In the article “How to Help Children and Teens through Anxiety at Bedtime,” author Karen Young denotes that bedtime can be an anxious time for some children and teens. Although sleep helps the brain process the day’s work, it can also enhance anxiety. In detail, the amygdala, the part of the brain that controls one’s fears and emotions, is sensitive when it comes to sleeping. When the brain is tired, it no longer has enough resources to filter anxiety and may misinterpret experiences as threats. This means that the brain will employ the fight or flight response to “protect” the person, even when the threat is not real or present and the child will feel more uncomfortable and nervous. Lack of sleep and lack of internal resources can make anxiety worse, which in turn will make sleep for the next night tougher.

During this time, it is important that you, as a parent, can support your child emotionally and physically. Even the separation from a parent at night can be nerve racking for a child. Fears may also be triggered from the past. Children then turn these fears into monsters under the bed, something that gives the fear a voice. It's crucial to remember that the feelings are always real and always allowed, even when the content or the “story” of the fears are not real. Validating, listening, and providing support are the ideal steps for parents to make in this situation. For example, acknowledging and validating their fear (“It sounds so scary”) and then providing the support by letting them know you are there to keep them safe and you trust that they are safe (“I am here to keep you safe and our house is very safe”).

We as humans like to make up stories to provide meaning for a situation. The same thing happens with fears. In order to make sense of our feelings, we make up a story as to why we are fearful, sometimes they’re accurate, sometimes they are not. Harvard researchers found that “the content of a dream can be changed by [simply] talking about that dream just before bedtime” (Young). Talking about the dreams they would like to have can make all the difference without even knowing it. Talking about their fears and worries are also helpful.

Young also mentioned that sometimes children may just feel nervous and scared, instead of knowing why they feel that way. Anxiety may not present itself as an observable emotion, such as anger or aggression, it may just be a feeling of being unsafe.  Some children may become controlling or demanding at bedtime. In actuality, this isn’t about them trying to be difficult, it’s about trying to control the environment so they can feel safe. They are unaware that being controlling is them being anxious. There are two problems that can arise because of this:

1. It becomes difficult to relax when trying lead and manage their environment that they do not actually have control over. 

2. Children may not be the best leaders, especially when they’re tired.

All children care about is feeling safe. We can help them by:

• Setting boundaries, consistently and lovingly (the lights will be turned off in 5 minutes, when the long hand gets to the 6)

• Validating their feelings (I see that you feel ___, I would feel that way too)

• Providing them with the fantasy-based wants or stories (I really wish we could play all night long together)

• Connect and provide them with a choice they can manage (Do you want 1 story and a song; or 2 stories?)

The first step in re-associating the brain with bedtime is teaching the brain that bedtime is safe. You can have a conversation with them to see if it makes them feel better if you stay with them for a little while before they fall asleep. Reading a book together, talking about your day and the shared experiences, and letting the child have something of yours (a shirt, pillowcase, small and safe toy) can all be helpful in fostering and focusing on the connection. This connection strengthens the feeling of safety. Slowly, you can increase their independence and decrease the time spent at bedtime to the point that you are only in the room for five minutes. It is important to focus on the process of feeling safe rather than the outcome, and know that little by little, the feeling is growing.

Sleep is the necessary for the brain to relax, process the day’s events and store learned information. It is difficult for children to do so if they feel unsafe, simply focusing on the emotion and building on the connection between you and your child can make them feel the more at ease and therefore will sleep better at bedtime. For more information on child or teen anxiety and parenting, please visit Hilber Psychological Services. 

• Written by Lily Schmitt and Tanya L. Hilber, PsyD

Reference

Young, Karen. “How to Help Children and Teens Through Anxiety at Bedtime.” Hey Sigmund. https://www.heysigmund.com/anxiety-at-bedtime/

Author Karen Young, from Hey Sigmund, denotes that anxiety is a learned habit, as long as you give in to it, it will never subside but if you break it down and analyze it, you will see all the components that are possible to fix.

Not only do children learn from experience, but so does the amygdala. This part of the brain, that’s responsible for anxiety, can recognize a trigger as a threat and associate it with anxiety. Once the child is triggered, the anxiety typically gets worse before it gets better in an attempt to avoid the “threat”. As a parent, it is your job to help your child from recognizing school as a threat. Now I know this is easier said than done, but it is possible. The difficult part is getting the brain to learn that it can feel calm and safe without avoiding school. When children go back to school, whether that is in person or through distance learning, they are separated from the only thing they know that will keep them safe, a parent. It is important to remind them that you will be right there waiting for them at school or after their virtual lessons.

Below are some strategies Young suggested easing the level of anxiety that children and teens may experience when they go back to school:

• Try to avoid avoidance, take it off the table: As long as you do not give your child an option to avoid school, they will have to learn how to be brave and resilient faster. Their reward is seeing you after school. Practicing attending in person or online will help them to move away from avoidance behaviors and fight the anxiety.  

• Protecting them is understandable but not a permanent solution: Remember that school may also trigger anxious thoughts, feelings, maybe a sick tummy, and an increased heart rate. As a parent, it is your first instinct to protect them from ever having to ever experience these emotions again. However, protecting them also never allows them to feel the weight of these emotions, or to give them the practice necessary in managing and decreasing their anxiety. In the future, they could turn to avoidance instead of persevering through their hardships. Instead, little by little, you can re-associate their feelings of anxiety with positivity and teach them how to be brave now.

• Help them feel safe, even when they aren’t with you: First validate their feelings, that it is understandable to feel scared. Let them know that anxiety is not a weakness, it is an emotion that everyone has, so it is okay to feel. Their brain may register this as a threat but this is when you, as a parent, step in and reassure them to look at the aspects they can control. Even when you aren’t there next to their side, they can feel safe because they set their situation up for success.

• Ease the relationship between them and their teacher: In order to make their relationship stronger, ensure that your child’s teacher is putting in the time to check in on your child and getting to know them by having a conversation with their teacher. By doing so, your child will see that it is safe to have a conversation with more and more adults because they feel safe with them. All it takes is a little interest and a caring attitude to make someone feel more welcomed. Distance learning can make this a little more challenging, but many teachers have been able to create ways to connect with children appropriately.

• Remember, your tone matters: A warm, loving, empathetic tone goes a lot farther than a harsh, low monotone voice. Your child will register this tone as a threat and view it as a punishment. Instead, reinforce your child’s actions by first expressing that you still love them, but that their actions were not the greatest choice. Your child will see that you truly are trying to take an interest in their well-being.

• Let them know they will be taken care of: Going back to school and getting back into the groove of things is always difficult, no matter the age. Young recommends to “validate how hard it is, and reaffirm that you know they will be taken care of at school” by acknowledging their feelings. Remember, they don’t need to agree with you, just be willing to try.  Distance learning or Virtual learning can help this transition and interrupt the anxiety “flow” and provide more opportunities to check in and reconnect with children.

• Sometimes all you can do is go with the flow: If your child feels overwhelmed, which is easy to understand, let them take a moment to take a step back and breathe for a second, whether this is going out for a walk or getting some food into their system. Let them know that you have been there too and you see them and that you know they can get through this    (Young). This takes patience and practice, because their brain won’t catch on right away, only until they know they can return to the present in a calm state of mind based on experience. 

Their sadness, hopelessness, and anxiety is not a permanent behavior. Even though it may be hard to do so now, slightly push them out of their safe bubble from being home all summer towards brave behavior.  They may not know it now, but they can persevere and have courage to get through the hard things that school brings, you may just have to believe it for the both of you for a little until then.

For more information on how we can help your child and family cope with going back to school during the COVID-19 pandemic, please contact us. For more information on therapy, visit our website at Hilber Psychological Services. To learn how we can help you and your children with Anxiety, please contact us. HPS is available and open for Telehealth Video Visits and In-person sessions.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD.

References:

Young, Karen. “How to Manage Back-to-School Anxiety – What Children and Teens Need From Us.” Hey Sigmund. https://www.heysigmund.com/how-to-manage-back-to-school-anxiety-what-children-and-teens-need-from-us/

When navigating Coronavirus as a Family, author Dara Winely, found that her discussions with her clients shifted from “talking about what brought them into therapy to how do I talk to my children about the coronavirus?” As we all have experienced, this global epidemic has brought fear and anxiety to many. In specific, to seniors, as they are the ones most at risk. While daycares and schools are closing down temporarily, families are having trouble occupying their young ones without always resorting to screen time.

Studies have discovered “that children in families with high cohesion are likely to demonstrate low anxiety symptoms compared to children in families with low cohesion (Peleg-Popko & Dar, 2001; Victor, et al., 2007).” Below, Winely suggests this weekly calendar of entertaining activities to do with the family:

Mazed Monday. 

• Work on a puzzle or make one

• Create a scavenger hunt around the house

• Create your own escape room. 

1. Agree on a theme

2. Have everybody come up with 3-5 clues

3. Place them around the house

4. Make a list of rules

5. Set a time limit

6. PLAY!

Tuesday Tunes. 

• Create a playlist together

  • Each person is responsible for adding 3-5 songs

• Have a karaoke night 

• Listen to music all-day

Wind Down Wednesday. During these times, it is okay to feel anxious and concerned about the future. It is best to just take a step back sometimes and look at what is right in front of you: your loved ones. 

• Start the day off with a morning exercise or stretch

• Meditate or sit in silence 

• Listen to soothing nature sounds, ocean waves, or piano music

Thriving Thursday. 

• Help your kids stay on task by creating a brief “to-do list” 

  • This may include chores, homework assignments, reading time, and playtime. 

  • It also helps to set some guidelines as to when these tasks should be done and what the consequences or rewards maybe if done so or not to ensure goals are met. 

  • Don’t forget to include breaks

Fancy Friday. 

• Have your child pick a fun, family activity

  • Picnics in the backyard

  • Backyard tent camping

  • Late night dance party

  • Dinner and a movie

  • Play a board game

  • Cook for the next day’s meals or dessert

Sit Down Saturday. 

• Take time to answer any questions your child may have

• Ask them if you can help them with the transition from in school to at-home learning

• Openly process new information with them

• Have family meetings to listen to everyone’s needs

• Check-in with your child

  • What is on your mind? 

  • What do you care about? 

  • What are your values? 

Soul Sunday. 

• Take time to reflect on this past week

  • Winley recommends to take 15 minutes to do so by asking yourself these few questions and sharing them as you wish:

1. What was your favorite part of your day/week?

2. What has been the most challenging?

3. What do you hope to change this week? 

• Journal

• Take some “me time”

• Write letters to loved ones, checking in on how they are doing

By taking this time to spend with the family and by reaching out to others, it may help you feel less isolated. You may even discover something new about yourself or others. For more information on how to manage family weeks with COVID-19, please visit our website at Hilber Psychological Services or Contact Us for more information.

• Written by Lily Schmitt and Tanya L. Hilber, PsyD

References

Fuhs, M. W., Nesbitt, K. T., & Jackson, H. (2018). Chronic absenteeism and preschool children's executive functioning skills development. Journal of Education for Students Placed at Risk (JESPAR), 23(1-2), 39-52.

Peleg-Popko, O., & Dar, R. (2001). Marital quality, family patterns, and children's fears and social anxiety. Contemporary Family Therapy, 23(4), 465-487.

Victor, A. M., Bernat, D. H., Bernstein, G. A., & Layne, A. E. (2007). Effects of parent and family characteristics on treatment outcome of anxious children. Journal of anxiety disorders, 21(6), 835-848.

Winely, Dana. “Navigating Coronavirus as a Family.” Psychology Today. 17, March 2020. https://www.psychologytoday.com/us/blog/take-care-black-women/202003/navigating-coronavirus-family

Author Wes Crenshaw illustrates that poor sleep and attention deficit disorder (ADHD or ADD) are actually related. In detail, Crenshaw notes that “Poor sleep can lead to ADHD-like symptoms and complicate a diagnosis.” In fact, researchers, in the “ADHD Is a Myth” crowd, found that individuals with ADHD are declared to have sleep apnea, narcolepsy, or primary insomnia. It is then suggested that parents should start monitoring their child’s sleep patterns; ”quality of sleep must be considered in making an ADHD diagnosis” (Crenshaw). 

In crenshaw’s experience of working with two dozen teens and young adults for sleep studies, he found that the best solution to poor sleep patterns resulting from ADHD is stimulant medication. Results show that “Some teens will sleep better after beginning stimulants [and] A few will have daytime sleepiness despite taking them” (Crenshaw). Be aware that by treating ADHD with stimulants, sleep patterns will improve for some people while remaining or possibly limiting the effectiveness of the treatment for others, especially those with ADHD-related insomnia. Crenshaw notes that ”we find the Daytrana patch helpful for those with stimulant-induced insomnia, because it’s the only medication that can be shut off early (by removing the patch).” 

For those who have not had sleep problems before and have not overused napping but start to lose sleep after starting a medication, it is recommended that either they stop using stimulants and/or switch to a non-stimulant for ADHD. However, Crenshaw declares that “if the stimulants are working, we prefer to tinker with their timing and release to improve sleep.” This is why it’s important “to assess sleep problems before any medication is prescribed” (Crenshaw).

When trying to help teens develop a consistent sleep-cycle, it is import to remember that the results will not be apparent right away. Children, especially teens and those with ADHD, will first resist having restrictions on when they can sleep. For example, when trying ”to help a client manage stimulants and sleep, [scientists learned] that the client is staying up late and, in extreme cases, reversing the sleep-wake cycle” (Crenshaw). This is why good sleep is critical in treating one‘s poor habits and crucial to understanding the ADHD-sleep conundrum (Crenshaw). Because, if they do start to have a regular cycle, their quality of sleep will improve. 

In efforts to try to help teens with ADHD sleep better, try to 

1. Make time for it. Eight hours are recommended, especially with an hour of prep time. 

2. Turn off screens. They wake up our brains even more with all of the games and light they produce. 

3. Say goodnight to the (artificial) sun. It is important to shut off/block out (using shades) all artificial light in the evening. The body will then signal the brain that the night cycle is coming and that it should start preparing for sleep. 

4. Rise with the light. Progressively increase the brightness of a light in one’s bedroom (by using a timer) like the rise of the sun. 

5. No napping. Although ”many teens compensate for poor sleep by taking naps” (Crenshaw), researchers discovered that naps actually cause unhealthy sleep. In actuality, a 10- to 15-minute nap in mid-afternoon is recommended instead; “These may improve functioning and improve sleep” (Crenshaw).

For more information on therapists at Hilber Psychological Services can help your children and your family with parenting, sleep hygiene, and ADHD symptoms, please visit our website or contact us. 

For more information on how Neurofeedback services can assist your child with ADHD and sleep issues without the use of medications, please contact San Diego Center for Neurofeedback.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD.

Reference

Crenshaw, Wes. “What Comes First: ADHD or Sleep Problems?” ADDitude. 18, June 2019. https://www.additudemag.com/adhd-sleep-problems-solutions/