By Linda Puga

As important as a child’s mental health is, it’s equally as important to look at how their journey impacts the people around them -- their caregivers. The ACEs Task Force of Tarrant County developed a video series called The Roadmap for Children’s Mental Health to help families navigate this health issue. These are some tips on how to take care of yourself to ensure you can be the best support system as a caregiver.

“Parents often have a lot of guilt, they have a lot of worries, they have a lot of uncertainty that they’re going through,” said Steve Chennankara, D.O., child psychiatrist at Cook Children's Psychology Clinic - Fort Worth.

First, recognize stress and model appropriate coping skills. Parents need to take care of their own mental health because as a caregiver, they make the medical decisions when it comes to their children, said Dr. Chennankara.

“For their own longevity, when it comes to endurance, they need to know that this is a marathon and not a sprint,” said Dr. Chennankara.

Second, be honest with yourself, your kids, and your peers. Manage stigmas in the ways you see fit.

“I don’t think there’s a one size fits all approach. So, recognizing and being aware of the stigmas that the parents have, or the child has, or a family member has, and bringing that to the light, and processing that, and working through that is important first,” said Dr. Chennankara.

After working through stigmas with yourself and your children, you can extend these practices with your next circle of friends and family, said Dr. Chennankara.

Third, be an advocate. You never know what people are going through, so make sure you’re intentional with the actions you perform and the thoughts you vocalize.

There are different levels of advocacy, depending on where you feel like you’re at right now. Something you can do is share testimonies from your child as a way to reduce the stigma around mental health.

Having these conversations helps kids know that they aren’t alone in struggling with mental illness. 

“One in four kids go through some type of mental distress throughout their developmental period,” said Dr. Chennankara.

Fourth, remember that your best is good enough. Don’t let your opinions get clouded by too many other people.

“There is no such thing as perfect parents. And, a child does not need a perfect parent. They need a present parent,” said Dr. Chennankara.

Remember that asking for help doesn’t make you weak or a failure, it leads to more awareness. Take advantage of all the resources you can.

In order for kids to trust caregivers with the big things, they need to listen to the little things.

Kindness and empathy are important, in fact they are critical. Both are foundational cornerstones for emotional and moral intelligence, and it is the core to a civilized world. Studies have also shown if one experiences empathy, it can stop cruel and/or violent behavior.

On this episode of Raising Joy, neuropsychologist Lisa Elliott, Ph.D., explains how kindness and kind words can change the life of a child. She says the importance of kind words cannot be underestimated towards children, especially in today’s climate.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Raising a child who struggles with their mental health can be scary, challenging and confusing. The ACEs Task Force of Tarrant County developed a video series called The Roadmap for Children’s Mental Health to help families navigate this health issue.

On this episode of Raising Joy, we are joined by Dr. Brian Dixon from Mindful – a psychiatric practice based in Fort Worth and Frances Wampler from the Center for Children’s Health led by Cook Children’s. Dr. Dixon and Wampler share the mission behind these videos, and how Wampler’s own experience with her child informed the project.

If your child is struggling with their emotions and you don’t know where to turn, this episode is a great start.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Since the school shooting in Nashville last week, Lisa Elliott, Ph.D., psychologist at Cook Children’s, has seen an increase in conversation about school shootings with her patients and their parents who need help as well.

“It’s on everyone’s minds,” said Dr. Elliott, who has been a psychologist for 29 years. “Many of the moms have brought in their kids and asked for help themselves in navigating this.”

Dr. Elliott relates to these moms. School shootings now hit differently as her son is a middle school principal.

“Prayer gets me through,” she said.

We asked Dr. Elliott how to help children process this tragedy, along with tips for parents themselves. 

You can also listen to the recent Raising Joy Podcast with Dr. Jillian Peterson, founder of The Violence Project, as she informs listeners about her research findings related to mass shooters and what parents can do to help prevent the next school shooting.

What advice do you have for parents who are struggling with how to share the news of the school shooting with their children? How do they know when it is appropriate to talk with them?

The most critical part of reacting to this in front of children is to stay calm and always be honest with your responses.

To begin with, it all depends on how the kids process and handle emotions. You can wait to see if they say anything about it, and if they do, address it right away. I can tell you that late elementary, middle and high school students are talking about it. Do not minimize their concerns and immediately correct any inaccurate information. Let them talk first and lead the conversation, finding out what issues they want to talk through

Walk through the worst-case scenarios and talk to the school if needed, letting your child know all the safety measures in place. For some children, this kind of information empowers them.

Also, help them to know how to be observant – to be the helpers. We have to instill hope – Fred Rogers from Mister Rogers shared that his mother told him to “Always look for the helpers” in times of sorrow, tragedy, fear and anxiety, because if you also see the helpers you know there is hope.

At home, reinforce ideas of security and safety and maintain routines, with frequent check-ins.

How can parents reassure their children if they are struggling themselves to feel that everything will be OK?

Remember that to be the best parent to your child, you have to take care of yourself first – just like the airplane scenario with oxygen masks when parents are told to put their mask on before their child. It is important to model healthy coping as children take their cues from you. They need to see we care, and it is OK for them to see you express emotion, however, you do not want to overwhelm them. 

Effective ways to cope include speaking with other parents at school, forming/joining a parent support group, leaning on family members for support, eating nutritious meals, exercising, meditating, praying and speaking with your child’s school counselor for advice on resources or books on supporting yourself and your family through a school-related tragedy.

How do parents know when their child’s anxiety is beyond what they are able to help with and they need to pursue professional counseling?

Watch for these symptoms – an increase in physical complaints such as stomachaches or headaches, change in appetite, nightmares, sleep disruptions, separation issues, panic symptoms, not wanting to participate in social activities, and increased anger.

If any of these persist for more than a few weeks, seek professional help.

How do we shield our children from too much information with social media, TV, etc.?

Do all you can to limit your child’s exposure to the news, and even adult conversations, as children are always listening. We know from trauma research that violent images can cause secondary trauma. And parents need to model that as well by limiting exposure.

What if children do not want to go back to school after hearing the news?

Let your child have one mental health day and do a lot of pouring into them and making memories together. Talk with them about how to handle problems and let them know we can still find joy. Do not let it be more than one day or it will only exacerbate the fear.

What are some tangible ways parents can provide comfort to children?

Keychains with a small photo frame where you can place a family photo have helped many of the parents I see comfort their children. Attach it to your child’s backpack or lunchbox so they feel close to family while at school. Matching bracelets they can wear also help – anything that makes them feel connected to you and your family.

When your child is struggling with their mental health, it can be difficult to know where to turn. Nationwide, waitlists for appointments with child psychologists and psychiatrists can be months long. As a result, pediatricians have become the first line of defense for families who need support.

Alice Phillips, M.D., wears many hats at Cook Children’s. She’s the Board Chair of Cook Children’s Physician Network and Medical Director of Ambulatory Quality. Dr. Phillips is also a pediatrician at Cook Children’s Pediatrics Cityview, and has seen mental health concerns in her practice increase dramatically over the past 26 years. On this episode of Raising Joy, Dr. Phillips talks to us about the role of pediatricians in the mental health crisis and the growing number of tools in their toolbox to help children.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

We’re born with a mind, body and soul. When something goes wrong with one, it often affects another. That’s especially true for individuals with diseases of the nervous system — or the brain, spinal cord and nerves — and it’s the motivation for the development of the new Jane and John Justin Institute for Mind Health at Cook Children’s Medical Center – Fort Worth.

The Justin Institute will connect nine specialties under one roof, including Neurology, Neuropsychology, Neurosurgery, Pain Management, Physical Medicine and Rehabilitation, Psychology, Psychiatry, Developmental Pediatrics and Developmental Psychology. It is slated to open fall 2023 in Cook Children’s newly expanded Dodson Specialty Clinics building.

"All of the departments and specialties involved in creating the Justin Institute have worked really hard to break out of their silos and build a system that gives our patients a connected and well-coordinated experience," said Teresa Baker, assistant vice president, Primary and Specialty Services, for Cook Children's Physician Network. "I'm really thankful for their teamwork and focus on doing what is best for the child, and our patient families will be, too, as they see it first hand during their visits."

Physicians began building the Justin Institute’s framework several years ago after identifying a missing link within the Neurosciences program. There was little coordination among overlapping specialties that treat the mental, developmental and physical diseases and disorders associated with the nervous system.

“A majority of people with diseases of the nervous system have accompanying mental health or behavioral health disorders,” said M. Scott Perry, M.D., an epileptologist and head of Neurosciences at the Justin Institute. “For example, about 50% of people with epilepsy will also have mental health disorders such as depression and anxiety.”

That may be because epilepsy, depression and anxiety share the same abnormal brain connections, or because the stress of living with the unpredictability of the disorder leads to mental health struggles. Either way, it’s important to connect the dots of care for those with overlapping mental, intellectual, neurological and developmental health needs.

“Kids get better when all aspects of their health and wellbeing are addressed, including their medical and mental health needs,” said Kristen Pyrc, M.D., Cook Children’s co-medical director of Psychiatry. “Many of our patients are seen by Neurology and Developmental Pediatrics and Developmental Psychology specialties, so we are hoping that being part of one institute will help increase collaboration amongst the disciplines and get patients to the appropriate resources more quickly.”

Everything for the Child

The Justin Institute is built around a patient-centered experience, where everything for the care of a child’s nervous system is in one place and coordinated through one referral, assessment and intake process. It’s designed to eliminate barriers to care like multiple appointments with multiple providers in multiple locations and to simplify the patient’s access to their medical team. For children and their families, it will make a day of doctor’s appointments much easier. For medical providers, it enhances their ability to coordinate care.

“The Justin Institute will help us more readily identify and align services earlier in the treatment process and steer families in the right direction, or in many directions simultaneously,” said Lena Zettler, MA, LPA, director of the Cook Children’s Department of Psychology. “For our patients who have had traumatic childhood experiences, plus mental health issues and neurodevelopmental disorders such as ADHD, this will provide better collaboration and coordination of care, hopefully in a more timely manner.”

It’s about improving the system, Dr. Perry explained. One that can admittedly be hard for families to navigate at times.

“Dealing with a disorder of the nervous system is stressful enough,” he said. “Getting the appropriate care should not make it worse. You shouldn’t have to pack up your child and go to four different places when you need a neurologist, neurosurgeon, psychologist and autism services when we can bring these services that commonly co-mingle together under one umbrella.”

At the Justin Institute, neurologists, neurosurgeons, psychiatrists, psychologists and experts in developmental and behavioral health will work together in one location where walking across the hall to consult with one another on a patient’s case will be the norm. For the patient, that translates to better, more comprehensive and connected care.

“The opportunities for collaboration between specialty departments when they are under one roof has the potential to really enhance the care that we all provide our families,” said Matt Robison, director of Cook Children’s Child Study Center, where kids with complex developmental and behavioral health disorders receive diagnosis, treatment and education.

Child Study Center’s Developmental Pediatrics department and Psychology program will physically relocate to the Dodson Specialty Clinics building as part of the Justin Institute, as well as Cook Children’s psychologists who currently function in different departments on the main hospital campus.

The move undoubtedly brings mental health care front and center and illustrates Cook Children’s commitment to connected care, according to Zettler.

“Cook Children’s understands there is no health without mental health,” she said. “Psychologists, in particular, have much to offer in assessment and complex diagnostics, and I am looking forward to future collaboration, projects and research that will be mutually beneficial for all.”

Cook Children’s already has a robust Neurosciences Research Program, but the Justin Institute will open the door for more cross-specialty studies, much like one currently underway examining the impact of epilepsy on the psychological health of children. Chrystal Cooper, Ph.D., a principal investigator with the Justin Institute, is leading that study.

“Dr. Cooper’s work is an example of the type of collaborative research that is possible across the divisions of the Justin Institute,” Dr. Perry said. “Our plan is to take the successful research program we have in neurosciences with a focus on epilepsy, cerebral palsy and movement and grow that team to include teams dedicated to autism, pain, stroke and more.”

To learn more about the specialties represented at the Justin Institute for Mind Health, visit Instituteformindhealth.org. 

For Lisa Elliott, Ph.D., back to school means a full schedule of therapy sessions that all have a common topic – bullying. Dr. Elliott has been a psychologist at Cook Children’s for 28 years and says bullying now starts as early as Kindergarten.

“We see it moving down in years considerably,” Dr. Elliott said. “Parents need to understand, given our culture, that most children will engage in bully behavior because it is being modeled for them through programs on TV, news media and reports, online exposure and adult actors, sports figures and political figures.”

The pandemic has only made the bullying issue even worse.

“COVID, isolation and increased use of social media have definitely impacted bullying – the number of bully incidents have significantly increased, and the severity has also,” Dr. Elliott said.

Since children spend a large amount of their time at school, teachers have the opportunity to demonstrate inclusion and empathy toward others.

“The reality is that teachers are critical role players, and their kindness matters,” Dr. Elliott said.

Types of Bullying

Four types of bullying exist – physical, verbal, social and cyberbullying.

Physical bullying accounts for less than 1/3 of bullying incidents and more boys engage in this type. 

Verbal bullying is the most common form affecting an individual’s self-esteem and feelings for years, leaving scars that last a lifetime. This includes spreading mean rumors, making accusations that are not true, gossip, lies, spreading embarrassing private truths, name-calling, taunting, belittling and cruel criticism.

Girls have the highest engagement in social bullying – a difficult-to-detect form of bullying including ignoring, isolating, excluding or shunning. It is the most potent kind, especially in the middle school and high school years.

As soon as children have cell phones, cyberbullying comes into play.

“Cyberbullying is 24/7 and has a rapid transmission. It reaches the world in an instant,” Dr. Elliott said.

Five years ago, cyberbullying in schools was addressed with the enforcement of David’s Law in Texas which requires schools to notify the parent of an alleged victim of bullying within three business days of a report, rather than waiting for the findings of an investigation. The school also must adopt policies allowing students to anonymously report incidents of bullying and may expel or place a student in a disciplinary alternative education program.

Signs and Symptoms of Being Bullied:

• Does not want to go to school/skips school/gets into trouble at school
• Grades suffer
• Stops talking about peers and school activities
• Loses interest in activities
• Physical manifestations (sleep disturbances, withdrawal and wanting to be alone, complaints of pain or illnesses, appears tearful, displays victim body language such as keeping head down, hunching shoulders and avoiding eye contact)
• Emotional manifestations (appears sad, angry or irritable, withdraws and acts timid, becomes overly moody or anxious, exhibits aggressive behavior)
•  Social/behavioral manifestations (withdraws socially, changes friends, engages in self-mutilation, threatens violence to self and others, talks of running away or suicide, suddenly stops using the computer or other mobile devices)

Signs and Symptoms of Being the Bully:

• Suddenly stops using the computer/device or turns off the screen when someone comes near
• Appears secretive about what they are doing on the computer/device
• Appears nervous when using a computer/device
• Spends an excessive amount of time on the computer/device

“If your child is bullying others, react calmly and don’t blame yourself because there are so many influences in a child’s life. I commend parents who recognize their child could be a bully,” Dr. Elliott said.

Equip Your Child with a Foolproof Tool

When talking to children about peers, the growth mindset of appreciating and valuing differences of opinion should be addressed. Tell your child how to help a classmate who is being bullied such as spending time with them and encouraging them at school and outside of school, helping them get away from the negative situation and telling an adult. 

After researching various strategies to deal with bullies, Dr. Elliott created a response tool that has proven to stop the bully from coming back for more harassment.

“If you show pain, hurt, fear or anger it feeds the bully,” Dr. Elliott said. "Ignoring the bully still gives them the idea they are successful in hurting the victim which fuels the fire and motivates them to keep bullying. The fewer words you say, the better – use words such as ‘OK’ and ‘whatever’ before walking away.”

This strategy acknowledges the bully while at the same time showing him that the tactics are not effective.

“I’ve never had a child or teenager tell me that it doesn’t work,” Dr. Elliott said.

Proactive Tips for Every Parent

Modeling empathy needs to be at the forefront when raising children. Focusing on others’ needs and feelings will contribute to a child’s overall happiness.

• Openly talk about bullying all the time
• Ask questions like “Has bullying ever happened to you? How did it make you feel?”
• Role play and ask “How do you think this would make you feel?”
• Teach empathy and kindness – have child open doors for people, get involved in a service project

“Kids are naturally born with kindness and empathy,” Dr. Elliott said. "What changes over time is what gets modeled for them and what they see.”

The licensed psychologists at Cook Children's have seen this issue throughout their careers. It’s a symptom of a feeding disorder she describes as “pocketing.”

Alaina Everitt. a licensed psychologist, said the issue of pocketing usually begins when children are young. The children may experience something painful, such as reflux or a sore in their mouth, and they find it difficult to eat.

The children then may begin a process of holding, spitting out or refusing food altogether.

Children who pocket food should be checked out by an occupational and speech therapist, even if they have had no other type of therapies or been diagnosed with any medical conditions, according to Everitt. She said those specialists can make sure there are no other problems, such as difficulty moving food around in their mouth with their tongue or if the tongue is weak. These children can usually be cured with basic therapy exercises to overcome these obstacles.

If it’s a sensory issue, more extensive therapy may be needed. Children with sensory difficulties, autistic children for instance, may need a lot of food for them to even feel it in their mouth.

“These kids will over stuff and pile food in their mouth and get the ‘chipmunk cheeks,’” Everitt said. “These children tend to like crunchy or spicy foods because they may have trouble tasting or feeling other foods because of sensory issues.”

Lots of toddlers will hold their food and that tends to be developmentally appropriate. If a child gets closer to age 5 then parents may have cause for concern.

As children get older, they become more skilled at pocketing food. The kids may keep their food in their cheeks until they discard it or the parents can’t get their children to swallow.

“It becomes a meal-time battle,” Everitt said.

Cook Children’s helps parents with a team approach to treating children with a feeding disorder. A pediatrician would help guide the child’s care. A dietitian may help the child find foods they can swallow. Speech and occupational therapists lead the actual therapy portion to teach swallowing and resolve sensory issues. Everitt comes in to help with any emotional or behavioral issues, such as anxiety or parent-child power struggles.

“Therapists have little tricks they teach parents; how to do the right type of massage or how to get in their child’s mouth with a vibrating tool as it helps them from a sensory perspective,” Everitt said. “These things can help children swallow easier. You also have to make sure they don’t have a swallowing problem at this phase and the speech therapist will help with that. If the kid has choked before or has trouble swallowing, why would they try to swallow? Even when that issue gets treated the kids are still scared and that’s when they come to me.”

Should we plan on making baseball practice?

Are we prepared if the storm hits our home or while we are driving?

What can I do to ease the fears of my child who is afraid of storms?

First, your outdoor plans may need to be put on hold. According to the National Weather Service, you should start paying attention to the weather around 4 p.m. today. Storms will increase in coverage during the evening and overnight hours.

Next, have a plan for your family’s safety. Kaysey Pollan, Environmental Safety and Emergency Management officer at Cook Children’s, says everyone should know where they are going to go during severe weather.

“If you don’t have access to underground shelter, move to the interior room or hallway on the lowest floor and get under a sturdy piece of furniture,” Pollan says. “If you live in a mobile home, get out and find secure shelter.”

In addition to knowing where to seek shelter, families should have a designated meeting place away from home (a neighbor’s house or a street corner in the neighborhood) where you would gather if you were separated during an emergency. Make sure everyone in your family knows where the meeting place is located.

If you are driving during a storm, stay in your car and try to find shelter (but not under an overpass). The only exception is if there’s a tornado coming toward you. If you can’t find shelter, get out of the car and find the most low-lying area (ditch, ravine, etc.). Lay flat on your stomach and cover your head with your hands. If it’s hailing, stop driving and find a place to park like inside a garage, under a carwash or a service station awning. If you have small children with you, put them under you and cover their eyes.

Whether or not your child is afraid of storms, it’s important for parents to stay calm during severe weather. Children are quick to pick up on their parents’ fears and anxieties and during an emergency and they will look to you for safety and reassurance.

“Parents should do their best to manage their own anxiety. If parents are calm it will help calm their children,” said Kristi Mannon, Ph.D., psychologist at Cook Children’s Medical Center. “Parents should do their best to avoid watching news coverage in front of their children. Parents can check on weather updates on their phone or a device away from their children in order to stay informed.”

Dr. Mannon also advises parents not to dismiss their child’s feelings or to scold them.

“If a parent needs to complete a task such as preparing dinner and their child is expressing fear, they can take a break for a few seconds, make eye-contact with their child, acknowledge their fear, and tell them they will talk about it as soon as dinner is ready,” she said.

“You can help your child stay calm not only by managing your own fears, but by having a supply kit ready to go,” said Justin Smith, M.D., pediatrician at Cook Children’s Pediatrics Trophy Club. “Make sure you have snacks and something for your child to drink in case you have to remain under shelter for an extended period of time.”

Also, don’t let darkness become an added fear. Dr. Smith advises parents to have flashlights in a place that is easily accessible, and not just the one on your smartphone.

“You don’t want to run the risk of your phone dying and losing your flashlight too. It’s always a good idea to have a real flashlight handy,” he said.

Another tip – distraction can go a long way with children.

“Have a box of items that don’t rely on electricity such as coloring books, board games, a deck of cards or a favorite stuffed animal,” he said. “This can help during the storm and if you have to leave your house during a disaster.”

It is also important to be honest with children about what’s going on. However, make sure the amount of information and detail you share is appropriate for their age level.

It’s also a good idea to know the difference between a Watch and a Warning.

A Watch means conditions are favorable for severe weather to occur over the next several hours. The National Weather Service advises you to continue activities as normal, but monitor the weather and be ready to act if a Warning is issued.

A Warning means head for cover! This is an indication that severe weather is imminent or already occurring at your location. Seek shelter on the lowest floor of a sturdy building and stay away from windows.

One easy way to prepare for severe weather is to download the tornado app created by The American Red Cross. It provides alerts, watches, warnings, and plan-ahead lists right to your phone.

The American Academy of Pediatrics also has compiled a thorough list if wants to prepare for a disaster. You can find it here. 

Lena Zettler, MA, LPA, director of Psychology at Cook Children’s Medical Center, said that belief requires “magical thinking,” which is a normal process and coping skill that kids possess.

“It is generally a useful coping mechanism for children,” Zettler said. “However, there is a wide variation as to when kids use less and less magical thinking to cope or understand the world.”

Kids have a lot of magical thinking at the age of 3 and much less of it by age 12. Magical thinking is what allows kids to believe. But, there are many other factors that also play into this belief: cultural reinforcement, religious beliefs, emotional situations, family stress, family beliefs/customs, peer and sibling beliefs, etc.

Speaking more as a parent than a professional, Zettler said parents should let their kids guide them on this issue. “If a 9 year old wants to stand in line to sit on Santa’s lap at the mall, is that a bad thing? Parents could find the joy in that desire and embrace it too,” she said.

But back to her professional opinion, Zettler said she believes parents worry WAY too much and this is a good example of one thing they shouldn’t get too worried about. She said the magical issue we are addressing is not a developmental task that has to be accomplished by a certain age.

“Let things unfold, I say,” Zettler said. “Let them believe if they want…what does it really hurt? On a lighter note, parents can rest assured, that it is generally an older sibling or cousin that may try to break the big news to their kids anyway.”

Besides, regardless of how old we are, we all want to believe a little bit. Don’t we?

Elliott knows it can be difficult for parents to come to grips with mental health issues their child may be experiencing.

“Regardless of the reason for the mental or behavioral health illness, we have to be responsive to our children immediately,” Elliott said. “Parents sometimes wait until it’s too late to seek help before harm comes to the child or someone else, simply hoping the problem resolves itself over time.”

Parents have reported not knowing where to turn for help or having the time and funds to navigate obtaining appropriate care.

Childhood mental illness occurs in about 20 percent of all children in any given year, according to the U.S. Surgeon General. Nearly 5 million children in America have some type of mental illness, yet experts estimate that only 20 percent of them will receive treatment.

“Early identification and treatment is critical and can be a lifesaver for the child,” Elliott said. “In addition, treatment can be beneficial for all of the child’s relationships and success in school.”

Elliott offers these early warning signs:

1. Significant mood changes, including sadness, depression, withdrawal, irritability or rages
2. Intense feelings with little ability to manage the feelings, including anxiety, fear and panic symptoms
3. Behavior changes including aggressiveness, dangerous behavior, and homicidal thoughts or changes in appearance, friends, interests
4. Physical harm including self-harm and suicidal thoughts/attempts
5. Substance abuse
6. Lack of self-care including, lack of cleanliness, not eat or over eating, sleep disturbances, weight changes, pays little attention to physical health, doesn’t care about homework
7. Change in functioning including inability to concentrate, easily irritated/frustrated, gets into fights/arguments, unable to get along with others, cannot complete projects/work

If parents note any of these changes they are encouraged to speak to their child’s doctor or find a specialist such as a psychiatrist, psychologist, social worker or licensed counselor.

“A proper diagnosis is essential for guiding treatment; and this process may include a health examination and/or psychological testing,” Elliott said. “Treatment may include medications, psychotherapy which includes teaching your child coping tools and how to respond to challenging situation, as well as helping parent training/skills.”

Other resources that provide information to help parents include www.watchdenton.org, National Alliance on Mental Illness (NAMI), National Institute of Mental Health, Mental Health America.

We mustache you a question.

Do you think developing your child's sense of humor is important?

It is. Lettuce explain.

We've all been told laughter is the best medicine, but have we really considered the social, emotional and health benefits of humor?

Children with good sense of humor have been shown to be happier, more flexible and more liked by their peers. 

They also tend to have a more positive frame of mind, higher self esteem and the ability to handle difficult or stressful situations well.

"It is never too early to start developing a sense of humor," said Christina York, Ph.D., a psychologist at Cook Children's. "All children will face very challenging circumstances, and humor may help them work through those sometimes-trying times of childhood."

Health benefits

Not only does laughter provide social and emotional benefits for your child, but a good sense of humor provides health benefits, including:

• Better pain management and toleration
• Improved digestion
• Increased illness resistance and immune function
• Less depression
• Lower blood pressure and heart rates
• Lower stress levels

Guide their humor

As a child explores new and funny things, always teach him or her what type of humor is acceptable for certain situations. If a joke is inappropriate, gently correct the child and provide alternate jokes or stories to tell instead.

Put a smile on our face by sharing funny stories about your children.

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.

New research published this week in the Journal of Clinical Psychiatry may challenge that stereotype or at least require us to broaden what we think ADHD “looks like.”

The research looked at the overall rate of ADHD comparing surveys of parents completed in 2003 and 2011. It might not surprise you to learn that the overall diagnosis of ADHD increased during that time. But you may not have heard that increases were found across all racial/ethnic groups, with the largest increase in Hispanics (83 percent). Perhaps another surprise was the fact that the increase in girls was greater than the increase in boys (55 vs. 40 percent).

Symptoms of ADHD can include difficulty paying attention, hyperactivity and impulsivity. Diagnosis is based upon a conversation you can have with your pediatrician or a psychologist and usually involves a screening questionnaire to be completed by a parent and teacher. Treatment starts with behavioral and parenting strategies to help children cope with symptoms but can require medication when these are not successful.

The study showing this increasing number of children diagnosed with ADHD certainly grabbed my attention. As someone who generally does not like medication for kids, I worry that this means the number of children on medications for ADHD is also increasing. As with all medications (and more than most), treatments for ADHD do not come without risk.

I do have some theories as to why the number of children diagnosed is increasing:

Theory No. 1 - Parents and teachers are more aware of the signs of ADHD.

Many hyperactive and impulsive children were previously labeled as trouble-makers and ended up spending lots of time in detention and in school suspension. Many inattentive children slowly started to have more trouble as classes got harder and parents and teachers eventually gave up on them as someone who just “wasn’t made for school.” Now we are realizing that those hyperactive/impulsive kids can’t simply “just sit still” and that those kids who were previously doing well shouldn’t be failing just because they can’t listen to lectures or get their paperwork turned in on time.

This particularly accounts for the increased rates of diagnosis in children of Hispanic and African-American descent. Previously, the stigma associated with all mental health conditions (including ADHD) prevented parents from seeking help. Also, because many girls are inattentive, rather than hyperactive and always in trouble, they could also go undiagnosed.

Theory No. 2 - Physicians are increasingly giving in to parent demand to “fix” their child.

This is by far my least favorite, but I just believe it is something we should at least consider. In a world where the expectation is that a pill can cure just about anything right now, parents increasingly want something today that will resolve their child’s behavior problems. Long term treatment plans that involve behavioral techniques and maybe even counseling aren’t as popular for all parents. However, we should fight against this as the diagnosis of ADHD and decision to start treatment should not be based on demand from a parent.

Theory No. 3 – The expectations and demands on children are changing.

Children are learning to read and do more intense math earlier and earlier. Homework was virtually non-existent when I was growing up until second or third grade. This is not necessarily the schools or teachers fault so don’t call up and gripe at your child’s teacher. Many of the requirements for what they teach and when they teach it come from above them. The simple fact is that, in trying to keep up with the success of other countries, we have decided to accelerate curriculum and to challenge students. It’s not always a bad thing, but it can be if you have a hard time sitting still for long periods or can’t keep yourself organized.

Theory No. 4 - New medications with less side effects have made parents more likely to seek treatment.

No one wants to see their child “turn into a zombie.” It’s still the number one concern I hear when starting treatment for ADHD. Fortunately, with newer medications, the side effects are much less severe and much less common. Loss of appetite and difficulty falling asleep are now the most common side effects I see, even those are not that frequent.

Keep in mind, each of these things are theories based on my experience. We will need to continue investigating why we are seeing this increase in the rate of ADHD. We all need to be observing our children for signs and symptoms, particularly if they are struggling with school but parents and teachers need to be careful not to attribute all school struggles to ADHD.

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About 3 percent of kids suffer from severe selective eating, to the extent that they can't eat out at a restaurant, said lead researcher Nancy Zucker, an eating disorders specialist at Duke University Medical Center in Durham, N.C.

Severely selective eaters are more than twice as likely to be diagnosed with depression or social anxiety, when compared with kids who'll eat anything, according to findings published online Aug. 3 in the journal Pediatrics.

Alaina Everett, a Cook Children’s licensed psychologist in Denton, says severe picky eating can be treated from a psychological/behavioral perspective as well as through oral-motor and sensory therapies and trying new foods for children who have severe selective eating can be terrifying.

“The fear is only intensified when parents make threats or express anger and frustration,” Everett said. “In our psychology department we emphasize the belief that kids do well if they can. Likewise they will eat well if they can. But there are obstacles that get in the way. Whether the original issue is a sensory processing disorder, oral-motor weakness or a gastrointestinal problem, all these kids have one thing in common, anxiety.”

From a psychological standpoint, these kids have had unpleasant experiences with food and the lingering trauma may be real. This is especially true for well-meaning moms who hide veggies in their kids’ favorite foods. If you have a seriously picky eater, Everett says this strategy will back-fire big time.

So how much anxiety can meal time actually cause?

“It is not uncommon in my practice to see children cry, scream, hide under the table, and quite literally shake at the sight of a novel food or when asked to join me at the table,” said Amanda Fyfe, a speech-language pathologist at Cook Children's in Arlington and Mansfield. “The anxiety severe picky eaters cope with is real and it can be intense. These kiddos often have months or years of negative food experiences fueling this fear, and unraveling it takes real work on everyone’s part. “

Fyfe says severely picky eaters:

• Have a significantly limited food repertoires (think 10 foods). These foods are probably similar in some way, although figuring out the rhyme or reason to what your little guy will or won’t eat can be mind boggling. It may be that his safe foods are the same color or have the same texture.
• Frustrate us with behavior that makes mealtime at home a catastrophe and eating out unheard of. He may refuse to eat with your family or cry and scream at the sight of the casserole you’ve so lovingly prepared.
• Refuse foods based on ALL sensory properties, including appearance, smell, texture, and taste. A picky eater may not even tolerate an offensive food on his plate. The sight of a non-preferred food may cause gagging, retching, and vomiting. Eating is more than simply chewing and swallowing. Interacting with, smelling, touching, and tasting are ALL important steps in the eating process. And disruption can occur at any step.
• May struggle to meet nutritional demands

“A child will not eat the broccoli and pork chops if you wait him out. He just won’t,” Fyfe said. “In fact, he may grow more and more rigid in his food selection because he IS hungry and grumpy. If a food or experience causes a child stress, discomfort, or pain, he will avoid it, plain and simple.”

Fyfe says these children are hypersensitive to foods in ways most of us might not even consider when planning our meals. Foods have to pass many tests before deemed acceptable for consumption, believe it or not, and severely picky eaters really put their meals to the test.

The first and possibly the most important test his dinner must pass? What it looks like. Children are acutely aware of the color of the food and may question why the color, shape, or size changes from bite to bite or from meal to meal. In addition, they might become overwhelmed by the smell of a particularly pungent food (think roasted broccoli, guys) and lose all ability to even consider tasting it. The texture of yogurt or pudding may cause a gag with incredible force. All of these reactions to food can lead to increased behavior disruption and meal time chaos.

“They can taste everything,” Everett said. “Zucchini pasta does not fool anyone and they are likely to stop eating pasta altogether. Presenting motivators like extra video game time can help, but it doesn’t solve the underlying anxiety. The scenario will just repeat itself when the next new food is presented.”

If your child shows signs of extreme picky eating, you will need some help. Talk to your child’s pediatrician about scheduling a feeding evaluation with a speech-language pathologist to determine the origin of the feeding woes and develop strategies to improve the eating experience for the entire family. A child psychologist may also be used if necessary.

http://www.npr.org/sections/health-shots/2015/08/03/428016725/could-your-childs-picky-eating-be-a-sign-of-depression

https://childhealthanddevelopment.files.wordpress.com/2012/03/kaytoomey.pdf

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.