All Are Welcome

Posted on July 12, 2011 by Dr. G

All Are Welcome is a faith inclusion training program made available by the South Carolina Autism Society. Thanks to Susan Leiby, the special events coordinator for the Autism Society, for posting the link to our Facebook page.

All Are Welcome offers lots of resources for churches, including survey forms, video links and worship videos. They have a very nice presentation narration that provides a good overview of the field of disability ministry.

What I found most interesting about their site was the results of a survey conducted by their steering committee of parents and caregivers of children with autism. Only 21% of the 63 families responding to the survey were actively participating in a church (all survey responders identified themselves as Protestant or Catholic). According to a Gallup poll conducted last year, 56% of  South Carolinians attend church weekly or almost every week. Also of interest were the reasons survey participants listed for not attending church.

The team behind All Are Welcome has created an excellent resource and has provided a template for disability advocacy organizations to follow in supporting inclusion of the families they serve at church.

For more information on All Are Welcome, contact Susan Leiby at (864) 241-8669.

Posted in Autism, Inclusion, Resources | Tagged , , | 2 Comments

An Inclusive Movement

Posted on July 10, 2011 by Dr. G

Over the last couple of weeks, I’ve continued to have experiences that reinforce how important it is for Key Ministry to actively seek out other ministries and leaders who are passionate about sharing Christ’s love with families of kids with disabilities, to offer to support and network those ministries and leaders, and to share our platforms with them in order to assist them in expanding the impact of their ministries.

We’re working together with Michael Woods from Making Room on a website (www.specialneedsministry.org) designed to serve as a “gathering place for those involved with special needs ministry focused on individuals and how they are ministering to OUR kiddos.  A site where people can both give (share what their doing and how) and receive (read what others are doing) among loyal yoke-fellows!” If you’re involved in some aspect of ministry to families of kids with disabilities and would like the opportunity to post about your ministry passions and experiences, leave your contact info below and we’ll set up a date for you to post on the blog. We’re almost ready to share another incredibly exciting opportunity for leaders in disability ministry, but more on that later.

This past week, I reconnected with two fabulous ministry leaders doing great work with families of kids with special needs, and met in-person for the first time with another leader whose work I’ve come to know through her books and her website.

Marie Kuch is a former youth pastor and television host based in Orlando who leads Nathaniel’s Hope. I’d encourage you to check out their website. They offer high-quality training for churches interested in offering respite to families of kids with special needs through their “Buddy Breaks” and do a truly remarkable disability awareness event called “Make ‘m Smile” every June in which they shut down Downtown Orlando and throw a big party for 5,000 or folks who are loved by Jesus. Here’s a video from last month’s event:

Aaron Scheffler oversees domestic operations for Mark 2 Ministries. Mark 2 Ministries exists to encourage and equip the local church to evangelize, disciple, and integrate into their congregation individuals with disabilities. Aaron works to train and resource churches throughout Indiana and beyond to minister to families impacted by disabilities. and host regional meetings for disability ministry leaders and volunteers  in greater Indianapolis to promote vision sharing.

Jolene Philo (pictured with her husband) is a former special education teacher and church staff member (she had served as her church’s Director of Assimilation and Discipleship) from Boone, Iowa who has written extensively about her experiences as a parent of a child with special medical needs. She was gracious enough to join our Key Ministry training at our most recent JAM Session in Des Moines last month, and she did a great job speaking at the CMX Expo last week in Lexington, KY. I was honored to have been asked to endorse her upcoming book, Different Dream Parenting, scheduled for release this coming October. Her new book offers lots of sound and practical advice to families embarking upon the experience of raising a child with special needs.

Over the coming weeks and months, we hope to meet (and introduce) many more leaders who are using their gifts, talents and passion to expand God’s Kingdom to include families of kids with both visible and hidden disabilities.

Posted in Hidden Disabilities, Key Ministry, Leadership, Resources | Tagged , , , , , , , , , , | 4 Comments

When Christian parents should seek out a Christian mental health professional

Posted on July 5, 2011 by Dr. G

Parent Child PrayingI had previously shared this post reflecting my opinion that Christian parents are best served by seeking mental health services from professionals who reflect excellence, regardless of their personal beliefs. Today, I’ll share a couple of significant exceptions to that rule.

The condition that most frequently (and appropriately) leads parents to seek me out because I’m publicly identified as a psychiatrist and a Christian is Obsessive-Compulsive Disorder (OCD).

All too often, I’ve seen non-Christian counselors or therapists misinterpret obsessive thoughts involving sexual content in kids from Christian homes. This type of obsession frequently involves the fear that they (against their will) will be compelled to engage in some sexual behavior they and their families clearly see as wrong. Another example of this type of obsession are kids who love their parents but develop obsessive thoughts that they’ll be compelled against their will to kill or severely injure them.

I’ve seen therapists fail to recognize the underlying problem (obsessive thinking) and produce unnecessary anxiety in the child or teen by trying to persuade them that there’s nothing wrong with the behaviors they dread. An ability to understand the family’s value system and worldview is helpful in such situations in understanding why the thought is so distressing…qualifying the thought as an obsession. By definition (see below), obsessions aren’t pleasant.

Another situation in which parents of Christian kids should appropriately seek out a therapist with a Christian background occurs when a significant faith component exists to emotions, thoughts or perceptions that are a focus of concern to the parents. For example, I have a kid who comes to our practice with recurring obsessive thoughts involving the fear that his salvation isn’t genuine, or that he’ll lose his salvation if it is genuine. Another such situation occurs when kids express the belief that God speaks to them or share a specific experience in which they thought God was speaking to them. The professional without an understanding of the child’s or family’s beliefs may not ask the types of clarifying questions necessary to distinguish genuine religious experiences from psychosis associated with mood disorders, thought disorders or substance abuse.

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Here’s a partial list of criteria for Obsessive-Compulsive Disorder from the DSM-5:

A. Presence of obsessions, compulsions or both:

Obsessions as defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted and that in most individuals cause marked anxiety or distress.

2. The person attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)

Compulsions as defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.

2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiologic effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder.

Updated May 23, 2014

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KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

Posted in Controversies, Families | Tagged , , , , , , , | 3 Comments

Should Christian Parents Only Use Christian Mental Health Professionals?

Posted on July 2, 2011 by Dr. G

shutterstock_104938268When your church or small group prays for someone undergoing heart surgery or receiving treatment for cancer, do you spend much time thinking about whether the surgeon or oncologist is a Christian?

After all, God is God and since He created the universe, it seems a given that He can use anyone or anything to accomplish His purposes, right? Why then does the question come up so frequently when the need for mental health treatment arises, especially for kids?

I think the critical issue for parents who have a kid in need of mental health care is finding a clinician with a track record of demonstrating excellence in their field, regardless of that person’s belief system.

The concern many parents experience about seeking help outside the Christian community is often centered around fears that they’re introducing a person into their child’s life who  might be inclined to actively undermine the parents’ authority or their child’s sense of right and wrong. Good professionals seek to understand the child’s world and the family’s world and demonstrate cultural sensitivity when serving families of different backgrounds. Identifying highly effective professionals with the appropriate training and experience to work with kids may be a major challenge in large parts of the country, especially when families are limited to clinicians who contract with a particular form of insurance. The question Christian parents should ask when they approach their pastors, friends, neighbors and professionals in search of referrals for their children are:

Will this person seek a thorough understanding of why my child is  experiencing difficulties leading to a plan to help them function better…academically, socially, in extracurricular activities and in an age-appropriate way as a member of our family? 

I started thinking about this topic earlier today while reading in the Book of Isaiah about Cyrus. Cyrus was the Persian king who overthrew Babylon and gave permission to the Jewish people to return to Jerusalem and rebuild the Temple. Check out this passage from The Message:

God’s Message to his anointed, to Cyrus, whom he took by the hand
To give the task of taming the nations, 
   of terrifying their kings—
He gave him free rein, 
   no restrictions:
“I’ll go ahead of you, 
   clearing and paving the road.
I’ll break down bronze city gates, 
   smash padlocks, kick down barred entrances.
I’ll lead you to buried treasures, 
   secret caches of valuables—
Confirmations that it is, in fact, I, God, 
   the God of Israel, who calls you by your name.
It’s because of my dear servant Jacob, 
   Israel my chosen,
That I’ve singled you out, called you by name, 
   and given you this privileged work. 
   And you don’t even know me!
I am God, the only God there is. 
   Besides me there are no real gods.
I’m the one who armed you for this work, 
   though you don’t even know me,
So that everyone, from east to west, will know 
   that I have no god-rivals. 
   I am God, the only God there is.
I form light and create darkness, 
   I make harmonies and create discords. 
   I, God, do all these things.

Isaiah 45:1-7 (MSG)

It’s God doing the work. He has things under control. He can use anyone or anything to accomplish His purposes.

With that said, in our next post I’ll suggest when parents should consider seeking out a mental health professional who is also a Christian.

Updated May 23. 2014.

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KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

Posted in Mental Health, Parents, Strategies, Uncategorized | Tagged , , , , , , , | 7 Comments

Be Not Anxious…Is Medication Safe for Kids With Anxiety?

Posted on June 30, 2011 by Dr. G

Welcome to our Summer Blog Series examining the impact of anxiety disorders on church participation and spiritual development in kids. Today, we’ll look at the safety of medications prescribed for kids with anxiety.

One of the greatest ongoing controversies in the fields of child psychiatry and pediatrics is the question of how safe SSRIs are in children, teens and young adults. The safety issue of greatest concern involves reported risks of SSRIs increasing suicidal thoughts during the first 30-60 days of treatment in persons under the age of 25.

In 2004, The FDA issued a “black box” warning, requiring manufacturers of all medications reported to have antidepressant effects, to include a warning in the package labeling for each drug stating an increased risk of suicidal thoughts in pediatric patients. The warning was subsequently extended to adults ages 18-25.

A more detailed description of this controversy is included in the chapter on sadness, moodiness and irritability. Some important points to consider:

In the 30 or so well-designed research studies involving approximately 5,500 children and teens evaluating the safety and effectiveness of SSRIs, there have been zero completed suicide attempts.

Rates of suicide among children and teens in the U.S. began declining around 1990, shortly after fluoxetine and sertraline were approved for use in the U.S., and continued to decline until 2003. In 2004, following a 20% decrease in the pediatric use of SSRIs resulting from the black box warning, the suicide rate went up for the first time in 15 years.

Rates of suicidal ideation among participants in pediatric trials of SSRIs for anxiety are lower than rates in studies of depression.

Kids being treated with SSRIs should be monitored closely for the development of any new-onset suicidal thoughts during the first two months of treatment and following increases in the dose of medication being used.  When the warning was first issued, physicians were encouraged to see youth treated with SSRIs on a weekly basis for the first month of treatment, and every other week for the next two months. While this recommendation was dropped, one additional benefit of combining CBT with medication is the availability of the therapist to closely monitor for the emergence of suicidal thinking in children and teens taking SSRIs.

What other side effects might my child experience from medication?

In general, the SSRIs as a group are well-tolerated. Most side effects are mild and resolve over time. Gastrointestinal symptoms such as nausea, pain or diarrhea, headaches, increased motor activity and insomnia are common side effects.  Children with a predisposition to bipolar disorder need to be screened carefully prior to initiation of an SSRI and closely monitored for the possibility the medication may worsen symptoms of a mood disorder.

With the exception of fluoxetine, children shouldn’t stop taking an SSRI suddenly because of the risk of withdrawal symptoms. Such symptoms include dysphoric mood, irritability, agitation, dizziness, headaches, anxiety, and insomnia. When discontinuing medication, a gradual dose reduction supervised by the child’s physician is generally the best approach.

How long will children have to take medication for anxiety?

Unfortunately, there are very few studies examining the long term safety and effectiveness of medication for anxiety in children and teens.

AACAP’s practice parameters suggest a medication free trial after one year on medication. Given the chronic, recurrent nature of anxiety symptoms, the likelihood of relapse among kids receiving medication for anxiety is greater than that among children taking an SSRI for a single episode of depression. Relapse occurs most frequently among children treated for OCD. Recurrence rates of approximately 90% have been reported within two months of discontinuation of medication for OCD. Participation in CBT may help to reduce relapse rates, but adequate studies to quantify such an effect are lacking.


 

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Be Not Anxious…The Role of Medication for Kids With Anxiety

Posted on June 29, 2011 by Dr. G

Welcome to our Summer Blog Series examining the impact of anxiety disorders on church participation and spiritual development in kids. Today and tomorrow, we’ll discuss the use of medication for kids with anxiety.

When should medication be considered for kids with anxiety? Medication is appropriate for children who experience moderate to severe functional impairment from anxiety symptoms, fail to respond or respond incompletely to psychotherapy or experience one or more comorbid conditions that require concurrent treatment. Medication is also appropriate when anxiety symptoms interfere with the child’s ability to participate in or benefit from talk therapy, or situations when the family is unable to access therapy for geographic or financial reasons.

What medications have been shown helpful in children and teens with anxiety? The serotonin-specific reuptake inhibitors (SSRIs) have been recognized as the medication of choice for treating anxiety, according to practice parameters developed by the American Academy of Child and Adolescent Psychiatry. This class of medications, including fluoxetine (Prozac™), sertraline (Zoloft™) and fluvoxamine (Luvox™) has been shown to be effective in treating children and teens with selective mutism, social anxiety disorder, separation anxiety disorder, generalized anxiety disorder and obsessive-compulsive disorder. The SSRIs as a class have been more extensively researched than any other category of medications for pediatric anxiety disorders and don’t typically require blood work or EKG testing upon initiation of medication or during the course of ongoing follow-up. Imipramine (Tofranil™) and clomipramine (Anafranil™) are members of an older class of medications known as tricyclic antidepressants that have been shown to be effective in treating specific types of anxiety in kids. These medications have fallen out of favor with many clinicians because they are associated with a small, but not insignificant risk of cardiac effects, resulting in the need for ongoing monitoring of EKG tests. Tricyclics are also far more likely than the SSRIs to result in death in the event of a purposeful or accidental overdose. Nevertheless, clomipramine was shown in one analysis of the research literature to be the most effective medication for the treatment of pediatric obsessive-compulsive disorder. No other medications have been shown in well-designed research studies to be effective in the treatment of pediatric anxiety disorders. Benzodiazepines (Ativan™, Valium™, Klonopin™ and Xanax™) may be used on a very short term basis to rapidly reduce acute anxiety that interferes with a child’s ability to attend school or participate in talk therapy as an adjunct to a SSRI, since several weeks or more of continuous treatment with an SSRI is often required for clinical response. Benzodiazepines must be used very carefully because sedation, disinhibition and cognitive impairment have been reported as side effects and children can become dependent upon the medication.

What do we hope medication will do for a child with anxiety? The goal when using medication is to reduce the frequency and severity of the child’s anxiety symptoms and allow them to function in an age-appropriate manner in school, at home, with friends and in extracurricular activities. For some types of anxiety, such as panic disorder and school phobia complete remission of anxiety symptoms may be possible. With obsessive-compulsive disorder, a 50% improvement in the frequency and severity of obsessive thoughts and compulsive behavior may represent a very positive response to medication. While some children may respond very quickly to the effects of medication, a rapid response (within a week or less) is generally the exception as opposed to the norm. For most anxiety disorders, two to four weeks or longer may be required to fully assess the clinical response on a given dose of a SSRI. Children with OCD may not fully respond to a given medication for eight weeks or longer. In the CAMS study, kids experienced the greatest improvement from medication in the first four weeks of treatment, but further improvement was seen between week 4 and week 8 in a study that permitted optimization of the child’s medication dose. If a child hasn’t responded to an optimal dose of medication for most types of anxiety within eight weeks or for OCD within twelve weeks, it is unlikely the child will respond to ongoing treatment with that medication.

When I’m discussing the use of medication for anxiety with a child and their parent(s), I usually tell them medication may make it easier for them to make use of the tools and skills they will learn in their therapy to help manage their anxiety symptoms. I don’t want to create unrealistic expectations for medication or subject kids to multiple medication trials because parents or kids are disappointed by a less than expected response.

If medication can result in episodes of anxiety, obsessive thinking or compulsive behavior that are 50% less frequent, last for 50% less time and are 50% less severe, the child will usually feel significantly better. They are then in a better position to effectively manage the remainder of their symptoms through the skills they learn in CBT.

Tomorrow: Are medications used to treat anxiety safe for children and teens?

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Be Not Anxious…Understanding Treatment of Anxiety Disorders in Kids

Posted on June 27, 2011 by Dr. G

Welcome to our Summer Blog Series examining the impact of anxiety disorders on church participation and spiritual development in kids. Today, we’ll discuss treatment approaches to kids with anxiety.

I’m going to do a couple of blog posts examining the treatment of anxiety disorders in children and youth. While these posts may not seem terribly relevant to serving kids in church environments, pastors and church leaders are looked to as resources by families when their children are in need of help.

In general, the most effective approach to treating kids with significant anxiety is a combination of medication and a very specific counseling approach referred to as cognitive-behavioral therapy (CBT).  While combination therapy may work best, not every child needs medication at the outset of treatment. The severity of the child’s anxiety and the degree to which anxiety interferes with the child’s day to day functioning usually determines the approach to treatment.  Kids with milder forms of anxiety will typically try counseling before medication. Kids most likely to require a trial of medication are those with moderate to severe anxiety, those with other psychiatric or emotional disorders in conjunction with anxiety and kids who have not responded or responded incompletely to an appropriate trial of cognitive-behavioral therapy.

The most comprehensive study to date examining treatment of anxiety in children and teens was the Child and Adolescent Multimodal Treatment (CAMS) study. In this study, 488 children between the ages of 7-17 diagnosed with separation anxiety disorder, social anxiety disorder or generalized anxiety disorder were randomly assigned to groups treated with sertraline (brand name: Zoloft) for twelve weeks, 14 sessions of CBT, medication plus CBT, or placebo pills.  Response rates were as follows:

From a statistical standpoint, the combination of CBT and medication was significantly more effective than therapy alone or medication alone. CBT and medication were equally effective, and both treatments were more effective than placebo pills.

What’s so unique about cognitive-behavioral therapy (CBT)?

CBT is the counseling approach with the most research support for effectiveness in the treatment of kids with anxiety disorders.

In CBT, children learn coping skills to develop a sense of mastery over anxiety symptoms or situations associated with significant distress. CBT approaches used to treat children with anxiety include educating the child and their parents about the anxiety disorder and the purpose of therapy, equipping them with relaxation techniques to help moderate physical symptoms associated with anxiety, addressing misperceptions that lead to negative expectations and negative self-image, exposing the child to situations, real or imagined, associated with anxiety symptoms, and development of strategies to help prevent the relapse of symptoms.  Behavioral interventions are designed to help positively reinforce the child’s willingness to expose themselves to anxiety-provoking situations.  Parents are taught the various interventions and strategies so they can serve as coaches, helping their children to practice the strategies at home.

The component of the counseling found to be most impactful in the CAMS study was exposure.  Exposure usually occurs later in the course of treatment and occurs when the child is deliberately placed in a situation that would usually provoke great anxiety, after having been equipped with coping strategies for managing their response to the situation.  For example, a child unwilling to go outside because of a fear of being stung by bees might go to a park in the middle of summer with their therapist for a picnic lunch.

Specific CBT interventions are tailored to the nature of the child’s anxiety symptoms.  Children with phobias may benefit from graded exposure to the object or situation that triggers fear. They may benefit from observing their therapist or parents as they approach the object or situation they fear.  Social skill training may be incorporated into treatment of children with social anxiety.

Two studies demonstrated that educating kids about the nature, causes and course of anxiety disorders without teaching other CBT techniques was of benefit in reducing anxiety symptoms.  Presumably, educational interventions along with supportive counseling result in kids becoming more comfortable with exposing themselves to anxiety-provoking situations.

Are other approaches to counseling or therapy helpful to kids with anxiety disorders?

While a great deal of case experience is reported using traditional psychodynamic psychotherapy to treat anxiety disorders in children, there is very little research support for such treatment approaches.

Several studies have examined family-based treatment approaches to the child with anxiety. The CAMS study included two visits specifically to train parents in the use of CBT techniques. Other studies have shown benefit from addition of a parental component to treatment in situations when one or both parents are anxious.

What are the limitations of talk therapy for kids with anxiety?

Not every child is going to respond to cognitive-behavioral therapy. In the CAMS study, 40% of kids who received CBT alone hadn’t experienced a significantly positive response after twelve weeks of treatment with the best therapy protocols conducted by expert clinicians at prestigious academic medical centers. Twelve weeks may feel like a lifetime to the child experiencing acute anxiety as well as to the parent who has to cope with feelings of helplessness watching their child suffer.  The benefits of talk therapy in the CAMS study only became significant by the ninth week of the study. Kids don’t immediately become proficient in the anxiety management skills learned in therapy sessions.

A very significant limitation of talk therapy is the degree to which success of the treatment is dependent upon the level of skill of the child’s therapist. Most clinicians will have had some lecture and class discussion of the principles of cognitive-behavioral therapy. Fewer will have had specific training or supervision in CBT. Fewer still will have had training or supervision in implementing CBT with children as opposed to adults. In many parts of the U.S. families may not have access to adequately trained clinicians. The most competent clinicians often choose not to accept the highly discounted rates of payment offered by insurance companies.

Wednesday: The role of medication for kids with anxiety

Posted in Anxiety Disorders, Hidden Disabilities, Resources | Tagged , , , , , | 2 Comments

Rules of the Community…Everyone Gets to Play!

Posted on June 26, 2011 by Dr. G

I had an interesting week. There were two events juxtaposed involving either myself or a member of my family illustrating two very different approaches to ministry.

Our twelve year old daughter spent the week on her first mission trip, participating in the 2011 Summer of Service at Vineyard Community Church in Cincinnati, along with 1,000 other middle schoolers from churches from approximately 20 different states. Thanks to the wonders of technology, I was able to watch the closing service on streaming video. The theme for the week was on making God famous by enhancing His reputation through serving others. Through putting on block parties in underprivileged neighborhoods in the city and engaging in other acts of service, the kids were empowered to take personal responsibility for advancing God’s Kingdom and encouraged to continue to do the same upon returning home.

In contrast to that experience, I was involved in a meeting earlier in the week with a leader who holds a very firm belief that ministry in 21st century America is clearly done best when led and directed by trained professionals with seminary degrees and experience in paid positions on the staffs of local churches. I certainly came away from the meeting with the sense that there was little that I could personally contribute that would be valued by that ministry organization and for Key Ministry to partner effectively with this leader, our efforts will need to be led by one of our team members who also serves as a “professional Christian.” I left the meeting feeling very devalued. I also left with a sense of sadness for the opportunities this organization may miss because of their stance that significant ministry is the work of professionals.

So what happens when kids like my daughter come home this weekend fired up about the opportunity to serve by making God famous and advancing His reputation? Will they be encouraged and supported by the local churches and other ministry organizations? I’d hope they’d be encouraged and resourced and supported…after all, they’re kids. What if their parents are the ones with a cool idea for advancing God’s reputation? How might such an idea be supported in your church?

We regularly hear from parents or family members of kids interested in starting ministries in their churches and in their communities to serve kids with special needs. Sometimes, they call us looking for resources after finding others who want to help them in developing their vision for ministry. All too often, they’ve encountered pushback or resistance from leaders in paid ministry positions.

The church should be different. I can’t find any passage of Scripture in the New Testament that suggests ministry is to be delegated to professionals. I can’t see why God would give gifts and talents and passions to those who make up His church and not give them the opportunity to use those gifts and talents in serving and honoring Him. See Romans 12: 4-8.

One principle we can derive from Scripture that will guide how we work together with other ministries and ministry leaders going forward is this…

Every person or organization with a love for Jesus Christ, a heart for sharing the Good News of His Gospel with kids with disabilities and their families and a demonstrable capacity to do ministry with a standard of excellence that advances God’s reputation in the world gets to “play” with our team.

I don’t want anything I say to be interpreted as a knock against folks who out of their love for the Lord and desire to serve Him spend years obtaining education to prepare them to do ministry more effectively. I certainly don’t begrudge anyone their wages for their faithful ministry. The fact that we at Key Ministry offer all of our services for free doesn’t mean that we’re opposed to consultants making a living doing similar types of ministry to ours. The Bible says they’re worthy of support. At the same time, there’s nowhere I can find in Scripture that says that ministry is an honor reserved only for the credentialed and well-connected.

One of my favorite activities with Key Ministry involves finding leaders from both within and outside the church and helping them to get networked with other folks in children’s ministry and disability ministry. It’s so cool when people feel accepted and are given a voice.

It’s very easy for folks in any line of work to fall into cliques, and folks who work in churches and ministry organizations are certainly no exception. All of us like the feeling of being “insiders.” But at the same time, people who want to get involved with ministry shouldn’t be made to feel like outsiders trying to get a seat at the table with the “popular” kids in a middle school cafeteria.

When we open ourselves to working with folks with different ideas or experiences who may ask hard questions about the methods we use, we can anticipate times when we’ll feel uncomfortable. But I don’t think that’s the way God wants us to work. I want leaders with a heart for God’s Kingdom to challenge us and ask the hard questions. Through working with other like-minded Christ followers, we’ll get better at what we do. We want to share our ministry adventure with other people. I’d also like to think that by pursuing inclusiveness in our trainings and communication, we can expand our influence far beyond what would be accomplished through our own efforts, while modeling a Kingdom mindset.

Want to work with us? Pull up a chair. We’ll make room at the table.

Posted in Key Ministry, Leadership, Uncategorized | Tagged , , , | 3 Comments

Be Not Anxious…Technology as a Ministry Tool for Kids With Anxiety?

Posted on June 23, 2011 by Dr. G

Welcome to our Summer Blog Series examining the impact of anxiety disorders on church participation and spiritual development in kids. Today, we’ll challenge you to think about how technology might be used to help kids with anxiety engage with church or share in Christian community with other teens.

Any parent of a teenager or anyone close to a teenager can tell you that most kids rely heavily upon electronic communication these days, either by cell phone or computer. The chart below demonstrates statistics examining cell phone usage and texting by age.  Click this link to an article discussing the data in greater detail.

I don’t have hard data to support this, but kids with significant anxiety symptoms are often more dependent than their peers upon electronic modes of communication, especially text messaging and instant messaging.  They can take time to contemplate their responses and perceive less scrutiny when communicating electronically.  Most teens will text more frequently than they call. Kids with social anxiety may text almost exclusively. One teenage patient who was enrolled in a research study through our practice sent 18,000 text messages and used zero minutes of talk time in one month, according to her cell phone bill.

What if churches began to make use of available technology to keep kids who struggle to overcome their anxiety engaged with youth ministry? Could kids who are too shy to attend church or participate in small groups connect with a local church through an online worship experience, coupled with discussion facilitated and monitored by a youth pastor or group leader? How far away are we from online small groups in which kids could see and talk to one another and their group leaders in real time? Could they become comfortable enough with an online peer group that they could begin to connect with peers in person at their local church?

Are you aware of any churches using technology to reach kids with anxiety disorders, or any other disabilities? Feel free to contact me if you’re a youth pastor interested in exploring this idea as a pilot project.

Posted in Anxiety Disorders, Hidden Disabilities, Inclusion, Strategies | Tagged , , , , , , | 1 Comment

Be Not Anxious…What Causes Anxiety Disorders in Children?

Posted on June 22, 2011 by Dr. G

Welcome to our Summer Blog Series examining the impact of anxiety disorders on church participation and spiritual development in kids. Today, we’ll look at some of the causes of anxiety disorders in children and youth.

Multiple risk and protective factors contribute to the experience of anxiety in any given child.

Genetics clearly play an important role in the development of anxiety. Children of parents with anxiety disorders are more likely to develop anxiety disorders. These effects occur independently of parenting style or family environment.

Temperament, also described as a child’s natural predisposition plays an important role in the development of anxiety. Children who are more shy and inhibited are at greater risk of experiencing anxiety. Such effects may be further mediated by activation or inhibition of other circuits in the brain.  Persons with social anxiety experience activation of the amygdala, one of the structures in the brain that makes up the limbic system, a brain circuit involved in the regulation of emotion. As a result, they are often prone to overreact to relatively innocuous social cues.  Anxious children also experience a failure of the brain’s prefrontal cortex to accurately assess the level of risk in a given situation. The end result is a child who interprets risk differently than their peers and experiences fear in situations that most of their peers tolerate.

The neurochemistry of anxiety is extraordinary complex. At least six different neurotransmitter systems in the brain demonstrably contribute to anxiety symptoms. Neurotransmitters are chemicals responsible for transmitting electrical impulses from one cell to another in the nervous system. An increase or decrease in the activity of one neurotransmitter system impacts the activity of all of the other systems.  Medications used to treat anxiety typically increase the activity of one primary neurotransmitter system.  Neurotransmitter systems involved in learning modulate the activity of systems associated with anxiety and vice versa.  To further complicate matters, another set of proteins collectively referred to as neuropeptides affect both memory and anxiety while functioning as hormones in other parts of the body.

Parents can model inappropriate responses to anxiety-provoking situations for their children and unintentionally reinforce maladaptive coping strategies and patterns of avoidant behavior. Children who on the basis of temperament are vulnerable to anxiety are more prone to the effects of overprotective, excessively critical and controlling parenting styles.

Children with insecure attachment relationships with caregivers (especially at risk are adopted children and children who have experienced significant trauma, neglect or abuse during critical stages of development) are at greater risk of developing anxiety disorders in childhood.

Anxiety symptoms may also be caused by a variety of medical conditions. Parents should consider having their child seen by their pediatrician or family physician to rule out such potential causes of anxiety, even in situations when mental health intervention is being pursued.  Such conditions include, but are not limited to hyperthyroidism, asthma, seizure disorders, migraine headaches and lead intoxication.

In my practice, one of the most common precipitants to anxiety symptoms is stimulant medication prescribed for the treatment of ADHD.

ADHD symptoms may play a protective role in mitigating against anxiety in kids with both conditions. One common therapy strategy used in working with kids with anxiety is to train them to distract themselves or to substitute other more pleasant thoughts when struggling with fears or obsessions. Kids with ADHD are naturally distracted by their inner thoughts and external circumstances. As a result, they are less likely to perseverate on a specific thought or fear. When they are started on medication for ADHD and become less distracted in response to the medication, they often become intensely more aware of bothersome or intrusive thoughts and experience far more difficulty ignoring or letting go of those thoughts.

Whenever I’m asked to see a child who has become more moody, irritable or emotional while being treated with ADHD medication, I ALWAYS ask detailed questions about anxiety symptoms.

Other prescription medications associated with anxiety-like symptoms include medications prescribed for asthma, guanfacine and atomoxetine. Anxiety is a potential side effect associated with many prescription and over-the-counter medications, including cold medications, antihistamines and diet pills. Energy drinks with high caffeine content are an increasingly popular precipitant to anxiety symptoms among teenagers.

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