Editor's note: This week, we welcome guest blogger Sarah Trosper Olivo, PhD, a licensed clinical psychologist and the co-founder of City and Country CBT, located in Manhattan, Brooklyn and Westchester, NY. Please read her complete bio below.
“He’s acting out so much with school work that it’s almost not worth the struggle. I’m exhausted!”
“She’s managing her study habits more effectively, but her teacher says she’s too shy to participate in class.”
I’ve heard these statements from families countless times as they try to pinpoint all the factors that are getting in the way of their child’s learning. When 
students struggle in academics or have a difficult time managing study habits, children and their families can often take a hit with their emotional regulation.
Anxiety, depression and some defiance in children can often pop up along with executive function difficulties. It’s a chicken-or-egg conundrum. Perhaps the emotional issue was always present but is now making academic struggles all the harder -- or oftentimes the effort of coping with learning issues leads to increased stress, sadness, or acting-out behaviors.
In either case, some families will find it helpful to supplement academic coaching with emotional or behavioral support.
But where to start? What treatments are out there?
The great news for families is that there are many well-researched treatments for emotional and behavioral problems. The challenge, however, is that parents can feel overwhelmed by their choices. I always encourage families to do their homework.
An important first step is to find out if there is an effective treatment that is already known to help with the issue. If your child struggles with anxiety, depression, ADHD or oppositional behaviors, there are gold-standard treatments out there that can help. Look at websites such as Effective Child Therapy or Association for Behavioral and Cognitive Therapies for a wealth of information about evidence-based treatments.
What are the most effective treatments for anxiety and depression in children? What is an appropriate type of ADHD treatment?
Cognitive-behavioral therapy (CBT)
CBT is one of the more researched treatment options available. This is a short-term treatment, which means months and not years in therapy. CBT focuses on teaching specific skills to children and their parents, so it can feel more like a class than the typical therapy sessions you’ve seen on TV shows. In CBT, your child would learn how his or her thoughts, emotions and behaviors are connected. The idea is that these connections can work for us, helping us make brave and beneficial choices, or they can work against us, keeping us stuck in a pattern that doesn’t do us any good.
In CBT, children and families set clear and concrete goals and track progress toward those goals throughout treatment. It is a collaborative approach with the therapist, client, and family working together on the best ways to support growth. The end result is to have the child and the family become their own “therapists,” armed with skills to manage everyday stressors and hurdles.
Interpersonal therapy (IPT)
In interpersonal therapy, which is an effective treatment for depressed adolescents, the therapist and client identify how relationship difficulties (e.g., social isolation, conflict with family or friends) are impacting the person’s mood. The therapist and client work to build skills in those areas so that mood improves, as does the client’s ability to communicate feelings and expectations in relationships. As with CBT, this treatment is considered short-term and goal directed.
Behavior management
Behavior management is effective as an ADHD treatment in addressing attention difficulties as well as oppositional behavior in the home or classroom. It can also be helpful in improving anxiety and depression. Behavior management focuses on how some problematic behaviors (e.g., calling out during quiet reading time) may be accidentally rewarded in the eyes of a young child (e.g., gets teacher's attention when other children have to keep reading). The therapist will work with the family or teachers to assess what behaviors should be rewarded instead, while reducing the acting-out or inattentive behaviors.
How will I know if my child’s therapist will be effective?
It can be very anxiety-provoking to make that first call to a therapist. Remember, you know your child best! I always love it when parents ask me questions because it means they are great advocates for their child.
You can often get a good feel for the therapist’s personal style in that first phone call. This will give you a glimpse into how warm and professional they’ll be face-to-face.
But don’t stop there; plenty of therapists are nice. You also want to ask them about their treatment approach. You wouldn’t go into surgery without knowing the surgeon’s plan, and therapy should not be any different. A therapist should be able to tell you outright whether they primarily practice CBT, behavior management, or something else. If a therapist tells you he or she has an “eclectic” or “integrated” approach, that’s usually a good time to really quiz the therapist on what this means. I would ask them to be specific on whether, and how often, he or she uses CBT, IPT, or behavior management in their treatment.
Find out how the therapist involves parents in treatment. Any therapist will want to meet families first before making concrete treatment plans, but he or she should be able to give you a range of what to expect.
Last but not least, trust your gut! The therapist is an expert in psychology but you are the expert on your child.
Executive Function coaches often collaborate with individual children's therapists such as Dr. Trosper Olivo. This enables coaches and therapists to provide the most effective supports for students with Executive Function challenges combined with emotional or behavioral difficulties. To find out more about how Executive Function coaching can help your child become a more effective learner, please click below.
Sarah Trosper Olivo, PhD, is a licensed clinical psychologist and the co-founder of City and Country CBT, a private group practice with offices in Manhattan, Brooklyn and Westchester. Dr. Trosper Olivo specializes in the evaluation and treatment of anxiety, OCD and depression in children, adolescents and adults. Prior to opening her practice, Dr. Trosper Olivo was the program director for the intensive OCD and CBT programs at the NYU Child Study Center. She completed her clinical internship at the Child Study Center and Bellevue Hospital Center and stayed at the Child Study Center for her postdoctoral fellowship. She received her PhD from Boston University’s Center for Anxiety and Related Disorders, and she received her BA from Duke University. In her spare time she practices anxiety management techniques when parenting her two young, energetic children.
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