Returning to School during A Pandemic

Returning to School during A Pandemic

We hear the government talking about reopening the economy and also reopening schools. However, since there is still a lot we have to learn about the Coronavirus, we do not know exactly how school should reopen and when. There has been discussions about options, but no one can make a firm decision yet. Therefore, we have to wait to find out how and when schools will reopen. Since there is no definite plan yet, this creates anxiety in children and parents.

Many of the children and teenagers, I treat, are asking about returning to school and what changes are going to be made at school. When I tell them that there is no definite plan yet, they are not surprised but you can also hear the anxiety it their voices. We have to remember that these kids have been living under quarantine orders for over 2 months now. Also during that time there have been few concrete answers for these children about the virus or returning to school. Furthermore, before the quarantine, these children were dealing with mass shootings on a daily basis and mass shooting drills. This was another situation they had to endure with no reasons as to why the shootings were occurring or when they would stop. Therefore, we have an entire generation of children and teenagers who have had to adjust to living with uncertainty about their safety.

Many parents are wondering how to handle this uncertainty about returning to school. Well one thing we can do to help children and teenagers is to validate their feelings. Instead of just telling them everything will be alright. We need to acknowledge that it makes sense that they are feeling anxious and uncertain about the future and going back to school. We have no answers and it’s natural to be anxious under the present situation. Therefore, instead of telling them their feelings are wrong or they are over reacting, validate their feelings. This will help them cope with their feelings and help them not to feel like they are crazy for feeling the way they do.

Also explain to children and teenagers that we are living in historic times. Inform them that the last time there was a pandemic was 100 years ago. We did survive that pandemic and we will find away to survive this one. It may take sometime but we will find a solution. However, while we are looking for answers, they are living history. When they are older and their grandchildren ask about the Coronavirus pandemic, they will be able to provide first hand answers because they lived through the pandemic. This may help with the uncertainty and provide your child with a different perspective they can use as they view the current situation.

Also reassure them that you know while we search for answers that this can be scary and confusing, but as their parent you are going to watch out for them. As soon as you hear news about what the plans are for school, you will share the information with them. Also reassure them you will not place them in a dangerous or uncomfortable situation. If you do not feel comfortable with the plans for returning to school, you will look at alternatives such as home schooling. Remind them that as their parents you can make different plans for them if needed.

However, while we wait for the plans assure them it’s okay to feel anxious or nervous. Also let them know you want them to share their feelings with you so you can help. There is no reason to be embarrassed about the feelings they are having or needing to talk about the feelings. Also explain you understand that sometimes it’s hard to talk to your parents about certain feelings. Reassure them that if they don’t feel comfortable talking to you that you will understand and make arrangements for them to talk to someone where they will feel safe.

The most important thing to remind children is they have been living with a great deal of anxiety and fear for a long time. Therefore, it’s only natural that they may need to talk about their feelings. It’s normal and a healthy thing to do and you are there as their parent to help them in any way they need.

Another thing that can help is to encourage your child to talk to their friends and their feelings too. They can use FaceTime or Zoom. By sharing their thoughts and feelings with their friends about returning to school, they will see they are not alone. Hearing that their friends have similar feelings can help them relax and not feel so strange about their feelings. It is also an excellent support group for them. If they start talking now about their feelings, it will make it easier to talk about their feelings as they get older and life gets more complicated. Also by talking about their feelings, it also hopefully keep the door open so they continue to talk to you too.

The idea of returning to school will create anxiety when they think about having to wear a mask and other possible changes. However, if we acknowledge the anxiety is legitimate and if we attempt to work with the children and their feelings, they should have less anxiety and an easier transition back to the new normal for schools.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about Dr. Rubino please visit his website at http://www.RubinoCounseling.com or his Facebook page at http://www.Facebook.com/drrubino3.

Helping Children Cope with Anxiety during the Pandemic

Helping Children Cope with Anxiety during the Pandemic

Anxiety is a common issue for children especially during the quarantine and having to attend school from home. Remember children’s imaginations are very active. During the last few months we have had little to no information about how the Coronavirus works. Therefore, there has not been a lot to explain to children and they have heard a lot on the news. Many parents tell me they have limited the access to news but with their IPads, phones and friends, they hear more than we are aware of. Also don’t forget, prior to the pandemic the children were dealing with mass shootings on a daily basis. Therefore, there is a lot going on to cause anxiety in children.

According to the CDC and what I have seen in my office, anxiety is at epidemic levels for children. The most common reason children are coming into therapy right now is anxiety or depression. Many parents want to know what they can do in between therapy sessions to help their child with their anxiety. I ran across an acronym by Lori Lite that is designed to help children who are anxious. The acronym is ASSURE. I will explain what is stand for and how to use it below.

A – Align with your child
 with their body language
 with their tone and volume of speech
 validate their feelings
S – Share your experience
your feelings in stressful moments
mistakes you’ve made and how you emerged from them
how you cope with stress in day-to-day situation
perspective you’ve gained from seeing “this too shall pass”
S – Skills-training
give them words for feelings and worries
get them involved in appropriate exercise and activities to release stress
teach and model coping strategies like visualization, deep breathing, positive imagery
U – Uncover stress-related signs and symptoms
body aches – head, stomach
irritability and mood change
appetite change
sleep changes
R – Reassure them
that they’ll come through
that you’re there for them
that you’re proud of the effort they’re investing in calming and coping
things will normalize – recall examples
E – Engage the topic when they’re calm
listen to what they say and don’t say
respect their process in overcoming stress and worry
brainstorm options while they’re calm, since that’s when the “thinking” part of the brain is turned on.
This may not eliminate their anxiety all together, but it should help reduce their anxiety. Also remember if their anxiety is severe also seek psychotherapy for your child with a therapist who specializes in treating children. Psychotherapy can now be done via telemedicine so there is no risk of exposing them to the virus. Between the mass shootings and the pandemic caused by the Coronavirus, our children are living through historic times. We have never experienced events like we currently are experiencing so there should be no surprise that children may need psychotherapy at this time.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. His practice does offer telemedicine. For more information regarding his work or private practice visit his website at http://www.RubinoCounseling.com or his Facebook page at http://www.Facebook.com/drrubino3.

Teenage Suicide During the Quarantine

Teenage Suicide During the Quarantine

Many parents ask me, if their child could be suicidal and what to do if their child is suicidal? This concern has increased since the CDC no longer ranks suicide as the third leading cause of death and now rates it as the second leading cause of death for kids 10 to 18 years old. Furthermore, since the quarantine has been in place, there has been an increase in suicides and deaths from drug overdoses. As a result, parents are worrying more about if their teenager may be feeling suicidal. Additionally, before the quarantine, parents were worrying more about suicidal teenagers as we learned more about suicides of survivors involved in mass shootings. The issue of suicide is very scary especially because we do not discuss mental health issues in our society. As a result, parents are not sure what signs they should be looking for or what to do if they feel their teen is suicidal. Parents are aware there is a teenage suicide epidemic, but have no idea what to do or how to get help.

A successful suicide attempt is definitely a tragedy for the entire family. However, an unsuccessful attempt can be a tragedy for the child and the family too. Depending on the method used, a child who has an unsuccessful attempt may have to live their entire life with major medical complications. They can cause brain damage which may cause them to lose the ability to speak or the ability to breath on their own. Therefore, they may spend the rest of their life on a ventilator. Guns are one of the top three ways teenagers attempt suicide. However, teenagers are not aware that guns jump when fired. Many teens who use a gun do not kill themselves, but they do shoot off their face. The result is they have to have numerous surgeries to reconstruct their face, but their face and life are never the same.

I read this very good article describing what to do if you think your child is suicidal. It provides the steps you need to take in a non-threatening manner. It also addresses issues parents often may not think about, if they are concerned about their child being suicidal. The most important step is don’t be afraid to ask your child if they are feeling suicidal. It is a myth that if you ask someone if they are suicidal that you will cause them to become suicidal. In fact, you may save their life by asking them if they are suicidal. By asking you let them know it’s ok to talk about their feelings. Also by asking you reassure them there is nothing wrong with them and that you are emotionally strong enough to cope with the situation. Therefore, you may save their life by asking, if they are feeling suicidal.

Another reason many parents do not ask their teenager about suicide is the negative stigma associated with suicide. Often when someone dies of suicide the family will give another reason. Many families also request suicide not be listed as the cause of death. The Lighthouse Project conducted at Columbia University is attempting to remove this stigma. The Project has also developed questions that family members, friends and first responders can ask a person who they think might be suicidal. The questions have shown to be very effective at identifying someone who is suicidal and having the person to get help. I am including the link to the Lighthouse Project so you can learn more about it and download the questions that are most appreciated for you, if you feel someone in your life maybe suicidal. http://cssrs.columbia.edu/. It is a very good list of questions and the research shows that the questions are very effective at identifying someone who is suicidal.

I have included the link to this article and I encourage parents to read it and to save it. What to Do if You’re Worried About Suicide |. https://childmind.org/article/youre-worried-suicide/#.W9PRyfwKel8.twitter.
Bottom line, if you feel your teenager is suicidal do not be embarrassed. Make an appointment to have your teen evaluated by a psychotherapist who specializes in suicidal teenagers. If you walk in on an attempt, call 911 immediately.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating suicidal children and teenagers. For more information on his work or private practice visit his website http://www.RubinoCounseling.com or Facebook page http://www.facebook.com/drrubino3.

Why Are We Ashamed of Mental Health?

Why Are We Ashamed of Mental Health?

Mental health is a topic we tend to avoid in our society. We avoid it so much that the month of May is dedicated to Mental Health Awareness. Many people are afraid that if other people know they are feeling down or anxious that people will think they are crazy. Many people think of someone living in the streets when you mention mental health. This is not reality. This negative stigma makes it difficult for adults to seek help for mental health issues. This negative stigma also makes it very difficult for children to ask for help when they feel depressed or anxious. They are afraid their friends won’t understand and won’t want to be friends with them. They are also afraid their parents will think they are crazy and be disappointed with them. These ideas are incorrect, but if mental health is overwhelming for an adult, imagine how it can be for a child.

It is very important that children and teenagers do ask for help when they are experiencing mental health issues. The CDC estimates 1in 5 children need psychotherapy for a mental health issue. Furthermore, the CDC has stated that Suicide is an epidemic for children between the ages of 10 and 18 years old and is the second leading cause of death for kids 10 to 18 years old. Cutting, self-harming behaviors, are also now at an epidemic rate in children. Most teenagers I work with, as a psychotherapist, have had suicidal thoughts and have cut before starting therapy with me. They also tell me about many of their friends who are feeling suicidal and cutting. According to the CDC, the Suicide rate and the number of teenagers engaging in self-harming behaviors has been increasing every year for the past twenty years.

While the need for teenagers needing psychotherapy is increasing, the reluctance to attend psychotherapy is increasing. Most teenagers I see for psychotherapy are afraid that their friends would stop being their friends if they knew they were going to therapy. They are afraid it makes them crazy and nothing will help because they are weak. They blame themselves for the feelings they are having. They are shocked when I explain that they are not weak and it is not their fault.

We need to change this stigma associated with mental health. Mental health should be treated the same way a physical health because they are the same. Clinical depression is caused by a chemical imbalance in the brain. If some one is diabetic, do we call them crazy or weak because their pancreas is not producing the correct level of insulin? No we do not. Therefore, when we have numerous research studies which show a link between physical health and mental health, why do we continue to view mental health so negatively? By doing so we are causing a number of teenage deaths. Suicide use to be the third leading cause of death for teenagers, however now according to the CDC it is the second most common cause, as I stated above. Many teens also die every year from eating disorders. Eating disorders occur in both girls and boys despite the belief girls only have eating disorders. Bullying is a severe problem and many teenagers are opting to commit suicide rather than discuss the pain and torture they are experiencing due to being bullied. This does not make sense that teenagers should be dying because the teen or their family are embarrassed to seek treatment.

I was researching this subject and found a video by the Anna Freud Institute. It is called, “We all have mental health.” It is a short video directed at teenagers and middle school students. It discusses the issue in a very relaxed manner and provides teenagers with options for how they can talk about their own feelings. I encourage parents, teachers and anyone who deals with children to watch this video. You may want to watch it with your teen and begin a discussion about feelings. The link to the video is https://youtu.be/DxIDKZHW3-E.

We need to start to change the negative stigma associated with mental health. Besides causing the deaths of teenagers, this stigma effects an entire family. A death impacts everyone in a family. Not being able to talk openly about a death because it was related to a mental health issue, creates more problems for the survivors. Nothing will change until we start to approach mental health differently. I also encourage you to look at the foundation started by Prince William and Henry, Heads Together. It provides a number of ways we can start to change the negative stigma associated with mental health and save lives.

Furthermore, at this time in our world, when we are in the middle of a pandemic which besides killing thousands of people daily, it is creating mental health issues for those in quarantine, those with the virus and our first responders. These issues will not disappear quickly just like the virus will not disappear quickly. As a result, we will have even more people needing mental health care. How will they receive it if they feel ashamed for needing treatment or if we continue to treat mental health as a disease? Mental health and physical health go hand in hand, when will we treat them equally?

Dr. Michael Rubino is a psychotherapist with over 20 years experience working with teenagers and children. For more information about his work or private practice visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3.

Mother’s Day Is A Difficult Day for Some People

Mother’s Day Is A  Difficult Day for Some People

Many people assume Mother’s Day is a happy day for people because they can honor their mother. However, for some adults, it is not a happy day. For some people their mother may have died when they were children. For some people their mother may have left them when they were children and they had to live in foster care. For others, their parents separated and their father raised them and they rarely or maybe never saw their mother. Therefore, Mother’s Day may not be a happy day. Also for children who were raised in foster care all their lives, today typically is a very difficult day.

While this may not be a happy day for adults, it also can be a very difficult day for children too. Some children may be dealing with the death of their mother. As I stated above, some children may have a mother who left the family and are not involved with them any longer. Seeing the television commercials or having other family members tell them that it still can be a good day can be difficult for them.

Additionally, this year we are under quarantine. This may make it more difficult for people to visit their mother or grandmother. If someone has been exposed to the virus or if their grandmother is over 70 and has other health issues visiting mom or grandma may not be possible. However, you can use Zoom or FaceTime, but this Mother’s Day will be different and some people may have a hard time accepting it.

I work with many of these children, I described above, in psychotherapy. Many don’t express their feeling, but they tend to deal with the emotional pain by acting out. They may be very oppositional during the week and the day as away to express their feelings. Other children may isolate and not want to be involved with anything having to do with Mother’s Day.

I have had parents ask me how they should handle Mother’s Day when a parent has passed away or left the family. They understand that it is a difficult day, but they do not know what to do in order to help their children.

My recommendation is let the child cope with the day in the way they need to. Try not to make an issue about the day. The other thing I recommend to a parent is to talk to their child. Acknowledge that Mother’s Day may be difficult but it is just one day. They may have a rough day today but tomorrow is another day. I also recommend to a parent, when a parent has passed away, to ask the child if there is anything they may want to do. A child may want to release a ballon with a note, they may want to visit the cemetery or they may want to do something for an aunt or another female role model in their life. If they do have an idea, go with what they want to do. If they don’t have an idea, let them know that is okay. If they come up with an idea then you can do it. If they do not have an idea, then remind them it’s just one day that you all need to get through and tomorrow will be better.

This approach can help children whose mother has left the family. Many children may believe their mother will return one day. Confronting this belief around Mother’s Day is not the time to confront it. However, if they have an idea regarding how they want to honor their mother, allow them to do it.

Hopefully this will help parents understand the issues their children may be dealing with on Mother’s Day and make it easier for everyone.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about Dr. Rubino’s work or private practice visit his website http://www.RubinoCounseling.com or on Facebook at http://www.Facebook.com/drrubino3.

What’s Next?

What’s Next?

The quarantine has caused financial and emotional problems for many people. It has disrupted what we consider normal life and many people do not see an end in site. As a result, many people have been demanding and demonstrating that the quarantines in all the states end so they can resume their lives. The President has been leading people to believe that this is a very easy task. However, reopening the economy is not as easy as the President or as many people may think it will be. The medical professionals have stated we are moving too fast and we need to listen to the medical experts who study viruses not the President.

We still have people contracting the virus and dying from the virus at an alarming rate. Los Angeles County reported a significant increase in deaths due to the virus over the weekend. New models just released expect that towards the end of May and the beginning of June we will see another significant increase in the number of people dying from the virus and contracting it.

Yes having to shelter in place is boring and it is costing people their jobs. Therefore, we have people worrying about how they will pay their bills and we have people who are becoming depressed and anxious due to not being able to leave the house. They feel that once the quarantine is lifted everything will be alright, but will it?

After the quarantine, what’s next? We cannot resume life as normal because we are still dealing with the virus. Therefore, we will need to wear masks and maintain social distancing requirements. As a result, we will not be able to attend movies or concerts. Restaurants will not be the same either due to social distancing requirements. Children and teenagers will not be able to attend school in the same manner and our work environments will change significantly too.

Now the quarantine and worry about contracting the virus has already placed a great deal of stress on many people. There now will be people who will be afraid of leaving the house because they are afraid of catching the virus. Besides these people, other people will be feeling stressed and depressed due to all the changes needed to open the economy. They were hoping to return to their lives and they will find out that they have to adjust to an entirely new lifestyle.

In addition to these changes, we will still be facing the issue of needing to take precautions so we do not catch the virus and we will still be worrying about family members who are at high risk due to age or other health underlying health conditions getting the virus. Additionally, we will continue to have family members who contract the virus and die. Just because we open the economy doesn’t mean people won’t be catching the virus and dying. Also it does not mean the economy will return to normal and people will be able to find new jobs. If restaurants are only allowed to operate at 25% capacity and tables need to be six feet apart in addition to having to use disposable menus, would you want to go to a restaurant under those conditions? The answer is most likely no. Therefore, since business will be down in numerous industries, no one will be hiring and people still will be worrying about paying the bills.

As a result of working with trauma victims for over 20 years, I understand the first impulse is to try to resume living your daily life as soon as possible so you feel a sense of control over your life that was taken from you. We have all been traumatized by the Coronavirus. We are the United States and we can handle anything. However, the Coronavirus has turned the tables on us. We are not in control, the virus is in control.

So what’s next? We listen to the medical professionals and we follow their advice. We have made some progress getting a handle on the virus. However, if we move to fast, the virus will come back and many more people will become sick and die. The President is not allowing the professionals to speak out because it is not good for his image. For those of you who say this is wrong, when there was a cruise ship in the San Francisco Bay waiting to dock, the President stood outside the CDC and said, “I don’t want it to dock because the increased numbers don’t look good for me”. We need to consider what is best for the entire country not just the President.

Therefore, as difficult as it maybe, we need to listen to the medical and mental health experts and develop a safe plan to reopen the country. A plan which will minimize the number of people who will become ill and a plan that addresses the mental health issues that will be triggered and exacerbated by reopening the economy.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children, teenagers and trauma victims. For more information about Dr. Rubino visit his website at www. RubinoCounseling or his Facebook page at http://www.Facebook.com/drrubino3.

How Much Screen Time is Appropriate before Bed?

How Much Screen Time is Appropriate before Bed?

How much time a child or teenager spends on electronics is always a big debate between parents and their children. Many teenagers act like they cannot live without them. Also teenagers tend to argue there are no negative side effects to computer screens. Many parent feel differently and have research to back up their point of view. However, most teenagers dismiss their parents opinions and they feel their parents are overreacting.

One of the major concerns parents have is what do electronics do to a child’s sleep. Many parents feel if a child or teen uses electronics up until the time they go to bed, the child will have a hard time getting to sleep and staying asleep. By the way, parents are correct based on all the research in this area. Parents also are concerned about teenagers watching YouTube or texting on their phones until 3 or 4am in the morning and then being to tired the next day for school or anything.

During the quarantine this probably has become a bigger issue in some households because kids don’t need to get up for school. I have written previous articles recommending that electronics be limited and definitely not before bedtime. I did some more research in this area and found the following information by Lori Lite maybe helpful in determining how much screen time is appropriate before bed. She runs a program and website regarding helping kids to relax and control anger.

First let’s start by looking at how electronics impact children and teenagers brains. Electronics, and especially screens, can be stimulating. While that might be a good thing during the day, it’s not at night when it’s time for kids to sleep.

Part of the stimulation from electronic screen time is from the blue wave light that comes from screens. During the day, many things stimulate our brains, and blue wave light is one of them. But at night, blue wave light exposure sends a signal to the brain that it’s daytime. When exposed to blue wave light, children may struggle to wind down and begin the process of falling asleep.

Besides the effects of blue wave light, screen time affects sleep if children become stimulated having conversations over the phone or text, playing games, or engaging in social media. Video games or movies might include disturbing themes or images that will affect sleep and emotional health.

How to Manage Screen Time for Better Sleep

Your pediatrician may have their thoughts about how screen time affects sleep Limiting screen time mostly to daytime hours is best. Blue wave light exposure during the day isn’t as problematic as nighttime exposure. And stimulation from screens during the day is normal.

As parents, it’s essential to set clear rules on screen time use. A good rule of thumb is to avoid screen time at least 2 hours before bedtime. Encourage kids to engage in other relaxing evening activities during that time as part of a healthy bedtime routine. They can read a book, work on a puzzle while listening to relaxation music, and get ready for the next day. The other rule parents should enforce is to avoid screen use in your child’s bedroom. Their bedroom should be an environment devoted to sleep and relaxation, and when you bring screens into it they may be tempted to engage rather than sleep).

Another factor to consider is how screen time has replaced play time in some households. Kids who are using screens for many hours a day may be sedentary while they do so. Activity and exercise are a part of a healthy lifestyle, as they reinforce a circadian rhythm that’s in sync with the environment and allow kids to be tired when it’s time for bed.

Screens have become a part of everyday life and are an important tool for kids and adults. It’s imperative for parents to show their children the proper way to use screens without negatively affecting their lives. Take the lead to demonstrate responsible use so children can enjoy screen time as well as a good night’s sleep.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about his work or private practice visit his website at www.RubinoCounseling.com or his Facebook page at www.Facebook.com/drrubino3.