I was watching an episode of The Good Wife the other night (I know, as usual about a decade behind the times) and there was a discussion about the way some people say “sorry” when they accidentally bump into someone in the stress and others say “hey, watch out!”.

It reminded me of a topic I’ve been doing a lot of thinking and reading about lately – the relationship between cognitive appraisal and attributional style in children and their subsequent behaviour.  In other words the way children think about arguments, problems or difficult situations with their peers and the way this influences how they act either angrily or calmly to these problems. 

For those who need a quick recap, this area of research started back in 1980 when a few pioneering psychologists (eg William Nasby, Ken Dodge and Nicki Crick in particular) started a series of experiments in which they showed children pictures of or told them stories about hypothetical problems with peers – for example someone getting knocked over in a game – and then asked them to say whether they thought another child had done this deliberately and intentionally or whether it had been an accident.

Have you talked to an angry/worried/upset child or teen today?

If you are a child mental health or education professional probably the answer to this is (using the words of my 11 year old): "duh!"

A significant part of our work with young people (the exact amount depends on our role of course) requires us to hear young people tell us about something distressing. 

They might be frustrated about something which has happened, worried about something coming up, annoyed by something they think is unfair, sad about something which has happened, jealous of someone else, embarrassed by an event - and so on.

I find it interesting to notice my reactions when young people tell us about their distress.   Despite many, many years of working in this role I still notice my instinct to want to just "fix it fast" when I hear children's distress.  This is not surprising perhaps - there are so many pressures - time constraints, professional roles, parental expectations - for me to make this child/teen feel better as quickly as possible.

Tricky question 7181# :  You’ve just talked to a parent who has a child who has just been diagnosed with a physical, mental health, emotional or learning disability and he/she says to you:  what should I say about this to my child? 

Or perhaps you work with small groups or classes of children in which some have a mental health/learning/health diagnosis (known about and observed by others in the group) – and one of them asks you:  “Why is Jodie like that?”

10% of young people are diagnosed with a physical disability and up to 20% with a mental health diagnosis during their childhood and adolescence.  Many more young people don’t have a formal diagnosis per se but have tough struggles in a particular area (learning, social, mental health, physical health). 

It’s not surprising therefore that as professionals one of the issues we need to grapple with is the issue of talking about challenges and diagnoses to children and young people.

In Australia, around 10% of children have a physical, cognitive or mental disability or disorder.  This means as professionals who work with children it is very likely we will have worked with hundreds of children/adolescents with:

• a speech or language disorder or disability

• autism spectrum disorder

• a significant learning disorder or dyslexia,

• a hearing or visual impairment

• attention deficit/hyperactivity Disorder

• a chronic health condition leading to physical disabilities

• and many others

Supporting these children and teens – in clinics, at school, extra-curricular or in home settings- as they overcome, cope (or struggle) with the various hurdles associated with their disabilities is incredibly meaningful and challenging work.  It makes us think harder, work harder and be more creative, compassionate and persistent than when we are working with children without these disabilities.  Despite its challenges - I love this work.

9 year old David comes home from school and told his Mum that his friend said him he was a loser in front of a group of friends. 

15 year old (in tears) Talia has her Dad pick her up from a party because a girl in another class told someone she likes her friend’s boyfriend. 

6 year old Joseph tells grandma that he hates school because the other kids try not to not play with him.

If you’ve worked with young people for any length of time, you will know of course that kids and teens have negative experiences with other children and young people very frequently.  From the age of 4 (when physical aggression starts to decrease) feeling hurt, frustrated, distressed and disappointed when interacting with friends and classmates becomes increasingly common. 

For example, one study found that children report having a conflict with one of their good friends approximately once per fortnight.  Another study found that approximately 60% of children and teens report having a “mutual enemy” (someone they dislike and who dislikes them) which presumably is associated with at least some negative interactions.  Other studies find that - depending on how you ask the question - 1 in 4 children/young people say they have experienced “bullying” during their primary or secondary years

A few months ago I was working with a 10 year old girl I’ll call Jennifer (as always, names and details changed). I was initially working with Jennifer on helping her reduce her anxiety about being around her peers.   However something else which was quite noticeable about Jennifer’s challenges was this:  she struggled to show almost any positive emotion.  Jennifer rarely smiled in sessions, and despite me doing a great deal of play, games and rapport building with her, found it almost impossible to talk positively or enthusiastically about any of her interests.   

When I asked Jennifer’s Mum about how she acted at home,  she told me that Jennifer frequently looked unhappy or anxious at school and around other children too – and had been like this for some time.   

I’m sure you’ve noticed in your work with children that some of them smile less frequently, and/or show less enjoyment, interest, excitement or happiness in their words or faces than other kids.  They have a “blank”, sad or worried expression on their face a lot of the time, often stay quiet when something positive happens to them, or talk much less enthusiastically or positively about their interests compared to other children. 

When I’m working with some young people, it almost feels like I can actually hear their internal threat detection alarm systems blaring saying : Run! Fight! Freeze! They don’t feel safe, relaxed or comfortable at any point in the day. It’s no wonder many of these children “self medicate” (gaming, agitated behaviour, anger attacks etc).

Do you work with children like this? There’s an inherent palpable tension about them and you can just sense that from an evolutionary perspective their body is gearing up to fight a battle.

As I’m sure you do, I’ve spent lots of time explaining the “fight/flight/freeze” response to children and parents (see the bottom of this page for a free article you can download and give to parents). I think it is really important for children/teens and their parents to know that when they are highly distressed, frustrated or angry, in the short term - their brain is not going to be able to think, communicate, remember complex information or explain ideas is reduced.    This can help parents/caregivers avoid trying to teach important lessons or have important conversations when young people are highly distressed. It can also help children/teens to know they need to take a break when this is happening for them.

It’s also important for parents/caregivers to know that if their child/teen has a high level of tension in the long term, is also going to lead to ongoing physical, emotional and cognitive problems (eg anxiety, headaches and stomache aches, muscle soreness, attention and learning problems, sleep problems). This can help increase compassion and understanding, and help motivate them to think about what they can do to tackle this problem.

But awareness is only the first step - we also want to help children/teens reduce their physiological tension. Traditionally psychologists, well-being co-ordinators, counsellors and teachers have used relaxation programs to help young people do this.

But do these programs work?

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.

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.

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.

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.  

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.

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.