Common Problems

Academically Gifted Children

People can be gifted in many different ways, some of which include music, athletics, or cognitive abilities. Academically gifted children are those that have high IQ’s and the ability to perform at a level usually not reached until later years. Many academically gifted children have unique ways of relating to the world because of their high cognitive abilities. They may learn at a faster pace, process material to much greater depth, and show incredible imagination, intellectual prowess or sensitivity not typically seen in the general population. Oftentimes highly gifted children need special advocates due to their tendency to be bored or turned off by tasks that are repetitive, mundane, or ones that they accomplished months or years earlier. Further, their creative abilities oftentimes set them apart from their age-mates. Often gifted children are fluent thinkers who may generate many possibilities, consequences and related ideas when faced with a problem. Generally, academically gifted children display an extreme curiosity about areas of interest and are willing to entertain complexity and thrive on unique problem solving.

Some academically gifted children do not necessarily view it as important to make good grades. As long as they know the material or information, some gifted children may not always feel it is necessary to demonstrate it just to get a grade. Some gifted children may not come into their full potential until they are in high school or college at which time they can latch on to areas of keen interest. While not all academically gifted children are high achievers, the academically gifted child has the potential to do so. Performing at a high level academically means that the child not only must be exceptionally bright but also must be intrinsically motivated to perform.

Some children with high IQ’s may also experience other problems. For example, one can be academically gifted and yet have a learning disability in a specific area. These “twice exceptional” children can be misperceived as lazy, stubborn, careless or unmotivated unless they are more carefully studied and their academic needs determined.

To qualify for AG classes, children must test at a certain level in one or more areas which are determined by the school system. Silber Psychological Services offers a variety of tests to help identify children who are academically gifted and to provide guidance to parents on social and emotional issues specific to this population.

Adoptions

Adopting a child is a wonderful way to start or add to a family. Adoption involves making some choices that are unique to the notion of “having children.” Some of these decisions include whether to pursue open versus closed adoption, the age of the child to be adopted, whether to adopt a child with special needs or different racial or ethnic backgrounds and how to deal with language barriers. Adoptive parents must decide how to assimilate the adoptive child into an existing family as well as the extended family and the community in which the family lives. Most adopted children make a relatively smooth transition into their adoptive families and their developmental stages are often indistinguishable from their nonadopted peers. However, a small number of adopted children or adolescents experience medical, psychological, or learning problems that require professional intervention.

Frequently, adopted children need to work through their feelings of sadness, abandonment, loss of family history and identity including helpful medical information. Some will fantasize about their biological parents and look at people around them to see whom they resemble physically or in their personality. As they approach their teen years, some adoptees may wish to search for their biological parents while others will have no interest or curiosity in doing so. These issues require thoughtful attention and parental guidance and are best approached in a relaxed and open manner. At Silber Psychological Services, we believe that learning about adoption is an ongoing process preferably to be welcomed with honesty, patience, and empathy. Adopted children need to be able to help set the pace as to how much and when they want information related to their adoption. Parents are there to guide, support, encourage and help with limits and healthy boundaries.

Learning more about the issues that can surface at different stages with adopted children can help adoptive parents and their children go through developmental stages more easily. Adopted children have a genetic blueprint that will differ from their adoptive family’s genetics that in part influences their behavior, school performance, and capacity to form relationships. For example, traits inherited from birth parents can play a strong role in certain problems that are often seen in childhood including ADHD, learning disabilities, or disruptive behaviors to name a few. Some adopted children have experienced inconsistent nurturing early in life that can impair their ability to form healthy attachments and trust with others in spite of being placed in a safe and loving adoptive home. Managing of these issues may require professional help.

Both adoptive parents and their adopted children may experience frustration, anger, sadness, or confusion when adoption issues arise. When your efforts to deal with these problems in successful ways fail and disruptive behavior or breakdowns in communication occur, it may be time to seek professional help. At Silber Psychological Services we can help with a wide range of adoption issues. We teach adoptive parents and children to find resolutions that can lead to more satisfying interactions and relationships in their life together.

Anger

Anger is an emotion that is commonly felt by all people. It is a healthy and normal feeling to have in response to many situations. However, when anger becomes excessive or is the most frequent emotion that an individual feels, it can have a very destructive impact on the person's relationships, their ability to function successfully at school or work, and their self-esteem. Excessive anger in children can lead to difficulties in relationships with family and with peers as well as with school performance. In children, anger is often a reaction to frustration. Some internal feelings that can cause frustration and trigger anger may include perceived inability to compete successfully with peers in sports or academics, embarrassment, loneliness, social isolation, or anxiety. Situations that can also trigger anger are physical or emotional bullying, excessive criticism from adults or being excluded from peer groups and activities. Children often respond with anger because they are not fully able to understand situations or to know how to change them. Understanding why a child is experiencing problems with anger generally takes time and effort.

Anger looks different at various ages. It takes time to master the ability to use words rather than physical aggression to express anger. Pushing, throwing things, hitting, pinching, biting, and yelling when angry are not uncommon in preschool-aged children. In early elementary school, children develop more sophisticated language skills. They develop empathy and are better able to understand the effect their actions and words have on others. By the later elementary grades, most children are able to express angry feelings verbally rather than physically. However, children with language difficulties or impulsivity issues may continue to express angry feelings through physical acting out, yelling, or refusing to obey school or household rules.

Teenagers experience new stressors and concerns that can trigger anger and frustration, including an increased need for independence and privacy, and increased academic, social and work demands. Some teens express frustration and anger by refusing to talk about issues while others act out physically by throwing objects or slamming doors. A few teens may actually go to the extreme of acting out their anger through physical aggression towards people. The peer group with which a teen identifies can also play a significant role in the acceptance of verbal or physical aggression as a way to express anger.

Dealing with angry children is one of the most difficult parts of a parent's job that often includes a wide range of emotions. How parents deal with their own emotions has a significant effect on how their children will learn to cope with emotions. Children need guidance in learning how to express emotions appropriately. Learning acceptable ways to express anger and other strong emotions can help a child deal with stressful and difficult situations in a successful and positive manner. This ability can help to develop good self control, self confidence, positive peer relationships, good physical health and success in school and work. When children continue to struggle with anger management it is wise to seek professional help.

The staff at Silber Psychological Services provides a variety of services to help your child or teen with this often difficult problem. Treatment can involve individual therapy, family therapy, social skills groups, parent consultation or compliance training and is tailored to each individual’s needs. We can evaluate underlying causes and teach specialized anger management skills to both the child and the parents. Consultation with school personnel is also a part of treatment when needed. At Silber Psychological Services our goal is to help individuals gain control of their strong negative feelings and teach them how to express them openly, directly and appropriately, while also helping parents and teachers learn ways to support and encourage these changes.

Anxiety

Most people experience periods of anxiety at some time in their life. Anxiety can occur in response to a time limited experience or situation or can be an ongoing issue that affects many areas of a person’s life on a regular basis. Whichever the case may be, anxiety is a very common problem that people report when they are seeking help from the staff at Silber Psychological Services.

Anxiety is a normal response to many situations or changes that all people experience. Anxiety is seen in all ages of people from infants to the elderly. Babies often experience separation anxiety at some time in their first year of life. Children who are being left with babysitters, going to day care or beginning kindergarten can experience a brief time of anxiety. School age children may experience anxiety when transitioning to a new school year, finishing a completed year or going to a higher level of education such as the move from elementary school to middle school. Moving from one house to another or family relocation to another city can cause anxiety. Changes in a family such as separation or divorce, the loss of a job, or the death of a family member often brings about anxiety in children as well as adults. Even though most people are able to deal with their anxious thoughts or feeling for many life situations, some still find it useful to seek consultation with a mental health professional on a short term basis.

Although the anxiety that occurs in life situations is normal and usually time limited, there are people who have difficulties that are intense and they continue to be affected by strong feelings that interfere with daily activities. A person may avoid certain situations such as school, work, or time with friends and family to the extent that they are not functioning in a way that allows them to enjoy life or to do what is expected of them. A child may refuse to go to school or be unable to focus on school work well enough to complete assignments. Adults and children may experience a level of anxiety that keeps them from enjoying social situations even with friends that have been a part of their life for a long period of time.

Some of the symptoms that are seen in individuals that are unable to handle their anxiety in a healthy way are worries and fearful thoughts that occupy their thinking most of the time, disturbance in normal sleep patterns, generally expecting that something bad is going to happen, a need to be constantly moving, irrational fears of situations that are normally enjoyable and safe, and physical symptoms such as feeling “jittery”, having heart palpitations or even increased blood pressure.

Severe anxiety often occurs when a person experiences an abnormal or extreme trauma such as a life changing accident, violent death of a loved one, or physical, emotional or sexual abuse. In such cases, the anxiety is often debilitating and cannot be resolved without professional intervention.

When people experience these kinds of symptoms and are unable to successfully continue their daily activities due to excessive anxiety regardless of the cause or situation, seeking the help of a mental health professional is a healthy decision. The clinicians at Silber Psychological Services are all skilled in dealing with the frequent problems of anxiety. A variety of Cognitive Behavioral Techniques can be used to help a person regain their ability to function in a healthy way on a daily basis. Our staff is also trained in more in depth forms of treatment that focus on uncovering sources of ongoing and extreme anxiety. A treatment plan may include Individual, Group and/or Family Therapy or some combination of the three. In severe cases where these techniques do not bring about adequate improvements, a psychiatric consult for consideration of medication may be warranted. At Silber Psychological Services we work with each person to develop an individual treatment plan designed to be most successful in treating that person.

Asperger's Syndrome

See Autism Spectrum Disorders (ASDs)

Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder or ADHD is an inability to pay attention, concentrate and focus. It may include impulsive and/or hyperactive behaviors but the hallmark is inattention. ADHD is diagnosed when these problems are more frequent and severe than found in individuals at a similar level of development. Although commonly referred to as ADD (attention deficit disorder) in the popular media, the official diagnostic label has changed to ADHD. ADHD affects 4-9% of the school age population and 2-4% of the adult population. It is more frequently diagnosed in boys than in girls although females are thought to experience problems, especially with inattention, at a more noticeable level in late teenage and early adulthood years with accompanying detrimental effects on their psychological well being. If left untreated, this disorder can have long-term adverse effects. However, effective management of the symptoms can minimize its impact and allow children and adults to lead fulfilling and productive lives. ADHD is one of the most frequent reasons that children are referred to psychologists.

There are many factors that can result in the presence of ADHD although heredity seems to be the largest contributor. Influences from the environment such as lead poisoning, alcohol or tobacco use during pregnancy, brain injuries, and problems with pregnancy or delivery may also affect attention levels. Many times the cause remains unknown. Children with ADHD often have family members with higher than normal rates of ADHD, antisocial behavior, mood disorders, anxiety, or alcohol problems. Research does not support popularly held myths that ADHD can be caused by food additives, sugar intake, television, poor parental management, poverty, or family problems.

Many people display some levels of inattention at one time or another in their lives. It is important not to confuse normal difficulties with paying attention with a level of symptoms that warrant a diagnosis of ADHD. At Silber Psychological Services we recommend a comprehensive evaluation to verify a diagnosis of ADHD and to rule out other possible co-existing conditions such as learning disabilities, oppositional defiant disorder, anxiety, and depression. An evaluation is an important tool in developing a plan of action that can alleviate some of the problems stemming from ADHD.

A thorough evaluation requires time and effort as no one test can confirm a diagnosis. An evaluation to determine the presence of ADHD will often include observations, a clinical interview, reports and rating scales from teachers and parents, a careful review of the family history, a physical exam to rule out other medical, sensory or health problems, and a psychological evaluation.

A psychologist administers a battery of tests to look at cognitive processes. Cognitive processes are mental activities including attention, learning, memory, speed of information processing, visual perception, language, and executive functioning. Executive functions are processes that allow our behavior to be goal-directed. Organization, planning, emotional regulation, behavioral control (inhibition), and working memory are part of executive functioning. A thorough ADHD evaluation examines these to determine strengths and weaknesses in order to ascertain the child’s individual needs.

After a diagnosis of ADHD is made there are multiple treatment strategies that can be implemented to maximize management of symptoms. These include medication, parent classes, educational interventions, social skills classes, individual therapy, professional organizing, and ADHD coaching.

There is no one ADHD treatment plan that fits everyone. Each family and child is unique thus finding the best approach for each family is important. With proper treatment, the good news is that children with ADHD can be successful and manage their symptoms. The ultimate goal is to help children control their own behavior. Parents frequently must strike a balance between being understanding and the providing of a supportive, friendly environment that establishes clear boundaries and encourages organization, the ability to start and complete tasks, and the ability to focus.

In most instances, there are a variety of options that parents can consider in helping their child learn to manage ADHD symptoms and lead a successful life. At Silber Psychological Services we have found that the most effective treatment approach includes a combination of educational, psychological and medical interventions. We provide information about ADHD and help parents develop the tools necessary to raise a child with ADHD. Learning to build specific skills that can help children develop resilience as they mature is an important aspect of treatment. Some of these skills include developing a self perception of academic competence, learning how to form friendships, pursuing a special ability or talent in an area of interest, and giving self affirmations of their worth.

Although the diagnosing and treatment of ADHD can be challenging, our staff has expertise in working with children and families inquiring about possible presence of ADHD as well as a diagnosis of ADHD in need of treatment.

Autism Spectrum Disorders (ASDs)

Autism is no longer considered an all-or-none diagnosis. Now the term "autism spectrum" is used to better capture the wide range of abilities and skills of children with ASDs. Diagnoses on the autism spectrum include: Autism, High-Functioning Autism (HFA), Asperger’s Syndrome (AS), and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS).

The hallmark symptom of an ASD is a deficit in the area of social skills. Children with an ASD often do not fully understand the unspoken "rules" of social interaction that come more naturally to others. They lack skill in making eye contact, knowing how to start and sustain conversations, determining how close to stand to someone, and reading the body language of others. Often, they do not understand the give-and-take or reciprocal nature of conversations and interactions with others. Historically, children with an ASD were perceived as not wanting to develop relationships with others. Generally this is not the case. In fact, many children with ASD want to connect with others but lack the skills to do so effectively.

Another common characteristic of children on the autism spectrum is having an area of special interest. They may spend hours taking objects apart and putting them back together or they may have become a “walking encyclopedia” of facts about their special topic of interest. Children with ASDs are known for “sharing” their special interest with others, regardless of the other person’s level of interest in the topic. Some common areas of special interest are: trains, fans, computers/technology, and weather patterns. It is the intensity of interest in a particular topic rather than the topic itself that contributes to a diagnosis of an ASD.

Children with ASDs function best with large amounts of structure and predictable routines. In fact, even minor changes to daily routine can be very upsetting. Transitions between tasks and activities can also be quite difficult for these children. The behavior of a child with an ASD can initially be very confusing to parents and teachers when “meltdowns” appear to be unprovoked or unpredictable. Once the ASD is identified, however, the pattern becomes clearer and strategies can be put into place to help prevent these episodes.

Children with classical Autism often have developmental delays in the areas of speech, the use of pretend play, and/or overall learning or academic success. They may also experience delays in their “independence skills” such as dressing and personal hygiene. It is important to understand that some children on the autism spectrum may have these delays or deficits while others may not. This is one reason why autism is now seen as a spectrum of disorders with more variation in symptoms.

Children on the higher functioning end of the spectrum have fewer deficits and often have average or above average intelligence with no delays in their development. Asperger’s Syndrome (AS) and High-Functioning Autism (HFA) are considered to be at the higher functioning end of the Autism Spectrum. There is debate as to whether these two diagnoses are different or essentially the same. The only diagnostic difference between the two is that children with AS cannot have speech or language delays. Children with HFA, however, may have a history of delayed language or speech development. The diagnosis of Pervasive Developmental Disorder-NOS is used when a child does not meet the diagnostic criteria for any other ASD (i.e. Autism, HFA, AS) but still exhibits enough symptoms from the diagnostic spectrum to set them apart from their peers.

There are also some secondary characteristics of ASDs that are not currently part of the official diagnostic criteria. Sensory issues, whether hypersensitivity (i.e., oversensitivity) or hyposensitivity (lack of sensitivity) are common. Not coping well with loud noises, having problems with “scratchy” clothes or having a high tolerance for pain are some examples of sensory issues. It is also quite common for children with an ASD to experience symptoms of anxiety. Furthermore, children on the spectrum tend to be physically awkward, clumsy, uncoordinated or may walk or run on their toes.

Assessment and Treatment of ASDs

While Autism Spectrum Disorders are lifelong, it is important to remember that the issues associated with ASDs are treatable. Many times parents hear the word “autism” and panic. There are a number of treatments that have research support for their effectiveness. Early intervention is very important and is directly related to positive long-term outcomes. Therefore, if you are seeing “red flags” that may be consistent with a diagnosis of an ASD, seek consultation from a psychologist who has experience with children on the autism spectrum. A psychological evaluation is often needed to clarify the diagnosis and develop an effective treatment plan.

At Silber Psychological Services, a thorough assessment for an ASD will include a detailed developmental history including information about when first concerns were noticed, your child’s language and motor development, and their particular social style and play preferences. The assessment will also measure your child’s cognitive skills (IQ) and daily living skills. Your child’s understanding of their social environment and their social skills will also be assessed. The evaluation will vary based on the child’s age and may include parent and/or teacher checklists, an initial interview, and possible observations of your child.

If a child is diagnosed with an ASD, the staff at Silber Psychological Services can help parents decide what approach to take. Your child’s strengths and weaknesses will be discussed and a treatment plan will be formulated to help your child reach his or her full potential. Recommendations may include participation in a social skills group, consultation with the school to help set the child up for success, and parent sessions to discuss the best parenting strategies for a child with an ASD. Recommendations can also include consultation with other professionals such as occupational therapists (OTs) or speech/language therapists that deal with sensory, motor, and/or language development issues.

This can be an overwhelming process for parents. Our staff can provide a great deal of support while helping parents sort through the vast amount of information about ASDs and find what is accurate and helpful. Parents may also wish to seek support and guidance from other parents of children with ASDs by participating in a local support group.

Behavior Problems

Does your child have difficulty taking “no” for an answer or become defiant no matter how nicely or firmly you give instructions or set limits? Do you have to closely monitor your child just to make sure that even simple tasks are completed? Does your child often spiral into a “meltdown” with tears or angry screaming if confronted about non-compliance? Is your child an expert at how and when to “push your buttons” for maximum effect?

At Silber Psychological Services, we frequently meet with parents who are concerned about their child’s behavior. They may be receiving complaints from the school, having concerns about play dates, or may simply be having difficulty getting their child to follow directions around the house. “Bad behavior” can range from relatively mild but frequent and highly annoying behaviors to severe temper tantrums that can last for hours. Some children appear to misbehave on purpose while others seem unable to control themselves. The parents of children with behavior problems are concerned and interested in finding ways to help their child improve their behavior. Often these children are experiencing stress, anxiety, or sadness. In seeking help, parents are hopeful that their child will feel happier once the behaviors have improved. Most often the parents we meet have tried a range of strategies that have been suggested by friends or written resources. Sometimes there has been short-lived improvement that leaves the parents feeling guilty, or ashamed that they were unable to “fix” their child.

The first step in helping a child learn to behave appropriately is a thorough assessment to determine what factors may be contributing to the behavior problems. A variety of issues such as problems with motivation, anxiety, ADHD, autism spectrum disorders, or situational circumstances such as a divorce or other losses can contribute to behavior problems. Our staff is skilled at isolating the causes of unacceptable behavior patterns. Even perfectly healthy and normally developing children can hit a “rough patch” of behavior, when transitions occur such as the birth of a sibling, a family relocation, or the beginning of a school year.

Whatever the underlying causes, the next step is to help the parents find solutions that can bring relief to the child and the family. Parents learn when, where and how to respond in effective ways, setting firm limits and appropriate consequences.

In working with school age children, our clinicians often work with teachers in developing a successful plan to get behavior problems under control. A variety of very effective behavior therapy techniques are frequently used. Diagnosing and treating teenagers often requires different strategies that are more flexible and creative and include setting basic expectations at school and home while considering common issues that adolescents deal with such as emerging identity, varied interests, and personal style.

The staff at Silber Psychological Services is available to hear your concerns and evaluate the behavior problems and patterns exhibited by your child. After a good diagnostic picture has been obtained, the clinician, parents, and teachers, if needed, can implement plans to help improve your child's behavior, level of compliance, and overall happiness.

Blending Families

With divorce occurring frequently in our modern day society, how to successfully “blend” families after remarriage has become a challenging issue! So many factors impact on the ability to “create” a totally new family system while also honoring what is left of the old family system. There are certainly no easy answers.

The clinicians at Silber Psychological Services are regularly involved with families that are going through the “merger” stage and have experience with what kinds of solutions are needed to develop a viable and positive family system as well as knowing what kinds of “solutions” have a tendency to prevent a positive “regrouping”.

Some of the factors that impact on how “family blending” goes are unresolved conflict with former spouses, children and stepparents with significant personality conflicts, stepparents that want to parent their new spouse’s children either too much or too little, difficult personality issues amongst the stepchildren, and the children having unresolved issues and loyalties related to their parents’ divorce and remarriage. Research has indicated that one of the most significant factors in a child’s ability to adjust to a divorce is the amount of contention between their parents. This is certainly a factor in successful family blending as well. Parents that have put aside their own personal issues related to a previous marriage and/or spouse are better equipped to “blend” a new family when they remarry.

At Silber Psychological Services helping a family to "blend" successfully can include parent counseling focused on the family unit, individual therapy for either parents or children with issues that are interfering with positive interactions in the new family system, group therapy with a child or family therapy sessions. The process of “blending” a new family is complicated. It takes time and commitment. Our staff is well equipped to help a “new” family pinpoint where the problems lie and learn successful ways to develop a system that builds up trust amongst its members and an ability to involve everyone in the process of “becoming family” over time. Every family is different and our staff focuses on developing an individualized treatment plan to serve each family.

Bullying

Bullying is physical or psychological intimidation that occurs repeatedly, is intended to inflict injury or discomfort on the victim, and creates an ongoing pattern of harassment and abuse. It typically includes behaviors such as hitting, name-calling, social exclusion, teasing, taunting, and threatening. Bullying involves a power imbalance. Bullies are often stronger, bolder, and more confident than their peers and pick on children who are weaker, more timid, and hesitant to retaliate. Bullying can even occur without face to face contact by using the internet or other digital communication devices such as email, text message, web pages, or chat rooms. This form of bully behavior is referred to as cyber-bullying.

Many people feel that bullying is just a natural part of growing up, but this is not true. Victims of bullying can suffer psychological and sometimes physical scars that last a lifetime. Recent studies suggest that as many as 1 in 10 children are regularly attacked either verbally or physically by bullies. Children who are bullied often exhibit symptoms of greater fear and anxiety, feel less accepted, suffer from more health problems, and score lower on measures of academic achievement and self-esteem.

As a parent, one important factor in reducing the incidence of bullying is being aware of the warning signs such as avoidance, coming home from school with bruises, scratches, torn clothing, or missing/damaged property, lack of friends, losing interest in favorite activities, sleep disturbance including bad dreams, and an increase in generalized fearfulness.

If you believe that your child may be the target of bullying, contacting the school to discuss the situation and explore interventions is an important first step. At home, parents can help by giving praise and encouragement for talking about the problem with adults. Helping your child make connections with classmates outside of school is especially important. Teaching your child to find humorous ways to view and respond to bullies, to be appropriately assertive with peers and to avoid certain vulnerable situations can all contribute to being able to deal with bullying behavior successfully.

If your child is bullying others, it is important to deal with it right away. Whether the bullying is physical or verbal, if it is not stopped it can lead to more aggressive antisocial behavior, thus interfering with your child's success in school and ability to form and sustain healthy and satisfying friendships. Although it can be very upsetting to discover that your child is exhibiting bully behaviors, it is very helpful to try to understand the reasons behind your child's behavior. In some cases, kids bully because they have trouble expressing strong emotions like anger, frustration, or insecurity in acceptable ways. In other cases, children have not learned cooperative ways to work out conflicts or deal with differences. Let your child know that bullying is unacceptable and that there will be serious consequences at home, school, and in the community if it continues.

Whether your child is the bully or the target of bullying behavior, keeping the lines of communication open and providing support, assistance and clear behavioral expectations can help your child overcome the bullying issues. However, even when parents intervene appropriately, bullying may continue and your child can continue to experience significant distress.

Our child and adolescent clinicians can provide a variety of services to meet your child’s needs if bullying is an issue. Treatment for bullying can incorporate both individual and group therapy. Individual therapy can be helpful to focus on improving a child’s coping skills and treating secondary symptoms, such as depression and anxiety. At Silber Psychological Services, we also run a variety of social skills groups which can assist a child in learning and practicing the skills required to cope with bullying and help develop more successful peer relationships. Parent consultation is frequently needed to achieve the best results in treatment.

Central Nervous System (CNS) Injuries

Acquired CNS injuries consist of brain and spinal cord injuries occurring after birth that are caused by either an external force or an internal “trauma” event such as a stroke, tumor, infection in the brain or a spinal cord “incident”. A child that has suffered an Acquired CNS injury can often experience a wide range of persistent cognitive, behavioral, social and functional difficulties. Acquired CNS injuries differ in severity and symptoms as well as the extent of impact the injury has on the child and their family.

Most children receive immediate medical attention for the physical aspects of their injury and then participate in some type of rehabilitation program. Unfortunately, however, despite the numerous emotional problems that can occur following a CNS injury, few families obtain mental health services for their child or the family. Acquired CNS injuries have a significant emotional impact not only on the child but on their entire family. Children with CNS injuries often need help in dealing with the emotional responses to their injury and the resulting life changes. It is equally important for families to receive help for the emotional adjustments and changes brought on by a CNS injury to a family member.

Some of the common concerns that can surface in a child following a pediatric CNS injury may include cognitive differences, behavioral changes, physical differences, communication difficulties, trouble with thinking and staying focused, social isolation, and low self-esteem. The child’s family may experience problems such as increased family conflict, symptoms of depression or anxiety in some of the family members, increased stress in those caring for the child, feelings of isolation, a loss of income resulting in financial hardship, feelings of grief and loss, difficulty in making sense of injury, decreased attention for siblings, and changes in usual family boundaries.

Research results show that children with CNS injuries and their families who experience some of the above emotional or physical changes generally benefit from seeking professional help.

At Silber Psychological Services we have staff members that have experience in helping children and their families stabilize after a CNS injury by developing a comprehensive plan that will promote healing and ongoing recovery for the entire family. Neuropsychological testing may or may not be necessary, but can be conducted to help formulate the treatment plan and monitor progress. In cases of CNS injuries, a wide variety of treatment approaches are needed to bring about successful results. The best research results available are utilized in the formulation of the treatment plan. Our staff can consult with the child’s school regarding IEP reviews and 504 plan reviews to ensure that appropriate goals are included in the child’s academic program that will simultaneously support ongoing recovery and academic progress.

Communication

There are a few things that cause more problems in relationships than difficulties in communicating with others. A large number of people that we work with are having difficulty in communicating openly, directly and successfully with significant people in their lives. Our focus is to help individuals learn new ways to communicate appropriately, to build self esteem and to increase understanding of how important good communication is in contributing to one’s ability to grow and develop into a healthy and happy individual. This goal can be achieved through the use of individual and/or group therapy, parent counseling, collateral consultation, and joint sessions with the client and one or more individuals with whom they are having the most significant communications problems. Learning good communication skills is a necessity to having satisfying interpersonal relationships.

Depression

Any one who has been through the teenage years or has been around older children and teenagers is well aware that anger, bad moods and general “angst” can be quite common during later childhood and adolescence. Although nowhere near as common as with teens and adults, younger children can also experience significant bouts of depression. Both the length of time and severity of the symptoms help to differentiate normal “bad moods” from depression.

Some of the most common symptoms of depression are having frequently depressed or irritable mood most the day, loss of interest or pleasure in all or almost all activities, significant weight loss or gain, a marked decrease or increase in appetite, sleep problems, extreme restlessness or sluggishness, noticeable fatigue or loss of energy, excessive feelings of worthlessness or guilt, noticeable problems with concentration, and recurrent thoughts of death and/or suicide.

Research shows that between 2 to 3% of younger children will experience depression at any give time. The problem of adolescent depression is more significant. Recent surveys reveal that in any 6-month period, about 14% of girls and 7.5% of boys between the ages of 12 and 17 will report symptoms severe enough to be diagnosed as depression. Of those who are depressed, some data indicates that well over 75% will experience suicidal ideations with 4 to 10% of boys and 10 to 20% of girls actually reporting a suicide attempt. Suicide is the third leading cause of death among teens. It is very important that all suicidal thoughts, particularly if the teen talks about a plan or actual intent to harm themselves, be taken very seriously. Although younger children are much less likely to engage in self-harm, expression of suicidal thoughts at any age is clearly cause for concern.

There is definitely hope for a large portion of children and adolescents who suffer from depression. Most who experience depression can be treated successfully with either psychotherapy, medication or a combination of both in more severe cases. Both Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy approaches have been shown to be very effective in the treatment of depression.

At Silber Psychological Services our clinicians are trained in the diagnosis and treatment of depression in children and teenagers and have specific training in CBT. Treatment of childhood and adolescent depression can be very challenging but the positive results are worth the effort.

Disasters & Trauma

When tragedies strike, the emotional consequences can be overwhelming. Whether the trauma is natural or intentional, small or large, sudden or expected, it can have a very significant impact upon children and families. Even without physical injury, there can be substantial emotional trauma. At first, shock and denial are normal protective reactions. Other emotional, cognitive, behavioral, and/or physical symptoms may eventually surface. Individuals that have experienced traumas may appear irritable, have irregular sleeping patterns, exhibit poor concentration, show signs of excessive worry, or display exaggerated startle responses. Some people become less emotionally expressive and appear to be detached from others. At times, traumatized children display behaviors that resemble other problems, such as Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Depression or Anxiety. It is not uncommon to see regressive behaviors, such as toileting accidents, even in a child who had been fully toilet trained. Sometimes, traumatized children will exhibit symptoms of Post-Traumatic Stress Disorder, such as intense fearfulness, feelings of helplessness, recurrent thoughts of the traumatic event, nightmares, severe and frequent distress, or avoidance of persons, places, or things associated with the event.

Parents and family members may feel very overwhelmed by not knowing how to manage these reactions following a disaster or trauma. Understanding typical responses to these abnormal events is one of the most helpful steps in the path to recovery. A psychologist can be helpful in educating people about normal responses to extreme stress. It is important that a family understand and accept that time and patience for mourning and healing is crucial. Reaching out to others for support, communicating needs, engaging in healthy coping behaviors and resuming normal routines as soon as possible are also necessary. A number of factors that can impact on the length of time required for recovery may include the degree of intensity of the event, the extent of the loss, other stressful events that may have preceded the traumatic experience, level of premorbid functioning, and a person's general ability to cope with emotionally challenging situations.

Treatment is generally recommended if serious problems persist and continue to interfere with daily life after an extended period of time. With children, ongoing aggressive behaviors and emotional outbursts, serious problems at school, preoccupation with the traumatic event, continued and extreme withdrawal, and other signs of excessive anxiety or emotional difficulties may suggest the need for professional intervention. An evaluation to rule out Post-Traumatic Stress Disorder or other issues may be warranted. A qualified mental health professional at Silber Psychological Services can help traumatized children and their parents understand and deal with thoughts, feelings and behaviors that result from trauma. Treatment modalities may include individual therapy and/or family therapy focused on finding the most appropriate strategies to help a family cope effectively and constructively with the emotional impact of a disaster or trauma and ultimately returning to a normal, healthy and satisfying family life.

Divorce

Although the divorce rate in America is very high, divorce still carries a stigma and raises many fears and concerns among divorcing parents about the long-term adjustment of their children. Study findings are inconsistent but most research suggests that the stress of divorce on children and their parents is felt most strongly in the initial stages. This is a time when parents often experience problems with co-parenting in a healthy way due to conflicts and differences that contributed to the dissolution of the marriage. Financial difficulties, social isolation, and problems with self image and self esteem can cause parents to be more self absorbed, less communicative, emotionally unavailable to their children, and more inconsistent with their discipline. Consequently many families benefit from increased social support during the initial stages of a separation or divorce. Family support can come through community organizations, divorce support groups, and professional mental health services.

Several key factors have an impact on the overall adjustment of children whose parents are separating including the children’s ages and gender, the custodial arrangement, and the intensity of ongoing conflict between parents. Typically, preschoolers exhibit the most behavioral difficulties following a divorce. Such problems may include increased aggression, noncompliance, and acting out behaviors due to the developmental inability to understand the reasons for a divorce. Both preschool and school age children even into high school may blame themselves for the divorce and fear abandonment by one or both parents. Behavioral difficulties of older school age children during the first year after a divorce may include a drop in academic performance, disruptions in their social relationships including withdrawal from peers, significant behavioral changes, excessive sadness or crying, or an increase in aggressive or destructive behaviors. The severity of these changes will determine the possible need for professional consultation.

There is some research evidence for gender differences in initial adjustment to divorce. Although research is not consistent, some studies show that boys experience more distress in the early stages of separation and divorce, while girls experience a “sleeper effect” and develop more difficulties later on. Boys typically show more aggression and acting out behaviors, while girls experience more anxiety, depression, and decrease in self esteem.

Custody arrangements are a third factor in children’s adjustment following divorce. Most studies indicate better adjustment when children have frequent, reliable contacts with both parents. The most important factor affecting children’s subsequent adjustment following a divorce is the parents’ ability to establish an amicable parenting relationship with one another. The more conflict and confrontation between parents after a separation, the greater the risk for long-term harm to their children. In fact, some studies conclude that it is the conflict between parents, regardless of whether separation occurs or not, which creates the most serious long-term emotional and behavioral difficulties for children.

There are many good books to help parents plan ahead for how they will inform their children about a separation, answer questions, and deal with any problem behaviors.

In addition to written resources, parents can often benefit from seeking professional consultation in moving through the early states of a separation with their children in the best possible ways. All of the clinicians at Silber Psychological Services have considerable knowledge in helping families negotiate this difficult life transition. We are ready to help on a short or long term basis depending on the needs of each individual family.

Early Kindergarten Admission

Silber Psychological Services will test children for early admission to kindergarten. We administer a battery of standardized IQ tests and achievement tests that are determined by state and local school board authorities. Frequently these include one of the Wechsler Scales, Stanford-Binet, Woodcock-Johnson Test of Achievement or Tests of Early Math or Reading. In order to qualify for early admission, the child must score in the 98^th percentile or higher on the IQ test as well as on EITHER the math assessment OR reading assessment. If the child does not qualify on the IQ tests, we allow the parents to opt out of the remainder of the assessment. A total assessment constitutes approximately two hours. A child cannot be tested for early admission until April 16^th following his/her fourth birthday and the testing must be complete by the first day of school. For more detailed information on early kindergarten admission in Wake County, reference the following website:

http://www.wcpss.net/forms/early-kindergarten-application-process.pdf

Eating Disorders

Eating Disorders are a complex combination of physical and psychological issues. Eating Disorders include Anorexia, Bulimia, Binge Eating Disorder and Eating Disorder Not Otherwise Specified. An Eating Disorder usually starts with excessive dieting and disordered or unhealthy thinking about food and/or one’s body. People with eating disorders are obsessed with food in some way. They often feel that their behaviors are beyond their voluntary control and experience a significant level of self-critical, negative thoughts and feelings about body weight, body image and healthy food intake. Unhealthy eating habits and weight fluctuations may disrupt normal body function. The focus on appearance, body image, calories, and weight eventually affects all thoughts and behaviors resulting in serious physical problems such as anemia, heart palpitations, bone loss, tooth decay, and disruption of menstrual cycle. The obsession with food or body can also lead to a deterioration in relationships, concentration, emotional stability and daily functioning. Other disorders which are also frequently present for people with Eating Disorders include depression, anxiety and substance abuse.

Individuals sometimes have eating disorders for long periods of time before their family or friends suspect a problem. People with Eating Disorders are often aware that their behavior is abnormal and may withdraw from social contact, hiding their behavior and denying that their eating patterns are problematic. Family members and friends often feel confused about how to best help because feedback and advice is usually initially rejected or ignored. The individual may claim to want “help with dieting” but this is generally not the solution. Eating Disorders seldom stop without professional intervention and, when left untreated, can result in serious emotional and physical consequences.

Proper treatment for a person with an Eating Disorder can make a difference. Professional treatment should be sought when the eating behaviors start having a destructive impact on someone's physical or mental health. Individuals with Eating Disorders are often very resistant to seek treatment, and families should be firmly encouraging and supportive in getting therapy started as soon as possible.

At Silber Psychological Services, our therapists have extensive experience in the treatment of eating disorders. A thorough evaluation and accurate diagnosis is the first step. When treatment is recommended, establishment of normal weight and healthy eating patterns is the priority. Psychological, social and family issues that may be contributing to the eating disorder are subsequently addressed. The therapist helps the client replace destructive, unhealthy thoughts, behaviors and coping strategies with positive and healthy ones. Therapists can also help family members to better understand the client's disorder and learn new techniques for responding. A multidisciplinary team may often be needed to provide the best treatment results. Individual Therapy, Family Therapy, and Group Therapy often occur simultaneously. Some clients may benefit from medication. The process of recovery is usually long-term, difficult and fraught with complications, but the journey back to health can be very successful and enormously gratifying for client and family alike.

Encopresis

Encopresis is a complicated and distressing behavior that involves the passing of feces in places other than the toilet, such as in underwear, on the floor, or in other clearly unacceptable places. It occurs when a child resists having bowel movements, causing impacted stool to collect in the colon and rectum. When a child’s colon is full of impacted stool, liquid stool leaks around the impacted stool and out of the body, staining the child’s underwear. In most cases, encopresis is a symptom of chronic constipation. It may also be the result of developmental or emotional issues such as premature toilet training, adjusting to birth of a sibling, some other kind of trauma, or developmental delay. Encopresis may or may not be purposeful on the child’s part.

Encopresis is fairly common, but many cases are not reported due to the embarrassment of the child and/or the parents. Encopresis is estimated to affect 1% to 2% of kids under the age of 10, usually occurs after age 4, and after the child has already learned to use a toilet. It is 6 times more common in boys than in girls, with no clear reason for this gender disparity.

Some of the symptoms of encopresis are leakage of stool on a child’s underwear without illness, avoidance of bowel movements, loss of appetite, abdominal pain, loose, watery stools or constipation with dry, hard stools, scratching or rubbing the anal area due to irritation, decreased interest in physical activity, withdrawal from friends and family, and secretive behaviors associated with bowel movements.

Approximately 20% of children with encopresis are also at risk for other emotional problems that may require intervention and can include embarrassment, frustration, shame, anger, depression, and low self-esteem. Teasing by friends or peers can contribute significantly to these emotional issues, causing avoidance of social situations such as birthday parties or events that include sleepovers.

If you believe your child has encopresis, consult your child’s pediatrician first. A medical assessment is necessary to ensure a correct diagnosis. There are some medications that can help encopresis. If further help is needed, Silber Psychological Services offers behavioral techniques that help identify and treat the social and emotional issues in children with encopresis. Punishing or humiliating a child with encopresis will only make the situation worse. Our psychologists will work with both the child and the parents to address the problematic toileting behaviors with positive behavioral strategies and lifestyle changes to overcome the encopresis. Encopresis is a difficult problem with a high relapse rate. Our clinicians at Silber Psychological Services will utilize the most effective techniques to avoid relapse and bring about a positive outcome.

Enuresis

Most children toilet train by 5 years of age and have no difficulties with bed-wetting or nighttime accidents. However, for some children, involuntary urination persists and can result in a child feeling embarrassed and ashamed while their parents may be frustrated and angry with continual need to change bed sheets and pajamas. Left untreated, enuresis may cause behavioral, emotional, and social difficulties in a child. In the majority of cases, bedwetting may be part of a normal developmental stage and children can be expected to stop having accidents on their own. In such cases, professional treatment is not necessary. In situations where a child is older than 6 years of age, they begin having accidents after a period of staying dry at night, they show signs of social, emotional, or behavioral distress, or the problem has persisted over time and does not appear to be resolving, treatment from a professional is warranted. At Silber Psychological Services, our psychologists may use a combination of behavioral, cognitive, lifestyle, and pharmaceutical approaches to help families determine the cause of bedwetting and to develop an individualized and comprehensive treatment plan to address the issue.

Fears and Phobias

Many psychologists believe that our emotions are reactions in the brain that often warn us of distressing situations that can cause hurt or danger. Fear specifically alerts us to danger, letting us know to be prepared to fight, flee or seek safety in a group. When a fear response becomes excessive and prolonged, an individual may develop anxiety that becomes associated with specific objects or situations and can eventually develop into a phobia.

In the Diagnostic and Statistical Manual, phobias are characterized by excessive, persistent or unreasonable fear that is triggered by the actual presence or anticipated presence of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Exposure to such situations or objects frequently causes immediate anxiety and may take the form of a Panic Attack which then becomes connected with that specific object or situation. In children, excessive anxiety may be expressed through crying, tantrums, “freezing”, or clinging. The individual with a phobia often avoids or endures the situation that provokes intense anxiety or distress. When a person has a phobia, avoidance, anxious anticipation, or distress in the feared situation it interferes significantly with their normal routine, occupational or academic functioning and social activities or relationships. There is often significant distress about having a phobia.

In children or teenagers, the fearful, avoidant, and anxious behaviors must be present for at least 6 months before being diagnosed as a phobia. Other psychiatric disorders such as Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Separation Anxiety Disorder, Social Phobia, Panic Disorder with Agoraphobia, or Agoraphobia without history of Panic Disorder must be ruled out as a cause of these behaviors. The key features of a phobia are the intensity, persistence and unreasonable level of response when compared to a typical or normal fear response.

Phobias have been studied for many years finding an incidence rate of approximately 10% in the general population with females outnumbering males by about 2 to 1. Although the rate of phobias in children may be slightly less than in the adult population, particularly when the criterion of at least 6 months duration is tightly monitored, it still occurs in at least 5% of children.

Even though phobias can be very powerful, people with phobias often respond very well to treatment. Typical treatment interventions generally include some type of actual or simulated exposure to the feared object or situation. Systematic Desensitization is a treatment strategy that gradually increases the amount of exposure to the feared object or situation. Another treatment intervention is called Flooding in which exposure to the feared object is very rapid and prolonged until the anxiety or fear decreases to a manageable level. Additional strategies can also include the use of “virtual” exposure using computer assisted imagery. If a phobia has been present for many years, medication may be needed to bring about the best treatment results in helping an individual with regulating these powerful emotional responses.

The professionals at Silber Psychological Services specialize in treating children and teenagers and have training in the treatment of fears and phobias. We will work with you and your child to determine what type of intervention will be most useful. Although these treatment interventions can initially increase the anxiety or fear that your child is experiencing, the final outcome of being able to deal with the feared object or situation in a healthy and normal manner is worth the initial discomfort.

Grief

Grief is a universal experience that requires patience, time and understanding. If a person experiences the loss of an important person, a beloved pet, a safe and familiar environment, a physical or mental ability, or a much cherished life dream or goal, grief normally will occur.

Children, adolescents and adults can experience the same kinds of loss. The intensity of the resulting grief will vary with the importance of the loss, the personality and coping skills of the bereaved person, the possibility for positive and active ways to deal with the grief and the response of the people in the person’s environment. Generally, if a person has supportive and empathetic people who are willing to help by talking and doing things to promote a healthy grieving process, the grieving person can sometimes go through the process without have to consult a mental health professional.

When a child or adolescent has experienced a loss, it can be very helpful to have the support and encouragement of other family members, friends and teachers. Healthy healing can be promoted by significant people who listen without prying and share how they felt when a similar loss occurred in their life. Providing age appropriate books on grief, suggesting activities that will encourage a positive grief process and spending some extra one on one time with the grieving person can all facilitate healthy grieving. Tears are a positive way to express and ultimately resolve grief and should be encouraged. Doing these things should facilitate the grief process.

It is very important not to put a time limit on the grieving process as this can vary widely from person to person. If a child or teen continues to show significant symptoms of depression such as frequent crying spells, heightened fear of normally comfortable activities, increased problems with separation from family, nightmares, loss of interest in previously enjoyable activities, or avoidance of social activities after several months, it would be advisable to seek professional help.

Our clinicians at Silber Psychological Services have dealt with many children and teens who are experiencing grief of varying intensity and are in need of talking with someone outside of their personal support system. Grief counseling with minor children usually involves some sessions with the parents as well as individual sessions with the child or teen. The stronger the grief reaction and the more severe or life altering the loss, the longer grief therapy may be needed; however, a specific time limit cannot be determined due to the differences in individual responses to therapeutic intervention. The therapist, parents and youngster will reevaluate the need for continued treatment based on the improvements. Having help from a seasoned professional can have a very positive impact in resolving grief. The staff at Silber Psychological Services stands ready to assist in helping children and their families cope with the grief process at any time.

Health Issues

Numerous children suffer from medical diagnoses (i.e. severe headaches, asthma, gastrointestinal issues, etc.) that cause them to experience pain, limit daily functioning, or produces other negative side effects. Additionally, these diagnoses may require children to follow medical regimens that are complex, intensive, and sometimes painful. For example, diabetic children are expected to conduct multiple daily checks of their blood sugar as well as administer injections of insulin. If they do not adhere with this regimen, the health consequences can be dire.

Often medical conditions cause children to experience a variety of negative social and emotional issues. Additionally, parents may experience their own negative emotions about their child’s diagnosis and can sometimes be at a loss as to how to help their child work through his/her own issues. Sometimes parents alter their parenting strategies when interacting with their child because of his/her diagnosis. Silber Psychological Services offers a variety of therapeutic services to help children with medical issues to help their adjustment, emotional well-being, and compliance. We also provide strategies to parents to help them positively support their child while maintaining structure within the household. Therapy depends upon the nature of the medical diagnosis. For example, children may be taught behavioral pain management, how to cope psychologically with their condition, or taught cognitive behavioral strategies to help increase compliance with medical requirements.

Intellectual Disability (ID)

Intellectual Disability (ID), formerly known as mental retardation (MR), is a condition that is diagnosed when a child younger than 18 years has significant limitations in their intellectual functioning and daily living skills that include communication skills, social skills, and self-care skills. These limitations often cause a child to learn and develop in ways that differ from children without ID.

Children with intellectual limitations are able to learn and usually care for themselves with varying levels of impairment ranging from mild to profound. The level of impairment depends on the child’s intelligence quotient (IQ). An average IQ score is 100 and children with ID have an IQ score of 70 or lower. Children with ID often have trouble adapting to ordinary daily living situations and lack the skills to manage these situations with the same success as their age mates. There may be problems with the concepts of time, language, and numbers. Or there may be problems with interpersonal relationship skills and issues dealing with responsibility, self-esteem, problem solving, and the ability to follow rules. Individuals with ID commonly struggle with practical skills in the areas of personal care, work skills, healthcare, schedules and routines, safety, and money management. However, with appropriate assessment and intervention, many children with ID are able to learn a great deal about these common problem issues and learn to function at least on a partially independent level.

Additional emotional and behavioral disorders often occur with ID and may further interfere with a child's functioning. Some children with ID recognize that they are performing at lower levels than their peers, which can have a negative impact on their self-esteem. Their deficits can cause them to become frustrated, withdrawn or anxious. Because children with ID often have social skills deficits, they may have difficulty making and keeping friends, and interacting appropriately with others. As these children age into adolescence and young adulthood this lack of social connection can lead to problems with depression.

In order to help children with ID, a thorough assessment of intellectual functioning as well as developmental delays needs to be completed. At Silber Psychological Services, we provide this kind of assessment through test administration, observations of your child, and interviews with parents and teachers to determine whether your child has an ID and the level of severity. Following this assessment, the psychologists at Silber Psychological Services will develop a detailed treatment plan to address issues commonly associated with ID, such as anxiety, depression, and low self-esteem. We also offer social skills groups to help teach children with mild ID appropriate social skills. Our psychologists are equipped to work with parents teaching them strategies to deal with the unique behaviors and needs of their child at home. Consultation with the child’s school is often necessary in helping teachers develop an appropriate and successful learning plan that meets your child’s needs.

Learning Disabilities

Learning Disabilities (LD) are specific neurological disorders that affect the brain’s ability to store, process, or communicate information. Learning Disabilities interfere with a child’s ability to learn and produce information but do not have anything to do with intelligence. Walt Disney, Thomas Jefferson, Winston Churchill, and Albert Einstein are just a few among many famous people that had LDs.

Although Learning Disabilities occur in young children, they are not usually recognized until the child reaches school age. About one-third of children who have LDs also have ADHD, a condition that makes it hard to focus and pay attention. A trained psychologist can help identify a learning disorder and distinguish it from other conditions that can inhibit learning. LDs affect approximately 5% of all children. They are not the same as intellectual deficiencies, Autism Spectrum Disorders or sensory impairment disorders. LDs are not caused by disruptive behaviors or motivational problems and are not the result of cultural, economic, or educational differences.

Some of the more common signs of LD may include:

Difficulty learning connections between letters and sounds
Reversing letters (b/d) or transposes words (saw/was)
Confusing arithmetic signs (+,-,x,÷, =)
Knowing information the night before but forgets the following day
Not recognizing words previously learned
An inability to distinguish between important and unimportant information
Problems with finding the right word to express an idea
Writing illegibly
Poor spelling ability
Difficulty with planning and organizing materials
Inconsistent academic performance
Great difficulty completing homework

A Learning Disability can occur in the following areas of learning:

Reading
Math
Written Expression
Fine Motor Coordination
Visual, Auditory, or Kinesthetic Processing
Memory

There are many types of LDs that may be similar but have different names. For example, a reading disability in North Carolina may be called dyslexia in other parts of the country.

Learning Disabilities can stem from many factors including complications during pregnancy or delivery, illnesses, early childhood injuries, environmental factors, and heredity. A good overview of the types and causes of LDs can be found at:

www.helpguide.org/

What do you do if you suspect a Learning Disability?

Talk with your child’s classroom teachers and other school personnel about your concerns and discuss whether or not an IEP (Individual Educational Plan) is necessary to individualize academic instruction to meet your child’s educational needs.
Consult with your pediatrician to rule out any physical, visual or hearing conditions that might be contributing to the learning problems.
Consult with a psychologist and request testing to make a definitive diagnosis.

The psychologists at Silber Psychological Services provide Psycho-Educational Evaluations or “testing” when a learning disability is suspected. Testing can help determine the specific diagnosis, rule out other issues, and can be used to make recommendations to enhance a child’s ability to succeed. Since there is no one test that can detect a learning disability, a variety of tests are given. The tests required may vary from one region to another, but usually an LD evaluation consists of three parts: a standardized intelligence test to assess cognitive functioning and potential, achievement tests that determine the student’s current academic levels, and a group of tests administered to examine processing abilities and rule out other problems that may be contributing to the student’s academic difficulties or memory.

After testing is completed, a written report explaining the findings is furnished to the parents, including specific recommendations about accommodations that are needed in the school environment. This report often helps provide a “roadmap” for receiving school services that will help the child. If a student has a learning disability, additional services such as tutoring or more intensive programs might be needed. The staff at Silber Psychological Services can help with formulating comprehensive recommendations for both in school and out of school services.

For information pertaining to the federal law, commonly called IDEA, go to www.ldonline.org/

While a diagnosis of a Learning Disability can be initially upsetting, it can also be a relief to know why certain types of learning are so difficult for your child. The earlier the diagnosis, the more quickly it can be treated. Research shows added benefits to early intervention, however, if an LD is identified later in school, it will still be effective. Some students will work with a tutor or a special teacher at school. Others will take classes on study skills or organizational techniques. Some will need an occupational therapist or a speech therapist. Often, our psychologists will suggest strategies that will help your child strengthen their abilities in the particular areas of weakness.

There is no cure for a Learning Disability. However, many types of LDs can be successfully treated, especially with an early diagnosis. Successful intervention can help change the way the brain works and most children learn how to adapt or learn strategies to compensate for their difficulties. With proper diagnosis, many colleges can also provide assistance for students with LDs. Our staff can provide advice regarding the wide range of issues that parents of children with Learning Disabilities face.

NervousHabits, Tics, and Tourette’s Syndrome

Tics are sudden, rapid, repetitive movements that often begin in childhood. Tics are frequently referred to as nervous habits and may involve motor movements such as eye blinking, squinting, shoulder shrugging, or vocalizations that include repeating a sound, grunting, coughing or sniffing. These behaviors are common in childhood, are usually short lived and often change or occur intermittently. A child may be eye blinking for several weeks and then switch to sniffing or coughing. This type of tic is called a transient tic.

Chronic tics differ from transient tics in their persistence and their unchanging nature. Both transient and chronic tics are heightened by stress, excitement, or fatigue. Tic disorders occur significantly more frequently in males.

Tourette’s Syndrome is the most severe tic disorder. It is a neurological disorder characterized by multiple, frequently changing motor and/or vocal tics that can be debilitating. People with Tourette’s Syndrome often have an urge to engage in compulsive behavior which can include getting “stuck” on repeating a word, a phrase or in rare circumstances, cursing. Although the cause of Tourette’s Syndrome is unknown there is some research suggesting an abnormality in brain function is involved.

Many children may function well in school and with peers in spite of their tics. If a child is exhibiting no other problems, parents may need to wait for the tics to go away. Others may find this troublesome to do because of the repercussions that it has on the child. For some children, having tics can be a source of embarrassment or shame or may intrude on the personal space of others. Some vocal tics can make it difficult for other students to listen. If tics become persistent or interfere with day-to-day functioning, professional help can serve to avoid lasting damage to the child’s self esteem or social development. It is important that children not be punished for tic behavior since tics are involuntary and the child cannot stop them. However, with family support, an attitude of acceptance, and professional intervention, the intensity of the tics and the resulting stress on the family can be greatly reduced.

The decision to treat or not to treat a tic disorder will depend upon what form the tic takes and the extent to which the tic behaviors are interfering with the child’s day to day functioning. To determine the need for treatment, a proper diagnosis is essential and begins with a medical exam to rule out neurological or other medical issues.

At Silber Psychological Services we believe that care must be taken to first rule out other existing problems such as ADHD, OCD, or mood disorders. If other problems are discovered, deciding what condition to treat first needs thoughtful evaluation to avoid making the tic behaviors worse. Interfacing with other professionals such as neurologists, psychiatrists, family doctors, and school personnel is an essential component of a thorough evaluation. Medication may be prescribed depending on the severity and chronicity of the tic behavior symptoms.

A primary behavioral intervention for the treatment of mild or transient tics is called Habit Reversal. Habit Reversal is designed to increase a child’s awareness of when the tic behavior is happening and teach a “competing response”. The child engages in this competing response until the tic behavior lessens. Parents are vital in helping their child during treatment.

While psychotherapy will not eliminate tics, it can be beneficial in teaching children how to deal with the “psychological fallout”. That is, the inability to control one’s body movements or sounds can be a significant source of anxiety, guilt, anger, and/or depression. Some children may withdraw, become aggressive, or become extremely perfectionistic in response to their frustration. At Silber Psychological Services we can help when additional problem behaviors develop.

Dealing with a child with a tic disorder can be stressful. Some parents may find it difficult to accept their children’s symptoms, while others worry about the genetic component, experience guilt, or try to overcompensate for the problems. Family therapy may be useful to address these issues. Learning how to be supportive without being overprotective can be quite useful. It is equally important to explore ways of modifying the environment at home or school to reduce stressors. Knowing what activities to avoid to reduce stress and “excitement” levels is also important. Becoming more educated about tic disorders can make a significant difference in a family’s ability to cope with a child with a tic disorder.

At Silber Psychological Services, we look forward to helping parents and the children affected by tic disorders to reach a comfortable degree of relief and to develop successful strategies for mastering the problems.

Neuropsychological Testing

Neuropsychology is the scientific study of brain-behavior relationships. Neuropsychological assessment yields an understanding of behavior while considering brain development and functioning. Most individuals referred for neuropsychological assessment have a history of abnormal brain development or functioning, a genetic syndrome, an acquired injury, a medical condition, or illness. Abnormal brain functioning resulting from the abovementioned causes can often be observed behaviorally in problems at school, difficulties with appropriate social interactions, trouble with self-help skills, conflicts at home, and emotional problems.

Individuals with known or suspected brain abnormalities/dysfunction should participate in a neuropsychological assessment instead of a psychoeducational evaluation because a more comprehensive and specialized assessment is often necessary for medical, school, and community planning.

Areas that may be examined during neuropsychological assessment include intellectual functioning, academic abilities, attention and executive functions, learning and memory, language, nonverbal skills, motor skills, self-help skills, behavior, social skills, emotional functioning, and personality. Common uses of neuropsychological evaluation include diagnosing clinical and medical disorders, estimating baseline functioning, monitoring changes of brain functioning over time, tracking decline or recovery of functioning in the presence of illness/injury, developing cognitive rehabilitation programs to aid in recovery from injury/illness, explaining the impact of a neuropsychological condition to family, school, and work settings to maximize functioning, and recommending appropriate placements and levels of care depending on the neuropsychological concerns.

Obsessive-Compulsive Disorders

Obsessive-Compulsive Disorder (OCD) is a type of anxiety disorder which is characterized by obsessions (recurrent, unwanted, and unpleasant thoughts) and/or compulsions (repetitive, ritualistic behaviors which the person feels compelled to perform). Most often, OCD causes marked distress, is time consuming, and interferes with a person's ability to function normally.

Common obsessions include “stuck thoughts”, repeated thoughts about germs or contamination, a fear of acting on violent or aggressive impulses, excessive feelings of responsibility for the safety of others, or the need to have things in a particular order. Obsessions exceed normal worries about real life problems. Compulsions can include excessive washing, cleaning, checking, or repetitive actions such as touching, counting, arranging, ordering, hoarding, or other various ritualistic behaviors. Compulsions are performed with the hope of getting rid of the anxiety caused by the obsessions. A person with OCD may have one or many symptoms.

Parents of children with OCD can experience considerable frustration. People with OCD often recognize that their obsessions and compulsions are irrational or excessive but feel that they have little control over them. Parents sometimes feel controlled by their child’s OCD but are unsure of how to stop this pattern and reduce the stress. The symptoms of OCD may appear similar to other problems such as oppositionality or difficulties with concentration. Professionals with experience treating the symptoms of OCD can help families resolve their frustrations, eliminate confusion of symptoms and help to minimize the impact of obsessions and compulsions.

A person with OCD may assume that they are weak or “crazy” for having the disorder, but OCD is not a sign of either. OCD is a biological disorder which is treatable. Symptoms of OCD may worsen during times of increased stress or conflict and occur in different ways over time. Families often feel very alone in dealing with this problem, but there are actually millions of people who struggle with OCD. While OCD affects people from all walks of life, it impacts a disproportionately large number of individuals with high profile professional positions (i.e., lawyers, doctors, etc.). An equal number of men and women show signs of OCD but it is more common in males during childhood. A combination of patience, understanding, advocacy, and firm guidance are needed to cope with living with someone with OCD.

Treatment for a person with OCD can be very effective and beneficial. A thorough assessment of an individual with symptoms of OCD by a qualified mental health professional such as a psychologist is an important first step. Therapists at Silber Psychological Services are skilled in these assessments, can identify core issues and triggers, and provide treatment for individuals with symptoms of OCD. The severity of symptoms and the extent to which they interfere with normal functioning are an important part of treatment.

Children and adolescents with OCD are often very relieved to discover that their thoughts and behaviors are understood and are treatable. Research has shown that Cognitive-Behavioral Therapy (CBT) is a highly effective treatment modality for OCD. CBT techniques may include exposure with ritual prevention, corrective thinking of distorted beliefs, imagery, and relaxation training. During treatment, parents are educated about the most effective strategies for dealing with their child’s behaviors. Medications are sometimes recommended depending on the severity of the OCD symptoms. Consistent follow through in therapy can eventually lessen the intensity and frequency of symptoms, allowing the person and their family to get back to leading a more normal and satisfying life together.

Oppositional Defiant Disorder

Oppositional Defiant Disorder is a recurrent pattern of defiant, disobedient, and hostile behavior toward authority figures. Typical behavior problems include arguing with adults, refusing to follow directions, persistently testing limits, and failing to accept blame for misdeeds. To be qualified as Oppositional Defiant Disorder, these problems must be more frequent and severe than in children at a similar level of development. Treatment of Oppositional Defiant Disorder typically involves providing behavior management strategies to parents for increasing compliant behavior and decreasing family tensions. Interventions may include parenting help, compliance training, and individual or family therapy.

Parenting Issues

Raising children may be more challenging today than at any other time in recent history. Parenting challenges are numerous and include issues such as dual career families, more distance from extended family, more family relocations, and fewer culturally prescribed roles and values in families. Children too are faced with new and stressful challenges. Some of these challenges include more choices and freedoms than ever before, a media highly focused on sex and violence, and a culture that encourages instant gratification. It is no wonder that the self-help child-rearing book industry is booming yet parents seem more confused than ever. Often these parenting books seem to raise more questions rather than providing clear answers.

In the midst of all the questions and confusion about child-rearing, one thing seems clear: most parents want their children to become happy, well adjusted, and responsible adults. In today’s culture, accomplishing this goal is far from easy. Any parent of more than one child can attest to the fact that children come in a variety of “flavors.” Parents of children with “easier” temperaments can rely on their intuition and upbringing as guides for raising kind, happy, and independent children. These parents often comment that “just a look” can bring about a positive behavior change. Then there are the children who are more “spirited” and come into the world kicking and screaming, challenging every rule that their parents try to enforce. Parents of these children are often exhausted when they finally seek help and are blaming themselves. They are reluctant to share their difficulties with family members or friends for they fear that others will blame their child’s behaviors on flawed parenting and being seen as the inadequate parents that they feel they are. What these parents often do not know is that these more challenging children are not generally a product of flawed parenting. On the contrary, as early childhood researchers Thomas and Chess found many years ago in studying infant behavior, some children are born with a “difficult” temperament. They cry loudly and often, are difficult to soothe, have problems with transitions, and do not respond well to structure and routine. Research suggests that these personality traits appear in early infancy and persist over time. Parenting children with such temperaments is a challenging task. When you add the additional stresses of parenting in today’s culture, it can be truly overwhelming for many parents.

When dealing with these more challenging children in early childhood, questions often arise regarding issues of toilet training, bedtime routines and sleep problems, how to get a child to follow directions, how to use time out, handling homework, getting compliance to requests, and establishing effective routines.

As children with more difficult temperaments get older, more challenging issues often develop including how to encourage motivation with school work, more involved homework issues, how much freedom to give in a variety of areas, dealing with sexuality, monitoring peer interactions in healthy ways, finding effective modes of discipline, and modeling respectful behaviors.

If you have tried different strategies over time with little success or your particular situation has reached a crisis point, then it is time to seek outside intervention. It is often helpful to have an outside “coach” to hear the perspectives of both parent and child and to help find clear cut solutions to changing unwanted behaviors. The staff at Silber Psychological Services has experience with Cognitive Behavioral Therapy (CBT) which is particularly useful in helping parents find effective ways to bring about more positive interactions with their children and more desirable behaviors in general.

Pervasive Developmental Disorders (PDD)

Pervasive Developmental Disorders are characterized by significant impairments in several areas of development which may include social interaction skills, communication, behaviors or presence of unusual interests and activities. The defining aspect of the disorder is how distinctly deviant the conditions are relative to the normal developmental level or mental age of that individual. Some specific developmental disorders are Autism Spectrum Disorder, Asperger’s Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder, (NOS) Not Otherwise Specified. These disorders are usually evidenced in the first few years of life. The diagnosis of Pervasive Developmental Disorder, NOS is used when there are impairments in development but the impairments are not sufficient to meet the full criteria for one of the other developmental disorders. This may be due to late onset, atypical symptoms, or subthreshold findings. Nevertheless, Pervasive Developmental Disorders require significant evaluations including medical, psychological, speech and language, and sometimes, physical or occupational therapy. Silber Psychological Services provide evaluations to determine the presence and treatment options of children suspected of having PDD. Further, our practice offers social skills group treatment for those whose delays reside in the social domain.

School Problems

Dealing with a child who is experiencing problems at school is a difficult issue for parents. Parents often must rely on someone else’s perspective or observations of their child and may not be observing the same behaviors at home which makes it difficult to know how to improve the situation. There are often multiple reasons why children experience problems at school which can make treatment a challenge.

Some of the reasons for problem behavior at school can include a lack of motivation, problems at home, difficulties with peer relationships, poor work habits and/or study skills, emotional and/or behavior problems (e.g., depression, anxiety, non-compliance), learning disabilities, attention deficit hyperactivity disorder, autism spectrum disorders, mental challenges, or medical problems. A personality conflict between a teacher and student or conflicts with peers can contribute to problems at school also. Finding the reason(s) for your child's inappropriate behaviors is essential in developing a treatment plan that can effectively modify behavior in a positive way and boost a child’s ability to perform at their fullest potential.

It is very important to seek help as soon as you recognize that there are problems. Scheduling a meeting with your child’s teacher is a necessary first step. Talking with the school psychologist, guidance counselor or your pediatrician can also be helpful. A thorough evaluation by an experienced professional is often needed to correctly diagnose the underlying causes in children with complex problems at school.

Children who do poorly at school often experience stress and develop different ways to cope with this stress. Some may act out their feelings while others internalize their feelings and develop physical complaints, such as headaches or stomachaches. Assisting a child with problems at school can be difficult and frustrating. Working with teachers, school administrators, counselors and sometimes other parents can feel overwhelming and intimidating. Staying calm, keeping an open mind and reminding yourself that you know your child can make you an invaluable asset in resolving the problems. Keeping communication lines open with teachers and collaborating amicably is very important.

There are many strategies that can help your child resolve their problems at school. At Silber Psychological Services our staff can provide a variety of services to help with this process. If needed, we can complete a comprehensive evaluation of your child that will assess cognitive, academic, attentional, and emotional strengths and weaknesses and help to determine the appropriate course of action. In some instances, a staff member may do a school visit with your permission to observe your child in their classroom, obtaining further data to shed light on the root cause of the school concerns. If the problems appear to be academic in nature, the psychologist will make very specific recommendations for effective interventions and will advocate for the child within the particular school system if necessary. If the difficulties seem more related to social or emotional functioning, a course of therapy may be recommended that can include individual or group therapy, regular consultation with the parents, or consultation with teachers and school administrators to share strategies for dealing with problem behaviors. Our staff is skilled in helping parents, children and school personnel deal with the gamut of school problems that children experience.

Selective Mutism

Selective Mutism usually starts in early childhood and is characterized by a failure to speak in situations where there is a normal expectation to talk. There is no problem with understanding language or the ability to speak normally. In comfortable situations, usually at home with the family or with a special friend, the child converses normally using appropriate volume, content and full sentences. Selective Mutism is especially difficult if it occurs at school as it can interfere with normal language development and learning. While Selective Mutism may have its roots in anxiety, it is the lack of speech that ultimately inhibits social development and education. Causes remain unknown but Selective Mutism is usually receptive to individual treatment if caught early. At Silber Psychological Services, we use a combination of behavior management strategies, desensitization, positive reinforcement and compliance training to assist children in overcoming difficulties in speaking across situations and settings.

Self-Esteem

Self-esteem is the way in which a person feels about him or herself. Although a person's self image may be naturally positive or negative, that sense of self grows and changes throughout life and is affected by many personal experiences. A strong and solid self-esteem usually makes life easier, happier and more fulfilling. A child with a healthy self-esteem tends to enjoy interacting with others, works toward positive solutions when problems arise, can express frustration without criticism, accepts both theirs and others’ strengths and weaknesses, and is generally optimistic. On the contrary, a child who has low self-esteem may avoid trying new things, exhibits a low tolerance for frustration, is overly self critical, sees temporary setbacks as unsolvable and generally views life with a sense of pessimism. Self-esteem affects the way someone lives, thinks, acts, gets along with others and succeeds in life. There are many factors that can contribute to poor self-esteem, including, but not limited to, traumatic experiences, depression, social problems, or family conflicts.

Parents are understandably concerned when their child exhibits symptoms of a poor or negative self-esteem over any period of time. Fortunately, parents can help their child build positive self-esteem by providing a loving, supportive, cooperative and safe home environment. An atmosphere of acceptance of imperfection and making mistakes within a family is very important. Pointing out a child’s strengths and recognizing effort is crucial. Parents can also redirect inaccurate comments and beliefs to encourage their child to develop an accurate, realistic and positive self image. Parents can encourage a better self image by role modeling positive self-esteem, confidence and optimism in themselves.

Seeking professional help can be useful if a child has ongoing feelings of low self-worth despite the efforts of their parents to address these issues. The staff at Silber Psychological Services can help assess a situation and figure out what underlying issues are preventing your child from feeling positive about him or herself. Psychological Testing may or may not be warranted, depending on the extent and length of the problem. Treatment would involve exploring underlying issues as well as learning strategies for helping your child improve their self image. A combination of individual, family or group therapy may be indicated. With appropriate treatment, a child can be assisted in creating a more realistic, positive self perception and healthier self-esteem.

Separation Anxiety

Separation anxiety is discomfort a child feels when either anticipating the absence of a parent or primary caregiver or when such an absence really occurs. Some separation anxiety, especially in a child’s younger years, is a normal sign of a strong and healthy attachment to a parent or caregiver. This developmentally appropriate anxiety occurs most commonly between the ages of ten and eighteen months and generally subsides between 18 and 24 months of age. At this stage of development, children are becoming aware of what is called “object permanence.” They are moving from an “out of sight, out of mind” mentality to an understanding that objects still exist even when they are not present. This enables children to recognize that even when a parent is not in their presence, he or she is still around somewhere. Children at this stage, however, do not have a fully developed understanding of the passage of time. Their memory for the consistent return of their parents is limited and they are often unable to soothe themselves when their parents are absent, causing a need for pacifiers, blankets, and stuffed animals for self comfort.

Toddlers will often show great discomfort when a parent leaves by fussing, crying, whining, or holding onto their parents at the time of anticipated or actual separation. Transitions to babysitters, preschools, and even going to bed at night can be particularly difficult for older toddlers when separation anxiety is at its peak. Separation anxiety may be more problematic in children who are by nature more sensitive or difficult to soothe (i.e., children with a “difficult temperament”). For these children separation anxiety may return at various transition points in their lives, such as the transition to kindergarten or a move to a new home.

For most children separation anxiety normally fades with time and they recover quickly from individual episodes of separation anxiety. It helps if parents are “matter-of-fact” and not overly emotional at times of departure. A parent’s own anxiety about absences from their child may prolong the child’s sense of discomfort. Routine, brief absences from children are actually beneficial and encourage independence, the ability to self-soothe, and to develop trust in the fact that parents will consistently return. During these early years, parents may wish to seek professional consultation if their child’s anxiety remains extreme, continues past age 2, or develops into a more pervasive pattern of fearfulness in more situations and circumstances.

Separation Anxiety Disorder refers to a set of symptoms and behaviors in which older children show marked distress at the actual or anticipated absence of a parent or other attachment figure. In older children these symptoms and behaviors are distinguished from the normal separation anxiety experienced in infants and toddlers and are not considered to be developmentally or age appropriate. Often, but not always, children who develop Separation Anxiety Disorder have had a history of significant anxiety and fearfulness. There may also be a family history of problems with anxiety.

Symptoms associated with Separation Anxiety Disorder persist beyond what is considered normal and can include fears about and/or problems with going to or staying sleep, fears of being home alone in any circumstance, fears about something bad happening that results in separation from a parent, or physical complaints (e.g. headache, stomachache, nausea or vomiting, etc.) when anticipating separation from a parent.

An actual diagnosis of Separation Anxiety Disorder is based on the number and severity of specified symptoms and the length of time that these symptoms have persisted. Consulting with a professional at the first sign of symptoms makes this disorder easier to treat. However, even if the symptoms have been present for a long time, Cognitive-Behavioral Therapy (CBT) is very effective in treating this disorder. With proper intervention and follow-through, parents are likely to see positive changes very early in treatment.

At Silber Psychological Services our staff is ready to help parents find effective ways to deal with Separation Anxiety Disorder and the resulting distress experienced by both the child and parents.

Shyness

Shyness is a discomfort often accompanied by avoidance that interferes with personal relationships. It is characterized by excessive self-focus on one’s thoughts, feelings and physical reactions. Severely shy children may avoid situations where they feel others will view them critically. They fear that others will make fun of any perceived flaw or mistake and subsequently find themselves withdrawing from situations until there is a certain level of comfort. Shyness may be accompanied by blushing, sweating, heart pounding or upset stomach. If excessive shyness persists, the person may continue to withdraw until they have few or no friends and a child may begin to avoid activities he or she finds pleasurable. Left untreated, shyness can lead to passivity, pessimism, and low self-esteem.

By adulthood, estimates range from 30 to 50% of the population who report chronic shyness in some aspect of their life that interferes with functioning. Shyness may result from many causes. These include a biological predisposition, stressful life events, shaming experiences, or highly critical environments.

Parents can help by showing empathy for the child’s emotions but also by communicating appropriate and clear expectations. Professional help is sometimes required and at Silber Psychological Services there are trained professionals to help children learn how to combat negative thoughts, role play challenging situations, and eventually tackle the situations where the child is experiencing difficulties. Group therapy can be a useful adjunct where the child gets to practice new skills in the context of a supportive environment led by a professional. As a result of treatment, especially social skills groups, the child has the opportunity to practice and develop adaptive interactions. Therapy is aimed at helping a child learn self-acceptance, assertive skills, and more positive appraisal of the actual situation.

Sibling Rivalry

Sibling rivalry describes the competitive relationship between siblings. To some extent, nearly every household experiences sibling conflicts. There are many factors that influence and affect sibling rivalry. Most brothers and sisters experience some degree of jealousy or competition, and this can flare into bickering, whining and arguing to teasing, tormenting and physical aggression. Sibling conflict can occur as often as 7-8 times per hour!

Understanding the factors involved in sibling rivalry is important to determining the severity of conflict and identifying strategies to resolve or reduce it. These include the developmental age of the children, access to and availability of parental attention, individual temperaments, special needs/sick children, and role models for resolving household conflicts by the parents.

In some families, the conflict between brothers and sisters is so severe that it disrupts daily functioning, results in significant family/marital stress or significantly affects a child’s emotional development, self-esteem or mood. In addition, severe sibling rivalry can result in physical harm to a family member or be an indicator of other psychological issues, such as depression, school problems or anger. In these instances it is wise to seek professional help. The staff at Silber Psychological Services provides a variety of services to help your family cope and intervene with sibling rivalry. Treatment can involve individual therapy, family therapy, or parent consultation and is tailored to each family’s or individual’s needs. We can evaluate underlying causes and contributing factors to help develop a specialized intervention program, including family and individual goals. At Silber Psychological Services, our goal is to help families be proactive and prepared in managing sibling rivalry in order to improve harmony, happiness and positivity within the family environment.

Sleep Issues

It is common for children to experience sleep problems throughout the different stages of development. Many of these sleep issues are normal and children will eventually outgrow them. However, some sleep issues can be prolonged and cause excessive fatigue as well as make it difficult for a child to function throughout the day. Some of these problems may include: waking excessively in the night, not falling asleep in a timely manner, problematic sleep-onset associations (e.g. needing a certain toy in order to fall asleep), separation issues from parents (e.g. not wanting to sleep alone), non-compliance with bedtime routine, significant difficulty waking in the morning, or night terrors. Not only can sleep problems cause sleep deprivation issues in children, they can also cause sleep deprivation issues in parents as they are often forced to interact with the child throughout the night.

Sleep deprivation can lead to serious problems. For example, the part of the brain that helps people to control their actions and responses to feelings is affected greatly by lack of sleep. Thus, sleep deprived children (and parents) have more trouble controlling their emotions. Additionally, not getting enough sleep can lead to issues in children such as behavior problems, attention problems, and poor performance in school. Therapists at Silber Psychological Services teach behavioral strategies to help children comply with bedtime routines, sleep independently, sleep longer hours, as well as work through a variety of other sleep problems. We use strategies and do not solely adhere to the “cry it out” method. We will work with your family to determine which strategies will be most effective to meet the needs of your family.

Social Skills

The ability to relate to people in a positive and effective way means that a person has good social skills. A child may experience problems with social skills for a variety of reasons. For instance, the presence of ADHD and attentional problems can limit a child’s ability to be aware of how their impulsive behavior may be causing problems in their relationships with peers and adults. Having an Autism Spectrum Disorder (ASD) can interfere with understanding the complex "rules" of social interaction. Anxiety and shyness in social situations can also have a negative impact on a child’s social skills. Regardless of the reasons, research shows that the absence of good social skills is predictive of problems in both childhood and adulthood. Healthy social skills are necessary to form satisfying relationships. The consequences of lacking effective social skills and positive relationships can be long-lasting.

Parents are rightfully concerned when they see their child struggling socially. Children with poor social skills are often isolated, actively ignored, or teased, which can have a negative impact on self-confidence, self-esteem, and general happiness. While many children find recess and lunch to be their favorite parts of the day, children who have social difficulties may dread these times. Hearing children speak negatively about their social experiences is certainly disheartening. Parents often feel helpless in knowing how to help improve their child’s experiences. Parents may initially want to intervene, but are also aware that this may exacerbate the problem in certain situations. It is especially important to talk and determine if your child is being bullied. If bullying is occurring, further steps need to be taken such as enlisting the help of adults in positions of authority in the situation, and teaching the child successful ways to cope with the bullying behavior. In situations where no resolution to the bullying occurs, parents may need to consider withdrawing their child from that situation.

Fortunately, social skills can be improved and research suggests that individuals learn social skills best in a group therapy format. A group setting allows the opportunity to practice skills and also fosters relationships with group members who have similar difficulties. Simply involving your child in more socially-based activities does not necessarily improve the quality of their social skills. In fact, simply increasing the amount of your child’s social activities may only serve to set your child up for more difficulties due to the lack of structured and direct guidance in many typical social situations. Step-by-step coaching with feedback, modeling, and opportunities for practice in a group setting has shown to be the most effective approach.

The staff at Silber Psychological Services offers social skills groups for a wide variety of ages and tailors each group to address age appropriate social issues. The group therapist also meets with parents to discuss the skills that need to be learned or improved. Teachers also may be contacted if needed. Most groups include a check-in time at the start of group, an activity that focuses on building specific social skills, and a snack/social time. Group therapy is a unique and beneficial opportunity to address a variety of social issues. Communication and conversational skills are addressed weekly during check-in, snack, and activity times. While children may be understandably apprehensive about participating in a group at first, after a few weeks, most enjoy being a part of the group. As their ability to make friends improves, children often look forward to group sessions. Our staff is ready to help children improve their social skills and increase satisfaction in relationships using this very effective treatment approach.