Preventing Youth Suicide: Strategies That Work

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American children are taking their own lives at an alarming rate. Over 7 percent of high school students say they engaged in non-fatal suicidal behavior, while 17 percent say they seriously considered suicide within the previous year, according to a nationwide survey. For children under 15, the prevalence of death by suicide nearly doubled from 2016 to 2017. Considering these sobering statistics, it’s no surprise that suicide has become the second leading cause of death for youth between the ages of 12 and 18.

Sadly, many parents don’t recognize the signs of depression in their children until a crisis occurs. It can be difficult to determine the difference between normal adolescent behavior and something far more serious. For National Children’s Mental Health Awareness Day I want to use this opportunity to share strategies that have been proven to decrease suicidality in children and teens.

A few years ago a teenage girl named Alyssa* came to me for therapy, along with her family. She described feeling disconnected from her parents, who didn’t understand her interests. She spent a lot of time in her room watching anime, playing video games, and chatting with her friends online. Like many young girls, she had negative experiences with peers at school and felt acute academic pressure.

Her parents saw no cause for alarm until they were contacted by a concerned school counselor, in whom their daughter had confided. When they learned Alyssa had thoughts about harming herself, they decided it would be safest to place her in a hospital while they made a plan to address her challenges, which included anxiety and depression.

Prevention Is Key

Fortunately, Alyssa turned to a trusted counselor for help. For individuals concerned about child suicide, a number of protective factors have been shown to help reduce the risk of suicidal behavior. These include community connectedness, abstinence from drugs and alcohol, close family relationships, strong peer support systems, and regular involvement in hobbies or activities. Joining activities that promote positive self-expression (music, art or drama) or self-efficacy (such as sports or skill-based activities), and continuing them through adolescence, can support building a positive and stable identity, the primary task and stress of teenage years.

Other protective factors are more difficult to cultivate. People with a positive self-image, strong problem-solving skills, and the ability to regulate their emotions tend to be more able to cope in times of increased stress. If a child is struggling in these areas, especially while distancing themself from family or friends, it may be time to think about family therapy. Engaging teenagers in therapy isn’t easy, so building a trusting relationship with a mental health professional early for youth with heightened risk factors is instrumental in suicide prevention.

Working with youth also comes with a unique set of challenges. They can be more impulsive, have trouble seeing a long-term perspective, and be heavily influenced by their friends and online relationships. These are just a few reasons why it’s important to find a therapist with extensive experience treating youth. The right professional can advise parents on what’s typical versus when to access other services, and how to keep channels of communication open.

Trust Evidence-Based Therapies

When a child is in therapy for suicidal thoughts or actions, it’s critical to use an evidence-based treatment approach. As a career therapist and Director of Youth Shelter Services at Grafton Integrated Health Network, my team and I rely on the CAMS model. Short for Collaborative Assessment and Management of Suicidality, CAMS was developed over 30 years ago to specifically assess and treat suicidal risk.

This method uses a highly individualized approach that allows patients to be actively involved in the development of their own treatment plans. Rather than shaming youth for their suicidal behavior, our therapists take an empathetic and non-judgmental approach, which helps us identify and treat the root causes of the client’s suffering. In randomized controlled trials, the CAMS model has been shown to more accurately assess the need for acute hospitalization and reduce suicidal thoughts.

We know this approach works. With the help of a psychiatrist, music therapist, and individual and family therapy using mindfulness and cognitive-behavioral interventions, Alyssa was able to feel more hopeful and connected, while reducing her thoughts of suicide. Her therapy included identifying and working towards positive future goals, improving problematic communication patterns, increasing connection in activities with supportive peers, and following a safety plan.

There is no quick fix for youth suicide, but promoting good mental health and seeking professional help early is the best prevention we have. It’s also never too late for a child and family to seek the right supports to build resiliency and move towards recovery.

* Patient name has been changed to protect privacy.

If you are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.

Preventing Youth Suicide: Strategies That Work

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Body Dysmorphic Disorder’s Impact on Kids Today

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The teenage years are hard on kids’ sense of identity and self-esteem, especially as their bodies and minds are changing and growing at a rapid rate. As a parent, it may feel like you are jumping through mental and emotional hoops, doing your best to build up your child while still maintaining discipline. However, adolescents who struggle with body dysmorphic disorder (BDD) may need more help than most parents may realize.

Body Dysmorphic Disorder Strikes at a Vulnerable Age

Body dysmorphic disorder is a mental disorder that leads individuals to constantly think about their perceived appearance flaws. These flaws may be small and therefore unobservable by others, but for someone with BDD, those perceived defects in their appearance can be all-consuming.

According to research, this disorder often strikes sometime during either childhood or the later adolescent years, with 16 being the average age of those diagnosed. Since teens are often going through many difficult changes during this time period, their BDD may go unnoticed by parents or simply seen as an extension of teenage angst. However, a child’s body dysmorphia and overall obsessive unhappiness with their appearance may not be their only mental health issue.

Comorbid Disorders Often Impact Teens with BDD

The same research that pointed out that adolescence is usually when body dysmorphic disorder begins also stressed that children struggling with this issue often had other comorbid mental health problems. As BDD is considered part of the obsessive-compulsive family of disorders, it is not surprising that anxiety is one of the common mental health issues present with BDD.

Depression is another major factor in those struggling with BDD, along with suicidal thoughts and attempts. Eating disorders were also found to be comorbid conditions in adolescents with body dysmorphic disorder.

In fact, a case report concerning a teen with severe body dysmorphic disorder also had several severe comorbid mental health disorders, regularly suffering from depression, delusions, and suicidal ideation. The professionals who wrote up her case suggested that BDD is underdiagnosed by professionals who focus on treating the co-morbid issues without directly addressing the body dysmorphia.

Signs Your Child May Have Body Dysmorphic Disorder

Now that you understand the impact body dysmorphic disorder can have on your kids, it is also important that you are able to recognize the signs of BDD. Commonly, those with BDD have an unhappy obsession with one or more of their body parts, such as:

  • Facial feature, i.e., acne, nose size, complexion, etc.
  • Skin and veins
  • Hair appearance
  • Genitalia
  • Breasts
  • Overall musculature

These signs can manifest in a number of symptoms. Some of the symptoms of BDD you may see in your son or daughter are:

  • Constantly preoccupied with a flaw in their features, which you may or may not see. Even if you do see a minor flaw, your teen perceives it as far worse.
  • Believe that their perceived flaw makes them hideous or visibly deformed.
  • Withdrawal from social situations and functions to keep people from seeing the flaws.
  • Spending an inordinate amount of time styling hair, makeup, or clothes to help disguise perceived flaws.
  • Believing that people are constantly noticing their flaws and are making fun of them.
  • Perpetually seeks yours and others reassurance about their appearance.

Ways Parents Can Help Kids Struggling with Body Dysmorphic Disorder

While body dysmorphic disorder can have a serious impact on your teen, you have the ability to help them overcome their disordered thinking. Some of the best things you can do are:

Be available to talk

Your support and insight can make a world of difference to your child. Even though teens may sometimes act like they never want to talk to you, knowing that you are there and willing to listen when your child needs it can help them feel heard and less isolated with their obsessions and anxiety.

Access professional help

In many cases of BDD, children need the help of professionals to assist in overcoming their obsessive thoughts. Should your child have depression or other comorbid conditions with their disordered thinking, a residential treatment center could be a nurturing environment staffed with the professionals your child needs.

Provide accurate health information

Weight and body composition unhappiness is a significant feature for those who struggle with BDD. This unhappiness may lead them to make poor health choices such as severely restricting their food intake.

Instead of allowing this behavior, you can provide them with accurate health information, whether it is the nutritional value of food or the best workouts to help them become more fit. The natural reward hormones released by exercise can also be beneficial in altering your child’s mindset.

Model healthy behaviors

Parental behaviors can play a profound part in a child’s self-perceptions, so it is essential that parents model healthy behaviors.

It can be tempting to make off-hand, critical remarks about your body, but while you may not mean them to a severe extent, it is easy for a young child or teen hear you and follow your example to a more extreme conclusion.

When it comes to body dysmorphic disorder, the sooner your son or daughter receives treatment, the higher the probability that BDD will have a less severe impact on them. So, if your teen has been complaining about their appearance, be sure to listen to see if there is an obviously obsessive and false component to what they are saying and be ready to get them the help they need.


Jacobson, Tyler. (2019). 6 Mental & Emotional Flaming Hoops You Jump Through for Your Kids. Retrieved

Bjornsson, A. S., Didie, E. R., Grant, J. E., Menard, W., Stalker, E., & Phillips, K. A. (2013). Age at onset and clinical correlates in body dysmorphic disorder. Comprehensive psychiatry, 54(7), 893–903. doi:10.1016/j.comppsych.2013.03.019

Thungana, Y., Moxley, K., & Lachman, A. (2018). Body dysmorphic disorder: A diagnostic challenge in adolescence. South African Journal of Psychiatry, 24, 4 pages. doi:

Jacobson, Tyler. (2019). How Parents Can Model Healthy Behavior for Their Kids & Teens. Retrieved

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Resilient Children Grow Up to Be Resilient Adults–True or Not?

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Problems in life are inevitable. Challenges cannot be avoided. Life is not always a bed of roses. The ability to recover from a difficult or unpleasant situation is resilience. Resilience means being able to get back on track, as strong as before, after an unanticipated setback such as physical or emotional trauma.

Resilience is not something a person is or isn’t born with; it is an acquired skill a child develops gradually. Kids are vulnerable. For some, the slightest stress can cause major anxiety issues that last a lifetime. Others can counter stress better.

Developing Resilience

It is during childhood that a kid is most likely to develop this skill. Resilient children grow up to be resilient adults as they learn how to deal with stress and difficulties from a young age.

Development of resilience in children occurs at three levels, which are:

Resilience is not something a person is or isn’t born with; it is an acquired skill a child develops gradually.

  1. Individual
  2. Family
  3. Environment

Development of resilience requires input from within, from family, and from the environment, which may also mean society at large.

Not all children can be the same physically, mentally, or emotionally. Everyone has a different threshold of bearing stress, but resilience can be developed at a young age through various methods.

Healthy Risk Taking

Children should not be sheltered by their families from taking risks. In fact, healthy risk taking should be encouraged. Healthy risk taking means letting your child take risks which could hold some risk but also reward.

An example is letting a child try a new sport. Even if they fail, no significant damage is done. This can teach children to face failure positively and come out more confident than before.

Let the Child Solve Their Problems

It’s natural for a parent to want to solve every problem their child has. If and when a parent does that, the child would never learn to solve problems independently. They would never learn what independence is. You should always let your child know you are there to support them. However, try not to walk your child to a solution. Let your child solve their problems independently.

Ask your child questions and let the problem bounce back to your child. Leave it to them to find the solution. It will develop problem solving skills in your child from a very young age.

Don’t Ask Why, Ask How

Avoid ‘why’ questions with your kids. Asking your child why they did something may often get you a response such as “I don’t know,” “I forgot,” or something similarly straightforward. Instead, ask your child how they plan on fixing something they messed up.

Try asking your child questions like, “You let the tap keep running; there is water all over the place. How do you think you can fix it?” Asking ‘how’ questions can promote problem-solving skills in your child. They will think about ways they can fix things. Letting a child analyze situations and solve problems is one of the most important keys to developing resilience.

Help Your Child Understand Emotions

A child may have difficulty labeling the emotions they are feeling. For development of resilience in children, it is important that they understand what they are feeling and deal with their emotions accordingly.

If you assist your child in labeling and understanding their emotions, they will be better able to cope with emotional stress and turmoil. An emotionally stable child will often grow up to become a resilient adult.

Support Your Child Emotionally

Children can be emotionally vulnerable. They may need constant emotional support from people they love. Children often need emotional support to feel strong. Knowing they aren’t alone in a situation will not only make them more confident, but they may be willing to try new and challenging ways to solve problems.

Tell your child how much you love them, and don’t forget to remind them how proud you are of them. Just by telling your child that you believe they can do it can really make them want to do it!

Characteristics of a Resilient Child

If you want to see how resilient your children are, keep an eye out to see if they can:

  • Tackle problems on their own
  • Manage their emotions
  • Take risks
  • Face challenges confidently
  • Solve problems efficiently

Long Term Effects of Resilience

When these qualities are inbuilt in someone from an early age, they are able to reach their long term goals and work their way through their problems independently. A resilient child is strong, self sufficient, self sustaining, and self reliant when all grown up. In this way, development of resilience in children holds special significance in their upbringing.

A therapist can help you learn skills to develop resilience in your child. To find a therapist in your area, start here.

© Copyright 2019 All rights reserved.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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How to Stop Nagging and Get Children to Listen the First Time

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Parenthood can feel like little more than endless nagging. Clean up your toys. Do your homework. No, don’t do that. No, you still can’t do that. Trying to get kids to listen can be exhausting. The frustration of nagging can also affect your relationship with your child. Parents can become angry and unkind, or they may spend so much time trying to get kids to listen that they are unable to enjoy playing with their kids. Children may become resentful or feel like the only attention they get from their parents is negative.

You don’t have to spend your kids’ childhood as an exasperated taskmaster. Here’s how to end the battle of wills for good.

What Is Nagging?

Every parent has to give their child instructions. Whether it’s teaching a child how to clean up a spill or reminding a child to pack their lunch for school, these daily reminders and instructions are par for the course.

Nagging is categorically different. Parents nag when they repeatedly remind children of their chores and obligations. The fundamental issue underlying nagging is that the parent takes on responsibility for the child. Rather than a child worrying about completing her own homework, for example, the parent manages the child’s time for them.

Nagging can be frustrating and annoying to both parents and children. It can also harm both parties in many ways, including:

  • Excessive emotional labor for the parent. Keeping track of a child’s responsibilities can be exhausting, especially when that work primarily or exclusively falls to one parent. A parent who must manage the child’s time and responsibilities has less time of their own. They also have less mental space for creative thinking, daydreaming, and strategizing. This can be exhausting and even depressing. When one parent does all or most of the emotional labor, this can negatively affect the parents’ relationship with each other.
  • Fewer opportunities to learn. Children can learn from failure. In fact, in some cases failure is a potent motivator. A child who can’t go on a field trip or a fun school outing may never again forget a permission slip.
  • Less independence for children. Children need some freedom to control their own time, explore their own interests, and make their own decisions. This helps foster self-efficacy that can propel them into successful, autonomous adulthood. Consider that a fifth grader might be more productive at night, or they may work better in 15-minute chunks than in one long hour-long session. Parents who nag their children exert unnecessary control over the child’s decisions and time. Giving children a little more freedom can help them find time management skills that work.
  • Making parenthood less enjoyable. Parenthood is exhausting and grueling. All parents struggle with feeling overwhelmed from time to time. Parents who continually nag their children, however, may feel even more overwhelmed. Nagging nurtures a negative relationship cycle that can make both parents and children angry and resentful.

Perhaps most importantly, nagging may not work. If nagging did work, parents wouldn’t have to do it all the time because children would begin remembering their obligations. So parents who nag often waste time and emotional effort on a strategy that’s doomed to fail.

Better Communication Can Lead to Better Compliance

It’s easy for adults to forget that being a kid can be tough. Empathy is key to understanding why your child doesn’t listen. In some cases, it’s as simple as feeling overwhelmed. An endless list of tasks that seem boring and irrelevant can cause kids to ignore parents. Consider instead working as a collaborative team. Some strategies that may help include:

  • Including your child in discussions about family goals. Solicit your child’s input on which tasks they think are fair and how frequently they should do them.
  • Getting your child invested in family life. It’s tough to motivate a kid to cut the lawn when they don’t care how the house looks, for example. Likewise, kids may not want to clean their room if they feel like they’re being forced. Helping kids see the benefits of various tasks—easily finding toys, for example—may help. In some cases, an extrinsic motivator such as an allowance may improve compliance.
  • Allowing your child to decide how to do the tasks you ask them to complete. Don’t force your child to complete homework at a specific time, in the room of your choosing, while you stand over them. Giving your child age-appropriate freedom to make decisions can improve compliance.
  • Recognizing what is and is not developmentally typical. A four-year-old cannot anticipate plans for tomorrow, and a six-year-old can’t set long-term goals. Know whether your expectations are reasonable.
  • Making time and space for your child’s goals. Are there things your child wants you to do—such as play soccer or help them paint their new chest of drawers? Negotiating time to do the things your child wants can help them feel like you value them and their time, potentially ending the fight over chores.
  • Being direct. Tell your child what you want them to do, and ensure they know how to do it. Don’t be passive-aggressive or attempt to guilt-trip your child.

Recognizing Needs Versus Wants

Every child is an individual with their own personality. Some kids will never care about an organized room. Others are meticulously clean. Allow space for your child’s unique personality by setting some minimum requirements, then allowing your child to decide how to meet those requirements.

Likewise, it’s important to distinguish things your child must do from things you would merely like them to do. Learning to play the piano is not a requirement for a happy, healthy childhood, while regular doctor’s appointments are. Every parent must either learn to choose their battles or spend their days in a state of perpetual frustration. Some questions to ask yourself when deciding to pick your battles include:

  • Is there a way I can give my child more autonomy to do this task? For example, can I let my child pick their own shampoo, or decide what time to take a shower?
  • Is there a different activity my child can do that accomplishes the same goal? Most parents want their children to be fit and active. That doesn’t mean they need to play a specific sport, or even spend time outside. A fitness video game, spending time in the garden, or ballroom dancing classes might help.
  • How can I give my child more control when they have no choice? No child wants to get a shot. Allowing the child to pick which arm the injection goes into or what you do after the shot might help.
  • Why do I want my child to do this thing? Sometimes tradition, your own childhood, or fears about what others might think can affect your parenting. There’s nothing inherently harmful about wearing mismatched clothes or going out with messy hair.
  • Is my child able to do this? A child who repeatedly “fails” to complete a task may not be deliberately disobeying you. They might not be old enough to complete the task, or they might have a condition such as ADHD or autism that makes the task difficult.
  • Is my child ignoring me as a way of acting out? Children may display behavioral problems due to bullying at school, trauma, or a recent change in the family, such as the birth of a new sibling.

Therapy for Deeper Issues

Don’t allow nagging to become a chronic issue. If you still can’t stop or your child struggles to meet their obligations, you may want to find a child counselor. The right therapist can:

  • Help you identify developmental factors that affect your child’s ability to listen.
  • Help you and your child talk through communication barriers and find common ground.
  • Identify underlying concerns that may impede communication. ADHD and other issues may cause a child to struggle to keep up no matter how much you nag. The right therapist can help you adapt your parenting style and find the right comprehensive treatment.
  • Help you discuss your own feelings about a child’s noncompliance. Many parents worry that they are inadequate or that other parents will judge them.

A compassionate therapist can help you end the nagging war. There is no shame in seeking support.


  1. Atance, C. M., & Meltzoff, A. N. (2005) My future self: Young children’s ability to anticipate and explain future states. Cognitive Development, 20(1), 341-361. Retrieved from
  2. Chen, J. (2019, January 31). Emotional labour was eroding my marriage—This is how we tried to fix it. Today’s Parent. Retrieved from
  3. How to give kids effective instructions. (n.d.). Retrieved from
  4. Myers, R. (2011, July). Why nagging doesn’t work. Retrieved from
  5. Normal child behavior. (2018, October 16). Retrieved from
  6. Penza‐Clyve, S. M., Mansell, C., & McQuaid, E. L. (2004). Why don’t children take their asthma medications? A qualitative analysis of children’s perspectives on adherence. Journal of Asthma, 41(2), 189-197. Retrieved from

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Challenges for Moms Who Have OCD

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I have written before about the challenges children face, and the lessons they can learn, when one of their parents is dealing with obsessive-compulsive disorder. In this post I’d like to focus more on moms who have OCD, and the difficulties they might deal with. I won’t be focusing on postpartum OCD, but rather on moms who have already been diagnosed with the disorder and have been living with it for a while.

Some of the most common types of obsessions in OCD involve various aspects of contamination such as fear of dirt, germs, or illness. The person with OCD might fear the worst for themselves, their loved ones, or even strangers. If you’re a mother (and even if you’re not) you likely know that dirt, germs and illness are an inevitable part of childhood. How can a mom with OCD possibly take her four-year-old child into a public restroom?

Surprisingly, most can and do. Over the years I have connected with moms who have OCD who do what they need to do, despite their fears. By caring for their children, they are actually engaging in the gold-standard psychological treatment for OCD — exposure and response prevention (ERP) therapy.

And because ERP therapy works, these moms find that the more they bring their children into those restrooms, or allow them to play at the playground without trailing behind them with sanitizing wipes, or agree to let them spend time at a friend’s house, the less their OCD rears its ugly head. In short, they habituate, or get used to, being in these situations and accepting the uncertainty of what might happen.

Another comment I hear often from moms with OCD is that because caring for a child (or perhaps multiple children, and even a family pet) is time-consuming and never-ending, they are so busy that they don’t have time to worry about all the things OCD thinks they should worry about. If your baby has a dirty diaper, the dog is barking to go out, your toddler just found the finger paints, and you need to get to the grocery store, you don’t have time to fret over your fear of contamination. You just change the diaper, tend to the dog, quickly wipe your toddler’s hands, and get out the door. OCD might be protesting in the background, but you have no time for its silly demands. Again, great ERP therapy!

Of course, it doesn’t work this way for all moms, and for some OCD is in control. To these moms, I say, first and foremost, please get help from a mental health professional so you can learn to quell your OCD until it is nothing more than background noise as you care for your children. The truth is, if your obsessive-compulsive disorder remains untreated, it will affect your the well-being of your children. Their world will be limited, they will pick up on your anxiety, and they might even mimic your behaviors.

For moms who are struggling with OCD, please resolve to put your children before your OCD. Learn how to spend quality time enjoying them, not ruminating over all the things that might go wrong in a given moment.

The irony is that OCD wants you to believe that giving in to its demands is keeping your children safe, when in reality, your behaviors are likely hurting them. Modeling healthy behavior and how to deal with life’s challenges might be the best gift you ever give your children.

Finally, being a mom with OCD can feel extremely isolating. But you are not alone. Join support groups (online and in-person), talk to an OCD therapist, and accept the love and support of family and friends (but no enabling!). You and your children deserve lives not compromised by OCD.

Challenges for Moms Who Have OCD

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Psychology Around the Net: April 6, 2019

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This week’s Psychology Around the Net dives into how to stop worrying about what other people think of you, ways to defeat procrastination, why pets can help boost physical and mental health (especially in older adults), and more.


Stop Worrying About What Others Think of You: 7 Tips for Feeling Better: The fear of rejection is at the root of caring what someone thinks of you. Learn how to understand what “rejection” really means, use rejection (when it actually happens) as a brilliant opportunity for growth, how to embrace your individuality, and more to overcome your fear of rejection and truly stop worrying what other people think about you.

How to Defeat Procrastination with the Psychology of Emotional Intelligence: A step-by-step guide to overcoming procrastination by using the psychology of emotion regulation and emotional intelligence, with some extra tips and tricks to boot? Sign me up! (Additionally, you might want to find out how anxiety affects procrastination.)

Here’s One Big Way To Help Working Mothers Thrive: This new study tackles how to reduce a mother’s work-family conflict and employment-related guilt.

Why It’s a Problem If ‘Joker’ Connects Mental Illness to Villainy: While most portrayals of The Joker have involved a character backstory that’s mysterious, if not outright nonexistent, there are hints that this new Joker will include not only a backstory, but a backstory that includes mental illness linked to becoming a violent criminal. However, shouldn’t we pause and determine whether the story links mental illness in general with violent and criminal behavior, or whether the story features one character who has a mental illness that drove him to violent criminal behavior?

Poll: Pets Help Older Adults Cope with Health Issues, Get Active, and Connect with Others: According to a recent national poll, pets can help older adults deal with physical and mental health issues; however, for some (18 percent of participants), pets bring various strains (for example, financial burdens and problems that arise from putting a pet’s needs before your own). Which is it for you?

What We Know and Don’t Know about How Mass Trauma Affects Mental Health: Researchers are working to figure out who is at most risk of suicide and other types of self-harm after mass trauma events such as wars and political violence, natural disasters, and — especially prevalent in today’s troubled climate — mass shootings, including school shootings.

Psychology Around the Net: April 6, 2019

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On Stage on the Spectrum

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About three years ago, I got an email publicizing a drama school called the Center for Applied Drama and Autism, C.A.D.A. I was instantly interested. A year before, my 10-year-old son Tommy had been diagnosed with autism. I had always wanted him to get into acting because I’d acted as a child, having been in shows such as Gypsy and Fiddler on the Roof at local dinner theaters. Tommy seemed as though he would be a natural because he had the ability to memorize scripts (he was an avid scripter; people who are autistic often are), and he was very funny.

The school was in downtown Akron, about fifteen minutes away from our home. I signed him up. Soon, one Saturday a few weeks later, we entered an old building on Main Street and searched for the acting studio. Down a staircase we went and soon we found ourselves in C.A.D.A.

Tommy was going to take improv. Improvisation classes, we would learn, are good for autistic people because they help them to be better communicators (learning to think on their feet) and ultimately find their own voices. These classes were also fun.

We’d done traditional social groups at centers for people on the spectrum, but these had turned out to be unsuccessful because they lacked vital context and purpose. Acting encouraged the participants to be social, but also to be creative, making up narratives and scenarios.

The first day at improv, Tommy and his classmates warmed up doing an exercise called “Zip, Zap, Zop,” in which they passed energy to each other. Then, they did an exercise called “Mirrors,” in which they mimicked each other as if they were looking in a mirror. Then came a game called “Bus Stop,” where they pretended to be waiting for a bus in a character of their choosing. Soon, they would be acting out fairy tales and even learning Shakespeare.

Tommy took to it. There was only one problem. Well, really two problems. The first was that there was a very loud service bell that people rang so that they could get in the building which was often locked. This service bell unnerved Tommy. He had sensory issues, so the bell was a hindrance in his play. The second problem was that I got cancer, and Tommy fell apart. While I was getting treatment, we had to stop going to drama for a time. But I survived cancer, and then, something else wonderful happened. C.A.D.A. moved! No more service bell. C.A.D.A. relocated to what is known as their blue box theater in Akron, where they currently reside.

Now in 2019 at the blue box theater, Tommy takes improv from Ruben Ryan and Brandon Meeker. He goes every Saturday. And he’s getting good. He can sustain a scene and create original dialogue that is purposeful and entertaining. Improv helps him stay in the moment, to be in the moment, completely engaged and fascinated with people and life. This is saying something for someone on the autism spectrum, who might often be disengaged and out of touch.

So whose brainchild is C.A.D.A.? C.A.D.A. was co-created by Wendy Duke, a drama teacher for over 40 years, and Laura Valendza, an actor and intervention specialist.

C.A.D.A.’s philosophy is as follows:

Our goal is to meet our students where they are now, and without coercion, help them to recognize their own abilities and gifts through empowerment and making connections. We do not wish to change the uniqueness of each student, but rather help each one deal with social and emotional situations that will occur throughout their lives.

We do this via individual and collaborative applied drama techniques such as theatre games, improvisation, role play, character study, voice and body work, mask work (commedia dell’ arte), and Play Back Theatre. Additionally, we encourage creativity and originality through student created puppet plays, playwriting and video production. Visual art, dance and music are all key components in theatrical productions and give our students an opportunity to expand their artistic gifts and interests.

What does all this mean? For a parent of a child on the spectrum, it means that my kid can study acting at a world-class acting school right in our own little Akron, Ohio.

Recently, Tommy was asked to be a “co-star” at C.A.D.A. This means that he will work with a class of younger students as sort of a mentor/helper. Tommy’s father and I couldn’t be more thrilled. Tommy has gone from a timid pre-teen who was frightened by everything, including a loud service bell, to a full-fledged teenage actor in a leadership role.

If your child has autism, you might consider enrolling him or her in acting classes in your hometown. I’m sure acting courses can benefit your child. These classes have made all the difference in Tommy’s life.

On Stage on the Spectrum

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 A Dream Deferred: Are You Living Vicariously Through Your Child?

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No life is free of disappointment. For some people, disappointment is a passing frustration or perhaps a reason to try harder to achieve a different dream. Some parents, however, deal with disappointment by living vicariously through their children.

Although many people have witnessed this phenomenon at sports games, spelling bees, and parent-teacher conferences, few researchers have studied it. A 2013 study was one of the first to provide experimental evidence that parents do indeed attempt to redeem broken dreams through their children. The researchers found that parents can feel pride in their children’s achievements and even heal old wounds. When taken to extremes, however, living vicariously through a child can damage both the child and the parent.

Signs You May be Living Vicariously Through Your Child

It can be difficult for parents to decide whether they’re involved and supportive or obsessed with pushing their children to fulfill their own broken dreams. Most parents encourage children to do things the parents enjoy. For example, parents who love reading may take their children to bookstores, while avid gardeners may relish spending time in the yard with dirt-loving toddlers. There’s nothing wrong with this, as long as parents follow a child’s lead and allow children to pursue their own interests.

Some signs that you might be living vicariously through your child include:

  • Becoming obsessively involved in your child’s activities, at the expense of your own well-being or hobbies. This behavior is sometimes called helicopter parenting.
  • Forcing children to do things they don’t want to do that are either unnecessary or offer no additional benefits. For example, all children must eat their vegetables and go to school, but there is no reason a child needs to do a specific activity, such as football or art camp.
  • Making decisions about your child’s life because of your own disappointments. For example, a parent might be living vicariously if they refuse to let a child quit basketball because the parent regrets quitting basketball.
  • Seeing your child’s behavior and activities as a reflection of your own worth.
  • Ignoring your child’s needs or interests. For instance, a parent might push their child to take art classes when that child really wants to play baseball.
  • Punishing a child for poor performance at extracurricular activities.
  • Experiencing intense emotions related to your child’s athletic or academic performance.
  • Telling your child how to think and feel about certain hobbies or goals. For instance, if a child insists that they hate baseball, a parent might angrily tell the child not to feel that way.

Why Parents Project Dreams Onto Their Children

Most parents want their children to have excellent lives. For many, this means encouraging children not to make the same mistakes they did, Many parents also feel pressure to give their kids certain advantages or to conform to an unrealistic ideal of parenthood. Parenting culture can be competitive, shame-inducing, and exhausting. When combined with a parent’s regret about their own childhood, it’s easy to see why some parents project dreams onto their children.

Most parents do not intend to harm their children and truly believe they are doing what is in a child’s best interests. It’s important to look beyond your motives and consider the role your emotions and experiences might play in your parenting decisions.

For a small minority of parents, children can act as a narcissistic supply. These parents may use their children as a way to gain acclaim or attention. This behavior pattern is prevalent among people with narcissistic personality, though not all people who do this have NPD. If you use your child to feel good about yourself, you may be behaving narcissistically.

Why Your Children Can’t Fill Your Dreams

Children are separate people from their parents. They inevitably develop different interests and dreams, even when they also share much in common with their parents. Attempting to fulfill a dream through a child is inherently harmful because it ignores that child’s individuality. Pushing a child into a predetermined role can snuff out the child’s unique gifts and interests, preventing the child from achieving their own dreams or realizing their own potential.

When parents try to get their own needs met by living vicariously through their offspring, it puts tremendous pressure on the child and reverses the proper roles.In a healthy parent-child relationship, love and support flow from the parent to the child. Attempting to fill emotional voids through a child can cause a parent to ignore a child’s needs or fail to give the child the unconditional love and support that are hallmarks of good parenting.

In its most extreme forms, living vicariously through a child can be a form of abuse. Parents may aggressively pigeonhole a child into a role, ignoring the child’s needs and feelings. Some parents even become physically or emotionally abusive in an attempt to get their children to excel at certain activities. These parents might spank their children for not practicing piano or insult a child’s appearance before a beauty pageant.

As children grow and learn, their key task is one of individuation—separating from their parents and establishing a unique identity. Parents must help them do this by supporting children to pursue their own dreams. When parents are unwilling or unable to do this, children’s emotional and intellectual growth may be stunted. This can make it difficult for children to succeed as adults, to feel a sense of self-efficacy, or to make decisions without a parent’s input.

How Therapy Can Help You Live Your Own Life

“It is a parent’s job to do what is in their children’s best interest. That includes the parent dealing with his or her own emotions in ways that best further the healthy development of the children. When parents try to get their own needs met by living vicariously through their offspring, it puts tremendous pressure on the child and reverses the proper roles. In this scenario the child is being pressured to meet their parent’s needs, which is very destructive to proper child development. In order to avoid this course, parents are wise to seek out psychological help so that they can process their feelings and unmet needs with a professional instead of burdening their children with those feelings and needs,” says Johannes Kieding, LCSW, a Tucson, Arizona, psychotherapist.

Therapy can help both parents and children deal with the harmful aftermath of vicarious living. Family therapy can help families manage conflicts stemming from this harmful parenting style by giving children a voice, fostering effective communication, and providing a safe space to discuss alternative parenting strategies.

Parents who feel compelled to live vicariously through a child can also find great relief from individual therapy. A therapist can:

  • Help a parent grieve the loss of their childhood ambitions.
  • Support a parent to set new goals and find new ways to fulfill their dreams.
  • Offer insight into parenting style and provide feedback on whether a parent is supporting their child’s dreams in a healthy way.
  • Address issues of identity. Some parents derive their sole source of identity from their children. This can initiate a cycle of guilt, shame, frustration, and resentment. A therapist can disrupt this cycle by supporting parents to establish separate identities.

A compassionate therapist can help you live a life of purpose without foisting your dreams onto your child.


  1. Brummelman, E., Thomaes, S., Slagt, M., Overbeek, G., Castro, B. O., & Bushman, B. J. (2013). My child redeems my broken dreams: On parents transferring their unfulfilled ambitions onto their child. PLOS ONE, 8(6). Retrieved from
  2. Diagnostic criteria for 301.81 narcissistic personality disorder. (n.d.). Retrieved from

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How Disorganized Attachment Can Lead to Dissociation

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Attachment may be understood as the relationship between child and caregiver (often a parent). This relationship is the most important in the child’s life, as the caregiver is the provider of all his or her needs. Not only is the child dependent on the caregiver for basic survival, but the child’s social, emotional, and cognitive development also take shape within this relationship.

Attachment and the Disorganized Response

In a secure relationship, the caregiver is able to recognize and respond to the child’s needs in a way that provides support. The caregiver’s behavior is predictable and stable. In a secure relationship, the child is more likely to develop healthy emotion-regulation abilities as well as a healthy view of the self and world. This is because when the child needs comfort and reassurance, they are available. Over time, the child develops a view of the world that when help is needed, it can be counted on. In addition, the child comes to see themself as worthy of love and support. In a safe and secure environment, the child is better able to take advantage of important opportunities for learning and development.

In contrast, children with unpredictable or abusive caregivers often experience inner conflict and may not form an organized response to fear or distress. When attachment researchers speak about an “organized response”, they are referring to the strategy the child uses when in need of care. For example, if the child’s caretaker is a source of both safety and danger (as in the case of a violent, neglectful, or abusive caregiver), the child may run to the caregiver when upset and then display ambivalence toward the caregiver, such as refusing to be picked up or displaying anger. This demonstrates a fundamentally conflicted situation for the child, as they need the caregiver for safety and at the same time needs to protect themself from the caregiver. In this way, the child can form a disorganized response to distress.

How Dissociative Symptoms Can Develop

Researchers have found that disorganized attachment is associated with dissociative symptoms. Children in a relationship with an unpredictable or sometimes traumatizing parental caregiver have a difficult time establishing a consistent view of the parent and of themselves. The parent is both needed and to be avoided. The child may not understand what makes them a “good” child or a “bad” child, as the caregiver’s behavior is often confusing and unpredictable.

In order to maintain a relationship with the caregiver—and attempt to make sense of themselves—some children simply forget or deny the abuse. Jennifer Freyd refers to this as betrayal blindness. Forgetting or denying trauma is a symptom of dissociation. It is an adaptive and defensive strategy that enables the child to function within the relationship, but it often leads to the development of a fragmented sense of self.

Disorganized Attachment Is Not Always the Result of an Abusive Caregiver

While disorganized attachment is often associated with abuse, sometimes loving caregivers who have experienced trauma themselves can behave in confusing ways toward the child. This happens because of the caregiver’s own inability to control their emotions. Traumatized parents can have a difficult time managing their emotions and providing a sense of security for the child even though they are not abusive or neglectful. Anger or fear can erupt unexpectedly and traumatize the child. A loving caregiver can be experiencing posttraumatic stress disorder (PTSD) or dissociative identity disorder and unintentionally behave in frightening or confusing ways to their child.

If a caregiver is dealing with their own trauma, it is recommended they seek therapy. In therapy the caregiver can learn to cope with stress, develop emotion-management skills, and learn more about understanding their child’s needs. Often caregivers who were raised in abusive families are unaware of how to appropriately respond to a child’s emotional needs because they themselves did not have their own needs met when they were children.

There are a range of therapeutic treatments for adults suffering from PTSD that have shown to be helpful. These techniques help reduce symptoms of trauma such as anxiety, depression, and chronic stress. Psychotherapy can provide emotional support to caregivers so they can begin to grow and provide a safe and responsive environment for themselves as well as their children.


  1. Bedard-Gilligan, M., & Zoellner, L. A. (2012). Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis. Memory, 20(3), 277-299. Retrieved from
  2. Firestone, L. (n.d.). Disorganized attachment: How disorganized attachments form & how they can be healed. Retrieved from
  3. Freyd, J. J. (n.d.). What is betrayal trauma? What is betrayal trauma theory? Retrieved from:
  4. Gillath, O., Karantzas, G. C., & Fraley, R. C. (2016). Adult attachment: A concise introduction to theory and research. Academic Press.
  5. Paetzold, R. L., Rholes, W. S., & Andrus, J. L. (2017). A Bayesian analysis of the link between adult disorganized attachment and dissociative symptoms. Personality and Individual Differences, 107, 17-22. Retrieved from
  6. Psychological treatment of PTSD in adults. (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. Leicester, UK: Gaskell.
  7. Waters, S. F., Virmani, E. A., Thompson, R. A., Meyer, S., Raikes, H. A., & Jochem, R. (2010). Emotion regulation and attachment: Unpacking two constructs and their association. Journal of Psychopathology and Behavioral Assessment, 32(1), 37-47. Retrieved from

© Copyright 2019 All rights reserved. Permission to publish granted by Fabiana Franco, PhD, therapist in New York City, New York

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Frequent Problem Behavior in Your Child? This Might Be Why

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Having to deal with problem behavior in your child can leave you feeling frustrated and helpless. But what if this behavior was sparked by anxiety?

A number of studies have found that children’s inability to process difficult emotions often leads to what commonly comes across as “problem” behavior. This may look like uncontrollable tantrums, unpredictability and impulsiveness, extreme clinginess, an inability to do what is expected (for example, an inability to follow simple instructions in school or at home), developmental difficulties, uncontrollable anger, extreme reactions, defiance and aggressive or dangerous behavior that puts your child or those around him in danger.

There is now solid evidence that the behavior of children suffering from high anxiety closely resembles that of children with behavioral disorders.1 What this means is that a child unable to manage her anxiety may be diagnosed as suffering from common disruptive behavior disorders such as attention deficit hyperactivity (ADHD), conduct disorder or oppositional defiant disorder (ODD).

Part of the problem associated with misdiagnosis lies in the fact that it is not always easy to establish what drives your child’s behavior. When dealing with a violent or extremely disruptive child, it may be difficult to make the connection between anxiety and the behavior displayed. In other words, a highly anxious child will not tell you that he doesn’t want to go for his swimming class because he doesn’t know how to swim and is scared of making a fool out of himself. What he is likely to do is go into defense mode to avoid that class, and this may translate into disruptive behavior, aggressive behavior toward his classmates, disrespect and a refusal to follow instructions, and so on. In reality, all these are simply attempts to escape his swimming lessons.

Problem behavior is often an attempt to escape from anxiety-provoking situations and other difficult emotions associated with such situations. By this I mean that although anxiety may be the primary emotion experienced, other secondary emotions such as fear, panic or shame can also develop alongside the primary emotion.

That said, all hope is not lost. Indeed, being aware that anxiety or other strong emotions may be behind your child’s behavior is a great starting point to help you deal with problem behavior more effectively.

Here are three things you can start doing today to better manage the impact of emotions on your child’s behavior:

1) Get the conversation about emotions going.

How would you define frustration? Emotions are not always easy to put into words, even for adults; imagine how hard it can be for your child to navigate big emotions. The first and most important thing to do is to teach her about different emotions using age-appropriate techniques. She needs to know that she is safe to express her emotions.

Appropriate techniques for kids include games, holding conversations around characters in the book she’s reading (“He sure looks sad”), asking the right kind of questions (“what made you happy today?” talking about your own emotions (I was sad when…), and so on.

2) Learn to anticipate anxiety-provoking issues.

The thing with anxiety is that it’s pretty good at hiding, but there are always ways to get around it. The easiest way is to pay close attention to your child’s behavior in order to determine anxiety-triggering situations. It is always easier to deal with a highly anxious child before the situation gets out of hand. What you need to remember is that just like in adults, there is a strong link between anxiety and a need for reassurance — You matter, no matter what!

Ultimately, teaching your child to identify how his body feels when he’s feeling anxious is a great way to help him learn to identity and manage anxiety by himself.

3) Teach your child to succeed on her own.

Dealing appropriately with strong emotions is about having a set of tools, some form of “tool box” that your child can use any time she needs to. Help your child identify appropriate responses to anxiety. Help her come up with “power cards” that give her a visual example of how she can deal with anxiety. Let her know that she has what it takes to deal with strong emotions by herself. No one said this will be easy, but by taking small steps toward the development of your child’s emotional intelligence, she is bound to get there.

Anxiety in children is a very common phenomenon and often lessens with time as your child learns to better react to difficult situations. That said, it can also be a sign of a more serious problem. Please seek professional help if none of your attempts seem to be working or if you feel unable to manage this behavior on your own.

Frequent Problem Behavior in Your Child? This Might Be Why


  1. Moskowitz , L.J., Walsh, C.E., Mulder, E., McLaughlin, D.M., Hajcak, G., Carr, E.G., & Zarcone, J.R. (2017). Intervention for Anxiety and Problem Behavior in Children with Autism Spectrum Disorder and Intellectual Disability. Journal of Autism and Developmental Disorders, 47(12): 3930-3948.Retrieved from []

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