Nov. 23, 2022

when our children are not good

This week's guest was Dr. Nghi Dang, a family physician who was bullied as a child after immigrating to the United States from Vietnam at age seven. After experiencing childhood depression, Dr. Dang now advocates for mental health dialogue between parents and their children, not just as a doctor, but as an author. You can check out his short stories, The Adventures of Max and Friends here. I'm grateful for Dr. Dang's willingness to start these conversations in and outside of his practice, as this discussion in our homes (or lack thereof) can  impact the emotional development of our kids. I'd like to use this space to elaborate a bit more deeply on why this is.

The first seven years of my career as a social worker were spent in the child welfare system, and I can tell you this with certainty: the mental health of children is often overlooked. Why?

In my humble opinion, it boils down to these three things:

1) Child mental health issues usually manifest in behavioral problems, because
2) Children are not taught to identify, name, or describe emotions, making it difficult to advocate for themselves, therefore
3) Children are constantly misdiagnosed.

In my last role, my job was to read extensive diagnostic assessments in order to determine which services were most appropriate for each child served at the nonprofit I worked for. I can say with 100% certainty the worst behaved children are not the least disciplined, but the most traumatized. These kids have gone through hell and back but don't have the emotional or psychological capacity to process it effectively. This is why they lash out in ways most children do: tantrums, hitting, acts of defiance. Looking at it this way, one can understand why children who have experienced more life stressors than average are tearing apart classrooms: they don't know what else to do, and it is their way of saying they feel dysregulated.

From a psychological perspective, childhood trauma impacts brain development immensely, particularly during ages 5-8. The amygdala, or the part of our brains that impacts threat detection, reward processing, and decision-making, enlarges with trauma. This means that biologically, traumatized children have developed a brain that is wired for hyper-vigilance - or always feeling "on edge." You know those days that just continuously go poorly, so by the end of the day you're ready to explode at the next thing that goes wrong? These children are on that ledge all the time. This also explains why those with adverse childhood experiences (ACES) have difficulty controlling impulses or understanding negative and positive consequences. 

And more often than not, these kids have been labeled not for their experiences, but how they've reacted to them: rather than being identified as a child who has had bad things happen to them, they are labeled as a child who is bad. This label stays with them. I once asked a child why they did something to hear the simple response of, "I'm just bad." Their understanding is limited because no one has ever told them otherwise. It was nearly a year of working with this boy before I finally saw him break down and say, "I'm just so angry all the time because of my dad," taking the blame off of himself and recognizing the emotion it had constantly internalized in him.

This is why it is so important to have an open dialogue about mental health in our homes as often as we discuss physical health with our children - any children. We should be teaching emotions like we do letters, numbers, colors, and shapes. This not only helps them identify their own feelings, but recognize the feelings of others, building social cues and empathy. This can be done through simple check-ins with emotion charts on the fridge, as well as kid-friendly games that help with emotional development (Amazon has endless options). Homes that are emotionally safe create spaces where kids are open to sharing "I feel sad" as often as they disclose their belly-aches. 

This leads to my last point, as discussed in this week's episode - just like adults, kids in mental distress will experience physical (somatic) symptoms, and often the wrong issue will be treated. Your child may be actually experiencing mental health issues if you notice any of the following:

1) Frequent nausea/vomiting or headaches
2) Digestive issues
3) Loss in appetite
4) Trouble falling asleep
5) Inattentive/forgetful behavior
6) Frequent unexplained crying/sensitivity 
7) Frequent angry outbursts
8) Misbehaving in specific environments
9) Sudden social isolation
10) Changes in academic performance

This does not mean there's something wrong with your child - it just means they could be experiencing the same anxious or depressive states we all do from time to time, and at grade school age, it may be a sign your child is being bullied (you are protecting the mental health of your own children and those of others when you teach them to be kind, by the way). However, this turns chronic, or escalates into other disorders when minimized or left unaddressed. This is why catching it early and teaching appropriate coping skills at a young age is so crucial. 

Keep in mind that children usually don't know how to voice some of these things, too. As a 10-year-old, my anxiety manifested into nausea and trouble sleeping, but I didn't know how to express it. Check in with your kids regularly to see how they're feeling, normalize their responses, and of course, use your natural instincts when something seems off, approaching them with a nonjudgmental stance. Think about how difficult it can be for you to navigate your emotions, and just how overwhelming that might feel for a little human still figuring out what they even are.

Side note, because as a former kid therapist I just have to say it: please, for the love of God, don't go diagnosis hunting. I can't tell you how many parents I've seen almost beg for an ADHD diagnosis for a kid who is simply anxious (don't you have trouble concentrating when you're preoccupied, too?) Yes, ADHD is a valid disorder that many kids genuinely suffer from, but if I had to tell you the most common misdiagnosis in children, there it is. Inattention, hyperactivity, forgetfulness or distractibility, are also all signs of situational anxiety or depression - so a safe rule of thumb is start with determining triggers for those before exploring the possibility of clinical mental health issues. 

Lastly - there is nothing wrong with taking your kid to therapy, especially if at-home discussions aren't working or your child has experienced a traumatic event. Just as we take our kids to the doctor and dentist to prevent physical health issues down the road, therapy can build mental and emotional health early on so they can better process the ups and downs of life as an adult. There are therapists who specialize in kid-friendly therapy that involves play, art, music, and other expressive tools children can use to process tough emotions.

If you have or know a child who you feel might be experiencing mental health issues, please feel free to email me. I'd love to help you find appropriate resources!

I hope your kids are good, but I'm here if they're not.

- MJ