As a CAMHS Child Psychotherapist, Here Are the Common Difficulties I See in Children
The mental health of children and teens is often of huge concern to their parents
CAMHS mental health clinician and child psychotherapist Alexander Gray offers his advice to parents
We have psychotherapists available who are trained to work with children and young people – find them here
Does your child present differently at home than at school? Perhaps you hear about them being anxious in class or falling out with friends, whilst at parties they are the life and soul?
We all act a little differently with family, friends and colleagues, so no wonder children learn this skill, but when the mask slips do they know who they really are?
As well as working in private practice, I am a clinician with CAMHS. I wanted to share some common themes I see coming up for both children and parents. Have a look at these common presentations and notice how you respond…
Most children referred to us are described as anxious. It’s a very general term and usually means there is something going on underneath that is not being dealt with.
As an example: your child complains of a stomach ache in the morning and won’t eat their breakfast, they say they feel sick and can’t go into school, but physically there doesn’t seem to be anything wrong. When you get to school, they are crying or acting out, clinging to your leg or saying they want to go home.
What do you do? Take them to the GP? Push them through the gate and hope the teachers manage the situation? They’ll grow out of it? Sounds like separation anxiety. So, we need to discuss what is going on at home that they might be trying to take responsibility for or behaviours that you, as parents, are exhibiting which makes them feel unsafe. What is the child’s experience of school and why might they not want to be there, away from home?
Your child will not complete their homework without a major fuss. They complain that school is boring and they can’t make it through the day. They seem to be emotionally dysregulated and will have a seemingly out of proportion meltdown if something doesn’t go their way. Often these are indications that your child lacks resilience. They are not able to tolerate sitting with something difficult or what they feel they are bad at. They may also find it hard to recover from difficult situations, saying it was unfair, or the teacher/friend doesn’t like them.
One way to explore this theme is with screens – laptops, phones and tablets. Children flick from one screen to the next, a game or video to a chat with friends. If they don’t like something, they move on. If they lose a game, they can immediately try again, or switch games. As soon as something is challenging or not stimulating enough, they lose interest and change direction. So, we need to challenge these children, gently to start with, but holding the boundaries of time and attention, whilst helping them reflect on their moods so they are better regulated.
Boundaries and sleep
Holding boundaries and encouraging children away from screens will also help with their learning, self-esteem, confidence and sleep. Children love to push buttons…they are testing us, their peers and teachers to see what is possible. If they don’t come up against consistent boundaries, they don’t learn their limits but crucially, this can also feel unsafe to a child, like they are in control, when the appropriate adult should be. Doing nothing is a wonderful test for a child, they will say they are bored, but out of this space comes creativity and imagination – it’s their experience of the world rather than what is fed to them through YouTube or TikTok, reality versus fantasy.
Not being able to switch off from this fantasy world can also contribute to poor sleep hygiene. Many parents worry that their children are going to bed late, unable to sleep as they have things on their minds, getting up during the night, or being unable to wake up in the morning. The light from screens actively suppresses the release of melatonin, our sleep hormone, meaning we do not feel tired in time for bed.
Children who play games or chat to their friends are also being stimulated, kept awake by their activities, rather than reading or having a bath, activities that tell our bodies to wind down. Concurrently, if a child is speaking to friends online, they are missing out on the in-person experience of communication and reading body language, which all adds to anxiety and results in poor sleep hygiene.
Screens aren’t the only enemy though. Children need to expend their energy. Nutrition, diet, spending time outdoors, are all key elements of good sleep hygiene. Not being able to get to sleep is the result of a series of bad decisions during the days and weeks before. It is hardest to fix when fighting the losing battle of telling yourself or child to go to sleep, it’s not a switch.
Instead, look at your routines, how do you look after yourself, what are you teaching your children? If you are exercising during the day, eating well, chatting to friends and family about your life and inviting them to do the same, then your sleep hygiene should improve and you and your children are more likely to feel rested and restored, open to a creative and rewarding life, rather than feeling exhausted and battling to get through the day.
Autism and neurodiversity
Sometimes, no matter what parenting techniques you use, or personalised strategies the school implements, your child will exhibit challenging behaviour that seems to get worse. You might hear the phrase, “it looks like there is something going on, underneath”. I’m not one for labels, but autistic traits can be useful markers to try and understand the behaviour of a child who is not responding to early intervention and has perhaps got a history of missing various expected developmental milestones.
Try to think of ASD traits as expressions of your child being different. Neurotypical people expect everyone to behave in an expected and agreed manner, but what happened to individuality? Schools work towards standardisation, home life is dictated by parents, communities require conformity. Children who are neurodiverse may not interact in socially acceptable ways. They may not react to conversational cues, read emotions in faces or respond to body language. They may not communicate verbally or in ways that are obvious. They may only be drawn to things they are interested in or struggle to adapt when their routine is disrupted by dress up days at school, or taking a new route home because of traffic.
These social and communication challenges can result in friendship difficulties, isolation, falling behind in learning and parents having to base a day or trip around this particular child’s needs.
Sensory processing can also impact daily life, so children may hear or smell things which others cannot, to such a degree that they may need ear defenders or have to leave a party because it is too overwhelming. Tastes and textures can be a challenge with clothes needing to be soft and familiar as well as foods being beige and bland. Neurodiverse children can often be anecdotally referred to as OCD because of their fondness for sameness. They can line up their toys in certain ways or have repetitive and restrictive behaviours they need to carry out or otherwise end up having a meltdown.
If you’re worried about your child, or how you are relating to them, please get in touch for a parent consultation where we can consider what their behaviour is trying to tell us.