What is loss?

Loss is a separation from someone or something you love or cherish. Losses can be physical (ex: death of a loved one) or symbolic (ex: romantic breakup or school change). Although the information described below will focus on the death of a loved one, it is import to acknowledge that teens experience many symbolic losses during adolescence (ex: termination of friendships, geographic moves, etc.). In order to offer genuine support, it is important that parents also acknowledge these losses as potentially painful experiences that adolescents may grieve.

What do teens understand about death?

Most adolescents have developed the ability to think abstractly. Therefore, usually they can grasp the concept of death as a permanent, irreversible, and universal experience that happens to all people. However, because teenagers have not fully developed long-term thinking skills, teens may still consider themselves immortal and invincible. Therefore, losing a loved can shake up a teen’s worldview and may prompt teens to question their own mortality. This may be especially true if a peer dies, as the death of a young person is typically unexpected.

What is grief?

Grief is a normal process that includes our reactions to loss. These reactions can be experienced and expressed physically, spiritually, psychologically, emotionally, behaviorally, and socially. Our reactions to grief: 1) help us to release the pain of our loss, 2) occur as we adjust to our lives without a loved one, and 3) help us to construct meaning around our experiences of loss.

What do grief reactions look like in teenagers?

It is important for parents to realize that grief may look different in teenagers than in adults. Each teen grieves uniquely and it is possible that two teenagers in the same family may have unparalleled grief responses to the same loss. For example, after the death of a grandparent one teenager may become noncompliant with family rules and have difficulty concentrating in school, and the other may become increasingly responsible and demonstrate improved academic achievement. This is normal and each teen’s grief response deserves acknowledgment and empathy. How a teen responds to the death of a loved one may shift depending on: 1) their emotional level of maturity; 2) their relationship with the deceased; 3) their previous experiences with death and, 4) the nature of the death (anticipated or unexpected).

Below is a list of commonly noted physical, emotional, and psychosocial grief responses teenagers may experience:

• Emotional Reactions: sadness, anger, irritability, guilt, loneliness, turmoil, relief, numbness, helplessness, or feeling abandoned

• Physical Reactions: sweating, nausea, racing heart, tightness in chest, vomiting, no energy, stomachaches, headaches, and bedwetting

• Psychosocial Reactions: Denial, repression, depression, lots of questions or no questions about the death, withdrawal from family, more apt to talk to people outside family, risky behaviors (ex: drug/alcohol use, reckless driving, sexual promiscuity)

What can I do to support healthy grieving in my teen?

1) Permit teens to grieve and model healthy grieving behaviors: Often times, well-intentioned parents try to encourage teens by placing unfair expectations on them such as “be strong” that can restrict how a teen grieves. Parental statements such as “he was just a classmate” also minimize a teen’s grief experience. You can encourage healthy grieving in your teen by letting them know it is okay to show that they are affected by the death of the loved one. Reassure your teen that each of us grieves differently and encourage your teen to find his/her own way to respond to the loss. Model healthy grieving behavior as teens will model you.

2) Listen, accept, encourage, and observe: Teens may be struggling to manage a roller coaster of emotions and thoughts after the death of a loved one. Let your teen know that you are there to talk with them about any thoughts, questions, or feelings they may have about the loss. Be accepting of how a teen feels and validate that emotional experience, even if it may be different than your own. Remain empathic and nonjudgmental. Do not force a teen to talk about the loss if they are not comfortable. Keep an eye out for signs of distress or danger. If your teen exhibits signs of unhealthy coping behaviors, seek professional support.

3) Help your teen find ways to express grief: Many teens prefer to “do” rather than to “talk”. Help your teen find creative ways to express grief such as creating a photo album (physical or virtual) to celebrate their memories with the deceased, journaling, or artistic expression (music, dance, drawing or painting, etc.). Allow your teen to have some choice in which formal grief rituals (ex: funerals) they want to participate in and prepare them for what they might experience during the ritual. Create family rituals that you can do together to celebrate the life of the deceased (ex: planting a memorial tree, candle lighting ceremony, etc.).

4) Maintain consistency with family rules and routines: Death and grief reactions can cause a teen to feel out of control. Teens may test the boundaries and limits. However, it is important to maintain the established limits and consequences—this provides a sense of safety and security in teens.

5) Connect your teen with support groups outside of your family: Your teen may feel more comfortable talking with other teens in a grief group. This can provide a sense of community and help teens know they are not alone. Lastly, help your teen connect with a mental health therapist who can help them process the loss and grieve.

Loss and grief can be difficult to navigate for parents and teens. Remembering these guidelines can help you to support your teenager in their journey to grieve and heal.

References & Resources for Parents:

http://www.wendtcenter.org/
http://childgrief.org/teenspage.htm
http://www.livestrong.com/article/153240-grieving-process-for-teenagers/

Posted by Jocelyn Smith

While temperament may predispose children towards certain responses to emotional experiences, children can also develop emotion regulation strategies through interactions with parents and caregivers. A parent who demonstrates supportiveness, empathy, and responsiveness can help a child develop better emotion regulation skills. A child having difficulty with homework may display frustration and “regulate” this emotion by giving up. Labeling emotions a child is experiencing (“I can see you’re frustrated with your homework”) can both help a child feel supported and promote emotional awareness. Parents might then suggest alternate ways to manage frustration (“try taking a deep breath”), an alternative strategy to manage the problem (“You might want to work on just this one piece”), and encouragement (such as saying “I like how you’re handling this”).

A parent’s supportiveness, empathy, responsiveness, suggestions, and encouragement can generate abilities to regulate emotions to help children perform a variety of tasks such as initiating social interactions and performing chores, and to manage a variety of emotional experiences. Sometimes life experiences, as well as emotional responses, can feel overwhelming to both parents and children. In these instances, therapy can offer a helping hand to support parents and children in the development of emotion regulation skills.

–Posted by Carlo Panlilio

When a child is born they will attach to their primary parent and form a fierce bond with an internal wisdom that this relationship is the key to their survival.   Breastfeeding becomes a metaphor for all their other needs. They seek physical contact, especially when they are in need of nurturance, assistance or reassurance.  Beyond infancy, a child will cry in their parents arms because this is where it is safe to let down, and to process the travails of life.

Adults need an emotional connection in much the same ways.  Dr. Susan Johnson, a Canadian psychologist, writes that “love drives us to bond emotionally with precious few others who offer us safe haven from the storms of life.”  Dr. John Bowlby, a British post-World War II psychiatrist, is considered the founder of attachment theory.  He claimed that we need close, connected, intimate relationships “from the cradle to the grave.”

Couples come into therapy with many difficulties: lack of physical intimacy, disagreements over finances, communication problems and cultural differences.  Dr. Johnson developed Emotionally Focused Therapy, so that couples would be able to rebuild the safe bond and emotional connection between them.   Once that attachment is re-established, the problems may no longer seem as unsolvable.  From a secure base, the couple finds new ways of looking at each other and their lives together.

Resources:

Johnson, Sue (2008).  Hold Me Tight: Seven Conversation s for a Lifetime of Love.  New York: Little Brown Company.

–posted by by Reena Bernards

One of the common fears for parents is that a diagnosis of ADHD will be stigmatizing for their child.   Sometimes an evaluation is put off because of this fear.  In my work with clients who have ADHD, I have learned that knowing the diagnosis is the entry card to the mysterious world of the brain.  Exploring how our brain works and understanding what goes on inside of this world will enable the child to take charge of his own functioning and facilitate progress in learning how to cope with this unique brain.

In my office, I have a basket of “stuff”, collected over time that can be used to construct or symbolize various brain parts and functions.  One of the first exercises in working with a child who has ADHD is to use this “stuff” to construct their unique brain.  There are race cars for the fast parts, feathers for the flighty parts, nuts, bolts and washers for the machine like working parts, clay for the more malleable, flexible parts and many other items that can be used creatively.

As the results of a neuro-psychological evaluation are transformed into these 3 dimensional models, the child begins to take ownership of the various strengths and weaknesses identified by the evaluation.  Suddenly, many parts of day to day functioning take on new meaning.  We can now discuss the neuro-cognitive aspects of living and working with an ADHD brain.

Neuro-cognitive Psychotherapy is a brain-based treatment approach that is a unique blend of cognitive-behavioral therapy and cognitive rehabilitation. This approach is a team approach based in the most recent research on brain functioning and ADHD.  The process integrates the client, the parents, the school and other important caretakers in a coordinated plan for learning and managing the symptoms of ADHD.  The key to building a treatment plan is to understand how the brain works in general and to discover how the brain of a particular child is functioning specifically. This brain based approach starts with a neuro-psychological evaluation that enables us to measure various aspects of executive function, memory function, and processing abilities. This evaluation may also examine emotional strengths and resources that the child has been using to cope with the stress of learning and living.
Once a diagnosis of ADHD has been made, educating the child about the specific strengths and weaknesses in their brain is the next step. In addition to building our own brain models, we may view images of brains from various websites.   Pictures of brains from web sites showing fMRIs have been very helpful. With the fMRI, we can see different areas of the brain light up as one thinks and problem solves. One of the most detailed collections of fMRIs can be found at the Amen Clinic site:  www.amenclinic.com.  You may want to log on to take your own tour of different brain images. We may also make drawings or abstract art that represents the various functions of the brain and how they interact with each other.
As a child comes to understand how his own brain is working, he is encouraged to present his understanding in a family session as a means of educating others in the family. In this way, the child is given power over the ADHD. The stigma that has been associated with inattentive or hyperactive behavior is replaced by knowledge that empowers the child to take more control over his life. The earlier this empowering process can begin, the more opportunity the child has to build compensating strategies, make changes in his environment and develop supportive relationships. Educating the child about his own brain, how it works, and how he can help make it work best is a central part of neuro-cognitive psychotherapy – de-stigmatizing the brain patterns we refer to as ADHD and giving the child a sense of understanding and control.

Gloria Kay Vanderhorst, Ph.D.

www.drvanderhorst.com

Increasing economic mobility, cultural changes, and the rise of no-fault divorce led to a steep rise in divorce about 40 years ago. A child who is born today into an intact family has over a 1/3rd chance of experiencing a family separation. Although most children who endure a family separation do not develop mental health problems, they are at higher risk for mood and conduct problems, and are more likely to experience relationship problems as adults. Children whose families plan separations carefully, and whose parents focus on cooperating and communicating effectively, are much better able to manage the separation, and are at far less risk of developing emotional or behavioral difficulties.

Divorce therapy can help families manage the many tasks of divorce and point the way towards a healthier future for all family members. Divorce therapists help couples clarify the status of their relationships, and if they choose separation, they assist them in doing so in a way that minimizes disruption and lessens traumatic effects on the children. They work with divorcing couples to manage their legal divorce so that it proceeds in an orderly manner and maximizes the well-being of all family members. They help separating spouses to leave their old problematic communication patterns behind and become effective co-parents.

As families separate and divorce, divorce therapists address a number of important family needs. They typically work with individual “households” to establish order, harmony, and new norms and rituals. They take special care to make sure that both parents remain involved in a positive way with their children. They may work with siblings to lessen conflict, adjust to new circumstances, and increase their skills for supporting each other. Therapists may also work with individual children to adjust to their new lives, and assist individual adults as they build new relationships and embark on new endeavors.

Salvador Minuchin, one of the founders of family therapy, once famously said that divorce was “not the end of a family, but the reorganization of a family”. Family therapy can be a very valuable tool for such reorganization.

–Posted by Jonah Green

Many treatments have developed in recent years that address the developmental challenges of those with autism, including speech and language therapy, occupational therapy, and social skills training. Certain recreational activities, and perhaps specialized dietary regimes, may also facilitate the development of children with ASDs. Certain psychotropic medications can result in improved behavior and concentration.

A variety of approaches to addressing autism feature family involvement. “Floor play”, which may improve social and emotion-regulation skills, involves intensive parent-child play. Collaborative Problem Solving, which aims to increase the ability of children to manage their impulses and think more flexibly, as well as Functional Behavioral Analysis, which focuses on improving behaviors, both involve parent-child interaction. Beyond specific approaches, research and experience have shown that parents can take a number of steps to enhance their children’s development, including focusing on strengths, maintaining consistent routines, encouraging play dates, and utilizing “social stories” to enhance social functioning.

Many of the aforementioned treatments are effective, and the approaches that involve parents can help them feel supported and empowered. Even so, none of these treatment approaches address the needs of families as a whole; and the needs can be numerous. While the presence of a child with autism in a family can be rewarding, many families face significant time and resource demands. In addition, stress and conflict frequently accompany the challenges of raising a child with developmental delay.

Stress on families can occur at each stage of a child’s life: family members often feel shock and confusion during the toddler years as they first notice delays and scramble to find accurate diagnoses and effective treatments; anxiety and confusion often accompany the struggle to access appropriate services during the school age years; feelings of anguish and disappointment may accompany the teen years, when parents may witness the rejection of their child by peers as well as continued delay; renewed time and resource demands may accompany the scramble to find services during the transition to adulthood; and family members may experience burn-out as they face the ongoing demands of caring for autistic adults.

Each family member and family relationship faces particular challenges throughout these time periods. Struggles to reconcile differences about parenting and treatment approaches can stress the parental relationship. Siblings may struggle with feelings of embarrassment, and are often jealous at the attention and care that parents give to their siblings; as adults, many face the stress of caretaking. Differences often ensue between extended family members and parents over both the causes and the remedies for the challenges of autistic children.

Family stress and strife can exacerbate the challenges of people with autism. Autistic individuals thrive in consistent, calm environments, and need families to serve as effective advocates and caretakers. When family members are anxious or depressed, they may be less able to access effective treatments. Furthermore, strained family environments may lead autistic children to act out more, and limit their ability to make developmental progress. As a result, stress on the family may increase further, creating a negative cycle.

The treatment that is best positioned to break these negative cycles is family therapy. Viewing families in their entirety, family therapists can address unmet needs in individuals and strengthen particular relationships. They can help family members to support one another and communicate more effectively, and assist them in accessing treatments and resources. They frequently work with parents to strengthen their relationship and develop a unified approach to parenting. They may also work to strengthen sibling relationships, and fortify relationships between individual parents and children.

Successful family therapy can generate “positive cycles” that can benefit all family members. Families can develop more cohesive, orderly, and supportive environments, and become better able to access effective treatment. Autistic children become better equipped to develop themselves socially, emotionally, and academically. As the strengths of autistic children begin to shine through, the positive impact on the whole family creates an even more nurturing and positive environment for growth and development.

–Posted by Jonah Green

12/17/09: A variant of this post can be found in Autmont, the online newsletter and forum for parents in Montgomery County who have children with autism.

With stakes this high, most parents are anxious to find a therapist who will be effective. Therapists for children and adolescents are more likely to be successful if they have the following characteristics:

-They have specific experience and training for working with someone your child’s age as well as particular presenting problem.

-They coordinate their treatment with families and involve families in the treatment, whether or not they conduct “family therapy” proper.

-They listen fully and work to understand situations before offering advice or interpretations.

-They build on the approaches that families already use, and work in consonance with the style and culture of their clients.

-They offer multi-causal explanations for why events occur, and examine how these causes tend to interact with each other. For example, instead of insisting that a misbehaving child acts out because “the parents reinforce it”, an effective therapist might explore how a child’s temperament, communication style, and stressors interact with the communication styles, stressors, and temperaments of all family members, and explore how each of these factors contributes to acting out.

-They maintain a focus throughout their work on the strengths of children and families, even as they directly address the concerns that their clients present with. For instance, in the above example, they would also assist the family in exploring when a child does behave well, and what might be contributing to it.

-They offer ideas and suggestions that spring from individual circumstances and particular family contexts. For instance, instead of jumping to recommend the use of “time-out” for the above child’s misbehavior, the therapist might first explore the stressors on the child, what the family has tried, and the status of relationships throughout the family. On the basis of such explorations, the therapist might recommend that the parents take action to improve their communication, or that the family prioritize the child’s sleep, as well as look at ways that the family can generate an atmosphere where positive behaviors on the part of the child are more likely to be reinforced..

-They tailor their therapeutic approach towards children’s developmental levels, temperaments, and personalities. Therapists nearly always need to include