Coping with your child’s mental health concerns with child psychiatrist, Dr. Fiana Klein
How do you know when to address mental health concerns you have for your child?
Today on the show, I am speaking with child psychiatrist, Dr. Fiana Klein, on how to help parents cope with their children’s mental health concerns. We’re covering how to tell the difference between normal worry and worry that needs to be addressed, what you can do proactively as a parent, and how to use language to help your kids navigate their feelings and experiences.
Dr. Fiana Klein has a private practice in Melville, NY. You can learn more about her here.
Thanks for joining us today. What questions did this episode bring up for you? Head over to the Parenting with Love and Authority facebook group to connect with like-minded moms and continue this important conversation. Talk to you soon!
“It’s important for parents to have confidence in themselves and in what they’re doing [because] children can feel that confidence and if they feel that the parent is there and the parent is confident in whatever, whether it’s worry or other behaviors, the child will feel the parents’ confidence in whatever they’re being told and act accordingly.“
Dr. Fiana Klein
Dr. Fiana Klein is a child and adult psychiatrist with a private practice in Melville, New York. She lives on long Island with her husband and two young children. She is passionate about children’s mental health and helping families in crisis through her work in emergency rooms, community mental health clinics, and her private practice. Dr. Klein works to treat children and adolescents as well as educate their parents.
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Intro: 00:00 Welcome to the Raiseology podcast with your host, pediatrician and parenting consultant, Sharon Somekh here to empower parents to raise resilient and independent children. Grab your coffee or your Margarita and let’s get started. This podcast is for informational purposes only and should be used to supplement rather than substitute the care provided by your physician.
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Sharon: 01:22 Welcome everyone to the Raiseology podcast. Today I have with me Dr. Fiana Klein. Dr. Fiana Klein is a child, adolescent and adult psychiatrist with a private practice in Melville, New York. She lives on long Island with her husband and two young children. She is passionate about children’s mental health and helping families in crisis through her work in emergency rooms, community mental health clinics, and her private practice. Dr. Klein works to treat children and adolescents as well as educate their parents. Hi Fiana. Thank you so much for being here today.
Fiana: 01:58 Hi, thank you for having me. It’s wonderful to be here.
Sharon: 02:00 Yeah, so today we’re going to talk about how to help parents cope with their children’s mental health concerns. So we’re gonna talk about childhood depression and anxiety and how as a parent, you may be able to cope with those diagnoses and really how to help your children navigate that process as well.
Fiana: 02:24 Yeah, and I mean, as a psychiatrist, I have many tools in my, so-called toolbox, you know, for medications to different therapy techniques. But despite these, I’m not home with the patients and their families. I’m not at home with parents are my role. I can chip away at some of what the problems are, but the bigger changes are slow and difficult than really fall on the parents. And that’s why it’s exciting for me to be here today to talk to parents about parenting and ways that they can help their children.
Sharon: 02:52 Yeah. And I think that that’s true of so many different things in, in parenting and in mental health in general, but not even right. Just even something as simple as, you know, an analogy, I guess I’m taking my daughter today to a physical therapist and clearly if all she does is what she’s going to be doing during her physical therapy sessions, she’s not going to get better. Right. We have to do the work at home too. And I think that this is something that is important to understand because I think that it’s, it’s hard to do that. And sometimes we shy away from things that might be difficult to do because we maybe don’t really truly understand the importance of it. And so that’s why I’m really happy that we’re having this conversation today to really help motivate parents to get the help that they need and, and figure out how they can best help their, their children. And part of the challenge for that, I guess, is that most parents are not mental health professionals. So how would you say that parents could best equip themselves to help their kids in that situation?
Fiana: 04:05 Well, I am, first of all, I’m really happy that you brought up the physical therapy and kind of a physical example because I think that oftentimes it’s much easier for people to put their mind around working on something more physical, whether it’s exercise or physical therapy or you know, even when their child is ill with some sort of more physical illness. It manifested itself in a way that we can see versus mental illness. It’s inside the brain. Parents can’t see it. No one can really see it. But both the child and the parent ended up suffering and having a hard time. And the work is similar to work with any sort of physical change is that, you know, it can’t be done once a week or once a month or once in a blue moon. It needs to be consistent. Then whatever treatment they’re seeking, that needs to be brought into the home for real changes to be made.
Fiana: 04:58 And I think, you know, it’s difficult for parents to be able to make those changes at home because there’s so much going on and it doesn’t, I’m not here to say that everything kind of needs to get turned on its head, but it’s little changes that can be made. And I think having a child suffer, whether it’s from depression, anxiety, or anything else, it’s difficult or a parent to see. And my first piece of advice is always something that I learned in medical school when I was responding to the first code, which is when someone doesn’t have a heartbeat anymore. And the attending that I was working with said before you go into any sort of code, the first code should check is your own. And I think this is something that I’ve taken with me, you know, and kind of generalized to parenting because when there’s a crisis, when there’s anything difficult going on, I think parents and everyone in general, you kind of need to take a look at yourself and check yourself before going to help anyone else. It’s similar to the airplane mask example that, yeah. And see that you need to put the mask on yourself before helping anyone else.mAnd I think that in any of these situations, a parent’s ability to stay calm and reassuring when their child is having a difficult time is really crucial.
Sharon: 06:11 Yeah, absolutely. And, and I think it’s important to also note that that’s really important for you to be able to stay calm so that you can feel secure in yourself and that you’re able to kind of help navigate the situation. But it’s equally important for your child to see that you’re able to stay calm and help navigate the situation. Cause it brings them a sense of calm as well.
Fiana: 06:42 Exactly and I think especially with worry and anxiety, oftentimes it’s what the child learns on what the child, these that can exacerbate things in terms of anxiety disorders are probably the most common condition affecting children and then the age ranges from toddlers to teens all over by obviously then into adulthood and about 30 or so percent is accounted for in terms of family history and the rest of the child’s own temperament and the environment that they’re in. And obviously all of these play together in terms of if there’s an anxious parent that creates an anxious environment that even if the child’s may or may not have been fully predisposed, the anxiety can develop. And that’s why I think it’s really important for parents to first get help for themselves, not only in terms of helping themselves and getting better themselves, but also in terms of what their children see and experience. And also in terms of dealing with the stress of having a child that is having a hard time because that’s going to add to the overall burden and stress for the parents.
Sharon: 07:58 Yeah. Yeah, I definitely can appreciate that. And I, I work with a lot of parents that, that are seeing that even in their little kids, right? Where and when I say little kids, even toddlers where they’re seeing a change in their toddler’s behavior based on how they are feeling at any given moment.
Fiana: 08:20 And I think, you know, it’s natural for, you know, our children to kind of take things from us and see the world through almost our eyes. Kids are really amazing learners and as their parents are their greatest teachers. And I think there are times when we kind of need to step back and see if there’s something that we’re doing that’s really affecting our kids. I know for myself, I, there was a moment where my son would start to act out every time after we had our house cleaned. And then I kind of realize that anytime you’d come home, school after the house had been cleaned, I’d be much more strict in terms of get your shoes up, get this off. Because I wanted things to remain clean right after the house had been cleaned and it was, you know, he was getting nervous even before because he knew the environment that he was coming into. And you know, it’s little things like that that kids pick up on really quickly and that can change their behaviors.
Sharon: 09:22 Yeah. What a great example because it’s one that you don’t really, you wouldn’t necessarily think about, but it’s, it’s such a, a subtle thing that if you hadn’t noticed that your behavior was different at that time, you wouldn’t understand that. That’s why his behavior was different. Right, right. I love that.
Fiana: 09:44 And then, you know, in general with anxiety and worry, I think it’s really important to make the distinction between fear and anxiety because fear is something that’s natural and adaptive. And we as humans need to have cause evolutionarily and just in the world, we need to be afraid of certain things in order to keep ourselves safe. And you know, for example, you want your child to be afraid of running into the middle of the street because you don’t want them to be hit buy a car.
Fiana: 10:10 But then anxiety, it’s more of a overall emotional state and it’s a place of worry and it can be, you know, really global and take on some physical manifestations and it’s, you know, can, it’s a range as well. And I can come from a place of having some extra worry to a place that’s really impairing and causing the child to have difficulties in their life. And you know, anxiety’s not one size fits all. There’s no one thing that means someone is an anxious person or has an anxiety disorder. Even within the anxiety disorders within are kind of manual, the DSM there about seven distinct disorders and then their disorders or sub categories and things like that. So it’s a really big topic and a really big issue that it doesn’t always present this just one thing.
Sharon: 11:02 Yeah. So what are some things that you might notice in a child that would help you distinguish between fear and worry?
Fiana: 11:13 Sure, so you know it sometimes it starts as kind of fear and then becomes more worry and anxiety disorders, things to kind of look for. And again, this varies by the age of the child, but changes in their eating or sleeping habits. Oftentimes in younger children, the behaviors that they exhibit might be more kind of tantrum behaviors or oppositional behaviors and especially younger children, they’re going to have a hard time verbalizing, I’m worried about this, I’m nervous about this, this makes me feel uneasy and instead refuse to put on shoes in the morning to go to school because there’s something that’s causing them worry in school. Or maybe it’s about getting into a car or whatever the situation is. And instead of being clear about what they’re really worried about, they themselves don’t understand. And so they’re going to present with more oppositional behaviors. Even in school age children, oftentimes kids will present with aggression or other oppositional symptoms.
Fiana: 12:16 And that’s because those are the kids that kind of stand out. And the anxious children often the quiet anxious children often take time to present and for things to be noticed that because they’re more likely to kind of be quiet, sit in the back of the class and not really cause a ruckus this in, it’s not until there might be a dip in grades or you know, a teacher seeing that they need to participate more, that we notice that there’s something really going on.
Sharon: 12:44 So let’s go back to that toddler example that you mentioned. So say you have a child who is refusing to put their shoes on in the morning and it’s causing a lot of frustration and strain to get out the door. How would you know if it’s a situation of just a child avoiding putting their shoes on in the morning because of the behavioral sort of doesn’t feel like it or a true reason that may need to be evaluated further?
Fiana: 13:19 Sure. I mean, I think it’s very rare for children to really just not do something just because they don’t feel like it. I think children very rarely have the real words for whatever they’re feeling. And you know, sometimes it’s either for attention or or because they think it’s funny to see mommy yelling or whatever the situation is, kids really want praise and they’re, they don’t like it when we get it upset at them. So it’s very rare situations that children are really doing something to really make the parent angry on purpose. I think oftentimes it’s because they like attention and children, especially very young children, they don’t see the difference between negative attention and positive attention. Okay. They just see attention. Now my mom is bending down and putting my shoes on even though I’ve know perfectly well how to put it, my shoes on.
Fiana: 14:19 And I think kind of the distinction between when it’s because they’re trying to avoid something or fearing something. It’s a difficult one to make and it kind of, you know, makes you take a, you’d have to take a bigger look at what going on. And you know, if the shoe situation is resolved, are they going to come up with another thing to make it difficult to get out the door because they’re avoiding going to school or whatever, wherever it is that they’re going, that they’re making it harder to get out the door. Are they showing other signs, let’s say, you know, once they’re in the school that they’re clinging and crying and you know, a certain level of separation worry and separation anxiety is completely developmentally appropriate but if the teacher is letting you know that the child is unable to kind of transition into the class and integrate into the class and are having a difficult time throughout the day, those are all clues that can point to it being a bigger problem and a bigger difficulty that the child was having.
Sharon: 15:27 Yeah. Yeah. I mean I think it’s a great point that there’s always sort of a reason behind their behavior and it sometimes requires us to be a little bit more detective-like to try to help figure it out. And then you mentioned that oftentimes the, the way that we are responding as parents could be a contributing factor. Can you speak a little bit more to that?
Fiana: 15:55 Sure. I mean I think that especially in worry and anxiety, the way that parents perceive the situation and react to the situation has a major factor in how the worries can progress or how we can kind of squash those. And I think especially in kids being worried or any anxiety, the parents naturally inclination is to try to lessen that anxiety. And oftentimes that’s by removing the anxiety-inducing event or situation when unfortunately oftentimes that makes things worse than then the child’s brain that’s kind of wired to be more of a worrier or anxious brain sees this, the parents’ decision to remove whatever the cause of anxiety is as reinforcing to whatever they were scared of that that’s a real threat.
Fiana: 16:42 You know, our kids learn us to what to fear in the world around them from us. So when they’re very little were baby proofing and not allowing them to go near the fires that they know that those are dangerous things. Yeah. Our child is worrying, let’s say about going to a ballet class or driving in a car and then we say, you know what? We’re gonna walk there instead. They might not be able to tell you this, but in their brain it says, okay, if mom is saying that we’re going to walk there and said, that means that the car really is dangerous and we shouldn’t go in the car. Yeah. And I think, you know, when parents are trying to do their best and remove that worry, it might now the fear might grow from being scared of going into the car, to being scared of leaving the house at all or to something completely different because anxiety has that way of kind of morphing and growing and changing.
Sharon: 17:42 Yeah. I actually did an episode on separation anxiety and I talked exactly about that sort of the, when you choose to remain in the classroom because your child is crying every time you try to leave, it’s like sending a message that they really do have a reason to be nervous and in this situation and that you’re nervous to leave. Right. And even if that’s not the actual reason that you’re staying, that’s how they might be reading the situation. So, and it’s, it is challenging as a parent to see your child in distress and then still hold to what you are doing and continue this I guess, how do I say this and not remove them from the situation that’s causing them to be anxious when you feel like it’s something that you could do, but it’s a great point that that could actually make itself make the situation worse and manifest in different ways later on that might be more difficult to a tackle.
Fiana: 18:49 Right on. I think it’s, it’s also important, you know, whether it’s the separation from school or any sort of potentially anxiety-provoking situation for the parents to kind of exhibit an air of confidence and an air of things are going to be okay. Um, and more than just the words of it, the actions of it and kind of, you know, maybe giving themselves a pep talk inside their own mind because even without any words, children are really great at perceiving what’s really going on in our minds and what we’re really thinking and feeling and their behaviors and their own thoughts and actions are perceived off of that. So, you know, and the example you gave with, you know, separation anxiety and the child crying and the parent having a difficult time of leaving the room, whether or not you’re staying in the room or you’re walking out of the room and standing at the window and looking, your kid’s going to feel bad and they need to feel that sense of security from you, that they’re going to be okay.
Sharon: 19:57 Yeah, 100% and I love that you said that sometimes it’s more about your actions than about your words. Because I do hear from a lot of parents like, you know, all but I’m really good at faking it, you know? And as good as we think we might be at faking it, our kids are way better at detecting it. And so yeah, it’s a really important point. And, and I, I know that the work to get yourself from the point of faking it to the point of really, truly believing it is challenging. And sometimes parents don’t always want to do that work because it may, it’s uncomfortable as you’re going through it, but the benefit on the other end to your child and to you is really amazing.
Fiana: 20:50 Yeah, I agree. You know, it’s hard, but I think as with any change, it takes time and with time it does pay off and it’s, you know, it’s like little exercises for your brain like, and you’re going to the gym and you’re working out and building muscle. That takes time and it’s hard and it’s challenging. I’m the same way with, you know, changing the way that you’re approaching a situation and thinking about a situation. It takes time and it’s hard, but the changes do happen.
Sharon: 21:19 Yeah. And I think it’s, it’s exceptionally rewarding too when you start to see that the change is happening, not just in yourself but in your child as well.
Fiana: 21:29 Absolutely. And you know, like I’ve said before, I think parents really want what’s best for their child and children really want their parents to be happy and want to please them. And I think that’s the really positive thing about any parenting, child interactions is that everyone’s kind of going for the same goal. And with the changes on this work, things really can go in a good direction.
Sharon: 21:57 Yeah. So what would be, I guess the, the most important piece of advice that you would give parents in this situation to help themselves actually be able to exhibit more confidence in general, right. That that will help them worry less and be able to really truly have that positive modeling experience for their kids.
Fiana: 22:29 I think, you know, oftentimes it does take the parent getting into treatment of their own and helping themselves. It really is an anxiety disorder that the parent is suffering from. And I think oftentimes, especially with things like anxiety and worry, people can kind of trudge through life and um, make it through relatively unscathed until there’s extra stressors, like being a parent and having to take care of kids and now your kids own worries and difficulties and behavioral issues, um, that really makes things exacerbated and then it becomes a problem and working on themselves. Um, there’s not like kind of a fix-all but I think having confidence and reminding themselves that by taking care of themselves, their parents will do the best in terms of taking care of their children.
Sharon: 23:24 Yeah. And I think it’s also important to recognize that this is, I guess to really just strengthen your point that this does take time. And I often have parents who are sort of expressing to me their impatience with the, and, and they just want things to have a quick fix and get better quickly. But unfortunately it is important to recognize that this, this does take time, but over time you’ll start to see little changes that are really rewarding.
Fiana: 24:03 Yeah, absolutely. And I mean I always, whenever I’m seeing patients in my practice or in the emergency room out, one of the first things I always tell them is that I’m not hiding my magic wand. And if I could do a quick fix and magically make things better, I would. But things get to where they are with time and it doesn’t happen overnight. And the same way we can’t make things better overnight and it takes time and it takes work to make it better. But like you said, once things do start to get better, it is incredibly rewarding.
Sharon: 24:30 Yeah. Your magic wand is, is very, it reminds me of my days and in pediatric practice where we used to say the same thing, that like if we could just make your child feel better, you know, we would put, sometimes it’s just takes time and, yeah, I mean, I guess that that would probably be, for me, the best piece of advice is just to try to have trust in, in what you’re doing to make changes and really patience to that you will get there, you know?
Fiana: 25:10 Yeah. And I think especially in today’s world with, you know, there’s so much advice out there, so many rights, wrongs and everything else, especially in parenting, that it can become really daunting for parents. And it’s important for parents to kind of have confidence in themselves in what they’re doing and how they’re doing. And children can feel that confidence and if they feel that the parent is there and the parent is confident in whatever, whether it’s worry or other behaviors, the child will feel the parents’ confidence in whatever they’re being told and act accordingly.
Sharon: 25:50 Yeah, absolutely. Do you have anything else that you want to add?
Fiana: 25:54 Yeah, I mean I think more, I think most parents were with anxiety with kids that are anxious and worried go on the trajectory that I talked about earlier in terms of the first, their first instinct is to kind of remove whatever the anxiety is. And then there are some parents and some are the same parents just for different situations depending on what it is, that kind of, we’ll try to just ignore the fear or the worry and don’t validate them. And you know, for children who are worried, those feelings are real and they really, whether it’s something that seems really silly and minor, they’re feeling that way and it doesn’t feel good to feel worried and overwhelmed by a situation.
Fiana: 26:16 So saying things like, don’t worry, it’s okay, is not really going to soothe the child who’s worried and whose body is sending them signals that you know, or pretty much the signals that our bodies are supposed to get when we’re being chased by a bear. And it’s often hard to strike a balance between validating the feelings but not giving into the worry. So saying, I understand you feel this way. It feels really crummy, but we still have to go to school and staying firm with not allowing the fear to take over while also sympathizing and John the child that you understand what they’re feeling. Um, and then when they’re able, another important point is when they’re able to conquer any sort of fear, anxiety situation, anything like that is to really reinforce it and tell them how proud you are of them and how you know, it was so difficult.
Fiana: 27:32 Also remind them that there, okay, so let’s say, you know, go back to the car example. A child that’s scared to drive in a car when they’re able to get into the car and drive to grandma’s house, letting them know, I know that that’s something that you were really worried about and you were scared and you didn’t feel happy the whole time we were in the car, but you did it. You made it. And look, we’re all safe. And that kind of add to their bank of reassuring reassurance in terms of a worry and showing them that these situations really aren’t bad and scary is their mind maybe making them out to be and now they have more evidence in terms of conquering it and that they are okay in those situations.
Sharon: 28:19 Yeah, absolutely. Well thank you for that. That’s good to, that’s a good reminder actually. And, and I would even sort of ask them if they are feeling proud because it’s, it will help them sort of build their own self confidence around it too, you know, and remind like sort of having them verbalize that about themselves just adds a little bit more power there.
Fiana: 28:44 Yeah, absolutely. And I think also kind of going off on that, um, in fact to what parents can do is parents kind of sh, you know, showing their vulnerability to their child and also teaching their children the language them certain things. So, for example, if a parent is worried about something, it’s okay to tell your child, Hey, I, I was worried about this today, but I was able to do it and I felt really proud of myself and that way the child can see and model off that behavior as well as that language for emotions and feelings that is often hard for kids to express.
Sharon: 29:25 Yeah. What a great point because we often do try to shield our kids from a lot of those things and certainly worry is one of those things. But even just when you’re feeling frustrated about something or when you’re sad about something that didn’t work out the way you wanted it to and then having your child sort of see that and see how you overcome that and what other good things may have come out of those experiences. And highlighting that for your kids really allows them to see that even from negative experiences, good can come out of those things. And, and even and and that I think it also validates for them that when they’re feeling a certain way, it’s not really abnormal that other people feel that way too.
Fiana: 30:11 Yeah, absolutely. Like I’ve said, as parents, we’re a children’s greatest teachers and they’re constantly looking to us for reassurance and were there examples. So if we’re able to kind of be open and honest and vulnerable around them, they’ll be able to do the same and be able to be open and honest and vulnerable around us.
Sharon: 30:35 Yeah. So I guess the next question I would have for you is, at what point would you say that it’s important for a parent to get help for their child in a situation where their child is feeling anxious to a point where the parent thinks it’s more than just normal worry or normal fears?
Fiana: 31:00 Right. I think it’s really when it becomes that the child is impaired in some way where they’re not able to function through their life. Whether it’s that there, you know, not able to sleep, they’re not eating the same, their school performance is affected. They’re isolating themselves from family, from friends or voiding situation that bring fullness to their life. And that’s when I recommend that the kids get treatment. Once kids are a little bit older and in school parents have a little bit of help from the school in that school and teachers are another set of eyes and they’re there with your kids for a big chunk of the day and they may be able to pick up on these things in the school as well and address them there. I mean I think schools, it can be a really big help in these situations and seeing what’s really going on and also in helping with adjusting the situation if it’s solely in the school or helping with guiding parents to the right place to get help.
Sharon: 32:05 Yeah and, and I would add also as parents that it’s important for us to be advocates for our children and to really speak up. If you’re seeing something that could be addressed at school that might be affecting your child and maybe the school isn’t noticing. And so, you know, I think it’s, it is important to remember that if your child is expressing a concern to you that it’s okay to bring that up to the other, you know, I guess the, the school administration, or the teacher and see if they’re noticing the same thing. And I think that that also shows your child that you have their back. Right. And that you’re really, you’re advocating for them as well.
Fiana: 32:51 Yeah, absolutely. Um, I, that’s kind of one of my big soapboxes in terms of parents advocating for their kids within the school and the school system because oftentimes the cause of whatever the behavior or anxiety or depression, whatever it is, can be something that can be modified within the school. It can be something that there is an undiagnosed learning disability or learning difficulty that the child is having, that really the responsibility is on the school to help with and make accommodation for, for the child and to, um, for parents to advocate for the schools to do that.
Sharon: 33:31 Yeah. So I think, you know, all in all really there’s, there are a lot of things that we can do as parents to help our kids. And it ranges from trying to advocate for them in, in other situations to helping them get the help that they need to really getting the help that we need in order to really, um, model the, the best behaviors and coping skills and, and mechanisms for them. So I really appreciate, Dr. Klein, that you are here today to talk about all those things and I will be posting Dr. Klein’s information on how to get in touch with her if you do want to further discuss or if you happen to be local to her and, and want to see what it would mean to make an appointment or if it’s even necessary to make an appointment with her so that that is an available resource to you guys.
Sharon: 34:29 And then, um, certainly we will be in the Facebook group discussing this. Um, if there are any further questions or comments, we’d love to, uh, continue conversation there.
Fiana: 34:39 Thank you for having me. And I hope that this is helpful for parents and we’re able to give them some tools to help their kids.
Sharon: 34:49 Yeah. And I think, um, I think it was, and, and hopefully parents will, will take whatever necessary steps there are to, to help the next generation of kids really be as, um, as mindful and, and successful as possible.
Outro: 35:13 Thanks for listening to the Raiseology podcast. Head over to www.Raiseology.com where you’ll find plenty of, you’ve got this resources for parents and any links or tools mentioned in today’s show. Be sure to hit subscribe on your podcatcher so that you can listen to the next episode the minute it’s out, until next time, have an empowered week.
Meet Your Mentor
Sharon is a general pediatrician, loving wife and mother to 4 daughters.
After a decade of practicing general pediatrics and working with families, she realized there often wasn’t enough time while tending to children’s medical needs to help parents in the way that would be most helpful in shaping their children’s futures.
The Raiseology Program was developed to teach parents how to raise their children with the love and authority necessary to promote resilience and responsibility.
Sharon’s experience with hundreds of families as well as her own help her meet you where you are on your parenting journey to help you make it what you want it to be.
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