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Selective Mutism

Understanding Selective Mutism

Selective Mutism is a disorder usually identified in children over the age of five. It is a form of anxiety that inhibits children from speaking in situations where speaking would be expected. These situations may be at school, with friends, with safe adults, etc. The child may be talkative at home or in certain environments, but will not say a word at school or at daycare. Most often a child will appear shy or uncomfortable when expected to speak. They may shut down or withdraw from the environment. They will most likely avoid attention from others and isolate themselves. At school, these children may not want to answer questions, do any public speaking or participate in group activities. Too often this leads to disciplinary issues or further reinforces the child's anxieties when forced to participate. The inability to speak must be limited to certain situations and not as a result of a medical issue that would prevent speech.

Signs of Selective Mutism

Child acts nervous around others

Child is always acting shy

Child does not want to speak to others

Child struggles to speak clearly and correctly in certain situations

Child struggles to communicate needs and wants

Child has been diagnosed with an anxiety disorder in the past

Teacher has talked with you about your child's resistance to class participation


Treatment for Selective Mutism has a great prognosis. Over time, the anxieties lessen, and the child is more willing to engage in verbal expression. Medications can be used to lower levels of anxiety however, various therapies can have a more dramatic impact. Behavior therapy is effective in that it reinforces any positive forms of communication. For example, a child’s teacher “says good morning. He timidly replies, “good morning.” If his teacher reinforces his use of communication positively his anxiety may be reduced and may encourage him to do it again tomorrow morning. Communication therapy helps the child effectively communicate needs and wants to adults and peers. Many children may shut down or use nonverbals to answer questions such as nodding or shaking their head. Having the child use “yes,” “no,” or “I don’t know” is a great place to start opening lines of appropriate communication. Small levels of exposure to the anxiety-producing situations can be helpful but must be taken slowly. For example, while out walking the family dog, a child gets nervous when a neighbor says “hello.” He might try to stay away from this neighbor hoping to avoid interaction. Exposure therapy would place the child in a situation where he would walk past the neighbor’s house regularly until the perceived threat subsides. He may then be able to respond with “hello” when his neighbor greets him again. This will take some time, and should be carefully monitored in order not to create more reasons to be nervous.

With respect to school, it is important to have open lines of communication with your child’s teachers. They need to understand your child’s strengths and weakness while not placing them in situations where they are bound to fail. Group participation, answering questions, and public speaking needs to be on their level with expectations increasing slowly over time.

The difficulty with Selective Mutism is that it can be tricky to diagnose. Make sure to consult with an experienced professional to get the correct diagnosis and treatment.

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Selective Mutism2018-02-12T12:07:34+00:00

Separation Anxiety

Understanding Separation Anxiety

Separation Anxiety can occur for children aged 6 months to 4 years. At this point, a child is capable of “representational thinking,” which means s/he can picture objects (like you) in his mind after they are gone.  Out of site no longer means out of mind for them.  This can lead to feelings of abandonment when you are not there. It is not clear why some kids pass through this phase with barely a whimper while others become consumed by it.

How common is separation anxiety?

Separation Anxiety affects approximately 4 percent of children. Many children experience some anxiety when their caregiver leaves the room or goes out of sight.  This type of behavior is common from 18 months to about three years of age. Most often, the child can be distracted from these feelings.

When does it become a problem?

If your child is unable to leave you or takes longer than his or her peers to calm down after your departure, your child may be suffering from separation anxiety disorder.

What are the signs of separation anxiety?

Excessive worrying or homesickness while being away from home or you.

Feelings of misery when his or her loved ones are not near.

Refusing to go to school, daycare, camp, or a sleepover because his or her loved ones will not be present.

Worrying or thinking that something bad is going to happen to you.

Separation anxiety disorder not only takes a toll on your child emotionally, mentally, and socially but on you and every member of the family as well.  It is important to get the help your family needs to alleviate the symptoms of separation anxiety in your child.

Strategies to help ease your child’s separation anxiety.

  • Wave bye-bye when you leave. Many parents try to sneak away while their child is engaged in an activity. Not the best idea. Yes, this helps you sneak away before hearing their dreaded cries and demands for you to stay. However, sneaking away can actually make your child’s separation anxiety even more severe.  If she thinks you might disappear at any given moment without notice, she’s not going to let you out of her sight the next time!
  • Help your child look ahead. Prepare her for your departure by talking about it ahead of time. Make sure your child knows where you are going and when you will back.  Talk about your child’s teacher or instructor with enthusiasm! If you haven’t noticed yet, your child really looks up to you for your approval, and if you talk about his teacher or instructor with lots of enthusiasm, he’ll be more inclined to agree.  Another strategy is to help prepare your child by acting it out with his or her toys. This acting out can be done several times to help normalize and prepare for the situation.
  • Try to be positive yourself. Children are so perceptive and can pick up on our own anxiety. It’s common to feel nervous or anxious about leaving our child for the first time. However, dramatic farewells will just validate your child’s feelings. It’s important to try to stay calm and positive, even when he or she is hysterical. Get on his or her level and reassure him or her that you’ll be back soon. To make things a little fun, you can both adopt a silly parting phrase, such as “brb” for be right back or “see ya later, alligator.”
  • Use a transitional object. Leaving your child with a reminder of you may help him or her cope easier. This can be anything from a photograph, something of yours, or even his or her favorite blanket or stuffed animal.  It’s important to keep in mind not to leave anything with your child that you may need, be it keys, wallet, or your favorite sunglasses. Keep in mind, for some kids this security object can instead become a constant reminder of your absence. It may be best to check in with his or her childcare provider to see how it is working.
  • Help your child with their feelings. It will take some time until your child can fully understand his or her emotions and how to identify them. However, you can help by teaching her simple labels for her feelings. For instance, when your child starts to panic or cry, tell her, “I know you are (insert feeling) that I am leaving.  What you’re feeling is called ‘missing.’ When I leave, I have those ‘missing’ feelings too.”  When children begin to learn to identify their feelings, they tend to be able to handle them better.
  • Set up gradual transitions. If you and your spouse have a date night planned, have your caregiver come earlier to help your child become better acquainted while you act as a calming presence. You can use the time to do a few activities altogether too to help your child see that it will be okay.
  • Leave at the same time. See if your childcare provider can take him or her out as you both say your goodbyes. Perhaps, they can walk your child to the classroom, take him or her to the park, or even for a quick stroll. This demonstrates to your child that you are both leaving.
  • Engage them in an activity. It’s usually best when your child is engaged in an activity before you leave. When it is time for you to leave, have a quick departure routine and leave.  Yes, he or she may still cry, however, the activity can serve as a distraction soon after.

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Separation Anxiety2018-02-12T10:21:30+00:00

When Parents Suffer from Anxiety

Parenting with Anxiety

Parenting with anxiety can have you feeling like you’re failing the most important people in your life, your children and spouse. Joy can become swept away and special moments turn into grey ones, clouded by constant worrying. Anxiety can prevent you from being the parent you want to be. Irrational thoughts begin to flood your mind, your heart begins to race uncontrollably and your body can turn into jelly. You suddenly find it difficult to be present with your children because you have become a captive to your thoughts. Often times, leaving you feeling powerless.

While everyone has some degree of anxiety, those of us with disorders have an overwhelming amount that can seep into our daily lives, making parenting harder. If you do have anxiety, know that you are not alone. In fact, 18% of the adult population has some kind of anxiety at any given time.

With proper treatment and adoption of any or all of the seven strategies below, you can reclaim your life from anxiety and be the parent you want to be for your child.

  • Go for a walk or exercise. Exercise has been shown to be a great way to relieve anxiety and can include anything from running, joining an aerobics class, circuit training, or yoga.
  • Take a timeout. Finding time to meditate or just taking a break for 15 minutes and engaging in deep breathing exercises can help you calm down when you feel your anxiety creeping up.
  • Play with your hands. You can even involve your children on this one, depending on their age. Play with modeling dough, build something with Legos, color, paint, draw, etc. because by doing so you are taking your mind off your worries. Plus, you’re accomplishing something tangible!
  • Sleep. I know this can be difficult with children, especially with younger ones. But, keep in mind that sleep is paramount to good mental health. Try to sleep when your kids are sleeping and not stay up too late when they are sleeping.
  • Eat well. Nutrition plays a big role in your mood and overall health. Try to eat a balanced diet that includes fiber and protein, giving you longer and slower energy to burn. For some parents, cutting back on caffeine has also shown to help reduce their anxiety. Some parents have also found chamomile tea to be helpful and provide a sense of calm.
  • Connect with friends. Having someone in your circle to talk to can really be helpful in gaining a new perspective. You may also find that voicing your concerns can help you feel more empowered. It’s also helpful to have someone that you can rely on to help you with your children when you really need it. There is absolutely no shame in asking for help!
  • Seek therapy. Therapy can really help you learn more about your anxiety and reshape your automatic thoughts before they impact your feelings. A therapist can also help you learn new relaxation techniques and retrain your brain. With therapy, you may find that your high anxiety days are fewer and farther between. You will also learn to recognize potentially bad days or moments much faster.

Keep in mind that there is hope and that your anxiety is treatable. It’s a work in progress and some people benefit from a multifaceted approach to treating it. Don’t’ let your anxiety deny you the joys of parenting and watching your children grow.

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When Parents Suffer from Anxiety2018-02-11T00:34:28+00:00

Common Childhood Anxiety Disorders

Childhood Anxiety Disorders are the most frequently diagnosed behavioral health condition among children and teens.

Here is a brief description of the most common childhood anxiety disorders. Please note that these descriptions are not intended to be used for self-diagnosis. Only a qualified behavioral healthcare professional can determine if your child is suffering from a childhood anxiety disorder. If you suspect your child may be suffering from childhood anxiety, we encourage you to use the Heads Up Checkup symptom checker to validate your observations and concerns.

Types of Childhood Anxiety Disorders

Separation Anxiety Disorder

These children have excessive anxiety about being separated from parents and/or primary caregivers, such as a grandparent or a nanny, or the home. For example, they may cling or cry when a parent leaves the home, or refuse to go to school, on play dates, or to sleep alone in their own bed. They may not be able to be alone in a different room from the parent or caregiver even in their own home.

Selective Mutism

Selective mutism is a childhood anxiety disorder that is diagnosed when a child consistently does not speak in some situations but speaks comfortably in other situations. These children are capable of speaking yet are unable to speak in certain social situations where there is a demand to speak, such as at school, at dance class, at soccer practice, or at the corner store. In other situations, these same children may speak openly with others and may even be considered a “chatterbox”. It is most commonly diagnosed at around five years of age or around the time the child enters school.  Parents are often shocked to find that their child is not speaking at school because they are found to talk so often at home.

Specific Phobias

Phobias are characterized by persistent, excessive and unreasonable fears of an object or situation, which significantly interferes with life, and the child or teen is unable to control his/her fear. Some common phobias for children and teens include fear of dogs and insects, swimming, heights, loud noises, and injections (needles).  Children with phobias will try their very best to avoid situations or things that they fear, or endure them with anxious feelings.  They may cry, throw tantrums, become clingy, or complain of headaches and stomach aches.

Social Anxiety Disorder

These children are fearful or anxious about or avoidant of social interactions and situations that involve the possibility of being scrutinized.  These could include social interactions such as meeting new people, a situation in which the child may be observed eating or drinking, and situations in which the child performs in front of others. The child is typically afraid of being embarrassed, rejected, or humiliated by others.

Panic Disorder

Panic disorder is characterized by the sudden onset of intense fear, called an anxiety or panic attack, followed by at least one month of worry about having additional attacks and/or fear of something bad happening as a result of the panic attack. Symptoms include difficulty breathing, racing heart, sweating, needing to escape, sense of danger or doom, and chest pain, among others.


Agoraphobia occurs when the youth has a significant fear of being in at least two locations where escape appears difficult or s/he might be unable to get help and therefore will avoid these situations as much as possible.

Generalized Anxiety Disorder

Children and teens with this disorder worry excessively and uncontrollably about daily life events and are often nicknamed “worry warts”. Their worries include fear of bad things happening in the future such as global warming or parents divorcing, being on time or making mistakes, a loved one becoming ill or dying, personal health, academic performance, world events, and natural disasters.

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Common Childhood Anxiety Disorders2018-02-12T11:53:16+00:00

Childhood Anxiety Cycles – How to Help

Don't avoid anxiety, manage it.

When it comes to childhood anxiety cycles, it's fair to say that we hate to see our children unhappy. But, we may actually be making our children’s anxiety worse by helping them avoid discomfort. The best way to help your child overcome anxiety isn’t to remove the stressors that trigger it. The goal is to respect your child’s feelings without empowering his or her fears – help them learn how to tolerate their anxiety so they can function better – even when they are anxious. As they learn to manage their anxiety – over time it will decrease or even go away.

8 Tips to Help Stop Childhood Anxiety Cycles

Please note that the following tips are not recommended as the sole treatment for a child suffering from anxiety. These tips are offered as tools to help you alleviate the stress that can come with an anxious child. If you are concerned about your child's anxiety, we recommend starting with the free Heads Up Checkup symptom checker. It is important to get your child treated by a behavioral health care professional as soon as possible.

Your goal should not be to get rid of the anxiety altogether, but rather, help your child manage it better.

It is fair to say that as parents, we hate to see our child unhappy.  However, the best way to help our child overcome his or her anxiety isn’t to try to remove the stressor that triggers it.  Rather, it is to help them learn how to tolerate their anxiety and function better, even when they are anxious.  The anxiety will then begin to decrease or go away over time.

Don’t avoid the anxiety-provoking situations or things.

As parents, we tend to fall victim of helping our children avoid things or situations that they may be afraid of.  Sure, this obviously makes our child feel better at the moment; however, it ends up harming them in the end.  By doing so, our children may learn that their coping mechanism is to avoid or remove the frightful situation or thing.

Express positive, but realistic expectations for your child.

We can’t promise our child that his or her fears are unrealistic.  We don’t know if they will get an A on that math test, do well on their piano recital, or like their first day of school.  Instead, we can express confidence that despite what happens, he or she will be able to manage it and be okay in the end.  By doing so, your helping your child see that your expectations are realistic and you’re not asking him or her to do the unmanageable.  In addition, the more your child faces his or her fears, the more likely his or her anxiety level will become less frequent over time.

Respect your child’s feelings.

Any time your child expresses his or her fears, try to listen and be empathetic.  It’s important to help your child understand what he or she is anxious about and encourage him or her to face the fearful situation or thing.  The goal would be to convey that 1 you know they are scared; 2 that it is okay; 3 you are there for them; 4 and that you will help him or her get through it.

Ask open-ended questions.

It’s important to encourage our child to talk about his or feelings, but we have to be mindful not to ask leading questions.  These would sound like “Are you scared about your first day of school?” “Are you worried about that math test?”  Open-ended questions are typically best and don’t feed into the cycle of anxiety.  These would sound like this: “How do you feel about your math test tomorrow?” “What are you looking forward to about school tomorrow?”

Be mindful of your body language and tone of voice.

Children are far more observant than we sometimes give them credit for.  They are pretty good at picking up on our non-verbal behaviors and tone of voice.  Even if we are anxious about how our child will respond the next time to a negative experience, we have to try not to send the message that they should be worried in that similar situation.

Keep the anticipatory period short.

The anticipatory period to a stressful event or thing is truly the most difficult period.  The goal is to eliminate or reduce it for our child.  For instance, if your child is nervous about getting his or vaccines, try not to talk prolong the event by discussing it for a long time, as this will only increase their anxiety.

Think it out.  

Anxious children will typically ask what if questions a lot when it comes to their anxiety.  You’re probably used to hearing “what if this happens”.  It’s helpful to talk to your child about what would happen if their fear came true.  It’s important to talk about how he or she will handle it.  This gives them a plan and having that plan can help reduce the uncertainty in an effective way.

Be a role model to your child.

It’s important to let your child see how you cope with anxiety yourself can help your child handle his or her anxiety.  Let your child hear and see you managing your stress and anxiety calmly and feeling good about getting through it.  We’ve mentioned this before and we will say it again; kids are very perceptive.  If they see that mommy or daddy is not handling their anxiety or stress in a positive and healthy manner, they will learn that they do not have to either.

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Childhood Anxiety Cycles – How to Help2018-02-12T11:54:21+00:00