Signs of social processing deficits

Making friends can be difficult for many boys  The ups and downs of friendships in the childhood and teen years are difficult to navigate and one of the challenges of growing up.  However, some kids have social problems that go beyond the norm.  Unfortunately, many boys feel the need to hide these struggles.  I am sure parents have heard terms such as non-verbal learning disability, Asperger’s Syndrome and pervasive developmental delays.  These terms can be confusing but in general here are a few warning signs to look out for and may signal that your son needs further evaluation:

• your son doesn’t “get it” when it comes to social cues or social pragmatics
• he has a restricted or very specific range of interests
• he doesn’t have a good sense of his body in space (e.g., standing too close)
• he has trouble initiating and maintaining friendships
• he takes things very literally
• he is a concrete thinker

For more information on these issues I recommend visiting  visit www.nldline.com or www.aane.org

The Trouble with “Anger Management”

Many of the referrals I get form teachers, social workers and PCP’s state that the client needs “anger management.”  I am still struggling with finding a way to make this term relevant and useful to many of the boys with whom I work.  Many of the boys and teens I see tell me that there is no way they will be disrespected and let  anyone, adult or peer, “punk” them.  Thus, I can teach them all of the de-escalation strategies I know but they will not be put into action unless the young person is able to release the burden of having to prove himself in light of a perceived slight.   The trick becomes helping the client understand that true power means knowing how to pick your battles and not allowing anyone and everyone to have the power to make you angry.  Of course, sometimes this message is not well received and therein lies the real challenge of making anger management relevant instead of cliche.

Improving Sleep Patterns

I have had a bevy of grumpy teen boys in my office this week trying to get adjusted to the early waking times that come with back-to-school time.  Many teens get accustomed to staying up late and sleeping in over the summer and then have to shift their sleep pattern radically to make it in by homeroom.  Tardiness early in the school year can set students back early, so here are 3 quick tips for getting a teen’s sleep back on track:

1) Make sure all electronics are shut off at a set time.  Late night texting and messaging can lead to red eyes in the morning.

2) Make sure homework is complete at least an hour before bedtime and books and study materials ideally should not be kept in the bedroom.  The bedroom should be a peaceful place and somewhere where teens can “ramp down” after homework time.

3) Make sure teens don’t deviate from their sleep pattern too drastically on weekends.  If the body is used to an 11-6:30 schedule during the week and then jumps to 3AM-noon on the weekends it makes it awfully hard to switch back to normal on Sunday night

Know what’s in your medicine cabinet

One of the disturbing trends among youth today is “pill parties.”  These are gatherings where teens bring prescription pills or over-the-counter cold medicines to a party and mix the medications with alcohol.  It goes without saying that mixing medications can be deadly.  Thankfully, drug stores and supermarkets are recognizing this trend and putting cold medicine behind the counter and asking for ID before purchase.  However, many parents are not as diligent when it comes to accounting for the old medications in the home.   It is so important for parents to take the initiative and keep prescription pills and medications in a safe place.    If you have old meds left over in the medicine cabinet, flush them.  Finally, while you may be sure that your kids would never take medications from the home but you cannot be sure that friends or acquaintances that come to the home won’t take medications if they are accessible.  It sounds cliche, but a little prevention goes a long way.

Therapy is not Always the Answer

One of the most frustrating things about the mental health landscape as it currently stands is that insurance companies will only reimburse for the standard 50-minute therapy session.   Many families drag their sons to therapy for them to sit there for an hour shrugging their shoulders while they play Monopoly with their therapists.  The truth is that many boys are just not accustomed to sitting in a room across from an adult in a 1:1 setting and talking about emotions.  Unfortunately, many boys drop out of therapy and families end up “going it on their own.”

Now let me be clear, for many boys (such as those suffering from anxiety or depressive disorder) individual therapy has been proven to be effective and helpful.  However, many families seek mental health assistance for problems such a disruptive behavior in school, problems with following rules at home, risky behavior, or problems with friends – problems that may not be best addressed via individual therapy.   Indeed, It can be unrealistic to assume that what takes place in one session a week will be generalized to the problems going on in the “real world.”  What often has a greater impact is the psychologist acting as a consultant to the boy and family and coming up with a targeted plan to address the behavior that involves frequent follow-up by phone and e-mail as well as substantive advocacy with the school.  While the HMO’s may not agree, it has been my experience that many boys and young men can be helped by thinking outside the box of the 50-minute session.  Please check back in to the blog as I plan to write more about what these services can look like and how we can make them both effective and affordable for families.

Boys, trauma and the schools

I am heading out to beautiful Ludlow Vermont on Friday to give a talk on trauma and learning.  The talk has me thinking about the needs of this population as we approach the start of school.  One thing to remember boys will often to be reluctant to talk about their experiences so you need to pay attention to their behavior. Here are a few tips for teachers and student support staff for working with boys who have experienced chronic trauma:

• Boys who experience trauma are more likely to have a short fuse, to be reactive and will benefit from support around how to recognize the triggers that activate them and the physiological cues that signal they are about to have a meltdown
• When a boy is in a meltdown, help him leave the situation and decompress before you process the situation; processing will not occur in the middle of  a meltdown
• Try to minimize transitions and maintain consistent schedules and routines
• Boys who experiences trauma are often hypervigilant so a seemingly innocuous gesture or statement may be taken as a threat
• Collaborate, collaborate, collaborate as much as possible with service agencies, families and community supports.  Treatment is only effective when all of the supports in a young person’s life are working together and on the same page.

That’s all for now, have a great last week of summer! JB

Back to school: An anxious time for many young people

Its that time of year: the temperatures are still high but change is in the air.  Days are getting shorter and the leaves will soon change and that means back to school for kids and teens across the country.  While back to school time can be exciting it can also be stressful.  If your son is prone to school anxiety it is worthwhile to take some time to talk to him about about his thoughts and feelings about the school year.  Since boys often aren’t exactly thrilled to talk about their feelings it is helpful to have this talk while performing an enjoyable activity (e.g., shooting hoops, throwing a ball, drawing, playing a video game, etc.).  Possible sources of anxiety to ask about include:

• conflict with friends or peers form last year that may have abated over the summer
• fear of new teachers or increases in workload
• dating concerns
• fear of new classroom, social groups, or school setting
• concern about performance in athletics

It is important to remind your son that he take the transition to school one step at a time and that the fear of the unknown is usually worse than whatever he will face at school.  Also, provide support and comfort that you will be there for him no matter what comes up this year and together you can manage it.  Finally, make the last week of summer fun! Go fishing, go for a walk or run, take one last trip to the beach, have an ice cream cone, watch a baseball game, or just hang out together but take advantage of this time before schedules get hectic in September.

Welcome to my blog

Welcome and thanks for reading.  I will be blogging about issues relevant to the mental health of boys and teens.  I am a psychologist from Cambridge, MA who specializes in treating hard-to-reach boys and teens.  Boys who act out can be a true challenge for parents, teachers and other professionals.  Unfortunately, many boys are resistant to seeking help for behavioral or mental health problems because they worry it will mean they are weird or different.  My goal is to help make mental health treatment more relevant and helpful for boys and teens as well as to help parents and teachers respond to boys and teens in trouble.