Therapist #stresses #importance of #asking #kids ‘How are you?’

Janice Mitchell is a senior clinical director and licensed clinical social worker with the Center for Human Development.

Mitchell was asked about mental health issues middle- and high-school students face as they develop.

The Public Health Institute of Western Massachusetts recently surveyed some 1,277 Springfield Public Schools eighth graders about their feelings, including suicidal thoughts, and whom they turn to for help when feeling sad or hopeless.

What feelings and range of feelings are normal for middle school students?

Middle school students basically do not feel good about themselves. Mood fluctuations range from low feelings of depression to using cutting as a relief to suicidal ideation (thoughts). Anger and rage can also manifest in kids this age.

What types of issues may they be dealing with that are a normal part of growing and how may this impact their feelings and their behavior?

Peer pressure, bullying or being victims of bullying, parental relational issues resulting from the push pull of control between parents and children, using drugs or not using drugs, having sex or not having sex.

What might cause a middle-schooler to engage in behavior or having feelings that are not really in what may be a normal range, and how might this manifest?

Issues at home can cause a person of this age to act out. Poor parenting, domestic violence in the home, any type of abuse would impact behaviors negatively. Parentification of a child can have a negative impact. (Child takes on the role of caregiver.) Sibling group issues at home. Being a target for bullies in the school and not being able to report for fear of reprisal.

A parent/guardian has to create an environment of safe communication with their child. There has to be an understanding that the parent /guardian will have the back of the child. If the case is more that the child doesn’t disclose a problem but the parent finds out through other sources, then the parent needs to directly speak to the child to verify. I think the key here is to create a viable support system for the child which begins with the family.

  How might a teacher deal with behavioral/emotional issues?

Teachers need to attend to the dynamics in their environment and not look the other way. Too often teachers are too busy. Teachers need to have a support network to which they can refer when issues or behaviors come up. This would include the parents, the school system itself and often, the police. Usually there are police in the schools. They are a resource.

When would therapy be advised? And how might a parent introduce the idea of therapy to a middle-schooler and how difficult a step is this for a middle-schooler?

Therapy is, more often than not, a difficult step for the child. The difficulty would lie in being singled out, the stigma of being a person who “needs” therapy: all of this just adds to the onerous task of being that age. It is also a difficult concept for the parent. I would advise therapy when all other supports have been exhausted. Often we use In Home Therapy which is a team that goes into the home to evaluate the situation. They also go into the schools. They can advocate for the child and do the work that can be done in the home. It is a good starting point for everyone.

How might therapy start to take effect for a middle-schooler?

Therapy will start to take effect when a connection has been made with the treating therapist.

How early do children start to identify with a gender and how early may they need support for that and what kind of support?

Gender identity begins very early. Children are socialized by gender; if you are a little girl, you are socialized in that direction; same with a boy. I think when a parent notices a disruption in that gender socialization then there is reason to be observant. I don’t think a rush to judgement is necessary.

We live in a world where all of this is so sensationalized that I think often, parents jump into the fray prematurely. Supports begin within the family: children who are confused by gender identity issues need to feel safe talking to a parent/guardian. Again, it is difficult enough to be this age never mind to be this age with problems you cannot go to anyone about. Schools have groups for kids with identity issues and there may be peer groups found in other social service agencies.

What kind of support does any child need in terms of coping with being bullied?

Bullying is the worst. Kids who are bullied need to be able to tell someone and have that person or persons seriously look into the problem. Often, schools and parents do not deal well with this issue and it can be worse for a kid to report bullying and have nothing done about it. With social media this investigation and resolution has got to be followed through on by parents, schools and police.

What happens when a child goes onto high school with mental health issues?

When a child goes on to high school with mental health issues, I believe one of two things can happen. Generally speaking middle school is the worst arena for kids. The problems tend to be exacerbated by the environment. If a kid makes it through the middle school years with issues and problems that have allowed a good solid support network to build up, then escape into high school may end up being a relief. That is the best case scenario.

Worst case scenario is that the issues which impacted the kid in middle school were not adequately resolved, a good support network was not available and generally, nothing changed for the better. This will result in problems. The kid might choose to use cutting to relieve psychic pain, drugs, alcohol, sex, criminal behaviors such as stealing or vandalism and last but not least, suicidal intent or ideation. For many years now, we have witnessed the devastation in schools caused by the use of weapons against peers, teachers, parents and caregivers.

Similarly, what types of issues arise in high school that may affect a teen’s emotions and behavior and how does this start to migrate out of a normal range?

Anything can affect the emotions of a teenager. Raging hormones for one thing: the roller coaster ride that is high school. Teenagers are faced with myriad choices, good and bad. I think the peer group can do a lot to either mitigate these feelings and choices or exacerbate them.

Some of the precursors to these moods and feeling can be popularity, or lack thereof, competition for good grades and good schools, the pressure to succeed and the pressure to survive. Not having strong connections or ties with peers with similar, mutually shared interests.

How can parents/teachers be better at recognizing and addressing when teen behavior is becoming troublesome?

Parents and teachers need to address the changes as they see them. They not only need to address them but there needs to be resolution of the problem. Ignoring these changes will not make them go away.

How can teens better recognize when their feelings and behavior are starting to interfere with their relationships and accomplishments?

Teens are not famous for being insightful so suggesting that insight into their feelings and behavior is mostly wishful thinking. It goes back to home and safety. A teenager can identify when something has changed for them but they may not be able to clearly articulate that to a parent or a teacher. If the home is not supportive then the individual may not have a place to start. I think that an acknowledgement of the changes has to come first but that is a learned behavior built out of being able to trust someone.

How much do issues of homelessness and substance and domestic abuse in the home impact young people and in what way?

Homelessness, substance abuse, domestic abuse, basically abuse of any type, is going to significantly impact a teenager. Home should be a safe place and if it is not then we had all better hope that the teen has found safety somewhere. Resiliency is built through adversity but too much adversity can totally destroy a person of that age. Toxic stress can have a lifelong impact when it’s neglected and not addressed.

What more needs to be done?

A more open and consistent dialogue about the importance of asking the young people in our lives a simple question: How are you? And not just simply asking, but listening to their responses. Actively listening for those opportunities to talk with children about how they are feeling emotionally. Are they stressed, anxious, worried about things at school, concerned about what may be happening at home.

The more we ask the question, ‘How are you?,’ the more responsive and supportive we are being to our youth who may need emotional support and guidance. It is a simple question we ask each other every day in passing, but if we asked it and really listened to what our children tell us, we could be more aware of their feelings and more involved in seeking assistance.

There is no weakness associated with finding help for emotional wellness. In fact, those who recognize a need for counseling or therapy services are actually strong. Strong because they are advocating for themselves or their loved ones in wanting them to feel better.