Category Archives: adolescents and young adults

Cultural competency with Muslim patients

As Ramadan begins, Embolden is working with several DC area schools and school systems, as well as offices/businesses, to create understanding and comfort for Muslim students and professionals who are fasting or participating in other spiritual activities. Muslim individuals differ in every possible way. The Muslim community has a rich variability that is a complex and nuanced mix of religion, cultural identity, family traditions, and individual personality.

Muslim individuals differ in socioeconomic background, family structure, level of religiosity, cultural identity, knowledge of spiritual practice, gender identity, community, career paths, and personality. There is no single coping style or mental health profile that Muslims share as a group. In order to serve Muslim clients and mental health needs best, an open stance of curiosity, inquiry, and humility is required by medical and mental health professionals.

On a pragmatic level, some schools are adapting to Ramadan, a time when students fast and cannot drink water from sunrise to sunset and often cannot participate in sports, by creating alternative activities during lunchtime, psychoeducational presentations for students and faculty and awareness for both the vulnerabilities and strengths that all students bring with them to school communities.

Also see Nine Reasons Why Cross-cultural Friendships Are Good For Your Health.

The Neuropsychological Costs Of Poverty

Poverty is Trauma
Kids growing up in poverty are constantly releasing the stress hormone cortisol, which can give them short attention spans, restlessness, and short tempers. Physically, they feel the same kind of heart-pounding stress an adult feels after a car wreck. And they feel it all the time.

If you think about the impact on education, imagine if right after you were in a car crash or had a huge health scare, I walked up to you and said, ‘I need you to take a test.’ Or, ‘you just need to sit down and focus.’  Could you do it? Would you perform well? It’s doubtful.

And for kids, with their frontal lobe and brain functioning still developing well into their 20s, lingering effects of poverty are even more significant.

Experiencing prolonged adversity takes its toll. Research indicates that even more striking than lack of adequate nutrition and limited access to consistent healthcare, chronic stress, across the longterm, makes children and adolescents susceptible to cardiovascular disease, high blood pressure, depression, and diabetes.

The impact upon the brain, development and functioning, for children with chronic financial adversity is commensurate with those suffering from other forms of post-traumatic stress disorder: the hippocampus part of their brains is atrophied; the amygdala, which regulates the processing of acute emotional responses, is overwhelmed. Chronic financial stress experienced by children can be devastating for learning/education, since the hippocampus and amygdala, in tandem, regulate emotional responses and are also critical in the formation of memory, consolidated knowledge, and spatial awareness.

Poverty Affects One In Six American Children
Poverty during childhood development has immediate effects on cognitive ability and neurological activity. Children from low-SES backgrounds show decreased levels of cognitive function and brain activity across numerous domains. The most severe effects are found in language/communication and regulation of executive function (attention, organizing, self-monitoring, prioritizing, planning).

Snapshots of family poverty in data from 2018 showed a troubling picture for America’s youth, with 13 million children food insecure and one in six children living in poverty (research stats were collected before the Covid-19 pandemic). Living in a financially unstable environment can threaten a child’s sense of safety because it may mean they cannot access basic needs, like food, shelter, and healthy relationships, on a consistent basis.

Children who live in poverty move more frequently, have families more likely to deal with eviction/housing instability/credit problems, have reduced ability to attend school on a regular basis or access curriculum virtually, and may have parents who work several jobs making them less accessible for quality child and parent time.

Long-standing financial hardship IS trauma. It changes the brain, affects everyday functioning, restricts life experience, and ultimately, personal outcomes.

Stats Sources:

    • Childrensnational.org (Disclosure: Dr. Siddique previously worked at the adolescent medicine department at Children’s Hospital, Washington DC)
    • American Academy of Pediatrics (Www. AAP.org)

Also see the mental health blog at Embolden on racial trauma and the brain:

Racial Trauma and Mental Health

What to Say to Teens

“They just don’t talk to me”.

That’s a familiar refrain. Parents often ask me for advice on how to help their kids speak to them more openly. These are some of my suggestions that I regularly use.

I am happy to listen when you feel like talking.
I believe you.
What I admire about you is…
What is the best way I can support you right now?
You have the right to be upset.
I would also feel scared if that happened to me.
I agree.
I’m sorry you’re going through this.
Thank you for trusting me.
I am proud of you.
I know it’s hard to talk about.
That’s a hard decision to make.
Making mistakes does not define who you are.

The Half Dozen, or How to Return to School

1. Be proactive about mental health
No news is good news is absolutely incorrect in this case. How can you recognize when your child is having a tough time? Look for signs and symptoms that something is wrong: these include isolation, irritability, low mood, poor frustration tolerance, difficulty sleeping, lack of motivation, lack of enjoyment of normal activities, crying, or concerns about safety. I’d recommend having a very low threshold for getting professional help.

2. Consider the effects of layers of change
In general, in any circumstances, going back to school is a big change. But it’s a whole new setting especially for kids who are going from elementary school to middle school or middle school to high school. All of a sudden, they’re expected to know what they’re doing. It’s a huge shift from being in their space at home to now being in this world of back to school. Or a new school. If your child is having a hard time with the transition, think about how they normally act when they’re stressed and look for those behaviors. For example, if your child gets headaches or stomach aches when they’re anxious, you’ll know that school is stressing them out should they start having them more frequently. Of course, big markers are mood changes, anxiety on Sunday nights before the school week starts, and outright school refusal.

3. Establish routines before and after school
Kids need stability during times of change. Be present, predictable and consistent. Family might be the only part of their lives that feels that way right now. Be there for them and follow their lead as much as you can. Maintaining appropriate times for bed, dinner, prepping for the week, recreational time, and chores is more important than ever. Doing as much as possible beforehand is also comforting to kids. Pack your lunch or snacks, put out clothes you want to wear, prep your backpack, go over the schedule for the next day, all the night before.

4. Be peaceful energy
If your child’s reactions seem different, perhaps snippier than usual or even overreacting to seemingly small stressors, the best thing you can do is meet the reactions with compassion, warmth, and calm, instead of reacting yourself. An overreaction can take the form of minimizing in order to be presumably reassuring, being overly solicitous of fears or worries, or just being impatient. Now is NOT the time, as I always tell families, to get into conflicts, or try to confront bigger issues in the household. Times of transition require calmness. As school starts, building up the daily routine and foundation of daily household functioning creates scaffolding.

5. Make things fun
I have kids pick masks that they enjoy, personalize their backpack or notebook with buttons and stickers, select snacks that they love to take to school, make a playlist of favorite YouTube snippets or music that cheers them up and give it a special name (mine is Monday, Monday), and bring something personal with them to school, a small stress toy, journal, or stuffed animal. In my office, I have an assortment of squeezy toys, animals and dinosaurs, and action figures. Sometimes clients like to pick and take a toy with them. It connects them to a sense of safety, known as a transitional object.

6. Reassure them that they are not alone
Many kids have not seen their friends or teachers in over a year. Kids have questions. They want to know how they are going to get from class to class on time. Are they going to miss their bus? How will they get around the school building without getting lost? What will they do if they start having anxiety during class? Where will they sit at lunch? What if they don’t know anybody in their class? Being able to discuss all of these questions without minimizing worries or concerns is needed. Making school advisors, counselors, and administrators aware of any medical or mental health concerns beforehand is also recommended.

The Neuropsychology of Chores

Neuropsychological research shows that those children who have a set of chores have higher self-esteem, are more responsible, and are better able to deal with frustration and delay gratification, all of which contribute to greater success in relationships, school, and future endeavors. These are all aspects of executive functioning, which include planning, organizing, sequencing, sustaining effort, and self monitoring, all mediated by the frontal lobe of the brain. One study by Dr. Martin Rossman showed that the best predictor of young adults’ career success in their mid-20’s was participating in household tasks when they were children. Also see the What Is Executive Functioning

In my practice, parents often express concern that their kids are so busy with school work, sports, and social life, that they have little or no time to contribute to household tasks. I believe that household tasks and chores are absolutely essential, contribute to brain development, and help with prioritizing, scheduling, and multitasking. I specifically assign household tasks that are developmentally appropriate as part of a treatment plan for each family.

The gains:
Life Skills
I often ask kids, are you important in your family? Kids begin to see themselves as important contributors to the family. They feel a connection to the family. Holding them accountable for their chores can increase a sense of themselves as responsible and capable. Not being taught the skills of everyday living can limit children’s ability to function at age appropriate levels. By expecting children to complete self-care tasks and to help with household chores, parents equip children with the skills to function independently in the outside world.

Self-Esteem
If you let children off the hook for chores because they have too much schoolwork or need to practice a sport, then you are saying, intentionally or not, that their academic or athletic skills are more important than life skills. I work with young adults who go off to college and don’t know how to do their laundry or who live with roommates and leave piles of dishes in the sink, causing friction. Chores are an important part of relationships, with family, colleagues, and friends. One goal I emphasize is for kids to plan and help make a meal for the family each week. By accomplishing goals that are not related to school or athletic prowess, there can be huge gains in self-efficacy and self-esteem.

Role Modeling
You can model a message that there are tasks that need to be completed in order for the entire household to run smoothly, and that everyone in the family is encouraged and expected to participate. Or, alternatively by being allowed to avoid tasks, children may receive the message that chores are boring, mundane, can be put aside, and are to be done by others.

Encouraging Participation
Young children naturally want to be a part of the family and want to help. Ideally, you will encourage their participation (even if it takes more work on your part in the short run). The size of the task does not matter; the responsibility associated with it does. Praise hard.

Withholding Judgment
When tasks are assigned, and completed on a consistent basis, they are creating new neural pathways. Being overly critical or judgmental is not the objective, making chores part of a daily routine is.

Assigning Chores
For those parents who did not begin a chore regimen when their kids were little, you can still start a plan now. You can take some time to think about what tasks you need help with in the home, what life skills your children need to learn, and what are each child’s interests and abilities.

Family Meetings
As you contemplate these decisions, you can ask your children for their feedback and input. This shows teamwork and connection. Also, brainstorm ideas for overcoming any obstacles faced in the past, such as children not following through, arguing, or not doing a thorough job. Many parents hold a family meeting to discuss chores and when and how they will be starting, revising, or re-instating them. Such times together can build morale, improve relationships, and facilitate creative problem solving.

Giving an Allowance
One question that parents frequently ask is whether allowance should be tied to the completion of chores. This is a personal call for families. Many parents want their children to help around the house as a contributing member of the family, not because there is money or other external rewards associated with it. The option I most often discuss is that chores and allowance can be separate. I also encourage providing an allowance or reward for a task that is above and beyond everyday routines, such as cleaning the garage, painting a shed, or other major house projects.

Earning Privileges
One alternative to paying an allowance may be to have children earn privileges for completing their chores. For example, a teen may earn the right to use the car on the weekends by washing the automobile. A school-age child may earn the privilege to have friends over to play if he throws away the trash and puts away the games after a previous gathering with friends. Often parents expect kids to finish their schoolwork, before they get on their favorite video game. All of these actions demonstrate earning privileges, and when done consistently, show that chores and fun are both important.

Teens and Their Dogs

Pets and teenagers, a natural connection. Having a companion animal has been shown to have significant mental health benefits for teenagers, especially girls, who often identify their dog or cat as their primary confidante.

Some of the research:

– Pets reduce loneliness
A 2018 study, published in the PNAS Journal, showed that pets reduced adolescent loneliness and social isolation, and helped kids feel they had a friend, especially if they lived in a city.  In the study, teens told dogs their secrets, talked to them, and cuddled with them.

-Pets provide emotional intimacy
A pet helps tweens and teens build empathy, particularly if the pet is hungry, sick, scared of thunderstorms or fireworks, or injured. Having a cat or dog to come home to, cuddle with, cry on, and play with provides teens with unconditional love and a safe space for emotional intimacy, particularly during the chaotic tween and teen years. In fact, one 2018 study in the Journal of Applied Development Psychology reported that children often feel closer to pets than their own siblings.

-Pets increase health and wellness
A 2017 study in the Journal of Pediatric Nursing reported that just a 10 minute visit with a pet reduced the stress hormone cortisol in teenagers. Imagine then, how having a pet around all the time affects longterm health.
The study showed that when you are in the presence of a pet you feel bonded and attached to, blood pressure decreases and respiration becomes more steady.

-Pets provide the benefits of physical touch
In 2012, the journal Frontiers of Psychology linked petting animals to the release of oxytocin in humans. This release reduces stress and increases feelings of well-being for pet owners.  Petting animals also reduces cortisol levels, the stress hormone.

-For long term social and emotional benefits
A 2019 study in the Journal of Applied Developmental Psychology observed that girls had a stronger response to having a pet, and may need the pet even more than boys during their turbulent teen years.

Why grandmothers rock

I currently see patient families, where multiple groups of generations live within a block of each other, or in the same home. Cousins, aunts and uncles, grandparents, and children.

I want to speak about grandmothers, because many of my young patients have been influenced and raised by their grandmother. Overall,  neuropsychological research indicates that grandmothering helped us to develop a whole array of social capacities that then became the foundation for the evolution of other distinctly important traits, including bonding, bigger brains, learning new skills,  respecting ancestry, cultural growth, and social skills. In ancient cultures and indigenous societies, grandmothers were part of the inherent learning and loving. Grandmothering is incredibly important.

10 Difficulties With Fall Distance Learning

Currently, approximately 4% of colleges are fully re-opening their doors to in person instruction for the fall semester. For younger students, public school has been variable, and often a hybrid model. While physical safety is paramount, it’s also important to acknowledge that there is an emotional toll for many students. In my practice, what I have most noticed is that assignments are piling up and not being turned in. According to a study conducted during the summer of 2020, over 75% of college students reported feeling more anxiety, stress, or even depression, due to online learning. A similar number of students have noted that they find it difficult to access their instructors between class sessions.

Additional concerns related to online learning:

Time management.
Students have to clock in by a certain time to be counted as present or otherwise tardy. Being at home makes it tempting to stay up late, and sleep deprivation and staying in bed are the norm for many young people during the current time.

Work management.
Many students have difficulty tracking assignments, due dates, and deadlines, online.

Zoom fatigue
The majority of students are muted and have video turned off. Several of my clients play video games and even sleep while attempting to be in class.

Distractibility
Pets, siblings, even parents, working from home, can be very distracting.

Lack of social interaction
In class, having your peers present with you makes it an experience that is much more supportive and positive.

Covid factors
While experiencing stress, anxiety related to health, or difficulty with social distancing, the majority of students have reported that these factors are not taken into consideration by their instructors or educational institutions. For example, a young woman reported that deadlines have to be met, no matter what the extraneous circumstances.

Lack of workspace or Internet availability
A number of students have been unable to get online except for on a cell phone. All of their classroom instruction was done from a cell phone, which is quite challenging. Often, their parents did not know how to access the information that was needed to successfully conduct a school day. Recently, through my practice, I was able to gather a group of volunteers, who helped families set up online learning. For other students, there is lack of space in the home to have a quiet classroom atmosphere. I discourage working from bedrooms because of the distractibility factor, but often there are no other spaces that are available.

Inability to access extracurricular activities
For many students, some of the most enjoyable and positive aspects of school include being in clubs, sports, and after school activities. Many of these have been diminished, which makes it even less palatable to be in school online.

Parental stress
The majority of students do not see their parents at work or experience the work stressors that their parents may go through. With many parents working from home, there is much more exposure to work related stress. One young client reported that her parents are in the home and yet they are never fully present. Conversely, for parents, having to monitor school related activities, while attending to their work responsibilities is very challenging.

Pacing
I strongly encourage my clients to take frequent breaks to stretch, move around the room, and eat snacks. The average attention span is 45 minutes or less, and lengthy online classes are often taxing and exhausting.

Distance learning tips for students

A few distance learning tips for students:

Identify a study space
Identifying a consistent study space in your home. A study space does not always need to be a separate room. Oftentimes, a simple table and chair works quite well. Keep in mind, however, that being in your room can make it tempting to engage in other activities. Completing your classroom work and homework in the same place each time creates a focused thinking habit that allows you to more quickly settle into the work that needs to be done. It also signals to other people in your home that you are in work mode.

Keep to your class schedule, even when you are home
If you were attending an in person study group or regularly met with a teacher in a classroom, continue to do your work at those same times. You have already established a routine and one of the best things you can with distance learning is to keep that routine. It is important to keep that time free from other personal obligations. Some students just login for the day, and then wander in and out, leading to undesired outcomes.

Use a day planner or calendar
Record ALL: Assignments, tests, quizzes, and projects.
If you have not started using a planner/calendar, now is a very important time to do so. When you’re at home,it’s easy to think you have more time than you actually do.  Phone reminders are not enough. With distance learning, time may appear to “fly by” as the semester goes forward. Use a calendar to create weekly lists of assignment due dates and tasks you may need to do to complete those assignments.

Get a tutor or academic coach
For more specific help with breaking up assignments and exam prep into manageable steps, speak to a therapist or executive functioning coach.

Communicate with your family
Changes in school, sports, parents working from home, and shifting event schedules may create a new level of activity in your home. It is completely natural to be a bit uncertain as these changes are underway. One important step is to talk with your family regarding the specific impact on you. What is hard for you, and what are some things that can happen to make things easier to do your work from home? Explain that you need a quiet, uninterrupted space for some time each week to continue to meet your school goals. This should include no interruptions from family animals or younger siblings.

Ask for help
Moving from one style of learning to another does require an adjustment in your study approach. Your teachers are aware of this and will work with you. Make it a habit to touch base by email with all your teachers on a weekly :basis. That way it doesn’t feel strange to do it after school has already been in session for several weeks.

Prepare for the day
Have your materials ready at your workspace. If you were heading to school or the bus stop, you would pack your backpack and make sure you have what you need. Including any written work, notebooks, pens and pencils, calculator, textbooks, etc. I recommend the use of a large notepad so that you can jot down questions as classes proceed. Many people are afraid to use the group chat and don’t want to draw attention. In that case, write down questions as they occur, so that you can email the teacher later to make sure you understood the concept or the assignment.

Keep up your energy level by self-care
It’s been shown that distance-learning is exhausting. Video is usually off, voices are muted, and classes are long. People have trouble focusing. Keeping this in mind, it’s important to know that the best way to refresh your brain is to get up and move around or stretch. Set a kitchen timer or alarm clock to go off every 25 to 30 minutes to remind you to get up and move your body. Also have healthy snacks to keep up your energy at the ready. Do not skip meals, because this creates a brain drain.

Keep up with friends
Many students miss the social aspects of seeing their friends in the cafeteria, in the hallway, or in the classroom. Virtual classrooms do not allow for much interaction. Keep up with a group chat or other friend-based activities so that you feel connected. The social aspects of school are extremely important, in addition to the academic focus.

Set Up family reading or quiet hours
With some teens/children also moving to distance learning, there is an opportunity to create a family study space. For example, consider creating a “family reading hour” where all devices are put away, turned off or silenced. Identify a goal for everyone including yourself. When you are finished, have everyone, including you, share a little bit about what they read or learned in class that day. “Teaching” others helps with memory and understanding of reading material. When the hour is complete, do a shared fun activity (play a game, watch a family favorite TV show, etc.) to reward everyone for meeting their reading goal.

Connect with your school counselor
It’s OK to reach out when you’re having anxiety about distance learning, a specific class, how to turn in assignments, or any other school related issue. Guidance counselors always tell me that they enjoy hearing from students, but with distance-learning, students very rarely reach out.

Work together on a family schedule
I have included one in this post that I personally use with families to break down the day, to make sure there is time proportionally allocated for all activities, and not just academic time.  This can be easily adjusted for each family’s specific needs.

Communication and mental flexibility
Basically, everything in this blog requires fine-tuning as circumstances change. More than ever, our times call for flexing. Having family conversations on all of these topics is the key to success.

The Power of Empathy

In 1909, the psychologist Edward Titchener translated the German Einfühlung (‘feeling into’) into English as ‘empathy’. Empathy can be defined as a person’s ability to recognize and share the emotions of another person, fictional character, or sentient being. It involves, first, seeing someone else’s situation from their perspective, and, second, sharing their emotions, including their distress.

According to writer and therapist, Dr. Brené Brown, empathy builds connection and communicates to another that “you are not alone.” Sometimes when someone shares something difficult or painful, it can be incredibly difficult. Feeling that one is alone makes it worse.

In Danish schools an hour a week is dedicated to the “Klassens tid”, an empathy lesson for students aged 6 to 16 years. It is a fundamental part of the Danish curriculum. The hour of empathy is as important as the time spent, for example, on English or mathematics. During the Klassens tid students discuss their problems, either related to school or not, and the whole class, together with the teacher, tries to find a solution based on real listening and understanding. If there are no problems to discuss, children are simply spent the time together relaxing and enjoying hygge, a word (and also a verb and an adjective), which cannot be translated literally, since it is a phenomenon closely related to Danish culture. Hygge could be defined as “intentionally created intimacy”.

How is empathy different from sympathy?
Sympathy is primarily about observation and an acceptance that someone else is going through challenging experiences. It can amount to “feeling sorry” for someone, which is an acknowledgment of a situation. It’s not a concept that requires someone to experience the emotion that another person is going through deeply. With this, there’s a natural detachment from the situation.

Four attributes of empathy:
1. Perspective taking. This means trying to see the world through someone else’s eyes. Oftentimes, to engage in perspective taking, we need to ask questions. “Can you tell me what is going on for you right now?” “What feelings are you experiencing?” Perspective taking can also involve you thinking back to past experiences and remembering what you felt like when you were there. If you have never experienced the same situation this person is describing, you can ask yourself “What might this feel like?”
2. Staying out of judgment. This is when you describe things as neither good nor bad. It also includes not shaming others for having the experience they are having. When someone shares something difficult with us, judgmental questions and comments might arise. Some examples would be, “What was your role in making this happen?” or “I don’t know why you are feeling this way about this.” Trying to fix the situation Instead of listening can also be disconnecting.
3. Recognizing emotion. When practicing empathy, it is important to look to others to learn from and recognize their emotional experience. What are they feeling? What kind of body language are they using that might clue you into what they are experiencing? Do they appear to be overwhelmed at this time or open to talking? Have you seen this person in a similar state before and can that inform how you might approach them now?
4. Communicate emotion. Once we recognize emotion in another person, it can be helpful to let them know that we are seeing them as well as their experience. Saying things like “I see that you are angry” or “It makes sense that you feel this way” are good examples. Communicating that message in the right way makes all the difference. Telling someone “I know what it’s like to feel sad” (or whatever emotion they’re feeling) shows them you understand their emotions. When this happens, the person dealing with the difficult emotions then feels they’re not alone. It’s also important to let the other person speak and not let it become about you in the moment.

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.