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• Economic disadvantage puts a child at risk due to increased exposure to environmental, familial, and psychosocial risks
• Recognition of greater risk for children who have Adverse Childhood Experiences including:
– emotional, physical and sexual abuse
– household challenges including mother treated violently, substance abuse in home, mental illness in home, parental separation or divorce, criminal in home
• ACEs in children include a range of experiences that can lead to trauma and toxic stress
• ACEs can impact children’s brain development and physical, social, mental, emotional, and behavioral health and well‐being
• There is growing evidence that it is the general experience of multiple ACEs, rather than the specific individual impact of any one experience, that matters
• Found graded dose‐response relationship between ACEs and negative health and well‐being outcomes across the life course
• The higher the score the more likely to have adverse mental health and physical health outcomes in adulthood including alcoholism and alcohol abuse, COPD, depression, early initiation of smoking, early initiation of sexual activity, adolescent pregnancy, risk for sexual violence, poor academic achievement, suicide attempts, illicit drug use plus many more
• Evidence supports that safe, stable, nurturing relationships have a significant protective effect on the intergenerational transmission of maltreatment, abuse, neglect
• Through early identification, we have an opportunity for early intervention and to provide trauma informed care to prevent the cycle of violence and promotion of health across the lifespan
• As part of every developmental and behavioral assessment and we must consider ACEs and the effect these experiences may be having on our patients
• Bright Futures is a system of care designed to promote health and focus on child and family strengths and wellness
• Periodicity Schedule for well child care includes recommendations for screening, developmental assessment, assessment of social determinants of health, promoting strengths and protective factors‐ encourages this broader perspective in assessing and working with families
• Family medical and psychiatric history‐ ask about genetic or mental health conditions in addition to medical history
• Parenting style, parent child interactions, description of how parent views child
• Social history‐ home, child care, resources, neighborhood, social support. History of trauma, violence, addiction, abuse, criminal justice system involvement. Past and current involvement in protective services, other services
American Academy of Pediatrics (AAP) Recommendations Developmental Screening
• Conduct developmental surveillance at every health supervision visit – Surveillance is flexible, longitudinal, continuous, and cumulative process ‐health care professionals identify children who may have developmental problems.
– There are 5 components of developmental surveillance: eliciting and attending to the parents' concerns about their child's development; documenting and maintaining a developmental history; making accurate observations of the child; identifying risk and protective factors; and maintaining an accurate record of documenting the process and findings.
AAP Recommendations Social Determinants of Health Screening
• Surveillance for risk factors related to social determinants of health during all patient encounters. Ask family members questions about basic needs such as food, housing, and heat. –Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education Survey Instrument (WE CARE) Free
–Whole Child Assessment; Center for Youth Wellness ACE Questionnaire (CYW ACE‐Q) Free
• Assess Family Strengths– Integrate patient‐ and family‐centered care in practice, includes asking about and reinforcing family strengths.
96110 Developmental screening (eg. developmental milestone survey, speech and language delay screen) with scoring and documentation, per standardized instrument
96127 Brief emotional/behavioral assessment (eg. depression inventory, attention deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument
96161 Administration of caregiver‐focused health risk assessment instrument (eg.depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument
Billing coding sheet from AAP: https://www.aap.org/en‐us/Documents/coding_factsheet_developmentalscreeningtestingandEmotionalBehvioraassessment.pdf
– Children with developmental delays may have related neurobehavioral disorders such as autism spectrum disorder or attention deficit hyperactivity disorder
• Child delayed in some area of development, can be one or more areas
• Part C of IDEA broadly defines the term “developmental delay” • Term varies from state to state• Each state describes evaluation and assessment procedures• Each state specifies level of delay in functioning (or other comparable criteria) that constitutes developmental delay
• What’s your state’s definition? Early Childhood Technical Assistance Center at: http://www.nectac.org/~pdfs/topics/earlyid/partc_elig_table.pdf
Individualized Family Service Plan (IFSP) 0‐3 years
• IFSP is a written document that outlines early intervention services the child and family will receive – usually in home
• Includes: – Child’s physical, cognitive, communication, social/emotional, and adaptive development
levels and needs– Family information, including the resources, priorities – Major results or outcomes expected to be achieved for child and family– Specific services child will be receiving– When/where in the natural environment (e.g., home, community) services will be
provided– Number of days or sessions for each service and how long each session will last– Who will pay for the services
DSM‐V Definition of ADHD Persistent pattern of inattention and/or hyperactivity‐impulsivity that interferes with functioning or development
In addition to meeting diagnostic criteria, the following conditions must be met:
1. Several inattentive or hyperactive‐impulsive symptoms were present before age 12 years.
2. Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
3. There is clear evidence that the symptoms interfere with, or reduce the quality of social, school, or work functioning.
4. The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
• Often has trouble holding attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish schoolwork, chores,
or duties in the workplace (e.g., loses focus, side‐tracked).
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
• Often has trouble organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
• Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
• Is often easily distracted
• Is often forgetful in daily activities.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013
Six or more symptoms of hyperactivity‐impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity‐impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
• Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
• Often unable to play or take part in leisure activities quietly.
• Is often "on the go" acting as if "driven by a motor".
• Often talks excessively.
• Often blurts out an answer before a question has been completed.
• Often has trouble waiting his/her turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games)
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013
• American Academy of Pediatrics developed evidence based practice guidelines in October, 2011. http://pediatrics.aappublications.org/content/early/2011/10/14/peds.2011‐2654
• The AAP worked with the National Initiative for Children's Healthcare Quality (NICHQ) to develop the ADHD Toolkit for use by primary care providers. Available for download at: http://www.nichq.org/childrens‐health/adhd/resources/adhd‐toolkit
• AACAP Work Group on Quality Issues. (2007). Practice parameter for the assessment and treatment of children and adolescents with Attention Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 894‐921.
• Developed for initial evaluation and follow‐up of ADHD in preschool and school age children (ages 6‐12) – Parent Initial and Follow‐up Scales– Teacher Initial and Follow‐up Scales– Available at: http://www.nichq.org/childrens‐health/adhd/resources/vanderbilt‐assessment‐scales
• Screens for coexisting conditions (conduct disorder, oppositional‐defiant disorder, anxiety/depression)
• Preschool aged children (4‐5 years): parent or teacher administered behavioral intervention should be the first line of treatment; medication (methylphenidate) may be considered if first line treatments are not available or insufficient
• Schedule/routine– Morning routine often difficult‐ develop a clear written or visual schedule– Irritability in the late afternoon, early evening
• Consistent rules (clear, brief) and expectations• Reward positive behavior, ignore negative behavior• Use incentives to get work done• <18 months, avoid use of screen media other than video‐chatting. Parents
of children 18 to 24 months of age choose high‐quality programming, and watch it with their children. Ages 2 to 5 years, limit screen use to 1 hour per day of high‐quality programs and co‐view media.
• Toddlers (1 to 3 years) & Pre‐schoolers (3 to 5 years)‐physically active every day for at least three hours, spread throughout the day
• Recognizes that this disorder affects entire family, behavioral therapy involving all members of the household may restore balance
• Starts with parent understanding of ADHD as a neurophysiologic deficiency
• Evidence Based Programs include: New Forrest Therapy, Triple P, The Incredible Years Series, Parent Child Interactive Therapy (PCIT) https://childmind.org/article/choosing‐a‐parent‐training‐program/
• In general, dosing of amphetamines is one‐half of methylphenidate dosages
• No evidence of difference in advantages of different racemic mixtures (D‐verses DL‐)
• For preschool children, methylphenidate is recommended as the first line medication for ADHD after a 10 to 20 week trial of parent management training, parent child interactive therapy or both.
– PATS study used immediate release methylphenidate TID and found to be safe and effective in 3‐5 year olds
• Not recommended for children under 3 years of age
• In children from 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained.
• In children 6 years of age or older, start with 5 mg once or twice daily
• Patients treated with ADHD medication should have height and weight monitored (using growth charts), BP, pulse each visit
• Patients should be assessed periodically to determine if continued need for treatment or if symptoms have remitted‐ can use summers for regrowth or trial off medication
• Treatment should continue as long as symptoms remain present and cause impairment
• AAP recommends every 3‐6 month follow‐up once stable
Oppositional Defiant Disorder • 30‐40% of children with ADHD have ODD• Must exhibit 4 or more of the following symptoms:
– Often loses temper– Often argues with adults– Often actively defies or refuses to comply with adults' requests or rules– Often blames others for his or her misbehavior or mistakes– Is often touchy or easily annoyed by others– Is often angry and resentful– Is often spiteful and vindictive
• For children <5 years, the behavior should occur on most days for a period of at least 6 months, if > 5 years, the behavior should occur at least once per week for at least 6 months
• Understand that behavior is communication• The child is overwhelmed so is lashing out‐doesn’t have the skill to manage
feelings and express them in a more mature way. • May lack language, or impulse control, or problem‐solving abilities.• Advice to Parents:
– Stay calm. – Don’t give in. Don’t encourage child to continue behavior by agreeing to what child
wants to make it stop.– Praise appropriate behavior. When child has calmed down, give praise for pulling it
together. When child expresses feelings verbally, calmly, or tries to find a compromise on an area of disagreement, provide praise for those efforts.
– Help child practice problem‐solving skills. When child is not upset help child try out communicating feelings and come up with solutions to conflicts before they escalate into aggressive outbursts.
• Neurological disorder that involves impairment in processing data from the different senses (vision, auditory, touch, olfaction, and taste), the vestibular system (movement), and proprioception (body awareness)
Autism Spectrum Disorder DSM V Diagnostic Criteria
A. Persistent deficits in social communication and social interaction across multiple contexts as manifested by the following, currently or by history:
1. Deficits in social‐emotional reciprocity, ranging from abnormal social approach and failure of normal back‐and‐forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
Autism Spectrum Disorder DSM V Diagnostic Criteria
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and the use of gestures; to a total lack of facial expressions and nonverbal communication.
Autism Spectrum Disorder DSM V Diagnostic Criteria
3. Deficits in developing, maintaining and understanding relationships, ranging from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or making friends; to absence of interest in peers.
Autism Spectrum Disorder DSM V Diagnostic Criteria
C. Symptoms must be present in the early developmental period but may not become fully manifest until the social demands exceed limited capabilities, or may be masked by learned strategies later in life.
D. Symptoms cause clinical significant impairment in social, occupational or other important areas of current functioning
• No babbling by 9 months• Does not respond to name by 12 months • Does not point at objects to show interest or gestures (point at an airplane
flying over) by 12‐14 months• No single word – 16 months• Does not play "pretend" games (pretend to "feed" a doll) by 18 months • Avoids eye contact and prefers to be alone • Gets upset by minor changes in routine• Self‐stimulatory behaviors‐flaps hands, rocks body, or spins self in circles • Any loss of language or social skills at any time• Child with a sibling with ASD
Repetitive motions are actions repeated over and over again. These types of activities are known as self‐stimulation or "stimming."
Thrive on routine
They might "lose control" and have a "melt down" or tantrum if in a strange place.
May develop routines that might seem unusual or unnecessary. Not being allowed to do these types of routines might cause severe frustration and tantrums.
• If screening significant ASD symptomatology, a thorough diagnostic evaluation should be performed to determine the presence of ASD
• Clinicians should coordinate an appropriate multi‐disciplinary assessment of children with ASD
• All children with ASD should have a medical assessment, including a physical examination, a hearing screen, a Wood’s lamp examination for signs of Tuberous Sclerosis, and genetic testing (G‐banded karyotype, Fragile X or chromosomal microarray)
• The yield of genetic testing in the presence of clinical suspicion is currently in the range of 1/3 or more of cases
• A: Antecedent‐the environment, the events or the behavior that precedes the Behavior of Interest, or Target Behavior. Also known as the "Setting Event," the antecedent is anything that might contribute to the behavior.
• B: Behavior‐what the child does. This is sometimes referred to as "the behavior of interest" or "target behavior. It is the behavior that you are focusing on, that is either pivotal (leads to other undesirable behavior, or contributes to other undesirable behaviors) a problem behavior that creates danger for the child or others, or a distracting behavior, that removes the child
• C: Consequence‐outcome. It is the outcome that is reinforcing for the child, so it reinforces the maladaptive behavior.? Does the parent give the child a preferred item or food, in order to stop the behavior? Obviously, the behavior had the desired effect.
• A physiologic response necessary for all human beings to survive.
• Fears‐ emotional response to a given stimuli or situation that is identified as threatening or scary. Fears are normal part of development
• Worries are the cognitive or thinking manifestations of fear and anxiety
• Anxiety disorders‐ diagnosed when fears, worries, or anxiety occur outside the range of normal developmental responses or are extreme and cause significant distress or impairment in functioning (school, home, social settings)
• Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
• The child finds it difficult to control the worry.
• For children, the anxiety and worry are associated with one (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):– Restlessness or feeling keyed up or on edge
– Being easily fatigued
– Difficulty concentrating or mind going blank
– Irritability
– Muscle tension
– Sleep disturbance (difficulty falling or staying asleep, or restlessness, unsatisfying sleep)
– Distress with separation or anticipated separation
–Worry of harm to caretakers, worry of untoward event causing separation, physical complaints with separation
– Anticipated separation, repeated nightmares of separation
• School refusal type of separation anxiety‐ described as a persistent pattern of not wanting to go to school, avoidance of school, or high distress associated with going to school
• Anxiety disorder involving discomfort around social interaction, and concern about being embarrassed and judged by others
• This discomfort will be experienced as fear and anxiety, and may be accompanied by autonomic arousal, including diaphoresis, apnea, tremors, tachycardia, and nausea
• Essential feature is anxiety caused by exposure to a feared social situation, duration of at least 6 months
• Condition in which an individual experiences intrusive thoughts, images, or impulses that creates a high degree of emotional distress
• The person feels a need to perform some type of ritual (either overt or covert in nature)
• The ritual serves two functions: (1) to reduce the intensity of the anxiety, disgust, etc. and (2) to prevent or lessen the likelihood of acting on the thought/image. This is referred to as “thought‐action fusion” (TAF)
Behaviors Related to Posttraumatic Stress Disorder in Preschool Children
• One of the following related to traumatic events:– persistent avoidance of activities, places, or physical reminders– people, conversations, or interpersonal situations that arouse recollections– diminished interest or participation in significant activities such as play– socially withdrawn behavior– persistent reduction in expression of positive emotions
• Two or more of the following:– irritable, angry, or aggressive behavior, including extreme temper tantrums– hypervigilance– exaggerated startle response– problems with concentration– difficulty falling or staying asleep or restless sleep
Cognitive Behavioral Therapy: Evidence Based Psychotherapy
• The Child/Adolescent Anxiety Multimodal Study (CAMS) found that high quality cognitive behavioral therapy (CBT), given with or without medication, can effectively treat anxiety disorders, OCD, PTSD in children
• Can be very effective in 2/3 of children, may be used in as young as 2‐3 years old
• Short‐term therapy, with anywhere from 8‐16 sessions
• Parent Role: co‐therapist, can provide incentives for practicing skills, can practice with child
• Some of the techniques used with young children include:– children’s symptoms are given a name and put in a story form, involves cognitive tasks of self‐reflection, autobiographical recall, and causal reasoning.
– fears are placed in a bigger context of other feelings and other situations.– children are taught self‐control with relaxation tools with the message that these carry a change in locus of control.
– children are asked to imagine themselves in future situations that may trigger anxiety. This is a cognitive task of perspective taking and causal reasoning.
Selective Serotonin Reuptake Inhibitors in Pediatrics
• Fluoxetine and Escitalopram have FDA approval for MDD
• Fluoxetine, Sertraline, and Fluvoxamine approved for OCD
• No SSRI FDA approved for anxiety, but NIH sponsored studies have demonstrated effectiveness of Fluoxetine, Sertraline, and Fluvoxamine for generalized anxiety disorder, social anxiety disorder, separation anxiety disorder.
• For depression: fluoxetine and escitalopram approved• For anxiety or OCD: fluoxetine, sertraline, fluvoxamine approved• Fluoxetine has much longer half life and may be well suited if missed doses
• Escitalopram has least effect on CYP450 isoenzymes compared with other SSRIs
• Onset of effect 3‐4 weeks• Onset of side effects, including abdominal pain, discomfort can occur within a few days
• May see some benefits early on such as improved sleep
• Risperidone and aripiprazole‐ second generation antipsychotics‐ approved by the FDA for the treatment of irritability, consisting primarily of physical aggression and severe tantrum behavior, associated with autism
• Multiple side effects, a last resort
Medication Indication Ages, years Initial dose, mg Recommended dose, mg
Maximum dose, mg
Risperidone Irritability in ASD 5‐17 .25 (<20 kg).5 (>20 kg)
• Time outs for nonviolent misbehavior can work well with younger children
• Avoid triggers. Most kids who have frequent meltdowns do it at very predictable times, like homework time, bedtime, or when it’s time to stop playing, whether it’s Legos or the Xbox. The trigger is usually being asked to do something they don’t like, or to stop doing something they do like. Time warnings (“we’re going in 10 minutes”), breaking tasks down into one‐step directions and preparing child for situations can help avoid meltdowns.
• Response depends on severity. Ignore as often as possible, since even negative attention can be encouraging.
• If child gets physical, ignoring not recommended‐can result in harm
• Put child in a safe environment that does not give access to parent or any other potential rewards.
• For young children can place in a time out chair. If child will not stay in the chair, take to backup area where child can calm down without anyone else in the room. Should not have toys or games in the area that might make it rewarding.
• Child should stay in that room for one minute and must be calm before allowed out. Then child should come back to the chair for time out. This gives the child an immediate and consistent consequence for aggression, removes all access to reinforcement in environment.
• Parent training. Therapist helps parents be more consistent, more positive with child
• Parent‐child interaction therapy (PCIT). Therapist coaches parents while they interact with child, guides parents through strategies that reinforce child's positive behavior
• Individual and family therapy. Therapist helps child learn to manage anger and express feelings in a healthier way. Helps parent‐child communication.
• Cognitive problem‐solving training. Therapy aimed at helping child identify and change thought patterns that lead to behavior problems.
• Social skills training. Therapy that helps child be more flexible and learn how to interact more positively and effectively with peers.
• F98.9 Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence
• F63.81 Intermittent explosive disorder
Helpful Resources for Parents and Providers Caring for Children with MH Disorders
CHADD (Children and Adults with Attention/Hyperactivity Deficit Disorder) http://www.chadd.orgo A resource for both parents and providers that includes: Home of the National Resource Center for ADHD, ADHD toolkit, information on training
opportunities, medications and natural treatment options and publishes a magazine ‘Attention’. Must pay to be a member for full access to their website. ADDitude Magazine (https://www.additudemag.com)
o Wide range of information for both providers and parents. Quarterly magazine available online and in print. Restricts access with charge both for magazine and membership.
American Academy of Pediatrics (AAP) Healthy Children https://www.healthychildren.org/English/health‐issues/conditions/adhd/Pages/Understanding‐ADHD.aspx
o Wide range of information on variety of physical and emotional topics related to ADHD. No cost to access website. Not very interactive. American Academy of Child and Adolescent Psychiatry (AACAP) ADHD Resource Center
http://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/Home.aspxo Wide range of information on ADHD and other co‐morbid psychiatric conditions along with treatment options. Free information for both parents and
providers. Website not very interactive. Child Mind Institute https://childmind.org/about‐us/
o Provides information on symptoms and treatment of mental health disorders. Excellent parenting suggestions and guides. Section for educators. Includes a symptom checker for parents.
National Alliance on Mental Illness (NAMI) https://www.nami.orgo Provides information on disorders and treatment. Superior information for family members and caregivers. Has LGBTQ section.
National Institute on Mental Illness (NIMH) https://www.nimh.nih.gov/health/topics/attention‐deficit‐hyperactivity‐disorder‐adhd/index.shtmlo Extensive information on symptoms and treatment options. All evidence based information. Technical information and probably more useful to
provider than parents.
Resources Autism
• PCP support‐ First Signs http://www.firstsigns.org/
• Child Mind Institute: http://www.childmind.org/en/health/disorder‐guide/autism‐spectrum‐disorder
• Autism and Medication: A Guide for Families of Children with Autism Safe and Careful Use‐ available as PDF at https://www.autismspeaks.org/news/news‐item/autism‐speaks‐launches‐autism‐and‐medication‐tool‐kit.
•CHADD (Children and Adults with Attention/Hyperactivity Deficit Disorder) http://www.chadd.orgA resource for both parents and providers that includes: Home of the National Resource Center for ADHD, ADHD toolkit, information on training opportunities, medications and natural treatment options and publishes a magazine ‘Attention’. Must pay to be a member for full access to their website.
•ADDitude Magazine (https://www.additudemag.com)Wide range of information for both providers and parents. Quarterly magazine available online and in print. Restricts access with charge both for magazine and membership.
•American Academy of Pediatrics (AAP) Healthy Children https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Understanding-ADHD.aspx
Wide range of information on variety of physical and emotional topics related to ADHD. No cost to access website. • American Academy of Child and Adolescent Psychiatry (AACAP) ADHD Resource Center
http://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/Home.aspxWide range of information on ADHD and other co-morbid psychiatric conditions along with treatment options. Free information for both parents and providers. Website not very interactive.
•Child Mind Institute https://childmind.org/about-us/Provides information on symptoms and treatment of mental health disorders. Excellent parenting suggestions and guides. Section for educators. Includes a symptom checker for parents.
• Sesame Street Toolkit: https://www.sesamestreet.org/sites/default/files/media_folders/Images/Resilience_Edguide_Probsolve.pdf
• How to Foster Resilience in Kids: https://childmind.org/article/foster‐resilience‐kids/
• Building Resilience in Children (AAP): https://www.healthychildren.org/English/healthy‐living/emotional‐wellness/Building‐Resilience/Pages/Building‐Resilience‐in‐Children.aspx
– Sections for both parents and children, this app teaches young kids how to calm down and solve everyday challenges. Children enjoy the interactive “play time” with a Sesame Street monster, and educational tools are identified for parents to help manage their child’s anxieties or anger issues.
• Calm
– Practices meditation, with a focus on relaxation and sleep. “Sleep Stories” function tells tales to help users fall asleep easier. There’s also a special section for “Calm Kids.”