As a new parent, I had an insatiable number of questions about my child and my
parenting - am I doing this, right? Is my baby OK? Is there a better way to do this?
No matter how many questions were answered, I always had more.

In between our early pediatrician visits I filled up the Notes App on my phone with
new questions for our next visit. Most of the time, I had already spent hours
googling, asking friends, calling the on-call nursing service to ask the same questions
to try and somehow get answers for my never-ending list.

Many women in my clinical practice suffer from postpartum anxiety or depression.
This means that in the year postpartum women (and/or sometimes their partners)
might be worrying excessively, suffering from insomnia, experiencing low appetite,
navigating fears about many aspects of life, experiencing physical symptoms or
panic attacks, having persistently low mood, feeling overwhelmed, crying
frequently, feeling irritable or apathetic, experiencing mood swings along with a
range of other symptoms.

When someone's default is compromised because of her emotional state, it can be
particularly hard in this digital age that we live in to trust oneself and her decisions
when everything out there seems to contradict. If you google "when to sleep train"
you might find 20 articles saying different things about when, if and how.

The rates of postpartum and pregnancy-related mood disorders are higher than
many people realize ...

• Roughly 80% of new mothers' experience "normal" baby blues in the first few weeks after a baby arrives.
• 1 in 7 experiences serious levels of anxiety or depression during pregnancy or postpartum in the first 3 months following the birth of a child. If you follow these women for a year postpartum the rate increases to 1 in S!
• 1 to 2 out of 1000 women suffer from postpartum psychosis
• 1 in 10 fathers experience postpartum depression

(the above three statistics are cited from: Wisner KL et al JAMA Psychiatry, 2013; Paulson et al.JAMA. 2010)

Suicide is one of the three leading cause of maternal death around the world.
Bleeding and hypertension were number 1 and 2. The peak risk for suicide in this
study was 7 to 9 months postpartum.
(Dell & O'Brien. 2003)

Who is at risk for postpartum mental health mood disorder?

• Previous postpartum mental health disorder history (family history, personal history, symptoms during pregnancy)
• History of Mood Disorders (either personal or family history)
• Significant mood reaction to hormonal changes (i.e. historically had trouble related to mood changes during menstrual cycle, or mood changes during puberty)
• Endocrine dysfunction
• Limited social support
• High stress parenting (parents of multiples, single parents)

Why talk about these statistics?

1. They are treatable and so many women, (and partners) do not seek help because of shame and stigma. There is a taboo around many aspects of mental health, but it's amplified when it comes to becoming a parent. Women and partners can suffer day after day; often secretly feeling ashamed and feeling they made a mistake.
2. We want you to know there are treatments out there that are effective and help so many people every day.

Our hope is that if we can help people understand how common these symptoms are, particularly in the first year of life, identify the symptoms, and take a more proactive approach it will facilitate parents getting the help they need more often.

Med-Psych’s Parent Consultation approach is to both address the concern you have for your child from a medical perspective as well as help you identify whether there are parenting/psychological issues at play that impact your current struggle.

Whether a parent is experiencing a postpartum mental health disorder or simply something that is coming up for him/her surrounding a particular parenting struggle, we appreciate how important it is to help our clients understand their own reaction to the issue so that it can be most effectively addressed.

We know just how hard parenting is, and are here to help you through.

By Ariella Soffer, Ph.D.

In almost every parent consultation session in our practice, a caregiver brings up a situation that they worry will “make their child anxious/upset/worried/depressed” and their biggest concern is, “how do we prevent this from happening?” As parents and caregivers, and more generally as human beings, we want to shield those we care about from pain. What we will try and explain in this article is why you should not attempt to shield your child from anxiety and pain.

Let’s take a few examples:
Your kid hates going to the dentist. Do you avoid telling them that they have two cavities that need to be filled in the next two weeks because you know it’ll be upsetting? Or do you bring it up knowing you may be faced with an outright meltdown?

Your child doesn’t make the basketball team and all her friends did. She has a birthday party that day and you know all her friends will be discussing it. Do you send her to the party where you know she will be upset hearing them all talk about the team? Or do you hold her back so she can avoid dealing with those bad feelings?
Your daughter is scheduled for her vaccines after school, but she hates needles (and so do you). Do you pick her up from school with ice cream and let it be a surprise? Or prepare her for the visit in the morning before she leaves?

Your mother is in the hospital because she had a stroke, and your son notices that you and your partner have been taking turns going back and forth somewhere… Do you share with him that there is something wrong with grandma? Or keep him in the dark?

The most important takeaway from this article is that anxiety is not generated from discussing topics that are scary. Kids feel anxious when they are in situations where they feel ill-prepared to navigate a situation and feel confused, misled, and scared.

Considering example #3: If you arrive at the doctor and your daughter is not aware of the fact that she is getting her vaccines, she will feel like you lied to her and consequently be reactive and afraid. Try giving yourself and your child more credit for being able to handle the situation:

• Own your own anxiety about the vaccines, whether about the shots themselves, your own fear of needles, or your concern about being able to comfort your daughter.
• Prepare yourself and your child for the conversation. “We are going to talk about something that may be a little hard that we must do after school today. Let’s take a few deep breaths together and get ready to discuss it.”
• Review in detail all the steps that will happen. “We are going to go to the pediatrician, we will wait for a bit and then the nurse will bring you in and take your height, temperature, and weight. Then the doctor will come in and talk to us and then afterwards you will get a few shots (called your vaccines). It may hurt a little bit, kind of like a pinch. Here are some ways we can handle it together. I will be there with you the whole time. We can distract each other with a blindfold and phone, we can watch the whole time, or we can take some deep breaths together. No matter what, it’s important to get these shots so that you can be protected from the diseases that they prevent.”
• Ask your child if they have questions.
• Acknowledge the feelings they likely have. “This is probably going to be anxiety provoking, but I know you can do so many hard things.” When you do this, you are also instilling confidence in your child that she can get through this, and consequently without realizing it you are also telling her you know she can also do other hard things. It’s a way that she will continue to build her confidence over time.

Arming someone with preparedness builds confidence and capability
Think about a situation for yourself that was new. How did you prepare yourself? Rehearsal is a good way to get comfortable with something you have to do. You likely don’t go into a meeting without rehearsing, so give your children the same opportunity in an age-appropriate way.

As described in example #4, illness and death in a family is another big area of concern for parents. We always give the same advice here. Always be direct and honest (again, in an age-appropriate way) and tell your child what is happening. “Grandma is in the hospital because she had something called a stroke. The doctors are trying to find ways to work on her body and her mind so that she can get better. I am feeling sad and worried about it, but know that the doctors are doing everything that they can to help her. This may also be scary for you, so I understand if you have questions, and I am here for you to talk about it. We will be able to visit her when the doctors say we can.”

Another strategy that can be effective is creating a story that puts yourself in your child’s shoes to reflect how they might be feeling. “I remember when I was about your age and on the first day of school when nobody I knew was in my class. I felt pretty scared, but I remember that my dad told me that doing hard things was something that, while hard, I did all the time. He reminded me about the time I went to my first swim meet, and I didn’t know anyone on the new team, but then I swam in a relay and brought our team into first place and had so much fun!”

Kids want to feel less alone, both with their feelings and also in reality. You, as their parent, accomplish this by empathizing with their feelings and recognizing them (appropriately) and also helping to partner with them in tackling the situation at hand. Let’s take example #2 of your child not making the team. In this situation, you might be inclined to protect your child from feeling badly at the birthday party and holding her back so that she doesn’t have to face her friends who all made the team. What does this accomplish? It communicates to your child that you don’t think she can handle feeling disappointed. Our recommendation is to show your child that you believe in her. Tell her that she didn’t make the team and help her recognize that this doesn’t define her by letting her know that you understand and see her disappointment and want to help her through it. Work with her to try and figure out how she wants to navigate the hardship. It will make her a stronger person, more resilient, more capable, and more confident in herself to navigate disappointment and failure in the future.

Life is not easy. Your child will fail, your child will fall, your child will feel anxious, and your child will get scared. Take the opportunity you have as a parent and use these situations to help them build their skills, so that they can be confident and competent when they face adversity.

By Ariella Soffer, Ph.D., Clinical Psychologist and Janine Weisenback, LMSW, JD
Reposted with permission from WEforum Connect for Life | September 2023

Many of you have probably noticed that practicing gratitude has become trendy. While gratitude can emerge spontaneously, we are seeing a recent push to cultivate or deliberately practice gratitude. We hear people say, “Count your blessings,” and we are seeing more and more people use affirmations and have gratitude journals. But does it work? And in what ways can it help? Let’s break this down!

What is gratitude?

Gratitude is an appreciation of what an individual has received (Harvard Health Publishing, 2021). It is about noticing and appreciating the things we may take for granted. For example you may feel grateful for small or big things, such as having a good day, spending time with friends, paying the bills this month, having a place to live, experiencing love, and having access to opportunities.

Gratitude involves two primary components (Greater Good Science Center, 2022; Harvard Health Publishing, 2021):

1. Acknowledgment of the goodness in our lives.

• You can recognize that there are good things in the world and that you have received good things.

1. Recognition that there is an external source (at least, partially) for that good outcome.

• You can admit that some of your goodness is due to a source outside yourself. This could be other people who have helped you receive or achieve good things.

The benefits of practicing gratitude
Indeed, there are significant social and personal benefits to engaging in gratitude. Many studies have found positive outcomes in individuals who practice gratitude, including mental health and social well-being benefits. Further, it has been found to be beneficial for well-functioning individuals and people currently struggling with mental health concerns (Brown & Wong, 2017).

People who practice gratitude tend to be happier, are more helpful, and generous, have better sleep and academic (and professional) performance, and tend to be less depressed, less stressed, less lonely, and isolated (Brown & Wong, 2017; Mindful, 2022). In a review of the literature on the link between gratitude and health outcomes, the researchers found that in the majority of studies using gratitude interventions, practicing gratitude tends to lead to positive mental health and social well-being outcomes (Jans-Beken et al., 2020). In this review, women who engaged in a gratitude intervention had improved self-reported happiness when compared to women who did not engage in the intervention, and similar results were reported in older adults. Further, another study using a gratitude intervention demonstrated that it helped reduce negative affect and increased psychological resiliency in a sample of older adults. In addition, gratitude can help strengthen relationships and to develop healthier ones. In the same review described earlier, one study found that students who maintain a gratitude diary have a greater sense of belonging, and employees whose managers expressed gratitude for their work, were more productive on a day-to-day basis (Jans-Beken et al., 2020).

Gratitude can have important social and personal benefits across various settings, and these studies suggest that gratitude may be good for our bodies, minds, and relationships.

How does practicing gratitude lead to these benefits?
Practicing gratitude allows us to focus on the goodness we have in our lives and offers us opportunities to use words connected to positive emotions. Perhaps people who practice gratitude attend to more positive things in their life and are less focused on negative emotions (e.g., resentment) and negative experiences (Wong et al. 2018). Further, practicing daily gratitude allows us to notice the positive little things in our daily lives (e.g., the sun shining; a stranger being friendly to you) and, over time, strengthens our ability to notice more goodness (Mindful, 2022). When it comes to improved sleep, research suggests that gratitude influences sleep because individuals who practice gratitude have more positive thoughts (rather than negative thoughts) before falling asleep (Wood et al., 2009).

What are some ways we can practice gratitude?
There are many ways we can practice gratitude, and finding the one(s) that works for you may take time.

Here are some exercises to try:
Gratitude letters: Write letters or thank-you notes to people for whom you are grateful. You may decide to send this, or you may not want to; the simple act of writing it can help you appreciate the people in your life. You can also write one to yourself once in a while.

• “Three Good Things”: Identify three things that have gone well for you and identify the cause
• Mental Subtraction: Imagine what your life would be like if some positive event had not occurred
• Gratitude Journal: Keep a journal to note the big and little joys of daily life. This can help us notice more and more things we are grateful for throughout our day.
• Pray: People who are religious can use prayer to foster gratitude
• Volunteer to help others

Here is a great link for additional exercises

Why incorporate gratitude this holiday season?
The holidays tend to be filled with social gatherings with family and loved ones. These gatherings offer us opportunities to be surrounded by people and things we are grateful for and allow us to express gratitude. However, for many, this time of the year stirs up sadness, anxiety, or depression. Whether the holiday season brings you joy or makes you feel sad, practicing gratitude may offer you opportunities to find goodness in your life that is less obvious.

By Michelle Leon, M.A., Therapist, Soffer & Associates
Reprinted with permission from WEforum Breathe for Life December 2022

References:

1. Jans-Beken, L., Jacobs, N., Janssens, M., Peeters, S., Reijnders, J., Lechner, L., & Lataster, J. (2020). Gratitude and health: An updated review. The Journal of Positive Psychology, 15(6), 743-782.
2. Wong, Y. J., Owen, J., Gabana, N. T., Brown, J. W., McInnis, S., Toth, P., & Gilman, L. (2018). Does gratitude writing improve the mental health of psychotherapy clients? Evidence from a randomized controlled trial. Psychotherapy Research, 28(2), 192-202.
3. Wood, A. M., Joseph, S., Lloyd, J., & Atkins, S. (2009). Gratitude influences sleep through the mechanism of pre-sleep cognitions. Journal of psychosomatic research, 66(1), 43-48.
4. https://greatergood.berkeley.edu/topic/gratitude/definition#why_practice
5. https://greatergood.berkeley.edu/article/item/how_gratitude_changes_you_and_your_brain
6. https://www.mindful.org/an-introduction-to-mindful-gratitude/
7. https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier#:~:text=In%20positive%20psychology%20research%2C%20gratitude,adversity%2C%20and%20build%20strong%20relationships 

A psychoeducational assessment is often performed to evaluate the underlying cognitive processes that impact your child’s functioning in academic settings. The results of this type of evaluation will provide you with information about how your child processes information, approaches problems, and responds to learning demands. There may be many reasons why your child is struggling. As such, these evaluations often also involve a comprehensive inquiry into your child’s functioning across several domains in order to understand not only the cognitive and academic factors but also the psychological, emotional, and behavioral factors that may be inhibiting a child from reaching their full potential.

Typically, a psychoeducational assessment is comprised of multiple components. First, a psychologist will conduct a background review, in which they gather information about your child’s developmental history and functioning at home, at school, and in social situations. This information is gathered through various methods; academic, medical, and mental health records, interviews with you and your child, and completion of standardized questionnaires.

Next, the psychologist conducts psychological testing, which involves the administration of standardized, validated psychological tests. The testing battery is tailored to your child’s individual needs but often includes measures of intelligence, academic skills, memory, attention, executive functioning (e.g., organization, inhibition, flexible thinking), language, and emotional/behavioral functioning. Some of these tests are paper-and-pencil measures, while others are computerized. Testing can take anywhere between 2 and 8 hours, depending on the nature of the evaluation.

The psychologist then interprets these tests and writes a report. Your child’s test performance is interpreted according to norms, or standards of performance on a particular test established through large surveys of children with similar demographic characteristics, which allows the psychologist to determine whether a child’s performance on a given measure represents a strength or a weakness. Then the child’s test performance is integrated with other information gathered through interviews, record review, and questionnaire responses to develop a comprehensive understanding of the child’s cognitive, emotional, and behavioral functioning. This understanding leads to a formulation about how your child’s functioning across different domains may be impacting their academic performance. This information is then documented in a detailed report that includes recommendations for interventions at school and at home. Finally, the assessment process culminates in a feedback session, during which parents are provided with a detailed explanation of the results of the assessment. At this time it is also discussed how assessment results can be utilized to inform treatment planning and service provisions.

How do I know if my child needs to be tested?Every child’s abilities and needs are different. A few bad grades, some difficulty re-acclimating to in-person learning, or off-handed comments about having trouble paying attention in a certain subject are usually normative and probably do not warrant full-scale testing. However, some signs that your child may benefit from a psychoeducational assessment include:

• Your child consistently works/studies hard, but their grades do not reflect their effort.
• Your child understands the material they are studying in school but struggles to complete their homework because of poor attention, planning, or organizational skills.
• Your child’s grades in a particular subject are significantly lower than their grades in other subjects.
• A teacher has noticed that your child has difficulty paying attention and remaining on-task in the classroom.
• Your child experiences behavioral or emotional difficulties in school or at home.
• Your child consistently does not want to go to or does not like school.

If your child is showing any of these signs, you should always consult with your pediatrician first. If your pediatrician feels it is necessary, he/she will likely refer you to a psychologist or neuropsychologist who will be helpful in providing you with more information about how your child’s testing needs can best be met.

By Jacqueline Howe, Ph.D., Licensed Psychologist, Testing Director and Clinical Director at Soffer & Associates Comprehensive Psychological Services

Reposted with permssion from WEforum Heal for Life October 2022

How do we define “bullying” when the term seems to be thrown around in so many ways?The definition of bullying is: Unwanted, aggressive behavior involving real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time (Stop Bullying, 2022).

Let’s break down the definition to see what bullying might look like and how to recognize it as a parent.

Bullying embodies two primary features:

• Imbalance of power: Kids who bully use their power (either physical strength, access to embarrassing information, or popularity) to control or harm others
• Repetition: behaviors happen more than once or have the potential to happen more than once.
  
• 
  

Bullying can occur in several locations or settings, including at school, other places in the community (clubs, sports teams, friends’ houses), and online (“cyberspace” which includes text, apps, social media, forums, etc.). There are three types of bullying as outlined in the literature (Stop Bullying, 2022):

1. Verbal (teasing, name calling, inappropriate sexual comments, threats)
   
2. Social/Relational (excluding someone, spreading rumors, embarrassing someone in public)
3. Physical (hitting, kicking, spitting, tripping, taking or breaking property)
   

How frequently does bullying occur amongst school-aged youth?

• According to the 2019 National Crime Victimization Survey, School Crime Supplement (National Center for Education Statistics and Bureau of Justice), 22% of students ages 12-18 experienced bullying (This is a significant number of our children).
• “Tweens” (9-12 years old) are particularly vulnerable to bullying. 50% of kids 9-12 years old say they have experienced bullying at school and 14% shared they had experienced cyberbullying.
• 30% of students, grades 2 through 12, reported at least one experience of being cyberbullied.

One of the questions I often get from parents who call the practice is, “How do I know if my kid is being bullied?”
Your child may not feel comfortable disclosing that he/she is being bullied, potentially for fear of retaliation by peers, or a desire to handle the situation independently. Therefore, along with using the information provided above to determine whether or not your child is being bullied, it is important to pay attention to any changes you observe in your child’s functioning, such as:

• Resistance to attend school or participate in sports/activities.
• Anxiety signs and symptoms: headaches, stomachaches, changes in sleep patterns (trouble falling asleep, waking up frequently, oversleeping), and changes in appetite (eating more or less than typical)
• Injuries or marks from physical bullying
• A change in friendships or reluctance to spend time with friends
• Frequent crying and intense emotional reactions
• Desire to spend more time alone in the home
• An over-attachment to, or sudden withdrawal from, electronic devices

Potentially, a more complicated question to address is, “How do I know if my child is being labeled as a bully (and if so, how do I handle it)?”
The first thing I like to remind parents is that it doesn’t feel good for a child to behave meanly towards someone else. The more you can empathize with your child, the more effective your conversation with them will be. You will be more likely to get their version of the story and subsequently, have an impact on their behavior change.

Many children who are bullied will go on to become bullies themselves as a way to regain control and power in their lives. It is important to recognize that both bullies and those being bullied require intervention and support – and that often these may be the same kids.

The first time a concern is expressed, either by your child, another child/parent, or the school, set your parenting expectations and boundaries around behavior without judgment. Validate your child’s feelings without validating the behavior (bullying). Work to understand why your child is behaving this way – determine the function of their behavior and what their purpose is (essentially the “why” behind the bullying). You should also try to determine if your child is being bullied themselves, given the high overlap between victimization and perpetration of bullying, then work with your child/school/etc. to support them in taking responsibility and repairing the harm. As a parent, it is easy to react impulsively in these situations (on either side). Remember to take a breath and try to navigate the situation with your child, instead of for your child.

What are the psychological effects of bullying?
Children who experience bullying are at increased risk for mental health and behavioral problems, including depression, anxiety, sleep difficulties, lower academic achievement, and increased rule-breaking behaviors. One meta-analysis found that children and adolescents who experienced bullying were 2.2 times more likely to have suicidal ideation and 2.6 times more likely to attempt suicide than those not facing bullying. The risk for negative outcomes were higher among those who experienced cyberbullying compared to those who experienced “traditional” bullying (Gini & Espelage, 2014).

According to the National Center for Educational Statistics (2019), students who are bullied self-reported that bullying negatively impacts how they feel about themselves (27%), their relationships with family and friends (19%), their schoolwork (19%), and their physical health (14%). Early interventions for bullying are important because studies suggest that long-term
psychological effects of bullying persist into adulthood. Those who were victims of bullying between the ages of 9-13 had elevated rates of depression and anxiety between the ages of 19-26 (after controlling for other psychiatric risk factors). Those who were both victims and bullies suffered the most from depression, anxiety, and suicidality in adulthood (Copeland et al., 2013).

What can I do?
This article may have left you with more questions and concerns than answers. We are all protective of our children; we all want them to be safe. Talking to our kids about their emotional well-being and about being respectful community citizens is the best way to maintain an open dialogue and an honest line of communication. Professionals both within and outside of the school are available for consult when you aren’t sure whether an occurrence qualifies as bullying. These professionals can also help in handling a situation that involves both another parent and/or the school.

By Emily Weinberger, M.A.