Most children experience some amount of distress when separating from their caregivers. In fact, it's a sign of healthy attachment for a young child to have some tears on the first day of preschool or kindergarten. Research demonstrates that securely attached children tend to show some distress for a period of time and then gradually acclimate to this change. The question becomes: how much distress is typical and for how long does this period of distress typically last?
The first answer is not really an answer, but rather an assumption that all children are different, unique individuals. They follow their own developmental patterns. Some children are developmentally advanced in certain areas while also a bit behind in others. For example, some children have a strong sense that their parents exist even when out of their eye sight, while others take longer to achieve this developmental milestone. These same children will also vary academically, as well as in their abilities to relate to peers.
The phrase "separation anxiety," like "OCD," has entered into our every day language. However, such terms carry very particular meanings in the world of psychology. A main characteristic of separation anxiety is an overwhelming attachment to parents, sometimes with a persistent worry about the well being of the parents. Children may insist on calling their parents throughout the day, refuse to leave their side, and show little relief of their anxiety even after time has passed. Based on this definition, the phrase "separation anxiety" refers to behaviors that significantly interfere with a child's functioning in day-to-day life.
Therefore, not all anxiety at separation is "separation anxiety." More often than not, distress at separation is a normative behavior in the development of the child. In fact, there is cause for concern if the child shows no sign of anxiety when being separated from the parent. Reassurance that the parent will return, as they always do, will usually suffice in calming the child. After a period of time, the child's period of distress will shorten each day and then eventually dissipate. This process is not necessarily linear; sometimes children will have days that are harder to separate than others. However, the trend will be more calm during separation.
There are times when this period of distress does not reduce. It can last several months, or fluctuate throughout the year, with no clear sign that the child is better equipped to tolerate separation. Sometimes these worries increase over time and continue until ages 8 and above, when children are usually more accustomed to separation and routines such as school, camp, and parent work schedules. These might be some clues that a child is in need of a bit more support.
A younger child, ages 3 or 4, might need more reassurance that the parent still exists even though they are not in sight and that they will, in fact, return. Teachers will sometimes tell children, "Mommy will come and get you at the end of the day, just like she always does." This may need to be repeated several times. Younger children sometimes also benefit from bringing a picture of their parents to school and being allowed to glance at the picture when they are feeling nervous. Sometimes a child requires a gradual separation period, where parents will sit with the child for the entire school day, or for the duration of another activity. Eventually, parents shorten the time they spend with the child at school. Parents can explain each change to the child beforehand and, of course, consistency and actually following through with the plan is key.
Older children may also benefit from some school modifications. Some children will go to school for only a portion of the day and then, gradually, add more time at school and away form the parent. Some of the academic content might need to be taught at home in order to help the child keep up with school work. This tends to work best when parents, teachers, child, and therapists (if they are involved) are collaborating.
That being said, most "separation anxiety" is not separation anxiety at all, but rather a typical and healthy response to being away from a caregiver. Some reassurance, consistency, and support will usually help the child understand and normalize their experience
Perhaps no developmental stage is more infamous than adolescence. Rarely will parents raising teenagers report smooth sailing. The parenting journey typically tends to be a bumpy ride, with particular turbulence during the teenage years. This, however, is not without good reason. Teens are achieving critical developmental milestones: balancing independence and connection with family members, balancing outside expectations with ideas around identity, and balancing academic pressures with the growing importance of peer interactions. As you may have noticed, the key feature? Balance.
Teens are caught in a dance of seemingly competing interests. They may want to gain more independence while also craving ongoing support from their parents. They may struggle with perceptions of who they feel they should be and who they actually feel themselves to be. This dance is critical to their identities as a young adults and can lead to varying outcomes.
Parents, too, can get caught in the dance. Do we set stricter limits to prevent our teens from running into trouble? Do we allow them total freedom so that they can develop their own identities? How do we even set limits when teens can simply chose to not listen to us?
These are questions that most parents of teens have asked themselves. None of these questions have absolute answers. Just as teens are seeking balance, parents also must seek a balance, or more nuanced answers to these questions.
Leaning too far into limit setting, or establishing too much structure, will create significant tension between the parent and the teen and not allow for some of the freedom that is needed in adolescent development. Falling too far into no limits and too much flexibility will leave a teen without sufficient structure and guidance on the path to adulthood. Additionally, it is true that an adolescent cannot be forced to do anything. They cannot be put in time out, they cannot be forced to go to school, and they cannot be forced to listen. Any parents who finds themselves in power struggles with teenagers will inevitably lose.
It is for this reason that I do not utilize bullet points or clear cut steps for handling difficulties that arise in adolescence. There is no formulaic answer for handling difficult behaviors, such as staying out late or talking back. There is, however, a general approach, or an art, to working with your teens that tends to be helpful: finding balance, or compromise.
While reading this, you may wonder why you should be compromising with your teen. After all, he or she is your child and they should simply listen. They should stop dating, do all of their homework, not have an attitude, and go to bed early. Unfortunately, most parents of teens will also acknowledge that these are unrealistic expectations and will not just simply "happen."
Learning to compromise is an essential task. It involves negotiating with your teen so that both parties, both you and your teen, feel as if they have some control. For example, if a teenager continuously goes to bed at 2 AM and parents would like for their child to go to bed before 10 PM, what would be a time that parents and teens could settle for? Maybe the teen will attempt to go to bed at 12 AM. This may not be ideal. However, both parents and teens are learning to work together towards acceptable terms.
I often give parents and teens a note pad during sessions where they write down what they would like to ask of their family members. Teens sometimes ask for an opportunity to come home later on the weekends, while parents will sometimes ask for their child to come home earlier on the weekends. Parents and teens will then share what they wrote down and then negotiate towards a more acceptable situation. Teens and parents are quite literally encouraged to be on the same page regarding expectations. This same technique can be done at home, particularly when purely verbal discussions lead to further arguments and resentment.
Being a teen is no easy task. Parenting a teen is also no easy task. Finding a happy median between what you want and what your teen wants can be challenging and, yet, rewarding. This approach involves less struggle. The game of tug of war generally involves one winner. Of course, parents may have some "non negotiable" items; however, for the most part, compromise can be found in most areas. Balancing structure and flexibility is the key to a strong parent-teen relationship.
New parenting group offering at Heights Pediatrics: Parenting Young Children. See flyer below. Open to parents of children three through seven. Feel free to email me with any questions.
Getting kids to listen to directions can be a frustrating endeavor, particularly if those directions have to be repeated twice, three times, or more. Questions and thoughts often come up, such as "Why can't they just listen?" or "If only they would listen to what I am asking!" All of these thoughts are quite natural to have, especially if we have a youngster who has a bit more energy and is a bit more willful than others.
Part of the solution may lie in small, but powerful, changes in the way that we communicate with kids. How we ask them to do something can make all of the difference in getting a positive response. I have comprised a list of some of the more important changes to make. These are based both in research and practice experience:
1) Tell, don't ask.
When asking a child to do something, the key is not to ask at all, but to tell the child what to do. For example, "Brush your teeth" is quite different from, "Can you please brush your teeth?" Asking your child suggests that there is an option not to do as asked. The child is free to comply, to ignore, or say "no." Another common mistake is to say something along the lines of, "Let's cleanup." This invites the response "No!" or from an older child, "Let's not!" What you're aiming for is more of an instruction or a direction, rather than a question.
2) Give one instruction at a time.
When life gets busy, we tend to try to multitask. This often includes getting children ready for bed, cleaning up, and finishing any other number of assorted tasks at the same time. During these times, it's very common to give children more than one direction at once. This usually sounds like, "Put your toys away, brush your teeth, and put on your pajamas." Even from an adult perspective, this can sound confusing. For a young child, especially one that tends to be somewhat distracted, this can be an overload of information. It is likely that one of these instructions will be forgotten. Giving one direction at a time will result in a higher chance of each item being completed.
3) Give children options.
We all tend to avoid unpleasant tasks. Children are no exception, especially when this involves cleaning up toys or eating foods that are not considered a "favorite." We can get these tasks done, or encourage children to eat healthy foods, by helping them feel as if they have a choice. If there is a room full of toys to clean up, we can offer the choice: "You can clean up the trucks or the stuffed animals" or "You can chose the broccoli or the carrots." This way there is a choice; however, the parents can chose acceptable responses. Choices create win-win situations.
4) Learning to say "no."
Most of us have said "no" to a child at one point or another. It usually comes embedded in a larger message such as, "No, stop that, why do you always have to jump on the couch?" Although this longer statement may help temporarily relieve a bit of frustration, it skips over the message that you would simply like the child to stop. A clear, firm "No!" can do the job. It is important here to note that tone of voice is very important (this also goes for all of the above items). We should avoid yelling, and go for a more firm and clear tone. Yelling tends to agitate everyone who hears it and can lead to more oppositional behaviors. "No" should be reserved for truly unacceptable behaviors, such as unsafe behaviors and aggressive behaviors.
It can take time to utilize these items consistently. Although they are not difficult to understand, they go against our natural way of speaking. Additionally, all of us get angry and upset and forget about our best methods of communication. It can be helpful to practice one item per week and, when you feel like you have gotten this technique down, move on to the next. This way, each item becomes more ingrained in your communication style and there is a higher chance of using the technique.
When we feel stressed, most of our good sense goes out the window. Therefore, it is best to initially practice these skills when feeling calm. The more these skills are practiced during calmer situations, the more likely you are to use them in a more stressful and frustrating situation. None of us can be perfect communicators 100% of the time, though a move toward the items listed above may help to create a more peaceful, thriving home environment.
Parents of young children often have an intuitive sense when something may be troubling their child. Their child might be having more frequent than usual tantrums, difficulty getting to school, or showing some behaviors typical of younger stages. Most children exhibit these behaviors at one point or another, though sometimes parents have a feeling that something may be up.
Despite these feelings, parents put off seeing a professional regarding their concerns. Many parents think, "Maybe these behaviors will go away on their own" or "All children act this way." There may be a grain of truth to these thoughts; for example, many children do have difficulties and continue to function well enough in school and at home. However, these behaviors are usually not completely resolved. Sometimes they continue to trouble the child and become worse over time. I have worked with many teenagers who are in therapy for the first time. Almost always, the parents report concerns that began in early childhood, or between ages 2.5 to 5 years.
Parents may also be concerned that they are "over anxious" or that perhaps they are making something out of nothing. Sometimes this fear also prevents parents from reaching out to someone who can help provide guidance and relieve some of these worries.
Early childhood is a fantastic time to start therapy. Although play therapy can be used with children into the teenage years, younger children tend to be more responsive. While teenagers can refuse to come to therapy, younger children are generally more likely to engage with the therapist and the play materials.
If parents start young, they have plenty of time to work with their children on concerning behaviors. Child therapists often offer strategies for parents to utilize in the home. Parents can practice these strategies over the years, helping bolster the growth that their child makes in therapy. Great learning takes place in the preschool years, this goes both for academic achievement, as well as social-emotional development.
Parents may also feel concerned about the stigma that comes with psychotherapy treatment. At the same time, there can also be some negative repercussions that come from having a child who is perceived as "difficult" or hard to manage. Unfortunately, these children are often labeled as "problem children." Adults and peers develop patterns of interacting with children they view as problematic. Many times these exchanges are not in the child's best interest, but serve as a means to avoid a particular behavior. For instance, a child who refuses to engage in a classroom activity may be continuously allowed to withdraw in efforts to avoid an emotional outburst.
In considering what is best for children in the long term, preventive work is always the most effective route. Waiting, when there is a sense that your child is struggling, can sometimes create more difficulties in the long run. A good analogy is comparing emotional and behavioral health to physical health. It is usually not a great idea to ignore a physical ailment. Generally, this could cause more trouble in the long run. Emotional wellness functions similarly and early childhood is a perfect time to foster healthy social-emotional development.
If you are interested in learning more about play therapy and play interventions that you can implement in your own home, I will be leading a parent workshop at Heights Pediatrics on Monday, September 21. This workshop will be free for parents who RSVP. Please email me of you are interested in attending.
To learn more about play therapy click here
Parents often wonder how play can serve as a therapeutic intervention for their children. They may ask themselves, "Is my child just going to play? Is that really therapy?" Usually, parents bring their children to therapy because there is a troubling behavior that they want to understand and maybe even change. They may wonder how something as persistent as a repeated behavior can be addressed with something as commonplace as play. After all, don't all children play? Will this really encourage change in my child? And besides, we have toys right here at home.
Perhaps it is for this very reason that play therapy can be so effective. There are various research studies and books written on this topic. However, what may be helpful to remember is that children do not communicate in the same way as adults. Where an adult might be able to express themselves using words, children will often utilize symbolic play as a means of working through worries, fears, and other emotional states.
The development of symbolic play, or when children begin to imagine that one object can represent another (for example, maybe the banana can be a telephone), is a critical developmental milestone. Tea parties don't require actual tea, and a spoon used to feed a doll is filled with delicious invisible soup. A full meal can be served without dirtying a single plate! Later in this process, roles can be assigned: Teacher, Student, Parent, Firefighter, and so on. It is through these symbols that children indirectly explore uncomfortable feelings that they may be unable to articulate otherwise and that drive them to exhibit troubling behaviors. A children concerned with test performance may tantrum and run out of the classroom. Most children will simply say they don't want to do something rather than use words like "nervous," "scared," or "intimidated."
Play therapy helps a child express these feelings in a safe environment and through the natural language of play. What happens in the play therapy room can then translate into the child's everyday life. The play therapist helps the child learn to manage these feelings at home, in school, and in their community.
There is a function to the play that occurs. While it may just appear that the child is having fun, there are also important processes at work. Play is a process and fun has its function, all in the interest of positive, therapeutic change.
Groups are a fantastic way for children to develop the skills they need to negotiate their school and peer environments. Children tend to have fun in groups, while also building relationships and learning tools that they will carry with them into other settings.
Group work usually involves role plays and therapeutic games. It can serve as a great alternative to individual treatment or an add-on to ongoing individual and family therapy. Please feel free to contact me with any questions at email@example.com
Audrey Zwick, LCSW is a clinical social worker and child therapist that specializes in fostering social skills and coping skills in young children. Currently located in Williamsburg, Brooklyn.