This question is how I start my inquiry into family mental health history. How it fits with ACT is in understanding the stories, conscious or unconscious, that may have developed around this family history. For example, the parent may see their child as similar to “Uncle Bob.” If Uncle Bob is merely eccentric, but doing well as an adult, then perhaps this is not an issue. On the other hand, Uncle Bob may be living on the streets. The parent may then see their child as hopelessly on that relative’s sad trajectory. Parent-child interactions may be influenced by the parent’s anxiety, dread, and hopelessness in unhelpful ways. As just one example, this parent may be inflexible or inconsistent around limit setting.

If I had to pick one thing, it would be for parents to validate and not invalidate their child’s emotions and ideas. Then it’s important to direct the child’s attention to the valued goal in the moment. So, the basic two-step process would look something like, “Ah, I can see you’re having a lot of those anxious ideas about school, and I need you to get your shoes on now so that you can have breakfast. I’m making waffles.” Validate and redirect. I call it “parent aikido.”

I heard of a mother who tells her child, “I love you just the way you are, but I love you too much to let you stay that way.” This is tricky but central to raising kids. We’re talking about helping our children learn to over-ride their tendencies or urges given a particular context, e.g., circle time vs recess. We start by labelling the urges (You’re feeling restless/impatient/bored), validating these feelings as real and normal, and (not but) pointing out to the child that the situation they’re in calls for certain “expected” behaviors (Stay on your carpet square, hands to yourself, pretend to pay attention to the teacher). Acknowledge that this is challenging. Give lots of positives for success.

ACT uses exposure therapy in ways both similar to and different from traditional CBT. In ACT, we talk about “commitment exercises.” For example, a commitment to meet with your teacher this week to come up with a plan for that late schoolwork. We ask the client to mindfully notice the emotions and thoughts that will show up when the time comes to meet with the teacher. Then, regardless of whether or not the client actually follows through with the task, we follow-up with an examination of what transpired, what stuff showed up, what was engaged, what was avoided, and what can be learned. ACT differs from CBT in de-emphasizing any promise of becoming desensitized as a result of repeated exposure. Talking to your teacher about late work may never become comfortable. But it gets you to your valued goals. We sometimes say, “Get comfortable being uncomfortable.”

One way parents might be nurturing anxiety is through what Wendy Mogel (The Blessing of a Skinned Knee, Scribner, https://www.amazon.com/Blessing-Skinned-Knee-Teachings-Self-Reliant/dp/1416593063) calls “Interviewing for pain.” This often occurs at pick-up from school or at bedtime. “Did anyone eat lunch with you today?” “Was the test really hard?” “Did you miss me today?” “Are you worried about anything?” Often these questions say more about the parent’s anxiety than the child’s. I acknowledge/validate the parent’s strong desire to know what’s going on with their child. And then I wonder aloud if these questions may be giving the child the message that they should be anxious. At first, I may get a “Yes, but…” from the parent, so I drop it and look for another opportunity to bring it up. Most parents are receptive to information delivered with understanding and humility.

Yes, although the body of ACT research with children is quite small compared to the many studies with adults. One recent (2019) study out of Italy showed improvements in children’s hyperactivity-impulsivity, restlessness, and inattention after a rather intense course of ACT treatment; 26, 90-minute group sessions. Other studies have looked more specifically at how mindfulness practice (a key feature of ACT) can improve the symptoms of ADHD. This makes sense if we think of mindfulness practice as “attention management.” Debra Burdick has two books on mindfulness and ADHD, one for younger kids and one for teens, both through New Harbinger Publications. For adults with ADHD symptoms, I recommend Lidia Zylowska’s The Mindfulness Prescription for Adult ADHD from Shambhala publications (https://www.amazon.com/Mindfulness-Prescription-Adult-ADHD-Strengthening/dp/1590308476).