A Supportive Ear Can Make A World Of Difference https://youtube.com/shorts/CWLwmwADNYs?feature=share

James Donaldson on Mental Health - Study highlights the link between adverse childhood experiences and adolescent suicidality

Photo by samer daboul on Pexels.com

A recent doctoral dissertation reveals that adverse childhood experiences, such as abuse and neglect, predisposes adolescents to suicidality. Girls had a higher risk of a suicidal event occurring during treatment, and suicidality risk screening at intake to behavioral and mental health services failed to predict a large number of suicidal events.

Adolescent suicide is a major public health concern in the United States. Extensive research has been conducted on suicidality (thoughts of suicide, suicide attempts, etc.) among the general adolescent population, but less is known about suicidality among adolescents who are at-risk, or have been exposed to adverse childhood experiences.

Adverse childhood experiences include things like domestic violence, abuse (physical, sexual, or emotional), neglect (physical or emotional), and chaotic home environment, and exposure to them makes at-risk adolescents more likely to experience suicidality.

At-risk adolescents are also more likely to receive treatment for behavioral and mental health disorders in the community at clinics that are underfunded and understaffed. This is concerning given that at-risk adolescents have more severe behavioral and mental disorders symptoms and are challenging to treat, even at the most well-equipped clinics."

Karen L. Celedonia, Doctoral Researcher, University of Turku, Finland

Using a blend of quantitative and qualitative research methods, she examined factors associated with and factors that predicted suicidality and suicidal events among at-risk adolescents receiving behavioral and mental health services in the community in the United States.

Her research also investigated qualities that contribute to a strong therapeutic alliance between at-risk adolescents receiving behavioral and mental health services and their therapists, as well as analyzed the use of wide-scale suicide risk detection systems embedded in social media platforms.

Many suicidal events occurred despite negative risk screening at intake

The research findings revealed that thoughts of suicide and suicide attempt among at-risk adolescents were double and triple that of the general adolescent population, respectively. Sexual abuse was a strong predictor of suicidality.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Average time to suicidal event after suicidality risk screen at intake to behavioral and mental health services was around 6 months, and adolescents who screened negative for suicidality risk at intake had a longer time until a suicidal event occurred.

Female gender was a predictor of a suicidal event occurring during treatment, and interestingly, almost half of the adolescents who presented with a suicidal event had screened negative for suicidality risk at intake.

"This could potentially be explained by the therapeutic alliance between adolescents and their therapists not being fully formed at intake, and therefore adolescents may not have felt comfortable disclosing a history of suicidal thoughts and behaviors," says Celedonia.

Five qualities were identified by therapists providing behavioral and mental health services to at-risk adolescents as contributing to a strong therapeutic alliance between themselves and their at-risk adolescent clientele: ecosystemic approach; strong working alliance; professionalism; warmth and support; and open communication. Warmth and support was deemed the most important and most experienced quality by therapists.

Analysis of social media suicide risk detection systems revealed legal, ethical, and cultural concerns, to include the violation of the GDPR in Europe and HIPAA in the United States and the stigma attached to mental disorders, particularly in low- and middle-income countries.

The findings from Celedonia's doctoral research may help other community-based behavioral and mental health care organizations improve detection and treatment of suicidality among at-risk adolescents.

"Based on the results, it would be advisable to implement routine suicidality risk screening after intake to behavioral and mental health services, regardless of how an adolescent screened at intake. Furthermore, given the high prevalence of suicidality among at-risk adolescents, using treatment approaches that specifically target suicidality as the main target of treatment may prove more effective at reducing suicidality symptoms, thereby preventing death by suicide," says Celedonia.

Broader implications of the research include focusing efforts on the prevention of sexual abuse among children and adolescents, and providing more mental health support and resources to female adolescents.

Photo by samer daboul on Pexels.com https://standingabovethecrowd.com/james-donaldson-on-mental-health-study-highlights-the-link-between-adverse-childhood-experiences-and-adolescent-suicidality/

Photo by samer daboul on Pexels.com

A recent doctoral dissertation reveals that adverse childhood experiences, such as abuse and neglect, predisposes adolescents to suicidality. Girls had a higher risk of a suicidal event occurring during treatment, and suicidality risk screening at intake to behavioral and mental health services failed to predict a large number of suicidal events.

Adolescent suicide is a major public health concern in the United States. Extensive research has been conducted on suicidality (thoughts of suicide, suicide attempts, etc.) among the general adolescent population, but less is known about suicidality among adolescents who are at-risk, or have been exposed to adverse childhood experiences.Adverse childhood experiences include things like domestic violence, abuse (physical, sexual, or emotional), neglect (physical or emotional), and chaotic home environment, and exposure to them makes at-risk adolescents more likely to experience suicidality.

At-risk adolescents are also more likely to receive treatment for behavioral and mental health disorders in the community at clinics that are underfunded and understaffed. This is concerning given that at-risk adolescents have more severe behavioral and mental disorders symptoms and are challenging to treat, even at the most well-equipped clinics."

Karen L. Celedonia, Doctoral Researcher, University of Turku, Finland

Using a blend of quantitative and qualitative research methods, she examined factors associated with and factors that predicted suicidality and suicidal events among at-risk adolescents receiving behavioral and mental health services in the community in the United States.Her research also investigated qualities that contribute to a strong therapeutic alliance between at-risk adolescents receiving behavioral and mental health services and their therapists, as well as analyzed the use of wide-scale suicide risk detection systems embedded in social media platforms.

Many suicidal events occurred despite negative risk screening at intake

The research findings revealed that thoughts of suicide and suicide attempt among at-risk adolescents were double and triple that of the general adolescent population, respectively. Sexual abuse was a strong predictor of suicidality.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Average time to suicidal event after suicidality risk screen at intake to behavioral and mental health services was around 6 months, and adolescents who screened negative for suicidality risk at intake had a longer time until a suicidal event occurred.Female gender was a predictor of a suicidal event occurring during treatment, and interestingly, almost half of the adolescents who presented with a suicidal event had screened negative for suicidality risk at intake."This could potentially be explained by the therapeutic alliance between adolescents and their therapists not being fully formed at intake, and therefore adolescents may not have felt comfortable disclosing a history of suicidal thoughts and behaviors," says Celedonia.Five qualities were identified by therapists providing behavioral and mental health services to at-risk adolescents as contributing to a strong therapeutic alliance between themselves and their at-risk adolescent clientele: ecosystemic approach; strong working alliance; professionalism; warmth and support; and open communication. Warmth and support was deemed the most important and most experienced quality by therapists.Analysis of social media suicide risk detection systems revealed legal, ethical, and cultural concerns, to include the violation of the GDPR in Europe and HIPAA in the United States and the stigma attached to mental disorders, particularly in low- and middle-income countries.The findings from Celedonia's doctoral research may help other community-based behavioral and mental health care organizations improve detection and treatment of suicidality among at-risk adolescents."Based on the results, it would be advisable to implement routine suicidality risk screening after intake to behavioral and mental health services, regardless of how an adolescent screened at intake. Furthermore, given the high prevalence of suicidality among at-risk adolescents, using treatment approaches that specifically target suicidality as the main target of treatment may prove more effective at reducing suicidality symptoms, thereby preventing death by suicide," says Celedonia.Broader implications of the research include focusing efforts on the prevention of sexual abuse among children and adolescents, and providing more mental health support and resources to female adolescents.

Photo by samer daboul on Pexels.com https://standingabovethecrowd.com/james-donaldson-on-mental-health-study-highlights-the-link-between-adverse-childhood-experiences-and-adolescent-suicidality/

A Kind Heart, A Listening Ear https://youtube.com/shorts/7bL9S_uNkSs?feature=share

James Donaldson on Mental Health - How Can We Help Kids With Self-Regulation?

Some kids need help learning to control their emotions and resist impulsive behavior

Clinical Experts: Matthew H. Rouse, PhD , Alnardo Martinez, LMHC

https://www.youtube.com/watch?v=0tfYqP3D69E

What You'll Learn

- What is self-regulation?
- How can I teach my child self-regulation skills?
- Are there treatments that help with self-regulation?
- Quick Read
- Full Article
- What is self-regulation?
- What does emotional dysregulation look like?
- Why do some kids struggle with self-regulation?
- How do we teach self-regulation skills?
- Practice runs
- Help kids become self-reflective

It’s normal for two-year-olds to have tantrums. But if your child is five or older and still having meltdowns a lot, they may need help learning to control their emotions or behavior. This is called “self-regulation.”

Some kids are born having a harder time with self-regulation. Some don’t develop the skills if parents always jump in to solve problems or help them calm down. Children with ADHD or anxiety may also have this problem.  

Self-regulation is a skill that children need to be taught and practice. The trick is not to avoid hard situations. Instead, parents can coach kids through tough situations. Breaking an activity into smaller, more doable parts can help. For instance, if your child has a hard time brushing their teeth, start with just putting toothpaste on the brush. Praise them a lot when they do it and slowly add steps. 

When kids act out, encourage them to slow down and reflect. Kids can learn to ask themselves: What went wrong? Why? How can I fix that for next time?  

Practicing mindfulness can help with self-regulation. Mindfulness teaches kids how to focus on the present instead of the past or the future. For some families, parent training programs may also be helpful.

For older kids, a kind of therapy called dialectical behavior therapy (DBT) can help with emotion regulation and distress tolerance. 

If you’re a parent, chances are you’ve witnessed a tantrum or two in your day. We expect them in two-year-olds. But if your child reaches school age and meltdowns and outbursts are still frequent, it may be a sign that they have difficulty with emotional self-regulation.

Simply put, self-regulation is the difference between a two-year-old and a five-year-old who is more able to control their emotions. Helping kids who haven’t developed self-regulation skills at the typical age is the goal of parent training programs. And many older children, even if they’re beyond tantrums, continue to struggle with impulsive and inappropriate behavior.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

What is self-regulation?

Self-regulation is the ability to manage your emotions and behavior in accordance with the demands of the situation. It includes being able to resist highly emotional reactions to upsetting stimuli, to calm yourself down when you get upset, to adjust to a change in expectations, and to handle frustration without an outburst. It is a set of skills that enables children, as they mature, to direct their own behavior towards a goal, despite the unpredictability of the world and our own feelings.

What does emotional dysregulation look like?

Problems with self-regulation manifest in different ways depending on the child, says  Matthew Rouse, PhD, a clinical psychologist. “Some kids are instantaneous — they have a huge, strong reaction and there’s no lead-in or build-up,” he says. “They can’t inhibit that immediate behavior response.”

For other kids, he notes, distress seems to build up and they can only take it for so long. Eventually it leads to some sort of behavioral outburst. “You can see them going down the wrong path but you don’t know how to stop it.”

The key for both kinds of kids is to learn to handle those strong reactions and find ways to express their emotions that are more effective (and less disruptive) than having a meltdown.

Why do some kids struggle with self-regulation?

Dr. Rouse sees emotional control issues as a combination of temperament and learned behavior.

“A child’s innate capacities for self-regulation are temperament and personality-based,” he explains. Some babies have trouble self-soothing, he adds, and get very distressed when you’re trying to bathe them or put on clothes. Those kids may be more likely to experience trouble with emotional self-regulation when they’re older.

But the environment plays a role as well. When parents give in to tantrums or work overtime to soothe their children when they get upset and act out, kids have a hard time developing self-discipline. “In those situations, the child is basically looking to the parents to be external self-regulators,” Dr. Rouse says. “If that’s a pattern that happens again and again, and a child is able to ‘outsource’ self-regulation, then that’s something that might develop as a habit.”

Children with ADHD or anxiety may find it particularly challenging to manage their emotions, and need more help to develop emotional regulation skills.

How do we teach self-regulation skills?

Scott Bezsylko, the executive director of the Winston Prep schools for children with learning differences, says that acting out is essentially an ineffective response to a stimulus. The parent or teacher needs to help the child slow down and more carefully choose an effective response instead of being impulsive.

“We approach self-regulation skills in the same way we approach other skills, academic or social: isolate that skill and provide practice,” Bezsylko explains. “When you think of it as a skill to be taught — rather than, say, just bad behavior — it changes the tone and content of the feedback you give kids. ”

The key to learning self-regulation skills, says Dr. Rouse, is not to avoid situations that are difficult for kids to handle, but to coach kids through them and provide a supportive framework — clinicians call it “scaffolding” the behavior you want to encourage — until they can handle these challenges on their own.

Imagine a situation that can produce strong negative emotions, like a frustrating math homework assignment. If a parent hovers too much, they risk taking over the regulation role. “Instead of the child recognizing that the work is frustrating and figuring out how to handle it,” Dr. Rouse explains, “what they feel is that the parent is frustrating them by making them do it.”

Scaffolding in this situation might be helping the child with one problem, and then expecting them to try the rest. If they feel frustrated, they might get up and get a drink. They might use a timer to give themselves periodic breaks. The parent would check in on them at intervals, and offer praise for their efforts.

If a child is prone to melting down when they’re asked to stop playing a video game, scaffolding might be practicing transitioning away from the game. “You’d want to practice with a game in which they’re not overly invested — you don’t want to begin with high stakes,” Dr. Rouse explains. “Have them practice playing for two or three minutes and then handing you the game. They get points towards something they want every time they do it.”

Practice runs

Dry runs are another way to scaffold self-regulation. For instance, if you’ve had trouble with a child reacting impulsively or having a tantrum in a store, make a short visit when you don’t need to do serious shopping. Have them practice walking with you, keeping their hands to themselves. They get points towards some goal every time they are successful.

Dr. Rouse says that often parents get discouraged when things don’t go well the first time they try skill-building, but consistency and starting at a level that is appropriate for your child are key. Rather than giving up, try paring down the activity so it is more doable, and slowly give your child more and more independence to handle it.

For instance, if brushing their teeth is a problem for your child, you might start by focusing just on putting toothpaste on the brush, and respond with positive feedback and rewards when they do it. Once they’ve practiced that a few times, add the next step in the chain.

Similarly, if getting out the door in the morning is causing meltdowns, target one step at a time. First, say, getting dressed by 7:15. Once they’ve mastered that, set a target time for breakfast, and add that. Breaking the chain into small steps allows them to build self-regulation skills in manageable increments.

Help kids become self-reflective

Bezsylko stresses that when parents or teachers approach impulsive, inappropriate behavior calmly and give them time, kids can learn to choose better ways to respond to that situation. The feedback kids need is non-judgmental and non-emotional: what went wrong, and why, and how they can fix it next time.

“When kids are part of an environment that’s reflective and analytic as opposed to emotional and fast-paced,” Bezsylko explains, “they can learn to make better choices.” Slowing down allows children to become more thoughtful, reflective and self-aware. “We need to slow down and model self-reflection and self-awareness and self-regulation for our kids,” he notes, “but it’s also helpful and good for us, too.”

Bezsylko notes that mindfulness and meditation are good for everyone, but especially for children with self-regulation challenges. And Dr. Rouse mentions the many parent training programs available to help them become better coaches for their kids. For older kids, dialectical behavior therapy (DBT) is also an option, as it focuses on distress tolerance and emotion regulation.

At the end of the day, though, nothing can replace the work of the parent. “It seems to me,” says Dr. Rouse, “that the family environment is the most important piece.”

Frequently Asked Questions

How can I help my child regulate their emotions?

You can help your child regulate their emotions by coaching them to slow down and calmly respond to situations rather than being impulsive. Patience and positive feedback from the parent are important. With support and guidance, the child will gradually learn to handle challenges on their own. 

What is self-regulation in child development?

At what age can a child control their emotions?

https://standingabovethecrowd.com/james-donaldson-on-mental-health-how-can-we-help-kids-with-self-regulation/

Some kids need help learning to control their emotions and resist impulsive behavior

Clinical Experts: Matthew H. Rouse, PhD , Alnardo Martinez, LMHC

https://www.youtube.com/watch?v=0tfYqP3D69E

What You'll Learn

- What is self-regulation?

- How can I teach my child self-regulation skills?

- Are there treatments that help with self-regulation?

- Quick Read

- Full Article

- What is self-regulation?

- What does emotional dysregulation look like?

- Why do some kids struggle with self-regulation?

- How do we teach self-regulation skills?

- Practice runs

- Help kids become self-reflective

It’s normal for two-year-olds to have tantrums. But if your child is five or older and still having meltdowns a lot, they may need help learning to control their emotions or behavior. This is called “self-regulation.”

Some kids are born having a harder time with self-regulation. Some don’t develop the skills if parents always jump in to solve problems or help them calm down. Children with ADHD or anxiety may also have this problem.  

Self-regulation is a skill that children need to be taught and practice. The trick is not to avoid hard situations. Instead, parents can coach kids through tough situations. Breaking an activity into smaller, more doable parts can help. For instance, if your child has a hard time brushing their teeth, start with just putting toothpaste on the brush. Praise them a lot when they do it and slowly add steps. 

When kids act out, encourage them to slow down and reflect. Kids can learn to ask themselves: What went wrong? Why? How can I fix that for next time?  

Practicing mindfulness can help with self-regulation. Mindfulness teaches kids how to focus on the present instead of the past or the future. For some families, parent training programs may also be helpful.

For older kids, a kind of therapy called dialectical behavior therapy (DBT) can help with emotion regulation and distress tolerance. 

If you’re a parent, chances are you’ve witnessed a tantrum or two in your day. We expect them in two-year-olds. But if your child reaches school age and meltdowns and outbursts are still frequent, it may be a sign that they have difficulty with emotional self-regulation.

Simply put, self-regulation is the difference between a two-year-old and a five-year-old who is more able to control their emotions. Helping kids who haven’t developed self-regulation skills at the typical age is the goal of parent training programs. And many older children, even if they’re beyond tantrums, continue to struggle with impulsive and inappropriate behavior.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

What is self-regulation?

Self-regulation is the ability to manage your emotions and behavior in accordance with the demands of the situation. It includes being able to resist highly emotional reactions to upsetting stimuli, to calm yourself down when you get upset, to adjust to a change in expectations, and to handle frustration without an outburst. It is a set of skills that enables children, as they mature, to direct their own behavior towards a goal, despite the unpredictability of the world and our own feelings.

What does emotional dysregulation look like?

Problems with self-regulation manifest in different ways depending on the child, says  Matthew Rouse, PhD, a clinical psychologist. “Some kids are instantaneous — they have a huge, strong reaction and there’s no lead-in or build-up,” he says. “They can’t inhibit that immediate behavior response.”

For other kids, he notes, distress seems to build up and they can only take it for so long. Eventually it leads to some sort of behavioral outburst. “You can see them going down the wrong path but you don’t know how to stop it.”

The key for both kinds of kids is to learn to handle those strong reactions and find ways to express their emotions that are more effective (and less disruptive) than having a meltdown.

Why do some kids struggle with self-regulation?

Dr. Rouse sees emotional control issues as a combination of temperament and learned behavior.

“A child’s innate capacities for self-regulation are temperament and personality-based,” he explains. Some babies have trouble self-soothing, he adds, and get very distressed when you’re trying to bathe them or put on clothes. Those kids may be more likely to experience trouble with emotional self-regulation when they’re older.

But the environment plays a role as well. When parents give in to tantrums or work overtime to soothe their children when they get upset and act out, kids have a hard time developing self-discipline. “In those situations, the child is basically looking to the parents to be external self-regulators,” Dr. Rouse says. “If that’s a pattern that happens again and again, and a child is able to ‘outsource’ self-regulation, then that’s something that might develop as a habit.”

Children with ADHD or anxiety may find it particularly challenging to manage their emotions, and need more help to develop emotional regulation skills.

How do we teach self-regulation skills?

Scott Bezsylko, the executive director of the Winston Prep schools for children with learning differences, says that acting out is essentially an ineffective response to a stimulus. The parent or teacher needs to help the child slow down and more carefully choose an effective response instead of being impulsive.

“We approach self-regulation skills in the same way we approach other skills, academic or social: isolate that skill and provide practice,” Bezsylko explains. “When you think of it as a skill to be taught — rather than, say, just bad behavior — it changes the tone and content of the feedback you give kids. ”

The key to learning self-regulation skills, says Dr. Rouse, is not to avoid situations that are difficult for kids to handle, but to coach kids through them and provide a supportive framework — clinicians call it “scaffolding” the behavior you want to encourage — until they can handle these challenges on their own.

Imagine a situation that can produce strong negative emotions, like a frustrating math homework assignment. If a parent hovers too much, they risk taking over the regulation role. “Instead of the child recognizing that the work is frustrating and figuring out how to handle it,” Dr. Rouse explains, “what they feel is that the parent is frustrating them by making them do it.”

Scaffolding in this situation might be helping the child with one problem, and then expecting them to try the rest. If they feel frustrated, they might get up and get a drink. They might use a timer to give themselves periodic breaks. The parent would check in on them at intervals, and offer praise for their efforts.

If a child is prone to melting down when they’re asked to stop playing a video game, scaffolding might be practicing transitioning away from the game. “You’d want to practice with a game in which they’re not overly invested — you don’t want to begin with high stakes,” Dr. Rouse explains. “Have them practice playing for two or three minutes and then handing you the game. They get points towards something they want every time they do it.”

Practice runs

Dry runs are another way to scaffold self-regulation. For instance, if you’ve had trouble with a child reacting impulsively or having a tantrum in a store, make a short visit when you don’t need to do serious shopping. Have them practice walking with you, keeping their hands to themselves. They get points towards some goal every time they are successful.

Dr. Rouse says that often parents get discouraged when things don’t go well the first time they try skill-building, but consistency and starting at a level that is appropriate for your child are key. Rather than giving up, try paring down the activity so it is more doable, and slowly give your child more and more independence to handle it.

For instance, if brushing their teeth is a problem for your child, you might start by focusing just on putting toothpaste on the brush, and respond with positive feedback and rewards when they do it. Once they’ve practiced that a few times, add the next step in the chain.

Similarly, if getting out the door in the morning is causing meltdowns, target one step at a time. First, say, getting dressed by 7:15. Once they’ve mastered that, set a target time for breakfast, and add that. Breaking the chain into small steps allows them to build self-regulation skills in manageable increments.

Help kids become self-reflective

Bezsylko stresses that when parents or teachers approach impulsive, inappropriate behavior calmly and give them time, kids can learn to choose better ways to respond to that situation. The feedback kids need is non-judgmental and non-emotional: what went wrong, and why, and how they can fix it next time.

“When kids are part of an environment that’s reflective and analytic as opposed to emotional and fast-paced,” Bezsylko explains, “they can learn to make better choices.” Slowing down allows children to become more thoughtful, reflective and self-aware. “We need to slow down and model self-reflection and self-awareness and self-regulation for our kids,” he notes, “but it’s also helpful and good for us, too.”

Bezsylko notes that mindfulness and meditation are good for everyone, but especially for children with self-regulation challenges. And Dr. Rouse mentions the many parent training programs available to help them become better coaches for their kids. For older kids, dialectical behavior therapy (DBT) is also an option, as it focuses on distress tolerance and emotion regulation.

At the end of the day, though, nothing can replace the work of the parent. “It seems to me,” says Dr. Rouse, “that the family environment is the most important piece.”

Frequently Asked Questions

How can I help my child regulate their emotions?

You can help your child regulate their emotions by coaching them to slow down and calmly respond to situations rather than being impulsive. Patience and positive feedback from the parent are important. With support and guidance, the child will gradually learn to handle challenges on their own. 

What is self-regulation in child development?

At what age can a child control their emotions? https://standingabovethecrowd.com/james-donaldson-on-mental-health-how-can-we-help-kids-with-self-regulation/

Let Kindness Be Your Guide https://youtube.com/shorts/IDE_bRDlEjc?feature=share

James Donaldson on Mental Health - Rising to the challenge: Addressing the youth mental health crisis in our schools

Photo by Pixabay on Pexels.com

By Erica Palmer Smith
By Michelle Ries

Youth mental health is in a state of crisis. There is no denying that anymore. According to the latest data, nearly one in five adolescents in North Carolina suffered from depression and one in ten of our high school students reported attempting suicide. 

There has been a drastic increase in rates of anxiety, depression, and suicidal ideation amongst our youth in recent years and we know that what happens at school is contributing to those issues through peer pressure and bullying. That’s why schools have to be part of the solution. 

Schools are places of learning and connection. Schools are where young people spend the most important hours of their day and where some of their most formative moments will occur. Schools have a huge impact on their health and wellbeing. And that impact should be positive. 

But today there is a gap between the needs of our young people and the services available. In 2024, there were 1,928 students for each school psychologist in North Carolina — nearly four times the ratio recommended by the National Association of School Psychologists. For school social workers, the ratio was also nearly four times higher than what is recommended. 

That’s a challenge that we should address. We know that school personnel provide much needed support for students with developmental and social-emotional needs. They monitor progress, they develop prevention and intervention plans, and they help students who are in need or who are at risk of dropping out. They’re on the frontlines and they are often the first responders of our youth mental health crisis. And they need our support.

That was a focus of the 2025 North Carolina Child Health Report Card recently released by NC Child and the North Carolina Institute of Medicine. 

The report card included a special section on school-based mental health including access to support staff, referral services, the connection between physical activity and mental health, and the impact of social media on mental health. And we can learn so much from this report. 

We should address the causes of the youth mental health crisis (from new technology to social pressures) and we should also provide support to young people who are dealing with these issues. We are encouraged by efforts to increase pay for providers, develop the mental health workforce, and improve the state’s crisis system. And that more people are paying attention. 

The Whole Child NC Advisory Committee at the North Carolina Department of Public Instruction recommends improving access to school-based health services as a statewide priority. 

East Carolina University has a Healthier Lives at School and Beyond program utilizing telemedicine to reduce barriers to services in rural areas. There’s also the Carolina School-Based Telehealth Learning Collaborative, comprised of health care providers across the state that implement both physical and mental virtual health services in our schools. 

Several of our partners are raising awareness about the importance of school-based mental health services through the EarlyWell Initiative, Essentials for Childhood, and CaroNova’s NC Youth Mental Health Action Plan. And we will continue to as well. We know that what happens at school can affect mental health and we need the resources to make that a positive outcome. 

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

About the North Carolina Child Health Report Card: 

At the North Carolina Institute of Medicine and NC Child, we are dedicated to ensuring that communities and policymakers have the best information on the issues facing our children. For nearly three decades we have partnered together to publish a Child Health Report Card. 

The biannual report card provides a snapshot of the health and well-being our state’s children, and sheds light on the successes and challenges facing our youngest generations. 

This year the results were mixed. North Carolina received an “A” for insurance coverage and a “B” for maternal health and support. But we also received poor grades for oral health, healthy eating and active living, and education outcomes, and a failing grade for youth mental health. 

That’s why we are speaking out about the severity of the youth mental health crisis and the opportunity we have to make a difference. Our hope is that the report card will inform leaders and policymakers across the state. The report card tells us what’s working and where we need to improve so that every child can reach their full potential. And that’s our goal. 

Photo by Pixabay on Pexels.com

https://standingabovethecrowd.com/james-donaldson-on-mental-health-rising-to-the-challenge-addressing-the-youth-mental-health-crisis-in-our-schools/

Photo by Pixabay on Pexels.com

By Erica Palmer Smith

By Michelle Ries

Youth mental health is in a state of crisis. There is no denying that anymore. According to the latest data, nearly one in five adolescents in North Carolina suffered from depression and one in ten of our high school students reported attempting suicide. 

There has been a drastic increase in rates of anxiety, depression, and suicidal ideation amongst our youth in recent years and we know that what happens at school is contributing to those issues through peer pressure and bullying. That’s why schools have to be part of the solution. 

Schools are places of learning and connection. Schools are where young people spend the most important hours of their day and where some of their most formative moments will occur. Schools have a huge impact on their health and wellbeing. And that impact should be positive. 

But today there is a gap between the needs of our young people and the services available. In 2024, there were 1,928 students for each school psychologist in North Carolina — nearly four times the ratio recommended by the National Association of School Psychologists. For school social workers, the ratio was also nearly four times higher than what is recommended. 

That’s a challenge that we should address. We know that school personnel provide much needed support for students with developmental and social-emotional needs. They monitor progress, they develop prevention and intervention plans, and they help students who are in need or who are at risk of dropping out. They’re on the frontlines and they are often the first responders of our youth mental health crisis. And they need our support.

That was a focus of the 2025 North Carolina Child Health Report Card recently released by NC Child and the North Carolina Institute of Medicine. 

The report card included a special section on school-based mental health including access to support staff, referral services, the connection between physical activity and mental health, and the impact of social media on mental health. And we can learn so much from this report. 

We should address the causes of the youth mental health crisis (from new technology to social pressures) and we should also provide support to young people who are dealing with these issues. We are encouraged by efforts to increase pay for providers, develop the mental health workforce, and improve the state’s crisis system. And that more people are paying attention. 

The Whole Child NC Advisory Committee at the North Carolina Department of Public Instruction recommends improving access to school-based health services as a statewide priority. 

East Carolina University has a Healthier Lives at School and Beyond program utilizing telemedicine to reduce barriers to services in rural areas. There’s also the Carolina School-Based Telehealth Learning Collaborative, comprised of health care providers across the state that implement both physical and mental virtual health services in our schools. 

Several of our partners are raising awareness about the importance of school-based mental health services through the EarlyWell Initiative, Essentials for Childhood, and CaroNova’s NC Youth Mental Health Action Plan. And we will continue to as well. We know that what happens at school can affect mental health and we need the resources to make that a positive outcome. 

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

About the North Carolina Child Health Report Card: 

At the North Carolina Institute of Medicine and NC Child, we are dedicated to ensuring that communities and policymakers have the best information on the issues facing our children. For nearly three decades we have partnered together to publish a Child Health Report Card. 

The biannual report card provides a snapshot of the health and well-being our state’s children, and sheds light on the successes and challenges facing our youngest generations. 

This year the results were mixed. North Carolina received an “A” for insurance coverage and a “B” for maternal health and support. But we also received poor grades for oral health, healthy eating and active living, and education outcomes, and a failing grade for youth mental health. 

That’s why we are speaking out about the severity of the youth mental health crisis and the opportunity we have to make a difference. Our hope is that the report card will inform leaders and policymakers across the state. The report card tells us what’s working and where we need to improve so that every child can reach their full potential. And that’s our goal. 

Photo by Pixabay on Pexels.com https://standingabovethecrowd.com/james-donaldson-on-mental-health-rising-to-the-challenge-addressing-the-youth-mental-health-crisis-in-our-schools/

Sharing Your Story Can Light The Way For Others https://youtube.com/shorts/bj-k5sQGjWo?feature=share

James Donaldson on Mental Health - Perceived Burdensomeness Linked to Increased Risk of Suicidal Ideation in SMI Patients

Hibah Khaja, PharmD 

Measures of burdensomeness and belongingness were able to predict the likelihood of having persistent or intermittent suicidal ideation among individuals with serious mental illness.

Perceived burdensomeness and thwarted belongingness are significant predictors of persistent suicidal ideation (SI) and suicidal behavior (SB) over 12 months in individuals with serious mental illness (SMI), according to findings published in Schizophrenia Bulletin.

In this longitudinal study, researchers tracked 180 adults with SMI, including schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features, and major depressive disorder with psychotic features, over a 12-month period. They sought to understand how dynamic interpersonal factors such as perceived burdensomeness and thwarted belongingness contributed to the persistence of SI and the emergence of SBs.

Participants were assessed at baseline, 6 months, and 12 months, with additional daily ecological momentary assessment (EMA) surveys completed three times a day for 10 consecutive days following baseline. EMA surveys captured real-time data on feelings of burdensomeness, belongingness, social motivation, suspiciousness, and psychotic symptoms like hearing voices.

The cohort had a mean (SD) age of 42.9 (11.4) years, was predominantly men (67.8%), and racially diverse, with 40.6% identifying as Black. Most participants were unemployed (69.4%), and over 60% had a lifetime history of suicide attempt. Diagnostically, 37.8% had schizoaffective disorder and 35% had bipolar disorder with psychotic features.

Future studies may benefit from EMA over longer periods to unpack the influence of psychotic symptoms on the dynamics of burdensomeness, belongingness, and suicide risk, working to identify potentially personalized predictors of these constructs.

At baseline, 42.8% of participants reported current SI, and 15% were found to have persistent SI at all 3 time points. SB was reported by 13.3% over the follow-up period, with 87.5% of these individuals having reported SI at baseline.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Higher baseline burdensomeness (mean=3.87) and lower belongingness (mean=3.09) significantly predicted persistent SI when compared to those without SI. These interpersonal constructs also predicted the likelihood of SB during the study period. Persistent, rather than intermittent, SI was linked to psychotic symptoms such as suspiciousness and auditory hallucinations, as well as reduced social motivation.

While burdensomeness and belongingness were the strongest independent predictors of both SI and SB, network analysis revealed complex temporal dynamics. For individuals with baseline SI, greater suspiciousness preceded declines in belongingness, and increased social avoidance predicted future feelings of burdensomeness. These lagged relationships were not present in participants without SI.

“Future studies may benefit from EMA over longer periods to unpack the influence of psychotic symptoms on the dynamics of burdensomeness, belongingness, and suicide risk, working to identify potentially personalized predictors of these constructs,” the researchers concluded.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-perceived-burdensomeness-linked-to-increased-risk-of-suicidal-ideation-in-smi-patients/

Hibah Khaja, PharmD 

Measures of burdensomeness and belongingness were able to predict the likelihood of having persistent or intermittent suicidal ideation among individuals with serious mental illness.

Perceived burdensomeness and thwarted belongingness are significant predictors of persistent suicidal ideation (SI) and suicidal behavior (SB) over 12 months in individuals with serious mental illness (SMI), according to findings published in Schizophrenia Bulletin.

In this longitudinal study, researchers tracked 180 adults with SMI, including schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features, and major depressive disorder with psychotic features, over a 12-month period. They sought to understand how dynamic interpersonal factors such as perceived burdensomeness and thwarted belongingness contributed to the persistence of SI and the emergence of SBs.

Participants were assessed at baseline, 6 months, and 12 months, with additional daily ecological momentary assessment (EMA) surveys completed three times a day for 10 consecutive days following baseline. EMA surveys captured real-time data on feelings of burdensomeness, belongingness, social motivation, suspiciousness, and psychotic symptoms like hearing voices.

The cohort had a mean (SD) age of 42.9 (11.4) years, was predominantly men (67.8%), and racially diverse, with 40.6% identifying as Black. Most participants were unemployed (69.4%), and over 60% had a lifetime history of suicide attempt. Diagnostically, 37.8% had schizoaffective disorder and 35% had bipolar disorder with psychotic features.

Future studies may benefit from EMA over longer periods to unpack the influence of psychotic symptoms on the dynamics of burdensomeness, belongingness, and suicide risk, working to identify potentially personalized predictors of these constructs.

At baseline, 42.8% of participants reported current SI, and 15% were found to have persistent SI at all 3 time points. SB was reported by 13.3% over the follow-up period, with 87.5% of these individuals having reported SI at baseline.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Higher baseline burdensomeness (mean=3.87) and lower belongingness (mean=3.09) significantly predicted persistent SI when compared to those without SI. These interpersonal constructs also predicted the likelihood of SB during the study period. Persistent, rather than intermittent, SI was linked to psychotic symptoms such as suspiciousness and auditory hallucinations, as well as reduced social motivation.

While burdensomeness and belongingness were the strongest independent predictors of both SI and SB, network analysis revealed complex temporal dynamics. For individuals with baseline SI, greater suspiciousness preceded declines in belongingness, and increased social avoidance predicted future feelings of burdensomeness. These lagged relationships were not present in participants without SI.

“Future studies may benefit from EMA over longer periods to unpack the influence of psychotic symptoms on the dynamics of burdensomeness, belongingness, and suicide risk, working to identify potentially personalized predictors of these constructs,” the researchers concluded. https://standingabovethecrowd.com/james-donaldson-on-mental-health-perceived-burdensomeness-linked-to-increased-risk-of-suicidal-ideation-in-smi-patients/

Every Step Towards Asking For Help Is A Leap Forward https://youtube.com/shorts/5LhkqJuOSGA?feature=share

James Donaldson on Mental Health - How Anxiety Leads to Problem Behavior

Kids who seem oppositional are often severely anxious

Writer: Caroline Miller

Clinical Experts: Jerry Bubrick, PhD , Rachel Busman, PsyD, ABPP , Nancy Rappaport, MD

What You'll Learn

- Why do kids with anxiety sometimes act out?
- What are the signs that a disruptive child might be anxious?
- What happens when anxiety is mistaken for bad behavior?
- What kinds of help are available for anxious kids who act out?
- Quick Read
- Full Article
- Unrecognized anxiety
- A great masquerader
- Problems at school
- Giving kids tools to handle anxiety
- Anxiety confused with ADHD
- How to identify anxiety

The symptoms of anxiety that most of us think of are clinging to parents, avoiding things or being very shy. But problem behavior can also be a symptom of anxiety. That’s because some anxious children feel an overwhelming need to get out of the situation that’s making them uncomfortable. That behavior may look like anger or defiance. 

Signs that a child who is acting out might be anxious include lashing out, throwing tantrums, seeming distracted, moving around a lot (like leaving their seat or even running out of the room), arguing with others, and asking lots of questions. 

Adults may mistakenly think that children who are acting out are being difficult on purpose. Parents don’t feel respected and may be frustrated or exhausted. At school, when kids disrupt class or don’t follow instructions, they offend teachers. Instead of learning to manage their anxiety, they end up in the principal’s office.  

Anxious kids who act out may be mistakenly diagnosed with ADHD or a behavior disorder. That’s why it’s important to have a careful evaluation by a mental health professional, like a psychologist, psychiatrist or social worker, to find out what’s causing the behavior. Anxiety can be treated very successfully with cognitive behavior therapy, or CBT. Kids learn techniques to calm themselves down when they are anxious, and the anxiety fades over time. Medication is sometimes recommended, too.  

A10-year-old boy named James has an outburst in school. Upset by something a classmate says to him, he pushes the other boy, and a shoving-match ensues. When the teacher steps in to break it up, James goes ballistic, throwing papers and books around the classroom and bolting out of the room. He is finally contained in the vice principal’s office, where staff members try to calm him down. Instead, he kicks the vice principal in a frenzied effort to escape. The staff calls 911, and James ends up in the emergency room.

To the uninitiated, James looks like a boy with serious anger issues. It’s not the first time he’s flown out of control. The school insists that his parents pick him up and take him home for lunch every day because he’s been banned from the cafeteria.

Unrecognized anxiety

But what’s really going on? “It turns out, after an evaluation, that he is off the charts for social anxiety,” reports Jerry Bubrick, PhD, a clinical psychologist who treated many children with anxiety and OCD at the Child Mind Institute. “He can’t tolerate any — even constructive — criticism. James is terrified of being embarrassed, so when a boy says something that makes him uncomfortable, he has no skills to deal with it, and he freaks out. Flight or fight.”

James’s story illustrates something that parents and teachers may not realize — that disruptive behavior is often generated by unrecognized anxiety. A child who appears to be oppositional or aggressive may be reacting to anxiety — anxiety they may, depending on their age, not be able to articulate effectively, or not even fully recognize.

“Especially in younger kids with anxiety you might see freezing and clinging kind of behavior,” says Rachel Busman, PsyD, a clinical psychologist, “but you can also see tantrums and complete meltdowns.”

A great masquerader

Anxiety manifests in a surprising variety of ways in part because it is based on a physiological response to a threat in the environment, a response that maximizes the body’s ability to either face danger or escape danger. So while some children exhibit anxiety by shrinking from situations or objects that trigger fears, some react with overwhelming need to break out of an uncomfortable situation. That behavior, which can be unmanageable, is often misread as anger or opposition.

“Anxiety is one of those diagnoses that is a great masquerader,” explains Laura Prager, MD, director of the Child Psychiatry Emergency Service at Massachusetts General Hospital. “It can look like a lot of things. Particularly with kids who may not have words to express their feelings, or because no one is listening to them, they might manifest their anxiety with behavioral dysregulation.”

The more commonly recognized symptoms of anxiety in a child are things like trouble sleeping in their own room or separating from their parents, avoidance of certain activities. “Anyone would recognize those symptoms,” notes Dr. Prager, co-author of Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service. But in other cases the anxiety can be hidden.

“When the chief complaint is temper tantrums, or disruption in school, or throwing themselves on the floor while shopping at the mall, it’s hard to know what it means,” she explains. “But it’s not uncommon, when kids like that come in to the ER, for the diagnosis to end up being a pretty profound anxiety disorder.”

Problems at school

It’s not uncommon for children with serious undiagnosed anxiety to be disruptive at school, where demands and expectations put pressure on them that they can’t handle. And it can be very confusing to teachers and other staff members to “read” that behavior, which can seem to come out of nowhere.

Nancy Rappaport, MD, a Harvard Medical School professor who specializes in mental health care in school settings, sees anxiety as one of the causes of disruptive behavior that makes classroom teaching so challenging. “The trouble is that when kids who are anxious become disruptive they push away the very adults who they need to help them feel secure,” notes Dr. Rappaport. “And instead of learning to manage their anxiety, they end up spending half the day in the principal’s office.”

Dr. Rappaport sees a lot of acting out in school as the result of trauma at home. “Kids who are struggling, not feeling safe at home,” she notes, “can act like terrorists at school, with fairly intimidating kinds of behavior.” Most at risk, she says, are kids with ADHD who’ve also experienced trauma. “They’re hyper-vigilant, they have no executive functioning, they misread cues and go into combat.”

Giving kids tools to handle anxiety

When a teacher is able to build a relationship with a child, to find out what’s really going on with them, what’s provoking the behavior, she can often give them tools to handle anxiety and prevent meltdowns. In her book, The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, Dr. Rappaport offers strategies kids can be taught to use to calm themselves down, from breathing exercises to techniques for distracting themselves.

“When a teacher understands the anxiety underlying the opposition, rather than making the assumption that the child is actively trying to make them miserable, it changes their approach,” says Dr. Rappaport, “The teacher is able to join forces with the child himself and the school counselor, to come up with strategies for preventing these situations.”

If it sounds labor-intensive for the teacher, it is, she notes, but so is dealing with the aftermath of the same child having a meltdown.

Anxiety confused with ADHD

Anxiety also drives a lot of symptoms in a school setting that are easily misconstrued as ADHD or defiant behavior.

“I’ll see a child who’s having difficulty in school: not paying attention, getting up out of their seat all the time, asking a lot of questions, going to the bathroom a lot, getting in other kids’ spaces,” explains Dr. Busman. “The behavior is disrupting other kids, and is frustrating to the teacher, who’s wondering why they ask so many questions, and why they’re so wrapped up in what other kids are doing, whether they’re following the rules.”

People tend to assume what’s happening with this child is ADHD inattentive type, but it’s commonly anxiety. Kids with OCD, mislabeled as inattentive, are actually not asking all those questions because they’re not listening, but rather because they need a lot of reassurance.

How to identify anxiety

“It probably occurs more than we think, either anxiety that looks disruptive or anxiety coexisting with disruptive behaviors,” Dr. Busman adds. “It all goes back to the fact that kids are complicated and symptoms can overlap diagnostic categories, which is why we need to have really comprehensive and good diagnostic assessment.”

First of all, good assessment needs to gather data from multiple sources, not just parents. “We want to talk to teachers and other people involved with the kid’s life,” she adds, “because sometimes kids that we see are exactly the same at home and at school, sometimes they are like two different children.”

And it needs to use rating scales on a full spectrum of behaviors, not just the area that looks the most obvious, to avoid missing things.

Dr. Busman also notes that a child with severe anxiety who’s struggling in school might also have attention or learning issues, but they might need to be treated for the anxiety before they can really be evaluated for those. She uses the example of a teenager with OCD who is doing terribly in school. “They’re ritualizing three to four hours a day, and having constant intrusive thoughts — so we need to treat that, to get the anxiety under control before we ask, how are they learning?”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Frequently Asked Questions

Can acting out be a symptom of anxiety in a child?

Acting out can be a symptom of anxiety in a child because some anxious children feel an overwhelming need to get out of a situation that’s making them anxious. Their behavior may look like anger or defiance, lashing out, throwing tantrums, seeming distracted, moving around a lot, or arguing with others.

Are anxious kids misdiagnosed because they act out?

How are anxious kids treated?

https://standingabovethecrowd.com/james-donaldson-on-mental-health-how-anxiety-leads-to-problem-behavior-2/

Kids who seem oppositional are often severely anxious

Writer: Caroline Miller

Clinical Experts: Jerry Bubrick, PhD , Rachel Busman, PsyD, ABPP , Nancy Rappaport, MD

What You'll Learn

- Why do kids with anxiety sometimes act out?

- What are the signs that a disruptive child might be anxious?

- What happens when anxiety is mistaken for bad behavior?

- What kinds of help are available for anxious kids who act out?

- Quick Read

- Full Article

- Unrecognized anxiety

- A great masquerader

- Problems at school

- Giving kids tools to handle anxiety

- Anxiety confused with ADHD

- How to identify anxiety

The symptoms of anxiety that most of us think of are clinging to parents, avoiding things or being very shy. But problem behavior can also be a symptom of anxiety. That’s because some anxious children feel an overwhelming need to get out of the situation that’s making them uncomfortable. That behavior may look like anger or defiance. 

Signs that a child who is acting out might be anxious include lashing out, throwing tantrums, seeming distracted, moving around a lot (like leaving their seat or even running out of the room), arguing with others, and asking lots of questions. 

Adults may mistakenly think that children who are acting out are being difficult on purpose. Parents don’t feel respected and may be frustrated or exhausted. At school, when kids disrupt class or don’t follow instructions, they offend teachers. Instead of learning to manage their anxiety, they end up in the principal’s office.  

Anxious kids who act out may be mistakenly diagnosed with ADHD or a behavior disorder. That’s why it’s important to have a careful evaluation by a mental health professional, like a psychologist, psychiatrist or social worker, to find out what’s causing the behavior. Anxiety can be treated very successfully with cognitive behavior therapy, or CBT. Kids learn techniques to calm themselves down when they are anxious, and the anxiety fades over time. Medication is sometimes recommended, too.  

A10-year-old boy named James has an outburst in school. Upset by something a classmate says to him, he pushes the other boy, and a shoving-match ensues. When the teacher steps in to break it up, James goes ballistic, throwing papers and books around the classroom and bolting out of the room. He is finally contained in the vice principal’s office, where staff members try to calm him down. Instead, he kicks the vice principal in a frenzied effort to escape. The staff calls 911, and James ends up in the emergency room.

To the uninitiated, James looks like a boy with serious anger issues. It’s not the first time he’s flown out of control. The school insists that his parents pick him up and take him home for lunch every day because he’s been banned from the cafeteria.

Unrecognized anxiety

But what’s really going on? “It turns out, after an evaluation, that he is off the charts for social anxiety,” reports Jerry Bubrick, PhD, a clinical psychologist who treated many children with anxiety and OCD at the Child Mind Institute. “He can’t tolerate any — even constructive — criticism. James is terrified of being embarrassed, so when a boy says something that makes him uncomfortable, he has no skills to deal with it, and he freaks out. Flight or fight.”

James’s story illustrates something that parents and teachers may not realize — that disruptive behavior is often generated by unrecognized anxiety. A child who appears to be oppositional or aggressive may be reacting to anxiety — anxiety they may, depending on their age, not be able to articulate effectively, or not even fully recognize.

“Especially in younger kids with anxiety you might see freezing and clinging kind of behavior,” says Rachel Busman, PsyD, a clinical psychologist, “but you can also see tantrums and complete meltdowns.”

A great masquerader

Anxiety manifests in a surprising variety of ways in part because it is based on a physiological response to a threat in the environment, a response that maximizes the body’s ability to either face danger or escape danger. So while some children exhibit anxiety by shrinking from situations or objects that trigger fears, some react with overwhelming need to break out of an uncomfortable situation. That behavior, which can be unmanageable, is often misread as anger or opposition.

“Anxiety is one of those diagnoses that is a great masquerader,” explains Laura Prager, MD, director of the Child Psychiatry Emergency Service at Massachusetts General Hospital. “It can look like a lot of things. Particularly with kids who may not have words to express their feelings, or because no one is listening to them, they might manifest their anxiety with behavioral dysregulation.”

The more commonly recognized symptoms of anxiety in a child are things like trouble sleeping in their own room or separating from their parents, avoidance of certain activities. “Anyone would recognize those symptoms,” notes Dr. Prager, co-author of Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service. But in other cases the anxiety can be hidden.

“When the chief complaint is temper tantrums, or disruption in school, or throwing themselves on the floor while shopping at the mall, it’s hard to know what it means,” she explains. “But it’s not uncommon, when kids like that come in to the ER, for the diagnosis to end up being a pretty profound anxiety disorder.”

Problems at school

It’s not uncommon for children with serious undiagnosed anxiety to be disruptive at school, where demands and expectations put pressure on them that they can’t handle. And it can be very confusing to teachers and other staff members to “read” that behavior, which can seem to come out of nowhere.

Nancy Rappaport, MD, a Harvard Medical School professor who specializes in mental health care in school settings, sees anxiety as one of the causes of disruptive behavior that makes classroom teaching so challenging. “The trouble is that when kids who are anxious become disruptive they push away the very adults who they need to help them feel secure,” notes Dr. Rappaport. “And instead of learning to manage their anxiety, they end up spending half the day in the principal’s office.”

Dr. Rappaport sees a lot of acting out in school as the result of trauma at home. “Kids who are struggling, not feeling safe at home,” she notes, “can act like terrorists at school, with fairly intimidating kinds of behavior.” Most at risk, she says, are kids with ADHD who’ve also experienced trauma. “They’re hyper-vigilant, they have no executive functioning, they misread cues and go into combat.”

Giving kids tools to handle anxiety

When a teacher is able to build a relationship with a child, to find out what’s really going on with them, what’s provoking the behavior, she can often give them tools to handle anxiety and prevent meltdowns. In her book, The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, Dr. Rappaport offers strategies kids can be taught to use to calm themselves down, from breathing exercises to techniques for distracting themselves.

“When a teacher understands the anxiety underlying the opposition, rather than making the assumption that the child is actively trying to make them miserable, it changes their approach,” says Dr. Rappaport, “The teacher is able to join forces with the child himself and the school counselor, to come up with strategies for preventing these situations.”

If it sounds labor-intensive for the teacher, it is, she notes, but so is dealing with the aftermath of the same child having a meltdown.

Anxiety confused with ADHD

Anxiety also drives a lot of symptoms in a school setting that are easily misconstrued as ADHD or defiant behavior.

“I’ll see a child who’s having difficulty in school: not paying attention, getting up out of their seat all the time, asking a lot of questions, going to the bathroom a lot, getting in other kids’ spaces,” explains Dr. Busman. “The behavior is disrupting other kids, and is frustrating to the teacher, who’s wondering why they ask so many questions, and why they’re so wrapped up in what other kids are doing, whether they’re following the rules.”

People tend to assume what’s happening with this child is ADHD inattentive type, but it’s commonly anxiety. Kids with OCD, mislabeled as inattentive, are actually not asking all those questions because they’re not listening, but rather because they need a lot of reassurance.

How to identify anxiety

“It probably occurs more than we think, either anxiety that looks disruptive or anxiety coexisting with disruptive behaviors,” Dr. Busman adds. “It all goes back to the fact that kids are complicated and symptoms can overlap diagnostic categories, which is why we need to have really comprehensive and good diagnostic assessment.”

First of all, good assessment needs to gather data from multiple sources, not just parents. “We want to talk to teachers and other people involved with the kid’s life,” she adds, “because sometimes kids that we see are exactly the same at home and at school, sometimes they are like two different children.”

And it needs to use rating scales on a full spectrum of behaviors, not just the area that looks the most obvious, to avoid missing things.

Dr. Busman also notes that a child with severe anxiety who’s struggling in school might also have attention or learning issues, but they might need to be treated for the anxiety before they can really be evaluated for those. She uses the example of a teenager with OCD who is doing terribly in school. “They’re ritualizing three to four hours a day, and having constant intrusive thoughts — so we need to treat that, to get the anxiety under control before we ask, how are they learning?”

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

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Frequently Asked Questions

Can acting out be a symptom of anxiety in a child?

Acting out can be a symptom of anxiety in a child because some anxious children feel an overwhelming need to get out of a situation that’s making them anxious. Their behavior may look like anger or defiance, lashing out, throwing tantrums, seeming distracted, moving around a lot, or arguing with others.

Are anxious kids misdiagnosed because they act out?

How are anxious kids treated? https://standingabovethecrowd.com/james-donaldson-on-mental-health-how-anxiety-leads-to-problem-behavior-2/