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A reminder for the importance of therapy when using meds for anxiety…

http://well.blogs.nytimes.com/2013/09/16/behavior-therapy-aids-obsessive-compulsive-disorder/

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What Do We Tell The Kids?

Like most of you, I’m reeling from the tragedy in Connecticut yesterday. It’s always awful to hear about nonsensical acts of violence, but a school shooting targeting our youngest, most precious community members is almost too terrible to fathom.

We know that the images are going to be everywhere… on tv, social media, newspapers and magazines… for weeks and longer. Adults tend to make sense of these kinds of events by talking with others and by finding out all we can about who did it, why it happened, and all about the gory details. This delving into the details may be helpful and comforting for some. But this is not helpful for our kids.

I’m usually a big proponent of talking to kids honestly about all kinds of scary things. For example, I teach parents how to tell their children that a loved one is dying, how to prepare them for medical procedures such as surgery or chemo, and how to explain difficult life events like everything from divorce to natural disasters. But these things are a part of life that kids eventually need to know about and understand. The child who is shielded from information about a loved one’s illness will not get to say goodbye. The child who isn’t told what is going to happen during their upcoming surgery will be even more afraid when arriving at the hospital. But school shootings and the like are thankfully not a part of most people’s daily lives. So do we tell?

When do we tell?
For children ages 7 or younger, there is no reason to share information about such a brutally violent event. Children do not really even have the cognitive ability to understand death until around age 6, and even adults have trouble wrapping our heads around the mass murder of kids. Telling young children about the killing of kids their own age can therefore be quite confusing, scary, and potentially traumatic, and is therefore not recommended. An exception to this would be if the child is directly impacted by what happened in some way (like living in that town or having a friend who was there), then we would want to help that child understand what has happened and above all reassure them of their own safety.

There is no hard and fast rule about what age to start talking about this kind of thing, and the bottom line is that you know your children best and should make decisions about what to share accordingly. I am hearing a lot about parents telling their school-age children about the shooting because they feel pressured to do so either by the media or by fears that they will find out on the bus or at school or from older children. If you believe that your child is old enough to understand and will hear about the tragedy elsewhere, then you may want to prepare them with your own discussion at home. You may also choose to wait and see if they hear about it, and then follow up with a supportive conversation (or more likely, a series of supportive conversations). Remember that it’s never too late to answer children’s questions, acknowledge their feelings, and reassure them that they are safe.

Preteens and teens may have already heard about what happened, and those who have heard are likely talking about it with each other. Talking to one’s own parents, and even just knowing that one’s parents are available and willing to talk, can be a great source of comfort, reassurance, and guidance about how to cope with and make sense of such tragedy.

What do we say?
Before talking to your children, think about what it is you want to convey. Consider each child’s age, ability to understand and cope, and personality style. Then speak with each child separately and privately so that you can attend to their individual needs. Start by asking what they have heard about what happened, and then listen to their own fears and concerns. Reassure them that these acts are rare and they are indeed safe at school. Provide specific examples of safety measures in place at their own schools (such as security guards and locked entry doors). Answer their questions simply and honestly, providing only as much information as they are asking for. Follow their lead about how much and how often to talk about it. If they have heard enough, they will likely let you know that by changing the subject or moving on. Likewise, if they want to know more, they will likely ask more questions. Keep in mind that talking to kids about terrible things isn’t so much about what you say, but about hearing them out, being a soothing presence, and responding to their questions and concerns.

What else can we do?
Experts agree that one of the most important things we can do to prevent unnecessary fear and anxiety is to limit exposure to graphic or scary images and details. Turn off the tv news when your kids are around. (It’s not a bad idea to turn it off for your own sake as well). Be cautious when talking to other adults in person or by phone so that children do not overhear what is not meant for their ears. For older children and teens, reinforce their empathy by acknowledging their feelings and by talking about ways to help (such as sending a letter of support, making a donation, or doing community service in honor of the victims).

As our thoughts and prayers go out to the Newtown, Connecticut community, we will all do our best to keep our children safe and to reassure them that we will do everything in our power to keep them that way. If you have any thoughts or questions, please post them as a comment below or email me directly at michelle@michellepearlman.com.

How to talk to kids about scary events

How do we make sense of random acts of violence, such as the kind that happened in Tuscon this past Saturday?  I don’t know that we really can understand such events, at least not completely.  We do our best to pay our respects to those who were hurt or killed and their families, and we cherish our own families and give thanks for their safety.  And then most of us try to put these events out of our minds and get back to focusing on our daily lives.

For children and teens, these types of events can be even more frightening than they are for adults (who often are better practiced at compartmentalizing and putting scary thoughts out of our minds, at least temporarily).  For those whose children are old enough to hear about violent acts at school or from friends and media sources, it’s helpful for them to discuss their feelings with parents and other trusted adults.  This is especially true for those kids who show a desire to talk about what happened.

The first rule of thumb when talking to kids about potentially scary events is to meet them where they are at.  In other words, there is no need to either press them to talk, nor to discourage them from thinking about what happened.  Allow children to express their feelings and concerns in as much detail and as frequently as they want, and they will let you know when they have had enough (probably by simply changing the topic).  When a child or teen broaches the subject for the first time, it is helpful to begin by finding a quiet place to talk (preferably away from other-aged siblings) and letting them know that you are open to the conversation and glad that they came to you.  It also may be helpful to have children tell you what they already understand about what happened, and then to provide honest answers to whatever questions they may have.  It is okay to show children your own sadness and confusion over these types of events, and if you don’t have an answer to a specific question then that’s okay to share with them, too.

The media coverage of random acts of violence, particularly those involving children and/or public figures, can be exhaustive.  It is up to parents to regulate the amount and type of information children are taking in, including what they see on television, the internet and from other sources. While the media can serve to keep people informed and connected, it can also lead to further confusion and fear. Children and teens who have experienced traumatic events in their own lives may be particularly susceptible to these negative effects.  In general, the amount of media exposure should be limited to essential information and it should be received with the support of a parent or other adult who can help the child understand and make sense of what is being watched or heard.  It also may be helpful to remind children that while these events are repeatedly replayed in the media, they actually do not occur very often.  Showing children that you are available to talk, listen, and answer any questions they might have is the best way to help them cope while fostering empathy, understanding, and resilience.

Cool It Now

As the New Edition song says, “You got to cool it now… you’re gonna lose control.”  Or as yet another 80s classic says (this one from those wise old men known as Frankie Goes to Hollywood), “Relax!”  Seriously, one of the hardest things for kids to do is to calm down when emotions run high, such as when they are feeling upset, frustrated, or scared.   Let’s face it, it’s not always easy for us grown-ups to keep our cool, either. Fortunately, there are specific strategies that can be learned to make calming down easier.

When a situation is getting the better of us and we are starting to feel overwhelmed or out of control, our body reacts in specific ways.  We may feel our heart beating a little faster, or our muscles getting tense, or our face getting flushed.  These reactions may be thought of as our body’s way of telling us to stop, take a deep breath, and relax.  The following strategies may be used in these situations, and variations can be used for people of all ages, from tantruming toddlers to peeved parents.

1. Remember to breathe.  It turns out that deep breathing really can help you to feel more relax and calm the body’s natural fight or flight reactions.  Deep breathing comes from way down in the diaphragm, and you know you are doing it correctly when you can see your belly rise when inhaling and fall when exhaling.  This is in contrast with shallow breathing, which occurs higher up in the chest and can actually perpetuate feelings of anxiety and tension.  (Think about what breathing sounds like in someone who is crying uncontrollably- shallow gasps for breath, which may even lead to hyperventilation or feelings of nausea).  Children can be taught to take a deep breath in to fill the belly like a balloon and then to exhale to let the air out.  Another way to help smaller children with this concept is to have them lie down and place a book or other small object on their stomachs, practicing deep breathing until they see the object rise and fall with each breath.

2. Take a time out.  This one isn’t just for preschoolers, but for any of us that just need to step back from an upsetting situation to calm down and clear our heads until we can figure out the right course of action.  Parents can help their children by framing time outs as an opportunity to regroup and try again, rather than as a punishment for bad behavior.  While the rule of thumb for smaller children is one minute for every year of life (i.e., two minutes for a 2-year-old and so on), older kids may benefit from a gentle reminder to take a break during times of conflict and emotional upset to gather their thoughts.  Time outs also provide good opportunities to practice the type of deep breathing described above.

3. Relax.  Strategies that work to relax the body’s muscles have been proven beneficial in reducing symptoms of stress, pain, and anxiety.  It is helpful to go through each body part, one at a time, alternating between tensing and relaxing the muscles.  For example, clench your toes into your feet as tightly as you can, hold it for a moment, and then relax the foot.  Feel the difference between the tension and relaxation in your foot.  This strategy can be repeated up the entire body, doing one major muscle group at a time (i.e., one leg and then the other, followed by the stomach, chest, arms, fingers, neck, and face).  For younger children who may not be able to focus on one muscle group at a time, a simpler strategy may be used.  A common technique is to have the child make his body strong and stiff, like an icicle, and then soft and relaxed, like the ice has melted into a puddle on the floor.

4. Practice these strategies with your kids.  Teach through example by modeling how to calm down during stressful situations.  Let them hear you take deep breaths while sitting in traffic, or tell them that you are taking a moment to relax when coming home from work.  It is also okay to acknowledge that you are feeling stressed out from time to time, especially if you are able to show them how you handle these feelings. This will teach them important lessons about how to cope, and maybe you actually will get a moment for yourself to relax in the process!

Don’t forget… you!

It’s almost become a cliché to remind parents, and especially moms, to “put yourself on the list” of people to take care of.  But as with many things that you hear time and again (but only sometimes pay attention to) this is a very important piece of advice.  How many of us parents go through the day running from one activity and errand to the next, hurrying our kids along as we go, only to feel exhausted at the end of the day?  And an ugly truth is that even though most of these tasks and activities are for our children, it does them no good to see us stressed out.  (So we get to soccer on time, but we lose our patience on the way… and so the little one doesn’t get to put his shoes on by himself which always makes him so proud, and the older one forgets her water bottle in the chaos and feels unsettled throughout the game). So while I’m not usually a fan of new year’s resolutions, this year I am going to try to take a little better care of myself, and I urge you do try it, too.  And if you need a little extra motivation, remember that when we parents feel better (i.e., calm and energized) we can do a better job of taking care of the family.  Here are some tips to remember:

  • Schedule some time just for you.  Even if it’s just five minutes per day to stretch or close your eyes.  But really put it on the schedule!  Put a reminder on your cell phone, write it in your planner, or do whatever it takes.  Choose one thing that you really miss doing since life got so hectic, and find a way to add it back in, a little bit at a time.
  • Talk to your friends and be social.  The younger kids get playdates, and the older ones seem to be talking to their friends all day long.  Let’s learn from our children on this point, and add our friends back into the mix.  Meet a friend for coffee, or if your dearest friends aren’t close by give them a call or even plan a weekly skype session to keep in touch.
  • Exercise, even a little.  Take a 10 minute walk a few times per week (around the mall pushing a stroller definitely counts).  Get a workout dvd from the library or bookstore.  Wipe the dust off that old exercise machine in your basement.  Whatever works!
    Eat well.  Many of us or more careful about what we serve our children than about what we feed ourselves.  Add fruit, vegetables, or yogurt back into your diet.

  • Remember your annual trips to the doctor (general physician, dentist, gynecologist, and dermatologist). If you wouldn’t skip your children’s check-ups, why skip yours?

Honored to be in Rockland County’s Forty Under 40

I am honored to be included as part of this year’s class of Rockland County’s Forty Under 40.   This award, given by the Rockland County Economic Development Corporation, recognizes forty professionals under the age of 40 who are making their mark on Rockland County in positive ways through their commitment to growth, development, professional excellence and the community.  I am looking forward to meeting the other 39 honorees at the reception this evening!

Answering children’s questions about death

Given my work with bereaved kids and the recent publication of my book, other moms often ask me about how to talk to their children about death.  And the thing is, as much as we all know that death is clearly part of life itself, more often than not we are surprised when our children ask us questions about it… questions we may not be prepared to answer.  But the truth is that children do tend to wonder about death (when will it happen? why? how?), and the way in which we as parents answer these questions may help them to clarify this potentially confusing and difficult concept. Some questions come about when the child actually experiences the loss of someone they know, while other times the questions stem from the child’s natural curiosity and a growing understanding of the world around them.  For example, my own 4-year-old began to ask a lot of questions when he found out that the dinosaurs died out long ago.

The following guidelines provide some basic tips for parents about children’s understanding of death and loss, and about how to answer their questions.

Children often first start to think about life and death as preschoolers.  This makes sense, as this is the age during which all of life’s big questions are often asked.  (Why is the sky blue? Who is the fastest person ever?  When are you going to die?)  Children’s thinking at this age tends to be concrete and focused on the self, so clear and brief answers are better than abstract discussions about heaven or going to a “better place”.  (While talking about heaven is not necessarily wrong, I have often found it to lead to more confusion rather reassurance- especially for young children).  The most important thing to convey to preschoolers is that they will always be taken care of, and that we as parents will always do everything we can to keep them safe.  Children at this age are not able to understand the finality of death and tend to react most to the way in which events impact their daily lives.

By the age of 6 or 7, children are more likely to understand what it means to die and that it is not possible to see or talk to someone who has passed away.  As children progress through the school-age years, they are able to think more abstractly about death as a necessary part of the life cycle.  Using examples from nature (i.e., bugs, flowers, trees) may be a good way to introduce the idea that all living things have a time to grow and a time to die.

Adolescents are able to think about death in a way that is similar to adults.  When experiencing the death of a loved one, pre-teens and teens may think about how this experience makes them different from their peers and how it impacts who they are now and in the future.

Always provide honest and direct answers to your children’s questions.  A good rule of thumb is to keep talking as long as the child is talking, and to let the conversation follow the child’s lead regarding how much detail to provide.  This is true when talking about death in general or about the specific loss of a loved one.  Try not to avoid discussion of death, which might convey that the topic is off-limits and may ultimately lead to increased fear and worry.

Be available to discuss your children’s concerns on more than one occasion, as their interest in and questions about death will change over time.

There is no one right response to death and no correct way to grieve.  Reassure your child that it is normal to experience a variety of feelings in response to loss, including anger, guilt, and sadness. Some children find solace by spending time with friends, while others prefer to spend more time alone.

Consider how much detail to provide about death based on your individual child’s age, temperament, and desire for information.

Introducing one psychologist mom’s thoughts on kids, parenting, and daily life

My name is Dr. Michelle Yarmus Pearlman and I am a clinical psychologist who specializes in working with kids.  I also am lucky enough to be the mom of two very special kids of my own.  While being a mom is no question the most important and rewarding thing imaginable, it also provides me with the humble realization that even years of training from top programs about how to work with children can not prepare you for the true work of motherhood.  So, while I will probably end up writing a lot on this site about proven parenting strategies and how to handle various problems facing our families,  please remember that I know that it’s not easy out there!

My goal for this site is to provide information about children, parenting, mental health, and other relevant issues.  Please feel free to let me know if you have any questions or comments that you would like me to discuss here.

Thanks so much for stopping by!