Working with children who hate loud noises

Working with children who hate loud noises


This was (roughly speaking - I may have got the spelling wrong) the word *Josh yelled when a leaf blower was used outside our office in a session last month.  At the same time, he put his hands over his ears and ran to the corner. 

Josh hates loud noises and gets really distressed whenever they occur around him.  It’s especially hard for him when they are sudden.

And Josh of course is not unusual  – there are many children who are extremely sensitive to loud noise.  Many children I see clinically will report some sensitivity to noise.  Sometimes noise sensitivity is associated with a broader sensory disorder (for example, Autism Spectrum Disorder), but sometimes these are just noise sensitive kids without any further disorders in the background. 

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To The Bone (yes, netflix does it again)

Last night, I settled in with my large hot chocolate on the couch to watch the movie on eating disorders - “To The Bone”. 

For those of you who haven’t seen the shorts – this is a movie about a young woman with anorexia who gets treatment for an eating disorder.  She has a short stay in a group home facility, meets others with eating disorders, has some family therapy, a short romantic relationship with another person with an eating disorder and ponders whether she really does want to get “better” and overcome her eating disorder.

Along with many of you - I've worked with many kids/teens with symptoms of disordered eating and struggles with body image for many years - so I was keen to see whether this was going to be a useful movie I could recommend to families.

Unfortunately, I don’t think it is. 

But as usual when it comes to these kinds of issues, I have mixed feelings.  Here are my thoughts.

Here are the four aspects of this movie I like.

1. The movie will raise awareness of the existence and nature of eating disorders.  This is probably a good thing.  Although as professionals working with young people we are often (or constantly - depending on your role) - exposed to eating and weight related problems - society in general doesn't get a lot of exposure to this problem.  Movies like this therefore may be helpful in that people with an eating disorder may watch and feel comforted to be reminded they are not alone.  Those in the general community may learn about these disorders and feel compassion for those who suffer. 

However, while awareness is important - we should keep in mind that only about 2% of children and teens develop an eating disorder during their childhood/adolescence in this country.  While eating disorders are a problem for society as whole (and probably under-reported because of the shame and lack of motivation for some sufferers to go into what is usually a painful and difficult treatment) – they are not as common as anxiety or depression in young people.  I make this point because sometimes movies like these mean we start over-stating the prevalence of these disorders which I think is also unhelpful – and may even normalize something which is still uncommon.

2.      The movie shows some of the problems and suffering experienced by those with an eating disorder

The main character looks drawn and haggard (more on this in a minute), with excessive body hair, fainting episodes, talks about being hungry and is sometimes anxious and distressed.  The movie doesn’t shy away from the fact that eating disorders are painful.

3.      The movie also clearly shows how distressing an eating disorder can be for family members. 

The very real struggle for families with a family member with an eating disorder is not widely understood.  I liked that the movie made family suffering a prominent part of the character’s story.

4.      The movie also shows that treatment is available and can be effective. 

In the movie, several of the characters in the group therapy home seem to be improving which provides a positive message about eating disorder treatment.  I’m pleased about this – this could be life saving for those with eating disorders who haven’t yet sought treatment.   This is especially important because people with eating disorders often don’t get treatment quickly – there is an average of four years between the emergence of eating problems and first sessions of therapy.  And the longer people delay getting treatment, the less successful treatment is likely to be. 

On the flip side however, the only people getting treatment in this movie are those who are particularly sick.  I felt like this could suggest  that you need to be severely unwell before you can get help – which of course could be a particularly dangerous message for some young people who don’t think they are “sick enough” and need to get worse first.

So, all good then?  Should we start showing this movie in schools?  Suggesting families we work with see this movie?

No.  Unfortunately alongside these positive messages, the movie also contains some unfortunate messages and some unhelpful content. 

Here are five big problems with this movie.

 1. The movies clearly outlines some of the “methods” of eating disorders

You could learn a lot from how to develop an eating disorder from this movie if you were so inclined.  For example the house group members share tips and tricks to continue to lose weight/binge/purge secretly even while in treatment and the main character is repeatedly shown to use a range of strategies to maintain her disorder.   There is a real risk that some young people could use this movie as somewhat of a “how to” in eating disorders.

2. The key character with an eating disorder in the movie is funny, engaging, charismatic, talented and – despite looking sick – still conventionally attractive.   

Of course it’s not a crime to be any of these things (and what was I expecting with a Hollywood movie) but I can’t help but wish the main character had been older/less conventionally beautiful/with less obvious talent and maybe slightly more annoying.  Young people are desperate to be liked, cared for, admired and talented.  I wouldn’t be at all surprised to discover that many teens have watched this and feel envious and aspire to be like her.

3. It doesn't show the extent of the usual kind of suffering experienced by those with an eating disorders. 

Eating disorders are devastating and life destroying (for example, they have the highest mortality rate of any psychiatric disorder).  The character in the movie does look troubled at times, but throughout the movie she is often happy and making jokes.  She rarely seems as depressed and socially isolated as most of the young people with eating disorders I’ve come into contact with.  It's a particular shame that the social isolation and conflict often experience by young women with eating disorders is not highlighted - as in my experience sometimes these are powerful motivators for young people to get treatment/work hard at treatment.

4. It doesn't show what's involved in effective treatment.

In the movie, treatment appears to involve some cosy chats with Keanu Reeves (the strong, single, very attractive and very cool male therapist role model – not exactly representative of the kind of psychologists usually involved in eating disorder treatment 😊), living in a “party of five” type of fun house with a lot of peer support, some group meals where everyone chooses what to eat (this is unconvential for typical eating disorder treatment) and a very unsettling bottle feeding routine between the character and her mum towards the end of the movie. 

This is not representative of the kind of evidence based treatment for eating disorders, which suggests that family based, cognitive behavioural therapy – over many sessions – is most useful.  Also, from my experience, eating disorder treatment involves enduring a lot more tears, anger, panic, guilt and even feelings of disgust for most people.

So in conclusion – I can see four positive messages, and four unhelpful ones. 

However - given the potential danger in exposing young people to these unhelpful messages in this movie, I’d rather young people didn’t watch it. 

I believe that for some kids and teens who either have or who are at risk of developing an eating disorder, it could quite feasibly trigger jealousy, anxiety about current weight, desire for weight loss and disordered eating behaviour.

What’s the solution?

Although I’d rather this movie have not been made in the way it has, given that it has – we need to deal with it.  I’m not a fan of banning movies altogether for teenagers. 

What should we say to parents if they ask us?

The outright “no, you can’t watch it” might be appropriate for younger children.  I am saying to parents - if your younger child asks to watch it, and think you it’s unlikely they will be able to sneak onto Netflix later – say no.  Don’t forget to use this as an opportunity to talk with them about the issue however. 

I suggest to parents and caregivers they might say something like this:

“This movie is for adults and older teens.  It has some ideas in it which are upsetting and might make you feel worried about adult stuff.  If you still want to watch it in a year or two, we can do together.  Let’s watch X together instead”

I think we need to empower parents to "take charge" and prevent viewing for some younger adolescents.  An important message from us as professionals is that - just because "everyone else" is watching it, doesn't mean they have to let their young people.  Sometimes parents need to hear this from us, it gives them permission to do something they feel is the right thing to do.  I often tell parents/caregivers about other families I know who are putting this particular rule in place - there is something about the power of social norms which gives them the courage to do the same.

Having said all of this, there is no point parents/caregivers "banning" the movie for a teen who then goes and watches in on their phone.  If this happens the problem is exacerbated by secrecy, guilt and loss of conversation opportunity.  Here's what I am saying to parents about this:

"However if your older child – for example a 16 year plus teenager -  wants to watch it and can’t be distracted by another suggestion, ask them if you can watch it together and talk about it afterwards."

I am also providing them with some ideas about questions to ask (as always, being as specific as possible with parents about exactly what words they might consider using seems to help them be able to broad these conversations).  Here are some question ideas for parents/caregivers I've come up with - I'm sure you have some of your own.

How often do teens want to be thinner?
What’s the difference between wanting to be thin and an eating disorder – do you know?

How often do teens feel really anxious about food? Their weight?
How about you?
How realistic do you think this movie is?  In what way is it realistic/unrealistic?
I think there are probably a few different things which cause eating disorders – do you have any ideas about some of the causes?

Do you think the way we think about appearances in our society plays a part in causing eating disorders?

Do you think eating disorders are more like an addiction – or more like a anxiety problem?

Have you ever felt a bit like the character in the movie?

What would you do if you starting to feel like the character in the movie?

There are no right or wrong answers to these questions – but it will help you identify whether there are any risks you need to monitor, and help encourage your teenager to talk with you about their opinions and thoughts.

Here are some ideas about things to say:

I’ve read that this doesn’t accurately show what it’s like to have an eating disorder.  It seems like it’s a lot more complex, and much more painful than what this shows.

I like that it shows that there is treatment.  I don’t think this is the kind of treatment that is used here in Australia.
I would worry that it seems like there is something exciting or interesting about having this disorder.

I would hate you to ever get into that kind of cycle.  I know it would be pretty easy for it to start – it’s so addictive for some people to lose weight/throw up/not eat/exercise too much.  Because it’s really easy to get stuck into it, I’m going to do what I can to make sure you don’t get stuck in that cycle,

What else can we do as professionals?

Of course, we should also be asking questions and providing an alternative perspective if we are involved in conversations with young people about this movie.

We also need to get into the habit of "screening" for eating disorders in young people.  Particularly keep an eye on young people with perfectionistic traits and high levels of anxiety (shown to be associated with eating disorders)

Most of them are not getting help quickly, and hide the problem for a long time. Interestingly, some research suggests that most young people with an ED do actually talk with professionals prior to starting treatment but talk about other problems - health problems, anxiety and depression and other areas of concern.  This same research suggest that while young people frequently don't volunteer information about their disordered eating - they actually would welcome questions about it, given the level of suffering they are often experiencing.

A group of researchers in 2003 (Cotton, Bell, Robinson) found that the two best screening questions for eating problems were:  Does your weight affect the way you feel about yourself? and "Are you satisfied with your eating patterns".  We might have to modify these for younger kids, but this is a good start.

In terms of treatment, research suggests that family based treatment is superior to individual treatment for young people - so it's important that we are involving family as soon as possible.  And given the risks to safety which exist for young people with eating disorders, I believe this often means we need to consider breaking confidentiality when a young person confides in us about disordered eating behaviours.  Obviously we need to tread carefully here, but eating disorders are not something to be taken lightly.

If you'd like some support within this area as a professional, please feel free to click here for more information about our supervision.



Sexting: Guide for Professionals

Sexting: Guide for Professionals

Various research reports suggests that 10-20% of teens have sent or received a sexually explicit photo in the last 12 months (some studies estimate as low as 4%, some as high as 50% - depending on how you ask the question).  If we assume around 15%, this means the average sized secondary school will contain 150 -200 students who have recently sent or received a naked or semi naked picture of themselves.

Given the prevalence of this issue, we can’t bury our head in the sand.  Teenagers everywhere are doing this - including the teens we work with.

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The three fundamentals of supporting young people with anxiety

The three fundamentals of supporting young people with anxiety

In our clinics, the most COMMON area of challenge for the children /teens we see is managing anxiety.  This is a reflection of a wider trend - anxiety is the most common psychological symptom experienced by kids and teens in Australia.

Often in my writing, I drill down to the specifics of the work we can do as professionals, teachers and counsellors in helping young people cope with anxiety.  Today, I'd like to take a step back and think about the five broad goals we are trying to achieve when we work with children and young people who are anxious..

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What teachers/counsellors/youth workers can do to help teens at risk of self harm/suicidality

What teachers/counsellors/youth workers can do to help teens at risk of self harm/suicidality

A sad and tragic fact of our world in 2017 is this:  the most common cause of death for young people is suicide (see Australian Bureau of Statistics Leading Causes of Death report, 2015). While this data is somewhat misleading for the simple reason that young people don't die very often (and also important to know that death by suicide is more common in adults than in young people) - it is still distressing and worrying. This is especially true when we know that rates of deliberate self harm and attempted suicide is higher in young people than in any other age group.

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Questions to ask parents/carers of kids with "big feelings"

Questions to ask parents/carers of kids with "big feelings"

"Kids with big feelings" is a phrase I sometimes use to describe children who have a tendency to get more frustrated, worried, embarrassed, hurt and sad than other children their age.  I use this phrase because it avoids negativity and reflects the fact that these kids are often also particularly creative, joyful and hilarious fun!

If you work with children with "big feelings" you know that they can test their parents/carers' resources and frustration.   It's a tough job for these people.  And unlike most other "jobs", they get no training, time for reflection, formal planning processes or team building days...nope, they just have to do the best they can on the fly.

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17 question options to ask gaming/online video “addicted” kids and teens - to help them reflect

17 question options to ask gaming/online video “addicted” kids and teens - to help them reflect

As a professional who works with kids and teens you will know many families who struggle with issues related to gaming and technology use.  You will certainly know plenty of children/teens who are *desperate* to be non stop gaming/watching online video this school holidays.  You will also know many parents who have lectured their kids/teens about the need for a balance of activities until they are exhausted and who frankly want to throw all i-devices/gaming consoles off the edge of the nearest roof.

Thousands of kids and teens all over this country this school holidays are spending hours each day gaming.  It’s not surprising. As a society we’ve introduced a set of humans with partially formed brains (and willpower skills) to a highly addictive, satisfying and fascinating activity and naturally enough they are having trouble turning it off.

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"Moodiness" in kids and teens

"Moodiness" in kids and teens

One of the shocks for parents of the 9 plus age group is how frequently their kids get irritable, sad, stressed and "moody".  

Many of those parents remember how their younger kids were happy-go-lucky much of the time.  Sure, they'd still get upset at times - if they didn't get what they wanted or had a fight with their siblings, or had to do chores - they might have a meltdown - but there were three differences:

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4 Mistakes Parents can Make when their child gets in trouble at school

4 Mistakes Parents can Make when their child gets in trouble at school

Last week I ran a seminar for parents at a local primary school.  I had almost got to the end of the night and we were discussing rules for kids.

As professionals who work with families, we know that an important part of parenting is to set, monitor and enforce rules for children.  Parents have to do this to help them manage life, stay safe, build relationships with others, cope with school and learn skills.

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What are kids watching on youtube?  Four important questions for us to ask in classrooms/therapy rooms

What are kids watching on youtube?  Four important questions for us to ask in classrooms/therapy rooms

UK based research group Child Wise conducted research last year showed that children are watching an average of 3 hours a day watching youtube videos.  Most commonly, they are watching music videos, gaming videos, “funny” real life content, videos showing pets and animals, “how to” videos and sport.    

This raises the question of how appropriate these videos are for children.  It's hard to tell.  None of this content is “rated” as G, PG, M etc in the same way that commercially produced television has been in the past.  And with more than 300 hours of video being uploaded to youtube every minute, my guess is that external ratings guides like this are going the way of the dinosaur.

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13 Reasons Why - The 2 minute summary for teachers and counsellors (plus questions to ask teens who've watched the series) 

13 Reasons Why - The 2 minute summary for teachers and counsellors (plus questions to ask teens who've watched the series) 

I've been asked by several people over the last few weeks about my views about the popular Netflix show - 13 Reasons Why.  If you haven't come across it yet, this show is a Netflix series about a girl (Hannah) who suicides by cutting her wrists in a bath-tub.  The show follows the audio tapes she has made prior to her death which explain her reasons for doing so (primarily related to bullying, conflict and rejection by her peers).  I read the book version of this show a year ago, and found it sad and confronting.  I haven't watched the full series, but have seen snippets of it, and read through the plot of each episode (which varies a little from the book).

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Helping Kids deal with Negative Emotions in the Classroom

Helping Kids deal with Negative Emotions in the Classroom

Professionals working in classrooms have a huge range of tasks they are juggling every day - from meeting curriculum goals, managing behaviour, dealing with parental expectations, negotiating special learning needs to lesson planning - and hundreds more.

It's no wonder that sometimes dealing with negative emotions or mental health issues in students seems like an impossible task on top of another set of demands.

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