Recognizing the need for support during this difficult time, Cook Children's physicians have come together to offer guidance and reassurance. Cook Children's Licensed Psychologist and Prosper Psychology Clinic Manager Christina York, Ph.D., provides valuable advice and guidance for parents navigating this sensitive situation. 

1. How do I help my teen make sense of something so senseless? 
When traumatic situations occur, we naturally want to make sense of them quickly. But when situations don’t seem to make any sense, it can help to think about what we can learn from the experience. 

2. What are the common signs of trauma in teenagers after witnessing or hearing about a violent event?
Teenagers who have experienced trauma may show several common signs, including:

• Trouble sleeping or nightmares 
• Feelings of sadness, helplessness and hopelessness 
• Difficulty concentrating, which can affect their schoolwork 
• Increased fear and anxiety 
• Loss of interest in usual activities 
• Social withdrawal 
• Avoiding things that remind them of the event (like talking about it) 
• Changes in appetite 
• Physical complaints such as stomachaches and headaches 
• Acting out 
• Feelings of anger, resentment or wanting revenge.

These reactions will generally subside over time. If they last for longer than a month or continue to worsen, parents may want to contact a mental health professional. 

3. If my teenager witnessed a traumatic event, is there anything I should look out for? How can I support them?
Pay attention to sudden changes in your child's behavior, speech patterns, and the way they express themselves, as well as strong emotions. Be particularly aware of:

Academic and Social Changes:

• Drastic drop in grades 
• Refusal or reluctance to go to school 
• Loss of interest in usual activities 
• Social withdrawal and increased isolation (which may include feeling numb and disconnected from themselves and others) 

Sleep and Emotional Reactivity Changes: 

• Changes in sleep patterns (difficulty sleeping, sleeping excessively, deliberately staying awake, frequent nighttime awakenings) 
• Increased reactivity (sudden mood swings, being easily startled and on edge, and/or quick to anger or tears). 

Support them by listening attentively and validating their feelings, even if you don’t agree with their emotional response. Instead of reacting negatively, try reflecting back what you hear them saying (for example, "It sounds like you're feeling scared and angry right now"). You might be surprised by how much they open up when you reflect instead of asking questions. Ask them directly how they're feeling and what they think about what happened. Always respect their choice to talk or not talk about the traumatic event. 

4. When should I seek professional help for my teen? 
If any of the signs of trauma listed above continue or worsen after two to three weeks, seeking professional help is advisable. Furthermore, any expression of suicidal thoughts is a critical warning sign requiring immediate professional attention. Additionally, engaging in risky behaviors like substance use, possibly as a way to avoid thinking, talking, or coping with the trauma, is another behavior that should be addressed quickly by a professional. 

5. How do I help my child process all of their emotions? 
First, be patient and never force your child to talk. Think of it as gently opening a door, not pushing it open. Reassure them that whatever they're feeling—sadness, anger, confusion, fear—is normal. If they don't want to discuss the traumatic event directly, encourage other forms of expression like drawing, journaling, music, art, or physical activity. 

Understand they might find it easier to talk to another trusted adult, such as a pastor, youth leader, teacher, counselor, coach, relative, or neighbor, and don't take it personally if they do. 

When your teen does decide to talk to you, ask how you can best support them: by simply listening, offering feedback, or helping to problem-solve. Be ready for any emotion they express and validate it without showing displeasure, anger, or frustration, even if it's unexpected. Instead of asking many questions, let your child guide the conversation and use open-ended questions. Remember that silence is acceptable; when they are ready, they will talk. 

6. What should I do if my teen is experiencing nightmares or flashbacks? 
Nightmares and flashbacks are common after trauma. If these symptoms continue for more than a couple of weeks, it may be helpful to seek help from a therapist experienced in trauma. Again, don't force your child to talk about nightmares. If they are experiencing a flashback, avoid startling them (like shaking or yelling). Instead, speak calmly, sit with them, and allow the flashback to pass.

7. What are some immediate coping strategies I can teach my teen to manage anxiety and fear?
Immediate coping strategies include: 

• Deep breathing: Slow, intentional breaths
• Grounding: Focus on your five senses to bring yourself to the present moment 
• Distraction: Engage in activities like holding ice, listening to calm music or watching something lighthearted 
• Physical activity: Movement can help release tension 
• Get creative: Activities like drawing or writing can provide an outlet for feelings. 

8. How do I help my teen feel safe again? 
Provide them with reassurance. Limit their exposure to repetitive news coverage on television, radio, and the internet, as this can prevent them from emotionally detaching from the traumatic situation. 

Talk with your teen about what they have seen or heard. Help them identify and focus on “cues of safety” in their environment, such as trusted people, rather than solely focusing on potential dangers. 

Because they may feel a loss of control, help them focus on what they can control, such as their choices, their bodies and their daily routines. Sticking to routines can provide a sense of predictability and stability, which is especially helpful when life feels unpredictable and chaotic. 

9. How can I address my own anxiety and fear without transferring it to my teen? 
Parents, please remember you are not alone. Talking with your partner or a trusted friend can alleviate your anxiety. Consider seeking your own individual therapy. Additionally, support groups for parents may be available through mental health clinics, churches, or other community resources, offering a space to connect, discuss fears and learn coping strategies. Taking care of your own well-being shows your children that seeking help is valuable. 

We encourage parents to engage in activities they enjoy, utilize helpful coping skills like deep breathing, mindfulness, meditation, physical activity, and journaling, and prioritize self-care, including sufficient sleep. It's okay for parents to communicate their feelings to their children calmly, as demonstrating their own coping skills in front of children can model healthy ways to manage anxiety and fear. 

Resources

Below is a list of resources for families, compiled by Cook Children’s physicians.

How to cope with traumatic stress
How to help children and teens manage their stress
How to Help Children Cope With Trauma - Child Mind Institute
Acute Stress Disorder in Children: A Quick Guide

Checkup Resources | Healing From the Inside Out | Cook Children's 
Behavior and Emotion Resources | Cook Children's 

The national suicide/crisis hotline (call, text, or chat options): 988 Lifeline 

Whether you’re a younger kid starting kindergarten or a teenager starting high school, going back to school can create a lot of feelings. We asked Kia Carter, M.D., co-medical director of Inpatient and Consultation Liaison Psychiatric Services and Kristen Pyrc, M.D., medical director of Psychiatry Outpatient Services and the Partial Hospitalization Program at Cook Children’s Medical Center – Fort Worth, about how they talk to their own children when it is time to go back to school. They approached the subject from different perspectives because their children are different ages. Their back to school tips for parents cover all the bases, and we are thankful for their expertise and personal experiences as mothers!

Dr. Pyrc’s Back to School Tips for Young Kids:

• Little kids want to be big so badly, so parents should play up just how big they are going to be at their new school and all the fun things they can do when they get there.
• Read the book The Invisible String together, and remind your kiddo that you are always connected even when you’re not together.
• Tag in an older sibling or friend if you can! They can give the best advice and pep talks!
• If they are scared (which is totally normal), ask them what makes them worried. It may be the expected things like “Will I get lost? What if no one likes me?” or it could be something totally off the wall that an adult would never think of like “Who’s going to pet the dog when I’m at school?”
• Make drop-off short and sweet. Elementary school teachers are masters of distraction and comfort. I would give a quick hug and let the teacher work their magic.
• Kids look to us to know how to respond in new situations. Even if your mind is racing with worry, it’s important to put on a brave, reassuring face to set them up for success. You got this!

Dr. Carter’s Back to School Tips for Older Kids/Teenagers Addressing Anxiety:

• I encourage all teens to attend the school’s scheduled pickup/orientation as this is a way to decrease anxiety as they are able to see the school, walk their schedule and even see old friends which will help with those first day jitters when navigating such a big school. Also, you may see your old friends at these events which will help with that anxiety about reintegrating with old friends.
• Encourage teens, especially those new to a school, to join a club/afterschool organization to just get involved – this is an easy way to make new friends, provides outside engagement and even creates new hobbies/activities to keep kids busy. They may actually end up loving it. High schools have so many clubs, so most kids can find at least one extracurricular activity.
• Most middle/high school kids don’t want parents to be involved in drop off/make a big deal like we do in elementary school. As parents, we can support our teens differently like the night before or morning of – sitting down for a back to school dinner, eating first day of school breakfast with your teen a couple of minutes early, or reviewing their schedule with them the night before. This just provides some time to connect with your child in a space that is focused on something casual, while also providing the opportunity to talk about any first day anxieties and provide reassurance.
• Mostly teens worry about who they will walk the halls with, or who they will sit at lunch with, and so I would encourage teens when this is a worry – if your child has friends in their class, maybe try asking their friends if they can walk to the next class or walk to lunch together. Another tip is to try looking for familiar faces when walking the halls, or at lunch, because most likely other kids are also feeling the same way and don’t want to sit or eat alone.

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.

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. 

By Ashley Antle

What has enough concrete to fill eight Olympic-sized swimming pools, ductwork that equals the weight of 32 male African Elephants and 160 miles of wiring that could circle a football field more than 600 times?

It is the newest addition to the Cook Children’s Medical Center campus, which adds 240,000 square feet and six new services to the existing Dodson Specialty Clinics building. The expansion, opening in March 2023, is designed to make visits to one of the more than 35 specialty clinics housed in what will ultimately be a fully integrated facility easier and more convenient for patients and their families.

“Our specialty clinics are experiencing increasing demand for services from a rapidly growing, diverse population,” said Veronica Tolley, vice president of Primary and Specialty Services at Cook Children's. “The Dodson Specialty Clinics expansion will accommodate this growth, while also allowing clinics to consolidate to one location which is a tremendous satisfier for our patient population.” 

Children living with a disability or disease often require ongoing care from one or more specialized physicians, like a neurologist or oncologist, for example. Juggling multiple appointments, medical equipment and other challenges that come with a chronic condition can be difficult. The Dodson expansion places vital and often overlapping specialty services under one roof, connecting the dots of care, collaboration and convenience for physicians and families.

What’s New

While adding space for clinic growth, the expansion also will support the addition of a Peaks Tech Zone, a sibling center, a cafe, a pharmacy, retail space and a maternal/fetal medicine clinic.

A cross between a technology lounge and in-person help desk, Peaks Tech Zone is a place where families can get guided, hands-on experience with devices and online applications recommended for their child’s care. It includes a self-service space and a consultation area for one-on-one assistance from a health technology advocate, or techspert, who will help Tech Zone visitors do everything from setting up their MyCookChildren’s patient portal so they can view their child’s medical chart to syncing their personal technology with medical devices and apps recommended by their child’s physician. Visitors can also learn how to utilize virtual care, telemedicine services and any new Cook Children’s innovation that helps them meet the health needs of their family.

The Sibling Support Center will take a load off of parents and give kids a safe, fun and developmentally appropriate space to spend time during their sibling’s clinic appointment.

“There are many times when parents have to bring siblings to patient appointments, and sometimes the presence of siblings ends up preventing needed clinical care from being able to happen,” said Jill Koss, director of Family Support Services. “This Sibling Support Center will allow parents to focus on their child who is a patient and, even more importantly, will allow siblings to be the focus of specific programming designed to support their emotional, psychosocial and developmental needs.”

The Sibling Support Center is generously sponsored by Panda Cares through Children’s Miracle Network Hospitals charities. It will be located on the first floor of the Dodson expansion and open to patient siblings ages 3 to 12, Monday through Friday, for up to 90 minutes per visit. Programming will include creative arts activities, play supporting growth and development, music, dramatic play, video games for older children and more.   

The new space also makes way for the Jane and John Justin Institute for Mind Health, which will put commonly overlapping specialties that treat the mental and physical diseases and disorders associated with the nervous system under one roof. Those specialties include Neurology, Neuropsychology, Neurosurgery, Pain Management, Physical Medicine and Rehabilitation, Psychology, Psychiatry, Developmental Pediatrics and Developmental Psychology. The Justin Institute is 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 is slated to open fall 2023 in Cook Children’s Dodson Specialty Clinics building.

A new 10-level parking garage for physicians and visitors will support the facility and will be easier to navigate. No more driving around and around wondering if a space will be open from one level to the next. Using dynamic signage, an intelligent parking system will alert drivers to the number of spaces available as they approach a level of the garage, making self-parking more efficient and reliable.

“Following substantial completion and certificate of occupancy, many of our clinics who currently reside in our existing Dodson facility will begin moves to the new facility through a managed transition plan beginning in late March and continuing through 2024,” said Kim Arnold, space utilization and transition manager. “Countless thousands of children and their families will enjoy this new facility, the exciting features and benefits designed to serve them. We cannot wait to implement the transition of our clinics and services, and open the facility for our patient families.”

“Children are searching for their own understanding and making sense of the world they live in,” said family therapist Chris J. Gilbert, M.Ed, LPC, CCLS.

Parents may be wondering how to talk to their child and how to best support them. The most important thing is every child is unique and has different needs, Gilbert says.

“You are your children’s best expert,” Gilbert said. “Trust your gut, give yourself some grace if you do or say the wrong thing. The most important thing to remember is that your presence and willingness to listen is ultimately what your child is needing the most.”

Watching the news

Gilbert said to be mindful of what you’re watching on the news and where you’re watching it because children are very receptive to what they hear and see.

“If they do show interest in staying informed, I would say watching the news with them is OK and to give them perspective to what is occurring," he said. 

Gilbert said parents can also watch the news ahead of time, record it and rewatch it with them later. This allows parents to provide highlights and manage how much news they are taking in.

He suggested limiting the access of things that your child sees on social media.

“Parents, be available for questions and allow time for questions,” he said. “Do your best to provide information and know that some of those questions you won’t have answers to. It’s OK to say ‘I don’t know.’ It’s also OK if they are not interested or don’t show interest.”

Validate feelings

Parents, stay calm because children are very receptive to emotional and nonverbal cues.

“When having conversations, always attempt to validate feelings,” Gilbert said. “Feelings of anxiety and sadness are normal. Provide an environment of safety and allow them to share what they are feeling. Reflect what you heard and give them the space to share."

Kids may be seeing images and videos of the refugees fleeing Ukraine and feel sad or uneasy.

“Validate that, say ‘that’s horrific,” Gilbert said. “Allow them to vent and share their own frustrations and reflect that back.” 

No one emotion/feeling is right or wrong, everyone perceives what is going on differently and processes in their own way.

He said adults can’t always put answers to their questions, but it’s important to validate your child’s feelings.

Turn to action

Anxiety and worries about the unknown can be paralyzing. Turn those fears and angst into actions, he said.

“Families can brainstorm together for ways to help,” Gilbert said.

Some ways are:

• Donating to charity
• Writing letters to potential refugees
• Use your faith and pray with your children for the needs of others

All of this allows a sense of ownership, control, predictability and a healthy outlet which is something all kids need and frankly what we all could benefit from.

Parents, take care of yourself

“As for parents, I would recommend on relying on your own support systems as well as community support systems to work through your own fears and uncertainties about current events,” he said. “Allowing yourself these outlets provides you the best opportunity to be the most present and comforting to your own family and children.”

What should parents say if their children ask them about what happened at the Capitol?

First of all, stay calm. If you're not calm at the moment, then wait until you are and then ask them what they've seen, what they've heard, and do they have questions or concerns. Answer their questions, but don’t give them too much information.

The most important thing is to be a good listener, hear them, and try not to share too much of your own anxiety with them. If they say they're anxious, it's okay to say ‘I'm anxious too,’ but don't overplay that because you're their protector. Kids need to feel safe in their own homes and their own communities as much as they can.

Should parents bring this up to children, even if they don’t ask?

I think it depends on the age and maturity of the child. Some kids may hear about it, but really not have much of an understanding of our government and the Capitol. So with these kids, I would ask, ‘What did you hear? Do you have any questions about it?’ Just make sure you're answering their questions rather than bringing it all up yourself. But with some older teenagers, I would certainly bring it up and make it a point of conversation. Ask what their reaction is and see what questions they may have about it.

Should parents let their children watch the news?

I generally don't recommend for kids to watch the news, just because it reports so much of the violence and the negative things that happen. If I wanted them to hear more about a specific thing that happened, I would sit down and watch the news with them and be ready to answer any questions. I'd certainly rather they ask me questions than get information from other people and other sources.

How do you manage what children and teens see about events like this one on social media?

That is a tough one because there's so much out there that we don't really want to see. To me, it's almost like going into a library and looking at all those shelves and deciding ‘What do I want to pick out and read?’ Kids need to think about ‘What do I want to listen to and what do I want to pay attention to?’ I imagine their friends are going to be talking about it and as a parent, it's really important to be aware of what your kids are looking at and what they're seeing and hearing. When they're using social media at home, have them do it with the door open or at the kitchen table, somewhere you can walk by and see what they're doing and not be hidden.

Is there anything else you’d like parents to know?

I can't say strongly enough, watch what your children are looking at on social media. Talk to them about what they're looking at. If they quickly turn it off when you walk into the room, find out what they're looking at. It's so important to set limits on social media. Have them turn their devices into you when they're not supposed to be on them so you can have some control over that.

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.”

With more kids at home and without a lot to do, it’s not surprising most of us have eased up on our screen-time restrictions during the current COVID-19 pandemic.

However, statistics show it’s now more important than ever to be aware of what our children are doing online.

Tragically, the National Center for Missing & Exploited Children (NCMEC) report a significant increase in online child sexual exploitation.

Specifically, CyberTipline reports a 106% increase of suspected child sexual exploitation in March 2020 (2,027,520 reports) as compared to March 2019 (983,734 reports).

The greater amount of time a child/teen is online, along with the amount of free time now available to them, increases the risk that individuals may attempt to coerce kids into providing sexually explicit images or videos.

Perpetrators attempt to make casual contact in hopes of gaining a child’s trust and developing an online sexual relationship. Often these criminals threaten the child/teen in some manner to maintain compliance.

Unfortunately, children/teens are often so embarrassed that they were naïve and enticed or coerced to engage in these behaviors that it prevents them from coming forward. So it is imperative that they understand this was not their fault, they are not in trouble and by reporting they are actually helping others.

It is critical to keep in mind that reporting suspected sexual exploitation could help minimize or stop further victimization. If you suspect or know someone is a victim of child sexual exploitation you can:

• Contact your local law enforcement agency.
• Contact your local FBI field office.
• File a report with the National Center for Missing & Exploited Children (NCMEC) at 1-800-843-5678 or online at www.cybertipline.org.

Acknowledge All Feelings

• While children express stress in different ways than adults, they may still have many of the same feelings as adults. Sadness, worry, anger and feelings of loss may be common.
• Before moving to conversations about hope, ways to stay safe, and fun activities to pass the time, it is important to meet children right where they are emotionally.
• Validate your child’s emotions, “It is okay to be feel sad.” And let them know that you have felt that way too “I really miss seeing my friends, too.”
• Encourage expression of emotions in age appropriate ways. For example, art for younger children and journaling for older children.

Honesty is Best

• Even though you are doing your best to keep your child’s life feel as “normal” as possible, children can sense the changes going on around them, and they may have overheard adult conversations and news.
• Children also sense adult worry and anxiety.
• Children fear the unknown, and they often imagine things far worse than reality, so avoiding the discussion of Covid-19 with your children could cause more worry.
• To help your children to feel safe, explain Covid-19 in an honest, yet age appropriate way. See the resources below for age specific help.
• Begin by asking your children what they already know about Covid-19 or what they have heard, and build upon this knowledge. Your goal is to dispel misinformation and fears, not to cause more worry.
• For older children, use specific words children might have heard and ask if they understand the meaning (for example: social distancing, coronavirus, quarantine, pandemic)
• You don’t need to overwhelm children with information or great detail, but be willing to answer their questions openly, simply, and honestly.
• Follow your child’s lead. They will let you know when they have had enough information by asking to play or showing disinterest in the conversation.

Reassure Your Children

• Choose the right time to talk to your children. When you are feeling anxious or worried, this is not the best time. Take time to calm yourself before having important conversations with your children.
• Focus on what you are doing as a family to stay safe (washing hands, staying home, not attending social events, keeping distance from others while playing outside, and maintaining a clean home).
• Discuss how healthcare workers are doing their very best to take care of people who do get sick.
• Explain that most children are staying healthy, and most children have mild symptoms even if they get sick with this virus.

Keep Checking In

• As with any stressful topic, emotions and questions may change and develop over time.
• Revisit the conversation as things change, and be willing to discuss with your children when new questions arise.
• Watch children for signs of stress such as, lack of interest in typical play activities, trouble sleeping, or regression in development and contact your healthcare provider if needed.
• Reassure children that you will always be honest with them.
• Calm your children by explaining this will not last forever.

Routines Help

• Routines and predictability help children to feel safe.
• Keep old routines such as mealtimes and bedtimes.
• Create new routines and allow children to have control and choice in developing these routines.

Age Specific Resources

Preschool:

• Explaining Covid-19:
• Online book explaining social distancing

School Age:

• Printable book explaining Covid-19 (young school age)
• Video explaining Covid-19
• Comic explaining Covid-19

For other questions regarding COVID-19 and children, Cook Children's has developed a resource page with information for parents. 

Written by Cara Bozarth, a child life professional and clinical educator at Cook Children's.

The CDC found:

• That suicides increased by 56% during the 10-year span among people ages 10 to 24 years old.
• Suicide attempts among African-American teens increased by 73%.
• Suicide is the second-leading cause of death for teens from all demographics and the third-leading cause of death among black youths between the ages of 15 to 19 in 2017.
• In 2017, 2,200 teens between 15 to 19 years died by suicide.
• 1 in 5 high school students admitted to experiencing suicidal thoughts and 1 in 10 said they devised a plan to carry it out.
• The increase in the rate of suicides among 10- to 14-year old children have almost tripled between 2007 and 2017.

The CDC collected data from nearly 199,000 high school students by the CDC and Prevention’s Youth Risk Behavior Study.

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 its 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., a 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.”

While researchers say they aren’t sure of the exact causes for the rising suicide rates, experts point to a rise in depression among adolescents, drug use, stress and access to firearms might all be contributing factors.

Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Cook Children’s Behavioral Health Clinic in Denton, is simply fed up. She’s seen too many kids come into her office depressed, frightened or even suicidal because they can’t get away from their bully or bullies.

“I think that bullying is worse than ever before because of cyberbullying,” Elliott said. “Kids can’t get a break.”

No child is bully-proof. Elliott offers parents the following talking points when speaking to their child about bullying:

• Even people who say they're your friends can bully you.
• You should confront your friends when they're being hurtful to you or others.
• Retaliating may feel good temporarily, but refusing to stoop to the bully's level will win you more popularity in the long run.
• When you hear a false rumor, just ignore it and be yourself.
• You're most likable when you respect yourself and others.
• Bullies usually have their own insecurities. Returning meanness with kindness is the best way to break down their defense.

Elliott advises parents to monitor their child’s computer and cell phone, and encourage them to spend less time on social media. If bullying expands onto social media, then parents should talk to their child’s teacher, coach or another school official.

“Parents should watch for any change in a mood like sadness, depression, hopelessness, irritability, anger, and hostility,” Elliott said. “You may see more tearfulness and changes in activity level. Watch for more withdrawal from friends and family, change in friends and loss of interest in activities once enjoyed.”

Elliott says warning signs of teen suicide include:

1. Alcohol/Drug Use
2. Preoccupied with death (writing, drawings)
3. Talking about feelings of hopelessness
4. Talking about being a burden to others
5. Telling loved one's goodbye
6. Decline in performance
7. Giving prized possessions away
8. Isolating and withdrawing
9. Acting highly anxious or agitated
10. Acting reckless and taking risks
11. Rages
12. Changes in sleeping and/or eating
13. Dramatic changes in personality and/or appearance

If you would like to schedule an appointment, refer a patient or speak to our staff, please call 682-885-3917. 

Sources for this Topic:

• Cook Children's Behavioral Health Center
• Youth Risk Behavior Surveillance System (CDC)
• Report: Suicide Attempts Among Black Teens Increased by 73 Percent (The Root)
• Suicide attmepts increasing among black children and teens, study finds
• Youth Suicide Rate Increased 56% In Decade, CDC Says
• Suicides and homicides on the rise in young people (NBC News)

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.

Parents can help by making sure that children plan accordingly for testing days at school. Find out from your children and the school how they’re doing and the likelihood of not performing well on tests. This will help alleviate fears by pacing preparation for the tests, creating a plan to help kids succeed and encouraging them to problem-solve their worries.

Here are steps you can take to help your child during this stressful time:

1. Ask for help. If your child is especially anxious about test taking, set up a meeting with the teacher and school counselor to come up with a plan to ease fears on test day.
2. Go online and get sample items of practice tests from previous years and, if needed, practice with your children at home.
3. Practice deep breathing exercises at home. Then on test day, they will be able to put these practices into action.
4. Make sure your child gets plenty of rest. Studies have found that people who get eight hours of sleep before taking a math test are nearly three times more likely to figure out the problem than people who stay awake all night.
5. Control your children’s anxiety by making sure they are prepared. Focus on good study habits and the importance of not waiting until the last minute to cram before the test. There’s still time. Also, make sure your child has everything he or she needs going into the test. Even if it’s a new sharpened pencil. Make a check list the night before to avoid stress.
6. Stay away from entertainment as test time approaches. It’s not easy, but your child needs to study and not spend all night watching TV, looking at Facebook^® or being on the computer. You can wait on that until after the test.
7. Help your child keep mistakes in perspective. Everyone makes them and nobody is perfect. As you move closer to tests and studying, use wrong answers as a learning opportunity.
8. Eat right. Make sure your child has had enough sleep, exercise and healthy food. Avoid heavy food or desserts that may upset the stomach. Avoid  high sugar foods that may keep your child up all night and  make sure your child has a healthy breakfast (low-sugar cereal or oatmeal) the morning of the test.
9. Expect distractions. Let your child know someone in the class will have sniffles. Some kid will be banging his pencil on the desk. Someone may be humming. Those kids have their own stress. Just warn your child this is going to happen, but don’t let it be a bother.
10. After testing is completed, create ways to celebrate with your child. What you want to focus on in this celebration is the success of managing their stress, and not whether they passed or failed, which they won’t know for weeks.

“At the end of the day, I can’t help that my wires are a little bit differently crossed than yours,” Manziel said on Good Morning America. “I can’t help my mental makeup or the way that I was created.”

Manziel said he used alcohol has his method of self-medication and battled depression on his way to his “huge downfall.”

The former first-round draft pick told GMA that he was diagnosed with bipolar disorder a year ago. Today, Manziel said he is currently sober and taking medication for bipolar disorder.

So how do you know if your child is battling bipolar disorder?

Bipolar disorder is a mental health condition marked by extreme swings and mood and energy. It can affect the ability to function normally. The mood changes of bipolar disorder are more severe than normal ups and down.

Roxanne Boyd, LCSW, a family therapist for inpatient psychiatry at Cook Children’s, said people with bipolar disorder usually see multiple health care specialists before being diagnosed.

“For example, it can look at various times like depression, chemical dependency, even ADHD. In Johnny Manziel’s case, he was initially treated for chemical dependency,” Boyd said.

She added people with Borderline Personality Disorder are at high risk for chemical dependency, trying to manage their moods with alcohol, anxiety medication, like Xanax, or amphetamines.

Lisa Farmer, director of Psychiatric Services at Cook Children’s, said a differentiating character of bipolar disorder as opposed to unipolar depression is the presence of “clinical mania."

“Receiving a psychiatric evaluation is very important because of the risk of misdiagnosis. Medication management of depression, anxiety, and ADHD can be quite different from treating bipolar disorder. A psychiatric evaluation will help so the child is not treated with incorrect medication.”

Some use the acronym DIGFAST to refer to mania symptoms:

D-Distractability

I-Indiscretion or high risk behaviors

G-Grandiose thinking

F-Flight of ideas or racing thoughts

A-Activity increase

S-decreased Sleep

T-talkativeness or hyperverbal, pressured speech

"These symptoms will cause an impairment in the ability to complete daily activities and the symptoms will affect multiple aspects - school, home and even the inability to be successful in extracurricular activities and peer relationships," said Kia Carter, M.D., co-medical director of Psychiatry at Cook Children's. "In bipolar, I think the key is that we are looking for a combination of impairing symptoms and not just focusing on the mood swing that children or adolescents may present with."

Dr. Carter said making your pediatrician aware of any concerning symptoms early on can help with early detection and treatment if necessary. If your child is having these symptoms and there is an impairment in function, please call 682-885-3917. 

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?

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.

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.

Lisa Elliott, a licensed psychologist and clinic manager of Cook Children’s Behavioral Health in Denton, says some children may threaten suicide in an attempt to get attention or others may be struggling with depression.

“But it doesn’t matter,” Elliott said. “You must take the threat very seriously. If a child is talking about suicide, get help immediately. It’s critical not to ignore this cry for help regardless of their reasons.”

Following a suicide in the community, parents should take the time to talk to their kids.

“Use it as an opportunity to discuss their possible feelings of grief or confusion and be a listening ear and support them,” said Joy Crabtree, a licensed psychologist and clinic manager for Southlake and Northeast Clinic. “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.”

Research has found that about 90 of people who die by suicide experience mental illness.

Elliott says teens with chronic illness, such as depression, are no different than any other child and generally want to be treated just like any other kid. But they should receive professional help and be assessed for anxiety and depression.

“Parents should watch for any change in mood like sadness, depression, hopelessness, irritability, anger and hostility,” Elliott said. “You may see more tearfulness and changes in activity level. Watch for more withdrawal from friends and family, change in friends and loss of interest in activities once enjoyed.”

Elliott says warning signs of teen suicide include:

1. Increased use of alcohol/drugs
2. Preoccupied with death (writing, drawings)
3. Talking about feelings of hopelessness
4. Talking about being a burden to others
5. Telling loved ones goodbye
6. Decline in performance
7. Giving prized possessions away
8. Isolating and withdrawing
9. Acting highly anxious or agitated
10. Acting reckless and taking risks
11. Rages
12. Changes in sleeping and/or eating
13. Dramatic changes in personality and/or appearance

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

By the time parents and pediatricians recognize and treat the problem or recommend a feeding evaluation, that child may have had years of unpleasant eating experiences. So what happens? They refuse to eat. They throw tantrums at the table. They make mealtimes miserable for the entire family.

What’s a parent to do? You thought your child was “fixed.” The medicine has taken away the pain and the speech therapy has dealt with the sensitivities. Why isn’t he eating? But he has to eat, right? So parents now resort to other methods. They punish and they bribe or even worse, become short order cooks. These solutions may seem to work for a short time but ultimately the issue will linger. Why? The child is scared. He isn’t just defiant or stubborn. He is terrified, and the newest toy or video game won’t be enough to battle that anxiety.

When other options fail or it’s too late, a pediatrician or speech therapist may recommend seeing a child psychologist.

I know it must be confusing and frustrating to parents when they are shifted off to another professional, especially a psychologist. It does not mean that your child is crazy. We are not going to push medications on your child or push parenting classes on you. Though you may have heard differently from other professionals or well-meaning in-laws, we know it’s not your fault your child isn’t eating. For most of the children that end up seeing psychologists, a number of factors over time have played into the development of fears and avoidance.

There are also times where a child may start out eating anything and everything put in from of him then one day just starts refusing. Green beans were fine yesterday and now anything green is off-the–literal-table. Why? Did something happen? Some kids experience food trauma. Maybe they were given milk that was a bit past its expiration. Maybe they choked on a bite of sandwich. We all have had negative experiences with food that may have left us avoiding it for some time, but eventually we try it again. It is different with these kids. They don’t have the benefit of fully developed logic to combat that single negative experience. Instead, one atypical incident becomes the rule.

So now you are face to face with this psychologist. How can she help? My job is to help the entire family (even well-meaning in-laws) understand their child’s specific fear and to set rules and limits at mealtimes. My job is also to work with the child to break down the Big Scary Food into less scary baby bites. We teach relaxation skills and offer coaching to change the way the child thinks about food. Sometimes the anxiety may get in the way of the child’s progress in speech therapy. In these cases, my job may be to help the speech therapist with motivational techniques that can get the child to participate.

Who knew eating could be this complicated? Most of us have no difficulty putting away a burger or plate of lasagna. But for families living with a child that has a feeding disorder, the stress can be debilitating. Having a team of professionals to guide treatment and provide support is essential for the child’s success. It won’t happen by dinnertime, but there is hope. You can pack away that short-order cook apron and you can stop the McDonald’s chicken nugget runs. Your child can learn to eat again.

About the Author

Alaina Everitt, Ph.D., is a licensed psychologist at Cook Children's, who sees patients in Denton and Lewisville. Cook Children's Behavioral Health services provides a broad range of care that focuses on children from ages three years through 17, and their families. We also have some limited services available for children age 2. 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.

About Cook Children's Speech Therapists

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. Patients and physicians can make an appointment or referral by clicking here.

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.

Both can be a self-destructive losing battle.

Guilt is a negative emotion and often unhealthy – it can make anyone unhappy, dissatisfied and unproductive. For parents, guilt comes in all forms and I can especially relate to working moms. After all, I’m one myself. According to AmericanProgress.org women make up half of the workforce in the U.S.

Care.com found that 80 percent of working moms feel stressed about balancing child care, work, home and relationships.

It's important to understand there are a multitude of reasons why a mom is in the workplace. Some women may be the sole or primary breadwinner, others work because they can't afford child care and some work because they know that working will help them be a better parent.

It's critical for us as women and mothers not to pass judgement, but rather be supportive of all working women regardless of whether they are an employed mom or a stay at home mom. All mothers are working mothers!

But for the purposes of this article, I will focus on helping employed moms feel better about their decision to work. Often that requires us to look at the definition of what being a good mother is - a good mother is not determined by the number of hours we spend with our children. It's more about ensuring our children that they are wanted, valued and loved.

Working moms, by their example alone, can teach their children the value of hard work, ambition, independence and self-reliance.

The struggle that many working moms ask of themselves, me included, is there a way to balance work and being a mom? While it's a challenge, there are some things that working moms can do to help.

1. First and foremost is to realize we can’t do it all! We absolutely have to let go of some things, especially the unrealistic expectations. It's important to identify every household member’s needs and obligations and to realistically prioritize them. By changing our expectations, we can change other’s expectations of us.
2. We are bombarded with “expert” advice on what we “should” do to be a “good parent.” The bar that has been set for defining what a good parent should do is often ridiculously high and unrealistic. It is critical to remember we do not have to have gourmet meals on the table every night to qualify that we meet the good parent standard. What is most important, as noted previously is to make sure our children know they are very much wanted, loved and valued.
3. We have to enlist everyone’s cooperation and assign responsibilities, even to our children provided they are developmentally appropriate. When our kids were of school age, my husband and I shared the carpool responsibilities, as well as household duties.
4. When we are with our children it's very important to be present and intentional with them. Remove or minimize distractions, be engaged and interested in them. Set aside special time with each child, even if it's a few minutes a day. My son who is a grown man still talks about our hot chocolate/coffee stops as I would take him to elementary school.
5. Create special family activities that nurture each other, but create activities that fit into your schedule and budget. This might be a family board game night, baking cookies or reading a book together. Children also deeply value traditions – creating your own traditions with each child and as a family are very important.
6. Working moms often feel guilty about working and want to make their children happy. Our goal as parents is to raise our children to be responsible adults, which means we set realistic expectations, we assign responsibilities and chores, we follow through with consequences and we teach life lessons.
7. Learn how to set boundaries and how to express those boundaries in a kind way. It’s Ok if you can’t attend every PTA or school function during the day. Communicate that you would love to help and then provide for them the manner in which you can help and in that communication, include your time constraints.
8. Forgive yourself if something does not get accomplished or completed in the manner you had desired. By accepting responsibility and being flexible you are setting an example for your child that we all make mistakes, but we need to be accountable and responsible for them.
9. Create time for yourself and take care of yourself. You will not be good for anyone if you do not take care of yourself.
10. Utilize resources and supports. One of your best resources and support systems are other mothers. Find a local support group on the web or create one with your friends and/or co-workers who can share tips with and/or ask for help and ideas. Find daycares/providers that will assist with homework. Share carpooling responsibilities with other parents. Hire trusted and competent high school or college students to help with facilitating transportation to other activities.

Consider all of these options to help relieve the stress and provide more quality time with your children.

Remember what is most critical is to ensure our children that they are wanted, valued and loved, while raising them to be responsible adults.

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.

A study published in the Journal of Child and Adolescent Substance Abuse reports that about one in five underage people under 21 consumed alcoholic shots in the past 30 days. The study states the youth were more likely to binge drink, consume more alcohol and physically fight someone.

The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking as drinking five or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days.

While there were no significant differences by age, race or region, the amount of shots consumed among underage drinkers was slightly higher among females. The Centers for Disease Control and Prevention (CDC) reports that one in five high school girls binge drink.

“Binge drinking is usually a function, expression or defense of some earlier trauma that has not been exposed or dealt with,” said Lena Zettler, MA, LPA, director of the department of Psychology at Cook Children’s. “Chances are that the ‘one’ girl in the ‘one in five’ statistic was abused or is in real psychological pain.”

The CDC stated binge drinking results in about 23,000 deaths in girls and women each year and increases the chances of breast cancer, heart disease, sexually transmitted diseases, unintended pregnancy and many other problems.

Zettler said teens often binge drink around events, for example, they drink a lot in a short amount of time before a homecoming game. Girls are more vulnerable to binge drinking than boys, both because they more often are victims of trauma and they lack the enzyme to more effectively metabolize alcohol.

“Teen girls may have more of an issue with binge drinking because they might choose to drink liquor, especially vodka and white rum—as opposed to beer and wine—because of fewer calories,” Zettler said. “So rather than think about how much they are drinking in a short amount of time and what that is doing to their brain, they only focus on consuming fewer calories.”

Know the Risk Factors

Zettler believes there is probably a genetic predisposition for some binge drinkers, similar to the genetic link to other forms of alcohol abuse.

“I tell kids that when it comes to drinking and drugs, we are not all equal,” Zettler said. “In other words, you never know—maybe until it’s too late—if you will be the one who develops a problem or can’t stop drinking.”

Zettler suggests parents educate their kids about how binge drinking can have long-term brain effects, easily lead to alcohol poisoning (especially in girls), and put them at greater risk for being sexually assaulted or other harmful events.

A report released this week by the National Academies of Sciences, Engineering and Medicine calls bullying a “serious public health problem” and says the zero-tolerance policies schools use to automatically suspend students for bullying are ineffective.

Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Cook Children’s Behavioral Health Clinic in Denton, agrees.

“There are so many reasons why zero-tolerance policies don’t work. It’s primarily lip service to look good, but without back bone or laws to support the effort,” Elliott said. “The policy is clearly not working. We aren’t looking at the issues and not addressing the problems. We aren’t teaching children effective tools to handle bullying or conflict.”

Elliott is simply fed up. She’s seen too many kids come into her office depressed, frightened or even suicidal because they can’t get away from their bully or bullies.

“I think that bullying is worse than ever before because of cyberbullying,” Elliott said. “Kids can’t get a break.”

May parents in Cook Children’s six-county service region agree. According to the 2015 Community-wide Children’s Health Assessment & Planning Survey (CCHAPS), 16 percent of parents said their child has been bullied, compared to 10 percent in 2012.

Elliott says there are four types of bullying: physical, verbal relationship (or social) and cyberbullying. Each form of bullying is harmful alone, however combined they are even more harmful and powerful.

Elliott points to the death of David Molak, a 16-year old San Antonio boy, as an example of the harm that his family believes comes from the constant harassment a child receives in the world of cyber bullying.

“In today’s age, bullies don’t push you into lockers, they don’t tell their victims to meet them behind the school’s dumpster after class, they cower behind user names and fake profiles from miles away constantly berating and abusing good, innocent people,” Cliff Molak, the boy’s brother, said in a Facebook post that went viral.

Since the death of David, the Molak family has been working to get “David’s Law” passed in Texas, which would address the issue of cyberbullying in Texas and hold those charged with harassment on social media to pay at least a $500 fee or spend up to a year in prison. State legislation will vote on the law in 2017.

“We need consequences for the people responsible for this kind of bullying and harassment,” Elliott said. “Right now cyberbullying isn’t defined in the Texas harassment statute. A law like David’s law is about someone getting picked on around the clock. This is about constant bullying, where the kids feel like there’s no escape.”

No child is bully-proof. Elliott offers parents the following talking points when speaking to their child about bullying:

• Even people who say they're your friends can bully you.
• You should confront your friends when they're being hurtful to you or others.
• Retaliating may feel good temporarily, but refusing to stoop to the bully's level will win you more popularity in the long run.
• When you hear a false rumor, just ignore it and be yourself.
• You're most likeable when you respect yourself and others.
• Bullies usually have their own insecurities. Returning meanness with kindness is the best way to break down their defense.

And in the end to let kids know that they may be the best resources to end bullying where they live.

Researchers from Princeton, Rutgers University and Yale University found that kids could greatly reduce the amount of bullying and student conflict just by spreading the message against bullying. The engaged group of influential students in 56 New Jersey middle schools spread the message about the dangers of bullying using messaging platforms such as Instagram, print posters and colorful wristbands. They discussed how to handle conflict in their own way with the peers. The team saw a 30 percent drop in student conflict reports.

“Kids have to be involved and they have to stand up to the bullies,” Elliott said. “The kids are the teachers in the moment. We need to empower our children to be the game changers.”

In 2015, 463 people wre killed in distracted driving crashes in Texas and 3,000 more were seriously hurt

A study by AT&T states that nearly 4-in-10 smartphone users look at social media while driving and about 30 percent surf the net while driving.

The Texas Department of Transportation has begun its annual "Talk, Text, Crash" campaign this month, in hopes of stopping texting while driving and to decrease driving distractions. TxDOT reports that 1 in 5 traffic crashes happen because of "texting, talking and other distractions."

According to the National Highway Traffic Safety Administration, texting while driving:

• Impairs driving ability as much as drinking four beers.
• Increases crash risk by 23 times.
• Causes 1.6 million wrecks and 330,000 injuries each year.
• Accounts for 11 teen deaths every day.

Teens may even be aware of the danger, but in the teenage mind, the need to stay in touch often outweighs the need to stay safe.

"Kids who are learning to drive right now have grown up with smartphones and cell phones, so it seems natural to stay connected to their friends all the time," said Sam McCage, Ph.D., LMFT, LPC, manager of Behavioral Health Services at Cook Children's. "When teenagers don't respond immediately to texts, they might feel that they're being rude or will miss out on something important."

McCage said parents should talk to their kids about the dangers of being distracted on the road, but they should also be a good example for their children. Studies show that:

• 48 percent of young drivers have seen their parents drive while talking on the phone.
• 15 percent of young drivers have seen their parents text while driving.
• 48 percent of children ages 12-17 have been in a car while the driver was texting.

And for that extra measure of safety, mobile apps can block messages from being sent while your child is driving and there are devices which can stop all phone use while the vehicle is in motion.

Eleven people died, including one young child.

Maybe, someone you know was affected by the storm or maybe you had this thought: “That could have been me or my family.”

“This event may raise anxiety because it was so close to home,” Joy Crabtree, Psy.D., a licensed psychologist for Cook Children’s Behavioral Health in Southlake. “It’s important to stress to kids that even though some storms can be devastating. They are rarely deadly or cause such widespread damage.”

Saturday’s tornado outbreak was one of the worst in recent memory. The tornado that touched down in Garland was only the second EF-4 tornado to hit Dallas County since 1950.

Victoria McCain, a licensed psychologist for Cook Children’s, suggests giving young people just enough information that some bad things happened and how people are affected.

“Immediately follow this information with information about how people are helping, where affected people go for help, and how friends and neighbors act to help people affected by storm damage, and maybe how your family plans to help,” McCain said. “Older children may be curious about what happened and watch TV reports. Be sure to talk with your children about what they think and listen for their emotional reactions. Allow them to talk about what they think the people affected may be experiencing, emotionally and physically.”

Young children can be frightened by thunder and lightning and need reassurance during these events. Role model confidence and provide-age appropriate explanations about the day’s weather conditions.

Crabtree encourages a discussion following the aftermath of the storms, but only if your young children knows about the news of the tornadoes. Depending on their age and maturity level, it might be best to shield children from the news entirely.

Teens may have more questions and concerns because they are more aware of what happened. It’s OK to share with your child your own fears and anxieties about the events. Let them know it’s Ok to feel scared or frustrated, but it cannot overtake them.

“Be sure you are in control of your emotions and stress level,” McCain said. “Keep your face and body language pleasant and relaxed and convey confidence. Your kids will pick up on your fears and have trouble letting go of their own. Listen to what your child says about the event, validate his or her feelings by saying that everyone has feelings about what happened; show empathy by using feeling words such as saying, ‘You sound worried, scared, angry, mad, helpless, etc. about what happened.’”

You know your child better than anyone, check in with him or her often to see how they affected. Watch for signs of stress such as trouble sleeping, disturbed appetite, increase in bedwetting, being more clingy to you than before, irritability or wanting the comfort object they haven’t needed for a while. During this time, make sure to be there for your child and comfort with hugs as needed.

If bad weather is on the horizon, use activities to distract kids from the weather or from their own fears. Watch a movie or read books or play a game.

Reassure them that they are safe and if weather becomes severe, you are prepared. Let your child know that bad weather is usually predicted and it will give you time to get to your safe place in the home. Practice going to the safe spot in your home with the things you need such as bicycle helmets, flashlights, shoes, snacks, water and snacks (even for the pet).

Certainly, when severe storms leave behind damage and loss of life, it can raise anxiety levels for everyone. Reassure children about the advance warning systems for such storms and the steps that are taken to keep everyone safe. It may also be beneficial for kids to feel that they can help. That could be a gesture as simple as sending a letter or making a picture for those affected, or it could mean donating time or resources as well. Getting involved can be a great way to take anxious energy and turn it into something positive in order to help others.

“Talking with your children about ways to help those affected by the storm can be a good way to reduce the feeling of helplessness children feel after such an event,” McCain said. “Your child may spontaneously suggest a helpful action, or you may bring up the subject after you and your child have talked about the event and their feelings. Some families have established the way they handle charitable giving after tragic events and can involve their children in age-appropriate ways to participate. Some families are new to the concept and may be unsure of what to do. Contacting disaster relief agencies such as Salvation Army or Red Cross through their respective websites can give ideas that may inspire ways to give.”

If you have a child with ADHD and have chosen to go for a non-medical route, more power to you, and if it is working well for you, that is awesome. However, I also have families that have stressed for years because of something they have heard in the media or from their friends and they and their child suffered because they didn't want to place their child on medicine for whatever reason.

Won't They Get Addicted to the Medicine?

Children on ADHD medicines are not addicted and are not more likely to have addictions later in life.

Here is the definition of addiction: "compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly  : persistent compulsive use of a substance known by the user to be harmful."

ADHD medicine do not form compulsions in children who actually need them and they are not habit forming. Just like any other medicine, parents and kids will forget from time to time and the only effect they see from missing a dose is that their child's behavior is not as good that day. There are no other side effects.

Tolerance is the effect where a person develops a bigger and bigger need for a substance in order to develop the desired effect. While there are times when I do have to increase a dose of medicine it is typically more related to the size of the child increasing and the changing stressors (increasing difficulty, etc) at school that require the increase. Changes are often necessary around puberty as well.

Finally, there are no withdrawal symptoms when a person comes off their stimulant ADHD medicines. In fact, the child “comes off” their medicine every night and can take weekends or summers off without developing symptoms (other than being more hyperactive). By definition, this means that there is no withdrawal.

So, without compulsion and habit, tolerance or withdrawal, there is no single characteristic about these medicines that make them addictive.

As for the question about children with ADHD going on to have more addictions later in life, it seems that this is more related to the ADHD than the medicine and adequate treatment may actually help prevent some of these later behaviors.

I Don't Want Them to Act Like a Zombie!

I hear this complaint or concern with just about every consult that I see. Understandably, parents don't want their children to act differently or have a change in personality because they are on medication. Guess what? Me neither. If I were to see personality changes in my patients, I would change their medicine or come up with other treatment strategies. However, this is a very uncommon complaint when families actually start medication. In my 6 years of practice, I have heard this complaint only twice and both of the parents were extremely worried about it prior to starting medicines, which makes me wonder if they weren't looking too hard for it in the first place.

It is my opinion, this was a bigger problem before with the short acting medicines (like Ritalin). Because they needed to be dosed more twice in the day, the children may have experienced the change in their blood level throughout the day which led to more drastic behavior changes.

Will This Stunt My Child's Growth?

While there have been some studies showing a slight decrease in weight and height growth over the first year of starting a medicine, these differences disappear when you recheck the children at 2 and 3 years out from starting medicine.

What are the Common Side Effects?

The most common side effects I see from the ADHD medication (primarily stimulants) are loss of appetite and difficulty going to sleep.

Loss of appetite-We usually see this problem just after starting medication and it certainly can improve over time. The child usually has the biggest problem with lunch time as that is the when the medicine is at its highest level in the blood stream. Usually, you can make up for this problem by making sure the child eats a good breakfast and dinner and eats what they can at lunch. I follow my patients’ weights closely especially when there is a concern about the child's appetite.

Difficulty with sleep-Occasionally, we will have a child who has a difficult time going to sleep. Like appetite, this is most common right after starting the medication. My first treatment for this is to make sure that are taking care of doing the right things to help themselves go to sleep: no food or drink with 1-2 hours of bed time, no screens on in the room 1 hour prior to bed time, etc. If that doesn't work we can do a trial of melatonin. Other options are available if this doesn't work.

Some more rare side effects that I want to discuss are mood instability and tics.

Some of the medicines are worse that others about this but we will sometimes have a child who is very emotional and tearful when first starting the medicines. This typically happens in the afternoon or evening as the medication is wearing off. Usually, with just a period of observation, this will improve after about 1 week on the medicine so I first have my families continue trying for a bit and monitoring closely to see what happens.

Tics are involuntary movement disorders that result in a short jerking of the head, lip smacking or some other short, quick motion. These medicines do not cause tics, but in a child who is already predisposed to them for some reason can cause them to become much more obvious and frequent. If the tics are disruptive or concerning, we will usually need to switch medicine to something else as this does not usually improve over time.

Summary

1. Children do not become addicts because of ADHD medicines.
2. Children do not become zombies because of ADHD medicines.
3. Children do not become short because of ADHD medicines.
4. Children should be watched closely for loss of appetite or difficulty sleeping when starting ADHD medicines.

For more information

Visit our Checkup newsroom resource page to learn more about ADHD. 

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.

But recently, a mom wrote in for help, looking for advice to help her with a heartbreaking problem. Her husband is dying and she wanted to know how to talk to her young children about what her family would be going through in the very near future. For the answers, we went to our experts.

“It’s important to explain to children that a parent is sick, and it’s a type of sickness in which he or she will get sicker, not better,” Joy Crabtree, Psy.D., a licensed psychologist at Cook Children’s Urgent Care and Specialties in Southlake, Texas. “The dying parent should be involved as much as that person is able in terms of planning and engaging in special activities with the kids (together and separately) during periods that he or she is well enough to do so.”

Crabtree suggests lots of pictures be taken and the parent write special letters to each child to be opened later at specific ages or milestones. In the future, after the parent passes, there will be periods of grief that pop up and perhaps a sense of sadness or a feeling from the kids that they were robbed the opportunity to share proud moments or special occasions with both mom and dad.

“If that comes up, the kids can be encouraged to write those thoughts down, either randomly or in letter format,” Crabtree said. “They can simply keep an ongoing journal of what they wish they could tell the parent who died or even write it on a note and tie it to a balloon and set it free. They might keep a box of drawings or notes that they make for mom or dad.”

Crabtree suggest the children go into therapy and the dying parent join as well if possible to address and get support/guidance for questions/behaviors that are coming up for the kids. “There is certainly no guidebook or specific right or wrong way to handle the process,” Crabtree said. “It will be tough no matter what, but with open communication, sharing memories, and the understanding that all questions and thoughts are welcome, they can work through it together.”

Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, said she has seen a family go through this first-hand. She said the young father did an “incredible job of leaving a legacy” for his 2 year old by writing a book for her and lots of letters for her at critical points in her life, such as starting kindergarten, middle school, high school, graduation, turning 13 and 16, getting married and becoming a mom. The parents also bought charms for their daughter to be given to her on those critical dates.

Lena Zettler, MA, LPA, director of Psychology at Cook Children’s, said finding the right words to describe what’s happening will be crucial to helping the child through such a difficult time and the way the message is delivered will depend on the age of the child.

• Very young children will not understand the abstract concept of death, and saying that “daddy is passing on” may be more confusing.

• Children should know that their parent will not be asleep, and some concrete things like “death happens when our heart stops beating."

• Kids will usually ask questions that they are ready to hear the answers to, so listen to what they are actually asking about and answer that. Most times they need more concrete answers than we expect.

• When answering, give kids some time to process … say a few sentences, and then wait until the child is ready to hear more.

“We often use a lot of words and kids under 10 may not be able to process more than a few sentences at a time,” Zettler said. “Make sure all the kids get the same info, but it may mean talking separately to the children if their age ranges are broad (example, a 3 year old and a 10 year old). Include both parents in the conversations if both parents able physically.”

Zettler says if you don’t know the answer to a question, it’s OK to say you don’t know (for instance, “How long can daddy play ball with me?”). Also, kids of all ages need the same information over and over again, so be prepared to have many conversations. They may ask you a serious question and after a brief, but accurate answer from the parent, they may go right back to playing and acting normally. That is OK … they are taking in the amount of information they can process at that time.

“Celebrate mom or dad’s life NOW while that person is still here; talk about what is happening,” Zettler said. “Don’t forget that kids need to play. That doesn’t change when something like this happens. In fact, playing is the best way that kids have to learn new coping skills.”

Remember to provide support for the children and notify caring adults at the children’s schools. There may be additional support that teachers, nurses and counselors can provide.

Read age appropriate books on grief/terminal illness together (parent and child, or as a family). Books on death may not seem relevant while the parent is “just sick,” but books on death/loss may be more helpful after the death. Zettler says examples of books on terminal illness and coping with that for kids are: “Beyond the Rainbow” and “Help me Say Goodbye.”

Zettler says some children may struggle academically early on. Some kids, however, may seem less disrupted and more able to keep up their school work. That doesn’t mean they aren’t grieving, or that their academics may not suffer later. If they are getting behind academically, and they have not had school problems, before, don’t panic. They will catch up. If they have had problems before in school, definitely reach out to school personnel and consider getting the help of a psychologist or therapist.

“Kids will be afraid, unhappy and may act out more than usual,” Zettler said. “Don’t see this as abnormal or behavior ‘problems.’ You can still enforce rules especially if kids get aggressive but be patient with each other. Try to help them find words to express their feelings. Tell them that it is OK to have feelings. Reassure kids with words, with your presence, and with other comforting things like maybe a stuffed animal. It is OK if they “regress” during this time and do things they stopped doing when they were younger. If they really struggle with this or with difficult behavior, see a psychologist or therapist who has experience with pediatric grief or loss.”

Resources

“Preparing Your Children For Goodbye: A Guidebook for Dying Parents” by Lori Hedderman.

http://www.centerforloss.com/wp-content/uploads/2014/10/A-Childs-Grief.pdf

http://www.cancer.org/treatment/childrenandcancer/helpingchildrenwhenafamilymemberhascancer/dealingwithaparentsterminalillness/dealing-with-a-parents-terminal-illiness-toc

About our sources

Cook Children's Behavioral Health services provides a broad range of care that focuses on children from ages three years through 17, and their families. We also have some limited services available for children age 2. 

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.

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.

“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.

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.

1. Health. Often, teachers don’t know about your child’s health history. Many kiddos have severe nut allergies and teachers need to be aware of those food allergies, as well as if your child needs special medication or an EpiPen^® injection. You should let your teacher know if your child has asthma, is diabetic or has any other serious health condition.
2. Educational Diagnoses. Teachers may not know your child has been diagnosed with a learning difference, dyslexia or an attention deficit problem. This is an opportunity to let teachers know about a 504 plan or IEP for your child. This is also a great time to let your teacher know what your child’s learning style is such as whether they are an auditory, visual, or kinetic learner. Sharing your child’s areas of strengths and weaknesses is also helpful.
3. Emotional and Family. Inform your teacher of any emotional factors that may impact your child such as divorce, death, illness or a parent being stationed overseas. It’s helpful for teachers to know the emotional factors that are impacting your child’s life which may help your teacher to understand and communicate better with your child.
4. Schedule conferences. Teachers are bombarded with information at meet and greets during orientation and other group events throughout the school year. It’s hard to keep everyone and everything straight. My advice is to set up a conference with your child’s teacher as early as possible. One teacher told me she found it really helpful when parents provided a list of bullet points that included helpful information about their child, including the health and educational diagnoses, the strengths and weaknesses of the child, how the student learns the best, what the student responds to best when giving direction or correction, and some points about the student’s social and personality style. Go in and set up an appointment one on one, especially if your child has special needs or considerations.
5. Be a team player. Every teacher I have spoken with has told me what they appreciate more than anything is for the parent to ask the teacher, ‘how can we help you? What information do you want to know?’ Most teachers prefer that team approach.
6. Be honest with yourself about your child. This is sometimes the most difficult for parents, but it’s so important. Know your child’s strengths and weakness. One of our biggest problems in today’s society is not teaching accountability. Set that example. Make sure your child knows his or her responsibility. Teachers have a difficult enough job without always blaming them, the school or another child. Please make sure you know how your child contributed to a situation and then take appropriate action from there.

Of course every child is different, and special, which makes communication between you and your teacher so important in having a great school year; and appreciating one another.

The frightening footage of this type of violence at a school is difficult to watch for even the most hardened adult. So how do you talk to your child about catastrophes such as this? 

Joy Crabtree, Psy.D, a licensed psychologist for Cook Children’s Behavioral Health in Southlake, said parents must set the example for their children to follow. Dr. Crabtree encourages a discussion of the events, but only if their young children have learned about the incident elsewhere. If they haven’t heard about it, don’t share information with them. If they already know about it, answer their questions and most importantly, reassure them.

Crabtree said that in the cases such as today or recent school shootings in the news, parents need to think through whether their child can handle any news about it at all. Depending on their age and maturity level, it might be best to shield children from the news entirely.

“Since we are talking about a violence issue, and graphic violence that was targeted toward children, I don’t know that kids, certainly elementary age children, need to see any news or footage about it at all,” Crabtree said. “Students  were involved and that makes it even more difficult for them to process. Many children may be very frightened by this news and be scared something similar could happen at their own school. If they have heard about it, take as much time as needed to sit down with them and have a discussion/answer session, providing reassurance and support.”

For older children, such as middle school and high school, Crabtree encourages parents to again determine if their child is mature enough to handle the information.  If parents feel they can handle it, use the DVR or TiVo as your friend during the news. Watch it with your child and pause the TV to answer questions. Gauge your child’s emotions and turn the TV off if your child becomes too emotional or the news is too intense.

“Parents have to stay calm and cannot be glued to the TV,” Crabtree said. “If you have an elementary-aged child, and they haven’t learned the news, there’s certainly no reason to sit down with them and show them the story. There’s no need to cause fear in your children. By the time children are 7 or 8 years old, they can distinguish fact from fiction and will understand the consequences of what they are watching. Answer their questions, but only their questions. There’s no need to add more information that may scare them even more.”

Children may not understand the distance of the events on TV, make sure to calm their fears and let them know they are safe. If they continue to be fearful of their own safety, it may be helpful to get out a map and show them how far away they are from the incident that happened today.

“This news can be very scary to many children,” said Crabtree. “Parents need to realize this can really raise anxiety levels. They may feel that if it can happen there, it can happen anywhere. I can’t stress enough the importance of just being there for your child right now to support them.  Again, for younger children, only discuss it if they are already aware of the situation.”

Teens may have more questions and concerns because they can find information on the Web and discuss it with their friends at school. They may wonder why something like this happens. Share with your child your own fears and anxieties about the events. Let them know it’s Ok to feel scared or frustrated, but it cannot overtake them. Also, share with them ways that they may help by donating monetarily or giving blood in some instances. Sometimes when tragedy happens it helps them to work through their anxiety by becoming active and helping others.

Listen to your teen, or older child, regarding their fears and concerns. How an adult manages their own feelings can also provide a positive example for them.

Crabtree advises parents to watch to see if their children restrict activity, for instance if they don’t want to go to school or to the playground because it is too far away from home, or simply because they are afraid. Also notice if your child becomes withdrawn or more clingy than usual, and constantly wants to sleep in your bed.

“It is common for children to have a general fear, but if you see an overwhelming fear, it’s important to talk to their pediatrician,” Crabtree said. “If it continues to be a concern, then it may be time to get professional help.”