Anxiety? Try Lavender Oil

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Essential oils have been used for healing purposes for centuries by other cultures. Western cultures, particularly the US, have been slower to investigate and embrace the use of essential oils in mainstream medicine. Their effectiveness has been largely considered anecdotal and on the fringe. In my own practice, I am just beginning to advocate their usage as effective complementary and first-line therapies.

I am particularly excited about lavender oil and its use in treating anxiety. A new meta-analysis published last month concludes that oral lavender oil can be as effective as lorazepam (a benzodiazepine) in treating anxiety without the potential for abuse and without any serious side effects. This same meta-analysis compared lavender oil to paroxetine (an SSRI) and found similar results in treating anxiety. The only real side effect identified in the studies seems to be mild gastrointestinal issues which have been affectionately coined “lavender burps”.

I am excited to start using lavender oil in my practice as an anxiety treatment. If you are considering lavender oil, I recommend looking for supplements that contain Silexan (80 to 160mg) which is the brand used in the studies.

What You Need To Know About ADHD Medications

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Types of ADHD Medication

There are two main types of medications used to treat ADHD. Stimulant medications (all of them are either a form of Adderall or Ritalin) and non-stimulant medications (Strattera, Kapvay, Intuniv). Stimulant medications are the most widely prescribed. I will be addressing those medications in this post.

Are ADHD Medications Safe?

The short answer to this question is “yes”. Any medication can have side-effects, and ADHD medications are no exception. You just need to be aware of the potential side effects and know what to do and how to manage them.

What Are the Side Effects?

By far the most common side effect is a decreased appetite. In fact, this pretty much happens to everybody, so you should be prepared to address it. You will be eating less, so you need to make it count nutritionally.Here are my tips:

  • If you aren’t taking a multi-vitamin, start now. 
  • Experiment with smoothies. You can add superfood powders, protein powders, coconut oil, etc to a smoothie to up your nutritional intake.
  • Try eating a big nutritious breakfast first thing in the morning before your medication kicks in.
  • You probably aren’t really going to be that hungry for lunch. Try a meal replacement bar or shake. But, find something organic, made with real food, as natural as possible.
  • Keep healthy snacks on hand (nuts, fruit, etc.) so if the mood strikes, you can eat something good for you. Don’t squander what appetite you have on junk.

As an adult, you can make yourself down that smoothie even if you aren’t really hungry. With kids, addressing a suppressed appetite can be more difficult. It’s hard to make a kid eat. Your best bet is to do your research on meal replacement options. Find something as natural as possible. Most meal replacement options are focused on weight loss. Since that is not your goal here, consider how to doctor them up. Mix them with fruit (bananas tend to add a lot of sweetness), for example. If you are desperate to get your kid to eat, consider a scoop of organic sherbet in a blender with the meal replacement. Get creative.

Other possible side effects of ADHD stimulant medications are increased anxiety, difficulty sleeping, a mood or energy crash when the medication wears off, and a blunting or flattening of personality. About 15% of people will experience one of these side effects. These side effects can often be successfully addressed by changing the dosing or changing the medication.

As with any medication, there can be other rare side effects and some of them could be serious. Be sure and discuss any concerns with your doctor right away.

How Effective Are the Medications?

In my experience, these medications are very effective at treating ADHD for just about everybody. If you find you are not getting good results from these medications, most likely, you need a different dose or a different medication. 

Many people see a pediatrician or general practice doctor to get these medications. While they are qualified to write these prescriptions, this is not their specialty. They will not have as much experience managing dosages and will not have as much experience across the set of medication options.  If you find that you are not getting good results from your ADHD medication and you are not seeing a psychiatrist, consider switching to a psychiatrist.

There are a very small number of people that don’t tolerate these medications. In my 20+ years of practice, I have encountered around 20 people that cannot take the stimulant ADHD medications. In general, the medication works for these people but they experience more intense versions of the side effects that they cannot tolerate. Different dosages and different medications do not bring relief. Again, this applies to very few people.

In my experience, these medications are a good option for just about everybody. Most of my patients see good results very quickly. For some patients, I need to work with them on dosing and trying different medications before we find the right one. In the end, these medications are effective for just about everyone. I will tell you that my results in my practice are much better than what the literature will tell you so if you are familiar with the statistics, you may be questioning my statements. I believe the reasons behind the success that I see are twofold:

  • The demographics of my practice are such that most of my patients are highly motivated to seek mental health treatment and I have a very high compliance rate with them taking medications as directed, following up quickly with concerns, and being able to work through dosing and medication issues to find what works for them.
  • As I mentioned above, psychiatrists are specialists with more experience prescribing ADHD medications than general practitioners. We have more experience with dosing, addressing side effects, and a greater breadth of medications.

I believe that both of these factors have led to very high success rates in my practice and support my statements that these medications can be extremely effective if prescribed properly.

Can These Medications Be Abused?

These medications do have the potential for abuse. If parents are concerned about this with their child, they should be the one who manages the medication and distributes the dose. Keep in mind that studies have shown that people with untreated ADHD have a higher likelihood of substance abuse. In my opinion, the benefits of treating ADHD far outweigh the potential for abuse.

Do These Medications Stunt Growth?

The answer to this question has gone back and forth over the years with the advent of each new study. The current thinking is that these medications could result in some decrease in height based on the overall load of the medication over a number of years. Taking breaks from the medication on the weekend or over the summer can help mitigate this risk. I have been treating people for ADHD with these medications for years and I do not have a bunch of short people for patients, so this is not a common or profound effect.

In my opinion, this potential risk for diminished height is far outweighed by the benefits of the medication. Being successful in school, staying on top of the details of your life, feeling like you are living up to your potential, being successful at work, etc are great contributors to self-confidence and happiness in general. 

Additionally, I personally believe that the appetite suppressing effects of the medication contribute to the risk for diminished height. This underscores the need to ensure you are eating what your body needs.

Are There Effective Non-Medication Treatments For ADHD?

My short answer to this question is “not really”, but there are things you can do to help. Before you roll your eyes and think that I’m yet another doctor pushing pills, hear me out.

Exercise and Omega 3 Fatty Acids have been demonstrated to offer some benefits for ADHD. Vigorous exercise for about forty-five minutes can improve focus for the following couple of hours. Taking roughly 800-1000 mg of EPA (one of the Omega 3 Fatty Acids and the one linked to mental health benefits) can also improve ADHD symptoms for some people. 

Additionally, there are a small set of people who will find a gluten-free diet helpful. If you want to try it, go for it. Dietary intervention is always better than medication in my opinion.

There is a growing body of evidence linking gut health to mental health and linking inflammation (reducing inflammation) to mental health. So you should absolutely clean up your diet, eat real foods, cut processed crap, eat foods that nourish your gut, eat fermented foods and take probiotics, etc. If you do this, you will feel better and you will look better and your ADHD symptoms will most likely improve. Additionally, there is a specific diet, the GAPS diet, aimed at solving a variety of mental health problems including ADHD. Dr. Natasha Campbell-McBride devised this diet as a way to reduce inflammation and heal your gut. She has had great clinical success in addressing mental health issues with her patients that stuck to this diet. This dietary protocol is very strict and very restrictive and definitely not something most people are willing to tackle. If you think you have the discipline and the drive to do it, I highly recommend that you go for it.

I’m not saying that a cleaner diet and exercise won’t help your ADHD symptoms. But, I have yet to have a patient cure themselves of ADHD through diet and exercise alone, and not need medication anymore. Sticking to these dietary protocols strictly enough for long enough to allow your gut and inflammation to heal is extraordinarily difficult in our society of processed food, industrial agriculture, etc. I encourage you to do what you can to improve your diet. You will reap many rewards for your physical and mental health. But, don’t be surprised if you still want to consider taking ADHD medication.

What Trait Do Happy People Have In Common?

While there is no single key to happiness, there is one trait that most happy people have. It allows them to make good decisions resulting in positive outcomes that feed into happiness. What do these people have in common? The ability to deal with negative emotions.

Let’s face it, life sucks sometimes. Feeling stressed, upset, sad, angry, frustrated, and/or distraught is a normal reaction when life deals you lemons. How we deal with that can often have a defining impact on what our life is like longer term. 

People who don’t deal well with negative emotions tend to exhibit two patterns of behavior. The first is avoidance. Avoiding things that cause you stress and pain is not, at face value, a bad thing. But, life goes on and there are things that you need to handle or they will catch up with you. If you want solid personal relationships, you have to address issues, deal with conflicts, and show up even when it is unpleasant. If you want a successful career, you have to do things that you don’t always enjoy and deal constructively with knuckleheads who have influence over your career trajectory. If you want financial stability, you have to take the time to understand and manage your budget, and make unpleasant deliberate short term decisions for the sake of the long term. Ignoring the care and feeding of your personal relationships, avoiding crappy but beneficial activities at work, and neglecting your bank account might avoid some immediate unpleasantness. However, you’ll pay the price later when you’re running around last minute dealing with the fall out of your avoidance, or you’re unhappy because you’re broke or have a crappy job or don’t have a support network of friends and family. The moral of this story—don’t avoid, take care of life.

The second pattern of behavior that you often see with people who don’t deal well with negative emotions is reactionary decision making. Rather than accepting these feelings as part of life, these people will often obsess over their feelings, ruminate, spin out of control, and grasp for whatever decision in the moment makes it stop–binge-eating, drinking away the pain, buying things you want (but can’t afford). These short-sighted emotional decisions often have negative consequences down the road for financial stability, professional success, and personal happiness.

So what does dealing well with negative emotions look like? 

First, it means accepting your emotions as they are. Recognize that they are normal. Feel your emotions, don’t try to bury them or try to change them. Understand where they come from. Recognize that is okay to feel bad sometimes. Don’t be judgmental or beat yourself up for having them. 

Second, know that your feelings will change with time even though it might seem like the end of the world at the moment. 

Third, live your life. Don’t crawl into a hole and stay there. Don’t spend time ruminating and not living in the present. Keep living and keep moving forward, even if you don’t always feel like it. It will get better with time.

How do you achieve this? It is easier said than done. Depending on your personality, you will have an easier or tougher time. Here are some tips to point you in the right direction:

Mindfulness. Mindfulness is, according to Merriam-Webster, “the practice of maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis.” What does that mean? It’s all about living in the present (not obsessing about the past and not obsessing about how you wish things were), living the life you have (not the one you wish you had or could have had), and being accepting of your feelings whether they are good or bad (not clinging to them and not trying to drive them out). I recommend the Headspace app which guides you through mindful meditation and includes very brief educational videos and tidbits which provide a nice progression for understanding and achieving greater mindfulness.

Take a walk. Outside. Nothing clears your head like a walk. Try to enjoy the walk for what it is. Take in the sights, sounds, smells, and other sensations. If it’s a sunny day, you’ll get the added benefits of sunshine including vitamin D, increased energy, improved sleep, and a boost to your immune system.

Exercise. Any type of exercise that you enjoy (or don’t hate) is beneficial. Studies have shown that exercise can be as effective as antidepressant medications in treating depression for many people.

Sleep. 8 hours or as much as you need. When you are stressed and going through a tough time, sleep can be fleeting. Do what you can to maximize your sleep potential. Eliminate blue light in the evenings. Exercise. Get direct sunlight midday. Reduce/eliminate caffeine especially later in the afternoon. Take a magnesium supplement.

Gut health. Studies have shown a link between gut health and depression with certain probiotics being effective in helping treat depression. So, take a probiotic. Eat fermented foods like kefir and kimchi. Eat foods that promote a healthy microbiome–whole foods like fruit and vegetables.

Sometimes life does suck. For many of us, the natural tendency is to fight against the negative emotions and try to make them stop by whatever means. These tactics, the avoidance and the rash decision making, usually do not serve us well in the long run. In my experience, the people who describe themselves as happy have found a more constructive way to deal with the negative emotions when they occur. Next time life has you down, try a different more mindful approach and see what happens.

Sometimes our negative emotions are so overwhelming that we have suicidal thoughts and/or have trouble performing the basic functions of life. If this describes you, I strongly encourage you to seek professional help. Sometime’s life burden is more than we can carry alone. There is no shame in that. Don’t go it alone. Get help.

Stressed Out? Tips to Help You Manage It

Are you stressed out? I’m sure you know the symptoms–difficulty sleeping, lack of appetite, headaches, stomach aches, heart pounding, that sense of anxiousness. How can you manage your stress levels? Things won’t change unless you change them, so you need to start by taking stock of how you are living your life. 

Find Your Stressors

First, identify your stressors. Take a look at your schedule, your household, your job, your relationships… Everybody’s stressors will be different. The important thing is to think about it and make a list. 

  • Have you scheduled too much for your kids? 
  • Do you make too many social or volunteer commitments?
  • Is your house a mess and stressing you out? Or maybe you’re killing yourself trying to keep it clean?
  • Do you hate your job? Do you hate your boss?
  • Do you carry too much of the load in your relationship with your partner?

Make Change

You know what things cause stress. Now you need to figure out what to change. You need to do some soul-searching here. Why do these things cause stress and what can you do to change it? You must divorce yourself from all feelings of guilt, obligation, and commitment when making the list. You must banish all thoughts of “I can’t”, “I don’t have time”, “what will people think”, etc. Identify just one or two things to change to start. Here are some things to keep in mind to help make this journey easier.

Learn to say “no”.

Learn to say “no” to others and learn to say “no” to your own sense of obligation or guilt. You have control of your choices. Set your priorities and stick to it. 

If you have trouble saying “no”, try these simple techniques:

  • I would really like to say “yes”, but I am not sure I can make it work given my other obligations. Let me think about it and get back to you tomorrow. By doing this, you don’t have to make a decision on the spot, you can think about it, and you’ve set expectations that you might say “no”. 
  • I am happy to help. I am free on Saturday before 10am. Help on your own terms.

Say “no” to yourself too. Don’t let your sense of obligation to others or your perception of what others think is  right (e.g., what a good mother does) guilt you into saying “yes” to things you can’t handle. 

  • Your kid probably doesn’t need to do soccer, ballet, AND tennis.
  • Every meal doesn’t have to be hot and homemade. (I’ve served store-bought hummus and baby carrots for dinner and no one suffered.)
  • You don’t HAVE to volunteer for the school pageant just because they asked.

Teach people how to treat you.

If you let people walk all over you, they might just do that. If you have a relationship that is causing you stress because of how you are treated, have the conversations to start setting boundaries. Be clear. Don’t apologize for wanting to be treated equitably and with respect.

  • You can ask your partner to help out more with the baby.
  • You can let mom know that she should call before stopping by to make sure you have time to spend with her.
  • You can tell your boss that if he gives you more advance notice, you can do an even better job with assignments.

Find a way to set boundaries clearly and respectfully. Don’t be an enabler. If you indulge their behavior, they have no incentive to change.

Remember the basics–eating, sleeping, and exercise.

When you’re stressed, these things are more important than ever. And it can be harder than ever to make sure you are eating healthy, sleeping enough, and getting some exercise. Prioritize changes that will let you do these things. You will physically feel better and it will make everything easier.

Try breathing techniques.

There are a myriad of breathing techniques out there to help with stress, anxiety, and panic– the 5-2-5 technique, the 4-7-8 technique, etc. Go find one you like (a quick google search). They don’t take long to do and they have proven results. If you prefer a more guided approach, check out the Calm and Headspace apps. These techniques can be helpful on a daily basis to help keep things even keel, and they are good in a pinch in moments of extreme stress.

Don’t let fear of change stand in the way of progress.

If you want things to improve, that means change and doing things outside of your comfort zone. Fear of change is natural and okay. Recognize it, embrace it, and be proud of yourself for pushing through it. (Don’t forget your breathing techniques! They can help you get through the fear.)

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Addicted to pain killers? Effective treatments are available

Abuse of opiate-based prescription painkillers (Oxycontin, Vicodin, Percocet, etc.) is on the rise among both adolescents and adults. These medications can easily cause addiction, and the incidence of accidental overdose and death is increasing at an alarming rate. Trying to get off of these drugs can be a difficult journey. When trying to kick the habit, people experience a myriad of severe withdrawal symptoms that can include nausea, vomiting, diarrhea, muscle aches, sweating, and chills. My patients often say they “feel like they want to die” when going through withdrawal. While withdrawal symptoms are severe, they usually pose no medical risk to the patient. However, due to the severity of the symptoms, many people cannot make it through withdrawal on their own.

Fortunately, an extremely effective treatment option is available for opiate addiction. Specially certified doctors can prescribe a drug called buprenorphine during an office visit to assist the detox process. Taking buprenorphine allows a person to stop taking opiates without experiencing withdrawal symptoms. In addition, buprenorphine takes away the cravings for opiates, blocks the ability to get high on opiates, and is not fatal on overdose.   After taking buprenorphine for a period of time, a person can taper off of buprenorphine without experiencing the severe symptoms associated with opiate withdrawal. Additionally, buprenorphine treatment can be managed in a doctor’s office without the need for inpatient “rehab”.

There are two approaches for buprenorphine treatment—a quick detox and maintenance mode. With a quick detox, a person takes buprenorphine for a short period of time (two weeks to a few months) and then tapers off of it. With maintenance mode, a person takes a maintenance dose of buprenorphine for a longer period of time (six months or more) before tapering off of the drug.  I usually recommend the maintenance mode for my patients, particularly for those people whose drug habit has lasted longer than a year. Being on a maintenance mode of buprenorphine affords people the opportunity to make the changes necessary in their lives to allow them to stay off of drugs. They have the opportunity to get their work situation and finances in order, repair relationships and regain trust, get new friends who do not take drugs, and generally learn how to live without drugs. Once their life is in order, a person can then taper off of buprenorphine and be well prepared to stay drug-free. I have found that the relapse rate with a quick detox is much higher because they have not had time to make the changes necessary to support a drug-free life. Studies have shown that the longer you take buprenorphine, the greater the chance of maintaining abstinence permanently.

If you are interested in buprenorphine treatment, you should contact your primary care doctor. Alternatively, you can visit http://www.buprenorphine.samhsa.gov for a listing of doctors authorized to prescribe buprenorphine in your area. This website will also provide you with more information about buprenorphine.

You should be aware that there are other treatment options available for opiate addiction such as Naltrexone, Vivitrol, and Methadone. However, I generally recommend buprenorphine treatment for most of my patients because it manages withdrawal symptoms and cravings, it is a relatively easy treatment plan to follow, and it has a higher success rate.

As I mentioned earlier, it is possible to detox from opiates on your own without medical assistance. Withdrawal symptoms are severe and scary, but generally do not pose any medical danger for most people. However, certain medical conditions (pregnancy, heart problems, etc) can make the withdrawal process dangerous and may require monitoring or assistance from a doctor. If you are considering doing this on your own, please consult with your physician to make sure it is safe for you.

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Back-To-School Morning Battles. How To Deal

Transitioning from summer to school is never easy. Getting all of the kids out of bed, ready for school, and out the door on time can be a challenge. While we’d all like to start the day with a “good” morning, if you have school-aged kids, mornings can often turn into battlegrounds. Of course, no one solution will work for every child or every family, but here are some tools that you may find useful.

Get Enough Sleep

Make sure you child is getting enough sleep. Pre-school and elementary aged kids need 11 to 12 hours of sleep. Middle and high school aged kids need 10 hours of sleep. Set their bedtimes accordingly. A well-rested child won’t be difficult to get out of bed, and they are much more likely to be cooperative and move faster than a sleepy child.

Maintain a Consistent Sleep/Wake Routine

Try to have consistent sleep and wake times seven days a week. Having different weekend schedules can make falling asleep and waking up difficult during the week.

Try Melatonin

If your child is having difficulty shifting to a school time sleep/wake schedule, and in particular, is having difficulty falling asleep at the appropriate time, you might consider melatonin supplementation. Melatonin is a hormone naturally produced by the body that helps regulate the sleep/wake cycle. Some studies show that taking melatonin 30 to 60 minutes before you want to fall asleep can help you fall asleep and help adjust your sleep schedule. (It is often used to treat jet lag.) Clinically, I have seen good results with melatonin. To help adjust your child’s sleep schedule, give them melatonin 30 to 60 minutes before the time you want them to fall asleep. Make sure they are comfortable, relaxed, and in bed when you want them to fall asleep. Melatonin will not knock them out, it just makes them feel sleepy and less alert. If they are watching television, playing video games, texting, etc., you might miss the boat. I recommend a melatonin dose of 0.5mg to 9mg. I would start with a low dose and increase by 0.5 to 1mg every few nights until you notice it working well. Some kids will respond at low doses and others may need high doses. I would not give this supplement to any child under 7 years of age. I recommend short term use of a couple weeks to a few months to help adjust your child’s sleep cycle. If you have any concerns about taking a supplement, consult your doctor. Melatonin is available as an over-the-counter supplement. Stick with a reputable brand.

Use a Dawn Simulation Light

Another tool to help change your child’s sleep/wake schedule and help kids wake up in the morning is a dawn simulation light. Light triggers a hormonal response which naturally ends the sleep cycle and triggers the body to wake up.  A dawn simulation light gradually brightens over the course of 30 minutes to 2 hours, depending on the light and the setting, simulating sunrise and triggering the end of the sleep cycle. You awaken gradually and gently unlike a jarring alarm clock with can leave you groggy. Be sure and use this every morning at the same time including weekends.  At first, your child may not be fully awake at the set wake up time, but they should at least be in a lighter stage of sleep more prepared to wake up for the day. Over time, if your child is getting a sufficient number of hours of sleep, they should be able to wake up at the desired time using the light.

Allot an Appropriate Amount of Time for Getting Ready

Figure out the right amount of time for your child to get ready in the morning. Pre-schoolers and early elementary kids don’t know how to “rush”. They won’t really understand time-pressure and can be easily distracted by other things. Trying to hurry them can often backfire. Conversely, teen-agers may be willing to forego “primping” time and a hot breakfast to get 20 minutes more sleep. Also consider the full array of personalities—some kids are easily distractible and require more time, some kids care more about their appearance and will require more time, some kids don’t care that much about appearance and would rather sleep more, etc. Know your child and set their wake-up times thoughtfully.

Be Ready Early

If you have pre-school or elementary aged kids, I recommend that parents be fully ready (showered, dressed, etc.) before their kids wake up. Preschool and early elementary kids aren’t going to necessarily plow through their morning routine on their own in a timely fashion. Be prepared to help them every step of the way to keep them on track, and to deal with those meltdowns or burst of uncooperativeness that all kids seem to exhibit whenever you’re watching the clock. For older elementary aged kids, be available if they need you.

Write Down the Morning Routine

For pre-schoolers and early elementary, have a written morning routine for your kids. This is basically a list of all the things they need to do in the morning. Use pictures if your child can’t read. This list helps set mutual expectations and provides a reference for your child. You can even turn this into a check list or sticker chart to help motivate your child and create something tangible in which they can take pride.

Give Your Child Responsibility

By the time your child is in 2nd or 3rd grade, you should take yourself out of the morning battle and put the responsibility with your child. Agree upon a “morning contract”. The contract should include wake up time, morning tasks, completion time, and clear consequences for not being ready on time. It should also define clear consequences for not being ready on time. Set your child up for success by giving them plenty of time to complete their tasks. If possible, have logical consequences such as going to bed earlier that night so they have energy and can concentrate in the morning, or a monetary fine (your time is money and they are wasting it). Make sure there are clocks or timers in their bedroom and bathroom so they can keep track of time. Then, step back and let them take responsibility for their own morning routine. Make sure you hold up your end of the bargain and give consequences consistently.

Practice on the Weekend

If your child repeatedly demonstrates that they can’t get ready on time, you can try a weekend practice session. When they get up on Saturday morning, they can do their morning routine, then put their pajamas back on, get back in bed, and do it all over again and again. Up front, specify the number of times they will have to repeat the routine. Use a stopwatch so you can see their progress and how long it takes if they are truly motivated (but don’t expect average weekday times to come close to their fastest Saturday practice session time). Sometimes children are uncooperative with their morning routine because of strong anxiety about going to the school.

Arrive at School On Time Regardless

Younger children need to learn that they need to be there when school starts. If you are allowing enough time and providing enough support for your pre-schooler or early elementary child, and they are still being uncooperative and are making themselves late for school, don’t let it happen. Bring your child to school on time regardless. Drop them off in their pajamas with their outfit in a bag. Be sure and let them know of this plan ahead of time so they have the opportunity to correct the situation. Your child may start kicking and screaming (literally) when they figure out that you really plan to bring them to school in their pajamas. Stick to your guns. Get help getting them in the car if necessary and be prepared to hand off a screaming child to the school. It is a good idea to coordinate with the school ahead of time so they are not surprised by your pajama-clad child. Most kids will not arrive at school in their pajamas more than once.

Get Help From the School

If your older child is consistently late for school despite your best efforts, talk to the school about their tardiness policy. See if they will implement special measures for your child such as detention or curtailment of extra-curricular activities based on tardiness. The school wants your child to arrive on time, so you may find them very willing to help. Having the school get involved takes some of the burden off of you and puts more responsibility with the child.

Deal With Anxiety Head On

All kids have some anxiety about going back to school. Some kids experience moderate to high levels of anxiety that can cause real problems.  Kids can demonstrate high anxiety a number of ways. Some kids will be completely uncooperative with the morning routine while trying to stall and delay (in which case, many of the tools above won’t work), some will have stomach aches or other “illnesses”, some will throw a tantrum when it is time to walk out the door or leave your side, or you may find them literally kicking, screaming, and clinging to door frames as they refuse to go to school.  

The first step is to talk with your child about their anxiety and find out what worries them.  As a parent, try to validate their feelings. Don’t try to talk them out of their feelings or solve their problems. In other words, do say things such as “I understand”, “having a new teacher can be worrisome”, “being away from mommy can be scary”, etc. Don’t say things such as “there is nothing to worry about”, “you’re just being silly”, “don’t be a baby”, etc. Your child may have anxiety about something you can address. For example, you might find out they are scared of the school bus, they are bullied in the lunchroom, or they are confused about classroom procedures. Most of the time, however, they will need to work out their anxieties themselves.

As a parent, you need to validate their feelings but make them go to school. Allowing them to stay home for a couple days to “get over it” does not work and will probably make the problem worse. Your child needs to deal with their anxieties as soon as possible. Get them to school by whatever means necessary and be prepared to hand off a crying child to the school. This advice holds true for preschoolers as well as older children. Preschoolers often cry with varying intensity when being dropped off at school but usually snap out of it shortly after you leave. Try to make your goodbye short and sweet. Long drawn out emotional goodbyes will only make it harder for them and you. Older kids can have a variety of reactions including physical refusal, angry desperate crying, and silent tears. Leaving them at school in distress can be incredibly hard, but know that in the long run you are making the best decision for them. Obviously, you will need to work with the school to monitor their progress. If your child continues to be in distress, you can try a graduated plan where they go to school for a short amount of time and them come home. Each day you send them to school a little longer. Make sure that when they are home, they are doing schoolwork during school hours. Don’t let them watch tv to do something fun during school hours. If your child seems extremely anxious (i.e., freaking out) prior to the start of the school year, you can try this graduated plan from the beginning.  The only way to get over anxieties is to deal with them. You have the difficult job of forcing your child to do this.

Social Anxiety Causing School Anxiety

One cause of school anxiety is social anxiety. Social anxiety is significant emotional distress or fear about interacting with others or about being watched or judged. This type of anxiety runs deeper than school and is likely to have broad impacts on your child’s life beyond going to school. It can impact your child’s ability to make and keep friends, it can hold your child back from trying activities and having new experiences, and it can ultimately impact their self-esteem. If you believe your child suffers from social anxiety, I recommend that you seek help from a qualified mental health professional.

Other Medical Issues Impacting Sleep

There are a few medical issues than can impact a child’s ability to get up and get ready for school. If you feel your child may suffer from one of these conditions, please consult your doctor.

POTS, or Postural Orthostatic Tachycardia Syndrome, is a condition in which the blood vessels don’t respond properly to changes in gravity resulting in rapid jumps in heart rate. As a result, most kids with this problem will experience lightheadedness when going from sitting or laying to standing, standing for a prolonged period of time, or taking a hot shower. Children with this condition may also be prone to fainting, complain of frequent headaches, have low energy, and have difficulty waking up in the morning. This problem tends to occur more often in girls and most commonly begins during the teenage years. If your child is experiencing some of these symptoms you should check with your pediatrician. A referral to a pediatric cardiologist for a simple non-invasive test may be necessary to help diagnose this condition.

Delayed Phase Sleep Syndrome is a sleep disorder in which people have a delayed sleep-wake schedule. They aren’t able to fall asleep until very late at night (typically about 2am or later) but can then sleep a normal amount of time and get restful sleep. This condition is problematic because school and starts at about 7am, not noon. This problem typically starts around puberty when there is a natural shift in the sleep-wake cycle. Obviously, kids with this sleep disorder have a terrible time waking up for school. They are just too exhausted from having fallen asleep just a few hours prior to you waking them. In general, the treatment will require use of a light box, melatonin and other means to help shift the sleep-wake schedule to an earlier bedtime. Once a normal sleep/wake schedule is achieved, these teens will need to very strictly adhere to the schedule seven days a week to main the timing of the sleep cycle. Please consult your doctor if you feel you child is suffering from this condition.

Sleep Apnea is a condition in which children (or adults) wake multiple times during the night due to breathing obstructions. Usually, people with this condition are not aware that they are waking up. In kids, this condition is often due to enlarged tonsils or adenoids partially blocking their airway. Children with this condition do not get a good night’s sleep despite having slept for an appropriate duration. They will consistently be difficult to wake up and be tired throughout the day. One way to tell if your child is experiencing this problem is to watch and listen to them while they sleep. If they snore loudly, if their breath seems to “catch” while snoring, or if they are snoring and don’t seem to be sleeping soundly, they may have this problem. Consult your pediatrician if you think your child suffers from sleep apnea. Consider making an audio or video recording of your child sleeping and bring it with you to the doctor.

Unfortunately, there is no silver bullet to get you through the morning routine peacefully and efficiently. Every child and family situation is different and no single strategy works for everyone. I hope you will find some of my suggestions helpful. Just remember that kids are kids, so don’t expect perfection. If you try out a new approach, be sure and explain it to your child, apply it consistently, and give it time to work. Good luck!