Helping Your Child Beat the Back-to-School Blues

September heralds the end of the lazy days of summer and the beginning of the traditional academic calendar.  This reality presents a mixed bag of emotions not only for students, but also parents. Today’s post will focus on some tips to remember as you launch your child into uncharted territory.   The following post will focus on parental reactions.

Pre-School/Kindergarten

Careful planning, visits to the school and classroom, clothes shopping and embellishing the positive associations of school (fun activities, friends & big boy/girl status) are often initially clouded by the reality of separation from mom and/or dad.  Remember that young children do not adhere to the same sense of time that we as adults know too well.  Three hours in their young lives, especially when missing their primary love attachments feels like a lifetime!

Some children will march right off on the first day and seemingly not look back only to balk the following Monday after the first weekend home.   Other children will become emotional, yet - with some expert teacher/aide distractions - will settle once their parent leaves.  Another possible scenario is that your child bounces out of the car and excitedly enters his/her classroom only to be met by several classmates who are experiencing a meltdown, prompting your child to follow suit.  All of these scenarios may feel extremely frustrating yet are very normal!

Some Useful Tips

Exercise patience and keep your own separation anxiety under wraps. Do not underestimate your child’s sensitivity to your mood, a tear in your eye or even your hesitancy to leave him/her.  Resist the temptation to cruise the parking lot hoping to catch a glimpse of your child at play.  Even a preschool child can recognize the family vehicle and this sighting may escalate an existing meltdown or heighten your child’s anticipation of returning home.  

Make certain that you are either early or on time to pick up your child at the end of their school day!  Especially if they suffer from separation anxiety, do not tell them how much you missed them. This is not about you!  Avoid talking about what “fun” activities their younger siblings engaged in while he/she was at school.  Initially, down play life at home to highlight that school is the more engaging option. Make “special” time with your child to learn about their day.  Rather than focusing on a possibly frustrating emotional first day, praise your child’s positive moments and reassure him/her that tomorrow will be a great day.

Until your child adapts to the new environment, do not overbook them!  Lunch with the playgroup may be a great idea, but not the first week of school!  Depending on your child’s adaptability to school, reintroduce structured activities like sports, music and dance gradually. Recall the last time you embarked on a new adventure.  Even amazing experiences initially require a considerable amount of emotional energy.  The same holds true for your child! 

What about rewarding your child for staying in the classroom or not having a meltdown?  This can be a delicate situation.  There is a fine line between bribing your child and rewarding them.  Commemorating their first school experience with a keepsake (video games aren’t not commemorative) is a great idea if it is not conditional.  Bribing a child during a meltdown often reinforces their association of high emotion and rewards.  Remember: there are many years of first days of school ahead and this could be very unhealthy and costly (emotionally and practically).

If your child continues to have unrelenting adjustment issues as the first month of school approaches, perhaps a re-evaluation for school readiness would be appropriate.

Elementary Years

You made it through the kindergarten year but do not be surprised if entering first grade causes similar issues.  Again, the goal in treating separation anxiety is to work with the anxiety rather than react against it.  Reassure and express love and confidence in your child’s abilities.  Quite often, the adjustment process is minimized with each school year.

Exceptions to this rule of thumb would be during times of transitions at home.  Deaths, births, major illnesses, divorce, major changes in a family’s financial situation, relocations and even the addition of a family pet may cause a temporary escalation of separation anxiety.    Keep your child’s teacher in the loop and, if necessary, do not hesitate to seek professional support for your child.

Sudden resistance to school may be related to poor peer interactions, academic problems and/or some escalation of insecurity.  As your child moves into the tween years, physical development and hormonal changes must also be considered.  Supervise but do not hover!

Junior High and High School

Understand at these developmental stages, it is very uncool to display anxiety and/or insecurity.  Most teens would rather eat a balanced meal than have their parent visible on the first day of school even though they secretly desire support.  Expect the anxiety to surface as moodiness, a hypercritical attitude, multiple wardrobe changes prior to leaving the house, meltdowns that focus on body image and uncharacteristic nastiness toward younger siblings. 

The first day of tryouts, first dances of the school year and the first rounds of exams and report cards are also potential precipitating events that may cause heightened anxiety and the internal conflict of needing support versus not wanting to accept it.

Enlist the same tips for dealing with separation anxiety.  Back off from extra-curricular activities, regulate sleep and eating routines, and remain connected.  If your child has become noticeably more independent, perhaps this is an appropriate time to schedule “down time” together.  Again, if anxiety persists and is coupled with plummeting self-esteem, do not hesitate to seek professional advice.

Concluding Thoughts

The beginning of the school year often marks the passage of time in very tangible ways.  Look at the photos you have snapped each year on your child’s “ first day.”  Realize that most children and parents have mixed emotions about this transition.  Whether your child is obviously impacted or makes seamless transitions, your connection to them is very much present even if it doesn’t appear obvious on the surface. 

School is to children as work is to an adult.  Memories from your “first days” may be an extremely useful guide to how to assist your child in their transition.  Regardless of our age, when faced with a new challenge, we all benefit from empathy, support and reassurance from those who love us most.  Patience is never more necessary and valued than at these times.

Happy first weeks of school!!!  Stay tuned for the care givers perspective!

Managing Anxiety - Treatment Basics

The relationship between worry and anxiety was outlined in the last blog.  Common symptoms of anxiety were also discussed, as were markers for predisposition.  One of the most important points in my last blog was that anxiety has served as an effective warning system for our mind and body to communicate about impending danger.  It is only when that communication system gets over aroused or stuck in constant danger mode that anxiety becomes a diagnosable condition.

Treatment for anxiety is not dependent on meeting diagnostic criteria. Cognitive –behavioral therapy (CBT) has become the most widely validated treatment option for anxiety related thoughts and symptoms. Let’s explore some fundamentals!

A primary premise of CBT involves identifying, challenging and revising our automatic thoughts.  Automatic thoughts just “pop” into our heads, they are so second nature to us that we neither actively think about them nor question their accuracy.  For example, an automatic thought might be: “If I fail this exam, I’ll never graduate.”  Well, it is almost a certainty that if this individual does not “catch” that thought and challenge it (i.e. asking yourself “really?”) that his or her body will react with symptoms of anxiety.  Underlying our automatic thoughts is our core belief.  In this example a core belief may be: “Only losers fail.”  Those core beliefs are rarely motivating and frequently paralyzing.  The key is to catch the automatic thought – it will lead to the core belief.  Getting there takes practice though.  Initially we often don’t catch the thought until after we begin to feel anxious!  It all begins with identification of both the automatic thought and the core belief.

In phase two, the goal is to challenge the automatic thoughts and their underlying core beliefs.  Sometimes it can be as simple as asking yourself: “really?”  Frequently these thoughts are very exaggerated and their perceived assumptions extremely dire!  In the above example, it is highly unlikely that one exam would prevent an individual from graduating.  It is also a faulty assumption to connect one failed exam with identifying oneself as a loser.  The goal is not to deny reality; it is to challenge the faulty assumptions or the exaggeration of those assumptions so that our bodies don’t inadvertently prepare for battle.  We have come to understand that when the mind prepares for battle (worry), the body reacts with undesirable physical symptoms (anxiety).

When recognizing and challenging our automatic thoughts becomes second nature, the final task becomes to revise those automatic thoughts and the core beliefs.  The premise is to remove the exaggerated thoughts and replace them with more balanced thoughts and a more accurate core belief.  For instance, one failed exam does not equate with failure as a person.   A revised automatic thought could be; “I need to spend more time studying this topic.”  The core belief could be “ It takes effort to become successful.”   The goal of these revisions would be reducing the likelihood of any physical reactivity to the thought. Ultimately, the process trains the mind-body alarm mechanism to exercise discretion in responding.  This often results in a more empowered and confident individual!

Today the outline of this process has been simplified and is meant to give a brief overview of one of the effective strategies utilized in anxiety management.  It is also often utilized in concert with techniques of thought stopping (refocusing), visualization and relaxation training.  There are several user-friendly workbooks that I have found to be a great adjunct to therapy.  It is often very helpful when learning the techniques of how to reframe our thoughts to be able to label the automatic thought, the core belief, the challenge and the revised core belief in some visible record.  A workbook that offers that template would be advisable.

If you are struggling with worry and anxiety, seek the support of a licensed mental health professional that has received training in Cognitive–Behavioral Therapy.  Become a wise consumer.  Do not assume that all therapists have received this training or that all therapists are equally comfortable with this modality.  Ask them! Take the time to learn the foundations from a qualified mental health professional.  Then seek out the self-help workbooks as practice tools if recommended by your therapist.

Remember that your anxiety did not occur over night; it will take some time and considerable effort on your part to manage it!  Be patient with yourself during the process.  Negativity and self-criticism only compounds the very symptoms you are seeking to eradicate! The sooner you begin the process, the sooner you can reap the rewards.

Are Worry and Anxiety Related?

What is the relationship between anxiety and worry?  Can an individual worry and not feel anxious?  Similarly, can an individual feel anxious but not worried?  The age-old debate of which came first…the chicken or the egg once again applies.  In today’s post, I will discuss anxiety, theories of anxiety’s relationship to worry, its physiological symptoms and its origins.  The next post will discuss treatment options.

WHAT IS WORRY?

Is worry merely a different name for anxiety?  Worry is an integral component of anxiety, although worry is a process that can exist in the absence of anxiety.  Let’s identify worry as a primarily mental (thinking) activity.  When an individual worries, their mind is preoccupied with fear or dread. Often thoughts have a prevailing theme of negativity - rehearsing the worse case scenarios. Worry can range from the nagging little voice inside your head to unrelenting obsessions that can neither be ignored nor quieted.  Depending upon the severity of the negative thoughts and the permanency of those thoughts (statements that begin with never or always) some level of physiological reaction frequently follows.  Ultimately the mind convinces the nervous system to prepare for battle.  This then triggers a fairly predictable sequence of autonomic physical symptoms that characterize anxiety (e.g., fear, racing heart, sweating & tingling sensations).  In this theoretical framework, anxiety is identified as the reactive symptoms an individual feels within their body in response to their mental state of worry.

An alternative theory suggests that when an individual feels a myriad of undesirable physical symptoms that seemingly “come out of the blue” they often question their origin (a mental process) and may begin to either hyper-focus on the severity of the physical sensations or obsess about an ultimately fatal outcome when these symptoms worsen. Worry is the mental process triggered by feeling anxious rather than the cause of the anxiousness. Ultimately when worry sets in the autonomic system prepares either to take flight or to fight.  Some individuals may then experience the very scary physical symptoms known as a panic attack.  Following this logic, a panic attack is an extreme physical manifestation of anxiety. Understand that an individual may feel both worried and anxious and not experience a panic attack.

What conclusions can we draw from this chicken or egg debate?  Both positions identify a relationship between the mental processes and the physical symptoms that define the term anxiety.  Anxiety is neither all bad nor is it always a diagnosable condition!  Historically it has served as an alerting and preparation mechanism to safeguard us from impending danger.  For anxiety to meet DSM-V diagnostic criteria symptoms must be frequent, extreme and a source of ongoing distress (at least six months).

SYMPTOMS

Many symptoms of anxiety can mimic those of a heart attack - if you experience them seek medical attention immediately! Anxiety can present as chest pain or tightness in the chest, numbness and/or tingling in the arms and/or legs, labored breathing (as if an elephant is sitting on your chest), racing heart, cold sweats, dizziness, chills, tightness in the throat, elevated blood pressure, ringing in the ears, restlessness and/or agitation, gastrointestinal distress and most frequently a profound sense of impending doom.

Remember that when we’re anxious our bodies are activated to either flee or fight. A great illustration of this phenomenon has been captured by many National Geographic documentaries that feature hunting behaviors of animals in the wild.  The predator (lion) stalks and takes chase after unsuspecting prey (gazelle).  The gazelle exhibits the flight mode, the lion the fight mode.  Our brains have not yet evolved beyond these basic primal responses!

Additional physical symptoms of anxiety may include a cluster of symptoms characterized by tension: feeling keyed up or on edge, irritability, muscle tension, fatigue and sleep impairment.  Sleep impairment may range from difficulty falling asleep to early awakening to unsatisfying sleep (sleeping but not feeling rested).  Cognitive symptoms of anxiety may often include a temporary inability to recall names, events and previously over-learned information (mind going blank). The best example of this phenomenon is test anxiety-despite knowing the topic, the test appears to be written in a foreign language because the student cannot remember anything.  When a person feels anxious, it can also seem that any attempt to learn or take in new information is impossible.  This is another example of the mind going blank.  Once the anxiety dissipates, cognitive abilities return to their normal level of functioning. In summary, while the symptoms of anxiety are specific to the individual, general themes involve cardiac-like symptoms, tension symptoms and cognitive symptoms. Now let’s look at who, what and where regarding anxiety.

ORIGINS

Recent statistics indicate as of 2011, anxiety surpassed depression as the primary complaint identified by patients to their general practitioner.  Historically, women have been twice as likely as men to present with symptoms of anxiety.  Recent literature also suggests that men may be closing this gap as anxiety becomes less stigmatized within the general population.  Anxiety appears to be more prevalent in developed countries and spreads across lifespans.  The differentiating factors are age-related concerns.  For example, children may exhibit anxiety regarding school concerns while adolescents may be more likely to report anxiety regarding dating, school and independence.  Adults may report anxiety regarding advanced education, professional growth, marriage, families and aging parents.  The elderly may exhibit anxiety regarding their declining health status, grief from significant losses and their own death. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, cites “childhood adversities and parental overprotection” as risk factors for developing anxiety.  Also reported in this edition is that one-third of the risk of developing a diagnosable anxiety disorder may be related to genetic transmission.  This is roughly equivalent to the genetic factors associated with a diagnosis of major depression. The balance of the contributing influences may be related to personal temperament.  This means that certain individuals who are harm avoidant, behaviorally inhibited and display negative affect may be more susceptible to developing an anxiety disorder compared to individuals who are more comfortable with risk, are behaviorally extroverted and display positive affect.

CONCLUSION

As I stated earlier in this post, if you intermittently worry and feel anxious, that may simply be a reaction to specific life events and completely normal: life can be stressful!  To meet diagnostic criteria, symptoms must be extreme, chronic and incapacitating.  The presence of panic attacks, symptoms that necessitate frequent emergency room visits and symptoms that render an individual unable to maintain appropriate daily self-care and social relatedness are of significant concern to both behavioral health and primary care professionals. In these instances, after a thorough evaluation, a diagnosis of anxiety may be warranted.

Stay tuned for Part II where I will discuss treatment options.  Specifics regarding panic attacks will be discussed in a dedicated post on that topic.

Is Quantity More Important Than Quality?

Over the past decade, this question has elicited the most animated discussions among clients in my practice.  It mostly refers to time management, usually regarding primary relationships: children, parents (including in-laws) and spouses.  This post will explore the relationship of quality to quantity as well as pose questions that will assist you in uncovering your motivation as it relates to these choices.

For the sake of clarity, I will first describe the terms that form the basis of this discussion.  Quantity broadly refers to things that can be measured, whereas quality is more discreet and refers to a peculiar or essential element.  Time management refers to the ability of an individual to allot their personal resources in the form of energy and focus in their life.  For purposes of this discussion, I will make one important assumption: that the individuals who are struggling to balance quality and quantity are truly seeking what is in the best interest of their loved ones and not using quantity v. quality simply as a justification for selfishness. 

Children

The primary dilemma that I hear voiced in my practice by parents is how to maximize interactions with their children while engaging in demanding careers. An unfortunate reality is that in the lives of infants and especially toddlers their “firsts” (i.e. smiling, standing, crawling, walking) cannot be scheduled.  As most parents can attest, sometimes stepping into the next room can be too far away from the action, let alone across town!  Therefore, with these developmental stages, quantity seems to trump quality.  Parents have attempted to maximize quantity through job share opportunities, split shifts and telecommuting.  Video streaming has also been a way that some parents have been able to remain connected despite demanding careers.  Yet another option has been childcare delivered by family members. During these developmental stages consider that quantity is quality.

An interesting juxtaposition occurs as your child enters school.  As the child’s interests broaden their preferences may transition to quality time rather than sheer quantity with their parents.  The parental problem at this developmental stage is what constitutes quality time?  Is it the 10 to 15 minute commute to and from music lessons, dance or sports?  Is it observing from afar their child’s extra-curricular activities?  Or does quality time refer to time spent playing video games with them or supervising homework? 

Each family needs to define what constitutes quality interactions.  I would hope that the definition includes a movement away from activities that involve coaching, critiquing and/or instructing.  Focus more on activities that require interaction with each other – board games, walks, hikes and gardening.  This is also a good time to begin rituals like family dinner hours, dedicated times for quieting of electronic devices and pre-bedtime rituals.  Remember that even though children may be completely capable of reading to themselves, reading with their parent at bedtime often remains a significantly fond memory years later. 

With adolescence and emerging adults the potential for a complete role reversal with their child may occur.  It is often the parent who complains of little if any time spent with their child.  Parents may suffer from “separation anxiety” when their teen leaves the house because as parents they cannot assure their child’s safety.  It is also a pivotal time when guilt may be used by both parents and their children to leverage opportunities for quality time. 

Parents who have traditionally assuaged their own guilt about the quantity/quality debate during their child’s earlier years may now consciously ramp up these efforts because their child is more vocal.  If buying “things” or attempting to create quality time with extravagant getaways became an avenue from which to engage with your child, the tables may turn when they become teenagers.  The child who has become accustomed to this parental behavior may now raise the ante to capitalize on their parent’s feelings of guilt.  This may be an example of a ritual that began in the early years that became unhealthy.  Why not focus on getting to know your teen and allow them to know you beyond your parental role? For parents, it may stave off feelings associated with the impending doom of empty nest.

Parents and In-Laws

In my post  “When the Child Becomes the Parent,” I explained the fundamental shift that occurs as our parents decline with age.   As senior parents decline, they may project more emotional dependency upon their adult children.  They are at risk for increased loneliness and this often translates into depression and anxiety that in turn affects their physical health. This is especially true when they live alone. In this case, quantity rather than quality is once again preferred, especially if their memory has been affected.  It is more difficult for them to know whether you visited last month or yesterday because their sense of time often becomes impaired.

Active seniors however, may have established a satisfying social life prior to their decline.  A considerable number of my clients report feeling angry that their parent(s) “don’t have time for their family.” My suggestion would be to book your time with them!  Quality would be the primary goal at this life stage.

Spouses/Significant Others

Ideally, couples want to spend time together.  I believe that there is often an assumption about what constitutes quality time rather than a mutually agreed upon decision.  If one partner believes that co-habitating addresses both the quantity and quality dimensions while the other partner actually expects some undivided attention, this could become a recipe for disaster!  Risks of assuming that your partner adopts your viewpoint increases with years spent together.     

If your relationship pre-dates the era of electronic devices, I highly suggest you discover how your mate really feels about their usage while spending time together.  If you are familiar with the book The Five Love Languages, it is safe to assume that therein lays valuable insight into what defines quality to each partner. If you are interested in this topic but have yet to complete the surveys at the back of the book, follow this link: http://www.5lovelanguages.com.

SUMMARY

This discussion has suggested two important points regarding quality and quantity in significant relationships: (1) One size does not fit all and (2) Quantity and quality are interrelated.  Not only do our life stages dictate our needs and desires for time, energy and dedicated focus, our temperaments also serve as a barometer for need. Thus the nature of the relationship and the key people affected dictate which choice is most necessary.  Since relationships are constantly evolving, what may be relevant one year may not be entirely relevant five years from now.  The last and most important point is that quantity and quality are interrelated.  I propose that quality time is not dependent upon extensive planning or exciting activities, but rather a spontaneous shared moment whereby a precious memory is created. Most frequently it involves sharing simple pleasures (sunsets, star gazing, sunrises). A simple pleasure requires the gift of time to occur naturally. Your life will become exponentially richer when you create an opportunity for spontaneity.  This requires chunks of non-dedicated time not only to experience simple pleasures but also share them with your cherished loved ones!