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Are your child’s moods normal? Lisa Meyers McClintick, USA TODAY Guide to Kids’ Health, USATODAY 8 Sept. 2013
Any parent knows: An evening can go to heck in a matter of minutes.
Our 9-year-old daughter pipes up suddenly that she needs a pink dress to play Sleeping Beauty in class the next morning. It has to be pink. It has to be pretty. And she needs it now!
Any sort of reasoning—like the suggestion to wear a wedding-worthy yellow dress—won’t work. Frustrations explode into shouting, timeouts and all-too-familiar rants of “this family sucks,” followed by heartbreaking rounds of “I hate myself!”
The next morning, when nerves calm, the yellow dress is perfectly fine and our daughter cheerfully chatters about Belle’s ball gown in Beauty and the Beast.
The difference? The anxiety attack is over.
Sneaky and insidious, anxiety seizes our daughter like a riptide pulling her out to sea. Her negative thoughts build like a tsunami, and it’s useless to swim against them with problem-solving logic.
Like a real riptide, the only escape seems to be diagonally. A surprise dose of humor—tough to summon in the midst of a blowup—can spring her free. As one therapist explained, “You can’t process anger and humor at the same time.”
It’s taken years of keen observation and research, plus the support of educators and psychologists to help our kids, ages 9 to 13, cope with mental health issues that also include Attention Deficit Hyperactive Disorder (ADHD) and depression.
Recognizing that something isn’t right and pursuing help isn’t an easy journey. But it’s necessary. In the same way you’d pursue cures and solutions to manage chronic physical conditions like cancer and diabetes for your child, you have to advocate for your child’s emotional well-being. It requires being proactive, persistent and patient.
“If you can intervene early and get proper treatment, the prognosis is so much better,” says Teri Brister, who directs the basic education program of the National Alliance on Mental Illness.
KNOW THE SIGNS
“One of the most difficult-to-recognize issues is anxiety,” says John Duby, director of Akron Children’s Hospitals Division of Developmental and Behavioral Pediatrics. “(Children) won’t say, ‘Hey, you know, I’m worried.’ You have to be tuned in.”
All-consuming worries—about parents’ safety, bullies or natural disasters, for instance—can look like a lack of focus at first. Some kids ask frequent questions about “what’s next” for meals or activities. Changes to the daily routine (a substitute teacher or a visit to a new doctor) can trigger headaches, stomachaches or a sleepless night.
At its most extreme, anxiety induces panic attacks. Kids break into sweats, have trouble breathing and feel their heart racing.
Depression may cause similar symptoms to anxiety with headaches, stomachaches, not being able to sleep or sleeping more than usual. “They may withdraw socially,” says Duby. Kids may head to their room after school and not emerge until morning. Some kids are constantly irritable and angry.
“We often think depression doesn’t happen in children, but it does,” he says.
GET HELP
Step 1: Trust your instincts
If you’re worried about your child’s mood, trust your instincts as a parent, recommends Brister.
The red flags of mental health disorders tend to pop up during school years when children have to navigate academic expectations, make friends and increase responsibilities at home.
“You have to look for (behavior) patterns,” says Brister. These can include impulsive acts, hyperactivity, outbursts, an inability to follow directions or recurring ailments that may impair how the child performs in class, extracurricular activities or simply sitting through dinner with the family.
Most concerned parents start with a visit to the pediatrician. (PETER’S EDIT For Australian parents your family GP is a good place to start) The family physician can help you analyze symptoms and understand whether there might be an underlying condition such as food allergies or a chronic lack of sleep.
Step 2: Seek professional help
(PETER’S EDIT: In Australia a referral from a GP to a psychologist via a mental health care plan or ATAPS will ensure an informed, appropriate and timely assessment. If the issue is developmental, a referral to a paediatrician may be preferred or if your GP has a serious concern a referral to a child psychiatrist may be made. Wait times for each option should be relatively short in the private sector.)
When our son was 5, we sought testing for ADHD with a referral from our pediatrician. Unfortunately, we couldn’t even get on a waiting list for a psychology appointment. We were told the list had backed up to a two-year wait, so it was eliminated. We had to call weekly and hope for an opening.
When our daughter needed help as her anxiety escalated, it took a school district triage nurse to get us an appointment with a psychiatric nurse.
This is, unfortunately, not an uncommon scenario for parents. You need to use all the leverage you have to access experts in the school system or mental health clinics to help with your situation. Stay persistent and be pleasant rather than pushy.
And when you do get an appointment, make the most of it by consistently tracking the concerns you have about your child’s behavior and putting them in writing for the physician to read. Have a list of questions ready, and always ask about additional resources you can tap into, from support groups to books.
Mental health practitioners will also be gathering resources and information about your child from report cards, checklists and questionnaires. These can help pinpoint whether a child has anxiety, depression, ADHD, bipolar disorder, is on the autism spectrum or may have a combination of these. “It allows us to have a more objective view,” says Duby.
Step 3: Find your normal
Once there is a diagnosis, families can decide how to move forward. That might mean trying medications, working with a psychologist or setting up an Individualized Education Program (IEP) at school.
Additional services that may help include occupational therapy, which can identify specific movements, such as swinging, spinning or brushing outer limbs with a soft brush that may help your child’s brain process and integrate sensory information.
These tools and approaches can help families be proactive about preventing and managing mental meltdowns. It’s also essential to help children feel a sense of belonging at school and in community groups. Families need to build up their children’s strengths so they have the self-esteem and confidence to move forward, says Duby.
And parents should stay on top of the situation, watching for changes in behavior and mood, especially as children get older, says Brister.
Hormones may help or worsen conditions, which makes it important to have a diagnosis and support network before the teen years hit.
“I can’t emphasize enough how essential it is to recognize symptoms early and treat them,” she says.
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SIGNS OF DEPRESSION AND ANXIETY
Signs in children may differ from the symptoms we commonly associate with adults who have the disorders. Depression in kids may look like irritability, anger and self-criticism, says the National Alliance on Mental Illness. It could be as subtle as her making less eye contact with you than in the past.
School performance is another important indicator. Grades can drop off dramatically; students may also visit the school nurse more frequently with vague complaints of illness.
Children who suffer from an anxiety disorder may experience fear, nervousness and shyness, according to the Anxiety and Depression Association of America. They may worry excessively about things like grades and relationships with family and friends. They may strive for perfection and seek constant approval.
HOW TO CALM IT DOWN
Whether a child has mental health struggles or not, emotions inevitably boil over—especially as preteen dramas escalate. Here are ways to help de-escalate the situation and restore calm to your family life.
• Keep your body language non-threatening and stay as even-keeled as possible. Don’t get in the child’s face or use a raised voice.
• Teach kids how to breathe slowly through the nose, then exhale gently through the mouth as if cooling a hot bowl of soup.
• Create an “away space,” a place to cool down and take a break. Consider a quiet nook in a bedroom, a spot on the stairs for kids who don’t like separation or a backyard corner for those who find comfort in nature.
• Let kids know they can’t hit others, but it’s OK to punch a pillow or punching bag or to squeeze putty or a squishy toy.
• Figure out what’s physically comforting—feeling the softness of a blanket or stuffed animal, nuzzling the fur of a family pet or piling under heavy blankets.
• Listen to favorite tunes on a music player.
• Provide a journal for writing out frustrations or doodling when the words won’t come.
• When emotions simmer down, sit side by side to talk through how the situation could have been handled differently and work on solutions together.
ONLINE RESOURCES
(PETER’S EDIT: AUSTRALIA:
HeadSpace: headspace National Youth Mental Health Foundation Ltd is funded by the Australian Government Department of Health and Ageing under the Youth Mental Health Initiative Program. A great resource for parents and teens.
BeyondBlue : Resources for young people section )
OTHER:
HealthyChildren.org from the American Academy of Pediatrics has a section dedicated to “Emotional Problems.” Parents can tap into great information on how to help their child. Audio segments recorded by experts in the field can be used as a launching point for family discussions.
TheBalancedMindFoundation.org, founded by the mother of a daughter with bipolar disorder, provides help for families. Online, private support groups offer 24/7-support and online forums are a way for parents to connect.
WorryWiseKids.org, a service of the Children’s and Adult Center for OCD and Anxiety, has a wealth of information about the different types of anxiety disorders children can have, how to understand them and how to seek treatment for them.
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