Supporting Parents to learn about the challenging behaviour in their child/teen: How much, why and what to consider

Supporting Parents to learn about the challenging behaviour in their child/teen: How much, why and what to consider

Challenging behaviour in childhood and adolescent is ubiqitious.  All children and teens will argue back, be deceitful, fail to follow instructions and act angrily, rudely and unfairly towards peers.   Community surveys show almost all toddlers show aggressive behaviour and even in the middle years, over 60% of parents report concerns about their child acting aggressively at least once over the preceding 12 months.  One research study found that non-compliant behaviour was more frequently expressed a concern at a pediatricians office than physical health concerns.  

However, while a small percent (between 1-9% have more persistently and troubling challenging behaviour and meet the criteria for an oppositional defiant or conduct disorder), challenging behaviour generally reduces in frequency and severity gradually over time. 

There are many ways parents can help children and teens through this process.

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Friendly Conversations

Friendly Conversations

One of the important questions I ask the children and teens I work with is this: “would you please tell me about your friends”.    

This question sometimes surprises families. Having made an appointment to see a psychologist they are expecting questions about feelings, emotions and life challenges, and not necessarily those about who they hang out with.  But it’s essential for me to know about young people’s friendships because research shows peer relationships are vital to children and teen’s positive mental health.

For example, studies show that children and teens with good friendships record higher levels of happiness than children and teens without these friendships.  Other studies show that young people with positive peer relationships are less likely to act in disruptive and challenging ways.  Other studies suggest that young people with positive peer relationships are more likely than others to achieve better educational outcomes.  There have also been numerous studies suggesting young people who experience genuine bullying (i.e. not just “unkind” behavior) are more likely to experience mental health issues as adults.

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I Can’t Stop It! Tics and Twitches in Children and Teens

I Can’t Stop It!  Tics and Twitches in Children and Teens

12 year old Tyler* and his mum came to visit us concerned about something they called his “twitch”.   To show me what they were talking about, they bought along an iphone video of Tyler playing his xbox while this twitch was happening.  Basically Tyler’s “twitch” consisted of him tightening up one half of his face in a tight wink while swallowing hard at the same time.  This had been increasingly happening to Tyler for several months.  Now it would happen for hours at a time while playing his game, and also at times of stress at school.  Tyler felt embarrassed about it, and his Mum felt worried for him – their GP had recommended they come and see us.

As you probably know, Tyler’s “twitch” is usually called a “tic”.  Tics are defined in the DSMV as a “sudden, rapid, recurrent, nonrhythmic motor movement or vocalization.”  Tics can be simple – involving just one movement/noise – or complex – which are movements or vocalisations which involve a range of actions/noises.

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My child is "addicted to screens": Working with families with concerns about technology use in their child

My child is "addicted to screens":  Working with families with concerns about technology use in their child

One of the most common stressors for parents/caregivers in 2018 is managing their children's device or technology usage.  This is true for all families, but particularly true for children with behavioural, social and emotional challenges.  It can be particularly difficult for these families because:

  • Children are sometimes managing their distress/overload/stressors by using screens/devices/gaming to cope

  • Parents/caregivers of these children are dealing with more stress than average and find it hard to have the emotional resources required in managing this issue

  • These children are more likely to experience strong frustration and disappointment 

It's not surprising then that putting limits on these activities is extremely difficult for parents/caregivers and children.  Most parents understand they need to do this – but it’s one of the hardest issues parents face.

As professionals, we will often hear (if we work with parents/caregivers directly) about this distress.  Here are statements commonly heard:

  • I can't get my children off screens

  • Is he/she addicted?

  • What do you suggest? What can we do to reduce his/her gaming?

  • I'm sure that you know as well as I do that there are no easy answers. Unfortunately as professionals parents are often desperate for help, and it can be tough working with these families when we don't have any quick/easy fixes for them.

As with all issues in this job, I remind myself that there is no "one size fits all" solution.  I feel my role is to not give advice about this topic but instead work through various options with families. 

I start by asking many questions of parents/caregivers to help them identify their biggest concerns, previous strategies and what they most want from me.  For example:

  • How much/when/what is your child doing on devices?

  • What are the different concerns you have about device/tech use (getting at least 3 or 4 specific problems - ie not enough sleep, exposure to violence, potentially increasing defiance, sibling conflict, no creative activities etc etc)

  • If you had to choose 2 of these which concerned you most, what would they be?

  • Is there anything you'd like me to do/What would you most like my support with?

  • Do you have specific questions for me about this topic?

  • What have you tried?

  • What has worked to some degree, and for how long?

  • What else have you considered (in terms of their response/ways of managing) - and what makes it hard to do this?

  • What do you think is the next step?

I tell parents/caregivers that there are a range of different ways families manage this issue, and encourage them to experiment with these approaches to see what works best for their family.  

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Working with teens (and pre-teens) with emotional challenges: and thinking about their "rude" behaviour

Working with teens (and pre-teens) with emotional challenges: and thinking about their "rude" behaviour

Recently I was talking with a Mum, Taylor* who was despairing about the rudeness of her 15 year old daughter, Jess.  Jess was seeing us for support in managing her anxiety disorder and perfectionism, and I was talking with Taylor about how she was going with supporting her.  Taylor raised the problem of Jess’ rude behaviour at home.  She said Jess was polite and friendly to her teachers and friends, but this ended as soon as she walked in the door at home.  According to Taylor, Jess would often rudely make demands, grunt when she was asked questions or sometimes just ignore her.  Taylor knew Jess was dealing with difficult emotions – but she felt unappreciated, resentful – and worried about how this would affect her and her daughter in the future.

If you work with teens (or pre-teen), you may be nodding along – it’s not uncommon for teens to be surly, rude and disrespectful.    And this is especially true for teens or preteens who are dealing with difficult life situation, emotional or mental health challenges.  Let’s look at the main causes of rude behaviour in these teens.

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Working with the sad child:  tearfulness, sadness and depression in primary aged children

Working with the sad child:  tearfulness, sadness and depression in primary aged children

If you ask parents what they most want for their child, many will say something like this:  “I just want my child to be happy”.  Whilst most of them know, at a logical level, that they can’t make this happen, seeing their children frequently or deeply sad, is very confronting.

This is true for us as professionals too.  While we may be quite used to supporting and working with children who are anxious, frequently frustrated and disappointed, and know the steps to take in helping children manage these other emotions, there is something additionally challenging about working with a child who appears frequently or deeply sad.   

It is also challenging to work with parents of these children.  Often parents who have children who experience frequent or strong sadness themselves feel helpless, frustrated, worried – and like a failure at some very deep level.   Sometimes they express their pain in being particularly demanding towards us.  This then leads to even more pressure for us as professionals to “do something”!

However, the truth is - it is not uncommon for children to experience times of sadness.   Although only about 2-3% of prepubertal children will experience the type and extent of sadness psychologists will diagnose as a formal depressive disorder, many more children experience slightly less severe – but still persistent and frequent – sadness at some point during their childhood.

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Working with Tired Young People: 12 "sleep facts" to Tell Kids and Teens about Sleep in the Therapy/Classroom

Working with Tired Young People: 12 "sleep facts" to Tell Kids and Teens about Sleep in the Therapy/Classroom

As a professional working with children and teens, I see tired and sleepy children and teens in schools and in the therapy room almost every single day.   Research suggest that between 25 and 75% of young people are sleep deprived.  This is a wide variation - it seems to depend on how you ask the question and who you ask - but even if we take the middle figure, the suggestion that half of the next generation don't get enough sleep is concerning.  I haven’t seen longitudinal research on this but it seems to me that sleep deprivation in children and teens has become more prevalent over the past 20 years.

Given the significant effects of sleep deprivation on educational and psychological outcomes, I think it is important we continue to work on helping children and teens get more sleep at home.  Of course partly this needs to happen via parent education.  But I also think there is a role for us as professionals to be educating children and teenagers directly about this issue.

But other than "you need to get more sleep" - what exactly should we be telling them?  What do young people themselves need to know?

Below are what I believe to be the 12 most important sleep concepts young people should know and ways of phrasing them so that young people understand.

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“I can’t do it” - Working with children/teens who lack confidence in their ability to complete academic or learning tasks

“I can’t do it”  - Working with children/teens who lack confidence in their ability to complete academic or learning tasks

How many times have you heard a student say “I can’t do it!” or “It’s too hard?” or “I’m not smart enough?” 

Unfortunately, there are some students who really struggle with anxiety about their ability to complete learning, homework or other study tasks.  We can call this low academic confidence.

Although many students experience a lack of academic confidence at times, statistically it is more likely to be girls who experience it most frequently – and particular girls who are surrounded by “academically high achieving” peers.

Unfortunately when students don’t believe they are capable of learning something or completing a task – then they are less likely to do so, regardless of their actual level of ability.  And a chronic lack of confidence and anxiety about learning is associated with higher levels of stress.

I often talk with families who are really struggling with this issue at homework times.   For students who feel highly anxious about their ability to understand ideas and complete tasks, homework can be a nightmare.  Parents/caregivers have to reassure, cajole, support and mop up tears – and often get really stressed themselves.  Some research on homework has indicated that homework time is the most stressful time of the day for families – with one study showing that mothers daily mood ratings are worse on the days when they spend more time around teens/children who are doing homework.

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Supporting Children’s Social Skills – Good Game Playing without the Drama

Supporting Children’s Social Skills – Good Game Playing without the Drama

As professionals working with kids we know that children learn a great deal from “playing” with each other.   They learn to interact socially, learn about their environment and how the world works.  It is important for children to have unstructured time to play together without adults directing the action.

Unfortunately we also know that there are some children who often struggle with this unstructured play.  Arguments and fights develop quickly and get out of hand.  Some children find it really difficult to resolve problems among themselves.

In my experience, these children really benefit from us supporting them with these skills.  Here are some of the ways I work with children in this area.

1. Ask children questions about their game playing

Given the importance of game playing skills, when I'm working with kids I routinely ask about their recess/lunch/after school play with their siblings and friends.  For example here are some questions which might be useful to ask children (either in a classroom situation, written “playtime quiz” or when working with children one on one: 

Who are you playing with at the moment? 
What games are you playing? 
When was the last time you/your friend got mad during those games? 
What happened?
What are you good at when playing with friends?
When do you need an adult’s help when playing with friends/siblings?

Once we are aware of how kids are going with their game playing, we can then look at the kind of skill development needed. 

2. Helping children generate useful “rules” or guidelines to play

Before working on an area with a child, I attempt to see if I can get their permission.  For example, I might say:

"Could we do some brainstorming together to make playing games more fun?"

I then ask children to think about specific games they play rather than “playing” in general.   If parents are working with me – I’ll ask parents to help identify games they know the child/their siblings play together.

For example: 

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End of Year Learning: Helping Young People Self-Reflect in Class/Counselling Sessions at the end of the school year

End of Year Learning:  Helping Young People Self-Reflect in Class/Counselling Sessions at the end of the school year

These days part of my role involves supporting a team of people to work it with young people.  This means I get to read delightful publications such as the Harvard Business Review - something I never imagined myself doing many years ago!  However it seems I can't take off my "clinical psychologist hat" - while I'm reading these articles thoughts often come to mind about how the concepts apply to working with young people directly.

For instance, I've just been reading about what organisational psychologists call: "Post implementation reviews" which from my (albeit limited) understanding thus far seem to be the process of reviewing a project with a team after it is completed.  From the length of the article I'm assuming there must be more to them than this (?) but apparently doing a PIR (yes - there is an acronym :)) after the completion of a project significantly improves the performance of the team in their next project, even if the projects are unrelated.

This has made me think about the "PIR's" we do as professionals with children and teens about their school year.  As it draws to a close, I regularly spend time with the young people I work with asking them to reflect on what the year was like for them and what they'd like to do next year.  I believe these conversations often help them - socially, emotionally and academically - in the following year.

If you are working with children/teens in a classroom setting, or in a counselling room, it might be worth putting some time aside to help them self-reflect on their year.

Here's how to do your own PIR (see, now it's part of your vocab too) with child/teens you work with. 

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Working with children with anxiety

Working with children with anxiety

’ve just looked at our clinic calendars and despite us seeing 200 young people this week, our waiting lists for new clients are currently stretching out to around 2-3 months.  More than ever, there are children and young people facing challenges – and families who are looking for support and answers.

One of the major issues facing young people is anxiety.  Anxiety is the most commonly diagnosed mental health condition in children – and certainly it makes up a large proportion of the families who work with us.

Unfortunately, services can’t always keep up with demand for services in supporting kids with this issue – and getting help for children and young people who experience anxiety can take some time.

The good news is that supporting children to manage anxiety doesn't always *need* a psychologist.  Parents and carers, teachers and other professionals can be very effective at helping children manage anxiety and increase their confidence.  

Here are a few ideas all adults (including psychologists, as well as teachers, health professionals, parents and carers) might find useful in supporting children with anxiety.

1.      Focus on increasing brave and confident behaviour

The part of our brain which monitors threat takes notice of our body language, how we act, speak and where we go and don't go.  It then uses this information to help gauge how much threat we are actually experiencing.  When we ACT in brave and confident ways, our brain says "huh, everything must be okay" - and gradually we FEEL more confident.  When we ACT in brave and confident ways, we have experiences which tell us we can cope.  Brave and confident behaviour helps us feel less anxious.

This is true for children too.  The more we a child/teen acts in brave and confident ways, the less anxious they will feel.

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Calm Sentence Starter Resource for kids/teens with "big feelings"

Calm Sentence Starter Resource for kids/teens with "big feelings"

This week I've felt disappointed and worried about various situations.  One of my kids was sick and I was worried about him.  I had a disagreement with my partner and felt frustrated. I felt overwhelmed by my task list at work.

In other words, I'm a (fairly :)) normal human being who had a pretty normal week.  As humans, we all experience difficult times - and negative emotions - most of us at least weekly, if not every day.

One of the strategies most adults instinctively use to cope with these negative emotions is to generate calm, reassuring and positive sentences to say to ourselves to give us another perspective on our situation.   

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Supporting children through separation/family changes (handout for professionals)

Supporting children through separation/family changes (handout for professionals)

An article published by the Australian Psychological Society in 2009 estimated that 50,000 children in Australia each year experience separation and divorce each year.  This means as professionals who work with children, we are likely to have many children in our classrooms and therapy rooms who are experiencing this life change at any one time.  

Obviously there is a great deal of variety in how these children manage.  Some of them find the experience pretty hard going for a while. They might feel sad, worried about the future, irritated, guilty or frustrated.  Sometimes these feelings creep out as tricky behaviour, becoming "clingy", crying, "acting out", getting more frustrated than normal, anxious behaviour or struggles at school.

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