For this post, BuzzFeed Health spoke with Yamalis Diaz, PhD, clinical assistant professor of child and adolescent psychiatry at the NYU Child Study Center, and Jarrod Leffler, PhD, assistant professor of psychology at the Mayo Clinic College of Medicine and director of Mayo Clinic's Child and Adolescent Integrated Mood Program.
1. Kids go through ups and downs just like adults, but when those downs start causing problems in everyday life, it's probably time to talk to a professional, like us.
Trouble paying attention, being disorganized, worrying, trouble sleeping. Whether you're a kid or an adult, everyone experiences these from time to time. But in mental illness, these symptoms are often more severe. In fact, when trying to figure out if you should go see a professional, think about whether these symptoms in your child are happening 1) more frequently than the average person of that age, 2) more severely than the average person of that age, and 3) if all of this is making it hard for your child to function in every day life. If all three add up, then it could be time to talk to someone who can help.
2. Kids as young as 2 can start showing signs of an anxiety or a behavior disorder.
The signs may vary, but there are children who exhibit extreme tantrums or aggression, are completely avoidant of social situations, or show anxiousness over things that most other kids their age wouldn’t be concerned about. We've literally seen 7-year-old kids worrying obsessively about the war in Afghanistan and the violence in Charlottesville, Virginia.
And when it comes to developmental delays, like those related to autism, they can show up even earlier, in a baby as young as 6 months old.
3. Because it's hard to know right away which particular disorder a kid has, we first narrow it down seeing which of two major buckets their symptoms fit into.
We usually ask this question: Is it an internalizing disorder or externalizing disorder? Internalizing disorders are those only the person experiencing them can feel, like bipolar disorder, depression, anxiety, and adjustment issues. Externalizing disorders are those like ADHD, oppositional defiant disorder, and conduct disorder, the symptoms of which are usually seen by people in that person’s life.
Since there are so many mental illnesses — and variations of them — fitting the symptoms into one of these two categories gives us a general direction to go in. From there, we’ll be able to develop an evidence-based treatment plan.
4. We wish there was a one-size-fits-all way to go about treating kids, but there's not.
So many parents come to us wanting concrete answers about what they and their kids are dealing with and how to tackle very specific issues, such as tantrums, but unfortunately it's more complicated than that.
Some kids might need a certain kind of therapy — outpatient or inpatient therapy; family therapy, involving not only the parents and their child, but siblings, too; or cognitive behavioral therapy — while others might need medications plus therapy. Other kids, such as those with eating or mood disorders, might need a specialized program where only the child and their parents participate. No two patients will have the same exact treatment, and that's because every treatment plan is meant to teach your child the skills they need to develop into fully functioning adults.
5. If you think your child is showing signs of mental illness, talk to the other adults in your kid's life.
We'll usually make a diagnosis based on the entire history of your child from birth, including their family, school, and social histories. So if you think your child is showing signs, talk to other parents to get an idea of how your kid might compare, developmentally; talk to their teachers/counselors, who spend lots of time with them every day; and talk to their primary care provider, who knows their medical history (and can refer you to a mental health professional). Taken together, these are all clues that will help you figure out what your kid is going through and how to help them.
6. The more parents and guardians can support their kids at home, the better.
Ideally, everyone in the child's life — from siblings to teachers to babysitters and coaches — should be on board with helping the child with a mental illness thrive, but parents/guardians are their greatest partners in overcoming the difficulties of living with a mental illness.
7. And btw, if that sounds overwhelming, it’s our job to help parents learn how to do this.
Kids do not exist in isolation, so we work with their parents/guardians, too. That usually means figuring out the best ways for them to be partners in their child’s care. As much as we provide treatment for kids, we provide resources and support for parents, too.
8. If we could recommend two skills for kids to learn ASAP, they’d be communication and problem solving.
If you set the foundation for communication early on — modeling deep listening and trying to understand where your kids are coming from — the door will be open for them to speak comfortably with you when it really matters, regardless of the topic or who starts the conversation. That’s why it’s so important to listen to them, rather than talk at them.
Likewise, a lot of parents assume it's their job to find solutions to all of their kid's problems, but, in our opinion, that’s not actually the best setup. At some point in their teen years, they’ll need to start learning to solve problems on their own. For parents, that means asking kids to come up with solutions to their challenges and obstacles (within reason!), and then having them try things out on their own. Sometimes it might work and sometimes it might fail, but that's OK: The goal is to teach them resilience, not reliance.
9. The other thing we need to ask parents to do: Be pretty involved in their therapy process.
That means asking questions about literally everything, from what skills your child should be learning to the skills you should be working on with them at home. You want to have an idea of what the outlook is, and if, after some time, you don't see much improvement, then have a conversation with the therapist — you might realize, or they might even tell you, that it's time to see a specialist or get a second opinion.
10. We don’t usually expect kids (especially younger ones) to be pros at articulating their inner emotional landscape.
Developmentally, young children aren't ~there~ yet, where they're able to grasp and discuss abstract concepts. They also have limited insight and awareness of who they are and what's going on. So if they’re always worried, for example, and you asked them to think about their negative thoughts and to talk to those thoughts, they probably wouldn't be able to put it into words.
11. But that’s OK, because we are pretty good at getting it all out anyway.
There isn’t really a single specific way we’d tackle this since it depends on the child’s age and treatment, but to build rapport and open them up, we might try playing games with them or drawing. These are, themselves, therapies, but they also work to put the children more at ease — the child might feel more comfortable talking about their feelings while playing these games — and that can help them engage in the therapeutic process. Similarly, these techniques may expose certain behaviors (if the child gets frustrated, for example) and that can prompt a conversation, too.
12. There’s always the chance that a kid’s diagnosis might change.
Treating mental illnesses often means treating the symptoms of the disorder as they appear, so that they're less of an impediment on the child's life right now. But things change — kids mature, their brains develop, and they’re exposed to more and more things in the world. All these things can affect the symptoms they have, how they're able to talk about their symptoms, and, ultimately, their diagnosis. It's also worth mentioning that not all mental illnesses develop at the same speed — some may be more of a slow burn, with symptoms popping up over a few months or years, whereas the full scope of other illnesses can show up much faster.
When this happens, it’s not necessarily the fault of whoever made the original diagnosis — they were working with the symptoms that were present at the time... Unfortunately, this is one of the harder things we have to deal with since it can be so frustrating for parents.
13. We all go through similar training at first, but eventually each of us will choose a path to specialize in.
Describe our schooling in one word? LENGTHY. It can take about six to seven years of training to be a clinical psychologist, and that might include clinical internships or postdoctoral fellowships. All this extensive training basically sets us up with the skills to provide therapy, psychological testing, and research. We all come out of that training knowing these things, but because there are so many mental illnesses out there, we usually find something to specialize in, whether that's mood disorders and severe pathologies or ADHD and behavior problems.
14. No, we won't prescribe medication.
One of the biggest misconceptions about mental health professionals in general is that right away we're going to prescribe medication for whatever the illness is. Sometimes this keeps people from going to see a professional, and other times this is the first thing people ask about. Well, it turns out that psychologists cannot prescribe meds in the first place (we’re not MDs!), and even if we could, they wouldn't be our first treatment option.
Why? Because we know that there are all sorts of therapies that might work without having to resort to meds.
15. Consistency is huge when it comes to treatment being as effective as possible.
When it comes to getting the most out of outpatient therapy, it's crucial that kids’ visits are consistent — you can't just come by whenever there's a problem, especially if your child’s issues are particularly serious.
Oftentimes, the only thing a child needs to stay on track will be consistent therapy sessions. Without them, there's potential for conflicts to arise between family members or for the child to have a full-on mental health crisis, where the only way to stabilize them is in the ER or an inpatient hospital. And we definitely don’t want that to happen.
16. Insurance coverage for mental health services is actually one of the biggest obstacles to consistent care.
Sure, this is a problem for anyone looking for mental health treatment, but that doesn't mean it isn't important. Mental health care is covered at a lower rate than other medical illnesses — that ices out families who can't afford to pay copays or see a really good mental health professional. Sometimes insurance companies will even put a cap on the number of sessions a family is allowed to have. Unfortunately, with so many challenges to getting care, therapy ends up being a last resort for many families.
17. It's true: Teens can get moody, irritable, and argumentative. But when these behaviors become extreme or disruptive, it might be a sign of a bigger problem.
All kids go through puberty, so there's bound to be changes in their behavior, whether that's teen angst, fighting for independence, etc. Of course, it's hard to tell what's "typical" teen behavior and what's next level, but go with your gut and also be aware of common warning signs. And don't forget you can always try having a conversation with them or looking into therapy options.
18. Lots of teens use social media as an emotional outlet, which we wish parents were way more aware of.
It's really common in today’s world for teenagers to use social media and the internet as an outlet for their emotional issues — whether that’s just talking about being sad or even talking about suicide — probably because it’s easier to say things more freely online than it is in person. But parents won't catch these things if they're not monitoring their child's social media. Instead, it'll probably be one of the kid’s friends who reports the issue back to the parent, or to a teacher or counselor.
Every family’s values are different when it comes to privacy, so parents need to figure out what feels right for them in terms of staying on top of what their kids are posting online. Tracking how they expressing themselves online can help you keep tabs on their wellbeing and, if something they say sounds an alarm, you’ll be able to check in with them.
19. The reports are in: Therapy works!
From research, we know that there are A LOT of treatments that are effective. Of course, there are a bunch of factors that influence this, including the kind of therapy being used, the skill set of the therapist, the diagnosis of the child, and their consistency in going to therapy. But the bottom line is there’s a very high likelihood that the child and their family will benefit and see improvements if they go to therapy.
20. There are definitely times when the job can be especially tough on our hearts.
We are humans with our own emotions, too. So it can be tough seeing kids and their families dealing with so much hardship. For us, the hardest things are seeing patients admitted to inpatient facilities for their mental illnesses or dealing with a mental illness on top of another serious medical illness, like cancer. It’s hard to see patients dealing with a lengthy hospital stay, unknown trajectory, or painful procedure, because it almost makes sense as to why they're having behavior problems, or are anxious or depressed.
21. But at the end of the day, it’s all about helping this generation of kids feel better than the last.
Regardless of our own feelings, it's our job to help our patients understand and process their emotions, and let go of unhealthy patterns. We do this because we truly care about helping families and their kids function better — and by extension, future generations who will learn these skills. If we do that, then we can work to erase mental health stigma and start appreciating people with mental illness for who they are, instead of focusing on their illness or symptoms.