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Supporting Your Teen Through The College Application Process By Izzy Devorkin, NCC, RMHCI

11/28/2022

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November is College Application Month, an exciting and highly stressful time. The college application process can be a chaotic time for the entire family, and there are many ways to support your teen during this time. It’s important to know what steps can be taken to help make this a positive and productive experience for your child. 

Educate yourself
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As your teen begins the college application process, it’s important that you have an understanding of how the process works. It may feel automatic to compare your child’s college process with your own, but it’s important to remember that the process is constantly changing and evolving, and each individual has their own unique experience. It’s a stressful time not only for your teen, but for you as well. Having a good sense of the process and how you can best support your teen is a key ingredient in relieving that stress.

Taking the time to do your own research is a great way to develop a solid understanding of the process and what to expect. Increasing your knowledge on what your teen is going through allows you to be more actively involved in the process. This article gives a straightforward breakdown of the application process.

Be involved 

Involvement is crucial for helping your teen succeed with the college application process. Senior year of high school is a busy time, and having extra support can help decrease feelings of overwhelm. It may be tempting to do things for your teen, such as filling out parts of their applications, but it’s important that you serve as a guide along the way, offering assistance as needed. It may be helpful to have designated set times throughout the week where you and your teen work on all things college together. You want to offer the right amount of support without being overbearing. 

Help create a pros and cons list

One of the hardest parts of the college application process is deciding which colleges to apply to. Helping your teen figure out what they want in a college and creating a pros and cons list may be a helpful visual in the decision making process. Categories may include size, location, and price. This also gives you as the parent an opportunity to be transparent on how much financial help, if any, you are able to provide. When deciding what colleges to apply to, it’s helpful to have your teen make a list of ‘safety schools’ that they know they will likely be accepted into, ‘target schools’ that your child fits the criteria for, but may be a bit more challenging to get into, and ‘reach schools’ which have high expectations and low acceptance rate (Gordon, 2021).

Offer to read/edit your teen’s college essay

Writing a college essay is daunting for many teens. It’s an opportunity to talk about themselves and their accomplishments which may be difficult for some students. Assisting your teen in what to include in their essay may be extremely beneficial. If your teen has already started their essay, offering to read it or help make necessary edits can be helpful. 

Assist with creating a timeline for deadlines

Deadlines are important to follow when it comes to the college application process. To make sure things are getting done in a timely manner, and to lower household stress, working with your teen to make a timeline with deadlines is a necessary step for productivity. Putting the timeline where both you and your teen can see it will be a helpful daily reminder of what should be prioritized. Hanging the timeline on the fridge is a great visual and will decrease the temptation to constantly give reminders. It may be necessary to have a timeline for each college your child is applying to. Important deadlines may include college essays, letters of recommendation, due date of the college application, financial aid due dates, and scholarship due dates. Timelines can be personalized to the individual student and can be easily created using Excel. 

Offer support with financial forms and scholarship resources

Financials are one of the most stressful parts of the college application process. Expenses tend to add up fast between college visits and college application fees. Transparency regarding financials is crucial, and it’s encouraged to have this discussion sooner rather than later. Be transparent with your child on how much financial help, if any, you are able to provide. Offer assistance in filling out financial aid forms and searching for scholarship opportunities. It’s important to create realistic financial expectations so everyone is on the same page and there are no last-minute surprises.

Have confidence in your teen

It's easy to forget how capable a teen is when stress levels are high for everyone in the family. As a parent, you want to see your child succeed. You may feel the need to give constant reminders and want to do things for your child, but it’s important to remember that your teen is capable and the college application process is a great opportunity for them to practice independence. As a parent, you won’t be with them at college making sure they attend every class and complete every assignment, so this is a perfect opportunity to practice having patience and confidence in your child. There are many aspects of the college application process where you can offer valuable help, but things such as requesting transcripts and asking for letters of recommendation will need to be done on their own. This is also why having a timeline as mentioned above is beneficial, your teen is still able to complete things independently, but you can assist them with a visual reminder.

Validate your teen’s feelings 

In addition to stress, your teen is likely experiencing a whirlwind of emotions relating to the college application process. This is a great opportunity for you to engage in active listening. Active listening requires paying attention to what is being said, using eye contact and appropriate body language, and truly focusing on what the other person is saying rather than how you plan to respond. Many times your teen may just want you to listen and be present, and offer advice only when sought out. It’s important to validate the feelings of your child and help them understand that it’s typical to feel a roller coaster of emotions during the college application process, and you are here as a support. 

It’s important to communicate with your child that it’s okay for them to not be accepted into every college they apply to. Teens already put enough pressure on themselves, the last thing they want is to feel like they disappointed their parents. Just as you would celebrate their acceptances with them, validate their disappointed feelings if they don’t get into a school they applied to. 

Check-in yourself

It’s important to recognize that your teen is not the only one going through a large change. As a parent, you are also experiencing a lot of emotions relating to your child beginning the college application process. Although it’s an exciting and important time in your teen’s life, It’s okay to feel all the different emotions that arise. It’s crucial to check-in with yourself and your emotions and do what is necessary to take care of yourself. Find what helps you stay regulated and relaxed, whether it be taking a walk, stretching, deep breathing, or having alone time, it’s important to know what steps to take to keep you feeling your best. 

Celebrate

Remember to celebrate your teen’s accomplishments! Whether it’s celebrating the smaller victories along the way, or having a celebration when your child receives acceptance letters, it’s important to recognize their hard work and all the effort that was put in along the way. Remember to pat yourself on the back too, helping a teen through the college application process is no easy task! 


Resources:
https://www.verywellfamily.com/how-to-support-your-teen-through-the-college-application-process-4801641

https://grownandflown.com/50-ways-parents-help-teen-with-college-admissions/
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https://www.usnews.com/education/best-colleges/articles/college-application-process

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Uncertainty by Kirsten Ellingsen, PhD

11/11/2022

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Uncertainty is unavoidable in daily life. Not being able to tolerate uncertainty is a sure path to increased worry and anxiety. Learning how to better accept and cope with uncertainty is possible with practice. Strategies that can help are outlined below.

What is Intolerance of Uncertainty?
“Uncertainty” has been a frequently used and much felt word the past few years. Parents, children, and teens had to manage many unknowns and often experienced a loss of control related to plans for school, work, health, and safety. Having to tolerate or accept what might happen in the future reached a new meaning for many people. 

The concept of Intolerance of Uncertainty or “IU” is receiving more attention as it relates to anxiety. In fact, research has found a strong connection between IU and both anxiety and worry in children and adolescents https://doi.org/10.1016/j.jad.2017.07.035). 

Anxiety Canada’s handout How to Tolerate Uncertainty outlines behaviors people do when they have difficulty with uncertainty :
  • Seeking excessive reassurance from others 
  • List-making
  • Double checking 
  • Refusing to delegate tasks to others 
  • Procrastination/avoidance 
  • Distraction

How to be more comfortable with “not knowing” 

The unknown can be desirable for immediate events like the end to a good book or exciting movie. It can also cause considerable worry and stress when an anticipated outcome could be negative. This can be true for situations we think we have control over and those where we feel that we have absolutely no control. When the possibility of the (highly unlikely) outcome is terrible, it is sometimes difficult to focus on the 99% probability. (This is particularly true if you have experienced a negative life event that is rare). However, because we can very rarely be 100% certain about future events, it is helpful to learn to be okay with some uncertainty, even when a potential outcome would be difficult.

Increasing your ability to tolerate uncertainty can occur the following two ways: 

Changing how you think 
Changing what you do 

Change how you think: Changing how you think about unknown/future possible events is important when thoughts are unhelpful, excessively negative, and unlikely. Cognitive Behavioral Therapy is an approach that helps people understand the connection between thoughts, feelings, and behaviors. Change or modify one to change another. Think different to feel different. Act different to think about yourself or a situation differently. 

Catastrophizing is a common “thinking error” or thinking pattern associated with anxiety. This is thinking about or imagining the “worst case scenario” or highly unlikely negative outcome.  
One good check is to ask yourself: Do I predict bad things when I’m uncertain? 
Try asking and answering these questions to challenge persistent worry:

  • Anxiety increases when thoughts turn and get stuck on what if? For every What if? come up with three alternative “What else might happen”? reasonable responses.
 
  • Is this worry realistic? What is the probability of what I predict happening? Is this feared outcome likely? If so, can I handle it? 
 
  • Imagine and identify What is the Best, Worst and Most Likely outcome?
Could good things be just as likely to happen as the anticipated bad? 

  • What is in my control?

Worry can be helpful when it prompts us to think about and plan. It can provide motivation to take action to try to make sure behaviors are safe or outcomes we want are more likely to happen (studying for a test we want to pass). “By worrying, we are trying to figure out all the possible ways things could go wrong so we can be more certain of the outcome.” https://www.anxietycanada.com/articles/tool-4-make-uncertainty-your-friend/

Worry can be an effort to try to reduce feeling of uncertainty and make things more predictable. 
It is a problem attention to a possible future event or outcome that affects your ability to be present, enjoy or participate in life activities and when there is little control. Identify what you can control and what is outside of your control. If something is in your control, make a plan, and then act on it. When it is not, practice coaching yourself with helpful statement to let go of the worry. 

Change what you do. If you change your behaviors around uncertainty this will help change your feelings and thoughts about it.

Act as if you can tolerate uncertainty. See https://www.anxietycanada.com/articles/building-your-tolerance-for-uncertainty-act-as-if/ for an example of ranking by difficulty behaviors that help manage uncertainty and coming up with a progressively more difficult list of activities that require uncertainty to do. This practice or gradually facing uncertainty without the managing behaviors can increases confidence. Think about the outcome, how you felt, what you did to cope if the outcome was not positive. 
Ask yourself the following questions: Did things turn out ok even though I was not 100% certain? If things did not turn out ok, what happened? What did I do to cope with the negative outcome? What does this tell me about my ability to cope with negative outcomes in the future? 

Practice mindfulness: Focus on what is happening right now. Not avoiding, but intentionally being aware of the present moment, without judgment. This will increase your ability to handle discomfort of unknown and uncertainty. See also How mindfulness can help: https://childmind.org/article/how-mindfulness-can-help-during-covid-19/childmind.org/article/how-mindfulness-can-help-during-covid-19/ 

As hard as it is, learning to be able to accept some uncertainty in life is important for reducing excessive worry and managing anxiety. It starts with acknowledging this tendency and increasing awareness of what is happening to be able to use the strategies outlined above. If worry or anxiety has become overwhelming and is negatively interfering with your daily life, please reach out to a physician or therapist to find support. 

Additional Articles: Returning to a new normal 12 tips for handing uncertainty: https://www.anxietycanada.com/articles/returning-to-a-new-normal-12-tips-for-handling-uncertainty/
How Uncertainty Fuels Anxiety https://www.theatlantic.com/health/archive/2015/03/how-uncertainty-fuels-anxiety/388066/
Coping tips for Uncertain Times: https://health.choc.org/6-coping-tips-for-uncertain-times/

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Selective Mutism: Understanding Treatment Options and Key Terms in PCIT-SM by Kate Gibson, PsyD, ABPP

10/30/2022

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There are different types of therapy offered for treating Selective Mutism. Some are offered by Speech Pathologists and some by mental health practitioners. All use different strategies to work toward the same goal of increasing the child’s ability to speak when anxious. This blog focuses on understanding Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM), the approach offered at our practice and created by Dr. Steven Kurtz.

PCIT-SM is a behavioral treatment approach that uses positive reinforcement to help children increase their brave talking while decreasing the negative reinforcement cycle that is maintaining their anxious avoidance of speaking. Positive reinforcement of brave talking involves rewarding the desired behavior of talking. The negative reinforcement cycle that maintains SM involves children being self-rewarded by avoiding talking because avoiding talking is the quickest way they know to decrease their own anxiety.

Before focusing on brave talking PCIT-SM devotes time to building a relationship between the therapist and the child without prompting for speech. Activities that the child is interested in are completed together. This phase of treatment is called the Child Directed Interaction (CDI). This phase is essential for building comfort in treatment for the child before tackling the challenge of working on their anxiety. CDI is used to help a child warm-up at the start of each session. CDI is usually done in the presence of an adult such as a parent that the child already talks to. CDI is also used as a warm-up when a new person is introduced or another variable is changed. The concept of contamination plays a role throughout PCIT-SM.
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  • Contamination is the phenomenon of a child or teen with SM already having experience not speaking to a person, in a place, or in a situation. Children or teens with SM will be unable to speak with any contaminated subject without intensive practice and support. We avoid contamination by completely avoiding questions and heavily relying on the use of CDI skills from PCIT-SM. We also work to un-contaminate previously contaminated individuals in VDI by thoughtfully fading in people who are contaminated and/or working in places or situations that are contaminated.

When the therapist is ready to have the child work on their brave talking the Verbal Directed Interaction (VDI) phase of treatment is begun. Here are some key terms that will come into play during VDI: fade-ins, rehearsal, shaping, living and exposure lifestyle.
  • Fade-ins are the process of helping a child with SM talk to a new person. It involves slowly getting a child or teen comfortable speaking in front of and eventually to a new person, scaffolded by gradually moving the person being “faded in” closer to the child to encouraging interaction, and then passing the talking baton from the familiar person to the new person.
  • Shaping is used to establish a behavior that does not currently get performed. It involves breaking the ultimate goal down into smaller steps to take toward that goal. Shaping is a process of taking small steps starting with a lower difficulty action and gradually increasing the difficulty working progressively toward the ultimate goal. You want to wait until your child has more confidence with the step they are working on before increasing the difficulty. If you take things a step harder and your child is completely unable to do it then you probably need to break the steps down into smaller steps toward their goal. In PCIT-SM the therapist will support you in pacing the shaping steps. We think of it as taking steps up a ladder with each step or rung on the ladder being slightly harder than the last.
  • Rehearsal means practice! If you want your child with SM to order their own donut, they will need to practice first. If nonverbal greetings are also hard and you want your child to wave at their friend as they walk up to the school building, they will need to practice first. They will likely need to practice many times and in a variety of settings. Practice will happen in session but practice outside of session is essential for progress to generalize to your real life. Do not underestimate the power of practice in getting your child ready to face a new challenge with their brave talking or participating. Rehearsal could mean practicing with you multiple times, it could mean practicing with a bunch of different people, it could mean practicing in a bunch of different places. We call looking for any opportunity to practice “living an exposure lifestyle.” Pretty much anywhere you find people is a chance to practice and live that exposure lifestyle.

There are different intensities of treatment available for children with Selective Mutism. PCIT-SM can be delivered individually or in group. Generally children begin with individual therapy and after making progress may be referred for a weekly SM group. Sometimes children with SM take a good amount of time to warm up, making a traditional hour a week therapy model not the most effective approach. In these cases more intensive individual treatment may be recommended first. Intensive treatment could be a few longer sessions each week for a period of time or could be as much as full days of treatment spanning an entire week either in the office or in your home/school/community. Weekly SM groups are allow children to work on talking with adults and other children in activities that simulate things that happen in a classroom. Groups are a great opportunity to work on higher level goals. Some children also benefit from a more intensive group treatment approach. The SM camp models are known as Intensive Group Behavioral Treatments (IGBTs). Our practice will be offering an SM camp this coming summer 2023 called Mighty Mouth Kids Sarasota based on the MMK model developed by Dr. Steven Kurtz.

Your therapist in PCIT-SM will guide you every step of the way in using the strategies discussed here in and out of session to help your child succeed and will help guide you in the intensity of treatment your child needs to succeed!

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The treatment principles and terms in this Blog are drawn from PCIT-SM developed by Dr. Steven Kurtz of Kurtz Psychology Consulting.
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Understanding Oppositional Defiant Disorder (ODD) By Rachel Funnell, LMFT

10/21/2022

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Everyone knows that all children are defiant at times, especially when they are tired, hungry, stressed or upset. They will talk back, refuse to listen, yell, and argue. The truth is that oppositional behavior is a normal part of developmental for two year-olds to three year-olds and early adolescents. Oppositional defiance becomes an issue when it’s consistent and stands out when compared to other children of the same age and developmental level and when it affects the child’s family, social and academic life. So how do you know if your child’s defiant behavior is typical or not? Below are the signs and symptoms you want to look out for. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing Oppositional Defiant Disorder (ODD). The DSM-5 criteria include emotional and behavioral symptoms that last at least six months.

Angry and irritable mood:
  • Often and easily loses temper
  • Is frequently touchy and easily annoyed by others
  • Is often angry and resentful

Argumentative and defiant behavior:
  • Often argues with adults or people in authority
  • Often actively defies or refuses to comply with adults' requests or rules
  • Often deliberately annoys or upsets people
  • Often blames others for his or her mistakes or misbehavior

Vindictiveness:
  • Is often spiteful or vindictive
  • Has shown spiteful or vindictive behavior at least twice in the past six months

These symptoms can occur in just one setting or across multiple settings like home, school and in the community. 
ODD can sound like a very scary diagnosis to parents. It can make a parent feel like they aren’t good parents or they did something wrong. Or it can feel like something is wrong with their child. The truth is that there is no known single cause of ODD. However, there are lots of different treatment options for parents and their child. 

First, it’s important to get properly diagnosed. A lot of times, the child may have some signs and symptoms of ODD but don’t meet the specific criteria. Also, there are times that the child has another disorder that needs to be treated too, like ADHD, learning disabilities, depression or anxiety disorders. Without knowing the full picture, it will be hard to treat the ODD effectively. If your child doesn’t meet the criteria, the type of treatment might be a little different depending on the areas of need. 

Once properly diagnosed, the parent needs to look for specific treatment that treats ODD. Not every type of therapy is effective with ODD. The following are more effective treatment:    
  • Parent Management Training - this helps the parent and others learn how to manage the child’s behaviors. Parent-Child Interaction Therapy (PCIT) is a great type of parent management training that works with kids ages 2-10.
  • Individual Psychotherapy - this can help the child learn more effective anger management techniques.
  • Family Psychotherapy - this can improve communication and mutual understanding between the family.
  • Social Skills training - this increases flexibility and improves social skills to help increase frustration tolerance with peers. 
  • Medication - this can help control some of the more distressing symptoms and treat any coexisting conditions. 

In addition to the above, there are several things that the parents and others can do to help the child. 
  • Catch the child being good. Praise the child every time you see them doing a behavior that you want to increase. Be specific about what you like when talking to younger children. That lets the child know what you like and what they need to do next time. 
  • Avoid arguing. A child with ODD will argue if you engage with them. So pick your battles. If you can give options, then do that. Otherwise, pick your battles.
  • Take a break if you think you’re about to get elevated. This is a great way to model for the child to take a break. Also, allow them to take a break if they want one. 
  • Set limits that are age appropriate and reasonable. Be consistent with the consequences and make sure they can be enforced. No empty threats.
  • Manage your own stress so that you can stay calm during those challenging moments. 

A child with ODD can be challenging but it is treatable. With treatment, the child can have a very successful and fulfilling life. 

https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-With-Oppositional-Defiant-Disorder-072.aspx
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https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

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What Teachers Should Know about OCD By Tara Motzenbecker, LMHC, NCSP

10/14/2022

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What is OCD?
Obsessive-Compulsive Disorder (OCD) is a disorder related to anxiety, and kids who have it struggle with obsessions, compulsions, or often both. Obsessions are unwanted and intrusive thoughts, images or impulses that make the child feel anxious or scared. The child will often attempt to ignore, suppress or neutralize the thoughts (by performing a compulsion). Compulsions are things kids are driven to do to get rid of the anxiety or distress. They may be repetitive behaviors or mental acts. The compulsions are time-consuming or cause significant distress or impairment. 

It is like being bitten by a mosquito.  It itches (distress) so the child scratches it to make it better.  It feels better while scratching (compulsion), but as soon as the child stops scratching, the itching gets worse (distress). The scratching worked great for the child in the short-term, but made the long-term problem worse. 

How to recognize it at school
You might notice that a child is scared of germs.  They may be handwashing or using sanitizer in excess.  They may avoid touching other children or items. They might be asking to go to the nurse often because they are afraid they are sick. 
They might also be thinking they have to do something to prevent something bad from happening (e.g. they have to touch the doorway three times so their parent does not die in a car crash). It can be hard to know the mental part of this, but if teachers are seeing repetitive acts, it is a sign of OCD. 

They may ask to check-in with their parents frequently.  This may be coming from a need for reassurance that nothing bad has happened or that the parents will be picking them up. Or maybe they are frequently checking their backpack to make sure they did not lose something. 

They might have a case of the “what if’s”.  “What if there’s a fire alarm in the middle of the test?” “What if the water stops working?”

They might need to line up items or put things in particular spots without being able to explain why.  They just know that it doesn’t feel right until they fix it. You may see children getting up to fix placement or put things the “right” way repeatedly throughout the day. 

If you are noticing concerns, how do you bring it up to the parents?
Chances are, the parents are seeing some similar compulsive behaviors at home.  There is also the chance that it is only happening at school. Scheduling a parent-teacher conference to mention the symptoms present at school is a very gentle way to alert parents to the issue. Be sure to mention how distressing the symptoms appear to be for the child and/or the level of impairment the symptoms are causing at school.  Try not to use the term “OCD”.  Rather, explain that you are seeing some concerning compulsive behaviors or intrusive thoughts that are impacting the child at school. Check with your school counselor for referrals to professionals who specialize in the evaluation and treatment of anxiety-related disorders.  

How to assist in the treatment
If you have a student receiving treatment from a mental health professional for OCD and the symptoms are present in the school environment or with homework, you will need to be involved to some extent in the treatment. If the parent has not signed a release of information form allowing the therapist to communicate with you, ask the parent to complete one so you can speak directly with the therapist.  You may be asked to complete some questionnaire assessments about the child. Completing those as openly and transparently as possible will be beneficial for the child’s treatment. At times, the therapist may ask you to reduce accommodating a symptom.  For example, if the therapist and child are targeting the compulsion of erasing and rewriting, you may need to take the paper from the child after they have written their first draft answer.  
 
However, if the child is not ready to tackle that particular compulsion just yet, they may need accommodations. For example, a child who compulsively erases and rewrites and is not ready to tackle this symptom in their treatment plan, may need extra time to complete tests and school work. 

Frequent and open communication with the parents and treating professionals will ensure a quality team-approach to defeating the OCD. 

Further Resources
  • The International OCD Foundation is a great resource of information and research: https://iocdf.org/about-ocd/
  • Students with OCD: A Handbook for School Personnel by Dr. Gail B. Adams (2011)   https://www.amazon.com/Students-OCD-Handbook-School-Personnel/dp/0983436401

Tara Motzenbecker, LHMC, Registered Play Therapist, Licensed School Psychologist is organizing an in-depth teacher training on this topic.  This training will be open to individual teachers and to schools.  If you are interested and would like to be notified of scheduled trainings and further talks on this topic, please email info@ChildTherapySRQ.com.
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Combatting Panic Attacks By Jessica Custer, BA

9/30/2022

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Panic disorder affects many teens and can have a major impact on how they function in school and with peers. Research shows that many panic disorder is easily misdiagnosed or overlooked for overlapping symptoms with other anxiety disorders. Once Panic disorder has been diagnosed, there are many practical tools that can be implemented to help teens get back to a healthy level of functioning in every area of their lives. Panic disorder is treatable and often
CBT along with third-wave interventions are effective for teens to manage their anxiety levels that lead to panic attacks. One evidence-based treatment specifically targeted toward panic disorder in teens is Riding the Wave therapy, and this incorporates teaching teens to learn to identify their thoughts, emotions, and actions that may trigger panic attacks, and to learn to tolerate the discomfort of those, or “ride the wave” of anxiety. This treatment, along with incorporating mindfulness, meditation, diaphragmatic breathing, and therapeutic lifestyle  changes will help teen clients learn to tolerate anxious thoughts and feelings and calm their overreactive brains. I created a handout for teens to learn more about how to cope with panic in the moment, as well as things they can do daily to decrease the prevalence of panic disorder symptoms. These are helpful tools that a client can test out to find what works best for them.
  1. Knowledge- Know that a panic attack can be very scary, but they are not dangerous.
  2. Deep (Diaphragmatic) breathing- Breathe in through your nose for 4 counts, pause for 1 count, and breathe out through your mouth for 4 counts.
  3. Label it- It is not a heart attack, It is a panic attack. It is temporary and it will pass. 
  4. Close your eyes- Overwhelming stimuli can be a trigger and feed the panic attack. Close your eyes and focus on breathing.
  5. Mindfulness- Focus your attention on the present, recognize your  emotional state, and meditate regularly to reduce stress and help you relax. Mindfulness Grounding Strategy:
    1. Name 5 things you can SEE around you
    2. Name 4 things you can TOUCH around you 
    3. Name 3 things you can HEAR around you  
    4. Name 2 things you can SMELL around you  
    5. Name 1 thing you can TASTE around you 
  6. Focus Object- Find something to focus your attention on until the panic attack passes 
  7. Imagery- Visualize yourself in your happy place and focus on the details as much as possible. “feel the sand on your toes, warm sun on your shoulders, smell the pine trees, hear the rolling waves” 
  8. Calming Yoga- Practice yoga stretches and breathing. Use Youtube, or a favorite yoga App to guide you in your practice. 
  9. Smell Lavender- Lavender essential oil is calming and can help calm you. 
  10. Repeat a Mantra- This can be a favorite Bible Verse, or just a simple “This too shall pass”. Repeat it in a loop in your head until you feel the panic attack subside. 

Therapeutic Lifestyle Changes that can reduce panic attacks:
  • Daily deep breathing- 5- 10 minutes a day
  • Regular light exercise- yoga, walking, or light jogging
  • Reducing sugar and caffeine in your diet
  • Avoid alcohol and smoking

Riding the Wave of anxiety and Panic Attacks
So, we know that we cannot make the waves stop and we cannot rush them to move and go away any faster. They cannot be controlled or avoided. They will come and go, ebbing and flowing. The same goes for anxiety. If we resist the symptoms of anxiety by trying to control it, stop it, avoid it, or push it along quicker, the symptoms are more likely to get worse. So, what do you do about
the waves of anxiety? Well, you want to be more like a surfer. They are not intimidated by giant waves. In fact, to a surfer- the bigger, the better. Surfers are not trying to fight the waves, they are moving with the wave, flowing in the same direction. When you find yourself experiencing a wave of anxiety, try riding the
wave. 
Accept your symptoms, don’t suppress them.
Remember that anxiety and panic attacks cannot kill you. You cannot die
from them. Attempting to control the anxiety will only intensify the emotion.
Try thinking to yourself, “Ok, here it is again. I can handle this. It will pass.” 
Acknowledge your physical symptoms.
Anxiety not only impacts us emotionally and cognitively but also creates
changes in our bodies. Take notice of what your body feels like at the
moment. This may include heart palpitations, shortness of breath, heaviness in the chest, muscle tension, shaking, and sweaty palms. Watch and observe what is happening to your body without reacting to it with further fear or anxiety. 
Redirect Unhelpful Thinking.
Often our perceptions about our physical symptoms of anxiety lead to
further symptoms of fear and panic. Examine your thoughts and beliefs
about your physiological reactions. Instead of thinking “I can’t handle this”
or “I feel like I am going to die” try thinking of something more helpful. For
example, “I know I will be okay” or “I will let my body do its thing and move
through this.”
Utilize Relaxation Techniques.
Try taking some slow deep breaths. This may be called deep breathing,
belly breathing, or diaphragmatic breathing. Slow your breath and become
present in the moment. Focus on your inhale and exhale. You can also try
doing a visualization or mindfulness exercise to help ride the wave and wait
for it to pass. Remember to ride the wave of anxiety and it will eventually pass. You got this! Happy surfing! 

Helpful Apps:
Mindshift- meditations, journaling, symptom tracker, and it is free!
Reflect- Christian mindfulness and meditation app, also free!
Headspace- Great mindfulness and meditation app, good instructional videos, and inspirations as well. It is not free, but they do have a student discount rate.
Downdog Yoga - Great Yoga app that can be customized to your ability level. They offer a free account with your student email.

References

Baker, H. J., & Waite, P. (2020). The identification and psychological treatment of panic disorder
in adolescents: a survey of CAMHS clinicians. Child & Adolescent Mental Health, 25(3),
135–142. https://doi.org/10.1111/camh.12372
LPC, A. B. (2019, July 30). Riding the Wave of Anxiety. Therapists Raleigh Durham Chapel Hill
NC - Third Wave Psychotherapy. https://www.3rdwavetherapy.com/riding-the-wave-of-anxiety/
R.I.D.E. the Wave of Panic | Psychology Today. (n.d.). Retrieved September 22, 2022, from
https://www.psychologytoday.com/us/blog/life-without-anxiety/201110/ride-the-wave-panic
Pincus, D. B., Ehrenreich, J. T., & Spiegel, D. A. (2008). Riding the Wave Workbook: Riding the
Wave Workbook. Oxford University Press, Incorporated.
http://ebookcentral.proquest.com/lib/cochristuniv-ebooks/detail.action?docID=1573048
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Unlocking the Mystery of the Exceptional Student Education Process By Julia Hollinger, PsyD, NCSP

9/20/2022

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​Sarasota County Schools provides a continuum of supportive services to over 7,000 students with disabilities. However, navigating Exceptional Student Education (ESE) can be daunting for parents and private practitioners alike who may not be well- versed in the process or the lingo (see  Alphabet Soup). Below is an overview of the key concepts central to exceptional student identification.

Alphabet Soup: The ABCs of ESE

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At its core, the ESE process is comprised of three main components which are ideally executed in a linear fashion: Pre-referral, evaluation, and placement.

Pre-referral: Districts are responsible for implementing an MTSS process to provide struggling students with evidence based interventions to help determine the least restrictive environment in which a student’s needs can be met.

Evaluation: Conducted by the school if MTSS data indicates that a student is not responding appropriately to evidence based interventions and may require more intensive supports. The evaluation should answer two questions: 1. Does the student have a disability? And 2. Does the student require specially designed instruction?
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Frequently Asked Questions By Parents About Evaluation

Q: Doesn’t the school HAVE to, by law, honor my request?
A: No. The school is only required to respond to you request in a timely manner and to issue prior written notice stating the reason(s) for the school’s refusal to initiate an evaluation.
 
Q: I want an evaluation but I don’t want my child to be labeled or placed in special education.
A: Determination of eligibility for a disability and the need for special education is the purpose of a school-based evaluation.  If you would like an evaluation just for diagnostic clarification or to provide recommendations or strategies, a private evaluation may be more appropriate.
​
Q: What if I obtain a private evaluation or a prescription for an IEP by my child’s doctor or therapist?
A: You are encouraged to share any private evaluations and recommendations with the school.  However, recommendations pertaining to diagnosis or placement do not supersede the MTSS process. 
 
Q: My child already has a diagnosis. Doesn’t this mean s/he needs special education?
A: Not necessarily.  Privately diagnosed conditions may or may not translate to educational diagnoses, and your child may or may not need specially designed instruction.  Existing diagnoses do not supersede the MTSS process. 
 
Q: My child is struggling and I don’t know how else to help other than to request an evaluation.
A: Evaluation is a last resort after all other options have been exhausted.  It may or may not be appropriate for your child.  Your best bet is to contact your child’s teacher to ask how the school is helping your child and what more, if anything, you can do. 

Placement: Should a student be identified with a disability and found eligible for specially designed instruction, an IEP is developed and the decision of where the student’s needs can best be met is made by the team.

The IEP

The IEP written document for a student with a disability that is developed, reviewed, and revised in accordance with the law.  It includes information about a student’s present levels of functioning, goals and objectives, related services, specially designed instruction, testing accommodations, progress monitoring, and transition needs. IEPs are fluid documents and can be changed or revised at any time (with prior written notice and parent consent), but must be reviewed at least annually.  Parents have the right to due process should they be dissatisfied with the IEP.

The 504 Plan

For students with disabilities who do not require specially designed instruction, a 504 Plan may be an appropriate support.  A 504 Plan includes accommodations and changes to the learning environment that are implemented in the regular education setting for students whose disabilities interfere with their ability to access their education in the same manner as their nondisabled peers.  Like an IEP, a 504 Plan is a legally binding document that must be reviewed at least annually but can be revised at any time with parental consent.  In order to be eligible for a 504 Plan, the answer to all of the following questions must be “Yes”:
  1. Does the student have a physical or mental impairment?
  2. Does the impairment affect one or more major life activities such that the student is prohibited in having access to their educational program?
  3. Is the student substantially limited by the major life activity?
  4. Is an aid, service or accommodation needed to enable the student to participate in their educational program?​                    

More information on Sarasota County ESE can be found here: https://www.sarasotacountyschools.net/domain/1172
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How Parents Can Stay Calm When Your Child Is Not By Tara Motzenbecker, NCSP, LMHC

9/11/2022

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When a child is tantruming or losing control, it is extremely hard for parents to stay calm and regulated. This can be due to mirror neurons, which is when you observe the behaviors or emotions of another, the neurons in your brain fire as if you were having that same experience.  It can also be due to parents’ other emotions being triggered such as embarrassment or anxiety that you will now be late. 

Unfortunately, the mirror neurons continue working and until one person is regulated, the other will not be. Since a child’s brain is not fully developed, the adult has a better regulation capacity. Here are some ways parents can regulate themselves:

Breathe
Neuroscience shows that slow deep breaths in and out is the most effective way to calm your body. Breathing slows your heart rate and actually gives signals to your brain that your environment is safe - taking you out of the flight/fight response of anxiety and anger. The key is to breathe out for twice as long as you breathe in - think in for 4 and out for 8. Not only will your child’s neurons mirror yours to begin calming, but their breathing will also match up with yours, further calming their system. 

Self talk
The human brain can naturally go to negative thoughts such as “Ugh here we go again” or “now the day is ruined”. These thoughts can lead to further dysregulation.  Instead, try to be intentional and use positive self-talk such as “I can do this” or “All kids do this. I just need to breathe”. 

Grounding skills
Grounding skills help us stay in the here and now and allow us to be present and regulate through the duration of the tantrum. Some great ways to ground are identifying and naming (in your head) 5 things you see, 4 things you hear, 3 things you touch, 2 things you smell, and one thing you taste. It can also be as simple as holding a grounding object like a stone, intentionally noticing the air going in through your nose and out through your mouth, or looking for something around you for each color of the rainbow. 


​
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Better Communication with Teens By Kirsten Ellingsen, PhD

8/28/2022

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Communication is key to building a healthy relationship during the teenage years. Below are a few suggestions for how to connect and improve communication with your teen.
 
Use active listening skills.
Active listening includes reflecting and summarizing. It will help your teen feel heard, understood, and supported. The intention is to understand in a compassionate way. Moderate your reaction, particularly to statements that are triggering. Listen before jumping to advice or evaluate. This is particularly important when the topic might involve health or safety issues (e.g., sex, drinking, smoking, vaping, use of drugs, cheating). This is important even if the conversation is about a friend or classmate’s behavior, your response can limit or facilitate more open communication about challenging decisions and topics. Start with reflecting and accepting stated feelings.
(A quick guide to active listening: https://raisingchildren.net.au/teens/communicating-relationships/communicating/active-listening)
 
Reflect and Validate Feelings. 
When your teen shares a feeling, reflect this feeling back. You do not have to agree with the statement or opinion. You don’t have to agree with the behavior choices, but by acknowledging or summarize what your teen expressed feeling you show that you are trying to understand his or her experience and perspective. This facilitates connection and increases openness of sharing.
 
When you reflect pause or use “AND” not “BUT” if you are adding more information or your perspective.  Reflecting a feeling then saying but…. Is invalidating. (For example, “I hear that you are feeling disappointed about your test grade, BUT you did not study hard” vs “Ah, you are feeling disappointed about your test grade AND I am here to help you figure out what you might do next time”. “You are feeling angry about your friend’s comment, AND it is hard when a friend talks behind your back”)
 
Don’t Downplay Disappointments or Minimize Feelings.
In a similar way, when your teen expressed feelings be careful not to dismiss the feeling or minimize the feeling. Comments such as, “it is not a big deal”, “why are you so upset about that”, or “you are overreacting” are not helpful to connect to or understand your teen.  Even if you see the emotional reaction as ridiculous or disproportionate to the situation, this does not promote open communication. Dismissing concerns can leave your teen feeling frustrated, defensive, or hurt. Challenging the feeling can also shut down sharing (as does contradicting or telling your teen what he or she was feeling). Again, you do not need to agree, and you can still offer boundaries for reactions or behaviors, but first acknowledge and validate the feeling expressed.
 
Understand and Empathize.
The goal in healthy communication is to better understand the point of view or experience of your teen. Trying to put yourself in his or her shoes can help to increase empathy, which also models how to build closeness in healthy relationships.
 
Summarize (“what I hear you saying is that….”) and then empathize when your teen shares (“that sounds hard…” “it is understandable that you feel that way). Summarizing also allows you to check in with your teen that you understand him or her (“am I correct in understanding that you feel….”). Accept the emotions, even if they are temporary and the feeling passes (this also usually helps a teen move on faster when experiencing strong negative emotions).
 
Certainly, there are conversations that are important to teach and advise, set consequences for behaviors, and establish expectations and identify family values. Yet, picking the time and place is important. When your teen is talking about these topics, it is helpful to first hear and understand your teen’s perspective and experience to guide productive discussion.
 
Ask Clarifying Questions.
Ask Follow-up Questions without Judgment. When you want to clarify what your teen is expressing, try to ask questions out of genuine interest to understand him or her. Avoid judgmental questions that stop sharing. Be aware of loaded questions that are critical (“why can’t you…”). Be careful not to interrupt or interrogate with questions. Use open-ended questions rather than questions that accuse. Try not to jump to problem solving, but ask “how can I best support you in this/right now” to help your teen build independence and confidence in solving future problems.
 
Tone and Body Language.
Be mindful of tone and body language.  Responding slowly and intentionally to emotional statements or triggering comments will help. Yelling, nagging, sighing, guilting and sarcasm do not model or teach kindness and respect. Conversations about difficult topics are always more productive when you are calm and able to respond thoughtfully not reactively. Shaming and insulting damage relationships and can impede healthy communication and relationships. Maintain interest and eye-contact. Put down your phone and reduce other distractions to be able to focus on your teen. Positive body language can show that you care and are interested in what he or she is saying.
 
Communication demonstrates interest and love. Active listening that reflects feelings helps build connection. Deliberately working to understand your teen’s perspective and creating a safe space for your teen to talk and share feelings will enhance your relationship now and in the future. Communication also means sharing positive experiences, accomplishments, laughter, and specific praise for effort and how your teen handled hard situations.
 
RESOURCES
How to Talk so teens will listen & listen so teens will talk by Adele Faber & Elaine Mazlish
https://childmind.org/article/tips-communicating-with-teen/
https://www.unicef.org/parenting/child-care/11-tips-communicating-your-teen
https://parents.au.reachout.com/skills-to-build/connecting-and-communicating/effective-communication-and-teenagers

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Building Resilience in Children By Ginger Martin, PsyD

7/31/2022

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Children, like the rest of us, have been presented with a lot of changes and stress over the past few years. In fact, life in general throws a lot at us and our kids daily. Our lives seem busier, more planned out and scheduled, and at times more chaotic than past generations have experienced. So how do we help our children to develop resilience skills that they can use now and throughout their lifetime? The four skills can help develop resilience in kids (and we can learn from these too as their parents!).
 
Growth Mindset: Helping our children to develop a growth mindset means teaching them to focus on progress over perfection and on the process rather than the outcome. When we focus on those singular goals (i.e., getting an A, making the team, winning the contest), children are left with a win/lose mindset which can be limiting. Helping them to see the mini successes along the way gives them the ability to focus on personal growth. The idea is to have them notice the effort they put into the schoolwork, the perseverance they showed in practicing each day for the team tryout, and the way they learned from mistakes they made along the way in preparing for the contest. After all, the skills of consistent effort, perseverance, and learning from mistakes will get them a lot further in many areas of life than just achieving that A will.
 
Grit: Speaking of learning from mistakes and perseverance, grit is a fantastic skill to encourage in our children. Many kids are used to instant results and gratification and when challenges arise, it can cause discouragement or defeat. Instead, encouraging our children to see a challenge as an opportunity for growth is a way to build their grit. Research tells us that individuals who develop the trait of grit can achieve far more than their naturally talented counterparts. Working with kids to set goals and to work toward them, persisting when challenges arise, noticing small gains and progress, and celebrating their accomplishments will help them learn to persevere no matter the circumstance. They may even start to view roadblocks as a challenge to overcome rather than a dead end.
 
Emotional regulation: It sounds simple but identifying and understanding emotions is not always intuitive and is certainly not routinely taught to children. However, just as we teach children to recognize their body cues for hunger, thirst, and illness, we should teach them to learn and recognize their emotional cues and how to respond to them. Working with children to develop a healthy emotional vocabulary and to normalize talking about feelings in the moment is essential; how can we work on something we have no words for or do not understand or recognize? Using emotional vocabulary in everyday conversations, sharing your experiences with your kids, and modeling healthy ways to cope with those feelings can be great ways to teach your children. Starting with simple coping skills such as taking a break by oneself, talking to a trusted adult or friend, and taking some calming breaths helps children to slowly learn to control and manage even the biggest of feelings.
 
Band-aids vs Vitamins: As children learn skills to manage their feelings, we want them to have strategies on hand for when a tricky situation arises and they need to calm down (i.e., using a band-aid); however, we also want them to develop a daily practice to prevent their feelings from escalating so quickly (i.e., using daily vitamins). A Cognitive Behavioral approach indicates that two steps are necessary for managing feelings: relaxing our nervous system with relaxation and redirecting our thoughts. We can teach children these simple steps as well by introducing relaxation strategies such as deep breathing, meditation, mindfulness, yoga, and other forms of movement/exercise. In addition, we can teach children how to redirect their thoughts with “cool thoughts” which is to focus on what is true and positive (Although I didn’t win the game I had fun playing with my friends, If I finish this homework I can play my video game for 30 minutes, I’m not going to let this bother me). We want to encourage kids to practice these life skills daily which helps to minimize their reactions when things do go astray and also increases the likelihood that they will be able to use the strategies in the heat of the moment! Encouraging a daily gratitude practice is also a great antidote to negative thoughts, anxiety, sadness, and anger.
 
Self-Compassion: Overall, it is important that to build resilience in children we teach them that prioritizing their mental health is essential. It is not selfish to take care of your feelings, in fact we cannot truly help others, be productive workers, or supportive partners in relationships unless our own mental health is taken care of. These simple strategies will lay the groundwork for kids ensure that they have taken care of their feelings each day and are armed with strategies to manage whatever comes their way. Talking with our children about being kind, patient, and compassionate with themselves is essential to maintain self-esteem and confidence.
 
 
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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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