Every active, engaged parent quickly comes to realize that raising a child is an experience not without challenges. Virtually all of us have moments of doubt and concern, when our children – babies, toddlers, elementary schoolers, pre-teens or teens – exhibit behaviors that leave us scratching our heads to put it mildly.
Even the seemingly healthiest cumulative childhood experience involves growing pains, awkward moments, difficult stages and trying times where it can seem a struggle just to stay on track. But in some cases, the things every kid goes through, such as tantrums, misbehavior, sadness or anxiety, grow to unmanageable proportions. As parents, and as a community, we need to be better at recognizing red flags early and taking a mindful, compassionate approach to accessing the appropriate support to help a troubled child.
According to Julie Baker, a clinical social worker and certified school adjustment and guidance counselor for Ashland Public Schools, “‘Troubled’ can mean anything behaviorally, emotionally, socially or academically if you are talking about a school-aged child.” In her professional setting, Baker sees many kids on the autism spectrum, as well as a lot of children being diagnosed with attention deficit hyperactivity disorder (ADHD). She also says behavioral concerns and emotional stability among children often stem from family dynamics, ranging from difficulty in two-parent homes with staying consistent to single-parent homes and situations of divorce where there is a lot of financial and emotional stress.
Mona Potter, a child and adolescent psychiatrist at McLean Hospital, runs an outpatient program for kids with anxiety disorders, in addition to a community residence house for young women struggling with borderline personality disorder. “When I think of a child who is troubled, or in need of help, I think of the main domains of his or her life … how are relationships going, how are things at school, what is his or her ability to handle stress, both emotionally and behaviorally? Is it taking too much energy and effort for the child to manage day-to-day tasks?” she asks. “My radar goes up when a child is having a hard time keeping up with peers or is experiencing significant emotional distress while doing so.”
Part of responsible parenting is remaining present in your child’s life, observing and correcting behavior, staying in tune with relationships and monitoring progress in school. Still, many times parents struggle to be objective. We tend to let our emotions get in the way, either myopically scrutinizing the aspects of our child’s behavior and development, or viewing them through a spectrum understandably tinted by unconditional love.
To make detection even more difficult, Baker says oftentimes children compartmentalize their struggles, so they, for instance, only manifest themselves at school or in the home. This makes it all the more important to not only maintain open lines of communication with your kids, but also for you to utilize resources, such as the school system or a trusted pediatrician, to help identify signs.
“It could be as basic as not being able to follow multi-step directions, speaking disrespectfully to the parents, not getting along with peers,” says Baker of the symptoms of a troubled child. “You notice a lot of troubled kids don’t get invited to the birthday parties. Simple things like that.”
And while every kid has a bad day or experiences growing pains, Baker says establishing discipline and behavioral expectations at an early age make detection easier. “You should be able to apply a normal consequence, like a time-out or a loss of privilege, and the child should be able to respond,” she says. “Kids who have larger issues aren’t going to respond and oftentimes those physical and verbal behaviors are going to escalate.”
Potter breaks it down to two basic groups she designates as internalizing and externalizing disorders. “The externalizing behaviors tend to be more obvious,” she says, using examples such as lashing out, bullying, being really irritable, yelling and becoming angry. Since the internalizing disorders are often more difficult to notice until the behavior starts to escalate, Potter is always pleased when consulting with schools to see educators taking an interest in kids who may seem isolated or are more on the quiet end.
Other signs she mentions include acting secretively, answering questions in only a few words, having many physical complaints (such as headaches or stomachaches), having a change in eating or sleeping habits, experiencing a decline in school grades or motivation and not participating in previously enjoyed activities.
Potter says a solid foundation to work from is just knowing your child and understanding his baseline. “It is important not to jump on every little thing that comes up. It’s best to take a step back and look a little more broadly at the big picture of what’s going on with the child. We all go through times when we are a little more irritable or feel a little less equipped to manage our frustration,” she says. “Whenever I am considering making a psychiatric diagnosis, I’m really looking at how the child is functioning over time in different situations (for example, at home, school or in extracurricular or social activities).”
For Lisa, mother of Sandra (names changed for the purpose of anonymity), a now high-functioning teenager diagnosed with bipolar disorder around the age of 6, the signs things weren’t right were obvious. “Around the age of 2 or 3, Sandra’s tantrums were at a whole different level than I thought they should be and what my friends’ kids had,” Lisa says.
Remembering back to those difficult times, Lisa recalls feeling a lot of self-doubt and apprehension. “We would attempt to manage a crisis ... really trying to understand at what point we actually needed help,” she says. And when Lisa reached out for support, she didn’t initially receive a lot of empathy. “There were people saying it’s just the typical tantruming expected from a soon-to-be-toddler. As a parent of a child who has an illness, it felt very isolating because people didn’t understand.”
Because there exists a stigma with mental illness that is not present in other medical conditions, it can create a barrier that keeps families from seeking outside help, while at the same time blocking typical avenues of support. “It’s about taking away the stigma of it and treating it as a medical disorder,” says Potter. “It’s very difficult to do because there is a different response to mental illness. It’s incredibly important to reach out for support and not try to tackle it alone.”
“The earlier you identify an issue the better,” stresses Baker. “Not just shy away from it or be embarrassed, but try to confront it and get support.” Potter agrees, adding, “This is when you don’t want to be a firefighter, where you start intervening when you are already noticing symptoms.”
Baker and Potter emphasize the importance of regularly scheduled meetings or mealtimes, where families come together to talk and to listen. “So when a parent is concerned about something, such as [a child] not eating as much, looking in the mirror all the time or appearing to be afraid to gain weight, and asks about it, it doesn’t come completely out of the blue,” Potter says.
A common side-effect of being responsible for a child going through a troubled time is self-maintenance can fall by the wayside. “When you have a child who is troubled, for whatever reason, it’s incredibly difficult,” says Potter. “Parents can love their child and simultaneously feel exhausted and overwhelmed by the experience. This can elevate their own anxiety, sadness and frustration, and make it more difficult for them to take care of themselves.”
“Surround yourself with support. Surround yourself with therapy,” Lisa urges, confiding one of the first things her daughter’s doctor directed her to do was seek couples therapy to manage the stress, even though there were no existing issues in her marriage. Her younger son also attended classes for kids with siblings with mental illnesses. “Self-care is extremely important and hard to do,” she says. “Parents need to figure out a way to reenergize both physically and mentally. Otherwise, you will crash and burn.”
Lisa advises thoroughly evaluating available resources. Baker agrees, recommending parents of young children look into Early Intervention Services (see Resources box), which is available for free to any eligible child from birth to age 3. “You can get developmental health, speech and language [therapy], occupational therapy, physical therapy and a wide range of services,” she says.
Baker also reiterates the benefit of partnering with your school to share information, access resources and develop strategies to best support your child and family. And when there are greater forces at work, they can refer you to outside sources while everyone remains on the same page. “We really want it to be a partnership between home and school to get the best results,” Baker explains.
Potter notes many options exist for getting help. It doesn’t always have to start with a visit to a mental health clinician. “It can start with the schools. It can start with the pediatrician,” she says. “It is really more about a team approach to help parents be thoughtful about what their child’s needs are.”
She admits it can be difficult navigating the mental health field, whether choosing a psychiatrist, psychologist, social worker or other licensed mental health clinician, all of whom have very different educational backgrounds, expertise and approaches to treatment. “What we do know is the relationship matters,” says Potter. “Trust and empathy are critical for an effective counseling relationship.”
Lisa, who has experienced the personal and emotional journey firsthand, is best able to strip away the many complex layers to get to the very core of what it means to support a troubled child. “We wanted Sandra to know mental illness doesn’t define her,” says Lisa. “[Children] need to know how much you love them and understand them. And when you don’t understand, you will ask.” Clearly that message has gotten through to Sandra, who explains, “It’s knowing that no matter what I do, [my mom] will always love me. And that she will never judge me for it.”
For Signs of Trouble, read the next page! &pagebreaking&
For help identifying a troubled child, here are some common red flags for parents to look out for:
• Irritability, anger, low frustration tolerance with limited coping skills (for example, quick to have a big reaction to something that might not be that big of a deal).
• Mood changes – seeming quiet and withdrawn or overly excited and unable to slow down.
• Sleeping too much or too little.
• Not interested in doing things that historically have been enjoyable.
• Poor self-esteem, over-apologizing, seeking constant reassurance, comparing self to others.
• Unmotivated, frequently fatigued.
• Eating too much (“comfort eating”) or too little (due to low appetite or concerns about body image or weight gain).
• Talking about wanting to hurt oneself, wanting to escape, going to sleep and not waking up.
• Talking about wanting to hurt others. Intense jealousy or anger directed toward others.
• Isolating and wanting to be left alone despite friends and family reaching out. Not interested in connecting or engaging in relationships.
• Difficulty with empathy and compassion (particularly for older kids).
• Self-harm behaviors. Wearing long-sleeve shirts and/or pants in warm weather or lots of bracelets on wrists to cover up cuts.
Breaking rules or the law without much thought of who it impacts or the consequences.
• Change in school performance (grades dropping, acting out in class or skipping school).
• Not taking care of activities of daily living (not showering, grooming or getting dressed).
• Many physical complaints (for example, frequent headaches or stomachaches that interfere with one’s ability or willingness to participate in activities).
Remaining in an unhealthy relationship where one is taken advantage of by others, sexual promiscuity, participating in risky behaviors (such as abusing drugs or drinking alcohol).
• A change in peer group.
While some of these symptoms may be stronger indicators than others, it is important to note it is necessary to look at all of these in a broader context, as any single one doesn’t necessarily indicate a child is troubled.