Why Do Parents Contact Children’s Mental Health Services?
Although every situation is unique, there are some commonalities in the problems that parents call about.
You might be worried, for example, about your child’s behaviour: Perhaps he is refusing to do what you ask, and minor issues are escalating into arguments. Perhaps you’re worried about your child or teen’s emotional well-being, because there are signs of ongoing sadness, withdrawal, or anxiety. All of these problems contribute to stress in family relationships – between parent and child, and among siblings – and parents often seek help to reduce conflict in the home.
Parenting isn’t as straightforward as it used to be. The way that you were parented might not be the way you want to parent your own child, for various reasons. Sometimes there are snags when children transition from one developmental stage to another (especially as they enter the teen years) – and the parenting style that worked at one stage might not be effective in the new stage. Parents often contact CMHS with questions about which parenting approach would be most effective for their child.
Sometimes school is the major concern. Perhaps you’re worried about whether your child is coping with all the demands of school – doing what the teacher asks, getting her work done, and getting along with the other children. Perhaps your child’s teachers have complained about her behaviour or learning, even though she seems fine at home.
It’s important to get help for your child or teen if he or she is:
- Constantly refusing to do what parents ask of him or her
- Having frequent outbursts of anger
- Engaging in risky behaviour
- Threatening or hitting others
- Feeling sad for several days at a time
- Injuring himself or herself
- Experiencing frequent mood swings
- Worrying constantly
- Avoiding family and friends
- Losing interest in activities he or she used to enjoy
- Having difficulty sleeping
- Losing his or her appetite
- Lacking motivation and energy
- Drinking a lot or using drugs
- Unable to pay attention and/or unable to sit still for any length of time
- Getting lower marks at school
- Saying unusual things or having unusual thoughts
- Exhibiting unusual body movements
When is a Problem a Problem, and not just a Stage, Quirk, or Normal Up and Down?
Indeed, it is challenging for parents to decide whether their child’s problem is something that he will grow out of in awhile, or whether it could be a mental-health problem that should be assessed by a mental health professional. Parents are not alone in their tendency to find various other reasons to explain their child’s difficulty. Research has found that parents, teachers, and family doctors often miss signs of mental-health problems. Frequently, the child’s problems are “explained away” by referring to circumstances (e.g. being bullied), a characteristic of the child (e.g. he’s a normal active boy), or excessive worrying on the part of the parent.
Many people think that mental health problems in children are rare, when in fact research consistently has found that one out of five children in Ontario experience a mental health problem that is having a significant impact on his or her functioning. Despite this prevalence, the stigma associated with mental health disorders seems to persist. Stigma refers to embarrassment, shame, and fear, all of which get in the way of calling a mental health agency.
A child or teen’s mental health problem begins with warning signs relating to sadness, worry, noncompliance, impulsivity, inattentiveness, physical health problems (e.g. sleep problems), or poor school achievement. At this stage, the parent should watch the child or teen closely. For problems such as noncompliance and anxiety, it is recommended that the parent seek help if the symptoms are still present after 3 months. For symptoms of depression, however, parents should seek help much sooner – a couple of weeks if the teen or child is sad most of the day, and immediately if there is any indication of suicidal thinking or self-harm. Immediate help also is recommended for signs of eating disorders, substance abuse, and any problems that put your child’s physical well-being and safety at risk.
Mental health problems often begin with one or two symptoms that might not affect your child or teen’s life too much. There is a risk that over time, more symptoms might appear, or the symptoms might show up in other settings. Either of these changes suggests that the mental-health problem is becoming more intense. There is a growing likelihood that the mental-health problem now is impairing your child’s ability to function at her best at school, or to get along with her peers or family members.
Early assessment and treatment lead to better outcomes for children and teens. It is almost never the case that parents refer their child for a mental-health assessment too soon. A delay in seeking help often results in symptoms accumulating and further problems arising – in other words, the child’s situation becomes more complicated, discouraging, and more difficult to turn around.
Information for Parents about Mental Health Disorders in Children and Adolescents
It’s important to recognize that you, as the parent, don’t have the responsibility for diagnosing your child. In fact, diagnosis can be done only by some mental health professionals and medical doctors. You also don’t have to ensure that your child or teen is showing the symptoms of a specific disorder to request a mental-health assessment. It can be helpful, however, for all parents to improve their basic knowledge about mental-health problems in children, to allow them to get better at recognizing symptoms when they do occur.
This section looks at the symptoms associated with some of the mental-health disorders seen in children and/or adolescents.
DISRUPTIVE BEHAVIOUR DISORDERS
There are two main types of disruptive behaviour disorders. The first is Oppositional Behaviour Disorder (ODD). A child who is prone to intense temper tantrums, who argues a lot, who deliberately annoys others, and who often refuses to do what adults ask him to do might have ODD. Many children with ODD have other mental health problems, such as Attention Deficit/Hyperactivity Disorder (ADHD), anxiety, and/or depression.
Many children with ODD respond to treatment, if it is provided early enough. If ODD is untreated, there is the risk that the child might develop the more serious disruptive behaviour disorder, Conduct Disorder. Symptoms of Conduct Disorder (CD) include threatening others, physical aggression, damaging others’ property, lying and stealing, refusing to go to school, and running away from home. Children and adolescents with CD are at risk of failing at school and becoming involved with the police and youth criminal justice system.
Signs of depression can be variable, depending on the child’s age and personality. Young children often cannot state how they feel, and instead might complain of physical problems such as a stomach ache or headache. Although some children and adolescents openly express sadness by looking sad or crying, others might display less obvious symptoms. Irritability, rebelliousness, withdrawal from people and activities, and not paying attention can all be symptoms of depression.
It is especially important to be aware of depression in adolescents, because depressed teens are at high risk of suicide. Depression that isn’t treated in the adolescent years also can lead to long-term mental-health problems.
It is normal for a child or teenager to feel nervous about a single event, such as an important test. It is not normal, however, for a child or teen to feel anxious much of the time, or to be unable to cope with new situations because of anxiety. An Anxiety Disorder is present if the level of anxiety is high enough to interfere with the child or teen’s everyday activities.
There are several types of Anxiety Disorders, and it is possible for a child or adolescent to have more than one type of disorder. Generalized Anxiety Disorder is a condition in which the child is unable to control her multiple worries, and typically is tense and edgy. A child with Separation Anxiety Disorder is fearful of being away from parents and familiar adults, and often worried about something bad happening to themselves or the people they love. A child with a Social Phobia worries excessively about social situations such as speaking in front of a group of people, or meeting unfamiliar people, and usually tries to avoid these fear-inducing circumstances.
Symptoms of Obsessive-Compulsive Disorder (OCD) include frequent intrusive thoughts, and a compelling need to perform certain routines or rituals. The compulsive behaviours can be time-consuming and often interfere with normal everyday activities. A child with Panic Disorder is prone to panic attacks when he is highly anxious, and at these times might have symptoms of breathing problems, dizziness, and a pounding heart. Selective Mutism is fairly rare and characterized by the child refusing to speak in the situations in which she feels anxious. Post-Traumatic Stress Disorder (PTSD) also is not often seen in children, but occurs after one or more episodes of severe emotional distress and includes symptoms such as tension, sleep problems, and being unnecessarily watchful in daily surroundings.
Although it’s normal for children to run around, make noise, daydream, and get distracted, the child or adolescent with Attention Deficit/Hyperactivity Disorder (ADHD) shows these behaviours most of the time. Children with the hyperactive-impulsive type of ADHD often seem to be “driven by a motor”, are constantly moving, and don’t think before they act. Children with the inattentive type of ADHD aren’t overactive, but are distractible and disorganized. Many children with ADHD display a combination of hyperactivity, impulsivity, and inattentiveness.
The symptoms of ADHD can lead to many other problems, including conflict with adults and peers, trouble with the law, and poor school achievement. Symptoms of ADHD can affect social skills, causing the child or adolescent to feel rejected and isolated. As the child or teen with ADHD becomes aware of his apparent shortcomings, he is at risk of suffering from anxiety and mood problems. Other disorders, such as ODD, Conduct Disorder, and substance abuse might emerge.
AUTISM SPECTRUM DISORDER
Autism Spectrum Disorder (ASD) encompasses a range of ability levels and a variety of symptoms. Some children, for example, are developmentally delayed with no language, while others have average or higher intelligence and are verbal. Symptoms of ASD usually are observable by 12 to 24 months of age. There is urgency to diagnosing a child with ASD as soon as possible, because the best treatment gains are made when the child is young.
A child with ASD has difficulty with social communication and interaction. Typically, the child has difficulty reading others’ facial expressions, engaging in back-and-forth conversation, and adjusting her behaviour as needed by the social situation. The child might avoid eye contact or stare inappropriately; and might have delayed speech or peculiar habits of speech (e.g. inability to use pronouns, echoed speech).
Other symptoms of ASD are related to the restricted and repetitive patterns in the child’s behaviour, interests, or activities. The child, for example, might be insistent about eating the same food every day, or following routines of behaviour. Fixations on specific objects and interests are common in children with ASD, as is unusual reactions to sensory aspects of the environment (e.g. fascination with lights, excessive touching or smelling objects, intolerance of noise).
Websites for Parents
Children’s Mental Health Ontario
Centre for Addiction and Mental Health
Australian Parenting Website
Hastings & PE Counties Health Unit
Resources for Parents
Information for Parents from Canada’s Paediatricians
Online Parenting Magazine