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

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

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

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

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

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

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

• “Ugh, that sounds awful.”

• “That would upset me, too.”

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

• “What a rough day.”

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

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

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

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

• “You are so brave.”

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

• “You’ve got this!”

Practice Coping Skills to Relax and Manage Worries

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

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

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

Cognitive Behavioral Therapy for Teen Girls With Anxiety

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

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

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

Is Your Child a Highly Sensitive Person?

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

What Is a Highly Sensitive Person?

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

Being “Highly Sensitive” Is Not a Diagnosis

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

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

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

Signs Your Child May Be Highly Sensitive

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

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

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

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

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

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

How to Help a Highly Sensitive Child

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

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

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

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

Considering Child Counseling in North Carolina?

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

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

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

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

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.

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.

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.

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.

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.

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.

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.

Should My Child See a 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.

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.

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

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

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

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

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

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

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

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

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

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

What Are The Signs and Symptoms of School Anxiety?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More Help for Returning to School After Covid

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

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

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

Signs and Symptoms of Germaphobia in Children

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

What’s Germaphobia, Exactly?

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

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

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

What Makes An Intense Fear of Germs More Likely?

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

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

Common Symptoms of Germaphobia In Children

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

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

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

• Intense fear or terror about contamination

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

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

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

Signs Your Child Has Germaphobia

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

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

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

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

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

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

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

Cognitive Behavioral Therapy for Kids With Fears of Germs

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

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

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

Coping Skills for Kids to Manage Coronavirus Anxiety

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

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

Coronavirus Coping Skill #1: Imagine a Peaceful Place

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

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

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

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

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

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

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

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

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

Coronavirus Coping Skill #2: Worry Breaks

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

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

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

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

Coronavirus Coping Skill #3: Outdoor Movement

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

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

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

Coronavirus Coping Skill #4: Mindful Sensory Play

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

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

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

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

• Coloring with scented markers, crayons, or pencils

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

• Mixing washable paint colors in a sealed ziploc bag

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

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

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

More Resources for Kids Coping with Coronavirus Anxiety

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

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

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

What Causes Anxiety in Tweens?

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

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

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

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

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

Tween Anxiety Cause #2: Preteen Bullying Is The Worst

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

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

Tween Anxiety Cause #3: Body Image Awkwardness

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

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

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

Therapy Can Help Preteens Manage Their Anxiety

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

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

Will We See More Agoraphobia Symptoms in Children After Coronavirus?

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

First Of All—What Is Agoraphobia?

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

• Leaving the house

• Riding on public transportation, like a city bus

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

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

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

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

During Quarantine, Everyone Is a Little Agoraphobic

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

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

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

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

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

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

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

Is Agoraphobia Common in Children?

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

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

Signs and Symptoms of Agoraphobia in Children

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

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

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

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

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

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

How to Help a Child With Agoraphobia

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

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

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

Does Your Child Need More Help?

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

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

How Preteens Are Stressed About Covid-19 (And How You Can Help)

Preteens are often left out of discussions about mental health. Not quite little kids and not quite teenagers, it can be harder to find resources that are meant just for them. I was interviewed recently for an article on Healthline about how kids of different ages are dealing with coronavirus stress, and it inspired me to dig a little deeper into how tweens, in particular, are being impacted by the pandemic. I’ll be sharing some of the worries I’ve noticed are on preteens kids’ minds, and how parents can support their tweenage kids through this time.

What’s Considered “Preteen”?

For the purposes of this post, I’ll be considering ages 10-12 as preteen kids. Typically, kids in this age group are getting ready for or just starting middle school. Many children this age—especially girls—are dealing with the physical and emotional changes of the beginning of puberty. Lots of preteen kids are still playful and imaginative, but they’re also developing more of an interest and awareness of teen culture. It’s an interesting in-between time in a kid’s life, and it’s one of my favorite ages to work with in therapy.

Preteens Worry About Family Due to Covid-19

Preadolescent kids have more strongly developed empathy than kids in the younger age ranges. Whereas younger kids may be most worried about their personal safety during the pandemic, preteens have more awareness of how the coronavirus might also impact people around them. Since preteens have more access to the internet and media, they’re more likely to know basic facts about the pandemic, and understand that kids are not usually seriously affected by the virus. However, they’ve also heard that older people are more susceptible, which can lead to worries.

Many of the preteens I work with are voicing concerns about the well-being of their adult family members, both physically and financially. Lots of kids in this age group are aware of the impact the pandemic is having on employment and businesses, but they usually don’t have an in-depth understanding of their family’s own financial situation, which can lead to worries. Here are a few common worries I’m hearing from preteens about family:

• Worries that grandparents, great-grandparents, or other elderly family members or friends may contract the coronavirus and get seriously ill.

• Worries about their parents’ health if the family is affected by COVID-19, particularly if parents have pre-existing medical conditions.

• Worries about whether their parents can afford to be out of work, fears about having enough money to support the family, and concerns about how these financial changes could impact daily life.

How to Help Preteens With Family Worries

While children don’t need to know all the details of a family’s finances, it can be really helpful for preteens to hear reassurance from parents right now about how the family is planning to deal with financial setbacks. It’s often enough for kids to learn that there are no worries about continuing to put food on the table, or to hear about the family’s plans to get financial assistance to help support the family business.

On a similar note, discussing how the family is planning to care for older family members, and the steps that family members are proactively taking to stay safe, can alleviate some anxiety for preteens about the family’s health. Encouraging preteens to FaceTime or text family members who are living alone or have health concerns can empower them to feel involved in helping their relatives, and keep family connections going while social distancing.

Preteens Are Susceptible to Coronavirus Rumors

Many preteen kids have similar access to the internet and smartphones as their teenage siblings, but their critical thinking skills aren’t as developed as an older teen’s. Since the coronavirus is still dominating the news cycle, kids on the internet are likely getting all sorts of information about it when they go online, and this information may or may not be reputable. Even if your tween child doesn’t have this kind of access, her friends likely do, which allows rumors to quickly spread and become exaggerated as they pass through a social group.

Getting age-appropriate information about the coronavirus tends to reduce anxiety, but on the flip side, reading sensationalized news stories or information from questionable sources can make preteens’ anxiety worse. Many preteens view influencers on social media and YouTube as being trustworthy and relatable. They may not be as skeptical about information that’s presented as fact from what they perceive to be a trusted source.

How to Help Your Preteen Sort Out Coronavirus Facts From Fiction

Here are 3 common misconceptions I’m hearing from many preteen clients, and how you can help your child to make sense of all the information they may be getting from friends, the internet, and social media:

Where the virus came from: Conspiracy theories abound about the “real” source of the cornavirus, which can lead to increased confusion, anger, and fear for tweens. You can help your preteen by presenting the facts that we know for certain, as well as acknowledging that there are things we still don’t know for sure. It might be helpful to point out that when we don’t know something, people are tempted to fill in the blanks with information that might not be true.

Newly discovered symptoms of COVID-19: Doctors are making new discoveries all the time about how the coronavirus impacts people. However, there is also a lot of misinformation online about what problems can be symptoms of coronavirus. Tween kids need help making sense of what they’re reading, and understanding that many of these complications are very rare.

Racist content online: Sadly, some kids are telling me that they are reading or hearing things from others that express racism towards Chinese people for “giving” us the coronavirus. This can be really confusing for preteens who aren’t sure what they’re supposed to believe. You can help your child by making clear in no uncertain terms that we can’t blame any ethnic group for this illness.

More Support for Preteens Dealing with Coronavirus Stress

Many preteens are going to be able to muddle through this pandemic with some extra support and patience from the adults around them. However, if you’re noticing that your preteen’s anxiety seems to be getting worse over time, is much more intense than other kids his age, or is getting in the way of daily life, it could be a sign your child needs extra help to cope with this stress.

After seeing so many preteens struggling, I created a class called Worry-Free Tweens to help kids learn coping skills for anxiety and stress management. It’s a self-paced course that’s available wherever you are.

Online therapy can be a great option for preteens, who are usually tech-savvy enough to manage sessions without a lot of help from parents. Sometimes, just having an adult to vent feelings to who isn’t a parent can help preteens unload some of their stress. A licensed counselor can also arm your child with coping skills to help them deal with intense feelings and get through stressful times more effectively.

If you’re in North Carolina or New York, I’m able to provide telehealth to kids in these states. You can reach out to me here. If you are located elsewhere, check out Psychology Today for options near you.

Online CBT Therapy for Kids With Anxiety

Kids weren’t meant to sit inside all day, isolated from friends while overhearing scary things on the news. Our “new normal” in quarantine may be especially tough for kids, who are so reliant on their daily routines to help them feel safe in the world. If you have noticed a spike in your child’s anxiety symptoms since the coronavirus, you’re not alone. It’s an understandable response to a very strange, stressful time in our history. Fortunately, one of the most effective treatments we have to help anxious kids—cognitive behavioral therapy—translates easily into online work with a therapist. In this post I’ll be sharing the basics of how CBT can help kids with anxiety disorders, and how it works to get CBT therapy online.

What Is CBT, and How Is It Different Than Other Forms of Therapy?

What do you imagine when you think of therapy? Maybe that stereotypical image comes to mind of a patient lying on a couch, free associating about their childhood experiences while a therapist quietly nods. While some therapists still practice this more “old school” form of therapy (and it really works for some people!) therapy doesn’t always have this look and feel. CBT is a very popular approach to therapy that offers another way to deal with stress, anxiety, and mental health struggles.

CBT stands for Cognitive Behavioral Therapy, and it’s a style of therapy that focuses on helping people learn new ways to deal with problems in the present, rather than gaining insight into the past. While you might discuss past experiences with a CBT therapist, in general the goal is finding solutions in the here-and-now. To do this, clients in CBT therapy learn how to spot the negative thinking patterns and self-talk that can lead to exaggerated worries and depression.

In CBT therapy, your child might…

• Learn coping skills to manage stress more effectively

• Gradually practice facing her fears in order to overcome them

• Learn how to identify overly-negative thinking

• Practice replacing negative self-talk with more positive, realistic self-talk

• Learn social skills to express herself confidently and assertively

What Makes CBT So Popular for Kids with Anxiety?

One big reason CBT has become so popular for treating childhood anxiety is that it can help kids feel better faster. The coping skills children learn in CBT can be used right away to start managing anxiety, panic, and stress, so many children notice some improvement in their moods early on in treatment. CBT is often a shorter form of treatment, and in general, people in CBT need fewer sessions of therapy than people who aren’t. Kids who get CBT therapy for anxiety symptoms may be able to progress through therapy more quickly, and return to their lives with skills to handle future problems.

Another reason for CBT’s popularity is that there is a ton of research to show it’s effective. As a therapist, I like knowing that the skills I’m teaching kids to manage their anxiety have been studied over and over, and have been shown to be the most helpful tools for the job. I like feeling confident that the therapy techniques I’m using are the most likely to help a particular child, and have been shown to be safe.

How Does CBT for Children Work With Telehealth?

While some forms of therapy may look and feel a little different when conducted online, in my experience CBT sessions via telehealth feel pretty similar to my in-office sessions! Because CBT is more task-oriented and involves more learning and teaching, it’s a natural fit for online therapy. While I often incorporate games, art, and play into my child therapy sessions, CBT puts an emphasis on helping kids put their thoughts and feelings into words, too. I think the fact that it’s a more verbal form of therapy helps make online sessions flow smoothly.

If your child is enrolled in online CBT therapy, she might participate in activities like these:

• Role-play difficult situations with a therapist to figure out healthier ways to respond

• Learn relaxation skills in session, like deep breathing and mindfulness techniques

• Practice turning negative self-talk into more positive or realistic self-talk

• Set goals to practice at home during the week, such as practicing a relaxation skill or raising her hand more often in class

• Learn more about how anxiety works, which can help kids feel less alone with their feelings

Online CBT therapy might use books, worksheets, and other teaching aids to help children get the most benefit from learning new skills. I sometimes email simple worksheets to parents that kids can use to track negative thoughts during the week. I sometimes assign other “homework” assignments as well, such as practicing a new skill during the week or trying to reach out to friends more during quarantine. Usually, CBT homework requires no more than 5 minutes a day of work—I know kids are overloaded with school assignments right now, and I don’t want to add to that stress!

Online CBT Therapy for Kids in North Carolina, New York, and Florida

If your child is having a hard time dealing with anxiety during quarantine, CBT can help her manage this stressful situation and equip her with tools that she can use to deal with anxiety even after quarantine ends. As a first step, you may want to consider my online course, Worry-Free Tweens, which teaches CBT-inspired coping skills to anxious kids ages 8-12.

If you’re in North Carolina, New York, or Florida and looking for online therapy for your child, my (virtual) door is always open. I love using CBT to help kids and tweens overcome anxiety and worry. You can reach out to me here to learn more.

Pros and Cons of Online Therapy for Kids

While many people may not have considered online therapy as an option until quarantine forced us to take a lot of our lives online, it’s been around for years. Large companies like Talkspace and BetterHelp have mostly appealed to millennials who are comfortable with technology and may not have much time during a 9-5 day to make it to a brick-and-mortar therapy office. In addition, plenty of private practice therapists have used online therapy to help reach people who may not otherwise be able to access therapy, such as those in rural areas or people living with chronic illness. Until recently, though, most online therapy services were for adults, not kids.

Because I didn’t see many online children’s therapists out in the world, I was skeptical about whether kids could benefit from this kind of help. Since I want to help my community flatten the curve, when quarantine hit I decided it was time to find out for myself! While I am looking forward to the day when I can go back to my playroom, I have made so many exciting discoveries about online therapy that I would never have realized if quarantine hadn’t pushed me to give it a try. In this post I’ll be sharing some of the most surprising “pros” I have discovered about online therapy for kids, as well as the “cons” to be aware of, since no form of therapy is the perfect fit for every child.

What Kids Are a Good Fit for Online Therapy?

Online therapy, or teletherapy, may not be the best fit for everyone. However, in the past few weeks I have seen some children and families benefit more from online sessions than they have from in-person therapy. Here are a two scenarios where I’ve found online therapy has an edge over face-to-face counseling:

Children whose behavior problems only occur at home. I can’t tell you how many times I’ve had parents tell me that their child’s behavior at home and in my office is a night and day difference. Some parents have even asked if they should film their child’s behavior, because they’re afraid I won’t believe how tough things can really get behind closed doors.

While I don’t recommend filming your child, online therapy gives me a better chance at seeing behavior problems firsthand. Since kids are participating in therapy from home, in a familiar place, they often behave more naturally than they would in my office. Since I’m present on the screen but not physically in the room, it’s more likely that kids will fall back into familiar patterns with the parent as if I’m not there. This gives us the opportunity to work through the problem together, as it’s happening, in real time.

Kids who have a hard time opening up about tough subjects. While many kids enjoy and appreciate individual time spent with a counselor, I have found that some kids feel too exposed or overwhelmed in face-to-face sessions to get vulnerable about painful experiences. Play therapy and art therapy techniques can help give kids the feeling of “safe remove” from an issue that they need to open up, but so can online therapy.

Some kids may feel a little bit less “under the microscope” when they’re talking through a screen or typing, which can make it easier for them to speak their mind. I’m finding that many of my clients who are recovering from grief or trauma are able to speak more directly about their experiences than they were in my office.

The Pros of Online Therapy for Kids

Online counseling isn’t better or worse than face-to-face therapy—just different. Here are a few of the potential benefits that online therapy can offer for kids with anxiety, trauma symptoms, or behavior problems.

• Online therapy can feel more confidential, which can make it easier to open up about difficult subjects.

• Video and text chatting mimics the way that children are most comfortable communicating with friends.

• Kids can design their own “safe space” for therapy sessions that includes all their favorite comfort items: loveys, dogs, and favorite snacks allowed!

• For parents with demanding work schedules or non-traditional hours, online sessions can be easier to manage than in-person therapy, because there is no commute required.

• Home-based sessions can help kids and therapists work through tough behaviors at “the scene of the crime,” which can make it easier to practice new skills. Some kids enjoy doing roleplays of difficult situations using their own toys as props to find better ways to resolve conflicts with siblings or friends.
  
  
  

The Cons of Online Therapy for Kids

For some kids, individual virtual counseling may not be the best option. While some of these issues can be problem-solved in session, other kids might benefit more from another form of therapy, such as family counseling, parenting skills coaching, or face-to-face sessions, when available. Here are a few factors that I have observed can make individual online therapy more difficult for kids:

• Preschool children have a harder time paying attention to a screen for a full therapy hour, and seeing a familiar face onscreen instead of in real life can be a little confusing. For very young kids, shorter “check-ins” with a therapist paired with parenting support sessions might be a better bet.

• Some kids with ADHD may have a tough time with online therapy, since it might require them to sit still for longer. This is especially true for younger children. Adding in extra movement to sessions can help, but individual online therapy may not be the best fit.

• It’s a little harder to pick up on nonverbal information in online therapy, like subtle facial expressions, body language, and small changes in tone of voice. This is true for both the therapist and the client. If a child already has a hard time picking up on these social cues, online therapy can make it more challenging.

• Online therapy sessions rely mainly on sight and sound, and so the sensory experience is not as rich as in-person play therapy for kids with sensory processing needs. Adding sensory play materials like play-doh and scented markers at home can help to address this.

Learning about the pros and cons of online therapy for kids has inspired me to keep offering it as a service even in our post-quarantine world. I have a feeling that for many kids, combining face-to-face visits with occasional online sessions could give them the best of both worlds and make therapy more accessible for many families. If you’d like to chat more about online therapy, or set up an appointment for your child, I’m located in the Davidson, NC area and happy to help. You can contact me here.

How to Help a Child Cope with Anxiety

4 ways to take care of your child (and yourself) when stress is high

If you are the parent of an anxious child, you know how draining anxiety can be. Worries, rituals, and meltdowns can consume tons of time and energy, not just for your child but for the whole family. When a child’s anxiety is too strong to manage, the effects can ripple outward to impact siblings and parents. This is even more true during quarantine, when everyone is cooped up together and it’s harder to take time away to blow off steam. Even in unusually stressful times, kids can learn to feel more in control of their worries, and there is a lot you can do to help as a parent. Here are 4 ways to help your child learn to cope better with anxiety.

Help Your Child Understand That Anxiety Isn’t Bad

I often ask kids who are coming to my office for anxiety a trick question: is anxiety a good thing, or a bad thing? Many children assume that the goal of therapy is to totally eliminate their anxious feelings. As a parent, you can help your child understand that anxiety is an important feeling because it helps them know when something is not safe. Can you imagine what would happen if we didn’t feel at least a little anxious before crossing a busy intersection? Have you ever had a bad “gut feeling” about a person or situation that turned out to be right? Those are times when anxiety is good to have, even if it feels uncomfortable.

Because anxiety doesn’t feel good in the body, children often get anxious about being anxious: they notice their anxiety response starting to kick in, and worry that it means something is really wrong with them. In reality, their body is doing just what it is supposed to do by alerting them to danger…it just might be doing this at unhelpful times. Kids with anxiety have too much of a good thing: their “danger alarm” is going off more often than it really needs to. You can help your child understand that anxiety isn’t dangerous, it can’t hurt them, and that while you can’t eliminate anxiety (and you wouldn’t want to!) there are lots of ways to cope with the feelings to make them easier to deal with.

Practice Relaxation Every Day, Not Just When Your Child is Anxious

Helping anxious kids find ways to relax is usually one of the first goals in therapy. Many coping skills have been developed to help kids (and adults) unwind, but activities like exercise, art, and meditation can be just as helpful. In my opinion, it doesn’t really matter what coping skill you choose to use—what matters is how often you use it.

Practicing a relaxation technique is kind of like going to the gym. If you do it once, you might notice you feel a little better when you’re done. However, the boost probably won’t last very long. If you want to create lasting, positive changes, you’re going to have to do it regularly over a longer stretch of time. Deep relaxation techniques change the way our nervous system operates, helping us move out of the “fight-or-flight” mode that triggers anxiety and into the “rest-and-digest” mode that promotes calm. If a child is practicing a relaxation skill frequently, she may spend more time in this restful state and be able to access it more easily the next time she’s stressed, leading to less anxiety in the long run.

Practicing how to self-soothe daily has another benefit, as well: it helps kids master the technique before they really need it. You don’t want your child to be trying to figure out how to take deep belly breaths for the first time in the middle of a panic attack. Think of daily relaxation practice as being like a fire drill, helping your child master the coping skill while she’s calm, before she really needs it.

Focus on Your Child’s Strengths, Rather Than Worries

When a child is really anxious about something, it can be tempting to talk about it with them in detail in order to reassure them that their fears aren’t realistic. If your child is losing sleep at night due to fears of monsters in their room, for example, you may feel the urge to help them investigate in every closet and under all the furniture to prove that the room is 100% monster-free. While helping kids to spot unrealistic thoughts can be helpful, spending a lot of time talking about a fear in the moment can backfire and lead to more anxiety.

When we have a long conversation with a child about their worry, we might accidentally send them the message that it’s something worth being worried about. After all, if we’re spending all this time talking about it, it must be a possibility! Your child might wonder why you’d look under the bed in the first place if there wasn’t a chance the monster might be lurking under there. Long discussions can also encourage anxious children to ruminate, thinking about their worries again and again without coming to a resolution. This can make their anxiety increase, rather than decrease.

Instead of talking about the worry itself, focus on the positive strengths your child has that will help them deal with it. You might consider saying something like “I know you’re brave and you can do this,” “This is hard, but you’ve handled it before, and you can do it again,” or “You are so good at taking deep belly breaths!” This can help shift a child’s focus away from the problem, and toward a solution. It also sends the message that you understand how worried your child must feel, but you aren’t taking the worry itself seriously. You can be empathetic without reinforcing the fear itself.

Put the Oxygen Mask On Yourself First

You have probably heard this common advice from flight attendants applied to life outside of the airplane: put the oxygen mask on yourself first, before helping your child. It’s cliche, but it’s true! Helping a child to cope with anxiety is hard work, and it’s difficult to do if you’re feeling run-down or anxious yourself. Parents have to provide so much emotional labor for their kids every day, and they may find they’re giving and giving without getting much support back in return.

Kids are extremely attuned to how their parents are feeling. They look to the adults in their lives to determine how they should respond in a situation. During times of stress, your child is probably watching you closely, and paying attention to your facial expression and voice tones for clues to how you’re feeling. If a child senses that you’re feeling stressed, odds are good he’ll start to feel stressed out, too. This can lead to more anxiety or acting-out behaviors like tantrums and meltdowns. On the flip side, when a child sees that you’re managing your own stress, it sends the message that they can feel safe and relaxed, too.

When things are particularly stressful, a parent’s self-care might be the first activity to get crossed off the to-do list. If your child is struggling with anxiety, I’d encourage you to make your own self-care a priority. Figure out what helps you to cope emotionally, whether it’s taking an hour to exercise, going on a drive alone and listening to music, or calling a friend. Your kids will feel the effects of your improved mood, and you may find their anxiety decreases as your stress levels go down. When you practice self-care, you send the message to your children that coping with anxiety is a normal part of life. When your children see you managing your own stress, they learn that they can do it, too.

If your child’s anxiety is getting hard to handle at home, counseling can help make it more manageable, even during quarantine. You can read more about online counseling for kids here, or reach out to me to set up an appointment.