Category: Child & Adolescent Mental Health

What’s Normal and What’s Not? Sexual Behavior in Children

For most parents, noticing when your child is exhibiting sexual behaviors can be shocking and even scary. Most parents’ first question they ask themselves is, “Has my child been sexually abused?” or “Has something sexually inappropriate happened to my child?” The panic sets in.

These are common, normal responses that most parents express to me when they call my office to ask about their child’s recent sexual behavior, desperately trying to figure out if their child’s sexual behavior is “normal.” Being a parent myself, I can completely understand these fears and concerns. It is one of the most horrifying things that can enter a parent’s mind, to wonder or know that their child has experienced sexual abuse, and it’s a question that enters many parents’ minds at least at some point in their child’s developmental years, and their fears aren’t necessarily unfounded. Retrospective research indicates that as many as 1 in 4 girls and 1 in 6 boys will experience some form of sexual abuse before they turn age 18. Not only that, but children are most often sexually abused by someone they know and trust.

Unfortunately, many kids do not disclose being sexually abused. According to The National Child Traumatic Stress Network,  reasons for nondisclosure can include:

  • threats of bodily harm of child and/or family
  • fears of being removed from their home
  • fear of not being believed
  • shame or guilt
  • fear of getting the abuser in trouble if the perpetrator is someone the child or family cares about
  • the belief that the sexual abuse was their own fault
  • fear of getting in trouble themselves
  • not understanding that the perpetrator’s actions are abusive, especially if the abuse is made into a game

It is important to note that although many children who have experienced sexual abuse show behavioral and emotional changes, others may not. That is why it is critical to focus not only on detection, but also prevention strategies and open communication between caregiver and child.

So, what’s normal sexual behavior look like?

Normal (common), age appropriate sexual behaviors can vary by age and developmental level of the child. Let’s start with the youngest ages. Please note that the following are not exhaustive lists.

Age Appropriate “Normal” Sexual Behavior – ages 0 – 4 years

  • Comfort being nude
  • Holding own genitals
  • Unself-conscious masturbation; touches/rubs own genitals when going to sleep, when tense, excited, or afraid
  • Interest in body parts and functions; interested in watching/peeking at people doing bathroom functions
  • “Show me yours, I’ll show you mine;’ “playing doctor” games with same age peers
  • Touching/looking at private parts of familiar children/adults (e.g., in bath)
  • Using slang words for bathroom functions
  • Asks about genitals, breasts, intercourse, babies
  • Shows others his/her genitals
  • Interest in urination and defecation
  • Likes to hear and tell “dirty” jokes
  • Draws genitals on human figures for artistic expression or because figure is being portrayed in the nude

Age Appropriate “Normal” Sexual Behavior – ages 5 – 9 years

  • Heightened sense of privacy about bodies
  • Body touching/holding own genitals
  • Masturbation with awareness of privacy; touches/rubs own genitals when going to sleep, when tense, excited, or afraid
  • Curiosity about others’ bodies
  • Slang words and swearing for body parts; uses “dirty” words for bathroom functions, genitals, and sex
  • Accidental access to pornography (mild); looks at nude pictures (not excessively, not redirected)
  • Shows others his/her genitals
  • Interest in urination and defecation
  • Asks about genitals, breasts, intercourse, babies

Age Appropriate “Normal” Sexual Behavior – ages 10 – 13 years

  • Growing need for privacy
  • Masturbation in private
  • Curiosity/seeking information
  • Use of sexual language
  • Interest in/participation in girlfriend and boyfriend relationships
  • Hugging, kissing, touching known same age peers
  • Exhibitionism with same age peers within context of play (e.g., flashing, mooning)
  • Use of mobile phones with known peers

Concerning Sexual Behavior

The following behaviors are concerning sexual behaviors some parents see. This means you, as a parent, should be watchful and possibly even seek consultation, especially if there are a number of these behaviors present in your child or if one or two of these behaviors are prevalent and consistent and continue despite repeated redirection (and possibly even consequences) by the caregiver.

Concerning Sexual Behavior – ages 0 – 4 years

  • Masturbation in public, even after repeated redirection
  • Forcing another child in sexual play
  • Sexualized play with dolls
  • Touching parts of animal or unfamiliar adult
  • Masturbation and touching others in preference to other activities
  • Persistently watching others nude or undressing
  • Pulling down other children’s pants/skirts up against their will
  • Wants to be nude in public after parent has redirected
  • Plays with feces, purposely urinates outside of toilet bowl

Concerning Sexual Behavior – ages 5 – 9 years

  • Continually touching self in public, Evan after redirection; rubs genitals on furniture or other objects
  • Persistent nudity/exposing self
  • Continually wanting to touch others inappropriately
  • Touching genitals of animals after redirection
  • Persistently watching/following others (e.g., to the bathroom)
  • Pulling other children’s pants down/skirts up against their will
  • Wants to play sex/sexuality games with much older or much younger children
  • Explicit talk/art/play of sexual nature
  • Draws genitalia on some nude figures but not others and on drawings of clothed people; genitals may be drawn disproportionate to size of body
  • Shows fear or anxiety about sexual topics
  • Uses “dirty” words with adults after parent consistently redirects and uses healthy language themselves
  • Plays with feces; purposely urinates outside of toilet bowl
  • Asking peer/adult to engage in specific sexual act(s)

Concerning Sexual Behavior – ages 10 – 13 years

  • Attempting to expose others
  • Preoccupation with masturbation
  • Mutual masturbation with peer/group
  • Seeking out pornography
  • Taking nude sexual images of self
  • Talking about fear of pregnancy or STI
  • Persistent explicit talk/art/play that is sexual or sexually intimidating
  • Changes in behavior (e.g., flirting with adults)
  • Oral sex/intercourse with similar age peer
  • Continually touching self in public, even after repeated redirection; rubs genitals on furniture or other objects
  • Draws genitalia on some nude figures but not others and on drawings of clothed people; genitals may be drawn disproportionate to size of body
  • Asking peer/adult to engage in specific sexual act(s)

EXTREMELY CONCERNING Sexual Behavior

The following lists include behaviors that are “red flag” behaviors, indicative of child sexual acting out behaviors. These may be indicators of sexual abuse or another issue related to the child’s sexuality and need assessed right away.

EXTREMELY CONCERNING Sexual Behavior – ages 0 – 4 years

  • Disclosure of sexual abuse
  • Compulsive masturbation/self-injurious
  • Persistent explicit themes in talk/art/play
  • Simulation of sexual touch/activity (with or without clothes)
  • Persistently touching private parts of others
  • Oral sex with other children
  • Forcing other children to engage in sexual activity
  • Sexual knowledge is too great for age
  • Sexual behavior is associated with physical aggression
  • Any sexual behavior involving children who are 4 or more years apart
  • A variety of sexual behaviors displayed on a daily or near-daily basis
  • Behaviors are persistent and child becomes angry if distracted

EXTREMELY CONCERNING Sexual Behavior – ages 5 – 9 years

  • Disclosure of sexual abuse
  • Touching self in exclusion of normal childhood activities
  • Seeking an audience
  • Forcing other children to play sexual games
  • Rubbing genitals on other people
  • Accessing/showing pornography
  • Cyberbullying/grooming other children
  • Persistent bullying involving sexual aggression
  • Persistent sexual activity with animals
  • Endless questions about sex after curiosity is satisfied; sexual knowledge too great for age
  • Forces another child to play doctor, to take off clothes
  • Refuses to put on clothes; exposes self in public
  • Repeatedly plays with or smears feces; purposely urinates on furniture
  • Drawings of intercourse, group sex… sadism, masochism shown
  • Any sexual behavior involving children who are 4 or more years apart
  • A variety of sexual behaviors displayed on a daily or near-daily basis
  • Behaviors are persistent and child becomes angry if distracted

EXTREMELY CONCERNING Sexual Behavior – ages 10 – 13 years

  • Disclosure of sexual abuse
  • Compulsive masturbation, may be in public or private, to the exclusion of normal childhood activities
  • Force or coercion into sexual activity
  • Sexual contact with animals
  • Repeated/chronic peeping
  • Making others watch pornography
  • Touching other children’s genitals without permission
  • Forcing others to expose genitals
  • Penetration of dolls, other children, or animals
  • Oral sex/intercourse with person of different age or developmental ability
  • Refuses to put on clothes; exposes self in public
  • Repeatedly plays with or smears feces; purposely urinates on furniture
  • Rubbing genitals on other people
  • Any sexual behavior involving children who are 4 or more years apart
  • A variety of sexual behaviors displayed on a daily or near-daily basis
  • Behaviors are persistent and child becomes angry if distracted

“Typical” Sexual Behavior

Although parents and caregivers become concerned when a child displays sexual behavior, it is important to remember that some behaviors aren’t uncommon in developing children. Much sexual play with peers is an expression of their natural curiosity and should not be cause for concern.

According to The National Child Traumatic Stress Network, in general, “typical” sexual play and exploration:

  • occurs between kids who play together regularly and know each other well
  • occurs between kids of the same general age and physical size
  • is spontaneous and unplanned
  • is infrequent
  • is voluntary (the children agreed to the behavior and no one seems upset or uncomfortable)
  • is easily diverted when caregivers tell children to stop and explain privacy rules (the children are easily redirected)

Sexual Behavior Problems

Sadly, some childhood sexual behaviors do indicate more than harmless curiosity, however. Sexual behavior problems may pose a risk to the safety and well-being of the child and other children. Sexual behavior problems include any act that:

  • is clearly beyond the child’s developmental stage (for example, a three-year-old attempting to kiss an adult’s genitals)
  • includes threats, force, or aggression
  • involves children of widely different ages or abilities (generally 4 or more years apart in age, such as a 12-year-old “playing doctor” with a four-year-old)
  • Provokes strong emotional reactions in the child, such as anger or anxiety

Please be aware that while sexual abuse can be a cause of sexually reactive behavior or other sexually challenging behaviors, it is not always the case.

Responding to Your Child’s Sexual Behavior

If for some reason your child displays an inappropriate sexual behavior, the following list provides some guidelines for responses.

Guidelines to Follow If You Find Your Child Engaged in Sexual Behavior

The first step is to try to find out what actually happened. It’s important for parents to stay calm. After gathering your own emotions and making sure they’re under control, a parent might calmly tell the children that it’s time to get dressed and then ask the children to separate and go into a different room in the house. After collecting your thoughts – and consulting with your partner, if one is available – the parent could then talk to each child one-on-one.

Here are some questions to ask your child(ten):

  • What were you doing?
  • How did you get the idea?
  • How did you learn about this?
  • How did you feel about doing it?

It’s important to remain calm and keep an even tone of voice. Ask open-ended questions as much as possible, which allows the child(ten) to tell what happened in their own words (not just answering yes or no).

If You Are Still Concerned

If you believe your child’s sexual behavior is not typical or age appropriate, and believe he or she may have experienced a form of sexual abuse, contact the appropriate authorities, which include police, a medical professional (such as going to the hospital), your local Child Advocacy Center, and Child Protective Services. If you’re still not sure, consult, consult, consult! It never hurts to contact an appropriate professional or authority to get further consultation. A counselor or social worker experienced in working with abused children is often a good contact, even if it’s your first contact with the mental health professional. I get calls like this in my own office from time to time, and I promise, I don’t mind talking to you. They may ask for you and/or your child to come in for a consultation just to gather more information, but please don’t let this intimidate or frighten you. We just don’t want to guide you wrong and we want to be thorough. The Child Advocacy Center in your area is also an excellent resource to contact with questions or concerns.

Stay tuned for future posts about preventing sexual abuse and/or revictimization. And, please, if you have any questions, contact someone who can help and who can provide you with accurate information.

Monongalia County Child Advocacy Center 1-800-352-6513

www.monocac.org/ 

Email: [email protected]

Morgantown Police Department 304-284-7522 (or 9-1-1)

Monongalia County Sheriff’s Office  304-291-7260 (or 9-1-1)

West Virginia State Police 304-285-3200 (or 9-1-1)

Creative Resilience Counseling, LLC  304-292-4050

www.creativeresiliencecounseling.com

Email: [email protected]

Special thanks to The National Child Traumatic Stress Network.

Please check out their site, they are a WEALTH OF INFORMATION about child sexual abuse and other childhood trauma!

Additional thanks to ,Educate2Empower.

They are an excellent resource for educational materials on child sexual abuse and prevention!

Parent Q&A: Questions About ADHD

Question: My ex-husband, and father to our 11-year-old son, insists that our son’s ADHD is my fault, a result of my parenting style. He has an authoritarian parenting style, while I strive to be more authoritative. My son’s counselor is confident of his ADHD diagnosis and says that ADHD isn’t anyone’s fault, but I still can’t help but question if this is something I’ve caused. Can ADHD can be caused by the way someone parents?

Answer: Parenting, whether it’s poor or optimal, cannot and does not cause ADHD. ADHD is a neurobiological, neurodevelopment disorder that is present from birth and manifests in different ways across the lifespan. While trauma or parenting can modify a child’s symptom presentation and coping in some ways, neither plays a causative role in ADHD.

Imaging studies show differences in the structure and activity between brains of people with ADHD and those without. In people with ADHD, there is a consistent pattern of below-normal activity in the neurotransmission of dopamine and norepinephrine in the brain’s prefrontal cortex. As a result of the lower levels of dopamine, there is understimulation in the reward and motivation centers in the brain. The prefrontal cortex is found to be thinner and matures more slowly than non-ADHD brains. Please know, this does not imply any deficit in intelligence or in the ability to succeed.

An accurate diagnosis of ADHD should include:

  • an in-depth clinical history of both the child and the family
  • a physical exam to help rule out other possible causes of symptoms
  • a clinical assessment using standardized behavior rating scales or questionnaires
  • an evaluation of the child’s intelligence, aptitude, personality traits, and/or processing skills

A complete neuropsychological evaluation or educational exam is not always necessary, though if there are any concerns about learning or processing, full testing is generally recommended.

My point in relaying this information is to assure you, parents don’t cause ADHD, and parenting, regardless of your style, doesn’t cause ADHD. If your son has ADHD, he’s had it since he was born, it just may not have manifested in symptoms one may have seen until more recently because ADHD manifests differently across the lifespan and can look different from individual to individual. No worries, you didn’t cause your son’s ADHD.

Question: How do I get my child with ADHD to stop repeating behavior he CONTINUOUSLY gets in trouble for day after day? It’s exhausting. How many more times do I have to repeat the same thing? How many times do I have to discipline him for the same behavior? I put him in time out, I take things away from him. Nothing seems to make him stop just doing the same behavior all over again.

Answer: Kids with ADHD also have executive function deficits, which can contribute to children acting out more from their emotions, not logic or reasoning. Often we can tell them time after time after time, and even give them consequences for their misbehavior, but because they’re operating so much from their emotional brain, it doesn’t always click the first time (or the fiftieth). They struggle with decision making and always making better choices because of the deficits in executive functioning, which are housed in the thinking brain (the prefrontal cortex, which doesn’t fully mature until we’re in our mid-20s anyway). Remain consistent and firm. It may take multiple repeating before they get it. Also, try to wait to process feelings and the behavior or offer any logical reasoning to your child until he is calm and not totally thinking from his emotional brain. People cannot fully comprehend logical reasoning until they’re able to use their thinking brain too. Things said while they’re still in their emotional brain will most often go unheard, ADHD or no ADHD.

35 Things My Sons Should Know

In honor of Mother’s Day, I would like to share a short list of 35 of the things I want my sons to know as they grow to be young men. I have a 13-year-old son and a 6-year-old son, both as polar opposite as they could be, and I love them with everything I am and everything I will be. I was not raised by my biological mom after I was five years old; my grandparents took my brother and me in to their home to raise us until adulthood after my mom became unable to care for us anymore. Both my mother and grandmother have since passed away. I miss them always, but I can’t help but feel some sadness and disappointment that they were not able to watch my boys grow up. C and J, it is an honor and a privilege to be your mom. I love you.

Love always. xoxoxo

Things My Sons Should Know

  1. You will always be my babies. Sorry, but it’s not going to change.
  2. I have loved you even before you became a part of me.
  3. Your mom knows you better than anyone else in this world.
  4. An entire bottle of cologne will not help you smell better. (Sorry.) Go with a little over a lot.
  5. Go to school events. One day you might regret not going.
  6. Choose kindness. You never know what others are going through.
  7. Treat others the way you would like to be treated (even if you’re not being treated that way yourself).
  8. Choose your company wisely.
  9. Ask them out if you want to get to know them better. Don’t be afraid to let go if it’s not the right person for you.
  10. If s/he cheats on you, they don’t know you’re worth. Find someone who does.
  11. Don’t tell your mom you hate her. You’ll regret it.
  12. Know that I always try my best.
  13. Some people will never like you. Don’t worry about it.
  14. Don’t let the world make you bitter. Believe in what is good.
  15. Don’t believe stereotypes. Get to know people.
  16. You will make mistakes. No one is perfect all the time.
  17. Don’t let your mistakes define you, but learn from them.
  18. Strive to learn something new every day.
  19. Practice gratitude every day.
  20. Take no one for granted.
  21. Your words can build or destroy. Never forget that.
  22. Choose your words and actions wisely.
  23. Think before you act.
  24. You are more wonderful than you will ever know.
  25. Your mental health is more important than your grades or what school or program you get into.
  26. Take time to take care of yourself.
  27. No matter how angry you might get at me, I am and will always be your mom and you will always be my heart. I will never give up on you.
  28. I will never leave your side. Even if it’s in spirit, I’ll always be cheering for you.
  29. Aspire to do your best and when you’re not able, try to do better the next time.
  30. It’s okay to be angry. It’s not okay to be cruel.
  31. Spend time with family. We’ll be here throughout every broken heart and broken friendship and all the happiest moments of your life, if you let us.
  32. Be careful who you tell your secrets to. Not everyone should be privy to every aspect of your private life.
  33. Treat animals kindly. They are our best secret keepers and most faithful supports.
  34. Never pass up the opportunity to tell someone something you like or love about them.
  35. No one is strong all the time.

Happy Mother’s Day to all, moms of boys and girls, moms of grown adults, moms of furry or scaly pets, moms who have lost their child before their time, and moms who wait for their time. Blessings to each and every one of you.

The Getting to Know You Card Game

I’m always seeking out activities to do with the teenagers I work with. Much of the time, an activity I find seems either too young or too old and “boring” for this specific population. While most teens are able to participate just fine with traditional talk therapies, I still like the idea of mixing it up a little sometimes to keep it more interesting and engaging for them, especially while we’re still getting to know each other.

I created the Getting to Know You Card Game on a whim one day when I was trying to figure out a good way to get to know a particularly new teenage client of mine. She was a wonderful, bright girl who was pretty shy and I felt somewhat intrusive in our first few sessions just asking questions and getting mostly short-form answers because of her timidness. I was intrigued and I wanted to know more about her, and she was wanting to talk but couldn’t seem to find the words or the courage to open up to someone still so new.

The Game

The game only requires a standard deck of playing cards and this Getting to Know You Card Game prompt page I created. Upon starting the game, ask the teen to choose a color: red or black. This will be their color suit, and the therapist (or other player) will be the other. Then deal out all the cards to both players, each receiving an equal number of cards. The cards should be left face down in a pile. Choose someone to begin (if it’s your first time playing, I recommend the therapist go first to demonstrate how to play). The first player turns over the first card at the top of their deck to reveal the card. If it’s their suit color, notice if it’s a number card, an ace, a jack, a queen, or a king. The player looks at the prompt sheet and finds the appropriate card, then completes the prompt.

For example, if I’m red and I turn over a red 2 diamond card, I look at the prompt page and find the prompt for the number 2 – “something you don’t like to do.” I would then respond with my answer for something I don’t like to do. Then it’s the next player’s turn. If they draw a card that is their suit color, they proceed to follow the above instructions. If it’s not their suit color, play resumes to the opposite player. Play continues until you both reach the bottom of your piles. At this point, I generally shuffle the cards one more time and deal the cards for a second round, so as to keep the conversation going. You can do this as many times as you’d like. You can also switch color suits if you’d like. There are no losers in this game, but by the end you both know each other a little better.

The Prompts

The only rule of the game is that you provide a different answer each time you’re prompted to give an answer. For instance, if I draw two red 2 cards, the prompt is the same but I can’t give the same answer twice.

The prompt page can be found by clicking below, or you can just use the list below:

Getting to Know You Card Game

Ace – something you like to do

2 – something you don’t like to do

3 – a feeling you’ve had today (describe)

4 – something that helps you feel better

5 – how I cope

6 – something I did but didn’t think I could

7 – a time I felt happy this week (or something that makes me happy)

8 – a time I felt sad this week (or something that makes me feel sad)

9 – a time I felt anxious/worried/scared this week (or something that makes me feel anxious/worried/scared)

10 – a time I felt angry this week (or something that makes me feel angry)

Jack – a time I felt _______ this week (or something that makes me feel _______)

Queen – a coping skill that I want to try/am going to try

King – a goal I’m setting for myself this week

Since I created the game, I’ve played it with kids as young as eight and have even used it with young adults in the rapport building process. Occasionally, a client will ask to play it again further into treatment – no problem! It’s always helpful and often gets some good conversations started!

Hope you have fun. Happy relationship building!

50 Therapeutic Journal Prompts for Teens and Adults


The benefits of journaling have long been determined to be helpful for one’s mental health. Whether writing using fun, creative prompts or therapeutic prompts, writing can help integrate both sides of your brain, thus creating a more balanced version of you. Here are 50 prompts I use with my teen and young adult clients.

Journal Prompts for Teens and Adults

  1. What is the best compliment you have ever received?
  2. In your opinion, what is the best song ever written?
  3. If you could know one thing about the future, what would it be?
  4. What is something you feel nervous about right now?
  5. What is your happiest memory?
  6. What is something that you did that you are proud of?
  7. I get mad when…
  8. What calms you down when you get mad or upset?
  9. What is something that went right today/this week?
  10. If you could travel anywhere in the world, where would you go and why?
  11. Name two ways you can show self-control at school, at work, or at home.
  12. What would be the title of your autobiography?
  13. If you had to pick one song to play continuously, non-stop, in the background of your life, what would it be?
  14. What is one item you can’t live without?
  15. If you could add, change, or cancel one rule in your school/work, what would it be?
  16. If you could add, change, or cancel one rule at home, what would it be?
  17. Who do you trust the most and why?
  18. Where do you feel the most safe and why?
  19. What is one word you would use to describe your family and why?
  20. How do you think others view you? Why?
  21. If you could travel back in time to three years ago and visit your younger self, what advice would you give yourself?
  22. What do you like the most about yourself?
  23. Tell about a time when you felt sad. What helped you get through it?
  24. What is the first symptom you notice when you feel mad? Stressed?
  25. Who is someone you consider a real-life hero and why?
  26. Who do you wish you had a better relationship with, and what would make it better?
  27. List 10 things that make you smile.
  28. When things seem tough, I want to remember ____.
  29. What is something that you have overcome?
  30. What do you think you life would look like if you didn’t have anxiety or depression (or something else)?
  31. Write the words that you need to hear.
  32. What does your best day look like?
  33. What would you like to be remembered for?
  34. Build a list of 15 songs that can help change your mood.
  35. Write about three of your best talents.
  36. List three things that you would do if you weren’t afraid.
  37. What are five things that help you feel better when things are difficult?
  38. Write about 10 things you are grateful for.
  39. What is your favorite memory?
  40. Choose one thing that triggers your anxiety or depression, and write about a few ways that you can combat this trigger.
  41. What makes you happy?
  42. How do you define yourself?
  43. What is one fun fact about yourself?
  44. What is going right in my life?
  45. What’s bothering me? Why?
  46. One goal I want to set for myself this month…
  47. What does success look like to you?
  48. What makes you feel truly alive?
  49. What do you want your life to look like in five years? 10 years?
  50. What am I afraid of? Why?

Anxiety Series Part 4: Over 40 Parent Tips & Techniques to Help Your Child with Anxiety

If you have been following our Anxiety Series, you have read about the many ways that anxiety presents itself in children, where in Part 1, I explored the more visible signs and less obvious signs to look for as signs of anxiety in kids. In Part 2, I provided 20 simple anxiety-reducing strategies that work to integrate a child’s left and right brain hemispheres, thereby helping to regulate anxious children’s intense emotions. In Part 3, we explored the common relationship between school anxiety and separation anxiety in younger children.

In addition to the strategies you can find in Part 2 of this series, there are a number of additional strategies that parents and caregivers can do to help their anxious child, regardless of the reason why the child might be anxious. In Part 4 we’ll explore over 40 of these additional strategies that parents can use to help their anxious child.

Parent-Specific Tips

First, let’s start with some parent-specific tips to help your anxious child.

  • Manage your own state. Often we, as parents, don’t realize just how much our own emotional state affects our children. In younger children especially, who are still learning how to self-differentiate themselves and their feelings from their caregivers, our maintaining calm versus being anxious can make or break a kid when it comes to their emotional state. For instance, if we are anxious about our child going to school, if we let this anxiety present itself in all its glory, our child will also be anxious about going to school. As difficult as it might be, it’s important for parents and caregivers to somehow manage their own emotional state. If you must break down once the child walks out the door, so be it, but it’s essential that we try to hold ourselves together in regards to our anxious feelings when the child is present.
  • Validate their feelings. Please, please don’t assume that your child should have nothing to worry or stress about just because they’re a kid! When we see our child become anxious or worried, our instinct is to say things like “Don’t worry!” or “Calm down!” While we don’t mean any harm when we make these statements, few of us realize how unhelpful these phrases really are. Saying something like, “I know this is hard” or “I know how it feels to be worried sometimes too; it’s no fun” helps validate the child’s experience. Some really great phrases one can use to calm an anxious child can be found in this excellent article on The Mighty.

Read Books Together (Bibliotherapy)

There are a variety of helpful books out there that are specifically written to help anxious children by teaching them about what anxiety is, why they might be experiencing anxiety, and child-friendly strategies to try to help alleviate anxious feelings. Even if your child can read, I strongly encourage parents to read these books with your kids. Following is a short list of some of my favorite children’s books about anxiety:

  • “Worry Says What?” by Allison Edwards
  • “Please Explain ‘Anxiety’ to Me!” by Laurie Zelinger, PhD and Jordan Zelinger, MS Ed
  • “Jonathan James and the Whatif Monster” by Michelle Nelson-Schmitt
  • “Wilma Jean the Worry Machine” by Julia Cook
  • “Help Your Dragon Deal with Anxiety” by Stee Henman
  • “Scardedies Away! A Kid’s Guide to Overcoming Worry and Anxiety (made simple)” by Stacy Florila
  • “The Invisible String” by Patricia Karst
  • “I Can Handle It” by Laurie Wright
  • “What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety” by Dawn Huebner
  • “What to Do When You Don’t Want to Be Apart” by Kristen Lavalee, PhD

Watch Child-Friendly Mindfulness Videos

There are numerous mindfulness and calming videos online that you can find doing a google or YouTube search Following are some of my favorites for children.

Calming Apps for Kids

You may have already discovered several calming apps out there marketed for adults, but you may or may not realize that there are also calming apps out there for kids. Here are my top three picks.

  • Mind Yeti – This is available in the form of an app or you can also visit their website at mindyeti.com to find guided mindfulness sessions especially made with kids in mind to help children to calm down and focus their attention. Several sessions are available for free, though a paid subscription offer is also available for access to more sessions if you’d like. (I’ve found the free sessions to be more than adequate by themselves.)
  • Stop, Breathe & Think Kids – This app prompts the child to seek out a “mission” based on what they might need at that moment, such as missions to quiet, to focus, for caring and connection, or for energizing, to name a few. There are also missions children can tap into during a meltdown that can help to de-escalate them back into a calmer state of mind.
  • Breathe, Think, Do with Sesame Street – Especially designed for younger children, this app guides kids in participating in breathing exercises with the monsters of Sesame Street.

Self-Regulation Strategies

Self-regulation is a skill that allows kids (and grown-ups too) to manage their emotions, behavior, and body movement when they’re faced with a situation that’s tough to handle. And it allows them to do it while staying focused and paying attention.

Being able to self-regulate means that the child knows how to figure out that they need to calm themselves down when they get upset, they’re able to be flexible when expectations change, and they can resist giving in to frustrated outbursts (www.understanding.org).

Here are some activities you can help your child practice to help him learn to self-regulate.

  • Do Robot-Ragdoll. This exercise teaches kids how to scan their bodies for tension they might be holding in their muscles and learn how to release and relax it. Here are the instructions:
    • Stand up straight and stiff like a robot, clench your fists, and tighten all the parts of your body from your head to your toes. Hold this tight pose for 3 seconds. (Tip: Make your muscles go tight but not so tight that they hurt.)
    • Unclench your fists and make your body go floppy like a rag doll or wet spaghetti noodle. Feel how all your muscles are relaxed. Hold this relaxed pose for at least 3 seconds.
  • Belly Breathing (diaphragmatic breathing). Put your hand on your tummy, where your belly button is. Slowly breathe in and out. When you breathe in, your tummy should move out. When you breathe out, your tummy should move in. Continue to breathe in and out like this for a minute or so, watching your tummy, not your chest, move in and out as you breathe slowly. When I first teach this skill to kids and adults alike, I often ask them to start by lying down and placing an object such as a rubber duck on their stomach (naval) area, then asking them to practice breathing as described above. This helps a lot of people better see the movement of their belly going up and down over and over again.
  • Cookie Breathing. This is another kid-friendly way to teach diaphragmatic breathing. Click Cookie Breathing for a pdf of how to do it.
  • Drink water. Have your child sip cold water slowly. Doing this has a calming effect on the nervous system.
  • Blow bubbles. Blowing bubbles can help the child gain control of their breathing and thus, their mental state.

  • Do the “Downward Facing Dog” pose. This particular yoga pose helps reset the autonomic nervous system and activate several muscles in the arms, legs, and core. This stretch also helps muscles begin to burn additional blood glucose that is made available by the body’s fight or flight response.
  • Try an inversion. Bringing the head below the level of the heart (aka inversion) has a calming effect. Inverting the body has a restorative effect on the autonomic nervous system, which controls the body’s response to stress.
  • Push against a wall. This allows the body to get rid of stress hormones without having to go outside or even leave the room. Have the child try to push the wall over for 10 seconds, three times. Doing this allows the muscles to contract in a futile attempt to bring the wall down, then relax, which releases feel-good hormones into the body.
  • Go for a run. Running has been shown to reduce stress. Going for a 10 minute jog can not only affect your child’s mood immediately, its effects on their ability to cope with stress can last for several hours afterward.
  • Rock in a rocking chair. The repetitive nature of rocking offers stress relief. You can rock with your child or allow them to rock by themselves as a way to self-soothe any frenzied emotions.
  • Squish some putty. This is one of my favorite strategies. When you play with putty, your brain’s electrical impulses begin firing away from the areas associated with stress.

Visualization Tools

I found an excellent resource for various visualization exercises at KidsRelaxation.com. Here are four of my favorites. Click Visualization Tools for Anxiety for a pdf I created that summarizes the four listed here. 

First, guide your child into a relaxed space. Find a comfortable position with few distractions. Take a few deep breaths together and explain that you’re both going to use your imagination to “say goodbye to worries.” Ask them to close their eyes and look inside their body for any place that a worry might be. (This is similar to doing what’s called a body scan. Hint: Look for areas you might be holding stress; these places are generally more tense.) See if they can find where the worry is, then ask them to describe what it looks like. Then use one (or more, if necessary) of the visualization tools.

  • Rock – Transform the worry into a rock. Get a helicopter to drop the worry into an active volcano that will melt the worry and send it shooting far into the air as lava that runs slowly far away into the ocean. Repeat the process until all the worries have been transformed.
  • Bubble – Put the worry into a bubble and set it off into space. When it has floated very far away, pop the bubble. Watch the worry vanish.
  • Worry Soap – Place the worry on your hand. Get a giant bottle of neon, sparkly soap and squirt the soap all over your hand, making foamy expanding bubbles. Scrub, scrub, scrub those bubbles. Add a blast spray of water, washing the worry away down the drain.
  • Rocket Ship – Put your worries in a rocket ship and blast it off to outer space. Send the worries up, up, up to be transported to another galaxy far, far away. Allow the rocket ship to have an infinite supply of fuel so that it can travel light years away.

After doing a visualization exercise with your child, have them do an internal body scan and see if there’s any worry left. If there’s still worry left, repeat the process.

Brain Integration Exercises

As I talked about in Part 2 of my Anxiety Series, it’s crucial that our right and left brain hemispheres and our upstairs and downstairs brain are integrated. This simply means that all parts of our brain are communicating and working together. If you (or your child) is struggling with intense anxiety or other intense emotions, your right brain and downstairs brain are in overdrive and leaving out the left and upstairs brain, which is problematic because we are unable to think logically and rationally and be able to effectively problem solve when we’re only using the right and downstairs brain. Instead, we stay dysregulated longer and more intensely.

So how do we (and our kids) integrate our brain so we’re not stuck in our emotions? There are several strategies we can use, but here are some Brain Integration Strategies to try. These strategies are simple and amazing game changers! I’ve had parents of clients tell me that these are literally like “reset buttons” for their kids when they are feeling extremely anxious or otherwise emotionally dysregulated. Because Part 2 addressed this more thoroughly, I won’t list these strategies again in this post, but please refer back to Part 2. 

Other Coping Strategies

There are numerous other strategies we can teach our kids to help them better cope with their anxiety. Here are just a few more techniques to add to your toolbox.

  • Sing out loud. The physical act of singing out loud has been shown to release endorphins, the “feel good” chemical in the brain.
  • Count backwards from 100. Counting gives the child the chance to focus on something other than what’s bothering them; counting backwards offers an added concentration challenge without overwhelming their brain. What if your child isn’t able to count to 100 or count backwards from this high? Simply figure out a lower number, such as 50 or 60, that they are able to count backwards from based on their developmental and skill levels.
  • Repeat a mantra. Create a mantra that you and your child can use to help them calm down. “I am calm” or “I am relaxed” work well, but feel free to get creative and making something personal to you and your child!
  • Pop bubble wrap. Even most adults can tell you that this strategy is somehow pleasing and a good way to release stress.
  • Help them name their emotion. Often when kids become overwhelmed, it’s because they have difficulty identifying the negative thoughts and feelings they’re having. Teach your kids some emotion vocabulary, and ask your child to give their feeling a name, then help them talk back to it.
  • Teach your child how to rate the intensity of their feeling(s). You can google “feelings thermometer” or look on Pinterest to search for some kid-friendly versions. You can also teach them how to rate the intensity using their fingers. Click Feelings Intensity Rating Scale for a simple strategy that helps kids use their hand to demonstrate just how bad (or good) they’re feeling.
  • Strings of worry. Another way to help your child rate the intensity of what they’re feeling, Strings of Worry is a technique where you use a ball of yarn and scissors to cut off the amount of string correlated with the amount of worry they’re feeling. The longer the string, the more worried they are.
  • Puppet role-plays. If you have puppets at home, or can make some sock puppets, practice and role-play out anxiety-provoking situations with your child using the puppets. Not feeling particularly crafty? You can download a Sock Puppets app for iPhone or iPad (and maybe Android?) and role-play that way!
  • Draw a face for the fear/worry.
  • Create a comic using the worry monster and the child as characters.
  • Play The Worry Brain and Happy Brain Game (aka Talk Back to Your Brain). To teach your child how to talk back to their brain. try out this game. First you will be the Happy Brain and your child will be the Worry Brain.
    • Ask your child to say one thing that makes them worry. (Or play the game upon hearing your child state a worry.)
    • You present a contradicting positive scenario related to that worry. The idea is to provide a positive, practical thought that your child can easily understand.
    • Then try to switch roles. Let the child practice saying something positive this time.
    • Example:
      • Worry Brain: “I don’t feel good about going to the new school.”
      • Happy Brain: “I will meet new people and make new friends in the new school.”
    • Soon your child will be able to carry this dialogue in their head and will be able to talk back to their own worry brain when it talks to them.
  • Create a Calming Jar. You can check out Pinterest for ideas and instructions on how your child can create one of his own jars to help him relax and calm down.
  • Read/write an inspiring superhero story.
  • Make stress balls. Search Pinterest for how to make do-it-yourself (DIY) stress balls for ideas.
  • Worry Jar. Each time your child thinks of a worry, have them write (or draw) it on a slip of paper. Then have them fold the slip and place it inside a mason jar and seal the top so that the worry can be contained in a safe place until they feel they can better address the worry at a later, future time.
  • Worry Stones. I love making worry stones! They’re super easy. The idea is that the child can carry their worry stone in their pocket and rub the stone when they’re feeling anxious, releasing some of the extra energy that the worry is giving off and creating stress. Easy, excellent instructions for how to create worry stones can be found at http://creativeelementaryschoolcounselor.blogspot.com/2012/10/worry-stones.html.

  • Colors of Feelings. For this activity, you’ll need paper and a box of colored pencils, crayons, or paint. The idea is to give your child the opportunity to separate themselves from their worries and concerns.
    • Help your child identify which color they identify or associate with for each emotion they are feeling. (Example: Red = Angry; Orange = Worried; Blue = Sad; Yellow = Happy).
    • Ask the child to draw or paint a picture with the colors that express their emotions.
    • You can also be the one to draw the picture for them using a pencil, then let them fill in the colors according to how they’re feeling.

Hope these strategies are helpful for you and your children! Feel free to leave a comment if you have some more helpful suggestions for how to help anxious children!

Anxiety Series Part 3: School Anxiety and Its Relationship to Separation Anxiety

In Part 1 of our Anxiety Series, you read about the many ways that anxiety presents itself in children, exploring the more obvious visible signs and the more subtle ways that anxiety can show up in kids. In Part 2, I provided 20 simple anxiety-reducing strategies that work like magic to integrate a child’s left and right brain hemispheres, thereby helping to regulate anxious children’s intense emotions.

Now in Part 3, we will explore two very common forms of anxiety that are found in many children and teens today: school anxiety and separation anxiety.

What is School Anxiety?

School anxiety, also sometimes called school phobia or anxiety-based school refusal, occurs when a child’s anxiety makes him reluctant to attend school or even flat out refuse to go to school.

School anxiety may be the result of a broad range of anxiety-related concerns, like social anxiety, worry, panic, separation anxiety, and/or depression. However, in your kids especially, school anxiety is almost always related, in some part, to separation anxiety, though the anxieties around school can be myriad. School anxiety is not simply a child wanting to skip school!

Other Reasons for Anxiety-Based School Refusal

Starting a new school, moving, and a number of other stressful events can trigger the onset of school refusal. Some kids fear that they won’t do well in school, have fear of another student, fear getting sick in front of peers, or might be hypersensitive to teachers’ criticisms, regardless of how well-intentioned and constructive their criticisms might be. Other kids might start exhibiting school anxiety after they’ve been out sick or during or after a parent’s illness.

Anxiety-based school refusal is seen more commonly between the ages of 5 and 6 and between the ages of 10 and 11, and also at times of transition, such as entering middle or high school, but school anxiety can really occur at any age.

Signs of Anxiety

In Part 1 of our series, I reviewed various visible signs and less obvious signs you might see in children that are indicative that they are struggling with anxiety. Let’s review those briefly.

Visible Signs of Anxiety

  • physical distress (shaking, crying, hyperventilating, screaming)
  • fleeing, escaping
  • outright statements of anxiety or worry
  • outright questions expressing fears
  • refusal to engage in activities that cause distress
  • extreme distress upon contact with feared object, person, or place
  • refusal to be alone or without a parent
  • repeated rituals
  • panic attacks

Less Obvious Signs of Anxiety

  • clingy behavior
  • irritability
  • avoidance behavior
  • complaints of physical illness or physical ailments (i.e., headache, stomachache)
  • reassurance-seeking behavior
  • argumentative behavior
  • reluctance to try new things
  • extreme shyness, sensitivity
  • being easily distracted
  • slowness, procrastination
  • overly cautious behavior, indecision
  • exacting standards
  • sleep difficulties
  • physical aggression
  • threats of suicide to avoid anxiety-provoking situations

What is Separation Anxiety?

Separation anxiety is displayed as anxiety and excessive worry around leaving one’s attachment figures and/or the home, and it is the number one reason why kids are chronically truant and/or tardy from school. In fact, as many as 75 percent of kids with separation anxiety experience some form of school refusal behavior.

The symptoms a child experiences when separated from their attachment figure(s) and/or home are so distressing, they will do uncharacteristic things to avoid feeling this distress, such as:

  • throwing a fit
  • hiding
  • refusing to move
  • saying/yelling mean things
  • become ill or pretend to be ill
  • getting in trouble so they can get suspended or expelled so that they can stay at home
  • tantruming
  • drawing out their morning routine to the point that they will be late for school

Following are common signs of Separation Anxiety Disorder:

  • Distress when anticipating or experiencing separation from the home and/or attachment figure(s)
  • Worry about losing attachment figure
  • Worry about attachment figure being harmed
  • Worry about being kidnapped, lost, or otherwise separated from attachment figure
  • Reluctance or refusal to sleep away from home
  • Reluctance or refusal to leave the house
  • Nightmares about being separated from attachment figure or home
  • Complaints of somatic symptoms when separated from attachment figure or home

How to Help

There are numerous strategies parents can use to try to help alleviate their child’s anxiety-based school refusal as well as help reduce the worries about separation. A few parent-specific tips include:

  • Manage your own state, as the parent/caregiver. Kids are highly intuitive and can very often pick up on their parent’s mood and emotions. If you are displaying anxiety, your child can pick up on it and it will most likely make them anxious too. Try to be strong when you and your child are in the process of parting, at least until after you’re out of sight and outside of hearing distance.
  • Be consistent. If you say you’re going to pick your child up at 3:30 pm, please do all you can to fill that promise to her. Of course sometimes things happen that are unavoidable, but this should be the exception, not the norm. Do what you say you’re going to do.
  • Validate their feelings. Acknowledge their worry or fear and let them know that you understand this may be hard, but encourage and assure them that they can handle this and that you will always return.
  • Create a (quick) goodbye ritual with your child, and use it every time you part. Creativity and even silliness can be a bonus here, to help your child know that separating doesn’t have to be such a bad thing and that you love them no matter how far apart you are. Remind her that you will see her again later (if you are able, tell her when that will be).
  • Whatever you do, do not sneak away when separating from your child in effort to prevent a tear fest or tantrum. This only increases the child’s worry about being apart from you.

Stay tuned for Part 4 of my Anxiety Series, where I will offer a much larger variety of tips and strategies you can use to help your child with anxiety!

Anxiety Series Part 2: 20 Brain Integration Strategies to Help Your Child Struggling with Anxiety

Anxiety disorders are the most common type of mental health disorder in childhood, affecting 8 percent of all children and adolescents.

In follow up to my last post, I want to offer some strategies your child can try to help alleviate her anxious feelings. This post will only focus on brain integration strategies and represent only a few of the techniques that can help children better control their intense worry.

The Brain Science

First, let’s start with a brief lesson about the brain. Our brain is divided into two hemispheres: the left and the right. To summarize, the right and left sides of the brain specialize in some very different things:

Left Brain:

  • loves and desires order
  • logical
  • literal
  • linear (it puts things in a sequence or order)
  • cares about the letter of the law
  • linguistic (it likes words)
  • focuses on the text
  • focuses on the details

Right Brain:

  • more intuitive and emotional
  • “gut feeling” – cares about the meaning and feel of an experience
  • nonverbal, sending and receiving signals that allow us to communicate in ways such as through facial expressions, eye contact, tone of voice, posture, and gestures
  • focuses on the context
  • cares about the big picture, not the details
  • specializes in images, emotions, and personal memories
  • more directly influenced by the body and lower brain areas, which allow it to receive and interpret emotional information

In order to live balanced lives full of connected relationships, it’s crucial that our two hemispheres work together. The corpus callosum is a bundle of fibers that runs along the center of the brain, connecting the right and left hemispheres. The communication that takes place between the two sides is conducted across these fibers, allowing the two hemispheres to work as a team.

The brain has two sides for a reason: with each side having specialized functions, we can achieve more complex goals and carry out more intricate, sophisticated tasks. The key to thriving is to help these parts work well together – to integrate them. Integration takes the distinct parts of your brain and helps them work together as a whole. Each side needs to do its individual job while also working together as a whole; integration is simply that.

Your brain can’t perform at its best unless its different parts work together in a coordinated and balanced way. That’s what integration does: it coordinates and balances the separate regions of the brain that it links together.

It’s easy to see when our kids aren’t integrated – they become overwhelmed by their emotions, confused and chaotic. They can’t respond calmly and capably to the situation at hand. We want to help our kids learn to use both sides of their brain together, to integrate their left and right hemispheres. This means we need to help them bring in the left brain to get some perspective and handle their emotions in a positive, more effective way.

Kids struggling with anxiety disorders, in addition to those who have difficulty regulating other emotions such as anger and frustration, are experiencing emotion dysregulation when they feel anxious feelings. In terms of development, young kids (very young children especially) are right-hemisphere dominant. That means their emotions take over much more easily and more intensely than when they’re able to integrate their left hemispheres too.

Integrating the Brain’s Two Hemispheres

So how do we integrate our brain’s two hemispheres? There are several ways we can do this, but some of the easiest, child-friendly ways for our children to try include something called “crossing the midline.” Teaching our kids some very simple techniques can help them to regulate their anxiety, and other emotions.

Draw a line down the middle of your body. That’s called the midline. Every time you cross over that line, you’re helping connect the hemispheres in your brain, resulting in integrating your brain. These exercises can help regulate the part of the brain that controls your emotions. They help you feel relaxed and safe, they release that fight or flight response, and they allow you to respond more rationally instead of emotionally.

Following are twenty of my favorite brain integration strategies to teach children. While the exercises can be used while they are in the midst of experiencing anxious feelings, for best results, it is recommended that these types of exercises should be practiced a few times a day, 4 to 7 days a week. Doing the exercises to music can help make them more fun! Click here for a pdf of the exercises to print them out and save: Brain Integration Strategies

Brain Integration Strategies to Help with Anxiety

  1. Simple Tap – Touch your right hand to your left knee and then your left hand to your right knee. Repeat several times.
  2. Bend and Stretch – Lift left knee and touch with right elbow. Life right knee and touch with left elbow. Repeat several times.
  3. Catch a Star – Reach with right hand up in the air to your left and pretend to catch a star. Then reach your left hand up in the air to your right and catch a star. (You can also pick apples, oranges, etc.) Repeat several times.
  4. Pat on the Back – Alternate patting the back of your left shoulder with your right hand and your right shoulder with your left hand. Repeat several times.
  5. Piddle Paddle – Put fists on top of each other as if holding an oar. Pretend to paddle on the right side of the body and then switch hands and pretend to paddle on the left. Continue to repeat.
  6. Nose and Ears – Touch your right ear with your left hand and place your right hand on your nose. Touch left ear with right hand and place left hand on your nose. Repeat several times.
  7. Hug Your Brain – Say and demonstrate these motions as your child follows along:
    1. Thumbs up. – Stick up your thumbs in front of you.
    2. Thumbs down. – Point thumbs down.
    3. Cross your arms. – Cross fists with thumbs pointing down.
    4. Clasp your fingers. – Keeping wrists crossed, hold hands.
    5. Bring your hands in. – Bring clasped hands down and in toward your chest.
    6. Give yourself a hug. – Squeeze arms.
  8. You’re the Best – Say and demonstrate these motions as your child follows along:
    1. Thumb up. – Stick up one thumb.
    2. Across the chest. – Bring thumb to opposite shoulder.
    3. Pat on the back. – Pat opposite shoulder.
    4. Cause you’re the BEST! – Child hugs himself.
  9. Push and Pull – Stand with hands on hips. Twist left and push with palms up and then pretend to pull something towards you. Twist and push and pull to the right. Repeat several times.
  10. Disco Dance – Put right index finger in the air and point to the left. Bring right index finger down by your side. Place left index finger in the air and point to the right. Then bring down by your side. Do several times.
  11. Crazy Eights – Make the figure eight in front of you with your right hand, then your left hand. Make “lazy” eights by making eight lying down, with your right hand. Make lazy eights with your left hand. Clasp fingers on your right and left hand and make large crazy eights. Lean over and pretend to draw an imaginary “lazy” eight on the floor with your right hand and then with your left hand.
  12. Bending Exercise – Take a small ball in your hands and bend over and touch the ball to the floor. Legs should be shoulder-width apart. Touch the ball in front of you, then in the middle, then behind your legs. Repeat several times.
  13. Glider Exercise – Put a piece of tape across the floor like a pretend balance beam. Have child walk across it heel to toe. While walking across it, have them raise their right hand above their head as they step, then switch to their left hand as they switch feet.
  14. Clapping Exercise – Use tape to create a fake balance beam on the floor. Have child walk across the balance beam heel to heel while clapping their hands at the same time. They must clap at the same time their feet are stepping.
  15. Bongo Drums – (may have to use stickers to match opposite hand to opposite drum, for younger children) Have child play the drums by hitting the bongo by crossing over left to right and right to left.
  16. Windmills – Stretch out feet. Touch right hand to left foot. Stand. Touch left hand to right foot. Repeat several times.
  17. Picking Peppers – Stand with your feet stretched. Bend to the left and pretend to put something beyond your left foot with your right hand. Stand. Bend to the right and pretend to pull something with your left hand. Repeat several times.
  18. Shopping – Pretend to steer a grocery cart and then reach to the left with your right hand and take something off the shelf and put it in your cart. Reach with the left hand to the right and put something in the cart. Repeat for a few minutes.
  19. Climbing – Act like you’re climbing a ladder as you reach up with your right hand and lift your left knee. Reach with your left hand and lift your right knee. Repeat several times.
  20. Put the Fire Out – Pretend to get a pail and scoop up water on the floor by your right foot. Throw that pail of water over your left shoulder. After several times in this direction, scoop water from the left and throw it over your right shoulder.

Stay up to date and follow along for more upcoming posts about anxiety in children and teens, including more tips that parents can use to help alleviate their child’s worries!

Sources:

“The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s Developing Mind” by Daniel J. Siegel and Tina Payne Bryson

www.howweelearn.com/crossing-the-midline-activities-for-kids/

 

 

Anxiety Series Part 1: What Does Anxiety Look Like in Children?

Anxiety has a nasty way of not only afflicting adults in the multitude of ways we encounter it everyday, but it can also cause significant distress for children and adolescents too. My next few posts will be about anxiety and how it is experienced in children and teens. Along the way I’ll also provide parents some techniques that you can try with your own children should you notice signs of anxiety or if your child is experiencing an anxiety disorder.

First of all, let me make this clear: Kids do get anxious. Kids do get stressed.

So before I hear one more person remark, “They’re kids! What do they have to be stressed about?!” or “Kids don’t get anxiety!” I want to stop you now. If you feel this way and I’m unable to change your mind, I hope you will at least not say these things to your own kids because statements like these are some of the most unhelpful, invalidating things that your child can hear if he indeed is experiencing anxiety. And if he’s fortunate enough not to be struggling with an anxiety disorder, hearing adults say these types of things only helps to attach the stigma to having anxiety. It’s just not helpful, and it’s simply not true that kids don’t experience anxiety and that kids don’t get stressed.

Occasional anxiety is an expected and normal part of life. A child might worry about an upcoming test or school assignment, for example. Or they may worry about this weekend’s soccer game and if they will do well. Very young children go through a developmentally normal period where they might suffer from anxiety when they’re separated from their caregivers. But anxiety disorders involve more than temporary worry or fear. Kids who struggle with anxiety disorders experience intense, excessive, persistent worry or fear, and it doesn’t go away easily. In fact, without treatment, it may even get worse over time. The symptoms felt with an anxiety disorder can interfere with their daily activities and day-to-day functioning, such as in school performance and interpersonal relationships.

There are several types of anxiety disorders that can kids can experience, just like adults: generalized anxiety, social anxiety, separation anxiety, specific phobias, panic, and obsessive-compulsive anxiety. In part 1 of my series about anxiety in children, we’re just going to focus on what anxiety generally looks like when kids experience it, because you may be surprised to learn that it can actually look different from what you’d expect if you were to examine an anxious adult.

What Does Anxiety in Children Look Like?

When kids experience anxiety, they’re likely to notice it affecting them in three ways:

  1. Through mental processes or thoughts that they have… Anxious kids will have thoughts that center around some type of perceived or real danger or threat.
  2. Physically in the body… When a child becomes anxious, his body becomes more “pumped up” or aroused. This is caused by the fight or flight (or freeze) response that all humans experience as a built-in survival mechanism. A child may notice his heart beating faster, more rapid breathing, sweating, nausea, and so on.
  3. Affecting their behavior… Children experiencing anxiety may freeze, fidget, pace, cry, cling, shake, or behave in any number of ways. Anxiety also usually involves some type of avoidance, such as an obvious avoidance of a specific animal or a more subtle avoidance, such as a child who chooses to spend all their time helping to clean up the dinner dishes so they don’t have to talk to anyone at a family or social gathering.

The amount of anxiety varies from child to child and can vary from situation to situation.

Following are examples of some visible signs of anxiety you might see in your child. Note that some of these may be present in the experience of normal, expected anxiety as well as in anxiety disorders. Your child need not experience all of these signs to indicate that he is struggling with anxiety; he may may only display one or two, or he may only display less obvious signs and none of the more visible ones:

  • physical distress (shaking, crying, hyperventilating, screaming)
  • fleeing, escaping
  • outright statements of anxiety
  • outright questions expressing fears
  • refusal to engage in activities that cause distress
  • extreme distress upon contact with feared object
  • refusal to be alone or without a parent
  • repeated rituals

Below are less obvious signs of anxiety you might see:

  • clingy behavior
  • irritability
  • avoidance behavior
  • complaints of physical illness or physical ailments (i.e., headache, stomachache)
  • reassurance-seeking behavior
  • argumentative behavior
  • reluctance to try new things
  • extreme shyness, sensitivity
  • being easily distracted
  • slowness, procrastination
  • overly cautious behavior, indecision
  • exacting standards
  • sleep difficulties
  • physical aggression
  • threats of suicide to avoid anxiety-producing situations

As you can see, whether your child is experiencing an anxiety disorder or anxiety or worry that is more expected and normal, anxiety can look like a number of things that may or may not look like how we would expect anxiety to look. Most commonly, I see anxiety in children and teenagers present as irritability, aggression, avoidance behavior, sleep difficulties, and complaints of physical illness. It’s more common for me to see one of these signs before I ever notice signs of what we as a society thinks anxiety looks like in general (e.g., fear, nervousness, shakiness).

 

Stay up to date and follow along for more upcoming posts about anxiety in children and teens, including tips that parents can use to help alleviate their child’s worries! 

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Sibling Trouble: A Therapeutic Game to Enhance Cooperative Bonding (with Free Printable Game Cards)

If you have been following my posts that describe how I frequently adapt “non-therapeutic” games and turn them into therapy games, you will know that this is something I do A LOT. I’ve explored in past posts my adapted versions of Sorry!Checkers, Connect 4,  Perfection, and many others, and now I’ve decided it’s time to add my youngest son’s very favorite game to my already expansive supply of games I have adapted for therapeutic purposes.

If you’re new to this site, let me first explain what I’m talking about when I say “non-therapeutic” games. It’s simple: the difference is nothing more than what a game’s original intent and purpose were when they were initially designed. “Non-therapeutic” games are those that you can generally find at your local department store in the game aisle, such as UNO or Monopoly. “Therapeutic” games, in the original sense, are those which you can usually only find at play therapy specialty stores, such as playtherapysupply.com, childswork.com, or childtherapytoys.com, to just name a very few. For anyone not new to this blog, you know though that I can make most ANY game therapeutic, the same as how most any game can also be made educational!

Sibling Rivalry and Jealousy

Now on to what you’re here for: a game to help your children (siblings to one another) get along. I cannot count how many child and teen clients I see that experience a distressing amount of sibling conflict at home. To an extent, sibling rivalry and jealousy – sibling conflict – is developmentally normal. In fact, I don’t personally know of any sibling pair or group that gets along 100 percent of the time. I have an amazing older brother whom I’ve always gotten along with very well, and even we had our days as children where we would argue and fight and even sometimes pull hair. It didn’t happen on a day to day (or nearly every day) basis though, and our relationship never became so distressing that it affected our individual or family functioning. We would annoy and aggravate our grandparents, who raised us, but it did not seem to cause them a significant amount of stress or strife, they would tell us later.

That said, there are sibling relationships out there that do become distressing and concerning, for both the siblings and for the family in general. When a sibling relationship is strained, the family also becomes strained.

Interpersonal Differentiation

Family Systems Theory, introduced years ago by Dr. Murray Bowen, defines the family as an emotional unit, systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system. In other words, each person in the family affects each other.

There is a good deal of research that have found evidence that people in general can have quite an influence on the psychophysiological well-beings of those around them. Emotions particularly have a “contagious” effect, with negative emotions (such as anger, upset, sadness, etc.) being more contagious than positive ones (such as happiness, joy, etc.). So it makes sense that if one person is experiencing negative emotions, it’s likely the rest of the family will start experiencing those emotions too.

It is for that reason that it is essential that children learn interpersonal differentiation. Interpersonal differentiation is when we can distinguish our experiences from the experiences of other people we are connected to. Children especially have a tendency to feel the emotions they sense that their parent is feeling. If mom is feeling stressed, for example, the child begins feeling stressed too because he feels his mom’s stress. It is this differentiation process that will help children learn to differentiate what emotions belong to them and what emotions belong to mom (or their other parent or family member).

Why do siblings get along the way they do, with some who argue and fight all the time versus others who seem close and are able to get along very well? There are many reasons why sibling relationships can become strained or conflictual, too many for me to list for the purposes of this article. Personality differences, age, gender, family size and spacing, and birth order are among the top reasons that help determine and explain why some siblings get along better than other sibling sets.

Cooperative Bonding

It is very common  for kids to feel jealous of one another and to compete for their parents’ attention. It’s common for kids to disagree and to even get in occasional arguments. But it’s important that if your children are having significant difficulty getting along and the relationship is causing them or you or other family members a great deal of distress, please try to find help to resolve it. Therapists see lots of families for this very reason, you’re not alone. There are some things you can do, however, to help at home, whether to be proactive so that therapy is not needed or to use in conjunction with therapy as well.

An antidote to sibling conflict is to help the siblings have more experiences of cooperative bonding with one another so they can begin to realize that they have their own connection, that they’re not just competitors for their parents’ attention. Homeostasis between siblings can be obtained through a combination of self-differentiation experiences and sibling bonding experiences.

Enter the therapeutic use of games like Trouble.

How to Play Trouble

Trouble is a simple game for 2-4 players and is recommended for those ages 5 and up. Trouble’s board contains a fun pop-die roller (the POP-O-MATIC). The goal of the game is to be the first player to move all four of your pegs from HOME to FINISH.

Each player chooses a color and places all four of their colored pegs in their HOME spot. The players then roll the die (which involves pressing the dome of the pop-die roller, causing the die to jump and roll) to determine which player goes first. The one with the highest roll goes first and play proceeds to the left.

Game rules state that in order to move your pieces from HOME to START, you must roll a 6. If you do not roll a 6, and no pieces are in play (meaning that all of your pieces are still on your HOME), then your turn is over, and it is the next player’s turn. Once one or more pieces has been moved from HOME to START, you move your pieces around the game board based on the number rolled on your turn. Whenever you roll a 6, you get to roll the die again for a second turn. When you roll a 6, you can opt to either move a piece from HOME to START or you can move a different piece 6 spaces around the board if you have another game piece already at play.

*NOTE: With younger players, I generally throw out the rule that a player cannot move unless he rolls a 6, though he may still take a second turn if a 6 is rolled.

Pieces move around the board clockwise (left). You must count each space you move, whether it is empty or full. If you land on a space that has another player’s piece, the other player’s piece is sent back to their HOME. You may not land on your own pieces, including to move onto START.

To win the game, you must be the first player to move all your pieces into your FINISH. You must roll an exact number to move your pieces into an empty FINISH spot. If you roll a higher number than you can move (and you have no other pieces you can move), then your turn is over and your piece does not move. Pieces do not move around the board a second time.

If 3 or 4 people are playing, game play can continue even after one person has won so as to determine 2nd and 3rd places.

How to Play Sibling Trouble

Before playing Sibling Trouble, print and cut out the following task cards. If you have access to a laminator, I recommend laminating them for durability.

Sibling Trouble Task Cards

The game of Sibling Trouble is played the same way one would play the traditional game of Trouble, except that when a player rolls a 2 or 5 on the pop-die roller, he must draw a card.

The task cards include an array of activities, ranging from self-regulation skills one can use when they are experiencing sibling conflict (or dysregulation in general), cooperative bonding activities which require the siblings to work together to complete a task or activity, and scenario cards in which the player is asked to respond how he would handle a sibling conflict situation.

I start all my games by listing my two rules of game play in therapy: We play fairly and we congratulate the winner, regardless of who wins or loses. Usually we congratulate the other with a high five, even when the losing player shows unhappiness or anger or might be tearful because he lost. I also discourage boasting when there is a win – you can be proud and excited without being mean and rubbing it in.

When I use the game as a therapist, I encourage both (or all, depending on how many siblings I’m presently working with during the session) players to participate in the activities, though if one is reluctant to do so when it is not their turn, I will then only require both/all siblings to participate during the cooperative bonding tasks (those that require teamwork in order to successfully complete the task requested).

If a parent or therapist – or an older sibling (who is not involved in the sibling conflict) – is able to facilitate the game, I suggest that this will likely produce better outcomes, except in cases where the game has already been played a couple times and you know that the siblings will play fairly and likely not need a facilitator. A parent or therapist can especially help guide the players by modeling some of the self-regulation skills and briefly explaining how the skill would be helpful in times of conflict (or dysregulation).

If the siblings playing are not able to read or are not good readers, they will require someone to help facilitate the game, as it involves reading and practicing or otherwise responding to the task cards. Besides being the reader, the facilitator also serves the purpose of ensuring that the players are playing fairly, and it also reduces the number of disagreements between (or amongst) the siblings while the game is being played.

The cooperative bonding tasks sometimes require common items or objects found in most households, such as pencil and paper or even a potato! If the task card requires something not readily available, don’t sweat it. Just have the player draw another card. I included a good amount of cards for reasons like this, as well as so the game can be played over and over and the same task cards won’t keep arising. If the siblings run out of task cards, they can shuffle the ones they’ve already used and perform the tasks again. After all, practice improves the chances that the skills will be remembered in the future when they’re needed in the midst of a conflict. And the more cooperative tasks that siblings do together, the more likely that the siblings, over time, will begin to get along better and will result in fewer sibling conflicts.

The idea is to help siblings see that they don’t have to compete with one another, that they can cooperate and will still be given positive attention while learning how to be a team. At the same time, the competitive qualities of the game Trouble also gives the siblings a dose of the natural and developmentally normal dose of competition they desire.

Parents…

Parents, you can also play a part in improving the siblings’ relationship in other ways. Try to always be fair to each child (and that doesn’t necessarily mean that every child receives the same consequence, as long as the consequences given are equal in value and relate to the misbehavior they are being consequent for). Even though each child may complain that you’re being harder on them than on their sibling, know in good faith that you are being as fair as you can.

Also try your very best to give each child a good amount of positive attention. If Johnny always sees you praising Susie for her good grades, even if Johnny isn’t as good of a student, PLEASE praise Johnny for his positive efforts too and praise him for something he does show a talent for. If you are seen (or perceived as) giving Susie a lot of positive attention and not Johnny, Johnny is more likely to seek your attention in negative ways and he will probably end up resenting Susie in the process.

And if you spend a lot of one-on-one time with Susie, please try to spend just as much one-on-one time with Johnny too. Though it can be difficult most weeks, try to spend individual time with each of your children throughout the week. Kids, whether they will admit it or not, crave your time and attention!

Good luck! I hope you find the game useful!

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