Tips for Dealing with Back-to-School Anxiety

The countdown to the start of the school year has begun. And while most kids aren’t exactly looking forward to it, some kids are truly dreading the return to the classroom.

Anxiety over making new friends, being in a new school, facing bullies, feeling “uncool” or coping with academic pressure can make even a well-adjusted child anxious. And that anxiety or fear can build up in a child’s mind, leading them to act on it in many ways — from tummy aches and sleep problems to out-and-out refusal to go to school — says a University of Michigan Health System child psychologist.

Fortunately, there’s still time to do something about it. Parents can start now, in the summer, to help kids face their fears and calm their worries, says Michelle Kees, Ph.D.

Most kids can overcome their fears with the help of a parent, she says. But for children who show signs of anxiety over a longer period, or intense fears, parents shouldn’t hesitate to seek professional help from someone trained to help children and teens with anxiety problems and other mental health issues. As many as 5 percent of children have expressed some sort of prolonged “school refusal,” experts estimate.

Fear of school can also have its roots in other situations — such as stressful home events, learning problems or bullying — that need prompt attention. And serious untreated anxiety in childhood can put a child at risk for problems later in life.

“Going back to school can be a very exciting time for children, or it can be a time of great anxiety, apprehension and uncertainty,” says Kees, a clinical assistant professor of psychiatry, who treats children with anxiety disorders through the U-M Child & Adolescent Psychiatry clinic. “With any change that we experience in our lives, natural emotions such as anxiety can emerge. For children, this becomes more pronounced because every year they have this new experience of returning to school or starting at a new school.”

If kids and parents don’t deal with the anxiety and its causes, Kees says, “it can get out of control very easily. Often times, it’s a vicious cycle where a child will feel anxious about going to school, the parent will feel badly for the child, and allow them to stay home. The next day, it becomes even more difficult for that child to go to school.”

So, no matter what, parents shouldn’t let anxiety keep kids away from school, she says. Talk to school counselors and teachers, and mental health professionals if need be, to figure out what might be done. And most important of all, work hard to talk openly with your child about what’s worrying them, and how they might deal with it.

Depending on your child’s age, different things might be causing them to worry, and different techniques might be able to ease their back-to-school fears, Kees explains. She offers this advice:

Kindergarten and elementary school children
Parents of young kids often have a lump in their throat as they send their child off for the first day of kindergarten or first grade. Kids can pick up on that nervousness, says Kees, making their own worries even more intense. Months of buildup to the start of school, talking about it as a big event in the child’s young life, can also make a child anxious.

“Young kids who are anxious might avoid talking about going to school, or about school supplies, or about going to get their new school supplies,” says Kees. “Parents should begin early by opening a line of communication even with young children about school experiences and expectations, and about a child’s thoughts and feelings about school. Help children connect with their school by visiting it before school starts, especially if it’s a school they haven’t attended before.”

Shopping together for school supplies, and using the shopping trip as a time to talk about what to expect at school, can be a healthy way to keep a child talking. Parents should also try to connect their child with future classmates. “If a child knows someone who is going to be in the same classroom, that can greatly reduce their apprehension and fear of the unknown,” says Kees.

What if the first week of school arrives and a child still doesn’t want to go to school? He or she might not say it directly, but rather claim to have a tummy ache, a sore throat or a headache that quickly disappears once it’s decided to keep him or her home from school. Kids might hide when it’s time to get ready to go to school, or throw temper tantrums. Anxiety can also cause a child to have trouble sleeping or have nightmares while they’re sleeping. Little ones especially may become very clingy, and not want to leave a parent’s side – especially if they aren’t used to being away from parents during the day.

All of these signs of anxiety may end soon after the start of school. But if they continue for several weeks, Kees recommends that parents talk to a school professional or mental health counselor.

Middle school children
Making the transition from a small elementary school to a bigger middle school with different classes and more difficult work can be a big hurdle for some pre-teens. This age also comes with the added issue of meeting new children and facing social pressures about clothes, appearance and other things.

“For parents, recognizing anxiety in middle-school children can sometimes be difficult. This is the age when friends start to become more important than parents in a child’s view, and they may not share their feelings with you,” says Kees. “Possible indicators include coming up with excuses for not riding the bus or staying at planned school activities, or any behavior that involves avoiding going to school.”

Children who withdraw from friends or family, seem sad or less energetic, or just “aren’t themselves” may be experiencing issues about going to school or something more serious such as depression.

“If parents notice a dramatic change in their child’s attitude about school, their level of enjoyment or interest, as well as their performance, this is a red flag that something might be going on that should be addressed,” Kees explains. Parents can start by talking with their child’s teacher or school counselor, and perhaps seek advice from a mental health professional in the community.

High school students
Health Minute ImageBy the time they reach high school, kids face a growing amount of responsibility at school, including pressure to fit in, and to do well academically in order to prepare for college or technical school. This is also the time of a young person’s life when they develop their own identity and the self-confidence needed to be independent.

Starting high school comes with a whole range of anxieties, says Kees. “The fear of starting high school and thinking, ‘Where do I fit in, what will people think of me, and will there be peer pressure to do things I don’t want to do,’ can be quite overwhelming as a freshman, or even later,” she says.

Teens tend to talk with their friends rather than their parents when something is bothering them, says Kees, and if their parents ask if something’s wrong, they may deny it. But parents can try to keep the lines of communication open by talking to teens about their friends, about their interests and activities, and anything else that might help a teen “open up” and say if something’s on their mind. Teens with anxiety issues may also have frequent headaches, dizziness, nausea and muscle aches that don’t seem to have any cause, or may have trouble sleeping.

Anxiety and depression can go hand-in-hand in teens, and the late teen years are a peak time for depression to begin. Parents should keep an eye out for major changes in their teen’s behavior and attitudes, loss of interest in things that once held their attention, large drops in their grades, aggression or irritability, or withdrawal from friends and family. These kinds of signs can signal a more serious problem that will need professional help to address.

When anxiety about school “masks” something else
Kids of any age who don’t want to go to school, or avoid it, may be doing so because of a specific issue beyond general anxiety, worry or depression, Kees notes.

“Children who are bullied or teased often become anxious about going to school, and if the problem is not addressed, the anxiety will continue along with a host of other problems,” she says. “Similarly, children who are avoiding school may be doing so because school is hard for them — school anxiety many times emerges just before a child is diagnosed with a learning difficulty.”

The bottom line, she says, is for parents to reach out to their kids and talk honestly about what’s going on. And, if problems persist, reach out for help — through the school, the child’s doctor or nurse, or a mental health professional.

source: http://www.med.umich.edu/opm/newspage/2006/hmschoolanxiety.htm

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Hurt people, hurt people: Tips on Anger Management

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"Hurt people, hurt people." In other words, people who hurt others with their actions and words are people who are hurting inside themselves! When someone lashes out at another person, they are expressing their hurt in a destructive and irresponsible manner. Feelings of hurt and pain are normal parts of everyday life. Therefore, it is important to find solutions to our problems that are constructive and responsible in order to enjoy the pleasures that life has to offer, as well.

Feelings never tell us what to do. They only tell us that something requires our attention. So negative feelings can play a positive role in our lives. We must put ourselves in control of the painful emotions rather than be controlled by them. The first step in taking control is to ask the question, "What is causing these feelings?"

Sometimes the cause of the feelings is from recent events-job loss or health decline. Other times, the cause is a manifestation of negative emotion from long ago-unresolved issues of adolescence. Take the time to ask the question, think, and seek answers. This is important whether you are the one who is angry or the one who is on the receiving end of an angry person's wrath.

If you are angry and find yourself hurting others, here are some things that should help you deal with your feelings in a more constructive way:

1. Be mindful that you are entitled to the full range of feelings that life has to offer, one of which is pain. Make up your mind that you are not entitled to hurt others with those feelings. It is normal to feel pain. It is unacceptable to inflict it.

2. Take note of what makes you want to act ugly, sullen, and resentful. Is there a pattern? Do your assumptions about people and life need adjustments so that you're not so upset by (often unrelated or minor) irritants?

3. Remain current with your feelings and needs. Don't put off taking care of yourself. Feel pain, acknowledge it, and search for solutions. Reactions that are solution-oriented help you find good ways to deal with hurt.

4. Change you attitude about hurt. This allows you to avoid hurt in the first place. By this, I don't mean you should avoid things that make you feel bad. Adopt a personal policy not to let negative emotion control you. When you decide to take control, pain can't fester into an uncontrollable monster.

5. Don't choose the pain. I hate to say this, but some people hurt, because they choose to hurt. They decide that something is worth suffering over and believe that they need to "dwell here now." That's not to say that you should no longer discriminate between right and wrong. However, be more discriminating about that on which you're willing to expend mental energy.

6. Approach people and situations with patience and understanding. This causes you to slow down and act less impulsively. Imagine that a child spills milk at the table and an adult goes bonkers. The adult hasn't stopped to think about the fact that when children are growing up, the latter are clumsy at different developmental stages by nature, and that the spilt milk was not intentional or the result of laziness.

7. Look for non-destructive ways to express your anger. Being current, as previously mentioned, is one way. Others include, but are not limited to, taking slow deep breaths, biting your tongue, holding in your stomach, counting to ten, meditating, contemplating and praying. All of us do better when we control our impulses when expressing anger.


If you're someone who finds yourself in a hurt person's line of fire, you need some tools to manage their feelings as well as your own. Some options include:


1. Let them vent. Listen to their frustrations before you speak or act. Never interrupt, because until you hear their story, you know nothing. Find out as much as you can about the source of their pain and you'll know why they're angry.

2. Assess your level of responsibility in causing their pain. If you are directly involved, take responsibility and make things right. However, often you will find that you are not the target or cause of the pain. If you were just in the right place at the right time, don't take it personally.

3. Adopt an attitude of forgiveness. Try to understand that when people are hurt, they don't always think clearly and they say things that they don't really mean. It's easy to be consumed with reciprocal anger, so avoid the urge by forgiving them.

4. Be mindful of how you respond to them. The goal is to make things better, not worse. Sometimes they just want someone to acknowledge their pain. You can do so by saying something like, "I don't know just what to do to help you right now, but I want you to know how sorry I am about this."

5. Take control of your own feelings. Don't give up your power to them by allowing their words to control the way you respond. Their pain, even when directed at you, does not define you.


Hurt people can only hurt others if allowed to do so. With adults, know that you can judge the size of a person by the size of the things that they allow to make them angry. Yes, we've all had initial feelings of hurt as the result of others' actions and words. But, when we take a moment to really look at the situation, all of us have the power to draw the line and refuse to accept another's hurt.

Remember that people say and do boneheaded things from time to time without thinking. People forget, lose their tempers, underachieve by our standards, break promises, cheat, lie and do other things that disappoint us. Make allowances for people's differences. Human beings make errors. Values amongst us are varied. If you keep your standards very high, you are subject to be more sensitive around people with low standards. If you have low standards, you will feel offended and slighted by those who have high standards. That said, the bottom line is this: when someone is hurting someone else, they are acting from a place of pain and hurt. Diminish the hurt to make room for enrichment. Instead of hurt people hurting people, you then have enriched people enriching people.

Some tips on working with hospitalized children

This is an excellent article by Stephanie Innes of the Arizona Starnet:

advertisementThe adolescent boy is lying on his hospital bed with a wet towel over his eyes, which are burning from a recent chemotherapy treatment.
"Would you like me to bring you anything?" Allison Woods asks the boy, a leukemia patient at University Medical Center who has relapsed after a long remission and is scheduled to have a bone marrow transplant later in the week.
The boy shakes his head no, and sounds like he's crying.
Woods, remaining upbeat, suggests a stress ball.
"Yes," the boy says. "I'd like that."
Woods is what's called a "child life specialist," someone with whose aim is to make the hospital experience for children as pleasant as possible. Among other things, that means asking young patients what they want — whether it's honest information, a stress ball, or a reward for enduring "pokes" — hospital lingo for needles and other invasive medical procedures.
Increasingly, child life specialists are recognized by doctors, nurses and social workers as crucial members of pediatric medical teams. They operate on a philosophy of treating young patients and their siblings with respect and helping them gain a sense of control over what they are experiencing.
Reflecting a national trend, the number of child life specialists in Tucson has more than doubled in the last decade and both Tucson Medical Center and UMC — Tucson's two largest hospitals — plan to add more in the near future as they expand their services for children.
"The unknown is always petrifying, even for us as adults," said Jolene Eggert, TMC's child life manager. "I remember having my tonsils out and just screaming. My mom heard me screaming all the way up the elevator. She wasn't allowed to come with me."
It's different now. Parents and guardians are encouraged to stay with their children as much as possible, as long as the medical situation allows it. And the child life specialists prepare kids by reviewing what is going to happen to them.
While doctors and nurses often have to tell children what is happening to them, child life specialists are able to allow some choice, and in turn pass that information to the rest of the medical team. Is there an arm they prefer to use when having blood drawn? Is there a special toy they want to be there when they wake up from surgery? Do they want to know how the doctor will take their appendix out?
"A lot of control is taken from kids when they are in the hospital," said Woods, one of the six child life specialists at UMC. "This is something they can control. They guide the conversation, and they can refuse me, too."
Teddy bears with tonsils, anatomically correct dolls, visualization and books are all used to prepare kids for needles, ports, tracheotomies and anesthesia masks. Though they aren't invasive, masks in particular can be terrifying for a child who has never seen one and is lying helpless on an operating table.
The child life team invites children to play with medical equipment before they go into the operating room. One day last week, hospitalized children and their siblings at TMC used syringes to squeeze out paint and make art projects.
TMC has a coloring book about a turtle named Tomás who goes to the hospital and is shown under an X-ray and in the operating room. When there's a procedure that requires taking big, deep breaths, Eggert and her team work with kids beforehand by having them blow bubbles and pinwheels.
There are 3,400 active certified child life specialists worldwide — most of them in the U.S. — with most of the growth occurring in the past decade, the national Child Life Council says. The specialists must have a bachelor's degree, typically in psychology, family studies or a related field, complete nearly 500 hours of clinical internships and pass a national certification exam.
"Honesty was not the policy decades ago. Children didn't really have any voice. We big people thought we knew what was best and easiest and it was really what was best and easiest for us," said Linda Throne, director of nursing for women's and children's services at UMC.
"When I first came here 14 years ago, there was one certified child life specialist. There was another person put in that role long ago, before we really understood you need a certain level of education and national certification."
Often when a trauma patient comes in or a pediatric "frequent flier" returns, the doctor or nurse will be asked to "page child life." Medical personnel at UMC have found that when children feel calm and safe, they fare much better going through medical procedures.
"As our population grows, so will the number of child life specialists," Throne said. "They are an integral, respected part of the medical team and a very equal part of the team, too."
Ed Motzkin, whose son, 15-year-old William Motzkin, has had six surgeries at TMC in the past year, said his son often wants to go to the hospital and say hello to the staff, even when he isn't sick.
"He loves them. The child life staff actually develop a friendship with the kids," Motzkin said.
William said that when he missed school, Eggert and her staff coordinated with his teachers to make sure he could continue his studies in the hospital.
"They are really good supporters, and they are really nice," he said. "They would just be cheerful and would really make me laugh. Like if you are down, they have video games."
Both TMC and UMC have big yellow toy chests on wheels called Andrea's Closet. It's a program named for a young Phoenix girl named Andrea Brunk, who died of complications from leukemia in 2002. Andrea's Closet allows children to pick out toys when they have to endure the "pokes" of painful medical procedures.
At UMC, a Wii, televisions, Playstations and game chargers have been provided to the child life program by a local organization called the Kick Cancer for Stephen Foundation. It is named for Stephen Placencia, a Cienega High School student who died of cancer last year at age 17. His parents want to make sure that teens have age-appropriate activities in the hospital — something the child life specialists are working on, too.
"Stephen was a quiet, shier boy. He did appreciate what the child life people tried to do for him — they were always checking to see if we needed anything, if we didn't understand what was going on," Stephen's mother, Francie Placencia, said.
"It wasn't just Stephen — they always made sure our other three children were OK, and offered us resources in the community."
She noticed a difference when Stephen had a surgery in Pennsylvania, and there was no child life specialist offered to the family.
"There was not someone constantly checking, no game room, and no activities," she said. "It's always nice to know you have someone on your side."
Woods seems to instinctively know what her patients need.
She helps Sierra Johnson, a 3-year-old leukemia patient, cut up her sausage and eggs, plays a game of peek-a-boo that sends the toddler into fits of giggles, and then does a painting project with her. Sitting beside Sierra on the bed is a doll that, like Sierra, has a port in her chest with a tube attached to medicine.
At her next stop, she allows a 5-year-old girl with cancer to pick out some stamps from Andrea's Closet because the girl had "a lot of pokes" that day.
She holds the hand of a teen-aged boy with cerebral palsy and then attaches a colorful mobile to the edge of his bed.
After agreeing to getting a stress ball for the adolescent leukemia patient, she offers him several other activities, like movies. He declines. He wants to stay lying down, and his eyes hurt.
"How about a Bionicle, and maybe a GameCube for later?" she asks him.
"OK ... please," he replies.
Woods tries to make sure someone is there for him when his family isn't. He's being encouraged to walk to keep up his strength before the transplant.
"I'll come back later and we can either build the Bionicle or do walks if you are feeling better," Woods tells the boy.
"Yes," he replies. "I'll see you soon."
TMC team focuses on chronically ill children
Tucson Medical Center recently began a team approach to take better care of young patients who are chronically or terminally ill.
The new palliative care program is called Tucson Lifeline for Children — TLC — and is expected to accommodate 250 children per year eventually. So far, 52 have enrolled in the new program, which is headed by Dr. Gina Jansheski.
The children she sees have diseases like cerebral palsy, cystic fibrosis and spina bifida, and often have multiple other ailments, too. The program is part of a growing trend in health care, sometimes called the "medical home," where medical professionals from many disciplines come together to help patients as a coordinated team.
"It's like first-class service for our frequent fliers," Jansheski said. "I get paged when they come into the hospital and welcome them back. They are our special patients."
In addition to doctors and nurses, members of the TLC include child life specialists, dietitians, pediatric pain specialists, music therapists, Spanish-language interpreters, massage therapists and respiratory therapists.
Jansheski, who is director of TMC's pediatric palliative care and hospice, begins by spending about two hours with each patient's parent or guardian. She takes an inventory of the child's needs and the family's needs, too. The categories she covers include physical, spiritual, cultural, psychosocial, and advanced care directives.

How do YOU cope with Stress?

WAYS TO COPE WITH STRESS

Courtesy of the Tripler Army Medical Center, Honolulu, Hawaii


*Get up 15 minutes earlier
*Prepare for the morning the night before
*Avoid tight fitting clothes
*Avoid relying on chemical aids
*Set appointments ahead

*Don't rely on your memory ... write it down
*Practice preventive maintenance
*Make duplicate keys
*Say "no" more often
*Set priorities in your life
*Avoid negative people
*Use time wisely
*Simplify meal times
*Always make copies of important papers
*Anticipate your needs
*Repair anything that doesn't work properly
*Ask for help with the jobs you dislike
*Break large tasks into bite size portions
*Look at problems as challenges
*Look at challenges differently
*Unclutter your life
*Smile
*Be prepared for rain

Could you benefit from family therapy?

Attachment Disorders

Socio-economic status has nothing to do with the ability to establish successful attachment relationships. Children who have had a succession of nannies, or orphaned children who spend their early years in orphanages or move from foster home to foster home, are at risk for severe attachment disruption. It also can occur as a result of severe illness in the parent or the child, parental unavailability, or emotional trauma. Some children have inborn disabilities or temperaments that make it difficult for them to form a secure attachment, no matter how hard the parent tries. In any case, there generally are several factors involved. The major causes of attachment disorders are:

•neglect, including emotional neglect
•abuse, physical or sexual
•separation from primary caregiver
•changes in primary caregiver
•traumatic experiences such as death of parent or disaster
•maternal depression
•maternal use of drugs or alcohol
•undiagnosed, isolating painful illness such as colic or ear infections
Divorce

Separation and divorce can be devastating but there are things you can do to support and comfort your child. There are also things you may unwittingly do that can make coping with separation and divorce harder for your child --now and in future relationships.

Learn how to help your child cope with the negative short and long term effects of separation and divorce, as well as ways to help prevent trauma and decrease hardship. Challenges that are confronted effectively can improve relationships and strengthen your childs ability to cope.

When talking with your children about separation or divorce, it is important to be honest, but not critical of your spouse. Most children want to know why their lives are being upset. Depending on the age of your children and reason for divorce, this may require some diplomacy. As children mature, they will probably want more information.

Here are a few suggestions:

•Make plans to talk with your children before any changes in the living arrangements occur.
•Plan to talk when your spouse is present, if possible.
•Remind your children of your love.
•Be respectful of your spouse when giving the reasons for the separation.
•Tell them that your marriage problems are not their fault. Let them know they are not responsible for fixing them.
•Tell them about changes in living arrangements, school or activities. Let them know when they will happen. But do not overwhelm kids with details.
•Be emotionally available to comfort them. Even if there has been much conflict in the home, children may deeply experience the loss of the leaving parent, or the loss of hope for reconciliation.
Blended Families - Stepfamilies

Studies show that children of stepfamilies face a higher risk of emotional and behavioral problems. They also are less likely to be resilient in stressful situations. Although most parents are able to work out these difficulties within the family, they should consider a psychiatric evaluation for their child when he exhibits strong feelings of being:

•alone in dealing with his losses;
•torn between two parents or two households;
•excluded;
•isolated by feelings of guilt and anger;
•unsure about what is right;
•very uncomfortable with any member of his original family or stepfamily.
A psychiatric evaluation might be appropriate for both the child and the family when:

•the child directs his anger upon a particular family member or openly resents a stepparent or parent;
•one of the parents suffers from great stress and is unable to help with the childs increased need for attention;
•a stepparent or parent openly favors one of the children;
•discipline of a child is left to the parent rather than involving both the stepparent and parent;
•members of the family derive no pleasure from usually enjoyable activities such as learning, going to school, working, playing, or being with friends and family.
By devoting the necessary time to develop their own traditions and form caring relationships, stepfamilies can create emotionally rich and lasting bonds for each member. In the process, the children acquire the self-esteem and strength to enjoy the challenges that lie ahead.


source: http://www.drmarge.com/areas_of_focus/Family_Therapy.htm

Could music make your life better?

I know that all of you know that I am also a musicologist and music healer. Tonight as I listened to "America's Got Talent" I was so touched by a woman who sang her heart out and the judges loved her. When asked how she felt after this outstanding performance, she said she felt as though it were the second miracle in her life. "What was the first?" Sharon asked her. The dear lady then revealed that she was a cancer survivor for the last five years! Then Piers Morgan asked her if she believes that singing contributed to her healing. She replied that there was no doubt about that. Piers said" your singing has healed not only YOU but also everyone that hears you!"

What music is healing to you? What music lifts you up and gives you strength and hope? Find that music and listen to it often! It's free!!