Potty Training: What should you know? [video]

Many parents struggle with potty training. Difficulties may arise due to behavior issues or the child not being developmentally ready to start the process. I previously provided some basic tips in a post on my Psychology Today blog.

In this post, Dr. Anglim (Omaha Children’s Hospital & Medical Center) discusses mastering potty training. She will review everything from readiness to dealing with night time potty training.

Featured presenter:
Katie Anglim, M.D., FAAP

Children's Hosptial & Medical Center
Omaha, Nebraska

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5 Tips for Helping Children Cope with Early Childhood Trauma

I previously published a blog on trauma in children on Psychology Today.  Common forms of trauma include physical and sexual abuse, witnessing domestic and community violence, being separated from family members, and neglect.  According to the US Dept of Health and Human services (2013), child neglect is the most common trauma experienced by children.  Furthermore, children in the age group of birth to 1 year had the highest rate of victimization at 21.2 per 1,000 children ( DHHS, 2013) In regards to ethnicity, the most confirmed cases by CPS are among Whites (43.9%) followed by African-Americans (21.5 percent) and Hispanic Americans (22.1 percent).

Signs of Trauma in Young Children

Children’s reactions to trauma vary at different ages. Some of the common reactions of children are listed on the next page. If any of the behaviors or symptoms don’t improve or go away over time, it is important to seek professional help. Possible reactions to trauma may include:

• Fear of being separated from parent

• More clinging and dependent behaviors

• More aggressive behaviors

• More withdrawn behaviors showing little emotion

• Aimless motion, disorganized behaviors, and or/freezing

• Unable to comfort self

• Difficulty falling asleep, night waking

• May reenact scene in play

• Problems with toileting (bedwetting, soiling)

• Thumb sucking

• Loss of language skills and acquired language

• Memory problems 

Tips for Helping Children Cope with Trauma

1. Avoid blaming the child or displaying your anger: It is important to remain calm and use a calm voice with talking with children about their traumatic experience. 
2. Reassure the child that they will be safe: Many children fear for safety after experiencing trauma. It is important to let the child know that you will be present to support them. This may involve letting the child be aware of your whereabouts at all times.
3. Don’t minimize the child’s feelings: Avoid telling the child to “Stop being a baby, don’t cry”. Normalize the child’s emotions at let them know that it’s okay to be sad.
4. Follow the child’s lead: It’s okay to not encourage the child to talk about the trauma. However, it the child decided to open up to you be there to listen and support them.
5. Help the child identify their feelings: It is important for children to talk about their hurt or sadness. It may be necessary to seek professional help from a psychologist or licensed mental health professional trained to deal with trauma.

Copyright 2013 Erlanger A. Turner, Ph.D. 

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References:

Child Welfare Information Gateway. (2013). Child Maltreatment 2011: Summary of key findings. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.

National Child Traumatic Stress Network (2010). Early Childhood Trauma Retrieved September 2013 from http://www.nctsn.org/sites/default/files/assets/pdfs/nctsn_earlychildhoodtrauma_08-2010final.pdf

Osofsky, J. Helping young children and families cope with trauma. Retrieved September 2013 from http://www.nctsnet.org/nctsn_assets/pdfs/Helping_Young_Children_and_Families_Cope_with_Trauma.pdf

To Spank or Not to Spank: What the Research Supports

Last month, I had the opportunity to attend the American Psychological Association (APA) convention in Honolulu. As usual, I am re-energized after attending the sessions and learning about new perspectives on science and psychological practice. While attending a talk on spanking and children, it made me think back to all the conversations that I’ve had with parents in my practice around the use of corporal punishment (which includes domestic, school, and judicial). During the talk, Dr. Shawna Lee (assistant professor at University of Michigan) and her colleagues presented data on the frequency of parents that use spanking as a parenting strategy and highlighted the effects of spanking on childhood outcomes (e.g., aggression and compliance). Surprisingly, a high percentage of parents use spanking despite if not being an effective long-term strategy to change behavior.

As a child psychologist, I often discuss the impacts of spanking with parents. First, spanking tends to increase aggressive behavior in children. Secondly, the research shows that spanking is less effective to increase compliance than positive reinforcement. The pros and cons of spanking have been discussed for decades yet many still see it as a viable parenting strategy. Many times when I bring this up with parents they respond, "I was spanked as a child and I turned out fine". But what does the research support? 

During the APA symposium, Dr. Lee, stated that “spanking has the iatrogenic effect of increasing the very child behaviors it is often trying to reduce”.  In a recent study published in Development Psychology (Lee, S. J., Altschul, I., & Gershoff, E. T., 2013), the authors found that maternal spanking  at age 1 was associated with higher levels of child aggression at age 3; and continues to be associated with aggression by age 5. Furthermore, the study found that maternal warmth does not serve as a protective factor against child behavior problems. 

Being someone who is interested in early intervention to prevent more severe behavior difficulties I felt armed with new research findings that I could use in my own life and clinical practice. Overall, the research does not support the use of spanking as an effective parenting strategy and shows that it has significant negative outcomes for children. Currently 31 countries (not including the United States) have recognized the detrimental effects of spanking and have banned the use of corporal punishment in the home. Yet, the U.S. does not have a national policy against spanking. Furthermore, only a small percentage of states ban the use of corporal punishment in school. What are your thoughts on spanking and corporal punishment?

Copyright 2013 Erlanger A. Turner, Ph.D. 

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Note: A version of this was submitted to the Richmond Times Dispatch. 

Understanding Adolescent Self-Harm Behavior

Self-injury, also called self-harm, is the act of deliberately harming your own body, such as cutting or burning yourself. It's typically not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration. Self-harm behaviors may also be linked to a variety of mental disorders, such as depression, eating disorders and borderline personality disorder. 

The following video presents on adolescent self-harm behaviors.

Featured presenters:

Reo W. Newring, Ph.D.

Licensed Clinical Psychologist

Paige Lembeck, M.A.

Graduate Student

Children's Hosptial & Medical Center

Omaha, Nebraska

Tips for Effective Co-Parenting

Many parents raise children together while living apart. This may be the result of co-parenting after a divorce or because the parents never married. When you have a child with someone, even after the relationship ends, your parenting relationship remains. You both remain parents and are responsibile for your child/children. This person is now your child’s other parent – someone your child loves, looks up to, and will likely take after in some ways – not your spouse or partner. Although you are no longer a couple, you are now a co-parent. To make the process easier, avoid calling the other parent your “ex” and refer to them as “the father or mother of your children”.

Below are some additional suggestions to have an effective co-parenting relationship:

·         Don’t project your feelings onto the child or assume the child has the same feelings as you towards the other parent.

o   Accept your own feelings and try to understand your child’s feelings.

o   Remember it is okay to ask the child why they feel a certain way.

·         Avoid sharing your personal feelings or loss related to the divorce.

o   With the end of the marriage comes the end of that sharing.

o   Separate your feelings from decisions and interactions about your child.

·         “Fake it, til you make it”

o   Establish boundaries to help keep your feelings under control.

o   It is important to have some emotional distancing or disengagement

o   Imagine the other parent is your business partner. You have to be polite, have business like conversations, and work together to raise your child.

Preparing for the “Business Meeting”

In order to improve communication with the other parent, it is encouraged that you emotionally detach (and put your feelings aside) when interacting with each other. Respect the common ground you share that you both love your children and want the nest for them. The following suggestions or offered to help the “business of raising your children”.

• Have regular meetings to share important information
• Be polite, respectful, and business-like
• Keep the conversation focused on the children
• Avoid having the child as the “go-between” and carry messages
• Be prepared and structure conversations
•  Relay information about: emergencies, appointments, school, your child’s successes, or information about social activities. 

Follow me on Twitter @DrEarlTurner and on Facebook www.facebook.com/DrEarlTurner

Copyright 2013 Erlanger A. Turner, Ph.D.



Reference:

The Quick Guide to Co-Parenting After Divorce: Three steps to your children’s healthy adjustment by Lisa Gabardi, Ph.D. 

Sibling Rivalry: Tips to overcome sibling conflicts [Video]

If you’re a parent of more than one child, you probably have dealt with some conflict between your children. Most brothers and sisters experience some degree of jealousy or competition, and this can trigger arguments or fights. Dr. St. Germain (Omaha Children’s Hospital & Medical Center) discusses sibling rivalry and how parents can help manage difficulties.

 

Featured presenter:
Melissa L. St. Germain, M.D., FAAP
Pediatrician

Children's Hosptial & Medical Center
Omaha, Nebraska

Teen Suicide-Related Behavior: Risk and Protective Factors

May has been designated as Mental Health Awareness Month. Given the prevalence of suicide related behaviors (suicidal thoughts or suicide attempts) among adolescents, I feel it is important for us to become aware of this issue. It is particularly important for parents to be knowledgeable about what signs to look for and when it is appropriate to seek treatment.

According to the National Institute of Mental Health (NIMH), suicide remains the third leading cause of deaths among adolescents. Spirito and Esposito-Smythers (2006) reported that within a twelve-month period, 16.9% of adolescents seriously considered attempting suicide, 16.5% developed a suicide plan, 8.5% attempted suicide (female, 11.5%; male, 5.4%), and 2.9% of adolescents required emergency treatment as a result of a suicide attempt. In my recent Psychology Today blog post, I discussed the rates of suicide among lesbian, gay, and bisexual (LGB) youth. LGB youth also are at high risk of suicidal behavior due to bullying and lack of acceptance by peers and family. While depressive symptoms are a risk factor, even among those who exhibit depression or depressive symptoms, clinician face difficulties predicting self-harm or suicide attempt (Hetrick, et al., 2011). Therefore, it is important for parents to pay attention if they notice differences in their child’s behavior.

Risk Factors of Suicide

Risk factors for suicide are characteristics or conditions that increase the chance that a person may try to take her or his life. Suicide risk tends to be highest when someone has several risk factors at the same time. The most frequently cited risk factors for suicide are: 

• Mental disorders, in particular:
• Depression or bipolar (manic-depressive) disorder
• Alcohol or substance abuse or dependence
• Schizophrenia
• Borderline or antisocial personality disorder
• Conduct disorder (in youth)
• Psychotic disorders; psychotic symptoms in the context of any disorder
• Anxiety disorders
• Impulsivity and aggression, especially in the context of the above mental disorders
• Previous suicide attempt
• Family history of attempted or completed suicide
• Serious medical condition and/or pain

It is important to bear in mind that the large majority of people with mental disorders or other suicide risk factors do not engage in suicidal behavior. 

Warning Signs of Suicide 

• Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself
• Looking for ways to kill oneself by seeking access to firearms, available pills, or other means
• Talking or writing about death, dying, or suicide when these actions are out of the ordinary for the person
• Feeling hopeless
• Feeling rage or uncontrolled anger or seeking revenge
• Acting reckless or engaging in risky activities - seemingly without thinking
• Feeling trapped - like there's no way out
• Increasing alcohol or drug use
• Withdrawing from friends, family, and society
• Feeling anxious, agitated, or unable to sleep or sleeping all the time
• Experiencing dramatic mood changes
• Seeing no reason for living or having no sense of purpose in life  

Protective Factors for Suicide

Protective factors for suicide are characteristics or conditions that may help to decrease a person’s suicide risk. While these factors do not eliminate the possibility of suicide, especially in someone with risk factors, they may help to reduce that risk. Protective factors for suicide have not been studied as thoroughly as risk factors, so less is known about them. Protective factors for suicide include: 

• Receiving effective mental health care
• Positive connections to family, peers, community, and social institutions such as marriage and religion that foster resilience
• The skills and ability to solve problems

Protective factors may reduce suicide risk by helping people cope with negative life events, even when those events continue over a period of time. The ability to cope or solve problems reduces the chance that a person will become overwhelmed, depressed, or anxious. Protective factors do not entirely remove risk, however, especially when there is a personal or family history of depression or other mental disorders. 

What To Do When You Suspect Someone May Be at Risk for Suicide

1. Take it Seriously

• 50% to 75% of all people who attempt suicide tell someone about their intention.
• If someone you know shows the warning signs above, the time to act is now.

2. Ask Questions

• Begin by telling the suicidal person you are concerned about them.
• Tell them specifically what they have said or done that makes you feel concerned about suicide.
• Don't be afraid to ask whether the person is considering suicide, and whether they have a particular plan or method in mind. These questions will not push them toward suicide if they were not considering it.
• Ask if they are seeing a clinician or are taking medication so the treating person can be contacted.

3. Do not try to argue someone out of suicide. Instead, let them know that you care, that they are not alone and that they can get help. Avoid pleading and preaching to them with statements such as, “You have so much to live for,” or “Your suicide will hurt your family.”

4. Encourage Professional Help

• Actively encourage the person to see a physician or mental health professional immediately.
• People considering suicide often believe they cannot be helped. If you can, assist them to identify a professional and schedule an appointment. If they will let you, go to the appointment with them.

5. Take Action

• If the person is threatening, talking about, or making specific plans for suicide, this is a crisis requiring immediate attention. Do not leave the person alone.
• Remove any firearms, drugs, or sharp objects that could be used for suicide from the area.
• Take the person to a walk-in clinic at a psychiatric hospital or a hospital emergency room.
• If these options are not available, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for assistance.

6. Follow-Up on Treatment

• Still skeptical that they can be helped, the suicidal person may need your support to continue with treatment after the first session.
• If medication is prescribed, support the person to take it exactly as prescribed. Be aware of possible side effects, and notify the person who prescribed the medicine if the suicidal person seems to be getting worse, or resists taking the medicine. The doctor can often adjust the medications or dosage to work better for them.
• Help the person understand that it may take time and persistence to find the right medication and the right therapist. Offer your encouragement and support throughout the process, until the suicidal crisis has passed.

References

American Foundation for Suicide Prevention https://www.afsp.org/

National Suicide Prevention http://www.suicidepreventionlifeline.org/

National Institute of Mental Health http://www.nimh.nih.gov/health/topics/suicide-prevention/suicide-prevention-studies/warning-signs-of-suicide.shtml

Copyright 2013 Erlanger A. Turner, Ph.D.

Psychologists and Health Care Reform

Psychologists have been working in primary health care settings for over 30 years (McDaniel & LeRoux, 2007) providing assessments and treatment to patients and their families. Research shows that 24 % of patients who present themselves to primary care physicians suffer from a well-defined mental disorder, and 69 % of these patients present to physicians with physical symptoms and many of their mental health needs remain undetected (APA, 2010). According to a quote in the Monitor (January 2010) by Katherine Nordal, Ph.D. (Executive Director, APA Practice Directorate) “Psychologist are the leading experts…We have the skills to improve quality of life, reduce the level of disability associated with illness and at the same time dramatically reduce cost in our health-care system”.

Psychologists Role in Primary Health Care Settings (APA, 2010; Blount & Miller, 2009; McDaniel & LeRoux, 2007):

• Conduct cognitive, capacity, diagnostic, and personality assessments that differentiate typical behavior from pathology across the lifespan, side effects of medications, adjustment reactions, or combinations of these problems
• Offer behavioral health assessment and treatment that provide youth and adults with the skills necessary to effectively manage their chronic conditions
• Diagnose and treat mental and behavioral health problems (e.g. depression or suicide risk).
• Offer consultation and recommendations to family members, significant others, and other health care providers
• Contribute research expertise to the design, implementation, and evaluation of team care and patient outcomes
• Develop interventions that are responsive to specific individual and community characteristics that may impact the treatment plan

Want your voice to be heard? Take action and contact your locate state representative. Ask them to support The Mental Health Awareness and Improvement Act of 2013 

Copyright 2013 Erlanger A. Turner, Ph.D. 

Version previously published by Erlanger Turner, Ph.D. at http://www.apa.org/apags/programs/bulletin/2010/04/issue.pdf

Tips on Coping with Tragedy: In the wake of the Boston Marathon Explosion

On yesterday, we experienced another tragedy in Boston when an explosion occurred near the finish line at the Boston Marathon. According to the New York Times, almost 23,000 runners participated in the race and approximately three-quarters of the runners had crossed the finish line prior to the bomb exploding. President Obama made a statement following the explosion and stated “I'm supremely confident that Bostonians will pull together, take care of each other, and move forward as one proud city. And as they do, the American people will be with them every single step of the way.”

In the wake of another tragedy, below are some resources to help children and their families cope and process the event.

Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence  

Helping Children and Adolescents Cope with Violence and Disasters: What Rescue Workers Can Do

What Parents Can Do To Help Children

            Spanish version: Que Pueden Hacer los Padres

Tips of talking with children: A guide for teachers and parents

A Guide for Managing Stress in Crisis Response

  

Copyright 2013 Erlanger A. Turner, Ph.D.

Follow me on twitter @DrEarlTurner

References:

Image from the Boston Globe 

Resources for LGBT Health Awareness Week

LGBT (Lesbian, Gay, Bisexual and Transgender) Health Awareness Week is March 25^th – 29^th. The theme for 2013 is Come Out for Health. Per the American Psychological Association, the 4 principles for this year include:

• Consumer Empowerment — by making resources available to the LGBT community on how to approach their health care providers about their sexual orientation and gender identity; 

• Culturally Competent Services — by directing health care providers to resources on how to become a culturally competent source of services for the LGBT community; 

• Engaged Communities — by providing outreach materials to a variety of organizations to encourage participation in LGBT Health Awareness Week; and

• Inclusive Policymaking — by engaging Congress and federal administration during LGBT Health Awareness Week and providing resources to reach out to local and state officials related to LGBT Health. 

APA's Lesbian, Gay, Bisexual and Transgender Concerns Office provides a range of information and resources for increasing psychologists' and others' cultural competence concerning LGBT health and this year launched a new webpage for Lesbian, Gay, Bisexual and Transgender Health.

How can you get involved?

There are several ways you and your community can support LGBT Health Awareness week.

• Set up an event in your community (e.g., round table discussion, health fair)

• Write a letter to your senator and/or congressman in support of LGBT rights

• Pledge a commitment to LGBT health

Resources for professionals:

APA Guidelines for Practice with LGBT Clients http://www.apa.org/pi/lgbt/resources/guidelines.aspx

Marriage and Family Issues of LGBT People http://www.apa.org/pi/lgbt/resources/marriage-and-family.aspx

Fact sheet on Psychological and Social Outcomes of Children of Same-Sex Couples  http://www.spssi.org/_data/n_0001/resources/live/Factsheet_Psychological_Social_Adjustment_V5.pdf

LGBT Families of Color: Fact sheet http://lgbtmap.org/lgbt-families-of-color-facts-at-a-glance

Human Rights Campaign- Guide to state level advocacy against hate crimes http://www.hrc.org/resources/entry/a-guide-to-state-level-advocacy-following-enactment-of-the-matthew-she

Resource for parents:

Human Rights Campaign Parenting Resources:

http://www.hrc.org/resources/category/parenting

Resource Guide for Coming Out

http://www.hrc.org/resources/entry/resource-guide-to-coming-out

For African Americans http://www.hrc.org/resources/entry/resource-guide-to-coming-out-for-african-americans

For Latinos http://www.hrc.org/resources/entry/family-and-coming-out-issues-for-latinas-and-latinos

For Asian Americans http://www.hrc.org/resources/entry/family-and-coming-out-issues-for-asian-pacific-americans

An Ally’s Guide to Issues Facing LGBT Americans (for heterosexual supporters) http://www.hrc.org/resources/entry/an-allys-guide-to-issues-facing-the-lgbt-community

Stress in America: Where do you fit?

Recently the American Psychological Association (APA) released the findings of their annual nationwide Stress in America survey. The Stress in America survey has been released since 2007 as part of the APA’s  Mind/Body Health campaign.  The Stress in America survey measures attitudes and perceptions of stress among the general public and identifies leading sources of stress, common behaviors used to manage stress and the impact of stress on our lives. 

According to the survey, almost three-quarters (72 percent) of respondents say that their stress level has increased or stayed the same over the past five years and 80 percent say their stress level has increased or stayed the same in the past year. Only 20 percent said their stress level has decreased in the past year. 

Some of the most common sources of stress included money (69 percent), work (65 percent), the economy (61 percent), family responsibilities (57 percent), relationships (56 percent), family health problems (52 percent) and personal health concerns (51 percent). Given the level of stress experienced by American’s we need to continue to work towards strengthening our understanding of the connection between mental and physical health.

How does stress affect your overall health?

The National Institute of Mental Health (NIMH) identifies three different types of stress, all of which carry physical and mental health risks:

• Routine stress related to the pressures of work, family and other daily responsibilities.
• Stress brought about by a sudden negative change, such as losing a job, divorce, or illness.
• Traumatic stress, experienced in an event like a major accident, war, assault, or a natural disaster where one may be seriously hurt or in danger of being killed.

The body responds to each type of stress in similar ways. Different people may feel it in different ways. For example, some people experience mainly digestive symptoms, while others may have headaches, sleeplessness, depressed mood, anger and irritability. People under chronic stress are prone to more frequent and severe viral infections, such as the flu or common cold, and vaccines, such as the flu shot, are less effective for them. 

Ways to cope with stress

Previously, I published a blog on ways to cope with stress. Although not an exhaustive list it provided some simple strategies to cope with stress. The NIMH also provides the following tips:

• Seek help from a qualified mental health care provider if you are overwhelmed, feel you cannot cope, have suicidal thoughts, or are using drugs or alcohol to cope.
• Get proper health care for existing or new health problems.
• Stay in touch with people who can provide emotional and other support. Ask for help from friends, family, and community or religious organizations to reduce stress due to work burdens or family issues, such as caring for a loved one.
• Recognize signs of your body's response to stress, such as difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy.
• Set priorities-decide what must get done and what can wait, and learn to say no to new tasks if they are putting you into overload.
• Note what you have accomplished at the end of the day, not what you have been unable to do.
• Avoid dwelling on problems. If you can't do this on your own, seek help from a qualified mental health professional who can guide you.
• Exercise regularly-just 30 minutes per day of gentle walking can help boost mood and reduce stress.
• Schedule regular times for healthy and relaxing activities.
• Explore stress coping programs, which may incorporate meditation, yoga, tai chi, or other gentle exercises.

In addition to uses these strategies, it may also be helpful to seek professional help if you feel that you are extremely overwhelmed by life circumstances. The APA provides a free tool to locate psychologist in your area. You can also contact your local state psychological association for resources to help locate a therapist.

Copyright 2013 Erlanger A. Turner, Ph.D.

Follow me on Twitter @DrEarlTurner and on Facebook at “Get Psych’d with Dr. T”

Understanding ADHD: Overview and treatment

Attention-Deficit Hyperactivity Disorder (ADHD) is a common childhood problem associated with impairments in school functioning and difficulties with interpersonal relationships (with peers and family members). As noted in my blog post on Psychology Today, approximately 9% of children in the United States are diagnosed with ADHD each year. The video clip below provides a brief overview of ADHD and treatment.

Featured presenter:

Kimberly Levering, Ph.D.

Licensed Psychologist

Children's Hosptial & Medical Center

Children's Behavioral Health

Omaha, Nebraska

Dr. Levering’s Bio:

http://childrensomaha.org/KimberlyLevering