Raising a child with special needs is a complex process, and there are no "easy-to-follow instructions." While the CBT framework of feelings, thoughts and behavior – and how they work together – is helpful, parents often have to rely on their own observations, knowledge about their child, and learn to trust their "gut."

WHAT PARENTS CAN DO TO HELP CHILDREN MANAGE LIFE

These days, it isn't hard to find someone who feels "stressed out." The pace and volume of stimulation from family, friends, school, electronics, sports, and social media – just to name a few – is enough to overwhelm anyone, including children and teens with disabilities. Given the demands of life in the 21st century, it is often challenging for families to find balance while maintaining a household and supporting a special needs child.

What is "stress?"

Stress is primarily a physical response, but it can be experienced and expressed in many ways. When we feel stressed, the body thinks it is under attack and enters into a 'fight or flight' mode. Hormones (adrenaline, cortisol and norepinephrine) flood into our bloodstream, getting the body ready for physical action. We feel our heart pound, our breathing becomes faster and shallower, blood flow is diverted to muscles, and important bodily functions – like digestion – slow down. We are ready for a fight… or ready to run.

Not all stress is bad. In fact, stress can be helpful because it can give us the energy needed to tackle a new task, improve performance, or get through a challenging deadline. And the body's response is very adaptive if there is a real emergency, such as a fire But when we experience stress every day, and throughout the day, it can be damaging. As an educator and psychologist, parents often ask me for advice on ways to slow down the frenetic pace of living, and for strategies to help their child manage stress. Here's some guidance that can help parents balance their children's needs for positive growth and development while creating opportunities to relax, have fun and enjoy life. In order to help children cope effectively, it is important to first understand and identify how a child is emotionally and mentally processing life. One useful framework that psychologists often use is Cognitive-Behavioral Theory (CBT), which looks at humans' essential functions within three basic domains: thoughts, feelings, and behaviors.

Thoughts

Helping our children learn how to think about life is essential to helping them manage stress. There is a Chinese proverb that says: Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime. The same holds true for thinking. We must teach children and adolescents "how to think" about what they experience. For example, we can teach them a framework to make decisions by showing them how to look at the pros and cons of a situation, or how to gather evidence and seek truth. We can guide them as they form opinions by applying reason and logic. By encouraging children's grit, or tenacity, we teach that perseverance is necessary to be successful. The more often a child practices these "thinking frameworks," the easier it is to use them successfully. Remember, repetition leads to mastery!

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SHELTER FROM THE STORM: "We can help children manage their thinking by acknowledging their tension, offering words of encouragement and providing feedback to improve their strategizing around accomplishing tasks."

Teaching children and teens "how to think" will also help them structure their decision-making and improve their judgment as they learn to manage aspects of their own lives – and reduce stress.

Because some degree of anxiety is actually necessary to enhance performance, we can help children manage their thinking by acknowledging their tension, offering words of encouragement and providing feedback to improve their strategizing around accomplishing tasks. For example, if the thought of having to complete a school project is anxiety-provoking for a child, parents can help the student break the project down into manageable parts by creating an outline first, or suggest working in short time intervals (15-20 minutes and then hit the "pause" button and return to the project later on).

Once a child has the "foundation" for a way of thinking and problem-solving, we can teach our children values such as kindness, empathy, being good towards others, and discipline – an important "layer" on top of the foundation.

Feelings

Acknowledging our children's emotions is fundamental. Initially, children "feel" more than they think. Feelings are visceral and automatic—we don't plan them. Sometimes, feelings are expressed in exaggerated ways. Who has not witnessed a child meltdown in the supermarket because they cannot have the candy they want?

Most children do not have an "emotional vocabulary," so parents can help by watching and listening carefully, then "translating" what they see and hear into "feeling words," such as "sad," "mad," "annoyed," "frustrated," "disappointed," "worried," etc. Once children begin to learn how to label what they are feeling, we can teach them how to put their emotions into a proper perspective. They need to learn that disappointment and frustration are part of normal life. It is helpful to remind children that everyone experiences frustration (the toaster burned the toast; a sibling got the largest pizza slice; someone spoke rudely to us). It can help to provide a "feeling scale" from 1 (minor distress) to 10 (extreme upset), so children can see that all of life's experiences are not a 10. We have to help our children decipher what's typical and what's not. Therefore, we have to listen carefully to what children are telling us. Sometimes, how they say something and what they really mean can be different.

For example, 7-year-old Marina, who has ADHD screams at her dad that she needs to drink water right now or she'll DIE! Well, certainly water is an essential life ingredient but unless Marina has been walking in the desert for days, she needs to self-regulate the "need" for water vs. the "wanting" water instantly. We have to teach "emotional balance," understanding that people cannot live life in a healthy way when most of their emotional responses are at a level 10.

at a level 10. It's easier for kids to share their feelings when adults express their own feelings in ways that are not overwhelming the child. It is one thing to disclose feeling nervous or angry about something, but it's quite another to unload on a child how the boss is very intimidating and may fire the parent! Now the child might add worry about loss of household income to his or her own existing worries. Another way of acknowledging emotions is by telling children that we love them. While we may not like what they do sometimes, kids need to know that the parent's love is a rock for the child; always there to be counted on. The reassurance is comforting and soothing for the child. It provides emotional safety which can help them feel safer and share their true feelings more easily.

Sharing feelings should be part of the ongoing dialogue with children and adolescents. Riding in the car is a great time to share thoughts and feelings. You have a captive audience without directly looking at the child when sensitive information is being offered. Many kids need to "try on" their feelings, much like trying on clothing in a fitting room, and get feedback from the p a r e n t / c a r e g i v e r. Parents are the "mirrors" for their children's feelings – we can support, honor, dismiss, sort out, discover, empower, etc., whatever a child is feeling. The key is to listen, and not be too harsh with one's feedback unless the content is so dire or extreme that a more dramatic response may be warranted.

Another important aspect of managing feelings is to help kids learn to self-soothe in a constructive way. For example, if a child is bullied and feels sad and nervous about it, a constructive solution is to offer the child empathy by validating that it does hurt to get picked on repeatedly by others, and then helping to come up with solid strategies (Thought and Behavior domains) to address the issue. Figuring out how to stop being bullied (e.g., reporting the bullying to a parent or safe adult, learning prosocial skills, increasing selfconfidence, etc.) is far more effective than carrying the burden by oneself, which can increase the likelihood of social isolation and aggravation to the initial stress of being bullied.

Behaviors

It is important to understand your child's developmental level when looking at behavior, because a child's behavior has meaning and purpose at different developmental stages. For example, it is normal for a toddler to express frustration with a tantrum, but less typical for an 8-yearold. I often tell parents that typically developing children PITCHING IN: "Simple chores around the house help children feel productive and become contributing members of the family and their communities. Responsibilities teach discipline and self-reliance. These two dimensions are good antidotes for stress and anxiety, as long as the to-do list is reasonable for the child's age." "morph" or change about every three months. Behaviors that seem incredibly annoying today may soon be gone as the child advances to the next stage of growth. If a child is whiny or demanding, that may soon shift to eyerolling or heavy sighs when frustration or annoyance sets in. Observation is key in gaining insight about how a child is functioning. For example, is he keeping away from others and barely speaking, or is he overly active to the point of distraction? Behaviors should be varied, purposeful, and goal-oriented.

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PITCHING IN: "Simple chores around the house help children feel productive and become contributing members of the family and their communities. Responsibilities teach discipline and self-reliance. These two dimensions are good antidotes for stress and anxiety, as long as the to-do list is reasonable for the child's age."

and goal-oriented. Because "all play and no work," can be just as stressful as "all work and no play," kids need to have responsibilities and high expectations. Simple chores around the house (even a toddler can pull up a blanket and straighten a pillow to make their bed) help children feel productive and help them become contributing members of the family and their communities. Responsibilities teach discipline and self-reliance. These two dimensions are good antidotes for stress and anxiety, as long as the to-do list is reasonable for the child's age.

The key here is balance. Extremes contribute to high levels of stress and anxiety.

Raising a child with special needs is a complex process, and there are no "easyto-follow instructions." While the CBT framework of feelings, thoughts and behavior – and how they work together – is helpful, parents often have to rely on their own observations, knowledge about their child, and learn to trust their "gut." While some stress is normal, there are warning signs that a child or teen is significantly stressed and anxious. Take note when the child is uncharacteristically or persistently acting differently than their usual self (a significant personality change with heightened moodiness or tension). If the warning signs persist across several weeks, despite various attempts to work through the anxiety with the child, it may be time to consult with a mental health professional.

WARNING SIGNS OF UNHEALTHY STRESS IN CHILDREN:

• Moody or irritable

• Crying

• Excessive fear

• Acting out

• Increase in behavior problems/self-injury

• Clingy

• Over or under eating

• Social isolation

• Changes in hygiene or self-care

• Changes in sleep (not sleeping or sleeping a lot)

• Withdrawn

• Abandoning friendships

• Feeling "sick" (headache, stomach ache)

Parents must keep in mind that consistency is important, and as the saying goes, "Rome was not built in a day." Armed with a values-driven framework that offers children the reassurance, discipline (doing one's best every day and knowing that tomorrow is another day), warmth and love they need, we accomplish the goal of raising a "quality human being!"•

ABOUT THE AUTHOR: Dr. Viviana Litovsky is the Executive Director of Westbridge Academy, a private non-profit school in Bloomfield, NJ, serving students with social, emotional and learning disabilities. She has a private practice in Martinsville, NJ.