough personal space

• Seemingly in constant motion, with difficulty sitting still

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

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

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

• Doesn’t appear sensitive to pain

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

How to Get Help for a Child with Sensory Issues

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

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

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

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

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

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

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

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

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

• Irritability or meltdowns that immediately follow Zoom calls

• Fidgeting, difficulty sitting still, and trouble focusing

• Unusual frustration or arguments with peers during meetings

• Headaches, eye strain, or other physical complaints

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

But Wait! Zoom Isn’t All Bad News

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

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

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

Zoom Engagement Tip #1: Add More Movement

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

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

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

Zoom Engagement Tip #2: Create the Right Space

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

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

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

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

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

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

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

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

Zoom Engagement Tip #3: Shift Your Schedule

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

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

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

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

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

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

Zoom Engagement Tip #4: Be Picky!

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

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

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

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

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

Common Preteen Behaviors, Explained

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

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

Preteen Behavior #1: Super Focused On Body Image

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

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

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

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

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

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

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

• Praise your child for things other than looks.

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

Preteen Behavior #2: Sassy, Snarky, Sarcasm

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

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

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

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

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

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

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

Preteen Behavior #3: Craving More Privacy

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

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

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

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

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

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

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

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

Preteen Behavior #4: Following Trends

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

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

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

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

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

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

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

For More Info On Preteen Mental Health…

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

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

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

How Drama Therapy Helps Kids Build Social Skills

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

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

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

How Drama Therapy for Kids Works

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

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

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

Drama Therapy Helps Kids Recognize Tone

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

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

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

Drama Therapy Encourages Teamwork

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

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

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

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

Drama Therapy Turns Strangers Into Friends

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

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

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

Learn More About Social Skills And Drama Therapy

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

Choosing a Child Therapist, Psychologist, or Psychiatrist

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

How Can I Tell If My Child Needs Therapy?

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

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

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

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

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

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

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

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

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

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

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

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

When to See a Child Therapist

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

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

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

Your child might benefit from seeing a therapist if:

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

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

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

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

When to See a Child Psychologist

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

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

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

Your child might benefit from seeing a psychologist if:

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

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

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

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

When to See a Child Psychiatrist

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

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

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

Your child might benefit from seeing a psychiatrist if:

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

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

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

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

Therapists, Psychologists, and Psychiatrists:The Bottom Line

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

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

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