How You Can Help Improve Self-Esteem In Teenagers

Teens want nothing more in the world than to fit in. This leads them to go to extraordinary lengths to achieve a higher social status, which is often at the expense of others. The majority of teenagers fit into either the rejected or neglected peer hierarchy. This can lead to lowered self-esteem and it can make life miserable. Meanwhile, the popular hierarchy mistreats teens who are lower in social status; many do so for social recognition.

This can be a brutal cycle that’s often present in the educational system. Some teens are even less fortunate because their home life is unstable. For instance, a teen may be living with an alcoholic parent or an abusive parent, which can be a stressful environment for any teenager. This can create a sense of despair because the child feels like there is no escape. Some even take drastic measures and partake in destructive activities such as self mutilation. Life as a teenager can test even the strongest of wills, but there are ways around this unforgiving cycle.

An important rule of thumb when dealing with a depressed teen is to avoid rushing into their personal life. This may lead them to withdraw even more. A teen’s life is very secluded. Work is required in order to get them to speak without inhibition.

The parent should talk with their teen about any problems that they may be facing. At first, they will be hesitant to open up. This is natural because most teens feel like they can handle the problem on their own. The parents should take a more proactive method in dealing with the teenager if the problem continues to exist.

Stay persistent because it will take a lot of time for them to open up. They will soon begin to realize that the parent truly cares. Once this has been accomplished, the parent should plan a day where they can do something together. This will increase the rapport between the parent and child. This will also decrease their depression. Here are some other ways to increase the teen’s self-esteem.


Physical Activities as a Method for Building Self-esteem

Besides being very important to stay healthy and one of the wonderful things to do when they are bored, stressed-out or feeling depressed, physical activities are among the most direct methods for improving a teenager’s self-esteem. Activities such as camping, four wheeling, and even running are great ways to uplift the teen’s morale.

They will feel exhausted by the end of the day, and their spirits will be uplifted because they spent the entire day developing a skill or spending time with a loved one. The root of most teenagers’ low self-esteem stems from a lack of positive social interactions. An action-filled day with a loved one or friend will make them feel wanted and cared for.

Creative Activities Will Promote Self-expression in Teens

Teenagers need an outlet for their artistic side as well. This will give them the ability to express themselves in a positive way. Activities like writing, drawing, painting, and even photography can be very therapeutic. This can give the depressed teen a sense of self-worth.

Organized Sports as a Way to Build Stability

Another way of improving a teen’s self-esteem is to get them involved in an organized sport. This is effective because it allows the teen to socialize and work toward a common goal. Organized sports allow the teen to understand character, trust, leadership, work ethic, and integrity. This will give them confidence because they are actively working to achieve a goal, which will make them feel like they are important. We are social creatures and need interaction with others. Organized sports allow for this social interaction.

Therapy as a Treatment for a Teen’s Low Self-esteem

It may be wise to consider therapy if the previous steps do not work. This is often a good option when parents cannot reach the teenager on their own or in cases where clinical depression is suspected. Professional help can be really beneficial not only for the teenager, but the parents as well. Therapy may shed some light on the causes of the teen’s low self-esteem.

Dealing With Depression and Loneliness

Everyone feels lonely from time to time, but for some, loneliness comes far too often. Feeling lonely can plague many people — including the elderly, people who are isolated, and those with depression— with symptoms such as sadness, isolation, and withdrawal. Loneliness can strike a person who lives alone or someone who lives in a house filled with people. “Loneliness is subjective,” says Louise Hawkley, PhD, a research associate in the psychology department at the University of Chicago. “You can’t argue with someone who says they’re lonely.”

Although depression doesn’t always lead to loneliness, feeling lonely is often a predictor of depression one year or even two years later, and it certainly leads to sadness, Dr. Hawkley says. Freeing yourself of feelings like being isolated by depression is part of the healing process.

How to Fight Depression and Loneliness

Feelings of loneliness don’t have to be constant to call for action, but you will need to give yourself a push to get back into the thick of life and re-engage with others to start feeling better. These strategies for fighting depression and loneliness can help:

  • Make a plan. There are two basic types of loneliness. Acute loneliness results from losing a loved one or moving to a new place, for example. In these situations, chances are you know at some level that you’ll have to go through a period of adjustment to get through this feeling of loneliness. The other type of loneliness is the chronic subjective type, which strikes despite your existing relationships. Both require a plan of action. One strategy is making a point to meet people who have similar interests, Hawkley says. Volunteering and exploring a hobby are both great ways to meet kindred spirits.
  • Do something — anything. In depression treatment there’s a theory called behavioral activation, which is a clinical way of saying, “Just do it.” If you’re feeling lonely and want to change it, any small step you take — even striking up a casual, friendly conversation with the barista at your corner café — is a good move.
  • Explore your faith. There are only a few strategies that are proven to successfully protect against loneliness, and this is one of them. “People who have a personal relationship with their God or a higher power tend to do well,” Hawkley notes. There are a lot of factors at work here, one of them being that faith communities provide many opportunities for positive social encounters. You don’t have to have a close friend in the community to get the benefit, Hawkley says — just feeling that you belong in the group is enough. In addition, faith can help you accept the things in life you can’t control.
  • Bond with a dog. “Pets, especially dogs, are protective against loneliness,” Hawkley says. There are many reasons why this strategy works: Dogs get you out and about, they’re naturally social creatures, and you’ll have a living being to care about. If you’re not in a position to own a dog, find ways to help care for other people’s dogs or volunteer to help dogs at a shelter that need loving attention. Other pets, such as cats and fish, can also help ease loneliness.
  • Have realistic standards. “Loneliness is a mismatch between your ideal and what you actually have,” Hawkley says. Part of the solution may be to accept that you can have fun and light conversation with a variety of people, and that it’s okay if they don’t become lifelong confidantes. Also, reflect on whether you have any unrealistic standards that are making it hard to connect with others and stop feeling lonely, such as expecting too much from a new friendship too quickly or relying on another person too much.
  • Think beyond yourself. Depression can make you feel very self-focused, meaning that everything is all about you. But remind yourself that if you ask a co-worker to join you for lunch and the person can’t make it, you shouldn’t automatically assume that he or she has rejected you. The person might have a previous lunch date or too much work to leave his or her desk.
  • Reach out to a lonely person. Whether you’re feeling lonely now or just know how it feels, you may get an emotional boost from befriending someone else who’s lonely. Some people may view loneliness as contagious, and therefore lonely people often become even more isolated. “We believe there is a responsibility in the community to reach out to people who are suffering,” Hawkley says. In doing so, you can help others and yourself, too. Examples include volunteering for an organization that helps elderly people or visiting a neighbor who’s lost a spouse.
  • Call, don’t post. Social networks are fun and can provide an essential social outlet for some people, but Hawkley says research suggests that, on average, people do best if more of their relationships happen face-to-face or over the phone. Use a pal’s post as an excuse to call and talk about it instead of posting a comment back.
  • Make time for relationships. Everyone is busy, but relationships won’t wait until you’ve finished your PhD, raised your kids, snagged the next big promotion, or moved to your ideal city. Build them now. “No one on their death bed wishes they’d worked a few more hours,” Hawkley says.
  • Talk to a trusted friend or relative. Get some feedback and ideas, as well as a sympathetic ear, from a family member or friend with whom you trust your thoughts and feelings. This person could have some ideas about groups you might want to join to meet positive people.
  • Meditate. “Mindfulness teaches us that we are more than who we think we are,” says Jeffrey Greeson, PhD, an assistant professor of psychiatry at Duke University Medical Center. Developing a meditation practice can help you identify and release some of the thoughts that could be keeping you feeling lonely and undermining your efforts to meet new people.
  • Explore therapy. If you just can’t shake profound feelings of loneliness, isolation, and other symptoms of depression, you might want to talk to a mental health professional as part of your depression treatment. Look for a professional with a cognitive behavioral background, an approach that’s been shown to help with depression and loneliness.

Dealing with Learning Disabilities in Relationships

Learning disabilities may present many challenges to the individual other than the obvious. They can have a great impact on relationships and personal interactions. The effects are experienced by persons with learning disabilities and their partners. The problems can manifest themselves in a variety of situations.

A person with learning disabilities may be frustrated about the way a partner provides assistance by feeling stifled when too much is routinely provided, which may give rise to the perception that he or she is stupid or being treated like a child. Also, he or she may feel unfairly blamed for relationship problems, such as not listening or not trying hard enough, which may be due to his/her learning disabilities.

The partner without learning disabilities may experience resentment at having to continually tend to the needs of the other, while many of his/her needs may seem to go unmet.

As everyone has good and bad days, so do individuals with learning disabilities, but theirs are often much more pronounced and frequent. Their capabilities can vary widely from day to day without any predictable patterns or identifiable causes.

Since learning disabilities often are not visible, both partners may have difficulty understanding and accepting the limitations they create. No matter who has the disability, the problems must be worked out together. It is important to distinguish between difficulties which can be overcome (using strategies and accommodations) and those which are not likely to change.

The following are some helpful tips that may be useful for partners who have learning disabilities:

  • Have a good understanding of the way in which the learning disabilities affect your ability to process information, communicate, etc.
  • Explain to your partner how the learning disabilities interfere with many aspects of everyday life.
  • Request accommodations in a direct manner without feeling guilty or giving excuses.
  • To maintain credibility with others, avoid “crying wolf.”
  • Accept that some tasks may take longer.
  • Be as self-reliant as possible by finding alternatives to overburdening your partner.

These tips may be useful for the partner of a person who has a learning disability:

  • Try to recognize, specifically, how the learning disability impacts your partner’s ability to: pay attention, comprehend, conceptualize, visualize, communicate, be organized, follow conversations, interpret body language, etc.
  • Be aware that what appears to be a simple and logical way to carry out a task for you may not be the most logical way for the person with learning disabilities. Persuading the partner to “just do it this way” is not necessarily helpful. Conversely, you should accept that what seems like a roundabout method may, in fact, be the easiest way for your partner to complete the task.
  • Remember that the learning disability thought process may manifest itself in a nonlinear fashion, which may seem confusing.
  • Refrain from demanding that your partner “try harder” to correct a disability. This would be like expecting a deaf person to hear by trying harder.
  • Be aware that “symptoms” of the learning disabilities may be more apparent at the end of the day or when your partner is fatigued.

Socially constructed gender roles may compound the effects of learning disabilities. For instance, men have traditionally been designated as breadwinners. This has not been realistic for some men with learning disabilities who have had difficulties with job stability and career advancement. A couple can reduce the stress they feel by creating more realistic expectations and redefining their roles according to each person’s abilities, rather than tradition.

Although couples may feel that learning disabilities are a unique problem, they are shared by a great number of people. Due to the close interaction of a relationship, the effects of learning disabilities are often greatly magnified, thus creating additional stress for the couple. It is only with hard work and a lot of understanding that these problems may be resolved.

Negative Body Image of Women

Body Image of Women

Negative body image of women is a very hot topic these days! The female body image and what a person should or could look like in marketing and advertising in particular is a controversial issue. It is noticeable that the body size of women as portrayed in mass media has been steadily getting smaller. Marketers will often do anything that they can to sell a product and make a profit, and almost anything can be sold if it appeals to our sense of beauty or is considered attractive.

There are certainly some very direct messages associated with body weight in the media; celebrities, fashion models and show hosts are often seen as role models, especially by teenagers. They appear to demonstrate what it is to be successful and popular. Their body weight, appearance and beauty are often associated with their popularity and wealth. This is particularly obvious in what is referred to as thin-ideal media, a concept which has been looked at with interest by researchers in the field of social psychology(2). The term “thin-ideal media” refers to media images, shows and films that contain very thin female leads. This is something that comes up a lot in fashion magazines, clothing catalogs and pop culture television shows. Thin-ideal media highlights the idea that thinness is a good and desirable thing to be, even if it is to a level that is potentially damaging to a persons health.

Beauty sells, and this is somewhat of a problem when the media produce unattainable images for women. Eating disorders are often, though not always and not directly, related to negative body image.

While a negative body image may incite a woman to diet in order to lose weight it is not actually negative body image that causes an eating disorder; the sufferer has to be biologically predisposed to developing one. If negative body image alone caused anorexia then every person on the planet would develop anorexia as I am sure we have all at some point felt self-conscious about the way that we look. The fact that not everyone has an eating disorder means that there is something more to it than body image issues alone; that something else is most probably genetic factors.

Regardless, negative body image of women and men is not pleasant and it seems unethical that marketing firms should constantly place an unrealistic ideal in the faces of young people.

Causes of Negative Body Image of Women

There are many factors that may contribute to a poor female body image. We live in a culture where thinness and beauty are highly valued for women and wealth and success are often considered to go hand in hand with a slim figure. Media images of ridiculously thin women are everywhere – television shows, movies, popular magazines. The media often glamorizes a very thin body for women. These are also the pictures that are being shown to teenagers in a time of their lives that they are particularly susceptible to peer pressure and looking good.

Due to this influence, poor body image can begin to develop at a very young age. Over fifty percent of 9 and 10 year-old girls feel better about themselves if they are on a diet, even though the Centers for Disease Control and Prevention reports that only 18 percent of adolescents are really overweight. About 80 percent of girls in this age group say that they have dieted in an attempt to lose weight. Likewise some boys as young as grades nine and ten are being found to use anabolic steroids in an attempt to gain more muscle mass. It is more commonly thought that negative body image affects only girls and women, but this is not the case. Men and boys can suffer negative body image too, but they are simply less likely to admit to being affected than girls are because it is less socially acceptable for men to admit to caring what they look like.

The Effects of Poor Body Image

The effects of a poor body image of women can be profound. The weight loss industry is very profitable and marketing firms know exactly how to sell products to people with the promise that their lives will be better if they lose weight or buy a certain brand of clothing. “Low Fat” and “Fat Free” are two of the most successful marketing terms that a food product can use in order to sell better. Clothing firms use size zero models in their advertisements that are often photoshopped to alien-like dimensions that would be unachievable and unhealthy in any human being

For someone genetically predisposed to an eating disorder, dieting caused by a negative body image could trigger one. However for the majority of the population, what happens is a preoccupation with diet, low self-esteem, low self-confidence and never feeling that one’s body is adequate.

In addition to leading to the development of eating disorders, a poor body image can contribute to depression, anxiety, problems in relationships, the development of substance abuse problem, and consequently various health problems.

Poor self-esteem often contributes to problems in relationships, the workplace, and any area in life that requires confidence. Ultimately a negative body image can lead to unhappiness and depression both of which are also symptoms of low self-confidence. The saddest thing of all is that all of these negative feelings might be being brought about just so some company somewhere can sell more products.

Addressing The Problem of Negative Body Image

Changing the way the media portrays women is a long-term goal for many advocacy groups. There are currently national and international efforts to make marketers take responsibility for displaying pictures of men and women that are unrealistic. The #truthinads campaign is an example of this and some clothing producers have reacted to public pressure by promising never to use photoshopped models in their catalogs.

On the individual level, there are some simple things you can do to improve self-esteem like focusing on your accomplishments and good qualities, repeating affirmations and working with self-esteem workbooks available in any bookstore. For those with serious anxiety, depression or eating disorders related to poor body image, however, psychotherapy or other mental health treatment is recommended. There is no reason that you should feel embarrassed about low self-esteem as we have all had it at some point. If it is affecting your ability to be happy you should certainly ask for help.

Major Mental Health Related Concerns in Persons With Down Syndrome

At least half of all children and adults with Down syndrome face a major mental health concern during their life span. Children and adults with multiple medical problems experience an even higher rate of mental health problems. The most common mental health concerns include: general anxiety, repetitive and obsessive-compulsive behaviors; oppositional, impulsive, and inattentive behaviors; sleep related difficulties; depression; autism spectrum conditions; and neuropsychological problems characterized by progressive loss of cognitive skills.

The pattern of mental health problems in Down syndrome vary depending on the age and developmental characteristics of the child or adult with Down syndrome as follows.

Young and early school age children with limitations in language and communication skills, cognition, and non-verbal problem solving abilities present with increased vulnerabilities in terms of:

  • Disruptive, impulsive, inattentive, hyperactive and oppositional behaviors (raising concerns of coexisting oppositional disorder and ADHD)
  • Anxious, stuck, ruminative, inflexible behaviors (raising concerns of co-existing generalized anxiety and obsessive-compulsive disorders)
  • Deficits in social relatedness, self-immersed, repetitive stereotypical behaviors (raising concerns of co-existing autism or pervasive developmental disorder)
  • Chronic sleep difficulties, daytime sleepiness, fatigue, and mood related problems (raising concerns of co-existing sleep disorders and sleep apnea)

Older school age children and adolescents, as well as young adults with Down syndrome with better language and communication and cognitive skills presenting with increased vulnerability to:

  • Depression, social withdrawal, diminished interests and coping skills
  • Generalized anxiety
  • Obsessive compulsive behaviors
  • Regression with decline in loss of cognitive and social skills
  • Chronic sleep difficulties, daytime sleepiness, fatigue, and mood related problems (raising concerns of co-existing sleep disorders and sleep apnea)

Older adults present with increased vulnerability to:

  • Generalized anxiety
  • Depression, social withdrawal, loss of interest, and diminished self-care
  • Regression with decline in cognitive and social skills
  • Dementia

All these changes in behavior often seem to occur as a reaction to (or triggered by) a psychosocial or environmental stressor, e.g., illness in, separation from, or loss, of a key attachment figure.

Who Should You Turn To for Help for Assessment and Treatment of Mental Health Concerns?

Many families live in areas without a mental health professional skilled in working with children and adults with Down syndrome. We therefore recommend the following approach for families.

Consider making a preliminary search in your area for potential providers with experience in working with children and adults with developmental disorders. This may include asking your primary care provider, inquiring at work with your employee benefits officer responsible for your medical coverage to give you a list of providers who indicated an interest in evaluating children and adults with developmental disorders. It always helps greatly if you already have a primary care physician who can make referral recommendations or who already has someone in mind who similarly can make an appropriate referral for you. If you have access to the Internet you visit the website for your medical coverage provider and search for professionals in your geographic region who indicated an expertise in developmental disorders. Finally, you may consider calling the local department or case coordinator in your district for additional services that may be available in your area.

It is always worth making an initial consultation visit to familiarize the child or adult with the professional and to see if this is a good match for your needs. Such an introductory visit is helpful as it enables the child or adult with Down syndrome also to feel comfortable with the place, provider, and it also enable you to get a timely appointment in a crisis situation in the future when a critical situation arises. It is often much more difficult to get an initial appointment and to be able to do so in an acute situation has become increasingly difficult, especially in well known centers.

Please remember that the ideal mental health provider skilled in Down syndrome is someone who has knowledge of developmental disorders and who also has had experience in working with children. It may be advisable to first seek a mental health provider who works in a pediatric medical center or who works in close proximity to a pediatric practice.

In geographic locations with limited proximity to such services it is always worth remembering that each state in the US has what is known as a University Center of Excellence in Developmental Disabilities (UCEDD) which is part of the Association of University Centers in Developmental Disabilities. Many of these programs have been in existence for over 30 years and are located in tertiary care centers with interdisciplinary services that include mental health professionals (child psychiatrists, psychologists, social workers), as well as developmental-behavioral pediatricians. The UCEDD programs can also provide advice regarding referral to adult service in the community and help locate mental health providers that have expertise in working with individuals with Down syndrome.

If it is very important to select a psychiatric provider with expertise in medication management with individuals with developmental disorders, it is critical that you find someone who has worked in close proximity to a medical practice, or agency serving the needs of individuals with developmental disorders.

If My Child Has a New “Behavior Problem,” Are There Some Medical Causes That We Should Rule Out First?

This is a common question that many medical as well as mental health providers are asked by concerned parents. There are a number of baseline tests that need to be completed to rule out medical conditions that are often associated with children/adults with Down syndrome presenting with a “behavioral problem.” Among these we recommend considering the following conditions:

  • Thyroid function tests can be completed by the primary care provider or by a developmental and behavioral pediatrician or even a psychiatrist as part of an initial assessment.
  • Sleep related difficulties need to be evaluated by a primary care provider, developmental-behavioral pediatrician or psychiatrist as part of an initial assessment with referral to a sleep disorders clinic or laboratory as needed to rule obstructive sleep apnea – see further discussion below.
  • Underlying contribution of constipation or bowel related difficulties need also to be ruled out by the primary care or developmental-behavioral pediatrician with interventions as may be necessary and referral to a nutritionist for counsel. There is a great opportunity to use healthy diet as a tool to reinforce positive behaviors.

As part of the comprehensive checklist of potential medical conditions it is important also to make sure that the child/adult with Down syndrome has been evaluated for hearing (audiology), vision (ophthalmology), anemia (hematology) and GERD (GI).

Finally, caveats or steps to consider in addressing any of the above potential medical concerns in the context of treatment of “behavioral problems” include the following:

  • Step 1: Emotional/behavioral problems in children and adults with Down syndrome occur commonly and are not always due to an underlying medical condition. Nevertheless, these medical conditions associated in children and adults with Down syndrome need to be ruled out as part of a comprehensive assessment approach.
  • Step 2: Medical conditions, even if they may not cause the emotional/behavioral issues, may nevertheless exacerbate them or make the child or adult with Down syndrome resistant to treatment of the emotional/behavioral problem.
  • Step 3: Correction of a medical condition, e.g. hypothyroidism, may not remove the underlying emotional/behavioral issues. The opposite is also true; for example, a child or adult with hypothyroidism plus depression is unlikely to respond to treatment of depression with antidepressant medication alone unless the hypothyroidism is corrected. Because emotional/behavioral and physical issues are intertwined, the two need to be treated concurrently.

What Are the Symptoms of Generalized Anxiety, Obsessive-Compulsive Disorder and Depression in Down Syndrome? How Are They Diagnosed and Treated?


These are the most prominent presentations among children and adults with Down syndrome. This manifests as an increased level of both baseline as well as situational anxiety with clear cut stressors for each. Situational anxiety is often manifest during transitions and anticipation of new situations, e.g., transitions from home to school, transit, meal or bed times, as well as during novel and unfamiliar situations with uncertain expectations in the environment.


Increased level of restlessness and worry may lead the child or adult to behave in a very rigid manner, even resulting in a state of being “stuck,” as is often reported by caregivers where the child or adult needs to follow familiar routines in these situations. They also engage in repetitive, compulsive, as well as ritualistic behaviors that raise the question of obsessive-compulsive disorder. The child or adult under these circumstances tends often to be unhappy, fearful, and the two states – generalized anxiety and obsessive -compulsive behaviors – may often co-exist. The disruptive, oppositional and inattentive child with Down syndrome often does not tend to be unhappy, but rather quite silly, happy, and excited. The problems are quite challenging for parents or caregivers to navigate, as the child/adult with Down syndrome with generalized anxiety or obsessive-compulsive profile has a tendency to be stuck, frozen, and require great degree of negative attention that, in turn, is reinforced, and continues in a vicious cycle.


Unlike in children with Down syndrome with impulsive, oppositional, and attention deficit profile, the restlessness, fidgeting, and compulsiveness associated with generalized anxiety state has an identifiable onset with a more intermittent course. There is a need to take a detailed history in all these situations in order to identify the source or environmental triggers contributing to the anxiety in relation to change in immediate home, school or work environment. In such circumstances assessment of antecedents, behaviors, and consequences (ABCs) and development of a behavioral modification and management plan is essential. The use of antidepressants or anti-anxiety medications may help and should be reserved for more persistent and serious level of symptoms.


Children and adults with symptoms of depression often present with extreme social withdrawal, sad (but not labile) affect, and inability to enjoy many activities they used to love. Parents or caregivers often report that the child/adult’s demeanor had not previously been like that. Disrupted sleep commonly co-occurs in both depression and anxiety states and do not necessarily help us to distinguish between them. A most remarkable aspect of depression in children and adults with Down syndrome is its association with environmental noxious triggers. These may include previously unrecognized medical illness or pain or psychosocial stressors, e.g., older sibling moving to college, sudden or chronic illness in a family member, death of a long household pet, absence of a teacher (leave, illness). All these ordinary events seem extraordinary for children and adults with Down syndrome with a disproportionate psychological impact, as compared to a typical person under similar circumstances. In summary, children/adults with Down syndrome remain exquisitely sensitive to changes in their environment which they often perceive unfavorably. We recommend that if any negative changes are to be anticipated that supportive counseling services and supports be put in place in anticipation of their impact. Attempt to treat persistent depression in the context of ongoing stress with pharmacological intervention is often futile without individual supports. Combination treatment involving both psychosocial and pharmacological components is needed. The argument for pharmacological intervention is strengthened if the children and adults with Down syndrome is deemed to already have a biological vulnerability (e.g., positive family history, previous episode of depression, concurrent medical illness).

What Are the Inattentive, Impulsive, Hyperactive and Disruptive Symptoms in Persons With Down Syndrome? How Are They Diagnosed and Treated?

Children and adults with Down syndrome often have significant processing difficulties and present with a very remarkable difficulty in sustaining attention on tasks. In children with greater cognitive and receptive-expressive language deficits, especially for younger age groups, the difficulties in attention are often accompanied with impulsive and hyperactive behaviors. This pattern of inattention, impulsivity and motor hyperactivity is consistent with a diagnosis of Attention Deficit Hyperactivity Disorder. For this reason, many children with such characteristic behaviors are treated with stimulant medications.

The response of children and adults with Down syndrome has not yielded encouraging results. In a sub-population of children and adults with Down syndrome there is a definite adverse behavioral activation in response to these medications. The most commonly observed adverse effects include: irritability, agitation, aggressive behaviors, transitional anxiety, and sleep related problems. Parents or caregivers need to be forewarned about these adverse effects since it can occur very soon after the initiation of treatment and can be very troubling for them to witness. A small group of children with ADHD symptoms may nevertheless benefit from stimulant medications, but even for them they may increase in anxiety, as well as obsessive compulsive symptoms. For this reason, the main emphasis in treatment of ADHD-like symptoms needs to focus on behavioral and therapeutic strategies to enhance adaptive functioning and performance in the home and classroom settings.

For children with high-degree impulsivity and disruptive behaviors the use of low dose of clonidine has been helpful, but this medication may also be limited in its efficacy as it may lead to daytime drowsiness in some children. It should be emphasized that the use if clonidine, per se, can be effective only in addressing impulsive, hyperactive and disruptive behavior, and does not necessarily improve primary attention. Clonidine administered at bed time may also help the child to settle down to sleep.

What Are the Behavioral Concerns Related Commonly Associated with Chronic Sleep Difficulties? How is This Assessed and Treated?

Children and adults with Down syndrome commonly experience a range of sleep-related difficulties either as primary sleep disorder or associated with mental health problems (e.g., generalized anxiety and mood disturbances). Irrespective of the etiology, sleep difficulties impair the ability of a child or adult with Down syndrome to maintain alertness and attention during the day, as well as maintain better control, e.g., frustration tolerance. Chronic sleep difficulties in children and adultswith Down syndrome need to be evaluated thoroughly by interdisciplinary team in order to rule out any contributory medical conditions.

Children and adults with Down syndrome, in particular, are at increased risk for development of obstructive sleep apnea with mild to moderate cessation of breathing during sleep that leads to reduction of oxygen saturation in the blood. Although the diagnosis of sleep apnea is suspected on the basis of history that often includes evidence for periods of daytime sleepiness, fatigue, it is necessary to conduct further tests to confirm this diagnosis by means of referral for a sleep study at a sleep disorder laboratory often available in major medical centers.

What Are Major Environmental Triggers of Behavioral and Emotional Difficulties?

Children and adults with Down syndrome are often exquisitely sensitive to psychosocial and environmental stressors. Illness or loss of close loved ones and family is particularly devastating and almost invariably leads to a complicated grief reaction during which time the child or adult with Down syndrome may experience regressive change in their ability to think, reason, remember, process information, and learn. The psychosocial and environmental triggers also lead to a state of generalized anxiety, obsessive compulsive symptoms, and depression and sleep difficulties. They may be associated with weight loss, poor self care, and inability to be motivated to attend school or go to work placements. If the situation persists and there is no concerted attempt to intervene with psychosocial counseling, treatment with appropriate medications, and behavioral interventions, the mental state may persist and be associated with longer term decline in psychosocial and cognitive functioning.

Is Oppositional Defiant Disorder Common in Children/Adults With Down Syndrome?

Many children and adults with Down syndrome have a wonderful disposition: they are fun loving and their interactions generally involve teasing, making jokes, giggly outbursts that often may also lead to intrusive, uninhibited social behaviors. Many respond to structure and behavioral interventions with clear-cut reinforcements and rewards. Sometimes these behaviors become out of control and take over the overall interactions. They become increasingly oppositional, unable to listen, and quite single-minded and self-immersed, e.g., sitting down or lying down and refusing to get up, or continuing in a self-directed activity with disregard of consequences at meal, bath and bed times, or during transitions. The oppositional behaviors occur in individuals with all levels of cognitive and language skills, but are more difficult to manage in those with greater receptive-expressive communication difficulties. In the classroom setting, behavioral management and one-on-one aide may help to keep the situation in better control and to enable learning. Oppositional behavioral problems in children with receptive-expressive and cognitive limitations also tend to be associated with increased level of impulsive and hyperactive behaviors and often co-occur with ADHD symptoms.

Are Mood and Bipolar Disorders Common in Children and Adults with Down Syndrome?

A comprehensive approach is needed in assessment of a child/adult with Down syndrome presenting with mood instability. It is essential to rule out any underlying medical and neurological conditions, and especially to consider the possibility of adverse effect of medications that may lead to secondary mood instability.

A young child with Down syndrome that presents with persistent oppositional, impulsive, disruptive, irritable, and aggressive behaviors should be considered under a possible mood disorder. In our clinical experience the coexistence of true bipolar disorder and Down syndrome is relatively unknown. The use of anticonvulsant medications (as mood stabilizers) need only be considered under careful supervision. Likewise, the use of atypical neuroleptic medications ought to be considered only as a last resort, again, with careful monitoring of their potential side effects. These latter medications tend to be limited in efficacy and should be used sparingly and in low doses. Since children and adults with Down syndrome are already at increased risk of weight gain over their lifespan, the increased appetite leading to weight gain associated with atypical neuroleptic medications, can be destabilizing. Concurrent behavioral and nutritional interventions are therefore always essential.

Are We Entering a New Age With Improved Assessment of Mental Health Concerns in Children and Adults With Down Syndrome?

The assessment of mental health concerns in children and adults has improved considerably in recent years. There is now wider range of available screening and diagnostic tools for assessment of mental conditions across different developmental age groups in terms of measurement of domains such as non-verbal problem-solving abilities, language and communication and adaptive and behavioral functioning. Much of our current knowledge is based on clinical experience and although emphasis varies depending on the orientation of each provider, e.g., behavioral modification, pharmacological intervention and social skills training, parents would be wise in seeking a holistic philosophy for integrated care (medical-mental health, behavior-pharmacology-social skills).

Despite the fact that many individuals with Down syndrome experience significant cognitive delays and other associated physical conditions, they have a very wide range of abilities, and each individual develops at his or her own pace. Even though they may be delayed in their progression, many achieve meaningful developmental milestones and lead enjoyable and highly enriching lives. There is a need to develop a better evidence base with expanded research in mental health aspects of Down syndrome. The increased awareness of the mental health issues bodes very well for the future.

How Your Autistic Child Can Benefit from Equine Therapy

For thousands of years the bond between man and animal has proven to be effective in creating an emotional, healing bond. Horses are used by physical, speech, and occupational therapists to reach their patients on a personal level through what is referred to as “hippotherapy.” Children with autism also benefit from equine therapy due to the motor, emotional, and sensory sensations that come with riding a horse.

Creating the Emotional Bond
Autistic children have difficulty bonding emotionally to others. As the parent of an autistic child, you know that it is hard for your child to make eye contact, communicate what he is feeling, and express himself to those he cares about. Rather than verbal communication, autistic children experience physical communication with the horses. They brush them, hug them, and pat them. By learning to care for the horse, they associate the care they provide with feelings and an emotional bridge is constructed. This bond can lead to social and communication skill production with other people in his life as well.

Cognitive and Language Skills Development
Autistic children often have difficulty comprehending normal directions. By engaging in equine therapy, your child follows directions through a fun activity that makes taking direction easier to grasp and remember. He will also give the horse direction, which provides him with more opportunities to communicate. Your child is naturally motivated to move; thus, he is excited and motivated to communicate. During his therapy his cognitive concepts will naturally improve. For example, equine therapists have children throw colored balls into baskets while riding, touch their eyes, mouth, and ears during a song, and identify scenes—all incorporated during riding.

Sensory Benefits
Balance and spatial orientation are experienced through the vestibular sense organs. These are located inside the inner ear and are stimulated through direction change, incline, and speed. Riding a horse helps liven these sensory preceptors, which helps make therapy exciting and motivates your child to continue to be engaged.



How Pets Can Nurture Children’s Relationships

The human-animal bond is indeed a special bond worth exploring. At any age, children can benefit from the mutual nurturing relationship between themselves and a pet. Whether it’s in the classroom or the family home, the responsibilities of caring for another living creature can foster healthy relationship habits for children.

A few more details on the many ways pets can help establish positive routines:

  • Therapeutic Presence
    The safety and comfort derived from a pet can lessen a child’s stress and anxiety while bolstering a sense of security. Pets are great therapy animals that can aid in the healing process after experiencing trauma or grief. They also can provide a safe outlet for sharing feelings.
  • Non-Judgmental Reading Practice
    Another way animals can help foster good practices is by being a nonjudgmental audience. There are many non-profits dedicated to providing service animals to classroom or extracurricular groups that bring animals in as reading companions. They bring a sense of security and lower the risk of embarrassment and shame many children feel when learning something new.  The classroom guinea pig, bearded dragon or bunny can fulfill the same role every day.
  • Teaching Responsibility
    For all children, pets are an excellent way to instill life skills like responsibility, compassion, and caring within a community. Since pets require daily care, they can be a great tool to teach kids how to participate together and to share duties like feeding, cleaning cages or tanks, or monitoring the animal’s health.
  • Physical Education
    Animals are a great way to get kids outside to play. Since pets need constant interaction, they can be an excellent catalyst to promote physical activities and in turn aid the development of the brain and body.

Other aspects of nurturing that stem from child/pet relationships include lessons about life like birth, illness, reproduction, and death as well as building a knowledgeable connection to nature and respect for the care that living things need.

The positive benefits of sharing life’s moments with a caring animal are priceless in terms of the memories made between a child and their pet.

Children’s reactions to parental separation and divorce

Separation and divorce are painful processes that disrupt the lives of Canadian families. A large body of research has mapped out the common reactions to divorce, and identified ways to ease this painful process. For the majority of children who experience the dissolution of their parents’ marriage, the effects are modest and relatively short-lived (1). Within two years of a separation, the majority of parents regain their equilibrium, establish polite but distant communication with their ex-partner, and their children, in turn, adapt to the new living arrangements. Nevertheless, most children report painful feelings about their parents’ divorce, and a significant minority of children suffer extended and prolonged symptomatology related to parental divorce that may include both internalizing and externalizing problems.


Parental conflict before, during and after a divorce has harmful effects on children. However, there is a clear consensus among researchers and clinicians that the child’s best interests are served by maintaining a relationship with both parents, except in cases of severe marital conflict and abuse . Unfortunately, many fathers who face a bitter relationship with their former partner simply drop out of their children’s lives. If that happens, children may suffer the double disadvantages of the psychological loss of a parent, and the loss of financial support. A key challenge that faces divorcing parents is, therefore, how to establish a new co-parental relationship with a former marital partner. Experts advise parents to set aside their own negative feelings, and develop a collaborative and cooperative business-type relationship with the person who they may consider to be the source of great personal distress. In recent years, there has been growing recognition of the benefits for children and parents of alternatives to the adversarial legal system in the resolution of disputes about shared parenting after divorce; alternatives include mediation and assessment services. Valuable information regarding mediation services is available from Family Mediation Canada.

Parents often seek the advice of health care professionals about the timing of their divorce, and wonder whether there is an age at which children are immune to the negative effects of parental separation. Children of all ages are sensitive to parental divorce; their reactions are expressed in ways consistent with their developmental stage. Moreover, children are sensitive to all parental conflict, including suppressed, polite hostility. Parents should be reassured by the research finding that children are also sensitive to the resolution of conflict. Even very young children are aware that a dispute has been resolved. Furthermore, if children have the opportunity to witness the resolution of problems, they also benefit by learning important problem-solving skills. Consequently, the parents’ dilemma is not the timing of the divorce, but how to resolve conflict with their partner whether they stay together or separate. Mental health professionals play an important role in helping parents develop a new co-parental relationship. Parents must learn to establish new boundaries between themselves and the person with whom they were intimate. They must develop effective communication and problem-solving skills.


Children who have experienced their parents’ divorce display a range of emotional and behavioral reactions in the months following the event. Following their parents’ separation, children may regress, display anxiety and depressive symptoms, appear more irritable, demanding and non compliant, and experience problems in social relationships and school performance. Parents often feel troubled by and unprepared for their children’s reactions to a separation and divorce. Children need to know that they are not responsible for the separation, that they are loved by both parents, and that their needs will be met. Children’s expression of distress differs from that of adults. For example, compared with adults, children may be more open to communication through books, workbooks, stories, play and drawings. Parents must achieve a balance between acknowledging and accepting the expression of negative feelings on the one hand, and providing clear, consistent rules and structure on the other.


After a separation, parents must decide about their children’s living arrangements and parental roles. Joint physical custody occurs when both parents share parenting decisions, and the child lives not more than 60% and not less than 40% of the time with each parent. Joint legal custody occurs when both parents retain rights to make parenting decisions; however, the child may live primarily with one parent. Sole legal custody occurs when one parent loses parental rights to make decisions, but still has parental obligations to support the child financially. Sole legal custody may be appropriate if one parent has shown a gross inability to parent or is abusive toward the other parent. Joint physical custody may present the best or worst of all worlds. It appears to be most successful when parents have a fundamental respect for one another, communicate in a clear fashion about their children’s needs, can afford to live in the same school district, and are able to provide the child with two sets of essentials so that the child is not burdened by carrying many possessions from home to home. Joint physical custody may be a nightmare of tense transitions for the child whose parents have a conflictual relationship.


During the divorce process, adults experience a roller coaster of emotions to which their children are extremely sensitive. It is crucial that parents avoid overburdening a child with their own unhappiness or irritability. Furthermore, during the transition period of separation and divorce, the parenting skills of adults are at a low ebb. Unfortunately, at a time when children especially need support, warmth and firm, consistent control, many parents are least equipped to provide it. Parents are encouraged to activate their adult support systems and, if necessary, to seek professional help in their new parenting roles. Seeing a parent coping well with the challenges of divorce may alleviate children’s sense of burden or responsibility, and provide an effective model for handling distress. Problem-solving interventions for parents are effective in helping them cope with divorce. Children’s groups show some positive effects, but when recovering from divorce, children take their lead from their parents – if the parents are functioning well, the child is more likely to do well. Thus, interventions focused uniquely on children may be of limited usefulness.


Although divorcing partners debate the fairness of how much time children spend with one parent compared with the other, the quality of the parent-child relationship is more important than any ratio of time spent with parents. The importance of the child’s relationship with both parents, and the value of being nurtured by both parents, cannot be overemphasized. Each parent brings unique qualities to the parent-child relationship, and the child’s life is enriched by involvement with parents with differing styles, backgrounds and values. The challenge for divorcing partners is to develop a new relationship that is focused on shared parenting. Children benefit from the same kind of parenting whether their parents live in one household or two (ie, they benefit from warmth and structure).

Several strategies can be helpful to parents who adopt a shared parenting role. Children benefit when there is regular communication between parents that facilitates the exchange of information regarding the child. For parents who find verbal interaction with one another difficult, this may take the form of a communication book or e-mail messages. Additionally, parents are encouraged to view their parenting plans with flexibility by recognizing that their arrangements will require adaptation and revision as their children grow older and circumstances change.


For the majority of families, separation and divorce provoke a time of crisis and destabilization. Yet, research demonstrates that after an initial period of distress, most adults and children are able to adapt effectively to new family structures and dynamics. Health care professionals are well placed to assist families in making the adjustment to a new set of demands and challenges. Parents are typically concerned about how divorce may affect their children; thus, it can be very reassuring for them to learn about the common reactions that children have to divorce, and to learn that strengthening their own support systems, developing a non adversarial co-parenting relationship and maintaining a quality parent-child relationship will help their child adapt.

The Benefits of Therapy Animals

We can all attest to the mood lifting and stress relieving benefits of having a pet around. We can’t help to smile when our dog cuddles up to us or our cats crawl into our lap. There are proven physical and mental health benefits to owning a pet and being around animals. Therapy animals are a way for people in lonely, stressful, or traumatic situations that might not be able to own pets to share in the health benefits. Therapy animals, often dogs, are used in retirement and nursing homes, schools, hospices, disaster areas, for veterans, and people with disorders or disabilities. Some people even have therapy pets, specifically for the health benefits that animal companionship provides.

Therapy pets are different from service animals. According to the Americans with Disabilities Act, in the United States, “A service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability.” This includes tasks like pulling a wheelchair or reminding a person to take medication. For more information about service dogs and how they differ from emotional support animals, comfort animals, and therapy dogs, check out the ADA’s guide to Service Animals and Emotional Support Animals.

The Physical Benefits of Therapy Dogs and Cats

  • lowers blood pressure.
  • improves cardiovascular health.
  • releases calming endorphins (oxytocin).
  • lowers overall physical pain.
  • the act of petting produces an automatic relaxation response, which is believed to reduce the amount of medication needed by some people.

mental health benefits therapy animalsThe Mental Health Benefits of Emotional Support Animals and Comfort Pets

  • lifts spirits and lessens depression.
  • lowers feelings of isolation and alienation.
  • encourages communication.
  • provides comfort.
  • increases socialization.
  • lessens boredom.
  • reduces anxiety.
  • aids children in overcome speech and emotional disorders.
  • creates motivation for the client to recover faster.
  • reduces loneliness.

Uses of Therapy Animals

Pet Therapy

Pet therapy or animal-assisted therapy is becoming a common way for health professionals to improve patient’s social, emotional, and mental functioning with the support of animals. These therapy animals range from cats and dogs to horses and dolphins.


Many colleges and universities bring therapy dogs to campus, often around mid-terms or finals, to help students relax and destress. Students say that interacting with these animals can be very mood lifting, especially if they have family pets they don’t often get to see.

In Hospitals

Many hospitals have formal or information programs to bring animals in for patients. Cedars-Sinai has a program called POOCH, where volunteer dogs visit patients that have requested a visit.

After a Disaster

Some organizations work both locally and nationally to send therapy animals to tragically affected areas. These therapeutic animals help people recover from physical ailments and emotional trauma.

Want Your Pet to Become a Therapy Animal?

Your pet can become certified through organizations like Pet Partners or Therapy Dogs International. While Pet Partners’ team of therapy animals is 94% dogs, they register eight other species too (including cats, guinea pigs, llamas, pigs, and rats).

While it might sound like a fun and fulfilling activity for you and your pet, there are many qualifications that have to be met. Being well-behaved and well-trained is a must for your pet, and they must enjoy and voluntarily approach strangers.

Animal behaviorist Patricia McConnell notes that although “a therapy [animal] must be able to tolerate all manner of rudeness, it’s your job to eliminate as much stress as you possibly can … as the human half of the team, you play several roles, and one of them is to be your [pet’s] advocate.” You must be able to read your pet’s body language at all times to access their mood and intervene as you can.

Therapy work can be stressful for many animals, but if you believe that your pet has the right temperament and would enjoy the work, look for a local or online class about volunteering for animal therapy.

What’s ADHD (and What’s Not) in the Classroom

Many children with ADHD show signs of the disorder before they reach school age. But it’s in school, when they are having trouble meeting expectations for kids in their grade, that most are referred for diagnosis.

ADHD is one of the first things that’s suspected when a child’s behavior in class, or performance on schoolwork, is problematic. A child who can’t seem to sit still, who blurts out answers in class without raising his hand, who doesn’t finish his homework, who seems to be daydreaming when the teacher gives instructions—these are well-known symptoms of ADHD.

But these are also behaviors that can be a result of other factors, from anxiety to trauma to just being younger than most of the kids in the class, and hence a little less mature.

That’s why it’s important for teachers and parents both to be aware of what ADHD looks like in the classroom, and how it might be confused with other things that could be influencing a child’s behavior. Observing kids carefully is especially important when kids are too young to be able to articulate what they are feeling. And referring struggling kids for diagnosis and appropriate support can help them succeed in school and other parts of their lives, too.

ADHD symptoms

There are three kinds of behavior involved in ADHD: inattention, hyperactivity and impulsivity. Of course all young children occasionally have trouble paying attention to teachers and parents, staying in their seats, and waiting their turn. Kids should only be diagnosed with ADHD if their behavior is much more extreme in these areas than other kids their age.

These symptoms of ADHD are divided into two groups—inattentive and hyperactive-impulsive. Some children exhibit mostly inattentive behaviors and others predominantly hyperactive-impulsive. But the majority of those with ADHD have a combination of both, which may make it very difficult for them to function in school.

Here are behaviors you might observe in school in those two categories.

Inattentive symptoms of ADHD:

  • Makes careless mistakes in school work, overlooks details 
  • Is easily distracted or sidetracked
  • Has difficulty following instructions
  • Doesn’t seem to be listening when spoken to directly
  • Has trouble organizing tasks and possessions
  • Often fails to finish work in school or chores in the classroom
  • Often avoids or resists tasks that require sustained mental effort, including doing homework
  • Often loses homework assignments, books, jackets, backpacks, sports equipment

Hyperactive or impulsive symptoms of ADHD:

  • Often fidgets or squirms
  • Has trouble staying in his seat
  • Runs and climbs where it’s inappropriate
  • Has trouble playing quietly
  • Is extremely impatient, can’t wait for his turn
  • Always seems to be “on the go” or “driven by a motor”
  • Talks excessively
  • Blurts out answers before a question is completed
  • Interrupts or intrudes on others conversations, activities, possessions

Serious impairment

It’s important to keep in mind that not every high-energy or impulsive child has ADHD. Children are diagnosed with ADHD only if they demonstrate these symptoms so often that they are causing real difficulty in at least two settings—i.e. at school and at home. And the pattern that’s causing them serious impairment must persist for at least 6 months.

Age matters

It’s also important, when considering a child’s behavior, to compare it to other children the same age—not to the range of kids in his class or grade. Within any given grade, kids’ ages can differ by almost a year, and a year can make a big difference in a child’s ability to self-regulate.

Two studies in the last few years concluded that kids who are youngest in their class are disproportionately diagnosed with ADHD. A Michigan study found that kindergarteners who are the youngest in their grade are 60% more likely to be diagnosed with ADHD than the oldest in their grade.  And it doesn’t affect just kindergarteners: a North Carolina study found that in fifth and eighth grade, the youngest children were almost twice as likely as the oldest to be prescribed medication for ADHD.

Other causes

When children exhibit behaviors that we associate with ADHD, it’s important to keep in mind that they could be caused by other underlying factors. A child who is inattentive could be distracted by chronic anxiety, by a worrisome or painful situation at home, or because she’s being bullied in the playground. These are all things a child might be embarrassed by and go to some lengths to keep secret.

Another thing children often hide is undiagnosed learning disorders. If a child is fidgeting when she’s supposed to be reading, it may be that dyslexia is causing her great frustration. And if she bolts from her chair, it could be because she is ashamed that she doesn’t seem to be able to do what the other kids can do, and intent on covering that fact up.

Girls are different

The stereotype of ADHD is boys disrupting the classroom by jumping up from their seats, getting in other kids’ business, or blurting out answers without raising their hands. But girls get ADHD too, and they tend to be diagnosed much later because their symptoms are more subtle. More of them have the only inattentive symptoms of ADHD, and they get written off as dreamy or ditzy. If they have the hyperactive-impulsive symptoms they are more likely to be seen as pushy, hyper-talkative, or overemotional. Impulsive girls may have trouble being socially appropriate and struggle to make and keep friends.

But a big reason that many girls aren’t diagnosed is that they knock themselves out to compensate for their weaknesses and hide their embarrassment about falling behind, losing things, feeling clueless. The growing awareness, as they get older, that they have to work much harder than their peers without ADHD to accomplish the same thing is very damaging to their self-esteem. Girls who are chronically hard on themselves about their lapses may be struggling with thoughts that they’re stupid or broken.

Red flags

Keeping a keen eye on kids’ behavior in the classroom is important not just because it affects their learning—and potentially the ability of other kids in the class to learn—but also because it’s a window into their social and emotional development. When kids are failing or struggling in school for an extended period of time, or acting out in frustration, without getting help, it can lead to a pattern of dysfunctional behavior that gets harder and harder to break.

That’s why it’s important for parents to get a good diagnosis from a mental health professional who takes the time to carefully consider the pattern of a child’s behavior and what it might (and might not) indicate. Being not only caring but precise about defining and treating a child’s problems when he is young pays off many times over in the long run.