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“When Something’s Wrong; Ideas For Families”

by Staff Writers at Healthy Minds Canada, formerly CPRF

CHAPTER EXCERPT: “When Something’s Wrong: Ideas for Parents”

Managing Problem Behaviour in Children

“Research shows that one in five children have a mental health problem and that this number may be even higher due to under- reporting. Many children exhibit difficulties both at home and in school, showing problems with mood, behaviour, or thinking. It’s important to highlight that some children with these difficulties may have a brain dysfunction, and/or a language or learning disability for which effective treatment is available. Early identification and treatment is vitally important, since rapid attention can dramatically improve outcomes and reduce the stress levels for all people involved in the situation.

The onset of mental health difficulties can vary with the condition, and they are often hard to diagnose. For example, clinical depression has been seen in children under the age of five. It is not uncommon for some children to be diagnosed first with one condition and then another condition, as symptoms more clearly emerge. Sometimes two or more conditions exist together. Again, the expertise of experienced health practitioners is essential for proper assessment and treatment.

Don’t be afraid to get a second or third opinion. The more you can find out, the more information you will have to help your child. And remember, don’t forget to seek support from family and friends for yourself, as you embark on this journey of seeking answers and appropriate treatment for your child. There are often no “quick fixes.”

Of course, children may also exhibit normal but problematic behaviours temporarily, during stressful periods such as divorce, the death/illness of a loved one, or moving to a new city or school. In addition, difficulties may arise from problems with schoolwork or social interactions with others. These behaviours may not necessarily be an indication of a disorder. As a parent, you may be able to deal with these problems on your own, but you may also want to seek assistance from a health practitioner to make sure that they do not reflect more severe conditions.

In summary, then, many behaviours that appear in children and adolescents may be of short duration and quite normal for their age and stage of development, while others of longer duration and intensity need professional intervention.

Some children with mental health problems may abuse substances, such as drugs or alcohol (i.e., self- medication) in order to cope. Substance abuse must be taken seriously, but any underlying cause(s) need to be addressed as well. For example, if a child is abusing drugs to calm anxiety, he/she may require treatment (e.g., therapy or prescribed medication) for an anxiety disorder. If you are concerned about substance abuse, discuss this with your family doctor or mental health professional. A large amount of information is available on substance abuse and addictions, but for a couple of places to start, try the Canadian Centre on Substance Abuse (CCSA) at www.ccsa.ca or the Centre for Addiction and Mental Health at www.camh.net

CHAPTER EXCERPT: ANXIETY

What is the difference between “normal” anxiety or sensitivity and an anxiety disorder?

Anxiety is a normal reaction to many stressful or threatening situations or to uncertainties in life. It’s normal for a child to feel anxious about his/her first day of school, or for an adolescent to feel anxious about a major exam or first date. And, it’s also normal for a parent to feel anxious for their children, as they go through these experiences. Normal anxiety is a good thing, because it prepares the body to handle a situation that may be more stressful or may require more concentration than usual.

An anxiety disorder is characterized by having feelings of anxiety that are so severe they interfere significantly with daily living (e.g., with school, home, and relationships). Children with anxiety disorders worry all the time. Then they often worry about how much they worry, even when there is no reason to worry.
Anxiety disorders arise from a complex mix of genetic and environmental factors. Anxiety runs in families, so if a parent or grandparent is very anxious, the child may be also. As a group, these disorders are the most common mental disorders in youth and affect up to 10% of children and adolescents. Anxiety disorders can begin at any time, but they commonly appear at early school age. They can be made worse by common stressors.

How do I distinguish between “normal” anxiety and an anxiety disorder?

As a parent, observe your child’s behaviour:
• Frequency – How often does your child become anxious? When does anxiety occur?
• Intensity – How severe is the anxiety, and how difficult is it to manage?
• Duration – How long does the anxiety last?

Ask yourself:
• “Is this problem interfering with my child’s life?” If it is, what areas of your child’s life are being affected?
If you notice that there is an increase in the frequency, intensity and/or duration of your child’s symptoms, or that your child’s life is being adversely affected by his/her behaviour, it is a good idea to seek the help of a qualified health practitioner for a proper diagnosis (see Working with Your Health Practitioner in this handbook).

There are different types of anxiety disorders. Six common ones, listed in alphabetical order, include:
1. General Anxiety Disorder (GAD)
2. Obsessive Compulsive Disorder (OCD)
3. Panic Disorder (PD)
4. Post-traumatic Stress Disorder
5. Separation Anxiety Disorder
6. Social Anxiety Disorder

Each of the above anxiety disorders will be described in the following pages. At the end of this section, treatment strategies are discussed and additional resources are listed.

SAMPLE DISORDER OVERVIEW: General Anxiety Disorder (GAD)

General Anxiety Disorder affects about three to five per cent of youth and is often found together with other anxiety disorders (e.g., social anxiety disorder) or depression. GAD often begins in early adolescence and occurs more frequently in introverted children – those with excessive shyness and/or a tendency to show few, if any, emotional reactions. While most young people do worry about things, young people with GAD worry constantly about everyday activities. It is the extreme, severe nature of their worries that interferes with their lives. They worry about what’s going to happen next and that they won’t be able to handle it.
All youth who are anxious need reassurance and acknowledgement of the reality of their concerns. However, youth with GAD require reassurance frequently, the reassurance usually only provides temporary relief, and they may require professional help.

Behaviour Characteristics

Constant worry or tension
Extreme need for reassurance
Physical symptoms (e.g., headaches, stomach aches)
Avoidance of stressful situations (e.g., tests/exams)
Clingy behaviour in young children

Coping Strategies
• Early intervention is key to managing the disorder and preventing further disability.
• Get help from a qualified health practitioner, including a professional diagnosis. An accurate diagnosis will help to prevent any incorrect “labeling” of your child by others.
• Obtain a second opinion if necessary.
• Find a support group for both you and your child, and exchange strategies.
• Learn all you can about the disorder and educate your family and your child about the disorder.
• Don’t compare your child to siblings or other children. Treat your child as a unique individual.
• Re-evaluate and modify strategies as necessary. Work closely with your child’s teacher, doctor, and school team.
• See Managing Problem Behaviour in Children, Working with Your Health Practitioner, and Resources in this handbook for more information.
• Reassurance alone may not be sufficient to resolve an anxiety condition. Additional strategies will likely need to be used.

• Establish realistic expectations and interactions (e.g., role-play the meeting of new people or taking a test with your child).
• To generate discussion, ask your child “What’s the worst that could happen?” and “Then what would you do?” Offer practical solutions.
• Encourage lots of physical exercise to reduce anxiety, nutritious eating, and regular sleeping patterns (e.g., going to bed at the same time each night).
• Create (with your child) a short “Things To Do Today” sheet. This activity gives children an overview of what they are capable of doing in a day and reduces the anxiety of working through a long, never-ending list. Prepare them for the fact they may not get everything completed on their list, and congratulate them for what they do accomplish. Confidence builds when items are completed. Start again the next day and encourage them to manage this process on their own over time.
• Do weekly planning (with your child) to assist him/her to organize tasks into small units and prepare for assignments and tests. This activity works best when planning occurs along with your child’s teacher.
• Model calm behaviour yourself and assure your child you will always be there for him/her.
• Create a coping journal with your child. In it, include ideas to help him/her deal with anxiety, step by step. Discuss rewards for each situation in which your child manages to reduce his/her anxiety, and gradually tackle more difficult situations as your child becomes more comfortable.

Here are some examples of ways to reduce anxiety:
– Take five deep breaths.
– Draw pictures that show how he/she is feeling in different situations.
– Count from 50, backwards, or say the months of the year backwards, slowly.
– Visualize a calm place.
– Take time out, away from a situation that creates anxiety (e.g., play in the yard, stop the activity and think of something fun or calming).

Additional Coping Strategies
– Go for a walk with a parent, friend or pet.
– Talk to a parent or friend about fears.
– When child is away from home, call home to talk to someone.
– Take any doctor- prescribed medication, if required.

• Show your child how you cope with stress. Talk out loud in stressful situations about what you’re doing to handle the situation (e.g., you’re late, keys locked in car, you’re lost, problem at work). Express confidence that you’ll cope and solve the problem.
• As a parent, do your best to acknowledge that your child’s fears are real. Don’t diminish his/her concerns. For example, don’t tell your child to stop worrying about a test. Instead, say you understand it’s a tough situation, but you have confidence and know he/she will do his/her best, and that’s all that matters.
• Encourage your child to come to you with any problems or concerns, at any time.
• “Check in” with your child at the end of each day. Debrief and review any significant events.

TREATMENT
Young people with anxiety disorders can be helped by medications and carefully targeted psychotherapy, once the condition is professionally diagnosed. The choice of one or the other, or both, depends on the preference of both the patient (and patient’s family) and doctor, and also on the nature and severity of the condition. If choosing a therapist, find out whether medications will be available if they are needed. Psychiatrists or other physicians can prescribe medications and they often work closely with psychologists, social workers, or counsellors who provide psychotherapy.

Before treatment begins, a careful diagnostic evaluation is necessary to determine whether symptoms are due to an anxiety disorder(s), and if so, which one(s). Not all anxiety disorders are treated in the same way. In addition, any coexisting conditions present in the individual will need to be evaluated. In some cases, conditions such as a substance abuse disorder or depression have such an impact that your doctor may wish to treat these conditions at the same time, or before treating the anxiety disorder itself.

During the assessment phase, it’s important to give your doctor and/or therapist as much information as possible, such as, if your child has been treated previously for an anxiety disorder, if your child was/still is on any form of medication or natural supplements, how long any medication was/has been taken, and if your child has previously been treated with psychotherapy. These days, if one treatment doesn\’t work, the odds are good that another one will, and new medications and treatments are continually being developed through research.

As a parent, your support, participation, and positive outlook are crucial to enable your child to build coping skills. You spend much more time with your child than any therapist, teacher, or doctor. So, don’t underestimate your strengths!”

SAMPLE EXCERPT FROM “WHEN SOMETHING’S WRONG: IDEAS FOR FAMILIES” contributed by HEALTHY MINDS CANADA (now Jack.org)

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