Childhood Anxiety: Recognizing the difference between stressful circumstances and clinical anxiety

Springtime is a wonderful time of year; however, it can also be a stressful time for children and teens of all ages.  For younger kids and preteens, it’s the time of year for state mandated testing in schools, which can certainly raise stress levels.  For teens, it is the time of year when seniors hear back from colleges and many juniors begin the college application process. These adolescents are confronted with major decisions about their future, a source of worry and anxiety for many.  For those seniors waiting to hear from colleges, it can be a time of anticipation and apprehension.

As a parent, how can you tell whether your child or teen is experiencing heightened levels of stress due to temporary circumstances versus if he or she has clinical levels of anxiety and should see a therapist?  When parents ask me, I tell them to consider the length of time and the impact of the stress on your child’s life. How frequently does he or she experience this anxious behavior? How long have the worries been a concern?  To what extent do their worries negatively affect your child’s life?

Many children and teens suffer from debilitating worry.  Recent national polls have found that 1 in 8* children suffer from anxiety.  Many kids miss school, social activities, and a good night’s rest due to ongoing worrying.  With this in mind, what signs should parents be looking for? Anxiety can present through physical, emotional, and behavioral signs, and the following list provides common indicators for each of these categories.   

Physical Signs of Anxiety

• Your child complains frequently of headaches or stomachaches, for which his or her pediatrician has found no medical reason;

• If your child’s eating habits have changed significantly, including an increased or a decreased appetite.  Again, you should first seek out your pediatrician to rule out any physical reasons for this behavior; however, if those are ruled out and your child is still not eating properly, it could be a sign of anxiety;

• He or she starts to shake or sweat during mildly stressful situations, such as school testing or performances; and

• Your child has trouble falling or staying asleep through the night.

Emotional Signs of Anxiety

• Your child cries often, especially in response to seemingly minor issues;  

• Your child is extremely sensitive to feedback, even when the content is not critical in nature;

• He or she is irritable regularly, without any clear reason;

• Your child is afraid of making even minor mistakes;

• He or she has regular panic attacks or is afraid of having panic attacks (Panic attack symptoms may include sweating, trembling, shortness of breath, a choking sensation, chest pain, nausea, dizziness, fear of losing your mind, fear of dying, skin flushing, a racing heartbeat or heart palpitations, feeling that danger is nearby, and feeling an intense need to escape the situation.);

• Your child has phobias (e.g., bees, dogs, shots) or exaggerated fears (about things like natural disasters) that prevent him or her from participating in activities or interfere with his or her daily life; and

• Your child has frequent nightmares about losing a parent or loved one or is obsessing about death in general.

Behavioral Signs of Anxiety

• Your child asks “what if?” constantly, and it’s related to terrible things happening. For example, “What if an earthquake happens?” or “What if a robber breaks into our house?”;

• Your child avoids participating during circle time or other class activities at school every day;

• If your child refuses to go to school on a regular basis;

• When your child avoids social situations with peers after school or on weekends that he or she used to enjoy (e.g., extracurricular activities or birthday parties);

• If your child constantly seeks approval from parents, teachers and friends, and reacts negatively to any form of constructive criticism; and

• Your child frequently says “I can’t do it!” without a real reason.

If your child is showing the aforementioned signs on a regular basis, I urge you to seek mental health support for him or her.  There will always be stressors in life, and you can’t protect your child from everything. However, therapy can help your child learn to manage his or her anxiety and continue to function in life, even when stressed or worried.  It is important to keep in mind that untreated anxiety tends to get worse over time. When a child—and sometimes the whole family—works to avoid triggering situations, the worries only grow more powerful. The best way for children and teens to conquer anxiety is to learn to face and master their fears.   

If you are concerned about your child’s anxious behavior, I encourage you to contact me for assistance.  I look forward to working with you and your child to provide strategies and support. Please don’t hesitate to call me at 703-825-0502.
 

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University. Dr. Gottlieb utilizes an integrative approach to therapy, incorporating both CBT and Family Systems techniques. Treatment goals are discussed with the child/adolescent and family, and are developed with the individual child's needs in mind. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/

Strategies for Teachers: How to talk to parents about their child’s classroom struggles

As a psychologist who specializes in neuropsychological and psychoeducational evaluations, I see many parents who have recently received recommendations from their child’s teacher or school support staff that they should consider having their child assessed.  Parents, and sometimes the child himself or herself, may be worried when they arrive for an intake meeting.  They might have questions about the testing process, concerns about the child’s school performance, or could be struggling to process the situation.  However, I am rarely the initial point of contact for these families.  Rather, teachers (and pediatricians) are often the first to notice when a child is struggling.

Teachers see students on a daily basis and have unique insight into a given child’s academic, behavioral, and social functioning.  In addition, they have age-based comparative data.  Therefore, teachers are often one of the first people to notice when a student is struggling due to attention and learning challenges, processing concerns, or behavioral issues.  This role is both influential and challenging.  Even when parents are aware that there is an issue, it is difficult to hear their child is struggling.  Therefore, it is particularly important for teachers to consider how they convey this information in a way that is compassionate, honest, and clear.  Ultimately, the goal is to work together with the parents, child, and other professionals for a supportive, team approach.      

Throughout my clinical work, I have developed a list of techniques and strategies that tend to be effective in this challenging situation.      

1. Contact parents early.  When a child is struggling in the classroom, early intervention is very important and typically leads to the best outcomes.  Over time, if the problem is not addressed, the child will fall further behind.  In addition, what may begin as an academic or attention-based challenge, can lead to feelings of low self-esteem and growing social-emotional difficulties. Furthermore, parents typically appreciate ongoing feedback, rather than waiting until the issue has reached “crisis mode.”  The evidence is overwhelming; the sooner developmental delays or learning disabilities are addressed, the better the outcome for the child.

2. Create a “positive-feedback sandwich.” People are typically more receptive to constructive feedback if you position it between two positive comments.  Begin with a positive experience you had with the student.  Then, express your concerns while also explaining ways that you and the child are already working together to address the challenge.   Keep in mind, it often helps to provide specific scenarios, as they can be easier to process than broad generalizations.  Finally, as the sandwich metaphor implies, end on a positive note by giving the parents a genuine compliment about their child.

3. Listen to the parents.  While it is important for you to keep the parents informed about what is going on in the classroom with their child, it is typically very helpful to listen first.  Ask the parents about their observations at home regarding homework, any history of learning challenges, or if they have any concerns.  Ask the parents about their child’s strengths and weaknesses, interests outside of school, and how he or she talks about his or her school day.  Do you see similar challenges in the classroom?  Remember, everyone behaves differently in unique environments.  This does not mean observations in one setting are “correct” and the other is not.  

4. Recommend solutions that incorporate the school, parents, and child.   Often teachers make the mistake of thinking they must develop the solutions to a child’s classroom struggles on their own.  Instead, think of the student’s parents, and other relevant professionals, as part of a team.  It is important to offer solutions from your own unique perspective, while also asking for suggestions and input.  This approach can help parents and students regain a sense of control and agency amidst a challenging situation.    

5. Avoid using labels too soon in conversation.  While you may have a sense that a child is likely to have a specific learning disability, attention challenge, or processing issue, it is important not to label his or her behavior prematurely.  Although labels can be very helpful after the complete picture has been assessed, they can be limiting if used before various causes are considered.  In addition, certain terms can be difficult for parents to hear and may not encourage openness and collaboration.  

I consider teachers and other educational professionals to be my partners in working with children and their families.  Please feel free to contact me (703-825-0502) with any questions you may have regarding how to speak to parents about their child’s classroom struggles. I look forward to working with you, your students, and their families.  

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University.  Dr. Gottlieb works with children and adolescents, and their families, to provide comprehensive neuropsychological and psychoeducational assessments to better understand the individual child’s attention capacities, learning profile, emotional functioning, and behavioral presentation. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/

Is your Teen Experiencing “Adolescent Angst”, End of the Quarter Stress, or Something More?

It’s that time of year when many people, including teenagers and pre-teens, feel tired, irritable, upset, or blue.  For many adolescents, it is also a time of academic stress, as the second quarter comes to a close.  For older teens, college application season is in full force, which can exacerbate this pressure.  You might think it is “normal” for your teen to be moody, especially during the winter when there is less opportunity to go outside for exercise, sports, and other activities.  However, for some individuals, this winter “slump” can be severe and may have lasting effects.  

Seasonal Affective Disorder (SAD) is a form of depression that can develop from inadequate exposure to sunlight.  As you might expect, there are more people who experience SAD in the most northern and southern parts of the world, (e.g., Alaska); however, even people in our area can experience symptoms.   

For some individuals, SAD can be a serious issue and shares many signs and symptoms with Major Depression. Understanding your teen’s risk factors for SAD can help you identify symptoms, should they arise.  While SAD, and depression in general, is more common in adolescent girls than boys, the symptoms are not exclusive to one demographic.  As with many types of mental health issues, the risk of SAD is higher for teens who have a family history and a genetic predisposition (e.g., have a close relative suffering from depression).

According to the National Institute of Mental Health (NIMH), here are some symptoms of SAD to watch for in your teen:

• Increased need for sleep, and a lack of energy. Many teens enjoy sleeping in on the weekends, but if your teen is having problems crawling out of bed every day, it may be a sign of SAD.

• Change in appetite or weight. Certainly, the fall and winter are times when we typically crave more comfort foods (e.g., sweets and carbs), and the fact that it coincides with so many food-focused holidays such as Thanksgiving, Hanukah, and Christmas adds to this experience.  However, it’s important to take note if your teen’s eating habits change drastically during this time.   

• Irritability. Teenagers often experience moodiness with all of the new hormones surging through their bodies.  However, once again, you want to note if it is more extreme, consistent, and/or pervasive.

• Inability to concentrate and difficulty completing tasks. Focus and concentration are two of the key ingredients to academic success. If your teen’s grades begin to slip at this time of year, or if his or her teacher asks for a conference to discuss his or her lack of focus and motivation, it may be a sign of SAD.

• Problems with relationships, withdrawal from friends, family and social activities. During adolescence, many teens struggle with their relationships.  However, for some, these challenges can be more extreme.  If you notice a sudden or progressive change in your teen’s social behavior (e.g., an outgoing adolescent who now wants to spend all of his or her time in his or her room), it is important to take note.

• A sense of hopelessness, worthlessness, or guilt.  When teens experience symptoms of depression, it is often accompanied by feelings of low self-esteem and a sense that they can’t or don’t deserve to feel better.  These feelings are important and may be red flags for a mood disorder.   

• The aforementioned symptoms appear to increase seasonally during the fall and winter. January and February are often difficult times for individuals with SAD or related symptoms.  It has been dark for several months and the holiday rush is over, with seemingly little to look forward to in the upcoming weeks or months.

Over a few months, the lack of light and the increased symptoms of depression can lead to feelings of hopelessness, and a general sadness about life.  There are many cases where SAD leads to depressive symptoms that can extend into the rest of the year. Furthermore, untreated depression can get worse over time. In extreme cases, a teen can begin experiencing suicidal thoughts, a serious threat to their welfare.

As with any mental health issue, it is important to seek appropriate treatment and support. If you are concerned about your teen’s mood or behavior, do not hesitate to contact me for assistance.  I look forward to working with you and your child to provide solutions and support.  Please don’t hesitate to call me at 703-825-0502.

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University. Dr. Gottlieb utilizes an integrative approach to therapy, incorporating both CBT and Family Systems techniques. Treatment goals are discussed with the child/adolescent and family, and are developed with the individual child's needs in mind. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/

Signs of Childhood Depression

How to know when your child’s behavior is more than just the “holiday blues”

At this time of the year, everywhere you turn you are surrounded with images of gregarious, happy families. Television shows, holiday specials, and social media showcase idealized family gatherings, bountiful piles of gifts, and unbelievably happy people. However, for some children, the holidays can be one of the most difficult times of the year. The expectation that they should be happy and carefree is simply unrealistic. School can be a significant stressor for children during the winter months, and the additional pressure of the holidays can be hard on everyone. This is why so many people suffer from the “holiday blues.”

There are plenty of reasons for unhappiness around the holidays. They create economic stress and time pressure as we rush about to create the “perfect” holiday experience. Families may be dealing with loss, divorce, or other situations that are not depicted in our idealized holiday vision. In addition, the winter holidays come at a time when it’s cold and dark outside, which often leads to fewer opportunities for exercise.

The holidays can also bring up difficult emotions.  It is a time when children really miss those family members who have passed away or are too ill to participate in the festivities.  Splitting time between divorced parents can be particularly difficult, as children may feel guilty for not spending time with one of their parents, or may not want to spend time with a normally absent parent just because it’s the holidays.  For some older kids, midterm exams create additional stress.  This can be exacerbated because they typically take place at the same time as major extracurricular activities, like holiday plays and concerts.

General feelings of unhappiness are not the issue though. It is important to distinguish the “holiday blues” from more consistent mood patterns. Depression is a persistent condition that lasts for weeks or months at a time, and interferes with a person’s ability to function in daily life. It has a number of causes, including genetics and neurochemical imbalances, as well as environmental, psychological, and social factors. Here are some of the signs you should monitor for during this season and year-round.

• Increased sadness or irritability. While everyone feels this way sometimes, if your child is feeling this way for more than two weeks, it may be a sign of something more serious.  
• Changes in sleeping patterns and appetite. Excitement about the holidays can cause kids to sleep less and eat more. However, you should be looking for the more notable symptoms, such as not wanting to get out of bed, showing extreme fatigue, or not eating regular meals.
• Your child suddenly complains of vague physical ailments, such as headaches or stomachaches, when they are normally quite physically fit and healthy.
• He or she withdraws from activities that used to be his or her favorites, whether it’s sports or after school activities. They could even be losing interest in their favorite hobbies around the house.
• Deteriorating academic performance, losing interest in school, and “playing sick.”
• Reckless and impulsive behaviors such as angry outbursts and hostility. Or perhaps your child starts to express feelings of worthlessness or undue guilt.
• Your child retreats into himself or herself and refuses to tell you what’s wrong. In this case, see if there is someone in his or her life with whom he or she is willing to talk, and if not, seek a professional for him or her to speak with.

It is important to understand that all children express some of these symptoms at times. However, for children experiencing depression, these symptoms interfere with daily function often impacting family life, academic performance, and peer relationships.  

If you observe these behaviors in your child, seek professional help for him or her. Unaddressed social and emotional challenges during childhood can increase in severity as children get older and could lead to secondary challenges (e.g., social isolation, learned helplessness, and family turmoil). If your child is showing symptoms of depression during the holidays, address it, and it is quite possible your whole family will have a happier holiday as a result. I look forward to working with you and your child to provide support and guidance. Please don’t hesitate to call me at 703-825-0502 or email me at shira@gottliebchildpsych.com.

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University. Dr. Gottlieb utilizes an integrative approach to therapy, incorporating both CBT and Family Systems techniques. Treatment goals are discussed with the child/adolescent and family, and are developed with the individual child's needs in mind. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/
 

Beyond the Feedback Meeting: Implementation, Consultation and Support

When your child’s teacher expressed concern at parent-teacher conferences that your child may be struggling due to a learning disability and/or attention challenges, you may have been encouraged to seek neuropsychological or psychoeducational testing. Or, maybe you have become concerned after seeing your child’s first quarter report card and have begun to look into the process yourself.  

In my last blog post, I spoke about how to talk to your child about these evaluations.  Now, I would like to talk about what happens after the assessment, including how I work with families, teachers, and other professionals in your child’s life to put the findings and recommendations into action.  

While there are commonalities among psychologists in how the testing process is structured, my practice is unique in important ways.  Throughout my clinical experience, I have found that parents often finish the testing processes feeling overwhelmed.  They may be struggling to make sense of a testing report that is difficult to understand.  Or, they may feel inundated with information that is given at a single feedback meeting without guidance regarding next steps.  When I developed my practice and testing style, I prioritized writing reports that are accessible and providing hands-on follow-up consultation.

Overcoming attention and learning challenges is a journey, and I am committed to helping my clients and their parents as they begin implementing strategies and recommendations.  This begins with a 90-minute feedback session about two weeks after testing is complete.  At this time, there will be a comprehensive and accessible written report outlining the findings and recommendations.  For a young child, this is a parent meeting.  For an adolescent, the student may be included in the feedback session.  The level of preteen or teen involvement is discussed on a case-by-case basis and is carefully fitted to the adolescent’s developmental stage. 

While the traditional testing process ends with the feedback meeting, I view the feedback meeting as the beginning of a new phase.  My comprehensive package includes a follow-up meeting and additional consultation.  For many children and adolescents, this includes attending an IEP or 504 Plan meeting at their school, or a private school equivalent.  This allows me to work with the teacher and relevant school staff, creating a team to support your child’s learning.  For many children, particularly children ten and under who are struggling in the school setting, this will not be the first time I have visited their school.   For these children, I organize a school observation with your child’s teacher and school prior to meeting your child.  Then, when it comes time to implement strategies following the evaluation, I have a better understanding of your child’s school environment as well as a collaborative relationship with your child’s teacher and school.     

In addition, I often consult with therapists, psychiatrists, pediatricians, tutors, reading centers, and executive functioning coaches.  These individuals are part of your child’s team.  My goal is to work collaboratively, while providing a deeper understanding of the assessment findings and recommendations.   I’ll also provide strategies for you to work on with your child at home, referrals to other professionals, and resources for you to access additional information.

I’m committed to providing accessible written and in-person feedback following your child’s evaluation.  Furthermore, I am dedicated to facilitating follow-up consultation and support.  I am here to help you navigate the next steps.  I look forward to working with you and your child.  Please call my office for more information (703-825-0502).

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University.  Dr. Gottlieb works with children and adolescents, and their families, to provide comprehensive neuropsychological and psychoeducational assessments to better understand the individual child’s attention capacities, learning profile, emotional functioning, and behavioral presentation. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/

Preparing Your Child for Neuropsychological or Psychoeducational Testing

You’ve just attended parent-teacher conferences at your child’s school and his or her teacher has recommended that he or she be tested for a learning disability and/or ADHD. You are understandably concerned, and may be worried about the next steps.  As a psychologist who specializes in neuropsychological and psychoeducational testing, I understand how this recommendation can be challenging to hear.  However, it is important to remember that your child has probably been struggling for a while, and leaving these difficulties unaddressed will lead to further issues (e.g., the child who “can’t read” begins to feel “stupid” and, consequently, his or her overall self-esteem is negatively affected).   Testing is the first step toward getting your child the tools and support he or she needs to succeed in school.  Seeking appropriate support will help your child learn while also improving his or her confidence and sense of self-efficacy.        

(NOTE: Look at some of my past blog posts to find out more information about the testing itself.)

Your next step is to take your child to a psychologist for an evaluation.  While neuropsychological and psychoeducational testing have some differences in their etiology and focus, there is significant overlap and similarities between the two types of assessments.  The most appropriate type of evaluation can be discussed based on your child’s individualized needs.  In general, the clinician uses the evaluation process to understand your child’s strengths and challenges cognitively, academically, and socially/emotionally.  A comprehensive battery of psychological and educational tests is used, in tandem with more qualitative measures (e.g., a clinical interview and observation) in order to provide this understanding, clarify possible diagnoses, and develop recommendations.         

As a specialist who conducts neuropsychological and psychoeducational evaluations, I want to give you some some tips for how to talk to your child or teen about the upcoming evaluation.  Before you come in, there are some questions to ask yourself so that you can provide the most pertinent information about your child.  What behaviors have you observed in your child that have caused concerns or questions to arise? Please share with me any observations you can about your child’s strengths, weaknesses, personality or temperament, and academic interests. What challenges has your child’s teacher noted?  Are there specific academic skill areas in which your child struggles (e.g., reading, writing, or organization)?  Are there concerns about attention, anxiety, or mood?  These are important aspects that we will discuss during the parent intake.  This background information allows me to tailor the testing battery to best fit your child’s unique profile of strengths and challenges.     

Next, keep in mind that many children and teens who are struggling worry about taking another “test” that will show what is “wrong with them.”   Thus, it is important to be mindful of how you describe the process to your child. You should describe the upcoming evaluation in a way that will reduce anxiety and encourage cooperation.  I have experience working with a variety of children and teens, including some who are initially anxious or resistant to the testing process.  These children are able to work with me to complete the necessary items and typically realize that many of the activities are fun and engaging.  At the same time, there are ways that you as the parent can help to prepare your child before bringing him or her in for testing.

Discuss what to expect:

Talk to your child in general and in age-appropriate terms about what he or she can expect.  I typically avoid using the word “testing” with children as many of the kids I work with have already developed a negative association with exams.  Rather, I recommend explaining that he or she will be completing a variety of activities including puzzles, questions, stories, drawings, and games.  Some of these activities will be challenging and others may be easy.  The activities are used to help us understand how he or she learns best, or how to make school less frustrating.  For children who might experience test anxiety, I recommend stressing that these activities are not graded, and the only thing we ask is for them to do their best.  

Importance of being rested and well fed:

Make sure your child gets a good night’s sleep before the testing session. The best assessment is when your child is awake and alert.  If your child becomes sick, reschedule the testing session.  Make sure your child is well fed. A hungry child is a distracted child so make sure they have a protein-filled lunch or breakfast before the testing sessions.  I often recommend that children bring snacks as well.  

Schedule for success:

Consider the time of day when your child performs best.  I offer both morning and afternoon sessions, and often schedule testing sessions on the weekends.  Based on my experiences, I have found most younger children work best in the morning and mid-day, while many teens focus best in the afternoon.  When possible, avoid scheduling testing at a time that means your child will miss his or her favorite activity.  For example, if your child is missing a laser tag birthday party to come in for the evaluation, he or she is more likely to be distracted and resistant to working on the activities.      

I look forward to working with you as part of your child’s team to provide a better understanding of his or her strengths and challenges, as well as recommendations and follow-up consultation.   My goal is to be part of a team with you, your child, and his or her school in order to help provide the tools he or she needs for a successful school experience!  Please don’t hesitate to call me (703-825-0502) if you have any questions or concerns about the testing process.

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University.  Dr. Gottlieb works with children and adolescents, and their families, to provide comprehensive neuropsychological and psychoeducational assessments to better understand the individual child’s attention capacities, learning profile, emotional functioning, and behavioral presentation. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/

Encouraging Your Teen to Take Ownership of the Therapy Process

As a parent, it is your responsibility to ensure your adolescent’s physical and mental health.  Sometimes, this can mean bringing your teen to therapy, even though he or she is less than thrilled to be there.  As a child and adolescent psychologist, I have significant experience working with teens who may have mixed feelings about attending therapy.  Over time, I encourage the teen to take ownership of the therapy process including his or her own strengths and challenges.  When working with adolescents, an important goal is supporting the teen (and parents) as he or she transitions to a place where he or she can self-advocate.  This is not always a linear path, and the process varies based on the individual needs of the client.   

I begin by providing your teen with a safe emotional environment. The process starts with an initial intake meeting involving both the parents and teen.  Doctor-patient confidentiality and its limitations are explained at the onset.  For high-school age minors (14-17), I will talk with you and your teen upfront about how, while he or she is a minor (and therefore as a parent, you have certain legal rights to the content of therapy), it is in the best interest of everyone involved, and the therapy process, if the teen is afforded a certain amount of privacy.  Many teens won't feel comfortable opening up to their therapist if they believe their parents will be told the details of their conversations.  

At the same time, we discuss the limits of confidentiality, particularly for a minor.  For example, if your teen is in danger of harming himself or herself or others, you as the parent will be informed, as well as relevant professionals.  I also talk with the parents and teens about the importance of working as a team.  Typically, this involves periodic (e.g., monthly) parent meetings which can involve meeting with parents without the teen or together as a family session.  These meetings are not used to discuss the details of your teen’s therapy.  Rather, these sessions are designed to keep the parents updated on overall progress and ongoing issues, while also working to address potential family and/or parenting challenges.  I will let your adolescent know about these meetings, and will stress that I value his or her privacy.  However, I will also make it clear that parents are an important part of the therapy team.  Often the teen and parents are both involved when determining the topics for these meetings.  This teen-focused approach may change based on individual circumstances.  For example, when your child’s challenges are predominantly family oriented, your role in therapy will likely expand.  Additionally, the adolescent’s developmental stage is considered and adjustments are made to the therapy process, as appropriate.  

Therapeutic confidentiality is one of the most important steps to having your teen open up about his or her struggles.  It’s always my priority to help your teen understand he or she is safe to discuss anything with me, which ensures he or she takes ownership of the therapeutic process.  With this in mind, I’ve found the importance of meeting your teen where he or she is at emotionally, especially during the initial sessions. Some teens take longer than others to develop a rapport and become comfortable with the therapy process.  They may feel misunderstood by adults and view a new adult as another person who “won’t get them” and is “trying to fix them.”  Thus, while listening first is always recommended, it is particularly important for these teens that I listen to where they are at emotionally before working with them toward goals and change.  This, understandably, frustrates some parents who are eager to see change immediately.  I know how concerned you are for your child’s wellbeing; however, therapy can take time. I will work with you, as a parent, to provide support and understanding as I also work with your teen to take ownership of his or her mental health treatment.  

One issue that often creates tension between parents and teens is their use of technology and online communication (including social media).  For many teens, their online life is of great importance, socially and emotionally.  Online interactions can help teens connect and build friendships; however, they can also be sources of significant emotional stress.  Social media has changed the way teens experience peer pressure and is often a powerful tool for bullies.  Furthermore, these same devices are used for educational purposes, and it can be difficult to monitor your teen when he or she is on the computer, tablet, or smartphone.  For many of the teens I work with, this topic becomes an important part of therapy as they begin to learn how to manage their use of technology.  For a fourteen-year-old, parents may be more involved in monitoring the use of technology, with the goal of helping their teen develop self-management skills by the latter high school years.  I also work with parents to help them understand the impact of technology on their teen’s social lives.  In fact, as your teen’s therapist, one of my most important jobs is serving as a bridge of communication between you and your child, as well as school staff and additional professionals, when relevant.

I look forward to working with you and your teen to create a therapeutic environment that will allow him or her to take ownership of his or her mental health, while also supporting you as a parent.  Please call my office for more information (703-825-0502).

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University. Dr. Gottlieb utilizes an integrative approach to therapy, incorporating both CBT and Family Systems techniques. Treatment goals are discussed with the child/adolescent and family, and are developed with the individual child's needs in mind. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/

Understanding Adolescent Anxiety

When to seek professional help

As a clinical psychologist who specializes in therapy services for children and adolescents, I see a number of teens and preteens who are experiencing anxiety and depression. Google “rise in adolescent anxiety,” and you’ll discover that the mainstream media has been raising the alarm for the past decade about the fact that American teens are more anxious than ever. In fact, it seems like it’s almost “trendy” for teens to talk about their “anxiety” and “stress.”

But what does it really mean for someone to suffer from anxiety? What are some of the symptoms that parents should monitor? Most importantly, when should you seek professional help for your preteen or adolescent?

Let’s start by looking at some statistics. According to a 2016 article in Psychology Today, 25% of 13 to 18-year-olds have mild to moderate anxiety; 5.9% have severe anxiety. Girls are more likely than boys to be diagnosed with an anxiety disorder, and the median age of onset is 11-years-old.  

Anxiety is often related to depression. A study published in the Journal of Pediatrics in 2016 found that the prevalence of teens who reported a major depressive episode (characterized by a period of two weeks of significant depressive symptoms that interfere with one’s daily functioning) jumped from 8.7% in 2005 to 11.5% in 2014. However, despite the rise in teen depression, the study, which analyzed data from the National Survey on Drug Use and Health, reported that there hasn’t been a corresponding increase in mental health treatment for adolescents and young adults. That’s concerning because it means there are a growing number of young people who are being identified as having symptoms of anxiety and depression, yet they are not being treated. According to the Department of Health and Human Services, more than two million adolescents aged 12-17 reported severe depression that impeded their daily functioning. In fact, the American Academy of Pediatrics now recommends depression screening for all young people ages 11 through 21.

While many individuals experience periods of increased stress, an anxiety disorder entails excessive worry (disproportionate to the situation) that interferes with daily living.  Reasons for increased anxiety include social difficulties which can be exacerbated by social media; societal and parental pressures; media fears related to violence, terrorism, and safety; bullying (including cyber bullying); and school pressures such as over-commitment between school, sports, social life and family obligations.

As a parent, it is important to be aware of the signs and symptoms that your teen may be suffering from an anxiety disorder.  These may include restlessness or feeling on edge, fatigue, irritability, constant worry, avoidant behavior, poor concentration, difficulty sleeping, muscle tension, upset stomach, and shortness of breath.  

If you think your teen or preteen is experiencing anxiety and/or depression, I highly recommend considering therapy now rather than waiting for the symptoms to worsen.  Over time, untreated symptoms of anxiety and depression can lead to secondary challenges, including poor school performance, withdrawal from friendships, loss of interest in extra curricular activities, substance abuse, psychosomatic illness, and low self-esteem.

I have significant experience working with preteens and adolescents experiencing anxiety and depression.  My work often includes consultation with schools and other mental health and educational professionals. I use an integrative approach in therapy, utilizing a combination of cognitive behavioral therapy (CBT) and family systems methods.  Treatment goals are discussed with both your child and your family to develop a plan with the individual adolescent’s needs in mind. For more information, please contact me at 703-825-0502 to learn more about therapy services for your preteen or adolescent.

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University. Dr. Gottlieb utilizes an integrative approach to therapy, incorporating both CBT and Family Systems techniques. Treatment goals are discussed with the child/adolescent and family, and are developed with the individual child's needs in mind. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/