Raising a Kid Who Can

The Takeaway

• ✔ The roots of good mental health are rest, recreation, and routine.
• ✔ Sleep has a massive impact on cognitive function and mental well-being. Unstructured play provides critical thinking skills, movement activates brain connections, and routine relaxes the brain and sets it up for success.
• ✔ If your kid has hit a rough patch, it's likely that at least one of these elements is out of whack.

The Setup

Catherine was recently asked to assess a young boy for ADHD based on concerns expressed by his teacher. During her initial evaluation, the boy confessed that he was secretly reading late into the night with his flashlight under the covers. She "prescribed" a no-flashlight rule for a week. Soon after, unbidden, the teacher wrote a note to the parents about what a difference the "doctor's visit" had made in their son's ability to pay attention at school.

Why Is This Essential?

As parents, one of our most important jobs is to help our kids build a strong foundation for psychological health so they can function well both in crisis and in calm. The roots for good mental health (at any age) are rest, recreation, and routine. We call these the Three Rs.

Inevitably, there will be times when one or two or all three of the Three Rs will be out of whack. We have all experienced the frequent tension between the demands of modern life and the Three Rs. Rushed meals, fewer opportunities for movement and exercise, wacky sleep cycles— if too frequent, these daily disruptions raise concern about long-term consequences for mental health and brain development in our children.

The Three Rs are intrinsically connected; imbalance in one affects the others. For instance, the bulk of the sleep disturbances we saw in children during the pandemic were likely exacerbated by a lack of movement and dysregulated routines. Kids (and their parents) lost the boundaries of their daily schedules. Bedrooms morphed into classrooms. With limited playground time and reduced sports schedules, the structure for movement, exercise, and outdoor time largely disappeared. Results? Reduced quality of sleep.

We want you to find balance. If your child seems a little unmoored, is struggling in some way, or is just having a bad week, take stock of the Three Rs. Remember, your child's brain never takes a break. It works equally hard, day and night. Whether managing all your child's vital life systems or their motor, sensory, and cognitive processes, the brain continues to take care of your child's body all the time, even when they are asleep. Even a small adjustment in just one of the Three Rs can make a big positive difference for your kid.

Curious About the Science?

What Science Says About Rest

The old adage "sleep is the best medicine" applies to more than just physical illnesses. Sleep is one of the most critical components for body and brain health, impacting everything from cognitive function and mental well-being to growth, height, and immunity. Reduced or disrupted sleep can completely unravel frontal lobe attention and self-control, both in children and in adults. Sleep problems are correlated with multiple psychiatric disorders, including anxiety, depression, and ADHD. Sleep deprivation has been shown to quadruple the risk of teenage depression and significantly increase the risk for teen suicidality.

A recent study from the University of California at Berkeley concluded that deep sleep seems to be a natural inhibitor of anxiety. The study showed that a night of good sleep reduces activity in the amygdala, whereas a sleepless night can trigger amygdala activity and cause up to a 30 percent increase in anxiety levels. When we are sleep deprived, our body and brain benefit from adrenaline to keep us awake and alert. But adrenaline is also designed for moments of potential danger, which means that we become more reactive, more anxious, and more likely to lose control of our emotions.

Another fascinating function of sleep is related to the flow of cerebrospinal fluid (CSF), the lubricating fluid that bathes our brain and keeps it cushioned inside our hard skull casing. New research has shown that the channels in the brain expand while we sleep, allowing large waves of CSF to flow through and flush out toxins and debris. We can think of this sleep-time CSF flush as a nightly "power-wash" of the brain, preventing the buildup of adrenaline and toxic waste by-products.

Research has also shown that sleep plays a critical role in learning and memory. For example, in one research study, people who studied information in the evening, had a good night's rest, and then were tested in the morning performed better than those who studied in the morning and were tested that same evening.

We see lots of sleep struggles in our young patients. One reason is stress, which affects sleep on multiple levels—when we sleep, how long we sleep, how easily we fall asleep, and how soundly we sleep. Another is excessive screen time and/or screen use too close to bedtime. Our brains require rest and rejuvenation from screens and devices. As early as 2010, researchers showed that when students unplugged and significantly reduced their screen use, they reported a dramatic improvement in their quality of life.

Other studies have found that adults unplugging completely after the workday resulted in feeling recharged for the next day. As we discussed earlier, modern life's constant connectivity and disruptions—the incessant pings from emails, texts, tweets, and digital notifications—exhausts our brains. Unplugging our devices may refresh the prefrontal cortex (PFC), creating motivation, energy, and engagement with the world.

With our busy lives, we know it can feel impossible to prioritize a healthy night's sleep over our kids' grades, sports, family time, and chores. This is an area where we ourselves find it especially hard to practice what we preach. But we promise: Everything you and your child struggle with will get better if you first have the foundation of a healthy night's sleep. There is never a time when consistent, right-sized sleep won't help. There are no magic pills to raising a healthy, well-adjusted kid, but sleep may come closest to the promise of immediate improvement in at least some aspect of your child's life—and your own.

What Science Says About RECREATION

Humans are built to play. Experts in human evolution have shown that fun and recreation—exercise, movement, laughter, time spent outside, time to be social, unstructured playtime—are essential for the growth and development of children's brains and even the survival of our species.

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Exercise for Worriers

Jennifer was working with a parent of a worried 8-year-old named Sadie. Sadie had a lot of anticipatory worries that kept her from being able to go to recess or hang out with friends. Some worries were related to outdoor sensory experiences, such as thunderstorms or being stung by a bee; others were more home- or school-related, like fear of a home robbery or someone throwing up on the bus.

Poor Sadie's fight-or-flight system was turned on for much of her day. She needed a way to methodically release the anxiety-triggering chemicals that her nervous system, feeling constantly under threat, was producing. Jennifer decided to put her on an "Exercise Program for Worriers." They enlisted her older brother to skip, walk, and/or jog with her to school each morning. Her school counselor had her join a speed walkers group—meeting up with other like-minded kids to walk for the last ten minutes of lunchtime. Her grandmother officially timed her while she ran around her apartment building two times right when she got off the school bus. Every time she had a worry at home, she was encouraged to jump twenty times on the tiny indoor trampoline her family had in the TV room. Even without any formal talk or play therapy, within two weeks Sadie and her family reported her anxiety levels at less than half what they had initially been.

To begin, the experience of unstructured play is crucial for nerve cell connections being made in kids' growing PFCs. (Emphasis on unstructured, meaning free play without rules or directions from parents, teachers, coaches, or other adults.) Unstructured play is also a critical ingredient for teaching the brain two important life skills: the ability to predict what will happen, both with people and the world, and the ability to manage uncertainty and surprise. Studies have shown that older kids who are highly playful report less stress and better coping skills than their less-playful peers.

Play also brings movement, an essential component for a healthy life. When we stay in the same position for long periods of time, the body circulates less oxygen. When less oxygen circulates in the bloodstream, the feeling of fatigue increases and results in lower energy efficiency and motivation levels.

Spending time outdoors is essential, too. Studies show that simply spending ninety minutes outside, in a natural setting, stimulates beneficial changes in the PFC. Daily contact with nature lowers stress, improves mood, and reduces anxiety. Time spent in green spaces and outdoors can improve cognition in children with attention deficit disorders.

One exciting recent discovery is a little-known metabolic factor called brain-derived neurotrophic growth factor (BDNF). BDNF is naturally created in the body, especially during exercise. In the lab, when scientists put BDNF on nerve cells it caused neurogenesis (the creation of new nerve cells) and supported the survival of existing nerve cell pathways. Harvard professor and BDNF guru Dr. John Ratey calls BDNF "Miracle-Gro" for the brain.

BDNF boosts memory and IQ, increases the thickness of the cortex and hippocampus, and helps protect neurons. There is evidence that BDNF stimulates neurogenesis in older adults, including people with Alzheimer's. Conversely, lower levels of BDNF have been associated with depression, cognitive decline, and even a shorter life span.

As far as we know, there is no way to manufacture BDNF. We can't take a BDNF pill to support brain health. However, there are ways to encourage the brain to make more of it—one of which is regular exercise. According to Dr. Ratey, this means getting to at least 70 percent of your maximum heart rate for thirty minutes, four or five times a week. Exercising once or twice a week may feel good and can relieve stress, but to receive the deluxe brain benefit, our kids need to be running, jumping, chasing, and playing cardio-intense sports more regularly. And we want them hot with exertion, short of breath, covered in sweat. This type of physical effort uses more brain cells and using more brain cells activates the genes that make BDNF.

Last but not least, as Stanford neuroscience researcher Dr. Allan Reiss has shown, humor is also important for cognitive and emotional development. Both child and adult brain networks are activated in positive ways by humor and play, delivering enormous servings of dopamine, along with some mood-enhancing serotonin.

More than ever, we need to step up and incorporate movement, daily play, and humor into our everyday life. The good news is that evolution has designed kids for exactly this purpose. All you have to do is make sure your kids have ample opportunities to laugh, move, and play.

What Science Says About ROUTINE

One of humanity's most amazing neurological gifts is our ability to anticipate the future by learning from past and current events. With this power, we can work to prevent bad things from reoccurring. But this also means that our human brains fear uncertainty. Uncertainty diminishes our sense of control, which can cause anxiety (both immediate and anticipatory). It can make us feel overwhelmed and trigger a sensation of "brain fog." Uncertainty causes our obsessive anticipatory circuits to come up with endless "what if" scenarios, conjuring up worst-case scenarios and catastrophe.

Routine is an antidote to uncertainty. Routine relaxes the brain and sets it up for success. As parents, we can help our kids feel more organized and focused by maintaining structure and routine. Having a routine reduces the need for on-the-spot decision-making and supports self-regulation by taking the guesswork out of daily life. It gives kids a boost of empowerment by supporting a sense of self-control.

Even the illusion of structure can convince that boss of our brain, the PFC, to think, "I've got this." Picture the sense of calm you might feel upon entering your child's classroom on back-to-school night and seeing a daily activity schedule neatly written on the whiteboard. Or the relief and satisfaction you might see on your kid's face when they cross off a homework assignment on their to-do list. Whether we are young or full-grown, our sense of control is optimized when we can rely on a general framework of what will happen each day. Having a routine engages our PFC and regulates those pesky anxiety loops—and it's a more constructive way to hack into our dopamine circuits than playing video games for two hours.

Structure is a kind of mental health. Several studies have found that having active daytime routines promotes healthier sleep cycles. Another study showed that family routines help reduce oppositional and negative behaviors in children. Solidifying the morning routine reduces stress not only in the morning but also later in the day. Knowing what we can expect, and having rituals and plans we can count on, whether fun or monotonous, gives both parents and children daily anchors in a sea of uncertainty. Do not underestimate the power of a solid routine!

Routines and "Real Life"

While we tout the importance of routine, we also need to be gentle and flexible. Routine is not rigidity. Sometimes our work or home lives are necessarily unpredictable—for example, when parents travel for work or have changing shifts, when someone in the family is going through a serious illness, or when childcare is unreliable. Even if some parts of family life are chaotic, parents can still work to stabilize what they can. Look for opportunities to build ritual and routine (for example, a military parent might pre-record bedtime stories before a lengthy deployment). And in times of change or transition (a big move, a divorce, a pandemic), implementing new routines and rituals might be the first priority. Even in families with great predictability to their days, some routines will go lopsided. Some days may become unexpected pajama days. But other days might be planned pajama days that can go on the family calendar.

What Do the Three Rs Look Like in Your Family?

Take a Look at Your Child

• Family relationships: Does your family structure provide support for the Three Rs (Rest, Recreation, Routine)? Do you prioritize them for your child? Is one R particularly challenging for your family?
• Friendships: Does your kid engage in both structured and unstructured time with friends? Do they have opportunity for sleepovers and playdates, but not to the point of exhaustion? When they are with their friends, do they spend any time outside? Do they run, move, jump, and chase?
• Learning: Do teachers, coaches, or other adults involved in your child's life express any concern about your child being sleepy, lacking attention or focus, or lacking interest in movement?
• Sense of self: Can your child notice what they need for themselves in all Three Rs? Do they connect their mood to the quality of their sleep the night before? Do they notice if they can concentrate better after walking the dog? Can they speak up or adjust when they feel they are getting out of balance?

Concern-o-meter

Using a piece of paper, draw a Concern-O-Meter or other rating scale from 1-10. Pick a color for each category. Draw a colored arrow for each to give yourself a visual picture of your child in this moment.

Take a Look at Yourself

• Are your values aligned with your parenting choices?

Simple as the Three Rs might be, this Essential may require you to do some soul searching to honestly identify your priorities for your child. (Travel sports or downtime? More sleep or better grades?) Every family has constraints and competing needs that may impact their ability to make the Three Rs a priority. What elements of your daily/weekly/monthly/yearly life are fixed (work hours, childcare needs, financial limitations) and what are flexible? Accepting that you may not be able to change everything, what can you adjust to better serve your long-term goals for your kid?

• If your kids are young, are you taking advantage of your ability to have a direct effect on the Three Rs?

The age of a child matters greatly in how we can effectively address the Three Rs. With very young children, it is much easier for parents to create a routine and ensure it is followed, as well as to control the amount of sleep kids get, the food they eat, and the recreation in their days. Are you paying attention and following through?

Be Honest with Yourself

If you're a hypocrite, own it! If you're ambivalent, admit it! Who isn't? Perhaps you don't garage your cell phone, but you can get a good night's sleep anyway. Perhaps you really value good grades and think your child can get by with less sleep for a year or two in order to make that happen. Before you determine where you want to be with your child's Three Rs, determine where you are with yourself and your priorities. We aren't recommending that you be perfect, or even perfectly consistent—only that you be honest, with yourself and your kids.

• If your kids are older, are you using your parental influence to encourage them to observe the Three Rs, and are you consistent in your messaging and actions?

As kids get older, parents' control shifts to influence, and adolescents' barometer for hypocrisy is huge. At this stage, leading by example and having thoughtful conversations is more effective than issuing mandates. It may become more difficult to enforce the Three Rs, but it's still extremely important to give them your attention: practice them in your own life and prioritize them in your parenting and messaging to your children.

• What are your favorite things to do with your kids?

Does time spent with your kid also contribute to the Three Rs? Relaxing with your kids provides important connection time that can help kids cope with stress. Have you found unplugged activities that you and your kids enjoy doing together? What about family inside jokes, laughs, and all-around silliness?

How Do You Think You Trend?

Plays for Your Playbook: REST

* Supporting Good Sleep

There are a thousand ways, and reasons why, kids might have a tough time with sleep. If they have trouble falling asleep, are they struggling to turn off their thoughts, do they have worries about monsters, or are they still physically amped up? If they fall asleep but then wake up a lot, are they seeking your reassurance, craving your warm body, or still learning how to put themselves back to sleep? If they wake up before dawn, are they feeling anxious about the day, or are they hardwired early risers?

If you want to help your child improve the quality of their sleep, try some of the tips below. See if you notice any shifts in your child's functioning (or your own). And as always, remember that sometimes the techniques that don't appeal to you are exactly the ones that you might end up finding the most helpful.

➔ Notice whether your child's brain is able to go "Off Duty." The brain has a daytime setting, when it is "On Alert," and a nighttime setting, when it is "Off Duty." On Alert always overrides Off Duty, so if a child feels On Alert, they won't be able to access their sleep system. As an example, studies show that people don't get good-quality sleep the first night they are in a hotel—even if their mind is calm, the body is still set to On Alert, not yet used to the surroundings. Ask yourself, does my child feel chill enough to go Off Duty, or is their On Alert system still engaged? Many of the following Plays can help your child get to their Off Duty state.

➔ Set a sleepy mood. Melatonin, a brain chemical that promotes sleep, develops in the body during times of low light. Create an atmosphere of low light in the house, especially in your child's bedroom at least an hour before bedtime, so your child's brain can release a melatonin boost for a naturally sleepy body. Reduce the use of electronics—cell phones, tablets, computers, and other screens put out a blue light that signals the brain to stop producing melatonin. (Remove devices from kids' rooms at night when they are young so they don't get in the habit of sleeping with them. Model good sleep hygiene by having a family "phone bedroom" where phones can "sleep"—and get charged—outside of the bedrooms.) Small doses of a melatonin supplement have shown benefits in resetting the sleep cycle, so if your child still struggles with sleep after trying other methods, consider discussing a melatonin supplement with your pediatrician.

➔ "Pretend" to sleep. Lots of kids assume they should be able to go right to sleep once they lie down, but for many people, getting to sleep takes up to twenty minutes. Some children may feel like they are doing it wrong, somehow, if they are just lying there waiting for sleep. Let them know we all "pretend" to sleep for a while before we actually fall asleep—knowing that this is how everyone does it may bring them some comfort and confidence.

➔ Sleep is best, but rest is a close second. If a kid can't seem to fall asleep or can't get back to sleep after waking in the night, assure them that lying quietly is also rejuvenating. It is also a practice they can control, unlike sleep. So make high-quality rest the goal (and sleep will often follow).

➔ Go for boring. Help your child find the sweet spot of bedtime activities that are interesting enough to keep their mind from going to those late-night worried places, but boring enough to help their bodies wind down and bring on sleepiness. Familiar music and books (whether audio or print) are especially soothing. For younger children, read them a book they know by heart. For older kids, recommend familiar books from their childhood, especially comforting or lighthearted novels and comic books that are easy, quick reads and don't tax reading comprehension at that late hour.

➔ Use sensory activities. Bring your child's body into the present, away from the past (which may be a source of sadness and regret) and away from the future (a possible source of anxiety). Try working into the bedtime routine items that engage the physical senses: a soft and fluffy blanket, a hot-water bottle, lavender aromatics, mint tea, low-fi music, or even a lava lamp whose light your child can watch shift and change.

➔ Go for repetition and ritual. Do bedtime activities in the same order. Repetition trains your child's brain to recognize certain lower kinds of light, clothes, beverages, and hygiene routines as signals to slow down and turn on that Off Duty setting.

➔ Practice progressive muscle relaxation activities. You can find audio recordings of these progressions online or on various apps. They are usually just five to ten minutes long and give the brain a "job" of concentrating on each individual part of the body, in turn. The practice encourages the brain to quiet while simultaneously relaxing muscles and releasing stress.

➔ Try slow exercise in the evening. Exercising the muscles in the evening with slow movements, like stretching or resistance training, has been shown to bring on quicker and deeper sleep. For example, a slow uphill walk an hour before bedtime can be a helpful sleep-inducing activity. High-intensity aerobic activity, on the other hand, can raise body temperature and create too many endorphins to allow sleep.

Recommended Sleep Guidelines

Here are the recommended minimum and maximum hours each age group should regularly sleep during a twenty-four-hour period for optimal health: