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Anxiety in Kids

anxiety in kidsAnxiety disorders are the most common mental health diagnosis in kids; ten to twenty percent of all children will meet criteria for an anxiety disorder before the age of 18. But it’s hard for parents to figure out when worry is part of typical child development and when it’s a concern.

Some anxiety in kids is normal. Anxiety can inspire children to do stuff like wash their hands and double-check their homework. Anxiety becomes an issue  when kids get stuck in it to the point where its getting in the way of their lives. For example, it’s fine if a child double-checks his math sheet; it’s not fine if he can’t sleep because he’s obsessively going over and over the numbers, erasing the paper to the point that his pencil rips through and begging you to check it for him.

When worry becomes extreme and/or intrusive, that’s when it’s time to get help. If your child is missing out on her regular everyday life or missing out on events that you know she would otherwise enjoy then her anxiety has become a problem.

Anxiety is often co-diagnosed with depression (particularly in teens) and anxious kids may also be misdiagnosed as having attention problems. (Anxious kids often have a hard time focusing particularly in contexts that worry them — at school, for example.)

Which Kids Become Anxious

Some kids are born with a more anxious temperament than other kids and these children often have anxious parents (because temperament — innate personality traits — is generally believed to be nature although how we live out our temperament depends on nurture). If you have struggled with anxiety there’s a higher chance that your child will, too.

The kind of temperament that tends to anxiety is sensitive, cautious and negative. You might recognize yourself in some of these traits, too.

Sensitivity: These kids are aware of their surroundings and may pick up on details that other people miss. They may be the first ones to notice someone’s new haircut or when someone else replaces their contacts with glasses. They may overhear adult conversations even though they’re in a room four doors down. They may detect subtle changes in someone’s demeanor and ask you later why Aunt Cora was mad. These kids may also have sensory sensitivity; the world feels less comfortable for them whether they are sensory seeking (wanting more intense sensory input) or sensory avoidant. His anxiety may be heightened because he’s uncomfortable in his socks or because he doesn’t like the way this new school smells.

Cautious: I’ve met plenty of anxious kids who go hurtling into space on their bikes or rollerblades but lots of anxious kids will be the ones hanging back from the fray. They may be the ones observing the party before they join or the ones who read up on shark attacks in Florida before your summer vacation. They may be the ones who need a lot of cajoling, the one who makes the family late for the wedding because she wants you to tell her — again — exactly what’s going to happen there. They may be reluctant to try new foods or new things.

Negative Emotionality: This is another way to say pessimistic. These are the kids who are sure bad things will happen. They’re the ones who counter your encouragement with a lot of concerning “what ifs.” Says Dad, “Let’s head to the pool!” Says child, “But what if the lifeguard isn’t on duty? What if I get a cramp? What if you don’t notice I’m drowning?” This is a child whose theme song could be Mel Brooks’s “Hope for the Best, Expect the Worst.” And when you say, “You’re being ridiculous” they’ll counter with, “I’m being realistic.” This is a genuine worldview they have and logical arguments may not make a dent in it.

You can see that these can be great traits in small doses — and the anxious kid can be a pleasure much of the time — but when taken too far, these traits can be crippling.

Sometimes there’s a specific event that triggers a child into an anxiety disorder. For example, a child who gets lost at the mall or who witnesses someone get injured. Or a big life event like a move or a change in school may impact some kids differently than their siblings or peers. Lots of children will spend their early years worrying and then when they hit their tweens, that’s when the worry turns out to full blown anxiety.

Anxious parents can inadvertently make things worse for their anxious kids both because they share certain personality traits but also because anxiety is one of those super-catching emotions. Think about it — back when we were hunting and gathering, it made sense for one person’s anxiety to trigger another person’s anxiety. If a tornado is bearing down on your tribe it’s a help if everyone gets ready to run. We have mirror neurons — so called because we reflect our emotions back to each other — to keep us all in step. This is why when faced with a child wailing about the upcoming spelling test we get revved up, too, and pretty soon everyone is yelling.

If you have questions, hit me up.

Second in the series: Child Anxiety Symptoms

Last in the series: Helping Kids with Anxiety

Support Women (and have fun doing it)

momologuesOne of my very most favorite local organizations is POEM (Perinatal Outreach and Encouragement), an organization devoted to supporting women who are struggling with postpartum depression, postpartum anxiety and/or recovering from a traumatic birth. POEM was founded and directed by three women who came out of their own PPD experiences committed to helping their fellow moms and has been in operation since 2005.

POEM’s annual fundraiser is a performance of Momologues, a play sharing women’s stories with motherhood. The year’s play is happening May 2nd at The Emerald Room, Makoy Center, 5462 Center St. Hilliard, OH 43026. You can get your tickets by clicking here. (I have clients until 9pm that night so I am very sad to be missing it. I hope your schedule allows you to catch the show!)

I interviewed Tonya Fulwider, the director of POEM, which is now under the umbrella of Mental Health America Franklin County, about the performance.

How did POEM get involved in showing the Momologues?

The short story is that in a brainstorming session, someone actually organically came up with the idea for a play/stand up/show/poetry slam entitled “MOMologues.” After Googling it, we discovered the production with that name, which had, only days before, begun talks with a production company to allow others to produce the show. We were among the first to produce a staged reading of the show outside of the original authors and cast in Boston. We’ve kept in touch with lead author and director, Lisa Rafferty, over the years.

We wanted to spread the word about the services that POEM provides, shed light on the issue of maternal mental health, educate on the realities of motherhood and celebrate mothers. The truth is, that while PPD and related illnesses are real and common, much of the work we do is addressing realistic expectations: it’s not all bliss; childbirth will likely not be a magical, bonding experience; being a mom is often hard, boring, frustrating – with moments of amazement, wonder, and the biggest love imaginable – but is mixed in with day to day stresses and regular life challenges. This led us to try to find a way to merge the two issues: maternal mental health promotion/awareness, and myth-busting about the realities of motherhood.

Am I right that this is the third year or has it been going on longer?

This is our 4th year. We showed first script in the series for the first two events in 2011 and 2012 (which covered pregnancy through about Kindergarten) and MOM2 (which included comedy from preschool through elementary) in 2013. We’ll perform the final script in the series this year, and have plans to produce a Columbus-area specific script in 2015 that will cover all stages of motherhood.

Who are the performers?

All cast members are moms of diverse experiences and backgrounds. Most are local theatre performers as well.

  • Emcee Ann Fisher (WOSU 89.7FM)
  • Casting by Amy Anderson
  • Melissa Muguruza (also our director)
  • AJ Casey
  • LiLi Keon
  • Tammy Muse

What will people see in The Final Push that may be different from the first two incarnations?

The Final Push is a staged reading that features much about the hijinks of kids in middle school, high school, and seeing them leave home – but references other maternal experiences as well. While each script focuses on a grouping of years, most moms will be able to relate to the stories, either as mothers or in their interactions with their own mother, partner/spouse and in other social situations. Each play in independent – you don’t need to have seen other years to enjoy any of the sequel productions.

We selected this script for this year to complete the series, as we intend to create our own original work for 2015, collecting stories from local moms of all ages and backgrounds. Everyone has a funny, moving, you’ll-never-believe-this story about motherhood and we want to bring moms together to feature these stories unique to our own community. Sharing our own authentic experiences is powerful, fun, uplifting, moving, and bonding. It’s much of what we do in our program, and it’s a perfect way to celebrate moms each May, the month we celebrate Mother’s Day.

Finally can you talk more about how this benefits POEM?

As mentioned, The MOMologues serves as a creative platform for talking about maternal mental health — something that isn’t talked about, really, all that much considering how many women and families (nearly 1 million in the US each year) deal with these devastating illnesses. Yet, it seeks to also go beyond the specific issue and program support to say: Let’s get together, moms. Literally, get together. Let’s support each other. Let’s laugh at ourselves, and certainly our kids. And, yes, it’s a fundraiser too 🙂 All of the proceeds from The MOMologues go directly to POEM program services: the outreach program, phone support line, information and referral services, support groups, Mentor program.

Now registering for Parenting for Attunement, a class that helps you become the parent that your child needs and that you are meant to be. Learn more by clicking here.

Sharing around this week

fallpumpkin-insideHere are some things that caught my eye and that I shared on my Twitter or Google Plus or on my Building Family Counseling Facebook page this week:

  • Catie, my co-facilitator for the All Adoption group has decided to create a casual, peer support Central Ohio Adoptee only group! If you or anyone you know might be interested in meeting up monthly, please join the Facebook page to get more info. This is SO SO NEEDED and I’m really thrilled she’s doing it!
  • I loved these pictures from the Humans of New York book review over at Brain Pickings. I don’t think I’d be happy living someplace so crowded but I sure do like knowing that it’s there to visit.
  • My friend Janine’s father died last week and she shared this post of her memories of being a little girl and spending time with him. Janine is a terrific, terrific writer and ought to be in your feed readers.
  • Spilt Milk wrote about having her children nearly removed from her care when she was struggling with a crisis in her mental health. Mentally ill mothers can be good mothers, too.

Finally, please click the last link for a quick pick-me up!


A Diagnosis Discussion

toomuchthink-insideAt the community mental health center where I work every single person I see gets a diagnosis. There’s a preliminary diagnosis after the first session, which I may write without even seeing the client. (When we do an intake on a child we see the parents without the child for that first diagnostic assessment so the preliminary diagnosis is based on the parents’ report.) The preliminary diagnosis isn’t set in stone; it’s considered a starting point. Clients at the clinic use insurance or Medicaid to get services and they require a diagnosis to open the case so we give one based on the information that we have.

Then a few more sessions in we write the actual diagnosis. By then we’ve seen the client, we have a fairly full history and we can make a full five axes diagnosis. We base that diagnosis on the client’s symptoms and history and when we write the treatment plan we refer back to it and it all works very nicely.

The reasons behind diagnosis are pretty clear — when we make a diagnosis we are creating a picture of the client for ourselves, for other clinicians who might work with her, and for the client herself. As we design treatment plans and measure progress we can refer to the diagnosis to get a better understanding of the work we’re doing together. When we case consult at our clinical meetings we can use diagnosis to better communicate the issues for our client in order to get appropriate feedback to improve her care.

That’s all good, right? Usually it is good. But sometimes it’s frustrating.

Diagnosis is an imperfect art. You know that old joke about rabbis? Here, I’ll tell it to you: What do you get when you have three rabbis? Four opinions. Same goes for therapists. Sometimes a person is experiencing such clear symptoms that it’s very easy to say, “Ahh, yes! Recurrent, persistent and intrusive thoughts? Behaviors meant to neutralize these thoughts? Repetitive hand washing, counting and rules about light switches meant to stave off distress? That’s 300.3 Obsessive-Compulsive Disorder!” Easy-peasy. Everyone gets it.

But other times you can have a client and it’s not nearly as clear for lots of reasons. Like clients may not really know their own history. They may exaggerate or understate the length of time they’ve had symptoms or the severity of those symptoms. Sometimes I get a client’s records and find out she’s had several different diagnoses (this is especially true for children). This speaks to the fact that it is all open to interpretation.

A diagnosis doesn’t just exist in the clinical setting; our clients live with it. I’m not talking about the symptoms or history that lead to the diagnosis; I’m talking about the label. The diagnosis doesn’t just live in her file, all nice and neat and detached from real life. The diagnosis lives in her experience of herself.

Part of working with a client around her diagnosis is helping understand that she isn’t her label. She is not “a depressive” or even a “depressed woman;” she is a “woman with depression.” Even if her illness dictates some of her choices (medication, counseling, etc.) it is not HER. But it can be hard, particularly when I have a client who has been living under the shadow of a diagnosis for some time.

This is especially important when it comes to teenagers. Teens are already trying to figure out who the heck they are and getting a diagnosis in the middle of that can be heady stuff. A diagnosis can be used like a shield to protect her from expectations, to excuse herself when she hangs back, and to rationalize her failures. She may become her diagnosis, reading information on the internet and shaping herself to fit the criteria.

I have a lot of clients who come in with a self-diagnosis based on reading magazines, talking to friends or just a general understanding of what a label actually means. (Lots of clients use words like “anxious” and “panic attack” and “bipolar” without understanding their clinical definition.) They sometimes feel very defensive when I tell them that they don’t actually meet criteria. Feeling sad about a pet dying is not clinical depression; it’s appropriate grief. Feeling nervous about going on a first date is not social anxiety disorder; most of us are nervous before a first date. Feeling happy one day and sad the next is not bipolar disorder; it’s part of the human condition. Our sadness and our fears and our struggles do not need labels to be real.

When I give a client her diagnosis I first give her a rundown about how we got to it. I explain that a diagnosis is a label for a cluster of symptoms and that our focus will be on addressing symptoms. I tell them that a diagnosis is just a way for us all to communicate with each other and it’s not more real than what they’re actually experiencing. It’s a tool, I say, OUR tool, THEIR tool and we own our tools; our tools do not own us.

I don’t take insurance in my private practice and one reason is that it allows me the freedom to give or not give a diagnosis. A diagnosis should serve the client and sometimes I think a client is best served by not being given one.

Score one for the nice boys

Being a mama’s boy, new research suggests, may be good for your mental health. That, at least, is the conclusion of a study presented at the annual meeting of the American Psychological Association by Carlos Santos, a professor at Arizona State University’s School of Social and Family Dynamics.

Santos recently conducted a study that followed 426 boys through middle school to investigate the extent to which the boys favor stereotypically male qualities such as emotional stoicism and physical toughness over stereotypically feminine qualities such as emotional openness and communication, and whether that has any influence on their mental well-being. His main finding was that the further along the boys got in their adolescence, the more they tended to embrace hypermasculine stereotypes. But boys who remained close to their mothers did not act as tough and were more emotionally available. …

Using a mental-health measure called the Children’s Depression Inventory, he also found that boys who shunned masculine stereotypes and remained more emotionally available had, on average, better rates of mental health through middle school. “If you look at the effect size of my findings, mother support and closeness was the most predictive of boys’ ability to resist [hypermasculine] stereotypes and therefore predictive of better mental health,” Santos says.

buddies-insidevia Emotional Openness May Be Good for Males’ Mental Health – TIME.

How about we stop this whole “mama’s boy” stereotype altogether, ‘kay? Let’s just say that human beings — male or female or self-identified other — are healthier and happier when they are allowed and encouraged to be in touch with their feelings and taught skills to communicate effectively.

I mean, duh, people. Really and truly DUH.

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