Helping Your Child Transition to Adolescence

Q: How can I help my soon-to-be middle school child adjust to adolescence?

A: Just when we start to figure out effective parenting techniques, the onset of adolescence makes a lot of what we do as parents obsolete. If our parenting and discipline strategies do not evolve with our children’s development, we quickly find ourselves battling with them seemingly all the time. To understand why, we must first understand the key developmental task of adolescence: individuation. This is our child’s transformation from being dependent on us to becoming a self-sufficient individual. This process begins at the end of elementary school and continues into young adulthood. It includes profound emotional, social, physical, hormonal and neurological changes. No wonder our child suddenly becomes such a handful!

The trick is to support this process instead of fighting it. More specifically, consider the following suggestions:

• Honor the transition: Create opportunities to celebrate this monumental shift in your child’s life by acknowledging it through discussion, ritual and recognition.
• Talking with instead of talking to: Like it or not, the days of lecturing are over. It’s time to start listening more than talking.
• Use empowerment strategies: When conflicts arise, look to your child to contribute to the solutions. Encourage your child to have a voice in the discipline plan.
• Join the experiment: As scary as it may seem, experimentation is also part of normal adolescent development. When appropriate, allow for short-term negotiated agreements that give your child more control over his/her life. If the experiment fails, process that together and revise your plan.
• Shift from control to advice: Your advice will prove valuable for the rest of their lives. By making this shift now, it is much more likely to be considered in the future.
• Express feelings of pride and love; While adolescents may act like they don’t care, don’t be fooled. They need your positive feedback more than ever.

Parenting an adolescent can feel an overwhelming and, at times, impossible task. By using effective strategies and hanging in there, your child will successfully come out the other side. And so will you!

Self-Harm Behavior

By Dr. Jan Hittelman

“My 13-year-old daughter is a cutter. She also smokes. I have done everything I can to stop her, but she did it again last night and I took her to the emergency room. On the way home, I asked her what I could do to help her stop cutting. She said if I would let her smoke cigarettes at home, that would help, because smoking soothes her and helps alleviate her need to cut.”

“What should I do?”

Cutting and cigarette smoking share a common thread; both are unhealthy ways to deal with negative emotions. While all of us struggle with feelings like sadness, anger, and anxiety, we each deal with our feelings very differently. Some adolescents have tremendous difficulty experiencing and working through their negative emotions and are limited to self-harm behaviors as a maladaptive coping mechanism. It is difficult for most of us to understand, but for some individuals cutting can seemingly provide their only source of relief and often develops into an addictive behavior that is very difficult to stop.

Common misconceptions regarding cutting are that it is a suicidal gesture and/or attention-seeking behavior. Those that cut use it as “a way to survive” and are usually not looking to kill themselves. Given how effectively they hide their scars by wearing long sleeves and purposely cutting in areas that are generally under clothing, this is clearly not an attention-seeking behavior. Rather, cutting is a desperate behavior that demands our attention.

Self-harm behaviors are a serious indicator that the individual needs professional help. It is important that the mental health professional have expertise in not only treating adolescents but also self-harm behaviors. Common co-occurring issues that also need to be treated or ruled-out include: history of sexual abuse, family dysfunction, risky sexual behavior and substance abuse.

Finding the right therapist for your daughter, who can help her learn how to deal with negative emotions in a more effective way and thereby reduce (and eventually extinguish) her self-harm behaviors (including cigarette smoking), would be the critical next step.

Screen Time Addiction

Q: How do I know when my child is spending too much time on the computer or playing video games?

A: As more people engage in high tech recreation, there are increasing concerns regarding the effects of these activities and the potential harm of excessive computer and video game use. Some of the key factors to consider are:

Time dedicated to computer and video game use: Many experts recommend limiting use to two hours a day. A more practical time guideline can be based on the individual and the impact of use on daily functioning.

Impact on healthy daily functioning: Excessive use is more of a concern if it negatively interferes with school performance, peer socialization, family interaction, exercise/weight control, and interest in other activities.

Behavioral Effects: There are numerous studies that show a correlation between exposure to violent video games and aggressive thoughts or behavior. None of these studies, however, can demonstrate long-term impacts or conclude that video gaming itself causes aggressive behavior.

What’s a parent to do? The first step is to have an open discussion with your children regarding computer and video game use. If your child has a healthy social life and continues to function well at home and in school, simply monitoring use may be sufficient. If the amount of daily use time is excessive and/or you have concerns about your child’s social, emotional or behavioral health, try setting clear guidelines. In addition, consider gaming and recreational computer time as a reward for completing homework, household chores, or engaging in prosocial activities. Help your child replace use time with other fun activities. Simply taking away the activity and leaving a vacuum, will likely lead to conflict and efforts to “get around” newly imposed rules.

It is also important to understand that excessive videogame/computer use may be a symptom of underlying emotional issues (e.g. depression, anxiety, social adjustment, etc.). Addressing the surface behaviors without treating these issues will only result in a reoccurrence of the undesired behaviors and/or new ones taking their place. If you have concerns about your child, consider an assessment by a mental health professional to determine the extent of the problem and better understand the underlying issues that may be fueling the behavior.

Dealing with a Difficult Teacher

Q: What’s a parent to do? Your child confides in you about a teacher’s behavior in the classroom, but expects you to keep silent about comments/actions that are demeaning, hurtful, even abusive.
How does one bridge not wanting to speak forth for fear of reprisal on a child already stressed and scared — against feeling the need to communicate with administrators, who should be made aware of what’s happening in the classroom. How do we advocate our children’s concerns without creating conflicts or damaging relationships?
Signed, Between a rock and a hard place

A: There are certain factors that must first be considered before deciding on a plan of action. These include: accuracy of information reported, severity of reported misconduct by the teacher, and the child’s age. Based on these factors let’s consider some scenarios and possible responses:

If we believe that the information is accurate and the misconduct severe, it is important that it be addressed. Consider meeting with the teacher first and give your child the option to attend (the older the child, the more appropriate the invitation). If this meeting is unsatisfactory, request a meeting with the principal, who should decide whether or not to invite the teacher to this initial meeting. Continue working with the principal until a mutually agreed upon plan of action is developed. While you can then go beyond the principal, if you have been reasonable it is unlikely that this will be necessary.

If the situation is less clear and/or the misconduct is not severe, first make sure you’re your child feels heard and supported. After allowing your child to fully share his/her thoughts and feelings, brainstorm possible next steps together. Discuss options (e.g. talking with the teacher, talking with the principal, writing the teacher a note, trying not to let the teacher’s style be as upsetting, promising to let you know if it happens again, etc.) and empower your child with the final say on what approach to use (the older the child, the more appropriate the empowerment). If these issues continue, consider the recommendations as outlined above.

It is also important to remember that our children will need to effectively deal with a variety of teachers, some more challenging than others, throughout their educational career. If the circumstances are not severe, helping children learn how to deal with these issues on their own (especially as they get older) will help them deal more effectively with challenging people in other areas of their lives as well.

Helping Your Child Transition from the Summer Back to School

By Dr. Jan Hittelman

Q: After the summer break, what are some suggestions on transitioning my student from a more laid back summer schedule to a school routine and avoiding the chaos that comes with early weeks of school?

A: Much like the calendar year, the school year also has a certain seasonality or flow. We now find ourselves at the beginning of the cycle, which provides a unique opportunity to set the rhythm for a successful school year. By doing this with intentionality we can address both the transition back to school as well as the inevitable adjustments to a new year.

Here are some strategies to consider:

Introduce ritual to mark the transition: Create an opportunity to focus on and celebrate your children’s start in a new school year. Surprise them with a special meal; perhaps with their favorite foods and/or a special activity. Share your feelings of pride and excitement of the new adventure they are about to begin, as well as reflecting on the positive events of the past summer.

Provide an opportunity for them to share their positive and negative expectations:
Our children have a lot to say if given the opportunity to express it. Let your child know that you’re genuinely interested in knowing how they feel about the upcoming school year.

Normalize their concerns and offer your support: Help your child understand that it’s normal to have apprehensions at the beginning of a new school year. Consider sharing some of your own school experiences when you were their age. Let them know that you’re in their corner and will be there for them if/when challenges arise.

Check in with your child periodically throughout the school year: Instead of focusing only on the school projects, getting homework done, and being ready in the morning, encourage your child to share about their emotional experiences regarding school. Try to be less of a problem solver and more of a good listener.

Broaden your definition of “success”: Try to remember that a successful school year is much more about effort than grades. In addition, be sure to emphasize and celebrate personal, social, and emotional growth as well.

By planting these seeds early on you will increase the chances that your child will blossom throughout the upcoming seasons of this new school year.

Addressing Teen Sleep Issues

By Dr. Jan Hittelman

Q: I’ve read your columns encouraging a later start time for high schoolers, as well as health reports regarding teenagers’ sleep patterns. Do you think this is a serious enough concern that parents should be speaking out to BVSD about the matter? Maybe we should consider nourishing our children’s bodies not only through lunch-menu changes, but also time-schedule changes.
– Mom of a tired, stressed teen

A: The short answer is yes. As a community we should encourage school systems public and private to make the shift to a later start time for high school students. Most experts agree that elementary age children need about 10 – 11 hours of sleep. That high school youth need about 9½ hours. The challenge for adolescents is that their biological clock shifts to a later sleep/wake cycle, often making it difficult for them to get to sleep before 11:00pm. Given that the typical high school day can start as early as 7:30am, it can be an impossible task for teens to get enough sleep. Locally, a recent study asked Boulder County high school students if they had gotten enough sleep in the last week. Locally, ninety-two percent of Boulder County high school students surveyed responded that they did not “get enough sleep to feel rested in the morning seven out of the seven days preceding the survey” (Youth Risk Behavior Survey, 2005).

The main challenges for schools are shifts in busing and after school sports schedules. In addition there may be parents and faculty opposed to a schedule change in terms of their own work schedules. The benefits, however, far outweigh the challenges. Since originally writing about this issue, more and more research has emerged confirming the seriousness of our teens being sleep deprived. For example: “Our findings confirm that on school days, adolescents are obtaining less sleep then they are considered to need, and school start time is the factor with the greatest impact,” write the authors of an article published in the March 2009 issue of the Journal of Pediatrics.

Dangers of Alcohol Poisoning

By Dr. Jan Hittelman

Q: I had a disturbing conversation with a friend about a parent’s experience with alcohol poisoning. The child had already been in trouble with the police, over alcohol use; and had passed out drunk again, when the parent was called to pick up the teen. The parent did not take the teen to the Hospital because the parent was afraid that the police would be involved again. I’ve known several teens in the past, whose lives were most likely saved by prompt medical attention. Is there any assurance that we can give parents that Medical Care asked for by a parent or guardian is not subject to reporting, so that they will do what is right for the child?

-Parent of 2 Teens

A: In June 2005 the Colorado General Assembly passed a series of laws (House Bill 05-1183) that include protections for the minor and up to two additional persons from prosecution if they call 911 to report that the minor is in need of medical attention due to alcohol consumption, give their names, stay on the scene and cooperate with medical and law enforcement personnel when they arrive. You can read the exact language of the law by clicking on: www.state.co.us/gov_dir/leg_dir/olls/sl2005a/sl_282.htm
These laws were enacted due to “incidents of death related to underage binge drinking”.

The danger of not taking someone who is suffering from alcohol poisoning to the hospital is that they can die. Alcohol is a depressant and when too much alcohol is ingested, there is a risk of slowing down the respiratory system and the person simply stops breathing. Tragically a parent would simply assume that they’re “sleeping it off”. It is important to be safe not sorry and seek medical attention.

When Gordon Bailey died from alcohol poisoning several years ago at a C.U. Fraternity, his parents were interviewed. Surprisingly they indicated that they themselves did not really understanding the fatal nature of alcohol poisoning and were haunted that they never sat their son down and educated him about this. The good news is that you can. After educating yourself on the subject, be sure to educate your children. And don’t wait until they’re in high school. These conversations should begin no later than the beginning of middle school, if not earlier. It is important to revisit this and other potential self-harm behaviors (other substance abuse including cigarettes, sexual behavior, bike helmets, seat belts, and other risk behaviors) frequently as your child develops and matures.

Ironically the two most dangerous drugs on the planet are the two that are legal; cigarettes and alcohol. This sends a very confusing message to our children. Particularly because parents and our general culture model the use of these two drugs far too often.

If you are aware that your child is regularly abusing alcohol, it is critical to intervene.
Depending on the seriousness and chronicity of the alcohol abuse, some of the interventions that may be necessary include: Alcohol classes, driving restrictions, substance abuse treatment, and attending Alcoholics Anonymous.

Addressing Alcohol Use in Teens

Q: What objective evidence is there that absolute prohibitions against alcohol in the home reduce teenage drinking vs. a European approach of drinking moderate amounts, such as wine at dinner? Secondly, how do researches reliably measure rates of teenage drinking? Don’t most substance abusers lie about their consumption, even to themselves?
Concerned Dad

A: Surveys of this kind generally rely on self-report. They are typically anonymous, which tends to increase the respondents’ honesty. That said there is no guarantee that they will be honest, as you point out. Still the results both in the U.S. and Europe consistently reflect disturbing rates of alcohol use by adolescents.

In terms of European drinking patterns, there has been increasing concern in European nations regarding the dangers of alcohol consumption. According to a recent study, “while 266 million adults drink alcohol at relatively lower risk levels, over 58 million adults (15%) drink more than this (i.e. 5 or more drinks at one time), including 20 million (6%) drinking at even more harmful levels. 23 million Europeans (5% of men, 1% of women) are dependent on alcohol” (Anderson, P., and Baumberg, B. 2006. Alcohol in Europe. A public health perspective).
The truth is that we would all be better off if we refrained from alcohol use altogether.

While there are reports that moderate alcohol consumption provides some health benefits, using that time to exercise would be far healthier. The best thing we can do for our children is model abstinence where drinking is concerned.

Homework Battles

By Dr. Jan Hittelman

Q: My son is 9 years old. He is quite competitive, yet shy and sensitive in many ways. He gets angry when I help him with his homework or correct his mistakes. I fear he is not getting a good education because of this “dance” we do around trying to help him vs. trying not to upset him or make him feel as if we are criticizing him on his mistakes. So, any advice how to handle this?
Elementary Mom

A: Homework battles are more common than you may think. It is important to realize that the family conflicts that result from this may be more costly than the benefits. Consider empowering your son by discussing these challenges with him at a more positive moment (not in the heat of the homework battle). Let him know that you want to support him with his work and that you’re interested in hearing what he thinks would be more effective than what you’re doing now. For example, offering your help only when he asks for it. Try to find some room for compromise and agree to re-evaluate the situation together after a week or so of trying out the new system. I often encourage parents to make this shift before middle school. This is the right time to help your child become more independent and responsible for his schoolwork. Otherwise these battles will likely increase.

Empowering Middle School Youth

By Dr. Jan Hittelman

Q: My child is in middle school and not interested in doing the daylong-supervised activities that worked so well in elementary school. How do I balance my need to provide him with safety and structure during break with his desire to relax and be more in charge of what he does?

A: Middle school represents a dramatic shift in development as children begin their journey through adolescence. The challenge you’re experiencing is a function of this transitional time in you child’s life. Our children are aware of this shift much sooner than we are. It is important we understand that as our child changes, so too must our parenting techniques. Whether we realize it or not, as parents of middle school children, we are faced with a fork in the road in terms of our parenting approach; we can either continue to parent as we did before, or allow our parenting strategy to evolve along with our children.

Parents of younger children need to provide them with structure, guidelines, and direction. When they begin moving through adolescence, we must shift our approach by encouraging our children to think for themselves. During this time of development, children struggle to create their own structure, guidelines, and direction. As parents we want to nurture this growth and become good advisors in helping them make healthy choices.

By letting you know that he wants to relax and be more in charge of what he does, your child is letting you know that you have come to that fork in the road. You can either try to force your way and register him for daylong-supervised activities during spring break or you could have an in-depth discussion with him about his concerns as well as yours. Even if at the end of that discussion you make the decision to enroll him in those programs, you have shown him the respect that a young adolescent needs as he begins the journey to adulthood. Better yet, perhaps you can integrate one or more of his ideas into the spring break plan. Just as we can teach our children, they can teach us as well, if we are truly able to listen.

Sandy Hook Elementary: Our Shared Trauma

By Dr. Jan Hittelman

Hearing about the unimaginable tragedy at Sandy Hook and the profound impact that it has had on all of us, reminded me of another national calamity during my childhood; the assassination of President John F. Kennedy. While I was only seven years-old at that time, I vividly recall how this tragic news stunned everyone and life seemed to stop for a moment while we all grappled with comprehending the enormity of this tragedy and sense of loss that befell us, not just in our country but around the world. Given my young age, I couldn’t completely understand what had occurred; let alone how to deal with it emotionally. All I knew was that my mother and grandmother watched in tears as the news unfolded on television. In some ways, I never fully recovered from that moment of trauma and shock, even after all these years. Unlike that historic event, this time most of the victims were young children. These young victims were about as old as I was when JFK was shot. What makes it much more personal for both children and their parents, is that we cannot help but think: what if that was my school? What if it was my child? Like the JFK assassination, we have all experienced a profound trauma that will take time to heal. As parents, what can we do to help our children, as well as ourselves, to move on from this and begin to heal?

Regardless of what we may say or do, events like this require time to allow us to heal, so first and foremost we must be patient. While we slowly recover, it is important to refocus on our parental priorities; to verbalize and demonstrate our love for our children, while treasuring and cherishing precious moments with those we love. Too often we take our greatest gifts for granted, and tragedies like these remind us to refocus on what’s really important.

As parents, teachers, and community members, we must do our best to reassure our children, letting them know that events like these are extremely rare and therefore we need not fear that something like this will happen to us. It also critical that we provide our children with opportunities to freely express their feelings and provide them with support, acknowledging that we would likely feel the same way and that there are a lot of caring adults in their life who are here to support and protect them. It is also a lesson for all of us, to not take what we have for granted and make the most of this lifetime we are so fortunate to have. This is a time to revel in positive family activities to allow us to reaffirm how much we are blessed and our love for each other.

We cannot undo what happened but we can do our best to wrap our arms around our children as a community and hopefully as a society, to get serious about reducing gun violence, increase mental health awareness, and to make resources accessible for those in need.

Importance of After School Activities

By Dr. Jan Hittelman

After the school day has ended, it is estimated that 40 percent of young people’s time is often unstructured, unsupervised, and unproductive (Carnegie, 1992). Several studies have documented increases in a variety of at-risk behaviors for youth during the hours immediately after school, especially between 3:00 and 6:00 P.M. When youth participate in quality after school programs, the benefits are dramatic.

Dr. Beth Miller (Miller, 2003) summarized the research on after school program participation, which found that after school program participation reduced negative behaviors (e.g. juvenile delinquency, substance abuse, dropout rate, conflicts between youth, school suspensions) and increased attitudes and behaviors linked with school success (e.g. better school behavior, better emotional adjustment, better work habits, improved relationships with parents, improved grades).
While many families routinely involve their elementary-age children in after school programs, there is a significant drop-off among middle and high school youth in after school activity participation. Ironically this is often when after school program participation is most critical, as the percentage of students who are unsupervised significantly increases at this time. For example, 23 percent of 10-year-olds spend some time caring for themselves compared to 44 percent of 12-year-olds (Capizzano et al., 2000). There is also overwhelming evidence that many students experience a marked decrease in school engagement during the middle school years. Data on nearly 100,000 students from the Search Institute suggests “the middle school years are typically a time of lowered interest, motivation, and effort in school” (Scales & Leffert, 1999). During the middle school years, children are also going through dramatic physical, emotional and cognitive changes, transitions that translate into new potential strengths as well as new risks (Dryfoos, 1990; Jackson & Davis, 2000).

Duffett and Johnson (2004), in a survey of youth in middle and high school grades, found that even youth concur with the importance of after school program participation. Seventy-seven percent of the youth surveyed agreed “a lot of kids get into trouble when they’re bored and have nothing to do.” Eighty-five percent agreed that kids who participate in organized activities such as a team or a club after school are “better off ” than those who have a lot of free time on their hands.

Helping Your Adolescent Learn Self-Control

By Dr. Jan Hittelman

As a parent, getting through your child’s adolescent years can be tough. The good news is that there are effective strategies that can help you to dramatically reduce conflicts and avoid potentially hostile confrontations. Instead of fighting over control, we must provide teenagers with opportunities to learn self-control. Instead of battling over our children’ irresponsible behaviors, we must encourage them to take more responsibility for their decisions and actions. Consider the following strategies:

Shifting from dependence to independence: This shift is a normal developmental progression from adolescence to young adulthood. As parents, we need to teach our children how to behave more responsibly and yet not make their decisions for them or oppose their efforts to take control over their lives. The best strategy to promote a healthy shift from dependence to independence is regular and frequent use of empowerment by giving your child a voice in his or her own discipline plan. While empowerment is useful with children of all ages, parents need to place more and more of the decision-making responsibilities on them as they become older.

Control versus advice: The more controlling the parent, the more likely the teenager is to rebel and eventually defy the parent. As our adolescent children shift from dependence to independence, we as parents need to shift from controlling to advising. Your child needs to learn to make his/her own decisions to function effectively as a young adult. Help your child by offering suggestions and then say: “But what do you think makes the most sense for you?” And whenever possible go with the teen’s ideas.

The school of hard knocks: As parents we naturally want to protect our children and help them avoid making mistakes or suffering the consequences. In the long run, however, we may be doing them more harm than good. If you foster responsible independence, it is quite likely your child will make some poor choices. That’s part of growing into adulthood. Unless his actions are likely to be life threatening or extremely harmful, making mistakes is a productive learning experience.

When to just listen and not lecture: Listening is a way of communicating respect. Lecturing implies an assumed lack of knowledge or ignorance. That’s why children often become defensive and avoidant in response to lecturing. This is especially true of adolescents who are secretly crying out for parental respect for their independent judgments and choices, as their developing sense of autonomy emerges. Use open-ended phrases and questions, such as: “I’m really interested in knowing more. What was that like for you?” Respond with supportive phrases such as: “I think I would feel that way too, if that happened to me.”

“Just Saying No” Is Only the Beginning

By Dr. Jan Hittelman

Being an effective parent can feel like a real uphill battle. This can be particularly true when our children are adolescents. A major challenge for parents of adolescents is that their developmental tasks include shifting from dependence to independence and experimentation. As a result, issues related to compliance with parental requests and experimentation with drugs, alcohol and other risky behaviors often make this a very difficult time. Both the challenge and solution for parents is to remain firm in their efforts to provide guidance to their children as early as possible, even when it seems most unwelcome.

Consider experimentation with marijuana. Local surveying of high school youth typically indicates that almost half have tried marijuana. Some youth and health service providers believe that these percentages are underestimates. Many parents of adolescents indicate that they too experimented with marijuana in their youth. Thus the conclusion often drawn is that teens will be teens and experimentation is inevitable, so why fight a losing battle? The more road blocks, through open discussion and efforts to provide firm boundaries, the better the chances are that your child will either not engage in this behavior or if they do, will hopefully not “over engage” to the point of irrevocable results. It is very difficult, for example, for the most expert professional to predict which youth will simply experiment with substances like marijuana and move on and who will develop lifelong patterns of chemical dependency. Similarly, we also know that marijuana is the second-most frequently found drug (after alcohol) involved in automobile accidents and the primary substance abused by adolescents in drug treatment.

It is also important to note that even the most vigilant parent may be unable to prevent their child from developing substance abuse problems, but there are steps that you can take to reduce the chances:
• Encourage ongoing discussions about substance use. Research shows that kids whose parents talk with them regularly about drugs and alcohol are 50 percent less likely to use them. For tips on effective ways to have this conversation, check out: www.TalkingWithKids.com and www.TheAntiDrug.com.
• Be clear that any experimentation with drugs/alcohol is unacceptable. For students who believed their parents would strongly disapprove, current marijuana use was 5% versus 30% for youth who believed their parents would somewhat disapprove.
• Ask questions about parties that your children attend in terms of drug/alcohol use and adult supervision. When hosting a party understand your legal responsibilities and provide appropriate supervision.
• If you suspect substance use, consider an assessment and/or drug testing to determine the severity.
• Be a good role model. Parental use of drugs/alcohol sends a message that it’s OK to do.

Leading Teens to Counseling

By Dr. Jan Hittelman

Q: How do I get my unwilling teenager to talk to someone, such as a therapist?
Sign me, Concerned Mom

A: The pivotal challenge in creating getting your teen to meet with a counselor is getting them to willingly attend the initial session. Who wouldn’t be uncomfortable with the prospect of sharing personal information with a complete stranger? Particularly when you know you’re “not crazy,” don’t particularly like the idea and are other-referred (aka, dragged in by your parent). Luckily, there are steps that you can take that will greatly increase your chances of success:

Do your homework. A common mistake is to pick a random therapist, have it not work out, and have your teen more resistant than ever to see “another shrink.” Make sure that the therapist you go to is licensed and experienced. You can check a psychotherapist’s license status online at: www.doradls.state.co.us/alison.php. Next, try to make sure that he/she has experience working successfully with adolescents. You can accomplish this by getting recommendations from friends, coworkers or community professionals (your pediatrician, school personnel-guidance counselors, school interventionists, etc.). In addition, don’t be reluctant to first interview the therapist over the phone or in person. Ask about their experience working with adolescents and how they would approach treating someone with symptoms like your child is exhibiting. Does this seem like someone your teen could relate to?

Empower  your teen. It is important to give your teen a voice in the decision making whenever possible. After explaining why you feel that talking to someone is important, consider sharing the decision making with him or her. For example, say: “While you need to go to this initial appointment, we can talk together afterward to decide together if continuing would be a good idea.” Any effort to respect his voice in the decision-making process will increase his investment and eventual benefit.

Provide him with an out. One reason that teens (and others) resist the idea of counseling is that there is a concern that it may go on forever. During the initial meeting, I suggest to parents that they make an agreement with their teen to attend four to six additional sessions. If he doesn’t feel that it’s worth his time and (his parents’) money, he can rethink it at that point. That doesn’t necessarily mean stop altogether, but reevaluate it.

Reinforce his efforts. Along the way, make sure to let your teen know that you’re proud of his efforts. This would ideally start with that initial session and continue throughout treatment.

Yawning Youth

 By Jan Hittelman

Q:
What is the optimal number of sleep hours for elementary middle and high school children? Does adequate sleep help children’s mental health and learning ability?
Curtis Stringer, Southern Hills Dad

A:
Most experts agree that elementary age children need about 10 – 11 hours of sleep. Most middle and high school youth need about 9½ hours, while some can function well with as little as 8¼ hours of sleep. Unfortunately most studies indicate that both younger children and adolescents are getting less sleep than they require. Elementary students typically average about 9½ hours of sleep and in one study less that 15% of teenagers reported getting even 8½ hours on school nights.

An additional challenge for adolescents is that their biological clock shifts to a later sleep/wake cycle, often making it difficult for them to get to sleep before 11:00pm. Given that the typical high school day can start as early as 7:30am, it can be an impossible task for teens to get enough sleep. As a result there are currently efforts underway in many states to delay the start of the school day until 8:30am or later. This can be a scheduling challenge for school administrators and some parents in terms of busing, after school sports, childcare and carpooling. The research, however, from school districts that have switched to a later start time indicates: improved enrollment, attendance, alertness, and overall mood.

The National Institutes of Health (NIH) identifies adolescents (ages 12 to 25 years) as a high risk group for problem sleepiness based on “evidence that the prevalence of problem sleepiness is high and increasing with particularly serious consequences.” (NIH, 1997).
The most disturbing consequence involves injuries and deaths related to drowsiness while driving, which results in at least 100,000 car crashes each year, according to the National Highway Traffic Safety Administration (NHTSA, 1994). Young drivers age 25 or under are responsible for more than half of these accidents. Research also shows that sleep deprivation impairs: attention/concentration, communication, problem solving, decision-making, healthy eating, mood and motivation.

Locally, a recent study asked Boulder County high school students if they had gotten enough sleep in the last week. Ninety-two percent responded that they did not “get enough sleep to feel rested in the morning seven out of the seven days preceding the survey” (Youth Risk Behavior Survey, 2005).

There are many things that parents can do to improve their child’s sleep habits. These include: encouraging a consistent sleep schedule and bedtime routine, limiting caffeine, using the bed only for sleeping, not having a TV or computer in the bedroom (as studies show that children with TV’s in their room sleep less), and avoiding exercise at night.

For more information on children and sleep, you can visit the following websites: www.sleepforkids.org & www.sleepfoundation.org.

Parent-Child Communication

 By: Jan Hittelman

The way that we communicate with our children, both verbally and nonverbally, has a profound impact on their compliance with our requests, their sense of self, our mood and theirs, and ultimately, the parent-child relationship. Too often, conflicts begin as a result of a real or perceived slight in the way we communicate with each other. Being thoughtful with the words we choose and our intentions in terms of what we want to express, can help us to be more effective communicators.

Some basic strategies to improve our communication techniques with our children include:

• R-E-S-P-E-C-T: It is important to treat our children with the same level of respect that we want them to show others.
• Provide positive feedback: We need to remember to let our children know what they’re doing right to reinforce those behaviors.
• Teach and model making positive self-statements: Identify and challenge your children’s negative inaccurate beliefs about themselves.
• Encourage your child to share his/her opinions: Some of the most effective discussions with our children are when they do most of the talking.
• Be a good listener: Often our children are looking less for advice and more for someone to really listen to them.
• Foster pleasant discussions: Too often, what we talk to our children about is their behavior, homework, and doing their chores. Try initiating fun, interesting, and heartfelt conversations as well.
• Be aware of nonverbal communication: Our facial expressions, eye-contact (or lack of), the tone and volume of our voice, body language, etc., all influence the messages our children receive.

Parents Need to Grow Up Too

 By Jan Hittelman

Is anyone really ready to be a parent? There’s a shared experience among most new parents; a sense of disbelief that the hospital staff will simply let you walk out with a newborn child. It’s like giving a set of car keys to someone who hasn’t learned how to drive. Yet our parenting has a profound impact not only on our children’s development but also on our own. The challenges of parenthood provide us with an opportunity to grow as individuals. Like our children, we also have developmental tasks. From the first moment, we have no option but to be role models. How and what we model is totally up to us. The same is true of the relationships we develop with our children. If our primary focus is disciplining undesirable behavior, then our long-term relationship with our children will be negatively impacted. It takes conscious effort to focus more on the positive within our children and within ourselves. This brings us back to the developmental task of parenting. Our own level of emotional development impacts the relationship we develop with our children. The more emotional, social, and behavioral issues that we are struggling with, the less capable we will be to develop a healthy relationship with our child (or others). Thus parenting provides us with the opportunity to mature and address issues that we may have previously avoided. But the choice is ours. If we choose not to deal with our own anger problems, for example, we will likely have a higher level of conflict with our already challenging adolescent. If we regularly drink alcohol, our ability to positively impact our child’s view on substance abuse may be compromised. Sometimes our toughest challenge as parents is not our children’s behavior, but our own.

As parents it’s natural to focus on and correct children’s behavior. We rarely consider, however, how our own day-to-day behavior impacts that of our children. Children are extremely sensitive to their parents’ subtle moods, actions, and words. They internalize these characteristics as they develop their own identity and approach to the world. Of course our children bring their own emotional, behavioral, and social issues, in addition to what they learn from us and others. But even if they have significant issues from birth that are uniquely their own, our behavior will still have a significant impact.

Consider channeling your desire to be a good parent into taking better care of yourself by identifying and addressing your own issues and challenges. The better adjusted and happier you are, the healthier your parent-child relationship will be.

Teenage Wake Up Call

 By Jan Hittelman

Over the last several years, this column has discussed the effects of sleep deprivation on high school students. Adolescents are usually sleep deprived for two reasons; increased metabolic rates that make it difficult for teens to get to sleep until 11pm on average and early start times for high school. Research indicates that adolescents typically require 9+ hours of sleep each night. Sleep deprivation negatively impacts school performance, as well as physical and emotional well-being. There’s also an increased risk of accidents, which are the number one cause of death for teens. Not to mention how difficult the “morning routine” can be when adolescents are literally too tired to wake-up.

While we cannot do much about their metabolic rate, we can do something about school start times. Many school districts across the country have shifted to a later start time and have seen a multitude of benefits.

In December of 2009, the Boulder Valley School District (BVSD) formed a committee to look at this issue. They subsequently submitted their recommendation to Superintendent King. According to Dr. Rhonda Haniford, Centaurus High School Principal and committee co-facilitator, “The District’s position is that they are supportive of principals exercising flexibility. They support schedules that allow students to start later”. While this falls shy of changing the start time throughout the district, it does provide students and families with the opportunity to request a later start time from their local high school principal. In other words, it’s a start.

Hopefully, BVSD will do a good job educating parents regarding this policy change. If enough parents opt for the later start time, one day we may see all of our adolescents finally benefiting from a good night’s sleep.

Here are a few ways that you can help your teen get a healthy night’s sleep:

• Contact your local high school principal now to find out if your school will be offering this option in the fall.
• Minimize caffeine products like coffee, tea, soda, and chocolate, especially later in the day.
• Consider moving electronics out of the bedroom (TV, computer, cell phone, iPod, etc.) or agreeing on shutting everything off by a certain time.
• Avoid eating, drinking, and exercise within a few hours of bedtime.
• Encourage completion of homework earlier in the day.

For more information: www.sleepfoundation.org

Dieing for a Drink

By Dr.  Jan Hittelman

Despite a reduction in crime overall in 2009, locally there has been a surge in alcohol-related arrests, as reported by the Camera (“Major Crime Down, But Drinking Up”, March 5, 2010). This includes offenses by adults as well as minors. University of Colorado Police, for example, report “ a 24 percent increase over 2008 and 45 percent more than 2006”. It is quite common for high school students to report that while their parents don’t want them to drink and drive, they know that “everybody” drinks alcohol at parties and it’s really no big deal. Many people don’t realize that the high from alcohol is due to its toxic nature. It’s the subjective experience of alcohol poisoning. Most adolescents don’t realize that you can die from drinking too much alcohol, falsely assuming that at worst you’ll throw up (which does not prevent alcohol poisoning) or just sleep it off. Unfortunately, many people die from alcohol as a function of their respiratory system shutting down or choking on their own vomit. There are also few intoxicants that are as addictive as alcohol or as dangerous to our overall physical health, with the exception of the other “legal” drug: tobacco. The fact that alcohol is legal is often a reason that adolescents, and perhaps adults, underestimate its deadly potential.
While it is illegal to sell alcohol to minors, it is easily accessible by having an adult purchase it for them or even more conveniently by taking it from their parents’ liquor cabinet.

What’s a parent to do? Consider these suggestions:

• A good place to start is to look at our own behavior and what we are modeling to our children
• Help your children understand that even though alcohol is legal, it’s more dangerous and addictive than many “street drugs”
• Educate your children regarding the devastating effects that alcohol can have on the developing adolescent brain
• Make sure they know that if they do experiment with alcohol and need help, they can call you and you will come get them
• Have ongoing discussions with your child about alcohol and other drugs

As parents we must educate our children, starting in elementary school about the dangers of drinking, how it affects us physiologically and the wisdom of abstinence. Alcohol abuse is serious business. Does your child know that?

Realizing New Year’s Resolutions

 By Jan Hittelman

The fresh start of a new year brings the promise of things to come. Too often our feelings of optimism soon give way to disappointment, as we are often unable to realize our new resolutions. Another year when we don’t lose weight, exercise more, do better in school, become more prosperous, etc. Should we give-up on resolutions to avoid feeling like failures? Perhaps if we approached our resolutions differently, we could experience success.

Consider these guidelines when trying to set personal goals:

• Give it serious thought: Goals that are impulsively set are rarely reached. Put some time and thought into what you want to accomplish and the necessary steps to get there.
• Be realistic: Make sure that you have the motivation, skills, time and resources necessary to accomplish your goal. Don’t set yourself up for failure.
• Clearly define your goals: Instead of a vague resolution like losing weight, set a specific target of a small number of pounds lost over a reasonable time period. Setting achievable goals will also increase confidence.
• Start small: Breaking down major goals (e.g. exercise more) into more achievable smaller goals (e.g. go for a 10 minute walk each day) increases the likelihood of success.
• Reward yourself: As you make small accomplishments towards your goal, reinforce your effort by doing something enjoyable to celebrate.
• Keep a record: Journaling or noting your day-to-day accomplishments and challenges will help you monitor your progress and stay focused.
• Get support: Share your goals with others and enlist their assistance. Simple praise and encouragement from others can help sustain our motivation to succeed.
• Be prepared for steps backwards: With any significant endeavor, we tend to have successes as well as failures. Have a game plan to recover from set backs and get back on track.
• Teach your children: Help them to develop effective goal setting skills by using the above strategies.

While we tend to focus on New Years for our resolutions, learning to be an effective and realistic goal setter is an invaluable skill that will benefit you all year long.

In Search of Treatment for Depression

 By Jan Hittelman

Last month’s column focused on teen depression. A reader whose son has suffered from depression most of his life took exception to the following statement: “The good news is that depression is highly treatable. Talk therapy, medication or a combination of the two has been shown to be highly effective.” Her story poignantly depicts the challenge that many families experience in trying to obtain effective treatment.

Initially she “noticed he was having more and more of a problem with depression that would not “lift”, and it had gotten so bad I really feared that my beautiful, kind, shy, and intelligent son would kill himself”.

At first she tried to utilize her health insurance. Her son was initially diagnosed with Attention Deficit Disorder and placed on stimulant medication. His depression worsened. Subsequently he was switched to a different medication, but indicated that her son “felt like a zombie.” She added, “Their “talk therapy” sessions were 20 minutes long and consisted just of drug monitoring, no cognitive behavior therapy, which is the most effective therapy for depression”.

She subsequently brought him to a licensed psychotherapist and noted some improvement, but “after another six months, my son no longer wanted to go because he felt “nothing was getting any better… During this time, my son had flunked out of college.” He subsequently attended Front Range Community College and his mom notes that “Being held accountable by an entity who NOTICED him (at FRCC) and also having a very good advisor there, who also noticed him and leveled with him, has helped. Time has helped. Getting a job and moving away from home has helped him more than anything… He is now doing better and has learned a lot of skills and lessons along the way.”

She sums up her son’s experience as follows: “Drugs have never helped my son except to briefly make him feel slightly disoriented. And “talk therapy” is something apparently only those with money receive”.

I applaud this challenged mom for her ongoing efforts to assist her son. While their journey has been challenging, I wonder how much more challenging it would have been if his depression went unnoticed. This is often the case, as children and adolescents who are depressed can present with irritability instead of a sad mood. One must also wonder how her son would have responded to a more effective treatment strategy. Finally, there is a powerful message as to the importance of caring individuals noticing him and putting effort into assisting him at his school.

We can learn a lot from this parent’s story. While dealing with depression can certainly be a great struggle, we must do everything that we can to try and address it. It is also clear that as a community we must make sure that resources exist to provide effective treatment for our family, friends and neighbors regardless of their ability to pay. Finally and perhaps most importantly, we each need to care enough to notice and let those in pain know that we care.

Saying the F Word More

 By Jan Hittelman

Determining the root causes of most psychological disorders can be quite challenging and complex. It can be like detective work — getting a thorough history, identifying the specific symptoms and exactly how they present, interviewing the client and family members to really try to understand it through their eyes, assessing potential genetic predispositions, ordering various tests and evaluations, etc. And even after doing all that, the underlying reasons for the disorder can remain elusive. There is, however, one exception: poor anger control. Almost every child, teen, or adult that I have assessed who presented with anger issues had difficulty expressing their feelings. Despite being very angry, they were very unassertive. Their unexpressed feelings build up like a pressure cooker. Inevitably they explode, usually over something fairly minor, to the shock of those around them. Their reaction tends to be disproportionate to the (current) situation, because it is a result of a multitude of negative feelings that have been bottled up and never appropriately expressed. Of course there are other issues to address (e.g. poor coping skills, low frustration tolerance, family history/modeling, etc.), but unassertiveness is a key issue.

There is one important caveat to diagnosing anger symptoms and that is to rule out underlying depression. For children and adolescents, depression can present as irritability rather than a sad mood, which is more common in adults. If depression is fueling the anger, then the depression must first be treated.

Anger issues are more common in males than females because our culture continues to propagate the myth that it is a sign of weakness for boys to cry or show their feelings. Consequently, many boys/men lack the skills to do so. Fortunately, there are research-proven anger management techniques that if practiced can dramatically reduce the intensity and frequency of angry outbursts. Will they still occur? Probably. That’s because anger is a normal emotion. The key is how we handle it. Here are some simple strategies to better manage anger:

• Say the F word more! I love telling clients this, because they almost always respond by saying: “Oh, I already use that a lot”. We then discuss the other F word; feel. This leads to more in-depth discussions about assertiveness.
• Stop blaming others for your problem. Until we take ownership, we’re not going to take responsibility and make the necessary changes.
• Change your thinking. It is not the events that occur but how you evaluate or think about them that defines your emotional reaction.
• Be aware of triggers. If you know what your triggers are you can prepare yourself in advance.
• Learn relaxation techniques. When you start feeling agitated use that as a reminder to do something relaxing.

Utilizing these techniques will help you be in control of your anger, instead of your anger being in control of you.

Happy New Year?

 By Jan Hittelman

Ushering in the New Year typically brings an optimistic and celebratory energy where all our resolutions seem potentially achievable. Because of the unfolding economic crisis that will continue to play out, it may be difficult for many of us to embrace a sense of optimism this year. The vast majority of us have never lived through an economic upheaval like this along with such significant unknowns.

In addition to the economic consequences that will impact each of us in a variety of ways, there will most certainly be resulting emotional consequences. These two variables, economic and emotional, have significant impacts on each other. For example: the worse the economic forecast the more stressed we will feel, the more emotionally devastated the laid off worker feels the bigger the challenge to effectively secure employment, the more creature comforts we must forego the lower our ability to tolerate our situation, etc.
Years ago I worked with a gentleman who discovered that he had a chronic, life-threatening illness. At first he was devastated by the news, but in time he was able to deal with his condition amazingly well. He introduced me to the phrase “when life gives you lemons, make lemonade”. As a result of his positive attitude, he didn’t need to meet with me for very long. This effort to adopt a positive attitude did more for him than any anti-depressant drug or treatment ever could. The individuals who effectively weather this financial storm will not only be those who are in a better financial state, but will also be those who minimize harmful negative thought patterns that only serve to dig us deeper into a hole of despair.

It is easy to feel powerless in relation to the overwhelming economic realities that we are facing as individuals and as a nation. What we do have tremendous potential control over is our thoughts, beliefs and attitudes regarding the circumstances in which we find ourselves. Thus, while most of us are likely to experience increased economic hardships in the New Year, some of us will also be fortunate and discover a new sense of resiliency and a reevaluation of what’s truly important in our lives.

As most of us can attest, negative experiences are often our greatest teachers if we have the time and insight to learn from them. In these challenging times lives an opportunity to learn and grow as individuals, as complacency shifts to endurance and economic comfort takes a second seat to emotional well-being.

You know that you’ve had a tough day when you say things like: “well at least I have my health”. Perhaps a good resolution is to remind ourselves what is truly important in our lives and spend more time being thankful for our blessings than bitter about our losses. Clarifying our priorities and trying to maintain an optimistic view, will help us to minimize the negative emotional effects of a challenging economy. Hopefully we can make it the year of lemonade and not just lemons.

Praise and Self-Esteem

 By Jan Hittelman

We talk about self-esteem a lot and, of course, we all want our children to have a positive sense of self, but how to help them get there? Research indicates that it takes more than just providing positive feedback. What may be more important is to reinforce and encourage children in developing the skills needed for success, including feeling safe taking risks and understanding that learning requires that we make mistakes and that it’s OK.

Dr. Carol Dweck of Stanford University, a leading researcher on motivation and what fosters success, notes, “What’s really effective is praising the process that the child is engaging in. Effort, strategy, perseverance, improvement—these things tell them what to do next time”. Thus our feedback should be specific in terms of reinforcing healthy skill development. For example, instead of saying “nice job getting an A in math” we want to focus on the skills that resulted in that A: “you really worked hard on understanding your math concepts by getting extra help from your teacher, keeping up with your assignments, and studying so hard for your tests”. Better yet, encourage your child to identify the specific behaviors that helped them to achieve success.

Dr. Dweck’s research indicates that when children believe that their intelligence is fixed, it can limit their self-confidence. When they are taught that their brains are developing and grow new neurons when challenged, their performance improved.

Many current researchers view self-esteem as being a consequence of a broader range of social and emotional skills, which include things like empathy, problem solving, self-discipline, coping with challenging situations effectively, negotiating, teamwork, having good frustration tolerance, and simply learning how to get along with others. These successes are certainly as critical as academic success and it’s important that parents focus on their children developing these skills as well.

By reinforcing our children’s initiative and effort, they will likely develop the skills necessary for success.