It’s a commonly accepted perspective in the field of mental health that all behaviors have a goal. When it comes to understanding youth who are challenged with an autism spectrum disorder (ASD), the key is realizing that all behaviors represent efforts to communicate. Rigid expectations of social behaviors and decision-making based on age can interfere with supporting a person on the spectrum, especially when communication is expressed differently when compared to the general population. While the behaviors of someone on the spectrum may seem unusual or even at times disruptive, the best approach for understanding a person with autism, especially youth, is to determine the goal, how the goal is communicated through their behaviors, and the intersectionality of those behaviors with peer interaction, transitioning to adolescence and adulthood, and adapting to new environments due to a military permanent change of station (PCS) or sudden absence of a parent. Intentionally diversifying sources of support can improve outcomes for youth especially as they transition into adulthood.

Understanding Autism[1]^,[2]

Autism Spectrum Disorder (ASD) is defined as a neurological disorder that, because of its effects on brain functioning, can negatively impact daily interactions such as socializing, displaying affection, and communicating. This impact has far-reaching implications, spanning multiple domains and presenting in an unpredictable manner. The severity of the disorder is compounded by co-occurring conditions and adverse reactions to sensory stimuli, such as lighting and noise.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides further clarifying terms, using two identifying categories of symptoms to provide a basis for diagnosis of autism:

• Persistent deficits exist in social communication and social interaction across multiple contexts and restricted, repetitive patterns of behaviors, interests, or activities.
• Some of the characteristics include repetitive movements and speech, inflexibility, fixated interests, and hyper-/hypo-reactivity to sensory input.

Similarities With Other Youth[3]^,[4]

Youth with autism are prone to experience the same desires for friendships and intimacy as their peers. They share the same right to have educators and family educate them on this topic. These youth will also experience peer pressure and bullying, as all youth do. Kids with ASD crave same-aged allies just like others their age. They are vulnerable to missing non-verbal cues that mask sarcasm, teasing and even malicious intent. Peers who are not on the spectrum but have demonstrated healthy social skills are ideal for helping youth with autism to communicate and understand communication.

Differences From Other Youth[5]

Understanding autism in youth is more than a simple exercise in definitions and categorizing symptoms—a concerted and diligent effort for research is needed across disciplinary domains. The CDC’s Study to Explore Early Development (SEED) has provided the most comprehensive study of ASD in the United States, examining the health, functioning, risk factors, and signs present in preschool-aged children. Such a study empowers others to support the ability of a person with autism to effectively communicate. Amid a scarcity of research exploring ASD among pre-/teens, the SEED’s usefulness has been further expanded to survey the families of 800 children between the ages of 12-16 who were a part of the initial phase of SEED. Although similarities between neurodivergent youth and neurotypical youth can easily be identified, this study shines a necessary light on the differences between adolescent cohorts.

The findings in this report reveal that adolescents with autism experience a need for greater support in the areas of physical and mental health, as well as extending the use of healthcare beyond the stage of adolescence, in contrast to peers their age.

In comparison to adolescents in the control group of this study, children with autism were 90% more likely to have co-occurring mental or physical health conditions and at the same time more than three times likely to not access appropriate health care for those needs.

Being included in general education classrooms is a boon to social competence in youth with ASD, but not a fix. Social deficits create a need for interventions that coach social skills for them, such as initiating or inviting others to play and engage, while these skills naturally occur in typically developing youth.

A peer helper can assist with bridging the gap between these differences, offering the chance for youth from both cohorts to experience and engage in friendly behavior in a variety of environments, such as classrooms, recreational areas, or after-school events.

It may be difficult for a child from either cohort to articulate the differences, but the relational tension will be present, nonetheless. Interventions should assist both children, equipping them with clearly defined choices that improve the likelihood of forming a healthy social connection between them.

Challenges for Military Families

Military sources indicate that more than 13,000 military dependents, the majority being children, have some form of autism. No matter where they go, their families will always be the immediate support system, a system vulnerable to emotions and challenges related to the difficulties of military life: a permanent change of station, frequently absent or deployed parents, changing primary care managers and parental/marital stress.

A diagnosis of ASD means that every day a caregiver must plan every activity to prevent behaviors that will likely be misunderstood by those untouched by ASD. Even when connecting the youth with an organization that can provide care and interaction outside of the home, the caregiver will need to provide specifics about their child’s needs and determine if the environment they are entering is an adequate fit. The environment should include staff trained to intervene and redirect especially by understanding what behavior that seems disruptive is trying to convey on behalf of the child. Most parents and caregivers find themselves repeatedly having to explain to other professionals why their child reacted the way they did.

Another frustrating factor that families looking for support outside of the home encounter is simply a lack of affordable and competent sites. The emotional toll on a parent or caregiver from frequently reaching a dead end can exhaust even the most resilient. The chances of finding a great fit for a youth with ASD is generally cut in half by the lack of behavior management services, the expense of the programs, and the sad reality of untrained staff.

Military families also encounter increased hardship introduced by the search for evidence-based treatment services, especially when a new duty station proves to be a disruption to receiving quality care. Not all stations have ease of access to needed services.[6] Military children and their families move every few years. These frequent changes hinder the ability to maintain secure relationships in the school setting and with each move, the rigors of advocacy for individualized services are reborn. Any family who has dealt with a military move can vouch that the process is replete with paperwork. A family who has a child with autism has their work nearly doubled. Important documents and steps to take include, but are not limited to, the most recent copy of an IEP, a current behavior plan, medical documentation, connecting with the receiving school play son, a new therapist, and finding a neighborhood accessible to community-based services.

Financial strain is another stressor faced by military families. Spousal unemployment can easily become a dynamic for a family with a child on the spectrum. It is often simpler and more cost effective to care for the child at home, especially when hours for paid time off become depleted due to frequent calls from the school for a parent to come deescalate the child.

Frequent moves, financial strain, and harried reintegration processes can mount into a tremendous pile of stress leading to feelings of isolation and marital discord in many cases. Finding and building a support system, albeit challenging, is not impossible and is worth its weight in gold. Despite all the barriers and challenges of a military lifestyle, friendships and systems that are built often turn out to be lifelong relationships. Military living means that a challenge posed for one is a challenge accepted by all.

How the MFLC Program Can Help with Communication

The Military and Family Life Counseling program supports service members, their families and survivors with confidential non-medical counseling where they are stationed. Recognizing behavior as a form of communication is a skill possessed by Military and Family Life Counselors (MFLC) counselors. MFLCs are in an excellent position to support families and schools by providing referrals and psychoeducation about the need for behavior to be interpreted rather than reacted to.

Anxiety for anyone is an emotion that disables executive functioning. MFLCs can equip staff and family with language that prevents and even deescalates anxiety in youth with autism. A person with ASD may look away for a moment or two before responding to directions. Rightly interpreting this behavior can prevent the wrong reaction and a misunderstanding. A pause in responding doesn’t necessarily mean unawareness or lack of intellect—for the person with ASD, looking away may mean, I need a quick break from stimuli.

MFLCs can also help by increasing awareness of incorrect assumptions, such as the aforementioned “pause” as a lack of emotionality, and biases built into labels such as low or high functioning. MFLCs can coach staff and family to ask, “what support do you need,” rather than assuming wrongly about the support needed at any point on the spectrum.

Effective communication is essential in at least two settings: school-based and healthcare. Data show a strong correlation between time spent in general education classrooms and increased academic skills and knowledge, receipt of a high school diploma, and/or increased access to typical peers, which promotes a primary desire for youth in general: healthy social relationships. The ultimate benefit is enhanced integration in the community. Youth participation in work opportunities, paid and unpaid, during high school is also connected to better outcomes in adulthood. To get started with the MFLC program contact your installation’s Military and Family Support center.

Tips for Preventative Healthcare

The single greatest external factor in fostering support for a teen preparing to enter adulthood is preventative healthcare. While under the care of their family, youth with autism benefit from services such as the Exceptional Family Member Program (EFMP), Extension for Community Healthcare Outcomes (a virtual interdisciplinary network for providers which includes parental feedback), Tricare, and Individualized Education Plans (IEP)/504 plans. However, as discussed, youth with autism are less likely to continue healthcare into adulthood. The goal for preventative healthcare is to equip the person receiving the healthcare with an awareness of what their health can and should look like and the right to receive that care.

An ideal strategy for improving health outcomes and reducing service gaps for youth with autism involves interdisciplinary training promoting the use of evidence-based interventions. Operation Autism lists several, including the most widely used, Applied Behavioral Analysis (ABA), Picture Exchange Communication Systems (PECS), and Speech and Language Therapy (SLT) across multiple contexts. At a minimum, as recommended by the CDC, care should be timely, coordinated, and family centered. Practitioners and school administrators should encourage parents and caregivers to enroll youth early in services, such as insurance plans and residential living, that support the transition to adulthood.

According to measures included in the Health Resources and Services Administration Maternal and Child Health Bureau National Performance as reported by the CDC SEED 2 study, practitioners should ensure three elements are met when establishing a wholesome health care transition:

• The youth should spend time alone with the primary care provider,
• The PCP should actively work with the child to understand healthy living, and
• The parent should know how the child will be insured when they reach adulthood.

Conclusion

The research-to-practice gap is steadily closing with studies such as SEED and the increase of evidence-based practices (along with the collective disapproval of ineffective and harmful treatment practices). Understanding the needs of youth with autism has been difficult but is no longer the apprehensive feat it once was, and while military families with ASD may have additional stressors, there is a system of support available to help navigate these challenges. Ultimately, communication is a gift for all human beings to use in the quest to understand one another, and establishing healthy communication with youth with autism is not simply a matter of teaching them what to say but it largely entails the ability to interpret what they are already saying.

This article was originally published on MFed Inform.

[1] Low Functioning to High Functioning Autism: A Prescriptive Model for Counselors Working With Children Across the Spectrum. Katherine Feather, 2016. https://www.counseling.org/docs/default-source/vistas/article_11d2bf24f16116603abcacff0000bee5e7.pdf?sfvrsn=4ca9442c_4

[2] Operation Autism. (n.d.). Life Journey through Autism: A Guide for Military Families

[3] Autism Speaks. 2013. Leading The Way: Autism Friendly Youth Organizations. https://www.autismspeaks.org/tool-kit/leading-way-autism-friendly-youth-organizations

[4] https://www.plannedparenthood.org/planned-parenthood-massachusetts/local-training-education/parent-buzz-newsletter/parent-buzz-e-newsletters/sexuality-education-youth-autism-spectrum

[5] Health Status and Health Care Use Among Adolescents Identified With and Without Autism in Early Childhood — Four U.S. Sites, 2018–2020. Powell PS, Pazol K, Wiggins LD, et al. https://www.cdc.gov/ncbddd/autism/autism-spectrum-disorder-in-teenagers-adults.html

[6] Toward Innovative, Cost-effective, and Systemic Solutions to Improve Outcomes and Well-being of Military Families Affected by Autism Spectrum Disorder. 2015. Klin et al. https://pubmed.ncbi.nlm.nih.gov/25745376/

“Oh my! It’s raining cats and dogs out there!” A second-grade girl remarked as she stared out of a classroom window. Another child, wide-eyed and twirling her braid, turned and stared in shock and disbelief at the raindrop scattered windowpane. “What do you mean, those poor puppies!?” she cried. “Nooooo….” scoffed another classmate, “There are NO ANIMALS. She means it’s raining REALLY HARD.” The concerned child saddened about the well-being of the possible tumbling animals outside, slumped down in her chair, trying to avoid the gaze of everyone. Her eyes welled with tears, and she remained silent throughout the rest of the class. She continued to twirl her hair with more vigor. Soon the sun began to shine via the droplets on the windowpane, and she stopped twirling her hair to stare at the beautiful array of light. “This is a prism, a spectrum of light.” She whispered to herself.

Children with Autism Spectrum Disorders have their own unique struggle. Like the spectrum of light, Autism diagnosis defines a broad range of conditions that demonstrate marked struggles with language (expressive/receptive), repetitive/restrictive behaviors, social skills, and nonverbal communication. This vignette of an interaction between three 8-year-old children provides an example of a receptive language issue. For this little girl, she struggled to understand an idiom likening the raindrops to “cats and dogs falling from the sky.” Dr. Stephen Shore stated, “If you met one person with Autism, you have met one person with Autism.” He is an author, a professor of Education, and a member of the board of Autism Speaks, an organization created to educate and advocate for those affected by Autism throughout their lifespan. His quote incites awareness that while a child may be diagnosed with autism, their presentation and needs will be unique. (APA, 2013)

Autism Speaks shares statistics and trends that have shown a steady increase in the diagnosis of autism spectrum disorders (ASD). Diagnosis has become more comprehensive in recent years. Awareness and early detection have been associated with an increase in the frequency of diagnosis. The Centers for Disease Control (CDC) reported in 2021 that 1 in 44 children was diagnosed with an autism spectrum disorder in the United States. Autism affects children across all socioeconomic statuses and minority groups. Minority groups are diagnosed at a later age and at a lesser frequency than other demographic groups. Families face multiple challenges after diagnosis. These include parents having difficulty maintaining ‘out of the home’ employment while becoming full-time advocates for their children. The additional cost of providing treatment and care per child with ASD is approximately $60,000 per year (Autism Speaks, 2017).

Risk Factors of Military Children with Autism

While 1 in 44 children in the general population is reported to be diagnosed with Autism, the statistics are not entirely clear for military children. In 2020, TRICARE reported that across all branches of service, 34,361 military children were diagnosed with an autism spectrum disorder, with about 60% being children of active-duty Service members. It is suspected that these numbers are underreported (Klin et al., 2015). Military children with Autism and their families face unique stressors and struggles compared to their civilian counterparts. Military families must secure a treatment provider and participate in testing, diagnosis, treatment, and educational support while remaining mission-focused.  Stress is escalated with uncertainties about deployment, war, and geographic separation from their support systems in permanent changes of duty station (PCS) (OAR, 2019).

Case Study/Expertise

Although there have been many systemic improvements in services for military children, there are still barriers that exist due to the high mobility nature of military life. Most military families move every 2-4 years, requiring parents to establish new care providers for their children once they arrive at their new location. For children who require specialized care, it is even more daunting. After months of treatment in their current duty station, they are required to “go back to the end of the line” once they locate a new service provider. High frustration levels were also reported due to a lack of satisfaction with the quality of the care their child receives at their new provider. Families not only geographically isolated from their previous providers, but military parents with children with autism reported higher stress levels and social isolation across qualitative research after relocation and during separation (Klin, et al, 2015).

Deployment cycles lead to increased behavioral and emotional issues for military children. Parents have reported that once their child’s problematic behaviors have stabilized after their parent has deployed, their behaviors may increase once again once the parent returns from deployment. Children exhibit increased emotional withdrawal and repetitive behaviors when their Service member parent is deployed. It has been reported that the parent left behind to manage the care of the entire household can experience feelings of guilt and worry about providing adequate parenting alone (Davis and Finke, 2015).

Permanent Change in Duty Station (PCS) also takes a unique toll on the military child with autism. Friendship and social interaction are protective factors and good for overall mental health. Military children move frequently and must make new friends in their new hometown and school. Autistic children innately struggle with making social connections, making it harder to establish new positive social connections with peers. Autistic children were reported to be lonelier and more withdrawn after relocating to their new location (Davis and Finke, 2015).

Magellan Federal Best Practices

As mission partners, Magellan Federal Military & Family Life Counselors (MFLCs) can become the help multiplier for these special families. MFLCs may serve as referral linkages, connecting families to the life-changing services locally or at their next duty station before moving. MFLCs may create an Autism Resource Connect (ARC)—a smooth connection to autism resources for military families from one base to the next. This proposed program component can partner with base resources to maintain an updated roster of local providers to ensure that before, during, and after the process of permanent changes of duty station (PCS), families can ensure a comprehensive and smooth transition to local support. Utilizing the current Military Family Life Counseling network of counselors, resource lists can be maintained locally and can be shared with their counterparts at other installations.

Although MFLCs do not provide direct support for the child diagnosed with autism, their families may benefit from the non-medical counseling support. MFLCs can provide support through individual, marriage, and family counseling. MFLCs can also connect with local Exceptional Family Members Programs (EFMPs) to provide MFLC briefings/presentations to families currently within the program advising of support that can be provided to the family unit. Although the child with exceptional needs is out of the MFLC program scope, the parents and siblings are not.

Another gap that appears to exist in care for these military families is the support of the siblings of children with autism. School MFLCs have particularly great advantages in identifying and serving these unique children. Siblings of children with autism, particularly older siblings, tend to externalize stress and frustration through negative behaviors. MFLCs situated in middle schools and high schools may be instrumental in providing support for these children. These siblings empirically have shown higher tendencies to experience loneliness, academic struggle, and aggression (Walton & Ingersoll, 2015).  MFLCs can create spaces of peer support in the groups.

In April, we celebrate the Month of the Military Child. We wear purple in support and solidarity-creating awareness of the unique challenges of the military child. Military children and families affected by autism experience these challenges compounded by navigating life’s daily routine challenges. While awareness is wonderful, awareness is the first step. Magellan Federal supports children diagnosed with an autism spectrum disorder and their families by bridging gaps in support and care. Specifically, MFLCs provide briefings and psychoeducation regarding available services to supportive base programs. Autism is a life-long disability. With support, every individual can reach their potential. The outcomes for children are exponentially better with early diagnosis and intervention. MFLCs can make a difference. One Team. One Mission.

Resources

OAR. A Guide for Military Families(2019) https://operationautism.org/wp-content/uploads/2019/12/A_Guide_for_Military_Families.pdf

Autism Speaks www.autismspeaks.org

Exceptional Family Member Program https://www.militaryonesource.mil/special-needs/efmp/

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Autism Speaks(2019). Autism and Health Report https://www.autismspeaks.org/sites/default/files/2018-09/autism-and-health-report.pdfb

Davis, J., & Finke, E. (2015). The Experience of Military Families with Children with Autism Spectrum Disorders During Relocation and Separation. Journal of Autism and Developmental Disorders, 45(7), 2019-2034.

Klin A, Wetherby AM, Woods J, Saulnier C, Stapel-Wax J, Klaiman C, Jones W, Rubin E, Scahill L, Call N, Bearss K, Gunter C, Courtemanche CJ, Lemieux A, Cox JC, Mandell DS, Van Decar JP, Miller RA, Shireman CL. Toward innovative, cost-effective, and systemic solutions to improve outcomes and well-being of military families affected by autism spectrum disorder. Yale J Biol Med. 2015 Mar 4;88(1):73-9. PMID: 25745376; PMCID: PMC4345541.

OAR. A Guide for Military Families(2019) https://operationautism.org/wp-content/uploads/2019/12/A_Guide_for_Military_Families.pdf

Walton, K.M &Ingersoll, B.R. (2015) Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protector Factors.

Those that raise their right hand to serve our country in the military, make a minimum of two huge transitions during their lifetime; the transition in by taking an oath to support and defend the Constitution of the United States against all enemies, foreign and domestic; and the transition out. Personally, I remember my transition into service being filled with a spectrum of emotions and above all, the feeling of being proud—proud to be able to make the commitment to my country; proud to say I was a member of the most elite military in the world; proud to become part of something bigger. Though each experience is unique, I believe feelings of pride are common with those that make the commitment to serve their country. Military members are immediately immersed in an unfamiliar world with new rules, language, friends, and many new opportunities. It is a time filled with excitement, change, growth, and fear of the unknown. Many military members look back on this time with fond memories—many with a yearning to go back, like the common wish to reunite with childhood. In contrast, the transition out of the military, also a huge transition point in one’s life, is not the same. I’d like to offer my unique personal experience of what I found most challenging and provide some excellent resources that are available to all veterans and family members through the Transition Assistance Program and Military and Family Life Counseling Program.

The Challenges of Transitioning Out of Service

For me, the “transition out time” was a period filled with excitement and opportunity for growth, but it was not at all easy to navigate. Although I had always had a plan in my head for what I would do once I was discharged, the guidance and resources were not as formulaic as the transition into military life. I was excited to become a civilian free to take any job I wanted, but it was overwhelming not to have concrete steps for how to get there.

It is widely known that the military has a way of building its members up to feel as though they can accomplish anything and believe that they have a step up when it comes to the civilian population. While this may be true, it can be harmful to solely rely on this expectation. It is better to be aware of the potential challenges in advance so you can arm yourself with available resources and tools to navigate a successful transition.

In my experience, these are the top three challenges when transitioning back into civilian life:

1. Unrealistic expectations

• It will be easy to get any job I want.
• I will get paid more as a civilian doing the same thing.
• Working 40 hours a week will be east compared to being on call 24 hours a day.
• My experience will be respected; everyone loves military members.

I will get paid enough retirement that I won’t need to work.

2. Loss of identity

• No longer a leader or looked up to by others daily
• Loss of purpose
• No one really understands what you did in the military
• Bored with the new job
• Loss of connection to your familiar support system
• Work no longer makes a difference on a large scale
• Communication style in the civilian world is not the same

3. Limited immediate support 

• Just a number to the VA
• No longer have a chain of command to help
• Waiting list to get support
• Navigating resources alone

Combat Veteran’s Careers states, “The military provides a sense of purpose, well-defined roles and hierarchy, camaraderie, honor and mission—things that can be hard to find or define in the civilian world.” In my experience, this could not be more true. Although I planned and prepped for my exit, I still fell victim to some of these common beliefs and challenges. So, if you have a plan—or even if you don’t—I encourage you to take advantage of the programs and resources available to you while you are still in service to get a jump start on your transition to a successful civilian career. Here are a few I found helpful, and that Magellan Federal assists in delivering.

Available Career Resources

Transition Assistance Program (TAP)
The Department of Defense TAP provides lots of information, tools, and training to share tips on everything from resume prep to financial planning. For example, I remember them bringing in models to our installation from a local suit store to help us prepare for business dress. TAP is available to all transitioning service members and has a wealth of eLearning guides, trainings, and workshops. Connect with your local Transition Assistance Office or view more information on the DoD TAP website.

Military and Family Life Counseling Program (MFLC)
Military and Family Life Counselors (MFLCs) are on the ground at installations around the world providing confidential non-medical counseling to service members and their families to address issues such as improving relationships, stress, parenting, and grief. MFLCs are also armed with a plethora of training resources specific to making the transition from the military to civilian life. I highly suggest connecting with an MFLC at least a year out from your final separation date, even if it is just to help you organize your thoughts and help you more clearly define the path to your future. Contact your installation’s Military and Family Support Center to get started.

Education and Employment Initiative (E2I)
E2I is a Department of Defense program that assists wounded, ill, and injured Service members with education and career opportunities as part of their recovery and transition to civilian life. E2I’s Regional Coordinators work with Service members to identify skills and match those skills to a desired career path. Contact your Regional Coordinator to request an application, or visit the E2I website.

Tips for Successful Transition
While these programs and other resources will help you build a good foundation, it is ultimately up to you to put a detailed plan in place and complete the necessary steps to prepare for your civilian career.

1. Learn about careers—complete a self-assessment, compare occupations, and research industries
2. Find training—research basic adult education, apprenticeships, certifications, and scholarships
3. Network—connect with professionals in your career of choice to help with advice, job leads, and contacts; inform them of your skills and employment goals

It’s never too early to get a head start on preparing for a career that’s best for you and your family after service. I hope these tips will get you started planning today with confidence.

References
• CombatVeteranstoCareers.org, “5 Reasons Veterans Struggle to Transition to the Civilian Workforce,” view article
• Military OneSource

Have you ever been so happy or upset that it was difficult to function and go about your daily tasks and responsibilities? Or maybe something was bothering you and you didn’t feel quite right, but you couldn’t pinpoint exactly why. Sometimes it’s easy to identify our emotions, especially when they are very strong or overwhelming, like in the case of grief or joy. Other times, it can be more difficult, such as when experiencing shame or even love.

Identifying our emotions is a first step in managing them, and both are important skills in getting through life’s ups and downs and feeling more in control about how we approach and react to people and situations. Of course, we must feel our feelings. We should acknowledge and celebrate happy times, listen to our instincts if we are afraid, and otherwise give ourselves the time we need to fully experience our emotions. In this post, we’ll focus on and provide support for when we are struggling with nagging or intense emotions.

Recognizing your emotions

You might be wondering why recognizing your emotions and feelings is important. Maybe you think it’s obvious what you are feeling at any given moment. In some cases, it is. Even then, it is important to name the emotion or feeling. This allows you to get what you need from it and effectively manage it so it doesn’t become disruptive in your life. It can be difficult to deal with an emotion and move on if you haven’t identified what it is.

For example—You’re sitting at your desk at work and not feeling like yourself. You’re anxious about the work you must complete. You could sit there and continue trying to push through with the nagging feeling. Or you could take a moment to identify and name the emotion so you can take the appropriate steps to move on from feeling less than your normal self. This could be as easy as saying to yourself, “I am overwhelmed.” Now that you’ve identified the emotion and given a name to it, you can use your knowledge about how to deal with feeling overwhelmed and seek additional help if necessary.

A great resource for helping to identify your emotions is an emotion wheel. Magellan provides a tool you can use here. Print it or keep it open in your web browser so it’s handy when you need to name an emotion that may be distracting you or getting you down.

Accepting your emotions

You’ve recognized and named the emotion you’re feeling. Now what? What do you do to get to a better place of focus and contentment? You can start with accepting what you’re feeling is legitimate and worthy of your attention. And while you may not be happy about the situation that is causing your emotional response, we know that situations will arise that are out of our control. For instance, we may experience negative emotions due to a breakup with a partner, seeing a child make a poor decision, or watching a friend go on the vacation we so badly want. No matter the situation, fighting our emotions only serves to give them more fuel to thrive, which may not be exactly welcomed.

A tool to help you accept your reality and let go of resentments is called radical acceptance. Find more on this technique along with a short video and helpful exercise worksheets linked on our website for Mental Health Month.

Managing your emotions

When we know what we’re feeling, have accepted it, and are giving ourselves grace to deal with it, we’re in a better place to act and feel better. One technique that can help you do this is looking at your thoughts from a different perspective. For example, if you’re feeling lonely, think about the supports that are available to you—some may be just a phone call away. When you flip that lonely feeling and remember there are people who are there for you, your thoughts become more rooted in reality. You can then take action to feel less lonely by calling upon family or friends or searching online for ways to meet new people.

Throughout the often-challenging process of dealing with emotions, it’s important to be kind to yourself and practice self-care. Take time to do the things you enjoy. While you’re doing them, you can revel in the positive emotions you feel in the moment.

Support is also available in the form of mood tracking apps, which can help us understand the stressors and triggers that cause negative emotions. Find a clinically-reviewed list of these apps linked on our website for Mental Health Month.

Finally, when emotions are overwhelming and causing distress in your life, like causing changes in your personality, eating or sleeping habits, it’s important to seek the support of a therapist or other mental health or medical professional. You don’t need to suffer. There is help available that can make a difference.

Additional emotional support resources

For more on recognizing, accepting and managing emotions, visit our website for May Mental Health Month, MagellanHealthcare.com/Mental-Health-Month, and be sure to check out the Mental Health Awareness Campaign Toolkit.

April is the Month of the Military Child, which celebrates and acknowledges the children of our service members. While living with a military family member can make children resilient and strong, this lifestyle can sometimes make them more susceptible to bullying in a school setting.

The Army’s Adolescent Support and Counseling Services (ASACS) program is a wonderful resource for military families looking for bullying awareness and prevention tactics. The ASACS program provides confidential counseling for adolescents and families to help them thrive while supporting a loved one stationed overseas.

Magellan Federal provides 23 ASACS counselors and four Clinical Supervisors at 22 Department of Defense schools worldwide and is intimately familiar with bullying issues that are prevalent within the military adolescent population. If you are a teacher, counselor, parent, or caregiver, here are some effective techniques our counselors have used to educate and help safeguard military children against bullying.

Educate with Games with Prizes

Create a bullying awareness event to open a discussion about what bullying looks like and how to take action. Have students write down what they would do if their friend was bullied on a sticky note wall and participants spun a wheel to answer questions about bullying scenarios to win a prize. This helps children understand how to identify bullying and actionable skills they can call upon to get help.

Encourage Role Play
We have also found success with conducting lessons on healthy communication through role play. Ask kids to create skits to demonstrate different communication styles. These will help participants identify assertive, aggressive, passive-aggressive, and passive communication, body language, and appropriate social filters to promote healthy communication and dialogue.
Then discuss how other communication styles could be hurtful and why social filters help to improve relationships and decrease instances of bullying.

Organize a Kindness Event
Organizing a school-wide prevention activity can help promote kindness and gratitude on a greater scale. Encourage students to write notes to friends, students, teachers, and staff about what they appreciated about that person. One of our recent events had about 700 messages written!

Schedule Ongoing Discussions
Conduct mini lessons on topics such as bullying prevention and empathy building. Setting aside a scheduled time to chat about bullying-related topics will keep it top of mind and build trust. These talks can also be used as an alternative to detention.

Bullying is a serious issue for military children, who may be more vulnerable in school settings due to their unique lifestyle. As caregivers, educators, and advocates, we must collaborate to provide resources and support to create a safe and inclusive environment for all children. By implementing these effective techniques, such as educating through games, encouraging role play, organizing kindness events, and scheduling ongoing discussions, we can equip military children with the necessary skills to identify and stand up to bullying. Let’s continue to prioritize the safety and well-being of our military children, not just in April — but every day.

Discussions about mental health in the Black community shouldn’t be limited to Black History Month in February and BIPOC Mental Health Awareness Month in July. The conversations and action steps geared toward providing education, support, and resources require a year-round effort.

A recent article published by the Kaiser Family Foundation, shares that although Black people have made great contributions and achievements in the United States, “they continue to face many health disparities that adversely impact their overall health and well-being,” which have been “exacerbated by impacts of the COVID-pandemic, ongoing racism and discrimination, and police violence against and killings of Black people.”

What impact do these factors have on the mental health of individuals in the BIPOC community? Magellan’s medical director Rakel Beall-Wilkins, M.D., MPH shares her perspectives on depression and suggestions on ways to be supportive.

What is depression and what are some signs or symptoms?

Dr. Beall-Wilkins: Depression is a clinical illness characterized by:

• Prolonged periods of low or sad mood.
• Loss of interest or pleasure in activities.
• Changes in appetite, sleep or energy levels.
• Feelings of worthlessness or hopelessness.
• Thoughts of death or suicide.

Depression can be caused by medical illness, substance abuse, and stressful social, academic, or occupational situations, but it can also develop more readily in individuals who have a family history of depression or other mental health conditions.

Other signs of depression may include:

• Withdrawing from social activities, relationships, or hobbies.
• Escalating drug or alcohol use.
• Declining self-care in the form of poor personal hygiene and grooming.
• Expressing feelings of hopelessness, worthlessness, and/or helplessness.
• Neglecting to attend to chronic medical conditions or maintain follow-up with healthcare providers.

How does depression impact individuals in the Black community?

Dr. Beall-Wilkins: As of 2020, the National Survey on Drug Use and Health found that 6% of Black American adults and 12.9% of Black American adolescents experienced a major depressive episode within the last year. Despite increasing levels of depression within the Black community, studies also show that Black Americans are less likely than their White counterparts to receive psychotherapy or medications for their depressive symptoms. This disparity is largely attributed to limited access to healthcare coverage and culturally competent behavioral health providers, as well as pervasive cultural stigma.

Is it possible for someone to experience depression that is triggered by external factors and societal issues, such as violence, police brutality, political unrest, and racism? If so, how?

Dr. Beall-Wilkins: Yes, it is possible for depression to develop as a result of exposure to sociopolitical strife. In fact, during the week following the highly publicized death of George Floyd in May 2020, rates of depression and anxiety spiked from 36 to 41% among Black American respondents to the Census Bureau’s 2020 Household Pulse Survey.

Likewise, a 2018 study published in The Lancet found that police killings of unarmed Black Americans resulted in an increase in poor mental health days among Black American respondents. Though they may not know the victims of these circumstances personally, it is very common for Black Americans to collectively internalize the trauma of these events and feel despair over the possibility that a similar fate could befall them or their close family members and friends. Moreover, the repeated nature of these events can elicit sadness, hopelessness, and fear that things will never change.

What are tips for an individual that recognizes they are showing signs of depression?

Dr. Beall-Wilkins:

• Visit your doctor and seek treatment: Regularly follow up with a primary care provider to ensure there are no untreated or undertreated medical conditions that may contribute to the development or worsening of depressive symptoms.
• Stay connected: Stay connected to close friends, family, and spiritual community for support.
• Diet and exercise play a role: Eat a balanced diet and engage in physical activity for at least 30 minutes a day, three times per week.

Resources:

• National Alliance on Mental Illness’s (NAMI) cultural dimensions website for BIPOC/AAPI communities.
• DSM-5 (American Psychiatric Publishing, Copyright 2013 (American Psychiatric Association) 
• Stanford University 
• Anxiety and Depression Association of America 

The body is an amazing instrument. Major organs work together to allow you to breathe, convert food into nutrients, move in space, reproduce, protect yourself or heal from illness, and perceive and make sense of the world around you. While the body is capable of so much, why do many individuals dislike their bodies? The answer to this question is more complicated than it may appear.

What is Body Image?

Body image is a term that describes thoughts, feelings, beliefs, attitudes, and perceptions about one’s body (Hosseini & Padhy, 2022).

Specifically, body image is defined as:

• How you see your body, including your height, shape, and weight, and individual body parts,
• What you think and believe about your body,
• How you feel about your body, and
• What you do to address your feelings, beliefs, attitudes, and perceptions about your body.

Body image is an important component of overall wellbeing and influences how people function on a day-to-day basis. Body image exists along a negative/positive continuum and may change at any time. When realistic expectations, acceptance of and/or satisfaction with the body occur, a positive body image is experienced. Conversely, when thoughts, feelings and beliefs about the body are inconsistent with an ideal image one forms in their mind, a negative body image occurs (Office of Women’s Health, 2021; National Eating Disorders Association [NEDA], 2021).

How is Body Image formed?

The development of body image is a complex process. It begins in early childhood and evolves over time. The process consists of interactions between external and internal factors (Hosseini & Padhy, 2022; NEDA, 2021).

• External Factors: Cultural/Environmental/Social—Messages from parents, siblings, peers, teachers, and the media influence beliefs and assumptions about the body. Comparisons to others coupled with a culture that focuses on beauty, perfection, and anti-aging may contribute to shaping opinions about the self. This is often seen on social media as it often perpetuates that beauty and perfection are the ultimate goals, with filters and editing tools creating a distorted reality. The constant bombardment of images promoting youthfulness can make individuals feel inadequate and self-conscious about their appearance. Traumatic experiences (accidents, sexual/physical assault, emotional neglect) may impact body image. Developmental milestones such as transitioning from child to adulthood, starting a family, dealing with adult children leaving home, and aging/retiring from work may increase the probability of fluctuating body images.
• Internal Factors: Personality/Emotional/Psychological—Anxiety and depression, and personality characteristics such as perfectionism, rigid thinking, and high expectations of self may influence or reinforce body image.

Tips on Achieving and Maintaining a Positive Body Image

Your wellbeing is in part, dependent on your body image. Therefore, working towards and maintaining a positive body image benefits your physical and psychological health, as well as your relationships with others. These recommendations may help you in your journey (NEDA, 2021) toward an optimal body image.

• Remember your body is merely the shell in which your emotional, physical, and spiritual person resides. Your body does not define you.
• Take care of your body. To function properly, your body needs a consistent dose of nourishment, including food, physical activity, and social relationships.
• When thoughts about your appearance start to overwhelm you, remind yourself of all the things your body can do. Your body allows you to move through space, view the world around you, problem-solve, experience different emotions, and connect with others.
• Limit negative media influences: Unfollow sites that equate extreme body types (for example, very thin or very muscular) with happiness. This includes unfollowing people and influencers on social media that put a focus on unrealistic body images. Receive information on healthy dieting from your doctor, not the media. Observe the contents of advertisements with critical eyes and ears before making impulsive decisions to adopt the message or purchase the item.
• Surround yourself with positive people and messages. Being with people you trust and receiving messages that inspire you help to prevent an unrealistic body image.

Be mindful of signs that may signal a path toward a negative body image. It is normal to engage in some of these behaviors every now and then. However, if you find that these activities are starting to interfere with or prevent you from accomplishing routine daily activities, it may be time to discuss these issues with your doctor. Avoid these behaviors:

• Looking in the mirror multiple times a day.
• Believing that happiness is equated to physical attractiveness.
• Comparing your appearance to others.
• Avoiding social situations because you are not attractive enough.
• Wearing loose or bulky clothes to hide your body shape.
• Engaging in extreme diets.
• Declining invitations where eating is involved.
• Refusing to be part of a photograph or editing photographs of yourself before sharing them.
• Approaching hygiene needs or shopping for clothes with dread.
• Feeling depressed or anxious, or having trouble concentrating after you eat.
• Asking friends and family about their opinions regarding your appearance.

An ideal body is not measured by how you look. An ideal body is one that functions optimally and allows you to embrace what life has to offer. Slowly shifting your thoughts from self-criticism to ones of appreciation and respect may improve your overall wellbeing.

References

• Hosseini SA, Padhy RK. [Updated 2022 Sep 5] Body Image Distortion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546582/
• National Eating Disorder Association. (2018, February 22). 10 steps to positive body image. Body Retrieved from https://www.nationaleatingdisorders.org/body-image-0 https://www.womenshealth.gov/mental-health/body-image-and-mental-health/body-image
• S. Department of Health & Human Services. February 17, 2021, Office of the Assistant Secretary of Health. Office of Women’s Health. Body Image https://www.womenshealth.gov/mental-health/body-image-and-mental-health/body-image

Introduction

When disasters or tragedies occur, people seek information from traditional news sources and social media. Staying up to date is part of being an informed citizen, and while consuming media can be beneficial in moderation, “doomscrolling” — exposing yourself to a never-ending stream of distressing information — could be negatively impacting your overall wellbeing.

If you find yourself overwhelmed by the constant flow of negative information but can’t bring yourself to turn away from Twitter, you are not alone. For 50 years, Magellan Federal has helped more than three million civilian employees and their families enhance their emotional wellness and reduce stress. The following information and tips can help you to avoid doomscrolling if your social media usage is getting in the way of your wellness.

Doomscrolling Defined

Doomscrolling (also known as doomsurfing) is the term used for persistent and excessive reading of negative news online. It was popularized by Quartz reporter Karen Ho in 2020 during the lockdown at the height of the COVID pandemic. Like many of us,  Ho struggled with compulsively reading upsetting news about the ongoing pandemic. She would send nightly tweets (pictured right) to her followers encouraging them to take a break from doomscrolling bad news and to get a good night’s sleep (8).

Doomscrolling Characteristics — What to Look Out For

Doomscrolling differs from regular social media usage and has four main characteristics that makes it a distinct activity.

• This is a persistent activity that becomes habitual.
• It is caused by environmental factors.
• The sessions are multiple hours, and the user often loses track of time.
• The content viewed is negative, distressing, and timely.

While typical social media usage may have one or more of the above-mentioned factors, all factors are present for doomscrolling. Further, a study used to create a doomscrolling scale found the activity was highly associated with “online vigilance, problematic internet/social media use, and FOMO” (fear of missing out) (13).

Reasons for Doomscrolling

Fear of the unknown is the primary motivator driving people to engage in doomscrolling, however, multiple factors may contribute to and perpetuate their fear.

Biological Imperative

During times of crisis or tragedy, people gather information to reduce uncertainty, create a plan, and attempt to exert some measure of control over the situation (17). This behavior is rooted in survival instincts related to paying more attention to negative information than positive and scanning the environment for danger to protect one’s family (14).

Fear of Missing Out (FOMO)

While FOMO typically refers to anxiety experienced as a result of seeing an exciting or interesting event happening elsewhere, FOMO also applies to doomscrolling. With no end to social media posts, there is always one more piece of information that could be read.

Perpetuating the Cycle

With doomscrolling, the information collected on tragedies and disasters that was meant to reduce uncertainty and allay feelings of anxiety instead increases these feelings, particularly when the events are beyond one’s control. As we scroll, we’re flooded with information that for the most part, we can do nothing about, except to keep scrolling and sharing, perpetuating the cycle. As a result, we feed the paralyzing loop of information that can lead to feelings of helplessness and despair (11).

Algorithms

It’s no secret that the goal of social media titans like Facebook and Twitter is to have users interact with their products for as long as possible. To that end, these platforms create algorithms to learn their customers’ habits and then customize the online experience to them (15). The more a user interacts with the platform, the more the algorithm “learns” what content to provide, without concern for possible user harm (8). As a result, the curated content displayed for each user plays on their emotions to keep them engaged—even negative ones. Naturally, repeated exposure to distressing content can have a negative impact on mental health.

Risk Factors

Current research findings show that certain individuals are more likely to engage in doomscrolling than others.

• Men and younger adults regardless of ideological beliefs (13)
• Those with anxiety or depressive disorders
• People who score high in neuroticism
• Those who are addicted to social media (12)
• Individuals with previous childhood maltreatment experiences

Effects of Doomscrolling

Since the start of the pandemic, there have been multiple studies on the mental health effects of doomscrolling. Recent research findings suggest doomscrolling is associated with:

• Increased anxiety and psychological distress
• Lower mental well-being
• Increased depression
• Increased phone use
• Post-Traumatic Stress Disorder (PTSD) symptoms
• Decline in sleep quality

Prevention & Coping Techniques

As with most harmful habits, the best time to address them is before they start. Many of the techniques and tips provided below can be used to both prevent doomscrolling (or any excessive social media use) and also to help reduce doomscrolling once it has become a habit.

Technology Tips

• See no evil: Provide feedback on social media posts with negative content by using the “hide post” or “block/mute” features. This will provide information to the platform algorithm to provide less of this type of content (9).
• Set a time: Reduce the amount of time online by using screen timers and stick to no more than 30 minutes as any more has been connected to increased levels of anxiety (3, 17).
• Scroll with purpose: Picking a specific subject to get information on will not only help meet the new scrolling time limits, but it will also create a sense of accomplishment when the information is obtained (17).
• Subdue screen colors: As all casinos know, the more flashy and colorful something is, the easier it is to keep someone’s attention. Changing social media settings to “gray–scale” will make the screens more monotone/less visually appealing and can make it easier to stop scrolling (3).
• Search for the happy: Known as “hopescrolling,” this can lead to more positive thoughts and can help “reset” social media algorithms to show you more positive content.

Beyond Online

• Connect with others: Share the burden with loved ones and others within your social networks to reduce anxiety (17).
• Connect with yourself: Perform regular self-check ins by listening to your body and paying attention to how you are feeling to understand when it is time to take a break (16, 17).
• Connect with the outdoors: Engage in hobbies that involve the outdoors including exercise and fresh air while leaving technology, and feelings of anxiety behind (17).

Clinical Support

• Nonmedical counseling: Qualified counselors can help create a plan to address the problem. Non-medical counseling is short-term and addresses general conditions of living, life skills, improving relationships, and stress management.
• For Clinicians: Since clients also consume social media for entertainment as well as coping measures, it may be helpful to work with them to identify alternative hobbies or activities they will enjoy that will not involve social media or other digital technology (10).

Summary

In a global society with a 24-hour news cycle and social media that offers infinite scrolling, there is always more news to consume. People can fall victim to doomscrolling when distressing events occur, leading to increased anxiety and stress, creating a self-feeding cycle that can be difficult to break.

For those wanting to stop doomscrolling, it is important to first acknowledge the behavior, be honest with how it may be affecting your mental health, and be proactive in your approach to modify your actions. No matter what your relationship is with the news, this technique will help maintain a healthy relationship with social media and overall digital wellness.