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7 and under
* Crying that is unusual for the
* A change in sleep habits —
nightmares, fear of going to sleep,
waking up fearful in the middle
of the night— or eating habits.
* Aches and pains upon awak-
ening in the morning where a
physical cause has been ruled
* Headaches and stomachaches,
often in conjunction with a fear
of going to school.
* Changes in toileting, such as
wetting the pants over the age of
5, or other regression, such as
* Expressed fears to the parent
or someone else indicating in-
creased worries and uncertain-
* Physical symptoms such as eye
twitches or wringing of hands.
* Trouble separating from par-
All children will experience
stress and some will have ad-
justment difficulties, says Dr.
Stettner, but symptoms like these
which last more than a couple of
months warrant intervention.
Dr. London asks parents if
they see problems in two of the
three spheres of a young child's
life: peer relationships, school and
home. "If the child has problems
in more than one sphere which
are not transitory over time, the
parents probably need help in
getting their child through what
is a developmental crisis.
"After talking with the par-
ents, a professional can tell a lot
from an initial evaluation with
the child. In some cases, I might
tell the parents to watch things
for a couple months before initi-
ating therapy," he says.
* Episodes of lying and theft
which may be attention seeking.
* Withdrawal from parents and
* Change and difficulty in social
* May have more intense out-
bursts and temper tantrums, in-
cluding destructiveness toward
* More crying than normal.
* Change in eating habits, espe-
cially overeating or undereating.
* Overlap with younger children
in terms of nightmares, aches
and pains, twitches and other
"If these symptoms persist for
more than a couple of months,
we're dealing with more than just
an adjustment problem," says Dr.
Stettner. "We see lots of adjustment
problems in September with the
start of school. It's a critical time
for kids to experience anxiety."
"When behavior interferes
with learning or social growth,
it's time for intervention," says
Dr. Jeffrey Last, a clinical psy-
chologist specializing in children
and adolescents who practices in
Southfield and Sterling Heights.
The other part of the equation
in borderline cases, he says, is
how much parents are able to tol-
erate. The need for therapy in
these instances is not determined
so much by what the child is do-
ing, he says, but by the family's
reaction. A negative reaction to
a child's behavior may reinforce
that behavior, which in turn cre-
ates more problems for the child
and the family itself
In addition to the start of
school, other common anxiety
triggers include the birth of a sib-
ling, the death of a loved one and
divorce and/or remarriage, says
Dr. Stettner. "With these kinds
of situations, it is often helpful to
take a proactive stance."
13 and above
* Changes in social-emotional re-
lationships, including withdraw-
al from parents or peer group.
* Change in eating habits in-
cluding overeating, undereating,
bingeing and purging.
* Change in sleep patterns in-
cluding sleeping too much or too
little and waking in the middle of
the night or very early in the
* Experimentation with drugs,
often involving secrecy (whis-
pered phone calls); lying; steal-
ing (including stealing from
parents); excessive use of gums,
mints, eyedrops and sunglasses.
* Association with friends par-
ents have never heard of and nev-
er get to meet.
* Moving to a more deviant, act-
ing-out peer group which is not
* Frequent skipping of school; de-.
fiant behavior at school.
* Interest in cults.
* Voiced worries about accep-
tance, feelings of rejection, com-
ments about death and dying like
"Nobody loves me," "Life isn't
Risk-taking behaviors —
drinking, drugs — always need
to be examined, says Dr. London,
although all children exhibiting
them may not need therapy.
"These teens need education, if
not counseling." With teens, he
continues, if there is a significant
problem at school, in the home or
with peers, the child should be
followed to determine if the situ-
ation is persisting. If it is, inter-
vention is appropriate.
Stresses in adoptive families
often are manifested in the ear-
ly teen years, Dr. London adds.
"Identity issues are so crucial at
this age," he says, "and the adop-
tive family is often tested."
Depression runs in families. "A
child with a depressed parent is
more likely to be depressed," says
Dr. London. And while in adults
the chemical system of the brain
is often the culprit, the causes of
depression are not as clear-cut in
THERAPY page 8
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