Helping your Child Regulate Emotions
Your Child's Emotional Health
"The good thing is that there's a lot more awareness and understanding of mental illnesses in children today," says Courtney Ferrell, PhD, a licensed clinical psychologist who specializes in children's mental health at the National Institute of Mental Health. "In the past, people used to see a child acting up and think, 'Oh, he's not being disciplined,' but now they realize it could potentially be ADHD [attention deficit hyperactivity disorder]."
But the line between "just a stage" and mental illness is often hard to draw. "All kids go through periods when they're anxious or afraid or sad," says Joan Evelyn Kinlan, MD, a child and adolescent psychiatrist in private practice in Washington, DC. "The key is when those emotions become so severe that they interfere with regular daily activities."
Diagnosing and treating mental illness in kids can certainly be a stressful process; an important step is finding a good clinical child psychologist and/or psychiatrist who can diagnose and give your child talk and behavioral therapy. (Find a psychiatrist at the American Academy of Child & Adolescent Psychiatry; aacap.org) What everyone also needs is support—from parents who are going through the same thing and the growing community of teachers and doctors who are better informed. Use this guide as a starting point so that if you suspect your child is struggling, you can get the right help.
These are the most prevalent mental health issues in kids, but they're not the most commonly diagnosed, says Dr. Ferrell. "Anxiety disorders such as obsessive-compulsive disorder, panic disorder and phobias are known as the 'quiet disorders.' These children aren't disruptive, so they don't usually stand out," she says. "The behavior has to happen consistently and interfere with daily functioning in order to receive a diagnosis." Other things that could cause anxiety, such as being bullied in school, also need to be ruled out, says Dr. Kinlan.
Most kids are treated with behavioral therapy, and medication can help with severe cases. "Parents play a big part because they can really help the child learn how to handle the anxiety-provoking situations," she says.
Generalized Anxiety Disorder
what to look for"This is the child who worries excessively, and about things that kids normally don't stress over—like the family finances," says Dr. Ferrell.
what helpsGuiding the child to think about his fears in a different way. "The therapist teaches the child how to recognize catastrophic thinking and how to better manage it," adds Dr. Ferrell.
Separation Anxiety Disorder
what to look for"A child who always has a hard time being away from a parent and it interferes with her daily life—she doesn't want to go to school, or refuses to go to sleep without a parent in the room or close by," says Dr. Ferrell. Stranger anxiety is normal and peaks at about 18 months; the red flags are if the child doesn't seem to grow out of it and she persistently worries about losing a parent.
what helpsBuilding the child's confidence in her ability to separate: gradually putting her in situations away from parents, and providing lots of positive reinforcement when she's able to do it.
what to look forKids who are extremely distressed in social situations or avoid them altogether. (A child who's just shy, on the other hand, will gradually start to open up once he's been in the situation—such as a party or a class—a few times.) "Social anxiety peaks in preadolescence, but often symptoms first show up in preschool in kids who are slower to engage with other people," says Dr. Ferrell.
what helpsRole playing is a big part of therapy. "A parent might help the child practice ways to introduce himself to someone new on the playground," says Dr. Kinlan. "Start slowly and make it fun."
what to look forA fear that stops the child from doing things she'd normally enjoy. "Someone with a bee phobia, for example, may be so afraid of them that she refuses to go outside for recess," says Dr. Ferrell. Physiological symptoms such as sweating and trembling can happen, too, even in reaction to a picture.
what helpsAs with social phobia, treatment involves gradually exposing a child to the source of her fear. "If she can't even look at a picture of a bee, we start by having her look at the picture for just a few minutes, then go from there," says Dr. Ferrell.
Obsessive Comulsive Disorder
what to look forRepetitive, strictly methodical behavior, like washing hands several times, having to brush teeth in a certain way or needing to "even things up." "For example, if a child steps on something with his right foot, he then has to step on it with his left," explains Dr. Kinlan. Another big sign: When you ask the child to stop the behavior or hurry up, he can't do it. "The obsessive part is time-consuming, disastrous thoughts; the compulsive part is doing something to get rid of those thoughts," says Dr. Ferrell.
what helpsTreatment is similar to that of the other anxiety disorders: With the help of a therapist, the child is exposed to the source of his anxiety, prevented from doing the ritual and works through the feelings surrounding it.
what to lookfor A child who's hyper, impulsive and unable to focus in more than one area of her life (say, at home and at school), and these symptoms last for more than 6 months, says Dr. Kinlan. If a child is acting up in the classroom but is fine at home, she may have a learning disability. "Girls with ADHD can sometimes go undiagnosed because they're often not hyperactive but daydreaming in the back of the room," says Dr. Kinlan.
what helpsA combination of medication and what therapists call psychosocial intervention, which gives the child practical coping strategies. For instance, homework can be difficult for kids with ADHD, says Dr. Ferrell. Parents can help by breaking up the work into smaller 20- or 30-minute chunks, putting each assignment into a separate folder and giving lots of positive reinforcement for getting it done.
what to look forSadness that lasts for an extended period of time—a few weeks or more—and causes the child to lose interest in his usual activities or hobbies. "There's also a hint of irritability that you typically don't see as much in depressed adults," says Dr. Ferrell. "If the child is usually 'the good kid,' and now he's constantly ornery and disrespectful, that's a big warning."
what helpsPsychiatrists often prescribe antidepressants, but parents can also help by slowly getting the child back into activities he enjoys.
"Adults who are depressed tend to shut down, and kids do the same," says Dr. Ferrell. "So it's about putting him in situations that spark positive feelings and help him remember what he liked to do." You might invite a good friend he hasn't seen in a while to dinner (start with a small, structured time period so that it's not so overwhelming).
It's crucial to treat depression—untreated kids are at risk for suicide, especially if they're also using drugs or alcohol, points out Dr. Kinlan.
Video: The Importance of Raising an Emotionally Intelligent Child: Erika Brodnock at TEDxHackney
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