Blog

Comprehensive testing for ADHD involves a multi-faceted assessment process designed to evaluate various aspects of a student’s cognitive, behavioral, and emotional functioning. The testing process typically includes the following components: Initial Intake Interview with the Parent, Clinical Interview with the child/adolescent, Behavior Rating Scales, Intellectual Assessment, Cognitive Assessment including executive functioning skills, Academic Achievement Testing, Behavioral Observations, Medical and Developmental History Review, Collaboration, and Considerations for Comorbidity. These components are explained below: A comprehensive clinical interview with the parent is conducted to gather information about developmental history, academic performance, social interactions, emotional functioning, and behavioral challenges. The interview will also explore the presence of ADHD symptoms and their impact on daily life. The use of standardized behavior rating scales, such as the Conners 4, the Behavior Assessment System for Children (BASC), and the Comprehensive Executive Function Inventory (CEFI) are completed by parents, teachers, and, if age appropriate, the student, to assess the presence and severity of ADHD symptoms across different settings. An evaluation of cognitive abilities through standardized assessments is used to assess intellectual functioning, executive functioning, attentional control, processing speed, and working memory. This helps identify potential cognitive deficits and strengths related to ADHD. An assessment of academic skills and performance in the areas of reading, writing, and math is conducted to identify potential academic difficulties associated with ADHD and rule out other learning challenges. Direct observations of the student’s behavior, attentional patterns, impulsivity, and hyperactivity during evaluation help provide insights into their behavioral presentation and interactions. A review of the student’s medical history, developmental milestones, and any relevant health or neurological conditions that may contribute to ADHD symptoms, as well as consideration of family history and genetic factors. Collaboration with teachers and other educational professionals (with parent permission) to obtain input on the individual’s behavior, attentional difficulties, academic performance, and social interactions in the school setting. Evaluation for the presence of comorbid conditions, such as anxiety, depression, learning disabilities, or other behavioral concerns, to ensure a comprehensive understanding of the child/adolescent’s clinical presentation. After completing the assessment process, the clinician provides feedback to the family, offering a diagnosis, if applicable, and recommendations for intervention, treatment, and support services tailored to the individual’s specific needs. Comprehensive testing for ADHD aims to provide a thorough understanding of the child/adolescent’s cognitive, behavioral, and emotional functioning, allowing for accurate diagnosis and the development of targeted intervention plans to address the challenges associated with ADHD. It is essential for the testing process to be conducted by qualified professionals using standardized and evidence-based assessment tools to ensure accurate identification and support for individuals with ADHD.

November: National Adoption Month Written by: Kimberly Treharne, LMHC Did you know that Florida Governor Rick Scott declared November as National Adoption Month? Last year 3,469 children found their “forever families” in Florida alone! Based on the numbers, there’s a good chance that someone in your family or circle of friends has been touched by adoption. It’s important to know that there are many reasons parents choose to adopt; including infertility, being adopted as a child, religion/spirituality, being single, being a gay/lesbian couple, adopting through foster care, or a combination of many factors. Some parents choose the route of international adoption, while others adopt within their family. Some adoptions are referred to as “open” which preserves open communication and visits with the biological family, while other adoptions are considered “closed” and without biological family contact. Some people are adopted at birth, while others find their forever home just shy of their 18th birthday. Adoption is a special way in which families are formed. While adoption is more common than most think, adoptive children can face unique challenges throughout their development and into adulthood including feelings of rejection or abandonment, low self-esteem, feelings of difference or exclusion, and loss or grief. Most adoptive people will go through a time (or many times!) of questioning their identity and having strong desires to find their birth family. Adoptive parents face unique challenges as well, including financial and/or legal stress in trying to adopt, grief and loss in infertility, emotional challenges through adjusting to parenthood, and trying to know the “best” way to support their adoptive child. Adoptive parents and children experience tremendous joy and love, but like every family, need support and guidance at times.  Get support: There are many online support groups, forums, and communities for adoptive families. o http://www.adoptioncouncil.org/ o https://adoption.supportgroups.com/ o http://www.adoptivefamiliescircle.com/groups/ o https://adoption.com/forums/  Get reading: Find age-appropriate books for children so that they have the words to tell their adoption story. For parents, know that there are adoption books on almost any adoption-related issue. o http://www.parents.com/parenting/adoption/facts/childrens-booksabout- adoption/ o http://www.theadoptionmagazine.com/my-10-favorite-childrensbooks- about-adoption-link-up/  Get treatment: Find an adoption-competent family therapist to address the unique challenges faced by adoptive families.November: National Adoption Month Did you know that Florida Governor Rick Scott declared November as National Adoption Month? Last year 3,469 children found their “forever families” in Florida alone! Based on the numbers, there’s a good chance that someone in your family or circle of friends has been touched by adoption. It’s important to know that there are many reasons parents choose to adopt; including infertility, being adopted as a child, religion/spirituality, being single, being a gay/lesbian couple, adopting through foster care, or a combination of many factors. Some parents choose the route of international adoption, while others adopt within their family. Some adoptions are referred to as “open” which preserves open communication and visits with the biological family, while other adoptions are considered “closed” and without biological family contact. Some people are adopted at birth, while others find their forever home just shy of their 18th birthday. Adoption is a special way in which families are formed. While adoption is more common than most think, adoptive children can face unique challenges throughout their development and into adulthood including feelings of rejection or abandonment, low self-esteem, feelings of difference or exclusion, and loss or grief. Most adoptive people will go through a time (or many times!) of questioning their identity and having strong desires to find their birth family. Adoptive parents face unique challenges as well, including financial and/or legal stress in trying to adopt, grief and loss in infertility, emotional challenges through adjusting to parenthood, and trying to know the “best” way to support their adoptive child. Adoptive parents and children experience tremendous joy and love, but like every family, need support and guidance at times.  Get support: There are many online support groups, forums, and communities for adoptive families. o http://www.adoptioncouncil.org/ o https://adoption.supportgroups.com/ o http://www.adoptivefamiliescircle.com/groups/ o https://adoption.com/forums/  Get reading: Find age-appropriate books for children so that they have the words to tell their adoption story. For parents, know that there are adoption books on almost any adoption-related issue. o http://www.parents.com/parenting/adoption/facts/childrens-booksabout- adoption/ o http://www.theadoptionmagazine.com/my-10-favorite-childrensbooks- about-adoption-link-up/  Get treatment: Find an adoption-competent family therapist to address the unique challenges faced by adoptive families.November: National Adoption Month Did you know that Florida Governor Rick Scott declared November as National Adoption Month? Last year 3,469 children found their “forever families” in Florida alone! Based on the numbers, there’s a good chance that someone in your family or circle of friends has been touched by adoption. It’s important to know that there are many reasons parents choose to adopt; including infertility, being adopted as a child, religion/spirituality, being single, being a gay/lesbian couple, adopting through foster care, or a combination of many factors. Some parents choose the route of international adoption, while others adopt within their family. Some adoptions are referred to as “open” which preserves open communication and visits with the biological family, while other adoptions are considered “closed” and without biological family contact. Some people are adopted at birth, while others find their forever home just shy of their 18th birthday. Adoption is a special way in which families are formed. While adoption is more common than most think, adoptive children can face unique challenges throughout their development and into adulthood including feelings of rejection or abandonment, low self-esteem, feelings of difference or exclusion, and loss or grief. Most adoptive people will go through a time (or many times!) of questioning their identity and having strong desires to find their birth family. Adoptive parents face unique challenges as well, including financial and/or legal stress in trying to adopt, grief and loss in infertility, emotional challenges through adjusting to parenthood, and trying to know the “best” way to support their adoptive child. Adoptive parents and children experience tremendous joy and love, but like every family, need support and guidance at times.  Get support: There are many online support groups, forums, and communities for adoptive families. o http://www.adoptioncouncil.org/ o https://adoption.supportgroups.com/ o http://www.adoptivefamiliescircle.com/groups/ o https://adoption.com/forums/  Get reading: Find age-appropriate books for children so that they have the words to tell their adoption story. For parents, know that there are adoption books on almost any adoption-related issue. o http://www.parents.com/parenting/adoption/facts/childrens-booksabout- adoption/ o http://www.theadoptionmagazine.com/my-10-favorite-childrensbooks- about-adoption-link-up/  Get treatment: Find an adoption-competent family therapist to address the unique challenges faced by adoptive families.

BLOG October 2016 Food Dyes and ADHD: What do parents need to know?   Did you know that October 2016 is ADHD awareness month? Among the other many important things to be aware of this month, we decided to address a topic that parents often ask about, particularly as we approach Halloween.  Do sugar and food dyes cause hyperactivity in kids? Can dietary changes affect ADHD?   The short answer to this question is “maybe.”  The longer answer involves a more complicated attempt to summarize what data we have on this topic. The food dye controversy reached a peak in 2007 after the publication of a controversial study by the University of Southampton in the UK suggesting a link between six food dyes – the “Southampton Six” – and hyperactivity in children.   These six dyes are: E110 (sunset yellow/FD&C Yellow #6), E104 (quinoline yellow), E122 (carmoisine), E129 (allura red or FD&C Red #40), E102 (tartrazine/FD&C Yellow#5) and E124 (ponceau 4R).  This study (as well as follow up studies in the U.S.) lead to the FDA’s and European Food Safety Authority’s concluding that there was not enough evidence to alter acceptable daily intake of these additives.  And yet, further investigation of this issue, including a look at earlier studies, yields conflicting results.   A study in 2004 compared behavior in children receiving fruit juices with food additives and fruit juices alone.  This demonstrated that there were no statistically significant behavioral differences in these groups.  And yet, another study in 2004, revealed artificial food colors might promote hyperactivity in children with ADHD.  This study was limited by some flaws in its design, as well as the fact that parent ratings differed from teacher and clinician ratings. In terms of other dietary restrictions and interventions, the general consensus is to consider dietary interventions only in groups of children who have documented sensitivities or allergies.  Parents frequently report a worsening of hyperactivity after an excessive ingestion of candy or diet soda, but majority of controlled studies did not demonstrate significant adverse effect of sucrose or aspartame.  Furthermore, two reviews found insufficient evidence to recommend dietary interventions for attention deficit hyperactivity disorder (ADHD) in children What about supplements instead of ADHD medications, such as stimulants? Several small studies have shown that a combination of omega-3 and omega-6 fatty acids might improve some ADHD symptoms in children and adolescents.  In terms of fish oil, this seems to be a situation in which the possible benefit outweighs any potential risk, and there may be some additional perks, including improvement in overall heart health.   So, what’s the bottom line on sugar, food dyes, and supplements, and their effect on hyperactivity and ADHD? Food dyes and excess sugar are probably not good for us anyway. They can contribute to dental issues, cavities, as well as childhood obesity, and other concerns.  And while there is not sufficient evidence to say that they worsen ADHD, it probably makes sense to limit the intake of these additives for most children.  Finally, if you are interested in considering omega-3 fatty acid supplementation, please consult with your child’s doctor to determine the most appropriate regimen.   References – Lancet 2007 Nov 3;370(9598):1560, – Arch Dis Child 2004 Jun;89(6):506 full-text,  – J Dev Behav Pediatr 2004 Dec;25(6):423, J Am Acad Child Adolesc Psychiatry 2011 Oct;50(10):991 (N Engl J Med 2014 Feb 27;370(9):838, J Fam Pract 2010 Apr;59(4):234)

What would we do without our smartphones?  We have become so dependent on our mobile devices, it’s hard to remember life without them.  Finding time to disconnect from our work, social lives, and the media can have many benefits.  Still, we find it impossible at times to put down the mobile devices.  So why not use these same devices to improve our mental health and overall well-being.  There’s a growing market for mobile applications that promise to improve our mood, reduce stress, create healthy habits, help us heal from trauma, become more mindful, and even raise our children. The wonderful thing about mobile applications is that they have the ability to reach a much wider audience.  Help via a mobile device may be more cost effective and available to those who may not otherwise have the time or energy to read a self-help book.  Some mobile apps may be utilized best to supplement psychological services, as individuals can carry tangible reminders or activities with them that relate to the tools they learn in therapy.  The following is a small list of the countless available apps to address self-improvement. Anxiety and Depression Mind Shift – This app is ideal for teens and young adults experiencing anxiety.  It addresses issues with sleep and perfectionism, as well as test, social, and performance anxiety.  The goal of this app is to assist in confronting anxiety provoking situations while also changing your thoughts about such situations.  It utilizes relaxation techniques and various other tools to address anxiety. Breathing Zone -This is an app that teaches several breathing exercises that vary in length from 5 to 60 minutes.  It includes a breathing analyzer as well as visual and auditory signals to assist with breathing.  It can be utilized with your eyes closed to further enhance relaxation.  One of the primary goals is to reduce your overall heart rate.  The manufacturer even claims that daily use can help to manage high blood pressure. Breathe2Relax -This app teaches diaphragmatic breathing exercises that can assist with mood stabilization, anger control, and anxiety reduction. CBT* ABC way – As featured on the American Psychological Association’s Mobile psychology web page, this app was designed by clinical psychologist Dr. Yvette Tazeau.  It can be used with children, adolescents, and adults with anxiety and depression symptoms.  This app can be used alone or to supplement therapy.  It is designed to teach users to pay attention to negative thoughts, while learning to challenge them with more reasonable and realistic thoughts.  This is based on the theory that negative feelings are connected to negative thoughts, and that by learning to monitor and challenge negative thoughts you can help to reduce negative feelings. Pacifica – This app has numerous features that attempt to reduce anxiety and improve your overall mood.  It offers various relaxation techniques and assists you in tracking both your mood and daily health habits.  There is also a thought diary option that will aid you in changing negative thinking patterns. IntelliCare – Includes over ten different applications to address both anxiety and depression. MoodKit – This app was designed by psychologists in an effort to improve your daily mood.  It features four integrated tools that help you to engage in mood-enhancing activities, identify and change unhealthy thinking patterns, rate and chart your mood over time, and create custom templated journal entries to promote well-being. Also check out OPTIMISM, MoodPanda,  T2 Mood Tracker, Live OCD free and Worry Box. Relaxation Headspace – This meditation and mindfulness app uses guided and non-guided exercises ranging from two minutes to an hour in length.  You can specify which areas you would like to address such as health, performance, or relationships. Equanimity – Equanimity is a meditation timer that also features graphical tracking and a journal feature. The meditation timer features simple graphics to minimize distractions during meditation. If users have several stages in their meditation routine, the app can be programmed to chime at the appropriate intervals. Users can view their meditation history in the form of a visually annotated log or a text-based journal. All of the data recorded in the app can be exported as an email or spreadsheet. BREATHE– Breathe is a mindfulness app that helps you stay calm by sending you gentle deep breathing reminders throughout the day. HelloMind – The developers of this app describe utilizing “Result Driven Hypnosis” techniques to address numerous areas such as relaxation, motivation, poor sleep, and low self-esteem. Additional resources for further relaxation include Personal Zen, Hello Mind, and Mindfulness Coach.   Apps for Parents Behavioral Apps No More Meltdowns – This app originated from a book by Dr. Jed Baker that was created to assist caregivers in managing and preventing out of control behavior in children.  The app assists parents in tracking behavioral outbursts in order to identify themes and understand the cause and nature of the meltdown.  Strategies are provided as well as assistance creating a plan to address future meltdowns. Chore Monster – Parents can create scheduled chores with designated point values for chore completion.  Rewards can be correlated to points obtained and children can review their progress while keeping track of potential rewards and how to achieve their goals. Time Timers – This creative app allows parents to create colorful timers to help children keep track of time while encouraging motivation and on task behavior. Child Development Vroom – From birth to age 5, this app can help to promote brain development through everyday activities.  Daily brain building tips are offered and catered to your child’s age.  Each tip is accompanied by a scientific explanation of how the suggestion can assist in brain development.   Divorce Divorce App – This app is based off of the book Mango Season Doesn’t Last Forever, by Dr. Robert Woliver.  It is designed to help children recognize that they are not alone when their family is going through such a difficult experience. Specific suggestions are offered for different developmental stages from ages 2-18.  Children’s drawings are utilized to illustrate their stories, feelings, and needs.  The app also includes activities to help children understand the divorce and a quiz for parents to gauge how well they are reacting to their child’s needs. Post-Traumatic Stress Disorder PTSD Coach – Developed by the Department of Veterans Affairs’ National Center for PTSD, this app was originally created for service members, veterans, and their loved ones.  It provides a self-assessment tool, symptom-tracker, educational materials, and suggests coping skills to address and monitor symptoms. Suicide Prevention ReliefLink – This app’s team of creators was led by the American Psychological Association President Nadine J. Kaslow, PhD, at Emory University.  The app was recently recognized at the White House by the Substance Abuse & Mental Health Services Administration where it was awarded first place in the Suicide Prevention: Continuity of Care and Follow-up App Challenge.  ReliefLink includes numerous features, such as a mood tracker, a personalized safety plan, coping strategies, and an emergency button that connects users to friends, hospitals, and other resources. Operation Reach Out – Designed to prevent suicide among military personnel, veterans, and their loved ones, this app assists in keeping individuals connected to help. Addiction Step Away – This app includes numerous features to assist with alcohol addiction.  For example, it teaches users to become more aware of their triggers, and drinking patterns and assists with setting realistic goals.  The app also offers personalized suggestions for alternative activities, and provides strategies to help with cravings, boredom, and negative moods.  A support team is also set up along with the ability to share progress with others for additional support. IM Quit – Targeted to treat any addiction, this app allows you to track your behavior over time and share your successes with others.  IM Quit also offers encouraging quotes and suggestions to stay on track with your goals. 12 Steps AA Companion 2 – Designed to be used for alcohol addiction, this app tracks your progress while including much of the Alcoholics Anonymous Big Book plus personal stories.  Support from other AA members can be found easily with this app.  For example, your smart phone’s GPS system can be used to direct you to a nearby AA support person. Healthy Habits Way of Life – With the ability to specify up to ten habits at one time, this app will help you beat unwanted habits or create desired habits.  You can set

ANXIETY IN CHILDHOOD: DEVELOPING TOOLS TO HELP YOUR CHILD COPE: By Dr. Tia Westheimer Although unpleasant at times, feeling anxious is a very natural part of human existence.  The purpose of anxiety is to alert us to and protect us from true threats of danger.  When danger is perceived our bodies prepare us for immediate action.  Most people have heard of the body’s “fight or flight” response.  This represents a series of changes that take place in our body to prepare us to either fight off or escape from danger.  The sympathetic nervous system is activated and hormones such as adrenaline and cortisol are released into the body.  As a result we may feel dizzy, sweaty, or shaky as we experience increased heart rate, blood pressure, and breathing rate.  Blood flow to major muscle groups is slowed along with slowed digestion, which may result in nausea. Despite the body’s brilliant design to protect us from danger, the threat of actual danger occurs far less often than one may tend to experience anxiety.  The manner in which we interpret and handle our feelings of anxiety can greatly impact our overall level of stress and eventually our quality of life. When a child experiences anxiety, caregivers often feel confused, helpless, and even frustrated at times.  It is important to remember that some level of worry in children is normal.  It can even help them to stay alert and focused.  However, excessive worry is likely to become overwhelming and begin to interfere with a child’s mood and ability to enjoy life.  There are many things you can do to help children cope with their level of worry.  First, knowing what is normal for your child’s age and level of development is key. Are My Child’s Fears Normal? As children age, the focus of their worry will likely change.  When a child worries, it does not necessarily mean that they are suffering from anxiety.  Ask any child you know, chances are, they can tell you about something that worries them from time to time.  Below is a list of very common fears for children at different developmental stages: Typical Developmental Sequence of Fears in Children as defined by Chansky (2014). INFANCY: Babies’ fears are immediate and concrete.  In response to a growing ability to differentiate familiar faces from unfamiliar faces, stranger anxiety (clinging and crying when a stranger approaches) develops around seven to nine months and typically resolves by the end of the first year.  Infants fear separation, loud noises, and sudden movements. EARLY CHILDHOOD: As a healthy attachment to parents grows, separation anxiety (crying, sadness, fear of desertion upon separation) emerges around one year of age and improves over the next three years, resolving in most children by the end of kindergarten.  As children’s worlds expand, they may fear new and unfamiliar situations as well as real and imagined dangers from such things as big dogs, spiders, the dark, sleeping alone, scary movies, ghosts or monsters. ELEMENTARY SCHOOL: With access to new information and a growing ability to grasp the gravity of events, children begin to fear real-world dangers—fire, burglars, kidnappers, storms, natural disasters, illness, drugs.  With experience, they normally learn that these risks present remote, rather than imminent, danger.  They continue to struggle with what is real and what is not—so fears of ghosts, witches, and zombies are common. MIDDLE SCHOOL: The growing importance of social status leads to social comparisons and worries about social acceptance.  Concerns about test grades, crime, social isolation, athletic performance, and social-group identification are normal. HIGH SCHOOL: Teenagers continue to be focused on social acceptance, but with a greater concern for finding a group that reflects their chosen identities.  They tend to worry about the narrow focus of their social relationships as well as about the larger world. Moral issues, and their future failure or success. When Worry Turns Into Uncontrollable Anxiety The following symptoms are likely when a child’s fears and worries have manifested into anxiety that begins to interfere with daily functioning.  If one or more of the following scenarios applies to your child, they are likely suffering from excessive anxiety and find their fears difficult to control.   Physical symptoms-Such as headaches, stomach aches and even vomiting. Anticipate future events with excessive worry, days or even weeks leading up to the event. Extreme avoidance-avoiding school, outings, vacations, time with friends or family. School refusal-refusal to attend or frequent difficulty returning to school following weekend or holiday breaks. Interference in family, social, academic or daily functioning. The use of logical discussions and reassurance to dispel fears is frequently ineffective. Constant reassurance seeking Symptoms appear to persist and or worsen over time. Sleep disturbance-difficulty falling or staying asleep Avoids safe things or things that were once pleasurable. Exposure or discussions of feared items that results in crying, tantrums or behavioral outbursts.     So What Can You Do?  Start talking! It’s not uncommon for children to not only avoid things they fear, but to avoid discussion related to their fears.  It is much easier to help your children if you can begin to understand what worries them.  Be investigators together to find out what aspects of certain situations are triggering a feared response.  The more we understand the more we can demonstrate compassion for how they are feeling.  If children feel that you do not understand them, they are less likely to buy into the interventions you propose and you are less likely to have a positive impact. It is important to remember that the situations that feel threatening to your child are very real for them.  Even perceived threats can activate the fight or flight response.  In my clinical work, I often times ask parents to think of something that would be extremely frightening for them, such as holding a rodent or a tarantula, being robbed, or trapped in a box.  I explain that when a child’s fears are causing disruption in their daily routine they may be experiencing the same physical and psychological manifestations of those fears, despite how trivial or illogical those fears may seem to others. Help children to understand that fear is a normal and natural feeling state that we all experience from time to time.  Let them know that anxiety helps to warn us of real danger and therefore, we don’t want to eliminate it completely.  However, we can learn to tolerate and cope with it.  Share some age appropriate things you have worried about in the past and since overcome.   Validation and reflection are key.  Do not confuse validation with agreement and encouragement of fears, as they are much different.  You can respect your child’s feelings without reinforcing their fears.  Let your child know that you understand that this is very frightening for them and that you are there to help him get through it. Reflect how he is thinking and feeling back to him to be sure your understanding is accurate. Educate your child.  Help your child to understand how anxiety can make our bodies feel certain ways.  Explain to your child that anxiety can confuse us by acting as somewhat of a bully sometimes, creeping in at the wrong times.  Make sure they understand that it will get better over time. Model healthy ways to handle anxiety for your children by managing your own stress in a positive way. Challenging Thoughts Begin to assist your child in challenging his current way of thinking.  Ask questions that allow the child think critically and realistically about their struggles. How likely is it that your fears will come true? Examine the evidence. What is the worst thing that could happen? What would (someone you admire or look up to) say about this fear? What other outcomes are likely? Progressive Muscle Relaxation (PMR) This method has been around for almost one hundred years.  It involves systematically tensing and relaxing various muscle groups.  Children, and adults, have a tendency to tense their muscles when they feel stressed or anxious.  This can result in more anxiety just as the opposite can be true.  Muscle relaxation has been demonstrated to support the tolerance of anxiety.  If you can teach your child to recognize when they tense their muscles, they can then learn to relax those muscle groups in an effort to reduce their worry and begin to feel calm. There are countless free PMR scripts that can be found online for various age groups. 

What’s up with They Pronouns? By: Dr. Erin Robinson Pronouns are something we use every day without much thought, but which have significance in identifying the people we are talking about.  The pronoun, “he” or “she” holds a rolodex of images, meanings, and assumptions about the person being discussed.  Some of these assumptions are driven by internal ideas of men and women, and others based on societal expectations. So what happens when we are confronted with they/them pronouns? We have to think!  All of the preconceived notions of men and women existing on a binary must be altered.  This usually causes discomfort, and as a result, people dismiss these pronouns as invalid because they do not fit into our orderly constructs of gender.  However, there are people who view their gender ambiguously, or fluidly, and do not ascribe to traditional gendered pronouns, like “he” or “she”, and rather prefer pronouns such as “they” or “ze.”  By telling someone their pronouns are invalid, you are all invaliding them as a person. Outward appearances do not necessarily give you information about what a person’s gender identity is, and therefore should not be used to make assumptions about one’s identity.  Gender identity is defined as “a person’s inner sense of being male or female, usually developed during early childhood as a result of parental rearing practices and societal influences strengthened during puberty by hormonal changes.”  Gender identity evolves over time and may diverge from the traditional male/female binary. Here are some ways to be conscious of gendered language and using correct pronouns: If you are not sure about someone’s pronouns, use gender-neutral pronouns Ask! What pronouns do you use? Check in over time as gender is fluid and therefore pronouns change as well When introducing yourself, you can also incorporate your pronouns into your introduction, “Hi, I’m Nic, I use she/her pronouns…. If someone introduces themself with pronouns you are not used to…practice! As long as you are trying, people will be grateful for your efforts and not expect you to be perfect all the time This chart can help to understand how to use gender neutral pronouns correctly: (credit: apps.carleton.edu) Dr. Robinson specializes in working with gender diverse clients and their families.  She conducts trainings on gender diversity and creating safe spaces for LGB+T communities.