Recognizing mental health concerns in children

Think Tank podcast

Title: Recognizing mental health concerns in children

Speaker: Amy Hopkins, Clinical Writer and Liason

Amy Hopkins: When your child isn't feeling well, you want the world to stop. You want every other role in your life to disappear. All you want is for your child to be okay. And if you're worried that your child is struggling mentally and emotionally, it isn't as easy as making them chicken noodle soup and telling them to rest. Today on the podcast, we're going to talk about recognizing mental health concerns in children and what we can do to help. Welcome to the Think Tank Podcast.

Hello, Pod Squad. This is Amy Hopkins, and today we have Dr. Deborah Fernandez-Turner back on the podcast, Dr. Turner is a board certified child and adolescent psychiatrist and an advocate for mental health and wellness. She is also a mom and my dear friend. Thank you for being here to talk about this very important topic.

Deborah Fernandez-Turner: Thank you for having me.

Amy Hopkins: So Deborah, Dr. Turner, helping adults and adolescents and children with their mental health is not just something that you're passionate about. You've dedicated your life to it. Why do you think talking about mental health and getting treatment is so important?

Deborah Fernandez-Turner: Mental health is the core of everything someone does from their physical health to their functioning, to their happiness, and taking care of your mental wellbeing, whether it be helping yourself through a depression or just helping yourself feel better about yourself and building your self-esteem is really core to everything else in life.

Amy Hopkins: And with our children, we're watching them develop and we're watching them grow. And so if we know how important mental health is and mental wellness and doing things to take care of ourselves, then we can pass that along to our kids. So as a parent, what signs should we be looking for that our child may be struggling with a mental health issue?

Deborah Fernandez-Turner: Parents know their children truly. And paying attention to that parental gut feeling that something isn't quite right is absolutely key. Never ignore that gut sense that, "Wait a second. My child used to be super bubbly and always on the phone with their friends, and now they're holed up in their room with the door shut." And this is a big difference for them. Never ignore that feeling that something is off. Always get that checked out. But some things to kind of keep in mind, if you're noticing a change in that base mood, so everybody has a mood that they sort go back to, it's just sort of where you live. And if you notice that that's different for your child, either it's too much where they're always pushing hard and can't stop talking and that's different for them, or you notice that they're pulling away not themselves, and again that's different for them, it's really important to dig in a little bit and get some help in figuring out what's going on.

Amy Hopkins: And that might be something too like they were really into school and now they're not into school, or they're not sleeping or they're not eating, or they were really into science club at school and now they're not into it at all. So you trust your gut. Totally 100% I believe in that. But what do you think about talking to other people that interact with your child, like teachers and school officials? What do you think? Do you think that's a good thing to do? Do you think that's crossing the line? How do you feel about that?

Deborah Fernandez-Turner: It's always a tough call, right? And again, I go back to you know your child best. But at the same time, if you're worried, reaching out to a teacher and saying, "Hey, have you noticed something?

My kid seems a little bit different to me. What do you see?" Especially if it's a trusted adult, a teacher they really like, or a coach or a family friend or the parent of a friend, that can be added information that can really be invaluable. And they may or may not see a difference. And even if they don't and you still feel something's not quite right, that hasn't alleviated that gut feeling of something's off, still it's time to go check that out and have an external person sort of do that assessment for you.

The other thing that I forgot to mention is it's really important to listen and just sort of openended listening. And really hearing between the lines of what your child is saying is really key. It's so easy for us as parents to say, "Oh my goodness, we have to get here and we have to do this." And, "Oh, come on, let's hurry up, get in the car. Let's keep moving things on." And asking questions that promote that end goal, whatever that may be, getting to practice, getting to whatever, but that time to just say, "Hey, how are you doing?" And then really listen and listen.

Try to listen in between the lines because kids may not tell you outright, but they may tell you. They may just say, "Oh, I'm terrible at all of these things. I'm just..." Really diminish themselves. And if you start hearing that decrease in self-esteem, that lack of confidence, I think many of us feel a lack of confidence, but if you look at it and you're like, "This is new," again, take that seriously and try to find that external assessment

Amy Hopkins: And it's kind of different. I'm listening to you and it's like a young kid versus an older, like an adolescent. I have teenagers and I think my question before like, "Is it okay to talk to the teacher?" Because I know my kids would be mortified if I had gone to the school and started talking to people. But a younger child, like elementary school, definitely you would want to bring in people that work with them or spend time with them every day. One of the things that you just said I felt like is key is that no matter what age they are, you've got to talk to them. You've got to find time to sit down and connect with them. And sometimes that's really all they need, right? It's like they need a minute to process something that happened at school. So you talked about not wanting to go to practice or that they feel like they're bad at everything. Well, some kid could have said that to them and they've internalized it. And instead of talking to someone or believing in themselves enough to say, "No, I am good at soccer. No, I am good at science. No, I am good," they don't have that coping strategy, so they internalize it and say, "Yeah, I'm bad at everything."

So I really love that you were talking about like, just take the time to connect. As busy as our lives are, we have to find time to connect with our kids, especially if we feel like something's off. So as the resident expert here, how do we talk to our kids? Little, big, how do we talk to them in a way that they know we're a safe space, that they can share what they're feeling? Because we do know that there is stigma no matter what age you're at with saying, "I'm unhappy" or, "I'm sad" or, "I'm struggling." So how do we connect?

Deborah Fernandez-Turner: You know, it's a really good question. I think many people who are struggling with mental health don't even realize it themselves, whether they're an adult or a child. And it really takes those questions of somebody else asking for you to say, "Oh, wait a second, I don't have to feel this way. This isn't right." Right? And that's the first step to really understanding that help is there, help is possible. So starting with those really open-ended questions can be really helpful.

And then when you get a response, don't try to fix it. And that is so hard. I mean, I'm a mom. When my kids are adults, really hard to not try to jump in and say, "Oh, I can help you with that." Or, "I've been through that and I know how to make this better." Just don't. Just listen and ask a follow-up question, and maybe another follow-up question. "Tell me more about that. How does that feel for you? Tell me how you experience that." And then validate. "Right. I hear you. I get it." Maybe you have some past experience. I keep that to yourself, right, so that you're saying, "Wow, that must be really hard for you." And you're acknowledging their specific experience and not bringing anything else into that. And you'll find they'll start to open up a little bit more.

Keep those doors open Again, non-judgemental. Don't try to fix anything. Just keep asking the questions. Be the ear.

Amy Hopkins: It's funny because my daughter I remember at one point said to me, "I just need you to listen and not fix it." And I was like, "Oh gosh, I know better." But in that moment when they're sharing something like, "Oh, somebody said something that hurt my feelings," like the mama bear comes out and you're like, "Oh, well you should have..." You don't think to just pause and just be curious and let them get the emotion out. Let them express. And it also lets them know that you trust that they can handle it. "I'm so glad you came to me with this and you're sharing this with me. How did you handle it?" So you're letting them know that you trust that they have the ability. And then you can say, "Do you need me to help? Do you want me to help? And how do you want me to help?"

So that is literally something my daughter taught me that I should have been well rehearsed in. But even though you have all the skills for somebody else, when it comes to your kid, they kind of go out the window. I feel like they did for me sometimes.

Deborah Fernandez-Turner: Right. Yeah. Now you are 100% on the money there. Absolutely. But you're right, staying curious and having that open-ended, loving and supportive space and being okay with what they tell you. Because as soon as you give a big reaction, you're done. So really not being afraid of what they may tell you even if it makes your heart hurt. And as parents, your kids tell you that they're sad or that they're anxious or that even if they have thoughts of harming themselves, if your kids are saying that, that is such a gift because they came to you and they told you and they felt safe enough to say that. So see the gift. And again, that non-judgmental supportAmy Hopkins: Honor it.

Deborah Fernandez-Turner: Honor it. Exactly. That's exactly right.

Amy Hopkins: Especially we know teenagers, when you get a gift like that, they're rare. So when they come around, you have to really be prepared to take a breath, let it settle and not just react because it is, it is a gift when they come to you and they share something big. They share a big emotion, they share a big feeling that they're carrying. Because at that point in their lives, everything is about their friendships. And so we're just mom, we're just dad. And so coming to us is a huge step for them. So I love that you said it's a gift because it's a huge gift.

I'm seeing warning signs in my child. She's not eating. She's sleeping more. She's not doing the things that she loves in school. She seems down. Where do I start? What would you recommend would be like first steps if I am seeing things that are making me concerned outside of talking to them, which you already mentioned? We're talking to them, we're asking open-ended questions. What's the next step in getting them the help that they need?

Deborah Fernandez-Turner: I'll start with there's no wrong door, right? But a really great first step is your primary care doctor, especially if you have a pediatrician that your kid has a relationship with. Give them a heads-up that you have mental health concerns. Let them know ahead of time. There's nothing saying that you can't leave a message for the doctor ahead of time to give them that heads up so that maybe the doctor can spend five minutes alone with your kid and ask some key questions that they may not feel comfortable telling parents, right? And the other piece to that is fatigue, loss of interest, poor focus. All of those things can be caused by a medical issue. And so you really need to make sure that there isn't a problem with a thyroid, right? Or a vitamin deficiency, right? Vitamin deficiency can cause fatigue and look like depression. Those are fairly easy to fix. So that's where starting with your PCP is a really good option. They can help you rule those things out.

Amy Hopkins: So starting with your primary care physician, giving them a heads-up, you're concerned about this, and find out if there is a vitamin deficiency. Is that a blood test? Is that where they start?

Deborah Fernandez-Turner: Depending on what the pediatrician or primary doctor finds, they might recommend some blood tests, because remember, they'll do a whole physical so they'll have a better understanding from their perspective as to what may or may not be going on. So exactly, they may order some lab work. Or they may decide, "You know what? I'm not hearing any of the other symptoms that go with those things. So let's think about therapy. Let's talk about medication for depression if it's really soothing."

Amy Hopkins: I think that's really interesting too, that a vitamin deficiency or hypothyroidism can look like a mental health condition. So I think that's really powerful knowledge to have. So starting there sounds like a really good idea. So starting with your PCP, doing a full medical exam, getting some history, talking about what's happening in their life, what's happening with their development, all of those things.

So you had mentioned they might start medications. I know as parents, there's a lot of us that are fearful about starting medications with a young brain. What are your thoughts on that?

Deborah Fernandez-Turner: It really is a very personal decision. So what I used to advise parents that I was working with with their children, I'd say, "Think through some key domains." If you have a child who is functioning very poorly socially, if their self-esteem has plummeted and they're not functioning well in their own self-image, and then third academically, which that's their job, so if their schoolwork, their self-esteem and/or their social functioning is really poor, it's important to remember that any loss of that development time is really significant for a kid. So you have to weigh the risks and the benefits. Are there potential side effects to medication? Of course. There's potential side effects to everything, right? So you have to understand what that is and what that looks like.

And then weigh that against a kid who for a year is thinking poorly about themselves because their brain won't let them think well, or a kid who is not doing well in school, which just feeds into the poor self-image. So you have this negative cycle. And the same if they're not connecting and making those important social developmental milestones that happen at every single year through childhood, that's a big loss. So you have to weigh those risks alongside the risks of medication.

Amy Hopkins: So one of the things I remember you saying in another conversation that you and I had was what are the risks of not treating.

Deborah Fernandez-Turner: Right.

Amy Hopkins: And that was such a powerful thing to me. I had talked to you about my own children, things that they have gone through and different things. And that was the thing that hit me, was what's the risk of not treating. Allowing your child to suffer through these developmental years was not an option for me. It was a very hard decision, because again, I did have fear about medication on a young brain, on a developing brain. But the important part for me was, are they going to survive this time in their life if they're not treated? Are they going to look back at this time in their life and not hit those things and not do the things that really are going to impact them later in life?

I also think that it's important with adolescents too, that you let them be a part of the decisionmaking, right? So you talk to them about these are your options with medications. How do you talk to your kids about medications and risks and stuff like that when they may not want to share how they're feeling about taking medications?

Deborah Fernandez-Turner: It's really helpful to have a really good medical partner. Whether it be your primary care doctor that you're working with or a therapist that you're working with or a psychiatrist, having that person that can help inform and support is so vitally important because a parent can't really have all of those conversations no matter the age, right? You can't just hand somebody something and, "Here, put this into your body because I said so." Right? So really acknowledging their own agency over themselves at whatever age they are. And you do this in a developmentally appropriate way, depending whether they're four or 17. You bring them in and you help them understand. You give them some choices, right? If they're little, the choices are different than if they're older. But make sure you give them choice so that, again, they have that a sense of agency over their own body.

Amy Hopkins: So we've talked a lot about medications, but usually the first line is therapy. You've worked with children, you've worked with adolescents, you've worked with adults. What are your thoughts on finding the right fit for your child where they are in their developmental stage with therapy?

Deborah Fernandez-Turner: There's a couple of things about therapy. First of all, I always like to encourage parents to also get their own therapy through this process. Having a child with a mental health need is not easy and it is not standard parenting. But sometimes the heartbreak is really significant and you really need that external person to support you.

So first and foremost, don't forget you through this whole process. Almost every parent I worked with, I would get set up with therapy as well. And they didn't need it for a long time. It was really just to help with building some skill, understanding what was going on, their big emotions, because you can't talk about your big emotions with your family, right? You really can't. You can't say those things to your children so you need that outlet. So that's item one.

Kids now, especially adolescents, they are totally into the therapy. All of their friends have had therapy. It is not the stigma that it was when I was a kid, which is many, many, many years ago. For kids, getting into therapy, a lot of parents have been surprised with like, "I told my kid I thought that we should do therapy and they're like, 'Oh, yeah, my best friend does therapy and this is their therapist and that's who I want to see'." It's like, "Okay."

Amy Hopkins: They talk about it. It's normalized. I do love that about that generation that my kids are in, is that there is not the shame that we carried growing up. Because I remember being in 6th grade and my mom and I were oil and vinegar. I mean was at the age, I was coming into my own and my mom threatened me with therapy. I remember that and just feeling like the shame about going and talking to somebody who could actually help me figure out what I was feeling. But my kids have been in therapy because of the situation in our lives where their dad was sick and had cancer, and I talked to them about therapy before he passed away. It was like, "Do you guys want to have someone else outside to talk to?" They're like, "Oh, yeah, no big deal." And I love that that it's just like, "Sure. Everybody can benefit from somebody to talk to."

The one thing that you said that I just want to hit on so very quickly is this idea as parents, we do still hold. There is still stigma that we associate with getting help. And I think it's that idea that if I need help, then I'm a bad parent. You're not a bad parent. The fact that you are seeking help means that you are a good parent because you are recognizing that you don't have all the answers and it's okay to get help to try and figure out what's next to do. So it's really moving past that shame.

Deborah Fernandez-Turner: You're absolutely right, and that is part of someone's own therapy, to work through all of those negative associations that we grew up with. Certainly in my childhood, nobody went to therapy. It was not okay. And if you did, you were considered "crazy." So that isn't how it is for the kids right now. And work through that, letting go of that shame and letting go of the guilt of, "I must've been a bad parent for my child to need therapy." That's another piece to work through and to process with your own therapist. The goal is for everyone in the family to live their best life, whatever that looks like for them. And so that's where having everybody work through some of that is incredibly beneficial.

The other question that you asked was about finding a fit. And that can be really hard, and that's okay. It's important to find the person who is right for you and for your kids. And remember, that's probably not going to be the same person. My kids have been in therapy over the years, and my youngest said to me, "I have a three strike rule. I go three times because the first time I'm anxious and they don't know me very well. The second time, I'm still a little anxious and maybe they still don't quite know me. By time three, if it's still not a good fit, then it's just not a good fit." To have a 15-year-old understand that really was pretty impressive. So there you go. The three visit rule that my family has used over the years.

Amy Hopkins: I love it. And it works, because I will tell you, I had the opposite with my kids in that they went to a therapist for a long time that neither one of them felt was helping them. And not until there was this crisis point when things started happening in our family with my husband's illness, their dad's illness, that they're like, "This isn't helping. We're talking about TV shows when we're in there." It's okay to say to your kids, "You have to connect with this person. You have to feel safe with this person. And it's okay if you don't connect with a counselor too." Again, we're people, we're different. There's different specialties. There's different therapy focuses that therapists use and counselors use. So it's okay to say, "It's just not clicking, it's not working. I don't feel safe. I don't feel like I want to share my deepest thoughts and feelings and things that I'm going through." So it's okay to move on and find somebody who does meet.

I compare that to the same thing as going and finding a primary care physician. You don't always click with the primary care physician, right? You go and they're cold or they have no bedside manner. It's literally no different. So it's not a failure on your part if you say, "Yeah, this isn't a fit." And it's not a failure on your kid's part if they say, "Yeah, this doesn't fit." So keep looking until you find the person that you feel safe and comfortable with.

Deborah Fernandez-Turner: Oh, absolutely. I think the other thing to remember is that therapists, doctors aren't surprised by that and aren't offended because it isn't personal. It really is about, "This isn't the right fit for me right now," and it's okay. Everybody wants the right fit. You wouldn't necessarily take a job that was a terrible fit for you, right? You would keep looking for another job. So again, giving your kids no matter what age they are, four years old, five years old, 10, 17, doesn't matter, giving them the ability to say, "Maybe they can't opt out of therapy totally." That's not the choice. But maybe the choice is, "This person hasn't been a great fit for me. Maybe I can try someone else."

Amy Hopkins: So right now, Dr. Turner too, there's a lot of options for therapy, right? There's in-person. You can do tele-video. There's different modules, self-paced modules you can do online that help with depression or anxiety or different things. So that might be a way for you to allow your children to have some options in their care decisions.

Deborah Fernandez-Turner: Absolutely. And I'd also add to that, life is busy. Life is really busy, and sometimes it isn't easy to get to a therapy office. And so utilizing telehealth, utilizing some of these other digital options as further support, it's a great way to go especially today when you have to go from school to practice to a job, to all these other things. Taking one hour where that literally is what you do, you turn on your phone, you click the link, and you've got your hour conversation might make it really accessible. And for a kid who is a digital native, that may make it even feel more comfortable for them.

Many people really do enjoy the telehealth aspect. And there are many practitioners who are doing a hybrid, so you can meet the first couple of times in person to see if it's a fit and then transition to online once you have an established rapport. So there are a lot of choices out there. The other thing to remember is there are a lot of crisis lines out as well of many different varieties. So I don't want to forget to mention that making sure that your kid has access to every type of crisis line that exists. Again, no judgment. Just give them the list of all of them so that they can call the one where they feel the most comfortable on that given day if they need to call. "No judgment, no expectations. Here's all the phone numbers. Use them when you need to," and leave it at that.

Amy Hopkins: Yeah, absolutely. And a big shout-out to 988. That is a really great resource not just for your children, but for yourself. If you're needing support, they can help guide you. They can help find you services.

And the other thing I want to point out really quickly too is, if you have an employee assistance program, that might be a great place to start too and just finding out what services are available to you to help with life and balance. Again, you may not need a year worth of counseling to figure out how to talk to your kid about this stuff. You may just need a few sessions, and those sessions may be covered by your EAP. So it's worth checking into what resources you already have available and utilizing those in your quest for better health, better mental health and balance in your life.

Deborah Fernandez-Turner: The key thing to remember when you're thinking about mental health for children and adolescents is there is no wrong way to support your child. The most important thing is to be present with a lot of love and without any judgment and make sure that you find whatever help makes sense for you and your family, given your really unique circumstances. The goal is to have everybody thriving and growing and developing together. So with that as the goal and keeping that in mind, moving in that direction, again, no wrong door, just keep moving forward with that love, support and non-judgmental attitude, and it's going to be okay.

Amy Hopkins: As parents, we all want happy, healthy children. When our children struggle mentally or emotionally, it can feel overwhelming. But learn as much as you can. Trust your gut. Talk and connect with your child and get the help you both need. You're not alone and you don't have to do it alone. There's no extra points for suffering. Until next time, thanks for joining me on the Think Tank Podcast.

Disclaimer: The Think Tank Podcast is brought to you by Resources for Living and developed by The Think Tank Podcast team. It features Amy Hopkins, Brig Dunsmore, Angela Bell, Leslie Zachariah, Emily Lockamy and Narciso Bowman. If you need support managing life's issues, know there's help available. Check with your human resources to learn more about benefits that can support your mental wellbeing. And remember, if you are in a mental health crisis, please call or text 988 to connect with the crisis lifeline.