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.

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.

Worries

Worrying is a common human activity which everyone engages in. While children and teens have specific worries at various times – such as worry about school, doctors, robbers, dogs, or friendships – some children tend to worry about almost everything! When worry is frequent or across the board, it can become a serious source of distress in your child’s life. Moreover, your child’s intense worrying can also have an impact on you as you spend endless hours trying to offer reassurance and inspire greater confidence.

If your child worries a lot, consider the following tips:

Worry is a Form of Stress
In its mildest forms, worry is a stress-inducing activity. Worry involves thinking about stressful events like something bad happening, something going wrong or some disaster occuring. Such thoughts send stress chemistry through the body. Some people say they worry in order to prevent something bad from happening. Their logic is that it is not “safe” to be too sure of a positive outcome and believing that things will work out just fine can actually cause them to go awry. Interestingly, no spiritual or religious discipline advocates such an approach; on the contrary – every spiritually oriented philosophy encourages POSITIVE thinking in order to help positive events occur. Nonetheless, many people claim that worrying is somehow helpful to them. Some say that it prepares them in advance for disappointment so that they won’t be crushed if things do turn out badly. Like the superstitious philosophy above, this really makes no sense. Suffering in advance only ADDS a certain number of days or hours of pain to the pain of disappointment of something not turning out well. It would be better to be happy in advance and just feel badly at the time something actually goes wrong. Besides, most of the things that people worry about actually turn out O.K. which means that they have suffered many hours for no reason whatsoever! In short, there is really nothing that we can recommend about the habit of worrying. It is simply a bad habit that wears us down.

Because worrying is a habit, the more one does it, the more one will be doing it in the future. In this way, worrying is just like playing piano – practice and more practice makes it easier and faster to play the (worry) song. The worry habit builds up a strong neural pathway in the brain. However, once a person stops worrying, the neural pathway shrinks from lack of use and more productive thoughts will more easily and rapidly occur. But how can one stop worrying? And how can one help his or her child stop worrying?

How to Stop Your Own Worry Habit

  • As soon as you are aware that you are worrying, start thinking about something else – anything else. For instance, look at what is right in front of you and describe it. This breaks up the worry activity and interrupts the automatic habit, sort of “blowing up” the worry pathways in the brain.
  • Set aside 2 periods each day to specifically worry about a problem that you have. Allow five or ten minutes for each period and worry all you want. If you find yourself worrying at any other time of the day, STOP and remind yourself that it is not your worry period. Be sure to worry during your scheduled times.
  • Learn “mindfulness meditation.” This technique can help you release worries as well gently. (See more information about related techniques below).
  • Take the Bach Flower Remedy (see below) called “White Chestnut” for general worries (especially those that keep you awake at night) and “Red Chestnut” for worries about your close family members like parents, spouse and kids.

How to Help Your Child Stop the Worry Habit
When your child expresses a worry, name his feelings and don’t try to change them. For instance, if your child says, “I’m so afraid I’m going to fail my test.” you can say, “I understand Honey. You’re afraid you won’t pass.” Or, if your child says, “What if no one at the new school likes me?” you could say, “Yes, it’s scary to think that the kids won’t like you.”  The main part of this technique is NOT trying to talk the child out of his or her worry (i.e. “Oh don’t worry about it, you’ll be fine!”). If you refrain from offering reassurance, your child will begin to reassure HIMSELF! It’s not much fun worrying out loud when no one tries to reassure you. This discourages the child from thinking so negatively – or at least, cuts it very short. Also, by naming and accepting the worry WITHOUT trying to change it, your child learns to be less fearful of his or her own feelings. Rumination (worry) is much less likely once the original feeling has been acknowledged. When you are in the habit of acknowledging and accepting the child’s fear or concern, the child learns to accept his or her own feelings as well and this causes them to release quickly.

Help Your Child Access Positive Imagination
Children often have wild imaginations. This imagination is commonly used to conjure up thoughts of bad things happening (i.e. robbers breaking in, a dog attacking him/her, etc…). Teach your child how to imagine good things happening instead. Show him how to imagine guardians, angels, friendly lions or knights etc. Imagination can be a powerful tool. For a young child, make up stories that employ protective images. If you are raising children within a faith-based framework, draw on this resource. Consult the teachings of your faith and pass these on to your child. Research shows that people of all ages who draw on their faith actually do much better emotionally, suffering less worry and stress in the long run.

Techniques to Calm the Mind
Breathwork and other forms of meditation can help retrain and calm a worried mind. Teaching a child to focus on his breath for even three minutes a day is a very powerful way to introduce him to the idea that he has some control over his thought process. By paying attention to the “in” breath and the “out” breath for just a few minutes, the child can have a mini-vacation from worry. He can turn for that vacation as part of his daily routine AND whenever he is feeling stressed from his own worrying process.For instance, instruct your child to think the word “In” when he’s breathing in and to think the word “Out” when he’s breathing out. Focusing on the breath in this way for even three minutes, produces powerful anti-anxiety chemistry in the brain.

Refocus Attention
Worriers focus on the negative – all the things that can go wrong. The worrier eventually builds up a strong negative tendency in the brain, automatically looking for worst case scenarios at every opportunity. To help counter this brain development, teach your youngster  how to notice the good in his or her life. For instance, institute a dinner time or bedtime ritual that acknowledges all the things that are going right in life, all the ways things are good, all the prayers that have been answered, etc.  A few minutes of this practice each day can be enough to stimulate a new direction of neural development in the  brain. Self-help techniques like EFT (emotional freedom technique) can be very helpful for people who worry.

Use Bibliotherapy (read stories)
Ask your local librarian for suggestions for age-appropriate books and movies that highlight children’s abilities to courageously and effectively face challenges and solve problems. Such stories can help reduce a child’s sense of helplessness and vulnerability.

Talk about Resilience
If your child worries about terrorism, war and other threats to personal safety, address the worry directly. Keep in mind that with all the forms of media available today, it has become increasingly hard to shield a child from disturbing news and images. Therefore, trying to protect your child from such things should not be your goal. Instead, focus on giving your child the information he needs to feel reasonably safe and secure and then acknowledge that there is no absolute guarantees that bad things won’t happen. You can convey that people have always been able to “step up to the plate” and handle what comes their way. People can face adversity with courage. If you know some examples in your family life or in your community, share them with your child. You can also look to the larger world and select some heroes who have clearly demonstrated the human capacity to cope with challenge and difficulty. This approach is more helpful and calming than making false promises that nothing will ever go wrong in your child’s life.

Consider Bach Flower Therapy
Bach Flower Therapy is a harmless water-based naturopathic treatment that can ease emotional distress and even prevent it from occurring in the future. For worries, you can give your child the flower remedy called White Chestnut. White Chestnut helps calm a “noisy” brain. If your child experiences specific worries, such as a fear of that someone will get hurt or fear of illness, you can offer the remedy Mimulus. For vague or unclear fears (i.e. scared of the dark) you can use the remedy Aspen. Walnut is used for those who are strongly affected by learning about bad things happening in the media or other places. You can mix remedies together and take them at the same time. To do so, you fill a one-ounce Bach Mixing Bottle with water (a mixing bottle is an empty bottle with a glass dropper, sold in health food stores along with Bach Flower Remedies). Next, add two drops of each remedy that you want to use. Finally, add one teaspoon of brandy. The bottle is now ready to use. Give your child 4 drops of the mixture in any liquid (juice, water, milk, tea, etc.) four times a day (morning, mid-day, afternoon and evening). Remedies can be taken with or without food. Continue this treatment until the fear or worry has dissipated. Start treatment again, if the fear or worry returns. Eventually, the fear or worry should diminish completely.

Worry as an Anxiety Disorder
When a child’s worry does not respond to home treatment or when it is causing significant distress or interfering with the youngster’s functioning at home or school, assessment by a mental health professional is important.  The child may have a mental health disorder that can benefit from treatment. For instance, excessive and chronic worry is a symptom found in Generalized Anxiety Disorder (GAD). In GAD, worry symptoms are often accompanied by a variety of physical symptoms, such as shortness of breath, fatigue, restlessness, and trouble sleeping. In other words, the worry habit can also make child feel physically unwell. A mental health professional can assess and effectively treat excessive worry, helping your child to enjoy a healthier, less stressful life.

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.

Helping Kids Through Trauma and PTSD

We all deal with stress everyday. Rushing to get to school in time, making ends meet during a recession, dealing with a particularly annoying in-law — stress is a part of life. And in most occasions, the stress we face is manageable.

But some sources of stress can be incredibly intense, overwhelming and beyond our physical and/or emotional resources to deal with. When this happens, the stressful event is said to be traumatic. All parents want to protect their children from things that can unsettle or harm them. But sadly, there are many things in life that even the most conscientious of parents can’t control. Our children may witness or experience traumatic events despite our best efforts to shield them. When this happens, they may have difficulty bouncing back. Sleep disturbances, sadness, anger and fear may plague a traumatized child long after the traumatic event has ended.

What is a Trauma?
Trauma is a psychological reaction to highly stressful events, particularly those that threaten life or safety. When an experience is considered traumatic, it means that the coping resources of the person witnessing or experiencing it are not enough to deal with the impact of the event, and some degree of psychological shock or breakdown occurs. Events that most people consider traumatic include vehicular accidents, crimes, natural disasters and physical or sexual abuse. Although parents may think that trauma results only from catastrophic events like war or rape, it can actually occur as a result of more normal and common events. For instance, a child can be traumatized by being chased by a dog, by a harsh reprimand from a teacher, from a threatening bully, or from being laughed at while giving an oral report. What makes an event traumatic differs from person to person, as individual coping abilities must be taken into account. Personality factors, psychological profile and past history all play a role in producing a traumatic reaction.

A trauma response often includes symptoms like reliving the event over and over again (by obsessing about it; experiencing intrusive thoughts that interrupt thoughts and activities), panic attacks, nightmares, numbness & fog responses, avoiding people, places and things that trigger a memory of the event, depressed and/or angry mood and increased nervousness (startle response).

Trauma can initiate a syndrome that shows up long after the traumatic event or events have ended. Like an initial trauma response, it affects physical and emotional functioning causing nightmares, hypervigilance, panic attacks, intrusive memories, numbness and other symptoms; the syndrome is called PTSD or Post-Traumatic Stress Disorder. It can occur weeks, years or decades after the traumatic events have passed.

Those who have some level of anxiety to begin with and those who have suffered several previous traumatic incidents are more likely to develop PTSD than other people. Lack of a support system or lack of adequate emotional support right after a trauma, also increases the chances of developing PTSD later on.

What is the Best Way to Handle PTSD?
PTSD is a mental health disorder that can be effectively treated. Self-help is part of the process for teens and adults, including finding support groups, reading up on PTSD, engaging in effective stress-management routines (including regular exercise, relaxation techniques and routines for self-care), utilizing alternative treatments to strengthen the nervous system (such as herbal remedies, Bach Flower Therapy, Aromatherapy, homeopathy, accupuncture and so forth). Parents can help incorporate calming strategies into a child’s routines.

Parental support is critical when a child is dealing with trauma. Unlike adults, younger children don’t yet have the ability to understand what they are going through. Not only is the original event traumatic, but their trauma symptoms too, can be traumatic. For instance, physical symptoms like tremors and nightmares, mental symptoms like obsessions and hallucinations, and emotional symptoms like fear and anxiety can be overwhelming for a child to be experiencing.

The first line of business is to help children manage their emotions. Encourage them to talk about their feelings. A traumatized child may talk about the same thing over and over again, and this is okay. The content of the sharing is less important than the process of getting things out. If a child finds difficulty in expressing what he is going through verbally, either because of age or because of the trauma, then consider non-verbal ways of venting emotions. Letting it all out can also be done using drawings and pictures, clay sculptures and toys, play-acting, and storytelling.

Second, give your child a rational explanation of the traumatic event, that is appropriate to his or her age. The more information the child has, the less he or she is likely to generalize the event to other situations. For instance, knowing that a car crashed because it skidded on the snow can help a child feel safe in cars with good snow tires and in cars driving on dry roads. Without this information, the child may conclude that all cars are dangerous at all times. (While this is in fact true, the healthy state of mind is one of sufficient denial that a person can comfortably drive and be driven at all times. Phobic and traumatized people, on the other hand, over-exaggerate the likelihood of a catastrophic event occurring again, such that they can’t live in a normal way.)

When a child is suffering rather mild symptoms, parents may find that self-help interventions are sufficient. For instance, learning how to do EFT (emotional freedom technique) with the child may complete calm the youngster’s nervous system. However, parents may prefer to take their child to a child psychologist who practices EFT or EMDR. Both of these techniques are used to rapidly heal the trauma of one-time events. If the child is experiencing many symptoms of trauma, it is essential that parents DO NOT try the self-help approach. Instead, they should take their child to a mental health professional who is specifically trained in the treatment of PTSD.

The Bach Flower Remedy called “Rescue Remedy” can help reduce temporary and chronic symptoms of trauma and is especially effective for home-management of symptoms in between psychotherapy sessions. If you are aware that the child has just suffered a traumatic event (like watching someone get badly injured or being personally assaulted, injured or threatened), offer Rescue Remedy immediately. It may help prevent a traumatic reaction from setting in.

However, the fastest and most effective way to end the debilitating symptoms of PTSD is to get the proper professional help. Not all mental health professionals are equally trained in the treatment of PTSD. Make sure that your practitioner is! Therapeutic interventions include EMDR (Eye Movement, Desensitization and Reprocessing), EFT and other forms of Energy Psychology, TIR (Traumatic Incident Reduction),  and other specific tools for the treatment of trauma.

The good news is that children respond well to treatment of trauma. They can experience a complete healing of their symptoms and a return to “normalcy.” In fact, child are often even happier, calmer and more mature after trauma therapy than they were before the traumatic event(s) occurred.

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.

Types of Depression

“Depression” is a common mental health condition. However, the word refers to many types of mood issues, rather than just one straightforward condition. In fact, there are many types of depression, depending on symptoms, severity, cause and duration of the illness.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the following are some of the types of depression:

Major Depressive Disorder
When people use the term depression, they usually mean a Major Depressive Disorder. Unlike short-term feelings of sadness, which can be due to any situation that can cause one to feel rightly sad and upset, major depressive disorder is an intense and debilitating condition affecting many aspects of one’s mood, energy and physical functioning.

A person with Major Depressive Disorder can suffer from feelings of hopelessness and despair, self-incriminating thoughts, crying spells, fatigue, weight loss, sleep disturbances, lost of interest in activities and relationships, inability to work, and thoughts of suicide. Major Depressive Disorder, also called clinical depression, is diagnosed if the debilitating symptoms are manifested by the patient for at least two consecutive weeks and causes significant distress and/or impairment in functioning.

Dysthymic Disorder
A less severe form of depression is called Dysthymic Disorder or Dysthymia. The feelings of sadness and helplessness in Dysthymia are less debilitating, and are often merely aggravated by other physical or mental illnesses. Symptoms of Dysthymia come and go, and vary in intensity per episode. However, it can be a chronic disease that runs in families. Diagnosis requires at least two years of chronic low mood. People with dysthymia tend to underfunction at home and at work, due to low energy, low mood, chronic irritability and negativity, low motivation, sleep issues, low self-esteem and other symptoms. If left unmanaged, Dysthymia can progress to a Major Depressive Disorder.

Bipolar Depression 
Bipolar Depression, also called manic-depressive disorder or bipolar disorder, is a mood disorder that is characterized by cycles of extreme elevated moods (called mania) and depressive episodes. During the manic stage of the disorder, patients can exhibit symptoms like extreme alertness, difficulty sleeping, increased energy and erratic euphoria. But this “high” is often followed by an extreme low typical of a Major Depressive Disorder. Bipolar Depression comes in two types – Bipolar I and Bipolar II. The first is a very disturbed state in which manic episodes can lead to high risk behaviors, highly inappropriate behaviors and troubles with the law (picture a teenager standing naked on a neighbor’s rooftop singing at the top of his lungs). Bipolar II is characterized by more eccentric-looking behavior that is out of character for the person (picture someone enthusiastically filling her entire house with antiques that she’s thinking of selling in order to make an enormous fortune – even though she’s never done anything like this before).

Loved ones of people with Bipolar Depression often miss the illness in the patient, because the manic stage is mistaken for a sign of recovery. But note that the mania stage has a particular irrational urgency to it, and is not to be mistaken for actual happiness. In fact, a depressed person with Bipolar Depression is anxious, irritable and prone to self-defeating behaviors during their emotional high.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) refers to depression that only comes during particular times of the year. For instance, there are patients who exhibit symptoms of depression only during the cold winter months, but they are otherwise fine during the summer. In other cases the opposite is true; it’s the summer that brings in the blues. In tropical countries, the rainy season can be the most troublesome part of the year.

Psychotic Major Depression (PMD)
There are occasions when the depression is so intense; it causes a loss of contact with reality. A person with Psychotic Major Depression may experience hallucinations (sensing things that don’t really exist) or delusions (irrationally interpreting events and observations). Psychotic symptoms in PMD are often temporary, and will go away once the cause of the depression is addressed. The condition is not to be confused with schizophrenia, which can also cause depression.

Atypical Depression
A kind of depression that is difficult to diagnose and treat is called atypical depression. As the term implies, atypical depression is depression whose symptoms don’t always follow what is traditionally associated with clinical depression. The symptoms also appear to come and go, and can be lifted by positive life events. It is believed that atypical depression is primarily biological in origin, a product of chemical imbalance in the brain.

Symptoms of atypical depression may include loss of energy, unexplained and uncontrollable crying, insomnia or hypersomnia, irritability, unexplained aches and pains, difficulty concentrating and loss of interest in daily tasks.

Depression in Teenagers

The teenage years are known to be emotionally challenging. Kids are going through so many transitions and are experiencing so many pressures at this time. Aside from the physical changes of puberty and their effect on body image and personal confidence,  there’s also adjustments to high school and dating and new challenges in the realms of alcohol, drugs, sexuality and the virtual social universe. For the most part, adolescents negotiate all of this without too much trouble. However, a percentage of teenagers will struggle with addictions and mental health challenges. Adolescence is the time when many people first experience panic attacks, eating disorders and mood episodes.

Teenage depression is one mood disorder that is fairly common, affecting around 20% of teenagers. Some forms of depression are comparatively mild while others can be so intense that they are life-threatening. In all cases, adolescent depression must be taken seriously. Parents need to know about depression and what they can do to help their kids.

What is Depression?
Depression is a mood disorder characterized by low mood (which, in teenagers, is most often expressed as irritability or “moodiness,” but can also be expressed as sadness), hopelessness, trouble making decisions, feelings of guilt or worthlessness, weight gain or weight loss and sleeping problems (most commonly, waking up around 2 or 3 a.m. or getting up way too early).  Unlike episodic sadness, depression is stronger and seems harder to manage. A person who is depressed cannot simply “shake the blues away” or decide to cheer up. In fact, they feel flat, like there is nothing that can make them happy or give them pleasure. When this state of mind is so intense that it interferes with a child’s social functioning (i.e. she is withdrawing from her friends) and/or academic functioning (i.e. she can’t concentrate, can’t study, is doing poorly in her schoolwork and grades are slipping) and it has occurred pretty consistently for a two week period, it may be an episode of “Major Depressive Disorder.” When the state of mind is less intense (does not interfere with social or academic functioning) and chronic (lasting for at least 2 years fairly consistently), then it may be a form of depression called “Dysthymia.” Of course, diagnoses of either of these disorders occurs when the mood disorder is NOT being caused by something else (like withdrawal from drugs or use of alcohol or a traumatic experience, etc.). The only real way to know if a child is depressed is to have her assessed by a psychiatrist or clinical psychologist. The child’s symptoms may indicate another disorder entirely or the child may be “normal” – just going through a rough time. However, it’s crucial that parents don’t try to diagnose their child themselves. Clinical depression can lead to suicide in teenagers.

Experts believe that depression has a biological origin. While a family history of depression doesn’t automatically condemn a teen to get the disease, it increases the likelihood of depression when other risks factors are present in the child’s life. Risk factors for teen depression include a history of childhood depression (chronic unhappiness in childhood), instability in the family, troubled or weak relationship with parents, poor emotional management skills (too much anger, moodiness or anxiety), lack of social support (good friends and/or loving relationships) and stressful life events like loss (of a significant relationship) or failure (to make the team, or get desired grades, etc.).

How can Parents Help a Teenager with Depression?
It’s ideal if you can establish an open relationship with your child before depression strikes. This way, she is more likely to come to you for help when what she is feeling becomes too overwhelming to ignore. You can help by listening. In fact, it is more important to listen than to talk. A depressed child does not need a pep talk. She needs professional care. Let her talk about her feelings without offering her advice or easy solutions. Instead, use emotional coaching (name her feelings). For instance, you can say things like, “That sounds really hard,” or “I can see how much that’s bothering you” or “I hear how hopeless you feel.” Follow such remarks with, “I think the best help for these kinds of feelings is professional help. A psychologist who works with teenagers knows all about this stuff and knows how to help kids feel so much better. These are such important issues and they deserve the best help that we can find. How would you feel if I asked Dr. Green (the child’s pediatrician) for a referral to a good psychologist?” If the child doesn’t want to accept help, wait a couple of days and raise the subject again. The best help you can give your child is to get her to a mental health professional. If firmness is required, then use it. Do whatever you would do if you suspected that your child had diabetes. (You would do whatever was necessary to get your child to a doctor; do the same thing for this condition). Your child will thank you once she is experiencing an improved mood!

Treatment for Depression

Contrary to popular belief, depression isn’t  simply a case of “bad attitude.” Someone suffering from depression can’t just talk him or herself out of it or cheer him or herself up with a good movie or a round of exercise. Depression is a serious mental illness, whether it comes in the form of severe sporadic episodes (major depressive episode) or whether it is a chronic state that affects overall functioning (dysthymia).  If you’ve suffered from depression yourself, you know that the sadness and lethargy that comes with the condition can be debilitating. But while depression can be overwhelming, it’s also a mental health condition that is very treatable. Many people recover even from severe depression, and many treatment options are known to be effective.

The following are some of the  ways a person can cope with depression:

Work with a Qualified Mental Health Practitioner
Seek a highly trained psychologist or psychiatrist to help you overcome depression. While social workers, psychotherapists and counselors may be trained in general counseling techniques, they are not necessarily trained in the treatment of serious mental health conditions. You have a right to know what kind of training your practitioner has in the condition that you are suffering from. Just ask. Clinical psychologists and psychiatrists have training in the diagnosis and treatment of depression. Psychologists provide therapy such as CBT (cognitive-behavioral therapy), Mindfulness Psychotherapy for Depression, Interpersonal Therapy, Experiential Therapy,  and many other treatments. Psychiatrists may or may not have training in psychological treatments for depression, but they DO have the appropriate training in the biological aspects of the disorder and can provide appropriate medication and other biological treatments. If you suffer from mild depression that doesn’t interfere with your ability to function, you may benefit from the services of any therapist who works with mood issues (as opposed to clinical depression).

Consider Alternative Therapies
Some people don’t need or don’t want psychotropic medication for their depressive symptoms. There are many excellent alternative therapies that can contribute to the relief of mood issues. Herbal medicine, homeopathy, Bach Flower Therapy, acupuncture, nutritional therapies and more, are all available to address symptoms of depression. You can find more information about these therapies in books or online.

Additional Aids in Fighting Depression
The following may also prove useful to you in reducing symptoms of depression:

  • Following a structured exercise program (look for a qualified fitness trainer to guide you), yoga or martial arts program may provide a chemical boost that reduces the symptoms of depression.
  • Some hospital programs for depression offer 8 or 12 week courses in mindfulness meditation to reduce depression. Ask your doctor about these, or find a private program in your area.
  • Support groups may prove effective in reducing depression symptoms. These can be done in person, but there are also online support groups available. Look for one in your area or speak to your doctor to get reccomendations.

Self-Help
There are many excellent books and on-line resources for depression. Take advantage of them! You can also find CD’s with guided imagery for depression, affirmations, hypnotic suggestions and more. There are emotional-relief strategies that you can learn on-line as well such as Emotional Freedom Technique (EFT) – an effective tool for combating mood symptoms. Do research and learn what’s out there. It may not all be for you, but there will be something that you can benefit from.