To Medicate or Not

Your child is struggling with behavioral or mood problems and non-pharmaceutical interventions aren’t enough. Your pediatrician or therapist suggests a psychiatric consultation. Natural concerns arise, like whether your child will become addicted to this medicine? Can I trust the research or is the pharmaceutical industry manipulating data? Will there be any long-term adverse effects? Can my child do more to play their part in getting better—maybe just a little more exercise, meditation, or more therapy. Will the medicine do more harm or good? Is this an off-label use of a medicine without supporting data? Is your adversity to psychotropic medicine trumping your child’s self-determination? At what age should you empower your child to make the decision of what to put in their body?   Will the decision affect your relationship with your child?

In making this decision, being well informed and listening and knowing your child is crucial. Examine the global impact of your child’s symptoms on their functioning and quality of life. How does the mental health problem affect their school work, their social life, their self-esteem, their ability to reach their long-term goals? Is the increased risk of suicidal ideation that several anti-depressants are associated with outweighing potential benefit?

Potential Issues

One issue I see in my practice relates to compliance. Is the child willing to take the medicine daily and have a parent who will remind and facilitate the process? Suddenly stopping medicine can be very painful and worsen mental health problems. Sometimes children are able to convince adults they do not need medicine due to their caretakers’ own ambivalence about it. Due to the slow acting nature of common psychotropic medicine, children and parents often stop before therapeutic benefits. This can leave children with the feeling that they are helpless and incurable.

Stoppage often occurs because lack of results, but this is not to say a different medicine or dosage will not work, but often patience runs thin.  Another issue I have run into is weight gain as a side effect, leading the child to have insecurities around body image.

The stigma and discrimination about people with mental health problems can result in medication refusal. Children frequently hear the terms “she is so bipolar;” “did she forget to take her meds today?” and the loose use of the word crazy.

Lastly, the prescribing physician’s bedside manner makes a big difference in symptom improvement and medication compliance. Does your child feel comfortable talking to the doctor? Do they feel understood and valued? Does the doctor respect self-determination or are they preachy and patriarchal?

 

Source: Cheung, A., Emslie, G. J., & Maynes, T. L. (2004). Efficacy and Safety of Antidepressants in Youth Depression. The Canadian Child and Adolescent Psychiatry Review13(4), 98–104.

Meeting Your Child “Where They Are”

One of the guiding principles of social work is to meet the client “where they are.” For example, when I worked with a child who was into music and the arts, I didn’t suggest parents enroll the child in a summer basketball camp. For the child who comes into my office with a somber face, I do not greet them with a chipper pat on the back “it’s great to see you.” This all seems like common sense, but sometimes ignoring a child’s lead can be detrimental. Recognizing and embracing where the child is at socially, educationally, likes, dislikes, mood at the moment, strengths, and interests helps your child feel understood and valued, which is key to having a strong attachment with them. This greatly benefits their mental health and behavior.

As parents, we often offload our own values, preferences, and traumas on our children and fail to meet their needs and interest first. Still, knowing how much to push and how much to step back is a hard. Do we be “tiger moms,” teaching grit and perseverance or do you listen to the child when they say they want to step back or quit something. Do you enroll in them in math enrichment classes to give them a step head or let them learn with the rest?

A classic example was the father who wanted to become a professional jazz musician but never made it for a variety of reasons. The father introduced music to his son who excelled.  The child ended up having great talent but not the desire the father had, but the father insisted. Eventually, the child gave up music all together, creating distance in their relationship and the son most likely experienced feelings of shame and guilt.

I was pushed into piano lessons and competitions from the age 5-10. I learned discipline and hard work, practicing nightly with my mom and a piano teacher weekly. This may have helped my development, but it certainly was not my interest. I liked the praises when I played songs and my mom’s approval, though I also remember entering competitions and never winning. I remember getting an award for “hardest working” student.  What effect did this level of competition and scrutiny have on me at such an early age? Finally at age 10, I mustered up the courage after months of deliberation and feelings of guilt to quit.

Later in life, my parents exactly met me where I was when they tapped into my interest in Spanish and travel. At 17, they found a program in Costa Rica where I studied, traveled, and lived with a family for a summer. I had a great time, and the trip greatly influenced the trajectory of my life for the positive.

In another instance, one of my clients hides from her mom when she has depressive symptoms.  Their relationship has improved greatly during therapy, with mom realizing her daughter will not flat out tell her when she is not well. Mom now meets her daughter where she is at by being more observant of her body language and behavior and asking about her mood when red flags (e.g. staying in her room a lot, sleeping too much) arise. When mom expresses her concern non-judgmentally, the daughter speaks candidly.

I work with a fourteen old who wanted a Nintendo Switch, but his parents could not afford it. His mom always encouraged him to work, herself a hard-working immigrant service worker. Here his mom tapped into his interest in getting a console and having his own money. We helped him enroll in a summer job program where he is excelling and learning a lot of life skills. He is also ready to get his first paycheck and spend it on the Switch.

Another memory that sticks happened several years back seeing what I thought was a toddler boy playing with my son at a playground. Biologically, the child was a girl, the father said, but liked dressing as a boy, having a boy’s haircut, and playing with boys. The father explained to me how they were following his daughter’s lead. I thought how much of a relief this must have been for his daughter who can be who she really is.

 

Lying: What’s it about

 

Everybody lies sometimes. It’s part of life, and sometimes it’s even appropriate for your child to lie. If a school classmate asks if they like their new shoes, saying yes may be the appropriate response, even if they don’t.

Most of the time, however, young people lie to cope with difficult feelings related to embarrassment, shame, low self-esteem, to avoid an unfavorable consequence from an adult, or to get out of doing something. Lying is a behavior that serves a purpose, however, chronic lying should be seen as an indication your child is having a hard time at something.

In my practice, I observe children lying particularly surrounding their academics. They often tell parents they have done homework or did well on an assignment when the opposite is true. The lying serves as a temporary way to deal with difficult feelings and/or to prevent negative attention from parents or classmates. Chronic lying of this nature could indicate a variety struggles but an obvious one is that your child needs additional academic support, may have an unidentified learning disability, or is enduring some type of emotional stress that is making it hard to concentrate or get motivated.

Other types of lying I observe relates to a child’s desire to fit in socially. The lie is often about having material possessions, experiences, or relationships they may fantasize—so much so, the fantasy may seem like reality to them. The lies frequently relate to embellishments or exaggerations of real life stories either to provide greater entertainment value or to make the child more interesting, heroic, or important. Sometimes children lie because they have not developed or are not secure in their social skills.

Inevitably, the lie comes back to the bite the young person, eroding trust with parents and causes more social difficulties, perpetuating the lying cycle.

Solutions

Parents can help their child become more truthful by understanding their fears and concerns without judgment. Parents may be putting too much pressure or have unrealistic expectations in which the child feels trapped and feels the need to lie. Social lies typically relates to poor self-esteem which could be a result of a number of factors. Improving the young person’s ability to value and accept themself while also identifying feelings of hurt and loss that lead them to lie typically ameliorates things. If the young person has poor social skills, this is something that can be learned.

Life Transitions: College

Life Transitions: College

Your teenager has worked hard throughout high school and finally been accepted to college. There are cheers but deep down probably a lot of fears too—- the world your teenager knows  (home, sense of belonging, community, childhood friends) will shortly become turned upside down. College is a place of growth, adventure, independence, and learning—many say the best period of their life. At the same time, the stresses from this transition can be a period where mental health and substance abuse problems emerge.

Mental Health/Substance Abuse Issues

Worry and stress are typical during this transition—through adversity, young people learn and grow, however, sometimes overwhelming stress leads to mental health problems. If there is a history of mental illness or substance abuse in your teenager’s family, the risks are even higher. Some common mental health issues that arise during college are eating disorders, substance abuse disorders, depression, anxiety; less common is bipolar disorder, schizophrenia, and personality disorders.

Here is a list of stressors and behaviors to be mindful of:

Social Stressors

Your child has to rebuild their social network. This is not always the easiest thing to do. Pressures to fit in can be high. Doubts about their uniqueness, self-worth, and personality might arise. Rejections and losses can hit particularly hard without having their supports from home around them. Maybe your child used to have a best friend to help with disappointments who is no longer as available.

Loneliness

If your child is spending most of their time in their dormitory room alone or if they do not return messages or pick up the phone (for lack of a good reason), this is cause for concern. Loneliness is associated with many physical and mental health problems, including depression.

Overworked

Striking a balance between academics, play, sleep, eat, work, and social life can be tough. Your child may not be able to get the same grades they did in high school, which can lead to feelings of frustration and thoughts they are a failure. If they always self-identified as “smart,” a drop in grades, although normal, can feel like a tremendous loss. Further, your child may realize they need to work much harder to obtain the grades they did in high school, ignoring their core needs, which makes them vulnerable to physical and mental health problems.

Sleep

With all of these exciting changes, young people may put sleep as secondary. Too much or little sleep could be an indicator or contributor to a mental health problem. Ask how much your child is sleeping. Do they have trouble falling asleep? Do they wake up during the night? Do they have nightmares? Are they sleeping too much? Do they feel like they do not need to sleep?

Trauma/Sexual Assault

One out of six females and one out of thirty three males become victims of an attempted or completed rape during their lifetime (RAINN, 2018). Often, the assault is something they conceal out of fear or shame, most of the time they know the perpetrator. The symptoms following a sexual assault can vary greatly, but some warning signs would be a drop in grades/school attendance, isolation, depressive symptoms, increased aggression and irritability, being “in the clouds” a lot, nightmares, increased sexual promiscuity, sleep problems, avoiding certain people or places that are reminders of the trauma, and anxiety symptoms.

Substance Abuse Problems

College is frequently a time when a young person begins to experiment with alcohol and drugs. If there is a family history of substance abuse problems or if your child has a preexisting mental health problem, they are more vulnerable to substance abuse. Behavior that could indicate a substance abuse problem could be a significant drop in grades and attendance, doing things the young person regrets later (getting a DUI, having unprotected sex), failing to meet other obligations, being in a social group that relies on substances to have a good time. If your child does not have healthy ways of coping with stress, they become more vulnerable to substance abuse.

What can be done?

The earlier your child recognizes and seeks help during their struggles, the better the outcome. Most universities have counseling services they can turn to or can provide referrals to outside providers. A therapist can help guide and support your child during their struggles. A therapist can also provide referrals to other providers, if necessary.

Parents can keep an open line of communication, be non-judgmental, refrain from comparisons, focus on the present issue, use good listening skills, share experiences of their own struggles and help guide their child to appropriate resources, all the while respecting their self-determination. (e.g. if a child turns down your offer to contact student behavioral health, respect that.)

Too much parental involvement can reinforce a child’s feelings of failure and inadequacy (e.g., I can never do things right on my own! My parents will always think of me as a child!). If your child studies in another part of the country, offer to visit them. They may say no. Let your child decide when and for how long you stay. Offer your child to come home during academic breaks. If your child is seeing a counselor or therapist, see if you can be involved in some sessions by phone or by person. Develop a line of communication with your child’s friends if they approve.

Ultimately, your child is an adult and has to be treated as such. Top down efforts to control and fix situation, typically do not turn out well. Support your child in listening and finding out what’s most helpful in overcoming their challenges.

What’s going on with my child’s behavior?

If you are on edge and can’t focus at work because you are waiting for the call from school or if you are worried your child is coming home sad or angry, you know what’s like to have a child with a behavioral or adjustment problem. School behavior problems develop for various reasons, but typically they are related to some underlying mental health problem or stresses in the home and/or social environment that overpower their ability to cope.

 

Common issues:

  1. High levels of conflict in the home due possible separation, economic problems, introduction of new family members, parental addiction, mental or physical health problems.
  2. Having poor social skills, social anxiety, lots of social pressure, low self-esteem or being different due to a disability
  3. Academic underachievement and not receiving the necessary support
  4. ADHD, depression, anxiety, or the effects of trauma
  5. Limited coping skills to express feelings of hurt or anger

What you can do?

Family therapy can help youth deal with changes in the household by giving them the space to be validated and heard by adults. If not understood by their caregivers, youth can do self-sabotaging behavior at school to get “even” or call attention to parents—negative attention can be better than none. Having low self-confidence and poor social skills, can lead to children being excluded and often bullied. This can create the child to take out their feelings of resentment and hurt through acting out. Poor social skills can lead your child to not take risks (e.g. starting a new activity) which can lead to isolation and pain. Academic underachievement can result in a young person giving up and not focusing on their work. With time on their hands, children get bored and often act out. This serves to get attention (negative), frequently as a way of saying they are not well and need help. Individual and group therapy can help with the abovementioned problems as well.

What do the numbers say?

When a teacher says your child is hyperactive, has difficulties paying attention, and misbehaves, professionals can be quick to say the child has ADHD, however, remember 11% of youth have a mood disorder (e.g. depression). 10% of youth have a behavior or conduct disorder (e.g. ADHD); and 8% of youth have an anxiety disorder ( e.g., social anxiety, PTSD). (National Alliance on Mental Illness, 2017). 20% of youth ages 13-18 live with a mental health condition.

Most mental health problems children suffer from mimic a handful of ADHD symptoms.

What’s often lacking?

Healthy coping skills are something all children need to develop to reach normal development and deal with adversity and create resilience. Sometimes youth use hitting or verbal disrespect to deal with feelings of frustration. Youth often cope with feeling of isolation and boredom by becoming addicted to electronics. Teenagers can turn to substances to help alleviate difficult feelings. Sometimes children are hard on themselves in order to motivate academic or social success—this has the exact opposite effect, typically. Having healthy thoughts about oneself is fundamental to a good self-esteem and normal social/emotional growth.