Tag Archives: Children & Adolescents

Children & Adolescents

Supporting families with engagement strategies during COVID-19

By Carson Eckard June 18, 2020

To combat the toxic stress caused by the COVID-19 pandemic, I have created a list of activities to positively engage children during this time. The following list includes a description of what each activity is, what materials are needed (with an understanding that many families are under financial hardship) and the possible psychological benefits of the activity.

These activities are designed for entire families, including adults, to reduce stress and promote healing during the pandemic. Most of these activities can be done either inside or outside and can be tailored to individual interests, ages and ability levels.

 

Obstacle course

This activity will get the whole family moving. Use objects around the house to get the family involved. This could include climbing under or over chairs, throwing a bundle of socks into a laundry basket, spinning, using paper strips in place of lasers, and so on.

Inside, a slower pace can be taken to ensure that nothing gets broken and no one gets hurt. If you have access to an outdoor space or a sidewalk in front of your home, you can create an obstacle course out of chalk. Here’s an example.

This website includes a list of materials to use.

This slideshow has ideas for children in wheelchairs.

Materials: Whatever you have in the house

Ages: Toddlers and early elementary-age children

Psychological benefit: Obstacle courses can target many aspects of a child’s brain, including sensory input, motor planning, coordination, sequencing and problem-solving. They can also reduce psychological stress and anxiety. When more people participate, the teamwork and competition can provide some of the social interaction children have been missing from environments such as school.

 

Broadway play

This activity allows children to engage in imaginary play by creating plots to their own stories. When the story is written, have the child cast the characters in the story, find props (or imagine them) and direct the scene. If there aren’t enough family members to act out the scene, consider playing multiple parts at once or having the child draw the characters instead. Children may need direction and prompting, but allow them to be in control of constructing their own narrative. Activities that could be added include constructing sets and props and making movie posters.

Materials: Whatever you have in the house — paper, markers, drawing materials, prop-making materials and so on

Ages: Toddlers through early middle school age

Psychological benefit: During the pandemic, children may be struggling with an inability to control the situation. When they are able to control a scene and story in a healthy way, it can reduce their stress and promote individuality and resilience. Furthermore, creativity reduces anxiety and depression and can help children process toxic stress.

 

Board games and card games

When everyone is stuck at home, board games and card games are a great option for helping the entire family to connect. For younger kids, games such as Go Fish, Candy Land, and Guess Who? could be hits, whereas older kids may like Monopoly, Clue, and Sorry!

If you don’t have any board games at home, use paper or cardboard to create your own. WikiHow has information on steps to take when you’d like to create your own board game. Make sure your child is part of the creative process of creating the game if you choose to make your own.

For more information on why board games are good for a child’s mental health, as well as a breakdown of age-appropriate games, check this link from Manhattan Psychology Group.

Materials: Cardboard, paper, markers, small toys, etc.

Ages: Any

Psychological benefit: Playing fun games decreases anxiety and can increase confidence in children. Some games include aspects of problem-solving and can access the cortex for children who feel safe. Board games allow for healthy cognitive and social development for children.

Mazes and finger labyrinths

Mazes and finger labyrinths are easily made at home. They are a great brain teaser for kids and can also be extremely relaxing. Finger labyrinths are just like mazes, but instead of drawing a line to the exit, a finger is used to follow the path. When paired with deep breathing exercises, this can have a meditative quality.

For help on constructing labyrinths made out of materials such as rice, play dough, paperclips and more, go to this website.

The Labyrinth Society offers an online resource for downloadable and printable finger labyrinths.

The All Kids Network has many printable mazes for kids.

Materials: Paper, printer, something to write with

Ages: Whereas mazes are most engaging for children ages 3-6, finger labyrinths are a good mindfulness activity for children of all ages

Psychological benefit: Mazes offer many benefits to a child’s development, including problem-solving and motor control. Children will need patience and persistence to complete the puzzle and, once done, may experience a boost of confidence. Finger labyrinths originated in prayer but are also used as a grounding exercise.

 

Dance party

Turn up your favorite songs and get moving. Be sure to build a playlist the entire family can move to. Only upbeat jams! Spotify is a free service you can use to build playlists if you establish an account. Spotify playlists that might make for super fun dance parties can be found here. You may need to look around to find a playlist without explicit lyrics, but Spotify does offer an explicit content filter in its settings. Other free services include Amazon Music, Pandora, iHeartRadio and YouTube, but most have ads and can incorporate explicit lyrics, so be careful.

Materials: A phone, laptop, tablet or any device that plays music

Ages: Any

Psychological benefit: Dancing is both great exercise and a form of creative expression. Dancing keeps your heart healthy and muscles strong, improves coordination and balance, and provides an outlet for emotions. Music activates the cerebellum, stimulates the release of hormones that reduce stress, and improves self-esteem.

 

Karaoke party

On a similar note to a dance party, a karaoke party could be another viable option for the family. Because you want family members to sing, I recommend using YouTube and allowing each person to pick a song of their choice, unless you have a premium subscription for a music streaming service. As a finale, try singing a few songs that everyone knows together. For an added bonus, try creating a song by making your own lyrics and finding objects around the house to use as instruments.

Materials: A phone, laptop, tablet or any device that plays music; maybe a prop to use as a “microphone”

Ages: Any

Psychological benefit: Singing releases hormones that reduce stress and make us feel happy, improves mental alertness and helps us control our breath flow, which can help us regulate. Singing also helps children’s communication skills and self-esteem. Studies show that singing stimulates the vagus nerve responsible for our senses, motor function, digestion, respiration and heart rate. When stimulated, the vagus nerve reduces stress, lowers the heart rate and blood pressure, and reduces inflammation.

 

Play teacher

Let your child become the expert and pretend to be a teacher of whatever they are passionate about. This can take a more “formal” approach by pretending to be in school, or it can be more informal, simply asking them questions about the things they are interested in. This helps children realize that adults don’t know everything and allows them to develop as individuals.

Materials: None

Ages: Elementary school age (Note: It is beneficial and important to ask children of any age what their interests are to strengthen your relationship with them)

Psychological benefit: Taking on a formal “school” scenario involves imaginative play. Imaginative play allows children to experiment with different interests and skills. Furthermore, children who engage in pretend play are understanding social relationships, expressing and understanding emotions, expressing themselves both verbally and nonverbally, and practicing problem-solving skills. If imaginative play isn’t your cup of tea, have conversations with your child about what they are passionate about or interested in. Having these kinds of conversations will help you and your child relate to each other more.

 

Yoga

Although it may be difficult to practice advanced yoga poses with younger kids, it is possible to find something appropriate for their level. One of the most important aspects of yoga is breathing. Try doing the yoga poses with your child. Model a positive attitude and a willingness to try new poses, and compliment the child when poses are attempted. Make sure the poses are not too advanced for children or they may become frustrated.

Here is a free YouTube video of yoga poses that you can do with children. If you do not have access to a video device or the child would not benefit from structured instructions found in a video, you can find printable yoga poses from Kids Yoga Stories. If you and the child are new to yoga, it is vitally important to follow a guide to ensure that you are not hurting yourself or the child.

Materials: A guide to follow (either pictures or a video)

Ages: Any

Psychological benefit: It is no secret that yoga has therapeutic qualities such as offering a sense of calmness and relaxation. Furthermore, yoga enhances children’s flexibility, strength, coordination and body awareness. Doing yoga can reduce muscle tension held in our bodies and is another activity that stimulates the vagus nerve, which reduces stress, lowers the heart rate and blood pressure, and reduces inflammation.

 

Indoor sports

This category can depend on whether there is space to move around and interact with each other, but there are options for small spaces too. Each activity is meant to allow children to have fun and can be created with multiple objects around the house.

The Fatherly website has many ideas, such as balloon tennis, for bigger spaces. Roll up some paper and make a ball or a puck to kick, throw or hit around the house. Use a balloon to play volleyball or keep-up. If you have a smaller space, perhaps finger football might suit your needs.

Materials: Anything you can find around the house

Ages: Early elementary to early middle school age

Psychological benefit: If your family doesn’t have much space to run around and play, even the simplest games such as finger football increase coordination. In addition, these sports need multiple participants, which assists in the social development of the child.

 

Video games

Many video games are not family friendly or age appropriate for children. However, many options are available for younger kids both online and offline. PBS Kids offers many educational games for young children. Older kids may benefit from playing games online with their friends. Among popular options are Fortnite, Roblox, Minecraft, League of Legends and titles usually found on consoles, such as NBA 2K and Call of Duty. Many of these games are not free (some can be very expensive), and many are not appropriate for all kids. Have a conversation with the children in your life about what their friends are playing, and then set healthy boundaries around screen time.

There are also online video games that you can play with your family and friends. Popular options include Kahoot!, Jackbox Party Pack, digital board games through apps, Mario Kart Tour and others. Many of these games require only your phone or another device with internet access.

Materials: Games to play and something to play on

Ages: Any (as long as you monitor what games they are playing)

Psychological benefit: Your child is likely missing their friends from school and other environments. Allowing children to play video games with their friends online can help them stay connected and have fun. With all ages, video games offer an outlet for motor development, the release of stress relief hormones, social interaction, problem-solving, development of leadership skills, and increased alertness.

 

Call-and-response songs

If you’ve ever been to summer camp, call-and-response songs will be familiar to you. These songs are started by one person and imitated by another person or group. For children, particularly children with special needs, transitions between activities may be challenging. Side note: I worked at a summer camp with children with autism spectrum disorder, and mealtimes were one of the most stressful parts of the day for them. Singing a simple song such as “We put our foot up on the tree, we put our foot up on the tree, we put our feet up on the tree so that we can eat” makes these times less stressful for all.

Performing a quick redirect activity such as a call-and-response song can lighten the mood and offers a fun incentive for completing an activity. Although there are already call-and-response songs that you can utilize, you can also make your own (or change the words to an existing song) to suit the child’s needs. This activity could also be paired with dance moves or even a camp-themed day.

Go to Ultimate Camp Resource for a list of call-and-response songs. Design Improvised has a great list of themed summer camp ideas to use if you’d like to host a camp-themed day at home.

Materials: None

Ages: Toddler through elementary school age

Psychological benefit: Singing has profound mental health benefits. Singing forces a person to control their breathing. If someone is anxious and having trouble regulating their breathing, singing can help. Singing also improves mental alertness and confidence.

 

Grounding activities

The purpose of a grounding activity is to refocus on reality. It is particularly effective for children who suffer from anxiety, high levels of stress, trauma, dissociation, self-harm tendencies and suicidal thoughts. When children experience these events, they are more likely to enter a state of fight, flight or freeze because they feel they are in danger. Grounding techniques help move the brain from survival mechanisms to a calm state.

Although grounding activities are used in circumstances of higher emotion, they should be practiced often (and even when children are feeling happy) to ensure that children can perform them while in a dysregulated state of mind. You should take time out of the day for all family members to practice these skills together.

Sound search: Sit calmly in a comfortable position. The person lists the sounds they hear. Focusing on other senses helps bring the child back to safety and stabilization.

Coloring break: Although this is most effective for younger kids, it can be used for any age. Even if you do not have coloring pages, encourage the child to draw or color on a piece of paper. Support whatever they need to create in the moment. Crayola has printable coloring pages both for kids and adults.

Sensory bin: A sensory bin is a container filled with materials to stimulate the senses. You must know what types of sensations the child feels are soothing and what sensations may make the child excited. When used with soothing objects such as water or sand, a child may be able to focus on the container instead of overwhelming thoughts. The good thing about sensory bins is that they are easy to make and easy to store when needed. This technique is used mainly with younger kids, but a child of any age may appreciate a sensory bin if it is filled with the appropriate objects. Go to Your Kids Table for a list of ideas on what to put inside a sensory bin.

Positive affirmations: Building a mantra, based on a child’s strengths, that the child can repeat when they are feeling overwhelmed may be beneficial. The idea of having a child repeat a positive mantra when overwhelmed is to help the brain focus not only on the words they are saying but also on the breath needed to form the words. Whenever a family member or friends see the child becoming overwhelmed, they can support the child by guiding the child through the mantra.

Breathing techniques: You can teach children to utilize many different breathing techniques. Breathing exercises calm the brain’s reactions to threats by getting more oxygen. The adult should make sure the child has no anxiety about breath retention and that the child is slow and intentional instead of hyperventilating. If the child is hyperventilating, try to get them to exhale longer than they inhale. Model the techniques for them. Repeat the technique for as long as it takes the child to calm down. Breathing techniques take many forms, such as:

  • Sniff the Flower, Blow Out the Candle: The child imagines holding a flower in one hand and a candle in the other. The child must focus on breathing in through their nose while bringing the “flower” to their face, as if sniffing it, and then exhaling out the mouth while bringing the “candle” to their face.
  • 4-7-8 breathing: The child should breathe in through the nose for 4 seconds, hold their breath for 7 seconds, and exhale out their mouth for 8 seconds.
  • One-nostril breath: The child should place their finger over one nostril and breathe in deeply. The child should then switch to the other nostril and breathe out.

 

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Carson Eckard is a rising second-year graduate student in the community and trauma counseling program at Thomas Jefferson University. He graduated with his B.S. in psychology from Thomas Jefferson University in December 2019. He is passionate about advocating for clients, particularly LGBTQ+ youth. Contact him at Carson.Eckard@jefferson.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

School vaping cultures: Acknowledging the impact of COVID-19

By Zachary Short and Nicole Baliszewski June 4, 2020

This past January, global tobacco conglomerate Altria saw a major drop in its stock value on the New York Stock Exchange, depreciating at a value of almost 40% versus its record-breaking highs in 2017. What caused this sudden dip in one of the biggest-rebounding industries of the 21st century? It would be fair to suggest that the COVID-19 pandemic has caused some major complications for both the traditional and electronic cigarette corporations located across the United States.

As a respiratory-based infectious disease, COVID-19 poses an unparalleled threat to the health and safety of individuals across the age spectrum with significant histories of vaping or smoking. In fact, a recent study in the New England Journal of Medicine found that Chinese patients with a history of smoking were twice as likely to suffer from severe infections associated with diseases such as COVID-19 in comparison with those without any smoking history.

Having always opposed the youth vaping/smoking culture, counselors and community advocates across the nation are currently working to answer a significant question: What actions can we be taking to protect our communities from the combined threat of COVID-19 and recent vaping trends?

The truth is, now is the prime time for considering how we can influence our communities to create better post-quarantine schools for our students.

The loss and revitalization of the smoking industry

Only five years ago, health specialists with the Truth Initiative anti-smoking campaign speculated that the tobacco industry and most of the nation’s smoking addictions would expire with the Generation Z demographic. But vaping, the process of inhaling prepackaged aerosols (also known as vapor), has led to the resurgence of nicotine products within school systems.

Through a combination of peer pressure and social media campaigns, students from all backgrounds have found themselves under the influence of Altria’s newest partner, Juul Labs, maker of the Juul electronic cigarette. Largely as the result of the popularization of this flavored electronic smoking device, the number of high school students who use nicotine products has increased from 3.6 million to 5.4 million in the span of only one year, according to the Centers for Disease Control and Prevention (CDC).

How significant it would be to know that schools were free of the harmful aftereffects of adolescent smoking, leaving school counselors and clinicians available to attend to the important mental health developments that are so essential in our school systems right now. Instead, we find ourselves dealing with another truly concerning issue: According to the Truth Initiative, 1 in every 4 high school students now uses e-cigarettes.

These concerning statistics represent a call for preventative action in middle schools across the nation. A number of schools and organizations have taken such counteractions to trends in vaping by launching interventions such as confiscation, disciplinary action, and even educational programming. But the culture of vaping continues to persist as a significant concern for parents and educators.

The most terrifying thing about the Juul product so far is that it appears to come off as being innocuous to many people. Most students and parents recognize it as the small USB-shaped device that produces fruit-flavored smoke. Very few seem to grasp the long-term consequences of vaping habits. That being said, those consequences might already be here.

The individuals at risk

Based on data collected by the CDC in early March, evidence suggests that COVID-19 poses a serious threat to all individuals ages 65 and older. Fortunately for students under the age of 18, the percentage of those infected and harmed has been relatively low by comparison.

While most parents find some comfort in hearing that the student demographic is the least impacted by the pandemic, the statistics can change drastically if students are part of the vaping culture that is rampant among youth. According to data provided by the CDC for China’s mainland population facing COVID-19, individuals with respiratory issues predominantly associated with even a small history of smoking or vaping have a 6.3% case fatality rate, in contrast to 2.3% overall. Recognizing how exposure to vaping increases a person’s health concerns, imagine the increased risks that our students could face should their still-developing physiques come in contact with both nicotine products and a respiratory infection.

“What they say is about 80% of people feel the flu, but they will be OK. Where we are getting into trouble is that it can lead to severe pulmonary distress,” says Anna Song, an associate professor of health psychology and leader of the Health Behaviors Research Lab at the University of California Merced. “Smoking is a risk factor for having this disease progress, be incredibly severe, and lead to mortality.”

As we know, COVID-19 has posed widespread challenges to the health and lifestyles of the global population. Societal and educational norms have begun to deteriorate, and everyday tasks and responsibilities now come with an unprecedented health risk to individuals and their families. Of great concern to us is that the unattended trends and cultures of our school systems could be having a negative impact on our students right now. To allow these trends to persist beyond this pandemic is to continue putting our students at risk unnecessarily.

A unique opportunity for change

What makes now such an ideal time to invest in removing the harmful vape cultures that continue to linger in our school systems? Students are largely being required to undertake remote learning during this time, and that may continue for many students even as a new school year begins. The changes and circumstances that come with students’ remote learning actually promote our greatest opportunity for the development of an anti-smoking culture.

Society is recognizing that our plans, policies and preparation were inadequate to succeed in the face of an unanticipated global pandemic. Thus, things are beginning to change. Legislation is developing to create preventative actions around practices deemed unhealthy by medical specialists, and educational policy is constantly being reformed to reflect the needs and issues present in our impromptu teaching conditions. If there was ever a time to acknowledge the statistics that point to the harm that nicotine products pose to our adolescents and to advocate for the safety of our children, it is now.

Large systemic changes are challenging and often are out of our hands, but educators and parents currently have the opportunity to make a notable difference in students’ environments. During this time of partial quarantine, most families are now all in one location — the home. Our students currently find themselves in a setting where they are under the watchful eyes of their families and where smoking purchases and practices are essentially impossible.

In addition to that, they are also in a potential learning atmosphere. Through the joint efforts of educators and parents, our youth can be exposed to real educational and intimate conversations regarding the dangerous practices of smoking. These conversations can mean the world to students who currently feel that their futures and health might be dictated by vaping culture.

COVID-19 has had a harsh and unpredictable influence on our way of life, but it also presents us with a rare opportunity to support our students through one of the greatest health issues of their generation. So, making use of the present, it is time that we as a supportive community of counselors consider what we should be doing to help facilitate and emphasize this process of growth for students’ mental and physical health.

Our responsibility to intervene

As of early April, individuals within Rowan University’s Department of Psychology have been conducting their own research to confront the vaping culture that remains prevalent during the COVID-19 pandemic. Their research takes an interesting approach to behavioral analysis with younger age groups, including the development of interesting activities such as mobile- and video game-based interventions that promote smoking abstinence.

Fortunately, this is just the tip of the iceberg when it comes to the collective efforts of universities to combat vaping trends in student populations. Even educational institutions outside of higher education are recognizing the statistically supported danger that vaping is putting our students in when facing the current health pandemic. As a community, it is our collaborative responsibility to provide education and to take the necessary precautions to protect our students’ health. We are just beginning to understand the proper steps to take when working from a remote distance.

Educating the community: Providing knowledge of the increased risks and hazards of smoking behaviors is the first step to reducing nicotine consumption within our school systems. Given the myriad resources available on the consequences of vaping from the CDC, the National Institute on Drug Abuse and even university websites such as Johns Hopkins Medicine, it is the obligation of school counselors and other school personnel to appropriately share this information with our local communities. It is important to remember that this information needs to be given not only to the students we support, but also to our educational partners and to the families who are acting as our immediate support systems in homes at this time.

Promoting real conversations: With the knowledge and statistics being supplied to our students’ homes, it is more important now than ever that school systems promote real conversations with students regarding the present vaping cultures. Whether it is school counselor-to-student or parent-to-student conversations, we need to understand what the student perspectives are when they see products such as Juul in the media while also witnessing terrifying statistics regarding the spread of a global virus.

With those who are currently smoking, it is vital that we understand their concerns and interests so that we can provide them the appropriate support they need. These conversations are the optimal opportunity to promote and communicate resiliency, empathy and community support to our students. And with those who have never touched a vaping device, communicating this information and the associated risks is the best possible preventative action at this time.

Advocating for policies: To reiterate, now is a turbulent time when leaders are reflecting on educational preparations and policy and how they might be applied for future incidents. In addition to redesigning our school’s remote learning policies, we need to be working as a professional community to advocate for anti-vaping policies within our schools. It is essential that school counselors reflect on school policies regarding smoking tolerance, as well as preventative actions to take, so that they can create real opportunities to support student health.

Fortunately, states and health institutions are rallying to create a number of anti-vaping models that can be implemented or referenced by school counselors looking to better their schools. One such model is the Make Smoking History campaign, conducted by the Massachusetts Department of Public Health, to reduce the percentage of vaping disciplinary actions taken in middle school settings. This is the time to ask for and support the voices of the education community to find out what should be done for the development of our educational systems — not just on a school-by-school basis, but from a legislative perspective.

Forming support groups: Finally, acknowledging that this is a difficult time for individuals who have a dependency on smoking tools to which they no longer have easy access, we need to prepare and create remote counseling groups to support them through potential issues such as withdrawal or rehabilitation. A number of counselors may struggle with the concept of remote group counseling, but these students still need emotional and mental health support to cope with their new distancing from vaping. Counselors should utilize the medical resources and personnel within their school districts to support students in their transition to healthier living. Ultimately, it is groups such as these that we should be planning to implement more frequently in our later return to school.

The truth is that in the midst of a global health crisis, most individuals view the issue of vaping in school systems as relatively small. But the fact is that vaping is a real health issue for our youth, and in combination with the threat of COVID-19, it puts our newest generation of students at exceptional risk for loss. In a moment in history when many counselors are at home and wondering what they should be doing to support their students, imagine what significant change could occur if we all directed a portion of our efforts to acknowledging and countering the present vaping culture.

 

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Related reading, from the Counseling Today archives: “Pushing through the vape cloud

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Zachary Short is a master’s counseling in educational settings student at Rowan University. He currently works as a clinical research intern in a high school setting, where his research in student behavioral outcomes is being supported through the Mental Health Grant Demonstration Program. Contact him through LinkedIn: linkedin.com/in/shortzachary/.

Nicole Baliszewski is a master’s counseling in educational settings student at Rowan University. She currently works as a clinical intern in a middle school setting, where she seeks to provide trauma and mental health support to the special education student population. Contact her through LinkedIn: linkedin.com/in/nbaliszewski/.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Supporting families on their autism journeys

By Lindsey Phillips May 1, 2020

Maria Davis-Pierre, a licensed mental health counselor (LMHC) in Lake Worth, Florida, first suspected her daughter might be on the autism spectrum when she was 6 months old and showed signs of sensory issues. Then at 10 months, her daughter, who had been saying simple words such as “mama,” “dada” and “ball,” suddenly stopped speaking. When Davis-Pierre and her husband tried to get their daughter to mimic them saying the words, she acted as if she had forgotten them. As a therapist, Davis-Pierre understood the importance of early intervention, so she was proactive about getting her daughter a diagnosis. But it wasn’t easy.

Her pediatrician referred her to health professionals who specialized in developmental delays in infants and toddlers. They tested her daughter and thought she had autism spectrum disorder (ASD), but because she was still so young (around 18 months), they didn’t feel comfortable officially diagnosing her. They recommended she see a pediatric neurologist.

After more tests (which cost the family thousands of dollars out of pocket), the pediatric neurologist agreed about the presence of ASD but was also uncomfortable officially diagnosing the child at such a young age. Davis-Pierre told the doctor she was going to sit in his office every day until her daughter got a diagnosis. One week later, that finally happened.

Davis-Pierre thought the next steps would be easy, especially given that both she and her husband are in the health care field. But what she experienced was more frustration.

“At no point — even with the neurologist — was there a check-in with the parent: ‘OK, this is the diagnosis. This is what happens next,’” Davis-Pierre recalls. “It was, ‘OK, here’s your paperwork. This is the diagnosis. Now, go figure it out.’” According to Davis-Pierre, the health care professionals didn’t provide her family with resources or give any consideration to how the family’s culture would factor into their daughter’s treatment.

When Davis-Pierre spoke with other parents of children on the autism spectrum, she found out that this treatment was the norm. And it left her — and the other parents — feeling overwhelmed.

This experience prompted Davis-Pierre, an American Counseling Association member, to start Autism in Black, a private practice that specializes in helping black parents of children with autism get the help they need.

In a blog post on the website GoodTherapy, Janeen Herskovitz, an LMHC in Ponte Vedra Beach, Florida, points out four areas in which counseling can help parents of children with ASD: adjusting to the diagnosis (which is often traumatic for parents), learning parenting skills, staying connected to their partners, and managing stress. Professional counselors can also help families prepare for developmental transitions, learn to effectively communicate with one another and extended family, and navigate cultural barriers.

Working through developmental transitions

ASD “is a neurodevelopmental disability, which means at different developmental stages, our clients are going to run into different developmental barriers, and they’re going to need us as counselors,” says Chris Abildgaard, a licensed professional counselor and director of the Social Learning Center in Cheshire, Connecticut. So, it’s important for counselors to understand where families are on their journeys, he points out. Is the family adjusting to the diagnosis? Are they struggling to communicate with their child? Are they helping a child through puberty? Counselors should also prepare to help families with life milestones such as going to prom, getting a driver’s license or grieving a death, Abildgaard adds.

Some families experience grief when they first learn about the ASD diagnosis, says Michael Hannon, an assistant professor of counseling at Montclair State University in New Jersey. These families will be reconciling a new reality and having to let go of certain elements of the relationship they expected to have with their child. “It’s really about [the family] learning to adjust to the needs, strengths, capacity, and some challenges of the people they love living with autism,” he adds.

Another challenging transition for parents and caregivers is when the child enters adulthood. Parents have likely been involved in every aspect of the child’s life, especially in the school system, so it is a significant adjustment when the child takes over this responsibility, Davis-Pierre says. She helps ease this transition by having parents teach their children to advocate for themselves before they reach adulthood. The more parents involve children with ASD in the day-to-day decisions about their lives and school, the more they realize that their children are capable of advocating for themselves, she says.

Abildgaard, an ACA member who specializes in ASD (and author of the 2013 Counseling Today article “Processing the ‘whole’ with clients on the autism spectrum”), has noticed that families sometimes push their child to do something that the child isn’t ready for or doesn’t want. For example, parents often ask him how they can make their child have a friend. Counselors need to educate parents that relationships take time and that individuals on the spectrum may not fully understand the intricacies of relationships and friendships. They will need support and coaching in this area well into their late teens, early 20s or beyond, he says.

Counselors can also help parents make plans and prepare for certain life events and developmental transitions, Abildgaard says. He finds visuals useful in helping families with a child on the spectrum to process events. Recently, he had a family who was going on a trip to a large city. He brought out his whiteboard and on one side wrote down all the thoughts and feelings the parents were having about the upcoming trip, such as feeling anxious that their child would have a tantrum and run from them. Then, Abildgaard asked the parents to consider their child’s perspective and why he might have a tantrum. On the other side of the whiteboard, he wrote down the child’s thoughts and feelings, such as being overwhelmed by all the lights and sounds.

This activity helped the parents realize the link between their own thoughts, emotions and behaviors and those of their child. It also started a discussion about proactive strategies the parents could take to decrease the likelihood of their child experiencing sensory overload. This, in turn, lowered their anxiety about the trip, Abildgaard says.

Helping families stay connected

Having a child with autism affects the entire family system, Abildgaard says. It affects how parents interact with each other, how parents interact with each of their children, how siblings interact with each other, and how the family interacts with extended family members.

Couples don’t typically preemptively discuss the possibility of a having a child with a disability, Davis-Pierre notes. So, when a child is first diagnosed with autism, parents often have to reassess the roles, expectations, responsibilities and core values of the family, she says.

Counselors may also have to coach families through complicated life events such as divorce. Abildgaard, an adjunct professor in the Department of Special Education at the University of Saint Joseph, reminds counselors that regardless of the situations that families bring to them, it is important to break these situations down into manageable parts for the clients.

When the parents of a client with ASD were going through a divorce, Abildgaard, a nationally certified school psychologist, brainstormed with the parents how best to explain the situation to their son. Abildgaard also learned from the client’s school that the child had been making comments about the divorce there. Abildgaard says his role as a counselor was to help the client process and express his feelings about the divorce. To do this, he said, “Tell me some things your eyes are noticing that are different at home.” He made his language concrete and specific, which allowed the child with ASD to talk about what he had been noticing, such as his parents arguing more. The boy also said he was scared to talk about these things with his parents, so he and Abildgaard worked through his anxiety together.

Then, Abildgaard brought the entire family into his office to discuss these issues. He chose to have them come in during the morning hours when his office would be quiet so the family would be more comfortable and not feel rushed or distracted.

Balancing the parenting of both neurotypical and neurodiverse siblings is another common challenge that Hannon and Davis-Pierre hear about from their clients. They try to help parents learn how to better communicate with their children and to maximize and be intentional about the time they spend with each child.

Hannon, a licensed associate counselor in New Jersey, uses empathizing strategies to help parents understand what their neurotypical child is feeling. For instance, he asks, “What would your neurotypical child say about this experience right now?” and “What would the child say about how you attend to the sibling with autism compared to how you attend to his or her needs?” This exercise allows parent to empathize and reconcile some outstanding issues with their neurotypical children, he explains.

Davis-Pierre’s clients also report struggling to know how to engage with their neurodiverse children. “We’re so used to looking for [the child to verbalize] … the actual feeling that we’re not looking at the behavior of what the child is showing,” she says.

She has parents role-play to gain perspective on what the child might be thinking or feeling and to increase awareness of behavioral patterns. (For example, Davis-Pierre has noticed that her daughter expresses happiness by flapping her arms and spinning in circles.) If appropriate, she has the child role-play with the parent, but if that is not possible, Davis-Pierre does it herself. To increase understanding, parents can also keep a behavioral journal or use the picture exchange communication system, which allows individuals with little or no verbal communication to present a feeling card to communicate their feelings, Davis-Pierre adds.

Children on the spectrum pick up on their parents’ and caregivers’ emotions more often than people think, Abildgaard points out. However, if they do sense these emotions, they often don’t know what to do with them. Children on the spectrum may appear to be ignoring the person or emotion, but in many cases, they just don’t have the language or perspective-taking ability to process the emotion and the “right” response to it, he explains.

So, Abildgaard works with parents to help them process their own emotions and then explain those emotions to their children so they aren’t left to interpret them on their own. In fact, parents can overtly model how to handle certain emotions such as anger or frustration. Abildgaard often suggests that parents (especially those with younger children on the spectrum) put themselves in “time out” to show their children that even adults need breaks.

Cultural implications

According to a 2014 report from the Centers for Disease Control and Prevention, 1 in 59 children in the United States have been identified with ASD. But this number doesn’t take into consideration cultural and racial implications such as delayed diagnosis. According to a 2019 news report on Spectrum, which bills itself as “the leading source of news and opinion on autism research,” black children with autism are often diagnosed later than white children, misdiagnosed more frequently with other conditions such as behavioral problems or intellectual disability, and underrepresented in studies of autism.

Hannon attributes the disparities in diagnosis rates to 1) inequalities in access to health care, 2) mistrust of health care systems among people of color and 3) greater misdiagnosis of symptoms in minority children as behavioral rather than developmental.

Davis-Pierre says the history of racism and discrimination in U.S. health care may persuade some black families not to be completely honest with health care professionals when discussing their children because they fear their children will be taken away. For example, frustration and exhaustion are normal responses for families caring for a child on the autism spectrum, perhaps leading someone to say or think to themselves in a particular moment, “I just can’t do this another day.” But many black families fear serious repercussions should they admit to such passing thoughts with a counselor, Davis-Pierre explains.

Even the treatments families choose for their children are often informed by one’s culture. Applied behavior analysis (ABA) aims to help individuals on the spectrum increase behaviors that are helpful and reduce behaviors that may be harmful to them by positively reinforcing desired behaviors. Debate has swirled, however, over whether ABA is helpful or harmful. According to a 2016 article on Spectrum, some have criticized the therapy for being too harsh in how it corrects maladaptive behaviors and for attempting to make people on the spectrum “normal” instead of advocating for neurodiversity.

But for some families, Davis-Pierre says, ABA makes sense. For example, a black child spinning in circles and banging his head against something in public will often be viewed differently than would a white child who exhibits the same behavior. In this instance, ABA can help protect the black child by helping him learn to replace the maladaptive behavior — one that could put him in danger — with a more socially accepted behavior, Davis-Pierre explains.

The harsh reality is that black people often have to operate differently in public settings because of prejudice and racism, she continues. So, she advises families to consider their child’s behavior and safety when choosing the best treatment for their child’s autism.

Davis-Pierre, author of Self-Care Affirmation Journal and Autism in Black, also finds that clinicians often don’t respect the culture of the home when treating children who are on the spectrum. A client once told Davis-Pierre that she had a therapist come into her home and not remove their shoes despite seeing a place for them by the front door. This act made the parent feel disrespected, and she no longer wanted the therapist in her house working with her child.

Another of Davis-Pierre’s clients was upset by a therapist who had made a decision involving her child without consulting the mother first. While the therapist and child were working together in the family’s home, the child wet himself. The therapist wanted to help the parents by changing the child herself. When the mother discovered that the therapist had gone through her child’s clothes drawers to find clean underwear, she felt as if the therapist had been snooping.

Abildgaard says his role as a counselor is to help clients on the autism spectrum adapt to different social situations and understand social context and social norms for particular settings and cultures. Counselors need to be aware of clients’ cultural and religious norms before instilling certain perceived social skills such as maintaining eye contact, he says. For example, as Abildgaard points out, some Asian cultures make eye contact only with certain people or in certain situations. So, counselors should understand the whole child before prioritizing what social skills or competences are most relevant to focus on in session, he asserts.

Religious beliefs can sometimes pose another barrier to seeking treatment. For instance, Davis-Pierre says, people in the black community are often taught to pray about their problems and not to discuss problems with anyone outside of the family. Counselors may assume that families who aren’t willing or enthusiastic participants in therapy are resistant, but as she points out, they may actually be having an internal struggle between seeking counseling and feeling that they are still maintaining their faith in God.

Davis-Pierre often uses genograms to help clients identify family patterns, such as other family members with a developmental disorder, or cultural values that have been passed along that no longer work for the family. Through genograms, she has noticed that her clients’ families often inherit a pattern of keeping secrets that hurts, rather than helps, the family dynamic. Davis-Pierre acknowledges that even she had a difficult time explaining to her extended family why she and her husband are so vocal about their daughter being on the autism spectrum.

Hannon and Davis-Pierre say that counselors have to be brave and willing to talk about clients’ and families’ cultures and about inequalities based on race and ability status. Starting this conversation can be as simple as including a question such as “What cultural traditions should I take into consideration?” on the intake form, Davis-Pierre says. This question shows that the clinician is already thinking about how culture affects treatment, she explains.

Supporting dads

Abildgaard argues that fathers are often overlooked when thinking about an autistic individual’s support network, so mental health professionals must do a better job of incorporating dads into the therapeutic process. He has noticed that mothers with children on the spectrum are often more proactive about independently finding and supporting each other, whereas fathers, even though they are involved in their children’s care, don’t tend to form support groups on their own. Abildgaard suggests that counselors could offer focused support services such as fathers’ groups or “dad’s night out” events to help these men learn from and bond with other fathers in similar situations.

Such support groups matter when it comes to providing care to individuals on the spectrum. Hannon, an ACA member who specializes in the psychosocial aspects of autism on fathers and families, often co-leads a group for fathers who have children with ASD. These men have reported that just being connected with other fathers who share similar experiences can be life-changing. In these groups, dads find others who speak their language and understand their journeys, which makes them feel heard, Hannon says. Groups also help fathers become more aware of their own needs and challenges and discover effective coping and adjustment strategies, he adds.

Fathers also spend a significant amount of time thinking about their children’s prognoses, their children’s futures, and the ways they can prepare their children to live full lives, Hannon says. In his dissertation, he studied the experiences of black American fathers of individuals with autism. At the ACA 2018 Conference & Expo, Hannon presented his findings from a grounded theory study on how diverse fathers orient themselves to their children’s diagnoses. Fathers often want to help their children who are on the spectrum, he continues, but if they have been raised with certain gendered expectations, counselors may need to take a few extra steps to help these dads increase their efficacy with day-to-day activities such as helping with temper tantrums.

Counselors may also need to help fathers retain focus on their emotional journeys because men are often task-oriented in how they solve problems, Hannon points out. Also, because men have often been socialized to engage only with specific emotions such as lust and anger, counselors may have to dig deeper with them to reveal the other underlying emotions. For example, counselors could suggest, “You’re angry, but it sounds like the source of your anger is fear for your child’s safety.”

Generational pushback

Parents sometimes face generational challenges in caring for their children. Hannon describes a common scenario that fathers often share with him: They leave their children in their grandparents’ care, providing suggestions for ways to best communicate with the children and guidance on particular eating preferences. To which the grandparents might respond, “We’re not doing any of that. We’ll do what we want with our grandchildren. They just need a good talking to.”

Such scenarios often leave parents of children on the spectrum feeling frustrated. If the parents and grandparents have a good, healthy relationship, then counselors can help parents learn to communicate openly and honestly with the grandparents. Hannon advises parents to lead with love and acceptance before critiquing the grandparents’ interaction with the children. Parents can first emphasize how the grandparents love their grandchildren before saying that they just want to show them additional, special ways to show love to a grandchild on the spectrum. 

When Abildgaard works with grandparents who need help accepting their grandchild’s diagnosis of ASD, he starts by saying that he could use the grandparents’ help to allow him to better understand their grandchild. Once this barrier is broken down, he finds that grandparents tend to ask more questions and start honest dialogues about grandchildren who are on the spectrum. 

Counselors can also help clients realize that while it is OK to establish boundaries with extended family, they should aim to set realistic boundaries that honor both the child on the spectrum and the family, Davis-Pierre says. For example, if a family depends on grandparents to provide child care, then the family must be particularly careful in setting boundaries. At the same time, the family can still have a respectful conversation with the grandparents about the needs of the child and family.

Adjusting language

Abildgaard’s clients with ASD sometimes complain that their parents always ask the same question after school: “How was your day?” Because, from their perspective, their days are always the same, the children wonder why their parents ask something they already know the answer to. 

Abildgaard advises parents to instead use concrete language such as “Tell me two good things about your day and one thing you would have changed.” This phrasing gets to the heart of what parents actually want to know from their child and makes the conversation more productive, he says. 

Abildgaard is also careful about the language he uses with clients with ASD and their families. Recently, the mother of one of his clients (a boy in sixth grade) told him that her son ran out of his classroom at school. When the boy walked into his office, Abildgaard said, “Tell me two good things about your day and one thing you would have changed.” This prompted the client to tell Abildgaard he had run out of his classroom.

After admitting this, the boy looked at Abildgaard, seemingly waiting to be chastised. Instead, Abildgaard asked the boy, “What do you think I’m thinking right now?”

The boy responded, “You’re thinking you are mad at me.”

Abildgaard drew a thought bubble on a whiteboard and wrote the client’s thought inside the bubble. Then he drew another thought bubble and wrote what he was actually thinking: “I’m wondering what made him run out of the room.”

The boy’s body language instantly relaxed. This exchange took Abildgaard out of the authoritarian role and shifted the conversation from focusing on the problem to focusing on how to solve the problem.

Similarly, Hannon recommends that counselors focus on strengths, and not just deficits and challenges, when working with families who have a child on the spectrum. He makes a point of asking parents about the victories they have had that week or month.

This question prompted one of Hannon’s clients to share how his son had used appropriate language and displayed empathy — a skill the child had previously struggled to demonstrate — that week.

The child’s mother had said, “I’m going to run through the shower.”

The child on the spectrum responded, “No, you can’t do that because you’re going to fall.”

Even though the child hadn’t grasped the true meaning of his mother’s words, he had shown concern for his mother and responded appropriately, which was a huge victory for this family, Hannon says.

Support often makes all the difference. Davis-Pierre and her family’s autism journey may have had a challenging start, but they eventually found health care providers who worked with them as a team. With this support, Davis-Pierre and her husband were able to stop focusing so much on the challenges and instead start enjoying their child for who she is.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The Counseling Connoisseur: How to talk to children about the coronavirus

By Cheryl Fisher March 17, 2020

The novel coronavirus, which causes the respiratory disease COVID-19, has made headlines for several weeks and has drastically impacted life as we know it. The outbreak, which the World Health Organization recently labeled a pandemic, has disrupted global commerce, shaken the United States stock market and led to travel restrictions and international border closures. Here in the United States, in an attempt to slow the coronavirus spread, major events have been canceled, educational systems are resorting to online forums, and organizations are recommending that employees telecommute. Medical providers are offering telehealth services, and places of worship are examining alternatives to in-person worship services. As of March 13, President Trump declared a national emergency, which may bring additional restrictions.

The coronavirus and children’s mental health

Global anxiety is high, and our clients are negatively impacted as they stockpile supplies and prepare for the unknown. Meanwhile, in the midst of the chaos, children struggle to make sense of all that they are seeing and hearing. Overwhelmed with information, children are responding in a variety of ways. Professionals who work with children report an increase in insomnia, rumination, intrusive thoughts, nightmares, and acting out behaviors.

“After twenty years of successful classroom management, I am finding it hard to command the attention of kids whose energy is so amped up,” says Steff Linden, an educator and children’s mindfulness yoga instructor in Annapolis, Maryland. “They are running around, tripping over themselves, and bumping into each other. These behaviors are examples of children who are overstimulated. They know something is going on, but they don’t know how to react, and they feel helpless and stuck.”

Children can’t escape the tension created by the viral crisis, so they begin creating an understanding which is often complicated by misinformation. “I had a kid poke his finger in my arm and yell, ‘You’ve got the coronavirus! I touched you!’” Linden reports.

Children are acting out their fears through behavior and play. Therefore, it is vital to address their concerns in a way that is reassuring and honest. Here are some tips for talking to children about the coronavirus: The acronym CAPES.

C: Create a calm setting. Children pick up on the emotions of the adults around them. Adults need to manage their anxiety before attempting to address the concerns of children. It is essential to provide a calm setting before talking with children about COVID-19.

A: Ask what they already know. Children are already talking about the virus. They may have misinformation that needs to be corrected. Ask children what they have heard about the virus? Ask them about their concerns and fears. Children tend to worry about their own safety and those in their immediate world such as friends, family members, and even pets.

P: Provide age-appropriate answers. Answer children’s questions with honest, factual and age appropriate answers. Provide answers that are bias-free. Explain that COVID-19 is caused by a new virus and makes people feel sick with a cough and fever. Help battle stigmatizing any particular population by emphasizing that the coronavirus is no one person or country’s fault.

E: Empower them with tools. Children feel powerless over this big virus that has people buying out toilet paper and Clorox wipes. Provide them with actual tools to use that will be empowering by teaching them to wash their hands using soap and water while singing a happy tune for twenty seconds, cough or sneeze into their elbows—not their hands—or a tissue that they immediately toss in the trash and use no contact greetings such as jazz hands or Namaste.

S: Safety. Children turn to adults for a sense of safety and well-being. Assure children that it is not their job to worry about the virus and that you have a plan in place to care for them. Explain ways that you are keeping them safe by making sure they get enough sleep and providing them with nutritious meals. Tell them that their regular visits to the pediatrician and daily vitamin (if they take one) help keep them healthy. Even with school closings, provide daily structure that includes time for non-directed play to help children act out and process feelings. Help them make a list of ways they are healthy and safe. There are a lot of unknowns with COVID 19, so focus your conversation on what is known.

 

As counselors, we can help parents and our child clients better manage the plethora of information that is available. We can assure children that the adults in their lives are up for the task of taking care of them. The acronym CAPES can remind us how to be superheroes in an effective way to the young members of society who are powerless.

And, as always, we must remember our own self-care during this challenging time. Take a peek at my thoughts around a counselor’s guide to surviving flu season my column from February 2018, “The Counseling Connoisseur: Compassion and self-care during flu season.”

 

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Important links:

COVID-19 update and resources from Counseling Today

COVID-19 related resources from the American Counseling Association

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

One in three American kids affected by adverse childhood experiences

By Bethany Bray November 5, 2019

One-third of American children have gone through a negative experience that can have lasting implications for their physical and mental health, according to the U.S. Health Resources and Services Administration (HRSA).

Data from the agency’s most recent National Survey of Children’s Health indicates that 33% of children ages 17 and younger have gone through an adverse childhood experience (ACE) such as domestic violence or parental incarceration. Approximately 14% of children have gone through two or more ACEs, with a higher prevalence among black youths and those who live in households that are below the federal poverty level.

Among the children who took the 2018 survey, the most prevalent ACE was the divorce or separation of a parent/guardian (23.4%), followed by living in a household with someone with a drug or alcohol problem (8%), and the incarceration of a parent/guardian (7.4%).

“The new HRSA data is important because it helps us remember that all children are vulnerable to adverse experiences,” says Evette Horton, a licensed professional counselor supervisor and president of the Association for Child and Adolescent Counseling, a division of the American Counseling Association. “Our job as counselors is to assess for these adverse experiences and enhance the resilience factors that we know support children and adolescents. These include evidence-based mental health treatments, strengthening family support systems, and connecting to other resources in the community. Professional child and adolescent counselors are well-versed in promoting protective factors and stand ready to support children with any adverse experience.”

The U.S. Centers for Disease Control and Prevention defines ACEs as “all types of abuse, neglect and other potentially traumatic experiences that occur to people under the age of 18.” These experiences can range from the death of a parent to emotional or physical neglect and witnessing violence in a home or neighborhood.

Research has connected ACEs to health problems later in life such as mental illness, heart disease, addictive disorders, cancers and diabetes, and risky behaviors such as illegal drug use, unintended pregnancy and suicide attempts.

HRSA collects information on a range of children’s health-related topics from households across the U.S. for its annual survey; the most recent survey includes data from more than 30,500 children.

HRSA cannot directly compare the 2018 rate of ACEs to data from previous surveys because the language in a question asking about ACEs was changed last year. However, when excluding data for the question that was altered (regarding financial hardship), there was not a significant change in the number of ACEs between the 2016, 2017 and 2018 surveys.

 

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More from HRSA on the National Survey of Children’s Health: hrsa.gov/about/news/press-releases/hrsa-data-national-survey-children-health

 

Fact sheet on the 2018 survey: mchb.hrsa.gov/sites/default/files/mchb/Data/NSCH/NSCH-2018-factsheet.pdf

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Related reading, from Counseling Today:

Coming to grips with childhood adversity

The toll of childhood trauma

Informed by trauma

Counseling babies

Standing in the shadow of addiction

What’s left unsaid” (on child sexual abuse)

Interventions for attachment and traumatic stress issues in young children

Touched by trauma

 

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Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.