Category: Anxiety, Depression & More

Holidays and Family Estrangement

Lonely looking senior looking out the window at the treesFamily estrangement refers to the loss of a former relationship between parents and children, siblings or other extended family members. Holidays are times when this estrangement can lead to anxiousness, PTS and other conditions. Estrangement reflects physical or emotional distancing and minimal contact or communication for an extended period. It can result from many things: physical, sexual, verbal, child or elder abuse, neglect, divorce, trauma, money, inheritances, substance abuse or something else. When people are estranged from their parents, their feelings may often be complicated. There may be a mix of relief, grief, sadness or anger. Often they see the decision to cut ties with that family member as a life-saving measure.

Estrangement: An example

One young man I’ve worked with was sexually abused for 5 years as a Adolescent girl standing and looking bored with her face resting on her handchild by his older, schizophrenic brother after his father died. When he finally told someone at his school, the Department of Social Services intervened.  He was moved to his aunt’s house where he lived until graduation. Since he has no contact with that brother who currently lives with their mother, he also has no communication with her. This is a choice he made for his own mental health. He believes his mother chose his brother’s well-being over his own.  In order to move on with his life and cultivate healthier relationships, he needed to sever their communication. He still deals with his traumatic past when memories arise periodically, but he’s been able to find a loving partner and create his own family.

How to manage the holidays with estranged family members

If you decide to see estranged family members over the holidays, it’s critical to establish clear, firm boundaries about your contact. Consider emailing in advance. Let et them know what you don’t want to discuss and what you do. Often these visits can be very triggering and activate old wounds.

If you feel afraid that the contact will not be safe for you, it’s okay not to push yourself.

Ask yourself these questions if you choose to interact:

      • A mother and daughter sitting and looking distraughtHow long can I actually spend with this person before I start to feel overwhelmed or uncomfortable?
      • What is my safety plan for when I am triggered?
      • Who is my ally in this situation? What is my plan for checking in with them throughout the gathering?
      • How can I appropriately leave when I need to and where will I go?
      • Who will help me process this experience when it’s over just in case I need that?

Whether you choose to connect with an estranged family member or not, check in with yourself. This has been a hard year, make sure you aren’t putting more on your shoulders than you can handle this year.

Read more blog posts:

Source: Span, P. (2020, September 10). The causes of estrangement, and how families heal. The New York Times. Retrieved December 20, 2021, from https://www.nytimes.com/2020/09/10/well/family/family-estrangement.html

 

Gratitude in an Age of Uncertainty

Mother smiling in the living room, cuddling with her two young adolescent childrenIt’s clear that this holiday season won’t look like anything we’re accustomed to. Unable to gather safely with beloved family and friends, many of us (myself included) are planning for much smaller dinners. With all of the uncertainty we’ve been facing as individuals and as a country, it’s more important than ever to teach and practice gratitude for what we have and what’s gone well. How can you do this when you (and your family) may be frustrated, disappointed and anxious?

Gratitude: Thankful

Words such as "Thank you" "Heroes" "Doctors" "Nurses" "Courage" and more, written in black blue and red and aligned in the shape of a heart

The Cambridge Dictionary defines gratitude as “a strong feeling of appreciation to someone or something for what the person has done to help you.” I like this definition because it’s grounded in human relationships, and is more specific than ‘being thankful.’

For some people, it may be easy to feel generally thankful. For others, it may be tougher. Perhaps someone you care about has been sick or died; your children are struggling with remote/hybrid school; or you are dealing with food, housing or job insecurity. Whatever your particular situation may be, shifting the focus and noticing how someone has helped in recent months may open your eyes and your heart to a more accessible type of gratitude.

Expressing appreciation can lead to stronger relationships

An adult standing in front of a blank background, holding their hands over the heart and smiling at the camera.

In our crazy busy lives, we may toss a perfunctory ‘thank you’ for a small act of kindness without wholeheartedly expressing it. Though we may value a patient teacher, an attentive nurse or a competent mechanic, we often don’t take the time to let them know. I believe that the holiday season, starting with Thanksgiving and continuing on through the New Year, offers us an opportunity to express genuine gratitude with people who have touched our lives.

Children and teens with ADHD, who may miss social cues or be unaware of how their actions impact others, really benefit from slowing down and taking stock of helpers in their lives. Teaching kids to notice how people treat them and how to acknowledge consideration and generosity shows them that these qualities matter. They learn compassion, understanding and empathy.

Here are a few tips to practice gratitude in your family this year:

1. Notice what you have, not what you don’t.

We all can live in the ‘shoulds’ and ‘wants’. “I should be able to do X.” “I want a new phone.” When your son or daughter rails on how unfair it is that they don’t have this or that, trying to convince them otherwise wastes your time and energy. Instead of lecturing them and going negative  yourself, take a deep breath, validate their longing and encourage them to keep a list of what they want for the future. Try not to engage but, if you must say something, remind them to focus on what they have and set goals for getting what they want.

2. Build awareness of gratitude: A family activity

Toddler in a yellow shirt holding up a handwritten card that says "Thank you" in different colors.

Grab a stack of Post-Its or scrap paper, and gather your kids together for a 15 minute activity. Ask them to write down 3 specific things in their lives that they appreciate. From sports teams, to their iPad, to hot showers–anything is acceptable.

Next, ask them to connect those items to the person who made sure they happened or provided them. Post these on a large piece of paper, bulletin board or wall in a common area, such as the kitchen or living room. This activity helps your kids see that the cool stuff in their lives is linked to real people.

3. Express gratitude, simply or creatively:

Family around the thanksgiving table, holding a tablet device to connect with other family member virtually.

Similar to learning how to give an authentic apology, kids with ADHD may not express appreciation as we typically expect. While eye contact and a heartfelt ‘thank you’ are ideal, your child or teen may do better with writing or expressing their gratitude in other ways.

Consider doing something fun this holiday: Write everybody’s name down on separate pieces of paper. Then, place them in a hat. Have each family member pick a name, and then write or draw a thank you note for an act of kindness that person has shown during the past week, month or year. Place these notes on plates, and open them together before your meal.

The day after Thanksgiving is also a holiday

The day after Thanksgiving is often filled with Black Friday shopping. But, it’s also a holiday. On October 8, 2008, President George W. Bush signed The Native American Heritage Day bill into law. This day is designated to pay tribute to Native Americans and their important legacy. Consider taking a few minutes to talk with your children about these contributions and how they have enriched our lives.

Read more blog posts:

Source: Meaning of gratitude in English. Cambridge English Dictionary. (n.d.). Retrieved December 20, 2021, from https://dictionary.cambridge.org/us/dictionary/english/gratitude

 

Reducing Teen Stress and Anxiety during Pandemic

The Enormity of the COVID19 Experience

My heart goes out to teens and young adults. Staying compassionate, offering to collaborate on tasks and being available to talk through emotions is critical in reducing teen stress and anxiety during this pandemic. Don’t try to solve issues. Offer suggestions and avoid getting hurt if they aren’t taken. Young adults often like to figure things out for themselves, which means trial-and-error learning. Sometimes the best support you can give is managing your own frustrations, sharing your feelings without blame or guilt and validating their successes.

Strategies and Practical Approaches that WORK

  1. Help teens acknowledge these uncomfortable feelings without trying to fix them – It’s natural to have low morale and feel stuck right now. This situation is no one’s fault and everybody is trying hard to manage the best they can. Focus on building their resilience. Consider past difficulties and reflect on how they overcame them. Explore how those strategies could apply to current challenges. Write these strategies down so teens can refer to them later.

  2. Set realistic and appropriate goals – Teens may not be able to concentrate with hybrid learning as well as they have in the past. Keeping that in mind, work together and come up with do-able daily and/or weekly routines. Collaborate on a daily schedule that includes timed work and break periods, exercise, physical distance socializing and screen-free times. Having a reliable routine will keep kids grounded and on track. It helps them with predictability in these uncertain times.

  3. Instill gratitude – every day, no matter how small, find one thing to be grateful for.  Eating a yummy dinner, FaceTiming with a dear friend or playing a fun video game. It’s easy for teens to dismiss what they have in favor of longing for what they don’t. Help them shift their perspective to see the positive things that are going on instead of focusing on the things they are missing.

  4. Wonder instead of worry – When teens don’t know what to expect and feel perpetually uncertain, their anxiety increases. In these times, they’re likely to act out because they may not have the language to express the combination of anger, frustration, sadness and worry that’s underneath their behavior. Help them tolerate the insecurity and pivot. Being curious instead of worrying means wondering about possible outcomes from a place of confidence that they can handle whatever arises.

To be honest, I used mental health days with my daughter when she was a teenager. About twice a semester, she would hit a wall: she needed sleep and some down time to get her head back in the game.  So, we periodically gave her a “Sick-and-Tired” day off from school. It wasn’t planned but we had agreed as a family in advance that she could have 2 such days per semester. It was a successful collaboration: she felt that she got the mental health day she needed and we saw a positive difference when she returned to school.

Deeper Dive:

https://drsharonsaline.com/2020/06/30/whats-a-normal-level-of-anxiety/ https://drsharonsaline.com/2020/03/10/kids-and-mental-health-days/    

ExQ Infinite Know How: Confident and Curious Webinar

Now that the novelty of returning to school has started to wear off, our students are facing the reality of hybrid and online learning. The 2020-21 academic year promises to amplify anxiety that complicates a successful educational experience. Given the very real challenges students, teachers and parents are confronting daily, ordinary worries about academics, extracurricular activities and social relationships seem to be ballooning into troublesome anxiety. Steps taken by well-intentioned adults might actually be counterproductive for students coping with the unusual stress of this complicated time. Educators need new techniques for helping children and teens manage their anxiety so they can learn more effectively. Join Sucheta Kamath, CEO & Founder of ExQ and her collaborator an author and a clinical psychologist Dr. Sharon Saline, Ph.D. to learn about tips and tricks from their collective toolboxes to help improve daily interactions between anxious students and those who care for them. Click here to access the Webinar Guide. Click the logo below to watch the Webinar.

Teens with ADHD Habits that Hurt their Mental Health and How to Change Them

In the course of the past few months, I’ve seen a few major habits in teens that seem to be hurting their mental health more than help them. Here are my recent observations and some tips to turn these behaviors around.

Too much time on social media

Social media not only seems to suck up time faster than you notice but it also is built so that people compare themselves to others. These comparisons are rarely favorable and people walk away with not feeling positive about themselves. As one adolescent girl told me, “No one ever posts pictures of their face mid-menstrual break-out or of their bombed test grade.” Teens especially feel pressured to keep up with friends, stay in touch and maintain an image that they’ve created. This creates more stress in their lives which interrupts their ability to reflect on themselves, what they think and create a sturdy sense of self.  Tip: Schedule screen-free time during each day. Whether it’s during a meal or after-school to take a break, help teens create some screen-free time to give their eyes and their brains some much-need time away from technology to recover. 

Eating fast food on the run

We are so much of what we eat and we eat non-nutritious food quickly, we’re not providing our brains or bodies with the appropriate fuel needed to think and function well. Sharing a meal is not only good for adolescent physiology but it also provides an opportunity for them to connect with people face-to-face and talk about our lives. During a sit down meal, our bodies slow down and properly digest our food so we can ::absorbe the nutrients and simultaneously take a much-needed break from the chaos of our lives. Tip: Create regular family meals in your routine. Set aside particular days and times when the family gathers together to share some nourishment. Engage your teen in cooking as well. This is a great opportunity for them to learn a useful and rewarding life skill as well. 

Having arguments via texting or emailing

girl texting on the phone with her mom standing behind her looking at her watch

Nobody can take an emotional weather report via electronic communication. If you say something difficult or sensitive this way, there’s no way to perceive how your words affect the other person. You also may not perceive whatever feelings are brewing inside them. It’s easier to disengage and avoid accountability for your words and actions. Teens need to learn and practice interactional skills not only for healthy personal relationships but also for school, work and life situations where they have to deal with others.  Tip: Assist your teen in dealing with issues more directly, either by phone call, Zoom or safely in-person. Help them come up with some phrases they can say and role play these conversations so they feel more comfortable and confident.

Giving up before they even start

girl looking down and sad with a scribbled thought bubble drawn beside her head

Many teens with ADHD struggle with low motivation, negative outlooks and avoidance procrastination. They put off activities–homework, chores or hygiene–because they don’t enjoy them and may not see the value in them. Many kids have a history of not succeeding despite exerting themselves.  They don’t believe that they can do anything differently now. An adolescent boy told me, “I’ve tried before and failed so why would it be any different now?”  Tip: Break tasks down into smaller chunks. This will make projects more manageable. Help kids recall times when they made efforts and succeeded. Clarify what tools and actions they had used. Notice their efforting–their progress towards a goal and encourage them along the way. 

 

Message to Tween, Teens and Young Adults During Covid

This can be a tough time for emerging adults.

Seven months into the pandemic, and things are still “far from normal”. You’ve lost so much of what was familiar, valued and fun in your lives–being on campus and attending in-person classes, socializing with peers, working, romantic relationships, etc. It’s natural to feel sad, lonely, anxious, frustrated and disappointed. These are some comments I hear from my clients: “I can’t do anything!” “School is now only Zoom. ,All the good stuff is gone, and all we do now is work.” If your parents or other family members are pressuring you to do more, be happy and act grateful for what you have, it’s really important that you let them know how you feel. You’re struggling a bit. You need empathy not criticism. Consider saying something like: “This has been a hard time for me and most people my age. I’m doing the best I can to shift and accommodate the changes but some days it’s tougher than others.”

Don’t Struggle Alone

Contact your primary care provider or your college’s counseling services to get the names of mental health practitioners if you find that you’re:

  • sad or anxious most days
  • lonely and need someone to talk to
  • your sleep or appetite are disrupted (too much or not enough)
  • have trouble concentrating or taking pleasure in activities that you once enjoyed overusing alcohol or drugs

Ask for Help

Ask your parents if they can assist you in finding someone to talk to which can be intimidating and complicated for many young adults. Try telling them: “I think it would be good for me to find someone to talk to. I don’t want to worry you. I just have some things on my mind that I’d like to sort out.” Since untreated anxiety leads to depression and persistent depression is a debilitating condition, get some help now before things take a more serious turn.

Don’t give up. Something good is around the corner, promise! Learn more about School and Learning  

ADHD and Anger: Tools for Reducing Family Conflict by Starting with Yourself

Adolescent with ADHD holding her hands to her temples out of annoyance and anger putting her back to her mom as her mom holds her arms out in question behind herIt’s amazing how a small spark of miscommunication or defiance can trigger an explosion in families, especially those living with ADHD. For kids who struggle with executive functioning challenges including working memory, behavioral control and emotional regulation, parents aren’t often sure how to prevent or subdue these fires, symptoms of ADHD and anger, consistently. Instead, you end up playing whack-a-mole–going from one crisis to another and feeling increasingly burned out by the stress from these intense interactions. How can you prepare for the unpredictable nature of angry outbursts, without also resorting to unproductive threats, fruitless punishments and yelling?

Step One: Understand the Root of the Anger

The first thing you need to do is look at the  process of anger instead of focusing on its content.  Your kids can push your buttons like nobody else. It’s almost as if they are wired to know what triggers you and sets things off. You do the same for them. Whether it’s conscious or out of our awareness, family members irritate each other. During this time of hybrid or remote learning with extended and increased family time, everybody’s fuses are short. As parents, we may forget that kids with and without ADHD annoy us and push back for several reasons: 

      • To get what they want.
      • Because it can be fun to see you get upset.
      • In an effort to create space or separation
      • When they feel upset and can’t contain their feelings
      • To demonstrate independent thinking or actions

Kids with ADHD, because of their slower-to-mature executive functioning skills, may engage in these behaviors with more frequency and intensity than their neurotypical peers. We have to help them learn to manage better by monitoring ourselves first. 

Step Two: Know the Parents’ Role

Young boy with ADHD and anger crossing his arms and turning his back to his father who is looking frustrated at him and sitting on the couch with his laptopAs parents, our job, regardless of how provocative our children and teens may be, is to stay steady, centered and neutral. Of course, it’s tough to be calm when your son is cursing at you because you told him to stop gaming now or your daughter is crying because she’s exceeded her time limit on her phone and wants more. Most of us just want the arguing and tears to stop. So we do whatever it takes to make that happen–even if it means giving in to their demands, backtracking on what we say we were going to do or screaming louder to dominate and frighten them. These solutions will not improve your situation.

Step Three: Give Kids the Tools to Manage Emotions

Kids with ADHD need tools to manage the big, tidal waves of emotion that threaten to swallow them up. Sometimes, they will keep on arguing and pushing you even though they know things will end poorly.Marla, age 14, told me: “I don’t want to give in or I can’t give in. Then I’ve lost.” Letting go seems like another failure. Delay tactics, avoidance, and denial are all methods to distract you from holding onto yourself and choosing a different response.

When young male deer or elk come of age, their antlers are covered in velvet. These bulls need to remove this velvet and they rub against trees to do this. They eat, drink, frolic with comrades and continue to come back to the tree for respite and aide. They need assistance taking off their velvet and transitioning to adulthood. Our children do the same. We are the tree: we stay rooted, we weather storms, we offer protection, we may be punctured by a sharp poke from an antler. But we are steady, dependable and strong. The tree never yells at the elk and tells them to back off and go away. The tree may lack the necessary bark to help with the removal of the velvet and may not be able to meet the buck’s needs. That is okay. The bull can roam elsewhere, eventually returning for another attempt to rub away the remnants of adolescence with the bark of that familiar tree. 

Now I’m not saying parents should be silent trees, absorbing abuse from their children. Rather, I’m advocating a position of self-Control rooted in self-awareness and patience. Of course, you have to set limits about inappropriate language, aggression and harmful behaviors. You are still responsible for the health and welfare of your son or daughter and your own sanity matters. What I’m suggesting is that you use this example as a metaphor: to actively say to yourself when your child is having a meltdown (as one of my clients does), “I’m being the tree. I’m being the tree instead of exploding.” You use it as an affirmation, as an image of strength, as a comfort that this too will pass. 

Step Four: Practice the 4 P’s.

Mother trying to get son's attention who is on the computer listening to headphones and raising his hand for his mom to go away

Kids have told me over and over that they don’t like conflict in the family any more than their parents do. This is your golden ticket to reducing arguments with them. Follow these steps to change your approach and respond differently when anger rears its ugly head:

    • Predict:

      Although each situation may vary, the process of how your child or teen responds when they are angry is more consistent. What are the types of responses you notice? How were these issues resolved? Jot down some of your ideas. Then schedule a calm time to discuss the anger pattern with your son or daughter using neutral statements such as “I’ve noticed…” or “It seems like…” Share a few observations about your reactions too.

    • Prepare:

      Preparation leads to success. No, you can’t plan for every situation or eventuality but you can have a basic, consistent approach for when someone is showing you with their bodies, words or actions that they are triggered and losing it. Use Stop, Think, Act (see resources) and plan for a Time-Apart until things cool down. Together, make a list of soothers (activities that settle someone down) to assist with this process.

    • Practice:

      Collaborate on how you’ll decide to call for a Time-Apart and which activity to use. Set a time-limit for this period of regrouping. Remember that it takes the nervous system at least twenty minutes to recover from an acute stress reaction which includes intense anger. New skills and patterns require a lot of repetition and scaffolding for them to take hold. Stay patient and take the long view.

    • Pivot:

      If what you are doing in a given moment to respond to a face-off isn’t working, pivot and try something else. Think outside of the box and leave yourself reminders on your phone or Post-its so you don’t have to come up with something when you’re stressed. You want to let your child or teen know that you mean business without yelling or escalating. To that end, make sure you’ve agreed to a fall- back plan that everyone agrees to. The aim of the agreement is collaboration towards changed family dynamics. Set up a non-cooperation clause from the start.

Father smiling and helping his daughter with ADHD with her homework, who is beside him looking at him and smiling as well Good luck, breathe deeply and remember: stay rooted to rise up.

Read more blog posts:

Watch on YouTube:

Deeper Dive: Anger Management and ADHD https://drsharonsaline.com/product/home-seminar/

Socializing in a Pandemic

People who are very engaged in social media must use caution to ensure that they don’t place more value on their virtual friends, or how many or few they have, versus their in-person relationships. We can all get distracted by the online world, believing that things are happening without us (FOMO: Fear of Missing Out) or feeling pressure to respond to posts immediately. This focus means that we may well struggle with interpersonal conversations, especially about difficult subjects, in real time, face-to-face with true friends. I recommend to all my clients, especially those with ADHD who can struggle socially, that sending messages or ‘talking’ online, where you don’t often see another person’s reaction, can possibly make you misinterpret their intentions. In relationship, we have to learn through interpersonal communication and time spent together in the same space to read each other’s emotional weather report and respond appropriately. When people spend more time engaged with each other rather than their screens, they perceive and understand social nuances and learn how to deal with positive and negative feelings with empathy and consideration. This enriches relationships and deepens connections. Read more:

ADHD and Screen Sanity: Why a digital break is good for everybody right now

Millennial Loneliness and Depression

Change those habits that hurt mental health: Do something different today!

With everybody struggling now more than ever, I see a few major habits in my clients living with ADHD that hurt their mental health more than help them. Let’s look at these behaviors and explore how you can make a few shifts that will improve your family’s daily living and relationships. Instead of trying to change all of these at once, pick one to work on at a time. Notice any progress with specific praise and be patient. Change take time and practice.

  1. Spending too much time on social media: Social media not only seems to use up time faster than everybody notices but it also is built to so that people compare themselves to others. These comparisons are rarely favorable and people walk away with not feeling positive about themselves. As one adolescent girl told me, “No one ever posts pictures of their face mid-menstrual break-out or of their bombed test grade.” Kids feel pressured to keep up with friends, stay in touch and maintain an image that they’ve created. For kids with ADHD who often struggle socially, this creates more stress in their lives. This tension interrupts their ability to reflect on themselves, what they think and create a sturdy sense of self. Solution: Make sure your son or daughter has in-person, COVID safe interactions with peers to balance online socializing. Talk about FOMO and explore the difference between what kids worry about in their minds and what’s actually happening with their friends. Help them create a conversation starter if they are shy or a practiced response when they overwhelmed. Many kids with ADHD need help having a phrase or two in their vocabulary to facilitate connections with peers. Talk with them about the cultivated images other kids post about themselves and how those may contrast with who they are inside. Normalize their insecurities and social challenges and experiences most kids deal with as part of growing up.
  2. Eating meals on the run:  So many kids eat fast food or grab something to munch while watching Youtube videos. Many families eat dinner in front of the television with little conversation. Sitting together to healthy meals build connections while modeling how to slow down and eat socially. When kids rush to gobble a slice of pizza and chips, they’re not providing their brains or bodies with the appropriate fuel needed to think and function well. Solution: Sharing a meal is not only good for our physiology but it also provides an opportunity to connect with people face-to-face and talk about our lives. During a sit down meal, our bodies slow down and properly digest our food so we can absorb the nutrients and simultaneously take a much-needed break from the chaos of our lives. Set aside a few times per week to have a family meal if you can’t do this nightly. Ask your son or daughter about “a high and a low or a happy and a crappy” moment that happened during the day. Even if the meal is short, you’re showing them the importance of healthy eating and how meals are social events.
  3. Having arguments via texting, messaging or emailing: Disagreements that happen over texts can often inflame situations instead of lowering tension. Kids often say things over text that they wouldn’t say in person either because the statements are inappropriate or because young people lack the courage to communicate their thoughts this way. Since we can’t see or perceive the effects of what we are saying via online communication, there’s no way to detect how how the other person is perceiving those words and feeling inside. It’s easier to disengage and avoid accountability for your words and actions. Solution: When we communicate face-to-face, we can detect these reactions. Kids need to learn and practice interactional skills not only for healthy personal relationships but also for school and other life situations where they have to deal with others. Practice direct communication at home with attentive awareness. Give neutral feedback when you notice your son or daughter is upset by saying “I heard you say X, did I get that right?” or “I notice that you are starting to raise your voice. Can you please change your tone?” Ask them to notice your facial reaction and what this is showing them. This helps them become more attuned to the impact of their words and actions on others. Brainstorm other ways to deal with relationship issues so they understand the options they can rely on.