Dealing with phobias – let’s not jump in the deep end!

Most of us have something that we would rather avoid.  Some of the things we commonly fear are probably dangerous in certain circumstances, but we like to avoid them in all situations if we can. Spiders, snakes, heights, flying, clowns, the dark…there are a long list of things that can unsettle people from time to time.

When someone has an extreme or irrational fear of something and the fear is causing them significant issues in their lives, we call this a phobia.

A fear of a specific creature, object or situation is referred to as a simple or specific phobia – although some people who have simple phobias would not see them as being simple.

Some phobias can be extremely debilitating making it hard for people to go about their day to day lives.  Many parents will know of the troubles that a fear of the dark can cause a household when a little person needs lots of support to get to sleep at night.   I have seen someone with a spider phobia that was so significant, she was having trouble sleeping for fear that a spider may crawl into her mouth. She also avoided walking on any grassy areas when she could.  I’ve also had quite a few little ones over the years who have been phobic of balloons.  This has meant they’ve often avoided birthday parties and they have made their parents cross the road to avoid shops that might have balloons on a display or sign in their shop front.  One person I saw could not even handle people saying the word “balloon”.  Clearly, all of these little ones had phobias that were getting in the way of their lives in way too many ways.

Some people are born with a predisposition t o develop a phobia and we do know that anxiety can run in families.  Most phobias develop in our young years.  They might be precipitated by a scary experience.  In fact, most of the young people I have seen in my practice with phobias often blame a brother or sister for exposing them in a pretty scary way to something that they then stayed sacred of for a long time.  It may also be that the younger member of the family has watched a movie that might have been scarier than they could manage.

Stephen King and big brothers might have a lot to answer for, but in this day and age, parents also need to be mindful of scary internet content, too.

A internet gaming character called Freddy in “Five Nights at Freddy’s” also has a lot to answer for when it comes to generating fear in those who may be too young to understand.

People, young and old, will go to quite a deal of trouble to avoid the things that they are phobic of and this is where a psychologist might focus the main thrust of their treatment of a phobia.  In the early years of psychology, phobias would be dealt with by exposing the person to the thing they were frightened of and forcing them in that situation in what was called “flooding”.  When I think of flooding I often think of Indiana Jones movies where Dr Jones has to fall into or crawl through a pit of insects or snakes.  However, we would be unlikely to treat phobias in that way anymore.  We really want to focus more on people learning how to manage rather than just being thrown in the deep end.

Instead, we usually work with the child to walk through a series of graded exposures.  We would firstly generate a scale of scariness with the person who is scared.  In the case of balloons, it might be that they might rate a picture of a balloon as about 20 scary points, a video of balloons 30, touching a deflated balloon as 40 , and inflated balloon as 80 and popping an inflated balloon as 90.  Everyone will likely generate a slightly different list.

We have to be careful we do not assume that all phobias are exactly the same.

We would then teach the child some things that could do to manage the anxious arousal (maybe breathing exercises and some self talk) and we would start with the lowest level task and help the person manage that fear until it was very easy for them.  We want them to really take their time and actually manage rather than just hold their breath and do it quickly without registering it.  When they and really mastered their fear at one level then we would move up to the next level.

Interestingly, some knew research is emerging to suggest that sometimes a dose of a certain antibiotic (D-Cyclosterine) can assist children who are getting treatment for phobias.   It is thought that the antibiotic works on learning and seems to assist children progress through their graded exposure tasks.

So, if you have a little one who is fearful of something, if it’s at the point where it is significantly interfering with their lives on a regular basis and the fear is extreme and very distressing, be sure to seek some psychological help.  If you have noticed some fears starting to develop, while it is tempting to help your child avoid the things that distress them, see if you can encourage them to face their fears in a gentle and gradual way.  Don’t drop them in the deep end of their fear.  Negotiate an easy starting point and build from there.  Rewards for being brave will also help.

Oh, and as always, adults who model brave behaviour in the face of simple fears will be much more helpful than adults who freak out!

How to help your kids listen to you

When an adult wants a child to listen to them, they usually have two kinds of things they want them to hear. Either …

(A) they want the child to do something – turn something off, bring something to them, pick something up from the floor, get their lunchbox, clean their teeth, or,

(B) they want to have a deep and meaningful conversation about something that is really important to their personal  or family values and they want to tell the young person they are concerned or worried about something.  They want to impart certain tips or a viewpoint  – strangers, friendships, smoking, drugs, or relationships.

Feeling heard by a child, whether it is to tell them to do something or to impart deep and meaningful advice, has a lot to do with how you approach them and assist them to manage their attention.

When an adult wants a child to listen because they want them to do something straight away, psychologists call this “compliance”.  When an adult has asked a child to do something and the child has not done what they asked, we call this “noncompliance”.  Noncompliance is acommon complaint of parents or adults caring for children.

For many years now, there has been good psychological research on the best ways to assist your child to comply with your requests.  A lot of the bits that need to change are actually to do with the ways that the child is given the request.  In the literature, this is called a “command”.  If you really want to increase a child’s rate of compliance, it will take some effort on the adult’s part.

  1. Get your child’s attention. I’ve talked before about the complexities involved with all the processes required to allow a child to screen out unimportant things from their attention and respond to important things.  Now in this day and age, you have to compete with a lot of interesting stuff – computers, tablets, phones, television, music or even friends.  However, before you ask a child to do something, you need to make sure that your child is paying attention to you before you tell them what you’d like them to hear.
  • Go to them,
  • Use their name and
  • Establish eye contact.

I’m afraid that yelling at them from the kitchen across the house to wherever they might be watching their favourite DVD or playing their favourite game  will not enhance the likelihood that a child will do what you want them to do.

  1. State what you want clearly – you will need to be sure that you do not use too many words and that you watch the tone of what you say.
  2. Maintain eye contact until the child has started the behaviour.
  3. Be sure to let your child know that you have noticed that they have done what you have asked.

As a child gets older, you still need to be sure that you have their attention when you want them to listen to you.  In a dangerous situation, most adults will have an Adrenalin-fueled tone to their voice that will assist a child to attend, but in day to day family life the adults can help a child to learn to listen by being mindful of what they are competing with when it comes to a child’s attention.

If the child is engaged in something that is really interesting to them, you will have a lot to compete with in order to be attended to and heard.

If you are in a bit of a negative cycle and you feel like you are not being heard, sometimes it’s best to start again and choose your timing wisely.  If it’s a child’s favourite television show, wait until the show has ended or until there is an advertising break and then approach the child.

If your child is playing a game online, you really need to get to know the sort of game they are playing.  A child can put a lot of effort into some games and if they miss a crucial part because an adult wants them to do something right at a hot time in the game, then the likelihood of them listening to you or complying will be low.  When your child approaches you for time on a game, ask them about the game and how long they need to play and help them budget their time around chores and bedtimes.  They may be best to put the game off until say, after dinner, rather than have it likely interrupted around chore o’clock.

If the sort of listening that you would like your child to do is the deep and meaningful kind, then your strategy should be a little different.

Deep and meaningful conversations are best done one-on-one with nothing getting in the way of anyone’s attention – yours or theirs.

With a younger child, it can be handy to share a book together – even more handy if the book is about the subject that you wish to broach.  Then, in discussing the book, you can listen to your child’s take on things and then add any wise advice that you would like to impart.  Other quite shared activities could be constructing toys, colouring-in or some sort of repetitive handicraft.

Sometimes, with a teen, a road trip or a walk can be a good time for a deep and meaningful conversation.  If the topic is a bit of an embarrassing ones, I think many teens feel better talking while you both look ahead at the road instead of having to face you head on.

Paying attention to a child’s attention and helping them to screen out competing stimuli, can really help you be heard.

Of course, if you catch your child attending well to an adult, be sure that you tell them that you liked that way they attended to that person.  Oh and, as always, be careful that you model good listening, too.

Giftedness: A bonus or a burden?

Definitions of giftedness vary, but generally identify that a gifted child has above average ability in one or more areas of human potential (intellectual, creative, social or physical).  Also, there is a sense that this ability is a natural ability as opposed to one that has been trained.  Usually, the gifted are considered to fall in the top 10{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de} of ability range for their age.

A review of the research on giftedness discovered that most parents are reasonably accurate when it comes to labeling their child as gifted.  Whilst some people do seem to broadcast that their child is gifted, other parents do not want to make a fuss about their gifted child.

Identifying giftedness as early as possible allows us to support a child to fully develop in their area/s of talent and to watch for some pitfalls that may accompany having great abilities.

More formally, giftedness is usually identified by psychological assessment that will probably involve an intelligence test and an achievement test.  These allow comparison between one child and what is expected of a child of that same age.  Obviously, though, if a child is gifted in a creative or physical domain, an IQ test may not show this, so it’s important that an assessment involve looking at the child progress of development and any of their records as well as the observations of their teachers, coaches and the like.

Gifted does not mean good or better.

Gifted children have an advanced capacity to learn and whether this capacity is met or actualised, will depend on the opportunities they are offered.  In fact, it is not unusual for a gifted child to achieve poor grades at times as some gifted children will purposely dumb things down if they think their capacities will show them in a bad light to their friends or ease any pressure or discontent they feel.  It is also possible for a gifted child to have a learning disability.  A child may have superb potential in one domain of learning, but struggle to achieve in another particular area.

Gifted kids can become bored and frustrated if the work they are offered in school does not stimulate or stretch them.  Sometimes, boredom can lead to behavioural issues, poor learning or study habits, or even a disengagement from school. I have seen children in my practice who have spoken about trying to reconcile some of the gaps between themselves and others.  One thought that because all of her friends found mathematics difficult, that she must have been doing it incorrectly.  So, she started to convert mathematical problems to Roman numerals in her head and then of course this was very difficult.  She started to get things wrong, but she felt more like the others.  In my experience, gifted children can be prone to over thinking things at times.

There has also often been the concern that gifted children will be more often subjected to more bullying.

Research  into bullying and victimisation, however,  has found that there was no difference in the rates of gifted children as bullies or being bullied.  Rates of bullying varied from school to school and it appeared that bullying had more to do with school culture than whether or not the child was gifted.

When it comes to giftedness, it does seem that there may be a link between dysfunctional or unhealthy perfectionism and the goals that parents have for their children.  In one review of the literature, it was found that troubles with perfectionism were more likely associated with parents who had performance goals or wanted their child to meet certain standards in certain areas as opposed to the parents who had an emphasis more on wanting their child to be able to continue to learn.

Education politics often focus on those students who struggle with the curriculum and do not always allocate resources to gifted students.

Parents of gifted children often become highly involved in schools.  Services offered to gifted children vary broadly from school to school.  Some gifted students are home schooled or their parents seek out private home schooling.  However, gifted children don’t necessarily need an expensive education.  They do need a teacher that can respond to them to continue in a way that will extend them in the areas of their high abilities.  Parents of gifted children often report that having a gifted child can be quite exhausting.  Many parents of gifted children work hard to provide a home life that is enriched with additional intellectual stimulation.  Especially in the early years, when a gifted child starts school, the environment at school may be less stimulating than the environment that the switched-on parents have been providing at home.

Gifted children also need adults who will expect that their elevated abilities will not necessarily be across all areas of learning or achievement.  Children who are gifted, like other children, will have asynchronous development. That means that they won’t keep developing at the same rate across all of their human abilities.  Gifted children need to have teachers, parents and schools that can track how they are going and adjust what is offered to keep the child at that “just right” level of stimulation.

Some gifted children will be accelerated at school.  Acceleration is when students move through the curriculum at a faster rate than usual.  This might mean that they skip a grade or start some higher education options earlier.  Many gifted children may have a situation where they do most of their work in the classroom, but may spend one or two subjects (eg maths or IT) with a higher grade level.  There are some who worry that accelerating a child can be harmful because as we all know, a child’s social-emotional development may not match their learning abilities. There is often a concern that putting a gifted children with older students will leave them vulnerable, but researchers tell us that there is no evidence that acceleration has a negative effect on the social-emotional well being of a gifted child.  In fact, gifted students who are accelerated tend to outperform those gifted children who are not.

So, when it comes to supporting children who have significantly higher abilities than others, it is important to:

  • Remember that clever kids are still kids and encourage their children to ask questions and use their imaginations through play
  • Create a home that encouraged self competence, models positiveness and promotes learning over achievement.
  • Seek to develop supportive relationship with school or seek other ways to extend the child at home or in the broader community.
  • Carefully choose a school that will cater for the child’s needs and one that will welcome parents’ input and feedback.
  • Monitor their general happiness levels and be careful not to expect more from them because they can have an intelligent conversation with you does not necessarily mean that you should ask them age-inappropriate advice on how to run the family budget or seek relationship advice. React to children in a developmentally appropriate manner and allow them to make decisions commensurate with their age.

Just because they can read a chapter book earlier than their peers does not meant that they can go without that special shared time with a story or cuddle just before bed.

Overall, it takes a village to bring out the best in children and gifted children are no exception.  We need to be sure that each child receives support that takes into account their abilities as well as their age and that does not assume that their abilities will be equal in all areas or that their ability to cope will match their special abilities.

For more information, you can try these websites:



Anger Issues: Innies and Outies

I love anger.  You’re probably not supposed to have a favourite feeling because all feelings are important, but I do love anger.  Anger has so many great functions.  It can energise us. If unleashed, our anger can help us run faster, bite harder, and throw, move and break bigger things than we can when we are not so angry.

If emotions are the human dashboard that guides us through our body’s journey through life, when someone’s anger flares, it’s a great warning sign.  Anger is a way our body and brain use to yell at us to pull over and make sure we pay attention to something that is not quite right.

Often, anger is behind us when we finally decide to do something about a problem that has been building or neglected for quite some time.  Anger can be useful to get stuff done.

However, anger can also be dangerous and debilitating.  When anger gets out of control, it can be the emotion behind hurtful and destructive behaviour.  Anger can give kids, and adults, a bad reputation and make others disinclined to want to spend time with them.

An important part of parenting or educating a child is helping them to know how to get the best of their anger – helping a child get the best of the motivating and problem solving aspects of anger without hurting someone, breaking something or making a rash decision.

Sometimes we need to consider is the anger a problem, or is the child’s situation the problem.  Some young people have plenty of legitimate things to be upset and angry about.

Managing anger is one of those Goldilocks kind of things.  It’s important that we get the balance “just right” – Expressing too much anger in the wrong kinds of ways at one end and holding anger in and letting it build on the other end.  When we consider anger, we need to consider the problems that might go with externalising anger (letting it out) as well as internalising anger (holding it in).  So, just like belly buttons,  anger problems in kids and adults are usually of two kinds – “outie” anger issues or “innie” anger issues.

“Outie” anger issues are probably those that usually come to mind when we think of anger problems – yelling, profanity, damage to property, verbal abuse, road rage and physically hurting others.  Typically we help people manage outwardly expressed anger by understanding the things that trigger them and learning to take alternative action to deal with the tension that rises in them – to take a slow breath, take other’s perspectives, think about consequences, take a “time out”, exercise or do some hard physical work and learn to problem solve.  There are also new programs emerging that assist those to manage their outwardly expressed anger by tuning into the part of themselves that is grateful for what they have and to be compassionate towards others.  These processes take time, but do work as long as they are modified for each individual’s age and circumstances.

“Innie” anger or anger that is held in or internalised is also a problem and can have big implications for mental health and interpersonal functioning.  Some will hold their anger in until they reach a point where the smallest of things will set them off.  For those watching from the outside, the reactions seem out of proportion with the trigger. That’s usually because the trigger may have little to do with all of the other problems that have been held in and not expressed or dealt with.  When this kind of anger erupts it can take everyone by surprise.  It can seem confusing and can be very hard for a person to control.

“Innie” anger can also be linked to experiences of shame or self loathing.  A young person may learn to respond to something that makes them angry by appearing cheerful for a range of reasons – they may not want to bother others or stand out, they may be told by people who are important to them not to be angry, they may feel that others won’t like them if they are angry or they may be punished for expressing anger.  Instead, they develop a strategy for dealing with things where the  outside part of them doesn’t match the inside.  They lose touch with their ability to feel and express healthy emotions and this can have substantial mental health consequences.

It’s important that we help young people to know, label and understand emotions in themselves and other and learn how to express them in ways that are healthy.

Properly expressed anger is a fine and powerful thing for everyone to have in their interpersonal armor and coping tool box.

To encourage young people to express their anger in useful and safe ways we need to:

  • Model appropriate anger – Speak up in appropriate ways, let people know when we are upset by things and take necessary, responsible action – join a protest, start a group, write a strongly-worded letter, articulate the problem and ask for what they would like to be done
  • If you are responding to a child’s anger, be sure to help them label the feelings and be clear that you want them to manage the feeling differently rather than to banish the feeling
  • Encourage the safe expression of individual opinion in your household or school
  • If someone hurts someone else with their anger outbursts, be sure to have them make some amends – again for the behaviour and not for the feeling
  • Encourage exercise, loud vocalisations (some, myself included, might call that singing) and asking for help.
  • Develop compassion for others and for ourselves by modelling kindness and recognising others needs and our own needs, too.

Anger can be awesome, ferocious, strong, protective and proud. Without anger we can be vulnerable and taken for granted.  Turned in, anger can fuel shame and sadness.  The key to anger is feeling it, knowing it, showing it in the right kinds or ways and then using it’s powers to get problems fixed.

How long has it been since you gave your anger some attention?



Not happy with how we look: Negative body image & Body Dysmorphic Disorder

Can you imagine what is would be like to have your beautiful young son or daughter come to you with such hatred for their appearance that they are begging you to take them to a plastic surgeon?

I think from time to time we all check out our image in the mirror and make an evaluation of it.  Some people (young and old) make such critical evaluations of their appearance that they start to believe that they are unable to contribute to any sort of life because of their appearance.  When this becomes debilitating, we usually consider a diagnosis of Body Dysmorphic Disorder.

Our body image is different to an image of our body.  An image or photo of our body captures how it is at any point in time.  Our body image, though, is the representation we have of our own bodies.  It is essentially a judgement or series of judgements we make about how we think we appear.

When you ask people to tell you about their bodies, rather than give you facts , for example, on the colour of their hair or their measure height they usually give you judgemental words like plump, skinny, solid, pale….even ugly.  For most of us, this is not a problem, but for a few, the way their body image becomes central to their level of happiness.

When we determine our worth or happiness by our judgement of how we look, things can get pretty complex.

Body Dysmorphic Disorder or BDD is a diagnosis used when there is an intense preoccupation with a perceived flaw in physical appearance. (For most BDD it is with people’s own appearance, but BDD by proxy can mean that parents become obsessed about flaws in their children’s appearance).  Individuals with BDD often spend lots of time checking and worrying about a particular aspect of their appearance. They may spend a lot of time comparing their appearance with others, and engaging in behaviours designed to try to hide or conceal the area of concern or generally try to avoid being seen by others.

It is thought that BDD affects 1-2 percent of the population and it does not seem to vary with gender.

In the clients I have seen with Body Dysmorphic Disorder, they usually focus on one feature in particular – their teeth or the shape of their lips and sadly, if they do take steps to have these adjusted to their liking (people with BDD are often frequent customers of plastic surgeons), it does not always mean that their happiness improves and they will then go onto to target the next part of their body that they find the most displeasing.

The thinking if ultimately something like “if I can just change the way I look, my life will be wonderful”

BDD is  much more than just vanity or being dissatisfied with how they look, it can become obsessive and often co-morbid (or exists together with) with depression, anxiety (especially social anxiety) and I have seen it accompanied by self harm and suicidal ideas, too.  It can make it hard for a young person to leave the house, go to school or uni, or meet up with friends…or if they do, there needs to be much time trying to cover or adjust a certain aspect of their appearance.

This means BDD can interfere with living with others.  Those with BDD will often continually seek reassurance about their appearance or spend lengthy times in the family bathroom or be frequently late for work or school. There is often quite a deal of secrecy and shame associated with BDD and BDD can quite often be associated with financial difficulties, too, with money being spent on treatments or cover ups.

Oversimplifying it, but in an attempt to explain how BDD starts and is maintained we could consider it  going something like this example (although imagine it being much more complex/less staright forward):

  • Someone tells me I have a crocked nose
  • I believe that I have to look perfect to be liked by others
  • I spend hours trying to cover up my crooked nose with makeup, but that all gets too hard and the products I use have cause swelling and redness, so I start avoiding going out whether others will see me crooked nose. I keep checking with the people I love about my nose, but that doesn’t satisfy me for long.
  • I stop socialising, friendships drop away and I never get to test the idea that I have to look perfect for others to like me or want to be friends with me.

Where does BDD come from?

It is thought that most BDD starts in adolescence and that much goes untreated for many years.  Adolescence is a time of many body changes, and also for some, an increased risk for acne, but other times of life where the body changes can also be triggers – like the emergence of wrinkles or loss of hair with aging or new scarring after an accident or medical issue.

Those at risk of BDD or serious negative body image have often been teased or excluded and are also more likely to associate with peers or even family members who are very focused on appearance. Certain personality types may be more prone but also, social and cultural pressures are thought to contribute including social media. I have also seen BDD that began following a period of childhood and family trauma.

There are so many industries that depend on us being dissatisfied with our body image – Industries worth billions of dollars.  They flood the media with direct and indirect messages about happiness being derived from appearance.

How can we prevent it?

Sadly, at this stage, we don’t’ have any strategies that definitely prevent BDD.  I like to try to educate children about the powers of advertising and the tricks marketers pay to make us buy things.  However, the best the research can suggest is that people seek treatment early.

So, if you are a parent of a teen, it is usual for them to spend more time in the bathroom and in front of the mirror as they approach puberty, but if the checking is accompanied by frequent negative statements about their appearance, constant comparisons of themselves to others, regularly needing reassurance that they look okay, and avoiding socialising or leaving the house, you  should increase your level of concern.

The first point of call should be your GP or Mental Health professional.  A proper diagnosis is essential.BDD has some similarities to Eating Disorders in that it is also about body image, but the preoccupation is usually different, with eating disorders normally being about weight and shape and usually leads to a change of eating patterns.

Treatment can include medication and psychological intervention.  Psychological treatment is focused on tackling negative body image by building body acceptance and using techniques to help reduce the amount of time spent obsessing, checking or seeking reassurance about appearance.  Psychologists can also help with uncovering and challenging assumptions and negative predictions that link appearance with ideas of success and happiness.  Psychologists can also help a person to tackle their avoidance or behaviours that set up self fulfilling loops around unhelpful assumptions

There is some very useful information at the BDD Foundation website.

If you have young children (preschool and early primary) and you are concerned about them developing a negative self image, perhaps you could share “You are Like You” with them to open up some conversations about their thoughts about themselves.


A good night’s sleep

“Get back into your bed and go to sleep!”

“But I just need a glass of water!”

Sleep – we all need it.  It’s a time when our body does important rest and restorative work and our brains take time to process information.  Sleep has a big role to play in our physical and mental health.  Troubled sleep can be linked to the well being of a child or others in the family and poor sleep can also indicate other mental health problems for the child.

As an infant grows, normally their sleep patterns will settle or become more consolidated. That is, instead of getting their sleep in a series of naps,  sleeping hours and waking hours become longer.  Sleep patterns change as a child grows – at first, most often during the first  6 months – bubs will have 6 to 8 sleeps in a 24 hour period and as they grow, they start to consolidate or join  up these sleeps – hopefully with more at night and less during the day.

There is variation in how much sleep we need, but for adults generally it’s 8 hours, primary school 9-11 hours and preschoolers around  11 to 14 hours.  Newborns usually sleep 14-17 hours, but not all in one go.

Two main things determine how sleepy we get.

  • Thing 1 – sleep will depend on how long it has been since we last slept and
  • Thing 2 – circadian rhythms – our internal body clocks mean we get sleepy at certain times of the day regardless of when we last slept

We can measure sleep in different ways.  We can have people report subjectively on their sleep by, for example, keeping a sleep diary, or we can use machines like polysomnographs. In fact, studies using high tech equipment indicate that the EEG activity in different parts of the brain, front versus back or left versus right, appear to reflect different ways that the brain organises itself as a child grows.

It is thought that sleep has strong links to the way brains process information and poor sleep or not enough sleep can affect thought patters, emotion and behaviour.

Sleep problems vary, too.  People can have troubles getting to sleep (called sleep onset problems) and these can start in preschool and last well into adolescence and adulthood.  People can experience insomnia (trouble getting to seep or staying asleep), sleep-related breathing issues (sleep apnoea, tonsillitis), hypersomnolence or too much sleep (narcolepsy), circadian rhythm issues, parasomnias (sleep terrors),  and sleep related movement disorders (restless leg syndrome).

Sleep problems can originate from a number of casual factors and that is why it is important to get a proper assessment if sleep is becoming a big problem for a young person.

Sleep problems can be caused by:

  • being uncomfortable or environmental issues
  • pain or illness
  • neurodevelopmental disabilities like autism, certain syndromes like Rett or Tourette’s syndromes and intellectual disabilities
  • medications and stimulants such as caffeine
  • certain mental health issues – depression, anxiety, conduct disorders, ADHD or trauma
  • parent mental health, parent stress and parenting skills

Sleep issues are linked to mental health disorders in a “chicken and egg” way.  Some sleep issues are a symptom of mental illness and other sleep issues may contribute to the development of a mental health concern.  When it comes to mental health, we definitely shouldn’t ignore someone’s sleep issues and it’s important that clinicians take the time to ask people about their sleep.

Before we get into what helps, it’s important to think about what does not help. The plethora of information and opinions available to parents is overwhelming and one of the areas that people love to share opinions about is children and sleep. Remember before about the age of six months, it is very likely that a bub will wake in the night and that this is what most babies do.  Over time, they should start to condense the times that they sleep having fewer sleeps during the day and more, longer sleeps at night.

Warning –  If you are having a sleepless night with your young one, don’t go surfing the net…especially when you, yourself, are sleep deprived.  You may drown in a sea of opposing advice about how to settle an infant.  Should you co-sleep?  Should you feed in the middle of the night?  Should your young one be in bed by a certain time?

There are plenty of people who will give you an opinion.  You need to choose something that is inline with your parenting values and you need to weigh up the pros and cons of your child, their needs, your health and family functioning and your ideal values before deciding how you might proceed.  I know a lot of families choose very attachment focused parenting options sometimes and these will usually include co-sleeping and are lovely if families have the time, determination, energy, health and support to manage the impact of co-sleeping.  However, if a lack of sleep or disturbed sleep is impacting on your child’s happiness and wellness, your day to day life, or your relationships with important other people, then it’s worth getting some help and prioritising what is important to you.

The things that can help with sleep problems will vary depending on the nature of the problem, but might include:

  • routines and methods to settle young ones . Generally speaking, routines help our brains to predict what is coming next and this can help to calm us.  However, the things that calm each of us can differ – a lot!  One of the earliest tasks of parenting is to work out what will soothe your baby and what upsets them.  There are differences, even with babies from the exact same parents – How you swaddle them , when you bath them, when you use more vigorous play and rocking, how much they like to be held and touched and by whom.
  • avoid caffeine and stimulants (including computer or light exposure –  the light from computer screens and tablets can be quite stimulating)
  • try to have a regular bedtime and make night time boring – not too much active play on the way to bed!
  • try to have children use their beds just for sleeping. Bed needs to be comfy, not fancy.
  • consider light and dark exposure. Make it clear that there is a day time/night time difference in the amount of light in the room where you want the child to sleep
  • behavioural treatments can help with bonuses for bedtime routines, staying in your own bed all night, for tantrums around bedtime and also gradual exposure for removing an adult from the room when the child is going to sleep
  • assistance with nightmares and dreams – helping kids get back to sleep after a nightmare is on of my favourite things to do.  I like to help them with a little bit of education about the brain and dreams, some grounding exercises and lots of happy imaginings.
  • medication or surgery. Where it is medically indicated, some people sleep better with medication and your GP or paediatrician will be best to guide you.  If a little one’s sleep is regularly disturbed by breathing or illness issues, surgery to remove tonsils and adenoids might also help.

So, generally, if a little one is having trouble getting to sleep, there are a range of factors that could be causing the issue – medical, behavioural, environmental or familial.  The best treatment will depend on tackling the likely causes and your family doctor, paediatrician, or maternal child health nurse will be able to help you unravel the possible reasons.  A Psychologist can help with some of the behavioural aspects of getting to sleep and also any mental health concerns that might be contributing.  Overall, sleep issues are well worth investigating and treating.  A good night’s sleep can help us manage many of life’s day to day hassles and enjoy life’s day to day delights.

For more, especially on adult sleep, the National Sleep Foundation ( has some excellent information.

Procrastination- helping young people “get on with it”

“I’ll do it later.”  “I’ll start tomorrow.” “I’m waiting until I’m in the right mood.” “I work better under pressure.”  “I’m waiting for the rest of my group to get started.”

We all put things off from time to time or find it hard to make a decision.  For the most part, we can usually come up with the goods in time to avoid dire consequences.  However, some young people get so stuck in putting things off that it starts to have a big impact on their life.

Some people might procrastinate about health checks, career choices, finances, chores, and relationship issues,  but the type of procrastination that we know the most about is academic procrastination. Because the majority of research is done in universities, it’s much easier for researchers there to utilize the students in their courses when they study (we know a lot about the psychology of first year under-graduate psychology students).

We do know that chronic procrastination is difficult to change and, like most things in psychology, procrastination is complex.

Some people procrastinate a little bit and some people do it a lot.  Some do it to the extent that their lives, and perhaps the lives of others they care about, start to be affected.   Those students who procrastinate regularly risk poorer academic performance, including withdrawing from courses or failing to complete requirements.

In an attempt to untangle the complexity of academic procrastination, one of the things that researchers  have found is that there is a link between academic procrastination and certain personality traits.  Procrastination is associated with certain personality types; with certain levels of motivation; with stress, anxiety and mental health; and then it can still vary from situation to situation.

Generally, students are less likely to procrastinate if they are conscientious. Conscientiousness is about having a desire to do well and to be careful and vigilant. However, even the most conscientious student might procrastinate if they are frozen by anxiety or stress in a situation where, for example, they really want to please someone.  Procrastination is also affected by how close the deadlines might be and the size of the reward people are working towards.

Some people procrastinate because they are worried and some procrastinate because they are not worried enough!

Further clues to what might be going on for a procrastinator can be found in the students’ typical pattern and mood as well as their excuses, rationalisations or justifications.

Some people procrastinate because of perfectionism or fear of failure.  These anxious people form only a small proportion of the overall group of procrastinators, but usually they are the clearest to define or to see what might be maintaining their delays or indecision. Anxious procrastinators become confused, uncertain or fearful.  These students usually need help that targets their fears and worries to help them get unstuck.

However, the most common procrastinators are those with a high need to socialise and preference for a lot of variety in their life – the students who have a desire to try a big variety of things or who find it hard to tolerate boredom.  Some cite social reasons for procrastination.  Some are easily swayed by friends or offers to socialise.  Others procrastinate as a means of being a little bit antisocial or rebellious.  Still others procrastinate because they’re discontent with studies or have lost interest in, or energy for, the overall goal.

If you are a parent, teacher or an educational counsellor, you may well be keen to know the best way to assist a student who might be delaying work to the point where you can see it is starting to have a negative effect on their work and/or their mood.

Assisting someone to overcome procrastination is not a one size fits all approach because of the complexities involved.

It’s important to consider the various factors affecting the student at any given point in time and listen closely to their excuses and justifications to help guide you to assist them.

Not all procrastination needs treatment for anxiety, but those prone to anxiety, perfection and fear of failure may need some help from a mental health practitioner. If your child is prone to perfectionism or fear of letting other people down, try to help them celebrate and learn from mistakes, to ask for help and to broaden their interests to things that they may not be so good at.  See my previous blog.

Sometimes, there may be a need to improve conscientiousness by working on impulsiveness and self discipline.  At times, we need to help children learn to regulate their behaviour.  There are a number of in-school programs being adopted in Australia such as RULER  or Positive Education.  It will take researchers some years to work out whether these programs assist to reduce academic procrastination, but it makes sense to work on learning how to label and understand your emotions and learn to adjust them for different environments.

Those who cite social distracters may need some help with assertion or learning to say “no” to persistent social offers (see my blog about teaching children assertion)  or use available software to help them manage their social media use.

If “energy’ is an issue, perhaps have a student reflect on their own patterns of energy.  Are they a morning person or does their brain come alive at night?  Also remind them about exercise and eating well.

For some, it can help to look at their goals and rewards.  Break big jobs down into smaller ones but also make sure that the jobs are chained together for one big endpoint or reward – set smaller sub-goals, but don’t lose sight of the big one.

Overall, if you notice a student in your household or classroom is procrastination, don’t put off bringing it to their attention and asking if they would like some help with it.  Asking early and providing the right support early may prevent academic failure or withdrawal.

Assertion: Helping young ones manage difficult people

There are few certain things in life.  Sadly, like head lice in schools, there will likely always be difficult people that cross paths with your child from time to time.  And just like head lice, it’s wise to check in with your kids from time to time to see whether they are dealing with someone they are finding difficult and to help them with a plan to manage.

Now, when I say check in with your child, you would know by now that I don’t mean putting them through the third degree.  Most, but not all children will tell you if things are difficult with someone at school.  If you have noticed a change in your child’s mood after school that’s lingering over a number of days, it’s wise to check in with them directly.

Standing up for yourself and asking, respectfully, for what you need are important skills to learn – to learn to listen and understand others and to assert yourself.  Assertion skills are handy throughout our total life span, but of course we need to make sure we teach respect for ourselves and others in age-appropriate ways.

If your child complains of a bossy friend, it can be handy to talk about the assertion spectrum and balance in interpersonal relationships– although I don’t call it that with kids.  I tend to refer to it as the “Cool, Wussy and Aggro Seesaw” thing.

If we are aiming for a balanced and respectful relationship, we need to understand aggressive, assertive and passive behaviour…..Introducing Aggro, Cool and Wussy.

Little Aggro person is always angry and bossy and other people tend to feel a bit bossed round when they play.  If friendship is like a seesaw, then Aggro definitely gets the seesaw off balance.  Aggro is the one who likes to make other people feel sad (because it makes Aggro feel better).  Little Wussy person is the one who is sad to be around, tends to put themselves down, complains or whinges, is not very confident and looks lonely.  On the Friendship Seesaw, Wussy people usually put themselves in the down position, making it easy for other people (especially Aggro ones) to pick on them – not that anyone should pick on anyone…but if you want to avoid being put down, you need to make sure you’re not repeatedly looking or behaving like a Wussy.

Then there’s Little Cool Person.  Little Cool person is the ultimate in keeping the friendship seesaw balanced.  Little Cool person looks happy and takes care not to put others down.  Little Cool takes turns, shares, listens and speaks up. If Little Cool has a problem, Little Cool speaks up in a clear voice and asks for help (not whinges).  If Little Cool starts to feel a bit Wussy or Aggro, Little Cool will work out ways to make him or herself feel better – have some quiet time, do a drawing, go for a run, find someone else to play with.   In sessions, we might make some puppets or paper-plate masks and model Cool, Wussy and Aggro options for different problems.

With the Cool, Wussy, Aggro thing and the Friendship Seesaw, kids can start to think about their own behaviour as well as that of others when things start to get difficult.

As teens, interpersonal difficulties become much more strongly felt.  Teens can, for the most part, more easily take the other person’s perspective and understand some of the factors that can be making that perfect difficult to be around or to spend time with.  With assertion, teens can also begin to understand that alongside assertive, passive and aggressive positions, comes the passive aggressive position that leaves others feeling manipulated and confused.

It’s especially important that teens learn to communicate with others respectfully and can ask for their needs to be met without needing to rely on manipulating others or having others guess what it is they want or need.  Kids need to learn about how to say what they want or feel without blaming others.  They also need to know the importance of speaking up about things that are bothering them rather than leaving their needs and wishes unexpressed.  Helping them to use assertive “I statements” can assist.  Using “I statements” the emphasis is on saying what “I feel”, in what circumstances (“when”), and what “I would like”.  “I feel concerned when young people can’t ask directly for what they need and I would like adults to help them to communicate respectfully and comfortably”.  Assertive communication takes some practice and, as always, is helped by some good modeling from the important people around our young ones.

The way we manage difficult people in our life has significant impacts on our happiness and stress levels.  The inability to solve interpersonal problems without causing distress to oneself or others is characteristic of some serious adult mental health concerns.  The ability to solve interpersonal problems can prevent much life angst.

Interpersonal difficulties are a great time to have children start to look at their own behaviour as well as the behaviour of others. With the Cool, Wussy, Aggro thing and the Friendship Seesaw, kids can start to think about their own behaviour as well as that of others when things start to get difficult.

Self Harm: How could a young person do that to themselves?

In clinical psychology or mental health realms, when a young person deliberately causes harm to him or herself as a way of managing or communicating distress to others, we refer to this as self harm.  Self harm in times of distress most commonly includes cutting, burning, re-opening old wounds or head banging and the results can be superficial or very extreme and requiring hospitalisation. Self harm can also co-occur with other distressing conditions such as depression, anxiety, substance use and eating disorders. Whilst not all young people who self harm are suicidal, there is definitely an overlap and when someone is self harming, especially when they are causing extreme damage to themselves, there is an increased chance of accidental death.  So, it is incredibly important that any sort of self harm by a young person is given the appropriate response.

Whilst any self harm is concerning, the latest figures on mental health and young people in Australia tell us that rates of self harm are dramatically increasing.

If we look at people who have injured themselves and needed hospitalisation, the figures show that between 1996−97 and 2005−06, the hospitalisation rate for intentional self-harm among young people increased by 43{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de}, from 138 per 100,000 young people to 197. In 2010-2011, that number had increased to well over 600 per 100,000 young people.

Recently, the results of ‘Second Australian Child and Adolescent survey of Mental Health and Well-Being’ that surveyed over 6300 families and youths aged 4-17 were released.

As many as one in 10 teenagers – or about 186,000 – had engaged in some form of self-harm in their life, including a staggering quarter of teenage girls aged 16-17

….and those are the figures that those surveyed were willing to speak up about – Self harm is a very private behaviour that people may be reluctant to report.

Self harm can cause significant, long lasting body issues and it can also be really hard on friends, family and those who are aware of the self harm, but may feel powerless to stop a young person from hurting themself in that way.

When we look to the research to help us understand the problem of self harm the research includes mostly small studies. It also tells us that young people who self harm are a really diverse group and difficult to clump together. This heterogeneity means that what works for one young person who self harms may not work for another.  That means, we really need to carefully assess and understand each person who is self harming and find out what purpose it serves for them and then, how best to help them.

Self harm can serve many purposes for a young person.

It can be the way they:

  • regulate strong unpleasant feeling
  • control feelings of numbness or bring themselves back when they feel disengaged from their lives (dissociation)
  • test to see if they could suicide or kill themselves
  • try to feel in control over something
  • deal with internal conflict
  • re-directed aggression – if they are not comfortable being angry with others, sometimes they can turn that onto themselves
  • communicate and try to control of others
  • express and try to get rid of shame or guilt
  • seek out strong sensations or risk
  • deal with an underlying mental health or physical health condition

From my experience, I would say that it’s most likely that self harm in young people is the way they deal with negative or distressing feelings, especially when they themselves feel like nobody cares about them.

When you think about it, just about anyone is capable of self harm.  So – what stops us?

Most of us would have lots of barriers in place or lots of reason why we would not want to harm themselves – it hurts, it’s messy, it can scar, it would upset others or we might be concerned about what other people might think.

For a young person to harm and hurt themselves, one of the first things they need to do is push those internal barriers away.

The normal barriers that prevent us from hurting ourselves, can be overcome by a range of things and some in combination:

  • Alcohol and drugs can lower lots of barriers for lots of people. If a young person is drunk or under the influence of a substance that alters their thinking, they can push past the rational and logical reasons that would normally stop them form doing something.
  • Religion or cult involvement may sometimes encourage a young person to push themselves past lots of different barriers in order to reach some higher level of status or to be closer to a deity.
  • Impulsivity can mean that people can act without thinking. They can rush in and do things that they later regret because their ability to control and urge or an impulse is compromised
  • Grief can mean overwhelming emotions or a blunting of emotions. If they are overwhelming enough or sufficiently numbing, a young person may be able to push past the reasons not to self harm in an attempt to (in the case or overwhelming emotion) seek relief or (in the case of numbing) “feel” things again.
  • Social influences are especially strong for young people. If they want to fit into a group that are also hurting themselves, they may push past the rational reasons to seek a sense of belonging.  Sadly, there are numerous social media sites that encourage self harm or depict self harm as fashionable or darkly mysterious.
  • Practice can push away barriers to self harm. If a young person has previously experienced lots of piercing, tattoos or other experiences that involve discomfort in order for a specific outcome, it can be easier for them to push past the pain involved in self harm.
  • Being able to switch off from feelings can make it easier to decide to harm yourself. Switching off from feelings or dissociation can be something that young people learn to do if they have been in abusive or traumatic circumstances before.  It’s not always a conscious choice to switch off, but if they have dissociated before, then they can switch off again at other times.  That means they can switch off the reasons for not harming themselves.

When we are trying to help and support a young person who is self harming, we need to understand the purpose self harm has for them and how they push themselves past the internal barriers that would normally prevent them from self harm.

Self harm is often very private and very hard for young people to talk about.  Help is best left to qualified professionals, but – if you are a first responder – need to look at the safety needs first and avoid a million probing questions….those are best left til later, calmer and more professional circumstances.  I love this advice from Cornell about “respectful curiosity” and I’d encourage you to read it.

Professional treatment will consider the underlying concerns and the functions and put in place a safety plan for the young person.  Good treatment should assess dangerousness, suicidality and then go about trying to assist the person to be safer, to deal with problems that can be dealt with (problem solve), learn to communicate with others, learn to understand and sit with big emotions, and find other ways of dealing with distress.

Clearly, self harm in young people is not something to muck about with or to ignore.

For 24 hour support or crisis help:

  • Lifeline 13 11 14
  • Beyond Blue 1300 224636
  • Your local emergency services and hospital

For treatment, contact your GP or a registered Psychologist

For resources on how to help a friend… try this from Cornell.  If self harm is an issue at your school, or amongst the young people you care for, I’d love to come and talk with you some more to help you to help.

Are you paying attention? ADHD and attention problems

It’s very, very hard to learn new things when your brain won’t let you focus and won’t let your body be still.  ADHD is a syndrome that is brain-based and highly genetic.  It’s also a syndrome that gets bandied around lots – so much so that I think many teachers, and perhaps judges and legal representatives, roll their eyes when they hear about it.

Being able to attend well is yet another feature of our remarkable brains.  Paying attention is something we take for granted when it works well.  Without having a brain that can attend well, it gets harder to get started on a job, it can be difficult to keep focused, it can be hard to sustain effort, and very tricky to hold things in your memory long enough to work on them.  Attention can also have implications for our ability to manage our emotions and frustrations and to regulate or give ourselves feedback.   All of these brain functions depend on parts of the brain being structured and connected properly, both in physical structure plus in the ways that the brain’s chemicals move between and around these parts of the brain.

Properly diagnosis ADHD means that these executive brain functions are not working properly and that a child will need extra help to get things done. Attention Deficit Hyperactivity Disorder (ADHD) has three types an inattentive type, a hyperactive type and a combined inattentive-hyperactive type.

It is so very important that a very thorough assessment is done of a child with attention problems before we call it ADHD.

A child’s ability to attend can be affected by lots of things including brain injury and emotional trauma.  If you have been through a frightening situation, your brain will want to keep scanning the world for the next scary thing rather than learn how to do algebra.  When it comes to a child’s attention, we also need to check that the problems are not being caused by vision or hearing issues, autism spectrum concerns or by some other emotional issue or learning disorder (it can be hard to pay attention to reading if you are struggling with reading).  Simple things like sleep, getting the right amount of natural light, avoiding drugs and alcohol and having breakfast  can all aid attention and focus.  A gifted child might also have troubles maintaining attention if the work is so easy that they just feel like drifting off to think about something more challenging and exciting.  Diagnosing ADHD can also be made tricky because it can co-occur with many of these other issues.

On more than one occasion over my years of working with children, I have heard others say that the label of ADHD has been misapplied to a child.  Sadly, this can give those who genuinely have attention problems a bad reputation.

People will also often suggest that because a child can focus on a video game, that they do not have problems with attention.  It’s not that simple.

I’ve also heard people question whether properly diagnosed ADHD is really a problem or whether the child is just lazy or manipulative.  Is it that they can’t do it or that they won’t do it?  Sometime it’s a bit of both.  If it’s hard to do something, then we generally don’t like doing it.  It feels awful.  If we can help the child learn with the scaffolding they need, then learning becomes more pleasant and they will be less inclined to avoid it.

There are some things that make it harder for a child with attention problems.  If they really do not like a particular teacher or a particular subject, then things can get worse.  Children with attention problems seem to do better where teachers are perhaps a little firmer and confident.  They definitely do better when teachers understands their condition and work with them around the best ways to get things done.  It can help if they sit away from distractions and close to the teacher.

Children with attention problems really need help in being organised.  I remember watching one little fellow in a classroom.  He was sitting with his back to the board and the students were copying something the teacher had written onto a worksheet.  He sat down to start, but couldn’t find his pencil.  He decided to go and ask a friend if he could borrow one.  I watched him leave his seat and take a good five minutes to make it to his friends (so many distractions along the way), get the pencil, and then the long journey back to his spot, via his spilled lunchbox on the floor.  Of course, once he sat down, he had to keep twisting to read the board, remember what he had read, then turn back and write it down.  He was already behind his classmates in getting the work done and he was not going to finish it in the time allowed.  With a little more scaffolding (someone there ensuring he had what he needed, that he was sitting facing his work and the board, and that he had gotten started) could have made a big impact to how that lesson went for him.

BE VERY WARY – there are plenty of fad treatments and programs with little evidence to support them out there waiting for desperate parents and grandparents to part with hard earned coin to assist their struggling child.

The evidence-based treatment for thoroughly diagnosed ADHD involves a combination of medication to manage the brain’s functioning and therapy to address thoughts, organisation and coping strategies.  Medication should be carefully prescribed and monitored.  Through psychological therapy, a child can be assisted to build new skills and coping strategies and there are often associated emotional and interpersonal aspects of ADHD.

ADHD can co-exist with depression, anger and problems getting along with others so each of these problems should be monitored.  Of course, then, it makes sense that the medical practitioners and the psychologists should work closely together with each other, family and school.

So what do we need to do to help kids with attention problems?

  • We need to identify these children early so we can give them the appropriate scaffolding before they incorrectly learn that learning is too hard or too boring. We need to help scaffold them before life gets too messy and complex and they decide it’s all too hard and give up on learning.
  • Once identified, we need to give them proper assessments.
  • If the assessment is quick and a label given after just one appointment, then I would query the diagnosis.
  • Assessment should involve talking with the child, talking with the parents, testing the child using certain psychological tests, and where possible, watching the child in a learning situation.
  • Once identified, then medication may be appropriate.  Again, if you are going to medicate a young child, you want the diagnosis to be spot on and you want to be closely monitoring.  If the medicine is not working, then something is wrong with either the diagnosis or the treatment, or both.

We need to know the profile of the child’s brain functioning so that we can use the strengths and scaffold the weaknesses to help them chose subjects and set learning goals.

The profile of their executive abilities can also tell us what kind of help they need on a day to day basis in the classroom – extra help in organisation, monitoring to keep them engaged, proximity to the teacher, extra breaks to manage fatigue, give them extra reminders and warnings that topics are about to change, fidget toys – all strategies crafted to match the individual and their specific profile.

Overall, you can see that ADHD and attention problems should not be discounted merely because a child can attend to their favourite computer game.  Attention is needed across all of life’s activities.

The ideal solution to attention problems will likely involve medical intervention, special education accommodations and psychological intervention for support with understanding ADHD, problem solving, behavioural skills and mood monitoring.