By Gene Beresin, Executive Director

Posted in: Hot Topics

Topics: Mental Health

When it comes to medical or psychiatric issues challenging our children of all ages, we often know something is wrong but don’t readily know how to assess the problem. We might see changes in their behavior or emotions that we know are deviations from their baseline.

For example, a child may have a rash, or lose their appetite, or become lethargic. We might then commonly go online to see what this could be – often a precarious enterprise. What might simply be strep throat with swollen glands, a quick search online may inform us that swollen glands can be a sign of lymphoma or an autoimmune illness.

Or from the mental health standpoint, a young person may be withdrawn, startle easily, or become irritable. And again, search online will indicate a wide range of signs that may indicate an anxiety disorder, or signs of post-traumatic stress disorder following an assault, or depression.

In short, as parents and caregivers this approach is a start, but tends to leave us shorthanded, and worried. Where can we turn?

We at the Clay Center have developed an approach that can lead us in the right direction and provide a guide for the steps we need to take to best support and care for our kids. Parents, even physicians, are far too often untrained in psychiatric diagnosis and treatment and need a guide to start the process of understanding the behavior of our kids, and how to help support their wellbeing.

What to Look For:

When you observe that your child has changed in some way, consider the following, in terms of a biological, psychological and socio-environmental approach.

The following are some general observations, and are not meant to be inclusive, but are a great start. And remember no one expects you to be trained in psychiatry or psychology, but as a parent, you are the expert in your child and if you see a change in the baseline behavior, here are some things to look for:

Biological changes:

• Changes in:
  • Appetite
  • Sleep
  • Energy
  • General appearance and self-care (like not showering, wearing the same dirty clothes, skin color, appearance that they look ill)
  • Concentration and attention
  • Motor functions (such as tics, startling, agitation or lethargy)
  • Verbal behavior (like a talkative kid that is now more mute)
  • Complaints of physical problems (such as headaches, stomach aches, joint pains, rashes, vomiting, diarrhea)
  • Weight gain or loss

 

Psychological changes:

• Thinking (such as confusion, lacking structure, strange or unusual ways of expressing things)
• Perception (like misperceiving events, experiencing hallucinations)
• Changes in self-esteem
• Problems with identity
• Excessive anger, temper outbursts, irritability
• Depression and sadness
• Stress
• Self-destructive behavior (such as cutting, use of substances, risky behavior)

 

Social changes:

• Social withdrawal
• Decreased interests
• Reduced performance (in academics, sports, other activities)
• Loneliness

If you notice one or more of these changes, most parents and caregivers would worry. Sometimes the worry is indicative of a significant problem and other times it’s simply a “phase.” Let’s consider how we consider the level of concern:

When to Worry:

• Developmental phases: All kids go through phases in development.
• For example, at about 9 months most kids develop “stranger anxiety.” Previously they can be passed from person to person without distress. But at some point, they realize, “Hey you’re not my parent!” and though previously they would smile and make great eye contact, but suddenly they’re bursting into tears and reaching for a parent or known caregiver. This is because they have developed to distinguish the familiar parent from a stranger. But kids grow out of this, and by a year or so, it’s gone.
• Or some kids may have a relatively good mood, wander around on their own at a year, but around at around 2 years, seem to be more irritable, clingy, and won’t leave your side. The so-called “terrible 2s” are simply a child coming to the realization that there is a real, external world that may be dangerous. And they regress because part of their becoming an independent person feels perilous.
• In these two situations, they are rather short lived, and though difficult for parents, are not worth excessive worries, because with some management they disappear.
• Signs of mental health problems: When behaviors noted above indicate that something is significantly wrong you would see changes that are:
• Significant deviation from normal phases of development that last far longer than they should. They appear to be long lasting or getting worse.
• Dramatic, exaggerated or increasing in intensity
• Impair functioning: academic, social, recreational decline
• Resistant to your efforts to help, such as having discussions, attempting to bring things back to normal
• Noticed by others besides you, such as other family members, teachers, community leaders, coaches, peers. This reinforces the concerns that the changes go beyond home but are present in multiple other settings

What to do:

Let’s consider what to do when you observe significant, longer lasting changes that are not simply phases:

• Have frequent brief conversations: There is no substitute for saying what you have observed and asking what your child is experiencing. But don’t expect clear, lucid answers right away. It may take several brief conversations.
• Listen and validate: While your child may provide descriptions that you don’t feel are complete or accurate, accept what they say, and indicate that you want to hear more. Beware of being critical or judgmental. You need first to find out what is going on before you suggest any form of remediation
• Reduce your own anxiety: When you are calm, in control you are in the best position to talk. Use methods of self-care: good diet, exercise, sleep, meditation, yoga to take care of yourself.
• Express your love and concern.
• Ask specific questions: about depression, anxiety, stress, loneliness and suicide. It is always important to ask if they were thinking about suicide and remember that it will not, as many believe, result in suicide. It will be a relief for your child.
• Read blogs from trusted resources such as the Clay Center about the signs and symptoms of psychiatric disorders. Your education is key!
• Ask whom they can talk with besides you: Often another trusted adult – grandparent, older sibling, teacher, coach, member of clergy or others would be more comfortable to talk
• Ask for advice: what does your child think you can do to help
• Social media: see what is going on, in terms of source of drama, stress, bullying, or ghosting
• Consider a professional evaluation: It’s always important to seek professional help. Start with your pediatrician and consider mental health professionals that you can contact

We are confident that following these guidelines will be important for your parenting. When you practice these skills over time you will become more competent and build your skills as a loving parent. And your kids will deeply appreciate your thoughtful concern.