Tag Archives: Children & Adolescents

Children & Adolescents

Feeling the strain: The effects of COVID-19 on children and adolescents

By Laurie Meyers April 23, 2021

One of the most contentious — indeed, at times, vitriolic — public health debates of the COVID-19 era has revolved around the safety of opening schools for in-person classes. For some politicians, the push to open seemed to be influenced by optics — a signal that states were “open for business.” At the same time, parents have struggled to help children and adolescents with their schoolwork and other aspects of distance learning and have longed for a safe way to get back to a less chaotic educational experience. Some parents were forced to leave their jobs to take care of children and still cannot return to work. Teachers and other school staff have expressed concern for their own safety and the safety of their families and students. 

Everyone agrees that online learning is not ideal for most students — and can be virtually inaccessible for marginalized populations — but in many areas, it seemed like the safest option. However, mental health professionals, educators, parents and community activists remain apprehensive about the negative effect that the lack of in-person instruction and interaction with peers is having on the mental, emotional, social, developmental and academic well-being of children and adolescents.

There has been much confusion about how often children and adolescents get COVID-19 and how likely they are to spread the coronavirus. Recent guidance from the Centers for Disease Control and Prevention (CDC) stated that while fewer children than adults have had COVID-19 in the United States, the number of cases among school-age children was rising. Not only can children and adolescents be infected and get sick, but they can also spread the virus to others. At the same time, the CDC revised its guidance for physical distancing in schools in March, saying that 3 feet of distance (as opposed to 6 feet) is sufficient in elementary, middle and high schools where masks are worn and where community transmission is low.

In many states, teachers and other educational system personnel have received vaccinations. School districts are implementing physical distancing protocols, and the American Rescue Plan Act of 2021 passed by Congress in mid-March includes money to improve building ventilation. With these developments, many schools that weren’t already open were planning a return to in-person education, either full time or on a hybrid basis. 

Amid all the debating and planning, one group has been noticeably silent: the students themselves. Many children and adolescents are struggling with a feeling of powerlessness, says Adam W. Carter, a former school counselor who is currently the coordinator of the trauma-informed counseling graduate certificate at Northern Illinois University’s Department of Counseling and Higher Education. “We’re not asking children if they want to go back to school, if they feel safe,” he says. “We’re making decisions as adults with [the needs of] children almost as an afterthought.”

The lack of agency in decisions regarding in-person schooling is not the only area in which many children and adolescents feel voiceless, say the sources Counseling Today spoke to for this article. Like adults, children and adolescents miss their friends; are frustrated by the inability to get together with others without fear of infection; mourn the loss of celebrations and the marking of milestones; are afraid that they, or a loved one, will get sick; and are tired of spending so much time in front of a computer screen. 

In other words, they have all of the stress but not as much control as adults do, notes Carter, an American Counseling Association member. Children and adolescents often don’t know how to talk about — or, for that matter, recognize — how the pandemic is affecting them. 

For example, “Children may not know how to talk about how they miss getting together at school or with friends,” says ACA member Barbara Mahaffey, a licensed professional clinical counselor and executive director of the Scioto Paint Valley Mental Health Center in Ohio. They might ask often about visiting others but not recognize that they’re having stomachaches and other psychosomatic effects because they’re lonely, she adds. “Children may not ask for help, and parents may not recognize a child’s distress,” Mahaffey says. 

Many parents are experiencing significant worry and stress about their finances or how they can keep their family safe from COVID-19. They may also be grieving the loss of friends or family members who have died from the coronavirus. Parents often believe that it’s best to shield their children from these concerns, but the reality is that kids pick up on the underlying fear without understanding its source, say Mahaffey and Carter. 

The strain on children and adolescents is showing. According to the Nov. 13, 2020, issue of the CDC’s Morbidity and Mortality Weekly Report, child and adolescent emergency room visits related to mental health began increasing in April 2020 and remained elevated through October 2020 (the latest date for which statistics were available). Compared with the same period in 2019, emergency room visits related to mental health rose 24% for children ages 5-11 and 31% for those ages 12-17. 

Missed connections

Children and adolescents want to be with each other, Carter says. Absent in-person classes and social activities, it is difficult for them to figure out how to interact. This generation is used to socializing through social media platforms and chat apps, but after spending six to seven hours online each day for school, interest in electronic gatherings has diminished throughout the pandemic, he says. Being in the company of others all day virtually but rarely if ever getting the opportunity to interact in person has produced a particular kind of loneliness for children and adolescents.

Counselors are also finding it difficult to connect with these clients online. Once the pandemic began and counseling shifted online, Sarah Zalewski, a licensed professional counselor (LPC) who specializes in child and adolescent counseling, knew she needed a new way to engage her clients. At the time, in addition to her private practice, Zalewski was working as a school counselor in a Connecticut middle school. 

“When they come into my office, I always have toys,” she says. “They love to play, [and] I do too.”

The toys functioned as an icebreaker, with students and young clients finding it easier to open up while their hands were busy, explains Zalewski, an ACA member. But with that icebreaker gone thanks to the abrupt end of in-person sessions, she had to start thinking of alternative ways to connect. “I didn’t want to do the traditional grown-up thing, like, ‘How was your day? What was school like?’” Zalewski says.

Zalewski thought about what she had been doing herself to cope with the stresses of the pandemic. One of her favorite coping mechanisms: playing video games. Given the popularity and ubiquity of video games, she decided they might offer a great way to bridge the gap with young clients.

In the beginning, Zalewski mainly discussed the games with her clients, asking them what games they liked and why. Whenever role-playing games entered the discussion, she explored what characters her clients typically chose to inhabit. Did they pick a warrior or a priest? How was the character similar to them? How was it different? In what ways did the character reflect who the client wanted to be in real life? “Why do you want to be a druid?” Zalewski might ask. “What is it about druidism that is really cool?” 

Zalewski emphasizes that counselors who try this approach need to know or learn the language of the games. “Gaming is a culture,” she says. “Use cultural humility. If you don’t know, for example, what a druid is — [because] it’s different in different games — ask. They love to talk about it.”

Eventually, Zalewski began playing the games with her clients. They start in Google Meet, where they do all of their communicating. They then use an online link or gaming platform. Zalewski has multiple screens, and clients often use tablets. 

Sometimes the games are relatively simple. For example, Zalewski recently began playing Connect Four with a young client as an exercise in frustration tolerance (because the client doesn’t always win). When a client expresses frustration during the course of a game, Zalewski probes for the source. Is it truly about the outcome of the game itself or is it frustration at a person in the client’s life that is coming out during the gaming session? Sometimes the frustration is really about the situation that children and adolescents find themselves in with the pandemic, including feeling like they no longer have the ability to do the things they once enjoyed.

Game-based problem-solving helps clients build coping skills as they are playing, Zalewski points out. In addition, she often directs young clients to use relaxation techniques that she has taught them, such as square breathing (breathing in for four counts, holding for four counts and then breathing out for four counts).

Zalewski also likes to use Roblox, an online platform that features various games and also gives users the ability to create their own games (a function that she likens to sandbox therapy). By creating games or even leading Zalewski through a virtual obstacle course, young clients can develop a sense of leadership, she says. 

Children and adolescents are struggling with the lack of social contact during the pandemic, Zalewski says, and this is often manifesting in anxiety, depression, anger and withdrawal. The isolation is particularly difficult on clients who have depression and attention-deficit/hyperactivity disorder, she adds. 

Because physical activity helps with mood levels and basic functioning, Zalewski tries to get her young clients moving through games such as Just Dance, Ring Fit Adventure (a fantasy adventure world that uses physical exercise to navigate in-game movement), and other virtual reality games.  

To keep clients moving, Zalewski will often give clients “homework” (with parents’ permission), asking them to play a game a certain number of times between sessions. Zalewski also encourages clients to engage in social interaction. Just like any other skill, social skills will atrophy if you don’t use them, she says. 

Many role-playing games enable users to communicate with each other in chat boxes. Zalewski says there are also “clans” and “guilds” that gamers can join. Another resource she likes is Discord, a platform that allows users to discuss games and other interests on secure topic-based text channels. 

Zalewski says her clients laugh at her for her enduring love of Pokemon Go. Still, she feels it is an encouraging way for children and adolescents to get outside with parents and interact with others in a safe, physically distanced way as they collect Pokemon.  

School daze

Although some children and adolescents are doing well with virtual learning, in general, it’s not developmentally aligned to child and adolescent needs, says ACA member Jennifer Betters-Bubon, an LPC and former school counselor. “We know young kids need to move,” she says. “They thrive on environments that provide sensory stimulation and movement. Even in traditional high school, kids get to get up and move through hallways and can interact with friends.”

“We have kids who are on Zoom for hours and not necessarily getting up,” continues Betters-Bubon, an assistant professor of counseling at the University of Wisconsin-Whitewater. “It’s fatiguing for their brains and bodies, [and] it doesn’t lend itself to building relationships.”

When adults feel the fatigue of too much screen time, they can usually disconnect, at least for a little while. “When children get tired, adults are still in charge,” Carter points out. And if a child asks to take a break, parents or caregivers may think that the lack of structure will cause them to fall behind. “They may not understand that children have the same need to disconnect,” Carter says.

Betters-Bubon is noticing a lack of motivation in the children and adolescents she sees in her practice. She believes that’s in part because schoolwork isn’t as engaging without the connection to other people and the school itself. “It can feel like ‘What is the point of doing this work?’” she says. Betters-Bubon points out that on top of COVID-19, students are dealing with the impact of racial trauma and other significant stressors, all of which influence their view of whether their current math assignment is really relevant right now.

Betters-Bubon says some of her younger clients are so disengaged that she has shifted the focus of her work to their parents. She has sought to keep middle and high school students engaged by asking them to create things between sessions such as a vision board of how they’re coping with their anxiety and then sharing their creation with her.

Now that many schools are opening up, at least on a hybrid basis, Betters-Bubon and other counselors say they are witnessing excitement among students about reuniting with friends, mixed with a lot of trepidation. Many of Betters-Bubon’s clients are experiencing anxiety — about the possibility of getting COVID-19, about catching up academically or, in some cases, about starting at a new school without the normal transition. Betters-Bubon has been doing a significant amount of exposure therapy work with child and adolescent clients. This involves having them imagine a list of scary things that they might encounter and working up to doing each one in ascending order. In some cases, she has been able to reach out to school officials to ask them to allow her clients to at least see the inside of their new environment before classes start. 

Betters-Bubon acknowledges that it’s a strange new world for students returning to school. Even the nature of recess has changed. Because of the need to maintain physical distance, her son’s elementary school no longer allows balls on the playground. Students just kind of stand around and concentrate on keeping themselves separated, Betters-Bubon says. As a result, they’re not engaging those gross motor movements essential to healthy growth that they used to engage when they could run around, climb on equipment and toss balls. Betters-Bubon wonders what the implications might be if this scenario becomes normalized. 

Some schools have implemented sensory paths in hallways with different obstacles to run and jump over, Betters-Bubon says. She’d like to see more of those, particularly outdoors. Noncontact games that involve actions such as students moving to different parts of a circle can also be an excellent way to keep children moving while still remaining physically distant, she says.

LPC Melissa Brown works with an Atlanta-area community behavioral health center as a mental health counselor in a local school district with a majority Black student body, most of whom live in poverty. The community has been hit hard, both by COVID-19 itself and by the economic devastation of the pandemic-induced recession. 

The school district has been on a hybrid schedule since January. Brown has tried to give students a sense of normalcy by providing that one thing that will be consistent. “When we meet, this is going to be your safe place,” she tells students. “We can talk about anything and do anything you want.”

Many of the children still worry that they or their loved ones will get sick, so Brown holds family sessions to help students and their families develop a plan to stay safe. The children are used to having a plan for what happens if there is a fire in the school, so the idea of coming up with something similar for home seems natural to them, she says.

In sessions, they talk about teaching kids how to wash their hands, come up with examples to demonstrate what 6 feet of physical distance looks like, and discuss why they can’t see their grandmother, uncle or friends today. They also look at alternatives, such as driving by a friend’s or loved one’s house or mailing them a picture.

Brown also tells parents that they have to be honest with their children. They can’t hide information that they think might be harmful because their children are likely to be exposed to it anyway through social media, the news or friends. Instead, parents can be their children’s first source of information, Brown says.

Grief and trauma

Brown has encountered a substantial amount of grief connected to the pandemic, particularly in elementary school settings. After attending a funeral every Friday for a month, one little girl asked Brown if it was wrong that she didn’t cry anymore. 

Brown frequently uses play therapy and art therapy to help younger children explore their feelings. Eventually, the little girl was able to process her feelings and contextualize them, such as, “This person who died was a friend of my mother’s, and I didn’t really know her” and “This was my grandfather, but he was sick with cancer, and I know he’s in a good place now.”

Zalewski has helped young clients process the loss of grandparents and pets. She notes that furry family members have become even more vital companions during the pandemic. 

One child particularly liked the idea of creating a memorial for a beloved dog. So, with Zalewski’s help, the client created a space on his island in Animal Crossing, a social simulation game that gives players the ability to build and create things. Zalewski and the child found a virtual dog and gave him a red bowl to drink from. The child’s real-life dog had enjoyed being outside and sniffing flowers, so they also created a fenced-in area with flowers, the drinking bowl, a sofa (in case the dog wanted to curl up) and a radio for the dog to listen to. Players in Animal Crossing can pick the radio’s music, so the child chose happy songs because they wanted the dog to be happy.

“Creating it was very powerful, and then [the child was] able to visit [the memorial],” Zalewski said. She suggested that the child share the memorial with their mom and dad, which ended up being an emotionally significant experience. They discussed how losing the dog felt to each of them and were able to mourn together, Zalewski says. She believes the process helped to normalize grief for the child. Mom and Dad were sad too, but they were getting through it, and the client could as well. 

“Now Mom and Dad and the kid can talk more comfortably about the dog,” Zalewski says. “It’s OK to be sad. Sadness won’t break you. It’s OK to share the happy stuff too.” 

Zalewski has also helped child and adolescent clients navigate the loss of loved ones such as grandparents. Many kids are hesitant to share some of their feelings about loss because they are afraid it might be painful for the people around them, Zalewski says. She helps young clients express their grief by inviting them to have a conversation with her about the things they remember about their grandparents or other loved ones who have died. “Everyone has loss,” she says. “I help them access the good memories.” 

These memories are often funny, such as how the grandparent always made the client a cup of coffee or tea, and the client always drank it, even though they thought it tasted terrible. Or they might remember a unique sweater that their grandmother made for them. 

“Many times, kids haven’t grieved before, and they don’t know how to do it,” Zalewski says. She provides a safe place to explore the feelings of being really sad and missing a loved one.  

Moving forward

“We are not holding space for children to be scared to return to in-person learning, especially with the increased safety protocols in place,” Carter says. “Masks, no touching, no singing, playground shut down — all of these things can be scary, yet we expect children to be able to turn that off and learn as usual.”

As schools continue to open, Betters-Bubon believes that a trauma-informed approach with a schoolwide focus on relationships is essential. “Integrated within a trauma-informed approach is social-emotional learning, embedding sensory strategies into the classroom and allowing for voice and choice,” she says. “It also would include a focus on staff wellness. School counselors would focus on teaching and assisting all staff in understanding the impact of trauma on the brain and on student learning, including helping schools carve out specific ways to build relationships.”

Betters-Bubon would also like to see more collaboration between schools and outside mental health counselors to focus on building resiliency in children and adolescents. This may involve taking a wider systemic view and working with the critical adults in students’ lives, she says. “I could see an increased need for family counseling in an effort to create systemic change within families that ultimately helps children and adolescents.”

 

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

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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.

Counselors weigh in on weighted blankets

Compiled by Bethany Bray April 16, 2021

The COVID-19 pandemic has been accompanied by a range of intense emotions, and for many people, this includes acute feelings of uncertainty and worry. It seems some people have tried using weighted blankets to find comfort, as sales have increased during the pandemic.

Manufacturers often tout the blankets as a nonpharmaceutical method to help quell anxiety, sleeplessness, stress, restlessness, unease and other symptoms.

A 2015 Journal of Sleep Medicine & Disorders study by Swedish researchers found that subjects with insomnia who began using weighted blankets reported improved sleep quality, being better able to settle down to sleep and feeling more refreshed in the morning.

In the realm of professional counseling, how do these claims stack up? Are these blankets truly helpful for symptoms of mental illness? Are practitioners and clients talking about the use of weighted blankets — and their possible benefits — in counseling sessions?

CT Online collected thoughts on the use of weighted blankets from professional counselors across the U.S. Add your experience in the comment section at the end of this article.

 

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The challenge to weighted blankets is that they provide physical weight but not the compression or true pressure that many with attention-deficit/hyperactivity disorder (ADHD) and autism may be seeking. Although many people do report that a weighted blanket assists in reducing their overall stress and allows more effective sleep, I believe the question really should be: Does the weighted blanket actually create those improvements, or are the reported positive changes actually due to the weighted blanket causing us to sit still for a little bit?

This slowdown during our typically fast-paced day might be a significant reason so many of us truly believe that weighted blankets help. Trend or not, I think weighted blankets show true promise in helping people learn to be more mindful of their busy lives.

I have found that weighted blankets appear to provide minimal benefits to kids with ADHD or autism. Although many of the kids I work with do enjoy the weight, parents nor children typically report significant benefits. In fact, although a large number of my families have purchased weighted blankets, very few use them on any consistent basis. I believe this is due to the concept of weight versus compression.

Although the weight can feel good, for the kids I work with, it does not provide enough sensory input to make a difference. Instead, they often seek compression or pressure.

Although weighted blanket [retailers] often talk about the “pressure” it provides, the difference is in the details. It does provide pressure, but not the deep pressure that many with ADHD or autism are seeking in times of dysregulation. In fact, kids with tactile and or proprioceptive sensory behaviors often seek out deep pressure to help regulate their nervous system. This means they often need more than what a weighted blanket can provide.

I have found that my kids who do like weighted blankets use all the weighted blankets in the house and they are oftentimes using three or four weighted blankets at once! This means the weight they are seeking is much higher than the 10% of their own body weight [that is the recommended guideline].

Although weighted blankets are definitely a trending item, I fully believe they are here to stay. However, they will probably be most useful for those who like to sleep with extra blankets purely because they like the [feeling of the] weight. For everyone else, I think compression items are often the way to go.

  • Michelle Tolison, a licensed clinical mental health counselor and owner of Dandelion Family Counseling in Charlotte, North Carolina. A registered play therapist, she works with children who are twice-exceptional (particularly those with ADHD).

 

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As a child therapist, I’ve long known that occupational therapists use weighted blankets to help children with sensory issues and anxiety, including children with ADHD and autism spectrum disorder. These blankets have moved into the mainstream, but just because they’re popular does not mean they can be used to help children without first consulting a medical doctor or an occupational therapist.

A weighted blanket provides deep pressure to the body, which can help induce relaxation. However, there are physical safety concerns when it comes to children and weighted blankets. They shouldn’t be used on a child younger than 2 years old. The child needs to be able to remove the blanket themselves, and their head should never be covered. If the pellets fall out of the blanket, they can be a choking hazard. Parents should always supervise their child when using a weighted blanket.

The American Occupational Therapy Association advises against sensory-based interventions, such as weighted blankets, unless children have been thoroughly assessed. In my opinion, professional counselors are not trained to provide sensory assessments nor suggest sensory-based interventions. Suggesting a weighted blanket as an intervention for a child would be outside of the scope of our practice and could be considered unethical.

If a parent has concerns about their child’s anxiety, hyperactivity, autism, sensory processing disorder, or just an inability to go to sleep and stay asleep, I encourage them to speak to their pediatrician before they utilize a weighted blanket. Their pediatrician may recommend an evaluation by an occupational therapist.

  • Pam Dyson, a licensed professional counselor supervisor and registered play therapist supervisor in Spring Hill, Tennessee, who offers virtual play therapy supervision and consultation services.

 

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During the COVID-19 pandemic, there’s no doubt that mental health symptomology is on the rise, most commonly anxiety and depression, but also for people diagnosed with autism and ADHD, since it seems to be much more of a struggle to regulate one’s emotional/behavioral state during these uncertain times. Interestingly enough, it’s also been noted that the sales of weighted blankets have increased during the pandemic. Coincidence? I think not.

Adding weight/pressure to our large muscle groups (with a weighted blanket) activates the body’s proprioceptive sensory system. Activating this system increases both dopamine and serotonin in the brain, helping people to feel more emotionally regulated, calm and in better control of their emotions and behaviors.

Dopamine is our main “feel good” neurotransmitter and main “focus” neurotransmitter. When there is an insufficient amount of dopamine being produced, retained or transported, it’s like there is a “reward deficiency syndrome” occurring. Therefore, the brain requires increased stimulation to obtain a sense of satisfaction/reward, which can be seen in the hyperactive response of those with ADHD or autism when they sensory-seek (spinning around and around) or when they novelty-seek (hanging over a two-story banister). Due to these struggles, they tend to seek excessive proprioceptive input with the intention to calm their nervous systems — but in maladaptive manners. Their excessive movement can come across as chaotic to themselves and disruptive to others.

During a pandemic, with an increased amount of time at home and without the full structure of school, clubs, organized sports, etc., that in itself can cause these symptoms to increase. A weighted blanket can assist in the retention of dopamine so these people don’t need to seek stimulation in such maladaptive manners and therefore can remain more in control of themselves. This means that a weighted blanket can be beneficial for people with autism and ADHD who have difficulty planning their movements and regulating their level of arousal. When they feel pressure from a weighted blanket on their large muscle groups, it can actually give them this proprioceptive input in a more organized manner, leading to increased attention, less internal chaos and less disruption to others.

Serotonin is a neurotransmitter that helps soothe us when we feel stressed. Serotonin is also involved in our survival mechanism to help regulate our sleep, food cravings/appetite and sexual desire. It’s involved in memory, mood/irritability levels and sensitivity/insecurity/self-confidence levels. With an insufficient amount of serotonin being produced, transported or retained, people tend to feel anxious, irritable and can have difficulty sleeping. A weighted blanket can add proprioceptive input to help retain serotonin in the brain, so one can feel calmer, soothed and more self-confident and self-secure.

Physical containment from a weighted blanket can help facilitate emotional containment [and] a sense of stability and promote behavioral regulation. (Think about it as a similar concept to “swaddling” a baby to soothe them when they are upset and to help them sleep.) It’s no wonder that the sales of weighted blankets for children and adults are on the rise during a time of uncertainty.

  • Donna Mac, a licensed clinical professional counselor at a school in the Chicago area that specializes in helping students with emotional disorders, higher-functioning autism, secondary learning disabilities and other health impairments.

 

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More than one client has reported an improvement in their sleep after using a weighted blanket (or even multiple regular, heavy blankets if they couldn’t afford a weighted one) at home to give them a sense of pressure. Given all that we know now about how trauma impacts the body, it makes a lot of sense to look at as many sensory modalities as possible when working with this population.

As a personal anecdote, I have a nephew on the autism spectrum, and there was a dramatic change in his behavior after he started using a weighted blanket to improve his sleep quality at night. I do realize that the plural of anecdotes is not data, but I’ve certainly had enough positive feedback from people to suggest it to clients as an option to explore.

  • Kirsti Reeve, a licensed professional counselor at a group practice, Transcendence Behavioral Health, in Royal Oak, Michigan. She specializes in working with self-injury, teens and trauma and is also a certified drug and alcohol counselor.

 

 

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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.

Delivering difficult news: From adults to future adults

By Kelsey Mora February 10, 2021

As a dual certified child life specialist and licensed professional counselor, the questions I most often get from parents and caregivers are “What will I tell the children?” and “How will I tell the children?” These questions come up when facing a new diagnosis, a loss of a pregnancy or loved one, a traumatic injury, or a suicide attempt.

Although I work in a setting and with a population where I am prepared to assist families and parents through such life-altering events, many clinicians are not. To support other providers when faced with similar questions from their clients, I have developed three key tips for delivering difficult news to young children. These tips can be applied not only to medical events and loss, but also to divorce, an upcoming move, a local tragedy, and other life-altering events.

1) Honesty really is the best policy.

Being honest with children builds and maintains their trust. By not telling children about an event, we risk the likelihood of them hearing false information from someone else or finding out about it in an uncontrolled way. This may involve an overheard phone call, a read text message or an encounter with a neighbor, friend or relative. As counselors, we can empower our clients by explaining to them that they, as trusted adults, have the ability to control the delivery of this information to their children and create an environment where it is OK for them to talk about the event.

When children are forced to come to their own conclusions about what is happening, their imaginations may create something far worse than the reality. The caregiver should follow the child’s lead by assessing what they already know before providing or correcting the information. It is important for parents/caregivers to use simple, clear and honest language with their children and to understand that this may need to be repeated over and over again.

Avoid euphemisms. Even though terms such as “cancer,” “dying” and “divorce” may seem harsh or scary for children, these terms are less likely to lead to misconceptions later. Adults can always clarify terms along the way, but starting with the real words is recommended. For example: “Dying means he will not come home; his body no longer works” and “Divorce means we couldn’t get along anymore. We have decided to live in different houses, but we both love you very much.”

Find an appropriate setting. Encourage the adult to identify a private, quiet and comfortable setting, preferably outside of the child’s safest place (which, for most children, is their bedroom). Consider the living room or dining table. Practice starting by giving a warning shot. For example: “I have something sad or difficult to tell you.” Help parents/caregivers to think about the best timing of the conversation. Who should be there?

Finally, it’s OK for adults not to know what to say or how to answer their child’s questions. They can say, “I don’t have all of the answers, but as soon as I do, I will tell you.” This builds trust and is still honest. Help the child to at least know what will happen next and what they can expect. Once the discussion has taken place, give the child or adolescent time to adjust. Rehearse by acknowledging, “I know this was not what you expected to hear,” and practice providing empathy and reassurance that they (the adult) will be there if the child or adolescent has more questions, concerns or feelings. Young children may need time to play, whereas older children may prefer being with their peers. Both responses are developmentally appropriate.

 

2) When in doubt, keep things normal.

Children benefit from structure and clear expectations. However, it can be very hard to maintain routine for children when disruption is taking place. When this is the case, encourage your adults clients to prepare their children for anticipated changes. For example, if the children are able to attend their extracurricular activities or playdates but will be picked up by a friend or relative instead of their parent, make sure this is communicated to them. Similarly, if the bedtime routine or school drop-off will look different, parents/caregivers should ensure their children know who and what to expect. Children are resilient, but they do best when prepared for change.

Help your adult clients consider ways to include the child. Children may benefit from having a role or purpose. For example, they could be responsible for packing a bag or making a card. When possible, parents/caregivers should identify choices to offer to give children a sense of control and mastery during a time that feels out of their control. The child should not be forced to do something such as say goodbye to their loved one, but they should be given the option and presented with different ways to do so.

Caregivers may think they know what is best for their child and then be surprised by the child’s decision. I have worked with children who have persistent regret over not participating in their parent’s funeral but were denied the opportunity because the surviving parent was trying to protect their child. Often, parents will ask, “What if they [the child] regret their decision?” I reassure parents that they can remind their child that they were given a choice and that they made the choice that was best for them in that moment.

 

3) Expressing feelings is healthy.

When your adult client says, “I have to be strong for them [the children]” or “I can’t let them see me cry,” ask the parent/caregiver: “What does being strong really mean?”

Children who grow up in a home where they are shielded from feelings may inadvertently learn to internalize their feelings. Parents, caregivers and other adults possess the potential to teach children about the healthy expression of all emotions — the good, the bad and the ugly. It is inevitable that children will experience heartbreak, disappointment and upset throughout their life trajectory. When they are faced with these circumstances, it is imperative that they have learned how to identify their feelings and express them safely and effectively. Being strong can mean demonstrating appropriate reactions to situations.

Help your adult clients name their own feelings. Have them practice “I feel” statements such as “I feel sad because your grandpa is in the hospital” or “I feel worried about everyone’s safety.” Then, encourage them to follow these statements with plans that can be shared with their children, such as “But I am going to do everything I can to help you feel safe and cared for during this difficult time.” This encourages children to express their own feelings safely and effectively and to feel comfortable asking questions when they have them because they know it is OK to talk about the situation. Furthermore, practicing this gives the adult client an opportunity to process their own thoughts and feelings about the event before being in front of their child.

 

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These three tips can be applied to and modified for children of any age facing nearly any difficult event. I have used these principles to provide guidance for parents and caregivers on explaining recent events, including the pandemic and social unrest, to their children.

Developmental reactions to difficult circumstances will vary by age. Infants may demonstrate increased crying, clinginess or fussiness. Toddlers and preschoolers may regress or display a fear of separation. School-age children may exhibit irritability, confusion and distractibility. Adolescents may display anger, take on new roles and express criticism. But when parents and caregivers provide honest information, present clear expectations and encourage healthy discussions, children and adolescents are more likely to experience a positive adjustment both during and beyond the situation.

 

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Kelsey Mora is a dual certified child life specialist and licensed professional counselor who works both in a hospital setting and for a private practice in the Chicagoland area. She specializes in helping children and adolescents cope with illness- and grief-related challenges and is specifically trained to coach caregivers on language and techniques to use when parenting their child through medical conditions, family life transitions and traumatic loss. Contact her at kmora@illnessnavigation.com or through her website at illnessnavigation.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.

Seeing the whole gifted child

By Lindsey Phillips November 30, 2020

Assessing symptoms and determining a treatment plan for clients is never a simple or straightforward task. That can be especially true when it comes to working with gifted and twice-exceptional clients.

Imagine that a second-grader who is highly intelligent comes to your counseling office. The child has some intense interests, which is not uncommon with individuals who are gifted, and they struggle with emotion regulation, which appears to be related to the child’s perfectionism and low frustration tolerance. You might assume that this client’s struggles are just a natural consequence of being gifted.

Emily Kircher-Morris, a licensed professional counselor (LPC) at Unlimited Potential Counseling & Education Center in O’Fallon, Missouri, made this assumption. It wasn’t until her client entered the fourth grade that Kircher-Morris learned that giftedness alone couldn’t “explain away” the student’s emotional struggles. After experiencing a major event, the client’s problems increased to the point that Kircher-Morris referred him to a psychologist for a full differential diagnosis. Upon receiving the results, she was shocked to find out that her client was not only gifted but also autistic.

“I had fallen into the [common] beliefs about giftedness: That the [emotional struggles] were just sensory intensity or perfectionism,” says Kircher-Morris, an American Counseling Association member who specializes in gifted and high-ability individuals. “I missed how intense his meltdowns were and that his intense interests were related to autism, not giftedness.”

It’s true that individuals who are gifted may possess an intense interest, but they can communicate about other topics in addition to that passion, whereas someone with autism spectrum disorder can’t easily talk about other topics, Kircher-Morris explains.

To make an accurate assessment of a gifted client, professional clinical counselors must first know what “giftedness” even means. The problem is that the exact determinants and measurements for giftedness vary from state to state and even school to school. But according to the National Association for Gifted Children (NAGC), individuals deemed to be gifted or talented have the capability to perform at higher levels than their peers, and they require modifications to their educational experience to learn and to realize their potential.

Neither Kircher-Morris nor James Bishop, an LPC at Blank Slate Therapy in Frisco, Texas, distinguish between “gifted” and “high achieving” because they say some individuals need to be cognitively challenged regardless of whether they meet the formal definition of being gifted. And sometimes gifted individuals have learning disabilities or mental health issues that require them to get help — a concept that can be difficult for individuals who are used to having things come easily to them, Kircher-Morris points out.

(Mis)Identifying giftedness

There is also a substantial amount of anecdotal information, as well as misconceptions, about giftedness, and Bishop, executive director of the Passionate Mind Institute, warns that even mental health professionals can fall prey to pseudoscience on the topic. For example, some counselors too easily embrace overexcitability as a common characteristic of gifted individuals even though there isn’t much current research to support the belief, he says.

People may incorrectly assume that someone cannot be gifted if they are not doing well in school or that gifted individuals never need help, Bishop continues. Some also believe that individuals who are gifted are more prone to depression, but research shows they are as well-adjusted, if not more so, than their peers in the general population, he adds.

Such misconceptions, as well as concern about clinical misdiagnoses, led Bishop, a member of ACA, to conduct a study to test the ability of mental health professionals to recognize gifted characteristics in presenting clients using vignettes that illustrated common issues and characteristics related to giftedness. Half of the 330 participants were prompted that giftedness could be a factor, but regardless of that prompting, Bishop found the majority of participants still clung to the diagnosis of a disorder over an assessment of giftedness. (See “The potential of misdiagnosis of high IQ youth by practicing mental health professionals: A mixed methods study” in the journal High Ability Studies.)

Bishop’s study suggests that even mental health professionals, not just educators, have trouble factoring giftedness into their clinical assessments. “Being mindful and educating yourself on the real struggles that gifted [individuals] face can make you a better clinician in terms of assessing a gifted [client] and being able to determine whether their problems are the result of a disorder or are simply part of their gifted nature,” says Bishop, who chairs the NAGC Social and Emotional Development Network.

But finding training in this area can be challenging for counselors. Bishop says he had to get a doctorate in educational psychology to become formally educated in the subject. He isn’t aware of any counseling program that offers a concentration in giftedness.

The lack of adequate training is a problem because, according to Michelle Tolison, a licensed clinical mental health counselor in Charlotte, North Carolina, giftedness should be a specialty just like trauma. In fact, she believes that without being adequately trained, counselors can do extensive damage if they work with clients who are gifted.

Bishop, author of a forthcoming book on anxiety and giftedness for parents, recommends that counselors attend national and state gifted and talented conferences for opportunities “to dive into the subject, meet people in the field and get a sense of how they [as counselors] can play a role.” In addition to the resources provided by Supporting Emotional Needs of the Gifted (sengifted.org) and NAGC (nagc.org), Bishop and Tolison, owner and lead therapist at Dandelion Family Counseling, recommend reading Giftedness 101 (by Linda Kreger Silverman) and Misdiagnosis and Dual Diagnosis of Gifted Children and Adults (by James T. Webb et al.).

The gifted gap

Most gifted children are identified through testing or teacher referrals in elementary schools. The problem is that there is no one standard test used in schools to determine giftedness. On top of that, many school districts don’t test every student. Instead, they rely on teacher referrals, which, as Renae Mayes, an associate professor in the counseling program in the Department of Disability and Psychoeducational Studies at the University of Arizona, points out, introduces bias.

To highlight this potential bias, Mayes, an ACA member whose research focuses on gifted education and special education for students of color in urban environments, poses several insightful questions: How are teachers trained to recognize giftedness? How are they trained to recognize that giftedness exists in many different kinds of bodies? Will teachers see a Black student who can’t sit still in their seat and has lots of energy as someone who is gifted and excited about learning, or will they perceive the child negatively — as someone who has a behavioral problem or wants to disrupt the learning environment?

The sad reality is that the current method of identifying giftedness has led to an underrepresentation of individuals from marginalized backgrounds in gifted programs. Researchers at the Thomas B. Fordham Institute recently found that in schools that feature gifted programs, only three states enroll more than 10% of their Black and Hispanic students in such programs; in 22 states, that figure stands at less than 5%.

Black and Hispanic students are also overrepresented in special education, Mayes points out. When children are put in special education, it often becomes the only lens through which they are perceived, she says, and the likelihood of them also being identified as gifted dramatically decreases. As Mayes notes, these children tend to be viewed through a deficit perspective, which often incorporates stereotypical understandings of culture and disability rather than allowing children to be seen for their gifts and talents.

According to the article “Myths and research regarding the socio-emotional needs of the gifted,” published in the September issue of The Gifted Education Review (of which Bishop serves as co-editor), individuals from different cultures may not be as readily identified as gifted. Among the reasons highlighted in the article are because these individuals’ cultural norms differ from those of the prevalent culture (e.g., what might be viewed as positive assertiveness in one culture might be perceived as too aggressive in another) or because they are gifted in their first language, which differs from the English language programs in their schools.

“There’s a big push in gifted education to modify how we identify students and make it tied to what kids need academically,” says Kircher-Morris, the president and founder of the Gifted Support Network, a nonprofit dedicated to helping the families of gifted and high-ability learners. “And schools are getting better about identifying kids younger, and they’re doing more universal screening,” which helps remove issues of bias that can arise with teacher and parent referrals.

Twice-exceptionality

Gifted individuals may also have a special need or disability. According to NAGC, the term twice-exceptional (also known as “2e”) describes gifted children who have the potential for high achievement but also have one or more disabilities, including learning disabilities, speech and language disorders, emotional/behavioral disorders, physical disabilities, autism spectrum disorder or other impairments such as attention-deficit/hyperactivity disorder (ADHD).

“People don’t often think that individuals who are gifted can also have [a] disability,” Kircher-Morris says. “It’s kind of counterintuitive, so you end up with kids who are exceptionally cognitively able but perhaps they have ADHD or are autistic and they need a 504 plan or perhaps even an individualized education program.”

Kircher-Morris, chair-elect of the NAGC Social and Emotional Development Network, has noticed that sometimes teachers don’t feel as though they have to make accommodations in environments such as advanced placement classes. These teachers just expect that if a student is in such a class, they should be able to do the work. She often reminds educators that not taking a challenging course is not an accommodation. Twice-exceptional students still need to be challenged; they just need some help along the way.

It can be easy for counselors and other mental health professionals to miss a diagnosis of twice-exceptionality, says Kircher-Morris, who hosts the Mind Matters podcast, which focuses on the development of high-ability and twice-exceptional people across the life span. She is also the author of the forthcoming book Teaching Twice-Exceptional Learners in Today’s Classroom.

Kircher-Morris has had several clients get psychological evaluations and come back with a misdiagnosis. She recalls an example in which one of her elementary-age gifted clients was having meltdowns at school, becoming emotionally dysregulated and having trouble understanding nonverbal cues. Kircher-Morris knew the client was gifted, and she strongly suspected he was also autistic. The boy’s parents were reluctant to accept that label because of the stigma surrounding autism. It was easier for them to just say, “He’s quirky because he’s gifted.”

When Kircher-Morris finally convinced the parents to get a psychological assessment for their son, she wrote a letter to the person doing the assessment and told them the child was gifted to ensure that would be factored in. But the person doing the assessment did not specialize in giftedness and ended up diagnosing the child as depressed because sometimes when he had meltdowns, he would say, “I hate myself. I wish I could die.”

Kircher-Morris knew the client wasn’t clinically depressed. Instead, he was having big emotions and wasn’t sure how to talk about them, she says. She adds that one day of testing and questionnaires is not enough to fully understand and diagnosis a person.

Kircher-Morris still works with this student, and now that he is in high school, his autism is more pronounced. When his schedule shifted and he had to start showering in the mornings instead of the evenings, he didn’t handle it well at first. Kircher-Morris worked with him on regulating his emotions around this change. The student also has some issues with friends at school, but other people in his life often view him solely through a lens of giftedness and assume that he shouldn’t have any trouble communicating, Kircher-Morris says. They don’t realize that as a twice-exceptional adolescent, he sometimes does have certain challenges.

Trying to identify a client as twice-exceptional is even more difficult because of the concept of masking. As Tolison notes, gifted individuals with a learning disability can fall into one of three categories:

1) The individual’s advanced intellect compensates for their learning disability.

2) The learning disability or special need overshadows the person’s giftedness.

3) The giftedness and learning disability mask each other to the point that the individual appears to have average intelligence.

Research shows that twice-exceptional children are often diagnosed later than their peers because their struggles aren’t as noticeable initially, Kircher-Morris says. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders states that individuals with autism, for example, may be able to compensate for their comparative lack of social skills until social expectations exceed their abilities, she notes. A gifted child who is also autistic may not have a language delay when they are little, but by the time they get to middle school or high school, their emotional and social struggles and rigid thinking become more problematic.

“And we’ve now lost all of that time to be proactive and to support them and to help them build the skills they need to be successful, confident and happy,” Kircher-Morris adds.

To avoid mislabeling clients, Tolison, a registered play therapist who works with children who are twice-exceptional (particularly those with ADHD), advises counselors to always consider what the client’s behavior is communicating. Are they fidgeting in the classroom because they are understimulated, or is it a symptom of ADHD?

Therapists need to recognize “the blend of symptomology between gifted and diagnosis,” Tolison continues. For example, mental health professionals shouldn’t presume a client is autistic just because the client is smart and struggles to socialize with peers, she says. Instead, she advises digging deeper and considering whether the symptoms decrease or dissipate when the client is in an ideal setting, such as being around others who have interests similar to theirs.

Giftedness and special education are often seen as being opposite ends of the continuum, Mayes says, but she asserts they are separate continuums and can exist simultaneously. “The disability is the how you do something,” she explains. Even though an individual may need to do a task or skill differently or may need help, they can still possess a higher cognitive ability, notes Mayes, who has published several articles on this topic, including “College and career readiness groups for gifted Black high school students with disabilities” in The Journal for Specialists in Group Work.

Mayes recounts a real case example of how these continuums can overlap in a client: A Black student who was in a gifted program in middle school had an accident and suffered a traumatic brain injury. The injury caused the boy to get bad headaches if he sat for long periods of time, and his vision became blurry. But his cognitive ability was unchanged. He just needed some accommodations to help him at school. His teachers didn’t believe he was actually having headaches, however. They assumed he was just trying to get out of doing the work. The boy internalized their disbelief and told his mother the teachers were looking at him as if he were a “lazy Black kid,” a stereotype he knew was prevalent at the school. Soon thereafter, the boy’s grades started to suffer.

His mother became a big advocate for her son and pushed for a special education and gifted label for him. Even so, the school refused. It wasn’t until the boy entered high school and the school counselor joined the mother’s fight that they finally got some accommodations for the student. When the boy translated his talent for STEM (science, technology, engineering and math) into a passion for band, the band director also advocated for him.

This student had to reconfigure his identity as not just a gifted student but as a gifted student with a traumatic brain injury, and he had to learn to self-advocate, Mayes says.

Asynchronous development

Gifted children’s cognitive, emotional and physical development are often asynchronous, meaning that their intellectual development outpaces their maturity or emotional development. Even though their intellectual skills are advanced, their social and emotional skills may lag behind.

“Cognitive giftedness is not necessarily the same as emotional maturity,” Kircher-Morris says. Because gifted children are often highly verbal and speak as if they are mini-adults, people incorrectly assume that their behavioral and emotional regulation skills will also be advanced, she explains. So, counselors should consider clients’ emotional development along with their cognitive development.

According to Tolison, “There can be upward of a 12-year spread between a child’s intellectual age … [and] their social/emotional age.” For example, a twice-exceptional child with ADHD could be 8 biologically, but with the intellectual capabilities of a 12-year-old and the social and emotional development of a 6-year-old. And at times, the child might have emotional outbursts that are on par with a 4-year-old, Tolison adds.

Tolison often helps her clients first understand emotional language. She finds the “anger iceberg” exercise helpful for teaching emotion identification and awareness. Because some clients might be gifted in empathy, this process is less about identifying emotions and more about learning how to express them, she adds. Tolison then helps clients focus on executive functioning skills such as planning ahead, organizing one’s thoughts, flexible thinking and demonstrating self-control — all of which can be challenging for individuals who are twice-exceptional. She may play chess or Othello with clients to help them work on impulse control, for example.

Kircher-Morris engages clients’ higher-level cognitive skills by adjusting her counseling approach. This can be as simple as using a more advanced technique with a younger client (similar to grade skipping in school), or it may involve tailoring a technique to make it more analytical and creative.

The emotion wheel, which describes eight basic emotions and their varying degrees, is a great tool for helping clients identify and name their emotions, Kircher-Morris says. But this tool may not stimulate gifted clients enough to keep them engaged, so she alters it to make it more cognitively challenging. Her emotion wheel is mostly blank. She leaves a few emotion words in different places around the wheel and works with clients to fill in the blank spaces. Sometimes they look up words in the thesaurus or online to find the “just right” word, and then clients evaluate and determine which words should go on the wheel. This activity builds on the higher-level vocabulary that gifted clients often possess, and it provides them with some autonomy in session, she says.

Letting gifted clients direct (but not dictate) sessions

Kircher-Morris finds that gifted children are often unaware that anything is “wrong.” They can be skeptical of counseling at first, especially if their parents are the ones who initiated it. And because these children are gifted, she says, they often want to know the “why” before they completely trust and participate in different counseling approaches.

For that reason, Kircher-Morris encourages these clients to ask questions and takes time to explain the psychology behind the interventions. She also allows clients to explore what works best for them and to develop their own ideas about what would be helpful.

When Kircher-Morris introduces the cognitive triangle exercise (which emphasizes the relationship between one’s thoughts, feelings and behaviors), she moves beyond just drawing the diagram on a dry-erase board. She also poses a hypothetical example to help clients better understand the underlying principle behind the activity.

An example she often uses is a student who has an upcoming math test. She asks, “What uncomfortable emotions might they be experiencing?” After she and the client brainstorm some possible feelings, she asks, “If they’re experiencing those uncomfortable emotions, then what thoughts might they be having?” She draws speech bubbles on the board, and she and the client fill them in together.

Then they discuss how these thoughts might influence the hypothetical student’s behavior, where the student could intervene and how this would change the outcome. Running through this hypothetical allows clients to better understand the way the exercise works before they apply it to their own situations, Kircher-Morris says.

The fact that gifted individuals have higher-level thinking skills also means they are more likely to find fault in others’ logic, Kircher-Morris says. In fact, because these individuals are often brighter than their parents, teachers and others with whom they interact, counselors might find themselves trapped in a logical corner when a gifted client pokes holes in their reasoning. Should this happen, Kircher-Morris advises counselors not to engage in a power struggle.

“Don’t try to assert your intelligence or the information that you have because that’s going to damage the rapport,” Kircher-Morris says. Instead, her approach is to acknowledge the valid point the client has made. For example, she may say, “I hadn’t thought about it that way. I’ve seen this counseling technique work with other clients, but maybe it won’t work with you. Let’s figure out what will work. Do you think any part of that activity might be relevant for you?”

Tolison agrees that gifted clients benefit from being able to have some control over their therapy, but she cautions counselors not to let them dictate the direction of treatment. She says she often has parents who come to her because they previously worked with another therapist who allowed their gifted child to take control to the point that they weren’t making progress. 

Often, gifted clients are excited to engage in a topic they are passionate about, but that can dominate the session. However, as Tolison points out, counselors can turn that passion into a therapeutic intervention. She once had a client who wanted to talk about the dwarf planet Pluto for most of their sessions. She seized on that as an opportunity to teach the client about mindfulness and social awareness.

She used the phrase “I noticed” to stop him from discussing Pluto: “I noticed you’ve talked 20 minutes now on Pluto. I love that you are sharing your passion with me, but can we take a break because I’m a little exhausted from learning that information right now. Let’s talk about something new.” This statement set a limit for the client while also helping them become more mindful of the passage of time and of other people’s feelings, Tolison says.

Tolison also encourages clinicians to be humble when working with gifted clients. “Sometimes the most therapeutic thing you can do for a profoundly gifted kid is be excited about what they can teach you because in that [process], they are also learning,” she says.

Embracing neurodiversity

Kircher-Morris’ goal is to help normalize the fact that different types of brain wiring exist. People with this brain wiring might be divergent from the norm, but that doesn’t mean something is “wrong” with them. Being gifted or twice-exceptional is simply part of the human condition. Normalizing neurodiversity will encourage people to realize that they need help and give them the courage to ask for it, she says.

Counselors are great at understanding the individual needs of clients, she continues, but unless they consider all the factors, including a person’s cognitive ability, then they may misread the situation and the client’s true needs. For example, if a cognitively gifted child is having a hard time making friends, a counselor might focus simply on helping the child build social skills and self-confidence. But then the counselor would be missing the opportunity to consider other possible factors such as bullying, the child’s high stress levels, their feelings of isolation or others’ upward expectations of them — all of which could inhibit the child’s ability to form authentic relationships, Kircher-Morris explains.

So, she advises counselors working with this population to make sure they view their clients’ struggles through a lens of giftedness. How does giftedness or twice-exceptionality influence these clients’ experiences and reality? Clinicians must also figure out how to leverage clients’ strengths with their cognitive abilities to work through any issues they are having, Kircher-Morris says.

Mayes says counselors must be more holistic in understanding clients and see them as more than their struggles or even their giftedness. “We need to take a broader approach in our professional development,” she says, “so we can start understanding more fully individuals’ identities beyond giftedness to include culture, class, gender identity, affectional identities and so much more.”

 

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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.

Techniques for helping children navigate anxiety related to COVID-19

By Celine Cluff and Victoria Kress September 29, 2020

Counselors are working hard to help children and families navigate the uncharted territories the COVID-19 pandemic has introduced. Many children, especially those who are already managing stressful situations, have experienced an uptick in anxiety this year due to the pandemic, the spotlight on racial injustices and ensuing conflicts, and the various related challenges 2020 has presented.

In this article, we discuss several strategies that counselors can use during these difficult times to help children manage their anxiety.

Clear communication

Children have many questions about the challenges we are currently facing. Adults should explain things to children in clear, concrete terms. For example, in trying to educate a 5-year-old on safety and the pandemic, it would be best to say something along these lines: “There is a virus that can make people sick, and we can catch it. It is important to wash your hands and to keep space between you and other people that is as long as your bed.”

Clear, open communication is key. Children are inquisitive by nature, and it is important to show them that an adult or caretaker is available for exchanges of information. Keeping that exchange simple and age appropriate will help set the child’s mind at ease without causing them unnecessary stress.

On the other hand, shutting down a child’s request for information (out of fear of upsetting them, for example) is not helpful to children. Having a dialogue with a child is always a good idea because it can alleviate some of the tension and turn it into an opportunity for connection and care.

Taming worry dragons

Jane Garland and Sandra Clark — creators of the Taming Worry Dragons: A Manual for Children, Parents and Other Coaches — provide one approach that can help children manage anxiety. A “worry dragon” is characterized by negative or unpleasant thoughts, scared feelings and worries that will not go away.

For some people, worry dragons show up only occasionally. For others, these creatures are constant companions. The dragons might even present themselves in a herd with some frequency.

It can be very tiring to spend so much energy worrying. Having worry dragons means that a person (or child) has a special talent, which is worrying all the time. These individuals are likely able to imagine the worst possible scenario for any situation and to see it in vivid color, with all the gory details.

Children can be taught that tame worry dragons do not scare people and, in fact, can even be useful. What follows are some tips and tricks on how to hone dragon-taming skills.

Scheduling

Children can learn to better manage anxiety through thought-stopping tools — such as dedicating time to worry. When children start worrying actively about topics such as death or the possibility of losing a caretaker or other loved one to COVID-19, this skill can prove useful. Note that this type of worrying typically starts around the ages of 4 or 5; this is when children become aware of mortality (nobody lives forever) and other realities. Mixing this realization with the active and vivid imagination of a child can lead to the creation of worry dragons.

Using an egg timer for “worry time” works well. If a child is repeatedly asking if they are going to be OK because they have been directly or indirectly exposed to news about the coronavirus, a parent or caretaker would get the timer and tell the child they can dedicate five minutes to worrying about the virus. Afterward, they are to leave worries about the virus behind and start doing something else. Because children like to know what happens next and respond well to routines, this technique can help them feel in better control of some of their unpleasant or unwanted emotions.

By using scheduling to integrate worrying into daily activities, the anxious child can take a proactive approach in taming their worries instead of the worries taking hold of the child’s mind at random times throughout the day (or night). 

Creative imagination

Another interactive way of helping children manage anxiety is to have them write or draw their worries on a piece of paper and toss them into a worry jar. By shrinking, harnessing, locking up or trapping worries in a small space such as a jar, the child can make the worries more approachable.

Another option is to buy some colorful miniature pompoms for the child, which they can then place into the jar. When the time comes to work with the jar (e.g., the child is worried about something in particular and cannot relax), the parent or caretaker would extend an invitation to the child to pick a color (or multiple colors) and talk about it as if it represented the worry they cannot let go. This approach helps distract the child (through the texture and visualization of the soft, fluffy, colorful pompoms) while still allowing them to process whatever is bothering them.

Creating a routine

Children thrive on routine, and they require scheduled downtime. Scheduling time to relax and recharge is vital to harmonious home life. A good place to start would be using some of the tools covered in this article in combination with giving the family time to connect, restore and feel love (preferably without the use of a tablet or other device).

The deepening of a connection to a loved one can be a reassuring experience when a child’s sense of safety has been compromised due to the unforeseen circumstances families find themselves in currently. The suggestions in this article were curated to help families navigate these challenging times together while equipping children with helpful tools to combat anxiety. These methods can be applied regardless of the source of anxiety because they are designed to increase the level of control in children who experience anxiety. Helping children hone these skills from an early age can equip them with valuable coping mechanisms to last a lifetime.

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Related reading, from Counseling Today columnist Cheryl Fisher: “The Counseling Connoisseur: How to talk to children about the coronavirus

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Celine Cluff is a registered clinical counselor practicing in Kelowna, British Columbia, Canada. She holds a master’s degree in psychoanalytic studies from Middlesex University in London and is currently completing her doctorate in occupational psychology. Her private practice focuses on family therapy, couples therapy and parenting challenges. Contact her at celine.cluff@yahoo.com.

Victoria Kress is a professor at Youngstown State University in Ohio. She is a licensed professional clinical counselor and supervisor, national certified counselor and certified clinical mental health counselor. She has published extensively on many topics related to counselor practice. Contact her at victoriaEkress@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.