So, first things first, why expand “the talk” to your child beyond giving them a book, showing them a video, or describing anatomy without further explanation? As a sex therapist, the majority of my clients come in feeling embarrassed to talk about sex or have a lot of misconceptions about it as adults because no one ever talked to them about it. Many people were raised with the underlying message that sex is awkward, taboo, or shameful to talk about – some were fortunate enough to have parents that were a bit more open to talking about it, but may still have only learned about anatomy, and not much else otherwise.
By closing off our kids from talking about sex, we’re modeling the notion that there’s something inherently wrong with sex – that it needs to be hidden and can only be discussed with our partner. The problem with this is that as adults, most people have no one to turn to when they’re experiencing sexual difficulties. Forget about talking to a friend, co-worker, spiritual leader, etc. – most people just avoid the topic. And if the doctor doesn’t bring it up (which they probably won’t since they too feel awkward talking about sex), who can one turn to for guidance and advice? Porn? The industry that takes sex and scripts and edits it to look more like a movie than real life? I don’t think so. While porn might teach a technique or two, it doesn’t address issues such as pain, dysfunction, lack of desire, etc. Therefore, by setting a new trend and talking to your child about sex, you’re setting them and society up for better sex education and therefore better sexual health.
So, when is the best time to start talking to your child about sex? The reality is, as early as possible, so that it never becomes a taboo topic in your home. Teach your child from an early age to label their anatomy properly. Teach girls the difference between vulva and vagina and let boys know about their penis and how sometimes it might grow, and that’s normal! Also, teach your children from an early age about consent. Rather than forcing hugs, kisses, or tickles, ask them if it’s okay to give them a hug, or ask them if they’d like to give Grandma a kiss. Teaching them from an early age that it’s okay to say “no” will help give them a voice early on to advocate for their own rights when it comes to their bodies. This is important not only for lessening any potential shame around sex and our bodies, but it’s also very important in the court of law. There have been cases where a perpetrator did not receive a full conviction because the child didn’t know how to describe the assault that happened to them, since they didn’t know how to properly label their body parts. And while this is an extreme example, it highlights the importance of teaching children proper anatomy and consent.
As children get older, continue to have the conversation about sex. Answer questions honestly and make yourself available as someone to talk to. If you catch your child self-pleasuring, rather than yelling, smacking hands, shaming, etc., provide a gentle tone and have a discussion with them in private and set the standard that you and your household value. If your values indicate that self-pleasure is not okay, calmly explain to your child why without including shame messages. If your values align more with self-pleasure being acceptable, try explaining to your child that it’s fine for them to do it, but in the privacy of their own room, etc. It’s natural for children to explore their bodies, including their genitals as they age. It’s very likely that at a young age, they will discover masturbation and experiment with it. However, by addressing it in a way that reduces shame through a gentle tone and explanation (rather than just telling them “no” or “don’t do that in public!” ), they are much more likely to be open to coming to you when sexual issues arise. In addition, shame around their body and their natural desires will be much lower.
Into adolescent and teen years, continue having the conversation. Explain to them about puberty changes so it doesn’t come as a shock when their bodies begin to change. You can give them a “welcome to puberty” package (razor, shaving cream, deodorant, tampons, pads, etc.) and let them know they can come to you with any questions they have about these changes. Make sure you explain to your kids not only the physical repercussions of sex (some potential side effects such as pregnancy, STIs, potential physical enjoyment, etc.) but also the emotional side effects (potential feelings of joy, connectedness, sadness, shame, etc. depending on the outcome of their experience) and again, that they can come to you to process any of these feelings/outcomes. Check and see if your child has a mentor with whom they’re comfortable talking about sex in case they still feel awkward talking about it with you.
While there is plenty of other information to be considered regarding the sex talk, the biggest highlights are these:
By being open with your kids about sex and their bodies, the hope is that in the future they will experience less shame and be more empowered with making their own decisions regarding their choices. No matter what phase of life they are in right now, it’s never too late to have the talk. You’ve got this!
Cyber bullying is bullying, no doubt about it. In fact, it can feel even scarier because the victim is isolated at home when reading it...and they often feel they have no one to go to for support. We believe this page does a great job defining the forms of on-line bullying and can be useful for teens, parents and educators alike! If you or someone you know is a victim of cyber bullying, please feel free to contact us for support. With Care Connect, we can get you an appointment with a licensed therapist within 48 hrs.
Tips for parents on cyberbullying management and prevention
How to tell if your child or loved one is a cyberbullying victim
There’s a chance your child, friend or loved one is the victim of cyberbullying but too embarrassed to admit it. Here are some signs:
Comforting your child after an incident of cyberbullying
Tips on preventing cyberbullying from happening to your child
Cyberbullying laws and in school policy
Often a child will not be able to deal with an instance of cyberbullying alone, and the situation may require intervention by the school in order to put a stop to the behavior.
You may believe that confronting the parents of the bully is a good solution, but they might react unpredictably, denying the charge, or becoming aggressive. Research finds that the bullies are often physically and verbally abused by their parents, and they may not be the best individuals to confront about a cyberbullying situation.
Approaching the school in order to deal with an incident of cyberbullying is the best choice. Even before going to the police, this is the best course of action, as the school will have the contacts of every student, as well as a law enforcement liaison on campus at all times who will best know how to proceed with the situation. If bringing in the cops is necessary, then they will likely do so.
Schools are mandated by state law in every state, to have an official anti-bullying policy, with Montana being the last to do so in 2015. Many states have laws that require schools to deal with off-campus behavior as well. Even if cyberbullying incidents take place off school grounds and after the last bell, they may still be forced to take action. Schools are required to keep classrooms a safe place conducive to learning, and off-campus cyberbullying can negatively impact this environment.
Sleep is a major issue for many adults and children who have been diagnosed with autism spectrum disorder (ASD). Recent studies suggest that up to 80% of young people with ASD also have difficulty falling and/or staying asleep at night. The incidence rate of sleep problems and disorders is also high among adults with ASD, particularly those who are classified as ‘low-functioning’. Lack of sleep can exacerbate some of the behavioral characteristics of ASD, such as hyperactivity, aggression, and lack of concentration. As a result, people with ASD who have a hard time sleeping may struggle at work or in their classroom.
We’ll look at some of the most common sleep issues among adults and children with ASD, as well as some suitable treatment options and tips for managing ASD and sleep on a regular basis. First, let’s look at how the medical and psychiatric communities currently define ASD.
What Is Autism Spectrum Disorder?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is considered the most authoritative guide for evaluating and diagnosing mental health disorders in the United States. According to the latest definition (last revised in 2013), the diagnostic criteria for autism spectrum disorder (ASD) are as follows:
The latest DSM revisions also note three distinct ‘severity levels’ that can be used to assess how much support (if any) a person with ASD requires on a regular basis.
Prior to 2013, ASD was broken down into different autism subtypes based on severity of symptoms. These subtypes were eliminated and omitted from the DSM-5, and their diagnoses have all been absorbed into the ‘ASD’ definition. Although these subtypes are no longer officially diagnosed, they are still widely discussed within the medical and psychiatric communities. Additionally, some are still included on other authoritative lists, such as the International Statistical Classification of Diseases and Related Health Problems (ICD) database maintained by the World Health Organization (WHO). The four most common subdivisions of ASD (as previously defined by the DSM) are:
The root cause of ASD remains unknown, though most researchers today believe that both genetic and environmental factors play a major role. Recent studies have pinpointed some genes that are prevalent in people with the disorder, and brain-imaging tests indicate that the brains of people with ASD develop differently than the brains of other individuals. The general consensus is that ASD originates from defects in the brain that affect how the brain grows and communicates with other areas of the body. Studies have yet to identify any specific environmental factors that directly cause or influence the development of ASD. However, the scientific community has debunked and rejectedthe longstanding belief among parents that child vaccinations lead to a higher incidence rate of ASD in developing children.
Diagnosing ASD in Children
Most children with ASD begin to display symptoms by age three, so early detection and evaluation is critical. The ASD diagnosis process for children is divided into two stages: developmental screening and comprehensive diagnostic evaluation.
Parents are urged to begin developmental screening at a young age to evaluate their children for ASD and other intellectual disabilities. The Centers for Disease Control (CDC) recommends ASD screenings for all children at the ages of nine, 18, and 24-30 months, adding that a reliable ASD diagnosis can usually be made by age two. Additional testing may be required for children who are considered high-risk for ASD, including those with family members who have already been diagnosed or those who have displayed ASD-related behaviors.
During the developmental screening stage, doctors watch for signs and symptoms of ASD diagnostic criteria. These include deficits in communication and social interaction, restricted interests, and repetitive behaviors. Speech and language skills are often delayed in children with ASD; they typically will not respond to their own name after 12 months. Other ‘red flags’ include refusal to acknowledge or point at moving objects after 14 months, showing little interest in playing ‘pretend’ games after 18 months, and sustained repetition of words and phrases, as well as physical signs like avoiding eye contact, constantly rocking back and forth, compulsory hand waving, and/or exhibiting ‘unusual’ reactions to sensory stimuli. Additionally, children with ASD often display at least one of the following traits or behaviors:
According to the CDC, the most commonly used developmental screening tools include the following:
If developmental screening yields results that are consistent with ASD symptoms, then a comprehensive diagnostic evaluation may be recommended. Family participation during this second phase is vital. Parents can describe symptoms and behaviors to the evaluation provider, who can then take these statements into account when conducting the diagnosis. The presence of at least one parent can ease the evaluation process for the child, as well.
In order to perform an accurate evaluation of ASD in children, doctors rely on a set of diagnostic tools. The CDC notes that a comprehensive ASD evaluation should include at least two diagnostic tools; the following four diagnostic tools are most widely used:
Once the comprehensive diagnostic evaluation is complete, parents can discuss the outcome with their physician and — if the child receives an ASD diagnosis — explore possible treatment options.
Considerations for Diagnosing ASD in AdultsASD is a lifelong condition. People with ASD typically begin to show symptoms of the disorder during their early childhood. In some cases, however, these symptoms will not become apparent until the individual has reached adulthood.
Due to the wide range of symptoms and severity levels, diagnosing ASD in adults can be a tricky process — particularly for those who have not received an ASD diagnosis as children. According to neurologist David Beversdorf of the Autism Speaks Autism Treatment Network, an adult seeking an ASD evaluation should first discuss the matter with his or her physician. During this consultation, the patient should explain why they are seeking an ASD diagnosis. These reasons may include changes in the way he or she behaves or interacts with others, as well as heightened sensitivity to sensory factors, acquired repetitive behaviors, or newly restricted interests.
Most licensed physicians are not trained to diagnose ASD themselves, but they will be able to steer the patient in the right direction — and, in some cases, refer them to a specialist with a background in ASD diagnosis. Due to a widespread scarcity of clinicians that specialize in ASD, Dr. Beversdorf suggests meeting with a medical professional that evaluates and treats young people for the disorders. These include developmental pediatricians, child psychiatrists, and pediatric neurologists.
One major issue for diagnosing adults with ASD has been a lack of reputable screening and diagnostic evaluation tools. With the exception of the Gilliam Autism Rating Scale — which evaluates subjects up to 22 years of age — these tools are designed for child subjects, not adults, who tend to be less honest and more secretive when undergoing these tests. Deceased parents are another obstacle for diagnosing adults, since mothers and fathers provide key information to clinicians during the early screening and evaluation stages of child ASD testing.
The Adult Repetitive Behaviours Questionnaire-2 (RBQ-2A) appears to be a step in the right direction. Introduced by the Journal of Autism and Developmental Disorders in 2015, the ADBQ-2A is designed to evaluate adults based on repetitive behaviors and restricted interests. Because the questionnaire excludes social communication and interaction, it should not be seen as a definitive evaluation tool for ASD in adults. However, RBQ-2A can be used to help adults decide whether their behaviors and interests are indicative of a disorder that may necessitate formal treatment.
How Does ASD Affect Sleep?
A 2009 study published in Sleep Medicine Reviews noted parents report sleep problems for children with ASD at a rate of 50% to 80%; by comparison, this rate fell between 9% and 50% for children that had not been diagnosed with ASD. The rate for children with ASD was also higher than the rate for children with non-ASD developmental disabilities.
In a recent study titled ‘Sleep Problems and Autism’, UK-based advocacy group Research Autism noted that the following sleep issues are common among children and adults with ASD.
People with ASD often struggle with daily pressures and interactions more than individuals who do not live with the disorder. Lack of sleep can greatly exacerbate the feelings of distress and anxiety that they experience on a frequent basis. As a result, may people with ASD who have trouble sleeping may struggle greatly with employment, education, and social interaction — all of which can impact their outlook on life.
Persistent sleep problems in people with ASD may indicate a sleep disorder. Insomnia is the most commonly reported sleep disorder among adults and children with ASD. Insomnia is defined as difficulty falling and/or remaining asleep on a nightly or semi-nightly basis for a period of more than one month. A study published in Sleep found that 66% of children with ASD reported insomnia symptoms. A similar study from 2003 found that 75% to 90% of adults then-diagnosed with Asperger syndrome reported insomnia symptoms in questionnaires or sleep diaries.
In addition, parasomnias such as frequent nightmares, night terrors, and enuresis (bedwetting) have been widely reported among children with ASD, particularly those once diagnosed with Asperger syndrome. The child’s inability to express their fears and discomforts upon waking — often due to ASD — can complicate the way parasomnias are addressed and treated. Additionally, children with ASD often wake up in the middle of the night and engage in ‘time-inappropriate’ activities like playing with toys or reading aloud.
Sleep researchers are currently studying the relationships between other sleep disorders and ASD. For example, Dr. Steven Park recently noted a possible connection between ASD and obstructive sleep apnea (OSA), a condition characterized by temporary loss of breath during sleep resulting from blockage in the primary airway that restricts breathing. Dr. Park’s theory suggests that the intracranial hypertension found in many babies and infants with ASD may also cause the child’s jaw to take on an irregular shape, which can lead to sleep-disordered breathing as well. Other studies have explored the link between ASD and disorders like narcolepsy and REM Behavior Disorder. However, insomnia and parasomnias remain the most common sleep disorders among adults and children with ASD.
Next let’s look at treatment options and considerations for adults and children with ASD who are experiencing a sleep disorder.
Sleep Therapy Options
If the preliminary assessment indicates the presence of a sleep disorder in a child with ASD, then treatment will likely be the next step. Cognitive behavioral therapy (CBT) has proven fairly effective in alleviating sleep disorder symptoms for young people with ASD. CBT is designed to improve sleep hygiene in patients by educating them about the science sleep and helping them find ways to improve their nightly habits. A study published in the Journal of Pediatric Neuroscience noted that children with ASD are often set in their routines, so establishing a consistent bedtime schedule can be quite beneficial to them. A healthy bedtime schedule might consist of the following:
Additional behavioral interventions may help children with ASD improve their difficulties with sleep. According to a ‘Sleep Tool Kit‘ published by the Autism Treatment Network, these interventions include the following:
In addition to CBT, light therapy (also known as phototherapy) may also help children with ASD sleep better. This form of therapy is usually conducted using a light-transmitting box kept near the child’s bed. By exposing the child to bright light early in the morning, this therapy can help boost melatonin production and make children feel more alert throughout the day.
The Middle School/childhood DBT® Program consists of:
To schedule an appointment call the front office at 513-939-0300
As of April 2017, the Netflix original series 13 Reasons Why broke a new record: it saw more social media volume than any other Netflix original series. During it’s first week alone there were over 3.5 MILLION tweets including its title (not to mention Facebook, Instagram, SnapChat, Tumblr etc)! The show was produced by Selena Gomez, who is no stranger to mental health topics. In an interview from June 2017, Gomez responds to questions about the dark comment by saying “Whether or not you wanted to see it, that’s what’s happening. The content is complicated. It’s dark and it has moments that are honestly very hard to swallow, and I understood that we were doing something that is difficult. But these kids today are so exposed to things that I would never even comprehend when I was 8.”
As a therapist, I can completely agree with what she is saying. I hear a lot of parents holding tight to their “not my child” or “not at my kid’s school” mentality…and I talk to enough middle and high schoolers to tell you YES, your kid is exposed to these topics and YES, it happens at your kid’s school (as well as on-line, via texting, on television and at sleepovers).
The thing I liked the most about 13 Reasons Why was that it exposed the sexualized cultures and chronic sexual harassment that young girls have come to expect in middle and high schools around the country. It seems to be starting younger and younger too…I have 5th and 6th graders regularly discuss the frequency of sexualized talk, jokes, and requests.
The thing I liked least about the show however, was the ease with which the main character killed herself and the graphic nature in which it was shown. No human being needs exposed to those types of graphic images in any context. It is unnecessary violence that further perpetuates our culture’s desensitization. I further dislike that the image is one more thing for people who are depressed and considering suicide to struggle with thinking obsessively about. They are already fighting so hard to block their own intrusive thoughts and images, I do not believe this horrific scene was necessary in order to get the show’s message across.
In response to 13 Reasons Why, our practice chose to ask our clients why they choose life. We asked them to write anonymously on post-it notes and put their answers on display in our lobbies on our (More than) 13 Reason’s Why Not posters. What we found was interesting. It seems that the majority of our answers fell into five categories:
The beauty of this is that we can draw a conclusion that if you continue to work on these categories in your life, then you will decrease your risk of suicidal thoughts and gestures. If you are struggling with finding reasons to live, I strongly suggest that you reach out to a therapist for guidance. Therapy is a collaborative experience in which the therapist will work with you to explore your values and help you set goals to achieve your life worth living. Please feel free to contact Compass Point Counseling Services if you live in the Greater Cincinnati area (www.cpcs.me), we’d love to help.
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