This is Mental Illness Awareness Week, so in honor of the children and families I work with, I am offering a few thoughts on what children need to be mentally well. Hopefully we can all think a little better about how to help children experiencing mental illness (and their families too!) heal and live into wellness.
1. Take care of yourself.
There are two questions to ask when caring for a child struggling with mental health or behavior challenges: What does this child need? and What do I need? BOTH need to be asked at the same time. One of the first things I tell parents I partner with is that the most important thing they can do to help their child is to find the support that they need themselves to be well. As a therapist, I am not able to care for these children well unless I am also caring for myself well. Caring for children is stressful, and caring for a child struggling with mental health challenges is even more stressful. Children need adults in their lives who are healthy. They also don't need to deal with our stress, anxiety and issues on top of their own. Children notice and absorb our emotions and reactions more than we see. Adults who are taking care of themselves are able to listen better, stay calmer when things get rough, and think more clearly. AND children need good models more than they need lectures. Children will learn how to live well when they see adults who are modeling wellness in their own lives and relationships, which includes asking for help for themselves when things get tough.
Parenting and helping children who are experiencing mental health and behavior challenges brings a myriad of emotions and thoughts- fear, anxiety, grief, shock, anger, hopelessness and helplessness. Parents, families and caregivers of children with severe behavior challenges may be traumatized by their behavior. Helpers who listen to children tell their stories of trauma and struggle may experience secondary trauma. If you know a family, teacher, therapist, social worker, doctor, nurse or other helper who are caring for a child who is struggling, be gentle with them. If you are a caregiver or helper, be gentle with yourself. It might mean giving yourself time to breathe and regroup, taking a parenting class, scheduling a few sessions with a therapist for yourself, taking advantage of all the supervision and colleague support you can get, becoming more educated on children's mental health and behavior challenges. Whatever you need to do to be a better caregiver- do it.
2. Listen to the story behind the symptoms.
Children are almost always referred for mental health treatment and therapy due to behavior issues. They can't pay attention at school. They won't follow directions. They get angry and blow up at the drop of a hat. They're getting into fights, can't keep their grades up and don't really seem to care how they're disciplined- nothing works. When I listen to the stories of these children I almost always hear stories of trauma- physical abuse, sexual abuse, neglect, significant deaths, hearing or seeing violence (Yes, what children watch on TV, hear on the radio, or play on video games does effect them. And yes, they can hear the fighting in the next room.), exposure to drug and alcohol abuse, having multiple guardians and separation from biological parents, even things like moving frequently, homelessness, or major injuries or illness. Often children have or are experiencing more than one of these, and they have no idea what to do with how they feel about this or the ways it changes how they think about their world.
What would you do if the moment you sat still all the pictures of someone hurting you came flooding back? Or if you see someone is getting angry with you, and usually that means getting hit? Or you didn't know if Mommy was safe while you were away? Or if you didn't know if you would be safe when you went home? Or everyone who is supposed to care for you hurts you, or leaves you, or dies?
Just today one of the Nurse Practitioners I work with said 90% of the children who are referred to her from schools or parents for ADHD medication have experienced trauma. I've had the same experience. Many of the symptoms associated with ADHD are also caused by anxiety- lack of concentration, rapid speech, fidgety, irritability, low frustration tolerance and easily angered. I have yet to meet a child with these behaviors who is not also experiencing some level of anxiety, and most likely that has stemmed from a story of trauma.
3. Take deep breaths.
The first "coping skill" I teach children is to breathe. We imagine a balloon in our bellies that gets bigger as we breathe in and smaller as we breathe out. It relaxes the body, gets more oxygen to their brain so they are able to think more clearly, gets them to pay attention to how their body feels, and helps them release whatever frustration or anxiety they're holding. We blow bubbles or a pinwheel to see how we can control our breath.
We also work on muscle relaxation. Doing "the turtle" teaches them to curl their bodies tightly inward and tense their muscles, then relax with a deep breath. Pushing their feet into the floor, clenching and releasing fists, or tensing and relaxing each muscle group in sequence helps release the emotional energy that is building up in their little bodies, and it shifts their focus away from unhelpful thoughts.
Coloring, playdoh, UNO, or bouncing a koosh ball are also favorites. These are helpful to give the hands something to do and get that worried or angry energy out. I keep a stack of mandala coloring sheets on my table that kids and teens (and me) will color while we talk. I create "special rules" for UNO or Jenga to help them tell me what they're thinking or feeling. When kids feel like they're playing, they don't realize that they're actually talking about important stuff.
Often our first reaction to "misbehavior" or "acting out" or strong emotions in children is to discipline. Perhaps we could help them change their behavior better by helping them learn how to cope with the emotions that led to that behavior.
4. Talk about emotions, lots of them.
I am often amazed at the lack of emotional vocabulary that children and teens have, and how difficult it can be for them to identify what they are feeling. Many are only able to identify "happy" "mad" or "sad". Unless children know how to "talk" about what they are feeling, the only way they know how to communicate their experience is through their behavior. No one, even an adult, is able to change their behavior successfully unless they have the self-awareness and emotional awareness to understand the behavior. Teaching children to be emotionally aware, and comfortable talking about what they are feeling, will form adults who are able to build healthy relationships and make choices to live well.
This is another great opportunity to get creative. It is more helpful and formative for a child if they are able to name their emotions themselves, rather than you or I telling them what they feel. While they need to know lots of different words for emotions and what they mean, they also need good listeners who do not judge their feelings. I often use color and art to help children identify different emotions. Or rating scales to identify the intensity. Or create games to match emotions with facial expressions, or situations, or thoughts and behavior, or coping skills. We also talk about feeling several emotions at the same time, and where we feel emotions in our bodies, and which emotions we show and which ones we hide, and how some emotions can be okay to feel (like anger) but can become unhealthy if we don't know how to cope with them.
5. DON'T ask Why.
Children usually do not have the ability to understand why, much less communicate it. Many adults don't even have this awareness. Asking a child why they did something and pressuring them to explain themselves only leads to the child feeling misunderstood, defensive and confused. That will almost always lead to them shutting down or blowing up. And yet adults just keep asking....
Adults have the ability to think about the world logically. We understand cause and effect. We can problem-solve somehow. If we could just understand why a child misbehaves or acts so impulsively, we/they could figure out how to fix it. But that's just not how it works. Children aren't able to think logically at the same level. They are still learning to problem-solve and think about what they are doing.
There are lots of ways to understand a situation without asking the "Why?" question- What was happening then? How did this happen? What were you thinking when that happened? How did you feel when....? What helps you to....? What makes it difficult to....? Asking these types of questions allows the child to talk about the situation openly without feeling they are being punished, and it invites them into the problem-solving process.
Children also don't always communicate best verbally. Sometimes they are better able to show you by drawing or writing about it. Children, especially younger children, communicate through their play. If you pay attention, the characters in their play may be living parts of the child's experience, or expressing the emotions of the child. A story about the picture they are coloring may be about them. This is how they are trying to understand how their world works. Pay attention to the emotion "language" the child connects with and learn to speak it with them.
6. Pay attention to your language.
The greatest barrier to asking for help with mental health challenges is the stigma surrounding mental illness. The language we use about children and adults, and their families, who experience these challenges speaks volumes to how unimportant they are to our society. Children are labeled "bad", "troubled", "disabled", "crazy", "wild". They're (intentionally or unintentionally) told that they need to say or do or be certain things in order to be "good", that they're not worthy, not able, that they don't belong. The more they are pushed away, the more they have to fight to find their place. And their families, many of whom have struggled with mental health for generations, have little to hold on to, to tell them that they are worthy and able to lead meaningful lives. Shifting our language to focus on strengths instead of problems opens space for healing and hope rather than more frustration and stress.
Children need to know that they belong. They know this, not just by hearing us say "I love you", but by the time we spend with them, the words we use to talk about them and to them, the look in our eyes when we see them. They need to know that they are good, no matter how much they struggle to conform their behavior or stay strong against the forces of depression and anxiety. They need adults who are able to see how hard they are trying and the good things they do, and shower praise on them. Children who are depressed or anxious or have a low self-esteem have a hard time believing those things themselves. Children who are trying to feel they belong by seeking attention will learn how to do this in a healthy way when adults around them celebrate their successes, no matter how small, more than punish their mistakes. They will know they belong when they are seen for who they are more than compared to their sibling or classmate or neighbor.
Children who experience mental health challenges are not "other" children. One of these is your student. Your patient. Your neighbor. Your sibling. Your child. These are the children who will one day (soon) be the adults who are forming the families of our communities. Let's work to help them heal NOW. Let's love them NOW. Let's listen to them and learn from them NOW. Let's invite them into our communities and homes NOW.
If you care for a child struggling with mental illness- Thank you! May you be blessed for this journey.
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