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“Am I fat?” How to Talk to Kids About Weight

In a society that is completely dominated by appearance, it can be tricky when kids start making judgements about their own bodies. With both obesity and eating disorders on the rise, parents are often caught in the middle between teaching their child behaviors for living a healthy lifestyle and avoiding being too critical about weight or appearance.
Listen to Yourself
Many parents avoid making direct comments of their child’s weight or appearance, but fail to consider how their comments about their own bodies may be rubbing off on their children. “I look fat,” “I hate my stomach,” “I can’t go out looking like this” are things many of us are guilty of uttering in front of our children and in doing this, we are actually modeling how our children will see and talk about their own bodies. Try focusing on healthy behaviors, rather than commenting on appearance. For example, saying something like, “I feel great for working out today” communicates the benefits of exercise, without drawing your child’s attention to weight or appearance.
Teach Children about Their Bodies
The majority of comments a child hears about their body are focused on what their body looks like. As a parent, you can shift the focus from how their body looks to what their body does. Helping a young child understand how fruits and vegetables give our brain and muscles important fuel or reminding your teenager how calcium builds strong bones are ways parents can teach healthy lifestyle skills without reinforcing negative messages about weight. If a child asks about their weight – which unfortunately, is happening with increasing frequency – respond by focusing on the function of the child’s body. “Can your body do everything you want it to?” is an easy response that takes the attention off of weight.
Eliminate Food Rules
Counting calories, labeling foods as “good” or “bad,” or always restricting certain foods can lead a child to have unhealthy food rules. The only rule a child should learn about food is the importance of moderation. There will come a day that your child is in charge of what goes in their body and we need to teach our children how to make this decision. Being too restrictive with what a child eats can backfire when the decision-making power switches from you to your child. Help your child practice making healthy choices while you still have control over what food comes in and out of your house. Much of this is also modeled by example. Demonstrating what moderation looks like can ensure your child grows up with a balanced perspective on how to structure their diet.
Never Punish Weight
Being overweight or obese in today’s society is shaming enough without your parents making critical comments about your body or telling you that you “can’t eat that.” If you don’t want one of your children eating something, don’t bring it into your house. Punishing a child because of their weight or incentivizing them for losing weight sends the message that self-worth is directly correlated to the number of the scale. Instead, encourage and participate in healthy activities with your child.
Talking about weight in the wrong way can have a negative impact on your child’s physical and mental health for years to come. Avoid controlling what a child puts in their mouth and focus on helping them learn how to make healthy choices.

Autism Intervention Options

Written by Dr. Andrea Potthoff PhD LP
Your child has just been diagnosed with Autism Spectrum Disorder (ASD). What now? With so many intervention possibilities, here are some of the most common and research-supported options to consider.
ABA Therapy
For children that are non-verbal, Applied Behavior Analysis (ABA) therapy is usually the first place to start. Research shows that the sooner a child begins ABA, the better their prognosis and language skills will be in the future. A report by the American Academy of Pediatrics demonstrated that early ABA intervention can result in improvements in IQ, language, and adaptive skills. ABA is one form of behavior modification. Depending on the needs of the child, ABA services may be used daily or several times a week.
Behavior Therapy
Using many of the same principles as ABA, behavior therapy focuses on increasing desired behaviors, such as prosocial behavior, and decreasing undesired behaviors, such as aggression. The goal of this type of intervention is to increase the child’s overall compliance with directions without resorting to conflict. Parent-Child Interaction Training (PCIT) is one type of behavior therapy and has strong research support. Behavior therapy uses concrete goals and measurable outcomes that will differ in terms of your child’s developmental level and severity of symptoms.
Social Skills Training
One of the hallmark symptoms of ASD is difficulty with social interactions. This may include trouble noticing and understanding nonverbal cues, engaging in turn-taking conversations, or responding appropriately in social situations. Social skills training is a behavioral therapy that helps individuals learn the rules of social interactions that do not come as naturally in individuals with ASD. Social skills training can be conducted in individual and group formats.
Academic Accommodations
Depending on your state and school system, a diagnosis of ASD allows your child access to many different academic supports. This can range from services such as being in a special education classroom, meeting with an interventionist once a week, or receiving speech/occupational therapy and depends on the severity of the diagnosis and your child’s needs. Often times you will need to advocate for your child to maximize the services they receive in this setting.
Family Therapy
A diagnosis of ASD can often have a substantial effect on parents, caregivers, and siblings. Family therapy can help address these challenges and improve communication for all family members. Sometimes this is needed shortly after a diagnosis and for other families, they find this type of intervention most helpful during transition phases (e.g., child entering adolescence, birth of a new sibling). Support for parents and siblings is always a valuable option to consider.
There are many other intervention options that exist for individuals with ASD and their families. When considering a potential intervention, we recommend considering the research support for the intervention and looking at the right fit for your child’s development level. Most likely, the best intervention for your child will change over time. If you have questions or would like more information about the interventions we provide, please call us at 612-470-4099.

Understanding Trichotillomania

Written by Andrea Potthoff PhD LP
What is trichotillomania?
Trichotillomania (Hair-Pulling Disorder) is characterized by excessive pulling of one’s hair. This can occur anywhere on the body, including hair on the scalp, eyelashes, eyebrows, facial hair, and body hair. Trich is seen more commonly in women, but also occurs in men. Trich occurs in all age groups and is most common in adolescence and early adulthood.
Many people describe the actual act of pulling the hair as very ritualized. They may only do it during certain activities or times of day. Patients also often report being very selective about which hairs they pull, noting that they pull hairs that “don’t feel right” or have a coarser or brittler texture.
It is also common among those that pull hair to ingest the hair they have pulled. This behavior can produce a high degree of shame and embarrassment. Unfortunately, this can also cause a number of medical problems depending on the frequency and amount.
What causes it?
Research suggests a genetic predisposition for trich and it is more common in people with a family history of obsessive-compulsive disorder (OCD). Often times it develops as an anxious coping behavior that then turns into a habit. Sometimes the pulling can be intentional and systematic and other times it can happen with little awareness. Many people find that the habit starts infrequently, but then becomes difficult to stop.
How is it treated?
Many people with trich report that the more they try to resist pulling, the more intense the urge becomes. When others comment on the behavior or notice the loss of hair, this can be an intensely shameful experience. Similarly, children scolded for the behavior continue to pull their hair. Although individuals are motivated to stop pulling, specific tools are needed in order to change the behavior. Reducing shame and guilt about the behavior is often the first step of treatment.
Fortunately, there are effective therapies for trich. The Comprehensive Behavioral Treatment (ComB) is the leading intervention for trich and addresses all aspects of the pulling behavior. There are four phases in ComB that include assessing the frequency and intensity of the pulling, determining causes and reinforcers of the behavior, determining what modalities to target, teaching strategies to reduce or eliminate the hair-pulling, and evaluating and modifying each strategy as needed. When working with children or adolescents, treatment also involves working with parents and caregivers. ComB is an evidence-based treatment, meaning that research has shown it to be effective in the treatment of trich.
Medication is also a treatment option for trich, although current research suggests that behavior therapy is more effective and the FDA has not approved any medication for the specific treatment of trich. It is important to also keep in mind that some medications may increase the frequency of hair-pulling.
If you would like more information about trich or to schedule an appointment please call us at 612-470-4099 or email us at andrea@dendrinospsychology.com.

Raising Your Self-Esteem

Written by Dr. Andrea Potthoff PhD LP
Many patients I see in my private practice talk about having low self-esteem. It seems to be an almost universal complaint. It may be difficult to imagine for some, but feeling good about who you are and accepting yourself can change most aspects of your life. Here are some techniques that can help improve your self-esteem:
Domains
One way to start building self-esteem is to start measuring it in different domains. Someone might think of themselves as having low self-esteem, only to find that this really only applies to their romantic life or career. Some key domains to think about are your career/work life, appearance, family relationships, friendships, romantic life, physical health, spiritual health, intellectual pursuits, and hobbies. Once we start breaking down self-esteem, we often find that we have more strengths than we were realizing.
Consider Where It Hurts You
One way to start building self-esteem is to evaluate ways in which your lack of confidence gets in your way. For example, maybe you make less money because you are too anxious about asking for a promotion. Or maybe you are not in a romantic relationship because your negative feelings about yourself make it hard to try dating. Whatever the case may be, take those areas of impairment and turn them into areas of motivation.
Say What You Want
Consider using an affirmation to start changing your level of confidence and self-acceptance. It may feel ridiculous at first, but research shows that there are numerous benefits of using affirmations. Try creating a short affirmation in the present tense. For example, “I am smart.” Repeat it out loud daily and especially during times of self-doubt. It can be difficult to change how you think, but saying what you want out loud is the first step.
Avoid Comparisons
In the age of social media, comparison is an everyday occurrence. It surprises few people that current research shows that social media use is correlated with lower self-esteem and depressive symptoms. In order to improve your self-esteem, do everything you can to limit comparing yourself to others. This might include deactivating your social media accounts, focusing more on what you are proud about, and avoiding social interactions that tend to bring you down.
Practice Self-Compassion
Recent research shows that self-compassion can buffer against the negative effects of low self-esteem. Self-compassion incorporates three main skills: being kind to oneself, acknowledging that failures and disappointment are part of being human, and look at one’s negative thoughts and feelings with neutral awareness. As long as people were rated as high in self-compassion, self-esteem had little effect on one’s mental health. Self-compassion is more like a muscle than it is a personality trait. The more you practice it, the more you have.
If you would like to learn more about ways to increase your self-esteem, please call us at 612-470-4099 or email us at andrea@dendrinospsychology.com.

How Pregnancy Affects Your Mental Health

Written by Dr. Andrea Potthoff PhD LP
Most of us have heard of the “baby blues,” but few of us realize the ways in which all stages of pregnancy can affect mental health. In the midst of all the congratulations, it can feel difficult to talk about and seek support for pregnancy-related mental health issues. Below are some of the most common mental health issues associated with having a baby.
Fertility Challenges
Before becoming pregnant, many women find that struggles with trying to get pregnant take a significant toll on their mood and their relationships. Fertility challenges can cause depression and anxiety. Unfortunately, stress and anxiety can reduce a woman’s chance of becoming pregnant. Relaxation and stress management are crucial skills when dealing with infertility issues.
Unexpected pregnancies can also be a source of anxiety, stress, and relationship difficulties. Even if this is a welcomed surprise, the adjustment of having a child unexpectedly can exacerbate mental health symptoms.
Pregnancy Difficulties
Once becoming pregnant, many women report a change in their psychological health. For example, while pregnant, many women experience an increase in anxiety. This is especially true if they have previously experienced pregnancy loss. Some women find that they cannot control their worries related to the pregnancy, while others report that their overall level of anxiety has increased.
A number of factors can affect mental health during pregnancy including the number of children a woman has, whether or not the pregnancy was planned, and her previous history of mental health symptoms. Some women decide to stop certain psychiatric medications during pregnancy and this can cause increased concern over mental health symptoms. Social support can be a key component for managing these symptoms during pregnancy.
Many women find that mental health symptoms start during pregnancy and continue postpartum. Monitoring your symptoms and reporting them to your physician can help you better understand how your brain reacts to pregnancy and a new baby.
Postpartum Issues
After having a baby, it takes time for your body to recuperate and this includes your mental health. With fluctuating hormones, comes a wave of possible mental health symptoms. Depressive symptoms, including low mood and loss of interest, affects 10-15% of women and can affect the mother’s wellbeing and child’s development. Despite the prevalence of mental health issues after pregnancy, screenings for depressive symptoms usually occur only once. It is not uncommon to experience suicidal thoughts during this time and suicide is actually the leading cause of maternal death.
Research also tells us that the time right after a child is born is one of the more difficult times for couples. Little sleep, new stressors, and constantly changing hormones can make navigating your romantic relationship challenging. Preparing your relationship for this change can help keep both partners on the same page.
Unfortunately, expectations around motherhood and stigma around mental health can make it hard to have conversations about how you are struggling. Seeking help from a professional is one option to consider. Therapy can offer support and skills for managing pregnancy-related mental health or relationship concerns. Please call us at 612-470-4099 or email us at andrea@dendrinospsychology.com to learn more.