Sullen and/or Uncommunicative

Kids – and especially teenage kids – can sometimes withdraw from family communication and particularly from communication with their parents. They may retreat in different ways. Sometimes they sulk around the house saying very little to anyone including family, friends and others. Sometimes they don’t say much to their parents while they maintain contact with other family members and/or they talk non-stop on the phone to their friends, text madly away or chat avidly online. Sometimes their mood is morose for just a few hours and then they’re “suddenly” all happy again. But sometimes they withdraw for weeks or months on end. These silent and sullen periods are confusing for parents; how can parents tell if their child needs professional help or if he or she is just being a kid who needs space?

If you are dealing with a sullen or uncommunicative youngster, consider the following tips:

No One is Happy and “On” All the Time
Neither children nor adults experience constant positive moods. It’s normal for all of us to feel stressed or low, off and on throughout a day. Circadian rhythms alone (our biological clocks) affect our moods and energy levels, as does our diet, our exercise (or lack of it) and the various life stressors that each day brings. It’s important to give kids space to be a little irritable or quiet; they – like the rest of us – may need recovery time. Therefore, there’s no need to panic when you see that your child is in a mood. Instead, note the child’s mood and ask if there’s anything you can offer. For instance, you might say something like, “You seem a little down. Do you want to talk or do you need a little neck rub?” If the child declines on both counts, you just say “O.K.” and move on. You have shown an appropriate level of interest and concern without being intrusive or annoying. However, if the child is normally pretty balanced and then enters into an unremitting low, sad-looking mood for two weeks straight, you should express more concern. “Honey, I’m getting concerned. You’ve looked really sad for two weeks now and this isn’t like you. Is there something going on that is hard for you to deal with or are you feeling sad for no reason in particular? I don’t mind if you don’t want to talk to me about it – maybe I’m not the right person. But if you’re having trouble getting into a happier place, I want you to know that Dr. So & So is very nice to talk to and she might be able to help.”

Normal Needs for Privacy
Mood issues aren’t the only reason that kids withdraw from communication with their parents. Sometimes they are just expressing a normal need for privacy. No one likes their life to be a completely open book. You don’t share everything with your child and your child doesn’t need to share everything with you. If you don’t give enough privacy voluntarily, then a child may take it by refusing to open up. One way to offer privacy is to avoid intensive questioning. For instance, don’t ask your child detailed questions like “Who did you talk to today? What did you talk about? What is Bobby doing this weekend? Were you invited? Why not? Have you spoken to Carey lately? Don’t you think you should?” and so on. Children subjected to such inquisitions often learn to give very little information about anything. However, even when parents don’t ask much, teenagers are notorious for wanting to keep a private life. They may have no noteworthy secrets; being quiet doesn’t always mean that the youngster is engaging in suspicious activities. It may just be a case of privacy for privacy’s sake (i.e. “I don’t tell my mom who I see on the weekend not because I have something to hide, but just because I don’t feel like telling her.”). Sometimes, of course, excessive secrecy does indicate a problem behavior. However, usually there are other behavioral clues that contribute to a suspicious picture (for instance: a sudden drop in school marks, red eyes, unusual irritability, strange behavior, a change in behavior and so on). A lack of open communication by itself, is not necessarily cause for concern and in fact, is considered to be pretty normal in adolescents.

Set Appropriate Boundaries
If your child is otherwise happy and well, it is fine to set boundaries for the expression of sullen and uncommunicative behavior. For instance, if your kid is able to talk nicely to his or her friends and others, then go ahead and ask him or her to speak nicely to the folks at home as well. Make sure, however, that you are being mostly positive and pleasant yourself – check your communication ratio. Are you 90% positive and only 10% in the criticism-instruction-discipline section with your teenager (80-20 with your younger child)? If not improve your own pleasant behavior first and then ask your child to do the same. There is no need to allow rude behavior in the home and doing so gives your child the wrong message that family members aren’t real people with real feelings. It’s fine to say something like, “You don’t have to have a long conversation with me if you you’re not in the mood, but when I greet you please just look up for a moment and say ‘hi.’ It’s not acceptable to completely ignore a person who is talking to you and especially,  your parent.” If the child continues to ignore you after you’ve provided this information, something deeper may be going on – perhaps there are parent-child relationship issues, discipline issues or mood issues that would be best treated with professional help.

More Serious Mood Issues
When a previously happy child suddenly becomes sullen and/or uncommunicative for an extended period of time, he or she might be suffering from an internal or external stress. Internal stresses include mental health issues like social anxiety or depression. External stress includes life events like marital breakdown, failing grades or bullying at school. In children and adolescents, depression often shows up as irritable mood rather than sad mood, and is accompanied by other behaviors like changes in eating and sleeping patterns, a tendency to isolate from people, excessive low self-esteem or insecurity, changes in energy and other symptoms. If you are concerned about whether your child’s behavior requires professional intervention, ask your doctor for a referral to a child and adolescent mental health professional with whom you can discuss the issue.

Loner or Socially Handicapped?

Is there something wrong with a child who doesn’t like to play with friends? Or, is it possible that the child is just a healthy loner? How would a parent know if and when to intervene?

If you are concerned about your child’s lack of social life, consider the following tips:

Content vs. Discontent?
Is your child playing happily on his own? Is he busy with books, toys, computers, and other resources in the home? Is he building, creating, learning, exploring and otherwise enjoying himself? Is he acquiring new skills or engaging in productive activities? If your child is thriving in his independent activities, he may just be an introvert – someone who is energized by his own personal activities and drained by being with people. Or, it might just be that he’s had enough people for the day, having interacted with his peers at school for 8 hours or longer; now he’s ready to spend time with himself. Not a full-fledged introvert, he just has a lower need for social activity. Adults are like this too – many grownups just want to relax at home in the evening after a day of interacting in the world. In short, if your child is happy on his own, don’t worry about his behavior and don’t push him to be with friends.

Fearful or Comfortable?
If your child would like to have friends but doesn’t know how to make meaningful social connections, he might benefit from some help. Try a bit of bibliotherapy – ask the librarian for age-appropriate books on the subject of how to make friends. Talk about the subject directly or do some role-playing in order to practice various skills: making and accepting invitations, being a host, being a guest, keeping friends and so on. Also consider enlisting the help of professionals – there are social skills classes and trainers and also mental health professionals who can help. If your child actually feels fear at the idea of inviting a friend over or fear at the idea of going to a friend’s house, then accessing the help of a mental health professional is definitely recommended: there are techniques and interventions that can help your child overcome social discomfort and anxiety.

All or Nothing?
If your child has even one or two regular pals, there is no need to worry about his social life. Not everyone wants or needs a big social net. Similarly, if your child has close and warm relationships with siblings, cousins, community members or neighbors, there is no need to worry that he doesn’t have more friends. However, if your youngster has absolutely no one to connect to there is more reason for concern. Having someone to interact with and talk to is an important life skill. Again, professionals are available to help your child learn how to create at least a small social circle.

Your Teen’s Right to Privacy

Today’s teenagers live in a world that their parents often find scary and alien. It seems that there are no protective walls around their youngsters – computers and cellphones open them to a wide world of exposure and vulnerability that the parents don’t even fully understand. Moreover, teens are more independent and are physically away from their parents more hours of the day and night. Parents are losing a grip – they no longer control or even know, what their child is up to. Many take to looking for clues as to their child’s whereabouts and activities, while others insist on constant check-ins and reports on the who, where, what & why of all activities. But how much does a parent really need to know about his or her teen’s activities? How far do the parent’s rights extend – does the parent have the right to full disclosure of all a teenager’s comings and goings? Does a teen have any right to privacy?

If you’re wondering where to draw the line on your teen’s privacy, consider the following tips:

Everyone is Entitled to Personal Space
It is healthy for every child to have a sense of privacy. This helps the youngster develop appropriate personal boundaries, a sense of “me” vs. “you” that helps the child come to know who she is and what she stands for – with the subsequent ability to stand up for one’s OWN values and beliefs. Privacy is attained by maintaining physical privacy – the ability to dress and bathe in privacy and the ownership of a private space (a bed, maybe a bedroom, a private wardrobe, personal possessions that are not for the use of others without permission). Your teenager is at an age where it is inappropriate to rummage through her drawers or belongings. Unless you suspect your teen is hiding drugs, weapons or other dangerous possessions, you have no right to search her belongings. In fact, the kind of privacy you should give your teen is the privacy he or she deserves. If your teen has grown up to be responsible, caring, and trustworthy, then there is no reason for you to watch his or her every move or even suspect impropriety.

Talk about Life
Raise interesting issues for discussion at your dinner table. Raise topics from your weekly news magazine or paper. Talk about what’s going on in the world and in your local community. Talk about violence, crime, sexuality, bullying, materialism, fashion, addictions, war – everything that is out there. Help your kids think about life and clarify their own values. Provide education in discussion format – not lectures and dire warnings. This will help your teen make good, healthy choices.

Be a Good Listener
Kids who can talk about their stresses tend to act out less. Instead of turning to drugs, stealing, sex or other distracting unhealthy activities, your child can turn to YOU for support, approval, comfort and nurturing. Work hard to listen without offering criticism or even education. Just show compassion and trust for your youngster, conveying that you believe in him or her.

Confront Untrustworthy Behavior
Catching under-aged teens drinking alcohol or stashing inappropriate materials are reasons to initiate an intervention, but this response has to be done appropriately. If the disturbing behavior is mild, parental intervention alone may be sufficient – heart to heart talks, discussion concerning consequences and other normal parenting strategies can be employed. If the offence is recurrent, however, or if it is serious, then it’s best to enlist professional assistance. Speak to your doctor for a referral to a mental health practitioner.

After your child has acted in an untrustworthy manner, it is tempting to “check up on him” from time to time. However, acting in a sneaky way is likely to backfire at some point. Don’t do anything that you don’t want your youngster to do. Therefore, if you don’t want to find your youngster searching your purse or your private drawers, refrain from that kind of behavior also. If you don’t want your youngster checking your email or social feeds, don’t do it to him. If something in your child’s demeanor makes you feel concerned, talk about it openly. It’s fine to ask your child to show you (on the spot) his last string of communications with friends if you have serious reason to suspect dangerous or illegal activity on his part. Otherwise, never ask for such a thing.

Some kids who are addicts will act in deviant and sneaky  ways because of their addiction. Work with a professional addiction counselor to create appropriate interventions in the home. If checking on the child is recommended by the counselor, then of course, follow the recommendation.

Checking In
For reasons of common courtesy and safety, it’s reasonable for your teen to let you know when and where he is going. Depending on the age of the teen, it will also be appropriate to ask permission to go there! If you have curfews in place, it is important to expect the teen to comply with them or renegotiate them to everyone’s satisfaction. However, once your teen is out and about, it is intrusive to call and check on him or her. If the child is traveling a long distance, it’s fine for him to call to say he’s arrived (i.e. he has taken a flight), but you don’t need him to call for local trips to friend’s houses. On the other hand, if your thirteen year-old daughter has to walk a few blocks alone in the dark to her destination, you might ask her to call – it depends on the safety of the area in which she is walking.

Act as if your child is completely trustworthy unless your child shows you otherwise. If there is a problem, sit down and try to work it through, explaining your concerns and working towards solutions. If this is insufficient, enlist the help of a professional family therapist. If the child is acting out – engaging in inappropriate and/or dangerous activities – do consider bringing a mental health professional into the picture.

Repetitive Asking (Child Asks Same Questions Over and Over)

Asking questions is a sign of an intelligence. In fact, it is recommended that parents encourage questions, as this gives permission to young curious minds to explore the world and seek understanding. But what if your child has a tendency to ask the same question, or variations of it, over and over and over again? If your child is a pre-schooler, then this behavior is just a normal phase – answer the questions a few more times and move on. If your child is already in grade school, however, this pattern of asking may indicate some sort of anxious feeling or condition. Knowing how to respond is important.

If your child keeps asking the same question over and over, consider the following:

Perhaps Your Child Doesn’t Feel Heard
It’s true for adults, and it’s true for kids as well: if a person feels the need to repeat himself, chances are he or she sensed that the message did not get across. A child can feel that his or her question wasn’t taken seriously, or perhaps the youngster found the answer unsatisfactory in some way. Asking again might be the equivalent of saying, “let me put the question another way,” – except that the child doesn’t bother to rephrase it or elaborate! If you suspect that your answer was somehow lacking, go ahead and give a more complete one now. If there is still a problem, ask your child to expand on his or her question so that you can understand what is really being asked for.

Your Child is Not Really Asking a Question, but Expressing a Feeling
“Why does Dad have to work all the time?!?” At first blush you’d think this question is a mere inquiry regarding why parents need to work. But it’s possible that your child is sad and missing his or her father. In this case, your child needs comfort, not an explanation. If you’re a parent with a child who repeatedly asks specific questions, ask yourself whether it’s possible that there is an emotional need behind the subject being asked. Your child may be confused, lonely or scared, but can’t communicate it directly. He asks a question and gets an answer that doesn’t satisfy him, so he asks again. If you answer the unspoken sentiment, the child will stop asking. For instance, instead of “Grownups have to work many hours in order to make money to support their families” you can say, “You really miss Daddy, don’t you? You wish he could be with us more of the time.” If your emotional coaching “hit the spot” the child will stop asking his question!

Your Child Didn’t Understand Your Answer
Questioning stops when a satisfactory answer is received. Unfortunately, parents sometimes forget that the younger a child is, the more difficulty he or she will have in processing abstract answers. Explaining that rain comes from evaporated water that becomes clouds may be too much for a three year old. You might need to adjust your answers more appropriately to the particular child who is asking. Often, the more simple the answer, the more satisfying it is.

Your Child is Trying to Break Down the Question
Kids have limited attention-spans and therefore may not have registered your whole answer. In addition, some kids have auditory processing deficits that cause them to remember limited amounts of information. For this reason, they may ask the same question again over and over again until they can put together all the information they’re after. If you notice that your child only remembers part of what you’re saying, try to break up your answers into small pieces. For instance, if a child asks “Why does it snow in some countries?” you can start off with a brief reply like, “because in some places it is so cold that the rain freezes into snow crystals.” Then the child can ask a NEW question, like “How cold does it have to be for that to happen?” You can then answer this new question in a few short words. That might lead to the next question, and so on.

Your Child is Expressing Wonderment
Children are in a constant process of discovery. Things that are ordinary for us adults, are profound new things for kids. It’s possible for kids to repeatedly ask a question as an expression of amazement. In other words, the child is confirming a new piece of information over and over again, because he is relishing it! For instance, a young child might say “Why is that tree so tall?” when he doesn’t really want an answer. He might mean “That tree is SO tall!” In which case you can just echo the sentiment. “It is so tall, isn’t it?” These conversations tend to happen with very small children.

Your Child is Expressing Anxiety or Insecurity
Sometimes repetitive questions are a symptom of anxiety or insecurity. For instance, when a child asks, “Is it time to go to school now?” every 10 minutes in the morning, it can be that the youngster is worried about being late. Similarly, if the child asks over and over again, “Are you sure this outfit looks alright?” it can be a sign of insecurity. In OCD (obsessive compulsive disorder), it is common for sufferers to constantly ask the same question or versions of the same question over and over, as they seek to reduce their anxiety. For instance, a child might ask, “No one has touched this bowl, right?” followed by, “The bowl wasn’t touched by anyone, was it?” followed by, “No one touched it all, even a little, right?” and so on. In all cases of anxious questioning, the best intervention is to refuse to answer more than once. Whether the issue is minor anxiety, normal insecurity or OCD-type intense anxiety, when parents refuse to answer more than once, they actually help reduce their child’s insecurity. Anxious questioning is uncomfortable for the child as well as for the parent.  When the child knows that he or she is only getting one answer per question, he or she eventually feels calmer and experiences less need to ask again and again. Parents are not helping anxious children by continuing to answer repetitive questions – in fact, they can actually worsen the child’s anxiety by doing so. When repetitive questions seem to be arising out of worried, insecure or anxious feelings, a professional assessment can be helpful. A psychologist or psychiatrist can let you know whether the child’s behavior will likely disappear on its own or with minimal at-home intervention, or whether professional intervention should be utilized to help reduce underlying feelings of anxiety or to address an actual anxiety disorder.

Tourette’s Syndrome

Perhaps you’ve noticed that your child is blinking excessively, clearing his throat or twitching – or all three. You wonder – is he stressed, nervous or troubled? Does he need therapy? Or perhaps you suspect that he’s just developed a bad habit. Maybe you’ve been nagging him to stop doing it – all to no avail. But here’s the more realistic possibility – your child has a tic disorder. A tic disorder is a repetitive sound and/or movement that is performed compulsively without a person’s conscious intention. If a person makes a sound (like throat clearing or coughing), the action is called a tic disorder. Similarly, if a person makes a movement (like shrugging his shoulders or turning his head to the right), it is also called a tic disorder. However, if a person make both repetitive sounds and movements, then it is called Tourette’s Disorder.

What is Tourette’s Syndrome?

Also called GTS (Gilles de la Tourette’s Syndrome, named after the French doctor who first described the condition), Tourette’s Syndrome is a kind of tic disorder. Tics are involuntary, repetitive and usually non-rhythmic movements or vocalizations. Persons with Tourette’s suffer from frequent and unintentional motor actions, such as blinking, nodding, shrugging or head jerking and they are also prone to unintentional productions of sounds such as barking, sniffing, grunting, or the repetition of particular words or phrases (including, in some cases, vulgar expressions – see below).

In some cases, Tourette’s Syndrome causes coprolalia — a compulsion to shout obscenities. There are also occasions when persons with Tourette’s engage in movements that may cause harm to their selves, such as involuntary slapping or punching of one’s own face.

Is Tourette’s Syndrome Common?
Tourette’s Syndrome, and tics in general, are more common than most people realize. It is estimated that 15 to 23 % of children have single or transient tics (tics that last a year or so and then stop), although not all cases progress to Tourette’s Syndrome. According to the National Institute of Neurological Disorders and Stroke, about as many as 200,000 Americans have the severe form of Tourette’s, while as many as 1 in every 100 experience more mild symptoms.

Tourette’s usually begins in childhood, with onset between the ages of 2 to 14 years-old. Episodes of Tourette’s wax and wane, and patients may experience long periods of time when they don’t have active symptoms. In general, symptoms are worse during late adolescence, and then gradually taper off towards adulthood.

Tourette’s is often found along with Attention Deficit Hyperactivity Disorder (ADHD) and/or Obsessive Compulsive Disorder (OCD).

What Causes Tourette’s Syndrome? 
The exact cause of Tourette’s Syndrome is not yet identified, but it’s worth noting that the condition tends to run in families. This implies that Tourette’s may be organic in origin, although environmental causes are not being discounted. The roots are traced to some abnormality in the brain structure as well as the production of brain chemicals that regulate voluntary motor behavior. Tourette’s syndrome also seems to be affected by stress, worsening during periods of stress and improving during vacations and other low stress periods.

What is the Treatment for Tourette’s Syndrome?
As with many conditions, prognosis is best when one employs a multi-disciplinary approach. Because of the link of symptoms with stress, training in stress management, as well as counseling and therapy is a good start for people with the condition. Some people have found alternative treatments helpful as well, such as Bach Flower Therapy, herbal supplements, and nutritional supplements. Any therapy that helps foster relaxation and well-being may be helpful or at least supportive in this condition. Support groups, for those with the condition, as well as their loved ones, are also helpful. When symptoms are severe, or if they cause the individual significant distress, there are psychoactive medications that can help manage Tourette’s symptoms.

For a professional diagnosis and treatment plan, it’s best to consult a neurologist, psychiatrist, and/or a clinical psychologist.

Motor Tics (Twitches and Jerks)

Motor tics are repetitive, involuntary movements. They are like an itch that just must be scratched – a person may wait or delay the urge to tic, but in the end, just has to do it. A tic can manifest as eye-blinking, shoulder shrugging, head bobbing, upper body jerks, knee bending and any other repetitive movement. Some include head-banging and picking at one’s skin in this category as well, although these behaviors are technically disorders in their own right.

If the tics last less than a year and cause distress during that time, they may be diagnosed as “transient tic disorder.” If they last more than a year and are never absent for more than three consecutive months, and they cause some distress, they may be diagnosed as “chronic tic disorder.”

If motor tics occur along with vocal tics (grunts, barks, coughs, words, mental words and so on), causing significant distress, then “Tourette’s Syndrome” might be diagnosed. Only a doctor or clinical psychologist can provide an accurate diagnosis. All tics are thought to have a biological basis and some medications can “unmask” (trigger) a latent tic condition. Medications for ADD/ADHD, for instance, have been known to trigger tic disorders in vulnerable individuals. The term “nervous tic” does not pertain to motor tic disorder. One needn’t be nervous at all to have a tic disorder. In fact, tic disorders are thought to be inherited and related to other brain disorders such as obsessive-compulsive disorder (OCD) and ADHD. Indeed, many kids have all three disorders together.

Helping Your Child with Motor Tics
Although “causing distress” is part of the diagnostic criteria of a motor tic disorder, it is a fact that PARENTS might be more distressed by the child’s movements than is the child him or herself. In fact, the  parent may feel anxious or very annoyed by them. There can be a definite urge to scream “STOP DOING THAT!”  However, tic movements are outside both the realm of the parent’s control and the child’s control. This lack of control can  also cause distress to the child. Children may find their movements to be embarrassing in public situations. For this reason, they may strive to hold back an urge to tic while out of the house, only to “let loose” once in the privacy of home, “tic’ing” with a vengeance. It’s like having an itch that you stall until you get home and then you scratch madly to address the build-up of the tension.

Asking the child to refrain from doing his or her tic DOES NOT WORK and may even lead to an  increase in  tic activity because of the stress that the demand induces. When children feel watched or rejected for making movements, they’ll actually make MORE movements!

Although chronic tic disorders are considered to be really chronic –  lasting a lifetime –  many people do experience spontaneous remission. That is, the tics just disappear on their own at some point. Sometimes neurological or psychotropic medications can help and may be an appropriate intervention when motor tics are severe and having a negative impact in the child’s life.  Speak to your doctor about these possibilities. Sometimes behavioral therapies can help (find a psychologist who is experienced in the treatment of tic disorders). Bach Flower Remedies have helped many people with tic disorders (consult a practitioner for an individualized, appropriate formula for your child) and some people have benefited from homeopathic treatment and other alternative treatments. EFT (emotional freedom technique) may help some people with tic disorders. In fact, any form of alternative medicine that reduces physical and mental stress, may have a beneficial effect on the course of a tic disorder – one must experiment in order to find out if a particular treatment will help his or her child. And, as stated previously, some children and teens just “grow out of them” over time.

Vocal Tics (Sounds and Noises)

Some children (and adults) make repetitive sounds that serve no communicative or health purpose. These sounds are called “vocal tics.” A vocal tic can be a cough, much like the cough one has when one has a cold, except that in the case of a tic – there is no cold and consequently no need to clear the passages of mucous! Sometimes the doctor will mistake this kind of cough for post-nasal drip – a small irritant in the throat. However, a true vocal tic is more like a bodily habit without a physical cause; there is no post-nasal drip. In addition, the cough does not stem from “nerves” or nervousness and therefore, it is also inaccurate to call it a “nervous habit.” A vocal tic is a biological disorder that is usually inherited. Calm people can have tics just as easily as anxious people. Nonetheless, stress does tend to aggravate tics, resulting in a temporary increase in symptoms.

Coughs are only one kind of vocal tic. A person can make any sound, including words. There are barks, hisses, grunts, sniffles, clicks and other noises. There are words or phrases that are repeated and in one kind of vocal tic (corprolalia), there are expletives (swear words) or “dirty words” that seem to jump out of nowhere.

If a child has both vocal tics and motor tics (repetitive, non-purposeful movements like jerking, bobbing, twitching and so on), he may have Tourette’s Syndrome. If he has only one kind of tic for less than a year, he may have transient tic disorder. Chronic Tic Disorder is the name given to tics that last longer than one year. Some children with tic disorders also have other disorders such as ADHD, OCD, mood disorders, anxiety disorders and conduct disorders. Many children, however, have simple tic disorders that improve with treatment or even on their own over time.

What Causes Tics?
Brain abnormalities can cause tics. Both structural changes in the brain and biochemical changes have been found in those who have tic disorders. Tic disorders run in family trees. Tic disorders commence before the age of 18. Sometimes they begin after taking a medicine (i.e. Ritalin, antidepressant medication, Cylert and Cocaine can all trigger tics in sensitive individuals). Sometimes tics may begin after a strep infection (in a similar way to PANDAS – the post-viral form of Obsessive-Compulsive Disorder). Sometimes injuries or other health conditions (even a common cold) can trigger the development of a tic. In all cases, the environment is thought to trigger a gene that is present in the child.

Although more tics occur when a child is feeling stressed or anxious, neither stress nor anxiety cause tics. Emotional distress worsens or aggravates a tic disorder temporarily. Stress reduction techniques bring tics back under control. The condition waxes and wanes – sometimes throughout life, but very commonly only until the end of adolescence when the tics may just disappear by themselves.

What Helps Tics?
Some medications can be helpful for tics – speak to your doctor or psychiatrist about this approach. Behavioral therapy can also be very helpful in reducing the tendency to tic. A psychologist can create the proper intervention for this kind of therapy. In addition, some alternative treatments have been found to be helpful in treating tics. For instance, nutritional interventions such as abstaining from coffee, pesticides, certain chemicals and so on, can sometimes help. Bach Flower Therapy (especially the remedy called Agrimony) has been very helpful for some children and teens with tics – consult a Bach Flower Practitioner for best results. Homeopathy and acupuncture might also be helpful. In fact, any intervention that helps reduce stress can help reduce the tendency to tic. Experimenting with several different healing modalities will help parents assess which one or ones have a positive effect on the course of the disorder.

Asking a child to stop making noises is NOT helpful and in fact, may lead to more tic behavior as the request itself induces stress. Tics are not done on purpose and they CANNOT be resisted. A child can delay a tic, but not stop it. Therefore, the youngster needs parental understanding and tolerance. The tic is not the child’s fault; rather, he or she is suffering from a disorder of the brain. Fortunately, tic disorders can be relatively mild, they can remit spontaneously and even when they do persist, they do not tend to interfere with academic performance or other normal functioning.

Suicidal Feelings

A certain number of people kill themselves each year, most of whom were suffering from severe depression. Fortunately, 90% of people with depression are able to live full lives while managing their episodes of depressed mood. Only about 10% will end their lives (this number depends on where a person lives – countries vary in their availability of effective treatments and support for depression, so there is a wide international variability in suicide rates).  The pervasive sad mood that comes with depression, as well as the increased tendency among the depressed to obsess on negative thoughts, makes them susceptible to the hopelessness and irrationality characteristic of the suicidal person. People do not “choose” suicide; they fall victim to it as part of their illness.

What are the Implications for Parents?
The link between suicidality and depression should serve as alarm bells when helping our children deal with mental health issues. If we have a loved one who is suffering from depression, it is always prudent to watch out for signs of suicidality. A depressed child is at risk for succumbing to suicidal thoughts; it is up to parents to help prevent this. Vigilant parents can be familiar with the warning signs of suicidality and take action. Moreover, they can do everything possible to get their child the right kind of help. In addition, they can work hard to reduce the other stressors in the child’s life – like school work (negotiate accommodations with the school) and conflict in the home. In fact, when the parents work on their own marriage and parenting skills to increase peace in the home, this can help tremendously.

What are the Warning Signs?
According to the American Academy of Child and Adolescent Psychiatry these signs are:

  • Change in eating and sleeping habits
  • Withdrawal from friends, family, and regular activities
  • Violent behavior or running away
  • Substance abuse
  • Neglect of personal grooming
  • Personality change
  • Difficulty concentrating, persistent boredom
  • Drop in academic performance
  • Marked personality change
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • Loss of interest in previously enjoyable activities
  • Speaking positively about death or romanticizing dying (“If I died, people will appreciate me more.”)
  • Writing about death, dying, or suicide
  • Engaging in reckless or dangerous behavior; being injured frequently in accidents
  • Giving away or discard favorite possessions
  • Saying permanent sounding goodbyes to friends and family
  • Seeking out weapons, pills, or other lethal tools

A child or teen  who is planning to commit suicide may also:

  • Complain of being a bad person or feeling rotten inside
  • Give verbal hints with statements such as: “I won’t be a problem for you much longer.”, “Nothing matters.”, “It’s no use.”, and “I won’t see you again.”
  • Become suddenly cheerful after a period of depression
  • Have signs of psychosis (hallucinations or bizarre thoughts)

The risk of suicide is high among those who have attempted suicide before, know someone who has killed themselves, and are pessimistic about the chances of getting relief from chronic depression. Also, teens who have a family history of mental illness and suicide are more likely to attempt suicide as are teens who have clinical depression or who suffer from active addiction. Teens who’ve already made a suicide attempt have a higher chance of committing suicide successfully. Vulnerable teenagers who suffer a serious loss (like the breakup of a romantic relationship) may try to stop the pain with suicide. A history of physical or sexual abuse, incarceration, alienation from parents and refusal to access mental health services all increase suicidal risk. Males have a higher “success” rate for suicide than females, but females make many more suicide attempts than do males. Also take note if your depressed child suddenly seems unusally happy. Sometimes this switch in attitude happens because a child has decided to end his suffering and he is actually experiencing a state of relief. Remember that depressed mood is a serious and potentially life-threatening condition and should always be professionally treated.

The American Academy of Child and Adolescent Psychiatry recommends taking a child’s suicidal statements seriously. If a child or adolescent says, “I want to kill myself,” or “I’m going to commit suicide,” ask him what he means. Don’t be afraid of saying the word “suicide.” You won’t be giving the teen an idea that he hadn’t thought about. Instead, you’ll help him or her think things through. Ask about depression, anxiety and unhappiness. Don’t just tell the child no to talk that way.  Show interest and concern and get your child to a qualified mental health professional (such as a psychiatrist or clinical psychologist).

Suicidal Behavior in Teens
Teenagers are a vulnerable group. They experience tremendous pressure from all sides: from inside their changing bodies, from their parents, from their schools and from their peers. No one can be perfect in every area and so everyone is doing poorly in something. But teenagers can feel isolated with their failures and setbacks, lacking the perspective that older people have that “we’re all in this together.” Teenagers are intent on fitting in, looking good, being acceptable. If the only group they can fit into is a violent, drug-ridden street gang, then that’ll be the group they might very well join, especially if they have little support elsewhere or few sources of success and strength.

Because the pressure is so intense, many teens do not cope well. Their survival strategies depend to a large extent on their genetic make-up and the strategies they learn at home. Some teenagers have “hardy” genes that help them survive and thrive under stressful conditions. They can laugh their way through almost anything or simply tough it out. Others are genetically vulnerable to bouts of depression. However, the depressed teen is more at risk than depressed adults. Teens are very focused in the present. They have trouble imagining that in a few years life can improve tremendously. Their impulsivity can lead them to put an end to it all right now because they just can’t see any way out.

What You Can Do
Parents can also help buffer teens from stress by keeping the doors of communication open. Make it easy for your kids to talk to you. Keep criticism to a minimum; instead, give praise and positive feedback generously. Have fun with your teenager and try to make your home pleasant, comfortable and safe. Keep conflict down with your spouse. Avoid drama. Take care of yourself and create a healthy model of stress management strategies for your kids to learn from. Create a positive atmosphere. Have a dinner table several times a week and use it to have discussions on politics, human nature, interesting things in the news or whatever—keep talking with your kids. Make your values clear. Bring tradition and ritual into your home.  Accept all feelings without correction or disapproval. Ask for behavioral change gently and respectfully. Never yell at your teenager. Never insult, name call, use sarcasm or any other form of verbal abuse. Instead, be sensitive to your teen’s feelings at all times. Discipline when necessary but only after you’ve warned a child that discipline will occur and only with mild discipline—never affecting the teen’s social life (see Raise Your Kids without Raising Your Voice for safe and effective ways of guiding teenagers).

If your teen demonstrates any of the symptoms of depression or suicidality, talk to him or her about what you are observing and arrange an appointment with a mental health professional. You can call suicide helplines in your area to get information about how to help your child. You can take your child for a mental health assessment. If your child is uncooperative, seek mental health guidance yourself. Since a suicidal person feels isolated and hopeless, any steps that family members take to address the situation can be powerfully preventative. Remember, too, that many parents have walked this road before you. Access on-line and community support if your child has been threatening suicide.

Asperger’s Syndrome

Named after Hans Asperger, the pediatrician who first described its symptoms, Asperger’s is a part of an umbrella of neurological and social conditions called “autism spectrum disorders.” Asperger’s Syndrome (AS) is more difficult to identify and diagnose than many autism-related disorders, mostly because symptoms can be attributed to many other conditions. But the diagnosis of AS is usually empowering, as persons with Asperger’s typically have an easier time mainstreaming than those with other autism spectrum disorders.

The onset of the disease is usually at 3 to 5 years old.

What is Asperger’s Syndrome?
Asperger’s Syndrome (also called Asperger’s Disorder) is a neurological condition characterized by:

Severe Impairment in Social Interaction and Skills
People with Asperger’s tend to be self-focused (which is not to say they are self-centered). They prefer to be alone and have very little need for companionship. They are more interested in their inner musings, and are prone towards introspection and daydreaming. They can appear rude when spoken to, and may have difficulty following the subtext of a conversation (they can’t “read between the lines”). They can be very selective  when it comes to associating with peers or adults. Additionally, many kids and adults with AS are prone to random bursts of temper.

Limited Repetitive Behavior
People with Asperger’s are also prone to various obsessions and narrow interests. For instance, they might be interested in  parts of objects (like clocks) or they might like spinning things over and over and over. They flap their hands (particularly when excited).  Some children with Asperger’s are called “little professors,”  as they like to recite to others (as if teaching) whatever it is they are currently obsessing about.

Lack of Emotional Reciprocity
People with Asperger’s have difficulty identifying their own emotions as well as empathizing with other people. They can’t read non-verbal cues that communicate feelings, and may even appear cold and dismissive of other’s distress or pain. They are also poor at using non-verbal cues themselves such as maintaining eye contact, showing appropriate facial expressions or using gestures naturally. Not surprisingly, considering all this, people with AS have trouble making friends. However, they often don’t care so much about this as they are not all that interested in social relationships.

People with Asperger’s Syndrome tend to have excellent language and cognitive skills, and may even excel in areas they obsess on. Some may have motor problems and clumsiness.

What Can Parents Do?
If parents suspect that their child may have Asperger’s, the best thing to do is to get a diagnosis by a qualified mental health practitioner. Developmental psychologists, as well as psychiatrists, are generally competent at diagnosing autism spectrum disorders, but it’s always better to consult one who specializes in the disease. Because Asperger’s is primarily biological in origin (it is not caused by trauma nor by bad parenting), it has an early onset; symptoms that look like Asperger’s, but appear later in life, are unlikely to stem from Asperger’s Disorder.

Early intervention is critical in managing Asperger’s Syndrome. Currently, there are no cures for the illness, but medications and therapy can assist in managing symptoms. Many with AS are able to live highly functioning and productive lives. It does help for parents and other care-providers to be educated about their children’s particular needs. Training in social and communication skills, as well as occupational therapy can help with the various symptoms of AS.

Autism

One of the greatest joys of parenting is being able to communicate with one’s child. This is why knowing that a child has Autism or Autistic Disorder can be so painful and difficult to accept. The condition significantly impairs a person’s social and communication skills, so that it can feel like the autistic child is living in his own little world. Autism does occur on a spectrum, causing severe impairment in some and only mild impairment in others. However, once a child has been diagnosed with this condition – whether it is mild or severe – parents find themselves raising a “special needs child.” This brings new challenges to the already challenging job of parenting.

What is Autism?
Autism is a neurological disorder characterized by difficulty in social interaction and communication, as well as tendency towards repetitive behavior. The exact cause of the disorder is not known, but it is believed to be a result of neurons misfiring and creating mixed communication in the brain. Symptoms of Autism appear early in a child’s life, sometimes as early as the first year. Unfortunately, there is no known cure for Autism yet, although parental support, behavioral therapy and special education can bring improvement in functioning and quality of life among children with Autism.

How Can I Tell if My Child Has Autism?
Like most developmental disorders, Autism is diagnosed using the American Psychiatric Association’s criteria found in the the Diagnostic and Statistical Manual of Mental Disorders. A diagnosis of Autistic Disorder is given to a child when he or she meets certain criteria. Below: is a list of symptoms characteristic of Autism.  A mental health professional can assess whether your child’s symptoms meet criteria for a diagnosis of autism or another disorder on the autistic spectrum or another diagnosis altogether. It is also possible that, despite having some symptoms, your child does not meet criteria for any diagnosis at all. This why proper diagnosis and assessment by a qualified mental health professional is so essential; teachers, friends and others cannot make an accurate diagnosis!

A. Impairment in social interaction

This category of symptoms include impairments in the use of non-verbal communication (e.g. eye contact and gestures), failure to develop appropriate peer relationships, absence of spontaneous attempts to seek enjoyment with other people (e.g. not showing interest in other children playing), and the lack of social and emotional reciprocity.

B. Impairment in communication

This category includes symptoms like significant delay in language development, impairment in the ability to initiate conversation, stereotyped and repetitive use of language, and the lack of spontaneous make-believe play that is typical of children within a certain developmental level. It’s important to note the communication issues that are symptoms of Autism are not due to learning disabilities or physical disabilities.

C. Restricted and repetitive patterns of behavior

Children with Autism tend to get preoccupied with a small range of activities, and are prone to engaging in repetitive actions. For example, they might enjoy hitting just one key in the piano for hours. They also get easily obsessed with things that children without the condition will merely pass; for instance they can get preoccupied with random parts of an object. They might engage in ritualistic behavior, hand flapping, and sometimes in self-injury (like head-banging) as well. These obsessions, preoccupations and rituals are inflexible for the child with Autism.

Are There Different Kinds of Autism?
Symptoms of Autism exist in a range, from mild to severe. Some children are more open to social interaction and communication than others. Some persons with mild Autism for example can still be mainstreamed in traditional schools.

Other disorders are listed under the category Autism Spectrum Disorder (ASD). These conditions are Autism, Asperger Syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (you can find more information on these specific disorders on this site and online).

What Can Parents Do?
If you are concerned about your child’s social behavior, emotional reactions, habits or personality, get a referral to a child psychologist or psychiatrist who can offer assessment and guidance. As for most developmental disorders, early detection and early intervention makes an important difference.

If a diagnosis of autism is confirmed, it’s time to learn as much as possible about the condition. There are many groups today that focus on Autism and  Autism Spectrum Disorders. The condition is more understood that it used to be, and parental support systems are well established. Benefit from the experience of others by accessing on-line support groups and/or joining groups offered by your local community mental health services. You will learn techniques for stimulating your child’s development at home. You will learn how to interact with him in order to bring out his best and reduce episodes of anger or anxiety. Becoming active in your child’s healing process is good for you as well as for the child, as it gives you more control and counteracts feelings of overwhelming helplessness. Your intervention can make a tremendous positive difference to your child’s development.

This being said, it is important to deal with your feelings about a diagnosis of Autism. Learning that your child has Autism can be a shock, and you might go through a grieving cycle as you readjust your hopes and dreams for this youngster. This is normal; there is a real loss when you know that your child has a developmental disorder. With time and/or professional help, you will eventually bounce back and open your self to the blessing of having a child with special needs. Interacting with a child with Autism requires a lot more patience and care than interacting with a child who doesn’t have the condition, but it has its rewards. The key is providing consistent stimulation in order to interest your child in social events. Training in communication skills, e.g. basic sign language can also help.