Behaviorial and mental health disorders in children
Equipping parents with resources and skills to keep their children healthy
Helping children deal with mental health and anxiety issues can be challenging for the entire family. Parenting New Hampshire reached out to a trio of professionals to learn how to spot these challenges and how to best deal with them.
Dr. Susan McLaughlin-Beltz, MA, PhD, CCTP; President/Neuropsychologist at the Neurodevelopmental Institute of New Hampshire, in Manchester.
Carrie Chiasson, PsyD – Licensed Clinical Psychologist, Portsmouth Neuropsychology Center.
Sandra Norton, LICSW, Director of Adolescent and Family Clinical Services at the Center for Life Management, in Derry.
What are some common signs of anxiety or mental health issues in children?
McLaughlin-Beltz: “Common signs of anxiety include restlessness, being easily fatigued, difficulty concentrating, irritability, low frustration tolerance, difficulty maintaining composure in highly active environments, sleep disturbances, physical ailments, difficulty separating from parent, aggressiveness, chewing on clothing or picking at skin, and crying. Children with other mental health issues may also exhibit some of these symptoms in different combinations.”
Chiasson: “While every child and adolescent will likely present slightly differently, there are some common signs of anxiety, stress, or budding mental health challenges. For instance, our bodies experience physical signs which include nausea and stomach pain, headaches or migraines, trembling, shortness of breath, or muscle tension. Children and teens also experience cognitive signs such as worrying, ruminating, dwelling, pessimism, and focusing on insecurities or negative outcomes. Finally, there are behavioral signs of stress which can include displays of clinginess, crying, irritability, avoidance, changes in sleep or appetite, reassurance-seeking, anger outbursts, and difficulty concentrating. It can be helpful to be aware of changes, meaning, if your child has always been a poor sleeper, that is not likely a sign of anything concerning, but if your child begins having difficulty falling or staying asleep when she usually is an excellent sleeper, it may be a signal that something is off.”
Norton: “Anxiety disorders are often characterized by persistent, irrational, and overwhelming fear that interfere with daily activities. Symptoms vary but can include irritability, sleeplessness, jitteriness or physical symptoms such as headaches and stomachaches. Other possible symptoms are:
- Physical Symptoms
- Change in appetite, eating more or less
- Headaches, Stomachaches
- Sleep disturbance, trouble falling asleep and or waking during the night
- Emotional and behavioral symptoms
- Having worries
- Not able to relax
- Having new fears or recurring fears such as being afraid of the dark, fear of being alone, fear of strangers, not wanting to sleep alone.
- Being clingy, not wanting to be away from a parent.
- Child may ask a lot of reassuring questions.
- Child may have increased anger, aggressive behavior and/or crying
- Child unable to control emotions
- Regression to behaviors of an earlier developmental stage, such as baby talk.
- Refusing to participate in activities like school or sports.”
What type of counseling is available for my child and what is involved?
McLaughlin-Beltz: “NINH offers a variety of mental health services to people of all ages, including young children. For children, we utilize evidence based approaches that include Cognitive Behavioral Therapy, Play Therapy, Neurofeedback, Trust-based Relational Intervention, and the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems. Our offices in Manchester and Berlin also offer neuropsychological evaluations to explore the basis for the mental health challenge, as well as assist with treatment planning. Finally, NINH also offers home-based therapy and case management services for families requiring more supports.”
Chiasson: “One of the most effective types of therapy for individuals with anxiety is cognitive behavioral therapy (CBT). It includes cognitive methods such as identifying maladaptive or unhelpful thinking styles and learning to modify them, as well as behavioral strategies that includes exposure with response prevention (ERP). ERP involves making and following a systematic plan with your therapist to face your fears, sticking them out long enough to experience relief. Counseling often also includes learning and practicing a range of coping skills as well as teaching parents/caregivers how to respond appropriately to anxiety. Coping skills that I teach often come from other off-shoots of CBT such as Dialectical Behavior Therapy and Acceptance and Commitment Therapy in addition to Solution-Focused Therapy. Treatment often begins on a weekly or bi-weekly basis and clients and families are usually responsible for engaging in some sort of practice between sessions to improve progress.”
Norton: “At the Center for Life Management our medical providers, clinicians, case managers and community outreach staff are skilled and experienced at working with children as early as pre-school age through adolescence. We provide the following treatment options:
Individual Therapy: Our initial goal starts with building trust with each child and teen so that we can communicate in a safe setting and form a healing partnership. Through this partnership, we create a relationship where it is acceptable to listen, share, challenge emotions and experience difficult emotions and to attempt new, healthier ways of living.
Family Therapy: Family therapy offers each family member a place to work together and gain understanding of each person's role in the family and improve communication.
Treatments specific to anxiety include:
- Cognitive Behavioral Techniques
- Changing negative thinking and self-talk
- Coping skills
- Behavior Modification Techniques
- Identify and modify behaviors
- Organization and time management
- Stress Reduction Techniques
- Thought stopping
- Worry control
- Relaxation Techniques
- Guided Imagery
- Progressive muscle relaxation
What’s the best way to discuss my child’s anxiety or mental health issues with him/her?
McLaughlin-Beltz: “It's best to have some individual time with your child in a setting he/she feels safe and comfortable. Discuss some things that can make many people and even animals get anxious such as thunder storms, talking in front of people, making new friends, getting called on in class, or going new places. Many times making up stories where the main character has to face a challenge and then talking about different ways to solve their problems can help children feel more comfortable sharing their fears. Also, ensuring the child that you are there to help them solve any problems that they feel unable to solve.”
Chiasson: “The tone of the conversation matters. I would urge parents to be matter-of-fact and clear without painting a picture of how horrible it might be to have anxiety or some other mental health challenge. It can also be helpful to normalize whatever it is you see going on in your child, as there are MANY other children and teens experiencing the same thing or at least something incredibly similar. Picking your timing can also be crucial. If you have a stressed teenager, right when she is about to start a project due the next day after just having gotten home from soccer practice is probably not the best time. Striking when the iron is cold will likely lead to better results than when emotions are already high.”
Norton: “When your child is struggling with a mental health issue it can be stressful for the entire family. It is helpful to build a support network of relatives and friends. It is important to listen to your child’s feelings, stay calm, praise even small accomplishments and modify expectations during stressful times. These are others ideas that may be helpful:
- Keep a calm, structured atmosphere at home. Daily routines and plenty of quiet time are helpful.
- Provide steps the child can take to relax
- Help the child devise and practice problem solving skills
- Encourage positive self-talk
- Reward desired behavior
- Help the child analyze anxiety provoking thoughts and identify anxiety reducing thoughts
- Help the child learn to recognize and name feelings. Show acceptance of negative feelings, but not negative behaviors.
- Talking it out really does help prevent a child from "acting out" negative emotions. If a child can't talk to the parent about difficulties, find someone with whom he can talk. Even short-term counseling can be beneficial to a child experiencing life stress.
- Provide creative outlets for the child – basic art supplies, books, Lego, whatever the child enjoys.
- Make Home a Safe Haven.
- Bring more laughter and pleasurable activities into the family's daily life.
- Emphasize family rituals and traditions.
- Hug your child often, and tell your child you love him every day.”
At what point in a child’s development does anxiety usually first occur?
McLaughlin-Beltz: “Anxiety can present itself at very young ages and can exist throughout one's lifetime. Children first experience stranger anxiety usually at the age of 10 months. Although this is a natural developmental occurrence, excessive anxiety at any stage in development puts one at risk for physical health problems, especially gastric issues and headaches.”
Chiasson: “There are not exact points in a child’s development where anxiety first occurs, as it can vary by the type of anxiety. I have worked with elementary school aged-children with anxiety whose parents report that their child has “always been anxious,” even as a toddler. Whereas, other children did not develop anxiety until they were teenagers. There are some differences in when specific anxiety disorders are typically diagnosed. For instance, separation anxiety disorder, is most common in children ages seven to nine and not diagnosed prior to age 3, as separation anxiety is fairly common between 18 months and 3 years. Generalized Anxiety Disorder is diagnosed across the lifespan though it can be present in childhood. Panic disorder is frequently not diagnosed until after age 20, though some children do experience panic disorder and panic-like symptoms. On average, the onset of social anxiety disorder is during adolescence, though some teens report having been shy as a child. Selective mutism is most commonly diagnosed around age 5 or when a child enters school. Specific phobias can arise in childhood though most seem to arise during adolescence or young-adulthood. Finally, most children with obsessive-compulsive disorder are diagnosed around age 10, though it can come much earlier (especially for boys).”
Should I share my child’s anxiety or mental health diagnosis with his/her school?
McLaughlin-Beltz: “Definitely, staff at school are there to help your child grow and develop the problem solving skills necessary to become successful adults. Some children need more support managing daily stressors and developing adaptive coping strategies.”
Chiasson: “It is certainly not a requirement to share your child’s anxiety or mental health diagnosis with the school, but I usually recommend it. I understand parents can be concerned about their child being labeled in a negative manner or the stigma associated with a diagnosis. However, the benefits outweigh the anticipated costs. If the school is alerted to a child’s areas of weaknesses and strengths, the school and family together can come up with an action plan for how to help the child learn and grow most effectively. With a diagnosis can often come services and accommodations through formal documents called a 504 Plan or an Individualized Education Plan. If the school is kept in the dark, it will likely make it more challenging for your child to succeed and reach her potential.”
Norton: “It can be beneficial to share your child’s mental health diagnosis with the school in order to help you and the teacher work together to support your child. The schools awareness of the situation will help the teacher better understand and respond to your child’s needs and the teacher can respond appropriately to common situations such as being late to school or difficulty completing tasks.”
What’s the best way to de-stress my child before school? At home?
McLaughlin-Beltz: “Movement and sensory experiences help de-stress children. Whether in school or at home, children need areas that they feel safe to express their feelings. Participating in proprioceptive and vestibular activities such as jumping on a trampoline, swinging, sandplay, rocking, listening to music, drawing, yoga exercises, or wrapping themselves in a blanket are good calming techniques. Some children need a place with no sensory input when transitioning home, so providing the child with a tent/fort to crawl into for 10-15 minutes prior to expecting homework or chores to be completed can be helpful. It is also important for the child to be well hydrated and maintain good sugar levels by eating snacks with protein.”
Chiasson: “If your child is stressed before school, start with providing empathy. Try to show understanding about where your child is coming from before doing anything about solving the issue. Other de-stressing ideas include helping breaking down overwhelming tasks into smaller ones, prioritizing, disclosing and normalizing your own mistakes, and lowering the stakes to reduce pressure. Help put things in perspective while also teaching the importance of focusing on learning and challenging oneself instead of focusing on a grade. If your child is worried about social stress at school, normalize insecurity and acknowledge risk taking.
“General stress reduction strategies to use at home include building your “stress insulators.” Some ways to do this include taking the time to do little experiments with the goal of increasing positive activities, increasing relaxation, and improving sleeping and eating habits. For instance, implement a family shopping trip to the store to pick out new foods, an early read-in-bed party, find even brief moments to do 1-on-1 time with each child, and let your child teach you something. Additionally, showing your child how you take care of yourself will not only show them ways to do so but it also demonstrates the importance of self-care.”