Connecting With Children
Interviewed by Rasa Fournier
Wednesday - August 10, 2010
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Dr. Gina Kellner
Child Psychiatrist/Kaiser Permanente
Where did you receive your schooling and training?
I graduated from Iolani School, went on to the University of Southern California and then came back to the University of Hawaii for medical school, general psychiatry residency and my child psychiatry fellowship.
How long have you been practicing?
Ten years. I’ve been practicing with Kaiser Permanente Hawaii for the past two-and-a-half years. And, prior to that, I was at Kalihi-Palama Health Center.
When a child comes to see you, what happens next?
Sessions vary depending on severity. Generally we meet every other week and then the therapists go from there. As a child psychiatrist, I do assessments, evaluations and manage medication, if it’s indicated.
Can you talk about anxiety children might face as they return to school?
Usually back-to-school anxiety is caused by the unknown factors related to school. Children aren’t sure who their teacher is going to be, what the new school year will be like, what the curriculum is, whether they’ll be able to make new friends.
What advice would you give parents to deal with these issues?
Some tips to help alleviate the anxiety are to talk to your child, ask what their worries are. For middle school kids, instead of asking, “What are you worried about,” maybe wording it, “What are your friends worried about?” For some kids who have difficulties with new situations, have them visit the school first and bring a friend. Visit the playground so there’s some familiarity. Sometimes you can go to meet the teacher and see the classroom before the actual school day so a child can get an idea of what to expect. Parents also can share some of their own stories - for example, what they experienced when they were entering first grade, what they looked forward to. For some kids who have difficulty making new friends, you can ask the teacher to do a buddy system, to assign them with another student.
Do you see differences in types of anxiety according to grade level?
I’ve been seeing quite a bit of kids transitioning into middle school. Some of the middle schools are starting earlier, from sixth grade, so that may be a contributing factor. When a child is entering kindergarten and first starting school is another common time.
Do many high school students come to you?
We do see quite a bit of adolescents. A common adolescent issue is figuring out identity. Adolescence is around the time that peers become more important. Family is still important, but peers take priority. So there may be issues with their peer group or lack of a peer group. Relationship problems also are common. Early adolescence is around the time that a lot of the anxiety disorders begin to manifest.
Does one gender have a harder time opening up to you than the other?
No. In terms of building rapport, boys and girls have different interests, but I would say it’s more dependent on individual differences. We try to focus on a child’s personality and temperament and work with that.
How do you get the more introverted children to open up to you?
Our therapists are pretty skillful at building a rapport with a child. One of the ways they do that is to have them play with toys - another method is the use of sand trays. That actually is a pretty effective method because it allows a therapist to see the themes that a child is thinking of. A lot of times it’s difficult for kids to verbalize what they’re feeling, so if you use a different type of medium you can see some of the themes that are bothering them. Sometimes we have them role play or draw a picture.
Can you discuss your parenting classes?
Kaiser Permanente offers several parenting classes. We have one for the willful child, one for parenting a child with ADHD (attention deficit and hyperactivity disorder), but the main one is called The Incredible Years, which is an evidence-based parenting class. There’s more than 30 years of data showing that it’s effective. It’s a 12-week course that meets once a week. The therapists who run it are specially trained to be able to bring this program to Kaiser. The class helps teach parents how to play with their child. It encourages them to spend one-onone time together, and it helps parents navigate their child’s emotions to prevent behavioral and conduct problems.
How do you distinguish a normal level of back-to-school anxiety from a clinical disorder?
If you see a child acting out or having behavioral problems, it may be just normal going-back-to-school anxiety, or it may be something more, if it persists. When the anxiety starts to interfere with functioning, we consider it a clinical disorder and the child should be referred for an evaluation.
Interfering with functioning could mean socially: if they’re losing friends, not spending time with friends. Or it could mean academically: You see their grades dropping, where someone who is typically an “A” student now is barely passing, not turning in their work, avoiding school. School avoidance is, unfortunately, not that uncommon.
What are some ways to help a child with ADHD prepare for the new school year?
I treat a lot of kids with ADHD and one of the common symptoms is being unorganized. It’s important when you start off the school year to find a good organizational system that will work and that a child will use - establishing structure and routines, including switching their bedtime to their regular bedtime for the school year at least a week before school starts, not the night before. And having an established place where they’re going to do homework, where they’re going to keep their belongings - for instance, deciding that their backpack goes in a certain area. And getting things prepared the night before school so they’re not scrambling in the morning.
Any other tips?
One important thing in terms of parenting is to spend one-on-one time with your child and play with your child - the kind of playing where you let the child take the lead. So when school is starting and schedules are getting more hectic, find a way to put aside some time to play with your child.
Do you notice more problems in this computer age?
I spend a lot of time telling families to limit screen time to two hours or less. Screen time includes anything that has a screen - TV, computers, hand-held video games.
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