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When my son was diagnosed with ADHD, I thought, as a psychologist, I was prepared for the continuing challenges of parenting. But I was wrong. All my knowledge went out the window as I attempted to plead, cajole, beg, bribe, yell my way through parenting my son.  Those early childhood years of his life were increasingly tough. There were many moments I wished that there could have been a support group, a therapist, someone, who knew what I was going through. So that all of these increasingly difficult behaviors weren’t on mine and my husband’s shoulders alone. We were very lucky. We had friends and family, and a WONDERFUL therapist who helped us through it all. And even with all the support, we felt isolated from our parent-peers.  There are many parents out there who don’t have the support base we had. And it’s not just parents of children with ADHD that experience this burn out. One population of parents in particular has an exceptionally high rate of anxiety and depression. Parents and primary caregivers of children with Autism Spectrum Disorder (ASD) have significantly high rates of depression and anxiety (50% and 40% respectively).  Despite this, very few seek treatment for themselves. We know that if treatment is received, we can decrease these rates of anxiety and depression, thereby increasing satisfaction and effective parenting techniques, and decreasing alienation and loneliness. A recent study by Lushin and O’Brien (2016) has found that using the Early Intervention Program to provide treatment to parents, either in a home-based or clinic-based setting (where their child receives services) helps reduce the symptoms and severity of the depression and anxiety related to parenting s child with ASD. Receiving treatment for their depression and anxiety helps them parent effectively, which in turn helps their children. The Early Intervention Program seems like a perfect vehicle to provide these services. And we know that the early the effective services are provided to the child (and that includes appropriate parenting), the better the child is in the long term. And the better we all are. Lushin, V., & O’Brien, K.H. (2016) Parental Mental Health: Addressing the unmet needs of caregivers for children with autism spectrum disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 55, 1013-1015. http://dx.doi.org/10.1016/j.jaac.2016.09.507

Considering the current political climate in our country, it’s important to talk to our children about how to be gracious winners and losers. Sometimes, we tell our children, we don’t always win. Sometimes, we remind them, we will. Both are ok. Both are part of life. But it’s important to remember that we live in a world with lots of other people who don’t feel the same way. Or who tried hard, and lost, or won. And it’s our place to come together afterwards and still live and get along. What many people might be feeling are strong emotions, adults included. Our children may not understand why we have these strong emotions; why we are feeling anxious or upset, or elated and confident. They may not know why the adults around them feel these strong emotions, or they might understand the concept of “winning” and “losing”. But they all feel our emotional cast offs. What most children don’t understand is how to process these strong emotions. Often regulating these feelings are hard; they get carried away and end up on an out of control emotional rollercoaster that leaves them feeling out of control. Here’s how to help:

1. Accept their emotions. They, and you, have a right to feel the way they do. It’s ok to be happy, or sad, or confused. All our feelings are ok.
2. It's how we express our emotions that count. We can have feelings, but our feelings can’t stop us from living our lives. We still must go to school, or work. We still must eat, and sleep, and do what is expected of us in our everyday lives. That’s what makes the world continue to turn.
3. We can learn to handle our emotions. Learning to sit in our emotions, to accept what we are feeling without judgement but acceptance, is key. There are lots of meditation apps that you can download to help everyone practice focusing: on your breath, on a though, on a feeling. When you control your emotions, your emotions don’t control you.

Being in control of our emotions will help our children be in control of themselves. And as a person, a family, and a country, we can be more in command of ourselves, which will allow us to continue to live our best lives. This holds true for a soccer game, a test, and an election.

I was at a function on 9-11, with parents and children all under the age of 13. In respect to the day, a 9-11 tribute was planned. One parent walked away, visibly upset. Understandably. We have lived through this day, and the following weeks: in real time, in our minds, in our waking and dreaming hours. But our children haven’t. They have only known a world where we don’t wear shoes on the security line in the airport, and metal detectors are common place. How do explain 9-11 to our children? At what age do we start? It’s important to be able to talk about scary events to our kids. Bad things happen. And we need to be able to speak to our children about them, in an understandable and relatable manner. If we can start speaking to our children when they are young, it will be easier for us (as parents) to talk to about, and for them (as growing minds) to process.

1. Don’t shy away from the truth, but give it to a child in a developmentally appropriate way: Young children don’t need to know that planes struck two iconic buildings in Lower Manhattan. But they do need to know that something bad happened.
2. Stick to the facts: It’s so easy to add commentary. Don’t. This is true in any tough situation. It muddies the waters and doesn’t help young children process what occurred. You can simply say, "Some people wanted to hurt America." If the child is older and prepared to hear more facts, give them slowly. Remember that what you say will inform how they react and think in the future.
3. Try to give hope: Even when things are hopeless. Children look towards the adult in their life to guide them. Even when we don’t have answers ourselves. It’s important to remember what we are doing to keep people safe, and how those actions, in turn, are keeping our children safe. We might find the lines in the airport long and cumbersome, but they help ensure that everyone flying that day is safe and secure. Present the positive to the child.

Sometimes, in the moment, we don’t know what to say. If that’s the case, it’s ok to say “I don’t know. Let me get back to you.” Seek out a pediatric psychologist or other qualified mental health professional to sort through the information and help you come up with plan of what to say. When you have a plan, you’ll be calmer and be able to talk to your child in a clear manner.

Talking to kids about scary times is tough. But it’s important we build that foundation for children. Because our children deserve to know how to process both positive and negative events in their lives. And it’s our job as parents to guide them.

What happens when being sad doesn’t go away? Or, what does it mean when a young child is jumpy, unfocused, sad, and angry, more often than not? When young children are diagnosed with Major Depressive Disorder (MDD) often medication and/or therapy are prescribed. Many times, despite our best efforts, children with MDD often relapse. A new study looked at children prescribed fluoxetine (Prozac) as well as relapse prevention cognitive behavioral therapy (CBT). Interestingly, regardless of whether children received relapse prevention treatment, 80% of them experienced remission; that means that 80% of children in the study got better! But there was a group of children who relapsed. Children in the fluoxetine and CBT relapse prevention group stayed mentally healthy more than three months longer than those just receiving medication. Booster CBT relapse prevention therapy, along with appropriate medication management, has been shown to be effective in helping children diagnosed with MDD. Reviewing mastered skills, before they are needed, can help prevent further relapse, and quicker recovery, so that kids can get back to being kids. Emslie, G.J., Kennard, B.D., Mayes, T.L., Nakonezny, P.A., Moore, J., Jones, J.M., … King, J. (2015). Continued effectiveness of relapse prevention cognitive-behavioral therapy following fluoxetine treatment in youth with major depressive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 991-998. http://dx.doi.org/10.1016/j.jaac.2015.09.014

Sometimes, walking into kindergarten can be super scary; new children, new teacher, no mommy. It may take a few days or weeks for some children to warm up and be comfortable. Those who don’t warm up, who continue to cry and have difficulty adjusting to novel social situations may be suffering from Social Anxiety. Social Anxiety doesn’t end in kindergarten, but may continue throughout a person’s lifespan. In young children, parents and caregivers are more likely to schedule social interactions, which help young children become less socially anxious. A recent study by Hoff et al (2015) found that older children who suffered from social anxiety had greater difficulty in social, academic, and overall functioning as they aged, even when home and family problems decreased. Interestingly, these social and academic problems were greater among children who suffered from social anxiety than those who suffered from other types of anxiety. It’s possible that socially anxious adolescents are more able to avoid social situations, whereas younger children’s social calendar is controlled by their parents. Whatever the cause, early intervention for social anxiety might prevent socially anxious younger children from becoming socially anxious adolescents and adults. Hoff, A.L., Kendall, P.C., Langley, A., Ginsburg, G., Keeton, C., Compton, S., … Piacentini, J. (2015) Developmental differences in functioning in youth with social phobia. Journal of Clinical Child and Adolescent Psychology. http://dx.doi.org/10.1080/15374416.2015.1079779

I just finished a bag of chocolate chips. To be fair, I had been slowly working through the bag for six months. But this morning, I finished the whole bag. By 9:30 in the morning. Getting all four kids off to school by myself wasn’t as difficult, or fraught with stress, as it could have been. But it’s wearing. And I know I’m not the only one. I’m not writing this to give myself, or you, a pep talk; I’m not looking for pity either. Just to say, sometimes, you have those days. Sometimes, my children are wonderful. They can be kind, and warm, and loving. They can be compassionate and conscientious. But most of the time, they aren’t. They yell at each other; they yell at their parents. They try to reinvent the wheel when it comes to homework and projects (“I don’t need to study”, or, “I kinda know it, it’ll be fine”). They don’t do their chores. Their rooms are a mess. And we, as parents, try to compensate. We say “It’s not a big deal, I can empty this dishwasher.” Or, “It was his first failure/suspension/whatever,” or, “Give him another chance.” Sometimes we just do it ourselves because it’s easier. And that’s exhausting. Raising children is mentally exhausting. Letting our kids make their own mistakes and missteps, while providing love and supervision is hard. Letting them know when they can try on their own (i.e. studying), and when the rules need to be obeyed (i.e. sitting down to a meal with the entire family), is tough. But there is a light at the end of the tunnel. Even the most oppositional child learns, eventually, what the family considers truly important. And the lessons they learn through their own trial and error make a greater impact than any amount of yelling or bribery we can offer. And so, go enjoy that occasional bag of chocolate chips. You earned it.

Many of us can walk into a familiar room and get a sense if something is out of place or moved around, or “not quite right.”   We can handle that.  We shrug our shoulders and think, “it’s not a big deal,” and we continue on with our day.  But what if you can’t? When obsessions (ideas or thoughts that continually preoccupy or intrude in one’s thoughts) and compulsions (irresistible urges to behave in a certain way, even if you don’t want to) interfere with daily functioning, it’s called Obsessive Compulsive Disorder (OCD).  Sometimes, the compulsions associated with OCD are driven by the thoughts, or obsessions. But sometimes, especially with some children, the compulsions are driven by that sensory experience of things “not being quite right.” Sensory overresponsivity is often seen in children who have an Autism Spectrum Disorder, and issues with anxiety.  Research is now showing that some children with OCD also exhibit sensory overresponsivity, and that it leads to a significant impairment in functioning. In the latest study by Lewin, Wu, Murphy, and Storch (2015) as much as one third of children diagnosed with OCD have sensory overresponsiveness, which is higher than the general pediatric population. This overresponsivity is more common among preschoolers as well and children who are also depressed, have disruptive behaviors, and ADHD. They found that the sensory overresponsivity was related to compulsion (doing) severity, not obsession (thinking) severity.  Children who had higher the sensory overresponsivity, suffered from a higher global OCD and impairment. As might be expected, the highest levels of sensory overresponsivity were found in children who had contamination obsessions, eating compulsions, and symmetry compulsions. Sometimes that feeling of “just not quite right” can stop us from getting on with our day. We can’t be the best “we” until everything is “perfect.”  But it never is.  Knowing where these feeling are coming from, with regard to OCD, can help us understand and treat it better.

In my various roles as a mother, a friend, a psychologist, president and a board member of a psychological association, I meet a variety of people with different outlooks on life. Most people have their own opinions on how to do things. However, if I were to take everyone’s opinions as fact, I would be befuddled, and confused, and sometimes, paralyzed. To help me deal with several different perspectives, I need my own set of tools to help filter the information I receive. That way, I can analyze any given puzzle to find the solution that best works for me. In a nutshell, that is what cognitive behavioral therapy is. It provides tools to help one look at the world in a certain perspective. Cognitive behavioral therapy strives to adjust one’s thoughts, feelings and actions, so as to help one function in the world better. A trained cognitive behavioral therapist can help your child see the world differently from how he or she is accustomed to seeing it. We work on helping children recognize their thoughts as separate and apart from themselves; we work on talking back to those thoughts. Moreover, we work on knowing when something can’t be changed and how to accept that. A cognitive behavioral therapist teaches children how to be responsible for their own actions, and not those of others. When you change how you act, you can change other people’s actions and reactions as well. And when we change our thoughts and actions, our feelings change, too. In the end, it’s not the only way to view the world. But it’s about helping your child grasp the way that might make sense to him or her. And if it does, then it’s the best way to effect change.

Remembering back to one hot spring day years ago, as siblings often do, my first and third son were just at each other; screaming, yelling, possibly trying to pull the other one’s hair out. And I had had enough. The lawn was a mess. It was a beautiful day. I screamed for everyone to go outside and start pulling up every weed that I could see. And three hours later, we had a beautiful lawn and garden. More importantly, my son’s behavior was impeccable for days. He was polite. He sat when appropriate. He was kind. He got along better with everyone. This lasted for about three days. Then everything went back to normal. Sigh. What is it about sweaty and sustained activities that changes these children? There is a plethora of scholarly articles that talk about how various parts of the brain are “rewired” temporarily through exercise. There are probably even more anecdotal stories you will hear about how this person’s life changed when they began to, say, play soccer. While there’s a lot of neurochemistry involved, here’s a simple analogy to understand how learning works with kids, especially those who have ADHD. Imagine you ride a bicycle through dry dirt which is hard and packed solid.  Regardless of how often you ride the same path, you probably won’t make a significant dent.  Now, try riding the same path after it has rained. The ground is wet and muddy. The more you ride in that same path, the deeper the trench you make with your tires. Even when it dries, that trench will still be there for a bit.  After a while, sure, it dries out and you have to start again. But riding over that same area, again and again, over years, creates a deep groove in the ground, and that’s the path your bicycle will naturally want to follow. This is how children learn. And the more they exercise, the more they are able to pick up on appropriate social cues and provide appropriate responses.  By being rewarded, even by the simple fact of feeling good because they aren’t being yelled at, the more likely they are to do that behavior again. These kids need a little more help to understand how they should behave. Exercise helps them read the social cues being thrown out all around them. The more they exercise, the more they are able to read the social cues. The more they practice that behavior, the more reinforced that behavior is. In the long run, children who regularly exercise will not only develop a love for it, but will have the tools to help them relieve and cope with stress.  Ultimately, it is a wonderful way to help them learn how to be able to learn.

Children are increasingly being diagnosed with Autism Spectrum Disorder (ASD) at higher  rates than previous years.  It can look different at different stages of life.  But what does it  look like preschoolers? Here are some behaviors to look out for.  Remember, if you are concerned, please  seek out an early childhood specialist, such as a psychologist, to get a clear diagnosis. Signs in Language Development

• Young children are learning to talk. So they remember words, and then forget words. They make up words. This is typical. Some children who are suspected of having ASD have words, and then lose them.  But, they don’t regain those words. They may use language in their own way, such as calling a “cookie” a “coocoo.”  These children are resistant to changing their language.

• Young children tend to repeat words just for the sake of repeating them. This, too, can be a normal part of language development. Children repeat words, as a way to grasp what the sounds are or how their mouth moves.  But children showing signs of having ASD have no obvious intention for repeating words.  For instance, they might hear someone say a phrase like “Do you want a cookie?” and repeat it over and over again.  They aren’t looking for a cookie; they are just repeating the phrases.

Social Cues Children with ASD often have poor eye contact.  Also, they often don’t respond when their name is called.  Their lack of response is not with a smirk or meant to give silent treatment.  There is simply just no response.  Many of these children also seem very independent. They don’t need your help because they do everything themselves. And when they can’t, they don’t ask for help; they may take your hand and use your finger to point or reach for what they want. At Play Play in early childhood develops at different rates. Some children like to play by themselves. As they get older they may choose to play near other kids, doing different or similar things. Only later do they play together, in a group, towards a common real or imagined goal.

• Children with ASD tend to play by themselves, their own games, even when most of their other same-aged peers have moved on to a more parallel or cooperative play.
• They may be interested in parts of a toy, playing with it in ways that are unintended, such as spinning the wheels of a truck over and over again. They may lay on their head, looking at the truck out of the side of their eye.
• Their toys may have to be laid out in a certain manner, according to their own organizational rules. They may play with their hands or body in ways that other children don’t, such as flapping, rocking, moving their fingers near their eyes.

As with all other diagnoses, if you have concerns, seek out a trained medical professional.  A psychologist, who specializes in early childhood, can help determine what the concerns are, and how best to treat your child. Autism Spectrum Disorder is not the end of childhood, but these children have a much better prognosis if they receive treatment earlier rather than later.