By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

We have a 5-year-old son and a 2-year-old daughter who can be very sweet with each other. Other times our son acts very aggressively towards her, squeezing or pushing her and yelling.

When questioned, he’ll say, ‘I feel like you love her more than you love me.’ Having been extremely jealous of my own sister, I can relate to what he is going through. How can I help him treat her with more kindness, feel loved, and not create the long-lasting jealousy that I felt?

Also, should we consult a counselor (or when do we know if we’re at a point when we need one?), and are there other books or resources you would recommend for families going through similar sibling rivalry situations?

Dear Concerned Parent,

On the one hand, there are several benefits to having a three-year spread between siblings — while your son is at preschool you can bond with your daughter, having a strong career alongside raising children can be more manageable with maternity leaves being spread apart, for the first three years of his life your son has had ample exclusive time in developing his sense of self in the world. Your 2-year-old daughter has a model and mentor to learn from in her older brother.

On the other hand, your 5-year-old son has been used to having you to himself, and he may now feel that he is being forced to share your time, care, love, and attention with his sister, and in doing so, it appears that he is feeling less important to you. While he is sweet sometimes with his sister, his emotional conflict likely occurs when he perceives that you do not have time for him in relation to his sister. In turn, frustration turns to anger, and anger to aggression as a solution (albeit a maladaptive one).

So what is your best course of action to correct your son’s behaviors?

Step 1
First, you will want to correct your son’s behavior when he acts out with anger and aggression, but you will also want to do it in a way that will increase his involvement and appreciation for his sister. Saying “no” or “go to time out” or reacting negatively alone to his behavior will likely validate his distorted feelings that you love his sister more than you love him, and that may perpetuate or worsen things.

Instead, the next time he crosses the line with his sister, I recommend that you separate him quietly from everyone and sit with him for 5-10 minutes. The timeout is a consequence, but it is also an opportunity for the two of you to dialogue; to discuss what happened on a feeling level for your son, and to come up with ideas for how to manage those feelings better the next time he struggles with his sister.

Step 2
Second, I also recommend that you speak about your son and your daughter positively in their shared presence. Your 2-year-old daughter’s vocabulary is limited, so you can be her voice with affirmative statements for your son to hear.

For example, when your son is encouraged to share something with your daughter or when he does something nice for her on his own, you can voice, “thank you so much for thinking about me…that feels good…you are such an awesome big brother.” You will want to repeat this often so that the two of them experience each other and their relationship in a positive way on a regular basis.

Step 3
Third, I also recommend actively enlisting your son as the “big boy” who helps his mommy with his little sister — singing songs to soothe his sister when she is upset, handing a towel to mommy after his sister’s bath, or fetching a diaper quickly for mommy when there is an urgent need, etc. Praise, praise, praise your son for being such a great big brother and babysitter to his sister — even for very small things to start.

You will find a nice listing of children’s picture books on the topic of sibling rivalry here. You might also find Siblings Without Rivalry: How to Help Your Children Live Together So You Can Live Too, by Faber and Mazlish, and Beyond Sibling Rivalry: How To Help Your Children Become Cooperative, Caring And Compassionate, by Goldenthal, to be good reads on the topic.

With structure and attention to your children’s needs and time, most sibling rivalry matters improve. However, should your son’s problem with his sister persist or worsen over time and with your efforts (say a few months), I would recommend seeing a pediatric/child psychologist for guidance and support.

By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

My 8-year-old son was recently diagnosed with ADHD. After an extensive questionnaire and the urging of his teacher, the doctor recommended we medicate him. However, I am struggling with what to do. I am told by other parents the medication is effective — but I can’t help thinking this is a fad diagnosis, as our society tends to medicate everything.

How do I know if he truly has ADHD, or is he just a “spirited” boy?

Dear Concerned Parent,

These are excellent questions that are often asked of pediatricians, family physicians, child psychiatrists, and psychologists by parents. Professionals typically rely on the DSM-5 or the ICD-10 for diagnosing, and children with ADHD generally experience difficulty in three areas: lack of focus/inattention, impulsivity, and hyperactivity. For a child to meet the criteria for ADHD, per the DSM-5 or ICD-10, significant attentional problems must be identifiable across the important areas of the child’s life — e.g., school and home. Typically, ADHD is diagnosed in children by age 8.

You Might Also Like: Parenting a Child With ADHD

For your doctor to recommend medication, he/she must’ve determined that your son met enough of the symptoms within the guidelines for ADHD. Based on what you’ve written, though, it appears that your doctor diagnosed ADHD and prescribed medication to treat it, relying primarily on a parent questionnaire and teacher feedback. It does not appear that any standardized or objective testing was conducted to identify your son’s problems or to rule out other potential issues or conditions. Pediatricians are well-trained to accurately diagnose ADHD; however, ADHD testing can also be very helpful for an accurate diagnosis since children with ADHD have higher rates of mood, behavior, and learning problems. So, knowing what is causing what and to what degree with testing may be essential to helping your son, especially since you seem reluctant to accept the ADHD diagnosis or the medication he received from his doctor.

You have a couple of options at this point. You could start your son on the prescribed medication and see if he improves. If you are too unsure of the diagnosis and the prescribed medicines for your son, you could instead have him evaluated by a child psychologist. That evaluation would, again, accurately identify the areas in which your son is struggling, to what degree he is struggling, and whether or not he meets the criteria for ADHD. The testing would also serve as a roadmap of sorts for specific recommendations based on your son’s results. You could also begin a course of cognitive-behavior therapy and parent training/guidance to address your son’s attentional struggles. Therapy and parenting work would teach your son (and you as a parent) coping skills and strategies, and if successful, you may be able to bypass medication altogether.

To your point that ADHD is “a fad diagnosis” and that we over-medicate as a society, the research actually supports the opposite. In 1995, the National Institute of Mental Health did a large-scale study on childhood ADHD and found that only 1 in 8 children diagnosed with ADHD were receiving medication or therapy for the condition. The United States consumes approximately five times more Ritalin than anyplace else in the world; however, better diagnosis and more accessibility to services are believed to be the reasons for this. Whether you agree with medications for your son or not, there is a large body of research to support the efficacy of certain medicines for the treatment of ADD and ADHD. So if your son does meet the criteria for ADHD and his functioning warrants a medication regimen, he would most likely benefit.

By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

I cheated on my husband about two years ago, and I’ve gone back and forth between feeling very guilty about what I did and being okay with my plan to keep it a secret. It was a one-time very, very stupid moment that I regret, and it happened with a coworker on a business trip. I still see my coworker, but I put a stop to things right after that night. He’s also married, and his wife doesn’t know either.

My close friends have all told me to not say anything (and most articles on the Internet pointed me in that direction), but after all this time, I’m still having a hard time letting it go. My relationship with my husband is great in so many ways and I couldn’t imagine ever being apart from him. I just feel so dishonest and like such a phony, and the kinder and sweeter he is to me and the kids, the worse I’ve felt about myself. I actually really don’t know why I did it, and I don’t want to make excuses for myself, but I often drink too much and even blacked out the night I cheated.

The way I see it is if I tell my husband, I will hurt him, and knowing him, he will divorce me. This will hurt not just me and him but the kids, and why should they suffer? If I don’t tell my husband then I’m the only one who suffers and we stay married and that seems best for me and for everyone else. Right? I’d love some advice on my situation.

Dear Concerned Parent,

I am reminded of the old saying, “What happens in Vegas stays in Vegas,” which, as you’ve learned, is actually not true for big moments. Sure, you’ve been able to successfully keep the secret of your isolated sexual indiscretion from your husband, but the experience remains with you today and at a high emotional cost.

The reason I think you’re having such a hard time letting go and moving on two years after that night is because of the strong love you have for your husband and your family. I can only imagine that the guilt you feel over what you did has been truly horrible for you.

Unfortunately, there really isn’t a one-size-fits-all solution to your moment or problem, or at least one that will make all of your upset go away or disappear. Your friends will certainly give you their advice, and so too will Google and I, but at the end of the day, only you can decide what’s best for you and your husband and family.

Certainly, an argument could be made for you to continue to keep your secret and for you to continue to work through your emotional conflicts. With that approach, as you shared, only you have been the one to suffer in your family, and with enough time and space, perhaps you’ll learn to accept what happened and let go of the pain all on your own. By keeping the event a secret from your husband, for the past two years, you and your husband have remained married and your family has remained intact; you’re all continuing to enjoy the love and security of being together.

That, as you also shared, could all go away if you were to tell your husband what you did; he would likely become hurt and angry, and he may even leave you, and your children would likely also be negatively impacted by whatever would come next — fighting, separation, and/or divorce. As you know as a mother, children are perceptive, and at the very least, your children would likely become aware of the pain both your husband would be experiencing together if you told him about your infidelity.

But, an argument could also be made for telling your husband what happened, come what may. In God’s eyes, marriage is a sacred covenant between a husband and a wife, and protecting the sanctity of your marriage is your shared duty based in love, honor, and commitment. Whether your wedding was a religious or civil ceremony, being faithful was an expectation and understanding you both had for one another when you exchanged vows and joined in your life together. Your husband is half of your partnership, yet by not knowing what happened, he’s completely in the dark. He may believe that the foundation of his marriage is strong, when in fact, it now has some very real cracks.

Doesn’t your husband arguably have a right to know about those cracks? Isn’t it arguably unfair for you to keep him from knowing the truth since it’s his life too? Shouldn’t it arguably be his choice to remain in the marriage or not and not yours by keeping your infidelity from him?

It seems that you and your husband had a fully whole relationship before that night; and your shared hearts had all of the important ingredients for true happiness — trust, honesty, commitment, and love. But now you have only the appearance of that, which, appreciatively, has been extremely difficult for you. While some of the important ingredients remain in your marriage (e.g., your love for him and his for you), you now carry some painful ones in your heart — deception, manipulation, and lies.

While it’s clear to me, based on what you’ve shared, that the status quo isn’t working for you, it’s also apparent that your ambivalence has, and continues to, cause you great pain. In my experience, ambivalence is often rooted in emotional conflict, so perhaps there were problems for you (and in the marriage) before that night. The idea that your relationship with your husband is great isn’t consistent with your drinking to excess, blacking out, and engaging in sexual relations with another man.

So, what do I think you should do? I recommend that you seek out the services of an experienced psychologist who can help you work through the complexities of your situation toward the best possible decision and outcome. A good therapist will also help you understand yourself and your struggles better, and he or she may wish to include your husband in that work. I think you already know that this is perhaps one of the most important moments in your life, and thus, I don’t think you should go it alone or rely solely on the informal advice of your friends, Google, or me to get it right. Take your time, work on yourself, and what you need to do will become clearer to you.

By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Technology is ubiquitous; computers, tablets, gaming systems, smartphones — wherever we are or go these days, it seems that some sort of screen is right there with us. While there are plenty of advantages to having become a technology-driven world, our children are also at risk for its misuse and overuse.

According to research on screen and media time use, teens spend as much as 9 hours a day on media, and tweens around 6 hours a day. And findings have shown that technology problems for children can start very early in life. Before their first birthday, one in seven babies is on a mobile device for at least an hour a day. Most concerning are the developmental research findings that have shown that exposure to certain types of technology (e.g., overstimulating media) for infants and toddlers can lead to later intellectual/cognitive, emotional, and behavioral problems.

As a child psychologist, I frequently meet with parents and their children or teens to help them better manage screen and media time use. In my work, there is very often a relationship between a child or teen’s screen and media time overuse and the emotional struggles, social struggles, academic struggles, and/or health struggles (e.g., weight gain and sleep problems) they are experiencing.

So, does your child or teen have a problem with technology? I invite you to take a look at the following questions to help you find your answer:

∙ Does your child or teen have a compulsive or addictive relationship with technology?

∙ Is your child or teen more comfortable in virtual reality than reality; is being with technology more attractive for your child or teen than being in real-time?

∙ Does your child or teen dysregulate or become upset when he or she does not have access to technology or when technology limitations are put in place?

∙ Has your child or teen talked about how he or she will have a career as a gamer, game designer, or YouTube personality?

∙ Does your child or teen isolate themselves for long periods of time with technology?

∙ Does your child or teen constantly talk about or become distracted by technology?

∙ Has your child or teen told you that he or she does not have problems with socializing because he or she is socializing during video games or online in different ways?

∙ Has your child or teen’s functioning suffered due to technology use (e.g., withdrawing socially, an increase in poor grades, gaining weight, exhibiting symptoms of depression or anxiety, or having mood swings and/or behavior problems in relation to technology)?

∙ Have your child or teen’s sleeping patterns, hygiene, and eating patterns been negatively impacted by technology use?

∙ Has your child experienced observable withdrawal symptoms when they cannot game or get online?

∙ Has your child or teen engaged in lying or devious behavior due to technology use?

∙ Has technology use led to a decrease in activities that were once enjoyable to your child or teen?

An affirmative answer to any one of these questions should be a red flag for you as a parent or parents. If you answered yes to two or three of the above questions, your child or teen likely has a very real problem with technology. So, what do you do? I offer the following tips to help parents with screen and media time management:

∙ Block adult contact with parent controls on all devices.

∙ Know what your child or teen is watching and doing.

∙ Set limits — if your child or teen is disagreeable with you setting limits, then there are programs available now that you can set to blocks of time for usage or that can turn off your child’s technology at a specific time each day or evening.

∙ Designate screen-free moments and zones in the house — no technology at meals or at other times or in certain spaces.

∙ Technology use should be in public, monitored areas of the Home — do not allow TVs, gaming systems, or computers in your child or teen’s rooms.

∙ Strive for balance in your child or teen’s day, and keep them busy — if your child or teen is outside of the house engaging in structured or unstructured activities, he or she is not at home over engaging in technology.

∙ Periodically check the browser history of your child or teen’s computer and monitor or check other devices.

∙ Show an interest in your child or teen’s technology — from video games to YouTube or social media, your child or teen will likely feel respected by you and closer to you if they experience you as an ally with technology and not just the rule enforcer.

∙ The quality of the content is just as important as the time spent engaging in it, so encourage positive and productive content whenever you can (e.g., helping your child or teen with organization or time management with an online calendar).

∙ Teach your child or teen appropriate behaviors that apply in both the real and online worlds.

∙ Lead by example — limit your own media use and model online etiquette.

By implementing the above tips, and with some time, screen and media time management can be achieved. Remember, technology should be a positive thing for our children and teens, and when used in moderation and appropriately, it can complement and enhance their lives. But if your child or teen’s technology problems have become too big to correct alone as parents, I recommend that you seek out the assistance of a child psychologist with training and experience in this area.

By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

My husband thinks I’m harming our son for life because of how I parent. Our son is 12 years old and diagnosed with ADHD in the 1st grade. My husband calls me “the enabler” because I admittedly double or triple-check things for our son, give him constant reminders, and stay up late with him to get homework and projects done.

My husband’s approach to parenting our son is to leave him alone to fail. My husband’s favorite line is, “How will he ever learn to do things for himself if you are always doing everything for him?” Our son isn’t doing great at school these days, so I’m afraid I have to disagree with the hard-knock approach to parenting my husband believes in. Can you advise me on how to get through to my husband that being hands-on is a must when parenting a child with ADHD? Your input is appreciated.

Dear Concerned Parent,

All children with ADHD, to varying degrees, struggle with mastering executive functioning skills and abilities — attention/concentration, organizing, initiating tasks, working memory, impulsivity, planning and prioritizing, self-monitoring, reasoning, and exercising good judgment. The prefrontal cortex is the brain’s main area associated with executive functioning and ADHD.

So, if your son has ADHD, he likely has executive functioning struggles and a weak frontal lobe. To that point, you are correct that the parents of a child with ADHD must be more proactive and hands-on. But being aggressive with your son doesn’t mean overmanaging him.

By managing and supporting reasonable expectations consistently and calmly, breaking things down, keeping (and sticking to) a schedule, reinforcing behaviors with rewards and consequences, modeling, being supportive and loving, and by repeating, repeating, repeating, you can do a lot as parents to bring about change for your child.

Manage & Support Reasonable Expectations Consistently
It’s not uncommon for a parent of a child with ADHD to have disagreements with their child. That’s because the parent (who most often does not have ADHD) may not always appreciate what it’s like to have executive functioning struggles. If you ask your son to do his homework, for example, he should do it, right? Wrong. A child with ADHD will often require more structure in these moments. That’s why the parent or parents of a child with ADHD must be reasonable regarding expectations. A child with ADHD may need the expectation or responsibility overly defined initially.

Based on your description, your son likely can do more, but his ADHD interferes. As a loving mother, it seems your solution is to jump in at times to ensure things get done. But this approach is upsetting your husband, and to his point, you may be doing more for your son than you should be. Here’s a thought — instead of doing things for your son, do something with your son. So, when it comes to homework, you could sit with your son while he does it and assist only when necessary. If he has chores, you can do your household tasks alongside your son while he completes his own. By managing and supporting your son consistently in this way, he will internalize the success he experienced in these moments, and over time, this will allow for authentic learning and change to occur.

Break Things Down
ADHD is a neurodevelopmental condition that impacts information processing, and children with ADHD tend to get overwhelmed when too much information is coming in at one time. Thus, keeping things simple for your son should also lead to good results. One way to do this would be to break things down for your son across his day, where he would have a well-defined morning, afternoon, and evening plan or routine.

Keep & Stick to a Schedule
Children with ADHD typically benefit from having a schedule to stay on top of things. In today’s technology-driven world, having an online program (e.g., Google Calendar or Apple Calendar) is an excellent way to introduce scheduling to a child. If your son has his phone, for instance, you and your son could color-code his activities and responsibilities into his day on the phone, and you and your son could even program reminders or alarms. If your son doesn’t yet have a smartphone at 12, you could use a computer or a laptop to help him with organization, time management, and task completion.

Sticking to a schedule can be difficult when life gets busy, but it’s essential for children with ADHD. Whether your son uses a paper schedule or an online one, it will work best if he uses it repeatedly and in the same way. Research on forming habits has shown that we can learn a new tradition within a few weeks when consistently practicing the new behavior.

Reinforce Behaviors with Praise, Rewards, & Consequences
It’s human nature to want new things, and it’s also human nature to keep the things we have and like. Rewarding your son for a job well done will get him some of the things he wants, and over time, it will also help him feel better about himself. Thus, rewarding good behavior creates a win-win dynamic: an external positive (good behavior = getting things or keeping things) and an internal positive (getting things = feeling good about oneself and oneself about essential others).

In general, children want to do well, and they also want to make their parent or parents proud, so praise is an essential reinforcement tool for parents. So, remember to praise your son generously for reasonable attempts and a job well done. While I disagree entirely with your husband’s position, as you’ve described it, I think children need to learn from their mistakes to learn and grow. Natural consequences are part of life; protecting your son from them is not good.

Model
There’s an old saying, “Do as I say, and not as I do,” and even the best parents fall prey to this sort of moment with their children from time to time. But as a general rule, this is a horrible way to parent since children learn, in large part, from watching their parents.

At 12, your son is developmentally at an age and period where he is expected to identify more with his same-sex parent. For preadolescent boys, these are “the shaving cream years” and “the fishing trip years.” This is the time in your son’s life when he will take in his father’s values, beliefs, and views on life in his process toward manhood. Based on what you’ve written, you and your husband don’t see eye to eye on your son’s ADHD. My concern is that your son, at 12 years of age, is aware of this, which could upset him. I recommend that you and your husband discuss how you would like to model your expectations for your son better; your son will do best when he sees his parents being more united in their support of his struggles and well-being.

Be Supportive & Loving
As you likely know, ADHD strategies are typically behavioral, but encouraging your son to express his thoughts and feelings is also important. At 12, your son needs to understand what it means for him to have ADHD, and behavior strategies alone will not lead to increased self-awareness or insight. He needs to be able to talk about the negative feelings he might be experiencing that are associated with his struggles, and he needs your support, guidance, and loving feedback as parents to do (and feel) better. Sharing some of your struggles from childhood with your son can also be a supportive and loving parent intervention.

Repeat, Repeat, Repeat
When it comes to changing or improving behaviors, children with ADHD benefit from lots of practice and repetition. Whatever agreed-upon expectations you and your husband set for your son, there will likely be plenty of trial and error, so remember to be patient. Just like we might do push-ups to make our chest and arm muscles stronger, children with ADHD need to do frontal lobe push-ups, so to speak, to strengthen their executive functioning skills and abilities.

I hope my suggestions here help you and your husband move from a place of disagreement to an agreement regarding your son’s ADHD. If things don’t improve for your son within a reasonable period, I recommend that you seek out the assistance of a child psychologist specializing in ADHD. That professional can work closely with your son (and you as parents) to address your concerns and your son’s needs.

By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

Our teenage daughter is interested in pursuing a career in ballet. She absolutely believes that ballet is her calling, and unfortunately, she sees everything else as being less important, including grades and spending time with her family. When she’s not at the studio dancing, she’s at the gym working out or somewhere counting calories…yes, she’s way too thin, too!

My husband and I have tried to talk sense into her, but we get into huge fights every time we challenge her to think through things. Her latest master plan is to take a gap year off after graduating from high school so she can study ballet in New York City. She not only expects us to pay for her year of dance education and training in New York City since we agreed to pay for her college, but she also plans on just showing up in the Big Apple without applying anywhere! We are unwilling to support this absurd plan. We told our daughter that we expect her to go to college and would pay for it in full, but we are not paying for her to hang out in New York City to take ballet classes. It’s not that we have anything against ballet, but we just don’t want our daughter to be a starving artist.

Our daughter is furious with us and tells us that she hates us and doesn’t care about anything. We read somewhere that you are the Chief Mental Health Consultant for the Loudoun School of Ballet and Company. So we were hoping that you could give us some guidance on our situation.

Dear Concerned Parent,

Yes, very few ballet students have the talent, discipline, perseverance, and good fortune to have a successful professional career in the field of dance. Yes, a dance career is typically a short one that is fraught with injuries, disappointment, and periods of unemployment. And yes, professional ballet dancers, even at the highest level, don’t make a great living. Yes, yes, and yes, your daughter would be choosing a hard life indeed as a professional dancer. However, based on what you’ve written, your daughter’s passion for dance is high, and as loving parents, you need to figure out a way to support her.

While I think your concerns are valid, taking a stance that’s in direct opposition to your daughter’s strong desire to dance professionally is a bad idea. Look where it’s gotten you. You want your daughter to attend college, and she wants to dance, so I think your approach should be one that aims for compromise.

I think that you should start by asking your daughter to consider attending college and majoring in dance, in NYC or someplace else. In fact, many fine universities across the country offer a Bachelor of Fine Arts in Dance (BFA), and several of these schools have great track records for launching their students into top ballet companies after graduation.

Or, if your daughter is already dancing at a high level, and if she doesn’t want to attend college, you could ask her to consider auditioning for ballet companies following her graduation from high school. She may have a greater chance of landing a contract with a regional company than an urban one since the competition would likely be tougher in cities.

I would also consider enlisting the help of your daughter’s current ballet teacher since your daughter likely has great respect for him or her. Your daughter’s teacher likely danced professionally with him or herself and had been in the industry for some time, so that person also has credibility and legitimate authority to help your daughter plan for her future in dance. I also recommend that you discuss your concerns regarding your daughter’s low-weight and calorie-counting approach to food with her teacher since competitive ballet dancers have increased rates of eating disorders.

As parents, it’s our job to protect our children, and again, your concerns are entirely understandable. Remember, though, as parents, it’s also our job to support our children’s dreams and to help them (as much as we can) turn their dreams into reality. Your daughter may or may not end up having a career as a professional ballet dancer, but she will always remember how you supported her (or didn’t) at this moment.

By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

We are pretty open in our house with our nudity. I have three children — two school-age kids (a boy and a girl) and a toddler daughter. Often, the kids, of their own volition, will shower or bathe together and have no issues getting dressed or undressed in front of the other. They even often hop in the shower with us.

My husband thinks, that as they get older, we might be too liberal and need to start putting up barriers. I think the lack of barriers, but respect and privacy when they (or us parents) desire, contributes to a healthy understanding and acceptance of not only their bodies — but of the opposite gender. What are your thoughts?

Dear Concerned Parent,

I think the concern your husband is expressing is good. Nudity with children as parents should be natural, as you write, but also developmentally appropriate. Nudity is a big part of toddlerhood, with parental bathing, dressing, and toilet training. Open parental nudity and bathing with toddlers as an adult is not really an issue since toddlers do not yet have a complete understanding of gender or body image, which could, in turn, affect their developing identities. Open nudity and bathing with one’s toddler could also promote the parent-child bonding experience.

For your school-age children (your daughter and son), however, privacy involving their bodies and exposure to adult nudity is more important. This is because your older children do have an understanding of their more private body parts, a rough and developing understanding of sex/gender differences, and an expectation for discretion socially.

In my experience as a psychologist, problems involving parental nudity and bathing with children can occur when parents are not sensitive to their children’s developmental needs. In those instances, being too permissive or too strict as parents at the wrong times can lead to later problems (e.g., bodily shyness or shame, poor boundaries, early sexual curiosity, and behavioral exploration).

While there is no absolute right or wrong answer to your question, I do not recommend continued parental nudity with your school-age children, and I do not think that your school-age son and daughter should be bathing together or dressing together. I would not make a big deal out of things with your children, but rather, I would find agreement with your husband on setting clearer boundaries that work for you both.

By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

I have three kids, and all of them are the biggest hypochondriacs! They are so over-concerned with the most minor of scrapes and bruises.

We go through an excessive amount of band-aids because any scrape, cut, or even blemish requires one (or three) tears, and crying will ensue. I remember being covered in bruises and scabs as a kid — it was just a normal thing to have. Any advice on how I can get them to cut the dramatics?

Dear Concerned Parent,

While you may have three children who all meet the criteria for Hypochondriasis, I would doubt that to be the case, since their symptoms would be negatively impacting their lives more profoundly.

Children with Hypochondriasis aren’t only overly sensitive or overdramatic, rather their anxiety can be debilitating. In reading your letter, it seems that your three children may have varying degrees of anxiety and/or may have highly sensitive personality styles. It is also apparent that they are wearing you down with their overreactions to their scrapes and nicks.

Keep in mind that your children’s responses, while strong, do not seem unusual. Children typically cry in response to scrapes and bruises. The tears, Band-Aids, and attention they are turning to you for, all serve to heal the moment — both emotionally and physically. As your children grow older, they will learn to self-regulate their strong, negative feelings without needing you as much or without the need for “dramatics.”

I recommend being there for them when they need you with tender care and emotional warmth, and as many Band-Aids, as they seem to need. Over time they will internalize your presence as being a healing one, with the message always being that they are OK when confronted by minor scrapes and bruises. “Gee, every time I go to mommy with a boo-boo, I’m okay” should eventually turn into “Gee, maybe I don’t need to go to mommy” or “Gee, maybe I can shake it off, and I don’t need a Band-Aid.”

One thing you can do to help your children manage their emotions better in these moments as a parent is to stepwise things towards greater independence and self-reliance. I’ll use my three-year-old son as an example here. Whenever my boy used to bang himself on something, he would cry and immediately demand an ice cube for me to place on his “boo-boo,” and I would hold him until the tears passed and the ice cube melted. After going through this routine many times, I then just had him rubbed and/or blow on the boo-boo (but without ice). Later I would just hold him, and my presence alone was enough to comfort him through the upsetting moment. I never needed to say no to the ice cubes because he eventually felt secure and safe enough to not ask for them himself.

If, however, your children remain overly sensitive and overly reactive to minor scrapes and bruises, you may want to consider meeting with a child psychologist to determine if any sort of treatment is warranted. Cognitive behavior therapy (and other methods) is very effective in the treatment of children with anxiety.

By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

My eight-year-old daughter is showing signs of anxiety. She has difficulty being confident in her fundamental decisions and almost breaks down with indecision. When do I chalk this up to her personality or seek help? Can someone as young as her exhibit anxiety that warrants therapy or medication?

Dear Concerned Parent,

Childhood anxiety is not uncommon, with estimates of significant concern occurring for 10% to 15% of school-aged children. Eight-year-olds are typically fearful or anxious about things that they have been exposed to — something they have heard from friends, something they learned about at school or in the media (e.g., a plane crash or shootings), going to the doctor’s office, something they experienced in their family, etc.

Specific phobias are also not uncommon for individuals your child’s age — storms, dogs, spiders, germs, planes, and eating only select foods are a few of the more common ones. Social anxiety and school avoidance are also two areas where anxiety can show itself in elementary school children.

Anxiety may or may not be the main problem for your daughter. While stress can lead to low confidence and breaking down when overwhelmed, as you describe, so too can other things, for example, low self-esteem, depression, ADHD, family struggles, academic or school struggles, etc.

The first thing you need to do is acknowledge with your daughter (if you have not done so already) what you see and your concerns. Invite your daughter to speak with you about what upsets her and develop a game plan for what you will do to support her (and what she can begin to do to help herself) when she becomes upset next.

I would have this one-on-one conversation casually, warmly, and in an attractive setting — maybe over a bowl of ice cream or frozen yogurt at her favorite spot. Suppose the two of you can identify the triggers or antecedents and develop productive coping strategies for the negative feelings and behaviors that follow. In that case, she should be on the way to some nice improvements.

If, however, your daughter’s struggles continue, I recommend you seek the help of a child psychologist. Cognitive-behavior therapy (CBT) is considered the best therapy for anxiety; plenty of very well-done studies support that. In my opinion, medications can and should be regarded as if parental efforts and CBT have not brought about the needed changes, and only if your daughter’s symptoms are in the moderate to severe range. Most parents do not want to turn to medications unless all other approaches have been exhausted first, which is my position. A child psychiatrist is the best professional to see if drugs appear warranted. Your pediatrician and your friends might be able to recommend an excellent doctor and therapist.