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Parent Self-Care By Rachel Funnell, LMFT

3/26/2020

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Why Self-Care is Important to Parents?: 
When you are a parent, self-care often gets pushed to the bottom of the priority list. After all, you have kids that need your help with homework, getting dressed, basic daily living skills, etc… However, when parents don’t make time for themselves and engage in self-care activities, they are more likely to be stressed, tired, anxious, depressed and have low frustration tolerance. But taking care of yourself isn’t a luxury, it’s a necessity. If you aren’t decompressing and engaging in activities that you enjoy and recharge you, then you aren’t going to be able to sustain momentum. Especially during the current COVID-19 Pandemic.
    If you as the parent begin to experience low energy, frustration, anxiety, depression or any similar symptoms, you will not be able to keep your children from experiencing the same. Kids are very in tune with their parents' emotional state. They may not be able to vocalize or cognitively understand what’s happening, but they are able to pick up on your emotions fairly quickly and easily. If you are feeling anxious or agitated, they will then become uncomfortable and mirror those emotions. This in turn will cause more stress, frustration and faster burnout. 
    Being “on” and at the ready for your children at all times can cause burnout and turn things that can be everyday enjoyments into feeling like everyday chores. For example, just playing with your kids could begin to feel overwhelming or frustrating. However, if you are recharged from regular self-care, you will be able to enjoy those moments more often. Self-care is not a selfish act but rather it allows you to be the best parent you can be. 
 
What does self-care look like?:
Self-care is anything that you do that is enjoyable and recharges you. But ultimately it’s making time for yourself on many different levels. Below is what that looks like at each level. 
Emotionally: 
  • Be creative -- painting, drawing, creating something can all allow you to express your emotions (even baking and cooking have been shown to use the creative parts of your brain and boost mood).
  • See a therapist -- talking to someone about the stressors of parenting, work or working on coping strategies is always helpful. 
  • Cry -- allow yourself to cry it out. 
  • Write -- journaling is very therapeutic and allows you to get your emotions out of your head.
  • Find things that make you laugh -- movies, books, shows
  • Say no to extra responsibilities -- saying no is very important, especially if you already have too much on your plate. 
Physically:
  • Exercise -- on your own preferably but can be with the family
  • Sleep -- this one can be hard with younger kids but it’s still important to try to make happen. This could look like asking a relative or friend or even a babysitter to watch your kids while you take a nap. 
  • Eat right -- this means getting enough fruits and veggies as well as taking vitamins to help with any gaps in your nutrition.
  • Get a massage -- massages help with relaxation which can help you recharge
  • Be affectionate -- either with your partner or even with your kids. But being affectionate is proven to lower stress levels.
  • Take a hot shower or bath -- hot water raises your internal temperature which allows your body to relax more effectively. You can also add certain essential oils like lavender to increase the relaxation experience.
  • Go for long walks -- again preferably without kids 
  • Have a cup of calming tea -- chamomile tea is great.
  • Stretch -- stretching is a great way to relax and can be done anywhere.
  • Engage in a sport -- tennis, basketball, soccer, etc.. 
Socially:
  • Spend time with friends -- go out to eat or get drinks, go see a movie, have a game night
  • Schedule time to talk to another adult each day.
  • Facetime or use video calling -- since we can’t get out of the house physically right now, use technology to help with socializing. 
  • Join parenting social group -- look online to find parenting groups that meet up
  • Join a community sports league
Intellectually:
  • Read -- read all those books you’ve been meaning to read. Read for fun or for educational purposes.
  • Play games -- there are tons of games online that you can play that boost your cognitive skills
  • Do puzzles -- any kind of puzzle is great for your brain
  • Listen to podcasts or radio shows    -- there’s plenty of podcasts on almost every subject. Take advantage of it. 
  • Write -- write stories, poems, songs 
  • Watch documentaries -- with all the streaming platforms out there you are bound to find something you’d like to know more about.
  • Engage in old or new hobbies 
  • Find a project that you’d like to complete and would be rewarding
Spiritually:
  • Go to religious services -- a lot of them are offering them online now due to social distancing. Some record them for you to watch at later times if you can’t do it live.
  • Meditate or pray every morning or evening
  • Do volunteer work or help out others in your community
  • Contribute to causes you believe in
  • Engage in social activities that are uplifting
  • Spend time outdoors and enjoying nature

How to set boundaries with others, even your kids:
It is important to set boundaries with others so that you can regularly engage in your self-care activities. Setting boundaries can be hard at first and you may even feel guilty. But it is important to remember that you can not be or do your best if you are not recharged and able to decompress. Below are ways to set boundaries with others, even your kids.
  1. Define your boundaries: let others including your children know that you are engaging in activities away from them in order to recharge and be ready to play with them later. 
  2. Make expectations known: let others know what you expect from them while you’re engaging in the self-care activities (i.e.: don’t call/text, don’t come in the room, etc…) and what they can expect from you (i.e.: what time you’ll be home, where you will be, how to contact in an emergency, who they can reach out to instead of you for non-emergencies, etc…)
  3. Validate others feelings regarding your absence but don’t give in: others including your kids may try to make you feel guilty for taking time for yourself. But explain to them the importance of you being gone AND how you understand that they are sad or upset about it. Validating feelings doesn’t mean you agree with them but rather that you understand why they may feel that way. 
  4. Stick to your boundaries: consistency is always key. If you are not sticking to your boundaries, others will not stick to them either. 

Tips for finding time for self care:
Knowing and doing are two separate things. You may know that you need to make time for self-care but how do you do it? Below are different ways to make that happen, even during the social distancing and kids being home from school. 
  • Enlist family, friends, neighbors or even a sitter to watch your kids while you take a walk or spend some time in another room by yourself. 
  • Tag team with your partner: Ask your partner to watch the kids while you go do something and then switch.
  • If you aren’t able or can’t leave the house, try to just take a shower or bath alone.
  • Take a day off of work just to engage in a self-care activity. 
  • Ask your partner to take a day off to stay with the kids so you can have a self-care day.
  • You and your partner can take a day off while the kids are at school and do something together. 
  • Hire a sitter so you can go out with friends or go see a movie or anything
  • If your child still takes naps, do something for yourself while they are napping
  • Schedule it like any other appointment. This will make it more likely that you will keep it. 
  • Take time when you can. Be flexible when opportunities arise and you find yourself with time on your hands. Even if it’s only a half hour.

Lastly, sometimes you are in a situation where you can’t take time for yourself. For example, with the social distancing. Below are activities you can do that promote self-care with your kids. Plus it will help them de-stress and re-energize.
  • Practice taking deep breaths -- there are lots of youtube videos online to help with doing this correctly.
  • Have a dance party
  • Go for a walk
  • Watch a funny video or show
  • Read each other jokes
  • Read a book together
  • Draw or color together
  • Listen to music together
  • Do each other’s hair
  • Dress up together
  • Make a comic or a short story
  • Play games
  • Make a fort
  • Plan your favorite vacation or your perfect day
  • Look up receipts to cook now or later

Self-care is vital for everyone but especially parents. Don’t put yourself last. It’s like the safety tip when flying. You need to put on your oxygen mask before you can help anyone else, even your kids. 

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Managing Worry, Especially in the Time of Coronavirus: What if… and What else…               by Dr Kirsten Ellingsen

3/14/2020

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Everyone worries. Take a moment to think about the automatic “worry thoughts” you had when trying to fall asleep last night or getting yourself (and everyone else) out the door this morning.  Passing thoughts of what is supposed to happen, what needs to happen, what might happen…  These thoughts might be particularly problematic now as many adults and children are experiencing a heighten amount of worry and anxiety with the spreading Coronavirus disease.
 
The first part of this blog will address helping children manage worry generally. Given the emerging concerns and impact of the Coronavirus disease / COVID-19, there is a second part of the blog that specifically addresses worry to help parents support children around this situation.

Part 1: General Worry Support for Kids
 
It is normal for children to experience worry and be afraid at times. A common trajectory of the different types of worry that children might have at different ages and developmental stages includes:
  •  Infants (0-1) often have a fear of strangers
  • Toddlers (2-3) commonly experience separation anxiety from parents/caregivers
  • Preschool age children (3-5) express fear of the dark, scary dreams, and concerns about “pretend” things such as imaginary creatures and masked characters, as well as loud noises such as thunder or fireworks
  • Tests, grades, natural disasters, fitting in with friends, bullies, being left out, death, and “bad guys” breaking into the house are common concerns for elementary school age children (7+ years of age) who often share concerns about “real-life” dangers
  • School success, academic performance, friendships, physical appearance and social status are common worries for pre-teens and teenagers
 
Worry can be productive and facilitate planning and problem solving for an upcoming event or figuring out how to prepare for an upcoming challenge.  It can enhance focus and motivation.  For example, if your child is worried about an upcoming test- this can encourage productive studying and enhance performance to be beneficial for academic achievement or if there was a hurricane predicted, you might use your concern to gather supplies and be ready to evacuate if necessary. Worry can help a child be more cautious and moderate risk when there is real danger.
 
When worry is addressed or facilitates productive action it is a manageable and helpful part of normal life. However, worry is an ineffective method to solve problems if thoughts begin to focus on extremes (the “what if…” 1% possible negative outcome discussions), become stuck or out of balance, and are left unchallenged. When worry is excessive, frequent and/or interferes with enjoying and full functioning in life it can become a serious problem.  It can also be a problem when the worry is unrealistic and the risk is significantly exaggerated to cause a child to not participate in an expected or otherwise enjoyable activity.
Worry is the thought component of anxiety. Physical sensations (our fight or flight response) and emotional reactions are also part of anxiety.  Relaxation strategies (diaphragmatic “belly” breathing, progressive muscle relaxation, and guided imagery) can help reduce the physiological symptoms of anxiety.  Some suggestions for helping children manage anxious thoughts and worry (particularly when it is problematic) are presented below.

TIPS and TECHNIQUES FOR MANAGING WORRY

Teaching children that they can reduce worry and that worry thoughts are connected to how they feel is the first step to helping them effectively manage worry. Helping children identify and choose more helpful and realistic thoughts is the goal, so that children realize that they are able to handle worry and feel better by noticing and transforming self-talk, perspective, and the thoughts.

For young children and infants experiencing common worries offer comfort. Hug your child, soothe your child, say comforting words, and help him or her feel safe.  Offer calm reassurance and connect with your child.
  • Limit scary images and shows for young children.
  • Be calm and listen to your child or teen, ask how he or she is doing.
  • Show that you care and that you understand concerns.
  • Help your child identify and express his or her feelings.

For older children and teens help turn worries into action steps to prepare for challenges. Facilitate problem solving and work together to come up with a plan rather than offering a solution or fixing the problem so your child is empowered to address the problem.
  • Help keep the worry in perspective. Validate feelings first. Don’t minimize feelings or dismiss worry (how helpful is it when someone dismissively tells us a concern is “no big deal” or tells us to relax when we are worried). Listen. Model calm. Acknowledge concerns and then help them come up with more useful thoughts.
  •  Model healthy coping and express how you manage worries.
  •  If worry is problematic, ask your child to tell you another helpful thought after the worry thoughts. If worry is unrealistic and out of proportion to the situation, provide alternative perspectives after listening and validating concern.
  •  Ask what is the worst thing, best thing and most likely thing to happen?
  •  Limit worry time. Designate 30 minutes (not near bedtime) to write worry or talk about worries. If worry thoughts occur during the day, remind the child to postpone thinking about worries until that set time.
  •  Often worry begins with “what if” questions.  When a child is concerned or scared about a what if this happens you can guide them to coming up with more helpful and realistic possible outcomes. One-way to do this is to ask your child to give you some “what else” endings to the worry thought.
 
Part 2: Worry and the Coronavirus Disease 2019 (COVID-19)
 
Uncertainty. A cornerstone of worry. Add the following: Global pandemic. Highly contagious. Unknown impact on health. Ongoing media updates of predicted infection rates. Now add concerns about limited health care system resources and response. Stock market impact and potential work loss. Finally, add school closures and the challenging of finding toilet paper and hand sanitizer.  My heart rate is staring to increase, yours?
 
It is no wonder that the level of worry for many adults and children is high.  Along with trying to keep up with the continuously updated infection rates and emerging scientific data and research findings are the barrage of social media posts of warnings, personal stories, and opinions. For many of us there is also a concern for those in our family who might be at higher risk for serious illness due to compromised immune systems, age, recent travel, underlying health conditions, or working front line in a clinic or hospital setting.  So how do we manage the worry and support our children during this time of uncertainty?
 
Below are some additional specific strategies for managing worry in this evolving situation.
 
Prepared not panicked. Focus on what is in your control. Aim for preparedness and not panic. Worry is helpful to facilitate problem solving and planning when it is realistic and can be used to identify action steps and taking action. Only thinking about what could happen, what might happen or worst-case scenarios without making and taking action will make you feel bad and is a very ineffective way to manage stress or problem solve.
 
Hand-washing and social distancing are choices that can minimize exposure and help slow the spread to help reduce possibility of overburden on hospitals. Stocking up on two weeks of essentials (food, drinks, medications) is one way to be prepared. This will help if (when) social distancing is recommended or requests to self-isolate.
 
Develop a plan consistent with CDC guidelines for reducing exposure and risk of infection, and follow recommended CDC steps if you have symptoms or become ill.
 
Here is a helpful step-by-step approach to help with uncertainty (5 Steps to Living with Uncertainty During Coronavirus. A guide for responding to anxiety and lack of control (https://www.psychologytoday.com/us/blog/biofeedback-and-mindfulness-in-everyday-life/202003/5-steps-living-uncertainty-during)
 
Check the facts.  The Centers for Disease Control and Prevention (CDC) provides updated information about prevalence and findings from ongoing research being conducted around the world. (See https://www.cdc.gov/coronavirus/2019-nCoV/index.html)
 
Limiting time spent reading about and thinking about Coronavirus and COVID-19. Try to limit time reading about the Coronavirus. Limit social media use and check reliable evidence based reputable sources only a few times a day. One strategy to limit worry is to give yourself a designated time to think about or read about it. Any automatic worry thoughts that arise get dismissed to a designated time (and tell yourself, I will think about that at X time. Preferably not near bedtime to minimize disruption to sleep.
 
Talk with your children.  It is almost certain that your children have heard about Coronavirus/COVID-19. Ask what they know and clear up misconceptions. Answer questions with clear and developmentally appropriate information.  Know what you want to say before having the conversation. Presenting information in a calm manner can help a child understand what is happening and manage worry. Assure safety. Reinforce what they can do and what might happen (If schools close, coming up with a new routine and plan and letting children help make some decisions will help with the transition). Limit time children view stories and news coverage and consider age and temperament of child when addressing questions.
  
Tips for Addressing Children’s Worry:  See blog above for general strategies.  Address children’s concerns calmly and with compassion. Try to be in a calm state when talking with your child. Don’t minimize or dismiss concerns. Let children express fears and concerns. Gently guide a balanced perspective and offer comfort. It is ok to not have the answer to some questions. It is ok to tell children, let me worry about that. I will come up with a plan and we will stay as safe and healthy as possible. 
 
This is a particularly good resource with a table that outlines some possible child reactions according to age group and the best ways you can respond. NCTSN Parent/Caregiver Guide to Helping Families Cope With the Coronavirus Disease 2019 https://www.nctsn.org/sites/default/files/resources/fact-sheet/outbreak_factsheet_1.pdf
 
For example, for Preschool aged children: recommendations to maintain routines, provide calm activities before bedtime, provide reassurance, have patience, allow temporary sleep arrangement changes as anxiety might be displayed by expressing fear of being alone, bad dreams, bed wetting, change in eating, increased temper tantrums or clinging behaviors as a reaction to worry and fears about this situation.
 
School age children might have stomachaches or report physical symptoms, show sleep and appetite disturbance, or withdrawal from peers and exhibit forgetfulness about what they learned.  Parent recommendations included helping children do regular exercise, talk about the situation and encourage questions, allow connection to friends via phone or internet, and play education games or activities.
 
Self-care: This is essential. Get adequate sleep. Exercise. Eat healthy.  Practice relaxation strategies (diaphragmatic breathing, progressive muscle relaxation). If you are having a hard time managing your own anxiety, please seek support. 
 
When is worry a problem?  While all children worry, some worry more than others and it can affect their enjoyment and engagement in life activities. Worry is problematic when it is excessive, lasts longer than expected for age, and interferes with functioning at home or school.  If you have concerns about anxiety please talk with your pediatrician or a child therapist. If you want more help in addressing your child’s worry or managing anxiety we are happy to help.

RESOURCES AND REFERENCES
  •  Helping Kids Handle Worry at https://kidshealth.org/en/parents/worrying.html
  • https://www.nemours.org/patientfamily/khlibrary/articles/anxiety.html)
  • https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Anxiety_Disorder_Resource_Center/FAQ.aspx#anxietyfaq1 
  • What is Worry worksheet: https://www.therapistaid.com/worksheets/what-is-worry.pdf
  • Go Zen 49 phrases to calm an anxious child (https://gozen.com/49-phrases-to-calm-an-anxious-child/)
 
Coronavirus / COVID-19 Resources:
  • Parent/Caregiver Guide to Helping Families Cope With the Coronavirus Disease 2019
https://www.nctsn.org/resources/parent-caregiver-guide-to-helping-families-cope-with-the-coronavirus-disease-2019
  • CDC: https://www.cdc.gov/coronavirus/2019-nCoV/index.html
  • World Health Organization, WHO: https://www.who.int/health-topics/coronavirus
  • Resource for Pregnant Women: What you need to know about the coronavirus if you are pregnant or postpartum: https://pebbleparents.com/coronavirus/?eType=EmailBlastContent&eId=e5a41508-9ccc-4fa4-bfca-8bea43479958
Children’s books that address worry:
  1. What to do when you worry too much: A children’s guide to overcoming anxiety. Worry Says What?
  2. Don’t feed the worry bug
  3. Hey Warrior
  4. When My worries get too big
  5. Emma’s Worry clouds
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7 Effective Ways to Ask for Help By Rachel Funnell, LMFT

3/5/2020

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For some people asking for help is very easy and natural. For others, it makes them feel vulnerable, weak or like a burden. However, everyone needs help from time to time. For those that find it hard to ask, it’s important to set yourself up for success. Below are seven effective ways to get the help you need and help you not feel so bad for asking. 

  • 1. Demonstrate and make it clear that you have tried to help yourself.
People are more willing to help others who have attempted to help themselves first. When you ask for help from someone, give a brief explanation of what you’ve already tried to do. This not only allows the person to know that you attempted but also what you have already tried and what didn’t work. It’s important to make sure that you don’t go into too much detail but give more specific bullet points. 

  • 2. Demonstrate that you have acted and taken the person's advice previously. 
It’s hard for someone to be willing to put effort into helping you problem solve if in the past you haven’t ever taken their advice. Let the person know how you’ve acted on their previous advice and the success you had from it. People are more willing to help you if they know that they have helped you in the past. 

  • 3. Pay attention to the timing of your request. 
Make sure that you are not asking at the last minute or at a time that is not convenient for them to talk with you. If you are unsure as to what would be a more convenient time, just ask them. For example, you could say “I’d like to ask you for some help with something. When would be the best time for us to talk?” 

  • 4. Use the “foot-in-the-door” or the “door-in-the-face”. 
These two tactics are fairly sneaky and should only be used sparingly. The foot-in-the-door technique is when you make a small request first to get the person into “yes” mode, before you make a larger request. The door-in-the-face technique is when you make a large request, get denied, and then make a smaller request, which seems more reasonable due to the earlier unreasonable request. 

  • 5. Don’t make someone guess what you want.
When asking for help, make sure the person knows exactly what you are looking for and what you want. People don’t often know exactly how they can help you, so be specific. Directly asking can be hard initially but with practice you will feel more comfortable with it. In addition, people feel good after helping others, so keep in mind that you are giving them an opportunity to boost their mood. 

  • 6. Make your requests using multiple channels.
This technique is especially useful with customer service situations. Often there are many different avenues available to ask for help. For example, the phone, live chat, secure messaging, face-to-face, and/or social media. It’s important to try these different ways in order to get what you are looking for. In addition, there is always someone higher up that can be of more assistance. If you find that the initial person is not able to help, ask to speak to someone that would have the answer. 

  • 7. Give help.
If you offer and give help to others, they are more willing to offer and give help back to you. This is particularly true in close relationships. People like to feel that they are not always the one getting asked for help and that you are willing to do the same for them. Plus it feels good to help others. 

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When Mental Health Challenges Come out of Nowhere- PANS/PANDAS Explained By Kate Gibson, Psy.d., ABPP

2/23/2020

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There are children for whom we see signs that they are anxious or unhappy or beginning to suffer emotionally or behaviorally. We try to get help for our children when these struggles become larger or begin to interfere more. Children affected by PANS/PANDAS, however, develop mental health symptoms literally overnight after being sick. These are not kids who were always a little timid then seemed to get more anxious once they started school; Not kids who latched onto routines that eventually evolved into more elaborate rituals that have to be done a precise way. These are kids who were anxiety, OCD and behavior problem free until getting sick one day, and then show full blown anxiety, OCD, or behavior problems that were not present prior to getting sick. Parents are often at a loss to explain what is happening and feel that all of a sudden they have a completely different child. 

Strep is the most common illness that those who have heard of PANS or PANDAS think of, but there are more illnesses besides strep that can trigger these reactions. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections. This is the condition associated with strep. PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. PANS can be caused by other forms of infection and metabolic issues. The common thread is that both are autoimmune and cause inflammation in the brain (encephalitis). This means that the antibodies that normally attack illnesses within our body attack our own body instead, and with PANS and PANDAS the area attacked is in the brain (basal ganglia). When the basal ganglia portion of the brain is impacted it affects a child’s thoughts, feelings and behavior.

Treatment for PANS/PANDAS generally involves blood tests (to diagnose the infection), antibiotics or other medicines for fighting infections (sometimes a long course), anti-inflammatory medicine (to reduce the swelling in the affected brain areas), and cognitive-behavioral or behavioral therapy (to address the emotional and behavioral symptoms as they do not tend to resolve with medical treatment alone). People are often understandably skeptical when they are told their child has a condition they have never heard of before. And can also be skeptical of the treatments that are recommended, that often require heavy rounds of medication. If we think about this as an attack on the brain, with our brain being the basis of our behavior, it helps us understand that to effectively treat it we need both medicine and behavioral treatment approaches.

For the medical treatment portion of your child’s care it is best to find a pediatric specialist who has extensive experience treating children with PANS and PANDAS. For the mental health portion many therapists who specialize in treating OCD also have experience working with children with PANS and PANDAS. Even if the child is presenting with symptoms that differ from OCD starting by talking to a therapist with extensive OCD experience can be a good first step if you are having trouble locating someone that treats PANS or PANDAS.

The sudden onset mental health symptoms are treated with cognitive-behavioral or behavioral therapies that target the specific symptoms with which that child is presenting. Behavioral and emotional symptoms triggered by PANS/PANDAS can include but are not limited to (taken from https://iocdf.org/pandas/):
  • Acute sudden onset of OCD
  • Challenges with eating, and at the extreme end, anorexia
  • Sensory issues such as sensitivity to clothes, sound, and light
  • Handwriting noticeably deteriorates
  • Urinary frequency or bedwetting
  • Small motor skills deteriorate – a craft project from yesterday is now impossible to complete (see images below)
  • Tics
  • Inattentive, distractible, unable to focus and has difficulties with memory
  • Overnight onset of anxiety or panic attacks over things that were no big deal a few days ago, such as thunderstorms or bugs
  • Suddenly unable to separate from their caregiver, or to sleep alone
  • Screaming for hours on end
  • Fear of germs and other more traditional-looking OCD symptoms

When the presentation involves Anxiety or OCD a form of CBT called exposure therapy is used to treat it. The form of exposure therapy used to treat OCD is called Exposure and Response Prevention (ERP). For tics and body-focused repetitive behaviors a form of behavioral treatment called Habit Reversal Training (HRT) is used. If problem behaviors are the main presentation behavioral treatments that heavily involve the caregivers such as Parent-Child Interaction Therapy (PCIT) or other forms of Parent Management Training (PMT) can be used.

Despite thorough treatment of symptoms children can have a recurrence of symptoms after getting sick again, which is called a flare (like a flare-up). Children often need another round of medical and sometimes a booster of behavioral treatment when they are having a flare.

You and your child are not alone. There is help out there for these sudden onset mental health struggles. Here are more resources.

Book For Parents:
Childhood Interrupted: The Complete Guide to PANDAS and PANS by Beth Alison Maloney

Web Resources:
PANDAS Network- http://pandasnetwork.org/medical-information/
PANSPANDAS-Hope- http://panspandas-hope.com/ 
International OCD Foundation (IOCDF)-https://iocdf.org/pandas/

Referrals for Medical and Behavioral specialists can be found at:
PANDAS Network: http://pandasnetwork.org/us-providers/
PANDAS Physicians Network: https://www.pandasppn.org/practitioners/

Children’s books that can help parents and professionals talk about PANS and PANDAS with children who are affected by it:
  • In a Pickle Over PANDAS by Melanie S. Weiss, R.N.
  • My Story About PANS/PANDAS by Owen Ross
  • PANS/PANDAS: Strength-Hope-Understanding: A Picture Book for Children, Family, & Educators by Suzanne Gushansky
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Managing Stress: Tips for Teens and Parents By Kirsten Ellingsen, PhD

2/13/2020

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The second semester of school can involve heightened stress for many teenagers. Academic demands and social pressure are two primary causes, but stress can come from a variety of sources.  While some stress can be motivating and provide a higher level of focus and energy to perform a specific task, when it becomes overwhelming, too intense, or impairs functioning it is problematic. Too much stress for too long can be both physically and emotionally harmful.
 
Teenage behaviors and symptoms that might indicate high levels of stress include: increased or unusual irritability, sleep disturbance, over-eating or under-eating, pattern of reacting too intensely to apparent minor problems, increase in nervous habits (e.g., nail biting), headaches, more frequent crying, muscle tension, increased expressed frustration, social withdrawal, difficulty concentrating, and low motivation.  It can trigger anxiety and anger. Teens who have poor coping strategies might also turn to alcohol and drug use or self-harm.

TIPS FOR TEENS
  • Be careful not to overschedule. Cut out activities if necessary
  • Be realistic. Do not aim for perfection. Set small goals and break tasks into smaller, manageable chunks.
  • Get good sleep. Get enough and have a good sleep routine
  • Relax. Learn and Practice relaxation strategies (diaphragmatic breathing, progressive muscle relaxation)
  • Make time for fun. Schedule activities you enjoy. Take a break. Listen to music, talk with a supportive friend, draw, write, create
  • Prioritize Health and treat your body well. Get exercise and eat well
  • Avoid excess caffeine, illegal drugs, alcohol and tobacco.
  • Find the upside. Attitude can influence emotions
  • Solve the little problems. Address small problems. Break tasks into smaller steps so that they are not overwhelming
  • Know what you can control. Focus on what you can control (reactions, actions) and let go of what you cannot (other people’s opinions and expectations)
  • Build positive relationships. Ask for help and support when needed
  • Learn how to be assertive. Practice expressing your needs and setting boundaries in a polite and clear way
  • Decrease negative talk. Use more helpful and neutral thoughts and self-talk statements such as I can handle this.
 
(From TeensHealth, Nemours https://kidshealth.org/en/teens/stress.html and https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Helping-Teenagers-With-Stress-066.aspx)
 
TIPS FOR PARENTS
  • Watch for signs of high stress and help identify sources of stress in your teen
  • Provide practical support
  • Have open communication and listen to concerns from your teenager’s perspective. Be available to talk and provide opportunities to talk.
  • Challenge negative thoughts (gently): negative thinking can increase negative emotions
  • Encourage a healthy lifestyle-exercise, adequate sleep and good nutrition
  • Model healthy and effective stress management
  • Help problem solve how to address stressors (For a handout to help create a stress plan see https://www.healthychildren.org/English/Documents/BR3_My_Personal_Stress_Plan.pdf)
 
Stress is inevitable. Helping your teenager build skills that help reduce and cope with stress will have a lifelong benefit. Maintain a positive relationship with your teen. Observe, communicate, listen, accept, and model healthy coping strategies. Have realistic expectations for yourself and your teenager.  Practice self-care. If you or your child need support or assistance managing stress, please contact our office.
 
*(Researchers at Harvard Center for the Developing Child distinguish between positive, tolerable, and toxic stress. The recommendations here are related to tolerable stress. For more information about toxic stress see https://developingchild.harvard.edu/guide/a-guide-to-toxic-stress/).
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How to Play with Your Child for Relationship Building and Behavioral Improvements By Tara Motzenbecker, MS, NCSP

2/6/2020

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Play is a child’s first language.  Play provides a context for self-expression, a medium to fulfill wishes, and allows children to work through problems. So when a parent can enter a child’s play world, the parent can truly become part of the child’s world.  Enhancing the parent-child relationship through play can lead to a reduction of behavioral issues, development of coping strategies and an increase in positive feelings or self-worth and confidence, for parent and child. Parents can also gain a greater understanding and acceptance of the child’s world and develop more effective parenting skills. Most importantly, play can help parents recapture the joy of parenting. 

By setting aside 30 minutes each week or 10 minutes each day devoted to special play time, the parent-child relationship can be greatly enhanced.  During this time, the child is the center of the universe and the parent is merely an observer that must be invited in. The child leads and the parent follows.  In this special playtime, there are no reprimands, questions, teaching, judgements, put-downs, requirements or reprimands. The parent follows the child’s lead by showing keen interest and carefully observing the child’s play, without making suggestions or asking questions, and by actively joining in the play when invited by the child. For 30/10 minutes, you (parent) are “dumb” and don’t have the answers; it is up to your child to make decisions and find solutions. If the child determines that the trains are best used upside-down, then that is how the trains will be used. 

During the play parents can verbally describe what the child is doing, verbally reflect what the child is saying and most importantly, reflect the feelings that the child is experiencing through play. 

While special play time is not an opportunity to teach, there may be times that limits need to be set.  Limits help a child feel safe and supported when used properly. Limits should be stated in a way that help foster self-control while also validating the child’s desires. Limits can be set around not breaking/damaging the toys, time and not physically hurting anyone in play. Consistency is key.  

Parents should prepare the play area ahead of time with boundaries and special toys that do not have specific rules such as board games or lego kits. Convey to the child that this is special playtime and they can play with the toys in lots of the ways they’d like. (This allows for freedom while also providing opportunity for limit setting as needed.) Anytime the child asks for permission or information, turn it back to the child by stating “You can decide” or “That can be whatever you want it to be”. 

After a few special play sessions, you will notice an enhancement in your relationship with your child and likely notice improvements in behaviors and self-control.

Tara Motzenbecker, Licensed School Psychologist, is available to speak more in-depth on this topic to groups at day cares, medical offices, schools and parent-groups.  Please call Parent and Child Psychological Services (941) 357-4090 to discuss a free seminar on this topic.
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15 Ways to Avoid a Power Struggle with Younger Children By Rachel Funnell, LMFT

1/30/2020

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When parents engage in power struggles with their children it actually creates distance and hostility between them. If there is distance and hostility, the children will become resentful, resistant, rebel or will comply but with low self-confidence. When there is closeness and trust within a relationship, you create a safe environment in which to learn. Your ability to be a positive influence will increase greatly when your children feel safe and close to you. 
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In order for you to provide this environment, you must learn to avoid power struggles. It takes two to create a power struggle. You as the parent must resist engaging in the power struggle in order for there to not be one. Below are 18 ways to help resist the power struggle as well as teach your children responsibility, self-discipline and problem-solving skills. 
  1. Create Routines: Get your child involved in creating them and making them. Be creative by having them cut out pictures or draw each step. Then have the routine “be the boss”. For example, “What’s next on the routine?”. 
  2. Make a “Wheel of Choice”: With the help of your child, draw a big wheel and divide into wedges. Brainstorm lots of different solutions to different problems. Let your child draw or write each one in the wheel. When there is conflict, ask the child to choose a solution from their “Wheel of Choice”. 
  3. Let your child come up with a solution: Kids are more likely to cooperate when they can get involved in coming up with solutions. A lot of times, if you ask them to come up with an appropriate consequence for a behavior, they will choose something you didn’t think of and sometimes a more strict consequence that you want to give. This will then allow you to “lessen” the consequence that they suggested and you can help them see what’s an appropriate consequence. 
  4. Create a Positive Break Area: Create a nurturing area where your child can take a break from what is upsetting them or creating conflict. If they don’t want to go, ask them if it would help if you went with them. If they still don’t want to go, model for them how to use it by telling them that you’re going to go to the break area. 
  5. Ask “what” and “how” questions: Ask “what happened?” or “how do you feel about what happened?” “What ideas do you have about how to solve this problem?” Note that these questions only work if you are genuinely curious about what the child is feeling/thinking and only works when the child is no longer in the conflict. 
  6. Listen: A lot of times parents struggle with listening to their children and only want to talk or lecture. Use reflective listening by summarizing or repeating back what they have said. Use active listening by trying to understand not only what they are saying but what they are meaning. If you are right, your child will feel understood and feel relief. 
  7. Decide what you will do: For example, “I will read a story after teeth are brushed.” Or “I will only drive when seat belts are buckled”. 
  8. Follow through: If you give empty threats then your child will not ever think you will go through with anything. Be firm but kind as you follow through. 
  9. Supervision, Distraction and Redirection: Children tend to get punished for doing what is developmentally appropriate: exploring. Instead of telling your child what not to do, especially after the fact, tell them what to do before hand. 
  10. Use ten words or less: One word can even be sufficient. For example, “toys”, “homework”. But ultimately, avoid lectures. 
  11. Invite cooperation: Say, “I can’t make you, but I really need your help”. (10 words)
  12. No words: Sometimes, no words are needed. This may mean pointing or taking your child by the hand and lead them to where they need to go. 
  13. Non-verbal signals: Plan in advance with your child what signals you can do to allow your child to know what needs to be done. This could be something like a sheet over the TV to signal that homework needs to be done before watching TV. 
  14. Limit Choices: When there are too many choices it can lead to wasting time deciding or could create more opposition. A good example would be saying “Would you like to do your homework before or after dinner?”
  15. Hug: Often times giving a hug can change their behavior and yours. It also creates closeness and a safe environment. 

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Talking about Death and Supporting Children After Loss By Kirsten Ellingsen, PhD

1/9/2020

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It may be difficult to know how to respond when a child experiences loss after the death of a family member or loved one.  Children manage their grief differently from adults and a child’s reaction and ability to cope with the loss is an individual process.  The age of the child, relationship to the person, and temperament of a child will influence how the child is able to cope with loss.
 
Providing opportunities to talk about and process the loss is important.  Be sensitive in responding to your child. Let your child know there are a lot of people in their lives and they will be cared for. If there are questions about you or other loved one dying consider age of child and provide reassurance. Emphasize that you expect to live a long time and that there are a lot of people in their lives and that they will be cared for and loved. Answer questions honestly, but provide a manageable amount of information so not overwhelming a child. Also, a child might repeat questions; answer consistently and understand that it might take time to grasp the finality. Assess what your child knows and clarify any inaccurate information. Provide information as needed and in small doses.
 
Parents can demonstrate their emotions and model how to communicate their feelings. Letting your child see you grieve and explaining the feelings behind the grief is helpful.  Children might react in unexpected ways. Playing can be an adaptive way to cope with feeling overwhelmed. A child might not respond initially or display sadness, anxiety, guilt or anger. Acting out, fluctuating between crying and play, and regressions in behavior might occur.
 
The handout Helping Your Child Deal with Death provides the following recommendations for parents (https://kidshealth.org/en/parents/death.html)
 
  • Use simple, clear words when talking about death with children
  • Listen and comfort
  • Put emotions into words (talk about your feelings and encourage children to talk about their feelings)
  • Tell your child what to expect (explain any anticipated changes in child’s life or routine)
  • Talk about funerals and rituals (explain what will happen and how people might respond or act) *Also let your child choose if they want to go.
  • Give your child a role (let child decide what he or she might want to do to help in an unfamiliar and emotional situations)
  • Help your child remember the person
  • Respond to emotions with comfort and reassurance
  • Provide comfort, but don’t dwell on sad feelings (introduce an activity that can help your child feel better)
  • Have ongoing conversations to check in and give child time to process loss
 
Consider the age and developmental level of a child when talking with a child about death.  Use simple language and concrete terms to explain death. Young children do not yet understand the permanence of death.  For example, preschool children might view death as temporary or reversible.  Keep your explanations brief and simple with concrete examples (e.g., not breathing anymore, heart is not working, will not see the person again).  Children under 12 years of age might not understand the permanence of death. They might concerned about losing a parent or another loved one. Euphemisms can also be confusing and scary (e.g. “went to sleep” or “went to a better place”). Use the words “dead” or “died”. It is okay to say “I don’t know” to questions.
 
Remembering the person who died and adjusting to life after loss is also part of healthy grieving.  Children can share memories, make a scrap-book, watch videos or look at pictures. Reading books together about death and loss also provides guidance and time to talk. There is no time limit on grieving and it is a process. Finally, as a parent or caregiver, it is important to focus on self-care: get adequate sleep, enough exercise and fresh air, try to eat healthy, and seek support when needed.
 
Additional Resources
 
  • Helping Children Deal with Grief: https://childmind.org/article/helping-children-deal-grief/
  • https://childdevelopmentinfo.com/how-to-be-a-parent/communication/talk-to-kids-death/#gs.lapsom
  • https://www.psychologytoday.com/us/blog/two-takes-depression/201612/the-dos-and-donts-talking-child-about-death
  • https://kidshealth.org/en/kids/somedie.html?ref=search
 
Resources for Teens: https://kidshealth.org/en/teens/someone-died.html
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Realistic Resolutions and Kicking the New Year Off Right By Kate Gibson, PsyD, ABPP

12/29/2019

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With the new year upon us many people will feel inspired and others pressured to go into 2020 with ambitious new year’s resolutions and goals. The new year can be a great reason to summon the motivation to follow through on goals that have been on the back burner, or to create new goals on which to focus your energy.

Only you know what is realistic. Renovating a home might be a realistic project for one person while dragging yourself out of bed on time might be a challenging goal to set for another person. Before selecting a resolution check in with yourself and what you are capable of right now. Be okay with whatever that is, even if it skipping the resolution this go around.

A resolution does not need to be a big project or a big change. Sometimes just recommitting to things you already have going on in your life is just as good a resolution as adding something new. Any size goal is truly okay. It does not have to be a big undertaking. If you do choose a big goal be sure to break it down into smaller manageable and attainable parts. Feel good about each step you accomplish and consider rewarding yourself along the way.
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If you are going to create a resolution that involves adding something new into your routine consider the amount of time you have to give. Ask yourself how much time you can consistently devote to this new activity- how many days per week, how many minutes or hours per day. If you make your goals too large or time consuming it will be harder to sustain your effort and keep going over time.

Parents may want to consider a family resolution or something that you can do with your children. This may be quality time, a project, or any number of things. Committing to doing something together can help you make sure that you get dedicated family time.

It is also completely fine to make a resolution focused on yourself and not time with or doing things for others. Particularly for parents if you are taking good care of yourself you will be able to more calm and present when you are with your family. Making a resolution to devote time to self-care can be immensely helpful for yourself and your family as a whole. Your resolution can be something personal just for you that you do not share with others.

If you are a parent and you choose to work toward a resolution and share what it is with others this can be a great learning experience for your children. It can be a great way for your children to see how a role model goes about setting a goal, and then how they go about working toward it and attaining it. If you need to make adjustments you can share those with your children and they will learn about the process of adjusting their own goals in life… and that it is not only okay but often necessary to make changes along the way.
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Whether you make a resolution or not make sure to make time for yourself and the things that are important to you in the year to come!
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Parents as Emotion Coaches By Tara Motzenbecker, MS, NCSP

12/21/2019

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According to John Gottman, a leader in the field of relationships and parenting, emotion-coaching is the key to raising happy, resilient, and well-adjusted kids. His research shows that it is not enough to be a warm, engaged, and loving parent. We also need to emotion coach our children. Children struggle to differentiate and to label their feelings.  Parents can help them learn what their feelings are, that their feelings are okay and how to recover from their feelings. 

Emotion-coached children tend to experience fewer negative feelings and many more positive feelings. When you look back on memories of your own childhood, you may recognize that some of the strategies below were used by your parents when you felt the closest to them – when you felt that they could really relate to you, when you were truly understood.

The five essential steps of Emotion Coaching:
  • Be aware of your child’s emotion
  • Recognize your child’s expression of emotion as a perfect moment for intimacy and teaching
  • Listen with empathy and validate your child’s feelings
  • Help your child learn to label their emotions with words
  • Set limits when you are helping your child to solve problems or deal with upsetting situations appropriately

Once a child understands and can regulate their own emotions, they will have higher self-confidence, perform better in social and academic situations and may even become physically healthier.  
 
The next time your child expresses negative emotions about something, or misbehaves in some manner, try to figure out the underlying cause of their feelings.
  • Show your child respect and understanding in moments when they feel misunderstood, upset, or frustrated. Talk through their feelings with them and try to understand their source.
  • Be aware of your child’s responses to your method of working through the moment with them.
  • In difficult interactions, make sure your child feels your empathy, by patiently validating their feelings and getting to the root of their expression.
  • Instead of focusing on your parental agenda in these situations, show your child that you respect their attempts to solve problems, and guide them with trust and affection. Work through these experiences together.

​Some phrases parents can use are:
“It’s okay to be upset. It’s good to let it out.” 
“I hear you. I am here for you. I’ll stay with you.”
“It’s okay to feel how you feel. It is not okay to _________.”
“How you feel right now won’t last forever. It’s okay to feel how you are feeling. It will pass and you will feel better.”
“Let’s take a breath, take a break, sit down, pause for a minute…..”
“You are good and kind.”
“I’ll be there when you need me.”
“Let’s have a do-over.”
“What can we learn from this? What is the lesson in this? What is the emotion trying to tell us?”
“You’ll remember next time.” 

​References
Gottman, John, and Joan DeClaire. Raising an Emotionally Intelligent Child. New York, NY: Simon & Schuster, 1998. ​
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    Parent and Child Psychological Services is a private practice serving children and families in the Sarasota, Florida area. The practice is owned and operated by Dr. Gibson, a Licensed Psychologist who is Board Certified in Clinical Child and Adolescent Psychology. ​

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