The information provided in this section is not intended to diagnose nor to take the place of appropriate medical consultation and care. Parents are encouraged to seek support if they suspect their child may be experiencing a mental health condition. Additional information on MISD partnerships and community resources for mental health support is provided in a separate section of this course.

General Information

Brain Development

As parents, we can see our children grow and develop physically from year to year. In addition to their body's growth and maturation, they also learn physical coordination and movement. They learn to regulate their eating habits and sleep cycle. It's amazing how much they have to learn! We also know as parents that there's a whole other side to our child's development though. Our children have to learn how to recognize and manage feelings, what is expected in social interactions, and how to manage impulses and delay gratification. Theses skills rely heavily on their brain development and experiences, which in turn impact their mental health. Since we can't directly observe how our kid's brains grow, how do we know what to look for and how to help? In this section we'll provide some basics on common mental health issues and provide information on ways to support positive mental health.

Online Resources

A lot of information is available online about mental health. It can be hard to know where to start! Here are a few sites to begin your research.

American Academy of Child and Adolescent Psychiatry has developed a helpful resource for parents on common mental health concerns.
The Child Mind Institute has several in depth guides and articles in their family resource center.
The Center for Disease Control (CDC) has developed fact sheets and additional information available here.
Mental Health Texas provides educational articles and additional information about resources in the community for support.
The National Institute of Mental Health (NIMH) has a collection of factsheets and brochures on various mental health disorders and topics here.
Psychology Today has a provided information on brain development here.
The Texas School Safety Center has put together a parent toolkit. See section three for mental health topics.
Children's Health publishes an annual report on the state of the child in North Texas. It considers many sociological factors in our community, including access to health care, economic security, and safety.

Books

The Whole Brain Child by Dan Siegel and Tina Payne Bryson
How to Talk so Kids will Listen and Listen so Kids will Talk by Adele Faber and Elaine Mazlish
Brainstorm: the Power and Purpose of the Teenage Brain by Dan Siegel
Brain Stages: How to Raise Smart, Confident Kids and Have Fun Doing It by Patricia Wilkinson and Jacqueline Frischnecht
Beyond Behaviors by Mona Delahooke
Raising Good Humans by Hunter Clarke-Fields
The Happy Kid Handbook by Katie Hurley
Between Parent and Child by Haim Ginott
Flooded by Allison Edwards

Common Mental Health Conditions

Depression

Statistics:

According to the CDC, 3.2% of children overall, ages 3-17, have diagnosed depression.
NIMH reports that diagnosis of depression is more common with increased age, with rates climbing to 20.1% of adolescents, ages 16-17, experiencing a major depressive episode.

Potential Signs of Depression:

Persistent sad, anxious, or “empty” mood
Feelings of hopelessness, worthlessness, or pessimism
Feelings of irritability, frustration‚ or restlessness

Strategies to Try:

Teach your child about feelings and discuss how they may first notice the feeling. For instance you could say, “sometimes I notice that I am feeling sad. I usually notice when my chest starts to feel heavy and my face gets hot. Tell me about what it’s like when you are feeling sad.”
Teach your child to rate the level of their feelings and identify actions they can take to be comforted and/or problem solve. Say, “it helps me to think of how big my feelings are on a scale of 10. For example, when we watched that sad movie last week, I felt sad at about 4 out of 10. It helped me feel better when you gave me a hug and by dinner I was back down at 0. Let’s try that strategy with your sad feeling. How big is your sad feeling today?” Once your child gives you a number, you can follow up by saying, “You told me your sadness was a 7. What can we do to get it to 6?”
Sometimes in our rush to comfort our children, we can unintentionally make it seem like their feelings are not valid. For example, it’s easy to say something like “there’s nothing to be sad about. Everything’s just fine!” It’s often more effective to echo your child’s feelings back to show your understanding and empathy. Try instead saying something like “You’re feeling sad right now. It’s very uncomfortable and you want it to go away. Tell me more and we’ll work on it together.”

Anxiety

Statistics:

(NIMH) An estimated 31.9% of adolescents had any anxiety disorder. Of adolescents with any anxiety disorder, an estimated 8.3% had severe impairment.
(NIMH) The prevalence of any anxiety disorder among adolescents was higher for females (38.0%) than for males (26.1%).
(CDC) 7.1% of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety.

Potential Signs of Anxiety:

Demonstrating excessive distress out of proportion to the situation
Easily distressed, or agitated, when in a stressful situation
Repetitive reassurance questions, "what if" concerns, inconsolable, won't respond to logical arguments
Headaches, stomachaches, regularly too sick to go to school
Anticipatory anxiety, worrying hours, days, weeks ahead
Disruptions of sleep with difficulty falling asleep, frequent nightmares, difficulty sleeping alone
Perfectionism, self-critical, very high standards that make nothing good enough
Overly-responsible, people pleasing, excessive concern that others are upset with him or her, unnecessary apologizing
Demonstrating excessive avoidance, refuses to participate in expected activities, refusal to attend school
Disruption of child or family functioning, difficulty with going to school, friend's houses, religious activities, family gatherings, errands, vacations

To learn more about the various types of anxiety, click here.

Strategies to try:

Pay attention to your child’s feelings.
Stay calm when your child becomes anxious about a situation or event.
Recognize and praise small accomplishments.
Don’t punish mistakes or lack of progress due to the anxiety.
Be flexible, but try to maintain a normal routine.
Modify expectations during stressful periods.
For more ideas, click here.

Eating Disorders

Statistics:

NIMH reports that the lifetime prevalence of eating disorders for adolescents is approximately 2.7%. They also noted that eating disorders are twice as prevalent in females (3.8%) than in males (1.5%).
According to John Hopkins Children’s Hospital, 30 million people in the US have an eating disorder and 95% of these cases are within people of ages 12-25.
Eating Disorders have the HIGHEST risk of death of any mental illness.

Potential Signs of an Eating Disorder:

Dramatic weight loss
Lack of appetite or interest in food
Complaints of upset stomach, abdominal pain, or other gastro issues with no known cause
Preoccupation with weight, food facts, or meal rituals
Routine bathroom trips immediately after eating
Eating alone or hiding food in odd places
Low self-esteem and poor body image
Poor dental hygiene despite brushing/going to dentist
Loss of menstruation for females
Withdrawal from friends, family, or preferred activities

Strategies to try:

Foster a healthy relationship with food. Try not to label food as good or bad, as this can set up feelings of guilt and shame when “bad” foods are eaten. Avoid using food as a bribe or reward and avoid talking about diets or placing your children on diets (unless recommended by a physician). Allow your child to eat when they are hungry and stop when they are full. Try not to force your child to eat if they don’t have an appetite or to always eat everything on their plate. Regularly sitting down to eat as a family is great way to observe your children’s eating habits and have conversations regarding food intake.
Encourage your children to feel good about their bodies! Model an acceptance of different body shapes and sizes, including your own. Show your children health eating and physical activity habits. Don’t criticize your child’s appearance, and encourage regular physical activity.
Encourage Self Esteem. Help them develop effective coping strategies and help them express their feelings, needs, and wants. We can also assist with monitoring their social media intake and having critical conversations regarding images and messages they are receiving from the internet and social media.

Post Traumatic Stress Disorder

Statistics:

(NIMH) An estimated 5% of adolescents between 12-18 have PTSD. This number is higher in females (8%) than males (2.3%).
(SAMHSA)- more than two thirds of children report at least 1 traumatic event by the age of 16. 19% of youth who are injured and 12% of youth who are physically ill have PTSD. More than half of US families have been affected by some type of disaster (54%).

Potential Signs of PTSD:

Nightmares, night terrors or sleep problems
Reliving the event over in thought, talk or play
Intense sadness, fear or worry
Irritability or angry outbursts
Lack of positive emotions
Eating poorly or overeating- weight loss or weight gain

As children develop, the signs and symptoms of PTSD can look very different.

Young Children (0-5)

Fear of being separated from parent or caregiver
Irritability or fussiness
Higher activity levels than peers

School Age Children (6-12)

Difficulty concentrating or paying attention
Feelings of guilt or shame
Anxiety or fears
Difficulty transitioning from one activity to another

Teens (13-18)

Feelings of depression, isolation or being alone
Self- harming or eating disorders
Risk taking behaviors- abuse of drugs or alcohol, risky sexual activity
Refusal to follow rules talking back

When the stress response is activated or a threat is perceived, kids with PTSD may feel scared, angry, irritated, alone or withdrawn.

Strategies to try:

Keep your calm; share your calm. When your child is upset, lower your voice, respond rather than react, acknowledge your child’s feelings, and be reassuring and honest
Avoid physical punishment. Loud voices or physical threat may heighten a child’s stress or panic. Don’t take behavior personally and allow your child to feel his or her feelings without judgement.
Be consistent and predictable. Setting reasonable routines and consistent limits and expectations will support your child. Try to use praise for desired behavior.
Be patient. Everyone heals from trauma differently and trust doesn’t develop instantly. Respecting your child’s individual recovery is important.
Allow some control. Using reasonable, age-appropriate choices encourages your child’s independence and allows your child or teen a sense of control.

ADD, ADHD

Statistics:

(CDC) The estimated number of children diagnosed with ADHD is 6.1 million (9.4%).
(CDC) Boys are more likely to be diagnosed with ADHD than girls (12.9% compared to 5.6%).

Potential Signs of ADD/ADHD:

Many in the medical community have moved away with the term ADD and just use ADHD – Inattentive presentation, ADHD – Hyperactive/Impulsive presentation, or ADHD – Combined presentation

Inattentive

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, keys, paperwork, eyeglasses, cell phone).

Hyperactive/Impulsive

Often fidgets with or taps hands or feet, or squirms in seat.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Often talks excessively.
Often has trouble waiting their turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)

Additional Criteria to Consider:

Several inattentive or hyperactive-impulsive characteristics should have been present before the age of twelve.
Several characteristics are present in two or more settings (such as at home, school or work; with friends or relatives; in other activities).
There is clear evidence that these difficulties interfere with, or reduce the quality of, social, school, or work functioning.
The symptoms are not better explained by another mental health difficulty (anxiety, depression, etc.).

Strategies to try:

Chunking Tasks – This is breaking tasks up into smaller “chunks” to make it more manageable. Home Example - “Eat breakfast, brush your teeth, get dressed, make sure you have your backpack, make sure you have your homework” vs. just telling the child to “Get ready for school” which will involve multiple unnamed tasks. The child could possibly check in with a parent after each task or follow a checklist of each item after it is completed and move to the next item on the checklist. School example – “Complete five questions and come check back with the teacher.” vs. “Complete the entire 20 question worksheet.”
Checklists – With common routines and chores, having a checklist that a child can follow can help them to stay on track and help them to not forget any tasks that may be part of their routine.
Limit Distractions – Setting up an environment for success can be key. Turning off the television, removing loud noises, moving away from multiple people in an area can help a child stay focused and more productive.
Frequent Breaks – Similar to chunking, but purposely working breaks into more difficult and lengthy tasks can help a child not get fatigued and be able to reset the their attention and focus between breaks to help them follow through and complete tasks.
Premack Principle – The use of a desirable activity to reinforce engagement in a less desirable activity. This can help with motivation and help the child see more value in the less desirable task. Example: Once you complete your math homework correctly and without distraction, you can play videogames.

Substance Use Disorder

Statistics:

(CDC) By 12^th grade, about two-thirds of students have tried alcohol.
(CDC) About half of 9^th through 12^th grade students reported having used marijuana.

Potential Signs of Substance Use:

Changes in physical appearances
Changes in school or job performance
Changes in behavior and personality
Changes in friend groups and interests
Physical evidence of drug use

Strategies to Try:

Talk directly to your child about drugs and alcohol. Don't be afraid to have these conversations.
Help your child deal with peer pressure. Make a plan with your child for how they can get adult help in discrete ways.
Encourage healthy, creative activities.
Help your child develop strong values.

To learn more about Substance Use, we invite you to take our separate course: www.tinyurl.com/misdtalks

In addition to these common concerns, many children are impacted at some point in their lives by grief. On the next page, we'll share information on grief and provide strategies to assist your child when a loss occurs.