Executive Functioning - for parents and children

Executive Function: Parents and Children

By Patience Domowski, LCSW

What is “executive functioning”? It’s a fancy term used to describe certain skills that are usually lacking in a child’s performance, often in school. These skills are the basic skills used to function in everyday life like memory, (remembering homework assignments and the routine), organization (keeping things together and knowing where things are in their backpack, desk, or at home), figuring out how and when to get things done at home and school (planning projects for example), and self-control to regulate their emotional reactions (getting easily frustrated).

Kids with executive functioning impairments are often diagnosed with ADHD or sometimes other disorders as well, or may just struggling with executive functioning regardless of another disorder. If a person has ADHD they struggle with executive functioning, however a child or adult can struggle with executive functioning without having ADHD. Executive Functioning disorder or impairment is often diagnosed by a school psychologist. If your child has this skill deficit they will likely be given some accommodations and adjustments at school to help them learn these skills such as with a 504 or IEP.

If a parent is also struggling with their own executive functioning and is trying to help their child learn these skills, it can be extraordinarily harder than for a more organized parent. The parents should ask for help from the school as well as other friends and family members if needed to learn to put some strategies in place to keep themselves and the child on track. If necessary a behavioral therapist can help as well.

Some basic strategies for parents to use themselves, and then teach their child include:

Organization:

• Set up and label containers, shelves, etc to organize where items go in the house. Do the same with school work papers. Put old school papers in a basket or box to save, or throw them out. Put current school papers in folders in child’s backpack and label what goes where. Practice with child organizing their own papers, so child learns to do the skill too. Parents can use the same strategy with other important household and work papers using a filing system or even scanning and saving on the computer instead of on paper.

Memory and Planning:

• Use a paper calendar on the wall at home, and a travel calendar to take with you (unless you use your phone calendar). Have your child use an agenda for school assignments. Write down appointments, reminders, homework, bills due etc.
• Use sticky notes as reminders. Put them up around the house.
• Use a checklist for routines and chores at home.
• Write out a plan for each day including time frames to get the things done. (Example: 4pm homework, 5pm play outside, 6pm chores. Etc, or more specifically: 3:30- math homework, 3:45 reading, 4:00 writing essay, etc)
• Use timers/alarms to keep you and your child on track for getting things completed. Maybe even make a competition- who can get ready in the morning the quickest, or who can stay on task to finish a chore first.

Self-Control/Self-Regulation:

• Recognize when you are starting to get upset and frustrated, before it gets worse, stop and take a breath and figure out how to relax or solve the problem. Start teaching your child the same strategy by pointing it out to them (“I see you’re starting to get frustrated with math. How about we take a little break?”, or “Mom is sure getting upset over this recipe not working out. I think I’m going to just try a different thing to make for dinner, instead of getting upset.”)
• Play games to work on impulse control and feelings management like running through a routine at another time to see if can improve on your timing or efficiency, or role playing how to handle a frustrating situation that might come up (at a time when nothing bad is happening).
• Come up with strategies for handling problems for both parent and child (can be separate lists) and write them up and hang them in the home where you can see them and use them. You can remind each other to use a strategy.

If needing help with motivation to use any skill or strategy, add in a motivating reward! Such as if you finish your routine in time, without reminders, you get a little piece of candy, or if you calm down quickly you get to play a game on your device for a few minutes. You can make it a fun and friendly competition with your child on who can keep on task the longest, finish their work quicker, or use more coping skills in a week instead of getting upset. Your child will enjoy calling you out when you’re off which will be a good reminder for parents, but also you can help your child recognize and correct their own struggles in a fun way.

Remember to ask for help as needed and not expect yourself or your child to be perfect. These skills take a while to learn but are learn-able, you just need more external assistants like calendars and timers. You can do it- and so can your child!

References and Links:

https://developingchild.harvard.edu/science/key-concepts/executive-function/

Helpful info on how to get helps at school for your child on this website:

https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/3-areas-of-executive-function

This tip sheet list also includes a free printable handout:

https://www.growinghandsonkids.com/executive-functioning-skills.html

Goal setting

Goal Setting

By Patience Domowski

If you don’t know what you’re aiming for, how will you know if you hit it? I remember my dad saying this to a class he was teaching on how to teach. He was discussed making lesson plans for a classroom. I think this also applies to life goals. How will we know if we’ve achieved something or gotten where we want to go, if we don’t make a plan or know what we want?

Often in my work with children and young adults who are unmotivated to do their homework, school assignments, prepare for the future, get a job, etc I help them identify goals and things they want in their future. By just focusing on the things that bother them about their current situation in life, it will further depress them and make them continue to not make progress. However if you focus on something you really want that may be in the near or distant future, you will be more motivated to take the steps to get there.

If you, or your child, or anyone you know, is feeling stuck and not doing the things they know they need to do, try these strategies for making goals and accomplishing them. After they make a goal worksheet and plan, connect their future goals to things they need to do now in order to motivate them. If someone wants a certain career, they need to start with trying hard in school as a child. If someone wants to buy something that costs alot of money, they need to start finding ways to make more money now- job, or selling items, cutting costs, etc. There is always something to start with now, even if the overall goal is a long time off.

Steps to achieving goals:

1) Identify a Goal! 

a) It can be a big or long term goal like ‘Own my own company’, or something smaller like ‘Pass Math class this quarter’.

b) It should be a goal that is something you really want- not just what you parents want or you think you should want. You won’t achieve a goal you don’t care about. You might not be super passionate about it at first, or feel the goal is too far in the future to care enough about, but trying to identify anything to start with will help you get more motivated to try in the little things now that will get you closer to your goal.

c) The goal should be concrete. Abstract goals like ‘Be famous’ or ‘Be successful’ are okay to start with but then you need to add concrete plans underneath that with more specifics such as if the goal is ‘Be a famous singer’ then add a more specific statement so you know you have achieved this goal such as  ‘Have my song played on the radio’.

d)The goal should be achievable. While you might not know now if you can pass Algebra, or become a football player, try to think realistically if this is possible. Do you want be a doctor but failed every biology class and can’t stand the sight of blood? That might be not a legitimate goal. Or saying you want to be a professional sports player but your coach doesn't think you’re really quite at that level of talent. So try to think of something more likely or even something similar like ‘Work in the Sports industry’, or ‘Have a career helping people’.

e) Write it down. (Or draw it, cut out pictures and make a vision board, other creative options).

2) Write an approximate date to achieve the goal.

a) You may not know when this will happen, but set an approximate time frame to accomplish the goal, such as ‘End of the school year’, ‘in Five years’, ‘after I graduate college’.  Giving a time frame will help you stick to the goal better than a ‘sometime in the far away future’ that may feel too abstract to even start working on yet.

b) If you aren’t sure about what date to place, can ask someone else for ideas of when they think you might achieve the goal.

3) Identify the steps to achieve your overall goal.

a) Write the steps down in an order of what needs to happen first, second, third, or just things that have to happen to get to the goal, if order doesn't matter. (To start, just jot down all your ideas and then go back and put them into a more sensible order.)

b) Steps should be specific, if possible. Example: ‘Do my homework’ to get to goal of passing this school year, or ‘pick three colleges/jobs to apply to’ if you are working towards planning a future college/career plans. Be as specific as possible, but can use more general ideas if needed. For example “Get into college” is general, but naming a specific college is better, but if you don’t know which college yet, general is fine. “Get a job”, is general, but more specific would be to name some job options you want to explore like ‘Get a job in an office setting’ or ‘Apply to plumbing jobs’.

c) If you don’t know what steps you need to get to your goal ask for help. Look online, ask your parents/teachers/friends, seek consulting from an expert if needed. (see step 4 below).

d) The in-between steps are the most important ways to make it to the overall goal. Make as many steps as needed. Sometimes there are only 1-3 steps to a goal, and may just take a few days or weeks, sometimes there may be 20 steps and may take years, but try to identify as many as you can think of, leave some space in case you need to add more in later.

e) To motivate yourself for a far off goal try to apply things in your current life to how it can help in the future. For example, if the overall goal is ‘Be my own boss at a company’, but you’re still in elementary/middle school then beginning steps may be ‘Study hard and get good grades in school’, and ‘Learn leadership skills and take leadership roles in clubs/activities’ now, or ‘Ask entrepreneurs I know about their experiences’, ‘Keep my things organized’, ‘Do volunteer work’, and other things that may relate.

f) Write target dates/approximate time frames next to each step, if applicable. The target date can be a time frame like ‘Next week’ or ‘Senior Year’, it doesn't have to be an exact day. Examples: ‘Ask my teacher about___on ___(Monday/date)’, or ‘Take the SAT’ by ___(December of Junior year)’.  Some steps may be ongoing, so write ‘daily’ or ‘as needed’, or when another step is completed, as your “date” like ‘Read my motivation posters Daily’, ‘Ask parents for help As Needed’, or ‘Shop for a car, once I have x amount saved’.

4) Identify people who can help you if needed.

a) Parents/Family, Friends, Teachers, counselors, networking people, consultants, etc. - write down specifically who, not just ‘teachers’ in general, if you can.

b) Write down who can help with which step, or who can help overall.

c) If you don’t know who can help, list anyone who has been helpful in the past that you can rely on,also  ask on social media for your contacts to suggest people such as ‘Hey friends I need someone who can give me advice on buying a car’, or ‘does anyone know who I can ask for help with getting a job?’

d) List their contact info, if needed, on your goal worksheet

5) Write down some positive motivational words, phrases, thoughts, etc that will help you get towards your goal.

a) If you’re artsy, draw some pictures, or put some stickers on your worksheet.

b) Make a poster or something motivating to hang on your wall in your room. Teens looking forward to college may want to hang a poster/banner of their future college logo on their bedroom wall. Adults who want to achieve a professional career position may post a picture or words that remind them of this goal on a bulletin board/vision board, or a photo that reminds them of what motivates them, such as a family member, or friend,

After you’ve written your goal plan, get started with Step 1 on your list towards your goal! Remember if you get stuck and are not sure what to do next- ask for help. Others can give you lots of advice. If you struggle with getting motivated even to start, ask someone you know will help you to encourage you and help you along so that you can get started. Remember you will NEVER reach your goal if you don’t make a plan and then start to follow your plan. Goals don’t just ‘happen’, you have to make them happen!

Goal Worksheet - Free Download to use. 

Positive Self Talk

Positive Self-Talk

By Patience Domowski, LCSW

Did you know that talking positively to yourself can change how you feel and behave? It’s amazing how much our minds and thoughts can affect our feelings and behaviors. This is the basis theory for Cognitive Behavioral Therapy, known commonly as ‘CBT’. CBT teaches that changing your thoughts (often through a strategy or coping skill called ‘Self Talk’) changes your feelings, which then changes your behavior.

For example: You see someone you know at the store or a restaurant and they don’t talk to you at all. If you think “That girl didn't talk to me because she doesn't like me”, you might feel sad, annoyed, jealous, etc. Your behavior may be to snub her, not talk to her, or be rude. However if you change your thoughts to “That girl didn't talk to me today; maybe she’s having a rough day, or she didn't see me. Or she was busy/some other reason,” then your feelings change to more neutral/content feeling, not caring about it, or even feeling bad for the girl. Then maybe your behavior might be to go talk to her yourself or just let it go. The situation didn't change- the girl still didn't talk to you, however by changing thoughts from negative (‘she doesn't like me’) to positive (‘maybe she is having a bad day or didn't see me’, or some reason not related to feeling badly about me) then your feelings become more positive and your behavior improves as well.

‘Positive self-talk’ is also used to help you feel better about yourself when you have negative thoughts about yourself. So if your thoughts are ‘I’m a terrible person’, ‘No one likes me’, ‘I’m so stupid’, which makes you feel sad, disappointed, like a failure and leads to behaviors of withdrawal, avoidance, etc you can work on changing those thoughts to ‘Well, I did the best I could’, ‘Not everyone likes me, but my friends do’, ‘I’m still learning and everyone makes mistakes’, then your feelings become more positive such as feeling hopeful, happier, etc and your behavior likely would be to try harder, not continue to think harshly on yourself, maybe be more active or social.

Just going into a situation thinking positively about the possible outcomes will help you notice more positive aspects of situations and likely you will have a better experience than going in with a negative viewpoint. For example maybe you’re dreading a family party because you don’t know a lot of extended relatives that are attending, or there are often family arguments. You head into the party dreading these awkward moments that may arise. Instead you can change the thought to ‘I’m going to enjoy myself, regardless of others’, and instead maybe focus on the food, plan to talk to the one or two people you like/get along with, or anything else that may not be too bad about the event. Then after the party you may realize that it wasn’t so bad because you were focused on the good parts, and even if you didn't know some people, or someone started a fight, at least you were focused on the people you did know, and you stayed out of the drama.

Although thoughts won’t affect what happens- you can’t magically think away something bad happening, but if you focus on the positives/good things, you will feel better than if you are focusing on or looking for the bad things.

The situation may remain the same, but the outlook is different. For example let’s say you and your friend have a day off school or work due to the weather. One person is happy because they don’t have to go to school/work, and can hang out at home doing something they’d rather do for fun. The other person is upset because they either don’t get paid for not working, or they have to make up a school day later, and they are thinking they will be bored while home and really wanted to see their friends that day. The situation is still the same- school/work is closed due to weather, however the positive person will enjoy their day, despite the consequences of lost wages or having to make up the day later, while the negative person will be miserable thinking of what they would’ve rather had happen that day.

Common positive self-talk phrases include self-esteem affirmations such as ‘I’m a good person’, ‘Others like me’, ‘I am smart’, ‘I am loveable’, as well as motivating statements such as:  ‘I can do it’, ‘I can think positively about this’, ‘It will get better’, ‘I just have to try’, etc.

If positive statements do not automatically come to your mind spend a few minutes trying to think of something positive about a situation or thought that you have, and if you get stuck, think what would you tell your friend if they were struggling with the same thought. It might be hard to think positively for yourself, but it may be easier to think of something helpful to tell a friend. If you are still stuck, ask a friend or family member for some help coming up with some positive thoughts and phrases. Write them down so you don’t forget them. If you usually think negatively, it will be very hard to remember the positives, and even harder to believe them! So have them written down so you can go to them and use them when needed.

As you work on thinking more positively, just like physical exercise, it will become easier over time. At first it will be super hard, but then your brain will help you think of them faster. The more you try it the easier it eventually becomes. The more you focus on the positives, the better you will feel. So when you catch yourself thinking negatively about something, try to change that thought right away or focus on another positive aspect of the situation, in order to think and behave better.

People with anxiety and depression mostly need to work on postive self-talk, but all of us have times of feeling down or negative and can use this coping strategy so start stretching the positive 'muscles' of your brain now so you can be ready for when you are having a negative day. 

An old quote from Henry Ford (inventor of the Ford automobile) says “If you think you can, or you think you can’t: you’re right!”

Screen Time: How much is too much?

Screen Time: How much is too much?

By Patience Domowski, LCSW

“Screen Time”- how much is too much? Is it affecting our children? Parents want to know!

According to the AAP (the American Academy of Pediatricians) children under age 1 should not have screen time, ages 2-5 should have about 1 hour and be on it with their parents, and over age 6 should set ‘consistent limits’ to make sure they have time for other important things. *

So what should those ‘consistent limits’ be? And how much time do they need for other important things? Unfortunately there is no clear cut amount of hours to recommend because each child and family varies.

What’s important to look at is what types of screen use is the child accessing and are they spending time doing things other than look at screens. Watching TV, or even Youtube videos is more mindless than playing a challenging or educational strategy game on a device. It’s important for parents to be aware of what their child is doing on their devices. Are they accessing videos that are inappropriate or adult-rated websites or violent games? Are they getting into cyber bullying and social media problems? These are things to be aware of and monitor. Check your child’s browser history, phone use, etc, periodically.

It’s important for good brain development and social skills for kids to spend time interacting ‘in real life’ not just virtually so make sure they are spending several hours playing outside, interacting with friends and siblings, and creating something - whether building with blocks or making crafts, or cooking. Being creative is helpful for teaching many important life lessons. Interacting with others provides opportunities for social skills development and promotes happiness. Make sure there is some family time where all devices are down (you too, mom and dad!) and you’re talking and playing together. Daily, if possible!

Is electronic usage affecting your child? Several parents have told me they noticed a big difference in their child’s mood and behavior when the child was on punishment and restricted from electronic usage. The child seemed happier and less difficult when not on their games, after being off for some time. Often children get overly frustrated with games, get upset when it doesn’t work out their way, get addicted to the immediate satisfaction of the game ‘reading’ them with points or level ups. If they aren't progressing in the game they get angry and irritable. If they are playing violent games they start acting out those behaviors on siblings, sometimes.  They are also not spending enough time doing other things if on their screens all the time, so they are getting bored (though they won’t admit it!) and lack of exercise may be affecting them too.

Many children are getting addicted to gaming. Signs and symptoms include:

• Constantly talking about the game, and no other subject, thinking only of the game all the time

• Has this drive or need to be on the game at all times, including not wanting to do other activities so can be on the game (wants to avoid school, sports activities, even seeing friends so has time to play games)

• Cannot go more than a few minutes without being on a device

• Has no other interests besides games

• Gets very upset if cannot be on the game or told to get off it

• Not getting up to use the bathroom, eat, or other important things while gaming

• Hours spent on the game without any other activity or interruption (often child won’t be aware of how many hours they have spent)

Take a quiz online to see if your child may be addicted.** (Link to quiz in references below). If your child seems to be suffering from this, there are resources out there such as therapists specializing in addiction, support groups, and other tips you can find on reducing gaming time and enjoying more of time outside of gaming. If you are concerned then there probably needs to be some intervention whether its as simple as parents limiting online time, to more intensive options such as contacting a therapist or support group for help.

Getting your child to do more activities may be helpful such as encouraging them to play outside, have real-life playdates, take up a club at school or other program, play a sport, or be involved in some other activity. For teens maybe volunteering, or getting a job can get them doing other things. If the child resists, you can still set limits on the time and type of screen time they are allowed and insist they cannot be on the games for x amount of time or during this time period even if they refuse to participate in another activity. Remember it’s okay for kids to be bored as that bored feeling can foster creativity. Have them come up with some other activities they can do instead of screen time. Maybe even reward them with a certain amount of screen time per other time spent (such as if play outside for 1 hour= can be on the ipad for 30 minutes later).

Important things to think about:

• Be aware of what your child is doing on their devices, including what websites, what games they play. Are they appropriate, etc. Look at the ratings on games, look online to check what professionals say about them. Plugged in, and Common Sense Media rate movies, games, TV shows, etc for parents so you don’t have to do the research yourself. (See links below). ***

• Recognize any differences in child’s emotions and behavior when on and off the games- are they more depressed, angry because of the games or when told to get off the games?

• How much time are they spending on games? Is it all their free time? Do they ever play outside or with other children in real life, or only online? Do they spend time doing anything else? Set limits and parental controls. Use the Media Time calculator, and Net Nanny controls if needed. ****

• Does your child have other interests besides video games, TV, or social media? Do they spend any time doing other activities? If not- encourage and insist on other activities in and outside of the home.

• Are their school grades suffering because they are only gaming and not doing homework? Have child finish their homework and parents check it before they can get on any devices.

• Are they showing signs of addiction? Can they go some time without reaching for a device? If they are showing some concerning signs look into getting some help and support.

References:

*AAP Guidelines: https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/american-academy-of-pediatrics-announces-new-recommendations-for-childrens-media-use.aspx

**Video Game Addiction test and resources

http://www.techaddiction.ca/video-game-addiction-test.html

Internet addiction

https://www.webmd.com/mental-health/addiction/features/video-game-addiction-no-fun#3

Types of treatment for Video Game Addiction

https://www.psychguides.com/guides/video-game-addiction-treatment-program-options/

***Plugged in Magazine, and Common Sense Media- Reviews of movies, TV shows, Video games, including rating their age appropriateness and other content.

http://www.pluggedin.com/

https://www.commonsensemedia.org/

****Media use calculator:

https://www.healthychildren.org/English/media/Pages/default.aspx

Net Nanny- sets up parental controls on devices and provides helpful blog articles

https://www.netnanny.com/blog/

Bullying- Signs of bullying and tips on how to help the victim and the bully

Bullying

By Patience Domowski, LCSW

Bullying is such as big issue. It can cause anxiety, depression, eating disorders, even suicide. We’ve heard of school shootings as a result of bullying. Kids who are being bullied shouldn’t be told not to worry about it, or it’s just normal, because it's really affecting them in a negative way. Kids who are bullies shouldn't just be ignored, or just told to stop and not actually be disciplined for it. Most often bullying occurs at school, however it can occur in the neighborhood, in the community, on the playground, at summer camp, anywhere. Adults can even be bullied in the workplace. Sadly, sometimes children are even bullied by adults like parents and teachers.

Signs your child is being bullied:

-They suddenly don’t want to go to school

-They act anxious around other children or want to avoid the bus or school

-They regress in any way like reduced speech, potty accidents, less social, avoiding others

-They start acting angry for no apparent reason

-They talk about kids being ‘mean’, or call a sibling or someone else something you haven’t heard them say before (may have learned it from others)

-Being afraid or not wanting to go to certain places like camp, sports, etc (where the bullying may have occurred)

If your child is being bullied:

-Ask them if they are being bullied, and describe what bullying means (not just someone being mean occasionally, but constant put-down negative words, or physical aggression)

-Let them know it’s not their fault

-Tell them you will help them figure it out/make things better

-Try to build their self-esteem with some positive encouragement and affirmation

-Encourage child to tell the bully to please stop, say ‘that’s not nice’ or ‘I don't like that’.

-Suggest the child try to befriend the bully- sometimes bully children are just poor at knowing how to make friends and just want attention. If your child is nice to them sometimes the behavior will change.

-Otherwise suggest the child avoid the bully as much as possible, ask to not sit near them in class.

-Encourage the child to report the incident to the teacher or school counselor, if at school. (Some schools have a ‘Bully Box’ where you can put notes about incidents in them for the counselor to review).

-If child is too afraid to talk to school staff themselves, ask if they want mom/dad to step in and contact them. If the child says no- assess if the incidents seem severe enough the parents should step in regardless. Try to find out why the child doesn't want to tell on the bully- of they are worried the bullying will get worse or kids will tease them for being a ‘snitch’. If the parents tell, however, usually other students wouldn’t know.

-If the teacher or counselor fails to respond or doesn't do anything, follow up and go up to higher admin if the bullying is continuing and child is very affected. Recommend counselor talk to the bully child and the victim separately to work on the issue. Sometimes principals have to be involved. In some severe cases children need to change classes or schools.

-If incident is happening in the neighborhood or community- try to avoid the bully child if possible, parents can try to talk to the bully’s parents, if they are amenable to that. If severe- contact the police (such as physical assault for example).

-If child is very affected- severe anxiety, depression, suicidal statements, etc- have them talk to a crisis counselor or therapist as soon as possible.

If your child is the bully:

-Talk to them about how it makes the other person feel, and how they would feel it if was happening to them

-If they can articulate it try to have them say why they are doing this (to join in with others, because they think it's cool, they don't like a certain type of people, etc)

-Teach understanding and respect. Even if they dont like someone it doesn't mean they have to be mean about it.

-Provide discipline and consequences for bully behavior

-Work with the school counselor on addressing the issue, if it’s happening at school

-Encourage your child to make friends with others, especially if they are different to help them to be more inclusive

-Make sure as a parent you are modeling good behavior and not making comments about others that are rude or disrespectful that your child might pick up on. Again- even if you don't like a certain person or type of person it doesn't mean you have to be mean! Best to just do nothing if you can’t accept them.

-Have your child talk to a therapist if they continue to struggle. There could be more issues going on with them and they are taking it out on others.

To help your child decide if they are being bullied or not use this worksheet.

To help your child decide when to 'tell' on someone or not, use this decision worksheet.

Shy/Anxious, and Sensory-Avoidant Children and Overwhelming Social Scenarios

Shy/Anxious/ Sensory kids getting overwhelmed in social settings

By Patience Domowski, LCSW

If you have a shy kid or a kid with sensory issues that is easily overwhelmed in large group settings it can be rough to attend a birthday party, or even a crowded grocery store. You probably find yourselves avoiding large concerts or parades and cringing when taking your child to church or other types of social events. Anxious kids struggle in large social settings and may shut down and refuse to speak, may cry, or even have a full meltdown. Sensory kids may also have a meltdown or tantrum behaviors due to the overdose of noise and light and people. Avoiding these situations may seem best but not always. If the child never learns to cope they will always struggle and it’s not always possible or even prudent to always stay away from large social gatherings. Here are some strategies to try to help your child manage these overwhelming situations.

Some simple strategies to try:

• If the child is sensitive to sound let them wear headphones, if light- sunglasses. They might look a little different but they will be at least able to attend, and over time they will often adapt and be able to take those things off. Just like when you enter a room that is too cold or hot, often your body will adapt after a few minutes.

• Practice going into loud and crowded areas for very short time, slowly increasing to help desensitize your child to the sensory stimulation. For example go to the grocery store for a few minutes and buy one thing, or go to church and sit in the back and go to the foyer when its too much, go to parties for just 15 minutes perhaps to start. When your child is doing well, then increase the time. (This may take several attempts and last a few weeks or months).

• Rehearse ahead of time. Do some role-playing with your child ahead of time such as pretending to be a new person you might meet and have your child practice what they will say if the other person says hello for example or asks them questions. You can switch it up and parent pretends to be the kid and the child gets to be the new person you are meeting.

• Prep the child for the event in advance (if possible) such as talking through who they will see, what will happen, what is expected etc. If possible look online to see what the place looks like so the child can see it so it doesn't feel so new and scary. If its a birthday party at someone’s house maybe try to do a playdate in advance so the child is comfortable with the home and the child and family before the party (if possible).

• Try to have your child identify in advance what is bothering him or her and see if you can help them work through it. For example if they are scared no one will play with them at a party, give them some suggestions on how to engage with other children. If they are worried that it will be too loud, suggest they bring headphones, and if they can’t handle it they can take a break outside perhaps. Try to help the child problem-solve the situation themselves, if they are old enough and willing, as they are more likely to use their own suggestions. If they need help, parents can give some suggestions too.

• If the anxiety is pretty severe and seems unresolvable, seek out help from your child’s pediatrician, school guidance counselor, or a child behavioral therapist. If the issue is more sensory related (sensitive to stimulation like sounds, light, etc) seek out help from an Occupational Therapist (OT) or your child’s special education teacher (they have one).

Books flyer

Books for Sale, downloadable flyer to share

Link to Amazon. 

Feelings by Age

Feelings by Age

What your child should be able to understand and express, by age

By Patience Domowski, LCSW

Age 0-1: Baby can express sadness by crying, anger by screaming, and happiness by smiling and laughing. Some babies can express surprise too with a facial expression, often following by happy smile or crying depending on how they feel about the surprise. Babies usually respond to their parents and other caregivers emotions and reactions such as being more fussy if they sense mom is upset, or laughing when big sister makes a funny face at them. [Known emotions: Happy, Sad, Angry, sometimes Surprise]

Age 2-4: These little ones are just learning how to talk to express their feelings. Parents can teach them to name their feelings such as saying “I’m Happy!” or “I’m Mad!” when they are acting like they feel that way with their behaviors or facial expressions. Often these kids have very strong opinions and feelings and may show big emotions like anger and disappointment in the form of tantrums and meltdowns and excitement or anger in screaming. Parents can try to have their child say how they feel. Parents can also model this by naming their own feelings so the child learns which emotion goes with which term. For example “Daddy is sad right now because you aren’t listening and putting on your shoes.” “Mommy is so happy to see you after a long day at preschool!”

Some strategies for calming child is to teach them to take deep breaths, give themselves a hug or ask for a hug, and taking a break (such as child going to a private area to calm down, or parents and older siblings leaving them alone in one area until they are calm). Teaching these skills when the child is not upset is helpful so they are ready to use the skill when needed. Parents can also model these strategies themselves by doing and naming them. For example “Mommy is angry right now because you made a big mess when I asked you not to. I’m going to take a break and calm down. I’ll be right back.” or “Daddy is really disappointed you didn't make a good choice and hit your brother. I’m going to take a deep breath.”

Also if the child resists using a strategy to calm down, parents can offer an incentive such as use of a toy or a treat for calming quickly. Often it’s best to ignore screaming and tantrum behaviors until the child calms (if they are too upset to reason with) and then praise them when they are calm and divert to something else. At the preschool age some children are more verbal and understanding than others so it will vary based on your child’s language ability to be able to talk out the feelings and handle them appropriately. [Known emotions: Happy, Sad, Anger, Surprise, Excited, Love, Scared, sometimes Disappointed, Frustrated]

Age 5-7: These early school agers should know the names of most common emotions by now and be able to do some calming strategies. Parents should continue to encourage them to name their feelings and model handling their feelings too. These children may also be recognizing how their actions affect others’ feelings too. Some kids are very sensitive to recognizing others feelings while others are more oblivious. Helping them be aware of how their behaviors and feelings impact others is important. For example if they are mad and hit their sister, it can make their sister feel sad. Or if they are jealous and take their friends toy, the friend may be angry. Expanding their understanding of emotions can grow beyond the basic feelings to more specifics like Happy vs Proud specifically, or Angry broken down into disappointment, frustration, or fear. There are many games and flashcards/posters to use to teach the various emotions. Having children learn what each feeling is called, what it looks like on someone’s face and body, as well as what can cause that feeling is really important for them to grow in emotional intelligence. [Known feelings: Happy, Sad, Scared, Mad, Nervous, Surprised, Excited, Proud, Loved, Disappointed, Frustrated. Maybe: Jealous, Anxious]

Ages 8-10: These kids should be pretty familiar with most emotions. They may continue to express their feelings in acting out ways, but should know some strategies for coping and calming down. If they still struggle they may need to see a specialist to help. They should be more aware of other people’s feelings and be able to offer comfort to others if needed. They should be able to name an experience that would cause a feeling. For example “If my brother messes up my lego creation, I would be mad” or “If my friend got a new toy and I didn't, I would be jealous”. [Known feelings: Happy, Sad, Mad, Scared, Surprised, Anxious, Excited, Proud, Disappointed, Frustrated, Jealous, Loved, Uneasy, Annoyed, Nervous]

Ages 11-13: Preteens are hitting that hormonal puberty stage where their feelings may be all over the place. They may be getting upset and angry for no clear reason and acting out more than usual. Helping them realize its their hormones that are out of whack, not that the world is against them may be helpful in helping them calm their reactions. They may need more space and understanding as they navigate this difficult time. Parents should be understanding but also not allow them to be disrespectful either. Often preteens need time and space to calm down and think through their feelings and when they are in a better mood often talking about it can help. [Known emotions: at this age they should know most if not all the emotions, but may struggle to differentiate specific breakdowns of feelings such as anxious versus scared].

Ages 14-18: Teens should be able to name and know all the emotions and may admit to struggling with certain ones specifically- like anxiety or anger. They should know some coping strategies to calm down and be able to manage their extreme feelings. If they are extremely up and down with mood it can be a sign of a problem and they may need expert help (ask your doctor or therapist). While it’s normal to feel all the emotions at some point the teen should likely not be all over the place severely such as excitement to furious in a few minutes, for example. As they mature they should be better handling their emotions and learning how to regulate their responses. [Known emotions: All of them. They may have slang terms for some feelings].

Overall it's important to teach children of any age the names of feelings as well as how to recognize them (by facial expression and body language) in themselves and in others. It’s also important for children to learn what causes what feelings. After they learn those basic skills then they can learn calming and coping strategies to feel better such as taking a deep breath when angry or anxious (it tells your brain and body to relax), taking a break (such as walk away, go to room to calm down ,etc). After the child is calm then they can work on a strategy to solve the problem! Even positive emotions like excitement can cause problem behaviors if the child gets too silly, or screams, gets super energetic, etc and may need to calm down. Learning when and where to act appropriately is helpful too. Such as its okay to be silly when playing, or loud when outside, but not during library time at school, for example. There are many books, games, flashcards, posters, etc available for teaching these skills. Look online for ideas. Also realize that if your child has any developmental delays or autism than often these skills will be very delayed and may not come naturally- they may have to be specifically and deliberately taught. For example most children can recognize when their parents are angry, or their friend is upset, but a child with a delay or autism may be completely clueless.

If your child is struggling beyond reasonable expectation seek out help from their pediatrician, school guidance counselor, or a child behavioral therapist.

Some online printable resources: 
Free Download of Various Feelings Activities

More Fun Feelings Crafts and Activities

These are for learning ESL but can be used by native English speakers too!

There are plenty more! Just do a search on Google or Pinterest for free printable emotions activities. 

I have some books on these topics as well. "Violet" discusses Anxiety, "Brianna" discusses Depression (deep long lasting sadness), "Julian" learns about Anger, and "Lily" learns about making friends/social skills (which is related to recognizing others' feelings). They are all for sale on Amazon. 

Aggression in Children and How to Handle it

Aggression- how to decrease behaviors

By Patience Domowski, LCSW

Aggression in children is really difficult. From yelling to hitting, its very disruptive and sometimes even dangerous. Especially as the child gets older it becomes more of a safety concern. A 3 yr old hitting a parent is not that big of a problem, but a 13 yr old could really hurt someone.

To solve this problem we need to figure out why it is happening. Here are some possible causes:

-Child cannot manage their emotions (needs coping strategies), gets easily angry, anxious, frustrated, etc

-Child cannot effectively communicate (hasn't developed full speech due to age or speech delay, or autism)

-Child has a mental health diagnosis (autism, bipolar, ODD, …)

-Child has observed and copied aggression from older siblings, parents, violent TV

-Child is very impulsive (can’t stop and control themselves)

-Child has discovered that this gets them what they want from others  (example: if they hit then people leave them alone, if they yell then dad gives in, etc)

-Child gets attention from their behavior (even though it is negative, some children still want this attention).

-Other reasons…

For some children there may be a combination of reasons. Sometimes the reason is easy to discover but other times it may be more complicated. Collecting data (writing down the behaviors and what happened before and after) and doing an FBA (Functional Behavior Analysis) can be helpful. Ask your child’s teacher or behavioral therapist about how to do one if it is difficult to figure out the ‘why’ for the behaviors.

To correct the behavior we want to teach the child a combination of better coping strategies and a more effective way to get what they want.

For example: if they get angry easily when their sibling takes their toy we want to teach them to calm down, and also the skill of asking for the toy nicely, or asking a parent for help. If the child wants attention then teaching the child a more appropriate way such as saying “Mom, play with me!” instead of hitting would be helpful. Also the parent should ignore the inappropriate behavior until the child does the expected response.

If the child is copying others aggressive behavior- whether in person or on TV shows/games/ etc it is important to limit this exposure. If the parents are showing aggression such as yelling and hitting children, then it's likely the child will copy this as well. If the parents can try to be more patient and handle their frustrations in a more appropriate coping way, this can greatly help the child. Parents may want to seek therapy on their own, or try anger management groups, or even medication to help, if they are really struggling with depression for example. If older siblings are exhibiting aggression it is helpful to try to get them some more help and teaching the younger child to not copy those behaviors. If the child is watching violent TV shows, movies, video games, eliminate or at least reduce the frequency the child is exposed to that. If the child resists, explain that if they reduce their aggression they can slowly return to those games/shows etc. Pay attention to the ratings on games and shows however and the child’s age.

For cursing- if it’s in conjunction with anger and aggression, use same strategies already listed to teaching better coping behaviors, but besides that mostly ignore it, or teach a silly replacement word “peanut butter jelly sticks!” The more attention you give the curse word, the more powerful they become. You can tell them not to say that word and maybe even why, and if necessary punish for it, but if you make a huge deal about it (such as yelling and lecturing) it will likely make it worse. Also make sure parents and older siblings are refraining from using those words completely. Even if parents tell child not to say a word, if they are saying it themselves, the child will still learn it and repeat it. With any behavior, parents need to model good behavior and not to do anything they would not want their child to do (for the most part). Sometimes an old fashioned ‘swear jar’ is helpful. The person that says the bad word is ‘fined’ and has to pay real money into the jar.When the jar is full some families will use it for a fun activity, sometimes the money would go to the non-swearing person, or maybe the family would donate it to a charity.

Make sure the child’s aggressive behavior is not getting them what they want. If they are hitting their sibling to get them to leave them alone, and its effective, that is going to maintain the behavior. Try to teach the sibling to respond better and quicker and teach the aggressive child to request space in a better way. If the aggressive behavior is getting them the attention or item they want from parents, parents need to try hard to not give in. Even though it makes the screaming stop now, it will just make the behavior worse the next time if you give in.

If the child has not developed appropriate speech, due to age or delays, it maybe be helpful to teach a simple hand gesture/sign language to use to communicate. Maybe a clap means ‘Can I have it?’ or a hand tap means ‘I need help’. Ask your child’s speech therapist for some ideas to figure out what will work best for your child’s speech needs.

For kids who don’t have good coping strategies have them write up a list (or draw) several things they can do when they are angry and then hang the list in a well-trafficked area in the home (living room or kitchen is usually good). The list should be visible because when someone is angry they are not going to go searching for a paper in a drawer to figure out what to do. The strategies can include deep breathing, walking away/ignoring, asking parents for help, doing something fun to distract yourself, and remembering to ask nicely for things. There are many coping strategy lists that can be found online. The key is to find which ones work best for your child and to have your child identify these as well. The more the child is involved in identifying the strategies the more likely the child will use them.  Also have the child act out the appropriate coping strategy when they are in a good mood, as a role play, or after they made a poor choice to reenact making a better choice.

Try giving a reward to the child for using a strategy. For example if the child takes a deep breath instead of hitting mom, or stops screaming by deciding to go chill out in their room, give them a piece of candy, access to a special toy, or extra ipad time for making a good choice. Praise your child for calming down, whether it took 10 seconds or 1 hour, immediately praise them when they are calm so they associate positive attention with calming down.

Try behavioral charts. Children are often not motivated to make a better choice internally - it’s easier for them, or not big deal for them to yell and hit versus breathe and ask nicely. But if you sweeten the deal by offering candy, toys, extra time, other privileges then they are more likely to make the better choice. Some kids will need the reinforcement reward immediately and some can wait until the end of the day or week. Think about your child’s needs and personality to figure out the immediacy of rewards. If you aren't sure how to do this seek out a behavioral therapist who is experienced in this and can help you. Once your child learns the strategies to handle their feelings more appropriately they are likely to reduce aggression and you can fade out the behavior chart, or use the rewards to target another behavior.

Sometimes if the child is so out of control and aggressive they have to be restrained. Parents can learn appropriate ways to restrain their children (ask the school, doctor, or a therapist). If the child is in danger to themselves or others it is okay to restrain them until they are calm and in control again. The police and mental health crisis workers can also be helpful in these situations. If aggression is a regular occurrence, behavioral interventions are not effective, and the behaviors are fairly severe, medication may be necessary. Talk to your child’s doctor or seek a child psychiatrist for help.

Helpful Links:

Swear Jar: https://en.wikipedia.org/wiki/Swear_jar

Child Restraining: https://www.k-state.edu/wwparent/courses/rd/toolbox/rdtool-37.html

Causes of Aggression:

https://childmind.org/article/aggression-in-children-causes/

Handling aggressive behavior:

https://www.empoweringparents.com/article/how-to-manage-aggressive-child-behavior/

Taming Aggression and Coping for parents:

http://www.parentingscience.com/aggression-in-children.html

Anger Strategies (Other helpful blog articles)

Sensory or Behavior?

Sensory vs Behavior
By Patience Domowski, LCSW

How do I know if my child’s behavior is sensory-related or a behavioral problem? Parents wonder this all the time. The simple answer is that it's often hard to tell and sometimes the reasons overlap. Often the issues can be both.

Sensory issues are sensitivities related to the senses- see, hear, feel, taste, smell. People can be over-sensitive or under-sensitive to senses. Children can be sensory- seeking: they do certain things to get certain sensory stimulation, such as excessively rubbing a soft blanket, or sensory-avoidant: they do things to avoid sensations they cannot handle, such as covering their ears for loud sounds. Some behaviors that are sensory related can also be behaviors for other reasons, which makes this so difficult to figure out. Some children are both sensory seeking and sensory avoidant for different senses.

Some behaviors you might see in a sensory-seeking child: running around and crashing into furniture/items, desires tight hugs and squeezes often, chews/sucks on toys/fingers/etc, bites/scratches/squeezes  people or furniture, likes to feel various items and objects, fabrics, textures. These behaviors are  not to get something they want from another person, like a toy, or attention, but for sensory input into their body.

Some behaviors you might see in a sensory-avoidant child include: won’t touch or eat certain textures- wet or soft items often like pudding or yogurt, screams and covers ears/eyes in certain bright lights or loud noises (may seem normal lighting or sound to a non-sensory person however, but to a sensory kid it’s overwhelming), avoids certain fabrics/clothing.

If a child is screaming or running around, those are not obviously sensory related behaviors, so how do you know the difference? The way to figure it out is to try to figure out the function, or the WHY, of the behavior. Is the child running around because they are trying to get your attention? (Behavioral) Do they seem to be very hyper and struggle to sit still? (Could be Sensory) Is the child screaming to get what they want, get attention, or because other people are doing it? (Behavior) Or are they upset with no clear reason why? (Could be sensory) Would the child do the behavior if no one was in the room with them? One of the simpler ways to figure out if a behavior is for sensory purposes is if the behavior would occur without any other interaction from another person. If the child was alone in a room and would still do that behavior, it is likely sensory- because they are not trying to avoid something they don’t want to do, get attention, or get something from someone else (the other functions of behavior). [For more info on functions of behavior see my other article on this topic].

Many children do sensory-seeking behaviors that are not a major problem as most children like to run in circles, dance around, touch soft items, etc. because it feels good to them. It's only a sensory problem when the behaviors are disrupting the family or school setting, or causing distress or interference in the child’s life. To have your child diagnosed with a sensory disorder please seek an evaluation from an occupational Therapist (OT). OTs are available through Early Intervention (if your child is under age 5), the school system, or private agencies.

If the behavior is for any other reason than sensory-stimulation it's a behavioral issue, not a sensory issue. If a child is throwing a tantrum because they didn't get candy, that’s behavior. If they are melting down because the lights are too bright- that’s sensory. Sometimes it's hard to know why so trying to figure out when the behaviors occur, what set it off, and the environment is very helpful. If your child is verbal, ask them what the problem is if they can verbalize it. Sometimes taking data is helpful to see patterns and figure out what settings the behavior seems to occur in most often.

So what do we do about it? We want to treat the behavior differently based on the function (or WHY) of the behavior. If a child is screaming for attention purposes, we would likely want to ignore them and teach them a better way to get attention. But if the child is screaming to avoid a loud sound, we would want to help them protect their ears- such as providing headphones in noisy environments. If the child doesn't want to wear underwear to be difficult or in control that is much different than a child who is complaining the underwear is itchy. So once we figure out WHY the behavior is occurring, then we come up with a solution.

OTs help kids de-sensitize and meet their sensory needs in more appropriate ways. So a kid who cannot tolerate certain clothing would probably be brushed until they could tolerate it. They would have the child do sensory activities like jumping on a trampoline or crashing into cushions to meet those needs instead of grabbing people or running into walls. Behaviorally the child can be given rewards for making good choices- like using a sensory toy or strategy, such as biting a chew toy instead of mom’s arm.  We want the child to meet their needs in an appropriate way or get them to a point that they don't need that problematic behavior anymore.

Often the behaviors are both sensory and behavioral and they can feed each other, so sometimes a combined approach to treatment is helpful. Many children with ADHD, autism, and anxiety also have sensory issues. However a child can have sensory issues without a mental health diagnosis as well. Try to have your child evaluated by both a behavioral/mental health therapist and an OT to figure out the right diagnosis as that will be very helpful in coming up with a treatment plan.

Because sensory and behavior needs vary so much per child, and figuring out the function can be difficult sometimes, it is important to meet with an experienced professional to help figure out a plan specifically for your child. OTs and Behavioral Specialists/Therapists are the best professionals for this. Some Physical Therapists (PTs) can be helpful as well. Not all child therapists are familiar with sensory issues however, so find someone who knows something about sensory concerns and behavior.

• More information on Sensory Processing Disorder, including symptoms and treatment see: https://www.sensorysmarts.com/signs_of_spd.html https://www.sensorysmarts.com/sensory_diet_activities.html
• https://www.understood.org/en/learning-attention-issues/treatments-approaches/therapies/sensory-diet-treatment-what-you-need-to-know
• http://lemonlimeadventures.com/is-it-sensory-or-is-it-behavior/
• https://theanonymousot.com/2013/03/28/is-it-sensory-behavior-or-both/
• https://www.brainbalancecenters.com/blog/2014/11/sensory-meltdown-vs-temper-tantrum/
• http://suelarkey.com.au/wp-content/uploads/2015/05/Sensory_Meltdowns_vs_Behaviour_Meltdowns.pdf

Depression in Young Children

Depression in Children
by, Patience Domowski, LCSW

            Depression is often characterized by symptoms such as severe chronic sadness; frequent crying, difficulty or resistance in doing regular activities like going to school or work, not interested or motivated to interact with others like hanging out with friends or going to social events. Sometimes there are also suicidal thoughts or actions as well. However in young children the symptoms for depression can look a bit different. Often parents are looking for the symptoms listed above in their child to identify them as “depressed” and are surprised or confused when their young child is identified with depression or a mood disorder when they really don’t seem sad.

            Children with depression may have the above listed symptoms, however oftentimes children present with symptoms of anger or rage outbursts, often very cranky or irritable, easily frustrated or upset, and overreaction or extreme aggression outbursts (often over small problems). Aggression can be physical- like hitting, kicking, throwing objects, or verbal- screaming, saying mean things.

            Sometimes depression comes from a specific event such as someone dying, parents divorce, being bullied at school, or a traumatic event. Other times it comes from “nowhere”- it could be genetic, or just something is off in the person’s brain chemicals. Often depression and mood issues are genetic and run in families. Sometimes symptoms only occur in one setting- such as just at home, or only at school. Sometimes they are worse or more prevalent in one place than another (more at mom’s house than dad’s house, for example in divorced families).

            It’s helpful to be aware of what depression can look like in young children because it differs from the typical symptoms we think of that are more easily seen in adults and teens. By being more aware we can help get children and families help sooner. If you see these symptoms or have concerns about a child, please have them see their pediatrician, school psychologist, or a behavioral therapist/mental health clinician. The clinician or doctor can help figure out what the problem is and how to fix it so the child is feeling better and behaving better at home and school.

There are a few different diagnoses that may be considered. Here are some general ideas of what each disorder means. They must be diagnosed by a licensed therapist or doctor however. This is not an exhaustive list or inclusive of all the symptoms, but just a very brief overview/explanation.

Depressive disorder – depression symptoms, as listed above
Mood disorder - mood issues, doesn’t fit exact definition of another disorder
Disruptive Mood Dysregulation Disorder (DMDD)- depression symptoms such as frequent irritability with oppositional defiant disorder (ODD) symptoms
Childhood emotional disorder- other emotional issues related to children
Adjustment disorder with depression- patient is adjusting to a trauma or life event that is causing the depression symptoms

            Prognosis is usually pretty good for young children who are identified and treated early. Some children will just “grow out” of their symptoms, while other children may need treatment. Sometimes the symptoms occur at different times and go away and then return in a different form. Children with depression/mood disorder don’t necessarily have a diagnosis for a lifetime. Children often may only have depression symptoms for a short period of time, or they may occur cyclically, while some may suffer for a longer period of time, even into adulthood. Usually with treatment children can learn to manage or overcome their symptoms. Parents can also learn how to better support and help their children going through this as well.

            Treatment for children usually involves first identifying the need such as noticing the symptoms, and reaching out to a child specialist to help. Getting your child diagnosed may also be the first step. Pediatricians, psychiatrists, school psychologists, mental health therapists and clinicians can diagnose, treat, or refer to someone who can help. Sometimes there is just an initial discussion with a therapist or doctor about the symptoms and other times there is a more formal assessment (including observations, testing, etc) for diagnosis. Treatment can include cognitive behavioral therapy with a child behavioral therapist, social worker, school counselor, or psychologist. A psychiatrist or pediatrician may recommend medication to help improve mood, which affects behavior. Sometimes if there are behaviors at school that are causing a problem there may be a need for a formal school evaluation and services provided via a 504 or IEP plan. Often a mix of treatment modalities such as medication, therapy, and school supports are the most effective.

Other helpful articles:

http://www.webmd.com/depression/guide/depression-children
http://kidshealth.org/en/parents/understanding-depression.html
http://www.nytimes.com/2010/08/29/magazine/29preschool-t.html
http://www.wingofmadness.com/depression-in-children/
https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Childhood-Depression-What-Parents-Can-Do-To-Help.aspx
http://www.medicinenet.com/depression_in_children/article.htm

 https://www.jenreviews.com/mental-health-diagnosis/

Panic Attack Advice

Panic Attacks Advice
Patience Domowski, LCSW

Panic attacks usually include difficulty breathing, hyperventilating (short, shallow breaths), trouble controlling your breathing, feeling overwhelmed, severely anxious, sometimes racing thoughts, pounding heartbeat, and other symptoms.

Panic attacks usually occur when in an anxiety-producing situation like a large crowd, feeling confused and overwhelmed over school or work assignments, or other environments or thoughts that cause anxiety. Sometimes panic attacks come out of nowhere too for no specific reason.

Here are some ways to calm down during a panic attack:

If possible, Go to quiet space away from crowds and people (At school go to the hallway, bathroom, nurse’s office, guidance office. Don’t stay in a crowded hallway or classroom, if possible). If you feel the panic attack is going to start soon, try to preemptively leave the area.

Focus on breathing. Try to take Deep Slow Breaths from your stomach, not from your chest. You can try breathing into a paper lunch bag too, if available.

Don't think about why you are panicking, or what is causing the attack. Try not to think about anything anxiety related, or trying to figure out why you are panicking. Focus on calming. Think about a happy place or memory. Say in your head a calming word over and over like “Peace”, “Calm”, “Chocolate”, or the name of your pet, for example. Pick a calming word in advance to use for when you’re having a hard time.

If your panic attacks are happening several days a week and  also affecting  your life – such as interrupting school day, causing you to not be able to go to school or work, etc, consider medication and therapy. Therapy can help you discuss what makes you anxious and come up with some coping strategies. Medication can help calm your anxiety in general, and a rescue medication you can take when you’re panicking that can calm your body down immediately.

Coping strategies

Coping skills List
by, Patience’s Behavior Therapy

It’s good for kids to have their own list of coping strategies hung up in the home or within easy access, for anxiety and anger. Here are some examplesand ideas for your list.

Here’s a list of things that can help calm you down when angry:

•      take a deep breath

•      count to ten

•      go to a quiet space (like your room) to calm down

•      walk away from what is making you mad

•      listen to music

•      take a walk/exercise/dance

•      pet your dog/cat

•      ask for a hug

•      draw/writewhat you’re mad about and then rip it up and throw it away

Here’s a list of ways to fix anger problems:

•      think about it differently

•      try to find the positive

•      try to understand the other person’s perspective

•      problem solve

•      talk calmly with the person who is upsetting me

•      remember “if I’m nice, than people are more likely to give me what I want”

•      If I do what I’m told quickly I have more fun free time and won’t be as grumpy

•      try to get enough sleep and enough to eat

Calming strategies for Anxiety

·         deep breaths

·         try to think of the positive/realistic situation

·         use logic

·         progressive muscle relaxation

·         listen to music

·         think of a happy place/time/memory

·         draw a picture

·         talk to someone

Click here for a downloadable printable list

Homework organizer

I made a homework organizer worksheet for all those kids who are having trouble keeping track of their homework, turning in assignments, etc. Having things organized is a huge stress reducer for kids with anxiety and depression, and very helpful for kids with ADHD who are struggling with organization. Now just make sure they bring this paper back and forth to school! 

Download Homework Organizer Worksheet here! 

Breathing exercises to help calm kids down

Taking DEEP SLOW breaths are important to help teach your brain and body to relax. These breathing exercises are great for kids with anxiety as well as anger or any strong emotion. 

Download this list of breathing exercises! Print out and hang up in your child's calm down spot to help them remember how to relax! 

Breathing exercises for Anxiety or Anger to help kids calm down. 

"If I have to tell you one more time!"

“If I have to tell you one more time!”

Reducing frequency of prompting

An Explanation of 123 Magic and Supernanny’s “warnings” techniques

by Patience Domowski, LCSW

Do you find yourself telling your child to do something (or stop doing something) a million times and they don’t listen? Do they ignore you until you really start to lose it and scream at them? Do you find yourself threatening things but nothing seems to work? Or are you always arguing with your child? Well here’s the secret solution!

To reduce telling children a “million” times to do something you need to have a specific consequence tied in as a result for not listening. So if the child isn’t doing what you’ve asked right away they learn they get something taken away and then they start learning to listen right away. The power is in the consequence. They might not care that you are frustrated, but they sure do care when you take away that ipad!

You may have heard of 123 Magic but don’t have time to read the book. I thought I’d summarize the strategy here. (Okay I’ll admit I haven’t read the book either, but I know the strategy!). Remember the “Magic” is in the consequence, not the words!

To use 123 Magic you give the direction and say “That’s One” to the child to let them know you told them what to do once. Wait a few seconds/minutes and if the child doesn’t comply you give the directive again and add “That’s Two”. After a minute if the child still refuses to comply then you say “That’s Three” and give them a consequence. Important note- 123 Magic is NOT counting to three. So it’s not “Pick up that toy, 1. 2. 3. Okay you’re in trouble now,” but rather giving the direction 3 times after 3 occasions of refusals.

Now before you start this you should prepare your child by explaining how it works (during a calm time, not in a moment of noncompliance). You should also have a go-to ideas of consequences in your head that you can use. It doesn’t always have to be the same consequence but it needs to be something the child cares about, and something that you are able to enforce/follow through with. Also don’t use a consequence that will punish yourself. Like taking away TV time when you know that’s the only time you can actually shower, for example!

Here’s how you can explain the new program to your child “Mom and Dad are tired of telling you MANY times to do things. It’s frustrating for us and then we yell at scream at you. I'm sure you don’t like when that happens either. So we’re going to use a new strategy. It’s called “123 Magic”. Isn’t that a cool name? Basically we will only tell you THREE times to do something and then you get a consequence. The consequence will be ____ (examples: lose a toy/go to room/loss of privilege/etc). So when we ask you to do something we will tell you “That’s one” so you know we told you the first time. If you don’t listen right away then we’ll remind you “that’s two” so you know this is the second time we asked you to do something. If we get to the third time we will see “that’s three” and you will have the consequence right away. You still have to do what we told you to do but you also get a consequence. If you do it before we get the Three then you don’t get the consequence.” Then practice it with something easy like throwing trash in the trash can or putting a toy in a box so the child gets in the habit of listening right away and understands how it works during a calm time/teaching time, not just waiting for a problem time.

After you’ve used this strategy a few times the child learns that they do not want to get to Three. They know you MEAN IT and you don’t have to scream at them. You just have to say “That’s three. Now you’ve lost ipad time tonight” in a calm tone. [Ignore any resulting screaming/crying and still insist the child completes the direction you gave them].

When you FIRST start using 123 Magic you might want to remind them of what they are going to lose. Here is an example for when you FIRST start using this system with a child who is refusing to follow directions.

Example “Pick up your jacket and hang it up. That’s one.” (wait a few seconds). “Remember if we get to 3 you don’t get to go out for ice cream with us tonight.” (wait a few seconds). “Pick up your jacket and hang it up. That’s two. If we get to three, you lose ice cream tonight.” (wait for compliance). “Okay this is 3. You lose ice cream tonight. You still need to pick up your jacket.”

After that there should be no more explanations. No more pleading. Nothing else. Just “That’s one” “That’s Two” “That’s Three”. You should NOT be saying “If I have to tell you again…” or “I’ve already told you x times” or explain why they need to listen, etc. Just give a simple direction with the numbers. Because they will know what the consequence is. Then take away the privilege or whatever the consequence is calmly and quietly.

Supernanny has a similar system where she calls it “Warnings”. It’s really the same thing. You can do it that way too. For example “Stop hitting your sister. That’s the First warning”. (behavior continues) “Stop hitting your sister. This is the 2nd warning.” (behavior continues). “This is the 3rd warning.” (wait briefly, if behavior continues then) “Okay that was 3 warnings- now no more computer time tonight.”

The “magic” is that there is no more arguing and parents don’t have to repeat themselves many times. Children soon learn to comply within 1-2 prompts instead of 20!

Check out the 123 Magic books program and read some articles by Supernanny as there are some great strategies there. Links are below. 

Also see my "resources" page for links to more articles. 

Reference:

http://www.123magic.com/1-2-3-magic 

http://csgreeley.org/sites/default/files/files/1-2-3-magic.pdf 

http://www.supernanny.co.uk/Advice/-/Parenting-Skills/-/Routine-and-Teamwork/Parent-child-power-struggles.aspx

http://www.supernanny.co.uk/Advice/-/Parenting-Skills/-/Discipline-and-Reward/Punishment-or-positive-discipline.aspx

Arguing- it takes 2 to tango!

Arguing

Just like it takes two to tango, it takes two to argue. So when a parent says the child constantly argues they are implying that the parent is arguing back too. How do we stop this as parents? Simple answer: STOP ARGUING. Don’t answer back. Ignore constant invitations to engage in arguing behavior. Remind your child you already gave them a response and that’s it. If they continue to ask, perhaps give a consequence.

Arguing problem example

Child: Mom, may I have a cookie right now?

Mom: No, we are saving the cookies for dessert tonight.

Child: But mom, I’m really hungry! I want a cookie now!

Mom: No, you just had a snack. It’s almost dinner time.

Child: I’m still hungry! I can’t wait for dinner! I want it now!

Mom: I told you, you have to wait until dessert time after dinner.

Child: But I want it now! You never let me have anything to eat! You starve me all the time! You’re the worst mom ever!

Mom: No, I feed you all the time, We’re eating dinner in about 15 minutes anyway.

Child: (Starts to cry/tantrum) I want a cookie! I hate you!

Mom: (loses cool) What is your problem?! I’m the best mom ever- some moms never give their kids cookies! If you keep acting like this I’ll never feed you again!

… okay maybe not to that extreme… In this example the child engaged mom in arguing, even though Mom did a great job sticking to her word and not giving in to what the child wanted, the child still was arguing to get what they wanted and mom was losing her cool and getting upset.

Let’s try this instead. Sometimes its called “Asked and Answered” (I didn’t invent that term, but it makes a lot of sense. Basically you just remind the child you already gave them a response. You might explain why, if not obvious, but then you let it go.)

Arguing Solution:

Child: Mom, may I have a cookie right now?

Mom: No, we are saving the cookies for dessert tonight.

Child: But mom, I’m really hungry! I want a cookie now!

Mom: I already answered your question. I’m not going to talk to you any more about it.

Child: I want it now! I want a cookie! I can’t wait! I’m starving! You never feed me! Why can’t I have one now? (etc…)

Mom: (ignores child)

Argument over.

Child can continue to scream/tantrum but knows he’s not going to engage mom in discussing this anymore.

Sometimes if child does this kind of behavior a lot I would add this..

Mom: If you keep asking for a cookie/screaming/crying, then you won’t get a cookie after dinner for dessert at all. It’s your choice.

Hopefully child will stop at this point. If they don’t then mom needs to stick to her word and no cookie during dessert time. Next time the child will likely remember this consequence and avoid this behavior completely. It may take a few tries to get to that point! 

Autism/Aspergers and teaching social skills at home

Autism/Aspergers

If you have a child on the autism spectrum you are probably realizing that parenting this child is extremely different that parenting neurotypical children.

[If you aren't sure if your child is on the autism spectrum have them evaluated by any of the following: their pediatrician, a developmental doctor, a licensed therapist, psychiatrist, Early Intervention evaluation team, child psychologist- either independent or at the child's school.

Signs of autism include at least some of the following symptoms -extreme difficulty with social interaction (including poor eye contact, difficulty understanding other person's tone or intent/meaning, struggles to make friends/initiate conversations, "tuned out", doesn't seek out others for interaction, doesn't understand emotions/how others feel), difficulty with communication (either not talking by age 2, barely talking, difficult to understand, difficulty with conversation skills/pragmatics/turn taking), repetitive behaviors/sensory problems (head banging, flapping, spinning in circles etc), restricted interests (will only play with dinosaurs, lines up cars, etc), other difficult behaviors (defiance, lack of focus, extreme inflexibility, difficulty transitioning between activities, needs a lot of help with basic life skills activities).] 

Children on the Spectrum need visual directions often, and help learning every behavior that most other kids will naturally pick up on without having to be specifically taught. I recommend find a good therapist and get them in a school/classroom that will meet their needs. Because autism is such a spectrum: from the severe nonverbal kids that might also have intellectual disability to the high functioning brilliant Asperger’s kids that your child’s treatment needs to be individualized and work best for their needs.

There is not really a one size fits all treatment for every kid on the spectrum but some basic tips include:

- use visual cues and directions

(social stories, picture schedules, show pictures or gesture/sign language of what you are asking them to do, write down reminders, instead of telling them what to do use picture cards or list the directions)

-don’t give long explanations just short, concise directions

With typical children explaining WHY is really helpful. With kids n the spectrum they often don’t care or don’t understand. Its usually just extra words they are confusing. SO just state what you want them to do in as a short a way as a possible. Example: “Put toys in box”- for autism child. For typical child you might say- “Please clean this room, because we are having guests visit tomorrow and I don’t want them to trip”.

-Teach and encourage your child to interact with peers.

Instead of expecting them to invite friends over to visit, you might need to take the initiative and invite the peers over and even teach/tell your child what they will play with. They might need some adult directives to play together instead of alone.

-teach them how to recognize and manage their own feelings as well as recognize and react to others feelings

Point out how you feel and how they feel so they start to recognize it.

Examples: “Mom is happy because you just gave me a hug! You can tell I’m happy because I’m smiling!” or “Dad is sad because you just kicked your brother. You can tell I’m sad because I’m frowning and shaking my head”.

“You seem so excited about going on vacation! I know you are happy because you are jumping up and down and smiling!” “You seem angry because your brother took your toy. I think you are angry because you have a mad face and are stomping your feet.”

-if they have sensory needs get them the sensory tools they need to help and a good O.T./therapy to help. [See sensory article] 

Homework battles

Homework battles

If your kid is giving you a hard time about doing homework there are a few options:

-let the teacher handle it/school consequences

-set up a reward system

-don’t allow child to play/watch TV until homework is completed

-offer help if they ask nicely

Parents vary on their stances on homework such as:

-“as long as it’s done”

-“it has to be done perfect”

-“I have no idea if he/she did it or not”

There are pros and cons of each approach. The first one is pretty typical and avoids most battles but still makes sure the work is done, the second one makes sure child is learning the work but can involve a lot of power struggles because parent makes child do it over and over to get it perfect. The third one inspires independence for your child but if they aren’t doing it the parents don’t even know until perhaps they start getting graded on homework (middle school, sometimes earlier depending on your child’s school). 

Depression Coping strategies

Note: Depression in children often looks different than depression in teens and adults. Instead of constant sadness, unable to function, crying, and suicidal thoughts, a child may be angry often, easily upset, grumpy/irritable most of the time, doesn't find things fun, complains often, and sometimes aggressive behaviors as well. For a diagnosis please see your child's pediatrician, or a licensed therapist. 

Some suggestions for depression:

·         Try to do something fun every day even if you don’t feel like it!

·         Incorporate exercise into your routine

·         Go to bed and get up on a regular schedule and try to eat balanced meals

·         Look for evidence that your negative thoughts are true. [For example if your thoughts are “I'm unlovable” then change that thought to “Is it true no one loves me? Oh wait, my mom does” so then you realize your thought isn’t true.]