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Middle Childhood (9-11 years of age)

Developmental Milestones
Your child’s growing independence from the family and interest in friends might be obvious by now. Healthy friendships are very important to your child’s development, but peer pressure can become strong during this time. Children who feel good about themselves are more able to resist negative peer pressure and make better choices for themselves. This is an important time for children to gain a sense of responsibility along with their growing independence. Also, physical changes of puberty might be showing by now, especially for girls. Another big change children need to prepare for during this time is starting middle or junior high school.

Here is some information on how children develop during middle childhood:

Emotional/Social Changes
Children in this age group might:

• Start to form stronger, more complex friendships and peer relationships. It becomes more emotionally important to have friends, especially of the same sex.
• Experience more peer pressure.
• Become more aware of his or her body as puberty approaches. Body image and eating problems sometimes start around this age.

Thinking and Learning
Children in this age group might:

• Face more academic challenges at school.
• Become more independent from the family.
• Begin to see the point of view of others more clearly.
• Have an increased attention span.

Positive Parenting Tips
Following are some things you, as a parent, can do to help your child during this time:

• Spend time with your child. Talk with her about her friends, her accomplishments, and what challenges she will face.
• Be involved with your child’s school. Go to school events; meet your child’s teachers.
• Encourage your child to join school and community groups, such as a sports team, or to be a volunteer for a charity.
• Help your child develop his own sense of right and wrong. Talk with him about risky things friends might pressure him to do, like smoking or dangerous physical dares.
• Help your child develop a sense of responsibility—involve your child in household tasks like cleaning and cooking. Talk with your child about saving and spending money wisely.
• Meet the families of your child’s friends.
• Talk with your child about respecting others. Encourage her to help people in need. Talk with her about what to do when others are not kind or are disrespectful. Positive Parenting Tips for Healthy Child Development
• Help your child set his own goals. Encourage him to think about skills and abilities he would like to have and about how to develop them.
• Make clear rules and stick to them. Talk with your child about what you expect from her (behavior) when no adults are present. If you provide reasons for rules, it will help her to know what to do in most situations.
• Use discipline to guide and protect your child, instead of punishment to make him feel badly about himself.
• When using praise, help your child think about her own accomplishments. Saying “you must be proud of yourself” rather than simply “I’m proud of you” can encourage your child to make good choices when nobody is around to praise her.
• Talk with your child about the normal physical and emotional changes of puberty.
• Encourage your child to read every day. Talk with him about his homework.
• Be affectionate and honest with your child, and do things together as a family.

Child Safety First
More independence and less adult supervision can put children at risk for injuries from falls and other accidents. Here
are a few tips to help protect your child:

• Protect your child in the car. The National Highway Traffic Safety Administration recommends that you keep your child in a booster seat until he is big enough to fit in a seat belt properly. Remember: your child should still ride in the back seat until he or she is 12 years of age because it’s safer there. Motor vehicle crashes are the most common cause of death from unintentional injury among children of this age.
• Know where your child is and whether a responsible adult is present. Make plans with your child for when he will call you, where you can find him, and what time you expect him home.
• Make sure your child wears a helmet when riding a bike or a skateboard or using inline skates; riding on a motorcycle, snowmobile, or all-terrain vehicle; or playing contact sports.
• Many children get home from school before their parents get home from work. It is important to have clear rules and plans for your child when she is home alone.

Healthy Bodies

• Provide plenty of fruits and vegetables; limit foods high in solid fats, added sugars, or salt, and prepare healthier foods for family meals.
• Keep television sets out of your child’s bedroom. Limit screen time, including computers and video games, to no more than 1 to 2 hours.
• Encourage your child to participate in an hour a day of physical activities that are age appropriate and enjoyable and that offer variety! Just make sure your child is doing three types of activity: aerobic activity like running, muscle strengthening like climbing, and bone strengthening – like jumping rope – at least three days per week.

A pdf of this document for reprinting is available free of charge from
http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle2.html
Additional Information:
http://www.cdc.gov/childdevelopment
1-800-CDC-INFO (800-232-4636) http://www.cdc.gov/inf

Young Teens (12-14 years of age)
Developmental Milestones

This is a time of many physical, mental, emotional, and social changes. Hormones change as puberty begins. Most boys
grow facial and pubic hair and their voices deepen. Most girls grow pubic hair and breasts, and start their period. They
might be worried about these changes and how they are looked at by others. This also will be a time when your teen
might face peer pressure to use alcohol, tobacco products, and drugs, and to have sex. Other challenges can be eating
disorders, depression, and family problems. At this age, teens make more of their own choices about friends, sports,
studying, and school. They become more independent, with their own personality and interests, although parents are
still very important.
Here is some information on how young teens develop:

Emotional/Social Changes
Children in this age group might:

• Show more concern about body image, looks, and clothes.
• Focus on themselves; going back and forth between high expectations and lack of confidence.
• Experience more moodiness.
• Show more interest in and influence by peer group.
• Express less affection toward parents; sometimes might seem rude or short-tempered.
• Feel stress from more challenging school work.
• Develop eating problems.
• Feel a lot of sadness or depression, which can lead to poor grades at school, alcohol or drug use, unsafe sex, and other problems.

Thinking and Learning
Children in this age group might:

• Have more ability for complex thought.
• Be better able to express feelings through talking.
• Develop a stronger sense of right and wrong.

Positive Parenting Tips
Following are some things you, as a parent, can do to help your child during this time:

• Be honest and direct with your teen when talking about sensitive subjects such as drugs, drinking, smoking, and sex.
• Meet and get to know your teen’s friends.\
• Show an interest in your teen’s school life.
• Help your teen make healthy choices while encouraging him to make his own decisions.
• Respect your teen’s opinions and take into account her thoughts and feelings. It is important that she knows you are listening to her.
• When there is a conflict, be clear about goals and expectations (like getting good grades, keeping things clean, and showing respect), but allow your teen input on how to reach those goals (like when and how to study or clean).

Child Safety First
You play an important role in keeping your child safe―no matter how old he or she is. Here are a few tips to help
protect your child:

• Make sure your teen knows about the importance of wearing seatbelts. Motor vehicle crashes are the leading cause of death among 12- to 14-year-olds.
• Encourage your teen to wear a helmet when riding a bike or a skateboard or using inline skates; riding on a motorcycle, snowmobile, or all-terrain vehicle; or playing contact sports. Injuries from sports and other activities are common.
• Talk with your teen about the dangers of drugs, drinking, smoking, and risky sexual activity. Ask him what he knows and thinks about these issues, and share your thoughts and feelings with him. Listen to what she says and answer her questions honestly and directly.
• Talk with your teen about the importance of having friends who are interested in positive activities. Encourage her to avoid peers who pressure her to make unhealthy choices.
• Know where your teen is and whether an adult is present. Make plans with him for when he will call you, where you can find him, and what time you expect him home.
• Set clear rules for your teen when she is home alone. Talk about such issues as having friends at the house, how to handle situations that can be dangerous (emergencies, fire, drugs, sex, etc.), and completing homework or household tasks.

Healthy Bodies

• Encourage your teen to be physically active. She might join a team sport or take up an individual sport. Helping with household tasks such as mowing the lawn, walking the dog, or washing the car also will keep your teen active.
• Meal time is very important for families. Eating together helps teens make better choices about the foods they eat, promotes healthy weight, and gives your family members time to talk with each other.
• Limit screen time for your child to no more than 1 to 2 hours per day of quality programming, at home, school, or afterschool care.

A pdf of this document for reprinting is available free of charge from
http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence.html

Additional Information:
http://www.cdc.gov/childdevelopment
1-800-CDC-INFO (800-232-4636) http://www.cdc.gov/info

Teenagers (15-17 years of age)
Developmental Milestones
This is a time of changes for how teenagers think, feel, and interact with others, and how their bodies grow. Most girls will be physically mature by now, and most will have completed puberty. Boys might still be maturing physically during this time. Your teen might have concerns about her body size, shape, or weight. Eating disorders also can be common, especially among girls. During this time, your teen is developing his unique personality and opinions. Relationships with friends are still important, yet your teen will have other interests as he develops a more clear sense of who he is. This is also an important time to prepare for more independence and responsibility; many teenagers start working, and many will be leaving home soon after high school.

Here is some information on how teens develop:

Emotional/Social Changes
Children in this age group might:

• Have more interest in romantic relationships and sexuality.
• Go through less conflict with parents.
• Show more independence from parents.
• Have a deeper capacity for caring and sharing and for developing more intimate relationships.
• Spend less time with parents and more time with friends.
• Feel a lot of sadness or depression, which can lead to poor grades at school, alcohol or drug use, unsafe sex, and other problems.

Thinking and Learning
Children in this age group might:

• Learn more defined work habits.
• Show more concern about future school and work plans.
• Be better able to give reasons for their own choices, including about what is right or wrong.

Positive Parenting Tips
Following are some things you, as a parent, can do to help your teen during this time:

• Talk with your teen about her concerns and pay attention to any changes in her behavior. Ask her if she has had suicidal thoughts, particularly if she seems sad or depressed. Asking about suicidal thoughts will not cause her to have these thoughts, but it will let her know that you care about how she feels. Seek professional help if necessary.
• Show interest in your teen’s school and extracurricular interests and activities and encourage him to become involved in activities such as sports, music, theater, and art.
• Encourage your teen to volunteer and become involved in civic activities in her community.
• Compliment your teen and celebrate his efforts and accomplishments.
• Show affection for your teen. Spend time together doing things you enjoy.
• Respect your teen’s opinion. Listen to her without playing down her concerns.
• Encourage your teen to develop solutions to problems or conflicts. Help your teenager learn to make good decisions. Create opportunities for him to use his own judgment, and be available for advice and support.
• If your teen engages in interactive internet media such as games, chat rooms, and instant messaging, encourage her to make good decisions about what she posts and the amount of time she spends on these activities.
• If your teen works, use the opportunity to talk about expectations, responsibilities, and other ways of behaving respectfully in a public setting.
• Talk with your teen and help him plan ahead for difficult or uncomfortable situations. Discuss what he can do if he is in a group and someone is using drugs or under pressure to have sex, or is offered a ride by someone who has been drinking.
• Respect your teen’s need for privacy.
• Encourage your teen to get enough sleep and exercise, and to eat healthy, balanced meals.
• Encourage your teen to have meals with the family. Eating together will help your teen make better choices about the foods she eats, promote healthy weight, and give family members time to talk with each other. In addition, a teen who eats meals with the family is more likely to have better grades and less likely to smoke, drink, or use drugs. She is also less likely to get into fights, think about suicide, or engage in sexual activity.

Child Safety First
You play an important role in keeping your child safe―no matter how old he or she is. Here are a few tips to help protect your child:

• Talk with your teen about the dangers of driving and how to be safe on the road. You can steer your teen in the right direction. CDC’s “Parents Are the Key” campaign has steps that can help. Motor vehicle crashes are the leading cause of death from unintentional injury among teens, yet few teens take measures to reduce their risk of injury.
• Remind your teen to wear a helmet when riding a bike, motorcycle, or all-terrain vehicle. Unintentional injuries resulting from participation in sports and other activities are common.
• Talk with your teen about suicide and pay attention to warning signs. Suicide is the third leading cause of death among youth 15 through 24 years of age.
• Talk with your teen about the dangers of drugs, drinking, smoking, and risky sexual activity. Ask him what he knows and thinks about these issues, and share your feelings with him. Listen to what he says and answer his questions honestly and directly.
• Discuss with your teen the importance of choosing friends who do not act in dangerous or unhealthy ways.
• Know where your teen is and whether a responsible adult is present. Make plans with her for when she will call you, where you can find her, and what time you expect her home.

A pdf of this document for reprinting is available free of charge from
http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence2.html

Additional Information:
http://www.cdc.gov/childdevelopment
1-800-CDC-INFO (800-232-4636) http://www.cdc.gov/info

What do we know?

• “Social cognition” means being able to understand our own and others’ thoughts, desires, intentions, and feelings.
• Children begin to develop social skills when they understand how people’s thoughts, desires, intentions, and feelings affect the way they act and behave.
• Infants are born with an innate preference for social interactions. From birth, they pay the most attention to human faces and voices.
• In the first months of life, infants are able to smile at people, and respond to others with gestures and facial expressions.
• By the end of the first year, infants start to share interest and attention in objects with you, and may decide whether or not to try a new activity based on your expression. For example, your infant may not play with a new toy if you appear anxious or worried.
• Around the age of two, toddlers distinguish a real object from a pretend object (ex. using a block as a telephone).
• As they grow older, children become able to talk about what they and other people like, want, think or know (around age 3). They also understand that people express different emotions depending on the situation (ex. knowing that an individual is happy when he gets what he wants or sad if he does not).
• Four-year-old children usually recognize that other people’s thoughts may differ from their own. They no longer believe that everyone knows what they know. This step in their development helps them to understand that their own thoughts do not always reflect reality.
• Children who are able to control impulsive thoughts and behaviours are better able to develop social cognition.
• Children who develop social cognition at a young age have the foundations for good social interactions before they start school.
• School-aged children with a well developed social cognition have a tendency to be better at resolving conflicts with friends, which in turn can lead to more positive relationships with their peers. But equally these children may be better at deception and manipulation.
• Social and cognitive understanding can have a positive impact on children’s later school success.

Information
This Key Message is a publication of the Centre of Excellence for Early Childhood Development (CEECD) and the Strategic Knowledge Cluster on Early Child Development (SKC-ECD). These organizations identify and summarize the best scientific work on early childhood development. They disseminate this knowledge to a variety of audiences in formats and languages adapted to their needs.

For a more in-depth understanding of Social Cognition, consult our synthesis and Experts’ articles on this topic in the Encyclopedia on Early Childhood Development, available free of charge at www.child-encyclopedia.com.

Several funders financially support the CEECD and the SKC-ECD, including the Social Sciences and Humanities Research Council of Canada, Université Laval, and private foundations. The views expressed herein do not necessarily represent the official policies of these organizations.

We are grateful to the Fondation Lucie et André Chagnon, the Margaret & Wallace McCain Family Foundation and the Alberta Centre for Child, Family and Community Research for their financial contributions to produce this Key Message.

Centre of Excellence for Early Childhood Development
GRIP-Université de Montréal
P.O. Box 6128, Succursale Centre-ville
Montreal, Quebec H3C 3J7
Telephone: 514.343.6111, extension 2541
Fax: 514.343.6962
E-mail: cedje-ceecd@umontreal.ca
Website: www.excellence-earlychildhood.ca
In this document, the masculine form is used to simplify the text. No discrimination is intended.

http://www.child-encyclopedia.com/sites/default/files/docs/coups-oeil/social-cognition-info.pdf

What do we know?

• It is normal for young children to sometimes feel afraid, shy or sad. However, for some children, these feelings last for a long time and can affect their development.
• Emotional problems like anxiety and depression often happen at the same time. Both can be described as feelings of inner emotional distress.
• It is more common for young children to have fears and anxieties than depression.
• It is hard to detect symptoms of anxiety and depression in young children (unlike aggression and hyperactivity). If anxiety and depression are not noticed and addressed in the early years, they can lead to mental health problems later in life.  However, it is important to know that this only happens in a relatively small percent of children.
• The children who are most likely to have emotional problems later in life are those who are behaviourally inhibited.
• Toddlers and young children who are behaviourally inhibited appear very shy, tend to avoid social contacts and withdraw from unfamiliar situations.
• Children usually first show signs of emotional problems when around other children.
• Young children with anxiety and depression are often fearful, worried and nervous around other children. They rarely initiate contact and are at risk for being rejected or ignored by peers.
• However, a positive peer relationship, such as having a best friend, can help protect anxious and depressed children against the negative consequences of emotional problems.
• Children’s environment, including their parents’ behaviours, family conflicts and traumatic experiences, can also lead at risk children to develop anxiety and depression.
• Parents can help protect children from later emotional problems by showing supporting guidance, allowing children to explore their environment, and by providing warm, sensitive and consistent response and discipline.

Information
This information sheet is a publication of the Centre of Excellence for Early Childhood Development (CEECD) and the Strategic Knowledge Cluster on Early Child Development (SKC-ECD). These organizations identify and summarize the best scientific work on early childhood development. They disseminate this knowledge to a variety of audiences in formats and languages adapted to their needs.

For a more in-depth understanding of anxiety and depression, consult our synthesis and experts’ articles on this topic in the Encyclopedia on Early Childhood Development, available free of charge at www.child-encyclopedia.com.

Several organizations financially support the CEECD and the SKC-ECD, including the Social Sciences and Humanities Research Council of Canada, Université Laval, and private foundations. The views expressed herein do not necessarily represent the official policies of these organizations.

We are grateful to The Lawson Foundation and the Margaret & Wallace McCain Family Foundation for their financial contribution to produce this information sheet.

Centre of Excellence for Early Childhood Development
Strategic Knowledge Cluster on Early Child Development

Université de Montréal
3050, Édouard-Montpetit Blvd., GRIP
P.O. Box 6128, succursale Centre-ville
Montreal, Quebec H3C 3J7
Telephone: 514.343.6111, extension 2541
Fax: 514.343.6962
E-mail: cedje-ceecd@umontreal.ca
Websites: www.excellence-earlychildhood.ca and www.skc-ecd.ca
In this document, the masculine form is used merely to simplify the text. No discrimination is intended.

http://www.child-encyclopedia.com/sites/default/files/docs/coups-oeil/anxiety-and-depression-in-children-info.pdf

What do we know?

• Discipline is what you do everyday–it is about teaching and guidance, not punishment.
• Discipline teaches children what is acceptable and what isn’t.
• Discipline that combines high levels of warmth and acceptance with firm control helps children to follow instructions, to respect rules, and to be attentive.
• Parents who establish clear rules and limits encourage the development of positive behaviours and attention in children. They also encourage children to explore their environment while respecting certain limits.
• Good discipline helps children develop their social skills (empathy, cooperation, problem-solving) and succeed in school.
• Children have a higher likelihood of developing behavioural problems when parents react with punishments or temper outbursts in face of misbehaviours.
• Attitudes toward discipline and control vary based on the social and cultural context.
• Too much parental control may limit children’s ability to make decisions for themselves and to express their needs to parents.
• In contrast, children who are allowed to do anything they want tend to have trouble distinguishing between what is acceptable and what is not. Poor parental supervision also increases the risk of injuries in young children.

Information
This information sheet is a publication of the Centre of Excellence for Early Childhood Development (CEECD) and the Strategic Knowledge Cluster on Early Child Development (SKC-ECD). These organizations identify and summarize the best scientific work on early childhood development. They disseminate this knowledge to a variety of audiences in formats and languages adapted to their needs.

For a more in-depth understanding of discipline, consult our topics Aggression and Parenting skills in the Encyclopedia on Early Childhood Development, available free of charge at www.child-encyclopedia.com.

Several organizations financially support the CEECD and the SKC-ECD, including the Social Sciences and Humanities Research Council of Canada, Université Laval, and private foundations. The views expressed herein do not necessarily represent the official policies of these organizations.

We are grateful to the Fondation Lucie et André Chagnon for its financial contribution to produce this information sheet and to the Margaret & Wallace McCain Family Foundation for its financial support of this revised edition.

Centre of Excellence for Early Childhood Development
Strategic Knowledge Cluster on Early Child Development

Université de Montréal
3050, Édouard-Montpetit Blvd., GRIP
P.O. Box 6128, succursale Centre-ville
Montreal, Quebec H3C 3J7
Telephone: 514.343.6111, extension 2541
Fax: 514.343.6962
E-mail: cedje-ceecd@umontreal.ca
Websites: www.excellence-earlychildhood.ca and www.skc-ecd.ca
In this document, the masculine form is used merely to simplify the text. No discrimination is intended.

http://www.child-encyclopedia.com/sites/default/files/docs/coups-oeil/discipline-info.pdf

The death of a family member, friend or other significant person is a lifelong loss for children. It is normal for children to miss the person who died and to experience grief that might come and go with different levels of intensity for some time after the death. It can be challenging to parents and caregivers to know what to do for, what to say to and how to help children who are obviously hurting. Here are a few suggestions about how to be helpful to a grieving child based on research and practice among children’s grief support professionals and volunteers. It is important to note that grief reactions in children are varied, wide ranging and unique to each individual. The following suggestions will help guide you as you seek to be provide understanding and compassion to children living with grief.

Grief is a normal reaction for children to the death of someone significant. When children experience the death of a person who has played a significant role in their life, it is normal for children to struggle, whether the relationship with that person was caring and loving, or contentious and difficult. The absence of a person takes time to fully accept and even then, children may continue to miss them in their own special way. In truth, children never “get over” a person’s death, but they can learn to live with the reality. Grief is not a problem we are trying to fix for a child; it is an experience they are living. Mood changes or feelings of grief, even several years out from the event, are a common part of adapting to life without someone and to the changes that come with that person’s death. Children need adults to be patient with them as they adjust to these changes.

Children need to know the truth. Most parents and caregivers would agree that they would prefer that their children not have to deal with the difficult truths that might accompany a death. So, quite often we avoid words like “dead” or “die,” or we shade over the truth about how a person died in a desire to protect children. Unfortunately, in doing so, we often create other problems. Although it may be challenging to share the truth about how someone died, honest answers build trust, help provide understanding and allow children to feel comfortable approaching us with questions because they know they can trust us to tell them the truth. Children know more than we think they do and by not telling the truth, we risk leaving children to process complicated information on their own, rather than with the loving adults in their lives.

Each child’s grief is as unique to him or her as was their relationship with the deceased. Because of this, the way children experience and express their grief will vary for each person. Some children have a need to talk about the person who died and their feelings about it; others might not talk about the person at all; and even others, might express their grief through art, play, music or writing. In whatever way children might experience and respond to their grief, these expressions are how they are adapting to life without the physical presence of that person and adjusting to one of memories. It is important not to assume what children might be feeling about a person’s death. Reactions vary from sadness, anger, fear, guilt and even relief. It is important to listen to children, meet them on their terms and come to understand their unique grief reactions.

Grieving children often feel alone and misunderstood. Many well-meaning adults avoid talking about the deceased person in fear that doing so will exacerbate the grief children are experiencing. In doing so, children might feel as though talking about or even expressing their grief is not acceptable. Also, many children feel like they are the only person who has experienced the death of someone in their life, even though there might be other friends experiencing similar circumstances. It is helpful to children when the adults in their lives provide opportunities to acknowledge the grief everyone is feeling. It is also helpful when children are able to gather with peers grieving similar situations. When children feel understood by family and friends and when they have the opportunity to express their grief in their own unique way, they feel less alone and, in turn, fare better than they would otherwise.

Children will experience grief over the death of significant people at different times throughout their lives. Many times, intense feelings of grief will last longer and come more often than we think they should. In time, as children have opportunities to express their grief, tell their stories, share their memories and process what this death means to them, they might find the intense feelings come less often. But, grief is a lifelong journey and children often experience their grief on different levels and at different times throughout their lives. When a child gets their driver’s license, scores a touchdown, goes to prom or graduates from high school, they might revisit their grief in a very intense way. This extends into adulthood as well, when they have children of their own, or get married. Grief has no time limit. Allowing children to share openly about feelings can help to normalize this experience and help them find ways to deal with these powerful feelings that will come and go…and come back again throughout their lives.

Grieving children often experience personal growth as a result of their loss. Personal growth is often a by-product of going through the grief. It is important to note that personal growth does not diminish the sense of loss or grief a person feels, nor does it imply that someone’s death was a positive experience. Yet, many children have reported that they are more compassionate toward others, value relationships with friends and family on a new level or experience a greater sense of appreciation for life after the death of someone.

Grieving children feel less alone when they are with other children who have experienced the death of a significant person and when they have loving, consistent adults in their lives. Greater than any education, information or advice we can give to children who are grieving is to allow children who are grieving to connect with other children going through a similar experience. When children have the opportunity to interact with one another, they feel less alone. It is also important for children to have adults in their lives who provide a safe environment that is consistent, teaches resilience and encourages accountability, while allowing children the freedom to express their grief. Research has shown that one of the top indicators of how well children will do after the death of a significant person in their life is directly related to the type of relationship they have with the surviving adult(s) in their lives and how well these adults are able to cope with their own grief.

Knowledge is Power. You do not have to be alone as the parent or caregiver of a grieving child. There are many resources available via the internet and in the form of grief support for your child. You can find children’s grief support programs near you at www.ChildrenGrieve.org and you can find encouragement and answers to some of your questions at the following websites:

www.dougy.org
www.hellogrief.org
www.achildingrief.com

Copyright © 2013 by National Alliance for Grieving Children. All rights reserved. You can quote, link to, re-post or translate this article, in its entirety, as long as you include the author name and a working link back to this website. www.ChildrenGrieve.org

References
Silverman, Phyllis R., Madelyn, Kelly (2009) A Parent’s Guide to Raising Grieving Children. New York, NY: Oxford University Press.
Worden, William J. (1996) Children and Grief: When a Parent Dies. New York, NY: Guilford Press.
Schuurman, Donna (2003) Never the Same: Coming to Terms with the Death of a Parent. New York, NY: St. Martin’s Press.
Emswiler, Mary Ann, Emswiler, James P. (2000) Guiding Your Child through Grief. New York, NY: Bantam Books.
Tedeschi, Richard, Calhoun, Lawrence G. (1999) Facilitating Post Traumatic Growth. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Kubler-Ross, Elisabeth (1969) On Death and Dying. New York, NY: Scribner.

https://childrengrieve.org/resources/about-childhood-grief

Authors: Lawrence Robinson, Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: November 2018.
Helpguide.org

Sure, it’s fun to share a good laugh. But did you know it can actually improve your health? It’s true: laughter is strong medicine. It draws people together in ways that trigger healthy physical and emotional changes in the body. Laughter strengthens your immune system, boosts mood, diminishes pain, and protects you from the damaging effects of stress. As children, we used to laugh hundreds of times a day, but as adults, life tends to be more serious and laughter more infrequent. But by seeking out more opportunities for humor and laughter, you can improve your emotional health, strengthen your relationships, find greater happiness—and even add years to your life.

Why is laughter the sweetest medicine for the mind and body?

Laughter is a powerful antidote to stress, pain, and conflict. Nothing works faster or more dependably to bring your mind and body back into balance than a good laugh. Humor lightens your burdens, inspires hope, connects you to others, and keeps you grounded, focused, and alert. It also helps you release anger and forgive sooner.

With so much power to heal and renew, the ability to laugh easily and frequently is a tremendous resource for surmounting problems, enhancing your relationships, and supporting both physical and emotional health. Best of all, this priceless medicine is fun, free, and easy to use.

Laughter is good for your health

Laughter relaxes the whole body. A good, hearty laugh relieves physical tension and stress, leaving your muscles relaxed for up to 45 minutes after.

Laughter boosts the immune system. Laughter decreases stress hormones and increases immune cells and infection-fighting antibodies, thus improving your resistance to disease.

Laughter triggers the release of endorphins, the body’s natural feel-good chemicals. Endorphins promote an overall sense of well-being and can even temporarily relieve pain.

Laughter protects the heart. Laughter improves the function of blood vessels and increases blood flow, which can help protect you against a heart attack and other cardiovascular problems.

Laughter burns calories. OK, so it’s no replacement for going to the gym, but one study found that laughing for 10 to 15 minutes a day can burn approximately 40 calories—which could be enough to lose three or four pounds over the course of a year.

Laughter lightens anger’s heavy load. Nothing diffuses anger and conflict faster than a shared laugh. Looking at the funny side can put problems into perspective and enable you to move on from confrontations without holding onto bitterness or resentment.

Laughter may even help you to live longer. A study in Norway found that people with a strong sense of humor outlived those who don’t laugh as much. The difference was particularly notable for those battling cancer.

Physical health benefits of laughter:

Boosts immunity Lowers stress hormones Decreases pain Relaxes your muscles Prevents heart disease

Mental health benefits of laughter:

Adds joy and zest to life Eases anxiety and tension Relieves stress Improves mood Strengthens resilience

Social benefits of laughter:

Laughter helps you stay mentally healthy

Laughter makes you feel good. And this positive feeling remains with you even after the laughter subsides. Humor helps you keep a positive, optimistic outlook through difficult situations, disappointments, and loss.

More than just a respite from sadness and pain, laughter gives you the courage and strength to find new sources of meaning and hope. Even in the most difficult of times, a laugh–or even simply a smile–can go a long way toward making you feel better. And laughter really is contagious—just hearing laughter primes your brain and readies you to smile and join in the fun.

The link between laughter and mental health

Laughter stops distressing emotions. You can’t feel anxious, angry, or sad when you’re laughing.

Laughter helps you relax and recharge. It reduces stress and increases energy, enabling you to stay focused and accomplish more.

Laughter shifts perspective, allowing you to see situations in a more realistic, less threatening light. A humorous perspective creates psychological distance, which can help you avoid feeling overwhelmed and diffuse conflict.

Laughter draws you closer to others, which can have a profound effect on all aspects of your mental and emotional health.

Laughter brings people together and strengthens relationships

There’s a good reason why TV sitcoms use laugh tracks: laughter is contagious. You’re many times more likely to laugh around other people than when you’re alone. And the more laughter you bring into your own life, the happier you and those around you will feel.

Sharing humor is half the fun—in fact, most laughter doesn’t come from hearing jokes, but
rather simply from spending time with friends and family. And it’s this social aspect that plays such an important role in the health benefits of laughter. You can’t enjoy a laugh with other people unless you take the time to really engage with them. When you care about someone enough to switch off your phone and really connect face to face, you’re engaging in a process that rebalances the nervous system and puts the brakes on defensive stress responses like “fight or flight.” And if you share a laugh as well, you’ll both feel happier, more positive, and more relaxed—even if you’re unable to alter a stressful situation.

How laughing together can strengthen relationships

Shared laughter is one of the most effective tools for keeping relationships fresh and exciting. All emotional sharing builds strong and lasting relationship bonds, but sharing laughter also adds joy, vitality, and resilience. And humor is a powerful and effective way to heal resentments, disagreements, and hurts. Laughter unites people during difficult times.

Humor and playful communication strengthen our relationships by triggering positive feelings and fostering emotional connection. When we laugh with one another, a positive bond is created. This bond acts as a strong buffer against stress, disagreements, and disappointment. Humor and laughter in relationships allows you to:

Be more spontaneous. Humor gets you out of your head and away from your troubles. Let go of defensiveness. Laughter helps you forget resentments, judgments, criticisms, and doubts.

Release inhibitions. Your fear of holding back is pushed aside.

Express your true feelings. Deeply felt emotions are allowed to rise to the surface.

Use humor to resolve disagreements and tension in your relationship

Laughter is an especially powerful tool for managing conflict and reducing tension when emotions are running high. Whether with romantic partners, friends and family, or coworkers, you can learn to use humor to smooth over disagreements, lower everyone’s stress level, and communicate in a way that builds up your relationships rather than breaking them down.

How to bring more laughter into your life

Laughter is your birthright, a natural part of life that is innate and inborn. Infants begin smiling during the first weeks of life and laugh out loud within months of being born. Even if you did not grow up in a household where laughter was a common sound, you can learn to laugh at any stage of life.

Begin by setting aside special times to seek out humor and laughter, as you might with exercising, and build from there. Eventually, you’ll want to incorporate humor and laughter into the fabric of your life, finding it naturally in everything.

Here are some ways to start:

Smile. Smiling is the beginning of laughter, and like laughter, it’s contagious. When you look at someone or see something even mildly pleasing, practice smiling. Instead of looking down at your phone, look up and smile at people you pass in the street, the person serving you a morning coffee, or the co-workers you share an elevator with. Notice the effect on others.

Count your blessings. Literally make a list. The simple act of considering the positive aspects of your life will distance you from negative thoughts that block humor and laughter. When you’re in a state of sadness, you have further to travel to reach humor and laughter.

When you hear laughter, move toward it. Sometimes humor and laughter are private, a shared joke among a small group, but usually not. More often, people are very happy to share something funny because it gives them an opportunity to laugh again and feed off the humor you find in it. When you hear laughter, seek it out and ask, “What’s funny?”

Spend time with fun, playful people. These are people who laugh easily–both at themselves and at life’s absurdities–and who routinely find the humor in everyday events. Their playful point of view and laughter are contagious. Even if you don’t consider yourself a lighthearted, humorous person, you can still seek out people who like to laugh and make others laugh. Every comedian appreciates an audience.

Bring humor into conversations. Ask people, “What’s the funniest thing that happened to you today? This week? In your life?”

Simulated laughter

So, what if you really can’t “find the funny?” Believe it or not, it’s possible to laugh without experiencing a funny event—and simulated laughter can be just as beneficial as the real thing. It can even make exercise more fun and productive. A Georgia State University study found that incorporating bouts of simulated laughter into an exercise program helped improve older adults’ mental health as well as their aerobic endurance. Plus, hearing others laugh, even for no apparent reason, can often trigger genuine laughter.

To add simulated laughter into your own life, search for laugh yoga or laugh therapy groups. Or you can start simply by laughing at other people’s jokes, even if you don’t find them

funny. Both you and the other person will feel good, it will draw you closer together, and who knows, it may even lead to some spontaneous laughter.

Creating opportunities to laugh;

Watch a funny movie, TV show, or YouTube video Invite friends or co-workers out to a comedy club Read the funny pages Seek out funny people Share a good joke or a funny story Check out your bookstore’s humor section Host game night with friends Play with a pet Go to a “laughter yoga” class Goof around with children Do something silly Make time for fun activities (e.g. bowling, miniature golfing, karaoke)

Tips for developing your sense of humor

An essential ingredient for developing your sense of humor is to learn not to take yourself too seriously and laugh at your own mistakes and foibles. As much as we’d like to believe otherwise, we all do foolish things from time to time. Instead of feeling embarrassed or defensive, embrace your imperfections. While some events in life are clearly sad and not opportunities for laughter, most don’t carry an overwhelming sense of either sadness or delight. They fall into the gray zone of ordinary life—giving you the choice to laugh or not. So choose to laugh whenever you can.

How to develop your sense of humor

Laugh at yourself. Share your embarrassing moments. The best way to take yourself less seriously is to talk about times when you took yourself too seriously.

Attempt to laugh at situations rather than bemoan them. Look for the humor in a bad situation, and uncover the irony and absurdity of life. When something negative happens, try to make it a humorous anecdote that will make others laugh.

Surround yourself with reminders to lighten up. Keep a toy on your desk or in your car. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh. Frame photos of you and your family or friends having fun.

Remember funny things that happen. If something amusing happens or you hear a joke or funny story you really like, write it down or tell it to someone to help you remember it.

Don’t dwell on the negative. Try to avoid negative people and don’t dwell on news stories, entertainment, or conversations that make you sad or unhappy. Many things in life are beyond your control—particularly the behavior of other people. While you might view carrying the weight of the world on your shoulders as admirable, in the long run it’s unrealistic and unhealthy.

Find your inner child. Pay attention to children and try to emulate them—after all, they are the experts on playing, taking life lightly, and laughing at ordinary things.

Deal with stress. Stress can be a major impediment to humor and laughter, so it’s important to keep your stress levels in check. One great technique to relieve stress in the moment is to draw upon a favorite memory that always makes you smile—something your kids did, for example, or something funny a friend told you.

Don’t go a day without laughing. Think of it like exercise or breakfast and make a conscious effort to find something each day that makes you laugh. Set aside 10 to 15 minutes and do something that amuses you. The more you get used to laughing each day, the less effort you’ll have to make.

Using humor to overcome challenges and enhance your life

The ability to laugh, play, and have fun not only makes life more enjoyable but also helps you solve problems, connect with others, and think more creatively. People who incorporate humor and play into their daily lives find that it renews them and all of their relationships.

Life brings challenges that can either get the best of you or become playthings for your imagination. When you “become the problem” and take yourself too seriously, it can be hard to think outside the box and find new solutions. But when you play with the problem, you can often transform it into an opportunity for creative learning.

Playing with problems seems to come naturally to children. When they are confused or afraid, they make their problems into a game, giving them a sense of control and an opportunity to experiment with new solutions. Interacting with others in playful ways helps you retain this creative ability.

Approximately 1 in 9 women in the United States experiences symptoms of postpartum depression, according to the Centers for Disease Control and Prevention. Now, the Food and Drug Administration (FDA) has approved brexanolone, an analog of the endogenous human hormone allopregnanolone and the first drug specifically designed to treat postpartum depression.

Some psychiatric drugs owe their discovery to chance — serendipitous observations of clinical benefit — or a process of incremental improvement based on drugs previously discovered by chance. Not so with brexanolone, which has a truly novel mechanism of action and was developed by design, thanks to a series of basic and translational neuroscience studies. FDA approval represents the final phase of a bench-to-bedside journey for this drug — a journey that began in the NIMH Intramural Research Program (IRP).

In the 1980s, NIMH IRP researchers discovered that metabolites (products formed when the body breaks down or “metabolizes” other substances) of the steroid hormones progesterone and deoxycorticosterone bound to and acted upon receptors for gamma-aminobutyric acid (GABA) — a major inhibitory neurotransmitter in the brain. These steroids were found to amplify GABA-activated chloride ion currents, thereby impacting the excitability of neurons.

This finding led to a series of studies, completed by researchers in the NIMH IRP and by researchers at institutions funded by NIMH, that clarified how these metabolites fluctuate during times of stress and during the estrous cycle in rats and the menstrual cycle in humans. Research indicated that the concentration of one of these metabolites (allopregnanolone) increases during pregnancy, but then drops after birth. In some women, this drop triggers the development of depression and anxiety.

A biopharmaceutical company utilized these basic research findings to develop brexanolone, a drug that can be used to treat postpartum depression by restoring levels of this metabolite. Successful clinical trials have led to FDA approval of an injectable version of this drug.

Want to learn more about this story? NIMH experts are available to provide information on postpartum depression and the importance of, and the science underlying, brexanolone.

Who:

• Joshua Gordon, M.D., Ph.D., NIMH Director
• Peter Schmidt, M.D., Chief of the Behavioral Endocrinology Branch, part of NIMH IRP
• Mi Hillefors, M.D., Ph.D., Chief of the Translational Therapeutics Program, Division of Translational Research

For interviews, photos, or additional background information, please contact the NIMH Press Office at 301-443-4536 or NIMHpress@nih.gov.

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

NIH…Turning Discovery Into Health^®

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When Therapy Doesn’t Work

What to do next

Joel L. Young, M.D.

For many people, therapy is a treatment of last resort. A depressed person, for instance, might delay therapy for months or even years, only to give in when his symptoms become so terrible that anything seems preferable to living another day with depression.  Because therapy patients often view therapy as a panacea—and one which they’ll only try when life gets impossible—the disappointment you feel when therapy doesn’t work can be deep, cutting, and profoundly demoralizing.

Mental illness is just like any other health condition, though. Whether it’s difficulty coping with stress or something more serious, such as post-traumatic stress disorder, the first treatment doesn’t always work. If you had heart disease, you wouldn’t throw up your hands and give up if your first medication didn’t yield results, so don’t do the same with therapy! If therapy has failed you, you still have plenty of options for feeling better.

Ask Your Therapist About Next Steps

If therapy isn’t working, the first person you should talk to is your therapist. She may opt to change her approach to treatment, pursue more “homework” options for you, or even refer you to another therapist.

Be sure to ask the following questions:

• How long should it take for me to see results?
• What treatment method are we using, and is it too early to try a different approach?
• Is there anything I can do to increase the efficacy of therapy?
• Could medication help? What about lifestyle changes?

Pursue Lifestyle Changes

Therapy is just one step in your treatment journey, not the whole journey. One of the greatest benefits of therapy is that your therapist can give you the confidence and strength you need to pursue lifestyle treatments. A good therapist can also recommend changes you can make that might improve your prognosis. Every person is different, and every mental health condition demands slightly different treatment. Generally speaking, though, the following lifestyle changes can often help you combat mental illnesses:

• Developing a regular schedule and taking time each day to plan your day. Remember, time is exactly like money, and by budgeting your time, you may find you have more of it—not to mention less stress.
• Take steps to ensure your lifestyle and environment are healthy. If you are in an abusive relationship, leave. If conflict with loved ones is an ongoing problem, work to resolve these conflicts.
• Eat a balanced, healthy diet rich in lean proteins, fruits, and veggies.
• Get at least 150 minutes of cardiovascular activity each week.
• Commit to a regular sleep schedule, getting up and going to bed at the same time each night. Aim for seven to eight hours of sleep.
• Start meditating. If meditation is not your style, try another activity that forces you to slow down and focus on your breathing, such as yoga or mindfulness-based cognitive therapy.

Do Your Homework

Therapy isn’t brain magic. There’s nothing your therapist can say that will mysteriously re-scramble things in your brain, immediately making your life better. Instead, therapy is hard work. Just as you’ll never learn algebra if you don’t do your math homework, you’ll never learn to better manage your emotions and life if you don’t do your therapy homework. By following your therapist’s assignments, you enable yourself to adopt new coping mechanisms and move beyond the struggles of the past.

But what if your therapist doesn’t give you homework? Homework doesn’t have to be specific or involve paper. Instead, it’s simply a matter of doing the things your therapist suggests with an open mind. If he asks you to focus on saying no less, give it a shot before rejecting it out of hand. And if your therapist doesn’t give you homework, it’s time to start asking for some—or begin working with a therapist who is a bit more proactive.

Try a New Therapist

The single best predictor of whether therapy will work is whether you and your therapist is a good fit. A therapist who accepts your values, understands your emotions, and who makes you feel accepted and heard is key to therapy. If your therapist isn’t offering you this, it’s time to try someone else.

What if you like your therapist but therapy’s just not going where you want it? It’s not enough to like your therapist, and there’s huge differences in competence from therapist to therapist. If therapy’s not working, consider whether your therapist is the right one for you. If your therapist hasn’t done at least the following, it’s time to move on:

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• Talked with you about treatment options and advised on what you can do to increase the effectiveness of therapy.
• Set specific treatment goals and given you a timetable for when you can see results
• Talked to you about medication for your mental health condition.
• Given you a diagnosis or a clear picture of what you’re in therapy to work on.
• Given you clear, specific recommendations for homework and other activities you can do to build upon what you’re learning in therapy.

Talk to Your Doctor

Research suggests that, for many mental health conditions, combining therapy with medication is the single most effective way to see results. If therapy’s not working, it’s time to consider taking medication. But medication is not the only thing your doctor can help you with. Health problems can interfere with your progress, and some physical health problems masquerade as mental health problems. The sluggishness some people experience with hypothyroidism, for example, can mimic common symptoms of depression. It could be that you’re struggling with an easily treated health problem, so ask for blood work and give your doctor a specific, detailed list of your symptoms and health history.

It can be deeply frustrating when therapy doesn’t work, but this is just the beginning of the journey, not the end. If you’re willing to research your condition, be a good advocate for yourself, and keep trying until something works, you can feel better sooner than you expect.