It’s the therapy stereotype, right? It’s always your mother’s fault! No wonder then that many of the parents I see come in feeling defensive or feeling guilty.
“Did I do something wrong?” they ask me. “Did I create these issues? Is it all my fault?”
My answer to this is probably going to feel frustrating: I don’t know and what’s more, I don’t think it matters.
Here’s the deal: different kids need different kinds of parents and sometimes those different kids live in the same family, which means the fool proof technique you had for dealing with one child’s tantrums is not necessarily going to work with dealing with the next child’s tantrums. In fact, it might make things worse. Remember there is no one size fits all parenting.
Let’s take childhood anxiety. Anxiety has at its core a whole lot of nature and a healthy dose of nurture. Parents with anxious temperaments often give birth to children with anxious temperaments. That’s not anyone’s fault; that’s genetics. Also parents who deal with the world in an anxious way inadvertently model that anxious way of dealing with the world for their children. That’s nobody’s fault either anymore than the way parents who read a lot tend to have kids who read a lot. Modeling is powerful.
That said, once the family realizes that their child is struggling with anxiety there is an opportunity to explore the way that parenting choices may be influencing that struggle.
Let me give you an example. Consider bedtime routines. Any parenting expert type out there will tell you that bedtime routines are terrific, right? Do a quick google and you have people promising you that having a routine will make your evenings “battle-free” and “sleep-inducing.” And I agree — having a predictable routine before bed is great sleep hygiene. But if you have a child with an anxiety disorder then that friendly little routine can become a prison where mom or dad has to stand in the doorway and say “Good night” exactly this way with exactly that inflection or the whole routine has to start over again.
Then it may be that changing the parent’s behavior is part of what needs to happen next — the solution may lie in part in the parent’s actions — but that’s not the same thing as saying that it’s all the mom and dad’s fault for creating a bedtime routine in the first place.
When my son was small I used to fantasize about having a Sims-type game where I could program all of my son’s characteristics into the computer and try out different parenting choices to see which would be the best one. Like, this Sim-baby I could send to preschool and that one I could keep home. This one I could be really stern with and that one I could lean more towards permissive. At the end of the game I’d know exactly the right way to raise my actual baby here in front of me.
Unfortunately we don’t have that. Instead we have a lot of advice and a lot of research, (which is helpful but not definitive) and a lot of books and neighbors and teachers and therapists and then we have our own hopes and dreams and histories and expectations. Then throw in kids with wildly different temperaments, abilities, interests, talents and challenges and well, we end up with a whole mess of confusion.
In short, we’re going to do some things right and we’re going to do some things wrong. Sometimes the wrongs are no big deal and sometimes we’re going to have to course correct. Sometimes a bedtime routine is awesome and sometimes it’s ripe with dysfunction for no other reason than there’s a perfect storm of this parent, this technique and this child and it’s not working.
(This is also why none of us should ever be smug with each other. Show me a parent who has a child who is a shining beacon of perfection and I’ll show you a parent who got lucky. In parenting, like in all things, some of us have it easier than others just because.)
So if you come to me and say, “Is this all my fault?” I’m going to say that I think you’re asking the wrong question. I’m going to encourage you to say, instead, “What can we do now to help things be better?”
Way back when, back when Hector was a pup and I had a lot less gray hair I used to schedule screenings like this at the YWCA in Portland. Now I’m sharing this with you but you gotta get on it — the screenings happen this Wednesday. If you can’t make it then give the ECRN+ a call and find out when they might be happening in the future.
Child Developmental Screenings - Mind and Body
Wednesday, January 28th 9 a.m. - 12 p.m.
Grove City YMCA - 3600 Discovery Drive, Grove City, OH 43123
What is a developmental screening?
A developmental screening is a snap shot look at a child’s development to determine if a child is reaching appropriate milestones. Your child’s social-emotional development (mental health) is an essential part of their overall growth. Mental health in childhood simply means reaching developmental and emotional milestones and learning healthy social and coping skills. Children with good social-emotional skills function well at home, in school and in their communities. In addition to their social-emotional screening, your child’s speech and language, fine and gross motor skills, self-help skills, vision, and hearing will also be checked.
Thanks to the generous support of The Columbus Foundation, the Early Childhood Resource Network+ will be providing FREE screenings to all children ages 1 month through 5 years. Screening appointments are not necessary but encouraged.
TO MAKE AN APPOINTMENT OR FOR FURTHER INFORMATION, CONTACT:
Katie Lombardi or Margie Dalton—Developmental Consultants 614-543-9000 ext. 218 or email@example.com
EARLY CHILDHOOD RESOURCE NETWORK+
6555 Busch Blvd, Suite 112, Columbus OH 43229 614.543.9000 ymcacolumbus.org/ecrn
Sometimes when you’ve won an argument you can help the person who lost save face by letting them get the last word in. I think this can be particularly helpful with kids.
You can help move things along by letting a kid stomp away mumbling. This seems counterintuitive and I know it’s tempting to holler, “What’s that? Who do you think is such a mean mom? Get back here, young lady!” but don’t give into it. If you pull them back, “What was that you said?” you’ve entered into a power struggle. Power struggles are tar pits; do not get stuck in them.
You can pretend not to hear it even if you do, which is going to help things get back to normal more quickly than if you bring them back in to escalate the argument.
We want our children to be respectful and for some families that makes it very hard to let someone grouch off to her chores muttering under her breath. But here’s the thing, if you let her do it, if you let her turn away and get a dig in that’s meant to be just loud enough for you to hear, you’re actually coming out ahead because you’re saying, “I am big enough to withstand and allow your muttering.”
Same thing with slammed doors.
Same thing with eye rolling.
Same thing with “whatever” under her breath.
You can address the things that are truly out of line in your family later (maybe in your family slamming a door is against the rules or maybe it isn’t, remember there is no one-size-fits-all parenting). You can address it when people are calmed down because it’s easier to work out one conflict at a time.
Make your point, let them mutter or stomp or slam. Once everyone is back to an even keel then bring it up, “Hey, when I talked to you about those chores and you rolled your eyes while I was talking, that upset me. In this family we show each other respect even when angry.”
One conflict at a time. Chores or eye rolling, not both at the same time. Otherwise you’re in the tar pit, mucking around in an argument you never intended to have and the chores still aren’t done. Which may be the very reason they’re doing all of that eye rolling.
(I have one child who is a master at this deflection. I say, “Pick up your socks” and that child stomps, arms crossed, pouts and says, “Why do you hate me” and I say, “I don’t hate you” and that child says, “You are so mean!” and I say, “I am not mean!” and it’s three hours later and there are still socks all over the house.)
So how could you respond?
You: “Please clean your room.”
Him: [sigh] “Ok, mother.” [eye rolling as he turns away]
You: “Thanks. I appreciate your help.”
You: “I said no PS3 tonight and I mean it.”
Her: [stomp] “You are so unfair!” [storm away, door slammed]
You: [nothing because you made your point]
You: “Please go change your shirt before we go out to dinner.”
Him: “This shirt is fine! I’m just going to get it dirty again anyway!” [turning away to go change, muttering, “Like your clothes are so awesome!”]
You: [nothing because you made your point]
You: “I said the trash needs to go out and it needs to go out NOW.”
Her: “It’s not like you make anyone else take out the trash! You pick on me! Why are you so unfair?” [as she storms off with the trash bag]
You: [nothing because you made your point]
If they still try to draw you in, stay one-note and stay calm, “I’m not talking about whether or not I’m unfair, I’m telling you to turn off the PS3.” “I’m not discussing standards of cleanliness right now, I’m telling you to change your shirt.” “We can discuss chore assignments later. Right now it’s time for you to take out the trash.”
Sometimes it helps to turn away physically to indicate the conversation is over. This shows that you’re confident. Resist the urge to keep an eye on them. Resist the urge to end any directions with, “OK?” As in, “Please go change your shirt before we go out to dinner, OK?” You’re just giving them permission to tell you how not OK they are with your instructions. Unless you’re really interested in their opinion, don’t ask for it.
Then let them mumble, mutter, stomp or storm away from you.
I’m not saying that ignoring a bad attitude is always the way to do things or the only way to do things but if you catch yourself getting stuck in arguments you never meant to have, try it — bite your tongue, sit on your hands, exchange meaningful angry glances with your partner but stay quiet — and see what happens.
We’ve always liked Andy Dwyer at our house and we hear the guy who plays him does some pretty nice things but I’m sharing this clip of Chris Pratt on The Ellen Show (heads up courtesy of Jezebel) because it illustrates some great parenting.
First, this guy knows about child development as evidenced by his understanding that the “terrible” twos are developmentally appropriate since many toddlers are frustrated by their inability to share the complex wants and wishes that drive their behavior. (This is why they freak out about details — the wrong shirt, the wrong spoon for the cereal, the wrong way to open a door and enter a room — they have a very specific idea about what they want and they can’t communicate it to you.) Knowing about child behavior can really help us be better parents because it explains so much; that helps us be more understanding and perhaps less frustrated. And having a grasp of our child’s development holds the keys to an effective response since knowing what drives the behavior helps point us in the direction to address it.
That bit about letting his son stay up later? See, that’s a parenting choice that I think is super personal and isn’t right or wrong. It’s not a problem if it’s not a problem and if it becomes a problem, well, that’s the time to change. I think people get hung up on details like this (how to do bedtime) but what we’re seeing at play here is the ongoing creation of a responsive relationship. You might do it differently. You might enforce bedtime anyway and that’s fine, too.
The second great thing he does is prepare his son for a potentially hectic situation. He does this gently in a way that suits his pretty articulate kid and he’s open to his son’s response. That shows terrific attunement, focusing on the situation and his son’s needs and then communicating in a way that allows his child room to create his own response. The holidays are rough for all of us and acknowledging that can be a huge, huge help in keeping everyone sane.
Ok watch the clip and then I’ve got a little more below.
Ok, so that thing where he warns his son and his son responds with a heartwarming platitude and Chris tears up just talking about it? That’s swell. But the thing that struck me is often we parents start with the platitude. We start with the expectation that this holiday is going to be fun, dangit! And wholesome! And everyone is going to have a really good time!!! And our children are saying (in words and deeds), Well, I’m overwhelmed. I find Santa terrifying. This mall is too crowded. This holiday food is too complicated. I want my routine. And we get super frustrated because we’re already stressed and then our grand plans are falling apart and our kids are melting down and Aunt Lucy is making that disapproving face she makes and ARGH!!!!!
So it’s a good reminder that before all this happens, we always have the opportunity to remember last time. We can remember how the last holiday went or how the last trip to the mall, the zoo, the visit to Dave & Buster’s or Chuck E. Cheese went and we can prepare ahead of time. We can also prepare our kids, “Do you remember how last time at Chuck E. Cheese you started feeling overwhelmed?” (this gives language to that feeling they have) “Remember it felt too loud?” (you can problem-solve for this, offer earplugs or a signal to get the heck out) Maybe your child will look up at you all doe-eyed and adorable (Chris Pratt’s son) and say, “It’s family.” Or maybe they’ll say what my son used to say, “I’m not going.” (My kid missed so many birthday parties as a sensitive toddler/preschooler/schoolager!) But you’ll get to process it and make good decisions before disaster strikes. (For the things my son could NOT miss, we did a lot of planning about how to manage it. Code words that meant, “Mom, Dad, please help me find someplace quiet to calm down,” Quiet days before the big event. Exit strategies. Plans to wind down after.)
Anyway, that Chris Pratt is charming. Good stuff. Good parenting. And nice to see on a daytime talk show.
This is the problem with parenting advice even really good parenting advice. Sure you can give pretty safe general advice if you look at a child’s developmental stage and you can give even better general advice if you also take the child’s temperament into account and then if you have some time to sit down and discuss the family culture and the school culture (if the child is in school) and the broader world in which the child exists, then you can give pretty good advice because it’s not general anymore.
Let’s take discussions about Ferguson. In one of my professional groups we’ve been talking about how Ferguson has been coming up in our counseling sessions. Sometimes it’s coming up because parents are wondering what to tell their kids. I don’t have a One Size Fits All piece of advice about talking to your child about Ferguson because there is no way I could do this appropriately. Instead I would need to know a whole bunch of stuff including but not limited to:
How old is your child? What race is your child? What race are you? How does (or doesn’t) your family talk about race? Has your child brought it up? If so, where did he learn about it? How are they discussing it at school or at the babysitter’s or around the family table at Thanksgiving? What is your child’s temperament? What are his questions? What are his concerns? And finally what do you think about Ferguson?
There is simply not one right way to talk about Ferguson.
There is not one right way to handle bedtime.
There is not one right way to deal with tantrums.
I do give advice here on my blog because there is some general advice that I think is generally good. But that doesn’t mean it’s right for you and your child and trust me, if you get in my office and talk to me I will know that.
Like bedtime routines. Generally speaking a predictable bedtime routine contributes to what sleep experts call “sleep hygiene.” Good sleep hygiene is important. However some kids need less predictable bedtime routines. Some kids with anxiety may become too dependent on predictable routines (such as kids who struggle with OCD) and so that general good advice doesn’t work for those families. Those families need something more personalized.
Or tantrums. Some kids tantrum because their parents are too lax. Some kids tantrum because their parents are too strict. Some kids just tantrum because that’s where they are developmentally and it has nothing to do with their parents.
If you come in and see me we’re going to spend at least the first session just talking about you and your child. I’ll have a lot of questions to try to get a picture of what your child is bringing to the problematic situation and I’ll want to know what you tried, what didn’t work, what sometimes worked and what was an unmitigated disaster. And we will revisit that as we go because we are always learning and working towards greater understanding.
We’re not just trying to solve this problem; we’re also trying to give you and your child insight for you both to take into the future. Part of this is building concrete understanding of our selves (parent and child, together and alone) and part of this is learning how to problem solve in a way that works for everyone in the family. That way when you’re looking at One Size Fits All Parenting (or other) advice you’ll know what’s worth considering and what’s not worth the bother.
And I’ll tell you what, the parents who come to see me often feel lost but they know so much more than they may realize when they’re peering into the murky crisis that brought them to my door. Sometimes the very first part of our work is throwing out all that unsolicited One Size Fits All Parenting advice (from friends, family and strangers) because that’s making the crisis even murkier.
“Shouldn’t she be past this by now?” they ask me.
“Why?” I ask back.
“Well, I read it somewhere/my mother told me/all her friends have stopped doing it.”
And yes, sometimes she should be past this by now and we’ll work on it but sometimes she shouldn’t be and that’s fine and once the parents know that they feel a whole lot better about it.
So. No one knows your child better than you do. I know that and if you’re doubting it, I will help you know that, too.
This is Goldilocks. She’s having a tough time.
This is the final post in the 3-part series about helping kids with anxiety. I reserve the right to blog more about it in the future because it’s a big topic and this is so general. Onward! To the helping!
Cognitive Behavioral Therapy or CBT is the counseling modality of choice for kids (and adults) with anxiety. Research on effective anxiety therapies tend to focus on these three areas:
- Understanding and addressing the physical response to anxiety
- Recognizing and challenging the thinking errors that perpetuate anxiety
- Using controlled exposure to the anxiety-provoking situation and practicing the tools
Again this is super simplified and super general. Kids (and adults) have diverse learning styles, challenges, expectations and histories so how this works will look very very different depending on the child. But to help you get the gist, I’ll use Goldilocks as an example. We all know her story, right? On the very off-chance you don’t, you can check out this short version so we’re all on the same page.
So let’s say Goldilocks’s mom brings her to me because she’s gotten very anxious since her disastrous meet up with the three bears. She’s having trouble sleeping, she’s having some bad dreams, she is having tantrums at the drop of a hat and she hates leaving her mom to get on the school bus because she’s afraid the bears will come break into her house. She also can’t bear the thought of eating porridge ever again and will fall apart if her mom serves it at breakfast.
The first thing we would do is talk about Goldilocks’s physical experience of being anxious. We would talk about how being chased by bears would rev anyone up but now we need to help her calm her body back down. We would talk about how since this happened every time her heart starts beating or she starts breathing fast that her body immediately thinks BEARS! even if she’s faced with something much less concerning like shoes that are hard to tie or being a little bit late for school in the morning. We would work hard on helping her identify where in her body she feels the anxiety — is it in her stomach? Does her chest feel tight? Does she make fists with her hands or does her mouth go dry? We would talk about relaxation techniques and figure out which ones work for her. She might start keeping a worry diary or we might make a list of everything that makes her anxious.
What I tell kids is that we’re going to be detectives and we’re going to work together to solve the problem of their worries. I am very strengths based (that means I encourage focus on what’s going right even as we are talking about what’s going wrong) so we would also discuss times they have managed their anxiety in the past so we can figure out what shores them up.
The next thing we would do is look at thinking errors (also sometimes called “negative cognitions”). Here are some super common thinking errors:
- All or Nothing Thinking: If I make one mistake then I’m an idiot.
- Catastrophising: If I don’t turn in this one homework, I will flunk out of school.
- Overgeneralization: I fell down at the roller rink one; I will fall down forever.
- Personalizing: It rained on my birthday because nothing ever goes right for me.
- Discounting the Positive: Sure my best friend likes me but that doesn’t count because she’s my best friend.
- Mind Reading: I know everyone on my soccer team hates me.
- Labeling: I’m taking so long to learn to ride my bike because I’m uncoordinated.
- Should Statements: I shouldn’t have such a hard time learning math. I should know how to wrap this present without help.
- Emotional Reasoning: I am in pain therefore I am right and you are wrong. I feel guilty and that proves I’m a bad person.
There are more but you get the gist and probably these are familiar to you either because your child does them or because you do them yourself. (Some of these are so ingrained in our cultural way of thinking that to confront them can be like wandering around in the dark your whole life and then stumbling over a flashlight and realizing you can use it to find the light switch and actually turn on all the dang lights.)
This is where I think counseling can help. I know in my own family that I can tell my kids something over and over but when they hear it from somebody else they believe it. Part of this is that they get tired of the sound of our voices (I haven’t seen studies on this but anecdotally I can tell you that my children get tired of the sound of my voice) and part of it is because it’s easy to get defensive with our parents. At least it was for me when I was a kid and then a teenager. If my mom disagreed with me it was automatically an opportunity for me to argue with her but if another adult said the same thing, it was an opportunity for growth and better understanding.
Yeah, we parents get it coming and going.
BUT! Let’s not resort to Overgeneralization! Sometimes parents have a lot of success doing this work at home without a therapist and there are workbooks (note I haven’t reviewed these so I can’t recommend one in particular) to help parents help their kids. AND even when kids are in therapy, we really need the grown ups in their lives to help them do the work. (I see a child an hour a week. Their parents are the ones bearing witness to the other 167 hours.)
Anyway. That’s the cognitive part of CBT therapy and it can take awhile. We’re talking about challenging ingrained ideas that make perfect sense to the person thinking them. That’s HARD and it takes practice.
For lots of kids, this is when we’re really leaning on the play part of play therapy because every little step we take needs to be ensconced in trust, respect and acceptance, which means a lot of time just hanging out and enjoying each other. The play therapy space (and the talk therapy space) is a place to safety say anything and be anyone and sometimes anxious kids just need one place where they can come and PLAY away from their worries.
Particularly with anxious kids whose anxiety ends up all centralized in their need to Do Good and Be Good, too much CBT pushing just triggers their anxious need to perform well. So sometimes my office is all about creating an island where they can goof off a little and experience themselves in a new way.
I’m emphasizing the slow part of this time in therapy because sometimes parents get (understandably) frustrated. They want to see change. At the beginning they get some concrete tools (breathing, relaxation, etc.), which feels great and proactive but it’s not a cure all. And then at this point things slow down and they may not see the any progress. But progress really is happening. Not to mention that this is where grown ups start slowing down, too, because it’s one thing to hear about Personalizing but it’s another thing to really get it and see how that kind of thinking is actually impacting your life.
The other thing is that anxious kids (and adults) have had people trying to talk them out of being anxious for a long, long time and that can make people hold on to anxious feelings even more tightly. They don’t mean to do this but being anxious, which many of them see as being concerned or cautious or careful or responsible (“I study all of the time because I’m a good student and if I’m not anxious about it then I’m being irresponsible.”) and often they get a lot of praise for being “good” in other anxious ways. (Oh the perfectionist students I see in my office! The ones who are running themselves into the ground for the praise and academic rewards!) To ask them to give up this way of thinking, well, that’s scary. It takes time.
Goldilocks may say to me, “You know this is all well and good but the minute I let my guard down I’m pretty sure Papa Bear is going to come charging in here, paws waving, and I can’t risk it.”
And so we’d keep working on it.
The next step of CBT is taking it out into the world and confronting those anxieties. Remember we’re simplifying these steps and we’re making them look more clear cut than they are (although they’re presented pretty clear cut in the Coping Kids group because we have a curriculum but we will adjust it as needed).
Goldilocks and I would keep on playing detective, we’d see what’s working for her and where she gets stuck. Maybe her big issue is not being able to eat porridge. Maybe I would get an empty box of oatmeal to have in the play kitchen or maybe we’d pretend to feed breakfast to the dolls. When she’s ready maybe we’d have ourselves some porridge together. We’d go slow and we would be mindful of how it feels. We would see any small move forward as a victory even if she never actually gets the spoon in her mouth for a long, long time.
Maybe I’d ask her mom and dad to take her for a walk in the forest and practice her relaxation techniques and see how that goes. She and I might might write a game plan beforehand that confronts the “what ifs” and has strategies in place for whatever scenarios she can imagine. Again, we’d go slow. She might only get herself out the door the first time and we’d applaud that step even as we think about how to get her off the stoop next time.
Or maybe she’d need to play out what happened, putting the bears in the sand tray and working to make sense of the event by playing out the scene over and over again, trying out new ways of experiencing it and new outcomes.
There are other more specific ways to deal with particular kinds of anxiety. Treatment for OCD, for example, is more complex. Which brings me to medication.
Medication for kids is a tricky thing. Although many family practice and pediatricians will prescribe medication, it’s best to seek out help from a child psychiatrist. But this is hard. Columbus — like lots of other areas — has a dearth of child psychiatrists and parents don’t always have time to go search one out. I encourage parents to have an ongoing conversation with their family physician and to be aware that having a psychiatrist becomes even more important as the child gets older because hormones can make getting the right meds in the right dose super challenging (and things can turn on a dime if someone hits a growth spurt).
Not all anxiety disorders NEED medication but medication can certainly make sense if a child is completely hamstrung by his anxiety to the point that he isn’t going to be able to participate in his therapy. (Some kids are so anxious that relaxation techniques aren’t going to be enough to get them to a place where they can do the cognitive work.) Or if her behavior is so problematic (tantrums, rages, violence) that the rest of her life is at a standstill then medication can make sense.
Ultimately this is a parenting choice and I support parents in making their own informed choices for their kids. I do think, though, that medication alone isn’t enough. We all need to learn how to function as our best selves within the gifts and limits of our particular personality make-up. Medication can help us get functioning but we still need to understand ourselves and how we work. We need to know how to get help.
Eventually, too, our children will be adults and will make their own decisions about how to manage their anxiety (since for most anxious people it’s part of their lifetime experience since our personality can be molded but we are essentially who we are) and getting therapeutic support gives them options.
I like the idea of saying to kids, “Hey, counselors are there to help us when we need it. You need to know how to find the right one for you and how to do the work of therapy and I will help you do that when you’re young so you can help yourself when you’re older.” So we can teach them how to be good consumers of therapeutic support by helping them find someone they like and feel comfortable with (because it all comes down to the rapport in the relationship).
This is a positive way to talk about anxiety and anxious temperaments. After all, some of us more athletically gifted and some of us need more help. Some of us are terrific musicians out of the gate and some of us need more practice. Likewise some of us have more struggles with anxiety or depression and that’s why we have therapists and that’s why we learn about medication options and that’s why we learn to take good care of ourselves.
Have questions? Let me know. Want to sign your child up for Coping Kids? Let me know. (I’m trying to plan summer offerings so if Coping Kids is something you’d like your child to attend then, please let me know so I can email you when I get scheduled and also find out if there are particular days or times that might work for your family.)
First in the series: Anxiety in Kids
Second in the series: Child Anxiety Symptoms