Five reasons limiting electronics is harder for kids with mental health conditions

shutterstock_158688710I was reading a very helpful little book this past week written by children’s ministry leader, tech guru and entrepreneur Matt McKeeParent Chat – The Technology Talk for Every Family. Matt’s book is especially useful for parents of school age entering a time when kids begin to demand access to smartphones and tablets that are becoming ever more central to the social world of “tweens” and young teens with each passing year. He shares great ideas for setting up a plan proactively to protect kids from the adverse effects of technology. I encourage parents, as well as pastors and children’s/family ministry leaders to check out the book “before the horse leaves the barn,” as is too often the case by the time the kids turn up in my office.

51Rai9Gzj5L._SX311_BO1,204,203,200_Outside of questions related to diagnosis,prognosis and medication, I probably get more questions as a child psychiatrist from parents seeking guidance as to how to limit their child’s exposure to technology. In particular, I get lots of questions around managing the behavioral responses from kids when their use of electronic devices starts intruding upon academic performance, family life and sleep.

Well-meaning parents often experience blowback from kids served by a practice like ours entirely out of proportion to any restrictions they seek to impose on technology. I’d like to share five possible explanations for the extreme emotional reactions kids with common mental health conditions often manifest when parents limit access to smartphones, computers, tablets and gaming systems.

  • Electronics often serve as a social lifeline for kids with anxiety. A number of years ago, our practice participated in a treatment study involving kids with anxiety or depression. I began to consider how technology might be useful in ministry with kids with anxiety when I came across a profile of a kid enrolled in our study with Social Anxiety Disorder who had 609 Facebook “friends.” We had another kid with social anxiety in the study who was sending 13,000 texts/month while managing to use zero minutes of talk time. Children or teens with social anxiety often struggle greatly to answer the phone, arrange “play dates” or to request services over the phone…ordering a pizza, or asking a classmate about a homework assignment.
  • Texting and messaging technology frequently helps level the playing field for kids who struggle with social communication. Kids with autism, Asperger’s Disorder and other social communication disorders frequently struggle with language pragmatics…interpreting cues from body language, facial expression, tone and inflection of voice. Texting and messaging tends to minimize their social disadvantages relative to peers because many non-verbal components of communication are off the table. Texting and messaging also offer the advantage of giving kids who are awkward in social situations more time to consider their responses than they experience when face to face with peers.
  • Electronics often represent the principal coping mechanism for kids who struggle with obsessive thinkingChildren and teens with Obsessive-Compulsive Disorder (characterized by the presence of unpleasant, intrusive, repetitive thoughts) often seek out nearly continuous mental stimulation in order to distract themselves from their mental distress. They’ll often cope reasonably well during the school day because of the nearly non-stop cognitive stimulation from listening to teachers, taking notes, completing work and interacting with peers. They often experience the most distress during down time at home, during vacations or at bedtime when they have less activity to distract them from their intrusive thoughts. Their tablets and smartphones are often used to fill every available moment of inactivity.

I had an opportunity to experience this firsthand during a home visit this past week with a kid I’ve seen for years with severe OCD. The child needed to use the bathroom partway through the visit, and after a period of fifteen or so minutes elapsed, the father thought he needed to intervene when he noticed that the iPad also went to the bathroom. The child’s profanity-laced tirade that ensued when the father tried to take the iPad away was qualitatively different than anything I’d ever seen in our office before, and persisted for at least thirty minutes afterward. Kids who haven’t identified and mastered other strategies to distract themselves from or block out their obsessive thoughts often become extremely dependent upon technology as a coping mechanism.

  • Electronics are a primary escape for kids with academic difficulties. Imagine yourself going to a job every day where you struggle to meet the expectations in your assigned role and find yourselves surrounded by peers who are frequently commended in public for meeting or exceeding expectations. Imagine that your family participates in and receives a written copy of your quarterly performance reviews. Imagine that after spending your day at this job for which you feel incompetent or inadequate, you’re expected to do two or three hours of work each night that reminds you of all the negative thoughts and feelings you harbored about yourself all day long. Wouldn’t you try to find an escape? Video games, YouTube, texting and social media represent that escape every night for kids with academic or social difficulties in school.


  • Gaming represents an opportunity to achieve mastery for kids who aren’t especially gifted athletically, academically or artistically. Kids with common mental health conditions are more likely to experience academic difficulties. They are less likely to have the motor coordination to be successful athletically compared to their peers. They may lack the fine motor coordination to excel as an artist or as a musician. Where do they hang their hat and experience success when compared to their peers? A disproportionate number of patients I’ve had who struggled to control the time they spent in gaming are kids for whom gaming represents the only area of their lives where they regularly outperform their peers. I also have far more patients who are gamers with unrealistic expectations of making their avocation into a profession than I have athletes who are convinced their future lies in the NBA or the NFL. Kids will react with unforeseen anger and hostility when parents try to limit access to the one activity from which they obtain a sense of competence and self-confidence.

I’m not saying that parents should back down in the face of extreme emotional reactions from their kids when they seek to place limits on access to smartphones, tablets, gaming systems and other forms of electronics. I am suggesting that parents consider why their child’s reactions to being parented in their use of technology are so extreme and to consider how they might address the why that fuels their apparent addiction to their electronic toys.


shutterstock_138372947Know a family impacted by disability in need of help finding a local church? Encourage them to register for Key for Families. We can help connect families with local churches prepared to offer faith, friendship and support, while providing them with encouragement though our Facebook communities. Refer a friend today!

Posted in Anxiety Disorders, Book Reviews, Controversies, Families, Key Ministry, Mental Health | Tagged , , , , , , , , , , , , , , | 1 Comment

Mental Health Ministry…So What?

shutterstock_234301618Editor’s note: Catherine Boyle from OutsideIn Ministries continues her series describing her church’s process in establishing a mental health inclusion ministry. Today, she looks at the impact intentional mental health ministry on all of the people in a local church. Click here and here for earlier installments in Catherine’s series.

Readers are encouraged to save the date for Saturday, November 19th when Dr. Steve Grcevich from Key Ministry will be joining Catherine and her team at Ironbridge Baptist Church in suburban Richmond, VA for a conference to celebrate the launch of their ministry. Registration info will be coming soon.

In the mental health ministry that’s underway at, there are lots of things we’re doing: looking at documented needs within our geographic community and within our church body, making decisions about training and securing the right resources to provide the needed training.  More details on that in the final paragraph below.

But the harder question, the one we wrestle with fairly often, is ‘So What?’ If we determine training needs and find the trainers and programs, if we set up a coping skills class for parents of kids with mental illness, if we establish support groups, will the newfound support break down the stigma? Will the methods and skills delivered in coping skills class become habit, or just head knowledge? Even with offering training and talking openly about mental health issues, will mental illness continue to be viewed as an ‘us vs. them’ problem?

These are fair questions. Truth is, mental health ministry will only have lasting impact if it is delivered and provided with love. Not mandated by the church leaders, but loving as a way of life of the broader faith community. Not the fluffy Hallmark© kind of love, but true agape – deep, personal, sacrificial.

Through the lens of mental health issues, here are a few modified verses from 1 Corinthians 13:

If a depressed person joins my small group, I will be patient, I will be kind. If an outcast kid in youth group acts weird, I will not seek my own clique, I won’t be provoked to irritation by their behavior, I won’t take into account the socially wrong thing he said. I won’t rejoice in the unrighteousness of those awkward people being cast out of my group, but rejoice with the truth that Jesus loves the one I find unlikable.

Ouch. Sacrifice and serving someone I don’t really like doesn’t sound like very much fun. But it sounds and looks and tastes and smells like the kind of ministry Jesus did. And it’s what He calls His followers to do. Love beyond your own ability to love. Love like that is impossible without the Holy Spirit operating through you.

More 1 Corinthians 13:

When my understanding of mental illness was small, child-like, I reasoned like a child: odd behavior has to be sin. When my understanding of mental illness and neurological differences grew through factual information, I did away with my childish interpretations, and though I still have a dim understanding of mental illness, at least I now understand more clearly, while my Lord fully knows my own flaws and frailties.

More than anything, mental health ministry is about your church community, as a whole, getting the concept that people with mental health issues aren’t problems to be solved, they are people to be loved.

The people most likely to provide that kind of deep, personal, sacrificial love to those who don’t fit neatly into our programs are the ones who have been wounded by mental illness, their own or that of someone they love.


One thing we’re working on that has been shown to be effective for other education topics: the power of stories.  Ask the wounded ones to share their experiences.  As theologian Henri Nouwen said of his own depression and why he wrote about it, “What is most personal might be more universal.”

If those who have experienced and lived with mental illness are willing, videotape their stories, so the beneficial and instructional aspects of their stories can be shared repeatedly. The professional mental health community has learned the great value that comes from engaging people with lived mental health experience in helping others navigate their own illnesses and recovery. Within the church community, we can learn from those with lived experience what has been helpful (or harmful) in allowing them to see their mental illness as part of the human condition and the journey of faith.

A 2014 survey of church attenders revealed that 65% of family members in a household of someone with acute mental illness want the local church to talk more openly about mental illness, so that the topic is not so ‘taboo.’ Only 2 in 5 of church-attending people with mental illness surveyed said their church has helped them think through and live out their faith in the context of mental illness. Sharing the stories of those with lived experience is one way to deepen church community and connection, begin breaking down the stigma, and begin delivering support to those suffering silently.

Here’s a link to the mental health ministry implementation outline at Ironbridge. We’re working through the third stage right now; we’re setting up training, working on consistent communications about mental health across the church body; we’re figuring out how to coordinate meeting practical needs.  More details on each of these in the months to come.


shutterstock_291556127Key Ministry encourages our readers to check out the resources we’ve developed to help pastors, church leaders, volunteers and families on mental health-related topics, including series on the impact of ADHD, anxiety and Asperger’s Disorder on spiritual development in kids, depression in children and teens, pediatric bipolar disorder, and ten strategies for promoting mental health inclusion at church.


Posted in Inclusion, Key Ministry, Mental Health, Strategies | Tagged , , , , , , | Leave a comment

How does the Gospel apply to self injury?

shutterstock_343217441A month ago, I wrote a post titled Four Reasons Teens Cut to COPE, sharing my own history of self-injury as well as the four most common reasons kids and adults hurt themselves. We do/did it for control, as an obsessive behavior, as punishment, or as an emotional release. For me, it was all four; for others, it might just be one or two. To read more about the why of self-injury, see that post here.

One comment jumped out at me and warranted a post of its own in response. Todd Benkert, a Southern Baptist pastor and adoptive dad who I respect a great deal, asked:

Shannon, given that self-harm is meant to help one COPE, how does the gospel apply to this need? How do you find that Christ would address each of these reasons?

As I answer, let me go ahead and define what I’m meaning in this post as the gospel: the good news that the God who created us in his image saw our helpless sinful state and sent his Son to live the perfect life we couldn’t, die as the ultimate sacrifice we could never offer, and defeat death once and for all by rising from the dead, offering an already but not yet promise: that those who believe may already have indwelling of the Spirit here on earth but that we persist in the reality that we’re not yet living in the perfection of heaven.

Phew. That’s some meaty theology in one sentence, huh?

Key Ministry exists because of that already but not yet friction. We already have the hope of Christ – hallelujah! – but our lives are marked with the not yet realities of life, including mental illness, disability, and childhood trauma. The church exists to be a community for those who know God and to shine the light of Christ into a dark world for all, including those who haven’t yet encountered our Jesus.

Cutting is a sign of already but not yet tensions. Some who injure themselves – be it by cutting or burning skin or punching surfaces or trying to break bones or some other means – don’t know Christ. Some, however, do. How do we respond in a gospel-driven way to both groups?


First, we must be humble. Just as we, in the church, wouldn’t try to treat asthma with repentance or set a broken bone with a Bible verse, we need to understand that professional help is almost always needed for those who persistently hurt themselves. For me, this includes both psychotherapy and psychiatric medications. When someone is engaging in self-harm, the behavior isn’t shameful or unspeakable. Self-injury occurs when the pain someone is feeling internally exceeds the resources available for healing. One such resource for healing is the professional help beyond what most churches are able to offer. This need for support outside of the church is one reason why those who attend worship services regularly may still go home and bring a blade across their skin.

Historically, the church has been slow to accept medical research about the physical and neurological foundations for mental illness, trying instead to treat challenges like these are purely spiritual. I’m seeing a change in this trend, thankfully. We still have work to do, though! We at Key Ministry are able to speak into that in a unique way, as Dr. Steve Grcevich – a clinical child psychiatrist – founded our organization and has served in a variety of roles ever since. In other words, as we train churches to respond to these needs, our approach will always involve a medical understanding of the problem.

But we’re Christians and ministry leaders too. So we also understand we aren’t just bodies with physical needs but souls with spiritual ones. One supernatural need we all possess is community. So, second, we must build relationships. Some refer to this as a ministry of presence or an incarnational ministry. After all, God didn’t just wave a magic wand or look down from the clouds to meet our needs; he came incarnate, wrapped in flesh, engaging our humanity from his own. Before the disciples in John 3 asked, “Who sinned that this man might be blind, him or his parents?” the first verse in that chapter tells us Christ saw the man. Before we jump to judging a person’s current state or trying to So how can we, in the name of Christ, come alongside those who hurt themselves? respond to them, we must first see the person. This response includes affirming each individual as a fellow image bearer of God, just like we are. Christ’s response – “neither this man nor his parents sinned, but this occurred that the works of God might be displayed in him” – does that. Each of us exists that the works and glory of God might be displayed and reflected in us. When it comes to self-injury, I’ve seen many well-intentioned adults respond out of their discomfort and try to fix the problem before loving the person. This will never work!

So how can we, in the name of Christ, come alongside those who hurt themselves? We can be with them, just as Christ brought healing as he walked side by side with the people he created. We can try to understand the reasons why. We can choose not to recoil from the behavior, even if it makes us uncomfortable, and instead dwell in discomfort with our hurting friend. We can help them access the resources needed – including professional support – to help them process pain in healthier ways.

Finally, we can share the already hope we have in Christ without denying the not yet struggles in the world. In other words, our gospel can’t just be one that stands before Daniel 3 furnaces and says, “God will save me and you from the fire.” No, it must also be able to say, “We believe in a God who can deliver us from the flames (and will certainly do so in heaven) but even if he does not on earth, we can still trust him.” We can’t proclaim a prosperity gospel (that is, a false gospel) which promises full healing and riches and comfort on this side of heaven. We shouldn’t offer Christ as the antidote to pain as if the Bible promises that becoming a Christian (or continuing in faith, for those who already know Christ) means we’ll never feel pain again. Our testimonies of how God has worked in our lives can and should not only include the highlights – how Jesus made and makes things new – but also the hard truths – how life still isn’t perfect in all the ways we might like it to be because we live in a fallen world. This isn’t denying the works of God in us but rather showing the hope of a heaven in which God, according to Revelation 21:4, will wipe every tear from our eyes as death and mourning and crying and pain are no more.

When those who are hurting cut into their skin or injure themselves in other ways, they’re saying that the world as we know it isn’t right or good or perfect. Our presentations of the gospel need to acknowledge that truth, or the hope we’re sharing will seem false. When Christ showed up to ultimately heal Lazarus, he didn’t start by calling him out of his grave. No, he met his sisters in their pain, he didn’t turn away from their agony, and he wept with them. We can do likewise. Then he raised Lazarus from the dead, but? Lazarus died again in due time. The miracle didn’t mean Jesus’s friend and Mary and Martha’s brother got to skip out on pain for the rest of his time on earth. And our salvation doesn’t mean that either.

Self-injury isn’t simple. The obsessive behavior component can make the habit into an addiction that is hard to break. If we act like we can simply solve the problem by walking someone through a salvation tract, then we’re treat the gospel like a magical incantation – hocus pocus or abracadabra – for self-harm. Not only does that dismiss the complexity of cutting, but it also presents a false prosperity gospel, promising a perfection on earth that the Bible never presents.

Let’s be humble. Let’s engage others in relationship. Let’s share the full gospel – both the already hope we can all have in Christ without sugarcoating the not yet tensions we experience in this world and the promise of an eternity without pain or tears or any reason to cut anymore. And let’s do it all for the good of our neighbors and the glory of God.


shutterstock_291556127Key Ministry encourages our readers to check out the resources we’ve developed to help pastors, church leaders, volunteers and families on mental health-related topics, including series on the impact of ADHD, anxiety and Asperger’s Disorder on spiritual development in kids, depression in children and teens, pediatric bipolar disorder, and ten strategies for promoting mental health inclusion at church.


Posted in Hidden Disabilities, Key Ministry, Mental Health, Shannon Dingle | Tagged , , , , , , , , | Leave a comment

Is the sexual revolution driving our kids to suicide?

shutterstock_298069748In the quarter century I’ve been practicing as a child and adolescent psychiatrist, I’ve come to appreciate the extent to which early involvement in sexual activity represents a risk factor for anxiety, depression, suicidal thoughts and suicidal acts among the kids served by our practice. From a developmental standpoint, there are lots of teenagers who aren’t remotely equipped to manage the intensity of emotions that accompany a sexual relationship. Buried beneath the headlines of a government-funded study released this past week, there’s lots of evidence that teens who voluntarily engage in sexual activity or are victims of sexual violence are far more likely to experience suicidal thinking or behavior than their peers.

The US Centers for Disease Control (CDC) released a new study this past Friday,  Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9-12. The study is based on data from the 2015 National Youth Risk Behavior Survey (YRBS), an ongoing project to monitor six categories of priority health-related behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus infection; 5) unhealthy dietary behaviors; and 6) physical inactivity.

Students by Sexual IdentityFor the first time, the CDC investigators asked questions about sexual orientation, gender identity and the sex of sexual contacts of survey participants. The resulting survey is the first nationally representative study of U.S. lesbian, gay, and bisexual high school students. Not surprisingly, the media coverage thus far (see here and here) has focused upon the data from the LGBTQ participants, who represented 11.2% of a sample in excess of 15,000 teens (2.0% identified as gay or lesbian, 6.0% identified as bisexual, 3.2% identified as “unsure” and 88.8% identified as heterosexual).

What we’re going to look at in this data set is how sexual experiences impact suicide risk across the board for high schoolers of both majority and minority sexual orientations.

Let’s start by looking at the association between sexual orientation in this study of high school students and presence of self-reported “serious” suicidal ideation in the last twelve months.

Serious suicidal thoughts

What we see here is that around 18% of U.S. high schoolers expressed “serious” suicidal thoughts in the past year – 15% among heterosexual students, 43% among LGB students, and 32% among youth identifying as “not sure” of their sexual orientation. Rates are clearly higher among females as opposed to males, in keeping with what we know about the sex rations of suicidal ideation in teens. Two observations…

  • The frequency with which high schoolers across the board endorse the presence of serious suicidal thoughts is unacceptably high for kids of all sexual orientations.
  • The statistics describing rates of suicidal ideation among LGBQ teens are especially  alarming and public health interventions targeted at reducing suicidal ideation and behavior among sexual minority youth are clearly indicated.

One of the responses we’ve seen to the very high rates of reported suicidal ideation among teens from sexual minorities is the implementation of anti-bullying strategies in schools across the country. The CDC made very specific support recommendations to schools for supporting youth from sexual minorities. The President made a video to express his support for anti-bullying initiatives. From the data below, we see that LGBQ kids report significantly more frequent victimization from bullying than heterosexual peers.

Bullying at school

In the sample, 20.2% of all students; 18.8% of heterosexual students; 34.2% of LGB students; and 24.9% of “not sure” students had been bullied at school during the twelve months prior to the survey. Put differently, LGB students are about 80% more likely and “Q” students are about 30% more likely to be bullied compared to “straight” peers.

In contrast, let’s go back to the slide on serious suicidal ideation and look at the impact of sexual contact on suicidal ideation in teens.

Suicidal ideation by sexual contact

  • Overall, students who experienced sexual contact with the same or both sexes were approximately 225% more likely to experience serious suicidal thoughts than students who had sexual contact with the opposite sex only and 370% more likely to experience serious suicidal thoughts than students with no sexual contact.
  • Boys who experienced sexual contact with the opposite sex only were twice as likely to report serious suicidal ideation than those with no sexual contact.
  • Girls who experienced sexual contact with the opposite sex only were nearly 60% more likely to report serious suicidal ideation than those with no sexual contact.

Let’s look at the statistics on high schoolers who developed a suicide plan

Suicide plan

  • Overall, students who experienced sexual contact with the same or both sexes are approximately 250% more likely to report having developed a suicide plan than students who had sexual contact with the opposite sex only and 390% more likely to report having developed a suicide plan than students with no sexual contact.
  • Boys who experienced sexual contact with the opposite sex only were 78% more likely to report having developed a suicide plan than those with no sexual contact.
  • Girls who experienced sexual contact with the opposite sex only were 55% more likely to report serious suicidal ideation than those with no sexual contact.

Here’s the data on suicide attempts and sexual contact

Suicide attempts

  • Overall, students who experienced sexual contact with the same or both sexes are approximately 285% more likely to report having attempted suicide compared to students who had sexual contact with the opposite sex only and 650% more likely to report having attempted suicide than students with no sexual contact.
  • Boys who experienced sexual contact with the opposite sex only were 215% more likely to report having attempted suicide compared to those with no sexual contact.
  • Girls who experienced sexual contact with the opposite sex only were 300% more likely to report having attempted suicide than those with no sexual contact.

Next, let’s look at kids who received medical intervention as a result of a suicide attempt

Suicide and medical intervention

  • Overall, students who experienced sexual contact with the same or both sexes are approximately over three times more likely to have been seen by a doctor or nurse following a suicide attempt compared to students who had sexual contact with the opposite sex only and over twelve times more likely to have been seen by a doctor or nurse following a suicide attempt than students with no sexual contact.
  • Boys who experienced sexual contact with the opposite sex only were seven times more likely to have been seen by a doctor or nurse following a suicide attempt compared to those with no sexual contact.
  • Girls who experienced sexual contact with the opposite sex only were more than three  more likely to have been seen by a doctor or nurse following a suicide attempt than those with no sexual contact.

Some thoughts that crossed my mind after reviewing this study…

To what extent is very early exposure to sexual intercourse a contributing factor to higher rates of suicidal thoughts and behavior in LGBTQ youth? Kids who experienced sexual intercourse prior to the age of 13 are more than twice as likely to identify as a member of a sexual minority. Girls with first intercourse prior to age 13 are four times more likely to identify as a member of a sexual minority.

Do all of our kids need “safe spaces” or do they need to learn resilience? When one in twelve high schoolers reports having attempted suicide at least once during the preceding twelve months, we have millions of kids who lack the ability to cope with the day to day challenges of adolescence?

What if sexual contact contributes significantly to the risk of suicide for youth from a subculture defined by sexual orientation and sexual expression? One issue begging to be explored in more depth is the extent to which suicide risk is reduced when kids from sexual minorities refrain from sexual contact.

shutterstock_98370545Finally, how is it still socially acceptable in this day and age for advertisers and social media platforms to promote sexual behavior in youth when a clear association exists between sexual behavior and suicide? Hats off to Abercrombie and Hollister for getting rid of their shirtless models. And how is it OK for parents to facilitate opportunities for their teens to engage in sexual contact with other teens? How are “coed sleepovers” any more acceptable than playing bartender to a basement full of teenagers just before handing them their car keys?

We live in a culture that puts great pressure on teens and adults to define themselves through their sexual behavior and sexual prowess. Many of our teens would be better served through discovering their identity elsewhere.


shutterstock_138372947Know a family impacted by disability in need of help finding a local church? Encourage them to register for Key for Families. We can help connect families with local churches prepared to offer faith, friendship and support, while providing them with encouragement though our Facebook communities. Refer a friend today!

Posted in Controversies, Key Ministry, Mental Health | Tagged , , , , , , , , , , | 4 Comments

Living in a manner that honors Christ’s reputation

shutterstock_381988402Some of our readers may have noticed that I’ve been away for the last few weeks. I’d made plans to use most of the time working on our upcoming book on mental health inclusion in the church, but became “sidetracked” by a consulting project in which I was asked to make recommendations for redesigning the systems for providing psychiatric care to kids in a nearby city.

While reflecting upon the attributes of an excellent system of care for kids with psychiatric issues and their families in the future, I’ve been spending quite a bit of time thinking about  my future in medicine and the future of the practice group in which I serve.

Aside from this blog and Key Ministry’s social media platforms, in a typical week I come in contact with more people through my work than anywhere else. This post from iDisciple articulates  my thoughts about work and worship far more effectively than I ever could. If I claim to be a Christian, my work and the work of the other people in the practice for which I’m responsible should reflect the attributes of Christ.

I’ve wanted families coming to our office to experience care that’s unmistakably different from what they’ve encountered in the past. What that means in practice is that I’ve placed very high value on setting aside the time to be thorough and complete in my evaluations of kids and teens, taking the time to understand not just the “what” but the “why” behind the problems that brought them to us in a way that leads logically to an effective treatment plan. I’ve also looked for opportunities (when medically appropriate) to go the extra mile for some of our patients in an extravagant way that reflects the extravagant grace Jesus has extended to all of us. Showing up in person to advocate for kids at school meetings has been one way in which we’ve gone the extra mile. House calls are another.

Our ministry, and the churches and ministries we serve also seek to reflect the attributes of  Christ through the ways in which we reflect Christ’s love to families impacted by disability. One year ago this weekend, a highly valued and exceptionally competent professional colleague of mine (who also happened to be agnostic) died very suddenly and tragically. He had been so impressed by the willingness of hundreds of volunteers at churches across our region to provide free respite care for families of kids with emotional, behavioral, developmental and physical disabilities that he volunteered his services as a trainer for our ministry. He joined the Board of another like-minded ministry in our region serving kids with autism spectrum disorders. I don’t know whether Ethan ever “prayed the prayer” but he was clearly impacted by his experience of Jesus as reflected by his followers.

Our practice has found itself in an environment that with each passing year grows more hostile to our model of caring for kids and families. I won’t bore our readers with the details, but the combination of much more expensive health insurance for many of the families we serve accompanied by much higher deductibles, substantial restrictions in use of flexible spending accounts, decreases in productivity from cumbersome documentation requirements and abusive “prior authorization” demands from pharmacy benefit managers, demographic changes (fewer kids in our region) and a steep drop in demand for counseling/therapy services have left us with an unsustainable business model.

The parallels between the struggles of our practice and the struggles that many of our brothers and sisters in Christ are wrestling with as they seek to be witnesses in an increasingly hostile culture that continues to shift beneath their feet.

Twin Design /

Twin Design /

Many of us put our lives are on display through our social media presence. And much as our practice is becoming worn down by the challenges to provision of excellent care in a hostile environment, many of our fellow Christians are struggling to discern what to do say or do when faced with a selection of potential leaders with attitudes ranging from ambivalence to open hostility about values that many of us hold dear…the culture of life, religious liberty, the design and purposes of the family and freedom of conscience.

In much the same way that our practice’s challenges have forced me to re-examine what we do at work and why we do it, the shift in the culture is forcing many friends who publicly identify as Christian to reexamine their views about candidates for office…and their advocacy of causes and candidates. The common thread I’ve been wrestling with is this…

How shall I proceed in a way that honors Christ’s reputation?

So…if we’re wrestling with a business challenge or providing a service or advocating for a specific candidate or cause, the question on the table is this – will this action reflect well upon the reputation of the One I claim to serve in front of a hostile world?


shutterstock_138372947Know a family impacted by disability in need of help finding a local church? Encourage them to register for Key for Families. We can help connect families with local churches prepared to offer faith, friendship and support, while providing them with encouragement though our Facebook communities. Refer a friend today!

Posted in Key Ministry, Uncategorized | Tagged , , , , | Leave a comment

One benefit of visiting a new church as a unique family

© 2014 Rebecca Keller Photography

© 2014 Rebecca Keller Photography

Our family stands out. We chose this life, as we adopted a child with visible disabilities and four children of different ethnicities than us in creating a family larger than most. I’m not complaining about our realities here. But I do miss the days when our family could slip in and out of any ordinary place without drawing stares.

When my husband and I realized God was leading us to change churches, we resisted. We were so known and accepted where we were. We didn’t feel like a spectacle. We started there as young newlyweds. As our family changed, our church was with us, one step at a time. They supported us when Zoe got her wheelchair. They asked the right questions to include her. They showed up when our son had his first seizure. They met dozens of practical needs for us while we adopted from Uganda and after we came home with six children under the age of seven.

The idea of visiting elsewhere terrified me. I knew we were well past the days of just showing up unannounced. When we found a place that felt right and my husband said it was time, I took a deep breath and wrote an email to their children’s coordinator. I included way more details than I probably should have. I hit send. I immediately regretted it, worried everything I said would scare her off. I got an undeliverable error message back. I was relieved.

I wrote a new, less specific email to the main church email address.

Then the reply came. It was to the first email, the one that was too long with too many of the hard realities of what it might look like to say yes to us.

She said yes anyway.

We talked on the phone. Every question she asked expressed a genuine desire to have us there. We showed up. Every interaction demonstrated that the teachers and some parents had heard a little about us, enough to not be surprised and welcome us well. We kept coming. They kept saying yes.

Between our first and second Sundays, they recruited two youth helpers to serve alongside Zoe. Then next week, the VBS director invited me to coffee to discuss how she could include our kids well. The following week, I sat down with the special needs ministry leader for all campuses of the church and the children’s coordinator for our campus.

As I left that meeting, it struck me: changing churches as a unique family is hard, but the same elements that make us stand out also make others notice us more easily. If it were just me and Lee and one or two typically developing kids, trying out a new church would have been easier. We would have required no email or phone conversation before showing up. I wouldn’t have gotten to know and be known so quickly by several leaders and volunteers who I now count as friends. We could have slipped in and slipped out for weeks before anyone remembered our faces and names.

We all want to be known. That’s not unique to our family. But because our family is unique, we were known more deeply at our new church early on. This has truly been a gift.


Dingles SpringCheck out Shannon Dingle’s blog series on adoption, disability and the church. In the series, Shannon looked at the four different kinds of special needs in adoptive and foster families and shared five ways churches can love their adoptive and foster families. Shannon’s series is a must-read for any church considering adoption or foster care initiatives. Shannon’s series is available here.

Posted in Adoption, Families, Inclusion, Key Ministry, Shannon Dingle, Special Needs Ministry | Tagged , , , , , , | 1 Comment

4 reasons why teens cut to COPE

shutterstock_209911381Let me start by saying this: I’m a bit of an expert on this topic but not in the way you think. My background and education is heavily in child development and education and communication, but I never studied self-harm in a classroom. I took a smorgasbord of psych classes, but those didn’t venture there.

No, I didn’t study self-injury in the tradition sense. I learned with a blade to my skin. My arms and thighs bear faint shiny lines, my skin’s memory of the deeper cuts.

I’m a natural researcher. I like to understand the why of complex issues, including my own. Even before I stopped my bloody habit, I read up on the primary reasons why kids hurt themselves.

(Note: throughout this piece and even in the title, I talk a lot about cutting. That’s because that was my particular self-injurious habit. But these reasons apply to other harmful behaviors, like burning yourself with matches, cigarettes, or friction, which is the more common method among adolescent males, while girls typically choose like I did. Also, this isn’t limited to teens. Adults and even younger children self-injure as well.)

Because acronyms help facts stick in our head, I’ve created one here: COPE. Teens – or kids or adults – cut for Control, as an Obsessive Behavior, as Punishment, or as an Emotional release. For me, it was all of the above. (Some kids start out of curiosity or after seeing others self-injure, but if it becomes habitual, one of these motivations has typically come into play.)

shutterstock_228348655Control: Um, have you been watching the news lately? This world feels out of control. Add to that the increasing demands on kids to perform, perform, perform in academics and athletics and church and everywhere else, and the pressure feels unsurmountable. Whenever everything seems out of control, many of us choose maladaptive behaviors to regain some semblance of control. For some, particularly when other hurts are out their hands, controlling one clear and easily understood kind of pain – like using a blade of some sort to make a red line on your skin – offers a sense of stability in an unstable world.

Obsessive behavior: Self-injury can be a compulsive behavior. Sometimes it starts that way; other times the compulsion develops over time. As the person links the emotional release (see E below) with the act of cutting, self-mutilation can shift from an act to a habit. The next time difficult feelings build, the craving to self-harm can too for those who cut. The behavior that may have been about control in the first place begins to take control. Something that was once a choice can become like an addiction.

Punishment: Sometimes kids – especially perfectionists – hurt themselves as a form of punishment. Not measuring up. Failing a test. Making a mistake. Disappointing a valued adult. Cut. Cut. Cut. Cut. As Demi Lovato put it in a 20/20 interview with Robin Roberts, “It was a way of expressing my own shame of myself on my own body. I was matching the inside to the outside. And there were sometimes where my emotions were just so built up, I didn’t know what to do, and the only way that I could get instant gratification was through an immediate release on myself.” (The video of that interview can be found here.)

Emotional release: We all get physical pain. If we stub a toe, for example, it hurts. Emotional pain is harder to understand. It’s intangible. Furthermore, the body’s neurochemical response to physical pain is to dispense endorphins, which improve a person’s mood. For me, cutting hurt physically – of course – but it felt good emotionally and made my brain clearer. The thin slices in my skin somehow – pun intended – cut through the pain and anxiety I felt. (This isn’t the answer for every self-injurious person, but now antidepressants have a similar and safer effect for me.)

As the acronym COPE suggests, this behavior is not typically related to suicidal desire. While some research indicates that those who self-injure are more likely to attempt suicide, the act of self-injury itself is not the same as a suicide attempt. Those unfamiliar with cutting often link it to the act of slitting ones wrist. I can understand that assumption, because the behaviors appear similar. In reality, though, people cut as a way to cope with intense emotional demands rather than as an attempt to fatally self-harm. Most people who habitually hurt themselves are not and will not be suicidal.

How would you know if someone is cutting? Some common signs of self-injury are wearing long sleeves in hot weather, having frequent yet similar unexplained injuries, or making excuses and unlikely stories about injuries. (If the injuries are bruises or something else that could be abusive in origin, reporting your concerns to authorities is a good first step to consider.) And of course, if someone tells you she is hurting herself, then that’s a clear indication.

How can you respond? First, don’t overreact. If someone who is engaging in self-harm trusts you with that information, you have entered a sacred space. Honor them. Listen. Ask how you can help him or her bear the pain. It’s okay (and wise) to ask if they have any cuts that require medical attention, either due to depth or infection, but show more concern for the person than the behavior.

Second, don’t underreact. Most pastors and ministry leaders aren’t trained to support kids with these sorts of struggles. You need to be somewhat knowledgeable, as you’ll likely be on the front lines for families as a sort of first responder before other helps are sought. But, please, don’t try to help where you’re not qualified. In the same way a primary care doctor isn’t expected to do complex surgery – and could do harm by attempting it – you can show great love to those you serve by identifying when someone better trained is needed.

Finally, be mindful that the cuts aren’t the primary problem. The core issue – the why – is what needs to be addressed. When adults treat cutting like the main dilemma instead of digging deeper, then kids learn to hide their behavior instead of changing it… and sometimes we’re comfortable with that because we didn’t really want to see the pain anyway. Let’s be willing to see the hurt and dwell in that discomfort with those who need support instead of merely trying to push pain further into darkness.

And what if this piece is describing you? If you’re reading this and recognize your own behaviors and reasons described here, please know you are not alone. (While I’m writing about teens, you’re not alone if you’re an adult engaging in these behaviors too. I started cutting when I was 11 – fitting the pattern shown in research that most self-injurers start between ages 11 and 15 – but all of my scars aren’t from adolescence.) Find someone to tell. Seek out professional help, not because you’re crazy but because this is an indicator you’re having great difficulty dealing with life’s demands. Needing help doesn’t mean you’re a failure; it means you’re human. All of us need support from time to time. If you’re hurting yourself to COPE, now’s your time to receive some extra measures of love.

Finally, trust me as I say something that might be hard to believe: you don’t deserve shame for what you have done or are doing to yourself. Self-harm is the tool you’ve found to deal with feeling overwhelmed. Just because you need to update your toolbox with a healthier strategy doesn’t mean you need to be ashamed of what you’ve done to get you to this day and place.

Self-injury might seem like a new phenomenon. It isn’t. Martin Luther beat himself for sinning, for example, but we all hurt ourselves in less extreme ways. Many of us – myself included – eat unhealthy foods as a way to deal with life. Others drink in excess or do drugs. Some smoke. All of these actions hurt our bodies. So instead of gasping at a way of hurting that seems foreign to us, let’s offer empathy and grace to one another and ourselves as we all learn to cope with better methods.


shutterstock_291556127Key Ministry encourages our readers to check out the resources we’ve developed to help pastors, church leaders, volunteers and families on mental health-related topics, including series on the impact of ADHD, anxiety and Asperger’s Disorder on spiritual development in kids, depression in children and teens, pediatric bipolar disorder, and ten strategies for promoting mental health inclusion at church.


Posted in Abuse, Controversies, Key Ministry, Mental Health, Resources, Shannon Dingle | Tagged , , , , , , , , | 2 Comments