Trauma-Informed Parenting 101: Parenting a Child with PTSD

Child Welfare Information Gateway. (2014). Parenting a child who has experienced trauma. U.S Department of Health and Human Services, Children’s Bureau. Retrieved June 2019 from https://www.childwelfare.gov/pubPDFs/child-trauma.pdf

Parenting after trauma: Understanding your child’s needs. (2015). HealthyChildren.org. Retrieved June 2019 from https://www.healthychildren.org/English/family-life/family-dynamics/adoption-and-foster-care/Pages/Parenting-Foster-Adoptive-Children-After-Trauma.aspx

What is a trauma informed parent? (n.d.). Trauma Informed Parent. Retrieved June 2019 from http://traumainformedparent.com/

ADHD and learning disabilities are problems children might have that interfere in their learning. ADHD, or attention-deficit/hyperactivity disorder, is an executive functioning impairment. An example of executive functioning is the ability to focus and pay attention to something long enough to take it in and process it. Other aspects of executive function include sustaining effort to complete a task and working memory. Additionally, ADHD can have a behavior component involving hyperactivity and difficulty remaining still. Like learning disabilities, ADHD directly interferes in a child’s ability to learn; however, ADHD and learning disabilities are different.

Is ADHD a Learning Disability?

Learning disabilities also directly interfere in a child’s ability to learn, but in a different way. Children who have a specific learning disability have problems processing and retrieving information. Learning disabilities are categorized as language/reading disorders, math disability, writing disability, auditory or visual processing disorders, or a nonverbal disability.

ADHD isn’t a learning disability. Learning difficulties in ADHD are caused by behaviors resulting from executive function problems. Like specific learning difficulties, ADHD can qualify as a disability classified as Other Health Impaired under the Individuals with Disabilities Education Act (IDEA). Both ADHD and specific learning disabilities, then, can qualify a child for special education services.

Learning disabilities and ADHD are distinct, but it’s possible for a child to have both. According to the National Institute of Mental Health (Bailey, 2007), 20 to 30 percent of kids with ADHD also have a learning disability. Dyslexia, a reading disorder, is the most common learning disorder associated with ADHD. What is it like for a child to have learning disabilities with ADHD?

When a Child Has Both ADHD and Learning Disabilities

Life can become quite challenging and frustrating for these children. The executive function impairments of ADHD added to processing and language, math, or other skills impairments create problems in nearly all, if not all, areas of a child’s life. Academics, relationships with family, teachers, activity leaders, and peers.

Friendships can be difficult to form and keep. Self-esteem is usually damaged, as is emotional health. Often, peers tease children who have ADHD, a learning disability, or learning disabilities with ADHD, calling them stupid and other such insults. These disorders have nothing to do with intelligence. With either type of disorder, there is a discrepancy between potential (what the child can achieve intellectually) and performance (how they do because of the disabilities).

How to Help a Child Who Has Learning Disabilities with ADHD

Currently, there is no cure for learning disabilities or ADHD. However, there is much that can be done to help kids who have a specific learning disability, ADHD, or both. Special education services and therapy are two common interventions to help students succeed academically, socially, at home, and in their greater lives.

When addressing these disorders together, it’s important to identify common symptoms the child experiences. Symptoms that can be part of both learning disorders and ADHD include:

• Disorganization
• Difficulty with transferring skills and knowledge (applying strategies learned in one situation to a different situation)
• Inattention and ability to focus (while this isn’t a part of learning disorders themselves, it can happen as a result of a child’s frustration and stress with school)

Understanding the overlapping symptoms helps because it provides a starting point in helping children deal with having two challenging disorders that impact them wherever they go. After understanding problems unique to the child, it’s important to separate the effects of ADHD from those of learning disabilities. This way, each can be addressed with specific focus. Helping a child with learning and other challenges separately from behavioral and attention areas can be very effective. This way, they can enhance individual skills and feel more in control over themselves and their progress.

While ADHD and learning disabilities are two distinct disorders, there is a connection between them. Both can negatively impact a child’s life, and both can be addressed with the child to allow them to create better experiences at home, school, and beyond.

article references

One of the constant problems parents face is getting children to do what needs to be done. Life requires that certain things be accomplished in a timely fashion. Children must get up, get dressed, eat, take care of basic grooming, take care of responsibilities, and participate in the chores of family living. If getting kids to do what must be done becomes a struggle, family life becomes a major hassle.

I believe that a major goal of parenting is to gain the child's cooperation. Ultimately, the child must tell himself what to do. I also believe that children need to know that they must do what is required. But children are different and situations are different. It's not an either-or situation.

The following Three Stage Discipline Plan is offered as a way to make sense of the options parents have in working with their children.

Three Stage Discipline Plan: Stage One

Stage I: Encourage the right response.

1. We can see what needs to be done and we want the child to tell himself what to do. We describe the situation or problem as we see it. The next step is to back off and let the child decide what needs to be done. "It is bedtime," not "Go brush your teeth and get ready for bed." Children blossom when they are allowed to tell themselves what needs to be done.
2. Sometimes we need to clarify the information if the situation is not obvious to the child. "Your wet towel is on the carpet. Wet towels can cause the carpet to mildew," instead of "Can't you ever remember to hang up your towel!"
3. Children need reminders but the reminders need to be kind. Children do forget and it takes years to develop the habits we take for granted. One word is often enough. "Bedtime." "Towel." Written notes are also useful, especially with children who are visual learners and do not remember what they hear.

Discipline Plan Stage Two

Stage II: The parents must give an order; but first, they must know what they will do if the kids don't respond.

Stage II is for children who are beyond encouragement, who don't respond to the opportunity to tell themselves. In Stage II, parents must think first about the consequences for non-compliance and then give the order.

1. Explain exactly what we want the child to do. "I want you to or I need you to ...."
2. The second step is to back off and give the child a chance to comply. If we stand over the child, we are inviting a contest of wills.
3. The third step is to recognize compliance. "Thank you for doing that." We can thank a child for being responsible, for being respectful, for cooperating. A child's obedience should not be taken for granted.

Discipline Plan Stage Three

Stage III: For children who choose to defy their parents.

The parents must take over. All children try it at least sometimes. Some children seem to spend their entire childhood testing all the boundaries. Stage III may be a constant state for parents of such a child.

1. Give the child who fails to respond to a Stage I or Stage II request two choices: compliance or consequences.
   • First, parents specify exactly what will happen for non-compliance.
   • Then the child is given the last opportunity to act.
   • If the child finally decides to comply, the child is told, "You made a good choice."
2. If the child fails to do what is expected, enforce the consequences.

   Don't allow a child to manipulate the situation at this point. The consequences have been set and should be carried out. If the child argues or begs and pleads, don't listen. This is not the time to feel sorry for your child.

3. Children must experience the consequences of their actions, of their choices.

   Consequences should be reasonable and related to the incident. If a child doesn't like the consequences, the parent has found the right one.

Mistakes to Avoid in Any Discipline Plan

1. Expectations that are too high.

   One mistake is setting expectations that are too high or unrealistic. Children can only be expected to do what they are capable of doing. Books on child development can help parents figure out if their expectations are in line with the child's capabilities.

2. Beginning at Stage III

   Jumping to a Stage III response immediately every time something needs to be done -- big mistake. We want to foster respect, responsibility, cooperation and self-esteem in our children. Perpetual Stage III parenting undermines those attributes and leads to very defiant children.

3. Verbal abuse.

   The greatest mistake is using methods that cause permanent damage to our children. Emotional abuse may be even more disastrous than physical abuse. Nagging, threatening, pleading, screaming demean the parent. Humiliation, name-calling, and inducing guilt demean the child. Neither are necessary.

Life would be simple if children did everything we asked, but that is not reality. Parenting is often hard work. With a difficult child, it is ALWAYS hard work. With the techniques in Stage I, II, or III of this discipline plan, it may be a bit easier.

Information on medication, therapy and other techniques to help your child deal with chronic pain.

"I cannot bear to see my child in pain, and I feel so helpless. What can I do to support her? How can I support her and not fall apart myself?"

As a parent, you want to protect your children from everything that can harm them. You teach them not to talk to strangers. You make them look both ways before they cross the street. But sometimes there are unfortunate things that you, as a parent, cannot keep your child from experiencing. Unfortunately, chronic pain is something that many children endure.

Illnesses that involve chronic pain affect children around the world. As a parent, you may feel helpless to support your child through pain flare-ups. You wish you could kiss the pain away, and make it all better. Although that may not be possible, there are some things that you can do to help your child get through painful episodes.

Distraction

This is a commonly used strategy that can help a child get through a painful episode. The type of distraction you would use depends upon your child's interests. If your child likes music, art, reading, television, talking on the telephone, or other activities, then you could encourage your child to practice these activities during painful episodes. The ability of the mind to focus on an activity rather than on pain is powerful. The same distraction technique may not work all of the time, and it is okay to try different techniques with your child until there is one that your child enjoys and is willing to participate in.

Massage

During some periods of pain, massaging the area of the body that is affected can help ease the discomfort. There are some massage techniques that can be used by the parent and the child that can help relieve pain. These techniques can be taught to the parent by a trained massage therapist so that massages can be done at home. Some hospitals have massage therapists on staff who can teach parents how to effectively massage children at home. Check with your local medical facility to see if this service is offered.

Heat

First, check with the child health care provider and confirm that using heat would be okay to try with your child. Applying a heat source such as a heating pad to the part of the body that is in pain can be beneficial to the child. Every child is different, as is every situation - some children may not like this technique, whereas other children will find relief from it. Heat can be applied using a heat pack, warm bath, or a whirlpool which has the added benefit of the water moving and providing stimulation that is similar to a light massage.

Relaxation Techniques

There are a number of relaxation techniques that can be used to help children manage their pain. Guided imagery, progressive muscle relaxation, and music therapy are some examples of relaxation techniques that can assist a child with pain management. These techniques can be taught to the family by trained professionals. Check with your medical center to see if these services are offered.

Therapy

Unfortunately, a child suffering from chronic pain may also experience both physical and emotional stress. If a child has a painful disease, the child can become afraid of experiencing pain and discomfort. For some children, the repeated cycle of experiencing pain can lead to anxiety and depression.

A child may not want to participate in some activities that they used to enjoy because they are afraid that they will experience pain and will not be able to enjoy the activity. Sometimes, a child may feel anxious about leaving a medical facility because they fear that they will experience pain, and not be near medical personnel who can help the child during the pain episode. This anxiety is not only seen in the children; parents can also share the same feelings. This anxiety may cause the parent or child to limit the child's activities and take away from the child's quality of life. If a child sees a parent getting anxious and becomes anxious, the parent may inadvertently reinforce the child's feelings of anxiety. Therapy can help a family through such emotionally stressful times.

Therapists can help families learn coping skills that encourage focusing more on the child and less on the illness. This could lead to improvements in the child's quality of life.

Medication Management

If your child receives treatment at a hospital, the hospital's medical staff will consider possible treatments that are available to your child. Depending on the diagnosis, there could be many avenues of treatment to explore. In other cases, there may be precious few alternatives to treat your child's illness. Whatever the case may be, as a parent, discuss any questions you may have with the medical team that treats your child. Do not be afraid to ask questions for fear of it being perceived as a "stupid" question. Or if you have asked the question already, but did not understand the answer, ask again, until you have an answer that you understand.

Regarding pain medicine prescribed for your child, some medications may be given while the child is in the hospital, and some may have to be administered at home. A parent should know the proper dose of medications, and the number of times the child would need to take it. If your child is old enough, begin teaching your child about their medications - the dosage and purpose of the medication, etc.

Also, If your child has any allergies, make sure your child has those memorized! Being knowledgeable about your child's medications is a key component of pain management. Knowing which medications work best for your child and any adverse effects that medications may have caused will help the medical staff determine the best treatment plan for your child.

See Also:

• Pain and Your Child or Teen
• Conquering Your Child’s Chronic Pain

Article submitted by Natalie S. Robinson MSW, LSW from the National Association of Social Workers

Detailed information on panic disorder in children and adolescents; including symptoms and treatments and how parents can help their children with anxiety and panic attacks.

What is panic disorder?

A child with panic disorder (PD) has sudden attacks of fear or severe anxiety. The fearful attacks happen several times over weeks or months. They may last a few minutes or they may last for hours. Attacks may happen for no obvious reason.

The attacks are not caused by fear of a single thing. That is called a phobia, like being scared of dogs or the dark. The attacks are also not caused by a traumatic event, like child abuse or being in a car accident. If caused by trauma, the child may have post-traumatic stress disorder.

All children and teens respond fearfully to the scary events of daily life. Their times of fear, however, are usually brief, and they go away without causing major problems. Panic disorder is when the fearful times happen over and over, begin suddenly without a clear cause, and are severe. PD interferes greatly with daily life at school and home.

How does it occur?

Panic disorder begins most often in the late teenage years into the mid-30s. It does, however, sometimes start in childhood. It begins with a few attacks that come and go. Often it never goes beyond this, but some children start having the attacks often.

A stressful event, like parents divorcing or a move to a new place, may trigger the beginning. But often PD begins with no identified stressful event. It is common for a child to have periods of time with attacks and then go weeks or months with few or none. What causes attacks to stop and return is often unclear.

Panic disorder runs in families. If a parent has panic disorder, children are more likely to have panic disorder, too. However, more than half of those with PD do not have a parent with a history of panic disorder. Children who were often scared when separated from their parents are more likely to develop PD later. Other than being hereditary, the causes of panic disorder are not certain.

What are the symptoms of panic disorder?

Panic attacks tend to come on suddenly. Children or teens with PD may:

Along with these main symptoms, children or teens may:

• be on guard all the time or startle easily
• eat very little or become very picky eaters
• have trouble concentrating due to worry
• perform below their capabilities in school
• have frequent headaches or stomachaches
• have trouble falling or staying asleep, or have nightmares
• lose interest in activities they once enjoyed
• talk about death, such as saying "I wish I were dead."

Panic attacks often happen at certain times of day, such as bedtime, or with daily events, for example, going to school. When this is the case, the child often worries as these times approach. The child feels helpless to prevent the attacks.

How is panic disorder diagnosed?

Your child's health care provider or a mental health therapist can tell you if your child's symptoms are caused by panic disorder. A mental health therapist who specializes in working with children and teens may be best qualified to diagnose PD. The therapist will ask about your child's behavior and symptoms, medical and family history, and any medicines your child takes. Sometimes your child may need lab tests to rule out medical problems causing symptoms like stomachaches, trouble swallowing, or difficulties breathing.

Children and teens may have other problems or disorders in addition to PD, such as:

• attention deficit/hyperactivity disorder
• bipolar disorder
• general anxiety much of the time
• depression
• posttraumatic stress disorder
• obsessive-compulsive disorder
• substance abuse problems.

How is panic disorder treated?

Cognitive behavior therapy (CBT) helps children learn what causes them to feel panic and how to control it. CBT teaches specific skills for managing the fear and worrisome thoughts about whether an attack is coming.

Other behavioral therapies are also useful. Gradual exposure therapy teaches the child to stay relaxed while being exposed to situations associated with panic attacks.

Family therapy may also be helpful. Family therapy treats the whole family rather than just the child. Children often feel very supported when parents and siblings attend therapy with them and work as a group.

Medicines are sometimes needed when the symptoms are severe. Medicines may help reduce the frequency of attacks or how severe they are. Medicines used to treat PD in adults may not work best for children and young teens. It is important to have an experienced professional working with you and your child.

How long will the effects last?

Most children and teens can get over PD with good treatment and family support. Very often PD lasts for weeks or months and then disappears or reduces dramatically.

If a child has had PD once, then they are at greater risk for future PD. The mental health professional treating your child may recommend continuing treatment after your child begins to feel better. Symptoms may return since PD often comes and goes without a clear reason for stopping and starting.

What can I do to help my child deal with panic and anxiety?

It is very important to help your children feel supported and reassured.

• Reassure your children that their feelings are understandable and that they are not "going crazy." The support and understanding that you provide can help children deal with frightening emotions.
• Let your child talk about the scary feelings and fears of attacks if he or she feels ready. Do not force the issue if your child does not feel like sharing his or her thoughts
• Let your child make simple decisions when appropriate. Because PD often makes a child feel powerless, you can help by showing him or her that he or she has control over certain parts of his or her life. For example, you might consider letting your child decide how to spend the day, especially allowing him or her to pick places where they feel safest from attacks.
• Tell your child (repeatedly if necessary) that the attacks are not his or her fault.
• Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.
• Do not criticize your child for acting younger than his or her age. If he or she wants to sleep with the lights on or take a favorite stuffed animal to bed, it's OK and can be soothing.
• Make sure your child gets enough sleep and exercise every day.
• Teach children and teens to avoid alcohol, caffeine, and stimulants like ephedra and guarana.
• Take care of yourself so that you are well equipped to help your child. You can't be supportive if you're neglecting your own emotional or physical health.
• If you suspect that your child is suicidal, get professional help immediately. Thoughts of suicide are serious at any age and require prompt attention.

When should I seek professional help?

When panic disorder seriously interferes with school, socializing with friends, or daily activities, your child needs help. If panic attacks happen more than a few times in a month, or if an attack is very severe, get professional help. The symptoms may not go away or may get worse without professional help.

Get emergency care if your child or teenager has ideas of suicide, harming him- or herself, or harming others.

Sources:

• NIMH - Anxiety
• American Psychiatric Association - Facts for Families, No. 50; Updated November 2004.

Comprehensive information on pain in children, the causes of pain, and treatment of chronic pain in children.

One in fifty children and adolescents live with severely debilitating and recurrent pain. As many as 15 percent of children suffer from headaches, abdominal and musculoskeletal pain but two percent of children have pain symptoms that can be severe enough to interrupt sleep, restrict physical activity and prevent them from attending school.

Studies have shown that children suffering from this kind of chronic pain frequently become emotionally distressed and have a heightened sense of vulnerability, which can have a major impact on parents and siblings.

What Is Pain?

Pain is an uncomfortable sensation or feeling. It is such an important factor in health that it has been called the "fifth vital sign [1]." It can be constant (always there) or intermittent (coming and going). Pain can be dull and aching, sharp, or throbbing. It can be both physical and mental, and every child experiences it differently. It is important to know that no one can describe what your child's pain feels like except your child. Pain may be just a nuisance, or it may interfere with your child being able to get through their normal daily activities.

What Causes Pain?

We feel pain when our brain sends out special signals to our bodies. Usually, we are sick or injured when our brains send these signals. Feeling pain usually serves a purpose—it is a signal that something is wrong.

What Is the Difference Between Chronic and Acute Pain?

Pain can be acute (lasting for a short time) or chronic (lasting for a much longer time, perhaps months or years). Chronic pain often goes misdiagnosed. Unlike acute pain, it serves no useful purpose, but rather causes needless suffering if it goes untreated. Untreated or under-treated chronic pain can disrupt the family routine, and interfere with your child's daily activities, which can, in turn, lead to long-term disability. The key to treating chronic pain is doing a good job of recognizing and describing it frequently along the way to ensure that treatment is working as it should [2].

How Can I Recognize Pain in My Child? Why Is Describing Pain So Important?

Everyone can feel pain, even babies and young children. Kids usually do not remember the pain they went through when they were younger than about two years old. Sometimes children have a hard time expressing themselves and may find it hard to tell you where it hurts and what it feels like.

For this reason, doctors and nurses are using new tools to help define pain in the kids they care for. Pain charts and scales for children use pictures or numbers to describe their pain. Describing the pain can help parents and health care providers understand how bad the pain is, and how to best treat it. Talking to your child's doctors and nurses about pain is important. The more they know about your child's pain, the more they can help. Pay attention to how your child acts. For example, when your child is in pain, they may be restless or unable to sleep.

Pain can be treated. It can go away! The first step in treating your child's pain is to tell your child's doctor or nurse about it. Your health care provider will ask several questions about the pain, including where it hurts, what it feels like, and how it has changed since it started.

Your child's doctor may ask you to keep a pain diary with your child, which keeps track of when your child has pain throughout the day. This diary can also document how the pain changes after taking pain medications. If medications do not seem to work, or if your child has a bad reaction, tell the doctor and keep a list of these problem medicines for future reference.

Why Is Treating Pain Important?

Kids in pain do not do as well as kids who keep their pain under control. Pain can slow down your child's recovery. Also, pain is easier to treat before it gets really bad. So it's a good idea for your child to keep close tabs on how they feel, so pain can be "nipped in the bud." If we treat pain right away—before it gets out of control—we find that we actually need less medication overall to get it and keep it under control.

How do I know if I should call the doctor?

Remember: pain is a sign that something is wrong. Call your child's doctor if your child is in severe pain or has pain that lasts more than one or two days. If your child is in the hospital, let your nurse or doctor know right away if your child has pain.

What About Pain Medication?

Most pain can be controlled with medications. It is a good idea to combine treatment with medicine with some of the non-drug pain-control treatments listed farther down this page [3]. There are many different kinds of medications that your doctor may want to try to help relieve your child's pain and discomfort.

Will my child become addicted to pain medication?

If your child is being treated long term pain, you may worry about them becoming addicted to pain medicine. Don't worry: addiction is very rare. If your child needs pain medications and sedatives for a long time, physical dependence may occur. Physical dependence is not the same as addiction—addiction is a psychological problem. Because of this physical dependence, medication doses will be decreased slowly to prevent possible withdrawal symptoms that can occur if the medicine is stopped suddenly. Nurses and doctors will watch your child carefully for signs of medication withdrawal. Comfort measures as discussed below can be helpful when doses of pain medications are being decreased.

Are there other ways to treat pain besides taking medicine?

Absolutely! Pain is best treated using a variety of non-drug treatments along with medication [3].

One of the most important measures to take is to be there for your child. If your child feels loved and supported, their pain won't hurt as much. Cuddle, hold, rock, and hug your child. Hold your child's hand, and let them know you love them. Calm your child, because anxiety makes the pain worse. If your child has learned some of the techniques for coping with pain, they may still need you or a nurse to coach them and remind them what and how to use these techniques. For example, you may need to guide your child in using relaxation techniques, even if your child is already familiar with how to do it [4].

Other examples of non-drug treatments include therapy, massage, hot or cold packs, relaxation and guided imagery, distraction, music, hypnotherapy, and reading to your child. It's a good idea to use many of these techniques together in ways that complement each other. For example, researchers found that using acupuncture and hypnotherapy together was effective at reducing chronic pain and well tolerated by young people in their study [5]. The experts who can help your child cope with and treat pain may include massage therapists, biofeedback technicians, physician-acupuncturists, child-life specialists, psychologists, and physical or occupational therapists.

Literature Cited:

[1] Lynch M. Pain: the fifth vital sign. Comprehensive assessment leads to proper treatment. Adv Nurse Pract. 2001 Nov;9(11):28-36.

[2] Chambliss CR, Heggen J, Copelan DN, Pettignano R. The assessment and management of chronic pain in children. Paediatr Drugs. 2002;4(11):737-46.

[3] Rusy LM, Weisman SJ. Complementary therapies for acute pediatric pain management. Pediatr Clin North Am. 47(2000):589-99.

[4] Cohen LL, Bernard RS, Greco LA, McClellan CB. A child-focused intervention for coping with procedural pain: are parent and nurse coaches necessary? J Pediatr Psychol. 2002 Dec;27(8):749-57.

[5] Zeltzer LK, Tsao JC, Stelling C, Powers M, Levy S, Waterhouse M. A phase I study on the feasibility and acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain. J Pain Symptom Manage. 24(2002):437-46.

[6] Kemper KJ, Sarah R, Silver-Highfield E, Xiarhos E, Barnes L, Berde C. On pins and needles? Pediatric pain patients' experience with acupuncture. Pediatrics. 2000 Apr;105(4 Pt 2):941-7.

[7] Favara-Scacco C. Smirne G. Schiliro G. Di Cataldo A. Art therapy as support for children with leukemia during painful procedures. Medical & Pediatric Oncology. 36(4):474-80, 2001 April.

See Also:

• Conquering Your Child’s Chronic Pain
• How to Support Your Child with Chronic Pain

Sources:

• University of Bath, UK
• University of Michigan Health System

Bribing Children is a Common Parental Tactic - But at What Cost?

CHICAGO - Call it a reward, or just "bribery."

Whichever it is, many parents today readily admit to buying off their children, who get goodies for anything from behaving in a restaurant to sleeping all night in their own beds.

Often, the rewards are for behaviors their own parents would have simply expected, just because they said so. The new dynamic - sometimes seen as a backlash to that strictness - has some parenting experts wondering if today's parents have gone too soft.

"It's definitely more our generation," Kirsten Whipple, a 35-year-old mom in Northbrook, Illinois, says with a quiet laugh. "I'm sure our parents would be appalled if they knew how much we bribe our children."

She can see why they might be - but she and her husband try not to overuse rewards and have found they work best for smaller things. For instance, they might offer their boys, ages 5 and 8, a special dessert or a chance to rent a video game if they listen to their baby sitter. A good report card might earn a dinner out to celebrate.

Whipple has noticed a downside though - what she calls a "sense of entitlement."

"Often times, it leads to good behavior with a question attached: 'What are you going to give me?'" she says.

That is part of what worries parenting experts.

"I think that reward systems have a time and a place and work really well to help develop capacities - if we need them to go above and beyond," says Marcy Safyer, director of the Adelphi University Institute for Parenting.

She remembers how, as a child, her own parents promised her an ice cream if she could sit quietly through religious services.

"But what often gets lost for people is being able to figure out how to communicate to their kids that doing the thing is rewarding enough," Safyer says.

Feeling rested in the morning, for instance, could be seen as the reward for not getting up at night.

"Instead, parents are paying their kids to get good grades; they pay their kids to go to sleep, pay their kids to be toilet trained," Safyer says, meaning payment as a material reward.

Parents and experts alike agree that the dynamic is partly a reflection of the world we live in - where many families have more than previous generations.

It is unrealistic to think a parent would not reward their children with material things sometimes, says Robin Lanzi, a clinical psychologist and mother of four who is the research director at the Center on Health and Education at Georgetown University.

"But you want to make sure that they match the behavior, so it's not something huge for something small," Lanzi says.

She recalls hearing about a father who offered his child a Nintendo Wii game system for scoring a couple goals in a soccer game.

"There's always this upping the ante," Lanzi says. "What was a reward 20 or 30 years ago is a whole lot different than it is now."

Elizabeth Powell, a mother of two young daughters in Austin, Texas, knows what she means.

"You want to raise them in a way that they're respectful and appreciate things," Powell says of her children. "But sometimes, you wonder now if kids appreciate even a new pair of shoes."

That was something she remembers being a big deal to her as a child - as were the ice creams and 45 rpm records, or very occasional trips to McDonald's.

These days, she sees children negotiating to get things in a way she never would've dreamed of. "A lot of my friends, I see them cave, just like I have a tendency to do - just to get them to be quiet," Powell says.

She and other parents agree that striking a balance with rewards - and not giving them so often that they mean nothing - is the goal.

Powell sometimes lets her 5-year-old daughter shop at a store she likes, if she behaves for an entire trip to the mall.

She does not want it to become an expectation. But she also concedes that having two children has made it more difficult to stick to the ideal, especially in public settings.

"There are times when you have a second child, and you've got to change a diaper. And you find yourself telling your (older) child that 'I will do anything you want if you will just stand here and behave,'" says Powell, who is 34.

"Sometimes, desperate situations call for desperate measures."

Those who specialize in child behavior say they hear those kinds of stories from parents all the time - and often try to suggest methods that do not involve material rewards.

Sometimes, "because I said so" is still a valid tactic. But for something like sleeping in their own bed, Safyer suggests putting stars on a chart for each night the child is able to stay in his or her room - and then making a big deal about the progress.

"Parents' pride in their children goes a long way," she says.

Claire Lerner - director of parenting resources for the Washington, D.C., nonprofit Zero To Three - also recalls a couple whose child would only brush his teeth if he got a reward.

She suggested the parents emphasize the benefits of just getting it done.

"To have a power struggle takes up a lot of time and eats into the bedtime routine," Lerner says. "So you can tell them that if they brush their teeth, 'We have time for an extra book or an extra lullaby or five more minutes in the bath' - whatever it is they really love.

"That's a real-life consequence."

Source: British Medical Journal

Proud, happy parents enjoy their children and do not mean to harm them yet too much attention can do just that.

In these days of smaller and smaller families, it is quite easy to go overboard on attention. The problems are not apparent in the beginning but within a few years, an attention-addicted child is a serious problem.

When many children are suffering from neglect, it seems strange to imply that too much attention can be a problem. For children, too much attention can produce many of the same behaviors seen in attention-starved youngsters. Both extremes produce demanding, insecure children. The neglected child is never sure of love since he has never experienced it. The attention-addicted child is insecure due to a fear that the attention will stop.

The Result of Too Much Attention? An Attention Addicted Child

If a child is always the center of attention and adult needs and rights are totally ignored, the child will become attention-addicted. There will never be enough. When this happens, parents become frustrated and angry with the child and the attention continues, but in negative ways. To a child, attention is attention, regardless of it's character.

When parents try to do other things, the attention addicted child will develop very manipulative behaviors to maintain the interaction. Some children became extremely demanding and aggressive, others become passive and helpless. They do whatever works for them. In the end, the child is truly dependent and unhappy since there is never enough attention to satisfy the child.

How We Give Too Much Attention to Our Children

There are basically two ways giving too much attention happens:

1. Every parent thinks their child is adorable and wonderful, but some parents gain personal satisfaction by showing everybody else their family star.

   If a child is displayed at every opportunity and urged to perform, the problems can begin. The performance may be evidence of precocious behavior or learned tricks. A child who learns to exist in the spotlight will have a difficult time when the spotlight is turned off. The greatest problem will be in sharing the spotlight with the next sibling.

   Children do not need to be dressed like little dolls and adored. They need to loved and given the opportunity to be part of the family, not the star of the family. Children need to be respected and not exhibited.

2. The second path to attention-addiction is taken by parents who give up all their rights for the sake of the child.
   • Parents can avoid this trap by maintaining a life of their own and respecting their own rights. Insisting that a child sleep in their own bed, for instance, is a positive step toward that child's independence. Insisting that a child goes to bed at a reasonable hour is also a good thing to do. Parents need private time. It is healthy for a marriage and healthy for the child to understand that there are limits and parents need time for each other.
   • Providing a child a book to look at while Mom or Dad reads a grown-up book is a good thing to do. There are times to read to the child and there are times for parents to read to themselves. If a parent refuses to stop (even though comprehension may be hopeless with a preschooler screaming at one's knees), the child will learn to respect the parent's right for personal time.
   • Children should not be allowed to interrupt adult conversations. They can be taught how to let their presence be known without interrupting. Show a preschooler how to lay one hand on the adult's arm or leg and wait patiently until the adult can speak with the child. By covering the child's hand with one's own, the child understands that the parent knows he is there.

     Parents must not give in by lecturing the child on not interrupting and then saying, "What do you want?" The child who is allowed to interrupt will continue to do so as long as he gets the adults complete attention.

     Mom and Dad may need to go into their room and lock the door to keep a child from interrupting their conversation. If they do, the child will learn that it is better to be quiet and with Mom and Dad than to interrupt and be without them.

We must pay attention to our children. They cannot thrive without it. At the same time, we harm our children if we do not set limits. By respecting our own rights, we teach our children to respect us. We also prevent the damage that attention-addiction can do to a child and the family.

Learn about school refusal; the signs and causes of school refusal and how school refusal is treated.

Refusal to go to school often begins following a period at home in which the child has become closer to the parent, such as a summer vacation, a holiday break, or a brief illness. It also may follow a stressful occurrence, such as the death of a pet or relative, a change in schools, or a move to a new neighborhood.

What is School Refusal?

School refusal is not a formal psychiatric diagnosis. School refusal, school avoidance, or school phobia, are terms used to describe the signs or anxiety a school-aged child has and his/her refusal to go to school. School refusal can be seen in three different types of situations, including the following:

• Young children going to school for the first time
  This is a normal type of school refusal. This develops with a child's normal separation anxiety, or uneasiness about leaving a parent figure. This type of fear usually goes away within a few days of the child attending school.
• Fear
  Older children may have school phobia based on a real fear of something that may happen to them at school, such as a bully or a teacher being rude. In this situation, it is important to talk with your child to determine what is causing his/her fears.
• Distress
  The final type of school phobia is seen in children who are truly distressed about leaving their parent and going to school. Usually, these children enjoy school but are too anxious about leaving their parents to attend.

Facts About School Refusal

• School refusal is the third most common cause of children missing school.
• Fifty percent of children with school refusal have other behavioral problems.
• Twenty percent of parents who have a child with school refusal have a psychiatric problem.
• There is usually a strong bond between the parent and child.
• Children may be depressed.
• School refusal is more common in girls than in boys.

Signs of School Refusal

While every child is different, the following are some of the behaviors that may be present in your child:

• The child may complain of other symptoms (i.e., stomach ache, headache) that get better as soon as the child is allowed to stay home

• The child may tell you that he/she is anxious or afraid of a certain situation that happens at school
• The child may not want to leave the parent because of a change in the life of the child, such as the following:
  • New school
  • Has just moved
  • New brother or sister
  • A sick brother, sister, or parent
  • Divorce
  • Death in the family

How is School Refusal Diagnosed?

School refusal is usually diagnosed with a team approach, including your physician, you, the child, and teachers and counselors. Your child's physician will be involved to rule out any real medical problems that may be occurring. A complete history and physical examination will be done. School officials may be contacted to obtain more information.

School Refusal Treatment

Since every child is unique, each situation will be handled on an individual basis. The following are some of the interventions that may be used to help your child:

• Return the child to school. Make sure the school officials understand the situation and do not send the child home for the wrong reasons.
• Consider family counseling if other problems exist.
• Allow the child to speak and talk about his/her concerns and fears.
• Slowly separating the parent from the child in school may also be used. One approach is to have the parent sit with the child in the classroom at first, and then the parent may attend school, but sit in another room. Next, the parent may continue to get farther away.
• A referral to a child psychologist or psychiatrist may become necessary.

Additional tips for parents of students with school refusal can be found here.

Sources:

• American Family Physician, School Refusal in Children and Adolescents, Oct. 15, 2003.
• American Academy of Child and Adolescent Psychiatry, Children Who Won't Go To School, Facts for Families, No. 7; Updated July 2004.
• Cincinnati Children's Hospital Mental Center
• Burke AE, Silverman WK. The prescriptive treatment of school refusal. Clin Psychol Rev 1987;7:353-62.

Discover the causes of teenage stress and how to help your teen manage stress.

Kids can be affected by stress, or have sad moods. They can also suffer from depression.

Some estimates say that up to ten percent of children in middle childhood may suffer from depression.

What might stress your child?

Common causes of stress include:

• arguments between parents or parents splitting up
• falling out with friends
• being teased too much
• being overwhelmed with work or homework
• school tests
• holidays

The last item in this list - holidays - may be unexpected. It's not only unpleasant events, but also some happy ones, that can be stressful to a vulnerable child. Even with celebrations, such as holidays and birthdays, some children and teenagers may react by becoming so overexcited that they end up stressed.

Some teens just seem to have a more happy-go-lucky temperament, and deal with most situations appropriately. They can get over disappointments and setbacks readily, and happily go back to dealing with life's challenges. Others find this more difficult - they may become withdrawn emotionally, or completely overreact to events.

Help your teen manage stress

• Build self-esteem and confidence - show lots of love and affection.
• Keep your children up-to-date - it's vital for you to keep children informed about what's happening in the family and what's likely to be coming up. Children can become anxious and bewildered at what's happening around them.
• Look ahead - anticipate incidents that might be stressful for your child and help them as much as possible to prepare for these, such as returning to school after the holidays, exams, or even a holiday. Talk well in advance about the event and any worries your child might have. This can really help to cut down anxiety.
• Keep an eye on your child for signs that he's finding things too stressful - be alert to any sudden changes in behavior, becoming more aggressive, not sleeping, or changes in diet such as overeating, or appearing to eat nothing. Do all you can to help at an early stage so that matters don't get worse.
• Talk and listen - encouraging your child to describe how he feels. Use reflective listening to check out what you're hearing, for example: "So you're saying you feel upset when you have too much homework." It's not necessary to solve every problem, but just talking things out can really help.
• Be realistic - don't have such high expectations for your child that he's completely stressed trying to live up to them.
• Involve your child - get him to help think up solutions to problems. This gives him a sense that he can make a difference and that things aren't hopeless.
• Use distraction tactics - a day out having fun somewhere can make a child forget he's upset over a falling out with a friend, or joining a new drama group can soften the blow of not making it onto the swimming team.
• Encourage independence - achieving things on your own always gives a boost, so you should try not to over-protect your school age child.

Just letting your child play more with other children can often help him to get things in perspective.

Tips to cut down stress

• Don't put too much pressure on your child to achieve - giving the message that he must do well in tests, or must get into a particular school can create too much stress for some children.
• Make your own behavior an example of how to handle stressful situations - if you can show that you don't fall apart when things go wrong, this teaches a useful lesson. If you freak out when the car won't start, or when the toast burns, this gives a message that it's all too much.
• Make sure your child has enough time to chill out - allow time to play, read or watch some TV. Rushing from school to music lessons or a tutor leaves no time to unwind and relax.
• Slow the pace of life down - you may have become used to rushing around, but your child needs more time to adjust to changes and to take things at his own pace.
• Don't forget or ignore your child in times of crisis or family change - it's hard for children to imagine what will happen next, and they need you to explain situations patiently to them.
• It can really help to lower the emotional temperature at home - if everybody is constantly yelling, rushing around and generally creating a stressful atmosphere, this is almost bound to rub off on children.
• Simple relaxation exercises can help some children - breathing deeply, and going floppy. You could even give your child a relaxing massage.
• Make sure your child gets enough exercise - set aside enough chances for your child to run around in the fresh air and balance this with making sure he also gets enough relaxing, regular sleep.

Of course, sometimes children have to deal with far more serious problems, such as serious illness, parents divorcing, or even the death of a parent. They will always need help and support from the important adults in their lives at times of major change.

Children often blame themselves for events over which they have no possible control. Just stressing that there's no way they could have influenced things can be a great relief.

If your teenager seems very depressed, or anxiety symptoms carry on for more than a month, it may be best to consider seeking professional help - contact your family doctor or get a referral from your county psychological association.