If you work in mental health with young people it will be no surprise to you that anxiety disorders in young people are common – although it is less common than the “self reported symptoms of anxiety” in young people (up to half of all kids and teens) – research suggests it is still a full 20% of kids and teens who meet the criteria for an anxiety disorder (GAD, Separation Anxiety Disorder, Social Anxiety Disorder or Specific Phobias).  A further estimated 5-10% of children and teens meet the criteria for a diagnosis of Obsessive-compulsive disorder. 

In the context of parenting, “using negative consequences” (sometimes called “punishment”) refers to a caregiver responding to a child’s challenging or disruptive behaviour by facilitating an ‘unpleasant experience’ of some kind for the child, with the intention that this will reduce that behaviour over time.  As professionals working in child mental health, this is a topic much debated and discussed!  This article addresses first how the use of parental punishments and negative consequences have been viewed by society and child psychologists throughout history, and second what modern day research may suggest about both the effectiveness of parents using punishments in changing children’s behaviour – as well as the potential harm they may do to children or parent/child relationships…

There are a multitude of inter-related factors of course which contribute to the mental and emotional health challenges of children and young people and it is very rare that any single individual factor is “the” reason as to why a child or young person experiences these difficulties. 

However, for us as professionals working in child/teen mental health - understanding and addressing possible individual contributing factors still has the potential for us to help improve mental health in the young people we work with.

Autonomy-supportive parenting (ASP) is a style of caregiving that emphasizes the nurturing of a child or young person’s ability to make their own choices, be self-reliant, and develop their own values and interests which guide their behaviours.

The first reference to ‘psychological autonomy’ with regards to parenting came from a series of studies in the 60’s conducted by Earl Schaefer and colleagues.  This group of researchers identified a group of negative, controlling parenting behaviours - such as inducing guilt, shaming and providing love only when children acted in certain ways – and created a scale to measure the extent of these behaviours in parents.  They labelled one end of this scale as “psychological control” and the other end as “psychological autonomy”.  It should be noted these authors didn’t actually define psychological autonomy nor even identify specific psychologically autonomy supportive behaviours but this initial thinking on this topic served as an introduction to the idea of autonomy support…

Emotion recognition can be thought of as the ability to identify and understand emotions in other people.  The concept of ‘emotional awareness’ can be thought of a person’s ability to notice and understand their own emotions.  Both emotion recognition and emotional awareness are of course precursors to the more complex skills of effectively managing and responding to emotions (in ourselves or others) which are sometimes referred to as the skills of ‘emotion regulation’…

As mental health professionals working with children and young people, our primary focus is of course on the mental and emotional well-being of the young humans we have the privilege of supporting.  However, anyone who has worked in child/adolescent mental health for more than 3 minutes knows that working with parents and caregivers of young people is also a critical part of our job.  Yet this parent work has many challenges and difficulties – in fact it is sometimes the hardest aspect of what we do.  It can therefore (understandably) be easy at times to deprioritise or delay this work –especially when parents themselves are finding it difficult to engage with us - and prioritise and focus on providing intervention solely to the child or young person instead…

Those of us who work in child and youth mental health meet *parents* (for brevity I’ll use ‘parents’ throughout this article, but I’m referring of course to all primary caregivers, biological parents or not) every week who are struggling with parenting related negative emotions and experiences such as parental stress, guilt, fatigue, frustration, anxiety and overwhelm. There is also a plethora of academic and research literature documenting the existence of these experiences for parents…

Depending on how it is defined and assessed, between 5% and 15% of children and young people have significant difficulties with what might be called “challenging behaviours” – for example, those such as following instructions from adults, verbal or physical aggression, impulsivity, high levels of conflict with peers or siblings, being deceitful, rule breaking and chronic irritability.

Although many private practitioners in Australia choose to not formally diagnose these children and young people with the DSM-5 disorders which have challenging behaviours as some of their primary symptoms (the reasons for this, and the risks and benefits of these diagnoses is outside the scope of this article), there are a number of these disorders which may be useful for us to be aware of when thinking about these young people, including the following…

Children/young people acting in ways which are (at least as perceived by adults) argumentative, aggressive, non-co-operative or deceitful has been labelled in many different ways by psychologists over the last 50 years - “externalizing behaviours”, behaviours of concern and challenging behaviours, to name a few.

Although all children and young people (and adults!) act in these ways sometimes and in some situations, these behaviours typically reduce (or are replaced by more socially acceptable methods of aggression!) gradually as children and young people mature…

Children and teens (like adults) often report thoughts, images and beliefs (internal experiences) which they find distressing (for example: “I’m horrible”; “people think I’m boring”; picturing themselves doing badly on a test).

There are multiple strategies and approaches for supporting young people to manage this type of distressing internal content.  For example, a cognitive behavioural therapy (CBT) approach suggests we help young people understand that these thoughts/beliefs contain errors (thinking mistakes), support them to test or evaluate them and to develop alternative, more helpful or accurate thoughts and beliefs…

Therapy homework (or home practice) has long been a part of mental health treatment for children and families.  It has been understood a variety of ways but can be defined as ‘tasks assigned to clients to promote skill acquisition between treatment sessions’ (Dozois, 2010). 

Homework completion/adherence has also been often studied - either as a standalone behaviour, or part of a group of ‘adherence’ or ‘engagement’ behaviours.  Most of these studies find that higher levels of homework completed – both by parents (parent management training/parent therapeutic interventions) and by children results in better outcomes, as well as lower drop out and higher treatment satisfaction…

What is Behavioural Activation?

Behavioural activation (BA) is a psychological treatment (or treatment component) which aims to help people understand the positive impact of particular activities on their mood, and to increase the frequency with which they engage in these activities. BA also ensures that these activities are valued, rewarding, and are completed even in the face of barriers - as therefore the protocol includes psycho-education, activity monitoring, values assessment, contingency management and problem solving skills…

One of the joys and privileges for mental health professionals working with children and young people is meeting a new young person/family for the first time and having them share their “story” with us.

However, there are also significant challenges for us in this first meeting (or assessment/session). We need to:

1. Undertake an appropriately thorough informed consent process (ensuring families know what we and our services do/don’t do, understand records, confidentiality, rights and responsibilities, including complexities with permissions/confidentiality with separated families). This can be a complex process so this will be covered in another article…