Conversations on mental wellbeing among adults are changing as people become more aware and open to seeking help. Those of us with access to social media and other resources are now learning how important self-care is. However, things aren’t the same for children or adolescents.
According to the World Health Organisation (WHO), 10-20% of children and adolescents across the world experience mental disorders. The WHO says that “children with mental disorders face major challenges with stigma, isolation and discrimination, as well as lack of access to health care and education facilities, in violation of their fundamental human rights”.
Lack of awareness and action
In India, awareness on mental disorders is growing, but parents are often at a loss when their children suffer.
“Even if a parent identifies certain behaviours as ‘red flags’ i.e. those behaviours that put the child or others around him in harm, they often don’t take action as they do not have the awareness and knowledge about how to separate those behaviours from normal childhood behaviours,” said Ruchika Kanwal, a psychologist at the Karma Center for Counselling & Wellbeing.
The lack of awareness among parents, experts say, can keep children from getting the care that they need. Psychotherapist and counsellor Anu Goel said some parents, even if they are aware, think, “this is not a big deal, it will be fine”.
The situation is a little better among younger parents, among whom there is some more “visibility” about mental health care, says Shaina Vasundhara Bhatia, psychotherapist and counselling psychologist. But parents who have not been part of or seen conversations around mental health while they were growing up find it difficult to come to terms with it.
“Some parents have a cliched understanding of therapy. They think of it either as taking medicines or of an agony aunt. Some parents are aware, but still get threatened or scared of the word ‘therapy’,” said Bhatia.
Meanwhile, thanks to the internet, adolescents are also becoming more aware of their mental wellbeing. Kavita Arora, a child and adolescent psychiatrist, said that she has seen several cases where adolescents have reached out to their parents to get them help.
“The scenario and trends are changing nowdays. With changing lifestyles and parenting styles, parents have become more liberal and understanding towards mental health and therapy. But I still feel it’s teens and youngsters who are coming in voluntarily than parents bringing them in. For developmental issues like Autism, parents are more aware and forthcoming,” Kanwal said.
What mental disorders can show up in children?
According to experts, neurodevelopmental disorders like autism spectrum disorder, attention deficit hyperactivity disorder and learning disabilities are the most common in children. However, said Arora, ”Learning disabilities are still a developing field and a very recent understanding. They become far more obvious as a child grows up.”
While psychotic disorders are less common, children can also develop disorders like obsessive compulsive disorder, anxiety disorder and post-traumatic stress disorder.
″Mood disorders such as depression and bipolar disorder can cause a child to feel persistent feelings of sadness or extreme mood swings much more severe than the normal mood swings common in many people. Disruptive behaviour disorder is also a mental health illness where children tend to defy rules and often are disruptive in structured environments,” said Kanwal.
Children can also develop mental disorders because of traumatic life experiences like abuse, neglect or parents separating.
When should parents be concerned?
Since children don’t express emotions like adults, their distress shows up in other ways. It helps for parents to be observant and look for changes in their behaviour and daily routines. “Every parent knows their child’s range of mood. So they must look out for anything that is away from their own normal, like changes in biorhythms of the child, like their eating or sleeping patterns. If these changes are persistent, then their radar should go up,” Arora said.
Apart from the ‘biorhythms’, children also show behavioural changes. Arora described the “normal” of any child as a chirpy child suddenly becoming quiet or a shy child suddenly becomes talkative.
“Be aware of feelings of overwhelming fear for no reason, sometimes with a racing heart or fast breathing, or worries or fears intense enough to interfere with daily activities.Ruchika Kanwal
Emotional distress can also affect their studies or make them lose interest in the things that they usually like doing.
“I think essentially, parents become very aware if their child behave in a very different manner from who they are as a person. Usually they lose interest in the things that they like to do. Parents should also look at the child’s academics and extracurriculars and see if these things are getting affected,” said Bhatia. She added that “the movies or TV shows they watch, the books they read, songs they listen to” are a great way of keeping up with the child’s life because “it is a gateway into their lives”.
Goel said children also tend to get aggressive. “This is often directed at the house help, siblings or other younger children.”
Debilitating, intense emotions are also something that parents need to watch out for. Kanwal said this could mean “overwhelming fear for no reason”, or fears that hamper the child’s everyday activity. Bed wetting, throwing tantrums or clinginess could also be signs of a child who is suffering.
7 things parents can do to help their child
The experts said that communication was key to ensure that the child felt they were being heard and that communication was key to make a child feel like they were in a safe environment and that they were heard. “You need to communicate with the children. Not that the parent lectures the child and they listen. The parents need to listen as well. It should be a two-way communication, letting the child express their feelings. We as adults feel we are always right. But we are human, we can be wrong too. You also need to ask the children what they are feeling,” Goel said.
2. Believe your child
Adults tend to ignore constant complaints from children, thinking of it as attention-seeking behaviour or tantrum throwing. Bhatia said, “Stay with what your child is saying. If they are constantly complaining about something, don’t dismiss the child. If they complain of a constant stomach ache, instead of saying get over it, get them diagnosed.”
3. Get a diagnosis
Experts say understanding your child’s illness is a big step towards healing. “The first step in helping a child living with mental illness is ensuring they’re properly diagnosed by a mental health professional. However, it’s not always that simple. One of the most difficult parts of discussing mental health is the range of illnesses, as well as the levels of severity each can entail. Consulting with a mental health professional and understanding your available resources can help you learn about your child’s specific diagnosis, the potential symptoms and how those symptoms can manifest differently in individuals,” Kanwal said.
While a diagnosis can be extremely overwhelming for the parents, especially for those who are completely new to the concept of therapy, experts says reading up and even getting a second opinion could help. “Listen to the professionals. Get a psycho-evaluation done and take the child for regular sessions. If you feel the expert’s opinion is very different from yours, get a second opinion. If you are not vibing with one particular specialist, don’t shun the process, go see another one,” Bhatia said.
4. Be patient and give them the freedom to express
Bhatia said, “I hear you when you want your child to heal fast. But you can’t really tell someone, you need to heal because I am telling you to. Give them their space and their time. Be patient. If you really feel that is taking a toll on you, may be there is something that is being evoked in you.”
5. Concentrate on the positive
While parents often, in the process of teaching a child good behaviour, begin to concentrate on the negative. Goel said that negative attention makes the child do more negative things. “If you only pay attention to the child when they do something negative, like dropping something or breaking something, then they think the parent will only give them attention when they do something negative. So they repeat the negative behaviour. Concentrating on the positive will also make the process more productive and constructive.”
6. Take care of your own self
While taking care of a child who is suffering, the caregiver often only concentrates on the child’s needs. “Everything in your life should not become about the child, otherwise the problem becomes an overbearing monster. It is very important to nurture yourself. Or else you will lose your shit,” said Bhatia.
7. Forgive yourself
Parents often take in as personal defeat if there is no instant improvement in the child’s condition. However, Kanwal said that it’s ‘virtually impossible’ to be absolutely prepared and know what is in store in the journey of healing, and the journey could be a learning curve for the parents as well. “It’s important to pick your battles and differentiate between what’s harmful behaviour, and what’s generally annoying. In the end, your experience navigating your child’s mental illness will be personal to you. While it’s almost inevitable that you’ll make mistakes along the way or react poorly at times, you have to be able to forgive yourself,” Kanwal said.
3 things parents must not do
1. Don’t shame them
Arora said that parents must not shame the child for any of their experiences. “Many parents shame the child, especially in cases of abuse. They should never shame the child. They also try to keep it under wraps and ask them to snap out of it. Because if they knew how to get out of it themselves, they would not be in this situation at all.”
2. Never raise your hand
“You are never going to get anything out of raising your hand on the child. If you hit your child, that is not good for the healing, the child is going to move further away from you. Some parents look back at their own childhood and think that made them respect their own parents. But most of the times it was fear, not respect. You have to decide if that is the kind of relationship you want to have with the child,” Bhatia said.
3. Don’t lash out
Kanwal said it was important for parents to remember that the child’s behaviour is caused by a disorder and hence not lash out at them. ” When you begin to feel angry or frustrated, remember that your child can’t “snap out of it” or “just be normal”.”
Why getting help early is important
All the experts agreed that getting help early can help later in life.
“Getting help early is the best bet. When children are younger the brain is more amenable to change. And is far more likely to build on healthier patterns,” Arora said.
Kanwal said that skills taught to a child can lay a foundation for future success. “If children can be taught the skills they need in their formative years, they can carry skills with them through their elementary years and beyond. On the other hand, if a child’s problem is ignored, the problem can grow over time and can become difficult to remediate.”