Understanding the impact of parental mental health issues on children is a priority today. Research on child development has informed us about the kind of environment and parenting styles children need to develop in the healthiest possible manner. There are numerous articles written to report clinical and research findings about the impact of mental illness on parenting behaviors (see Mann and Gregoire, 2000). In particular, the interaction between multiple factors influences the relationship between parents’ psychiatric disorders and children’s development; it is a complex picture. To date, little is known about the effects of parental OCD and what happens to the offspring. One study reported the finding that children with a parent with OCD are more likely than those without a parent with OCD to have social, emotional and behavioral disorders (Black, Gaffney, Schlosser and Gabel, 2003). Yet, the good news is that this is not so for all children. Why is this not discussed more in the literature given the prevalence of OCD? What are the risk factors for certain children? How could we offer earlier and better intervention for those families in need?

Obsessive Compulsive Disorder affects 1 in 50 adults, making it one of the most important disorders to research to gain understanding of how its symptoms impact these adults’ children. The typical symptoms associated with OCD include intrusive, unwanted thoughts, ideas, or images that evoke anxiety (obsessions); and behavioral or mental rituals performed to neutralize the anxiety (compulsions). When the obsessions and compulsions occur, they can disrupt the normal social and productive functioning of an adult. In this way, OCD impacts entire families because, just by the nature of the disorder, OCD symptoms invade the lives of others, not just the person with the diagnosis.

Accommodation is an intuitive way in which family members try to provide support to the person with OCD, but inadvertently this response reinforces the fears that underlie rituals. Accommodation can be defined as readiness to assist or appease others. In terms of OCD, Waters and Barrett (2000) identify the family context as a potential risk factor in the development and maintenance of the disorder. Storch et al. (2007) have published extensively about pediatric OCD and the role of family accommodation with regard to functional impairment and OCD symptom severity. With regard to adults, Van Noppen and Steketee (2009) identified family accommodation as the largest contributor to predicting OCD symptom severity in a series of path analyses. Despite what we know about how parents, spouses and other family members accommodate OCD, there is almost no discussion of what happens for children trying to cope with OCD demands for a parent. Our aim is to get the dialogue going, to understand what is happening and to develop effective family interventions.

The Family Accommodation Scale (FAS-IR, Calvocoressi et al., 1999) is a 13- item clinician-administered measure of the extent to which family members accommodate OCD symptoms in specific ways. The original scale was designed to assess the extent to which adults accommodate a loved one’s OCD by avoiding certain triggers, participating in rituals, providing excessive reassurance, and modifying personal and family routines. We have recently revised this measure so that it can be used to assess the extent to which children accommodate a parent’s OCD symptoms. We will begin to use this measure to identify children and families that need interventions to decrease accommodation, and to improve parenting practices which, if left uncorrected, may have a negative impact on a child’s development.

Children can accommodate a parent’s OCD symptoms in a variety of ways. The following is a series of clinical vignettes, each of which describes different types of accommodation:

1. Children may offer reassurance to their parents in order to diminish the anxiety they have regarding their obsessions.
   “Both of my parents are “germaphobes.” My Dad is afraid of the flu, and my mom is afraid of dirt. They are always sitting us kids down and lecturing us about washing our hands. As soon as we get home from school my mom leads us to the bathroom, and I’m pretty sure she sprays Lysol on our school stuff and shoes. Mom expects us to use hand sanitizer at school during the day, too. When I get home that’s the first thing she asks-not “‘How was your day?’ but, ‘Did you use your hand sanitizer?’” Now that I’m smarter, I just tell her yes no matter what.”
2. Children may avoid doing or saying things that could trigger a parent’s rituals.
   “My mother was always afraid we would drown. Whenever we went near water, a pool, the ocean, or whatever, she would make us wear a life preserver or she’d hold our hands tightly. She also had words she would say under her breath. Eventually the other kids and I grew to not like swimming, and said no to friends’ invitations to the beach. It was just easier.”
3. Children may participate in a parent’s rituals or complete rituals on his or her behalf.
   “It used to take my Dad so long to check the windows and doors in the morning when we were trying to go to school that I just offered to do it for him one day. He was relieved, and next thing I knew I was doing it every day. It was a pain, but at least I got to school on time.”
4. Children may help a parent avoid triggering stimuli.
   “My mother used to bring me into the bathroom with her in public places. Usually she avoided going, but if she needed to she would ask me to clean the toilet seat with a special spray she carried in her purse, and wipe down the door handles. I didn’t like doing it, but if I refused she would get really upset.”
5. Children may make decisions for parents to avoid a parent’s anxiety of “not knowing” the right choice.
   “In restaurants, my step-dad would take so long trying to decide what to eat. He would ask everyone what he should have, and sit staring at the menu for a long time. The waitresses would get impatient. One day my brother just ordered for him, and he said that dinner was the best one he ever had. My brother was proud that he helped, and then started making food choices for him more often.”
6. Children may modify their schedules or responsibilities to accommodate their parent’s OCD.
   “I clean the bathrooms at home now because my mom just can’t do it. She washes her hands over and over when she even stands in the bathroom, never mind touches anything.”
7. Children may complete household tasks for their parent with OCD.
   “My Dad fears trash day. My mom says he has to take out the garbage, and you can tell by the look on his face he is really afraid. They yell sometimes, and if my Dad can’t do it my mom ends up taking it out. She stomps her feet and mumbles angry things under her breath. I feel really bad sometimes, and if I get home early enough from school I try to take it out before any of that happens.”

Some research suggests that children of parents with OCD may be at higher risk of having anxiety, OCD or OCD-like disorders, or behavioral disturbances due to a genetic-environment interaction. That is, the vulnerability to develop OCD is likely heritable, yet not all kids with parents express OCD. Thus, there must be other factors that affect an individual’s biology. Further research has revealed the resiliency that many children demonstrate when raised under adversity. There is much interest in understanding what promotes resilience, which is a process that guides people to “bounce back” from stressful situations. (Dyer and Mc Guinness, 1996). If we could better define protective factors that reduce the likelihood of children exposed to extreme conditions due to the demands of OCD and develop interventions to assist families with these difficult circumstances, then we would certainly make public health strides.

Interventions aimed at decreasing children’s accommodating behaviors will help both the parent and the child. The parent will be better able to treat their OCD symptoms if they are not being accommodated by the family, and the children will be protected from involvement with the OCD and any disruption it may cause in their day to day life and overall development. The following is a list of interventions which could be offered to support families with a parent diagnosed with OCD:

1. Parenting education and support.
   Information on effective parenting practices and why it is important to keep children uninvolved in OCD rituals will help to decrease the impact of OCD symptoms on the child and foster a healthier relationship between the parent and child. Ongoing support, in the form of counseling or support groups, will ensure that parents are able to consistently employ effective strategies and not revert back to engaging their children in their rituals.
2. Psychoeducation.
   Educating children about OCD and ways to support a parent in treatment would offer children a way to help their parents in an age appropriate manner. Children will benefit from a better understanding of a parent’s behavior and how they can help by learning what they can say or do. With this information they will be less vulnerable to becoming engaged in OCD rituals and will feel empowered that they are part of the helping process.
3. Multi-family Intervention.
   Multi-family behavior therapy (MFBT) can be utilized to involve whole families in the treatment of OCD and in a group format. Families would receive support from each other, encouragement to stay in treatment and perform exposure and response prevention exercises effectively, as well as ideas regarding how to minimize the impact of OCD on overall family functioning.
4. Creating or expanding a family’s support network.
   Families impacted by OCD benefit from the support of a well informed and caring support network. Working with families to develop this network and use it to get through challenging times will also help to prevent children from participating in their parent’s OCD rituals.
5. Development of coping skills.
   Children, in general, are eager to learn and employ new ways to help themselves feel better. The introduction and reinforcement of coping skills will provide them with techniques and strategies they can use when they are experiencing anxiety, depression, or any kind of life stress (including any feelings brought on by living with a parent with OCD). The earlier these skills are introduced the more likely the child is to embrace them and utilize them during challenging times.

In conclusion, greater understanding of the impact of parents OCD on their children’s development and mental health outcomes is necessary so that effective interventions can be developed and utilized. Further research on this topic, in conjunction with the research on resiliency factors, are imperative so that we can anticipate which youth are at risk and implement appropriate services and supports. With OCD impacting one out of every fifty adults, effective recognition and intervention practices could have a profound impact on the next generation.

References

Black, D.W., Gaffney, G. R., Schlosser, S. & Gabel, J. (2003). Children of parents with obsessive-compulsive disorder- 2 year follow-up study. Acta Psychiatry Scand, April 107 (4) 305-13.

Dyer, Janye & McGuiness, Teena (1996). Reslience: Analysis of the concept. Archives of Psychiatric Nursing, Vol X, No. 5 276-282.

Mann, J. & Gregoire, A (2000). The effects of parental mental illness on children. Psychiatry, 1:5, 9-12.

Storch, Eric A., Geffken, Gary R., Merlo, Lisa J., Jacob, Marni L., Murphy, Tanya K., Goodman, Wayne K., Larson, Michael J., Fernandez, Melanie and Grabill, Kristen (2007). Family accommodation in pediatric Obsessive-Compulsive Disorder. Journal of Clinical Child & Adolescent Psychology, 36:2, 207 — 216.

Waters, T.L. & Barrett, P.M. (2000). The role of the family in childhood Obsessive-Compulsive Disorder. Clinical Child and Family Psychiatry Review, Vol. 3, No. 3, 173-184.

Bullying statistics

Every 7 minutes a child is bullied. Adult intervention occurs in only 4% of the incidences, peer intervention occurs in 11%, and no intervention occurs 85% of the time.  These numbers are concerning, and perhaps reflect how difficult it is to detect bullying and understand from afar which incidences are causing serious distress in the victim.  I have heard school counselors and teachers state that “kids have to work out peer situations for themselves” which reflects an ambivalence some adults report about when and who should intervene.

77% of students are bullied mentally, verbally, & physically. This statistic reminds us that while some children are targeted more than others, more students experience bullying than not during middle and high school.  While overall violence has decreased slightly in schools, there has been a huge increase in cyber-bullying.  Increased use of technology among teens has provided new ways to bully and a sense of “anonymity” and distance from the reaction of their victim.

All forms of bullying were significantly associated with increases in suicidal ideation, and 20% of respondents reported seriously thinking about attempting suicide (Hinduja & Patchin, cyberbullying research center, 2010).  While it is clear to most people that bullying is wrong and should be prevented, this statistic calls our attention the most to this important topic.  Bullying creates suffering and anxiety in its victims, but for many it is so distressing that they no longer want to live.  This may also be related to how well the victim feels people understand their experience and are working to help them resolve it.  It is important for all parents and adults involved in a child’s life to ensure that they feel safe at home, in school, and in cyberspace.

Massachusetts New Law

In May of 2010, anti-bullying legislation called Chapter 92 was unanimously passed by Massachusetts’ House and Senate, and the Governor signed it immediately.  This followed the highly publicized deaths of 3 Massachusetts children by suicide which was clearly related to bullying incidences.  Chapter 92 is the strongest anti-bullying legislation in the country, and it is considered by some to be a pilot for other states to follow.  The law is based on the legislation Norway created to address their “bullycide” incidences, a term created to mean suicides resulting from bullying, which has resulted in a dramatic reduction.

Because bullying leads to increased anxiety and depression in children and adolescents, I am encouraging parents and educators to familiarize themselves with the legislation to ensure that they are prepared to advocate for their children/students if a bullying incident occurs.  Also, if the child is considered a potential target of bullying their parents/school personnel should proactively put measures in place to prevent victimization before it happens.  Below is a summary of the main points of Chapter 92, and a list of resources available to parents and educators.

Chapter 92: An act relative to bullying in schools (Approved May 3, 2010)

See http://www.mass.gov/legis/laws/seslaw10/sl100092.htm for a copy of the full legislation.

Highlights of the law:

• Defines Bullying and Cyber-bullying comprehensively.
• Prohibits Bullying and Cyber-bullying on school grounds and off, either with school technology or with personal devices
• Requires schools to educate staff and students about bullying and its impact
• Requires schools to have a plan to handle bullying comprehensively
• Requires IEP’s of potential victims to address the skills and proficiencies needed to avoid & respond to bullying
• Requires ongoing professional development for school teachers, staff and administrators
• Holds principals accountable for ensuring that the plan is implemented and maintained according to guidelines
• Requires any adults working in schools to report incidents immediately and the school to investigate all reports promptly
• Specifies interventions post-investigation
• Requires schools to collaborate and work with law enforcement
• Describes two charges that may be filed against a perpetrator and the accompanying punishments if found guilty:
  • Crime of Stalking: shall be punished by imprisonment in the state prison for not more than 5 years or by a fine of not more than $1,000, or imprisonment in the house of correction for not more than 2 ½ years or by both such fine and imprisonment
  • Crime of Criminal Harassment: shall be punished by imprisonment in a house of correction for not more than 2 ½ years or by a fine of not more than $1,000, or by both such fine and imprisonment
• Calls for the formation of a special commission to review the General Laws and consider potential amendments, and to investigate all reported bullying incidents that require law enforcement intervention.  The special commission consists of:
  • Attorney General (Chair)
  • Representative of MA District Attorneys Assoc.
  • Representative of MA Chiefs of Police
  • Representative of MA Sheriffs’ Association
  • Representative of MA Association of School Committees
  • Representative of MA Association of School Superintendents
  • Representative of Association of Independent Schools in NE who represents a MA school

Resources for Parents and Educators

• What to do if your child is being bullied: Health Resources and Services Administration http://mentalhealth.samhsa.gov/publications/allpubs/bullying/SBN_Tip_21.pdf
• Cyberbully.org
• Stopcyberbullying.org
• Cyberbullying.us
• Olweus, Dan, University of Bergen, Bergen, Norway, olweus@psyhp.uib.no
• Handbook of bullying in schools: An international perspective. (2009) Jimerson, Shane R. (Ed.); Swearer, Susan M. (Ed.); Espelage, Dorothy L. (Ed.)New York, NY: Routledge/Taylor & Francis Group.
• The Bullying Prevention Handbook: A Guide for Principals, Teachers, and Counselors by John H. Hoover and Ronald L Oliver
• Bullying Prevention for Schools: A Step-by-Step Guide to Implementing a Successful Anti-Bullying Program by Allan L. Beane
• Bullyproof Your Child For Life: Protect Your Child from Teasing, Taunting, and Bullying for Good by Joel Haber and Jenna Glatzer
• Protect Your Child from Bullying: Expert Advice to Help You Recognize, Prevent, and Stop Bullying Before Your Child Gets Hurt by Allan L. Beane
• The Everything Parent’s Guide to Dealing with Bullies: From playground teasing to cyber bullying, all you need to ensure your child’s safety and happiness (Everything Series) by Deborah Carpenter and Christopher J. Ferguson
• Bullying in Schools – Is Your Child Being Bullied? What You Can Do as a Parent by Joy Adams
• The Bully Solution: A Parent’s Guide: Effective and Practical Ways to Empower Your Child and Stop Bullying in Its Tracks by Carol S. McMullen
• Podcasts: StopBullyingNow! And The Circle of Respect
• iPhone App:  Bully Shield! $.99

Resources from Mass.gov

The Massachusetts Department of Public Health, the Governor’s Task Force on Hate Crimes and the Massachusetts Commission on GLBT Youth developed  Direct from the Field: A Guide to Bullying Prevention which provides tools and strategies for working with  bullies, targets and bystanders.

The U.S. Department of Health and Human Services (USDHHS) provides a fact sheet entitled Best Practices in Bullying Prevention and Intervention which details strategies which interested parties can implement to improve school climate and make schools safer for all who attend.

Stop Bullying Now! is a USDHHS website which offers interactive, Web-based activities for young people to help them understand how to get help if they are the target, the witness or the aggressor in a bullying situation.

The National Youth Violence Prevention Resource Center is sponsored by the Centers for Disease Control and Prevention and provides links to a wide variety of resources for students, parents, educators, and law enforcement professionals seeking strategies and solutions to bullying problems.

Final Word

We will all need to work together to ensure that this legislation provides the safety net children need to feel that they can either avoid being bullied or get help when they are bullied.  It is my hope that it will eliminate bullycide altogether.  No child should have to feel that suicide is the only option they have to resolve victimization!

Look for Good Behavior

It is easy for busy parents to fall into the trap of commenting only on behavior that needs changing. “Don’t chew with your mouth full,” “Pick up your room” and “Stop yelling” are a few examples of corrective comments parents make in an attempt to train their child to behave differently. With positive parenting, the focus shifts to praising and paying attention to the good behavior that is happening. “I’m glad to see you have a healthy appetite tonight,” “I notice you made an attempt to put some things away in your room,” and “I am so proud of the way you are sharing right now” are examples of this style. Sometimes it is even helpful to reward the positive behaviors as a way of reinforcing the concept that the right behavior receives a positive response. For example, a parent might say, “You did such a great job getting yourself ready for bed that I would like to read an extra book to you tonight!”

Avoid Problems

When possible, it is okay to avoid situations that lead to parent/child struggles until the child demonstrates better skills to manage the situation. An example of this is shopping at the supermarket. If a child has a tantrum, begs for items despite being told ‘no’, or routinely behaves in a disruptive manner in that environment, it is best not to bring her or him for a while. The parent then has the opportunity to tell the child what skills they will need to see for their child to be allowed to help them again in the future.(“When you show me that you can take ‘no’ as an answer,” or “When you are able to stay right with me you can come with me to the store.”) It is also helpful to make expectations clear ahead of time, and stay firm while in the environment. Commenting on the positive behaviors can help the child stay focused on what he or she needs to do as well.

Acknowledge Feelings

Children are very attentive to how they are feeling, and they respond well when adults acknowledge their feelings. Listening to their words and reflecting back what you hear in greater detail helps them feel understood and expands their emotional vocabulary. For example, if your child gets into the car after school and lets out a long, emotional sigh, you could respond with “I can tell by the sound of that sigh that you had a long day. You must be feeling relieved to have that busy day behind you!” These statements can begin better conversations than simply asking, “How was your day?” because the child has already heard that you understand he or she has a lot of feelings and he or she does not have to worry about convincing you of this.

Set Appropriate Limits

This guideline is fairly self-explanatory. It is important to be clear and concise about family rules, and to make sure your expectations are age-appropriate. Some children benefit from a visual reminder of expectations, and they may enjoy making a list or drawing to post in a visible spot at home. This helps them feel a part of the process of developing and reinforcing rules, and helps them to be more invested in following through with them.

The same is true with consequences. I encourage families to discuss what the consequences should be when a person breaks a rule, and to change them as needed to encourage better cooperation. Most of the time children come up with fantastic ideas! Following through with consequences is critical to any behavior modification program. Make sure you are willing and able to reinforce the ones you choose.

Teach New Skills

Modeling is an important way to show children how you expect them to behave. If you consistently speak with them in a quiet, calm voice, you are teaching them that this is the behavior you are wanting from them. If parents raise their voices, especially when encouraging their child to calm down, they are demonstrating that yelling is okay to do. In that situation, I encourage parents to ‘re-do’ the interaction and explain to their child that the second way they behaved was the correct way. Most children can accept the idea that parents make mistakes, but they do not like it when parents behave in a way that is inconsistent with their own rules.

Reduce power struggles

“Choose your battles” is an expression that has circulated among parents for generations. I use it here to remind us all that, just like our children, we cannot always get what we want! Rather than reinforcing too many expectations, it is easier and more effective to choose the three most important at any given time.

Offering choices is another effective technique to engage your child in the correct behavior while giving her or him a sense of control as well. An example of this is asking, “Would you rather put on your pajamas upstairs or in the living room?” Either way the pajamas will be put on, yet the child gets to be a part of the process.

Let kids earn privileges! Children today have so much, and this weakens their investment in ‘working’ toward something. It should not be presumed that kids get desserts, treats, TV/computer time, or special privileges just because you love them. These are rewards in life, and it is important for kids to realize this. If they go into the adult world expecting to get what they want without working for it, they will be unprepared.

Where to go from here

Keep reading. There are so many wonderful books and resources out there, and no technique will work all the time. It is important to keep your parenting ideas current by talking with other parents/family members, gathering ideas (even when you do not have a problem), and experimenting to see what will work for your family at any given age/stage.

Finally, take care of yourself. A rested and well-nourished parent has the greatest likelihood of consistently using positive parenting techniques. Remember the airplane example of putting your oxygen mask on before you help your children with theirs if there is a change in cabin pressure? Parents must help themselves before they can effectively help their children.

Best of luck on your parenting journey!

Resources:

Books
• Love & Limits: Guidance Tools for Creative Parenting by Elizabeth Crary
• Positive Discipline A-Z: 1001 Solutions to Everyday Problems by Jane Nelson, ED.D, Lynn Lott, M.A., and H. Stephen Glenn
• The Everything Parent’s Guide to Positive Discipline: Professional Advice for Raising a Well-behaved Child by Carl E. Pickhardt, PhD
• Positive Discipline by Jane Nelson, ED.D
• Loving Your Child is not Enough: Positive Discipline that Works by Nancy Samalin with Martha M. Jablow

Books (Early Childhood)

• Positive Parenting: Raising Healthy Children from Birth to Three Years by Alvin Eden MD
• 365 Wacky, Wonderful Ways to Get Your Children to Do What You want by Elizabeth Crary
• Tired of Nagging? 30 Days to Positive Parenting by Virginia Stowe MSN

Websites:

• Positiveparenting.com
• Positivediscipline.com
• Positive Parenting Radio featured on MrDad.com

My Review
I discovered this book recently and find that I frequently loan it to families with anxious children. There are also 4 CD’s that coincide with the different techniques described (sold separately), and they offer examples of the progressive relaxation, breathing techniques, and other skills described in the book. The self-assessment devices allow you to easily determine your current state of functioning, and assist with setting goals for positive behavioral change. Each chapter offers a list of ‘Further Reading’, and occasionally Web resources that support further learning on the subject. I am particularly impressed by the chapters on “Nutrition & Stress” and “Exercise”.

This title is available for purchase from Amazon through the books section here on EasingAnxiety.com. Please send me your feedback if you read this book. Thank you!

My Review:
Cool Cats, Calm Kids is an easy-to-read book for young children, and a great discussion starter for families! I recommend it for children who admire animals and need some new ideas about how to manage stress. Parents that find it challenging talking about stress with their children also tell me this book is an excellent prompt. One parent told me “It made us laugh as we read it, and when we noticed stress during the day we had fun acting like cats”. If you are looking for a non-clinical book to share with your child and some humorous (and helpful!) advice to manage stress, this is the book for you!

This title is available for purchase from Amazon through the books section here on EasingAnxiety.com. Please send me your feedback if you read this book. Thank you!

Assessing one’s satisfaction with areas of their life can be simple. I use a worksheet with my clients (download here) that asks them to fill in their degree of satisfaction with their spiritual life, home life, friendships, etc. There are also blank spaces for them to write in areas I did not list. By filling in the grid, the client reflects on different aspects of life, and displays how satisfied they are feeling about them in a visual manner.

This is a useful therapeutic tool because it begins the process of creating and following through with personal goals. For example, if a person marks down that they are dissatisfied with their level of exercise, the next question is “What would help you feel better about it?” Perhaps the person then identifies joining a gym, meeting with a personal trainer, or finding an exercise partner as ideas that could help them improve their satisfaction with exercise. One of these ideas becomes the behavioral goal, and the person is asked what kind of support, if any, they will need to follow through with the goal. If no other supports are identified, I ask the person to fill out a calendar each day for several weeks with information about how successful they have been with implementing the new behavior (see below).

Once clients have had an opportunity to try adding the new behavior for several weeks, it is important to check in about how the process is going. Are they encountering internal resistance to the new behavior? Are they forgetting to mark their calendars? Have they learned anything important about themselves in this process? If there is resistance, it is almost always because the goal that was set was too challenging (like exercising every day when they have not been active previously) or because it was a goal someone else had for them but in which they were not completely invested.

I encourage you to think about ways to use these tools as you help someone fight against anxiety. School teachers could use them with their individual or collective students to improve satisfaction in the classroom, parents could use them to start family discussions and make changes in overall family functioning, and spouses/friends could use them to identify ways to be more supportive or perhaps ‘back off’ from their efforts to help. In general, these basic skills can be used in many ways to facilitate discussions and to create positive behavioral changes in people’s lives.

Not sure how these skills can be useful to you? Try them yourself first. By gaining personal experience with them, you might begin to realize new ways to use them in your other roles. Here are some examples of behavioral changes a person could try to make to decrease his/her anxiety:

• Add exercise 4-5 times per week to your schedule
• Spend time each day talking directly with friends/family (not including electronic communication)
• Improve sleeping habits (get to bed at the same time each night, wake up at the same time each morning, etc)
• Drink more water
• Make a positive change to your usual nutrition pattern (add more fruit/vegetables, etc)
• Devote 15 minutes per day to practicing relaxation strategies
• Keep a journal
• Decrease consumption of beverages with caffeine

After filling out the satisfaction grid, choose a goal for yourself that will improve how you are feeling in one area of your life. Print out the calendar, and practice marking it off each day with how you are progressing. This creates accountability and makes you more likely to reach your goal.

Good Luck! And please let me know how you do.

My Review:
I often recommend this book to families because it gives a thorough yet concise overview of different strategies for managing anxiety. It is very easy to read, and can be useful for families to read together and start discussions. If you are looking for clear, non-clinical descriptions and useful ideas that can be implemented immediately, this is a great choice for you!

This title is available for purchase from Amazon through the books section here on EasingAnxiety.com. Please send me your feedback if you read this book. Thank you!

1. EXERCISE: Moving our bodies is an excellent way to relieve tension and decrease feelings of anxiety. Children ideally should be engaging in routine cardiovascular exercise 3-5 days per week to keep their bodies healthy. If your child is not currently physically active, start by talking with their physician about how to get them started, how much and what types of exercise are appropriate for them, and any potential health concerns they may have.

In addition to routine exercise, children also benefit from moving their bodies before being asked to sit down and concentrate. This allows them to release any built up energy or tension, and decrease the amount of anxiety they may be experiencing. Some examples of helpful movements include jumping rope, jumping jacks, walking, and interacting with a yoga ball (rolling, bouncing, etc). Families can experiment with what types and how much exercise is useful, but usually 10-20 minutes is adequate. Movement breaks can also be planned during the homework period as well to further the child’s benefits (10-15 minutes per hour for older children, 5-10 minutes per ½ hr for younger children).

Finally, children can utilize special activities while they are working on their homework to help them maintain their energy and focus. These can include manipulating a fidget toy in their free hand, sitting on a yoga ball instead of a chair, and using a ‘chair band’ (large elastic band that attaches to bottom of their chair and can be stretched using their leg muscles. These movements relieve tension and anxiety, and in most cases help the child focus even better.

2. RHYTHMIC BREATHING: Another important technique to manage anxiety at homework time is to incorporate self-calming strategies. One very influential approach is rhythmic breathing. This involves taking a few minutes of quiet time and paying full attention to one’s breath. I teach children a simple technique (breathe in to a count of 3, pause, breathe out to a count of 3) and encourage them to explore others if they are interested. It is critical that children practice this technique for a few minutes each day, preferably at night as they are relaxing and preparing for sleep, so that their body is able to ‘learn’ the appropriate response. Once they are skilled at rhythmic breathing, they can use it before any anxiety provoking activity to improve their relaxation and focus.

3. REASSURING SELF-TALK: A second useful self-calming technique for homework time is ‘reassuring self-talk’. This involves the child speaking soothing words to themselves, either out loud or within their own mind, about whatever is making them anxious. For example, if a child is worried they will not understand their assignment they may be thinking “I’ll never get it”, or “this is going to take me forever”. These negative thoughts often perpetuate the child’s anxiety, and make it harder for them to focus on the content of their work. If they change those thoughts to more positive, reassuring ones, such as “even though this looks hard, I’m sure I can figure it out” or “All I have to do is try my best”, they will feel calmer and more productive during their homework time. This skill also requires practice and consistent use to make it effective. Encourage your child to write down or say out loud some examples of reassuring thoughts they can use before they sit down to work. It may help to first write down the negative thoughts they are having so they know what positive statements will be helpful.

4. CALM ENVIRONMENT: Schools understand that the environment a child is in has a direct impact on their ability to learn. This is also true at home. Most children require a calm, quiet environment to maintain their focus on their homework and to keep them relaxed. For these children, a quiet room should be selected, telephones should be turned off, IM and texting should be discouraged, and disruptions should be kept to a minimum (other than exercise breaks). If there are multiple siblings trying to work in the same area, questions and conversations should be held in a different location to minimize the impact on each other. Many teens feel they can do homework and text/IM just fine, but in my opinion it decreases their productivity and the quality of their work. Encouraging them to experiment with no distractions for 1-2 weeks often helps them to realize the difference less distraction makes and avoids arguments.

Care should also be taken to keep emotional discussions away from homework time. If possible, discuss daily challenges or emotional issues well before or after children are expected to do their work. If that is not possible, set a time limit for how long the situation will be discussed and then use exercise as a technique to help them relieve tension and re-focus (if necessary).

For children who prefer a less quiet environment, using music or radio talk shows as background noise can be helpful. It is important to not have the tone or content be too upsetting, and non-emotional music creates the most conducive environment for relaxation. This music is available in a variety of mediums, including CD’s, iTunes, Pandora, and even YouTube.

If your child has tried the techniques described above and still feels anxious before homework, please remind them to keep trying! These skills take time to develop, and consistent effort will help them feel better soon.

1. SPACE: Try to establish a quiet work area with supplies (paper, pencils, rulers, etc) available. Since many children find working alone in a room to be too isolating, a “family” work area is a good idea, as long as there are clear rules encouraging good work habits. A parent or other adult should be available to answer questions and refocus the children as needed. Homework time is useful for parents to catch up on their own jobs (writing letters, paying bills, etc.) and allows them to model on-task behavior.

2. TIME: Children need homework time to be set in a routine, predictable manner. Parents should have the teacher estimate how much time should be set aside for homework. If possible, the same time each day is reserved for homework. If daily commitments vary, homework “appointments” should be set each week and written on a calendar. Homework should not be squeezed in when there’s time; it should have top priority. Some children do best completing homework in one session, while others need breaks. Once you know what works best for your child, try to schedule time limited rests into the regular work routine.

3. ORGANIZATION: Have your child explain homework instructions to you so you can be sure he/she understands what to do. Then encourage the child to decide the order in which each assignment will be done. Children are overwhelmed when too many books and papers are in front of them. Only materials being worked on should be visible. Make sure completed work is placed in the child’s backpack to be ready for the next day.

4. HOMEWORK HELP: It is important that parents are available to clarify directions or to help with specific problems. However, the purpose of homework is to practice skills that have been learned in the classroom. If you find that your child really does not understand the work, let the teacher know so the lesson can be taught again in school. Your role is to encourage, supervise and reinforce good study habits.

Dr. Myrna Silverstein is the consulting psychologist and child advocate for Rhode Island Tutorial and Educational Services. For more information: www.ritutorial.org

How do I (the parent) decide if the school needs to know about my child’s anxiety?

The answer to this question is complex, and this is an area where it is helpful to have a therapist to talk to. Your child’s experience of and reaction to anxiety is unique, and many factors need to be considered in making this decision. Some questions to ask yourself are: 1) Does your child’s anxiety impact his or her ability to learn or function socially at school? 2) Would accommodations help to alleviate the child’s symptoms during the school day or in the evening at home?, and 3) Is your child’s school able/willing to provide the necessary accommodations?

Let’s consider the first question. Symptoms of anxiety can include physical discomfort (such as rapid heartbeat, shortness of breath, shakiness, and accelerated thinking), intrusive thoughts, and somatic complaints (stomachaches, headaches, etc). When a child experiences these symptoms, they can become overwhelmed and lose their ability to pay attention and perform in school. If you are unsure how much anxiety is impacting your child at school, it might be helpful to start by learning more about your child’s anxiety symptoms. I often ask parents and the child with anxiety to keep a log at the beginning of treatment as a means of gathering important details about their anxiety that we will need in order to treat it effectively. If the parent and child take a few minutes each day to record the situations or symptoms that occurred during the day, they will have a comprehensive list of triggering situations and the anxiety symptoms that follow. Reviewing the number of triggers and the extent of the symptoms should help to answer whether or not your child is being impacted at school.

The second and third questions refer to accommodations school’s can make to address the symptoms a child is experiencing during the school day. In the public school system, parents can contact their special education department. Children with physical or emotional disabilities that restrict or disrupt their daily life activities may be eligible for a” 504 plan” (Section 504 of the Rehabilitation Act of 1973). This is a legal agreement between parents and their school district which ensures that agreed upon accommodations are in place for the child throughout their academic program. A multidisciplinary team at school will work with parents to determine eligibility and the types of modifications or accommodations that will allow the child to be successful at school. In my experience, some private and parochial schools will also accept the terms of a 504 plan regardless of whether or not they are legally bound to do so. For more information about 504 plans, you may contact your town or district’s special education services office or visit wrightslaw.com.

In my experience, accommodations such as preferential seating, changes in the format or quantity of class/homework, changes to the presentation method of academic material, as well as organization and handwriting support can have a positive impact. Once you decide accommodations are necessary, where should you start? A discussion with your child’s teacher may be the best way to begin the process.

How to talk to the school?
If your child struggles with anxiety at school, the first step is to engage your child’s teacher in a positive relationship at the beginning of the year. It is important to introduce yourself, identify your concerns about how your child’s symptoms may impact his/her ability to actively engage in the classroom, and ask what the teacher has done in the past to accommodate similar students. Listening to the teachers’ response will give you an indication of how much experience they have had with anxious students, and how willing they are to make accommodations. While all teachers are unique and bring to their classroom their own personal style, most recognize the need to address children’s emotional needs and are willing to make adjustments for them.

At some point, all parents experience feelings of frustration and sadness as they watch their anxious child struggle at school. Despite this, it is critical to not allow those feelings to alter your relationship with your child’s teacher or school administration. By keeping communication open and frequent, and by keeping all comments and requests specific, your child’s needs as a student will be addressed. It is always in the best interest of the student for the adults involved in their care to maintain a positive working relationship, and for there to be no disruption in their communication.

If a parent has tried to establish the relationship with the teacher I have described above and feels they have been unsuccessful, or that their child needs greater support, the next step is to approach the school’s counselor or guidance department. Their role is to support students’ emotional health, and they usually consult with the teachers as well. Many anxious children report feeling relief that they have a person at school they can check in with, and get ideas about how to manage their feelings or handle difficult situations that arise during the day. School counselors are also able to observe children throughout the day and provide feedback to parents about what they observe.

If interventions at the teacher and counselor level are still not enough, it is time to request a meeting with all relevant school officials to determine if a 504 plan (or perhaps an IEP) are necessary.

What to ask for accommodations
The following link, http://www.worrywisekids.org/schools/sample_accomodations.html, provides a comprehensive list of accommodations that can be requested to support anxious children at school. It is often worthwhile to consult with either an educational advocate or a therapist that treats children with anxiety before requesting specific accommodations to ensure the correct ones for your child are selected.

As parents you play a critical role as advocate for your child! It can be a demanding job, but the resolution of your child’s anxiety at school depends on your ability to be proactive, consistent, and well versed on both the symptoms your child is experiencing at school, and the options he/she has to resolve them.