Big Crowds Anxiety

Excitement and anxiety can sometimes look similar in children before a major event. A child with “excited jitters” may still eagerly talk about the game and respond well to reassurance, while a child experiencing genuine anxiety may become consumed by worry or even try to avoid attending altogether.

Physical symptoms can also appear in anxious children, including headaches, stomachaches and trouble sleeping leading up to the event.

“Excited jitters usually come and go, but anxiety tends to stick around and interfere with daily routines,” said Amanda Jordan, PsyD, psychologist with the Cook Children’s Psychology Department.

Preparing children ahead of time by showing them videos or photos of the stadium, discussing what they can expect and creating a clear game-day plan, can help prevent anxiety symptoms. Parents can also use “first-then” language to help children mentally organize the experience.

For example: “First we’ll find our seats, then we’ll get a snack.”

Families can also benefit from creating a safety plan before arriving at the venue, including identifying meeting spots and teaching children how to find stadium employees for help. Creating a funny family code word for moments when a child feels overwhelmed can also ease stress and remind children it’s okay to ask for a break.

Stadiums Sensory Impact

For many children, sport venues can overload the senses with bright lights, loud music, strong smells and tightly packed crowds. Dr. Jordan says sensory overload can trigger the body’s “fight, flight or freeze” response, making emotional regulation difficult. Children experiencing sensory overload may become irritable, restless or emotional. Others may withdraw, stop talking, cry or struggle to make decisions.

Several sport venues, especially the newest stadiums, now feature dedicated sensory rooms or quiet spaces designed to help guests decompress. Dr. Jordan encourages parents to research venues ahead of time to learn what accommodations are available and where they are located.

Even if a stadium does not offer a formal sensory room, quieter areas such as patios, hallways or less crowded sections may provide children with a chance to reset before returning to the event.

“These spaces can help lower anxiety and give children a place to regulate during stressful moments,” Dr. Jordan said.

Behavioral Challenges

Emotional outbursts during games can happen when children become overstimulated or overwhelmed. In those moments, Dr. Jordan says parents should focus less on discipline and more on helping children feel safe and calm. Getting down to the child’s eye level, speaking in calm tone and validating the child’s feelings can help them decompress and rebalance their emotions.

Parents can also use grounding techniques, such as deep breathing exercise or offering simple choices to help restore a sense of control.

For example: “Would you like to sit with me for a minute, or would you rather go walk around for a little bit?”

Dr. Jordan also encourages families to discuss coping strategies before the event so children know what support may look like if emotions escalate.

The emotional energy inside a stadium can also affect how children interpret social situations. Aggressive reactions from adults or fans may increase a child’s anxiety or sense of insecurity.

“Kids learn how to respond by watching the adults around them,” Dr. Jordan said.

Parents can help by calmly explaining emotional reactions happening around them, such as cheering after a goal or frustration following a penalty call.

Practical Advice

It is recommended to pack a few “mental health essentials” before attending a major sporting event with children.

Some of these items can include:

• Noise-canceling headphones, or earplugs
• Comfort items like a soft blanket or a plush toy
• Sensory or fidget toys
• Snacks

 These items can help children self-regulate and make the big game day more enjoyable.

Parents should also recognize when it might be time to leave early. If a child cannot recover emotionally after taking breaks or using calming strategies, it is time to prioritize the child’s wellbeing and step away from the event.

It’s also important to emphasize that sensory sensitivities are not limited to children with Autism spectrum disorder (ASD). Children with attention deficit hyperactivity disorder (ADHD), anxiety or trauma histories may also struggle in overstimulating environments.

“Sensory overload can affect many different children – and sometimes even parents too,” Dr. Jordan said.

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• Pediatric Behavioral Health – Top 50
• Pediatric Cancer - #41 in the nation
• Pediatric Endocrinology - #35 in the nation
• Pediatric Neurology and Neurosurgery - #33 in the nation
• Pediatric Orthopedics - #49 in the nation
• Pediatric Pulmonology - #48 in the nation 

Cook Children’s Neurology and Neurosurgery programs jumped an impressive 12 spots in the rankings, from No. 45 in 2024-2025 to No. 33 in 2025-2026. 

“For 18 consecutive years, the Cook Children’s Neurology and Neurosurgery programs have been recognized for the high quality of care we provide each and every day. We established the Jane and John Institute for Mind Health to further strengthen our ability to provide comprehensive, coordinated and innovative care ensuring better outcomes for the children in our community and beyond,” Cynthia Keator, M.D., medical director of Neurology and Scott Perry, M.D., head of Neurosciences at the Justin Institute, jointly stated. “This year’s ranking recognizes those investments and is only a glimpse of what the future holds.” 

Cook Children’s Diabetes and Endocrinology programs moved up nine spots in the rankings, from No. 44 last year to No. 35. 

“Our team is dedicated to improving the quality of care and the patient experience for our children with diabetes and endocrine diseases,” said Paul Thornton, M.D., medical director of Diabetes and Endocrinology at Cook Children’s. “Our department has been recognized nationally and internationally for our Centers of Excellence and we are delighted that this has translated into this honor by the U.S. News & World Report.”
 
U.S. News & World Report evaluated children’s hospitals based on a variety of factors, including quality of care, clinical research programs, services and surgeries performed patient and family involvement and access to resources, staff dedication, recognition as a Nurse Magnet Hospital, and more. 

For Cook Children's Health Care System as a whole, the rankings highlight longstanding excellence in a variety of areas.

“For over a century, Cook Children’s has been committed to providing the best possible care and improving the well-being of every child,” said Rick W. Merrill, President and CEO of Cook Children’s. “Being honored once again by U.S. News & World Report validates the exceptional dedication of our entire staff in fulfilling our Promise.”
 

September is National Suicide Prevention Month and it can make the difference in someone’s life to have emotional and mental health support with access to the resources they need. Being open to mental health education and counseling as well as finding the right medication or treatment is key. Often, parents can be hesitant to have their child on psychiatric medication. Cook Children’s psychiatrists are answering parents’ questions and raising awareness to help alleviate stigma and treatment for children.

What are mental health conditions?

Depression, ADHD, anxiety and behavior problems are the most common mental disorders found in children. According to the U.S. Centers for Disease Control and Prevention (CDC), “Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, causing distress and problems getting through the day.”

Kristen Pyrc, M.D., Medical Director of Psychiatry Outpatient Services and the Partial Hospitalization Program at Cook Children’s, said they diagnose mental health conditions when they are limiting a child or teen’s functioning.

“Worries, sadness, and anger are all normal emotions, but we become concerned when a kid’s sadness or anxiety keeps them from doing things that bring them joy, or things they need to do to take care of themselves like attending school, showering and interacting with friends,” she said.

How can mental health conditions be treated? 

Both counseling and medication can be used to treat a child with a mental health condition that affects their everyday life, but parents are often hesitant about having their child try medication.

“I’ve found medication and counseling to be equally effective for a child with anxiety and depression, but the combination of both gets kids better faster and safer,” Dr. Pyrc said.

Akemi Watkins, M.D., in Cook Children's Behavioral Health also recommends medication when needed. “If a child has moderate to severe depression or anxiety, we’ll recommend starting medication because current evidence suggests that a combination of medication and therapy is more effective than medication or therapy alone.”

Why are parents hesitant about their child taking medication?

Many parents are concerned with their child taking psychiatric medication because of potential side-effects, medication dependency, the stigma associated with it and even their own experience with mental health medications. The cost of prescription medications, especially name brand, can also be a major hurdle.

If a parent is questioning their child trying medication, Dr. Pyrc recommends, “Consider the risk of not treating anxiety, depression and ADHD, and whether that keeps them from reaching their full potential.”

Is it possible to get financial help to access medication?

The cost of medication often prevents parents from having their child try it. Name-brand prescriptions, especially when they are new to the market, are also out of most people’s price range.

Both Dr. Pyrc and Dr. Watkins help patients have access to their medication by finding similar, lower cost medications and recommending ways to find more affordable pricing.

“GoodRx can help you find the lowest cost pharmacy in your area,” they said. Dr. Pyrc also tells patients about CostPlus Drug Company which has many psychiatric medications at much lower costs that can be mailed.

How can we make taking medication a routine?

Helping a child get used to a new daily routine of taking medication can be challenging. Dr. Pyrc advises “habit-stacking” to make it easier.

“It means ‘stack on’ taking medication to something that you already do every day. Most people brush their teeth twice a day, so getting into the habit of taking medication after brushing your teeth is easier than trying to remember to take it at noon,” she said.

Setting phone notifications can also be helpful and Dr. Watkins advises the parent or guardian to be responsible for dispensing medication for safety reasons.

Medication Success Stories

Both Dr. Pyrc and Dr. Watkins have seen a lot of success stories when children and teens find the right medication.

“One of my favorite memories was a 1^st grader who had ADHD and got into trouble at school every day to the point that he did not want to go to school,” Dr. Pyrc shared. “After we started medication, he brought me his behavior log that had a smiley face for good behavior every day. I still remember the look on his face glowing with pride, and honestly, that is why I do my job.”

Dr. Watkins also experienced seeing her patients’ overall well-being and mental health improve.

“I had a teenage patient with depression and anxiety, and she was started on sertraline,” Dr. Watkins said. “After getting to a therapeutic dose, she was less socially isolated, less overwhelmed with anxiety and said that she was having fewer days where she felt depressed. She felt more motivated to attend school and her grades eventually improved as her depression and anxiety improved.”

Additional Support

When parents are still debating whether or not to have their child or teen try a psychiatric medication, Dr. Pyrc recommends they visit with their pediatrician who can help them understand what is “normal” or if something does need to be addressed. She also recommends researching the American Academy of Child and Adolescent Psychiatry (AACAP) to learn more about anxiety, depression, ADHD, sleep disorders and Autism in the AACAP Parents’ Medication Guides.

The past nine months have been marked by upheaval, uncertainty, isolation and change with the youngest among us feeling the weight of it all, and doctors at Cook Children’s Medical Center are sounding the alarm.

“I’ve been employed as a psychologist at Cook Children’s going on 26 plus years and never in my time have I seen such an intense number of patients with severe anxiety and depression,” said Lisa Elliott, PhD, manager of the behavioral health clinic at Cook Children’s. “It’s not uncommon for us to have high acuity patients periodically, but that’s become the norm for weeks and weeks where 70 to 80 percent of our total number of visits for anxiety and depression are severe.”

Dr. Elliott attributes the uptick, in large part, to fallout from COVID-19. 

A June 2020 survey of parents published in the medical journal “Pediatrics” revealed that, since the start of the pandemic, more than 1 in 4 parents reported a decline in their own mental health, and 1 in 7 reported worsening behavioral health in their children. Both a decline in parental mental health and child behavioral health were reported by 1 in 10 families, according to the study “Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey.”

Cook Children’s mental health experts say screen time, social media, academic performance pressures and lack of sleep all stress a child’s mental and behavioral health. All of those stressors have been exacerbated this year by pandemic-induced factors such as school closings, virtual learning, social distancing and isolation, according to Kathleen Powderly, M.D., a pediatrician on the medical staff at Cook Children’s. If ignored, these pressures can be a breeding ground for anxiety and depression.

And mental health experts are bracing for what is yet to come during the holidays as it’s not uncommon to see an uptick in depression and anxiety in children this time of year, particularly when there has been a significant family change, like in the case of divorce or loss of a loved one, according to Dr. Elliott.

So what is a parent to do? How do we help our children process these pressures to protect their mental and emotional well-being?

“We have to instill hope and stay calm and reasonable about it and, at the same time, not show fear.” Dr. Elliott said. “This is critical because we are going to set the tempo for our children. We will be what they follow. So it’s critical that we are calm and follow the safety guidelines, but tell our children this is not the way it’s going to be forever.”

And what better time than the holidays to model, teach and inspire hope?

Generosity Breeds Health and Hope

As stressful as the holiday season in tandem with a pandemic can be, it also presents a unique opportunity to teach children a concept that studies show actually improves mental health. It’s long been known that generosity and giving incite the same increase in one’s happy hormones as exercising. Giving makes you feel good—emotionally and mentally.

“Research shows that in addition to eating healthy and getting quality sleep, there are three things we can do to help keep depression at bay,” Dr. Elliott said. “One of them is exercising and another is socializing because they both increase endorphins. But the one that has the most long-lasting impact is philanthropy work. Doing things for others.”

A 2018 study published in the journal “Psychosomatic Medicine: Journal of Biobehavioral Medicine” showed a correlation between giving and increased activity in parts of the brain associated with altruism, reward and parental care and behavior. It further demonstrated that acts of generosity toward a targeted, or known, individual in need resulted in reduced activity in the amygdala—a positive given the amygdala is an emotion processing brain structure that signals the fight-or-flight mode when under stress. Increased activity in the amygdala is often seen in individuals with anxiety.

In addition to the chemical reactions philanthropy produces in the brain, doing good for others can help reframe one’s focus. Seeing the pain, suffering and circumstances of others gives perspective on one’s own struggles.

“Volunteer work helps create compassion because it draws concern away from ourselves,” Dr. Elliott said. “That’s why doing for others is so valuable for children. It teaches them compassion and optimism, and helps them develop gratitude.”

It also promotes the concepts of empathy and resilience, which are important building blocks for emotional and mental strength and valuable coping skills that help children deal with other challenges that come their way, according to Dr. Elliott.

This year, the need for generosity and service to others is especially great, given the economic impact of the pandemic. COVID-19 safety guidelines may require outside-of-the-box thinking to safely, yet personally, meet a need, but don’t let that stop you. It’s a great opportunity to get creative with your child.

With the help of Cook Children’s certified child life specialist Lauren Lasrich, MS, CCLS, we’ve compiled a list of ideas to help you and your family get started.

• Pack a grocery bag full of items and ingredients needed for Thanksgiving dinner for a neighbor in need. Let your child help create the menu and shop for the items together, either online or in the store. Deliver the groceries to their doorstep with a homemade card created by your family/child.
• Gather the family to rake leaves and clean up the lawn of an elderly or disabled individual. You’ll help a friend and get some sunshine and exercise for yourself and your family at the same time. Sunshine and physical activity are mood boosters!
• Adopt a family in need for the holidays. Check with your child’s school to see if they collect Christmas gifts for students in need and offer to purchase something on the student’s/family’s wish list. Get your child involved in the shopping process, be it online or in store.
• Together with your child, research a local organization or charity that promotes a cause you connect with and find out how you can help them meet the needs of those they serve. Create a family donation jar and save change to donate to the charity.
• Organize a neighborhood food drive and collect non-perishable food items from your neighborhood to donate to a local food pantry. Let your child decorate a donation box and put it on your porch so that your neighbors can safely deliver their donations.
• The end of the year is a great time to reduce and reuse! Go through your house and collect gently used household and clothing items you no longer need/use to donate to a local charity.
• Write letters/draw pictures to deployed military members or health care workers. For information on how to do this, or other ideas for supporting our troops, check out How Can I Support the Troops? 5 Ways You Can Help Deployed Soldiers at uso.org.
• Do a drive-thru Christmas caroling tour in your neighborhood. Let your neighbors know ahead of time when you plan to be out caroling so they can step outside and enjoy the show. Decorate your car ahead of time as a festive and fun family activity.
• Make toiletry kits and donate them to a local homeless shelter.

Not only will these activities help others, but they’ll give your child a project to look forward to.

“I tell people, especially during the pandemic, you have to have one thing to look forward to,” Dr. Powderly said. “It may not be the same thing that you enjoy previously, but you have to have something to look forward to because it gives you hope, and that’s what we all kind of need a little bit more of right now is hope.”

What to Watch For

Knowing the signs and symptoms of anxiety and depression can help you help your child before things get severe. For children, look for three or more of these symptoms, according to Dr. Elliott:

• Excessive worry for more time than typical. The difference between normal worry and anxiety disorder is the severity.
• Difficulty controlling worry.
• Easily fatigued.
• Restlessness and difficulty concentrating.
• Irritability.
• Muscle tension.
• Sleep disturbances.
• Sudden change in grades and school performance.
• Disinterest in a previously loved activity.

If your child is experiencing any of these symptoms and you are concerned about their mental or behavioral health, Cook Children’s is here to help. To access any of the hospital’s behavioral health services, call 682-885-3917. For emergencies, call 911.

Widespread change due to the COVID-19 pandemic has swept the nation, which has left many parents struggling to keep essential appointments with, not only their physicians, but with behavioral health specialists as well. Parents are now questioning the safety of the world beyond their windows and this has led parents, as well as psychologists and psychiatrists, to the use of telemedicine.

While Cook Children’s launched the telemedicine program in 2004 before the pandemic gripped the United States, this unprecedented time has pushed the world to embrace telemedicine like never before. While many parents and behavioral health specialists opted to continue in-person visits, parents like Patti Stephens persistently waited for the opportunity.

“Even before the pandemic began, I had hoped to be able to utilize telemedicine when we moved in October 2018. I knew this move would be temporary, so I wanted the continuity of care,” Patti said. “Unfortunately, we didn't qualify for telemedicine services for psychiatry so I drove to Fort Worth for appointments or for behavioral therapy.”

Patti’s family of four children has made countless trips from their home in West Texas to various Cook Children’s locations since 2002, from one child in the NICU to annual well-child visits to family therapy visits. When Patti’s family was finally able to begin using telemedicine, it allowed their family extra time, both in commuting and rounding up all four children at times for one appointment. With telemedicine, Stephens said her children found comfort in being in their own environment and she found flexibility in being able to schedule an appointment whenever she needed.

When the pandemic made it to Texas, Cook Children’s physicians quickly realized telemedicine would need to move to the forefront of their care delivery. Similar to some parents, physicians had to adapt quickly and learn how to use this technology in a way that would benefit each patient.

“When I heard we were going to utilize telehealth, my initial concern was my lack of experience and confidence in using this approach. I became anxious about how to meet the needs of my families best,” Laura Wright, LPC-S Family Therapist, said. “Therapeutic relationship is foundational for therapy, and I was concerned that would be lost in translation using telehealth. I wondered if my patients would be able to focus and attend to sessions in their home settings with all of the potential distractions.”

Concerns around telemedicine faded as patients began to flourish in the comfort of their homes. Parents and physicians may have experienced a learning curve; however, young patients took to the new technology quickly.

“I found rapport to be better unexpectedly. Patients would excitedly show their room or pets, and I felt I knew them better,” Hari Kumarasen, M.D., a psychiatrist at Cook Children’s, said. “It gave me insights into the patient’s personality. Telehealth allowed me to make observations about the child, seeing them in their environment, which I wouldn’t have otherwise been able to make. I also found my anxious and scared children and teen patients are more chill in their own environment.”

Telemedicine allows for long-distance patient/physician relationships, and offers parents options for non-emergent questions if a patient is traveling or not able to make an office visit.

“I have long felt that teletherapy should be an option for both patients and therapists. Especially for parents who have multiple children in therapy. It is so much easier to make and keep appointments via telemedicine,” Patti said. “Also, if we have established a relationship with a particular provider and either the provider or family moves further away, we don't have to start over with building a relationship with someone new.”

When the world begins to feel relief from COVID-19, patients and physicians alike are hoping to incorporate telemedicine into their routines. The ease of access for healthcare has created a positive outcome from an outbreak that has affected society so negatively.

“This is something I would absolutely desire to continue using, if not solely, at least in part. The lack of a stressful commute has been beneficial to my well-being, sparking newfound enthusiasm and creativity in my work,” Stephanie Golden, LPC Family Therapist, said. “As for a majority of my clients, participating in a familiar, safe setting called “home” seems to facilitate a willingness to engage more readily and thoroughly.”

At the beginning of the COVID-19, insurance covered telehealth appointments because patients could not keep their appointments in person. As the pandemic continues, more providers are returning to pre-COVID payment methods, meaning more companies are asking people to pay out-of- pocket for virtual visits. That leaves those who have benefitted from the telehealth concerned that it will go away or become costly for patient families who need it most.

“I am very concerned that we will lose the ability to conduct telehealth services due to insurance coverage limitations. It has proven to be beneficial for many of our patients, especially during this time of a global health crisis with the highly-contagious pandemic,” Golden said. “It certainly is advantageous for parents, giving some peace of mind about keeping their children in a safe space, removing the burden of taking their children away from the classroom and critical learning, and easing the stress of transporting them to and from the counseling office setting.”

The introduction of telemedicine has given families more access to health care focused on the patient experience and allows us to reach a child no matter where they are in the state of Texas. Physicians and health care providers’ willingness to adapt during the pandemic has raised the bar for healthcare delivery systems.

“Several of my patients and parents have shared the hope that telehealth will continue to be offered/available, noting the convenience of the service,” Wright said. “Distance for our remote families, lack of transportation, multiple children’s schedules to juggle, school, commuting, and work are all barriers to mental health treatment. Telehealth breaks down those barriers to reach these families.”

You’re holding your child’s hand on your way to the first day of school. The squeeze on your hand is tighter than usual. Then suddenly your little one sees a friend, smiles, releases your grip and you watch them run to school together without a care in the world.

Everything is great.

But then you notice a tear in your eye. Suddenly, you realize your child isn’t the one nervous about going back to school. It’s you.

The back-to-school transition can be stressful for many parents, and the reasons are valid.

For example, knowing that your child struggles with change can increase your own feelings of tension.

You may worry that your child will struggle to fit in with peers and make friends.

Maybe your child had a bad experience at day care or a previous school year, leaving you both with lingering anxiety.

Some parents are concerned that schoolwork or a tight schedule may be too difficult for their child or that a teacher will not understand their child's unique needs. 

Maybe, you’ve waited until the last minute and just aren’t ready. The need to buy new clothes and school supplies may cause concerns about finances, and a steady stream of demands on your time can leave you feeling pressured and stressed.

Plus, there’s just the feeling that your young child is growing up too darn fast.

If you are stressed about your child's return to school, you may wonder if you should share your concerns. Sam McCage, clinic manager of Behavioral Health Services in Fort Worth and a licensed psychologist,  says that could be a mistake. Your child looks to you for signs that school is fun, exciting and safe and not something to fear, so it's important to discuss school in an upbeat and encouraging way.

"Recognize that children will sense your anxiety and their own will increase if you express your anxiety too much," McCage said. "If they ask about your concerns, tell them that you are excited for them and confident they will do well."

McCage reminds parents that "it's normal to feel anxiety about your child going back to school, but he says there are strategies to help you effectively manage your stress.

Here's how you can calm your concerns and enjoy this annual adventure with your child.:

• Visit the school and connect with your child's teacher and other school staff.
• Make arrangements for car pools, play dates and after-school care well in advance.
• Be patient and give the teachers time to develop a relationship with your child.
• Make sure you have realistic expectations about how your child should perform in school and extracurricular activities.
• Talk with other parents about how they handle their anxiety.
• Use humor to diffuse the stress.
• Schedule fun family activities with your children.

The number of children showing up in emergency rooms for suicidal thoughts and attempts is on the rise, especially during the school year.

According to a new study published by the American Academy of Pediatrics, kids ages 5 to 17 were admitted to children’s hospitals for thinking about or trying to kill themselves twice as often in 2015 as 2008. Researchers at Monroe Carell Jr. Children’s Hospital at Vanderbilt embarked on the study after noticing more pediatric patients being kept in the hospital with mental health issues.

They found that girls are attempting suicide more often than boys. They also found that suicide attempts were highest during the school year and decreased during the summer months.

“On average, during the eight years included in the study, only 18.5 percent of total annual suicide ideation and suicide attempt encounters occurred during summer months,” the research team wrote in the publication.

Half of the encounters examined in the study involved teens aged 15 to 17.

Numbers High at Home

This disturbing trend is also evident at Cook Children’s.

In 2016 and 2017, more than 390 children were seen by the Psychiatry department at Cook Children’s for an attempted suicide. The team was consulted on more than 1,040 total cases for issues including depression, anxiety and/or attempted suicide. The majority of the children who attempted suicide were female (317 female, 76 boys) and the average age was about 14 years old.

Also like the study, the majority of suicide attempts seen at Cook Children’s occurred during the school year.

Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s, realizes suicide in children and adolescents is a difficult topic for most parents. But she stresses it’s one that can’t be ignored.

“As a mental health professional, my worst fear is a child prematurely ending his or her own life,” Dr. Pyrc said. “As a mother, it is hard to comprehend the profound grief families must feel in the wake of a suicide.”

The American Academy of Pediatrics has updated their guidelines to recommend pediatricians routinely check for signs of depression in their young patients. The focus is to carefully screen patients ages 12 and over during annual checkups.

“I have found it is a good way to signal to kids and parents that we are open to talk about this and want them to ask us about it,” said Vanessa Charette, M.D., pediatrician at Cook Children’s Magnolia office in Fort Worth. “Even if nothing comes up, often a parent will return with the teen later wanting to talk about anxiety and depression.”

Suicide Attempts among Young Children

Another study published by the AAP found that younger children who die from suicide are more likely to do so impulsively while early adolescents tend to struggle with depression for some time then plan and carry out suicide. The researchers found that younger children were more likely to have experienced ADHD symptoms while early adolescents were more like to have experienced depression symptoms.

“What is important to realize is that in a young child, thoughts of suicide can occur without depression symptoms,” Dr. Pyrc said. “I have to wonder if some of the elementary-school-aged children meant to end their life, or if they act impulsively not fully appreciating the consequences. Unfortunately, the result is the same regardless of the child’s intent. A child’s life has ended prematurely, and family and friends are left with immense grief and a lifetime of regret.”

Dr. Pyrc said in childhood and adolescence, depression is more likely to present with irritability and angry outbursts than sadness. Young people are remarkably resilient and able to ‘compartmentalize,’ meaning they can feel deeply sad when alone but are able to socialize with their friends and appear happy on the surface.

Depression also manifests as changes in energy and sleep as well as social withdrawal, a drop in grades, or not engaging in activities they once enjoyed. If you see some of these signs and symptoms in your child, it may be time for an assessment. Starting with your pediatrician is a good first step because they can help assess for depression symptoms as well as rule out any medical problems that present similarly to depression.

Dr. Pyrc stresses it is vitally important to take children seriously when they say they want to die.

“I think it is easy to dismiss a statement like this from a child because it is hard to imagine that they fully understand what they are saying, but I would sure hate to be wrong,” she said. “I think it is important to believe our children and get help for them when they make suicidal statements. If you are concerned that a child may hurt him or herself or others, please seek professional help as quickly as possible. If you feel the threat is imminent, please take them to the Emergency Room for an assessment.”

So where do we go from here? As adults we do have to be strong for our children. But in doing so, we have to take care of ourselves first. So, go into your room, close the door, cry if you need to, talk to your spouse, talk to your friends, and say that it’s not fair. Because it isn’t. But be there for your babies. Reassure them, hug them, love on them, and remind them that on a daily basis you and many others, do everything in your power to keep them safe. Safety, and school safety in particular, has improved in recent years, yet these incidents continue to happen.

I know as parents many of us want to grab our child and run as far away from this messy world as possible. But when horrible events take place, all of us have a choice to make. We can pull back and limit our activities and those of our kids, time outside, etc., or we can try to look at the situation and see what we can learn from it and how we can contribute and make a difference, so that hopefully similar events don’t continue to happen.

Yesterday was horrific and many lives were shattered. I have heard a number of rumblings about the suspect’s background and history, some of which may be true, some of which may not be. As adults, as parents, as humans, we have got to pay attention to our at-risk youth and reach out. We have got to take the time to try to make a difference in the life of “that kid.”

When you see a child or adolescent that might be isolating themselves or appear withdrawn, angry, or sitting at the table by themselves, make it a point to reach out, say hello, and ask them if they are doing OK, or need anything. Take the time to be a mentor in the schools, your community, etc., to work with youth and ask about noticeable changes in mood, appearance, or behavior. Share experiences, teach them skills, coach them and encourage them. I am talking about taking the time to show kids you care. If mentoring and intervention starts early it can make a tremendous difference in the lives of at risk youth, and potentially point them down a different road in the future. When you see a child that is troubled, you can also try to get them connected with resources and professionals both within the school system and the community. If just one person reaches out to an at risk child instead of pulling away, it can have tremendous positive implications for that child, and many others.

The need for closeness, kindness and touch remains one of the most essential human needs that allow children to develop into thriving and independent human beings. Not only is healthy touch incredibly important, so are hearing encouraging and supportive words.

It starts at home with being respectful and polite to each other in terms of daily interactions and requests. If parents want their children to be respectful to them, the easiest way is to treat them with respect as well.

When kids see it and are treated with love and kindness, they pass it on to others also. Now nobody is perfect all the time and we all make mistakes and that is OK! Use those moments as opportunities to model being apologetic.

Let your child hear and see you say, “I’m sorry, I messed up” or “I’m sorry I hurt your feelings, what can I do to help you feel better?” As a parent, if you are trying to correct a younger child who was aggressive with a sibling for example, have them check in with that sibling to see what they can do to make it right. Do they need to get them an ice pack, a water bottle or a popsicle maybe? The point is to try to get your child to put themselves in the shoes of the other person to create perspective and the start of creating empathy as well.

As kids get older, teaching compassion and empathy for others needs to continue to be a focus. Some options for doing that might be through family service projects such as volunteering in the community or local organizations.

Children need to realize that helping others can be accomplished through donating your time as well as resources such as food as well as money. For some families, it might be important to teach kids from a young age to set some money aside in a piggy bank that they would like to donate to a specific cause or organization that is important to them.

When kids show an interest in raising money for a cause through a lemonade stand or other fund raising effort, help them and encourage them! Most importantly, when kids are raised in an environment where they see their parents and other family members or friends working and volunteering to help others, it becomes second nature to them and they do not think twice about joining in the “school supply drive” or forgoing their birthday party presents and donating them to the “Peter Pan Club.”

Raising kind, empathetic kids begins with surrounding them with an environment of love and warmth. It’s not a place where everyone is always perfect, but it is a place that when people make mistakes, they acknowledge them, take responsibility for them and do what it takes to make things right.

About the author

Joy Crabtree is a licensed psychologist and clinic manager for Southlake and Northeast Clinic. Our psychiatry department helps children, ages 2-17, and their families who are experiencing behavioral, neurodevelopmental and emotional challenges. Our staff is specifically trained to work with young patients and our psychiatrists are board certified in child and/or adolescent psychiatry. Click to learn more about our program.

To access any of our services, please contact our Intake Department by calling 682-885-3917. To expedite your call, please have your child's date of birth and insurance information ready. For emergency situations, call 911.

But too many Thanksgivings end up with huge fights or arguments in front of the kids. The past few months have been especially volatile with an election that could spark opposing sides.

As parents, as hard as it is sometimes, we have to be the grownups. Research from children of divorce shows us that it’s not so much conflicts between adults that are particularly problematic, stressful or damaging to kids, but it’s witnessing conflict without seeing a peaceful resolution.

Whether you are upset over who did or didn’t get in the White House or you are still holding a grudge from a loan that never got paid back, kids need to see us demonstrate the concept of agreeing to disagree while maintaining mutual respect for one another.

We can provide our kids with a good example of learning to listen, genuinely hear, and appreciate another’s perspective even when our ideas may differ. Our unique personal experiences shape our passions, feelings, thoughts, values and opinions. As such, it is impossible for us all to be the same, which is really what would be necessary for us to all agree all of the time. It takes all kinds of people with all kinds of interests and values to make our world work. If we didn’t have such a variety, everyone would be a chocolate ice cream-loving, brussel sprout-hating, mystery-reading , female veterinarian … which means our animals would all be very healthy but our grocery stores would always be low on our favorite treats and the library would have nothing interesting to read since all the books would be about curing sick animals.

Plus, there would also be no turkey on the Thanksgiving table.

So teaching our kids that variety truly is the spice of life because it enriches our experience is critical. At the same time, helping our children understand that even the best chefs make mistakes and use too much of a flavor at times which overwhelms the dish … it’s too spicy … is important too. Sometimes, parents and other grownups are like this when they share their feelings and their passions with others too intensely. We become very protective of our beliefs and opinions, expressing them too loudly and too harshly when we don’t feel heard. Kids really do love it when grownups admit their mistakes. When we are able to accept responsibility for our own lapses in self-control and emotional regulation (scaring or hurting others feelings because we got carried away), we are showing those relationships are important and worthy of mending by seeking forgiveness and reconciliation.

Kids need to see that the important adults in their lives can disagree and still accept, include and love one another.

With young children, consider using ideas/concepts that are familiar, meaningful and relevant to them. Rather than focusing on political, financial, social, or religious issues, you might talk with them about preferences they share with their close friends, as well as things they might disagree about.

For example, “You believe that plain cheese pizza is the best, and you love to go rock climbing. Your best friend loves pepperoni but is afraid of heights and prefers soccer. Your other friend loves cheese, thinks pepperoni is OK, and is bored by everything but video games and Legos. You think pepperoni is gross. “

Who’s right? Is there a right and wrong? Do your feelings about your friends change because they like different things than you do?

The idea you want to help them learn is that everyone’s thoughts, feelings and values are valid and should be treated with respect even when we don’t happen to agree. It’s also important to keep on loving and accepting others who don’t agree with us, even when that same acceptance is not being given in return. Our value does not change just because someone else tells us so. You wouldn’t agree if someone told you your eyes were rainbow colored … that would be silly! You don’t have to agree if they tell you what’s important to you is wrong either.

About the author

Whitney McGee, Psy.D, is a licensed psychologist at Cook Children's. Cook Children's Behavioral Health services provides a broad range of care that focuses on children from ages 3 years through 17, and their families. As part of family-centered care all of our professionals are qualified both through education and experience to work with children who have behavioral and emotional challenges. Our psychiatrists are board certified in child and adolescent psychiatry and our psychologists and therapists are all licensed independently in Texas. Locations include Denton, Fort Worth, Hurst, Lewsville, Mansfield and Southlake. 

To access any of our services, please contact our Intake Department. To expedite your call, please have your child’s date of birth and insurance information ready.

The American Academy of Pediatrics (AAP) says that while hyperactive behavior can be considered normal for some children, hyperactivity can, but doesn’t have to, be indicative of a neurological-developmental condition, such as ADHD.

ADHD is a diagnosis given when a person shows a persistent pattern of inattention and/or hyperactivity-impulsivity that negatively impacts his or her life.

“A hyperactive child is one who is more physically and/or verbally active than other children his or her age,” said Carolyn Cruse, PsyD, a licensed psychologist at Cook Children’s. “It is important to remember that what qualifies as hyperactivity in one age group may not be called hyperactivity in another.”

In addition, it's crucial for parents to note that having a hyperactive child does not necessarily mean the child has ADHD. When hyperactivity presents as a single symptom, it’s probably incorrect to assume the child has ADHD.

There are different subtypes of ADHD that could be part of a child’s diagnosis:

• Predominantly Inattentive Type - only symptoms of inattention are present and there are no or very few symptoms of hyperactivity.

• ADHD Predominantly Hyperactive-Impulsive Type- mainly symptoms of hyperactivity-impulsivity and a few symptoms of inattention.

• ADHD Combined Type - symptoms of both inattention and hyperactivity-impulsivity.

What Is Hyperactivity?

Hyperactivity shows itself in children as talking excessively, fidgeting or squirming in their seat at school or church, running or wandering when expected to walk or be still and having trouble sitting still for calm leisure activities like coloring or doing puzzles.

Parents sometimes describe their hyperactive children as constantly in motion or always on the go. The overactivity should be more than what is typically seen in other children that age and should negatively impact the child’s ability to function in school, home or other situations in order for it to be considered an indicator of ADHD. Thus, hyperactivity may be the first concern that is noted by parents or teachers.

“Parents should be concerned when their child’s overactivity is negatively affecting his or her ability to learn and behave appropriately in school, complete homework or follow the rules at home and/or participate in extracurricular activities,” Cruse said.

For example, a 5-year-old girl who is starting kindergarten may be observed having trouble sitting still in her seat and constantly wandering the room during “circle time,” but this would generally be seen as age appropriate. However a 7-year-old second grader who moves so much that he falls out of his chair and repeatedly gets out of his seat when he should be completing class work is more likely displaying symptoms of hyperactivity.

Hyperactivity can be seen in very young children or toddlers, but a diagnosis of ADHD should be made cautiously. In very young children, hyperactivity may appear as though the child is having difficulty functioning at home or school. These children are constantly shifting from activity to activity, jumping on furniture, climbing up cabinets and unable to sit still—even briefly—for quiet activities.

Again, the overactivity should be more than what is seen in other children their age. Younger children are also likely to display their hyperactivity and impulsivity as aggressive behavior. These children have not fully learned to respond appropriately to frustration or irritability and may impulsively respond with aggression. Older hyperactive children may also behave aggressively because of their hyperactive/impulsive tendencies.

Hyperactivity is seen in both boys and girls, though boys are more likely to experience hyperactivity at a heightened level that indicates ADHD, according to Cruse.

What Can You Do?

A hyperactive child will benefit from the chance to hand out papers in class, take a note to the teacher in the next room or simply walk to get a drink from the drinking fountain every so often.

Some hyperactive children actually function better when allowed to stand at their desk rather than sit. This cuts down on fidgeting and squirming in the chair. Parents may need to let their child have a chance to run and play once he or she get home from school to release pent up energy before starting chores or homework.

Parents can channel their hyperactive child’s energy into positive outlets such as sports, dance or karate. They can also use their child’s energy by making games out of small chores (make putting away toys a beat-the-clock game, putting laundry in the washing machine into a basketball game or sweeping the floor as a dance routine).

“Hyperactive children are often seen as very charismatic and fun-loving,” said Cruse. “They can often find fun in whatever they are doing and tend to be creative. When that hyperactivity is channeled appropriately, these children can grow up to be very high-achieving adults.”

Getting a Diagnosis

If parents believe their children’s hyperactivity is severe enough to be interfering with their daily functioning, and increasing their children’s involvement in appropriate physical activities has not improved the problem, they can contact their pediatrician or Cook Children’s Psychology department regarding a possible evaluation for ADHD.

Once a diagnosis of ADHD has been made, there are various treatment options to help improve a child’s functioning. A therapist/psychologist can help by teaching children to monitor their own behavior and learn to think before acting. They can also help parents learn more effective ways to handle their child’s hyperactivity. Schools can also make accommodations that will help with school performance.

Finally, medication is another treatment option that parents can discuss with their pediatrician or a child psychiatrist.

While the increase in self-injuries may not seem that extreme, Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, said the study does not tell the entire story. Sometimes the degree of cutting, for example, may not be severe enough to receive medical attention.

Elliott presents to schools, churches and community organizations on the issue of teens and self-harm injuries. She also treats patients in her practice.

“It can be difficult to determine the prevalence of these types of injuries accurately due to the secretive nature of self-harm prevalence,” Elliott said.

Elliott says that the most accurate numbers show that 20 to 23 percent of teens engage in some type of self-injury. The age of self-harm abuse typically begins between the ages of 12 to 14 years old.

Research shows that gender differences appear only to be associated with method of self-injury. Females are more likely to use cutting. Both genders use burning and self-battery. Caucasians are significantly more likely to engage in self-injury than non-Caucasians.

Methods of self-harm include:

• Cutting (70 percent of self-injuries)
• Carving
• Scratching/biting
• Burning/abrasions/branding
• Hitting themselves
• Picking/pulling skin and hair
• Head banging
• Tattooing
• Excessive body piercing

Injuries are most commonly found on arms, hands, wrists, thighs and stomach.

"This is something we see quite often, mainly in female teenagers, and it has increased dramatically in the last several years once it became a 'thing' that teenagers do and have seen or heard about," said Corwin Warmink, assistant medical director in the Emergency Department at Cook Children's. "It is a response to stress and anxiety and gives the performer a sense of control and eases their anxiety. It is not a suicidal behavior, but some studies have shown people who perform self-injury are more likely to commit suicide than people who do not. It also can be indicative of a more serious mental disorder."

So why do kids harm themselves?

“Kids who repeat self-harm injuries are often trying to ease some type of intense, overwhelming negative emotion such as anger, pain, anxiety or frustration,” Elliott said. “That’s the most common reason, but the second most common reason is self-punishment. They are expressing anger at themselves. This is strongly connected to self-derogation and criticism.”

Other reasons for self-harm include:

• Interpersonal influence – as a means to garner affection/caring from others, to identify/connect with others who have self-injured, to “belong” or fit in with a peer group.
• Stress management.
• To feel a sense of control over their own body, feelings or life situations.
• To provide a distraction from painful emotions through physical pain.

Kids who engage in self-harm behavior are more likely to tell and seek help from a peer their own age than tell a parent. Usually, adults only become involved if that peer tells a grownup and asks for help for his or her friend. Other times, a teacher or coach hears talk among other teens and steps in to help.

Elliott offers these tips to identify if your child is involved in self-harming behavior:

• Dressing in long sleeve shirts/hoodies even in hot weather.
• Wearing concealing outfits.
• Avoiding activities such as sports and swimming.
• Making excuses for having cuts, marks, wounds on body.
• Finding razors, scissors, lighters, knives in unusual places such as under the bed.
• Spending long periods of time locked up in bedroom or bathroom.

For more information

To schedule an appointment or refer a patient to Behavioral Health Services, please call 682-885-3917. To have Lisa Elliott speak more on this topic at your school, church or community organization, click here.

The documentary describes how Laettner bullied not only the opposition, but his own teammates. And where does the documentary say he learned such behavior? His older brother.

A University of Nebraska-Lincoln study gives a detailed look at bullying from siblings the Journal of Family Violence. The researchers talked to 400 undergraduates and found that students said they were bullied more by their siblings than by other children.

Last year, another study conducted by the University of New Hampshire discovered that 32 percent of children who said they were victimized by a brother or sister reported higher rates of mental-health issues.

Lisa Elliott, Ph.D., clinic manager of Cook Children's Behavioral Health in Denton, Texas, said she has seen several kids lately in her office dealing with problems related to siblings. Elliott, a licensed psychologist, said this goes beyond sibling rivalry or teasing. She is seeing abuse and parents need to be aware of the role they play in this issue. Especially if they are favoring one child over the other. Often times that "favored" child becomes the bully.

“Parents have to be careful that they don’t show favoritism, either directly or indirectly, intentionally or unintentionally,” Elliott said. “The perception of favoritism among siblings is one of the most harmful things parents can do to their children. It’s harmful to the child’s self-esteem, it increases bullying amongst siblings and it often creates very entitled children in the one who is favored.”

A study published in the journal, Pediatrics, showed that kids who had been bullied by their brothers or sisters for a prolonged period of time were twice as likely to report being clinically depressed when they grew up.

"I certainly think in most families there is likely to be some level of conflict or disagreements among siblings at different times," said Joy Crabtree, a licensed psychologist at Cook Children's Southlake Urgent Care and Pediatric Specialties.  "However, I think parents need to be aware of when it may be crossing a line, such as physical altercations, repeated name calling or degrading of a sibling etc. Sometimes it can happen out of ear shot of the parents so it’s important to talk about everyone maintaining respectful communication in the family. If a child feels uncomfortable or targeted, he or she needs to let mom or dad know because it may not be happening in front of the parent. If targeting is occurring, limits and boundaries need to be set so a negative pattern does not continue."

Research conducted by the Universities of Oxford, Warwick, Bristol and University of College London said that bullying among siblings is particularly upsetting because these children have no way out. Bullying includes persistent verbal or physical abuses, as well as just ignoring the other siblings for long periods of time.

“I see children in clinic who are upset about favoritism or jealous of a child or he or she feels an older sibling is being parental or bossy. Sometimes I see feelings of inferiority. But what I hear when it comes to bullying is something very different,” Elliott said. “This is abuse, either physically or verbal. These are siblings and they know each other better than anyone else. That familiarity allows them to say very hurtful comments that the sibling knows is a sensitive or private matter. Sometimes, I see ganging up on a sibling, where multiple brothers or sisters gang up on a child. In those cases, you see extreme physical aggression between siblings that can be every day and makes life miserable for a child.”

Elliott gives the following tips for parents to watch out for sibling bullying:

• All physical bullying needs to be addressed immediately and not tolerated.
• It is critical to understand the causes for the bullying to address whatever those reasons are –

1. If a child is feeling inferior help, build that child’s self-esteem.
2. If you are inadvertently showing what is perceived to be favoritism by one child, modify your behavior and be sure to praise each child equally with positive behavioral anchors.

• Don’t label your children as the “bright one”, the “musical one” etc.
• Finally, it is critical to teach your children how to problem-solve conflict effectively and how to have empathy for others.

“Try to react calmly and unemotionally,” said Joy Crabtree, Psy.D., a Cook Children’s psychologist in Southlake. “Discuss what words are off-limits in your family and why those words are unacceptable. Help your kids find other words that are acceptable in similar situations.”

Of course, children who use bad language heard the word somewhere beforehand. Most commonly, children can learn curse words by hearing them on television, video games or – oops – from their parents.

“The more children are exposed to those words, the more numb they become to bad language,” Crabtree said. “Hearing the words frequently makes kids more likely to use those words themselves.”

Parents should closely monitor the entertainment their children are exposed to and be good role models by using their appropriate language around their children. If the child continues to use bad language, parents should consider discipline methods that including taking away allowance, giving him or her time-out or limiting television or game time.

For more information

Cook Children's Behavioral Health services provides a broad range of care that focuses on children from ages 3 through 17, and their families.  As part of family-centered care all of our professionals are qualified both through education and experience to work with children who have behavioral and emotional challenges. Our psychiatrists are board certified in child and adolescent psychiatry and our psychologists and therapists are all licensed independently in Texas.

To access any of our services, please contact our Intake Department. To expedite your call, please have your child’s date of birth and insurance information ready.

Step 1: Groundwork

This phase is really a pre-step. Ideally, it should happen prior to the merger. Both parents need to take the time to learn and understand their own parenting styles and preferences. Whether you take a quiz online or read a 300 page book, it doesn’t matter as long as you understand your style well enough to be able to talk to your partner about your style of parenting. It may also be helpful to plan an "observation" date where you can watch your partner interacting and parenting his (or her) child. Afterward (not in front of the child) you can ask questions of your partner and discuss your differences and similarities. Be careful not to openly challenge your partner’s style. This is an opportunity to learn about each other, not to criticize.

Another very important part of the self-discovery phase is to check for emotional baggage. Most blended families are the product of divorce or the death of a parent which often involves intense personal emotions. Be sure your parenting style is not going to be affected by guilt, anger or defensiveness. Many parents feel so guilty subjecting their children to the turmoil of divorce that they parent out of guilt and become more permissive. It’s a myth that children need a break from discipline and structure following an event like this. They often need more structure and will find comfort in the predictability of your consistent parenting.

Step 2: Rebuilding

Bringing two families together creates an opportunity to craft something new. You and your partner get to construct a new household. Depending on the age of your children, this may be the perfect time to make new rules and establish new consequences. Having regular family meetings is particularly helpful and gives parents an opportunity to lay out details of the new plan while fielding the "But why…." and "How come…." questions. Even with proper explanation and clarification, details of the new plan are likely to be challenged and tested in the days, weeks, or months following the merge. This leads us to the final and most challenging step.

Step 3: Settling

You planned ahead, you laid it out, and now it’s time to let it settle. Some parts will work like a charm and other parts will seem like a complete failure. This is part of the parenting process and isn’t unique to blended families. However, blended families often come with circumstances that may make the settling process a little rough. There may be joint custody arrangements with your ex-spouse which make it necessary to think through rules and consequences you set in your home. You can’t ground your child from video games if he is going to be able to go over to his mother’s house and have unlimited play time. It’s better to set consequences you know you can enforce.

Another significant issue that might arise during your well-planned settling phase involves your child’s emotional and behavioral reaction to the divorce. If your child displays uncharacteristic behaviors such as sleep difficulty, appetite changes, poor school performance or social withdrawal it may indicate the development of an adjustment disorder, depression or anxiety. If this is the case, you and your child may need a mental health professional to steer you through the settling process. These issues can’t be addressed through consistent parenting alone.

Following these three steps does not ensure a perfectly blended family. It does, however, ensure that you will have established a foundation of open communication, compromise and flexibility that will enable your new family to weather any storm.

“When a child plays an electronic game and receives frequent intermittent rewards, their brains release dopamine – a neurotransmitter that is closely related to reward motivated behavior,” said Lisa Elliott, Ph.D., a licensed psychologist and manager of the Cook Children’s Behavioral Health Clinic in Denton. “In school or in other social situations, a child does not normally receive these rewards, making it more difficult for them to stay focused in a non-technology based situation.”

Elliott believes this is a factor contributing to the recent rise in ADHD. She said she is concerned about gadgets, especially video games, and what they could be doing to harm our children.  By allowing so much focus on technology and mobile devices, children aren’t learning to hold their attention without some type of reward.

Whatever the cause is, Elliott offers four simple ways to prevent the damage that gadgets could be causing your child:

1.Remove any screens from the bedroom.

2.Pay attention to the content your child is viewing, especially violence.

3.Set limits on screen time each day. The American Academy of Pediatrics recommends screens be kept out of kids' bedrooms and children should be limited to less than two hours per day of screen time. For children under 2 years of age, all screen media exposure is discouraged.

4.Create healthy playtime such as outdoors or being active.

These simple changes may make the difference in how your children perform this school year.And while your kids may be upset now, they'll thank you later.

About the source

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children's Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appoinment with her, call 682-885-3917.

About the author

Caroline Gayler volunteers in the public relations department at Cook Children’s Health Care System. She is a senior at TCU majoring in Strategic Communications. 

A young person with a history of depression is obviously at a greater risk of suicide. Parents want to be alert for any changes in their adolescent’s typical behavior. They may have been very active in sports in the past, or band, theater, or cheerleading, and now are less interested or involved. They may be isolating themselves, not only from family, but also from friends. Motivation may be dropping, along with grades. You may see sleep patterns change and the teenager may be sleeping for extended periods of time and be difficult to wake in the morning. One may also notice their need for sleep is decreased or they are having difficulty falling asleep. Appetite may change as well and they may eat a lot more or a lot less, and actually be losing weight.

If a young person is talking more about death, dying, and have a sense of hopelessness, that is a big concern. Drug use and other impulsive or risky behavior can place them at a greater risk of suicide as well.

When there is a suicide in a community, parents should discuss it with their kids, particularly since they have likely already heard about it at school or from friends. Use it as an opportunity to discuss their possible feelings of grief or confusion and be a listening ear and support them. Additionally, parents can ask their child if they have ever had any extreme feelings of sadness or thoughts about hurting themselves. If current feelings about wanting to hurt themselves are acknowledged, parents should let their therapist or psychologist know right away. If they do not have a therapist or psychologist, or they are not available, they should be taken to a local mental health facility or hospital emergency room for an evaluation.

Even if a young person does not have a desire to harm themselves, their feelings of grief and sadness about a peer’s suicide can be significant, regardless if they were a close friend or just an acquaintance. Again, be a support for them and encourage them to discuss, and work through their feelings. Answer any questions they may have and explain, if appropriate, any similar feelings the parents may have as well. This may also be an opportunity for the adolescent to make a positive out of a negative experience. They may consider starting a grief support group, work on a memorial for the person who has passed away, or engage in volunteer activities. Sometimes putting feelings of sadness into positive activities can be helpful in the grieving process.

Above all, parents should be “tuned in” to their children. When unusual behavior changes are occurring, ask about them. Additionally, reassure your children you are always there for them, no matter what issue they are facing.

If you feel your child needs help, please call 682-885-3917 for a referral into Cook Children’s Psychology department.

Additional resources:

• Cook Children's Psychiatry and Psychology department
• Dealing with depression
• Resources & education
• 5 ways to fight depression
• When depression is severe

About the author

Joy Crabtree, Psy.D., a licensed psychologist for Cook Children’s, sees patients at Cook Children’s Urgent Care and Pediatric Specialties in Southlake, the first such pediatric facility in town. Previously, she worked seven years in Denton at Cook Children’s Psychology. She moved to Southlake to be closer to home. She sees patients Monday through Thursday, and on Friday she evaluates patients for conditions such as ADHD or autism Joy is married to Tim Crabtree and they have three children. If you feel your child needs to speak to a psychologist or psychiatrist, talk to your pediatrician or call 682-885-3917.