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Taking Care of Children’s Mental Health


When most of us think about folks going to therapy for mental health, we think about adults — people struggling with substance abuse, domestic violence survivors, folks going through a divorce, and those who are dealing with the loss of a loved one, for example. 
Unfortunately, many in society tend to overlook a critical group that needs mental help therapy just as much as everyone else: the youth. 
Just because this younger segment of the population might not have mortgage payments and bank accounts to worry about doesn’t mean they’re immune from mental health problems. In fact, one recent report found that 27 percent of young people felt anxiety within the last week, while 15 percent felt depressed. 
Believe it or not, more than half of high-risk youth don’t have access to the therapy they need to ensure their mental, emotional, and physical well-being. In the next section, we’ll examine why that is. 
One of the main reasons kids are an underserved population for mental health services is because society hasn’t necessarily prioritized the importance of mental health counseling for young people as much as it should.  
Case in point? According to the American School Counselor Association, each school should have one counselor per 250 students to ensure they’re getting the mental health support they need to live their best lives. Despite that, the average school district has just one counselor per 455 students. 
Right off the bat, we’re collectively setting the tone that says something like this: While student mental health services are important, they’re not incredibly important to the point we need to make them a top priority. 
Perhaps this is because many adults think that kids who are suffering through issues are “just going through a stage” — and that their problems aren’t anywhere as serious as an adult’s problems might be. This couldn’t be further from the truth — particularly for those who grow up in less-than-ideal circumstances (e.g., in poverty or with an abusive parent). 
The COVID-19 pandemic 
Since kids can struggle with mental health issues in the best of times, it comes as no surprise that these struggles only compounded in the wake of the pandemic.  
All of a sudden, life was flipped upside down for those in the younger generation. Their routines were completely changed overnight. They couldn’t go to school, they couldn’t see their friends, and they couldn’t leave their houses. 
Not every child was able to seamlessly transition into the new normal. In fact, many youngsters reported having a hard time coping with attending class over Zoom and being separated from other students. Kids were also scared about the virus itself. For these reasons, it comes as no surprise that the prevalence of depression and anxiety was even higher than normal among this group of kids when COVID-19 set in. 
The good news is that by giving children’s mental health the respect it deserves and taking a proactive stance with treatment, it’s possible to help kids navigate through their issues and end up in a much healthier state of mind because of it. 
When parents prioritize their kids’ mental health and give them the support they need to get past the issues they’re facing, great things happen.  
When kids are in a solid place, they’re able to think clearly, learn new things, and improve their social skills. At the same time, parents’ mental health improves, too, since they benefit from a stronger relationship and can find joy in seeing their kids thrive. 
No matter what issues your child is struggling with, the right therapist can help them. For example, if you and your child aren’t getting along, you may benefit from parent-child interaction therapy (PCIT), which is designed to help kids and parents overcome concerns related to things like ADHD, anxiety disorder, autism, oppositional defiant disorder, and selective mutism, among other conditions. 
Essentially, both parties join forces in PCIT to work through issues together, and these learnings can help guide the relationship forward over the next several years. After somewhere between three and six months, the therapy sessions wrap up, and parents and kids build on their relationship from there. 
Similarly, if a child is working through physical or emotional trauma they’ve experienced, parents might want to look into whether trauma-focused cognitive behavioral therapy (TF-CBT) can help them overcome the obstacles they’re facing. 
At a basic level, TF-CBT is a cognitive behavioral treatment that helps children figure out how to overcome trauma, respond to stressful situations, and cope with difficult emotions. They’ll also grow more in tune with their emotions and more able to express their feelings in productive ways. 
By now, you have a better idea about how therapy can help improve children’s mental health. But what if you’re not a therapist — is there anything else you can do? 
While parents, teachers, and caregivers might not be able to give children professional mental health services, they can certainly help anxious kids work through their issues. Here are some ways they can do that. 
Maintain an open dialogue 
First things first: If you’re not talking to the children in your life on a regular basis, how can you possibly expect to know what they’re dealing with and what’s going through their minds?  
One of the easiest ways to help kids deal with mental health problems is by maintaining an open dialogue with them to understand the issues they’re working through. For example, as the pandemic first shut down schools, parents were in a unique position to talk to their kids about the virus and what the experts had to say about it. By being open and honest, parents can help assuage some of their children’s concerns — particularly compared to folks who didn’t have much to say to their kids about the issue. 
Bottom line? By engaging in conversation with your kids every day and knowing more about the issues they’re facing, you can begin to have healthy dialogues that can help kids overcome the challenges they face. 
Recognize the warning signs 
It’s one thing for a child to have a bad day. It’s quite another to have several bad days in a row, with no signs of anything improving anytime soon.  
While parents, teachers, and caregivers aren’t able to provide professional mental health services, they can become familiar with the warning signs that may indicate they are suffering from issues like depression or anxiety. Here are some of the indicators to be aware of: 
•	Lack of appetite 
•	Low motivation 
•	Withdrawal from activities 
•	Fatigue 
•	Worsened school performance 
•	Low self-esteem 
Seek help when it’s needed 
Once you’re familiar with the warning signs to look out for, you’ll know when it’s time to enlist the services of a mental health counselor to help your child or student live a happier, more fulfilling life. 

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How to stay connected with a teenager

Maintaining positive connections with your teen can be difficult as they begin to find independence.

This can be a challenging time for parents and teens to stay connected. Adolescents can react with a heightened sense of emotion and be more impulsive with their decisions.

I often hear parents during this period ask why a child they’d previously felt so close to is now so distant, so the question here is why?  

Here are some reasons why this may is happening:

Scientists have established there are several key changes in brain development during adolescence. As braincells and brain pathways connect more rapidly they perform better; each area of growth and behaviour change can really challenge the teen/parent relationship. This biological change is necessary as it supports coordinated thought, actions, and behaviours for a teenager’s transition to adulthood.

Teens become more outward looking as they explore their identity, focused on establishing connections with others away from their carers. As they develop new interests and become more influenced by people their age, they can begin to copy those they admire. At this stage teens can also misread facial expressions or cues, which is why they’re so quick to argue. The more logical area of their brain is still being built.


How to stay connected in a positive way
Hold in mind change is fast for teenagers in all areas: physically, socially, and psychologically. Coping with fears about relationships, fitting in, self-worth, hoping for acceptance – these can all heighten anxiety. Being emotionally available and empathic even when you are being challenging is key so press pause and acknowledge how difficult this process is. It will allow you to be open and be compassionate with your teen and yourself.
Remember social connection is vital for a child’s wellbeing. A good laugh with friends can introduce all the feel-good chemicals that help low mood or depression.
Avoid stereotyping adolescents and being hyper-critical. Enjoy their company as a new and exciting social connection.
Don’t underestimate how much they value their friends. It’s safer to be curious and non-judgemental within reason. Teens are full of interesting new topics and fashions. If they’re interested in a music artist, get to know the sounds rather than dismissing it. You may gain a shared interest.
Expressing how you feel or showing how you manage under stress can help a teen talk about their large and difficult feelings.
If they’re shouting and being unreasonable, try not to escalate the situation by joining in. They’re probably too angry or hurt to hear. Communicate later when things are calm.

What to look out for unhealthy connections and choices
When facing identity insecurity, teens may follow a group who they think is exciting or offers a sense of belonging. Look out for signs of risk-taking or dangerous behaviour which can be exciting initially, but develop into more serious difficulties:

going under the radar, truanting, dropping out from college or university
self -harm
weight loss, slurred speech, unexplained bruises and cuts, scalds, burns
erratic behaviour, becoming withdrawn, abusive and violent.

When connection is too difficult, psychotherapy can help
Sometimes communication has broken down and it’s important to open the channels again. This can be possible in a safe, non-judgemental space where even the most challenging issues can be thought about. Some teens find talking much too challenging. Exploring their feelings through the safety of imagery and the arts is a useful alternative to talking. Getting help early on can safeguard against issues affecting long-term mental health.

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Adults with a history of childhood trauma can benefit from recommended depression treatments, contrary to current theory

emotional/physical/sexual abuse before the age of 18) is known to be a risk factor for the development of major depressive disorder in adulthood

Adults with major depressive disorder who have a history of childhood trauma experience symptom improvement after pharmacotherapy, psychotherapy, or combination treatment. The results of a new study, published in The Lancet Psychiatry, suggest that contrary to current theory, these common treatments for major depressive disorder are effective for patients with childhood trauma.
emotional/physical/sexual abuse before the age of 18) is known to be a risk factor for the development of major depressive disorder in adulthood, often producing symptoms that are earlier onset, longer lasting/more frequently recurring, and with increased risk of morbidity. Previous studies have suggested that adults and adolescents with depression and childhood trauma were around 1.5 times more likely to not respond or remit after pharmacotherapy, psychotherapy, or combination treatment, than those without childhood trauma.

"This study is the largest of its kind to look at the effectiveness of depression treatments for adults with childhood trauma and is also the first to compare the effect of active treatment with control condition (waitlist, placebo, or care-as-usual) for this population. Around 46% of adults with depression have a history of childhood trauma, and for chronic depression sufferers the prevalence is even higher. It is therefore important to determine whether current treatments offered for major depressive disorder are effective for patients with childhood trauma," says Ph.D. Candidate and first author of the study, Erika Kuzminskaite.

The researchers used data from 29 clinical trials of pharmacotherapy and psychotherapy treatments for major depressive disorder in adults, covering a maximum of 6,830 patients. Of the participants, 4,268 or 62.5% reported a history of childhood trauma. Most of the clinical trials (15, 51.7%) were conducted in Europe, followed by North America (9, 31%). Depression severity measures were determined using the Beck Depression Inventory (BDI) or Hamilton Rating Scale for Depression (HRSD).

The three research questions tested were: whether childhood trauma patients were more severely depressed prior to treatment, whether there were more unfavorable outcomes following active treatments for patients with childhood trauma, and whether childhood trauma patients were less likely to benefit from active treatment than control condition.

In line with the results of previous studies, patients with childhood trauma showed greater symptom severity at the start of treatment than patients without childhood trauma, highlighting the importance of taking symptom severity into account when calculating treatment effects.

Although childhood trauma patients reported more depressive symptoms at both the start and end of the treatment, they experienced similar symptom improvement compared to patients without childhood trauma history. Treatment dropout rates were also similar for patients with and without childhood trauma. The measured treatment efficacy did not vary by childhood trauma type, depression diagnosis, assessment method of childhood trauma, study quality, year, treatment type or length.

"Finding that patients with depression and childhood trauma experience similar treatment outcome when compared to patients without trauma can give hope to people who have experienced childhood trauma. Nevertheless, residual symptoms following treatment in patients with childhood trauma warrant more clinical attention as additional interventions may still be needed. To provide further meaningful progress and improve outcomes for individuals with childhood trauma, future research is necessary to examine long-term treatment outcomes and mechanisms through which childhood trauma exerts its long-lasting effects," says Erika Kuzminskaite.

The authors acknowledge some limitations with this study, including a high variety of results among the studies included in the meta-analysis, and all cases of childhood trauma being reported retrospectively. The meta-analysis focused on symptom decline during acute treatment phase, but people with depression and childhood trauma often show post-treatment residual symptoms and are characterized by a high risk of relapse, thus they may benefit from treatment significantly less than patients without childhood trauma in the long run. The study design also did not account for differences between genders.

Writing in a linked Comment, Antoine Yrondi, University of Toulouse, France (who was not involved in the research) said, "This meta-analysis could allow to deliver a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy could improve depressive symptoms. However, physicians should keep in mind that childhood trauma could be associated with clinical features which may make it more difficult to reach complete symptomatic remission, and therefore, have an impact on the daily functioning."

More information: Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis, The Lancet Psychiatry (2022). www.thelancet.com/journals/lan … (22)00227-9/fulltext

Link: https://medicalxpress.com/news/2022-09-adults-history-childhood-trauma-benefit.html
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Why Do So Many Couples Divorce After 8 Years?

The infamous seven-year itch is real. How to avoid becoming a statistic.

Statistics show that the average length of first marriages when couples divorce is eight years.
The underlying dynamic is that our needs have changed over time, and the structure we've built no longer fits us. Couples divorce or distract.
The key is paying attention to feelings of restlessness and using them as information to update the relationship contract.
ccording to the census bureau, the average length of first marriages for divorcing couples is 8.2 years, the infamous seven-year-itch. But why seven instead of, say, 11 or 15? Good question. Here’s the thinking.

Adult development moves in roughly seven-year blocks.
It’s a given that we not only change as we move through our adult lives, but as researchers such as Levinson, Vaillant, and Sheehy have found, there’s something about that six–10-year zone: roughly seven years of stability and then two to three years of restlessness and transition before settling into the next stage. Sometimes the focus is on work and career—needing to take that job in Chicago—sometimes about aging and long-term plans, sometimes about working through your childhood and your relationship with parents—but sometimes about your intimate relationship.

In the Beginning
When you first fell in love, you psychologically needed something in your life—to get away from your parents, have stability or a baby, to feel important or cared for. While often never directly talked about, the other person provided this. You unconsciously made a deal: I’ll give you your #1 thing, and you give me mine.

Building a Life
In the first couple of years, you build a life with rules and routines together, so you have stability and do not have to invent your life anew every day: Who takes out the trash, how often does my mother come over for dinner, who initiates sex? Some couples never get through this stage—they argue about lifestyle and expectations and get divorced—but most of us make it.

The Crisis
But five, six, seven, or eight years in, one (or usually both) partner gets restless. The life they've built with its rules and routines is no longer working or fits. Why? Because your partner did a great job filling that Year-one need—you left home, have stability or a baby, felt needed—and now your needs have changed. But you’re stuck in this box of a life you’ve created, and what you often most liked about the other person is now driving you crazy: The solid, steady, grounding one now seems rigid and controlling; the spontaneous, fun-loving one is a bit too dramatic.
Break Out or Distract
This is the seven-year itch. Couples start arguing or pulling away. Someone has an affair. The underlying message is: “This is not working; I’m outta here. starting over,” and they divorce. And two or three years later, they remarry and start the process all over again.

Or instead of arguing, they don’t. They do their best to sidestep all these emotions and distract, focusing on kids—10 soccer games a week, ballet lessons—downshifting from being a couple to only being mom and dad. Or they focus on jobs and careers, working 80 hours a week to get that promotion, or they distract with something else—starting a dog kennel or buying a boat and waterskiing every weekend. If you go the distraction route, like those who divorce, you’re good for maybe another eight years—till the kids turn teenagers and your parenting is winding down, till you get that promotion and are bored or burnt out from your job and heading into your big midlife crisis. The restlessness and feeling trapped in the box of your life rears its head again.

The Challenge
Sounds depressing, but not inevitable. Instead of divorce or distraction, the challenge is to pay attention to that restlessness and those emotions and use them as information, helping you to take stock and see what you need now. Yes, you’ve grown out of the box of a life you’ve created, but you don’t need to start over from scratch or endure. Instead, you want to upgrade the relationship contract from year one. Decide what you each need to change—less heavy lifting and more teamwork, less feeling dismissed and more being heard, less frantic a lifestyle and more a settled one, more intimacy and sex.

And if you need help sorting out what you need, or can’t have these conversations easily on your own, get support from a therapist, a minister, or someone. These are important crossroads in your psychological life. Don’t go down the wrong path.


U.S. Census Bureau (2021). Number, timing, and duration of marriages and divorces 2016. Washington, D.C.

Levinson, D. (1986). The seasons of a man's life. New York: Ballantine.

Vaillant, G. (2015). Triumphs of experience. Cambridge, MA: Belknap.


New Research Shows Why Kids Need Play for Mental Health

A recent study finds links between children’s lack of play and declining mental health.

Has our drive to protect our children impaired their mental health—and made our conversations with them less rich? Recently Dr. Peter Gray, a psychology professor at Boston College and prominent researcher on child play, alerted me to his recent article exploring exactly this question. The article, in-press as of March 2023 in the Journal of Pediatrics, and written along with David F. Lancy of Utah State and David Bjorlung of Florida State, comes to startling conclusions.
Specifically, the ongoing decline in children’s mental health—and the current mental health emergency for children in the U.S.—appears at least in part to be driven by a lack of opportunities to roam, play, and act independently. When children have little time and encouragement to play, they lose their sense of autonomy. They are not encouraged to think independently, to imagine or dream, or even to navigate the complexities of the world around them. They also have few opportunities to pursue questions of interest to them and to have conversations that evolve from their authentic interests. That is, they don't learn what they care about—and why they care.
Gray cites an observational study of children in 20 parks in Durham, North Carolina. After controlling for many variables, the researchers found that children without an adult visibly present were much more likely to engage in vigorous play. Simply the fact of having an adult hovering seemed to inhibit the children’s play—from young children through teenagers. What’s more, when children don’t have the chance to play together, without constant adult intervention, their conversations with us are often less rich. We don’t have the chance to hear from them about their explorations and collaborations—and they don’t get that opportunity to tell stories to us. Why create stories and narratives for us, and describe their insights, if we are always there?
"We're Too Busy to Let Kids Play"
This research aligns with what I have seen as a speech-language pathologist, lecturer in education, and mother of two. Often, especially among wealthier families—ironically, families who tend to live in areas with more green spaces and safe areas to play—unstructured play is seen as an unnecessary luxury, even a waste of time. Having three or four activities per weekend day has quickly become the norm. Additional academic activities—notably Russian math—have become status symbols as well as attempts to ensure children’s school success.
While these activities indeed can provide a physical and mental boost, if they come at the expense of downtime and unstructured time, they can become counterproductive. Children have little chance for internal thought or decision-making, or for the more complex language of negotiation and collaboration. Worse, as Gray’s article concludes, these limitations are strongly linked to stress, anxiety, and depression, as children gain little experience stretching or challenging themselves. Without the opportunities to build skills, they often start lacking confidence. They may feel as if they can’t take on challenges—since they simply don’t.
Without Play, Kids Use Language Less Flexibly
Consider a child, “Jill,” who’s taken from one place to the other, under constant supervision: to the park, to school, to afterschool activities and to soccer practice. Her conversations are likely to be primarily responses to adult questions and directions; for example, following the directions of a craft activity in afterschool, or answering a parent’s questions about which slide she’d like to go on next. With little chance to speak with other children—or even to have quiet time for her mind to wander—Jill will likely not have much opportunity to use language to negotiate or collaborate.
She also isn’t likely to feel a strong locus of control, or a sense that she can exert control and make decisions about her life, even in small ways. In part due to these feelings, she doesn’t get a lot of practice dealing with issues or frustrations. She doesn’t need to talk herself through problems or find solutions. She mostly needs to respond.
Why does this matter? This kind of talking-through problems lets children build skills they desperately need. As research has shown, the amount of time children have for unstructured play links to their executive function skills and their abilities to regulate themselves, even two years later. When children have downtime, it isn’t simply “empty.” Rather, it is a rich space in which they can ask themselves questions, and can ask questions of others, learning to socialize even as they learn about the world. Our interactions can stretch them, if we aren’t hovering.
How Kids Can Play—And How Our Input Can Help
Consider Jill sitting at the sandbox with her friends, among a stack of buckets and construction tools. The friends decide to construct a play castle. They need to talk through how the moats should be constructed, how the towers should be placed, and who should get which bucket. We can help by sitting back and asking occasional questions, responding when children have trouble managing their arguments, and supporting their questions to grow.
For instance, we could ask questions after play, including, “What was the most interesting part of that structure to you?” or “How did you decide on what roles to play?” You might engage children by thinking about how they took initiative, what worked well and didn't, and with whom they enjoyed working and didn't. These types of questions can lead to far richer interactions than sitting in the middle of children’s activities, constantly chiming in.
Encouraging our society to prioritize these activities is critical, moving forward, to support the health and well-being of the children and teenagers in our lives. For families who fear retribution from social services or the police for letting children take on appropriate challenges, we especially need to provide support. Unstructured play should be an equal opportunity sport.

psychology today


What Has Caused the Long Decline in Kids’ Mental Health?

New review of evidence points to increased supervision, decreased independence

I begin with two well-established facts:
1. Over the past four or five decades there has been a gradual, but overall huge decline in the freedom of children and even teens to play, roam, and engage in any activities away from direct adult oversight and control. Long gone are the days when 5-year-olds walked by themselves or with friends to kindergarten, or kids of all ages could be seen playing in parks or vacant lots with no adults around, or 12-year-olds had paper routes or other responsible jobs they managed themselves. (For more on this, see here.)
2. Over these same decades, there has been a gradual, but overall huge increase in anxiety, depression, suicidal ideation, and actual suicides among children and teens. The rates of all of these are now roughly eight to ten times higher than they were half a century or more ago.
As an illustration of the extent of this crisis, a 2019 survey by the CDC (Centers for Disease Control) found that, over the previous year, 36.7 percent of U.S. high school students reported persistent feelings of sadness or hopelessness, 18.8 percent seriously considered suicide, 15.7 percent made a suicide plan, 8.9 percent attempted suicide one or more times, and 2.5 percent made a suicide attempt requiring medical treatment (Bitsko et al., 2022). Note that this was before COVID.
In a new Journal of Pediatrics article, my co-authors and I contend that the first fact is a major cause of the second.
For years, I have been arguing that this correlation, over time, between the decline in independent activity and the decline in mental health is one of cause and effect (e.g. here and here). Lack of freedom to behave independently and unsupervised causes mental anguish. Put another way, children’s and teens’ mental health depends on their being allowed increasing degrees of independent activity as they grow.
Recently, along with colleagues David Lancy (an anthropologist who has studied children worldwide) and David Bjorklund (a developmental psychologist who has authored textbooks on children’s cognitive development), I created a summary of the various lines of evidence supporting this causal hypothesis and submitted it the Journal of Pediatrics. We submitted it there because we wanted pediatricians to become aware of children’s needs for independent activity, so they might talk with parents about those needs.
The article has now been accepted for publication, with the title "Decline in Independent Activity as a Cause of Decline in Children’s Mental Wellbeing: Summary of the Evidence." It will appear soon in print and is currently available (here) in pre-publication manuscript form.
Our article brings together dozens of research studies showing that free play and other forms of independent activity promote children’s happiness not only in the short run, because independence makes children happy, but also in the long run, because independent activities promote the growth of mental capacities for coping effectively with life’s inevitable stressors. Through independent activities, where they must solve their own problems, children acquire the courage, confidence, and competence they need to face the bumps in the road of life with equanimity and effective action rather than panic or the feelings of helplessness that underlie depression.
We suggest in the article that our current societal concern for children’s immediate safety has overwhelmed and flooded out our historical understanding that children need increasing amounts of independent activity as they grow, to develop the character traits they need for mental health.
Our hope is that our article will encourage parents and society in general to balance concern for safety with the needs of children and teens for independent, unsupervised, moderately risky activity. We suggest that parents and children think together about activities the child might engage in independently, such as outdoor neighborhood play, independent travel in the neighborhood or city, running errands for the family, or a part-time job.
Parents might get together with other parents to arrange times and places where their children can play together in the neighborhood, with an adult watching for safety if that is felt necessary, but with minimal or no adult intervention. Parents might ask their child or teen, “What would you like to do independently?” and follow that with a discussion about how to do that, or something close to it, safely. We also suggest ways that pediatricians, family doctors, and public policymakers can help to promote such changes, and we also refer to the nonprofit organization Let Grow as a resource for ideas about how to bring more childhood independence into homes, schools, and communities.
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