Coping with the Epidemic of Anxiety Disorders in Children and Teenagers

Over the years children and teenagers have been exposed to stressful life events especially the last two years. The teens today have grown up with daily school shootings and mass shooting drills. Imagine being a second grader having to rehearse a man with a gun is on campus and you don’t know if you are going to live or die. Teenagers today have also grown up with terrorist alerts and having to be searched anytime they went to a concert or places such as Disneyland. Finally they have had to cope with COVID. Over 1,000,000, and counting, Americans have died from this virus (CDC). Many children and teenagers have lost grandparents, siblings and parents to this virus. Therefore, we also have many children and teenagers who are dealing with grief due to the loss of a loved one. We thought we had turned a corner regarding the Coronavirus, but we found out we have not turned a corner and we are still having spikes in the number of cases. There are still people being diagnosed daily with the Coronavirus and people dying daily from Covid. Many of these people have been vaccinated, however, most people being diagnosed and dying have not been vaccinated. Additionally, this time the virus is effecting teenagers and children. Since schools have resumed on site classes at least 1,000 children have died due to the Coronavirus virus (CDC).

This is a lot for a child or teenager to have to adjust to. Remember, their brains are not fully developed yet. Therefore they cannot understand things like adults do. Furthermore, they have very active imaginations which are fueled by misinformation on social media or from people such as Tucker Carlson on Fox. Having to cope with all of this together has resulted in a significant increase in depression, suicide, drug overdose and anxiety disorders. At my office we get at least 20 requests daily for teenagers seeking psychotherapy due to anxiety disorders.

The fact that we thought we were on the right track with the Coronavirus and we continue to have spikes is confusing and irritating to teenagers. Just as we think we are returning to our normal lives, we see that we need to still take precautions and maybe we will never return to our pre-Covid lives. Again we are not able to give children and teenagers any definite answers regarding when life will return to something normal. Now we have changed the rules again and they are expected to adjust.

With everything teenagers have had to cope with growing up, terrorist attacks, war, the economy collapsing, mass shooting and now the Coronavirus, we failed to make plans for their mental health care. Yes hospitals were running out of beds and physicians have become exhausted, but we are also running out of psychotherapists. Also psychotherapists are exhausted because they are dealing with adults and teenagers daily who dealing with depression, suicide and anxiety. However, psychotherapist do need some breaks so they can keep going. Finally, more and more insurance companies are declining claims or raising copayments so high that families cannot afford their copayments.

This is occurring when children and teenagers desperately need psychotherapy. Prior to the pandemic, anxiety disorders in children and teenagers were at epidemic rates (CDC). Since the pandemic there has been a 25% increase in children and teenagers being diagnosed with anxiety disorders. At this point anxiety disorders are the most common psychiatric diagnosis for children and teenagers (CDC). Yes depression, suicide, grief and trauma diagnoses have increased since the pandemic, but we have seen the largest increase in anxiety disorders (CDC). As a result, many children and teenagers have severe anxiety regarding school and many are stating they cannot go to school due to anxiety disorders.

This lack of mental health care is unacceptable in the United States. Parents call the Human Resource Department at your work. They negotiate your benefits with the insurance companies. Therefore, they can renegotiate your coverage so you receive the benefits your family needs. Also call your Senators and demand that insurance companies need to provide mental health care.

As a result, many parents have asked me how to determine if their child is coping with anxiety and what to do if they are coping with anxiety. I can understand why parents are concerned especially because many children tend to try to hide their anxiety because they don’t want to worry their parents. Additionally, parents are trying to find psychotherapist who can treat children and teenagers are parents are trying to figure out how they can afford therapy with the cost of living increasing and insurance companies restricting coverage.

Therefore, the APA (American Psychological Association) developed guidelines that parents can use to determine if their child is dealing with anxiety and what to do if they are dealing with anxiety. You can also use the guidelines for depression too. I have provided an outline to the APA guidelines below:

The American Psychological Association (APA) offers the following tips to recognize if children may be experiencing stress or anxiety:

• Withdrawal from things the child usually enjoys

• Trouble falling or staying asleep

• Unexpected abdominal pain or headaches

• Extreme mood swings

• Development of a nervous habit, such as nail-biting

Parents can actively help kids and adolescents manage stress by:

Being available

• Start the conversation to let kids know you care about what’s happening in their lives.

• Notice times when kids are most likely to talk – for example, in the car or before bed.

Listening actively

• Stop what you’re doing and listen carefully when a child begins to open up about their feelings or thoughts.

• Let kids complete their point before you respond.

• Listen to their point of view even if it’s difficult to hear.

Responding thoughtfully

• Resist arguing about who is right. Instead say “I know you disagree with me, but this is what I think.”

• Express your opinion without minimizing theirs – acknowledge that it’s healthy to disagree sometimes.

• Focus on kids’ feelings rather than your own during conversation.

• Soften strong reactions, as kids will tune you out if you appear angry, defensive or judgmental.

• Word swap.

o Say ‘and’ instead of ‘but’

o Say ‘could’ instead of ‘should’

o Say ‘aren’t going to’ instead of ‘can’t’

o Say ‘sometimes’ instead of ‘never’ or ‘always’

Consider

• Model the behavior you want children to follow in how they manage anger, solve problems and work through difficult feelings. Kids learn by watching their parents.

• Don’t feel you have to step in each time kids make what you may consider a bad decision, unless the consequences may be dangerous. Kids learn from making their own choices.

• Pay attention to how children play, the words they use or the activities they engage in. Young children may express their feelings of stress during play time when they feel free to be themselves.

• It is important to explain difficult topics in sentences and even individual words kids will understand. For little kids it might mean saying simple things like, “We love you and we are here to keep you safe.” For adolescents, it’s important to be honest and up front about difficult topics and then give them a little space to process the information and ask questions when they’re ready.

Call a psychotherapist who specializes in treating children and teenagers, if stress begins to interfere with your child’s daily activities for several days in a row. It is very important that you contact a mental health clinician so you get an accurate diagnosis and an appropriate treatment plan for your child.

You can find additional helpful information about kids and stress by visiting the Centers for Disease Control and Prevention’s Helping Children Cope webpage at https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/for-parents.html.

Dr. Michael Rubino is a psychotherapist with over 25 years experience treating children and teenagers. For more information about Dr. Rubino’s work visit his website at www.RubinoCounseling.com or his Facebook page at www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple or on Audible.

Middle School in the Year 2022

The school year is beginning and many parents are focused on their children’s transition into High School, College or Kindergarten. However, there is another important transition for children, Middle School. This is a major transition for pre-adolescents. As a psychotherapist who works with adolescents, I am very familiar with what is happening on High School and Middle School campuses and how big the transition is into Middle School these days. When kids transition to middle school they have to adjust to changing classes, having more than one teacher, increased homework and they are starting puberty and unsure of themselves. They are also not sure about all the academic changes. In addition to academic changes, physical changes with their own bodies, there are all the new social issues. Friends become more important and some students are talking about girlfriends, boyfriends and sex. This is a lot to adjust to at age 11. This is why we are seeing a significant increase in the number of middle school students being diagnosed with depression and anxiety disorders (CDC) In addition to all of these changes, there are all the stories they have heard about middle school. This only increases the stress and anxiety that middle school students in 2022 are feeling.

Many parents assume middle school in 2022 is similar to when they attended middle school, however the middle school in 2022 is very different than the middle school most parents attended. One example, when I ask parents, who have a child going into middle school or a child in middle school, if they have spoken to their child about drugs, alcohol and sex, I am told no and parents are surprised I asked this question about middle school students. I hear parents say every day that they don’t need to worry about drugs, alcohol or sex with their child in middle school because their child is too young for that right now. Well the reality is that Middle School Students in 2022 are drinking, using drugs and having sex. Many parents are unaware of what is happening in Middle Schools these days. Drugs and alcohol are just the tip of the iceberg. Children that are in the age group of middle school are now involved numerous dangerous activities such as selling drugs.

To begin with, most middle school campuses are better pharmacies than your pharmacy. I have had middle school kids say they can get Vicodin, Concerta, Ecstasy and of course weed and alcohol on their school campus. Some kids use at school and some use after school and on the weekends. More and more middle school kids are deciding to experiment with drugs and alcohol due to the pressure to feel successful as a teenager and so they fit in with friends. They also feel overwhelmed by the school shootings and the pandemic and they are looking for an escape. They see other kids at school using and they want to be part of the popular group so they think about and often try drinking or vaping.

Also many middle school kids are sexually active, but they don’t think they are sexually active. They think because they are not engaging in intercourse that they are not sexual active. Most 6th graders tell me oral sex doesn’t count as being sexually active. The kids say they are just “messing around” with each other and do not consider this sex. They also have no idea about sexually transmitted diseases or how to protect themselves from contracting STDs or getting pregnant. However, the number of middle school kids engaging in oral sex and intercourse has increased significantly over the last few years. The rate is now high enough that some middle schools, such as the San Francisco School District, are disrupting condoms to middle school kids. Yes, Middle Schools are giving condoms to children in the sixth grade. These kids are only 11 years old.

Another common issue in middle school is bullying. However, we are not just talking about one kid teasing another kid at school anymore. Today there is for a group of kids teasing one kid and it is not just at school. Now kids are using Facebook, Twitter, Instagram, Snapchat and texting by cellphone to tease and harass other kids. As many of you may recall there have been a number of kids who have committed suicide due to the teasing occurring at school. I wrote an article about a middle school girl who committed suicide and in her obituary she left a note to the other students just asking them to be nice to each other.

Another issue with teasing and dating is that students are not aware of the laws. As a result, many middle school students find themselves in trouble with the school district and often the police too. Harassment in middle school and dating often involves students texting or emailing pictures. Students are not aware that if they text a nude photo of another student or themselves that they have violated child pornography laws. Something many parents and students are not aware of is that a child can be charged with violating child pornography laws. When a child texts a nude photo of a middle school student, who is under 18 years old, it violates child pornography laws and the child who texts it and received it can both be arrested. The law is violated because the child in the photo is under 18 years old.

Also many kids in middle school, especially boys, don’t feel safe and are afraid of someone trying to beat them up before or after school. They say they have to fight because other kids are recording it and posting it on YouTube. Boys are bragging about their fights on YouTube and comparing how many people have watched their fight with their friend’s fight. Therefore, boys feel they must fight, otherwise if they don’t fight the other kids will think they are a “whimp.” Due to this fear many middle school students carry knives, metal pipes, guns or anything they can think of to protect themselves. This is very sad that kids have to live in fear for their lives and for safety reasons many middle schools have metal detectors. The number of mass shootings at schools and the mass shooting drills they do at school exacerbate this fear. It’s sad that a place they should feel safe in that students now are afraid for their lives. Also parents and students don’t realize, if a student is caught with any of these items on campus, they can be removed from their entire school district and required to go to continuation school. In addition, the school can have the student arrested. Due to mass shootings, schools take anyone possessing items that can severely hurt someone very seriously.

These are just a few of the issues that are occurring at all middle schools and they are very serious. Your child is not going to come to you to ask about these issues or tell you about them because they feel embarrassed and they are afraid of getting in to trouble. So parents even though you may feel embarrassed or awkward discussing these issues with your 11 year-old child, please do so. If you notice anything about your child’s behavior that seems different to you and you feel a sense of concern, ask your child about what is happening at school and with friends. Mention they are getting older and as a result the issues in their lives are becoming more difficult. Therefore, when you talk to your pre-teen mention drinking, sex or being teased and ask if they need to talk about it and they can talk about it anytime they need to. You may be saving their lives because they are dealing with things they know nothing about and these things can kill or have life long effects.

Here is a YouTube video that might help:

Life Talk | PSA: This could be your child (Teen drinking, alcohol,partying,peer pressure)

Dr Michael Rubino is an expert dealing with adolescents and adolescent issues. He has over 25 years experience treating children, adolescents, trauma victims and first responders. For more information about Dr. Michael Rubino’s work visit his website www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/Drrubino3.

Why Teenagers Stop Listening to Their Parents

Many teenagers report being frustrated with their parents because they feel that their parents do not listen to them. As a result, many teenagers decide not to listen to their parents. They feel their parents are disrespecting them by not listening, so why should they be respectful to their parents and listen to them. This does create a number of arguments at home because many parents get very upset when they feel their teenagers are not listening to them.

Honestly, the teenagers are probably right at times. Many parents may not really be listening to their teenagers, even though they feel that they are listening. Most people have poor listening skills. These are not skills we are taught in school or at home. Most people tend to be focusing on how they are going to respond to the person talking rather than completely listening to the other person.

Since this is a common issue, what happens when children and teenagers feel that their parents are not really listening to them? What teenagers have told me is that they feel angry and that their parent does not care about their feelings. When teenagers have these feelings they tend to stop talking to their parents and to act out. When they feel that their parents don’t care, they feel like they have permission to do whatever they want and at times they act out using drugs or not going to school as a way to get their parents attention.

Teenagers may act like they know everything and that they are not afraid of anything or confused about what to do, but this is only an act. They do not know how to handle everything and often feel overwhelmed by life choices. As a result they turn to their parents. However, if their parents are not fully listening they feel hurt and rejected. As teenagers their communication skills and reasoning skills are not fully developed. Therefore, they don’t know how to let their parents know they feel hurt and rejected. They also do not know how to let you know that they feel you are not listening and they need your help. Most teenagers feel saying they need their parents as a sign of weakness. This is because they are not fully mature and they are still children and they need their parents.

For many parents this may come as a shock. It comes as a shock because of how teenagers tend to react to their parents. Again, because teenagers are not fully mature they tend to act like they know everything and don’t need their parents. However, as I stated above teenagers do need and want their parents support. However, due to their immaturity, teenagers act like they don’t need their parents. However, parents need to understand that teenagers are not fully mature yet and their actions do not always match how they are feeling.

With this being said, it is very important that parents listen to their teenagers. However, since communication skills are a problem for most people especially listening skills, I have provided a list of listening skills that parents may want to try. Remember these skills don’t come naturally to most people so it will take a while for you to improve your skills. Also since teenagers can be confusing at times it makes listening even harder at times. In addition to these skills, if you are listening to your teenager, but you are still confused try asking a clarification question. Repeat back what you thought you heard and ask your teenager if you heard them correctly. This shows you are listening, you care and you want to focus on their concerns. This is exactly what teenagers are wanting from you. Here are the skills you may want to try:

1) Purposefully strive to focus on listening with an open mind, refrain from jumping to conclusions or forming an opinion while your child is talking.

2) Do not hurry them, listening requires patience. Wait for your child’s thoughts to take shape and give time for the words to form and find expression.

3) Always show respect and courtesy in listening to what your child has to say, no matter how much you may disagree with them.

4) Your own body language is important, make eye contact and always provide your attentive and undivided attention.

5) Don’t be thinking about how you will respond as this will take your concentration away from what they are really saying.

6) Exercise awareness of your child’s nonverbal cues, facial expression, tone of voice, body stance, general mood and attitude.

7) Don’t interrupt, hear them out and wait for the appropriate opportunity to ask questions.

8) Always remain calm when listening and never show your personal feelings of anger or disappointment.

9) Think of listening as personal growth as your children will always have something to say which will help you to grow.

10) Practice active listening with your heart to genuinely empathize with your child. Put yourself in their shoes to genuinely understand their feelings and emotions.

Remember this will take time and effort. However, by trying you are improving your relationship with your teenager and this is a tremendous benefit to you and your teenager if you can improve your relationship. Teenagers are facing a great deal of confusing and dangerous situations in today’s world and they need their parents now more than ever.

Dr. Michael Rubino is a psychotherapist with over 25 years experience treating children and teenagers. For more information about Dr. Rubino’s work or private practice visit his website at www.RubinoCounseling.com or his Facebook page at www.Facebook.com/drrubino3 or his podcasts on Spotify or Apple.

Could My Child Have ADHD? If so, What Do I Do?

Schools are starting to resume, however, many children are still experiencing issues due to the pandemic and remote learning. Children and teenagers reporting anxiety and depression have increased significantly since remote learning. Additionally, many students are still experiencing difficulties adjusting to their school schedules now that they are going to the school site versus logging on from home. These are issues parents need to keep in mind if their child or teenager is having difficulties with school.

Now that schools have resumed so has the fighting parents and teenagers have over getting homework completed and turned in on time. This means parents are once again getting notices from their children’s schools that their child is not doing homework and not paying attention in class. When kids were attending school remotely, many teachers and parents were not as concerned because they knew doing school remotely was very difficult. However, now that students are back in the classroom, teachers and parents are no longer ignoring attention issues or difficulties with homework.

As a result, some schools and family members may be suggesting to parents that their child has ADHD and needs medication. Many parents are not sure about the diagnosis and they are concerned about their child taking ADHD medication. I hear this very often from parents and do many assessments on children to determine if a child has ADHD. Yes ADHD is a really disorder, but too many teachers and schools rush to the conclusion that a child has ADHD and needs medication. Additionally given everything children have been through with the pandemic and remote learning, we need to be very careful about labeling a child with ADHD. There are a number of other options such as depression, anxiety and boredom.

According to statistics by the American Psychological Association, five percent of children in the United States have ADHD. It is also more common in males, however it does also occur in families. According to the CDC 15.9% of boys and 5.6% of girls have ADHD. However, not every child who has ADHD requires medication. Many children can be treated with psychotherapy and behavior modification. Therefore, if your child is diagnosed with ADHD do not rush to medicate your child. There are different subtypes of ADHD and different severities of the diagnosis.

If you child does have ADHD, they are entitled to accommodations such as extra time taking a test. It’s important to get them the accommodations they need. Children who have ADHD, but do not receive accommodations tend to show signs of low self-esteem around the fifth grade. Accommodations for ADHD can be covered by a 504 plan. However, if your child has severe ADHD and needs resource assistance too, they are entitled to an Individual Educational Plan (IEP). Many schools may tell parents ADHD does not qualify for an IEP. This is not true. The severity of the ADHD determines if a child needs an IEP. They would qualify under the categories of Emotional Disturbance or Other Health Impairments.

If you feel your child may have ADHD or their school suggests the idea, make sure you have your child appropriately assessed by a professional who specializes in ADHD. In the past schools would often diagnosis children with ADHD. Schools are no longer supposed to make this diagnosis. If they feel a child might have ADHD, they are supposed to have your child evaluated. Many parents take their child to their pediatrician, however, many pediatricians are not trained in diagnosing ADHD. I would suggest having your child evaluated by a mental health clinician trained in working with children and in assessing for ADHD.

As I stated above, if you are going to have your child evaluated for ADHD, make sure you take your child to a mental health clinician who specializes in children and in doing assessments. The assessment for ADHD is not very difficult and an appropriate evaluation by an appropriate mental health clinician should cost around $250 depending on where you live. I have seen some parents who have spent thousands of dollars getting CT scans, MRIs and PET scans. You do not need an expensive scan of your child’s brian to diagnosis ADHD.

The DSM V, the diagnostic manual that mental health clinicians use, list the criteria needed for the diagnosis. I am including a link to the Center for Disease Control which list the criteria for the diagnosis and other information about ADHD, http://www.cdc.gov/ncbddd/adhd/diagnosis.html. Typically the diagnosis can be made by a clinician interviewing the parents, having a play session or two with the child and observing the child at school or consulting with the teachers. However, remember if you are going to have your child evaluated for ADHD, you want a mental health clinician who specializes in treating children and assessing children for ADHD. Your child’s pedestrian should be able to refer you to someone or if you call your insurance they will probably have referrals.

Before you rush to have your child assessed, remember some basic facts. Most children between the ages of two to five are very active. They also have very short attention spans. Sometimes you need to give a child some time to mature especially if you have a boy. Remember boys mature slower than girls and tend to be more active than girls. It is important to keep these facts in mind when you are wondering if your child has ADHD.

Now if you child is more hyperactive than other kids his age or his attention span is shorter than most kids his age, there might be an issue. Also if there is a strong family history of ADHD in the family such as his father had ADHD as a child and paternal and maternal uncles all had ADHD as children, there might be an issue. Also if your child was born premature or there were complications during the pregnancy or child birth, there might be an issue. Premature babies or babies with a difficult pregnancy or birth are more likely to have ADHD and learning disabilities.

Bottom line, if someone suggests that your child has ADHD don’t rush to the pedestrian seeking medication. Compare your child’s behavior to other children and consider the risk factors. If your child doesn’t have many risk factors for ADHD maybe wait six months and reassess the situation. Also remember many children are experiencing anxiety due to the pandemic. Anxiety can easily look like ADHD. Therefore, instead of medication, maybe your child needs therapy for anxiety.

The most important thing to remember is if you decide to have your child assessed for ADHD, make sure you go to a mental health clinician who specializes in children and ADHD. You want a mental health clinician who specializes in treating children with ADHD and assessing children for ADHD. Also remember you do not need any expensive scans like a CT scan. There are other treatment options besides medication, so do not rush to medicate your child either. Consider all the treatment options.

Dr. Michael Rubino specializes in treating children and assessing children. He has over 25 years experience treating and assessing children and teenagers. For more information about Dr. Michael Rubino’s work visit his websites at www.rcs-ca.com, http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/Drrubino3 or his podcasts on Spotify or Apple.

Examine the Issue of Teenage Suicide

September is dedicated to suicide prevention. Therefore, I decided to write this article. As a psychotherapist who treats teenagers, I work with many parents who are worried that their teenager is depressed and may be suicidal. Many parents worry because suicide is a mental health issue for children and teenagers that often is ignored. In fact, suicide is no longer the third leading cause of death for children 10 to 18 years old, it is now the second leading cause of death for this age group (CDC). Also suicide is becoming more common in our society. If we look at the past few years Kate Spade, a designer, and Anthony Bourdain, the chef from CNN, both a profile people have committed suicide. Suicide is also common in soldiers who have been deployed over seas. Additionally, suicide is occurring more often in teenagers who have survived school mass shootings and for first responders for mass shootings and those dealing with Covid patients (CDC). Therefore, it is becoming common in our society, however, there are few resources available to people. Also the negative stigma associated with suicide prevents people and families from taking about the issue. I hope the information in this article helps you understand the issue of suicide. To start off with, I have included an article where six people describe their suicidal feelings and the help they need http://linkis.com/huffingtonpost.co.uk/AlJc2

http://linkis.com/huffingtonpost.co.uk/AlJc2.

In today’s society there has been a significant increase in depression, anxiety and suicide among teenagers and children. Depression and anxiety disorders are now at epidemic rates for children and teenagers (CDC). Additionally, as I stated above, suicide is now the second leading cause of death in children 10 to 18 years old. Yes 10 year old children are committing suicide daily. The increase is significant enough that Netflix was running a series about teenagers feeling suicidal. The show was called 13 Reasons Why. The suicide rate for teenagers has been increasing yearly for several years. It is increasing faster in teenage girls and is considered an epidemic. It is estimated 800,000 people a year commit suicide and approximately 25 times that attempt suicide (CDC). Again, suicide remains the second leading cause of death for kids 10 to 18 years old and it rises every year and we are not providing resources (CDC).

In my practice I am seeing more and more children and teens reporting they feel depressed, anxious and overwhelmed. One of the main reasons I hear for these feelings is that children feel a great deal of pressure to succeed in school. I have kids in 5th grade and 6th grade worrying about grades. They are worried not because their parents will get mad because if they don’t get As, they are worried that they will not get into a good college and won’t get a good job and won’t be able to afford a house. They only feel like a success if they can make a lot of money. They don’t even consider how compassionate and caring many of them are and the good they offer our world. In their eyes, compassion is nothing if you are not driving a Mercedes.

This is a great deal for a 5th grader or 6th grader to worry about at their age. It is also a terrible way for them to value theirselves. This is how we create Bullies because compassion is looked at as a weakness. Also because money and possessions are becoming more important than people.

I also see middle school students and high school students involved in several sports and other activities such as Boy Scouts. The kids are feeling pressured to do extracurricular activities not for fun but for their resume. They are again concerned about getting into a good college and being a success. This pressure is not coming from parents either. It is pressure kids are now placing on themselves. Again they believe they need to grow up and make a lot of money to be happy and successful.

Recent studies are showing a correlation between lack of fun and time to relax with the increase in depression in children and teenagers. A study in Psychology Today discusses this issue. I have included the link so parents can read this study and think about it. Also so you can look at your children and talk with them. See if they are enjoying life or feeling overwhelmed because they need to succeed. Money pays the bills but doesn’t guarantee happiness https://www.psychologytoday.co.

Many parents are not sure what to look for and do not want to over react. If you notice these signs they are indicators that your teen may be feeling suicidal and needs to be assessed by a mental health clinician. The major warning signs are:

• Aggressive behavior

• Verbal outbursts

• Withdrawal from friends

• Writing or talking about suicide

• Dramatic mood swings

• Reckless behavior

• Refusal to engage in daily responsibilities

• Giving way personal items of worth such as jewelry or furniture

If you notice any of these signs don’t be afraid to ask your

teenager if they are feeling suicidal or thinking about suicide.

Many people have the misconception that if you ask someone

about suicide that you will cause them to think about suicide.

This is not true. By asking someone if they are feeling suicidal,

you are letting them know that it is safe for them to talk about their feelings,

including suicidal feeling. If someone is feeling suicidal it

is essential that they feel safe to talk about their feelings and

thoughts. Therefore, asking your teen if they are feeling

suicidal will not hurt them, it can help them to talk and possibly

save their life.

I understand that the topic of suicide is scary and something our

society denies and views it as there is something wrong with

anyone feeling suicidal. But the truth is, it is a mental health

issue and it is nothing to be ashamed of. It is also an epidemic for

teenagers. If we want to prevent the number of suicides from

rising and help teenagers who are currently feeling suicidal,

we must talk openly about suicide and seek mental health care for

teenagers who are feeling suicidal.

Another factor related to this issue is family and friends. If someone commits suicide, family

and friends tend to feel guilty and ashamed. They blame themselves for the suicide and feel they

should have prevented it. However, if the person doesn’t express their feeling and there are few

resources, how do you prevent it? Also because of the huge negative stigma associated with

suicide, family and friends are embarrassed to talk about death. As a result, many families

and friends fail to get help after a suicide and their lives may be ruined for the rest of their lives.

We seldom consider the impact that suicide has on the family and friends. I have included a link

to an article which discusses the impact suicide has on family and friends

https://nypost.com/2018/06/06/after-kate-spades-death-think-of-the-survivors/. We need to

consider these issues and start to provide more resources for people feeling suicidal and family

and friends who survive a suicide.

Dr. Michael Rubino is psychotherapist who specializes working with children, teenagers, trauma survivors and first responders for over 25 years. For more information about Dr. Rubino and his work visit his website www.RubinoCounseling.com, www.rcs-ca.com or follow him on Twitter @RubinoTherapy.

I Think My Teenager is Suicidal, What do I do?

Since September is dedicated to preventing suicide, I decided to write this article for parents. 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 for the Coronavirus there has been a significant 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 due to survivors dealing with survivor guilt. 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 25 years experience treating suicidal children and teenagers. For more information on his work or private practice visit his website www.RubinoCounseling.com or Facebook page www.facebook.com/drrubino3.

Looking at the Lessons We Forgot 21 years After 9/11

Today is the 21st anniversary of the 9/11 attacks on New York City and the Pentagon. Our Country said it is a day we will never forget, however people in the early 20s were too young to remember and teenagers were not even born. They most likely have heard numerous stories about that day, but they did not experience the fear we all felt and the uncertainty we all were struggling with that day. 9/11 was the first time in history that the mainland of the United States had ever been attacked. It happened often in Europe but never here in the United States. On that day the safety we all were use to was destroyed. There will be a number of television documentaries this weekend about 9/11. Parents you may want to watch one of these documentaries with your children and discuss with them how they feel and answer any questions it may bring up.

There was something else that changed that day too. We witnessed how our first responders all pulled together in order to help victims and secure the Country. They did not come together for a day, they came together for months and exposed themselves to deadly dust and the possibility that building may further crash in on them killing them. They thought nothing about themselves. They were only thinking about helping survivors and families who lost loved ones. It was also amazing to see how first responders from all over the Country came to New York City and Washington D.C. to help. They also planned on being there for as long as needed which was several months. Regardless of the length of time our first responders were working 24 hours a day, seven days a week and no one complained.

We also witnessed citizens volunteer to help the first responders. We even witnessed a plane of citizens sacrifice their lives in order to protect a plane that was planning on hitting the White House. We all came together regardless of race, sexual preference, socioeconomic status and worked together. We were all Americans and we were going to work together to prove to the terrorist and the world that no one could stop the United States of America. Besides the citizens who volunteered at the sites that were attacked, people from all over the Country donated money, clothes and supplies for homes. Many people had lost their homes, survivors had medical bills and the first responders needed food, clothes and places to sleep. The main point is we all came together as Americans so we could help protect and save Americans impacted by this attack.

We owe a great debt to our first responders and we still do. Our first responders are responding the same way to the ongoing pandemic and the floods and wild fires all over the United States. They are working 24/7 to help victims of the pandemic and to help families who have lost loved ones. Many physicians and nurses have not had a day off since the pandemic started. The first responders continue helping victims of the pandemic while having to also help victims of hurricanes, floods and fires all over the Country. They do not think about themselves, they only think about the jobs and the people they need to save.

While our first responders continue to selflessly respond to the needs of our country, the citizens of our Country do not. Instead we are fighting with each other about who is right. The part that is really disgraceful is we are fighting with first responders and essential workers. When they have asked people to follow guidelines which have been established many of them have been beaten and some even have been shot and killed. We have a pandemic that has killed over 650,000 Americans. The tragedy on 9/11 killed over 3000 Americans. What would have happened after the planes hit the Twin Towers in New York City on 9/11 if we argued with first responders and if we shot at the first responders? I am afraid to think what would have happened.

Parents if you compare what is happening in our Country currently with how people responded on 9/11, it is very disappointing. It seems like we have forgotten. We are not acting together as one Country, we are fighting with each other and we are emphasizing our differences. Parents try thinking back 21 years ago and explain to your children what it was like when we all acted together as one and we were all proud of our Country and that we were all working together. Maybe if we can explain this to our children and teenagers maybe they can start to work together and once again be proud about all of us being Americans.

Dr. Michael Rubino is a psychotherapist who has over 25 years experience treating children and teenagers and trauma victims including first responders. For more information about his work visit his website at www.RubinoCounseling.com or his Facebook page www.Facebook.com/Drrubino3 or his podcasts on Spotify or Apple.

The Truth about Colored Fentanyl

Teenagers have been experimenting and using drugs for decades. Prior to the pandemic opioids were a major issue and so was heroine. In 2017, Opioids were becoming more expensive and teenagers started turning to heroine. Teens were turning to heroine because it was available and cheap. However, it was responsible for a large number of teenage overdosing and dying from heroine. The CDC documented a significant increase in teenage deaths due to heroine between 2010 and 2017. However, during this time fentanyl was being introduced to teenagers and it became very popular.

As it became more popular, people became aware of how strong fentanyl can be and how deadly it is in reality. It was cheaper than heroine but also more deadly. It is also very easy to overdose on. Fentanyl is a synthetic opioid intended to help people such as cancer patients manage severe pain. It’s 50 to 100 times more potent than morphine. It’s used illicitly because of its heroin-like effect, and even small doses can be deadly.

During the pandemic, teenagers were bored having to stay inside and not being able to see their friends as much as they would like to. As a result they started experimenting with Fentanyl because it was new, cheap and promised a great high. However, it also became obvious that the drug was very deadly. Deaths such as the singer Prince, who overdosed accidentally on Fentanyl, made it very clear that it was a very deadly drug. As a result of public health campaigns, parents and teenagers started to become aware of how deadly the drug was and people became cautious about it.

Obviously this did not sit to well with drug dealers. Fentanyl was still popular but it could be even more popular. The solution is that colored fentanyl pills and powders have been developed. These colored fentanyl pills and powders are becoming popular with teenagers. The colored pills and powders look safer and teenagers are therefore more willing to try and use it. This is putting a significant number of teenagers at risk of dying due to overdosing (CDC).

According to the government the “brightly-colored fentanyl is being seized in multiple forms, including pills, powder, and blocks that resembles sidewalk chalk. Despite claims that certain colors may be more potent than others, there is no indication through DEA’s laboratory testing that this is the case. Every color, shape, and size of fentanyl should be considered extremely dangerous.” Furthermore, Fentanyl remains the deadliest drug threat facing this country,” according to the DEA. Additionally, these brightly colored fentanyl forms appear safer to teenagers and as a result there is an increase in the number of teenagers using them. In addition to more teenagers using the colored fentanyl, more teenagers are dying due to the colored fentanyl (CDC, DEA).

More than 109,000 people in the United States died of a drug overdose in the 12-month period ending March 2022, according to provisional data published this month by the US Centers for Disease Control and Prevention. Fentanyl and other synthetic opioids were involved in more than two-thirds of overdose deaths in that time — up from just over half at the start of the Covid-19 pandemic.

In the two years since the start of the Covid-19 pandemic, annual drug overdose deaths have jumped 44%. There were 75,702 deaths in the 12-month period ending March 2020, compared with 109,247 deaths in the latest 12-month period ending March 2022.

Drug deaths among children are relatively rare. But unintentional overdoses led to 200,000 years of lost life for US preteens and teens who died between 2015 and 2019, and experts suspect that the problem has gotten worse during the pandemic.

Parents, please take this time to discuss and educate your teenagers about the colored fentanyl. Everyone does not know about it and many teenagers are believing the lies that the colored fentanyl is not really dangerous. Many teenagers can be misled because it does not look as dangerous as other drugs do. Therefore, take the opportunity to educate yourself and your teenagers and if you feel your teenager is already involved with it, seek professional help. If they are using fentanyl typically you will notice personality changes that are more extreme than just teenage personality issues. You may save the life of your teenager by talking to them. Anyone can get mixed up with fentanyl.

Dr. Michael Rubino is a psychotherapist with over 25 years experience treating children, teenagers and trauma victims including first responders. For more information about Dr Rubino’s work visit his website www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3.

Dr Michael Rubinio

Understanding Your Teenager

Month: September 2022