When a child is diagnosed with cancer, it can have a huge emotional and psychological effect on them. The response can vary from child to child, but most children feel a range of emotions, these feelings may include: shock, confusion, fear, anger, and anxiety. Reactions can also be different based on their developmental level and personality.

Some signs to look out for:

• An increased fear about separation
• Worry about medical procedures
• Increased clinginess to caregivers
• Increase in acting out behaviors such as screaming, throwing tantrums, hitting
• Withdrawal from others
• Loss of usual interests in play activities
• Feeling sad or depressed
• Experiencing nightmares and/or more difficulty sleeping
• Regression to earlier developmental stages such as thumb sucking or bed wetting
• Changes in eating habits

Older children may also have increased worries about missing school, falling behind, and not being around their friends. They may also experience feelings of guilt that they have somehow caused the illness because they behaved bad or did something wrong, or guilt about causing distress in family members.

Tips for parents:

• Communicating with your child is key
  • Be open and honest – for example if a procedure may cause pain, be honest but then reassure your child that the pain will be temporary
  • Help your child communicate what they are feeling, either verbally or non-verbally. For example, art, music, and writing can be good tools to help your child express what they are feeling
  • Remind your child they are not responsible for the illness
  • Prepare your child in advance for any upcoming treatments – talk to them about what will occur, how long it will take, any side effects, and what it might feel like after
  • Encouraging your child to ask questions is especially important
  • Prepare a bag with soothing/comforting items for them to have with them at the hospital – such as a blanket, stuffed animal, books, etc.

• Communicating with others
  • Pay attention to siblings needs, behaviors and emotions, and encourage them to talk about their feelings
• School
  • When your child does return to school, help prepare for questions that may be asked by their classmates about their cancer
  • Schedule a time to meet with the teacher, and other individuals involved so that everyone knows what to expect, and to discuss any accommodations that may be needed
• Play
  • Give your child time to play and engage in other age-appropriate activities

Recommended books for children and their siblings:

• Harry goes to the hospital: a story for children about what it’s like to be in the hospital (2008) By Howard J. Bennett. Age range: 4-8
• The bald headed princess: cancer, chemo, and courage (2010) By: Maribeth R. Ditmars. Age range: 8-13.
• Imagine a rainbow: a child’s guide for soothing pain (2006) By: Brenda S. Milles. Age range: 4-8
• Upside down and backwards: a sibling’s journey through childhood cancer (2014) By: Julie Greves, CCLS, Katy Tenhulzen CCLS, & Fred Wilkinson, LICSW. Age range: 8-13
• What about me? When brothers and sisters get sick (1992) By Allan Peterkin. Age range: 4-8

Remember, to also take care of yourself!!! Having a child diagnosed with cancer can take a toll on everyone involved, especially caregivers. It is important to take the time to process and understand your own feelings regarding your child’s illness and allow yourself some “self-care” time.

Children and families who are experiencing increased difficulties coping with an illness may benefit from seeking professional help with a psychologist. A psychologist can help support the family through the difficult time, and provide the child a space to express their feelings and teach tools to better cope with the illness.

 

At every party or large family gathering there are always the children who go immediately to play with the other kids and those who might need to hang back for a bit before joining in, or who would rather sit on their own and read a book or just hang out at the grownup table.

At parent-teacher conferences some children are described as being excited to share their knowledge with the class while others need much more encouragement to participate in class discussions so that they can share the knowledge and understanding of the materials that their teachers know they have.

Some parents may have experience with a child who, though seemingly popular, has to be pushed to go out and socialize with her friends or who is constantly worried that she has done something to embarrass herself in front of her friends. Parents who have a child that fits into the second category may sometimes wonder if their child’s behavior is normal or if there is something more going on. There are many possible explanations as to why some children are less likely to join in and play with a group, why they may not participate in class even when they know the information, or why they may not want to socialize with others even though they seem to have many friends. This post will discuss social anxiety disorder (SAD) and provide information explaining common myths and misperceptions regarding the diagnosis as well as treatment options for children who are struggling with social anxiety disorder.

One of the most common misconceptions about social anxiety disorder is that it is the same thing as shyness. And while it is true that someone can have both shyness and social anxiety, they are not the same thing. According to the American Psychological Association, shyness is “the tendency to feel awkward, worried or tense during social encounters, especially with unfamiliar people.” Social anxiety disorder, on the other hand, has a number of diagnostic criteria which include:

• A marked fear or anxiety regarding social situations where one will likely interact with or be observed by other people such as during recess time at school, giving a presentation in front of the class or eating lunch in the cafeteria at school.
• A fear of acting in such a way or of showing symptoms of anxiety such as sweating or shaking that will lead people to judge her negatively. Someone with social anxiety disorder is afraid that she will forget the answer if a teacher calls on her or that someone will notice her palms are sweaty if they shake her hand and that she will be embarrassed or rejected because of it.
• Avoiding social situations or enduring them with a great amount of fear or anxiety. Someone with social anxiety disorder may either avoid going to birthday parties or eating lunch in front of other children or she will do so but will be experiencing a high level of fear or anxiety throughout the time that she is engaged in the social setting.
• The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning. Someone with social anxiety may avoid playing with other children during recess and will choose to go to the library or hide out in the bathroom instead, she may avoid raising her hand in class to ask a question or going up to the teacher to ask questions when she is unclear about the material.

One of the most important differences between shyness and social anxiety disorder is that whereas someone who is shy may act less shy as she gets more comfortable, someone with SAD will feel anxious even around people that they know well and should feel comfortable with. Other common misconceptions about social anxiety disorder are that it only relates to performance, and while there is a subgroup of people with SAD that only suffer from performance anxiety, many people with the disorder have anxiety during multiple kinds of social interactions, not only ones that involve performing in front of a group of people. In addition, people sometimes believe that someone with SAD must have suffered from a traumatic event that led to their fear and anxiety regarding social interactions. Although someone with post-traumatic stress disorder may be more susceptible to social anxiety disorder, most people with SAD have not experienced trauma.

Treatment for social anxiety disorder involves both cognitive and behavioral components. With CBT (cognitive behavioral therapy), children will learn coping skills for dealing with their anxiety in stressful situations along with ways to challenge and change their anxious thought patterns that will lead to decreased anxiety in social situations. Social skills groups are also a helpful treatment option for children who may lack some social skills or could benefit from a small and supportive group environment in which to practice and become more comfortable being more social.

The term “stress” as it is used today was first coined by the endocrinologist Hans Selye in 1936. In his original definition Selye described stress as “the non-specific response of the body to any demand for change.” Since then, the word has been used in many different contexts to describe a range of experiences, many of them negative. We now know that sometimes stress can be a good thing. Turning on this stress response can give us the boost we need to become more productive and can improve performance, and our stress response can also be turned on because of positive events, such as buying a home or getting a new job. We also now know that the body’s stress response is something that affects all systems in the body, from the cardiovascular to the immune system and that although our bodies can adapt to short term stress, chronic or excessive stress can have negative effects on both physical and psychological health.

Stress can affect physical and psychological health both directly through the effects of an overactive stress response, and indirectly through the unhealthy coping behaviors we may engage in to deal with stress such as smoking or overeating. When we experience stress this turns on our stress response, also known as the “fight or flight response”, which essentially readies our bodies to either flee or fight a predator. This means that energy is diverted away from body systems that take care of longer term functions such as digestion, and is funneled to the systems that are needed in the moment such as the muscles of the arms and legs, to bring the energy necessary to either fight back or run like the wind. Although it is less common to experience a lion ready to make you his dinner on your walk home from the subway, we still experience stress in response to different predators be it rent payments, having a child go off to college or marital difficulties. When our stress response stays on for too long or is turned on too often this can cause problems in the body systems that are being pushed too hard and in those systems that are being slowed down. In terms of mental health, stress can lead to depression in those susceptible to depression. In terms of the cardiovascular system, these problems can lead to heart disease and an increased risk of heart attack. It is important to note that although heart attacks are commonly associated with men, heart disease is the number one killer of women in the United States and about the same number of men and women die from heart disease every year. The symptoms of a heart attack can be different in men and women so it is important for women to know the symptoms they should look out for. It is also important to note that women may be more likely to develop depression in response to stress than men, making stress management a particularly important matter for women.

So, what’s a stressed out New Yorker to do? Cognitive Behavioral Therapy (CBT) is based on the premise that thoughts, feelings and actions are connected. So if you are feeling stressed, knowing what factors are contributing to your stress and changing the things you do about it as well as the way you think about it can be helpful in reducing its harmful effects on your mind and body.

There are many different coping skills that can be placed into a heart healthy stress reduction toolkit such as:

• Exercise
• Getting an adequate amount of sleep
• Eating healthy foods
• Having an appropriate outlet for frustration (some options are exercise or writing in a journal)
• Social Support
• Meditation
• Positive self-talk
• Relaxation Exercises
• Engaging in enjoyable activities
• Psychotherapy

Another important element in stress reduction for heart health is replacing unhealthy coping skills such as smoking or overeating with heart healthy coping skills such as those mentioned above. This can be very difficult to do alone and a psychologist can help with this important change in behavior. A psychologist can also be helpful in working with people struggling with depression to feel more mentally and physically healthy.

Managing stress effectively can be difficult as thought and behavior patterns are not always easy to change. A psychologist can help to identify behavior patterns that may be contributing to increased stress and provide the cognitive and behavioral tools to decrease stress levels and improve psychological and heart health.

What is self-esteem?

According to Meriam-Webster’s Dictionary (2015), self-esteem is “a confidence and sense of satisfaction in oneself.” Having a positive sense of self-esteem can lead to psychological health and well-being, while having a negative sense of self-esteem may lead to psychological symptoms such as depression and anxiety. Our sense of self can also inform our decision making and the life choices that we make. For this reason, having a positive sense of self is important and is something that we should all strive to develop.

Do I need to work on my self-image and level of self-esteem?

If you would like to learn more about your sense of self, Psychology Today, provides a free, brief assessment of your general level of self-esteem. This 34 question assessment can be found at the following address: http://psychologytoday.tests.psychtests.com/take_test.php?idRegTest=3207.

How can one increase their self-esteem?

• Focus on the internal causes of your successes instead of the external. When thinking about an accomplishment, one might be tempted to focus on the external factors that led to success rather than the internal factors. For example, if you were to get a promotion at work, to what would you attribute the cause of your success? Would you believe that it was due to your hard work, talents and abilities (i.e., internal causes)? Or would you believe that you only received the promotion because the person who previously held the position retired (external causes)? Identifying and acknowledging the internal factors that led to your success will lead to an increase in self-esteem and therefore should be focused on when reflecting on positive life events.

• Identify your positive qualities. According to Leslie Sokol, PhD with Psychology Today (2010), one can increase their self-esteem by writing down a list of their positive qualities and reflecting on them. Include in this list any skills, talents, assets, resources, accomplishments or anything else that makes you feel good about yourself. You can also add to this list the compliments that others have given you. When experiencing moments of self-doubt, go back to this list to remind yourself of all of the positive qualities that you possess.

• Set realistic goals that can be accomplished. Although the saying “Shoot for the stars. Even if you miss you will fall among the stars” may hold some credence in certain situations, it is also important that we set attainable goals that can realistically be accomplished. When tackling large projects, remember to break them down into smaller parts so that you can feel a sense of accomplishment along the way.

• Surround yourself with the people who make you feel good about yourself. Spend time with the people who treat you with love and respect, and who acknowledge and congratulate you on your achievements. Although an individual with a strong sense of self-esteem may be able to disregard negative comments made by others, if that individual is constantly surrounded by this negativity, it will begin to affect their self-esteem. For this reason, it is important that we spend time with the people who make us feel good and that want to build us up instead of bring us down.

Many people are acutely aware of their physical health. Less focus is typically on their mental health. Both are important and impact one another. Unfortunately, there is a stigma that is associated with mental health because people often assume it implies mental illness. Mental illness is different than mental health.

Mental health is wide-ranging. The World Health Organization (WHO) defines mental health “as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

Having good mental health does not imply you will not experience negative emotions in life such as anxiety or sadness when you are faced with a challenge. However, good mental health does imply you may be better able to tolerate emotions, cope with hard times and continue to move forward.

Easier said than done sometimes, right?! Here are some tips that can help with improving your mental health:

1. Learn healthy stress management skills
   Being able to cope with stress is invaluable. Find different strategies that help calm you down and find joy. Utilize them consistently and add new ones when needed.

2. Seek quality social support
   Surround yourself with family and friends that are supportive and enjoyable. Once you do, communicate your feelings, make time to socialize and laugh with them.

3. Manage expectations & set goals for yourself
   Find a balance every day. Seek acceptance and evaluate your perceptions of yourself and others. Pursue goals and schedule yourself realistically.

4. Be kind to yourself
   Pay attention to your mind and body, they are connected! Treat your body well and focus on saying nice things to yourself. Try new things, keep learning and enjoying. Get enough sleep, make healthy food choices and be active.

5. Seek professional help if you need it!
   Sometimes we need help from a professional. There is nothing wrong with that. Reaching out for assistance is a positive thing rather than a flaw.

 

What is Social Thinking?

 

What is executive function?

Executive function is a set of mental skills that help you get things done. It is the ability to do all that it takes in order to keep your mind on what you are doing to execute a goal. Executive functioning allows us to activate awareness, self-regulate, establish goals and make long term plans, and help us stay in charge of our learning and actions. Who we are, how we organize our lives, how we plan and how we then execute those plans is largely guided by our executive system. It is the awareness and directive capacities of the mind, considered the “orchestra conductor” or “CEO” of your brain. These skills are controlled by the area in the brain called the frontal lobe.

Executive function abilities include:

• Maintaining attention
• Controlling impulses
• Keeping free of distractions
• Engaging in mental planning and problem solving
• Maintaining flexibility
• Time management
• Setting priorities
• Organizing
• Executing a task

Often adults with executive function problems are considered lazy and unmotivated, but this is far from the case. In fact, individuals with executive dysfunction try really hard to get things done. When individuals have issues with executive functioning, any task that requires planning, organization, memory, time management and flexible thinking becomes a challenge. This can affect their ability to work, maintain relationships and do things independently. It makes it difficult to keep track of time, make plans, complete tasks in a timely manner, to multitask, to apply previously learned information to solve problems, analyze ideas, and to look for help when needed. While some adults have learned some tricks or strategies to help them compensate throughout the years, many continue to fail to meet their responsibilities on a daily basis and run into trouble with their spouses, finances, or employers.

What does executive dysfunction look like?

• Difficulty getting started on a task
• Does things quickly, or incompletely
• Trouble paying attention and easily distracted
• Loses train of thought when interrupted
• Has trouble making decisions
• Difficulty multi-tasking
• Often misplaces reports
• Disorganized/messy
• Issues with organizing materials and setting schedules
• Socially inappropriate behavior
• Difficulty controlling emotions
• Difficulty processing, storing and retrieving information
• Trouble planning for the future

What is the treatment?

Cognitive behavioral therapy can provide mental tools to help an individual with self-monitoring thoughts and behaviors, organization, and teach social skills in order to appropriately respond to social situations.

Some Tips:

• Write it down
• Know (and accept) your limitations
• Educate yourself
• Have a coach – to help with organization
• Make check lists and to do lists
• Set time limits
• Set alarms
• Use planners/calendars
• Take step-by-step approaches to work
• Rely on visual organizational aids
• Organize work space
• Minimize clutter
• Ask for help

Habit reversal training (HRT) is an evidence-based multicomponent behavioral treatment developed to address a wide variety of repetitive behavior disorders/habit disorders. It is one of the most effective non-pharmacological treatments. It involves increasing awareness of these repetitive behaviors and learning to use socially appropriate behavior instead.

What are repetitive behavior disorders?

• Tics
• Tourette’s Syndrome
• Trichotilimania
• Nail biting
• Thumb sucking
• Skin picking
• Etc.

Who does Habit Reversal Training work for?

• Children
• Adolescents
• Adults

3 components of Habit Reversal Training:

1. Awareness training
   1. Increase awareness of the repetitive behavior urges and performance
   2. Helps person focus on instances that the behavior is likely to occur
   3. Helps the person gain better self-control
2. Competing response training
   1. Develop a competing response that replaces the old unwanted behavior
   2. Engage in competing behavior when feel tic urge
   3. Must be inconspicuous and easy to implement
   4. Examples – squeezing a squishy ball or playing with play doh
3. Social Support
   1. Involving family members, teachers, friends
   2. Provide positive reinforcement and feedback every time the person uses or practices a competing response

Other important components to the treatment are relaxation training in order to manage stress and decrease the behaviors, and generalization training to encourage practicing their new skill in different contexts.

At Manhattan Psychology Group, we treat many children and adolescents with repetitive behavior disorders with Habit Reversal Training (HRT). If you are concerned about your child’s habit, please call to schedule a consultation.

Children who have a persistent pattern of explosive anger, irritability, arguing, defiance or vindictiveness towards their parents or other authority figures may have Oppositional Defiant Disorder (ODD). Signs of Oppositional Defiant Disorder generally begin during preschool, but can sometimes begin later in the child’s development. Without appropriate treatment, symptoms of ODD can worsen and lead to serious problems for children with ODD for their functioning at home, school, and with peers. It is not always easy to tell the difference between ODD and more common defiance that we see in all children. Although the list below can help you determine if your child may have ODD, it is always important to have your child evaluated by a mental health professional who can help determine if your child’s difficulties are best explained by ODD or another disorder.

Symptoms of ODD

• Angry and Irritable Mood: Children with ODD may often lose their temper, seem touchy or easily annoyed by others, and appear angry and resentful.
• Argumentative and Defiant Behavior: Children with ODD may often argue with adults or other’s in authority, actively defy rules, deliberately annoy people, or blame others for their mistakes or misbehavior.
• Vindictiveness: Children with ODD may show a pattern of spiteful and vindictive behavior.

What Causes ODD?

ODD is thought to be caused by biological and environmental factors. ODD tends to run in families, so it is very common for a child with ODD to have another family member who also has ODD or another psychological condition, such as Attention Deficit Hyperactivity Disorder (ADHD), substance use disorders, or bipolar disorder. Children with ODD also have differences in the part of the brain that controls judgement, impulse control, and reasoning. This means that if something frustrating happens, children with ODD are less able to come up with a good solution to solve the problem and more likely to respond quickly without thinking. The part of the brain that helps to process social information is also different in children with ODD. When a child with ODD has a neutral interaction with a peer or an adult, they are more likely to interpret the other person’s facial expressions or actions in an aggressive way, so they often feel attacked by others and instinctively respond with aggression. Lack of structure and parental supervision is also associated with the development of ODD. Children also learn from models in their life—kids who grow up in aggressive households, are physically abused, or exposed to community violence are at risk of developing ODD.

How Can a Psychologist Help with ODD?

• ODD usually improves over time; however, children with ODD may go on to develop psychological problems as adults. It is important to get treatment early.
• Parents can learn how to best respond to oppositional behavior and how to interact with their child in a way that will help the child learn how to follow directions.
• The child can learn to cope with frustration and anger in a more appropriate way and improve their communication skills.