Search for tag: "children's behavioral health"

Parents often wonder if their baby is lazy. I have parents use that term all the time. If their child isn't doing everything they think they're supposed to be doing, the parent labels their child as lazy.

For example, I have parents telling me a lot that their 12-month-old is lazy because they're not walking. Your child isn't lazy. Walking can start any time from 9 months until 18 months.

Parents will tell me their child is lazy because they want to be fed. If your child is under 18 months old and still learning how to use utensils, that's not lazy. They're just still learning. If they're 4 and they want you to feed them, that's not laziness. It's them being manipulating and trying to get you to do what they want.

Parents will also ask me about why their child isn't talking. They think that their 18-month-old should be saying sentences and instead only says about five words. Well, the biggest language explosion happens between 18 months and 3 years old. By 18 months, they should be saying four words, in addition to mama and dada. Boys tend to talk later than girls too. Not sure why, but that tends to be what I see. Girls tend to be more social. Boys tend to develop their motor skills faster.

I get the opposite too. Some parents think their children are developing completely normally when, in fact, they're behind on motor or speech milestones. This is one reason we do the autism screening at 18 and 24 months, to catch those kids that are behind and determine: Is this expressive speech delay? Are there not enough opportunities for motor development? Is there a concern for autism? Does the child have a different diagnosis that requires evaluation by specialists?

Now, I'll end with this as a heads-up. There was a recent article published in the "Journal of Pediatrics" outlining about how developmental guidelines for the first five years of life needed updating, and the Centers for Disease Control just adopted these new guidelines.

It will take a little while for everyone to catch up with these new guidelines when pediatricians do their screening evaluations at well-child visits. But we have a general good idea of where your child should be. As pediatricians, we are really good at figuring out if your child is on track developmentally, or if they need to see a specialist for a speech or motor developmental delay.

If you are concerned about a specific developmental issue with your child, be sure to discuss it with your child's pediatrician.

Dr. Gellner: Technology for teens can be a good thing, but it can also cause a lot of new problems. Since smartphones came out, there's been a big increase in emotional issues in teens. Is this a coincidence? I'll discuss teens and technology on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kid Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: A new study by psychologists has many of us concerned. It says that the happiness, self-esteem, and life satisfaction of teens has been significantly impacted by the use of social media. Until 2011, it seems teen happiness was on the rise as it had been for a few decades. But from 2012 to 2016, there was a sharp decline. By 2013, 37% of teens had a smartphone, and by 2016, 73% of teens had one.

It seems that teens who spend more time on electronic communication through social media, texting, and video games are less happy with their lives and had lower self-esteem. Ask any teen that has a Facebook or Instagram account and they will tell you that everyone else has a better life than they do. They see their friends post things and they think, "My friend is so pretty. My friend gets to do so much cool stuff. Everyone looks like they're having the best day ever all the time." If you think about it, even us adults, we're guilty of thinking the same things.

Previous generations of teens had magazines that gave unrealistic views of body size, success, beauty, but now teens are bombarded every waking moment, it seems, by images of impossible standards. With social media, teens can post what they want on their feeds showing only the best pictures of themselves having the best experiences while hiding the struggles of everyday life. With as much time as teens spend on their phones, it's no wonder that they think that others have it better. Not only are they seeing their friends do all these fabulous things, their friends, and even strangers, can comment on pictures and videos they post. Those who comment can build them up by saying how awesome something is or they can be critical.

Posts can be shared too, which then expands the number of people seeing what is posted. Kids don't always realize that when they post something, it's out there forever and out there for anyone to comment on. That's often how cyber bullying starts, with a single post. That leads to negative texts, which can lead to being bullied at school, which triggers anxiety and depression, and sadly, can even lead to suicide.

As parents, one thing you can do to help your teen is to make sure you are included in their social network. That way, you can see what others are saying about your child and you can report any cases of cyber bullying to the appropriate authorities. Be involved in your child's online life, whether they want you to be or not, because it could really save their life.

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Interviewer: How to help your young child after a traumatic event. We'll talk about what you can do next on The Scope.

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Interviewer: Dr. Katherine Rosenblum is the director of the infant and early childhood clinic at the University of Michigan. When scary things happen to young children, we're talking about infants, toddlers preschoolers, what can you do to help them through that? Is this something that a lot of parents don't recognize first of all?

Dr. Rosenblum: I think it's something that people often overlook because we think young kids are really little, maybe it won't affect them so much, maybe they won't remember things that happened, and also because it's hard for them to tell us what they're thinking and feeling if they don't have the words for it yet. But in fact little kids are affected by scary things that happen in the environment or that happen to them. So we often think about how young kids actually do experience trauma or stress and what we want people to be thinking about is how we can help them to manage those feelings. I think how we can help them cope.

Interviewer: How do you define trauma or stress to that age group?

Dr. Rosenblum: Little kids deal with little stresses all the time. For example, starting at a new school, Mom or Dad is going to work and we have to adapt to separations. It's hard but kids can learn to manage that. It's a stress and it helps them learn I can manage little stresses.

Trauma, in contrast, is something that's so big that actually it overwhelms the individual's ability to cope effectively, and especially for little kids. When they're faced with something that is traumatic or really, really distressing, then what they need is a lot of help to be able to figure out how to recover from that and to be able to recover from that. It really requires additional support from outside.

Interviewer: So are we talking about emotional trauma exclusively or physical trauma as well?

Dr. Rosenblum: Actually, it can be a whole range of things. One of the most common traumatic experiences for young kids is accidents. They get injured or hurt. And that can be really scary and overwhelming and parents might see that after an accident they're afraid, they're more fearful, they're more clingy, that sort of thing, dog bites, things that can happen in the environment.

Interviewer: Falling off of a play set maybe even.

Dr. Rosenblum: Absolutely right. If it was really a scary experience, maybe they had a broken arm, or they had to have some sort of a medical procedure, those things can be really distressing. But with support they can really recover from that.

Big traumas are things that are just told really overwhelming to to the child. It might be witnessing someone being seriously hurt or injured, or really scary events that happen in the community. Those are things that we really think of as true traumas. They overwhelm that young child's sense of, "I can I can cope." It really creates a sense of intense fear or threat, danger.

Interviewer: Seems like we're talking about a wide range of things like from separation anxiety because a parent is going to work versus a traumatic accident. Are they all kind of dealt with the same way or do they require different strategies?

Dr. Rosenblum: The one thing that's sort of common across all of those things for young kids and the number one thing that young kids need when they're managing things that are challenging is the support and help of their primary caregivers, what we think of as their attachment figures, their parents. Young kids are totally dependent on their caregivers to help them navigate life's challenges, and whether those challenges are small or big they're turning to their primary caregivers for help with coping.

Interviewer: I'm sensing here as a parent a little bit of a struggle because on one hand, I don't want to over . . . because a little bit of stress and that sort of thing's good so I don't want to maybe overprotect or over . . . I mean how do you decide how much?

Dr. Rosenblum: It's really important to on one level follow your child's cues. So your child is going to be showing you, :I need you in some way," and parents have an intuitive sort of sense often of, "When my child needs me, I'm going to go to them and help them." Doesn't mean that you're going to prevent them from having to face challenges. Normative things like going to school, that's really important and you're helping them learn how to balance. But when young kids are experiencing something that a parent knows is really really stressful, then I think it's actually really important for the parents to sort of say, "Hey I'm here. I'm here with you. You're safe right now. I'm going to take care of you. I'm going to protect you"

Interviewer: And what does that interaction look like? Say a child falls off of a play set. You can tell the over the next couple of days there is a big fear there. My dad was a rancher. He'd say, "You get bucked off the horse you get back on". Is that the approach you take or is there a better approach?

Dr. Rosenblum: Let me sort of step back and share something with you that's sort of interesting. We often have people who sort of say, "Hey, I'm worried about spoiling my child. If my child is crying and I pick them up, is that going to spoil them?" What we actually know from the research is that when kids express feelings like being afraid or sad and they have parents who pretty consistently and reliably go to them and help them with those experiences, they actually end up as they get older being more able to cope with life's punches if you will, the hard things that come in life. They can sort of bounce back get up and do things better on their own as well.

So I think two things. One, we want kids to be able to try to sort of manage small things on their own. If your dad saw you sort of fall down and bump your knee, it might be totally appropriate to take a moment, sort of look and say, "Hey, wait a second, is he really hurt? Is he really distressed or is he going to be able to sort of bounce back from this on his own?" That's totally appropriate. But if he sees that you're really crying, that you're really hurt, and you're looking up, that's a time where we really hope a parent is going to say, "Hey buddy. You know I'm here for you. I've got your back. Come here and let me help you."

Interviewer: With an adult I might validate somebody's feelings a bit. "I totally understand why that was a scary experience." Do you do the same thing with kids?

Dr. Rosenblum: Absolutely. "That was really scary. But you know what? I'm here. I'm going to help you and you're going to be okay." Little kids really like to know that someone's there, someone's got their back, someone's going to scoop them up, give them a hug and then help them be able to sort of do that bounce, get back into normal daily routines and experiences. That's another piece that's really important here. I think the other part of your question was, "I don't want to over react." I don't think it's overreacting to really be asking how is my child managing, am I seeing . . . If something scary, something really big happens, use your child as your guide. Look at your child's behavior. Is your child looking more fearful, having trouble sleeping, a little bit more clingy? If all of those things are true then that's a time to give a little bit more. But if your child seems to be doing okay, all right, be a watchful observer. Use your child to help you determine what your child needs.

Interviewer: Would there be a point where you'd visit a counselor?

Dr. Rosenblum: Absolutely. So if your child is continuing to persist in showing more clinginess, looks very fearful, can't sort of do the normal routines, seems really distressed or you're just really concerned about them, trust your gut, talk to the primary and pediatricians are a great resource. They can help you sort out is this something that we can sort of wait and see and sort of watch and wonder? Or is this something where it might actually be helpful to get some extra help?

Interviewer: Do you have a resource if a parent's listening right now on their like, "This is great. I'd like to learn more"?

Dr. Rosenblum: There's a really wonderful website called the National Child Traumatic Stress Network and they have a website, NCTSN.org, and that provides wonderful resources for parents, for teachers of young kids about how to help kids manage really scary or big things. For smaller sort of things, the more every day sorts of occurrences, there are a number of resources that are available as well. The American Academy of Pediatrics has a website dedicated for parents and there's also a wonderful resource called Zerotothree.org. Again, lots of resources to help parents navigate life's challenges with young kids.

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Dr. Gellner: Face it. There are times we all let our tempers flare. But if your teen is more angry than you think they should be, it's time to put the fire out. I'll discuss ways to tame their tempers on today's Scope. I'm Dr. Cindy Gellner. Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Dr. Gellner: Your teen walks into the room and you can see it happen: they're volcano ready to erupt. It's true. All those hormones you hear so much about can indeed cause mood swings and confused emotions. Teens are under more stress today than ever as well.

They might be also one of those kids who really feel emotions intensely. But no matter what pushes their buttons, one thing is certain, there are times that they are going to blow a fuse. Anger is a normal emotion and there's nothing wrong with feeling mad. What counts is how they handle it.

Anger can be a really powerful emotion. So teaching teens how to manage it is sometimes a challenge. It takes plenty of self-awareness and self-control to manage those angry feelings. And these skills take time to develop. Little kids aren't very aware of what they feel. They just act it out in their behavior. That's why you see them having tantrums when they're mad.

But teens have the mental ability to be self-aware. They also have the ability for self-control, although they don't' know how to use it. Teens, or anyone, really, when they get angry, there's also another emotion that's the real reason for the strong emotion, such as hurt, guilt or frustration.

Help your teen figure out what else is going on. This is a great time to open up a discussion about feelings since teens usually won't open up on any day ending in "Y" unless they're forced to.

So there are five steps as a parent that you can tell your teen about that will help them manage their temper. First, have them identify the real problem. Did you just tell them no because they wanted to go out with friends and you said they need to clean their room? What are they really mad at? You, because you're being unfair? No. They're mad because they have to clean their room.

Then, help them think of potential solutions. This is where that self-control pause button comes in. Have them stop and think about the reaction, but don't just react out of anger. Ask them three things that they could do. They could yell at you and throw a fit. They could clean their room and then ask if they can go out or they can sneak out and run to their friend's house as fast as possible.

Third, they need to consider the consequences on each of these choices. Yelling at you will probably get them grounded. Cleaning their room takes work and they may miss out on some fun, but you'll probably let them hang out with their friends and then the bonus is they get to clean room. Sneaking out really ends well. When you do catch them, look out.

Next, have them pick a choice that they actually act on. By the time they've really thought this through, chances are you won't be yelled at and they haven't run away yet if they're still they're talking to you. So cleaning the room and getting to the fun is the best choice for all.

Finally, after they've made their choice and, hopefully, cleaned their room, then have them think about all that just happened. Did they feel they made the right choice? What did they learn about the decision-making process? Can they make the same positive choices on their own? Be sure to praise them for thinking things through before acting. Sure, these five steps sound like a piece of cake when you put them out there and everyone is calm. The real test comes when your teen is in full hothead mode.

Make sure your teen knows that there are other ways to manage their anger too. Lots of research had shown that exercise is a great way to improve your mood and decrease negative feelings because it raises endorphins, those happy hormones in our brains.

Listen to music. Have them wear headphones if their musical styles clash with your own. Writing, whether poetry, song lyrics in a journal or in a letter that they plan to rip the shreds and throw away, writing helps release intense feelings so they don't stand inside. Same with doodling. That's why adult coloring books are so popular right now. Some teens find that meditation and deep breathing helps.

Sometimes, anger is a sign that more is going on. Sometimes, it's a sign of depression. Sometimes, it's a sign that there is too much stress in your teen's life and they may be overscheduled or pushing themselves too hard.

Again, anger is a really strong emotion. It can feel overwhelming at times. Helping your teen learn how to deal with strong emotions without losing control is part of becoming more mature. It takes a little effort, a little practice and a little patience, but your teen can learn how to douse the flames and chill out with help and support from you.

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Dr. Gellner: It's a disturbing trend, teens cutting themselves. Why? And how can you help your child, if they are a cutter. I'm Dr. Cindy Gellner and we'll discuss this on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kid Zone, with Dr. Cindy Gellner, on The Scope.

Dr. Gellner: Cutting isn't new. But, this form of self injury has been more openly discussed lately. If you haven't heard about cutting, chances are pretty good, that your teen has and might even know someone who does it. It can be hard to understand why a teen would deliberately cut themselves. But parents who are aware of this problem, can really help. That's why we're talking about it today.

Many parents don't really understand what cutting is. It's when a person uses a sharp object to make marks, cuts, or scratches on their body, on purpose. Teens usually cut themselves on their forearms, thighs, or belly. Somewhere they can hide with clothing. They might use a razor blade, knife, scissors, a metal tab from a soda can, the end of a paperclip, anything that can injure the skin. And there is a sense of shame and secrecy that often goes along with cutting. So most teens make up excuses on how they were hurt if someone sees the marks.

Most people who cut are girls. But guys do it too. And it usually starts during the teen years. The bottom line is that cutting is a sign of a deeper, emotional issue. And if you want to help your teen, you'll need to figure out, what those issues are. The cutting often begins as an impulse. "So and so mentioned it feels good, so maybe I should try it." A teen might give in to peer pressure to try cutting as a way to seem cool, popular, or avoid being bullied by other teens.

Regardless of the reasons, cutting isn't a healthy way to deal with the extreme emotions, or pressures, that come with the teenage years. For some, cutting helps them deal with feelings that seem too intense to endure. From the normal teenage heartbreaks, to rejections from friends, dramatic situations, or even the pressure to be perfect. Deep grief can be overwhelming for some.

Cutting can be a way of testing whether they can still feel physical pain. Others describe cutting, as a way of waking up from emotional numbness. Many teens discover that once they start, they can't stop. There is a sense of control and relief to see and know where this specific pain is coming from. And a sense of soothing when it stops. It seems to give them a sort of stress relief, from deep painful emotions, or even a high. Endorphins are feel good hormones released during intense physical exertion. But, they can be released during an injury.

Unfortunately, cutting is a behavior that tends to reinforce itself. Many teens say they feel addicted to the behavior. Whenever tension builds, the brain craves relief and drives the self injuring teen to seek relief by cutting again. Some would like to stop but don't know how, or feel they can't. Other teens don't want to stop the cutting, it just feels that good.

Cutting is often linked to other mental health conditions. Like obsessive compulsive disorder, depression, or bipolar. Other teens struggle with personality traits that attract them to dangerous excitement of risky behavior, or self destructive acts. Some are prone to dramatic ways of getting reassurance that they are loved and cared about. Many teens cut for a long time before anyone else knows. It can take courage and trust, to reach out.

If confronted by the cutting, teens can respond in different ways depending partly on the teen, and partly how they are approached by it. Some might deny the cutting, while others might admit to it. But say it's not really a problem. Some might get angry and reject any help. But many teens are relieved that someone knows, cares, and wants to help.

Like quitting any habit, cutting can be difficult to stop. And a teen might not succeed at first. It takes determination, courage, strength, as well as support from others, who understand and care, to break this powerful desire to harm themselves. If you find that your child is cutting, please talk to your pediatrician or other mental health provider. Getting to the bottom of the cause of the cutting may take some time. But your child is worth it.

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Interviewer: Raising the potential of young adults with autism, up next on The Scope

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Interviewer: I'm talking with Dr. Anne Kirby, Assistant Professor of Occupational Therapy at the University of Utah. Doctor Kirby, you've published research that suggests that how well people with autism perform in life depends a lot on their parents. Can you explain what you mean by that?

Dr. Kirby: We found that parent's expectations are what we call mediating outcomes for adults with autism. What those parents say they expect after high school ends up usually playing out.

Interviewer: What are some of the behaviors or accomplishments that you're looking at?

Dr. Kirby: So three main areas that I'm interested in and that have been explored a good deal in the literature are employment after high school, living arrangements after high school, so whether they're still living at home with their parents or other family members or if they're living with roommates or independently or with a spouse. And then finally, social participation, so how often they're interacting with friends in sort of a social manner.

Interviewer: So you found basically a link between parents who have higher expectations for their kids, those kids tend to perform better during this age. How did you look at that?

Dr. Kirby: We don't exactly know whether parents are just doing a really good job of determining what their child is capable or of if their expectations are actually driving what ends up happening. But one example of how they may be driving, what happens is, for example, a parent that doesn't think that their child is going to be able to be employed after high school is most likely not going to be encouraging their child to get a part-time job while in high school or find summer employment, participate in volunteer work in the community, or take on other roles in the household and community that might be helping them build skills for later employment. And then, that would then turn into not having those skills later in life to be employed.

Interviewer: They might not realize the potential of their child if they don't put them in situations where they look and see what they can do.

Dr. Kirby: Right, exactly.

Interviewer: Could it also be that if a parent expects more from their child that then the child sort of believes in themselves and tries to accomplish more.

Dr. Kirby: Certainly, and there are some theories that suggest that not only what parents expect but what someone expects of themselves, which can be influenced by what parents expect of them, can make a big difference.

Interviewer: I'm wondering too, how much the parents' background might play into all of this. If someone is living in poverty, they might just have other things on their mind and may not have the time or ability to put these kids in different situations, like volunteer work, as you say, or things like that.

Dr. Kirby: Certainly, and so we did find that parents from a lower income background have lower expectations for their children and their children are having these less ideal outcomes that we studied. And I think the example you just gave is right on point in the fact that those families might have a lot more that they're dealing with and might not have the same resources to devote to helping build those skills.

But the other thing I've thought a lot about is that you can imagine a parent who's been struggling to be employed themselves would be less likely to think that their child with a disability is going to be able to find steady, high-paying employment if they're having trouble with that. And so some of it could be resources, but some of it could be perception of possibilities.

Interviewer: How much of a difference was there between kids whose parents had high expectations and kids whose parents didn't?

Dr. Kirby: So I think it's really important to mention that despite the fact that I'm saying high expectations lead to better outcomes, the outcomes are overwhelmingly poor. So very, very few people with autism in this national sample of over 1000 people with autism had employment of any kind at the end of this eight-year study. So they were in their 20s during this time. Similarly, very, very few of them were living independently and very, very few of them were socializing at any rate with their peers or friends.

Interviewer: I wonder how much of that, though, is just what is out there for these people to begin with. I mean, I think it's still a very new idea that people with autism can join the workforce.

Dr. Kirby: Right. And it's been said often that leaving high school for this population is like falling off a cliff. It's something that parents talk about and has been written about in the literature and popular news type articles. It's kind of repeatedly referred to as this cliff because they no longer have somewhere to go every day where they know what's expected of them. The world drastically changes for them after high school and at the same time, services are just totally disappearing. So they might exist. Vocational rehab is there and can help, but often families find themselves on wait lists for extremely long periods of time.

Interviewer: So how are you following up on these results? What are you doing next?

Dr. Kirby: So what I really want to know now is if we could make a meaningful change in what parents expect for their children and if that could then make a positive difference in outcomes for people with autism. And if that's possible, then it really might be a really important target for intervention, to not only focus only on intervening directly on children with autism and trying to give them work skills through groups and programs, but to work with families to really make a difference and how families are structuring what they do throughout the high school years to really prepare for life after high school.

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Dr. Jones: Both sexting and Internet safety are increasing concerns for parents of adolescents. I'm Dr. Kyle Bradford Jones, a Family Physician at the University of Utah. We'll find out why, coming up next on The Scope.

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Dr. Jones: Every year, the CS Mott Children's Hospital at the University of Michigan in Ann Arbor performs a poll of adults on the biggest concerns they have for children in the United States. The results of the survey this year showed that there are two topics that increased in rankings much more than any other: sexting and Internet safety. So what is sexting? This is basically sending any sexually explicit messages, which may or may not include sexually related photos, over text or over the Internet. So you can see how this adds a new element to the sexual experience for adolescents.

Now, there have been multiple studies that have looked at this. From a public health perspective, it's estimated from 7-31% of adolescents engage in sexting. But many of the studies have found multiple negatives from this. First of all, adolescents are more likely to engage in riskier sexual behaviors if they participate in sexting. This means more partners, more unprotected sex, which leads to more sexually transmitted infections and unwanted teen pregnancies. It also decreases the age at which they become sexually active, which can then worsen the other risky behaviors that we just mentioned.

Another negative about sexting is that it increases the likelihood of an adolescent using both legal and illegal substances, such as alcohol, drugs, etc. There is also the increased likelihood that adolescents will have low self-esteem and this contributes to emotional confusion in relationships, not only in the short term but can set them up for that for the rest of their lives. There's also the risk that any explicit pictures or messages can make it online in a public forum if a relationship goes poorly.

Now, sexting goes right along with Internet safety, which has many of the same concerns. So a lot of this concern over Internet safety has to do with inappropriate relationships, whether sexual or otherwise. Adolescents then spend too much time on other things on the computer, which can lead to poor socialization and even an increase in obesity.

A few things to watch for in your adolescent. Maybe lots of computer use in a private place, such as their bedroom and when you go to talk to them or check in on them, they might be trying to hide something. Another thing is poor social relationships with friends. So that they mainly have connections with Internet acquaintances they may be more willing to share personal info with. Another thing is obsessions with certain celebrities that may provide a poor example of sexuality and what is considered normal and so that is one thing to keep an eye on, on whom their role models are.

So in summary, sexting and Internet safety are increasing worries for parents and have many public health consequences. The best ways to get help and to get around this are to talk with your children about this so they understand your concerns and know that they can come to you when needed.

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Interviewer: Are you the biggest barrier for your child with autism transitioning into adulthood? We'll examine that next on The Scope.

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Interviewer: Helping any child into adulthood can be challenging and there are special challenges if your child has autism. Court Allred is with the Autism Spectrum Disorder Clinic in Neurobehavior HOME Program at University of Utah Health Care. What are some of the common things that parents of children with autism do that kind of hinder that transition? Are there some common things that you see in your role as a social worker?

Court: Yeah, the two main common that I see is the parent, they're coming to me saying, "My kid never leaves the basement," and when I listen to their story, it's because the parent has given them a debit card, the parent shops for their groceries. The parent doesn't make them do anything and then there's the parent that is pushing too hard, that is unable to see what their child really is capable of because the parent themselves is struggling with anxiety or fear about what's going to happen if their kid doesn't transition quickly or smoothly.

Interviewer: So doing too much or not doing enough. So there's a balancing act here.

Court: There really is and it's so subtle and it's difficult to say. In each individual case I have to, sometimes I'm recommending that they push a little bit and other times, I'm recommending that they stop pushing, that they stop pushing.

Interviewer: Is there any way that a parent can recognize that, or do you really need a third party such as yourself to come in and be able to identify that?

Court: Well if they're pushing too hard the easy, that's the easiest one to identify and that's because there's stress in the home. If they're pushing so hard and they're always fighting and they feel like they can't get their kid to do anything, and lots of tension in the home. The other one, if they're not pushing enough, usually it will be a loved one like a girlfriend or a boyfriend or a grandma or grandpa or aunt saying, "You really should make your son do the dishes. Your son should have a job by now." This parent usually is trying not to push their son too hard, they're overly accommodating and that can come from a background of being abandoned themselves or of really enjoying being a parent and being a caretaker because we take being a caretaker seriously.

Interviewer: This is challenging stuff. I mean, how do you help somebody through that?

Court: What I have to do is first I have to develop a relationship with the parent. That parent has to feel like I understand that their fears, they're based in reality. So once I have a relationship with them, I help them see that what they want is for their child to either transition or to have less tension in the home and so I just get them to see that what their child is capable of might be different than what they want their child to be capable of. Or that they are capable of more than they think they are.

Interviewer: So kind of an expectations thing.

Court: Really it comes down to managing expectations, adjusting expectations, lowering expectations sometimes.

Interviewer: Like some parents think that, they look at things that are too big and celebrate the things that are too big and really sometimes when you have a child with autism, you have to look at those small victories, am I right there?

Court: Yeah, a lot of the parents feel like my kid doesn't have a job, my kid isn't going to college and passing his classes, therefore he's failing. Then with that type of the case, we just say, "You know what, did your kid wake up at a reasonable hour today? Did he do some laundry? Did he do a chore as he agreed upon? Did he send in a job application?" Small steps, we get them to see small things because when they're looking at the big picture in long term, they have a hard time seeing, "Okay what is my child capable of doing right now and can I celebrate that small success?"
With the parent that isn't pushing enough, we have to start getting them to feel like it's okay for their child to be in distress. It's okay for their child to be unhappy and anxious and mad at them. So with that again, it's the small thing like make your kid get up and do the laundry and if he doesn't do that, then it's time to turn off the Internet.

Interviewer: Does the parent have to kind of be the one that's got the big picture in mind? So if the ultimate big objective is to get a job, that the parent has to come up with some small steps to get the child there?

Court: That's tricky because sometimes the kid's expectation is different than the parent's. People with autism, they struggle with seeing the big picture themselves and they don't recognize that what they're doing in the short term isn't facilitating long term. So a lot of them don't have a long term goal or they might say that they do but their daily behavior doesn't match that.
Parents, yeah they have a long-term view and sometimes we have to help them modify that because sometimes they're unrealistic and they feel like their kid will be able to get married one day and have a home and have a job and some of them will have for sure obviously. But sometimes they're going to need a group home setting with support. So then we have to help them modify that expectation as well and what steps to take to move forward in that direction.

Interviewer: I think it's also interesting that individuals with autism, we all kind of know what their limitations are, right, and it's a thing but parents that have issues because they felt abandoned as a child and now they're doing things to their own child, with or without autism, they can be blind to it, right?

Court: Sounds like we're starting to talk about normal parents with no neurotypical kids at this point. Being a parent is hard regardless.

Interviewer: So many parents bring that baggage into any parent-child relationship but it sounds like it's really magnified and can really have bigger effects if you have a child with autism.

Court: Yeah, I guess for me, we should probably not use the word "baggage." We should probably use the word like "issue" or "background."

Interviewer: Fair enough.

Court: Or their own individual path, something like that that's more neutral.

Interviewer: That's good.

Court: Then the other one we need to remember is they are all individual. Too many people that don't understand autism think they're the same, that they all struggle with the same issue, and that's why it's so hard working with autism, it's because each person is an individual with unique attributes and has autism. But yeah, if we can get parents to see that they can work on their own issues. It's not just about their son or daughter overcoming his issues. The parent needs to work on their issues too.

Interviewer: Because it all contributes.

Court: It does.

Interviewer: It all contributes to everybody. It's like a system.

Court: I get emails from parents all the time saying, "My kid didn't wake up when they said they were going to and I just think we're going backwards and what's going to happen in 30 years? I'm going to die?" I'm just like whoa, take a deep breath. In reality, he just didn't do what he said he was going to do and what do we do when people don't do what they say they're going to do? We implement agreed upon consequences. So let's just go back to the plan.

Interviewer: Instead of 30 years in the future.

Court: Yeah.

Interviewer: Yeah. Are there any resources that parents can go to? It really sounds to me like you do need somebody that is an expert in this to kind of help you identify if you're pushing too hard, not hard enough, give you some strategies to help. Are there other resources that a parent could go to?

Court: You know if they take their young adult and they see a specialist, any specialist hopefully will identify what the parent can work on themselves. They can read books. There are self-improvement books. You can look up specific titles like how to manage my anxiety or how to stop being a caretaker. A lot of it sometimes is codependence and there's tons of books on codependence and how to stop doing that.
But as a parent, what we try to get them see is that they need to push themselves as hard as they're trying to push their child. So if they want their child to be flexible with how they manage their time, then they as a parent need to be flexible and celebrating the small steps that their child is doing. They themselves need to see this is just a small little blip, this is just by the time they are a little bit older, things will work themselves out and it's not as scary as they think it is. It doesn't have to mean they're going to fail forever. A lot of it is then just learning to implement the very coping skills we're trying to teach their young adult.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Gellner: Dealing with cyberbullying can be tricky these days. I'm Dr. Cindy Gellner on The Scope with tips for kids and parents to prevent and stop cyberbullying.

Interviewer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Technology means that bullying is no longer limited to schoolyards or street corners. Cyberbullying can occur anywhere, even at home, via email, text messages, cell phones, and social media websites. Can happen 24 hours a day, 7 days a week with potentially hundreds of people involved. The effects can be devastating for the victim, feeling hurt, humiliated, angry, depressed, or even suicidal.

No type of bullying should ever be tolerated. Today we'll discuss tips to help protect yourself and your child online so you could deal with the growing problem of cyberbullying.

Cyberbullying occurs when someone uses any form of digital technology to harass, threaten, or humiliate another person. Unlike tradition bullying, cyberbullying does not require physical strength or face-to-face contact and is not just limited to a handful of witnesses. Anyone with an internet connection or mobile phone can cyberbully someone else often without having to reveal their true identity.

Cyberbullies can torment their victims 24 hours a day and the bullying can follow the victim anywhere do that no place, not even home, ever feels safe. And with a few clicks, the humiliation can be witnessed by countless people online.

If you or a loved one is currently the victim of cyberbullying, it's important to remember that you are not alone. As many as one in three teenagers has been cyberbullied at some point in their lives.

As with traditional bullying, boys and girls cyberbully but tend to do so in different ways. Boys tend to bully by sexting girls or sending messages that threaten physical harm to another child, a boy or a girl. Girls on the other hand more commonly cyberbully by spreading lies and rumors, exposing one's secrets, or excluding the victim from emails, buddy lists or other electronic communication.

In many cases, cyberbullying can be even more painful than face-to-face bullying. They can feel like there's no escape from being teased. A lot of cyberbullying can be done anonymously so you may not be sure who exactly is targeting you. This can make you feel even more threatened and can embolden the bullies as they believe online and anonymity means they're less likely to get caught.

Since cyberbullies can't see your reaction, they will often go much further in their harassment or ridicule than they would do face-to-face with you. Cyberbullying can be potentially seen by thousands of people. Emails can be forwarded over and over and social media posts can often be seen by anyone. The more far reaching the bullying, the more humiliating it can become.

Gay and lesbian youths are more particularly at risk for cyberbullying. If you are targeted by cyberbullies, it is important to not respond to any messages or posts written about you no matter how hurtful or untrue. Responding will only make the situation worse. Getting a reaction from you is exactly what the cyberbullies want. So don't give them the satisfaction of knowing how they hurt you.

It is also very important that you don't seek revenge on a cyberbully by becoming a cyberbully yourself. Again, it would only make the problem worse and it could result in serious legal consequences for you. Remember, if you wouldn't say it in person, don't say it online.

Instead of responding to cyberbullying, save the evidence of the cyberbullying and report it to a trusted adult. If you don't report incidents, the cyberbully would often become more aggressive. Be especially sure to reports threats of harm and inappropriate sexual messages to the police. In many cases, the cyberbully's actions can be prosecuted by law.

Cyberbullying is rarely limited to one or two incidents. It is far more likely to be a sustained attack on you over a period of time. So you too may have to be relentless and report each and every bullying incident until it stops. There is no reason for you to ever put up with cyberbullying.

You can prevent communication from the cyberbully by blocking their email address, cell phone number and deleting them from social media contacts. Report their activities to the internet service provider or to any social media they use to target you. The cyberbully's actions may constitute a violation of the website's terms of service, or may even result in criminal charges against them.

If you are being cyberbullied, remember it is not your fault. No matter what a cyberbully says or does, you should not be ashamed of who you are or what you feel. The cyberbully is the person with the problem, not you. Remember, someone who is a cyberbully is an unhappy, frustrated person who wants to have control over your feelings so that you feel as badly as they do. Don't give them the satisfaction.

Don't make being cyberbullied worse by dwelling on it by reading a message over and over. Instead, delete any messages and focus on positive experiences. There are many wonderful things about you to be so proud of who you are. Talk to a trusted adult, see a counselor, and seeing a counselor does not mean there's something wrong with you. It means you're taking charge of your own happiness and doing what is right for you.

Exercise, meditation, positive self-talk, and breathing exercises are all good ways to manage the stress from cyberbullying. Do something fun. The more time you spend doing activities you enjoy, such as sports, hobbies, or hanging out with friends who do not participate in cyberbullying, the less influence the cyberbully will have on your life.

Announcer: TheScopeRadio.com is University of Utah Health Science's Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: How do you know if your teenager is just being a mopey teenager or might have depression issues? We're going to find out next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Nathan Bexfield is at the South Jordan Health Center part of University of Utah Healthcare, and today we're going to give you some tips as a parent how you can figure out if your child might be suffering from depression or maybe if they're just a mopey teenager, and it can be difficult to tell the two things apart sometimes. So give us some insight.

Dr. Bexfield: So yeah, I think every parent of a teenager wonders how motivated they are to actually get out and do things, but depression is kind of on a whole different level. So with depression, obviously they need to be depressed, and being depressed is like not having really much joy in life. A good example of a kid that may have depression is that maybe this kid enjoyed playing soccer at one point, and that was their passion and they loved it and they wanted to do it a lot, but then suddenly they're not even really wanting to play soccer anymore, and you're wondering, "Well, why don't you get out and play with your friends?"

Interviewer: Yeah, not finding joy in things you used to find joy in.

Dr. Bexfield: Right, exactly. Exactly. Another symptom that can be a little more concerning with kids who might have depression is changes in eating habits. They might eat more than they used to or not eat as much as they used to. Also, watching their sleeping habits. So some kids oversleep. A lot of teenagers will oversleep.

Interviewer: Guilty.

Dr. Bexfield: But these kids are sleeping like 18 hours a day, a crazy amount of sleep, or not being able to fall asleep or stay asleep. So those are the things that you want to look at as well. And teenagers, another thing I find that a lot of them do is they get more irritable. Now I know what you're saying. Irritable teenagers, you're probably like, "Well, every teenager is irritable."

I'm talking like out of proportion irritable like you can't really even have a conversation with them without them just blowing up or getting really frustrated and angry, or crying a lot, extreme sadness. So those are some things I often see in kids of this age. I think extreme cases, there are kids that want to hurt themselves or have thought about suicide, which is very sad, especially to think of a teenage boy or a teenage girl who wants to hurt themselves.

Interviewer: Yeah, I've heard if it gets to that point, that you should seek help immediately.

Dr. Bexfield: Definitely.

Interviewer: If there's any indication that suicide's on the table you should go seek help, because it does one of two things. It either gets the child help and the parent help, or it calls the bluff, if it is bluffing, because sometimes that's what it can be. But what are some other things parents can do? If they recognize what they think to be symptoms of depression, should they seek out help right away or is there something parents can do?

Dr. Bexfield: Definitely. If you are worried about depression in your child you should go see your physician, whether that be your pediatrician or your family practice doctor, but go see your doctor, because we can do some simple screening tests and just have a simple conversation with you and the child, and just kind of find out how things are going. And if your child meets the criteria for someone who has depression, then there are certainly lots of things we can do. The big things that we do that I find works the best is starting an appropriate medication and also getting them into some sort of therapy to allow them to talk things out and have coping mechanisms in place. Sometimes that therapy works even better when the whole family is involved.

Interviewer: Medications, do you find that some parents are little hesitant?

Dr. Bexfield: I do, because there's a little bit of stigma that comes with taking medications for depression or any mental health issue. But the actual truth is there are a lot of people that have gotten a lot of benefit from these medications. So I think this is something that actually helps these kids, and I've seen it in my experience.

Interviewer: How often is depression caused by actually a chemical imbalance in the brain versus just what's going on in their life?

Dr. Bexfield: Well, I think it's a combination of both of those things. Certainly genetics plays a factor in it. If there's a family history of depression, then certainly that child may be a little more prone to depression or anxiety or whatever mental health disorders run in the family. Also, the environment plays a factor. What's your home life? What's your life at school? How are people treating you? How are you being perceived as being treated or how are you perceiving others as treating you? That sort of thing. So I think it's more than just a chemical imbalance versus environment. I think all those factors sort of play in, and once it overwhelms them, then they feel like they're drowning and they can't get up.

Interviewer: You've told me that depression is something that you see more and more often, you feel, in your practice at times, and it seems like you're something very passionate about. So what I'm getting at right now is what would be that one message you'd have to a parent if they think that their child is depressed? Even if they're not sure, because that's a scary step to take, right, to say my child might be depressed?

Dr. Bexfield: That one message I would get out is if you're worried at all, come see your doctor. Let's talk about it. The best case scenario, we can tell you, "Hey, you know what, your child is not really depressed and maybe this is something you guys need to talk about, communicate better," sort of a thing like that." Worst-case scenario is if you don't address it something really bad could happen and your child could end up being harmed.

Interviewer: So even if you have an inkling, no action is worse than action?

Dr. Bexfield: That would be my suggestion, yeah.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Gellner: There seems to be an increase in the number of children with mental health needs that pediatricians are seeing. I'm Dr. Cindy Gellner, and we will discuss that today on The Scope.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Nearly five million children in the U.S. have some type of serious mental illness, one that significantly interferes with their daily life. In any given year, 20% of American children will be diagnosed with a mental illness.

Identifying mental disorders in children can be tricky for health care providers. Children differ from adults. They experience many physical, mental and emotional changes as they progress through their natural growth and development. They're also in the process of learning with how to cope, adapt and relate to others in the world and around them.

There are several different types of mental disorders that can affect children and adolescents. These include anxiety disorders, attention deficit and hyperactivity disorder, disruptive behavior disorders, pervasive developmental disorders, eating disorders, elimination disorders where their behaviors is related to bathroom habits, learning and communication disorders and mood disorders.

Symptoms in children vary depending on the type of mental illness. In general, the symptoms include an inability to cope with daily problems and activities normal for their age, changes in sleeping or eating habits, and excessive complaints of physical ailments. Usually a parent will say that they'll bring their child to the doctor and there's nothing physically wrong with them and this happens over and over.

They can defy authority, skip school, steal or damage properties. Their frequent outbursts of anger, again, above and beyond what is normal for their age group, loss of interest in friends and activities they used to enjoy, excessive worrying or anxiety, hyperactivity or persistent disobedience and aggressive behavior.

The exact cause of most mental disorders is not known, but research suggests that a combination of factors, including heredity, biology, psychological trauma and environmental stress, may be involved. Many mental disorders run in families. As in adults, many mental disorders in children have been linked to abnormal functioning in particular brain regions that control emotion as well. Some mental disorders might be triggered by psychological trauma such as severe emotional, physical or sexual abuse. Stressful or traumatic events can trigger a disorder in a person with a vulnerability to a mental disorder, for example, if there's a lot of family discord in a child's life and the family has a history of mental illness, you're more likely to see problems in the child.

Mental disorders in children are diagnosed based on symptoms and behaviors. However, diagnosing mental illness in children can be especially difficult. Many behaviors that are seen as symptoms in mental disorders, such as shyness, anxiety, strange eating habits and temper tantrums, can occur as a normal part of a child's development. Behaviors become symptoms when they occur very often, like daily, last a long time, occur at an unusual age, such as children who are close to teenage years who are acting like they were five, or they cause a significant disruption to the child or family's life, such as if the child refuses to go to school.

If the symptoms are present, your pediatrician will begin an evaluation by performing a complete medical and developmental history and an exam. There are no lab tests that can diagnose mental disorders. If no physical illness is found, most pediatricians will help figure out a behavioral plan for your child and may prescribe medications. Your child may also be referred to a child or adolescent psychiatrist, psychologist or social worker who is specially trained to diagnose and treat mental illness in children.

Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. They have many other tests that they can do than your pediatrician may be able to do in the office. Whether it's a pediatrician or a mental health professional, the doctor must often rely on reports from the child's parents, teacher or other adults, because children often have trouble explaining their problems and understanding their symptoms.

Mental illnesses are like medical disorders such as diabetes or heart disease. They require ongoing treatment, and the treatment for children is not well understood. The most common treatment options include medication, psychotherapy which is a type of counseling, and creative therapy such as art therapy or play therapy when the children are very young.

Without treatment, many mental disorders can continue to adulthood and lead to problems in all areas of a person's adult life. This includes alcohol or drug abuse, violent or self-destructive behaviors and even suicide. When treated appropriately and early, many children can successfully control their symptoms.

Most research on mental illness has centered on adults. However, the mental health community has begun to focus on mental health in children even more as the prevalence increases. Researchers are trying to figure out nature versus nurture, or a combination of both, are contributing to the increase in mental health disorders in children.

Most mental health disorders are caused by a combination of factors that cannot be prevented. If the symptoms are recognized and treatment is started early, many of the distressing and disabling effects of a mental disorder may be prevented or at least minimalized.

If you think your child has a mental disorder, please speak to your pediatrician about it. Again, your pediatrician may be able to treat it or you may be referred to a psychiatrist. The most important thing is you follow through on all recommendations that are advised by your pediatrician for the best outcome for your child.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Dr. Gellner: It's hard to imagine someone intentionally hurting a child, yet nearly a million children are abused every year just in the United States alone. Child abuse is today's topic on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kid Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Child abuse happens when a parent or other adult causes serious physical or emotional harm to a child. Child abuse can take the forms of physical abuse, sexual abuse, neglect and abandonment, or emotional or psychological abuse. The most serious cases of child abuse can end in death. Those who survive may suffer emotional scars that can linger long after the physical bruises have healed. Kids who are abused are more likely to have problems building and maintaining relationships throughout their lives and they are also more likely to have low self-esteem, depression, and thoughts of suicide.

When people think of child abuse their first thought is of physical abuse, such as striking, kicking, or shaking a child. But physical abuse can also include holding a child underwater, tying a child up, intentionally burning a child with scalding hot water or other objects like cigarettes, using an object to beat a child, starving a child, or failing to provide a child with food intentionally. Abusive head trauma or Shaken Baby Syndrome is a specific form of child abuse and is the leading cause of death in child abuse cases in the United States. Most incidents last just a few seconds but that's enough time to cause brain damage and kill a baby.

Sexual abuse happens when a child is raped or forced to commit a sexual act. It's also any sort of sexual contact with a child that is meant to sexually arouse the abuser. So in addition to having sex with a child or even just inappropriate touching with a child, sexual abuse includes making a child pose or perform for pornographic pictures or videos, showing a child pornographic material, forcing a child to undress, not just normally like changing your clothes, but forcing a child to undress in front of you for gratification purposes, and flashing a child or showing one's privates.

Neglect is any action or inaction on the part of a caregiver that causes a child physical or emotional harm such as withholding food, withholding warmth in cold weather, or not providing proper housing. Basically anything that interferes with a child's growth and development constitutes neglect. This also includes failing to provide medical care when a child is injured or critically sick, locking a child in a closet or a room, and placing them in a dangerous situation that could lead to physical injury or death. Abandonment is a type of neglect.

Emotional abuse or psychological abuse is a pattern of behavior that has negative effects on a child's emotional development and sense of self-worth. Ignoring a child or withholding love, support, or guidance is considered emotional abuse. Just like threatening, terrorizing, belittling, or constantly criticizing a child.

Child abuse due to substance abuse problems include allowing a child to drink alcohol or take illegal drugs, manufacturing, ingesting, or distributing illegal drugs in the presence of a child, and in some states, exposing a fetus to illegal drugs or other substances while pregnant.

It would be easier if all child abusers followed a pattern and were easy to recognize, but the truth is that child abusers come from all walks of life. It's also sometimes difficult to tell the difference between ordinary scrapes and scratches of childhood and a physical sign of child abuse. Pediatricians often can tell the difference but not always.

Some ways that kids who are being abused might act include sad or angry, they may act withdrawn, fearful, have low self-esteem, or engage in self-harm, and many have persistent nightmares. Those who are abused usually have trouble developing and maintaining relationships. They are often unable to love or trust others, especially adults with whom they can be afraid of. A telling sign that something is just not right is when a child fails to seek comfort from a parent or other caregiver who happens to be their abuser.

Kids who are abused sometimes act out. They may lose interest in activities they once loved. They may turn to drug and alcohol abuse as well as sexual promiscuity. Other kids might not act out in the typical ways but will avoid going home after school or doing any activity that would cause them to spend time alone with the abuser. But just because a child is showing these signs doesn't necessarily point to abuse. Children who are going through stressful situations, like a parent separation or divorce, a family move, or the loss of a friend or family member, may also may undergo changes in their mood or disposition.

So what should you do if you suspect some child that you know is being abused? Remember that abuse is not a private family matter, although it most often occurs within families and is often kept as a family secret. Once you suspect child abuse, you need to act to protect the child from further possible harm.

It is your responsibility to contact your local child protective services agency, police, hospital, or emergency hot-line. You may remain anonymous. Pediatricians, by law, are required to call child protective services if there is any concern that a child has been abused. If you think you may have abused your own child or you're worried that you might make sure the child is somewhere safe away from you. Speak to a trained professional and that can be an effective way to work through the reasons behind your abusive feelings.

If you suspect that someone you know is abusing a child, keep the child away from that person until authorities have been notified. Never threaten a person or take the law into your own hands. Let the legal system decide an appropriate punishment for the abuser.

Pediatricians recommend that children who are suspected abuse victims be taken to a local children's hospital where the initial diagnosis can be made and treatment can be given. Hospitals often see abused kids, especially battered children, and they can do the needed X-rays or cultures for a diagnosis to be made. They also work very closely with social workers, child protective services, and the police department to file all the necessary paperwork for the child abuser to be charged.

Psychological help is also strongly recommended. Without it, children who may have been abused may suffer emotional problems or repeat the pattern of abuse with their own children.

Abuse does not have to ruin a child's life as long as it is stopped and dealt with. The earlier abuse can be identified and stopped, the less destructive it will be.

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