What Are the 4 Types of OCD?

Pop culture is getting better about representing people with mental health conditions on TV, in movies, and in books. It’s allowed many people to get familiar with mental health conditions that aren’t always talked about, but affect millions of people. At this point, you’ve probably encountered a character that has OCD. In all likelihood, this character was super clean, hyper-organized, and maybe a little nitpicky or eccentric.

Although more representation for mental health issues is a good thing, for OCD it’s come with a small downside. Most portrayals of OCD only focus on one or two types of the disorder. As a result, most of us have an overly narrow idea of what OCD looks like. While it’s true that some people with OCD are very neat and tidy, many aren’t.

If you are wondering whether your child may have OCD, it helps to learn about all 4 types. This way, you’ll be prepared to spot all of the signs and symptoms of OCD, not just the ones we see on TV. Let’s take a closer look at each of the 4 main types and how it commonly manifests in kids.

OCD Type #1: Contamination and Cleaning

Many people associate OCD with germs and germaphobia. But this type of OCD is more than just practicing good hygiene or keeping a spotless home. People with contamination OCD worry about coming into contact with things that could get them dirty, sick, or even just feeling unclean. They may worry about their belongings becoming contaminated as well, or that they might spread their contamination to other people.

Sometimes, people with contamination OCD are concerned with germs or dirt. However, lots of other things can trigger it, too. Some kids with contamination OCD might be triggered by bodily fluids, certain strong smells, or even just by people or things that feel wrong to them.

Feeling contaminated causes anxiety to spike, so kids with this OCD type will do whatever they can to avoid the feeling or make it go away. This often means compulsively cleaning, avoiding “dirty” places and things, having difficulty sharing belongings, or completing rituals that help make something feel clean again.

What Contamination OCD Looks Like in Kids

I’ve met more children with contamination OCD in the wake of the Covid-19 pandemic. This makes sense: we’ve spent over a year talking about washing and avoiding germs, which I imagine makes it an easy subject for OCD to grab on to. Here are a few common ways contamination OCD may show up for kids:

• Repeatedly washing hands or taking multiple showers a day

• Not wanting to touch or use objects that have come in contact with something “dirty”

• Difficulty sharing toys or allowing others to use their things

• Overwhelming worries about getting sick or making others sick

• Cleaning belongings (like toys or school supplies) more often or thoroughly than is normal

• Bathroom difficulties due to worries about urine or feces contaminating clothing

OCD Type #2: Checking and Rechecking

Ever walked out of the house, only to stop and wonder if you locked the door on your way out? We all get that nagging “did I forget” feeling occasionally, but for people with this type of OCD it’s a daily occurrence. It’s harder for them to brush these thoughts aside, because they happen so frequently and feel so intense. To calm the feeling, they check or re-do things over and over, even if they know they just did them moments ago. Unfortunately, the “did I forget” feeling doesn’t stay away for long, which leads to a need to check again. As you can imagine, this can be really aggravating and take up a lot of time.

Compulsive checking activities may be physical actions, like flipping a light switch or turning a knob on the oven. They can also be mental actions, like double-checking that the fire alarm still has batteries or that a door is closed. Sometimes, repeated worries prompt kids to repeatedly ask parents for reassurance. This is another kind of checking that might be easy for parents to miss.

What Checking OCD Looks Like in Kids

Symptoms of compulsive checking range from super subtle to very overt. How easy they are to spot depends on what your child feels compelled to check. Here are a few examples of compulsive checking that you might notice in a child with this form of OCD:

• Repeatedly doing things like locking and unlocking doors, flipping light switches, or turning faucets on and off

• Asking the same question over and over, without a decrease in anxiety—for example, repeatedly asking a parent if they are sick

• Going back to check on things more often than seems normal

• Repeatedly asking parents for reassurance that something bad is not going to happen

• Asking parents if the child has forgotten something or if their memory is accurate

OCD Type 3: Perfection and Order

This is the type many people likely imagine when they think of OCD. Along with germaphobia, this is the other common OCD form that gets a lot of representation in pop culture. People with this OCD type may worry about symmetry, organization, or doing things just right. In fact, this type is also sometimes called “just right OCD.”

While this may sound like the hyper-organized, neat freak stereotype we often associate with OCD, the reality is it’s much more complex. Some people with this OCD type may be neat and tidy, or be concerned with appearances. However, this type also includes compulsive behavior like tapping things an even number of times, arranging items to appear symmetrical, or fixing and re-fixing something that nobody else would notice was “wrong.”

This OCD type also includes people who feel compelled to do things perfectly. This might lead to a lot of anxiety when working on school assignments or participating in sports or other activities. Some people with this type might fixate on a facial feature or part of their body and worry that it is not good enough.

What Perfectionistic OCD Looks Like in Kids

Although this type is more understood, it’s helpful for parents to remember that “perfection” and “order” doesn’t necessarily mean color-coded school binders and a clutter-free bedroom. A child’s focus can be on a very specific area that we don’t usually think about as something that needs to be organized or even, which can make these signs of OCD slightly tricky to spot. Here are some ways perfectionism and “just right” OCD might show up in children:

• Extreme difficulty completing homework assignments, especially open-ended ones, due to a fear of not being able to do them well enough

• Needing to feel that things are “even” on both sides of the body

• Doing things a set number of times, for example, saying the same thing three times in a row or stepping on the “right” number of leaves outside

• Fixating on a small detail related to clothes, hair, or makeup

• Having trouble texting friends due to fear about not saying the right thing

OCD Type 4: Mental Rituals & “Bad” Thoughts

This type of OCD is a little different than the others. Most forms of OCD involve acting out some kind of repeated or ritualized behavior. The behavior may be subtle, but it’s noticeable if you know what you’re looking for. Mental ritual OCD is sneakier. Rather than doing something repeatedly, people with this type of OCD think something repeatedly. This can make it much more difficult for parents to identify. In fact, until fairly recently, mental health professionals had a hart time identifying it too!

Mental ritual OCD is relatively new. You may also hear it described as “Pure O” OCD, which is short for “purely obsessional.” It’s called this because there aren’t any compulsions for those of us on the outside to see. However, that doesn’t mean they aren’t there.

People with “Pure O” or mental rituals are often bothered by thoughts that feel inappropriate: for example, thoughts about violence or sexual behavior. Some people may also be preoccupied with thoughts about religion or worries that they’ve done something wrong. They may worry that having these bad, taboo thoughts means that they are bad people.

To counteract the “bad” thought, a person may try to replace it with a “good” one or perform some mental action to make it better. This could include thinking a special thought, saying a number or word inside their head, praying, or reassuring themselves that they are okay.

What Mental Ritual OCD Looks Like in Kids

Mental rituals are extremely difficult to spot unless the person experiencing them says something about them. Some children with this form of OCD may also repeatedly ask for reassurance as a way to cope with upsetting thoughts or mental images. That can sometimes be a tipoff that other mental rituals could be happening, too. Here are some ways mental rituals might show up for “Pure O” kids:

• Compulsively saying prayers or confessing to things inside their head

• Repeatedly going over memories to see if they really happened

• Saying special words, numbers, or thinking of a special picture to make a bad thought go away

• Checking to see if a bad thought is still there

• Repeatedly reassuring oneself that something didn’t really happen, or that they would never do that thing in real life

Are There Any Other Types of OCD?

Yes and no! The 4 types of OCD I’ve outlined here are used by both therapists and people with OCD to describe different ways that OCD can look and feel. However, you won’t find them in the DSM-5, the big book of mental health problems that therapists use to help diagnose people. So even though they are common and helpful, they aren’t super duper official.

While many people divide OCD into 4 broad categories, others may identify as many as 6, 7, or 8 different types. It all depend on how specific you want to get with your labels. Here are some other OCD types you may hear others mention:

• Hoarding

• Ruminating

• Intrusive Thoughts

• Mental Contamination

• Moral OCD

• Doubt or Incompleteness

• Thoughts of harm or self-harm

I Think My Child Has OCD…What’s Next?

If you read through these 4 types of OCD and recognized your child in one (or more) of them, you may be wondering where to go from here. I’ve written a fair amount about OCD in children and OCD treatment on this blog if you’d like to learn more.

Learning anxiety coping skills is a good first step to help your child at home. There are several educational and self-help books for kids about OCD, too. What to Do When Your Brain Gets Stuck is my favorite.

Although books and coping skills can help, many children with OCD will need more support to overcome their symptoms. Research suggests OCD is not likely to go away on its own without professional help. Fortunately, children with OCD have options when it comes to therapy. Cognitive behavioral therapy can be really helpful, and there’s even a version of it designed especially for kids with OCD called Exposure and Response Prevention.

If you’re looking for a child therapist in North Carolina, New York, or Florida, I may be able to help. I meet with kids in person (in Davidson, NC) and online (everywhere else) to work through anxiety, stress, and trauma. You can email me here to ask question or set up an appointment.

My Child is Afraid of Halloween! What Do I Do?

Maybe it’s just me, but I love a good baby Halloween costume. I started researching them long before I became a parent, and I’m excited to have at least a year or two of freedom to dress my baby up without objections from him about my style decisions. Eventually, though, all good things must come to an end.

As children grow up and begin to develop their own (strong) opinions about things, including Halloween. What if your child’s views are not so enthusiastic? What if they are downright scared of Halloween? You may be wondering if it’s okay to push them to face their fears so they don’t miss out on any fun—or keep their siblings from having a good time. On the other hand, you don’t want to overwhelm your poor kiddo by subjecting them to an evening of skeletons and eyeballs.

What’s a parent to do? Let’s take a look at a few strategies to help children who are afraid of Halloween feel secure enough to (gently) try out some spooky fun.

Is it Normal for Kids to Be Afraid of Halloween?

If everyone else’s children are eagerly jumping into their Pennywise costumes or laughing with glee at the scary chainsaw man on the haunted hayride, you may wonder if it’s normal for your child to feel so scared.

When you stop to think about it, many Halloween traditions are very weird and unlike our normal day-to-day life. It’s a day deliberately intended to scare people. On Halloween, kids get to do a lot of things they aren’t allowed to do any other night of the year, like walk around the neighborhood in the dark and take candy from strangers. No wonder some kids have a hard time adapting.

I wonder if the abundance of scary games, movies, and other content geared towards children has led to more kids fearing Halloween. I can’t tell you how many kids have come into my therapy office deathly afraid of characters like Pennywise, Annabelle, or the cast of Five Nights at Freddy’s. Even creepy memes can have a lasting effect on kids. Remember Momo? She was a major subject in my office for about 6 months in 2019.

I do think it’s worth mentioning that while mild anxiety is totally normal and understandable, extreme anxiety may be a different story. A child who is creeped out by Halloween decorations or who is hesitant to go trick or treating is experiencing pretty typical fears. On the other hand, if your child is so paralyzed by fear that they have nightmares the entire month of October, or refuse to go to public places because they might have decorations up, she may be dealing with a more severe phobia that could use some outside help.

How to Help a Child Who is Scared of Halloween

We all want to protect our children from harm and help them avoid upsetting experiences when we can. That said, please don’t wrap your child in psychological bubble wrap and avoid all things Halloween-themed. While this might help your child (and you) feel less anxious in the short term, it is likely to make your child’s fears stronger and more persistent over the long term.

Anxiety makes us want to avoid the things that scare us. We get the sense that something terrible will happen if we don’t. The problem is that every time we avoid something scary, we reinforce the idea that it is worth being afraid of. The longer a child avoids a scary situation, the harder it will be to return to it when the time comes. This is why it can be so hard to go back to school after summer vacation, and why so many kids developed separation anxiety after months of togetherness during quarantine.

To help an anxious child, we want to:

• Let them know their feelings are normal and okay

• Talk, read, and play about feelings and scary things

• Clear up any misunderstandings that might make anxiety worse

• Support them in gently and gradually facing their fears

Let’s see how we can apply those ideas to help a child who is afraid of Halloween.

Practice in Advance of the Big Day

The best time to start addressing Halloween anxiety is not October 30th. I say this knowing full well that this blog post will go up on October 30th, the night before Halloween. But, I am assuming that you are likely reading this blog post at some future time. Hopefully, Future You has decided to Google this issue in September or early October, which gives you plenty of time to prepare.

Kids learn and make sense of things around them through repetition and play. Ever seen your child act out the same game over and over for a week and then move on to something else? They’re learning! Children also thrive on routine, which helps the world feel more predictable and safe. Repeated conversations about Halloween traditions helps children learn what to expect, and takes away the element of surprise that can be so frightening.

Reading books about Halloween together is a great way to facilitate conversation. As an added bonus, books are a gentle form of exposure for anxiety. You are gently showing your child that he can handle talking and thinking about scary subjects, and you’ll be right there to support him.

Talk About the Difference Between Real and Pretend

Little kids have a hard time distinguishing between fantasy and reality. Their imaginations and ability to “make believe” can add a lot of magic to childhood. On the flip side, it can also add a lot of fear!

Older kids and adults can delight in scary movies because they know that there’s no chance of Godzilla lurking around the corner when they leave the theater. Pretend scary stories let us experience the adrenaline rush of a good scare at a time when we know that nothing bad can actually happen. Imagine how it must feel if you aren’t so sure the Godzilla won’t be there!

You can use TV shows and movies as an opportunity to show your child that the stories are pretend, and the actors are playing make-believe. Mister Rogers once invited the actress who played the Wicked Witch of the West onto his show to teach this exact concept. Onscreen, the actress showed how she put on her costume and makeup, and used a pretend scary voice to play the part. In reality, she was a really nice lady! You can talk with your child about how actors use makeup and costumes to look scary, when really they are normal people—there’s plenty of videos of actors in and out of costume to back up your point.

Use Exposure to Make Scary Items Feel Familiar

Exposure is a big part of the kind of therapy I practice for kids with anxiety, called Cognitive Behavioral Therapy. In exposure, we help a child face unhelpful fears, but we do it in a gradual way. This helps kids build up their confidence, and learn to tolerate anxious feelings without becoming totally overwhelmed.

You can practice exposure at home by giving kids a chance to look at and handle scary Halloween props in small doses. This could mean taking the scary mask from a sibling’s costume out for your younger child to handle and play with. It could also mean walking on the opposite side of the street from a Halloween display to view it from a safe distance before getting closer. It often helps to make these exposure situations funny: try talking with your child in a goofy witch voice, or encourage them to make fun of a monster that frightens them. It’s hard for things to be both funny and scary at the same time.

Involve Your Child in Halloween Prep

Helping your child participate in Halloween traditions in an age-appropriate way gives them another opportunity for exposure. It’s also another chance to highlight the difference between real and pretend by showing kids how things are made. A glowing jack-o-lantern seems a lot less intimidating when you saw the pumpkin that was scooped and carved to make it.

Giving your child a role in the Halloween festivities allows them to feel a sense of control over the situation. You can let your child pick out your decorations, play their choice of music, and decide what snacks to enjoy or what candy to give out to trick-or-treaters. Feeling in control can ease anxiety, and getting to pick out all the details might give children an added motivation to participate.

Fun is Most Important!

Okay, so I’ve gone on and on in this post about the importance of exposure and facing your fears. All of that is true! But also…Halloween is a holiday, and it’s one day a year. While I encourage you to gently help your child overcome Halloween anxieties, there’s no need to push them so far out of their comfort zone that the holiday stops being fun.

We’re looking for progress, not perfection. Maybe this isn’t the year that you go trick-or-treating in the neighborhood that goes all out for Halloween with super gory decorations. Maybe your young child would be more into a casual daytime party with friends rather than a nighttime trek with the big kids. Some aspects of Halloween may just be too intense for young or sensitive kids to handle, and that’s perfectly okay.

What’s most important is communicating to your child that having anxiety is okay, and that we don’t always have to do what it tells us to do. By staying calm and finding small opportunities for exposure, you are showing your child that you can handle their big feelings. They may be terrified of the ghost hanging on the neighbor’s house, but you aren’t!

Help for Anxious Kids in Davidson, NC

Do your child’s anxieties extend past Halloween? If you’ve got a sensitive kid who is prone to big feelings, it might feel like there’s a minefield of situations you have to tread carefully around to avoid triggering a meltdown. If anxiety is getting in the way of your child living their best life, counseling can help make things more manageable.

I am a former-anxious-kid-turned-therapist who loves working with children and tweens. I see kids in person for CBT and play therapy at my office in Davidson, North Carolina, just outside of Charlotte. If you aren’t close by, we may still be able to work together! I see kids throughout North Carolina, New York, and Florida for online therapy. If you’re not sure you’re ready to start therapy, or need some basic help right away, check out my coping skills course for anxious kids and tweens.

If you’re ready to start child anxiety therapy, drop me a line. I’m always happy to hear from you.

How to Help a Child with Intrusive Thoughts

Dark, bad, scary, negative, weird…whatever words you or your child use to describe intrusive thoughts, the effects are the same. Intrusive thoughts are like unwanted guests in our minds, barging in without being invited to spoil the party. While any child can have intrusive thoughts, they’re more common in children with anxiety, OCD, or a history of trauma. Keep reading to learn what you can do at home to help your child with the normal, common, but still very stressful phenomenon of intrusive thoughts.

Why Does My Child Have These Negative Thoughts?

If you’re curious to learn more about intrusive thought and why they happen, check out last month’s blog post. I break down what intrusive thoughts are in detail, with real-life examples. I also talk about what mental health problems might make kids more prone to experiencing them.

If you don’t have time to read the whole post, the gist is that intrusive thoughts are normal, and not always a problem. Many people—if not most people—will have intrusive thoughts at some point in their lives. They’re just one of the many weird things our brains and bodies do in an effort to keep us safe. When most of us have these seemingly random thoughts, we can shrug them off and quickly forget about them.

However, some kids are not so lucky. It can be harder for kids to distinguish between a useful thought and a useless one. This makes it more difficult to brush the thoughts aside. Instead, children may end up focusing on the thought and worrying about it. This leads to more anxiety, which increases the likelihood that these bothersome thoughts will pop up again.

An occasional intrusive thought is no problem, but kids with anxiety or OCD may get them so often that it feels debilitating. Children also sometimes experience these thoughts after a trauma as a part of PTSD.

How Can I Help My Child With Intrusive Thoughts?

There’s a lot you can do as a parent to support a child struggling with intrusive thoughts. You hold a powerful role in your child’s life. Your child looks to you as a guide to decide how she should think and feel about things, so your responses carry a lot of weight. By responding calmly and compassionately, you can help your child self-soothe and take the power away from overly dark or negative thoughts.

We’ll go over each of these in more depth in a minute, but here are 3 ways you can help:

• Normalize intrusive thoughts for your child

• Teach the difference between thinking and doing

• Help your child name and accept intrusive thoughts

These steps can go a long way toward helping kids handle disturbing thoughts with less worry and stress. Next, let’s break down each one to see why it helps and how you can practice it at home.

Let Your Child Know Her “Bad Thoughts” Are Normal (and Not So Bad)

Intrusive thoughts can be disturbing, but they’re also really, really common. So common, in fact, that one study found that 94% of people experience them. They’re just a part of being human! As common as they are, we don’t tend to bring up intrusive thoughts during polite conversation. Because nobody ever talks about them, a child may assume she’s the only one who gets intrusive thoughts. The thoughts can become a big source of shame, especially because they might be about taboo subjects.

Things always feel scarier when we don’t understand them. Teaching children about intrusive thoughts takes away some of their power. When you tell children that many people have these bad thoughts and they aren’t alone, you alleviate their shame. Reducing fear and shame not only helps your child feel better; it can also reduce her intrusive thoughts over time.

Try explaining this to your child: “Our brains are always thinking, and always looking for ways to keep us safe.” Giving us these “bad thoughts” is sort of like the brain showing us a flashing danger sign. The only problem is, the brain isn’t always right! Sometimes, the more we try to ignore these bad thoughts, the more our brain pushes the thoughts back. These thoughts can be really weird, or scary, or even be about things we’d never want to do in real life. As weird as they seem, most people have them sometimes and they are totally normal.

Explain That Thinking Isn’t The Same as Doing

Have you ever knocked on wood to keep something bad from happening? Or worn your “lucky shirt” on game day to help your team win? If so, you’ve experienced magical thinking. Magical thinking is the belief that our private thoughts and behaviors influence what happens in the outside world.

Magical thinking is really common in children, especially younger kids. It’s usually most noticeable from the toddler years through about age 7. If you think back to your own childhood, you’ll probably discover magical thinking everywhere: cootie shots, lucky charms, and “step on a crack, break your mama’s back” are all examples of magical thinking that are fun for kids.

However, there can be a dark side to magical thinking, too. Children often believe that their thoughts can cause things to happen in the world around them. If a child worries their thoughts are responsible for something bad happening, this can cause terrible fear and guilt. It’s easy to imagine how a child who gets intrusive thoughts about violence or crime could begin to worry about accidentally hurting others.

Help your child understand that having bad thoughts does not make you a bad person. It’s our actions and choices—not our thoughts and feelings—that hep us to be “good people.” Next, reassure your child that thinking angry or scary thoughts about a person can’t hurt them or cause something bad to happen. Even if they feel bad to us, thoughts are not that powerful.

Shine Some Light on Dark Thoughts By Naming and Accepting Them

When I think about kids struggling with dark intrusive thoughts, a quote from famous psychiatrist Dan Siegel comes to mind: “Name it to tame it.” Dr. Siegel came up with this phrase, and it’s since been adopted by many therapists to describe a simple process that makes strong feelings more bearable.

“Name it to tame it” is exactly what it sounds like. Often, the simple act of labeling our thoughts and feelings as we have them can make them feel better. This is because naming something requires us to take a step back and go into observing mode, rather than being totally absorbed and overwhelmed by our feelings.

Naming intrusive thoughts as they happen can be a helpful reminder that we are not our thoughts. Thoughts come and go, but it’s up to us to decide how much attention they deserve. Calling out intrusive thoughts for what they are is also a helpful reminder that they are common and harmless: after all, they’ve happened to enough people that we’ve given them a name!

You can help your child practice saying one of these phrases (or something similar) the next time an intrusive thought strikes:

• “My brain is giving me one of those garbage thoughts again.”

• “I’m having an intrusive thought right now.”

• “This seems like one of those thoughts I don’t need to listen to.”

Once the thought has been named, don’t dwell! We can just let the thought pass by. The more a child resists having intrusive thoughts, the more likely they are to pop up again. It may sound counterintuitive, but accepting intrusive thoughts can actually reduce how often they happen. By naming the dark thought and moving on, your child is teaching herself that they’re nothing to be afraid of.

Need More Help? Begin Child Therapy for Intrusive Thoughts in North Carolina

Sometimes, a child’s intrusive thoughts grow to be so big and overwhelming that at-home strategies aren’t enough to tame them. Maybe your child’s thoughts are part of a larger problem with anxiety or OCD. Sometimes, intrusive thoughts show up after a child experiences something traumatic or highly stressful. If your child’s intrusive thoughts are very frequent or very overwhelming, therapy can help sort things out.

Cognitive-behavioral therapy teaches children that they have more power than they might think over their thoughts and actions. They can learn to spot intrusive thoughts when they happen, and dismiss them rather than worrying about what they mean. Play therapy can also help younger kids work through anxiety and other feelings that are sometimes difficult to put into words. If your child survived a trauma, TF-CBT is a special, kid-friendly form of therapy designed to help children work through their symptoms in a safe way.

I’m a play and CBT therapist who specializes in helping kids with anxiety and trauma. I can work with families in three states: North Carolina, New York, and Florida. Children who live near my Davidson, NC child therapy office are welcome to stop by in person. If that’s not possible, no worries! I really enjoy online therapy and have found it to be just as helpful for many kids.

Ready to learn more? Drop me a line here. I’m always happy to hear from you.

Intrusive Thoughts in Children, Explained

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

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

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

What Are Intrusive Thoughts?

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

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

• Pop up out of the blue

• Come back repeatedly

• Feel unlike the thoughts a child usually has

• Be upsetting to the child

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

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

At What Age Do Kids Get Intrusive Thoughts?

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

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

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

Why Do Children Have Intrusive Thoughts?

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

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

What Mental Health Problems Cause Intrusive Thoughts?

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

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

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

What Are Some Examples of Intrusive Thoughts in Children?

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

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

• “What if I throw up in public?”

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

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

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

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

• Having an image of the trauma pop into mind

• Hearing or smelling something you associate with the trauma

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

• Imagining hurting someone else

• Picturing themselves stealing something

• Noticing other people’s bodies or imagining them naked

Are Intrusive Thoughts Normal?

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

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

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

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

Help for Kids with Intrusive Thoughts in Charlotte, NC

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

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

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

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

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

Does Childhood OCD Go Away?

If your child has OCD, you may worry at times about what the future holds. It seems like such an unfair burden for a young child to deal with. Maybe you’ve wondered whether your child’s OCD symptoms will eventually fade away, so she will be free to live life without constant worry. If you have, you aren’t alone.

“Does childhood OCD ever go away?” is one of the most common questions I hear from parents, especially at the beginning of therapy. And it’s totally understandable! OCD symptoms can be debilitating and time consuming. Handwashing, repeated checking, asking for reassurance, or long rituals are exhausting not just for the child, but for the whole family. Nobody wants a child be stuck with those symptoms forever!

I can’t predict what the outcome may be for your child, but I do know that therapy can lead to big, positive changes in the lives of kids with OCD. Today, I am digging into the research to see how common it is for childhood OCD symptoms to completely resolve. I’ll also take a look at what we can do to help all kids with OCD start feeling better.

How Common is Childhood OCD?

Childhood OCD is more common than you might think. While we may talk more about forms of anxiety and depression affecting kids, OCD also often starts early in life. Most studies estimate that 1-3% of kids have OCD, although their symptoms might fly under the radar for a long time. This is because because they can be hard to spot.

OCD most often starts when a person is a child or teen. Pretty much everyone with OCD starts getting symptoms before age 25. For childhood-onset OCD, the average age of onset is around 10 years old. It is common for boys to start noticing symptoms a little earlier, while girls might not develop OCD symptoms until later.

Some people may not get treatment for OCD until they reach the late teen or adult years, but their problems often began years earlier, during childhood.

You Can’t Outgrow Childhood OCD Without Help

Looking at the research, one thing that is really clear is that OCD is not likely to go away on its own. It’s not something that a child is likely to just outgrow or forget about. Kids with OCD need specialized therapy. The right counseling can help them learn how to deal with the intrusive thoughts that cause their anxiety and push them to repeat actions over and over.

OCD symptoms tend to ebb and flow over time: sometimes they’re better, sometimes they’re worse. Stress often plays a part in how bothersome OCD symptoms are. Some studies suggest that a small number of people might be able to “outgrow” their OCD without therapy: about 1 in 5. However, it can be a little tricky to tell if someone has really gotten rid of their OCD, or if they’re just in a low-stress time of life when it isn’t noticeable. It’s possible for symptoms to go away entirely when stress is low, only to return again during a more difficult time.

There’s also a risk that a child’s OCD could get worse without treatment. This can lead to small inconveniences, like chapped skin from too much handwashing, or major life impairments, like difficulty getting out of the house. Children with OCD are at an increased risk of also having other mental health problems, like anxiety and depression. Later in life, people with untreated mental health problems sometimes turn to unhealthy coping mechanisms like drugs and alcohol if they don’t have other good ways to deal with their symptoms.

The good news is that most people with OCD feel better after therapy. About 70% of people who get specialized treatment for OCD will improve, and usually they improve by a lot. The great news is that kids often get better results from OCD therapy than adults do. Catching symptoms early and getting help quickly leads to fewer symptoms later in life. Most kids will still have some leftover symptoms after therapy, but a small number of kids might see their OCD go away.

Sometimes, OCD Goes Away Completely (But Not Always)

Different experts have different opinions on whether or not it’s possible for OCD to completely go away. I don’t think I can argue with the experts! It’s not entirely clear whether people get cured of their OCD, or if they just go into remission from OCD. “Cured” means the symptoms are gone forever, while “remission” means the symptoms go away for a while, but may come back later.

Being the nerd that I am, I’ve looked over a handful of studies looking at the likelihood of OCD symptoms going away after therapy. It seems like it is possible for some people, and there are a few factors that increase a person’s odds. Kids whose symptoms start when they are young have better chances of remission than teens or adults. So do people whose symptoms are milder, and who are able to get therapy quickly. Finally, people who do not have other mental health problems alongside their OCD fare better than people who are also dealing with anxiety or other conditions.

Depending on the study you look at, you’ll see researchers estimating that anywhere from 32% to 70% of people go into remission after therapy, meaning that their symptoms are gone for a long time, or have gotten so mild that they aren’t getting in the way of things. However, this is different than being cured: there’s no guarantee that the symptoms might come back. The number of kids who are cured is much smaller and open to debate. Some experts guess that 20% of kids with childhood OCD are cured, while others think OCD never completely goes away.

You Can’t Always Cure OCD…And That’s OK!

As we just talked about in the last section, there’s a big difference between remission and cure. With good treatment, many kids with OCD will go for long stretches without problems. However, expecting your child to never have another OCD thought ever again for the rest of her life probably isn’t realistic. While some kids may fully outgrow their OCD, many won’t. Most experts consider OCD to be a chronic condition that, once you have it, sticks around for the long term.

That may be demoralizing to hear. The words “chronic illness” can sound very hopeless, especially if your child is struggling intensely right now. But just because OCD can be a lifetime diagnosis doesn’t mean it’s a life sentence. You may remember from earlier in this post that OCD affects 1-3% of people. That’s a pretty solid number! There are lots of kids and adults out there who are thriving, enjoying life, and just so happen to have OCD.

Help is Available for Childhood OCD in Charlotte, NC

OCD doesn’t have to run your child’s life. If you are tired of repeated worries and rituals taking up your family’s time, therapy can help. In counseling, kids can learn that OCD is just a way that some people’s brains think—and they have control over which thoughts they listen to and which they don’t. A skilled therapist can help a child gradually “talk back” to their worries and face their fears. Eventually, OCD stops being such an overwhelming urge and turns into background noise.

I’m a therapist based in Davidson, NC, just outside of Charlotte. I’m also someone who had childhood OCD! Everybody’s symptoms are different, but I remember what it felt like to be spending so much time every day dealing with worries I didn’t want to have. I love helping other kids manage their OCD fears so they can get back to enjoying childhood.

Cognitive Behavioral Therapy is a great option for OCD, and younger kids often benefit from play therapy, too. Is Davidson, NC a long commute for you? We can work together online if you live anywhere in North Carolina, New York, or Florida.

Want to learn more? Email me to ask a question or request an appointment.

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

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

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

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

What Causes Depression in Children and Teenagers?

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

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

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

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

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

• Chronic physical health problems

• Social isolation

• Poor sleep or nutrition

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

How is Depression Diagnosed in Kids and Teens?

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

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

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

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

• Decreased interest or enjoyment of activities most days

• Unintentional changes in weight or appetite

• Noticeably slower thoughts, speech, or movement

• Feeling tired or low on energy

• Feelings of guilt or worthlessness

• Difficulty thinking, concentrating, or making decisions

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

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

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

Signs of Depression in Children

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

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

• Trouble concentrating at school

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

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

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

• Difficulty handling rejection or criticism

• Low self-esteem

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

Symptoms of Depression in Teenagers

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

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

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

Depression symptoms specific to teenagers include:

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

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

• Frequently talking about death and dying

• Withdrawing from friends

• Dropping out of extracurricular activities they used to care about

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

• Cutting or other forms of self-harm

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

Counseling for Teens and Tweens with Depression in Davidson, NC

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

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

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

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

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

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

Panic Attacks and Anxiety Attacks Are Basically The Same Thing

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

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

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

What Does Anxiety Look Like in a Child?

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

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

• Frequent worries that seem like more than a phase

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

• Difficulty falling asleep, or trouble sleeping alone

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

• Clinginess and difficulty tolerating being alone

• Repeatedly asking for reassurance

• Irritability or seeming on edge

• Being easily startled by loud sounds or surprises

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

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

Signs Your Child Is Having Panic

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

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

• Shaking hands or full-body shivering

• Increased sweating

• Hot flashes or chills

• A racing, pounding heartbeat

• Hyperventilating, or feeling like it is hard to breathe

• Dizziness or weakness

• Tingling feelings in the fingers or hands

• A sense of losing control

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

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

Can a Child Have Both Anxiety and Panic?

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

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

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

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

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

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

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

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

Signs of Social Anxiety Disorder in Children

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

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

How to Tell If Your Child Is Shy…

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

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

…And How to Tell If Your Child Has Social Anxiety

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

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

Signs and Symptoms of Social Anxiety Disorder

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

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

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

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

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

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

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

What Social Anxiety Looks Like in Kids

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

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

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

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

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

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

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

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

Counseling for Kids with Social Anxiety

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

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

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

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

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

How Do I Talk to My Child About Counseling?

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

Common Concerns When Discussing Counseling

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

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

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

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

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

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

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

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

Describe the Problem as Belonging to Everybody

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

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

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

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

Explain What a Counselor Is to Your Child

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

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

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

Talk About How Child Counseling Works

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

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

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

Looking for a Child Counselor in Davidson, NC?

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

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

Does My Child Have Generalized Anxiety Disorder?

If you’ve been spending what feels like an overwhelming amount of time talking through your child’s worries, you might be wondering about Generalized Anxiety Disorder. It’s a pretty common mental health disorder, but it can sometimes be tricky to spot. Unlike other forms of anxiety, kids with generalized anxiety aren’t dealing with one specific fear. Instead, many day-to-day events can be the source of their worries. Today I’ll be writing about the signs and symptoms of Generalized Anxiety Disorder (GAD), and how you can help your child with anxiety.

When Does Worrying Become a Problem?

As uncomfortable as it feels, anxiety is a healthy emotion to have. If we never felt anxious, we’d have no inner voice letting us know when a situation is potentially dangerous. Kids are still learning about the world, so it makes sense that they’d be on high alert in new situations. It’s totally normal, age-appropriate, and even healthy for kids to worry sometimes.

Very young children usually worry about being away from their parents. By preschool, fears of animals, monsters, and the dark become more common. Grade schoolers often worry about more complex, “real world” fears like germs, serious illness, natural disasters, and kidnapping.

Kids with generalized anxiety worry about these common topics, too, but the nature of their worrying is different. While many kids might focus on a single worry for a few weeks or months and eventually move on, kids with GAD seemingly worry about everything.

They have a laundry list of worries, both big and small. Parents of kids with GAD may notice that their child’s stress level seems out of proportion to the actual situation, and it’s hard get that stress under control. The worry these kids experience is so intense that it affects their sleep, and can even lead to physical problems like tension headaches and fatigue.

Symptoms of Generalized Anxiety Disorder

Therapists use specific criteria to diagnose mental health problems like anxiety and depression. Here are the symptoms we look for when diagnosing Generalized Anxiety Disorder:

• Excessive worrying and anxiety about a variety of topics, events, or activities. The worrying has to happen most days, and last at least 6 months.

• The worries are very difficult to control—the child can’t easily shift away from them.

• The anxiety affects the child physically or mentally in at least one of the following ways:

  • Feeling on edge

  • Fatigue

  • Trouble concentrating

  • Irritability

  • Body aches, or muscle tension

  • Problems falling or staying asleep

• The anxiety (or the physical and mental problems it causes) get in the way of a child’s day-to-day life, and make it harder to participate in activities at school or home.

• There isn’t a more obvious reason for the worrying, such as a recent trauma.

Signs of Generalized Anxiety Disorder in Children

Here are a few more signs that might suggest generalized anxiety is to blame for your child’s worries. If your child is struggling with GAD, you might notice:

• A lot of time spent worrying about things that could happen in the future, whether or not they seem very likely to happen.

• Frequent complaints of headaches, tummy troubles, or other problems that don’t seem to have a medical cause.

• Your child seems to worry more often and more intensely than other kids of the same age, and has a harder time setting his worries aside.

• As soon as one worry gets resolved, another seems to rise up to take its place. The worries shift rapidly from topic to topic.

• Your child is extremely worried about bad things happening to herself or to you, even if you’ve never been in a dangerous situation before.

• Mildly stressful events at school cause major anxiety, for example, a test, big project, or a competitive game.

How Parents Can Help Kids with Generalized Anxiety

Kids who have generalized anxiety need help to relax, so they can ease their muscle tension and sleep more peacefully. Parents can help their kids develop healthy coping skills to relax the body and mind, like mindfulness, deep breathing, and progressive muscle relaxation. Trying one of these skills out one time might help a little bit, but kids with GAD will likely need daily practice in order to see results.

We know that sleep has a big impact on mental health, and sleep-deprived kids (and adults) are more prone to anxiety and depression. Kids with generalized anxiety can fall into a vicious cycle, where the anxiety causes poor sleep, and the poor sleep causes even more anxiety. Using relaxation skills at bedtime can help kids get in the right mindset to drift off—muscle relaxation and guided visualizations are especially helpful for this.

These skills will be even more helpful if they’re part of a “settling routine”: a simple ritual you and your child share each night. The repetition of the same routine sends a signal to your child’s brain that it’s time to unwind and go to bed.

Start Child Counseling in New York, North Carolina, or Florida

So, you’re noticing some signs of generalized anxiety in your child…where do you start looking for help? For some fast relief while you’re looking for a therapist or considering next steps, consider teaching your child some coping skills to deal with anxiety. My online course, Worry-Free Tweens, was designed especially for kids ages 8-12 and their parents. In it, you’ll find step-by-step directions for both you and your child on how to manage anxiety, panic, and overwhelming worries at home.

Kids who have been anxious for a long time may need more than a few coping skills to get back on track. Counseling can help kids stop the endless cycle of worry and learn to feel more in control of anxious thoughts. Younger children can work through their fears and practice coping skills through Play Therapy, while older kids can develop lifelong tools for anxiety management with Cognitive Behavioral Therapy.

I love working with anxious kids and tweens in my Davidson, NC office. Not within driving distance? I also provide online counseling services, and can see kids in New York and Florida remotely, too. If you’d like to get started, or you have any questions, feel free to reach out to me here.

3 Signs Your Child is Ready for Social Media

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

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

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

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

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

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

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

Readiness Sign #2: Your Child Has Healthy Body Image

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

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

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

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

Readiness Sign #3: Your Lines of Communication Are Open

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

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

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

More Help for Tweens and Teens

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

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

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

Should My Child Have Social Media?

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

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

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

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

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

How Social Media Hurts Kids’ Mental Health

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

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

The Safety Risks of Social Media for Children

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

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

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

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

Social Media Is a Child-Friendly Creative Outlet

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

Social Media Encourages Diversity

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

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

Need More Help? Try These Resources for Tweens and Teens

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

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

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

5 Books on Transracial Adoption for White Parents of Black Children

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

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

Who is This Book Recommendation List For?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mental Health Resources for Kids and Parents

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

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

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

Explaining CBT to a Child: 4 Topics to Talk About

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

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

What is Cognitive Behavioral Therapy?

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

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

Common CBT Techniques

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

• Relaxation techniques to calm the body

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

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

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

• Gradually exposing themselves to things that trigger anxiety

• Using roleplay to practice skills

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

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

CBT Topic #1: The Cognitive Triangle

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

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

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

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

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

CBT Topic #2: Thoughts or Actions Can Change Feelings

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

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

CBT Topic #3: Talking Back to Worries

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

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

CBT Topic #4: The Feelings Remote Control

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

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

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

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

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

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

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

Signs of Separation Anxiety in Older Kids and Teens

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

How Common is Separation Anxiety in Kids and Teens?

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

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

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

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

What Causes Separation Anxiety In Older Kids?

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

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

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

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

What Are the Symptoms of Teen Separation Anxiety?

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

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

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

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

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

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

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

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

Signs of Separation Anxiety to Look Out For

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

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

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

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

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

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

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

Begin Counseling For Teens With Separation Anxiety in North Carolina

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

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

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

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

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

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

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

“Mean Girls” Are a Myth

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

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

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

Having Fun is Good Therapy

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

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

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

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

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

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

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

…In Fact, It Can Help Anxious Kids Connect

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

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

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

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

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

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

Interested In DnD For Your Tween?

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

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

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

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

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

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

Perfectionism Can Hold Kids Back

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

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

What Are the Symptoms of Perfectionism in Children?

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

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

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

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

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

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

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

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

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

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

Can Perfectionism Cause Low Grades?

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

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

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

How to Help a Child With Perfectionism

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

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

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

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

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

When Perfectionism Turns Into Anxiety, Child Therapy Can Help

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

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

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

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

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

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

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

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

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

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

• “Ugh, that sounds awful.”

• “That would upset me, too.”

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

• “What a rough day.”

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

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

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

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

• “You are so brave.”

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

• “You’ve got this!”

Practice Coping Skills to Relax and Manage Worries

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

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

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

Cognitive Behavioral Therapy for Teen Girls With Anxiety

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

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

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

Is Your Child a Highly Sensitive Person?

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

What Is a Highly Sensitive Person?

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

Being “Highly Sensitive” Is Not a Diagnosis

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

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

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

Signs Your Child May Be Highly Sensitive

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

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

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

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

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

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

How to Help a Highly Sensitive Child

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

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

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

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

Considering Child Counseling in North Carolina?

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

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

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

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

5 Things Your Child Learns When You Play Together

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

Children Learn Through Play

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

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

Play Lesson #1: “I Am Important”

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

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

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

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

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

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

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

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

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

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

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

Play Lesson #4: “I Can Be Mindful”

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

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

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

Play Lesson #5: “I Am Loved”

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

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

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

Are You Considering Play Therapy in North Carolina?

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

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

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