Building Positive Environments and Reducing Stigma

Presenter: Shawn Ewbank, Psy.D.

View this webinar by clicking here

Download this webinar’s corresponding slides here.
In this talk, Dr. Ewbank helped prepare parents, teachers, clinicians, and individuals with anxiety to create environments where children with anxiety can thrive socially. He explained how adults might best respond in the presence of a child with anxiety. Also considered was how adults can help children to embrace their anxiety by becoming advocates for themselves.


  1. KelleyT says:

    Some anxieties are noticeable such as school refusal, but many can go unnoticed especially in a busy family. What should a parent do if they observe/suspect growing anxiety?

    • Dr. Ewbank says:

      In a busy family life, it can be easy to overlook anxiety in a child, especially if there are not clear changes in the child’s functioning. I would first look to determine whether there is a specific, reasonable cause to the anxiety. For example, in my talk, I discussed anxiety that is brought on by stigma. Anxiety could also be brought about by an ongoing traumatic situation, such as bullying. In these cases, adults should collaborate on ways to decrease the stressor (e.g. educate others to decrease stigma or inform the school of bullying and ask about their anti-bullying policies). If the child’s anxiety seems to be excessive in comparison to the causes, the child may have an anxiety disorder. In this case, I recommend an evaluation by a clinical psychologist and consideration of cognitive behavioral treatment for anxiety. To learn more about such treatments, a good place to start would be to download the archived version of the recent NJCTS webinar on Child Anxiety by Dr. Antinoro-Burke. If you are trying to determine whether the anxiety might be age appropriate, consider downloading the webinar on Developmentally Appropriate Anxiety by Dr. Ratnovsky. These can both be found at https://njcts.org/wordpress/archives/.

  2. KelleyT says:

    How would you recommend handling a child with ADD who does not want his grandparents or cousins to know what’s going on with him? I assume he is embarrassed, but not saying anything makes him look like he is making bad decisions all the time.

    • Dr. Ewbank says:

      Good question. I know that I just strongly advocated for increased education of others as a way to reduce stigma. In this case, I imagine it would be useful if the grandparents and cousins knew about the ADD. That said, the child should be involved in the decision about whether or not the grandparents or cousins are informed. I would be hesitant to educate anyone without the child’s permission (with a young child, 6 or under, the parent often could make the choice alone). If the child does not want to let anyone know, I would spend time trying to understand in detail why the child does not want others to know. If they are embarrassed, I would want to know exactly what they are embarrassed about. If the child is worried that the relatives will not like him anymore, I might encourage him to think of alternative reactions that they might have. It might be that the child needs more practice talking about having ADD or the anticipated reactions of others with parents and/or counselors. If the child is relatively comfortable here, I would see if there was anyone the child felt comfortable beginning the conversation with, a friend, a teacher, a coach, and/or one of the relatives. Practicing the conversation ahead of time may also be useful. Still, at the end of all of this, if the child still does not want to them to know, I would be inclined to support the child in their decision. I would continue to look for opportunities of the sort I talked about in the talk to increase their comfort level over time.

  3. KelleyT says:

    Please comment on special bussing or transportation provided for kids who for medical reasons don’t take the regular school bus, it seems to have such a stigma attached to it.

    • Dr. Ewbank says:

      This is a challenging question. I can only speculate about this from the position of a clinical psychologist. There are a few factors about the “special” buses that may make them likely targets for stigma. First, there is the matter of difference. As I discussed in my talk, things that are different from the norm are often subject to negative judgments and stigma. The buses often appear different. Moreover, many of the children who ride the buses have visible differences. The children who do not ride the bus will often generalize their negative judgments onto all of the passengers. When they share their negative judgments with one and other, making fun of people who ride the bus can become part of the common dialogue at the school. Those who ride the bus may now become victims of stigma and bullying at school. This is a terrible situation. I would argue that solutions to decrease stigma here do not fall on the child, but on the adults in the environment. Ideally, the school would have a proactive solution where they educate the children about difference, providing them with knowledge and laying out expectations for how children should treat one and other. Following this, teasing children who ride the special bus should be considered bullying and treated with the same serious response that is used in any other bullying situations. For more information about bullying and appropriate responses, please see: http://www.njbullying.org/.

  4. KelleyT says:

    You speak about a child surrounded by adults who should be supportive, but how about the child’s interactions with their sibs and any resentment that builds from them because of special privileges.

    • Dr. Ewbank says:

      This is a common scenario. Often a child with special needs of any sort receives different privileges and/or a greater amount of parental time and resources. This can be difficult for siblings. I have two suggestions: First suggestion, attempt to eliminate the concept of “fairness” within child rearing. Every child is different. Every child has different needs. As such, every child receives different treatment and has different privileges. Children often make demands for fairness and parents often claim to support this, even while treating different children differently based on their needs. As an alternative, be upfront about the idea that the household is not being run based on fairness, but based on the parent decision of what is best for each child. When issues of fairness are raised, tell your children that fairness is not your goal. Tell them that fairness is not really a realistic goal, but you do have expectations about how they behave in an unfair world. Second suggestion, if possible, schedule individual time with each sibling every week where you do an activity of their interest together. During this time, or at other times, encourage them to talk about their experience having a sibling who needs specialized attention.

  5. KelleyT says:

    Define what you mean by quality of life measures, that comment seems a little daunting.

    • Dr. Ewbank says:

      Very true. Quality of Life (QOL) does sound daunting, especially considering studies that say that stigma can lower this measure. Within the medical/psychological community, it is a measure of physical, material, social, and emotional wellbeing. It is usually generated from questionnaires that look at an individual’s ability to enjoy everyday life activities. Groups of individuals are than compared to determine if any medical, psychological, or neurological diagnosis or subsequent treatment cause it to be higher or lower. For example, a group of individuals with diabetes could be compared to a group of individual without diabetes. I must emphasize that within any groups there are individuals who are functioning well (higher QOL) and individuals that are not functioning well (lower QOL). One of my intentions in the talk on stigma was to provide adults with the tools to improve the QOL of children with visible differences that lead to stigma.

  6. KelleyT says:

    Would you comment on one parent (the dad) who supports a teen ager’s reluctance to talk about himself and the other parent who feels that he should be more open to discussing his situation? The parents are not on the same page about how to support this child creating its own level of stress and mixed messages in the family.

    • Dr. Ewbank says:

      As is clear from the talk, I am an advocate for finding ways for children, teenagers, (and adults) to open up about their differences. Still, I am also an advocate for parents keeping their disagreements about child rearing decisions private from their children. Even if parents cannot resolve the disagreement, it may be better to find a compromise solution. In this case, perhaps it would be that the mother takes an active effort in talking to the teenager about their visible difference while the father takes a neutral stance. On the other hand, maybe the solution would be that the teenager’s solution is supported for now. Adolescents are tough and sometimes the best a parent can do is to let them that you are there to talk if they want to in the future. In this situation, there is not necessarily a clear answer. I encourage a parent who is really stuck to seek support, and perhaps even guidance for themselves.