Child mental health is an important yet complex topic and talking about it is extremely necessary to support and promote child mental health. However, to talk about child mental health can be challenging for families, child- health and education practitioners, and the general public for many reasons. Among these reasons, lack of knowledge about child development, stigmatisation about mental health problems in childhood, and difficulties to access support and specialised treatment to children stand out in our society. The problem here is that when we can’t talk and access accurate information about a topic, there is little we will be able to do to change it. In this text, I invite you to reflect about these challenges, and learn more about child mental health and how to support and promote your child’s healthy psychological development.
But first, what are mental health problems?
In adults, adolescents, and children, mental health problems are characterised by the presence of a condition affecting their mood/emotions, behaviour and/or thinking. However, for such a condition to be considered a mental health disorder (MHD), its presence has to be persistent and interfere significantly in daily activities and functioning.
Are children affected by mental health problems?
Yes! Overall, half of all MHDs emerge in childhood worldwide. In Australia, data show that one in seven children receive a mental health diagnosis, with the most frequent ones being behavioural and anxiety disorders, attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). Importantly, it is also known that these prevalence rates of MHD in childhood have been increasing over time.
The information above shows that children are frequently impacted by mental health problems. However, the fact that the prevalence rates of mental health problems in childhood are not decreasing also suggests the importance of families, child- health and education practitioners, and the general public to reflect about factors getting in the way of supporting the mental health of children and more effective ways to improve it.
Three challenges to talking about and supporting child mental-health:
Now let’s talk briefly about the three challenges to talking and supporting child mental health I mentioned earlier: Lack of knowledge about child development, stigmatisation about mental health problems in childhood, and difficulties to access support and specialised treatment to children.
1) Lack of knowledge about child development
Be it due to lack of national or regional educational programs, low access to information, or stigmatisation or prejudice, the fact is that not all caregivers, relatives, child- health and education practitioners, and people in the general public feel confident to differentiate developmentally appropriate from abnormal behavioural and emotional characteristics in children.
Just like adults, children also get sad, angry, and anxious in response to environmental and relational adverse or unpleasant circumstances. These are ups and downs of life – and we all have them. In children, however, such ups and downs are even more challenging to resolve for many reasons. For instance, chances are that the child is experiencing the intensity of negative feelings for the first time in their minds and bodies. This means that differently than adults, children need a great deal of support from the environment (i.e.: caregivers, educators) to learn how to get out of and resolve their feelings and anxieties appropriately. Otherwise, as it often happens, child’s attempts of resolving their ups and downs without appropriate guidance from adults will involve aggression, defiance, meltdowns, etc. - as these are primitive stress responses hardwired in our brains to respond to stress through fight or flight mechanisms. Therefore, experiencing negative emotions and anxiety and needing extra help to resolve them is often developmentally appropriated in childhood.
However, there are instances when physical, emotional, and behavioural problems could be signs possibly indicating that the child needs specialised support for their mental health. Examples of these signs are described below.
Physical signs: since birth, the child seems to have trouble to walk, eat, sleep, complete toilet training, or speak appropriately.
Emotional and behavioural signs: the child shows impulsive or premeditated aggression, inability to learn to regulate their negative emotions, frequent meltdowns, persistent apathy and sadness, extreme distress by initiating new tasks or changing between activities, rigid and repetitive behaviours, difficulty making and/or maintaining friends, inability to remember and follow instructions.
As you can see, differentiating between developmentally appropriated difficulties and signs of mental health problems in children can be challenging because, in the real world, the two may look the same when the child is showing them. And the first can often develop into the latter when children do not receive attentive support from their environment to learn more helpful ways to deal with their ups and downs. In this respect, it is important to observe children closely and respond to their needs in a supportive way. This means seeking information and specialised help, when appropriated - as opposed to dismissing their difficulties for ‘attention-seeking’ or not noticing them.
2) Stigmatisation of mental health problems in childhood
Overall, stigmatisation about mental health is problematic because it increases symptoms in children and gets adults stuck in fear and judgement, therefore preventing them from seeking help. Stigmatisation about children with mental health problems occurs in three levels:
Level 1 - General public – Much like prejudice, this stigma is rooted in fear and lack of knowledge about mental health problems. Consequently, it is the cause of people’s negative attitudes toward children with mental health problems. Such attitudes are negative because they may include social isolation of the child and their family, and inappropriate labelling the child as “crazy” or “incapable”. They may also occur through using diagnostic terms to refer to children who have not had an official diagnosis asserted by a mental-health practitioner. For example, “he is ADHD”, “she is autistic”, among others. Experiencing such negative attitudes from others may increase confusion about what is really going on for the child. It may also worsen child’s symptoms and possibly generate more problems such as depression and anxiety – if this is not already present.
Level 2 - Caregiver-blaming: This stigma is highly emotional and difficult to overcome because it is rooted in caregiver’s beliefs that having the child under your care diagnosed with a mental health condition indicates you have failed as a caregiver. As a result, many caregivers do not seek support or treatment for problems they see in their child because an eventual confirmation of a MHD will increase and expose their feelings of failure - not only to themselves, but also to relevant others in their circle, and society.
Level 3 - Self stigmatisation: This stigma feeds from the two stigmas described above because the child receives inaccurate and/or negatively biased information from their caregivers and others about their mental health condition. This may result in feelings of shame, fear of judgement, and rejection that may get in the way of them engaging in treatment, learning, and developing appropriately. These feelings could potentially become negative beliefs about their identity, therefore increasing and perpetuating their mental health problems.
3) Difficulties to access support and specialised treatment to children
Overall, Australia is great in planning and providing mental health support for children with development of evidence-based interventions and specialised services available. However, studies have also shown that a good portion of caregivers and the general public do not know what/where these are or how to access them. This results in a general feeling of lack of services available at reach, which also seems to be among the main reasons children do not get treated for MHD during childhood years.
Daily things we all can do to support and promote child’s healthy psychological development:
Of course, child mental health promotion can be quite complex and involve families, community, health services, and educational institutions. However, on an individual level, there are also things that you can do daily to promote healthy psychological development of children under your care. I have listed some of those things below.
Observe and talk to your child about their emotions and behaviours:
Children need help with the basics. Observe their emotional and behavioural reactions and talk to them about what you see. Help them name their emotion and find out what triggered them. Expect that they will need your help to build skills and vocabulary to talk about their emotions and reactions.
Promote positive/appropriate behaviour:
Focus on a teaching (as opposed to a punitive) approach to negative/inappropriate behaviour/emotion dysregulation. This is done by taking a few seconds before reprehending your child to think of what you would like them to be doing instead and then communicate it to them. For instance, you could say ‘please come sit next to me’ instead of ‘stop running around’.
Focus on a praise and modelling-based approach to increase frequency of positive/appropriated behaviour/emotion regulation. This is done by intentionally giving attention to small positive behaviours and then praising your child whenever they do things you approve of (i.e.: Child is quiet playing – caregiver says: ‘I love it when you play quietly ‘; Child says please, thank you – caregiver says: ‘great job using your manners’; Child complies right away – caregiver says: ‘thank you for doing what I say straight away, I am proud of you’). Remember, praises are a therapeutical way to increase the frequency of appropriate behaviours.
Make the child’s environment as predictable as possible:
Child mental health needs stability to develop well. So have a house routine (e.g., morning, meals, play, sleep routines) and be consistent. Also, give the child warnings before delivering instructions or changing activities (i.e: in 5 minutes we will eat dinner at the table). Schedule resting times after school or homework with relaxing activities that the child enjoys. Finally, keep an eye in how you and other people around the child react to negative feelings and interpersonal relationships, strong negative reactions that are unpredictable cause children to feel unsafe and trigger anxiety and stress reactions.
Finally, keep it in mind that having a child under your care that is showing mental health problems is no one’s fault. So, attend to signs of physical, emotional, behavioural, and social struggles and, if these last more than a couple of weeks and start interfering in their daily life, seek help!
Reference and more information about the topic in the texts below:
Kessler RC, Berglund P, Demler O, et al. (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62: 593–602.
Lawrence D, Johnson S, Hafekost J, et al. (2015) The Mental Health of Children and Adolescents. Report on the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra, ACT, Australia. Available at: www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-m-child2 (accessed 10 January 2018).
Lebowitz MS, Rosenthal JE, Ahn W (2016) Effects of biological versus psychosocial explanations on stigmatization of children with ADHD. Journal of Attention Disorders 20: 240–250.
Pescosolido BA, Perry BL, Martin JK, et al. (2007) Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness. Psychiatric Services 58: 613–618.
Sawyer MG, Reece CE, Sawyer AC, et al. (2018b) Has the prevalence of child and adolescent mental disorders in Australia changed between 1998 and 2013–14? Journal of the American Academy of Child & Adolescent Psychiatry 5: 343–350.
More about Australia’s national strategy to support children mental health in https://www.mentalhealthcommission.gov.au/projects/childrens-strategy
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