Category Archives: Anxious children and parents

Not just a few worries and quirks: children and OCD

notobsessiveI had always known the 10-year old was an anxious child. Her parents had referred her for therapy as they felt she lacked confidence, was falling behind at school and seemed very secretive. I had spent many sessions with her, building trust and developing a relationship, and we had talked about her worries at school, the conflict between her parents at home.

But it took some months before she finally confessed to me that she thought she was “weird”. Thoughts invaded her mind and she couldn’t ignore them, upsetting thoughts that bad things might happen.

Specifically, she felt she had to check and recheck that she had tightened the tap after she washed her hands, as she couldn’t shake the feeling that she might leave the tap open and cause a flood.  This need to close taps and tighten them, to the point she would hurt her hands, had extended to her glue lid, the cap of her juice bottle – in fact to all items that needed closing.

She was very ashamed of her thoughts and behaviours and was sure she was a “freak”. “I just can’t stop myself,” she whispered. “What if I don’t check the tap and I flood the house?”

It was then that I knew that she wasn’t simply a nervous child, but was suffering from a serious form of anxiety disorder called Obsessive Compulsive Disorder (OCD).

It is estimated that about 1 in 200 children has Obsessive Compulsive Disorder (OCD) and that 80% of adults with OCD have had significant symptoms before the age of 18.

In children and adolescents OCD involves obsessive thoughts about things like:

  • contamination, dirt and germs,
  • illness,
  • putting things in order, arranging things symmetrically,
  • lucky or unlucky numbers,
  • the possibility of hurting others or causing something bad to happen,
  • danger to family or friends, and
  • losing or breaking things.

Children with OCD can’t simply choose not to think these thoughts; they cannot just put the ideas out of their mind and think positively. The thoughts feel intrusive and overwhelming and cause enormous distress to the child.

Children with OCD generally ‘deal with’ these obsessional thoughts, anxiety and preoccupations by carrying out particular repetitive actions. These actions quickly become compulsive rituals, examples of which are checking, hand washing, counting things, performing an action in exactly the same way every time, repeating a behaviour a specific number of times, and collecting and hoarding things.

It’s as if the child believes that the rituals will undo any possible harm and magically reduce anxiety and make things feel right. But in truth these compulsions are enormously time-consuming and increasingly interfere with all aspects of the child’s life.

Experts are not exactly sure what causes OCD, which can run in families. Some theories suggest that it involves serotonin, a chemical in the brain also called a neurotransmitter. When something blocks the flow of serotonin, the brain overreacts and misreads information. Instead of ordinary thoughts being filtered out, the OCD mind lingers on them and sparks off fear or worry like an overactive alarm system.

OCD can be a difficult condition to treat. Early diagnosis is not easy as children are often secretive about their obsessions and compulsions. But if untreated, childhood OCD tends to persist into adulthood and is associated with long-term negative outcomes, so it’s worth being proactive if you start to suspect your child is showing features of the disorder.

Below are some of the positive steps you can take.

Consult an expert

As with most difficult mental health issues, the support and expertise of an expert is often vital. First, this person will help you to distinguish between what is manageable anxiety and what is OCD. Second, even children with the most knowledgeable and accepting parents will often withhold certain worries and acts from them, but talk about them with an expert.

A combination of psychotherapy and medication might be suggested by a professional, but first do some research and inform yourself thoroughly before deciding how to move forward.

Prepare the family

If everyone in the family  understands what OCD is and that the behaviours that come with it are part of the condition, this creates a more understanding home environment. Also try to run a fairly structured home so that compulsive rituals don’t stand out as much and are less exacerbated by chaos.

Talk to your child

This is obvious. Be honest and open about the condition and talk about it with your child, without ever forcing the issue. You are a parent with a family to run and limits to set, not a psychologist. The more difficult work of dealing with OCD might need to be dealt with by an expert.

Deal with school

For the OCD child, stresses at school are usually worse than at home. Adults who teach your child will not be as well informed as you learn to become, and other children are often not tolerant or understanding. Therefore, meet all those who will come into contact with your child and help to educate them.

Managing and treating OCD is a challenge but possible – as the famous 18th century writer, OCD and Tourette’s sufferer Dr Samuel Johnson said, “Great works are performed not by strength, but perseverance.”

OCD hand

For useful links to resources in South Africa and internationally I can recommend the website of the South African Depression and Anxiety Group (SADAG) – http://www.sadag.org

Advertisements

Raising Brave Children

baby-supermanTimmy buzzed around my consulting room, playing Superman. Faster than a speeding bullet he rescued the doll family that he’d earlier tied up with some string. In the sand tray he intervened to prevent the marauding dinosaurs from stomping on the farm animals that waited anxiously for their hero to arrive. After performing an emergency operation on the toy bear, he flopped down onto the floor and said wistfully, “Where’s the real Superman when I really need him?”

Timmy, the courageous conqueror of crime, dinosaurs and illness, the hero of the hour, had been referred to me because he was scared all the time. He had nightmares, struggled to separate from his mom when he had to go to school and worried constantly about bad things happening. He was particularly afraid of swimming in the pool – he said his brain told him sharks didn’t live in swimming pools, but his heart and tummy couldn’t believe his brain.

In the course of play therapy my aim was to help Timmy face and manage his fears. To do this he would have to find his own inner superhero. SuperTimmy would have to demonstrate courage – defined by the Oxford English Dictionary as “the ability to disregard fear”.  Courage, also known as bravery, valour, tenacity and pluck, is not recklessness or fearlessness. Courage is informed by fear and able to learn from fear. Courage is doing what you know is right even when it’s not easy. Charles A. Smith, an American educator, points out that “courage finds its roots in two fundamental skills learned in early childhood – persevering despite adversity and remaining mindful despite fear”.

So how do we teach our children to be brave? Firstly we need to model being brave and proud of our own moments of courage. We also need to teach children to persevere. We can encourage this by praising and rewarding effort, focusing less on the outcome of a project than on the process. In order to teach mindfulness in spite of fear we can provide scaffolding – small amounts of support and reassurance to help children move gradually through increasingly anxiety-provoking situations. The parent’s support and soothing words help the child calm down enough to manage fear. Over time the child learns to calm himself down, so the ability to self-soothe is internalised. Current research suggests that this is a result of the strengthening of those brain pathways that manage stress. 

As well as offering appropriate support, we can also help our children develop confidence by “letting go”. In her excellent book on parenting, Letting Go as Children Grow, Deborah Jackson, a British writer, points out that while children need adult support, they do not need interference, which can damage their growth. If we learn to trust our children at each stage, they are more likely to find their own courage. When parents do a little less there is the likelihood that children will feel freer to do a lot more.

girl lighting fireOne way in which parents can build children’s confidence and courage is to think about the challenge offered to parents by Gever Tulley of The Tinkering School in Southern California. Before you ask why, here are five dangerous things he says you should get your child to do:

  1. Play with fire
  2. Have a pocket knife
  3. Take things apart
  4. Drive something
  5. Throw things and skim stones

We live in a dangerous world. So why on earth encourage our kids to do more dangerous things? Tulley reckons that we need to learn about our own power and potency. We do this by learning about the world and how and why things happen, its causes and effects, and by experimenting with the limits of our physical capacities. We must have the experience of being in control. Of course all of the above activities MUST be carried out under responsible adult supervision, with guidance, support, and yes, scaffolding. 

Allowing kids to explore and use tools encourages creativity, independence and a desire to learn. We risk having societies turn into sterile systems, where dirt, trees and appliances are taken away from kids, together with marvellous opportunities to learn by playing!

As parents we can tell our kids that fire is dangerous and useful, but until you actually build a fire, “play” with it, cook something on it, and learn to control it and put it out, you haven’t learned about fire. In reality our children will do dangerous things whether we like it or not. If they are forced to do so secretly without your help and supervision (not interference), they are more likely to hurt themselves. Children are more at risk if they have not had guided experiences with danger.

I thought of other things our Superboys and Supergirls should be encouraged to try as we watch them learning to be brave:  

  • Climb things, especially trees
  • Jump off and over things
  • Taste new foods
  • Act in a play
  • Make a new friend
  • Go on a ride at a funfair
  • Say what you feel
  • Play in the mud
  • Risk failure
  • Dance
  • Sing loudly

Perhaps it’s not only the parents who allow their children to run wild who are a problem. It’s also the parents that won’t let their children run at all.

 

Sleepover’s don’t need to be nightmares

Slumber party or night of the living dead?sleepover image

It’s 2.00am and out of the blackness of sleep something materialises in my room. It’s at my elbow, shaking me awake. I grope through the mist, trying to catch up to my racing heart. It’s my son’s 8-year old friend, sleeping over for the first time. He can’t sleep. So neither can I.

The sleepover, or its Americanised girlie version, the slumber party, is one of the modern rituals of childhood. Children and teenagers beg parents to allow them to host or attend sleepovers, with the promise of pillow fights and midnight feasts, the tests of ghost stories and truth or dare.

What can go wrong? Well for starters: imagine a giggling gaggle of hyped-up tweens and teens, transforming into squabbling, sleep-deprived, grumpy monsters ruining the rest of your family weekend.

Other parents have darker imaginations, depending of what they’ve read in the newspaper or which stories they’ve heard that week. Pornography, paedophiles, sex, drugs, alcohol or neglectful parents, take your pick.

Sleepovers are a rite of passage, a plunge into deeper waters. Whether you host one or send your child to someone else’s, you might feel as if your child is not ready. For some parents the shallow end of life is a much safer place to be. I understand this. I understand it completely.

When my son packed his things to stay over at his best friend’s, I smiled encouragingly through the lump in my throat as he left home for his first night out. He dragged a huge bag behind him, walking innocently forward. I trusted the hosting family but not chance, the possibility of some violent intrusion into their home, some horrible, random stroke of fate that I should be there to experience with him.

If you think I’m bad, try my husband. “What if a small rusting bit of a satellite breaks off, falls a few thousand kilometres and hits their house?” he asked, only half-joking.

Unsurprisingly, our son survived. There was no act of God or shift in the earth’s crust. I’d just forgotten about his sleepwalking, of course, a habit he’d recently started and which we had yet to understand properly.  I was probably sleeping fitfully when he fell out of the top bunk of his friend’s top bunk in the middle of the night, crashing onto the carpet, where his friend’s mom found him a few seconds later, sleeping peacefully.

My son was 7 years old at the time, but what is the correct age for sleepovers? There is no right time, of course. Some parents will be in their early twenties, others in their fifties – they just have to deal with it as maturely as possible.

Parents might refuse to allow their child a sleepover at a friend because of safety concerns and the fear of something going wrong, or just because they have different attitudes, values and parenting styles to those of the hosts.

Equally, not all children want to sleep out. Sometimes it’s the parents dying for a child-free Saturday night but their child says no.

Properly planned and supervised sleepovers are a fantastic way for children to consolidate friendships, expand their horizons and learn about how other families live. It helps children practise being flexible and autonomous within safe boundaries. It also helps parents practise letting go.

Some tips:

  • Make sure you know the family where your child will be spending the night. You should also ask what level of parent supervision will be provided and which other children might be sleeping over. And if you feel uncomfortable, you can say no;
  • If you host a sleepover, be vigilant, be responsible, keep them short, and don’t have too many kids over to sleep at one time. Remember Lord of the Flies?;
  • Don’t schedule sleepovers for every weekend or they lose their specialness and also start compromising family time and other activities;
  • Children should never be pressurised into sleeping out if they feel unsafe or uncertain;
  • If they would like to go but are nervous, put a plan in place that allows for you to make contact with your children and the host family, say goodnight and, if necessary, make a plan allowing them to come home if there anxiety gets the better of them;
  • Avoid a pattern of your child asking if he can sleep out, and then always phoning you in the middle of the night to be fetched. If this is happening, then your child is not ready for sleepovers – take a break and try again in a few month’s time; and
  • For anxious parents of younger children, consider something I read about, which is ‘sleep unders’, ‘half-overs’, or ‘late nights’. The children go off in their pyjamas, take junk food, play all the games they want, but at a certain point are fetched and tucked in under their own roof, where their parents can feel safe.

The author Elizabeth Stone wrote: “Making the decision to have a child – it is momentous. It is to decide forever to have your heart go walking around outside your body. ” And sleepovers, the precursors to leaving home, allow your heart to brave some tentative baby steps.

The First Day of School

  I don’t know who was more nervous about my son’s first day of grade 1, me or him. On the surface I had been positive and he was full of bravado but the unconscious told a different story – I’d had bad dreams and he had taken up sleepwalking.

At school children will experience some of their greatest challenges, successes, failures and humiliations. In separating from their parents they will learn about how the world works, about managing social interactions and about people outside their own families. They will face up to their strengths, weaknesses, interests and who they are socially, but not without some anxiety along the way.

Most children have similar sorts of worries around starting school. I asked three young kids what they remembered about that first day, and here’s what they said

1. “I thought I wouldn’t pass because I wasn’t clever at that time.”

2. “I was worried the kids would be mean to me and I wouldn’t find my way back.”

3. “I didn’t know who would play with me.”

These are typical concerns along with “How will I know what to do and where to go?”, “Where are the bathrooms?”, “What about bullies?”, “Do I need to be able to read or write or spell already?”, and “Can I cope with saying goodbye to mom or dad and will I cry?”

Such worries 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.

If parents have mixed feelings (such as guilt or anxiety) about sending a child to school, this can add to the child’s reluctance. A child’s experience starting school is influenced by their parents’ feelings and attitudes.

Parents of young kids often feel emotional as they send their child off for the first day of big school. Kids can pick up on that nervousness, making their own worries even more intense. Months of buildup to the start of school, talking about it as a big event, can also make a child anxious.

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 or a sore throat 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 especially if they aren’t used to being away from parents during the day. If you don’t deal with the anxiety and its causes, it can get out of control very easily. A vicious cycle is set up when an overly sensitive parent keeps an anxious child at home, only for it to be even more difficult to send the child to school the following day.

So, no matter what, parents shouldn’t let anxiety keep kids away from school. All of these signs of worry may end soon after the start of school. But if they continue for several weeks, talk to the teacher and get some guidance.

What Parents Can Do To Help Their Child

  • Show interest and be supportive. Take your kid’s fears seriously. Don’t criticise, mock or tease as they are easily humiliated. Talk to your children about their anxieties and help them articulate these. As I have written before, speaking fears out as words diminishes their unspoken power and renders them normal.
  • Talk to your child about what to expect – the activities, the schedule and the other children.
  • Share your own memories of school –  be generally positive, but realistic. Your own experience can be an opportunity to model coping strategies
  • Read books about going to school.
  • If possible take your child to school to get used to the layout (where his classroom is, where the bathrooms are, which desk is his, etc.) and to introduce him to the teacher. Many schools have orientation programmes for pupils starting Grade R or Grade 1 – these are extremely useful to attend.
  • Identify a buddy at school – this can decrease apprehension about being alone in the new setting.
  • Get your child in a routine some time before school starts, going to bed earlier and waking up earlier.
  • Make the getting-ready-for-school ritual as stress-free as possible. For example, with your child’s help lay out all books and clothes the night before.
  • Suggest that your child takes a familiar object or a family picture to school.
  • Be a coach – talk through and role play situations. Break down big tasks into smaller, more manageable steps.
  • Don’t overdo it though as this can make kids more anxious.

Remember to be realistic about who your child is. If they are temperamentally anxious or shy, starting school may be more difficult than for confident kids. Even in these cases don’t overprotect or underestimate their ability to manage stressful situations. It‘s not only important to trust your child’s ability to cope, but also to be able to trust the school and teacher and most importantly to trust yourself to let go.

Battery Chicken or Free Range Kid?

He was 22 years old when his mother gave him up to the police.

It was 1988, the last spasm of apartheid, and the military police had arrived at his mother’s flat in Durban to track down the military service dodger. But he was living elsewhere in Durban on the Berea, hoping that his mother would deny all knowledge of his existence, or at least his whereabouts.

Instead, she meekly handed over the information and he was located, formally charged and required to attend a tribunal in Pretoria several weeks later. “I wasn’t really surprised,” he said. “She was essentially a good person but fearful and timid, and I never felt she would protect me. When we first arrived in Durban, she dropped my brother at the gate of his new school and told him to approach the headmaster to sort out everything. That was for grade 1.”

Meanwhile, according to Google the ‘problem’ currently appears to be the other way round. In families, fictional and real, and in 1 600 000 internet hits (compared to 55 000 for the term ‘underprotective parent’), overprotectiveness, sometimes referred to as helicopter parenting, is the hot topic.

Modern society is a culture of information. But sometimes we have so much information about every new disaster, crime and moment of misery that it also means we live in a culture of fear. High levels of parental protectiveness seem necessary given the many dangers reported in our newspapers and community crime-watch emails. We are drowning in bad news.

Life can also seem more pressurised, jobs more scarce, the future more uncertain (let’s pretend it’s not 1914 or 1939 or any year of apartheid), so fiercely protecting your child seems to be a basic requirement of effective parenting.

But overstepping one’s parental role, not allowing children to learn from mistakes or fight some battles on their own, can prevent children from developing resilience and learning to manage difficulties.

Underprotective or indifferent parents are a different sort of animal completely. These parents aren’t creating a safe environment in which to allow their child to learn independence, but throwing them to the wolves. This happens when parents were themselves raised by neglectful or abusive parents, or where community or family structures have broken down.

So how to find balance? A parent should be more guide than bodyguard. When your toddler staggers past a sharp-edged table, walk quietly behind him at the ready rather than call out the danger and whisk him aside. Let your 5-year old daughter grapple with her shoelaces rather than always intervene. Advocate how your 10-year old can deal with her friendship dispute rather than automatically phone the friend’s parents. Allow your teenager to fight smaller battles with authority figures on her own – you don’t want to communicate that you have no trust in her strength of character.

What you want to raise is a free range child, not a battery chicken unfit for the normal rigours of
everyday life. The term ‘free-range kid’ was coined by an American writer, Lenore Skenazy. She says a free range child ‘’gets treated as a smart, young, capable individual, not an invalid who needs constant attention and help. For instance, in the suburbs, many school PTAs have figured out a new way to raise money (God bless ‘em): They auction off the prime drop-off spot right in front of the school — the shortest distance between car and door. But at the mall, or movie theater or dentist’s office, that would be considered the handicapped parking spot — the one you need if you are really disabled.” 

Don’t be scared, be prepared

Some stress is good for you, like eating brussel sprouts. And some level of stress is necessary and important, like having a root canal. It won’t seem so at the time, but the right amount of stress can extend your life. It focuses your mind, builds your immune system and gives you a sense of purpose. Even exam stress.
Here are some useful strategies to cope with the pressure of tests and exams:
1. Plan ahead – before you start studying make an I-survived-last-time list of occasions on which you survived or overcame pressure. This settles your fears and promises you will cope again.
2. Look at the big picture first: make a mind map or summary of work sections or chapter headings or aspects of a novel. Seeing a whole structure on one page reduces the scale of something huge to something manageable.
3. Avoid short-term energy enhancers such as energy drinks or endless cups of coffee – you get a short burst of energy followed by a long trough of lethargy.
4. Train like a soldier by developing strategies and routines in advance – learn specific essay structures, begin answers with key words from questions, circle instruction words. These are the little routines that equip soldiers to operate under duress.
5. Reward yourself – if you have a full day to study, schedule a break to watch your favourite TV programme that evening. This creates urgency and sets up the anticipation of something pleasant later.
6. Take care of your physical well-being. Eat healthily and keep up a regular exercise schedule. Exam-time is not a good enough excuse for junk-food and sweet binges.
7. Sleep is essential. Research shows that an adequate night’s sleep consolidates memory and enhances performance the following day. In relation to exams you are probably going to benefit far more from going to bed and sleeping than from desperately cramming through the night.
8. Have appropriate expectations of yourself. Don’t compare yourself to other people and try to resist external pressure on you to meet up to unrealistic standards. Base your own expectations on the best you think you can do, and in relation to your own previous performance and preparation.
9. Finally, keep things in perspective. While some stress is important, excessive levels of anxiety over exams will certainly be counterproductive