Mental health: When is there a problem?

Sara* had always been shy, but nothing that worried her parents, Louise and Brian Briscoe* of Mississauga, Ont. After all, they had both been shy as kids too. But, by the time she was 10, Sara was avoiding friends, wetting the bed and worrying she might be abducted from her home.

Sara’s anxiety first showed itself at age three. While on a camping trip, the family was caught in a severe thunderstorm that blew away the tents. From then on, Sara would cry and shake uncontrollably whenever a thunderstorm approached. “I knew this wasn’t the norm, but I didn’t think it was anything to worry about,” says Louise.

As Sara began seeing less and less of her friends through elementary school, Louise blamed the other girls for “being mean and excluding her.” Looking back now, she understands that this was the beginning of Sara’s withdrawal from her peers. Still, Louise recalls, “we thought it was natural for her to be shy and that she would just grow out of it.”

The year Sara turned 10 was a tumultuous time for the Briscoe family. Louise’s father was diagnosed with terminal cancer. Then Louise needed surgery to remove a tumour from her spinal cord. There was a chance she would never walk again. (Fortunately, she made a full recovery.)
External events played a part too. A police officer came to Sara’s school to talk about stranger awareness. For other students, this was an important learning opportunity. For Sara, it was terrifying. What’s more, the remains of nine-year-old Cecilia Zhang (abducted from her Toronto home in 2003) had been found in a wooded area near the Briscoes’ home. “Sara started to worry that what had happened to Cecilia might happen to her,” says Louise.

Sara’s growing anxiety was a concern to her parents, but they hadn’t yet considered it to be a sign of a mental disorder. This is not unusual, according to Stan Kutcher, a professor of psychiatry at Dalhousie University in Halifax and an internationally renowned expert in adolescent mental health. It can be really hard to tell the difference between “normal” changes as kids grow and a mental health problem. “Doctors even have trouble with it,” says Kutcher. Hitting and biting, changes in sleeping and eating, even withdrawing from friends — all of these could simply be part of growing up, or the signs of something serious.

Seeing — and admitting— that your child may have a mental health problem can be hard for other reasons too. Take family dynamics: One parent may be concerned, while the other may brush it off. Denial is common — the stigma of mental illness looms large and some parents can’t bring themselves to admit their child has a problem. It can also be hard to evaluate your kid objectively. “We were too close to really see what was going on,” says Louise.

So how can you determine if your child is suffering from more than just the usual “growing pains”?

Be alert to symptoms

Mental health disorders affect 15 to 20 percent of Canadian kids, and most show up before 25 years of age. Disorders manifest in different ways, but here are some symptoms to watch for:

• big changes in sleeping or eating patterns
• excessive fear, sadness or anxiety
• declining school performance
• avoiding people or places not previously avoided
• withdrawing from peers
• constant complaints of physical problems, such as headaches or stomach aches
• more aggressive behaviour
• marked hyperactivity or fidgeting not appropriate for the child’s age
• continual disobedience and opposition to authority
• disregard for other’s feelings or property

Intensity and duration are important. “The problems, whatever they are, are more likely to lead to a disorder if they’re intense and of long duration — three to six weeks or more,” says Kutcher. Just one symptom that is intense and long-lasting can indicate a problem. With two or more, a serious issue is even more likely.

For Sara Briscoe’s family, her symptoms finally made it clear something was very wrong. “Sara didn’t want to play with anybody or do anything. All she would do was watch TV,” says Louise. She couldn’t handle any change in her routine — a family trip the summer she was 10 proved too much for Sara. She couldn’t sleep, wet the bed and didn’t want to venture outside the hotel room. Frequent conflicts with her mother ended in bouts of screaming. She was sad and cried often. Later, she developed repetitive behaviours — opening and closing doors, obsessive counting, walking in and out of a room over and over again.

Look at family history

A family history of a mental health disorder greatly increases the risk (though doesn’t guarantee) that your child will develop the disorder. And a family history can give you greater insight into the symptoms your child may be experiencing. According to Kutcher, one set of symptoms in a child who has no family history of a mental health disorder may not be a worry. But the same symptoms in a child with a family history would raise a red flag.

Talk about your concerns

Try to confirm your observations with your child. Choose a time when she’s most likely to talk, perhaps in the car or at bedtime. Stop whatever you’re doing and listen and, even if it’s difficult to hear, let her finish before responding. Repeat what you hear to make sure you understand what she’s said.

Just starting the conversation can be the hardest part. “Parents are often fearful, so they come across as challenging, confrontational or accusatory,” says Ellen Katz, coordinator of social work education and senior clinician with The Hincks-Dellcrest Centre, a children’s mental health centre in Toronto. “It’s much better to come from a place of empathy and concern.” You might try this approach: “I love you so much and I’ve noticed some issues that I’m worried about. I may be totally off-base, but I’d like to talk.” Depending on the age and temperament of your child, this tactic may or may not work.

Children who can’t open up will need help navigating their emotions and putting a name to what they’re actually feeling. Start with any physical sensations your kid might have complained about. Katz suggests this approach: “You seem to be having a sore tummy a lot lately. Sometimes when kids feel this way, they’re feeling worried. I’m wondering if you might be worried about something.”

Don’t forget to touch base with other adults in your child’s life to see how the child is feeling and acting outside the home. Is she getting along with kids on her swim team? Ask her coach. Does he sit still and concentrate in class? His teacher can tell you.

Seek help

The earlier a mental health disorder is treated, the better for your child. So if you have a concern, act on it. “Take your gut feeling seriously and don’t assume this will necessarily go away on its own or the child will outgrow it,” says Katz. “No problem is too small and no question too minor to be addressed.”

The first call is usually to your family doctor or paediatrician. You might also contact an intake worker at a children’s mental health centre. Wherever you go, be prepared. “Document, document, document,” emphasizes Kutcher. “Don’t go with vague concerns. Be specific about what you’re seeing in your child: My daughter used to be an A+ student, but has become a C- student in the past few months; or my son rarely cried before, but now cries three times a day.”

Once you get help, be sure your concerns are taken seriously. “You know your child better than any health professional,” says Kutcher. If your concerns are dismissed, get a second opinion. Get your doctor to recommend someone or tap into trusted family and friends for suggestions.

Fortunately for the Briscoe family, their family doctor was receptive and referred Sara to a psychologist. Visits to a psychiatrist and social worker followed. Sara was then diagnosed with obsessive-compulsive disorder (OCD) — a type of anxiety disorder — and treated with a combination of talk therapies (cognitive behavioural therapy and role-playing) as well as anti-anxiety medication.

Today, Sara’s OCD is well controlled, although she continues to struggle with social situations and has only one close friend and a few casual school friends. “We’ve come leaps and bounds in the last five years,” says Louise. “But it will be an ongoing challenge.”

In hindsight, she admits Sara’s symptoms started at an early age. “I didn’t pretend that she didn’t have issues, but they were hard to understand at the time.” Louise offers this advice. “If you think your child has an issue, you’re probably right. And it’s probably a lot bigger than you realize. Get help. Don’t wait. Do what’s right for your child.”

*Names changed by request.