The latest research on youth violence; causes, risk factors, and how parents can foster resilience and self-esteem in children.

• Foreword
• Introduction
• The Facts
• Pathways to Violence: What Do We Know?
• Promoting Healthy, Nonviolent Children: What Works and What Doesn't?
• What Parents Can Do

Foreword

We all have a stake in reducing and preventing youth violence and in promoting the healthy development of the Nation's children and young people. Over the past years, when school shootings made headlines in communities, that imperative became even greater. Local communities recognized that no community is immune from the threat of youth violence. They also recognized that every community has the capacity to do something about it — beginning with families, schools, and other caring adults.

This same imperative led to a report by the U.S. Surgeon General on the topic of youth violence. The report concluded that the tools to reduce and prevent youth violence are known and available — they simply have not yet been used to their best and most productive end. With that recognition, Congress established a program — and the funds to support it — to improve mental health services for children with emotional and behavioral disorders who are at risk for violent behavior. Through those dollars, the U.S. Department of Health and Human Services (HHS) — working in collaboration with the Departments of Justice and Education — created the Safe Schools/Healthy Students Program to help improve the capacity of schools and communities to reduce the potential for youth violence and to improve school and community-based drug abuse prevention and mental health promotion efforts as well.

The Substance Abuse and Mental Health Services Administration's Center for Mental Health Services has taken the lead for HHS in this and other youth violence-related initiatives. One of the most critical activities has been the dissemination of evidence-based programs and knowledge about preventing youth violence. This volume, What you Need to Know about Youth Violence Prevention: An Evidence-Based Guide, takes a first, important step in that knowledge dissemination effort. Built for communities, schools and families, the guide highlights the findings and conclusions of the Surgeon General's Report, as well as data from other research to provide a quick introduction to what is known today about the roots of youth violence and how it can be prevented. It can help concerned communities identify evidence-based programs to adopt and adapt to local needs, and it can serve as a reminder to all Americans that, through action and attention, they can do something to help stem youth violence.

Charles G. Curie, M.A.,
A.C.S.W.
Administrator
Substance Abuse and Mental Health Services Administration

Gail Hutchings, M.P.A.
Acting Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration

Introduction

In response to a sudden series of high-profile school shootings, schools and communities across the United States have implemented hundreds of violence prevention programs. Which programs really work? How can we tell? Are any of these programs doing more harm than good?

This guide, based on the state-of-the-science Youth Violence: A Report of the Surgeon General, released in January 2001, and other selected research-informed sources, summarizes the latest knowledge on youth violence. It describes both risk factors that may lead to violence and protective factors that may both prevent it and promote healthy childhood development. It describes evidence-based programs that help prevent youth violence and presents the Surgeon General's vision — suggested courses of action — for youth violence prevention in the future. Publications and organizations that can provide additional information are listed.

Although more research and evaluation of existing youth violence prevention programs are needed, many programs can be implemented now. With the information already available, schools and communities can consider (and perhaps reconsider) their prevention strategies in light of the most current and reliable research findings. This guide can help meet the challenge of directing resources toward effective strategies and programs, disseminating scientifically validated studies, and providing resources and incentives for the implementation and evaluation of programs that are promising.

The Facts on Youth Violence

1. The youth violence epidemic of the early 1990s is not over. Confidential self-reports show that the numbers of young people involved in some violent behaviors remain at epidemic levels.
2. Most children with mental and behavioral disorders do not become violent as adolescents.
3. Most children who are abused or neglected will not become violent.
4. Most self-report data show that race and ethnicity have little bearing on a young person's participation in nonfatal violent behavior.
5. Juvenile offenders tried in adult criminal courts and incarcerated in prisons are more likely to commit felonies after release than young people who remain in the juvenile justice system.
6. A number of prevention and early intervention programs that meet very high scientific standards of effectiveness have been identified.
7. Weapons-related injuries in schools have not increased dramatically in the last 5 years. Compared to neighborhoods and homes, schools nationwide are relatively safe places for young people.
8. Most young people involved in violent behavior will never be arrested for a violent crime.

Pathways to Violence: What Do We Know?

The most important conclusion of the U.S. Surgeon General's report is that youth violence is a solvable problem.

• What does the research tell us about youth violence?
• What are the major trends in youth violence?
• When does youth violence begin?
• Why do young people become violent?
• What risk factors are correlated with youth violence?
• Can other factors lead to youth violence?
• What factors protect against youth violence?
• What role do culture, ethnicity, and race play in youth violence?
• How does media violence affect youth violence?

What Does the Research Tell Us About Youth Violence?

• The U.S. Surgeon General's report states that the greatest need is for the Nation to "confront the problem of youth violence systematically, using research-based approaches, and to correct damaging myths and stereotypes."
• The search for solutions to the issue of youth violence is challenging. Research conducted for the U.S. Surgeon General's report using extremely high scientific standards found that nearly half of the most rigorously evaluated prevention strategies did not achieve their intended outcomes. Perhaps these programs did not work because of a flawed program strategy—or because of poor program implementation or a poor match between program and target population. The research also found that a few strategies actually were harmful to participants.
• Many effective prevention and intervention programs are now in place, however. We have the tools and the understanding now to reduce, or even prevent, much of the most serious youth violence. We also have the tools to reduce less dangerous (but still serious) problem behaviors and to promote healthy development among young people.

WHAT ARE THE MAJOR TRENDS IN YOUTH VIOLENCE?

• The Surgeon General's report states that between 1983 and 1993, deadly violence involving guns rose to epidemic proportions. At the same time, the number of young people involved in other forms of serious violence rose slightly.
• Since 1994, however, gun use and homicide arrests have dropped, and nonfatal serious violence has gone down. By 1999, arrest rates for violent crimes other than aggravated assault had dropped below 1983 levels, but arrest rates for aggravated assault remained almost 70 percent higher than in 1983.
• Despite the current decline in gun use and lethal violence, the proportion of young people who report their involvement in nonfatal violence remains as high as in the peak years of the epidemic, as does the proportion of students injured with a weapon at school. The number of young people involved in gangs remains near the peak levels of 1996.
• Young men—especially those from minority groups—are arrested disproportionately for violent crimes. But self-reports show that differences in violent behavior between minority and majority groups and between sexes may not be as great as arrest records indicate. Race or ethnicity by itself does not predict whether a child or adolescent is likely to engage in violence.
• Schools around the country are relatively safe compared to homes and neighborhoods. Young people at greatest risk of being killed in school violence are from a racial or ethnic minority, senior high schools, and urban school districts.

WHEN DOES YOUTH VIOLENCE BEGIN?

Scientists have described two patterns for engagement in violence: early onset and late onset. These patterns help to predict the likely course, severity, and duration of violent behaviors over a person's lifespan. In the early onset pattern, violence begins before adolescence; in the late onset pattern, violent behavior begins during adolescence. According to the Surgeon General's report:

• Most children with behavioral disorders do not become serious violent offenders.
• Most highly aggressive children do not become serious violent offenders.
• Most youth violence begins in adolescence but doesn't continue into adulthood.
• Young people who become violent before age 13 usually commit more crimes, and more serious crimes, for a longer time. Their pattern of violence rises through childhood and sometimes continues into adulthood.

WHY DO YOUNG PEOPLE BECOME VIOLENT?

Research on youth violence has identified certain personal characteristics and environmental conditions that place children and youth at risk for engaging in violent behavior or that seem to protect them from that risk. These characteristics and conditions — risk and protective factors, respectively — exist not only within individuals but also in every social setting in which they find themselves: family, school, peer group, and community.

Risk factors can identify vulnerable populations that may benefit from intervention efforts but not particular individuals who may become violent. No single risk factor or combination of factors can predict violence with certainty. Similarly, protective factors cannot guarantee that a child exposed to risk will not become violent.

More research is necessary to identify risk and protective factors, to determine when in a person's development these factors come into play, and to discover why violence starts, continues, or stops in childhood and adolescence. However, research to date offers a solid basis for implementing programs aimed at reducing risk factors and promoting protective factors — and thereby preventing violence.

WHAT RISK FACTORS ARE CORRELATED WITH YOUTH VIOLENCE?

Risk factors for violence are different for youth with the early onset pattern compared to those with the late onset pattern. The most powerful risk factors for children ages 6 to 11 who commit violence at ages 15 to18 are involvement in serious (but not necessarily violent) criminal acts and substance abuse. Table 1 identifies these and other known childhood risk factors. The factors are ranked by the strength of their influence, as determined by statistical research undertaken for the U.S. Surgeon General's report.

Mid- to late adolescence is a period of significant developmental change and a time during which peer influences outweigh family influence. The strongest risk factors for adolescents ages 12 to 14 who commit violence at ages 15 to 18 are identified in Table 2.

An accumulation of risk factors is more important in predicting violent behaviors than is the presence of any single factor. The more risk factors a child or young person is exposed to, the greater the likelihood that he or she will become violent.

CAN OTHER FACTORS LEAD TO YOUTH VIOLENCE?

Some situations and conditions can influence the likelihood of violence or the form it takes. Situational factors - such as provoking, taunting, and demeaning interactions - can spark unplanned violence. The presence of a gun in certain situations can raise the level of violence.

The Surgeon General's Report found only limited evidence indicating a relationship between serious mental disorders and violence in adolescents or young adults in the general population, but young people with serious mental disorders who also abuse substances or have not received treatment may be at risk for violence.

WHAT FACTORS PROTECT AGAINST YOUTH VIOLENCE?

Protective factors - the personal characteristics and environmental conditions that help protect against a specific risk - provide some explanation as to why children and adolescents who face the same degree of risk may behave differently.

The research evidence about factors that protect against youth violence is not as extensive as is the research on risk factors, and the research must be considered preliminary. Although a number of protective factors have been proposed, only two have been found to moderate the risk of violence: an intolerant attitude toward deviance, including violence, and commitment to school. These factors reflect a commitment to traditional values. Both effects are small.

WHAT ROLE DO CULTURE, ETHNICITY, AND RACE PLAY IN YOUTH VIOLENCE?

Considered apart from other life circumstances, race and ethnicity have not been shown to be risk factors for youth violence.

• The evidence suggests that the link between race and violence is based largely on social and political differences rather than on biological differences. Ethnicity may account for limited opportunities due to prejudice, and ethnic minority families may face acculturation stresses. On the other hand, some features of ethnic cultures may serve as protective factors (Surgeon General, 2001; APA 1993).
• Prevention specialists generally presume that risk factors for youth violence identified in studies with primarily White participants are relevant also for such culturally diverse groups as African Americans, Hispanics, Asian Americans and Pacific Islanders, and Native Americans. Research on the roles that race, ethnicity, and culture may play among young people of specific minority groups is needed to shed light on the risk and protective factors that affect those groups.

HOW DOES MEDIA VIOLENCE AFFECT YOUTH VIOLENCE?

In the context of the ongoing debate on the effect of media violence on children and youth, the U.S. Surgeon General's report summarizes major research findings from the small body of research on the topic:

• Exposure to media violence can increase children's aggressive behavior in the short term. Media violence increases aggressive attitudes and emotions, which theoretically are linked to aggressive and violent behavior. Evidence for long-term effects of media violence is inconsistent.
• Violent behaviors occur infrequently and are subject to multiple influences. Existing evidence is insufficient to describe accurately how much exposure to media violence—of what types, for how long, at what ages, for what types of children, or in what types of home settings—will predict violent behavior in adolescents and adults.

Families play a critical role in guiding their children's exposure to the media, including television programs, films and videos, and computer and video games. Community groups—such as schools, faith-based organizations, and parent-teacher-student organizations—can teach parents and children how to be more critical consumers of media. In addition, Federal agencies can encourage needed research, share research findings with the public, encourage increased interaction between violence prevention researchers and media researchers, and create networks for sharing solutions to social and public health problems. For a more detailed discussion of the risk factors for youth violence, see Youth Violence: A Report of the Surgeon General, chapter 4.

Promoting Healthy, Nonviolent Children: What Works and What Doesn't?

• Why take the public health and development approaches?
• What are best practices to prevent youth violence?
• How do large-scale prevention programs work best?
• Is prevention cost-effective?
• Violence prevention programs by best practices category

WHY TAKE THE PUBLIC HEALTH AND DEVELOPMENTAL APPROACHES?

• The most common reaction to youth violence has been to "get tough" on violent offenders and to focus on punishment. The public health approach focuses more on the prevention of violence than on punishment or rehabilitation.
• The public health model looks at factors that put young people "at risk" for violent behavior. Practical, goal-oriented, community-based strategies that address these risks can help reduce injuries and deaths caused by violence—just as the public health approach already has reduced traffic fatalities and deaths attributed to tobacco use.
• Patterns of behavior change over the course of a person's life. A developmental approach permits primary prevention researchers to design violence prevention programs that can be put in place at just the right time to be most effective in the life of a child or young person. Preventive interventions must be developmentally appropriate to be effective.

The U.S. Surgeon General's report suggests the following approaches to address youth violence:

• Prevention and intervention programs must reflect the different patterns of violence typical of early and later onset.
• Early childhood programs that target at-risk children and their families are important to prevent the onset of a chronic violent career.
• Programs must be developed to identify patterns, causes, and prevention strategies for late-onset violence.
• A comprehensive community prevention strategy must address both early- and late-onset patterns and determine their causes and risk factors.
• Serious violence is an element of a lifestyle that includes drugs, guns, early sex, and other risky behaviors. Successful interventions must focus on the risky lifestyle of the young person.

The most highly effective preventive intervention programs combine approaches that address both individual risks and environmental conditions. Building individual skills and competencies, providing parent effectiveness training, improving a school's social climate, and changing young people's type and level of involvement in peer groups, combined, are particularly effective.

WHAT ARE BEST PRACTICES TO PREVENT YOUTH VIOLENCE??

The Surgeon General describes three categories of preventive interventions: primary, secondary, and tertiary.

• Primary preventive interventions are designed for general populations of youth, such as all students in a school. Most of these young people have not yet become involved in violence or encountered specific risk factors for violence.
• Secondary preventive interventions are designed to reduce the risk of violence among young people who display one or more risk factors for violence (high-risk youth).
• Tertiary interventions are designed to prevent further violence or escalation of violence among young people already involved in violent behavior.

The U. S. Surgeon General's report identifies prevention strategies found to be effective and ineffective for specific populations. Table 3 lists those findings.

HOW DO LARGE-SCALE PREVENTION PROGRAMS WORK BEST?

Limited research shows that the successful implementation of a large-scale program depends as much on effective implementation as it does on the program's content and characteristics. Important factors for success in implementing a national program in a local community are:

• Focus on a distinct problem;
• Appropriate program for the specific target population, participant, and family;
• Staff buy-in to the program;
• Motivated and effective project leadership;
• Effective program director;
• Well-trained and motivated staff;
• Plentiful resources; and
• Implementation of the program with fidelity to its design.

IS PREVENTION COST-EFFECTIVE?

Sometimes cost savings due to prevention and intervention programs are not obvious because of the time lag between the implementation of a program and the appearance of its effects. However, in the United States, where criminal justice focuses on get-tough laws and incarceration for serious violent criminals, hundreds of billions of dollars are spent each year on the criminal justice system, security, and the treatment of victims, or are lost due to lower productivity and quality of life.

Crime prevention, on the other hand, avoids incurring not only the costs of incarceration, but also some short- and long-term costs to victims, including material losses and medical costs. Other benefits may be difficult to quantify, but in addition to reduced medical costs, the indirect benefits of preventing serious or violent offenses include increased worker productivity, increased tax collection, and even reduced welfare costs.

It is important to match the intervention to the target population. This link has a critical effect on both the cost effectiveness and the overall effectiveness of an intervention. For more details about the cost effectiveness of youth violence prevention programs, see Youth Violence: A Report of the Surgeon General, chapter 5.

VIOLENCE PREVENTION PROGRAMS BY BEST PRACTICES CATEGORY

The Surgeon General's report identifies strategies and programs that work, that are promising, and that do not work to prevent youth violence. If a program is not identified in the Surgeon General's report as "model" or "promising," it does not mean it is ineffective. In most cases, it means only that it has not yet been rigorously evaluated or that its evaluation was not complete. The scientific standards that were used in the analysis of programs for the Surgeon General's report are given here.

Model

• • Rigorous experimental design (experimental or quasi-experimental)
  • Significant deterrent effects on:
    • Violence or serious delinquency
    • Any risk factor for violence with a large effect size (.30 or greater)
  • Replication with demonstrated effects
  • Sustainability of effects

Promising

• Rigorous experimental design (experimental or quasi-experimental)
• Significant deterrent effects on:
  • Violence or serious delinquency
  • Any risk factor for violence with an effect size of .10 or greater
• Either replication or sustainability of effects

Does not work

• Rigorous experimental design (experimental or quasi-experimental)
• Significant evidence of null or negative effects on violence or known risk factors for violence
• Replication, with the preponderance of evidence suggesting that the program is ineffective or harmful

Twenty-seven model and promising programs and two programs that do not work are presented in the U.S. Surgeon General's report. Some are school-based and some are community-based. They present a wide variety of approaches for dealing with problems ranging from poor parenting to bullying, drug abuse, and gang involvement. Table 4 lists these programs. Descriptions of the programs are included in the appendix of this pamphlet and in the U.S. Surgeon General's report, pages 133-151.

What Can Parents Do

• How does resilience enhance healthy development?
• What can parents do to foster resilience and healthy development?

We want all our children to develop in healthy ways, both physically and emotionally. It is not enough just to protect our children from taking part in violent behaviors. Research on resilience—the capacity to rebound in the face of adversity—provides us with important information on the strengths that individuals, families, schools, and communities call upon to promote health and healing.

HOW DOES RESILIENCE ENHANCE HEALTHY DEVELOPEMENT?

Davis (1999) discusses important characteristics of resilience. These qualities appear to work as protective factors to help us navigate the curves of life's pathways:

• good health and easy temperament;
• secure attachment to others and basic trust;
• cognitive and emotional intelligence, language acquisition and reading, capacity to plan, self-efficacy, self-understanding, and adequate cognitive appraisal;
• emotional regulation, ability to delay gratification, realistically high self-esteem, creativity, and sense of humor;
• ability and opportunity to contribute; and
• belief that one's own life matters.

WHAT CAN PARENTS DO TO FOSTER RESILIENCE AND HEALTHY DEVELOPMENT?

Many protective factors have been found to promote healthy development and resilience among young people. Collected here from a number of sources (see References and Resources) are some evidence-based steps parents can take to help their children develop with resilience and good mental health:

• • Give your children love and attention every day.
  • Show your children appropriate behaviors by the way you act.
  • Listen to and talk with your children-about anything-to develop an open, trusting relationship.
  • Reward your child for good behavior or a job well done.
  • Establish clear and consistent limits and rules.
  • Do not hit your children.
  • Know where your children are, what they are doing, and with whom.

• Communicate with teachers and be involved in your children's school.
• Set high expectations for your children.
• Create opportunities for your children to be contributing members of the family and community.
• Know your children well enough to discern the warning signs of unusual behavior.
• Know when to intervene to protect your children.
• Get help if you think you need it.
• Make sure your children do not have access to guns, drugs, or alcohol.
• Teach your children ways to avoid becoming either a victim of violence or a bully.
• Learn ways to avoid conflict in the family; learn about and use anger-control techniques, if necessary.
• Monitor the media to which your children are exposed.
• Encourage your children's understanding of your family's cultural traditions and values.

As part of the Safe Schools/Healthy Students Violence Prevention grant program, CMHS has developed the 15+ Make Time to Listen, Take Time to Talk Campaign. This communications campaign encourages many of the steps listed above, because research has shown that children whose parents are highly involved with them attain higher levels of education and economic self-sufficiency than do children whose parents are not highly involved. Parental involvement with adolescents is also associated with lower levels of delinquency and better psychological well-being. The need to strengthen the role of parents in American families is now identified by the media, national organizations, and Federal agencies as a national priority. For a free brochure, a conversation starter card game, and other helpful information from the 15+ Make Time to Listen, Take Time to Talk campaign, go to http://www.mentalhealth.samhsa.gov or call 800-789-2647.

Disclaimer

This publication was prepared by Irene Saunders Goldstein, with consultative assistance from Jeannette Johnson, Ph.D., for the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS) under Contract No. 99M006200OID, Anne Mathews-Younes, Ed.D., Government Project Officer. The content of this publication does not necessarily reflect the views or policies of CHMS, SAMHSA, or HHS.

Sources:

• SAMHSA'S National Mental Health Information Center

Child therapy for anxiety has been well-researched and shown to be effective in treating children who are anxious. In fact, the Anxiety and Depression Association of America asserts that most children need professional help to manage and overcome anxiety. If your child is struggling and anxious, you have numerous options regarding child therapy for anxiety.

Some anxiety in kids is typical. As kids grow and develop and navigate school and an expanding circle of activities, peers, and groups, it’s normal to feel anxiety as they adjust to new situations and determine if or how they fit in.

Sometimes, though, anxiety becomes intense if stressors are too big or too many and they begin to see many everyday situations as threats. Their anxiety can grow beyond what they can handle, and they begin to react to perceived threats in extreme ways, such as avoidance, becoming ill, frequent crying, and worrying excessively, making them seem “uptight.”

When anxiety begins to negatively affect their daily life, interfering with school, home, activities, or peer relationships, child therapy for anxiety might be in order. If their anxiety is increasing and interfering, it can worsen without professional help ("What Is Generalized Anxiety Disorder (GAD)?")

Therapy helps kids develop the tools to manage anxiety on their own. Several types of child therapy for anxiety exist. Here’s a rundown on what they are and how they can help.

Types of Child Therapy for Anxiety

Traditional research-based types of child therapy for anxiety include approaches such as:

• Cognitive-behavior therapy (CBT)
• Exposure therapy
• Education
• Acceptance and commitment therapy (ACT)
• Dialectical behavioral therapy (DBT)

This brief look at what each type of traditional child anxiety therapy does will equip you with information to consult with a therapist to determine if they’re a good fit for your child.

CBT is a type of talk therapy that teaches kids skills to decrease anxiety. CBT focuses on thoughts, especially negative thoughts, that contribute to anxiety as well as thinking patterns that keep kids stuck in their anxiety.

Exposure therapy focuses on behavior to reduce anxiety. The therapist works with the child to gradually, methodically, and safely expose them to their anxiety triggers. It is particularly effective for separation anxiety, social anxiety, phobias, and obsessive-compulsive disorder (OCD). Exposure therapy is often used in conjunction with CBT.

Education can, and typically is, a component of all types of anxiety therapy. The therapist will help your child understand what anxiety is and how it overtakes them. The more kids understand, the more they can distance themselves from their anxiety.

ACT helps kids learn acceptance and mindfulness to cope with thoughts and feelings. They learn practical strategies to deal with anxiety anytime it begins to interfere in their lives.

DBT helps children investigate how they deal with negative thoughts, emotions, and conflict. They come to see how they can take responsibility for their own problems, including anxious thoughts and actions.

These are traditional approaches to child therapy for anxiety. Another approach, developing since the middle of the last century and successfully undergoing research to show its effectiveness, is play therapy.

Play Therapy for Anxiety

In play therapy for anxiety, kids work through their anxiety and other challenges in a way that comes naturally to them: playing. Children communicate and problem-solve through play. In play therapy, the anxious child takes the lead, which gives them a sense of control over themselves, and their world.
A playroom is free from many of the things that make children anxious. Kids are allowed to be themselves and make choices.

In addition to free play, kids interact with the therapist to engage in fun, purposeful activities to reduce anxiety. Just some of the play therapy activities for anxiety are Bubble Breaths (learning deep, relaxing breathing by blowing bubbles), Worry Can (kids decorate a can (container) to store collected small objects representing their worries), Party Hats On Monsters (to make anxiety less intimidating and controlled by the child), and The Feeling Word Game (to give words to what they feel).

Play therapy for anxiety provides many benefits, including:

• A chance to experience success
• Empowerment and a sense of control over themselves, anxiety, and life
• Learning to make choices and decisions with no negative consequences
• Increased problem-solving skills
• Heightened self-awareness
• Improved ability to relax, self-soothe

Many types of child therapy for anxiety are available. Which one is best for your child depends on their specific anxiety and personality.  Further, no approach works for every child. Children, their anxiety, therapists, and treatment approaches are all unique. You know your child better than anyone. Meet with several therapists and ask about their approach to anxiety to help find the best fit for your child and their anxiety.

article references

12 questions to help assess whether your child might have a mental health problem.

Does my child...

1. Often seem sad, tired, restless, or out of sorts?
2. Spend a lot of time alone?
3. Have low self-esteem?
4. Have trouble getting along with family, friends, and peers?
5. Have frequent outbursts of shouting, complaining, or crying?
6. Have trouble performing or behaving in school?
7. Show sudden changes in eating patterns?
8. Sleep too much or not enough?
9. Have trouble paying attention or concentrating on tasks like homework?
10. Seem to have lost interest in hobbies like music or sports?
11. Show signs of using drugs and/or alcohol?
12. Talk about death or suicide?

If you answered yes to 4 or more of these questions, and these behaviors last longer than 2 weeks, you should seek professional help for your child.

Resources

• American Academy of Child & Adolescent Psychiatry
  3615 Wisconsin Avenue, NW
  Washington, DC 20016-3007
  202-966-7300 or 800-333-7636
  www.aacap.org
• Anxiety Disorders Association of America
  8730 Georgia Avenue, Suite 600
  Silver Spring, MD 20910
  240-485-1001
  www.adaa.org
• Depression and Bipolar Support Alliance (DBSA)
  (formerly the National Depressive and Manic-Depressive Association)
  730 N. Franklin Street, Suite 501
  Chicago, IL 60610-3526
  312-642-0049 or 800-826-3632
  www.dbsalliance.org
• National Alliance for the Mentally Ill
  Colonial Place Three
  2107 Wilson Blvd., Suite 300
  Arlington, VA 22201-3042
  703-524-7600
  www.nami.org
• National Institute of Mental Health
  6001 Executive Boulevard
  Room 8184, MSC 9663
  Bethesda, MD 20892-9663
  301-443-4513 or 800-421-4211
  www.nimh.nih.gov
• National Mental Health Association
  2001 N. Beauregard Street - 12th Floor
  Alexandria, VA 22311
  703-684-7722 or 800-969-6642
  www.nmha.org

How to do you know if your child needs professional psychological or psychiatric help and where do you go?

Parents are often in the best position to recognize when their child is having a problem. Even when parents do recognize that their child is having trouble, it is not always apparent that professional help is necessary.

The first step in assessing the cause of your child's difficulty is to ask him. Sometimes, gently asking your child questions such as: Why are you constantly sad? Why did you steal that toy from Annie's house? You seem upset, is something bothering you? Why are you so mad? will reveal the issues with which he's struggling. Giving him adequate time to respond is necessary; talking honestly with your child about his feelings may also be helpful.

Consulting your child's physician or teacher, or your minister, priest, or rabbi may help you identify problems‑both in the child and within the family ‑ that could be causing the upset. Frequently, a teacher will notice your child's trouble and call you in. Working together, you can often get the child back on track before schoolwork or social interaction is affected.

As a rule, it is the combination of parents' growing concerns and the observation of outsiders such as teachers, physicians, and family members, that lead parents to consult a clinician for their child. There are a few signs, when present over an extended period time, that indicate that your child has problems which could benefit from treatment.

Parents are often concerned about their child's emotional health or behavior but they don't know where to start to get help. The mental health system can sometimes be complicated and difficult for parents to understand. A child's emotional distress often causes disruption to both the parent's and the child's world. Parents may have difficulty in being objective. They may blame themselves or worry that others such as teachers or family members will blame them.

If you are worried about your child's emotions or behavior, you can start by talking to friends, family members, your spiritual counselor, your child's school counselor, or your child's pediatrician or family physician about your concerns. If you think your child needs help, you should get as much information as possible about where to find help for your child. Parents should be cautious about using Yellow Pages phone directories as their only source of information and referral. Other sources of information include:

• Employee Assistance Program through your employer
• Local medical society, local psychiatric society
• Local mental health association
• County mental health department
• Local hospitals or medical centers with psychiatric services
• Department of Psychiatry in nearby medical school
• National Advocacy Organizations (National Alliance for the Mentally Ill, Federation of Families for Children's Mental Health, National Mental Health Association)
• National professional organizations (American Academy of Child and Adolescent Psychiatry, American Psychiatric Association)

The variety of mental health practitioners can be confusing. There are psychiatrists, psychologists, psychiatric social workers, psychiatric nurses, counselors, pastoral counselors and people who call themselves therapists. Few states regulate the practice of psychotherapy, so almost anyone can call herself or himself a "psychotherapist" or a "therapist."

Child and Adolescent Psychiatrist — A child and adolescent psychiatrist is a licensed physician (M.D. or D.O.) who is a fully trained psychiatrist and who has two additional years of advanced training beyond general psychiatry with children, adolescents and families. Child and adolescent psychiatrists who pass the national examination administered by the American Board of Psychiatry and Neurology become board certified in child and adolescent psychiatry. Child and adolescent psychiatrists provide medical/psychiatric evaluation and a full range of treatment interventions for emotional and behavioral problems and psychiatric disorders. As physicians, child and adolescent psychiatrists can prescribe and monitor medications.

Psychiatrist — A psychiatrist is a physician, a medical doctor, whose education includes a medical degree (M.D. or D.O.) and at least four additional years of study and training. Psychiatrists are licensed by the states as physicians. Psychiatrists who pass the national examination administered by the American Board of Psychiatry and Neurology become board certified in psychiatry. Psychiatrists provide medical/psychiatric evaluation and treatment for emotional and behavioral problems and psychiatric disorders. As physicians, psychiatrists can prescribe and monitor medications.

Psychologist — Some psychologists possess a master's degree (M.S.) in psychology while others have a doctoral degree (Ph.D., Psy.D, or Ed.D) in clinical, educational, counseling, developmental or research psychology. Psychologists are licensed by most states. Psychologists can also provide psychological evaluation and treatment for emotional and behavioral problems and disorders. Psychologists can also provide psychological testing and assessments.

Social Worker — Some social workers have a bachelor's degree (B.A., B.S.W., or B.S.), however, most social workers have earned a master's degree (M.S. or M.S.W.). In most states, social workers can take an examination to be licensed as clinical social workers. Social workers provide different forms of psychotherapy.

Parents should try to find a mental health professional who has advanced training and experience with the evaluation and treatment of children, adolescents, and families. Parents should always ask about the professionals training and experience. However, it is also very important to find a comfortable match between your child, your family, and the mental health professional.

Sources:

• American Academy of Child & Adolescent Psychiatry

Is your child a victim of bullying? Here are concrete steps parents can take to help your child deal with the bullying behavior.

"Sticks and stones may break my bones, but names will never hurt me." Remember that old rhyme? It wasn't true when you were in school, and it isn't true now. Teasing, taunting and other forms of bullying can cause serious emotional harm to children that lasts much longer than the bloody nose or scraped knees. Ignoring or excusing the behavior, saying things like "kids will be kids," only perpetuates the situation.

Bullying takes place in every school: According to the Heroes and Dreams Foundation, a nonprofit resource center for parents in Minneapolis, on average, one student in 10 is bullied at least once a week, and one in three has experienced bullying as either a bully or a target during the average school term. The children most likely to experience bullying are in fifth, sixth and seventh grades. Boys are more likely to be involved than girls.

There are three types of bullying:

1. Physical (hitting, kicking, taking things or returning things damaged);
2. Verbal (name-calling, taunting, insulting); or
3. Emotional (shunning, spreading nasty gossip).

It is deliberate and hurtful behavior, usually repeated over a period of time. Bullying is almost always done to kids who are perceived to be more vulnerable than the bullies.

The fear of being harassed in school gets in the way of learning, and makes going to school a miserable experience. Being bullied can make children feel lonely, unhappy and unsafe. Children who are being bullied may develop stomach aches, nightmares, nervousness and anxiety.

What Parents Can Do

If your child complains about being bullied at school, or if you suspect that might be happening, here are some suggestions.

1. Make it clear that you accept your child's reports of what is happening and that you take them seriously. She needs to know she has someone on her side who is willing to help her. Today, you are her hero. Reassure her that this situation can be resolved.
2. At the same time, let her know that you do not think this is her fault. Her confidence has already taken a big hit, and she already feels like a victim.
3. While it is natural to want to protect your child by solving the problem for him, it will serve your child better if you teach him how to solve the problem himself. By learning the skills to stand up for himself, he can use them in other situations.
4. Ask your child how she has been dealing with the bullying, talk about what else can be done and discuss what actions you can both take to solve the problem. Reassure her you will consult her before taking any action.
5. Teach your child how to respond to a bully in a bold, assertive way. Practice with him at home by role playing. Participation in other activities builds confidence and develops social skills, making it easier to find ways of saying, "Leave me alone."
6. Suggest that your child stick with two or more other children when at the playground, the bus stop or wherever she comes face-to-face with the bully.
7. Make sure your child knows it is okay to ask for help from a teacher or other adult. Practice what he'll say so he doesn't sound like he's whining or tattling.
8. Determine if your child has healthy friendships with other children. If not, perhaps she can benefit by developing better social skills. Encourage her to invite friends over to your home and participate in school activities.
9. If necessary, meet with school representatives to discuss the problem.

Remember, bullying is not a normal part of growing up. Help your child develop the necessary tools to stick up for himself and others.

Sources:

• The Heroes and Dreams Foundation

Child therapy can address anger management to help your son or daughter. While parents can work with their child at home to reduce anger issues, therapy is often needed, too. As a parent, how do you know when child therapy is needed for anger management?

Feeling angry isn’t a problem, even for kids. Anger is just another human emotion that emerges when a child’s needs are unmet or thwarted. When someone or something threatens their sense of wellbeing, such as feeling accepted, safe, and physically and emotionally healthy, kids frequently react in anger. Healthy anger is in proportion to the circumstances that cause it, so children can manage it appropriately with a bit of help from parents or teachers. Anger can be positive when it motivates someone to change a situation or even themselves.

Anger becomes a problem for kids when it:

• Is frequent and/or long-lasting
• Is intense
• Disturbs relationships with family and/or school
• Masks other feelings
• Is destructive and harms others

If your child’s anger is spiraling out of control, it may be time to consider child therapy for anger management.

Purpose of Child Therapy for Anger Management

In general, therapists working with kids for anger issues seek to help them manage existing anger and to prevent anger reactions in the future. These are both skills that many children lack but are ones that can be learned and used.

To accomplish these goals, therapists work with kids to help them explore and understand their anger and what triggers it. A child can’t begin to manage their anger if they don’t understand why they feel so angry, even explosive, and don’t know what makes them feel that way.

Therapists also go a bit deeper to uncover whether anything underlies the strong emotion. This looks beyond what the trigger is to determine why that thing elicits such an extreme response. Sometimes, other concerns such as undiagnosed ADHD, anxiety, autism spectrum disorder (ASD), or learning disabilities are highly frustrating and overwhelming, causing kids to react in anger.

When children start anger management counseling, the therapist begins to understand them by listening and determining what, exactly, they’re communicating through their anger. They use assessment tools to determine how they can help a child with their anger. Some tools they use include:

• Children’s Inventory Anger Game
• Drawings
• Free play
• Self-rating scales where kids rate their anger levels in various situations

Child counseling for anger management isn’t one-size-fits-all. All children are unique, and so is their anger. Therefore, therapy is individualized to help a specific child with their specific anger. This is the case whether the child attends traditional therapy or play therapy.

How Traditional Child Therapy Addresses Anger Management

Also known as talk therapy, this approach involves mostly talking with children on their level, made possible with the use of games and similar activities. A common belief about anger in kids is that angry behavior happens because a child lacks the necessary skills to recognize, monitor, and adjust their emotions and behavior.

Child therapists facilitate anger management by teaching skills and practicing them with the child. These are examples of skills children learn:

• Emotional regulation
• Identifying situations that calm and those that trigger anger, and the ability to use the information to choose healthy settings
• Changing aspects of a situation that can be changed to positively impact emotions
• Identifying and changing thoughts and judgments about a situation and/or their ability to handle it (CBT skills)
• Becoming aware of angry, emotional reactions and modifying responses as they’re happening

These techniques of traditional therapy are proven to be effective. They don’t work for every child, though. Another option is play therapy for anger.

Play Therapy for Anger Management

Play therapy works for a wide variety of children and types of anger. Play is a natural way for a child to communicate. Children lack the verbal skills needed to talk about their inner experiences and often even their experiences in the world around them. Play therapy gets around this obstacle by letting kids communicate through play.

Play therapy techniques for anger allow play therapists to address anger management with children. Kids explore their feelings and reactions, their intense anger, and different ways to handle and change angry feelings in the following ways (a partial list):

• Puppets
• Clay
• Drawing/painting
• Games about anger management
• Music (making music and listening to songs)
• Movies (watching segments of movies to identify anger management techniques)
• Breathing techniques

With play, children can work through inner conflict and address situational conflicts. Then, they are ready to determine ways to manage and rise above their anger.

Child therapy can play a significant role in helping children with anger management so they can be successful at home and at school.

See Also:

• What Can Family and Child Counseling Do for Your Family?
• Are There Downsides to Participating in Child Therapy Groups?

article references

The mental health of your child is as important as his/her physical health. Learn more about mental health problems in children and how to nurture your child's mental health.

Mental health is how people think, feel, and act as they face life's situations. It affects how people handle stress, relate to one another, and make decisions. Mental health influences the ways individuals look at themselves, their lives, and others in their lives. Like physical health, mental health is important at every stage of life.

All aspects of our lives are affected by our mental health. Caring for and protecting our children is an obligation and is critical to their daily lives and their independence.

Children and Adolescents Can Have Serious Mental Health Problems

Like adults, children and adolescents can have mental health disorders that interfere with the way they think, feel, and act. When untreated, mental health disorders can lead to school failure, family conflicts, drug abuse, violence, and even suicide. Untreated mental health disorders can be very costly to families, communities, and the health care system.

(Ed. Note: Many children and adolescents have periods of emotional stress that would benefit from short-term treatment, but those problems would not necessarily result in what is called a "diagnosable" mental health problem. Examples of these mental health problems may include grieving the recent loss of a loved one or improving family relationships. A child's mental health has no relationship to his or her intellectual capacity. Children with and without the above mental health problems have IQ's that range from low, ie. mental retardation, to high.)

Mental Health Disorders Are More Common in Young People than Many Realize

Studies show that at least one in five children and adolescents have a mental health disorder. ("Mental Health Problems" for children and adolescents refers to the range of all diagnosable emotional, behavioral, and mental disorders. They include depression, attention-deficit/hyperactivity disorder, and anxiety, conduct, and eating disorders.) At least one in 10, or about 6 million people, have a serious emotional disturbance. ("Serious Emotional Disturbances" for children and adolescents refers to the above disorders when they severely disrupt daily functioning in home, school, or community.) Tragically, an estimated two-thirds of all young people with mental health problems are not getting the help they need.

The Causes of Mental Health Problems in Children Are Complicated

Mental health disorders in children and adolescents are caused mostly by biology and environment. Examples of biological causes are genetics, chemical imbalances in the body, or damage to the central nervous system, such as a head injury. Many environmental factors also put young people at risk for developing mental health disorders. Examples include:

• Exposure to environmental toxins, such as high levels of lead;
• Exposure to violence, such as witnessing or being the victim of physical or sexual abuse, drive-by shootings, muggings, or other disasters;
• Stress related to chronic poverty, discrimination, or other serious hardships; and
• The loss of important people through death, divorce, or broken relationships.

Signs of Mental Health Disorders Can Signal a Need for Help

It's easy for parents to recognize when a child has a high fever. A child's mental health problem may be more difficult to identify. Mental health problems can't always be seen. But the symptoms can be recognized.

Children and adolescents with mental health issues need to get help as soon as possible. A variety of signs may point to mental health disorders or serious emotional disturbances in children or adolescents. Pay attention if a child or adolescent you know has any of these warning signs:

A child or adolescent is troubled by feeling:

• Sad and hopeless for no reason, and these feelings do not go away.
• Very angry most of the time and crying a lot or overreacting to things.
• Worthless or guilty often.
• Anxious or worried often.
• Unable to get over a loss or death of someone important.
• Extremely fearful or having unexplained fears.
• Constantly concerned about physical problems or physical appearance.
• Frightened that his or her mind either is controlled or is out of control.

A child or adolescent experiences big changes, such as:

• Showing declining performance in school.
• Losing interest in things once enjoyed.
• Experiencing unexplained changes in sleeping or eating patterns.
• Avoiding friends or family and wanting to be alone all the time.
• Daydreaming too much and not completing tasks.
• Feeling life is too hard to handle.
• Hearing voices that cannot be explained.
• Experiencing suicidal thoughts.

A child or adolescent experiences:

• Poor concentration and is unable to think straight or make up his or her mind.
• An inability to sit still or focus attention.
• Worry about being harmed, hurting others, or doing something "bad".
• A need to wash, clean things, or perform certain routines hundreds of times a day, in order to avoid an unsubstantiated danger.
• Racing thoughts that are almost too fast to follow.
• Persistent nightmares.

A child or adolescent behaves in ways that cause problems, such as:

• Using alcohol or other drugs.
• Eating large amounts of food and then purging, or abusing laxatives, to avoid weight gain.
• Dieting and/or exercising obsessively.
• Violating the rights of others or constantly breaking the law without regard for other people.
• Setting fires.
• Doing things that can be life-threatening.
• Killing animals.

Comprehensive Services through Systems of Care Can Help

Some children diagnosed with severe mental health disorders may be eligible for comprehensive and community-based services through systems of care. Systems of care help children with serious emotional disturbances and their families cope with the challenges of difficult mental, emotional, or behavioral problems. 

Finding the Right Services Is Critical

To find the right services for their children, families can do the following:

• Get accurate information from hotlines, libraries, or other sources.
• Seek referrals from professionals.
• Ask questions about treatments and services.
• Talk to other families in their communities.
• Find family network organizations.

It is critical that people who are not satisfied with the mental health care they receive discuss their concerns with providers, ask for information, and seek help from other sources.

Don't Give Up

It's important that you keep looking until you find the right services for your child. Some children and families need counseling or family supports. Others may need medical care, residential care, day treatment, education services, legal assistance, rights protection, transportation, or case management.

Some families don't seek help because they are afraid of what other people may say or think. Other barriers also may get in the way, such as the cost of care, limited insurance benefits, or no health insurance. While these may be problems for your family, treatment is necessary. Some mental health providers and community mental health centers charge fees on a sliding scale based on a family's ability to pay.

Seeking help may require a lot of patience and persistence on your part. Be assured that there are several national organizations and advocacy groups that can help you find services in your community.

Nurturing Your Child's Mental Health

As parents, you are responsible for your children's physical safety and emotional well-being. There is no one right way to raise a child. Parenting styles vary, but all caregivers should agree on expectations for your child. The following suggestions are not meant to be complete. Many good books are available in libraries or at bookstores on developmental stages, constructive problem-solving, discipline styles, and other parenting skills.

Do your best to provide a safe home and community for your child, as well as nutritious meals, regular health check-ups, immunizations, and exercise. Be aware of stages in child development so you don't expect too much or too little from your child.

Encourage your child to express his or her feelings; respect those feelings. Let your child know that everyone experiences pain, fear, anger, and anxiety. Try to learn the source of these feelings. Help your child express anger positively, without resorting to violence.

Promote mutual respect and trust. Keep your voice level down--even when you don't agree. Keep communication channels open.

Listen to your child. Use words and examples your child can understand. Encourage questions. Provide comfort and assurance. Be honest. Focus on the positives. Express your willingness to talk about any subject.

Look at your own problem-solving and coping skills. Are you setting a good example? Seek help if you are overwhelmed by your child's feelings or behaviors or if you are unable to control your own frustration or anger.

Encourage your child's talents and accept limitations. Set goals based on the child's abilities and interests--not someone else's expectations. Celebrate accomplishments. Don't compare your child's abilities to those of other children; appreciate the uniqueness of your child. Spend time regularly with your child.

Foster your child's independence and self-worth. Help your child deal with life's ups and downs. Show confidence in your child's ability to handle problems and tackle new experiences.

Discipline constructively, fairly, and consistently. (Discipline is a form of teaching, not physical punishment.) All children and families are different; learn what is effective for your child. Show approval for positive behaviors. Help your child learn from his or her mistakes.

Love unconditionally. Teach the value of apologies, cooperation, patience, forgiveness, and consideration for others. Do not expect to be perfect; parenting is a difficult job.

Important Messages About Child and Adolescent Mental Health:

• Every child's mental health is important.
• Many children have mental health problems.
• These problems are real, painful, and can be severe.
• Mental health problems can be recognized and treated.
• Caring families and communities working together can help.
• Information is available; call 1-800-789-2647.

Source

• SAMHSA's National Mental Health Information Center

Find out how to help your child deal with bullies and bullying.

The Psychological Impact of Being Bullied

Ask any child what a bully looks like, and he or she is likely to describe someone who is bigger and stronger. Yet, while bullies certainly are known for their ability to overpower others physically, mental bullying can be just as damaging to children.

When children are picked on by bullies, whether physically or mentally, many feel the need to suffer in silence for fear that speaking up will provoke further torture. But bullying is not a problem that usually just takes care of itself. Action needs to be taken.

Parents and caregivers are sometimes reluctant to intervene in conflicts between children but they can teach children not to take part in—or become victims of—bullying. Children can be taught to assert themselves effectively. As a caring adult, you can:

• Demonstrate assertive behavior. Teach children to ask for things directly and respond directly to each other. It is OK to say "no" to an unacceptable demand. Let children role-play with puppets or dolls.
• Teach social skills. Suggest ways for children to compromise or to express their feelings in a positive way. Show children how to resolve problems firmly and fairly.
• Identify potential friendship problems and correct them. Teach children how to ignore routine teasing. Not all provocative behavior must be acknowledged. Teach children the value of making new friends.
• Teach common courtesy skills. Teach children to ask nicely and to respond appropriately to polite requests.
• Identify ways to respond to bullies. Help children identify acts of aggression, bossiness or discrimination. Encourage children not to give up objects or territory to bullies. This discourages bullying behavior.
• Demonstrate the rewards of personal achievement. Teach children to trust and value their own feelings. They will be more likely to resist peer pressure, respect warm and caring adults, and be successful in achieving their personal goals.

Children who are victims or witnesses to acts of bullying often suffer from serious emotional problems including depression and anxiety. If your child is facing this problem, please take action along with seeking professional help for mental health concerns.

Sources:

• SAMHSA'S National Mental Health Information Center

Learn how kids react to bullies and what the victim of a bully can do to put an end to bullying.

by Kathy Noll- author of the book: "Taking The Bully By The Horns"

Did you know that 23% of 9th graders have carried a weapon to school recently? According to the U.S. Justice Department, one out of three kids will be offered or sold drugs at school while one out of four kids is bullied either mentally or physically every day. Do we really know what happens to our kids when they leave the safety of our homes to go to school?

Unfortunately, bullying and child violence have become quite common themes in every school across the country, and outside the U.S. as well.

Dr. Jay Carter and I have written a book and run a web site that helps parents, teachers, and kids learn the skills they need to deal with bullies and low self-esteem. On this journey, we've encountered many sad stories that are all too real.

One that really stands out in my mind, and heart, is in the form of a letter written by a woman in IL. She starts out by thanking me for writing my book and wishing she would've had it for her son, Ricky, 5 years earlier.

Ricky was tormented every day at school by his "bullies." He was an asthmatic, and continually his classmates would take his inhaler medication from him to spray on themselves, in the air - essentially wasting it. This went on until one cold day in December 1994, that has left his mother devastated. Ricky was found dead at school. He died of an asthma attack. His inhaler, found empty.

This is only one of many depressing stories. We've all had bad experiences to some degree that seem to be too close to home. But what can we do?

One of the things that Dr. Carter and myself did to bring awareness was in collaboration with NBC10 News out of Philadelphia. At a local middle school, we hid 5 cameras in a classroom of 8th graders. Only one child, Jonathan, was in on our "sting" operation. He played the role of a bully while wearing a wired microphone. We then hid in a nearby classroom and monitored his classmates' reactions as he proceeded to harass them. He harassed them with the arrogance that only a bully knows. We had him making fun of people, pushing and shoving, and giving off a real "I'm the only all-important one" attitude!

The reactions varied as you can imagine. They were about as different as every child's personality. Some moved out of his way, timid and frightened, while others stood up for themselves screaming, "Get some manners!" One girl smacked him in the forehead! But we were also touched by the concern of many. We listened as they approached the teacher and expressed concern for Jonathan's behavior. They felt he must really be hurting inside to be taking out so much frustration on them.

Bullies really do have low self-esteem. If there is something about themselves they don't like, they feel that by putting you down, and teasing you, they are distracting from their own problems. Bullies are also angry. Most likely they were also bullied at some point. We call this the "Bully Cycle." Also in question would be the negative influence of peers, caretakers who may have abused or enabled them, and exposure to violence in the media.

What can the victim do about his/her bully? Try confronting them and telling them how they are making you feel. "What did I do to you?" In many situations, ignoring has the best results. If the bully no longer gets a reaction out of you, he/she will usually move on. It is no longer any fun. But what about the bully who is very abusive or violent? Make sure the school knows what is going on, and if they are unwilling to get involved, you need to contact the bully's parents. This type of bully should be avoided at all costs. Traveling to school in a group, and staying away from empty buildings are other wise options.

I'm sure you'll all agree that both the victims and bullies need help and support. Teach them that their actions have consequences. Instill in them the Rules for Fighting Fair: Identify the problem. Focus on the problem. Attack the problem, not the person. Listen with an open mind. Treat a person's feelings with respect. And finally - Take responsibility for your actions.

Let's all do our part to help prevent the children of our future from becoming "statistics."

If you are interested in seeing the segment we filmed for the 6 o'clock news at NBC10 in Philadelphia, please contact your local NBC stations and ask them to carry the piece on bullies that appeared Feb. 15, 2000.

Kathy Noll has written a series of articles on bullies and how to deal with bullies.

• Child on Child Violence
• Bullies Help For Parents and Teachers
• Bully Advice For Kids

If you'd like to learn more about bully and self-esteem issues, purchase Kathy Knoll's book: Taking The Bully By The Horn.

For many kids, child therapy groups are helpful. When child psychology researchers analyzed 56 studies about the effectiveness of group therapy in children and teens, they discovered that children and adolescents who participated in child therapy groups did better at the end of treatment than 73% percent of those that didn’t receive group therapy (Hoag & Burlingame, 2009).

Group therapy can be effective for a lot of kids and teens because it meets them where they are. Children have limited capacity to understand and talk about emotions. Teens naturally turn to peers more than they do adults. Guided interactions with peers, social skills building, and immediate peer feedback about how a participant’s behavior and emotions affect others are all aspects of adolescent and child therapy groups that make them successful.

Group therapy involves approximately six or eight members (sometimes more) meeting together with one or two therapists to work collectively to overcome a specific problem or learn new life skills. Members are screened for readiness and fit in a group. Groups can meet for varying amounts of time, and sessions typically last between six and 12 weeks. Adolescent and child therapy groups are comprised of children of approximately the same age, so peer interaction is natural and helpful.

Let’s look at what group therapy has to offer kids and teens as well as the downsides to participating in child therapy groups.

Purpose of Child Therapy Groups

The general goals of group therapy for children and adolescents are to

• Give participants a chance to communicate and be heard by peers
• Help them learn listening skills
• Provide opportunities to be respected and to give respect

Counseling groups can accomplish what individual therapy cannot. They can replicate difficulties faced in large group settings like classrooms, the playground, and activities. Group members participate in activities with each other that help them learn how to navigate group settings in their lives.

Each child therapy group has a unique purpose. They might center around specific problems like anxiety (including social anxiety), depression, eating disorders, grief and loss, bullying, or myriad other mental health concerns. Some groups are designed for skills improvement, addressing social skills, problem-solving strategies, skills needed for emotional regulation, or self-esteem-building skills.

When kids and teens can interact with each other and a group therapist to address these issues and more, they can reap numerous benefits.

How Child Therapy Groups Benefit Kids, Teens

Adolescents who participate in child therapy groups gain many age-appropriate improvements to help them navigate middle- and high school. Among them are

• Self-confidence, including confidence in social settings
• A sense of validation—other teens understand and share similar struggles
• Knowing that they’re not alone, that they have support from group members
• Improved communication skills
• Improved relationships with family, teachers, and, especially, peers
• Better coping skills for frustrations and problems, including handling and reducing stress

Children’s groups are often play therapy groups. Through play and in interacting with other children, participants enhance self-awareness, self-regulation, and empathy. Children’s play therapy groups decrease behavior problems by teaching important social skills through games and other interactive activities.

Adolescents and children can gain much from group counseling. However, this type of therapy is not for everyone. It has drawbacks that might outweigh the benefits for some children.

The Downsides to Participating in Child Therapy Groups

Treatment in group settings doesn’t work for all kids and teens. In some situations, the risk of harm to an individual and to all group members is greater than the potential benefits. For example, youth in crisis or who are suicidal should be counseled individually rather than in a group setting. Children or adolescents with extreme social anxiety would only have that anxiety exacerbated if they had to participate in group counseling.

Other disadvantages to group counseling for youth include:

• Personality clashes that detract from the forward movement of the whole group
• Unwanted and unkind comments from group members to each other
• Frustrations caused by participants interrupting each other or not taking activities seriously
• Trust/mistrust problems can make group members afraid to speak honestly
• Potential breaks in confidentiality (comments are supposed to stay in the group, but there isn’t a guarantee that members won’t talk about each other outside the group)

Child therapy groups can be positive, helpful experiences for a lot of kids and teens. Despite the benefits, counseling groups have risks. It’s important to carefully consider potential downsides before enrolling your child or teen in a group therapy program.

See Also:

• What Can Family and Child Counseling Do for Your Family?
• How Does Child Therapy Address Anger Management?

article references