Anxiety in Children and Adolescents

 

Anxiety in Children and Adolescents

Anxiety, to some extent, is a normal emotional state, but if you've noticed your child has been experiencing anxiety symptoms for an extended period, it may be time to seek professional help. With the right treatment and support, your child can learn new coping mechanisms to help them manage their symptoms.

What causes anxiety in children and teenagers?

It’s often not clear as to why some children or teenagers develop anxiety disorders, however there are some commonly agreed causes.

FAMILY HISTORY

If either biological parent has an anxiety disorder, either now or in the past, your child will be more likely to develop one as well. The age parental anxiety first started also has an impact on the likelihood of your child developing anxiety – the earlier you developed anxiety, the more likely your child will be to develop an anxiety disorder1.

Part of this may be due to genetic causes but it may also be due in part to upbringing. Children will often learn anxiety, fear or avoidance from anxious parents.

 

BRAIN BIOLOGY

The structure of your child’s brain and how the chemical reactions function in each individual are also thought to play a role in whether or not a child will develop an anxiety disorder.

Of particular interest is the part of the brain called the amygdala. The amygdala is responsible for our flight or fight response and studies have shown that children with an anxiety disorder often have hypersensitivity in this area2.

PERSONALITY TYPE

There are numerous theories that different personality types are more likely to suffer with anxiety than others, for instance those children who are emotionally sensitive or shy are more at risk.

However, some theorists would argue that emotionally sensitive children often learn a resilience about the world, that then protects them from developing conditions such as depression or anxiety later on in life, so there are no set rules.

CHILDHOOD EXPERIENCES

Many studies have shown, perhaps unsurprisingly, that children who face adversity or difficult experiences in their childhood are more likely to go on to develop a mental health condition such as anxiety or depression4 as adults.

Experiences such as acrimonious divorces, childhood abuse, trauma and death of a parent can deeply impact a child and leave them with difficult emotions that may impact on the rest of their lives. Seeking help and support early has been shown to be helpful in allowing children to work through difficult emotions and prevent the onset of further complications.

Anxiety Symptoms in Teenagers and Children

ANXIETY CAN SHOW ITSELF AS PHYSICAL CHANGES, AS THOUGHTS AND FEELINGS OR BE OBSERVED IN BEHAVIOUR:

  1. Physical symptoms of anxiety
  • Dizziness and feeling lightheaded
  • Hot and cold flushes
  • Stomach complaints, nausea and vomiting
  • Headaches
  • Difficulties sleeping
  • Easily fatigued
  • Loss of appetite
  1. Cognitive symptoms of anxiety
  • Obsessive worrying about illness or death of self or loved on
  • Fear that things will go wrong
  • Perfectionism
  • Social shyness and embarrassment
  • Feeling tense and on edge
  1. Behavioural symptoms of anxiety
  • Obsessive behaviours
  • Hair pulling, skin picking
  • Clinginess
  • Difficulties concentrating
  • Irritability and angry outbursts

WHAT CAUSES THE SYMPTOMS OF ANXIETY?

Anxiety symptoms are caused, overall, by a series of complicated chemical reactions that occur within the body.

In one of these reactions, when we feel stressed, chemicals are released from a part of the brain called the hypothalamus. These trigger more chemicals from another part of the brain called the pituitary glands, which in turn triggers cortisol to be released from the adrenal glands, located on top of the kidneys. This is known as the hypothalamus – pituitary – adrenal axis or HPAA for short.

The cortisol that is released is responsible for many of the anxiety symptoms commonly experienced.

Not all children will experience all the symptoms described above and often people with anxiety experience the same symptoms again and again.

 

TYPES OF CHILD AND ADOLESCENT ANXIETY DISORDERS

  1. Generalised anxiety disorder
  2. Depression and anxiety
  3. Obsessive Compulsive Disorder
  4. Phobias
  5. Panic attacks
  6. Social anxiety
  7. Separation anxiety
  8. PTSD

 

Generalised anxiety disorder in children and teenagers

Children and young people with GAD will have recurrent worries about lots of things. These worries will often be accompanied by a sense of restlessness or feeling on edge all the time. Your child might also become very tired, very sensitive and just not be ‘right’.

WHAT IS GENERALISED ANXIETY DISORDER (GAD)?

We all worry about different aspects of our lives at times. That’s completely normal. Children with GAD worry a great deal more, so much so that worrying gets in the way of schoolwork, friendships and family life, and these worries are often out of their control.

It can be hard for parents of children and teenagers with GAD to know how to manage their child’s anxiety; often the child’s concerns can seem unrealistic or even irrational. However, it is important to note that for the child, their concerns are very real and can be all consuming – causing huge emotional distress and often preventing them from taking part in normal day to day activities.

SYMPTOMS OF GAD IN CHILDREN AND TEENAGERS:

  • Difficulties sleeping / fatigue
  • Uncontrollable worry about different situations
  • Unrealistic fears about normal daily activities
  • Concern over future events or events years down the line
  • Perfectionism with schoolwork
  • Constant ‘what if’ ruminations
  • May feel responsible for lots of things that are completely out of their control, for instance your job promotion
  • Need for lots of reassurance
  • Difficulties concentrating on a task
  • Physical complaints such as headaches and stomach aches

HOW CAN I HELP MY CHILD?

Some life events will naturally cause your child more worry, for instance exam periods can be very stressful times and hormonal fluctuations can make anxiety more of an issue.

However, if your child or teenager has been showing signs of anxiety for more than a few weeks, if their mood has dropped, schoolwork suffered and if they are not spending as much time with friends or enjoying life in the same way they did before then it is advisable to seek professional help.

Your child may benefit from an assessment with a psychiatrist – a doctor with expertise in mental health. Not only with this assessment look at the anxiety symptoms your child is experiencing but will look at whether there are any other underlying factors or conditions that need to be considered, in order to find the most effective treatment.

Social anxiety in children and teenagers

Social anxiety or social phobia are terms used to describe an intense self-consciousness or fear of embarrassment triggered by being in social settings.

WHAT IS SOCIAL ANXIETY?

We all might worry sometimes about what other people think of us, teenagers and children are no different. These worries can mean we get nervous before a party or social event and are quite natural. Social anxiety is different. It is a diagnosable anxiety disorder that can leave sufferers with an immense and limiting fear that they may do something to humiliate themselves in public settings. It can mean that the child or teenager with social anxiety does not take part in activities, becomes socially withdrawn, develops school refusal and may lead to depression developing.

Social anxiety is common amongst teenagers, perhaps due to the changes that are happening to their brain which lead to teens being more socially aware and sensitive.

 

WHAT ARE THE SYMPTOMS OF SOCIAL ANXIETY?

It is normal for children and teenagers to feel worried before a presentation or performance at school or even feel a bit nervous before going to a party. We all do, and it is a natural, and to some degree, helpful reaction and can help prepare us.

However, if your child regularly feels or shows distress when faced with social situations, or if they experience the symptoms of anxiety in social situations then it may be useful to seek professional help.

As with many anxiety disorders, the symptoms of anxiety can be hugely unpleasant and distressing and for a child who is acutely worried about embarrassing themselves in front of others, their uncontrollable symptoms can make things even worse.

Signs you child may have social anxiety include:

  • Making excuses not to go out
  • Not socializing as much
  • Tearfulness or tantrums before an event
  • Sleeping badly the night before
  • Trembling
  • Dizziness
  • Feeling sick on route to an event

 

HOW CAN I HELP MY CHILD WITH SOCIAL ANXIETY?

The first step in helping your child is to make sure they receive a thorough diagnosis, as often social anxiety can accompany another condition, such as autism or depression.

CBT (cognitive behavioural therapy) and other talking therapies are some of the most useful ways of helping children and teenagers overcome their social anxiety. Working with a therapist, who understands social anxiety, can allow the child to understand their fears more and work on successful coping strategies they can apply in everyday life.

For some children and teenagers, their anxiety is so severe that medication is needed to help keep the symptoms in control and allow them to engage with the therapy. The first step is to receive a diagnosis by a child and adolescent psychiatrist, as the symptoms of social anxiety can be found in other disorders such as Autism.

Depression and anxiety in children

Depression with anxiety is the most common mental health condition in the UK and over half of people with anxiety will also have depression.

Whilst on the face of it the symptoms of anxiety and depression may seem quite different conditions, there are in fact many similarities. Research has shown that they can even cause each other1.

WHAT IS THE RELATIONSHIP BETWEEN ANXIETY AND DEPRESSION?

Anxiety is an emotion closely linked to avoidance. Children with anxiety will often shy away from new situations and may not try out new activities, often because their anxiety can leave them feeling helpless.

Depression is a condition linked to withdrawal. Depressed children will feel hopeless and lack the motivation to engage in activities. Whilst avoidance and withdrawal are not exactly the same, they are very similar and can ‘feed’ from each other.

It makes sense that if you feel unable to partake in activities and are excessively worried about your performance or abilities, you may end up feeling depressed as you become more socially reclusive. Equally, if you are struggling with depression, feel emotionally numb and useless, you may end up suffering with feelings of anxiety, as you worry about everything you are not able to do or what people think about you.

DEPRESSION AND ANXIETY SYMPTOMS

The symptoms of depression and anxiety in children and teenagers can vary hugely – which makes it understandably difficult for parents to know what is going on and how they can best help.

Many of the symptoms of depression and anxiety combined are similar – tearfulness, irritability, becoming withdrawn and difficulties sleeping. Symptoms will vary with age as well, young children often do not have the language necessary to describe how they are feeling so may ‘act’ out through their behaviour.

HOW CAN I HELP MY CHILD WITH DEPRESSION AND ANXIETY?

Treating children and teenagers who have anxiety and depression can be complicated as for effective treatment to work, psychiatrists may need to assess which condition to treat first. The symptoms can also be indicative of other conditions such as ADHD or ODD.

As a first step, your child may benefit from an assessment with a psychiatrist – a doctor with expertise in mental health. Not only with this assessment look at the anxiety symptoms your child is experiencing but will look at whether there are any other underlying factors or conditions that need to be considered, in order to find the most effective treatment.

Effective treatments for depression and anxiety include CBT other talking therapies and, in some cases, medication such as antidepressants.

Separation anxiety in children and teenagers

It’s totally normal for young children to become very upset and clingy when separated from their important adults. In some children this continues as they grow up or comes back when they are older. In my work, I see children who have experienced separation anxiety throughout their childhood and others who develop it later on.

WHAT IS SEPARATION ANXIETY?

Separation anxiety is defined as ‘developmentally inappropriate, excessive, persistent and unrealistic worry about separation.

It’s very normal for children to go through stages of separation anxiety as they develop.

It’s also very normal for children to go through stages of being ‘clingy’, but if your child regularly has anxiety when separated from you or if it is impacting on their ability to engage in normal daily tasks such as attending school or parties then we would recommend seeking help.

Often very little children will cry or have tantrums when they are separated from parents – many parents have experienced this as they drop children off to child minders or nursery. However, for some children, separation anxiety continues through childhood, which can mean going to school, staying at friends' houses or going to parties become very stressful events. Separation panic disorder is when the symptoms of anxiety impact on your child’s life, are persistent and severe in nature.

Separation anxiety is the most common anxiety disorder in children under the age of 12.

SYMPTOMS OF SEPARATION ANXIETY

  • Extreme anxiety before impending separation
  • Extreme worry and anxiety during the separation including restlessness and crying
  • Excessive worrying about the caregivers’ health and safety
  • Fixation on thoughts of accidents or death during separation
  • Difficulties sleeping far from caregiver, (sleepovers and school trips may be unmanageable)
  • Nightmares based on the theme of separation
  • Reluctance or refusal to attend school
  • Somatic responses such as headaches, stomach aches and vomiting

 

HOW CAN I HELP MY CHILD WITH SEPARATION ANXIETY?

We hear from parents everyday who have tried numerous techniques to help their child with separation anxiety but to no avail.

If you have a child with separation anxiety, the daily routine may be incredibly stressful and attending events without your child or going out for the evening can be impossible.

Whilst each child needs to be treated individually, cognitive behavioural therapies, other talking therapies, parenting support and even antidepressants can all help immensely.

As a first step, your child may benefit from an assessment with a psychiatrist – a doctor with expertise in mental health. Not only with this assessment look at the anxiety symptoms your child is experiencing but will look at whether there are any other underlying factors or conditions that need to be considered, in order to find the most effective treatment.

 

OCD in children

WHAT IS OCD?

Obsessive Compulsive Disorder is a serious anxiety related condition where individuals experience frequent obsessional and intrusive thoughts (or obsessions), often followed by uncontrollable urges and compulsions.

Perhaps the most frustrating thing for children with OCD is that they often know that their fears are irrational, but simply can’t control them.

The World Health Organisation have classified OCD in the top 10 of disabling illnesses because the condition can be so powerful that normal daily life can be impossible.

WHAT ARE OBSESSIONS?

Obsessions are persistent thoughts or worries that can be disturbing in nature and interfere with a child’ ability to perform daily tasks. The obsessions can be so powerful that are impossible to ignore and children with OCD can feel compelled to act out the compulsions (see below).

A key part of obsessions is that they are accompanied by extreme anxiety, making the child experience:

  • Dizziness
  • Nausea / vomiting
  • Racing heartbeat
  • Low mood / depression

Common obsessional thoughts and fears in children include excessive:

  • Fear of contamination from other people, objects, clothes, books or food
  • Fear of harming someone else
  • Concerns about the appearance of homework or themselves
  • Doubts about shutting doors, switching off lights, packing school bags etc
  • Superstitions that something bad will happen if a certain behaviour is not carried out
  • Arranging of items such as shoes, food, toys, items in bedrooms

WHAT ARE COMPULSIONS?

Compulsions are the second component of OCD and are repetitive physical actions or behaviours, which once carried out alleviate the extremely anxious feelings that the obsessions create.

Common compulsions in children and adolescents include:

  • Repetitive washing of hands, hair or the whole body
  • Touching certain parts of their body in a ritualised or specific pattern
  • Avoiding certain situations
  • Cleaning religiously and often starting again if the individual believes they haven’t done a good enough job
  • Arranging objects in a certain manner or pattern – disruption of which can be hugely traumatic
  • A ritualised bedtime routine
  • Repetition of certain words, phrases or counting (this can be in audible or silently to themselves)
  • Seeking continuous reassurance

OCD IS A VICIOUS CYCLE

One of the reasons OCD can be so hard to tackle without professional help is that compulsive behaviours provide only temporary relief from the obsessional thoughts and may end up reinforcing the anxiety cycle.

This is because they reinforce the idea that if the compulsion is carried out, the obsessional fear won’t happen. This cycle is very hard to break without support, which is why we would always urge parents who have concerns about their children to seek help.

HOW CAN I HELP MY CHILD WITH OCD?

Parents and children often feel relieved to have a diagnosis of OCD, as they have often suffered for a long time. The good news is that effective treatment for OCD in children is available.

The first step in helping your child is to make sure they receive a thorough diagnosis, as often the OCD can accompany another condition, such as autism or depression.

CBT, talking therapies and medication can all be used to help children and teenagers with OCD. CBT is a highly effective at treating OCD. Specially trained therapists will work with your child to gently increase their tolerance, through various exposure techniques, in a process called habituation. Whilst this might sound scary, in practice the exposure starts very slowly and builds as your child gains more confidence.

We offer parenting support and family therapy to help support the whole family through the treatment process. Research has shown that this can significantly improve the recovery rate for the child or teenager.

Panic attacks in children and teenagers

Panic attacks are surprisingly common in children and teenagers – between 3% to 5% of those under 18. More common in teenagers, they can be truly terrifying and have a significant impact on your child’s quality of life. We can help.

 

WHAT ARE PANIC ATTACKS?

Panic attacks are a type of anxiety disorder that can severely impact on a child’s ability to take part in everyday activities. Parents are often relieved to hear that panic attacks respond well to treatment.

  1. Panic disorder is the term used to describe when panic attacks happen frequently and occur over several months.
  2. For anyone who has not had a panic attack, they can be difficult to understand. It’s important to note that you cannot simply stop yourself having a panic attack, although being supported in a calm and reassuring manner can significantly help the individual.
  3. Panic attacks can be triggered by a specific event, for instance a crowded room or can come on with no explanation. The unpredictability of the panic attack can make them even more terrifying.

If your child or teenager has had more than one panic attack, if they are becoming more fearful of certain situations, becoming depressed, self-harming or have any other signs that you are worried about it is time to seek professional help.

 

PANIC ATTACK SYMPTOMS

There are two component parts to panic attacks or panic disorder as it is sometimes called. The first part is the panic attack itself; the second part is the fear of future panic attacks.

Panic attacks have terrifying physical symptoms including:

  • Chest pains
  • Dizziness
  • Racing heartbeat
  • Difficulty breathing
  • Sweating
  • Trembling
  • Numbness or tingling in fingers and limbs
  • Stomach complaints
  • A sense of choking
  • Changes to body temperature

During a panic attack the child or teenager may feel that they are dying, or that they are in a dream, and they may feel somehow detached from the situation.

The second part of the panic attack is the very real fear of having a future attack. This can result in the child or teenager choosing not to partake in activities, leave the house or even attend school.

HOW CAN I HELP MY CHILD WITH THEIR PANIC ATTACKS?

The first step in helping your child is to make sure they receive a thorough diagnosis, as often panic attacks can accompany another condition, such as autism or depression.

Whilst there may not be an obvious cause as to why the child has panic attacks, having a professional trained in understanding the condition can not only teach the child effective ways of managing the onset of an attack, but can also deal with any root cause.

Children and teenagers who suffer with panic attacks respond very well to talking therapies such as CBT (Cognitive Behavioural Therapy).

Some children and teenagers with anxiety disorders may need medication to help bring their anxiety levels down sufficiently for talking therapies to be effective. A psychiatrist will be able to assess your child’s needs and recommend the correct treatment programme for them.

Childhood Phobias

A fear becomes a phobia when it is excessive, arises in response to imaginary dangers and impacts on the child’s life.

WHAT ARE PHOBIAS?

A phobia is a persistent, excessive, and unreasonable fear of an object or situation. It is thought 5% of children and 16% of teenagers have a phobia in the UK.

It’s very normal for children to have fears about certain things – it is a natural stage of development. Children might be afraid of the dark, of dogs or going to the doctor. These fears are all part of how they begin to understand the world and will very often disappear over time.

Phobias are different from everyday fears as they usually become more severe as children get older. Children and teenagers with phobias will often feel ashamed about their fears, and try and hide them from others, particularly their peer group, because they worry, they will be seen as overreacting.

Having a phobia can have a very real impact on your quality of life, particularly if your phobia is something that is present in everyday life. If your teenager is afraid of the dark, going to sleepovers will be incredibly difficult. Having a phobia of dogs can make going to a park or a friend’s house impossible tasks.

 

WHAT ARE THE SYMPTOMS OF A PHOBIA?

Whilst we all have objects or situations that we don’t like and will positively try to avoid (spiders and snakes are the most common), those with a phobia have a very severe reaction that they simply can’t control.

Symptoms of a phobia include:

  • Increased heart rate
  • Sweating
  • Trembling
  • Shortness of breath
  • Feelings of choking
  • Upset stomach
  • Feeling dizzy or faint
  • Fear of dying
  • Numbness
  • Running away from the situation
  • Clinging to an adult
  • Crying or tantrums

WHY DO SOME CHILDREN DEVELOP PHOBIAS?

It is thought that phobias develop for both genetic and environmental reasons (nature and nurture).

We are hard wired to fear certain things – this reaction developed as a survival technique early humans used to temper their natural curiosity and keep them safe. We don’t fully understand the genetic reasons behind phobias, but research has shown they often run in families.

Phobias arise for different reasons but a bad experience in early years can trigger a pattern of thoughts that result in a powerful fear of a situation – for instance if your child falls ill after having an injection, they may develop an ongoing fear to injections, which can get worse over time.

Children may also ‘learn’ to have a phobia - for instance if a close family member is afraid of spiders and the child witnesses them screaming when they see one, they may also develop that fear.

HOW CAN I HELP MY CHILD WITH A PHOBIA?

As a first step, your child may benefit from an assessment with a psychiatrist – a doctor with expertise in mental health. Not only with this assessment look at the anxiety symptoms your child is experiencing but will look at whether there are any other underlying factors or conditions that need to be considered, in order to find the most effective treatment.

CBT and other talking therapies can be helpful for children and teenagers with a phobia in addressing their thought patterns and helping them formulate healthier coping mechanisms.

Graded exposure techniques can be incredibly useful to help overcome the fear a child or teenager may have, but it needs to be carefully administered by an expert, as if done incorrectly can make the situation a lot worse and damage the child’s ability to trust.

PTSD in Children

PTSD (Post Traumatic Stress Disorder) is a serious, upsetting condition affecting both adults and children. We can help.

It is the emotional response to a real or threatened traumatic event. The effects can be debilitating and long term if not treated.

WHAT IS PTSD?

PTSD is a very normal reaction to a traumatic event or situation. PTSD can be caused by a single traumatic event, or series of events that have happened in someone's life.
It can be caused by suffering a trauma directly, but also caused by suffering from the threat of a trauma.
It can be very hard for children to communicate their feelings after a traumatic event, perhaps because they don’t have the words required, or the emotions are so overwhelming they don’t know how to talk about them. This can make it much harder for those around them to understand what is going on.

CAUSES OF PTSD IN CHILDHOOD

Terrorism

Road traffic accidents

War

Natural disasters and fire incidents

Assault, sexual or physica

Victim or witness to a crime

Childhood neglect

Diagnosis of a long term or life limiting illness

Childhood abuse

Death of a family member

WHAT ARE THE SYMPTOMS OF PTSD?

Children aged 2 – 8 years: The symptoms of PTSD in young children are different to those in adults, partly due to how the immature brain processes information, but also because of the limited amount of emotional language available. Repeatedly re-enacting the event or drawing what happened, angry outbursts, disruptive behaviour and nightmares are all common symptoms of PTSD in children.

Young People older than 8: As children develop and mature, they start to display symptoms more like adults, including:

Intrusive memories

Flashbacks and reliving the event
Vivid memories
Upsetting dreams about the incident
Continuously thinking about the event
Having physical reactions when thinking about the event, such as heart palpitations, anxiety or feeling sick

 

Negative feelings

Loss of interest in social interaction
Feeling despair about the future
Being easily upset
Physical ailments that are not explained

 

 

WHY DO WE GET PTSD?

PTSD is thought to be our way of coping with the stress that the body and brain have gone through and as a way of us coming to terms with the event.

  1. Flashbacks are thought to help the brain prepare in case the event happens again.
  2. The feeling of being on edge is due to increased adrenaline in the system, getting the individual ready to ‘fight or flight’. In normal daily life adrenaline can be a useful chemical, but after a trauma level can become elevated and struggle to return to normal.
  3. Numbing and avoidance can be a mechanism for the brain to get some rest from constantly thinking about such upsetting events.
  4. The hippocampus is a part of the brain which is responsible for memory creation and storage. It can be adversely affected by the levels of adrenaline in the brain, released after the event. The increased adrenaline levels can stop memories from being processed as they should, resulting in flashbacks.

TREATING PTSD

Talking therapies are the most effective treatments for PTSD.

There are different types of therapy, which can be confusing, but we can help advise on which treatment would be best for your child, depending on their circumstances

  1. CBT (cognitive behavioural therapy) works by giving coping mechanisms to your child, to help them deal with the difficult emotions that arise after a trauma. Studies have shown CBT to be highly effective at alleviating PTSD symptoms.
  2. Trauma focused therapy work will directly work the event/s that caused the PTSD, with therapists who have specialist knowledge of trauma. It can be paired with CBT or carried out alone and may be better suited to some than CBT.
  1. EMDR Therapy can be particularly effective at working with complex, disturbing memories. It works by essentially ‘reprogramming’ some of the brain patterns and has very good outcomes for anxiety and trauma related conditions.
  1. Family Therapy – research has shown that the most successful outcomes can be when the whole family receives help; even if the trauma was only experienced by the child themselves the repercussions will be felt across the other members of the family.
  2. Parent Support – it is not easy caring for a child who has gone through traumatic experiences. Parent may feel incredible guilt, anger or frustration. A child’s behaviour can be challenging and difficult to know how manage. Parenting support can be a lifeline – offering sensible, caring and useful help and support to make things are home much easier and less stressful.
  3. Medication – Antidepressants and other psychotropic drugs can be useful for alleviating symptoms of PTSD, but often talking therapies are recommended. Medications need to be carefully prescribed and managed in children and we would always advise seeking expert help when considering whether medication is an option.

Behavioural Issues in Children and Adolescents

Behavioural issues in children and adolescents can often be a symptom of an underlying mental health condition. Understanding what this may be requires professional assessment so that you can find the right treatment and support that works to create the best outcome for you and your child.

 

Oppositional Defiant Disorder in Children and Teenagers

If you have noticed that your child or teenager has a behavioural problem or if you have been advised to seek help for your child because there is concern that they may have ODD - Oppositional Defiant Disorder – we will be able to help.

 

WHAT IS ODD (OPPOSITIONAL DEFIANT DISORDER)?

ODD is a behavioural disorder and most commonly diagnosed in the under 10’s. ODD is a term used to describe children who display pervasive anger, irritability and seemingly cruel or vindictive behaviours which cause a significant impact on the young person’s life.

SYMPTOMS OF ODD

There are several common symptoms that indicate your child may have ODD. These can be considered to fall within three categories2.

1) Irritability
    Losing their temper
    Being easily annoyed or overly touchy
    Often being angry / having tantrums or meltdowns

2) Hurtful behaviour
    Deliberately annoying others / winding people up
    Blaming others for their mistakes
    Showing spiteful or vindictive behaviours

3) Being Headstrong
    Defying requests made by adults
    Arguing with people in authority/adults


Whilst all children will, at some stage, display some or all of the above behaviours (it’s a natural part of growing up), to meet the diagnostic criteria for ODD, a child or teenager needs to display these behaviours for 6 months or more.

Some children will display these behavioural signs daily, others on a weekly basis – what is important for the ODD diagnosis is that the behaviours persist and happen frequently (weekly as a minimum is a good guide). Another key element of the diagnosis of ODD is the degree of impact these behaviours have on the child’s life.

Some children with ODD will only display these behaviours in one setting – which is normally the home environment. This is because it is at home that they are most likely to achieve the desired outcome – often these behaviours are less prevalent at school because things are more out of their control.

Children with severe ODD will behave in these ways in a variety of settings and with a higher frequency.

SEEKING HELP FOR ODD

We know that early intervention is the most effective way of preventing the behaviours of ODD from escalating. Many parents hope their child’s behaviour is just a phase or might be reluctant to seek help because of shame or embarrassment; however behavioural problems are very common, and treatment can make a real difference to your child’s life.

The benefits of seeking help for ODD:

  1. Prevent future problems - we know that children who have behavioural difficulties in childhood are more likely to have a mood or anxiety disorder later in life. For instance, children who display signs of defiance and vindictiveness are more likely to have conduct disorder later on in life.
  2. Increase understanding - getting an assessment early will help parents understand what the best treatment is for their child and how to prevent future issues from escalating. You will be able to share this information with the child’s school which will help teachers know best how to support your child.
  3. Improve family life - we know from helping thousands of families whose children have behavioural issues like ODD, that behavioural problems can play a real toll on family life.

    Marital discord (and even breakdown), constant arguments and tension within the home, poor parent-child relationships and in some cases, an inability to carry out normal family life (such as attending family events, birthday parties, shopping trips or days out) can all be a result of a child who has a conduct disorder or ODD.
  4. Your child’s future - there can be serious consequences for the child who has ODD. Some children will grow out of the behaviours as they mature, but some will go on to develop a condition like antisocial personality disorder as an adult, which can have a real impact on their ability to hold down a job, relationship or even mean they are more likely to engage in criminal activity.
  5. Your child’s mental health - we also know that around 50% of children with ODD will also have another mental health condition. The most common of these is ADHD, however depression, bipolar disorder and anxiety are also reasons why your child may have ODD. Treating the underlying condition can help with your child’s behaviour.

WHAT HELP IS AVAILABLE FOR CHILDREN AND TEENAGERS WITH ODD?

Assessment of ODD

It can be difficult to know if your child has ODD or another mental health condition that is causing their behavioural problems.

A Child and Adolescent Psychiatrist is the best person to assess your child and will spend time understanding if there are other underlying conditions.

As they are experts in child mental health, they will be able to formulate an effective treatment plan, which can significantly improve things for both your child and your whole family.

It might seem a bit scary getting a diagnosis, many of us are loathe to ‘label’ our children – however, we hear from parents every day who describe huge relief at having an explanation for their child’s behaviour and recommendations on how to help their child going forward.

A diagnosis can, therefore, be incredibly helpful in terms of both increased understanding, but also an ability to communicate to others why their child behaves as they do – which can ensure that children have the necessary provision put in place at school.

Conduct Disorders in Children and Teenagers

If you are concerned that your child may have a Conduct Disorder or if your school or GP has suggested that there could be an issue, then we can help you.

 

WHAT IS A CONDUCT DISORDER?

Conduct disorders are repetitive and persistent patterns of behaving, where the young person behaves in ways which go against social norms and that are not in line with normal behaviours for the age of the child.

Children and teenagers with a conduct disorder may get gratification out of hurting someone else, lying or stealing. Conduct disorders can be difficult to diagnose, as some of these troublesome behaviours can be a result of environmental factors or other mental health conditions

 

 It’s hard for parents to know what is normal for their child and what is a sign there might be an underlying problem. We speak to hundreds of parents each year who aren’t sure where to turn to help their child or teenager with a suspected conduct disorder – speaking to an expert in the field gives parents much needed support and advice and can ensure that their child receives the right help or treatment.

SYMPTOMS OF CONDUCT DISORDERS

There are several common symptoms that indicate your child may have a conduct disorder.


The symptoms of Conduct Disorders include:

  • Bullying, threatening and intimidating others
  • Getting into physical fights
  • Running away from home and/or not coming home at night
  • Using a weapon or something that could do harm to someone
  • Being physically cruel to others or animals
  • Stealing from others
  • Breaking into properties or cars
  • Forcing others into sexual acts
  • Damaging others property
  • Arson or setting fires
  • Lying too “con”
  • Playing truant from school

Children and teenagers with a conduct disorder may show all or some of the above. Some, although by no means all, young people with conduct disorder show no (genuine) remorse or guilt for their actions and even seem to get a ‘kick’ out of their actions or feel justified in their behaviours.

SEEKING HELP FOR A CONDUCT DISORDER

We know that early intervention is the most effective way of preventing the behaviours associated with a conduct disorder from escalating.

Many parents hope their child or teen’s behaviour is just a phase. Parents may hold back from seeking help because of shame or embarrassment; however behavioural problems are very common, and treatment can make a real difference.

The benefits of seeking help for conduct disorder:

  1. Impact on family life - having a child who has a conduct disorder can be incredibly stressful for the whole family – arguments between family members may be a daily event and parents are often at a complete loss of what they should do. It is particularly difficult if your teenager is increasingly independent or if you fear that they could hurt you or someone else in the family if you intervene.
    However, help is available and with the right help, your teenager’s behaviour issues can get better.
  2. Impact on your child’s future - we know that children and teenagers who have a conduct disorder are more at risk of developing conditions such as antisocial personality disorder as an adult.
  3. Risky behaviours - we also know that the risky behaviours that many with conduct disorder engage in can be extremely dangerous. Seeking help early is therefore key.
  4. Your child’s mental health - other mental health conditions such as ADHD, depression, Autism, and anxiety are common in those with conduct disorder. A comprehensive assessment of the issues your child or teenager is experiencing is, therefore, the first step to knowing what is causing their behaviour.

Seeking help from a professional who understands conduct disorders and can carry out a thorough assessment to understand the issues and causes for the behaviour is the first step to getting the right help in place for your whole family.

 

WHAT HELP IS AVAILABLE FOR CONDUCT DISORDERS IN CHILDREN AND TEENAGERS?

  1. Assessment
    It can be difficult to know if your child has a conduct disorder or another mental health condition that is causing their behavioural problems.

    A Child and Adolescent Psychiatrist is the best person to assess your child and will spend time ruling out other conditions. As they are experts in child mental health, they will be able to formulate an effective treatment plan, which can significantly improve things for both your child and your whole family.

    It might seem a bit scary getting a diagnosis, many of us are loathe to ‘label’ our children – however we hear from parents every day who describe huge relief at having a reason for their child or teenagers’ behaviour and have found it incredibly helpful in terms of both the understanding this has led to, but also their ability to communicate to others why their child behaves as they do.
  2. Parent/foster care training programmes
    Parenting programmes are recommended for parents, children and young people aged between 3 and 11 years who have been diagnosed (or have a high risk of developing) conduct disorders.
  3. Child-focused programmes and therapy
    Group and individual social and cognitive problem-solving programmes are recommended for children aged 9-14 who have been diagnosed (or have a high risk of developing) conduct disorders.
  4. Medication
    In some cases, medication can be hugely effective for other conditions that frequently accompany conduct disorders, although medication is not used for conduct disorder itself.

For children with ADHD (which is often undiagnosed and put down to ‘bad behaviour’), stimulant medication can have a significant impact on the child’s ability to concentrate and feel less frustrated. There are some medications that can be used effectively for other conditions, such as atypical antipsychotics that can reduce a child’s aggression and can be useful to help a child be able to fully engage in their behavioural therapy.

Anger, Aggression and Violence in Children and Teenagers

If you have a child or teenager who is angry, aggressive, or even violent, it can be extremely worrying as a parent, but not always clear how to get help.

Our team of behavioural experts help thousands of families, just like yours, every year, either face-to-face or online.

There can be many reasons why children or teenagers can have problems with anger, aggression, or violence.


Causes of anger, aggression, and tantrums in young children

  1. For young children, anger and aggression can be caused by difficulties at school, in their home life or with friends. Bullying, social pressures and difficulties in the home can all be incredibly stressful for children, causing them to ‘act out’ with explosions of anger.
  2. Aggression can also be a sign of a condition such as ADHD, depression, or anxiety or another complex emotional or mental health issue.
  3. Younger children often don’t have the right words to explain their emotions. They may find it difficult to talk about how they feel, and anger or aggression is a way of them to communicate this.
  4. Children must learn how to self-regulate their emotions and calm down and this takes time. Anger and aggressive behaviour can, therefore, be a result of not being able to catch strong emotions before they bubble over.


Causes of anger, aggression, and violence in teenagers

  1. The teenage years are a time of huge changes to the brain – for instance, part of the brain – the pre-frontal cortex - undergoes a significant amount of rewiring during adolescence. This part of the brain is responsible for decision-making, social behaviour, and personality expression, amongst other things so growth here can lead to teenagers acting in unusual ways.

    Rapid development and ‘rewiring’ in the pre-frontal cortex may lag the development of the “limbic system” – the part of the brain where chemicals responsible for alertness, pleasure and risk-taking lie. The result may be more impulsive behaviour, angry outbursts, and a difficulty in empathising with others.
  2. An important stage of teenage life is developing a sense of identity. One way of doing this is for teens to challenge and push the boundaries and rules they have worked to previously as children.
  3. Difficulties at school, home or with friends can also lead to angry or aggressive behaviour – children who are being bullied or feel stressed may lash out at those closest – often parents. Teens may not know how to communicate these feelings in a more measured approach.
  4. ADHD, Autism and conditions such as depression or anxiety can also lead teenagers to have angry outbursts or be violent towards others.

WHEN SHOULD YOU SEEK HELP FOR YOUR CHILD’S ANGER?

We get asked this question by many parents – after all, we know that tantrums are normal in young children and that the stereotypical teenager is often ‘moody’. So, when does normal behaviour become a problem that needs professional help?

Just as there is no instruction manual to parenting, there is no definitive list of when you should seek help for your child’s behaviour – it really does depend on what is normal for your child and how severe their behaviours are.

An important consideration is whether the behaviour leads to a significant impact on the young person’s life, be it at home, at school, with friends or with after-school activities.


Studies have shown that children who display continued angry or aggressive behaviours may go on to have difficulties in adulthood. Childhood anger and aggression can also be a sign of another mental health condition, such as ADHD, depression, or anxiety.


The following are some ‘red-flag’ warnings and if you perceive your child’s behaviour or aggression to be an issue, we advise talking to a child behavioural specialist. If nothing else, they may put your mind at rest.

Behaviour red flags

  1. Risky behaviours and activities that pose a danger to them or others
  2. Violent behaviours such as fighting, carrying knives or planning attacks
  3. Behaviours that are out of the norm or different for your child – this may include becoming socially withdrawn, teary, not enjoying activities they used to or not enjoying life
  4. Getting involved in illegal activities such as stealing, alcohol or drug taking
  5. Concerns raised by their school, for instance, fighting, not engaging in class, not doing homework, or playing truant
  6. Refusing to comply with reasonable requests or boundaries.

TREATING ANGER, AGGRESSION AND VIOLENCE

  1. Depending on your child’s circumstances, you may want to consider a Psychiatric assessment for your child. If your child is displaying signs of anxiety, depression, self-harm or ADHD, a full and comprehensive assessment with an expert in Child and Adolescent mental health will identify any issues present and determine the most effective treatment plan.
  2. Psychological therapy can be hugely helpful for children (even young ones) and teenagers to manage their emotions more effectively. Just as adults go through stressful or difficult times, so do children and often having someone to talk to, who they feel safe with, can make a huge difference in how they behave.
  3. Parenting support can also be incredibly useful for parents of children and teenagers who have behavioural problems. Not only does it allow parents to talk to a professional about their experiences, but parents will learn more effective ways of managing difficult times and preventing crises from occurring.

School Refusal

If you are concerned that your child may be struggling with School Refusal or School Phobia, then we will be able to help you.

WHAT IS SCHOOL REFUSAL?

Most commonly affecting those aged 5-6 and 10-11 years old, school refusal is a reluctance or refusal to go to school, accompanied with real emotional distress for the child.
In younger children, school avoidance or refusal may be due to separation anxiety. In older children, social anxiety is more often the underlying cause. School refusal is different to truancy – often children who are school refusers want to attend (whereas those who play truant often have a very strong dislike for school).

SYMPTOMS OF SCHOOL REFUSAL

The following are common signs that your child may be struggling with school refusal.

  • Frequent complaints of feeling ill (often in the morning and disappearing later in the day)
  • Frequent calls from school informing you your child is ill or upset
  • Your child frequently visits the school nurse
  • Temper tantrums/outbursts in the morning or Sunday nights
  • Crying and tearfulness
  • Pleading or begging you to let them stay at home
  • Truancy or lateness to lessons
  • Distress when dropping the child at school

Gaming addiction

Although internet gaming addiction is not recognised as a formal diagnosis yet, it is an area that has raised a great deal of interest for mental health professionals. For families who have a child or teenager who appears addicted to online gaming, it can often be difficult to find the right support and treatment.

WHAT IS A GAMING ADDICTION?

A gaming addiction, much like a gambling addiction, is a behavioural condition in which a person’s everyday life is significantly affected by a compulsive use of internet-based games or games consoles.

  • Behavioural addictions such as a gaming addiction are usually caused by several factors, but the main reason in the case of video games is that they are designed to be addictive.
  • Video games often offer rewards that may seem particularly hard (but nonetheless possible) to attain and both the anticipation leading up to receiving these ‘rewards’ as well as successfully completing a task, can lead to dopamine being released.
  • The body remembers the pleasurable feeling of playing the game, caused by the release of dopamine. To relive the positive feelings associated with this surge of dopamine, the individual will want to play the game again and again.
  • A vicious cycle is created, where the individual needs to play the game more and more in order to get the same ‘buzz’ or gratification as they initially did.
  • Many online games often have reward systems built into them, that can require players to build up points or skills in order to move on in the game. To achieve these points requires many hours of playing and thus, the player may find they spend more time than planned engaged in the game.

People with gaming addictions often have underlying problems and it is the case that mental health issues often cause gaming addictions rather than the other way around.

GAMING ADDICTION: THE RISKS

Most parents worry about their child or teenagers’ use of ‘screen’ time – we live in a society where many of our children may have access to the internet both at school, at home and on the move – so it’s not always possible to know exactly what your child is doing online or how much time they are spending playing online games.

Where once we worried about the types of games our children played (and much research has been carried out on the link between playing violent games and the impact it can have on your child’s behaviour1) we might now be more worried about the amount of time they spend gaming.

There are several risks associated with a gaming addiction – social, educational, emotional, behavioural, and relational. In many ways, a gaming addiction does not differ from an addiction to a substance or gambling and therefore needs to be treated early so that the most effective outcome is found.

Gaming addiction can also be a sign that your child has another mental health condition, like depression, Autism, or anxiety. The gaming can be used, like any other addiction, to help the individual manage difficult feelings or to ‘escape’.

Left untreated, the underlying cause of the gaming addiction can also increase in severity, making it harder to find an effective treatment option.

SYMPTOMS OF A GAMING ADDICTION

Children and teenagers are spending more and more time on the internet or in front of screens than ever before. As parents, it’s impossible to know how much is too much, although a good rule of thumb is to think about the impact it is having on other aspects of your child’s life. Internet usage should only be a small percentage of what they do every day.

Here are some of the common signs that your child may have a gaming addiction:

  • Being preoccupied with gaming
  • Talking about their games – unable to talk about anything else
  • Lack of interest in other activities they once enjoyed
  • ‘Needing’ more gaming time to be satisfied (known as ‘tolerance’ in addiction treatment)
  • Making excuses to have more gaming time
  • Lying or stealing to access gaming time/resources
  • Losing track of time whilst gaming
  • Sleeping less
  • Secretly gaming
  • Agitation or anger issues, particularly if stopped from gaming
  • Dreaming about games
  • Headaches, muscle aches, repetitive strain injury
  • Anxiety or depression if separated from their game
  • Poor personal hygiene

If you recognise 4 or more of the above symptoms in your child or teenager, it may be worth seeking some help.

 

TREATMENT FOR GAMING ADDICTION

Gaming addiction is just that, an addiction, and should be treated as such. Addictions can seriously harm the way that a person lives their lives and the lives of others around them.

  1. Therapies like CBT can be highly effective at breaking the cycle of addiction - by learning to challenge some of the underlying beliefs the child or teenager has about gaming (such as the need to get to a certain level or become the ‘best’) your child can learn better ways of dealing with some of the difficult sensations they may be experiencing.
  2. Through CBT your child will also be able to understand the negative consequences of their gaming addiction and working with a therapist, will be able to build up their self-esteem and confidence to allow them to enjoy other activities again.
  3. The skills your child will learn through a therapy like CBT will last a lifetime and many can be applied to other areas in their life.

Drug and Alcohol abuse in teenagers and children

Finding out, or suspecting, your child or teenager has a problem with drugs or alcohol is a very worrying time for parents – not only is it hard to know how best to help your child, but many parents will worry about the long-term impact it will have on their child’s health and wellbeing. We can help.

SIGNS YOUR CHILD OR TEENAGER IS USING DRUGS OR ALCOHOL

The brain undergoes a huge amount of development during adolescence, so using substances like cannabis, legal highs or cocaine can potentially have a greater long-term impact on a teenager than it would for fully developed adults1.

The signs that your child or teenager may be using drugs or alcohol will depend on several factors, for instance, what they are using and their own personality.

But, if your child is showing some of the following signs and you suspect something isn’t right, it’s always best to check things out – the following signs might be a sign of another disorder like depression or anxiety.

Behavioural signs you teenager may be using drugs or alcohol

  • Truancy from school
  • New social group
  • Going out more often / staying out late
  • Changes to personality
  • Hostility or violence towards others
  • Secrecy
  • Stealing/lying/valuables going missing
  • Increased risk to self and others
  • Low motivation
  • Anxiety and depression
  • Paranoia
  • Psychosis – hearing voices, hallucinating

Physical signs your teenager may be using drugs or alcohol

  • Bloodshot eyes
  • Tiredness and lethargy
  • Disturbed sleep
  • Loss of coordination
  • Memory problems
  • Lung complaints
  • Finding or smelling drugs/alcohol on them

CAUSES OF DRUG & ALCOHOL USE IN CHILDREN AND TEENAGERS

It’s likely that a combination of factors is the cause of your child or teen’s substance use and these can include:

  1. Experimentation
  2. Boredom
  3. Peer pressure
  4. Exam or school pressure
  5. Testing boundaries
  6. Managing difficult emotions/feelings
  7. Other mental health conditions

Research has shown that there is a strong likelihood that children and teenagers who use drugs and alcohol will have another mental health condition and may be using the substances to help them cope with some of their negative feelings.

The most common conditions are behavioural disorders. Up to 50%2 of young people who have abused drugs will have a conduct disorder (CD) or oppositional defiance disorder (ODD), but depression, anxiety, PTSD and ADHD are also common.

Studies with twins show that there is a strong hereditary link for drug and alcohol use, some estimate that around 50% of children or teens who use drugs and alcohol will have a close family member with an addiction3.

It’s common for young people to start by using drugs like cannabis or having the odd drink and then for things to escalate in terms of severity and frequency. We know that addiction is a progressive disease with long-term physical and mental health consequences, so early intervention is crucial to ensuring that things don’t get worse.

TREATING DRUG AND ALCOHOL ISSUES IN CHILDREN AND TEENAGERS

The first step to getting help for your child is an assessment with a child and adolescent psychiatrist, who will be able to determine if there are any other mental health conditions that could also be present.

If your child is depressed or has anxiety or ADHD, it may be that dealing with these conditions first will help them reduce their usage. Medication and talking therapies are effective in dealing with a wide variety of conditions.

Talking therapies such as CBT and Motivational Interviewing can be helpful for your child – by being able to talk to someone objective about their feelings and experiences, many young people will gain a sense of self-esteem and self-worth that is often lacking in those that turn to drugs or alcohol.

No matter what psychological therapies are used, there should typically be a family component to the treatment of substance use disorders in young people. This will allow all the family members to be heard and these sessions can support and embed the principles your child is learning through their individual therapy, into the home unit.

Support with Children Stealing and Lying

When stealing and lying become a regular occurrence, or when these behaviours are accompanied by other worrying signs, it may be time to seek the advice of an expert in child behaviour. We can help.

CHILD AND ADOLESCENT LYING

The ability to successfully tell a lie is one ability that sets humans apart from other animals. The average adult admits to telling a lie 13 times a week and lying is considered by many experts to be an important milestone in a child’s emotional development.

The process of lying is complex and involves a child understanding they are a separate entity to their parents – this ability normally happens at around the age of 2 or 3.

Whilst young children may lie because they are not able to separate fantasy from truth, by the age of 6 most children understand the moral implications of lying.

Persistent lying can be a sign that:

  1. A parent’s expectations are too high
  2. The child fears the consequences of the truth
  3. The child can’t explain their actions any other way
  4. The child is craving attention

Whilst many lies can be small and insignificant, if your child frequently lies or the lies are getting them or other people into trouble, it could be a sign there is an underlying problem that would benefit from some expert input.

If lying is accompanied by any of the following, you may want to speak to an expert:

  • Depression / low mood
  • Lack of empathy for others
  • Low self-esteem
  • Hurting other people or animals intentionally
  • Hyperactivity
  • Fire setting / risky behaviours

CHILD AND ADOLESCENT STEALING

Finding out your child or teenager is stealing can be deeply concerning – parents are understandably worried about not only the impact on the other party but may also feel guilt or shame about their role as parents.

If your child or teenager is stealing, it can be a sign of emotional problems that may benefit from expert help.

What causes a child to steal?

  • Emotional problems
  • Peer pressure
  • Low self-esteem
  • Friendship difficulties
  • Wanting to ‘buy’ popularity
  • As a way of feeling good about themselves
  • Neglect (needing certain items because they are not being provided for)
  • Being bullied

If stealing is accompanied by any of the following, you may want to speak to an expert:

  • Depression / low mood
  • Showing no remorse
  • Frequent stealing
  • Stealing expensive items
  • Low self-esteem
  • Hurting other people or animals intentionally
  • Hyperactivity
  • Fire setting / risky behaviours

 

WHY IS MY CHILD STEALING OR LYING?

Some stealing or lying behaviour is part and parcel of growing up – we have all made mistakes in our adolescence and they are how we learn about the world.

Lying can be a way of testing out boundaries, a key developmental need for adolescents. Others may lie or steal as a way of managing difficult emotions. Our arousal states are increased by the process of lying and stealing, and these behaviours can make a child feel more powerful, in control and even give them a bit of a ‘high’.

HELP AVAILABLE FOR STEALING AND LYING

One of the first steps that many parents find helpful is for their child or teenager to meet with a child and adolescent psychiatrist to assess if there are any underlying reasons behind the stealing and lying behaviour.

Research shows that children who lie and steal may have an underlying condition, such as a conduct disorder, ODD and emerging personality disorder, all of which can be helped by therapy and in some cases, medication.

Working with a psychologist or psychotherapist can help your child manage their emotions in a healthier way and teach them lifelong skills. For some children, medication can be effective in helping address underlying issues that may be causing the behaviour.

School exclusion

Behavioural problems are the biggest reason children and teenagers get excluded, either temporarily or permanently, from school. We can help address these issues.

THE IMPACT OF SCHOOL EXPULSIONS AND SUSPENSIONS

Every day in the UK about 40 children are permanently excluded from school and a further 2,000 suspended. The main reasons are behavioural, either aggressive or disruptive behaviour.

These school expulsions and suspensions can have a devastating effect on the family – not only is it a very stressful time and one that often results in a lot of family conflict, but if suitable alternative education can’t be found quickly, it can have long-term implications for the academic attainment of the child and the ability for the parents to carry out normal daily life, such as work.

CAUSES OF SCHOOL EXPULSIONS AND SUSPENSIONS

The main reasons children and teenagers are expelled or suspended are:

These aggressive or disruptive behaviours are often symptomatic of emotional difficulties or mental health problems the child may be experiencing.

Undiagnosed ADHD, ASD, conduct disorder, special educational needs, anxiety or ODD can all be reasons why a child or teenager may get into trouble at school. We know that poor behaviour is closely linked to low levels of self-esteem and may be a result of bullying, abuse or a trauma.

As the causes aren’t always clear and often a child or teen won’t be able to talk about why they are behaving the way they are – seeking help from an expert who can assess if there is an underlying cause for the behavioural problems is key.

SUPPORT FOR SCHOOL EXPULSIONS AND SUSPENSIONS

If your child has been excluded from school or is at risk of exclusion, one of the best places to start for parents is to understand exactly what the issues are.

A psychiatric assessment with a child and adolescent psychiatrist will be able to identify if there is an underlying cause, such as ODD or ADHD. They will work with you and your child to get a clear picture as to what has led to this situation.

From there, medication or talking therapies may be recommended.

CBT and other psychological therapies can be effective at helping children overcome their fears. Our Psychologists and Psychotherapists are experienced in helping children with school-related issues, so understand the complexities well.

Parenting Support can be invaluable in teaching parents the best way of handling difficult situations in a way that will support your child’s progress. It also gives parents a space to talk to a child behavioural expert about their experiences and frustrations – it can be very hard to talk to family and friends honestly about what is happening in your family.

Teenage and child bullying

Bullying can take many forms and isn’t always obvious to the adults in a child’s life. For the child being bullied, there are likely to be serious implications - unhappiness, stress, loss of concentration, self-esteem and focus on school and even physical ill health.

It’s a serious issue for both those being bullied and the bullies themselves.

WHAT IS BULLYING?

Most children at some times have been teased or have had difficult times with their friends. But when another child is tormenting them either physically, verbally or in other ways, it needs to be dealt with.

Increasingly, cyberbullying is turning into a problem. Bullies are taking to new media platforms - emails, chat rooms, instant messaging, social networking sites and texting to taunt and bully others – which can extend the comments to a wider group of children – increasing the suffering for the child being bullied.

SIGNS YOUR CHILD IS BEING BULLIED

Often children don't want to tell a parent they are being bullied – they may feel humiliated, feel they are at fault somehow or worry that by telling you things will get worse. As a parent, you might suspect something is wrong.

Common signs that your child may be being bullied are:

  • Stomach aches or headaches caused by the stress
  • Not sleeping well or having nightmares
  • Being more moody or bad-tempered than usual
  • Over-reacting to situations and taking it out on siblings
  • Belongings being damaged or going missing
  • Decline in concentration, focus and attainment at school
  • Worrying about going to school or not wanting to go out
  • Change in friendships or normal routines with friends
  • Becoming socially withdrawn
  • Crying, tearfulness or low mood
  • Bruises or tears/marks on clothing

THE LONG-TERM IMPACTS OF BEING BULLIED

It makes sense that being bullied is going to have a negative impact on your life – and studies with twins have looked at the long-term mental health effects. The study showed that those who have been bullied are more likely to develop anxiety disorders, depression and even paranoid thoughts. These conditions may not show themselves immediately – they can develop years down the line1.

WHAT IF YOUR CHILD IS THE BULLY?

Finding out your child is bullying another is a horrible and worrying thing – and parents often don’t know how best to stop their child’s behaviour. Confrontation and punishment are natural reactions for parents; however, bullying can be a sign that there is an underlying issue that needs to be dealt with.

Benefits of finding help for a child who bullies:

  1. Teach other ways of behaving - finding help for your child or teenager early is the best way to teach and reinforce alternative behaviours.
  2. Underlying mental health issue - if your child is bullying another, the likelihood is your child will also need some support – the bullying behaviour could be a sign of an underlying mental health condition like conduct disorder, ODD, ADHD or anxiety.
  3. Talk to an expert - you may want to consider an assessment for your child or teenager to understand the causes of their bullying behaviour. This might sound scary, however the Psychiatrists we work with help thousands of families every year who are in a similar position to you. Their main focus is making sure your child is ok – they aren’t there to judge you or your child.
  4. Consider talking therapies - a talking therapy, like CBT, can be hugely effective at helping children deal with their emotions in a more positive way and to understand the consequences of their behaviour. By involving a third party to help your child, it can improve your relationship with your child as you are no longer the only one trying to address the problems.

Seeking help early is the most important step you can take to ensure that negative behaviours do not escalate or becoming entrenched.

Causes of behavioural problems

One of the questions we get asked most is “Why does my child behave like this?” – it is perfectly understandable to want to understand what might be causing the behavioural issues and therefore, how to support your child. We can help.

BEHAVIOUR PROBLEMS ARE COMMON

There is no one cause for behavioural problems such as ODD (oppositional defiant disorder) or conduct disorders. Your child’s behaviour is a complex relationship between many different elements.

We know that behavioural concerns are very common (about 8% of teenage boys have behavioural problems, 5% of under tens) but the reasons for this aren’t always clear.

As a parent, this can be incredibly frustrating and it’s normal to feel worried, stressed, embarrassed or even shamed by your child’s behaviour. You might feel like you are a bad parent or can’t control your child and be worried about what other people think about you. Although understandable, these thoughts are rarely justified: behavioural disorders have complex causes.

CAUSES OF BEHAVIOURAL ISSUES

There are often several factors that can be responsible for why a child or teenager behaves in a certain way, including:

  1. Genetic factors – we know that some children are more inclined toward behavioural problems because of their genetic make-up. A family history of mental disorders can increase this risk.
  2. Other mental health conditions, such as ADHD, Autism, depression and anxiety are often accompanied by behavioural problems, such as shyness, anger or school avoidance.
  3. Physical issues - damage to certain parts of the brain can result in a child being unable to control some of their tendencies or being more inclined to aggression.
  4. Bullying or difficulties at school can result in a child ‘acting out’ with aggressive or violent behaviours as a way of them dealing with their experiences at school.
  5. Issues within the home, such as parental discord, family bereavements or illnesses and parental mental health issues can mean children and teenagers develop behavioural problems.
  6. Difficulties learning acceptable behaviours from others (which can be because of Learning Difficulties or language problems) can make it hard for children to learn socially appropriate behaviours.
  7. If your child has experienced trauma or abuse, even at an early age, they may be more likely to develop behavioural problems.
  8. Alcohol and drug usage can trigger behavioural issues within children. Parents aren’t always aware their child is using drugs or alcohol, but research has shown the use of substances like cannabis can have a significant impact on your child’s behaviour.

HOW TO HELP YOUR CHILD OR TEENAGER

Research has shown that early intervention is key to getting effective support and treatment for your child or teenager. About 70% of children with a mental health problem don’t get the right help at the right time – this can mean that the issues grow worse or develop into something more severe.

The reasons for not getting help early enough are often that parents feel their child will grow out of the phase, that it is a normal part of development or because they feel shame or embarrassment about their child’s behaviour.

Treating behavioural issues

There are many different, highly effective, treatment options available for children and young people who are struggling with their behaviour.

ASSESSMENT

One of the most useful first steps is to understand more about the issues that your child is struggling with. We know that behavioural difficulties, such as aggressive or defiant behaviour, can often be a way a child or teenager communicates difficulties they are having in another area of their life – for instance, issues at school or with their self-esteem.

It’s also very common for children who display signs of anger to have an underlying condition, like ADHD, depression, or anxiety. Some studies indicate that as many as 40% of children with behavioural issues will have ADHD.

An assessment with a child and adolescent psychiatrist will identify if there is an underlying cause for the behaviour and will also identify the best treatment route.

MEDICATION

Certain medications can be useful for helping children and teenagers manage their anger or aggression issues, for instance:

  1. If the underlying problem is ADHD, stimulant medication can be highly effective. There is a great deal of evidence showing that these stimulant medications increase levels of certain key chemicals in the brain (dopamine and norepinephrine) which allows the brain to function in a different way and helps the child’s behaviour – commonly increasing their ability to concentrate and decreasing their levels of hyperactivity.
  2. If the underlying condition is autism, there is evidence that atypical antipsychotics, such as Risperidone, may reduce severe aggression by acting on the dopamine and serotonin neurotransmitters.
    Medication is typically seen as a treatment of last resort for excessive anger in autism, and the advantages should be carefully weighed against the risk of side effects, but nonetheless, for some families, having medication to help their child’s aggression is a lifeline.

There are other medications that can be useful in helping a child or teenager manage their behaviours and reduce their aggression. Often, a talking therapy will be recommended alongside medication - the medication can often help the child engage more fully in their therapy.

TALKING THERAPY

Your child or teenager may benefit from having some time with a therapist or psychologist who will be able to work through any emotional or behavioural issues that your child has.

Children won’t always feel comfortable talking to their parents but will often open up to a therapist.

CBT (Cognitive Behaviour Therapy) has been shown to be effective at helping a child or teenager1:

  1. Regulate excessive anger
  2. Learn social problem-solving strategies
  3. Develop alternative social skills (other than anger)

Talking therapies are often the most preferred option for treating behavioural issues – not only are they the safest options (many medications have side effects) but the skills your child or teen will learn from therapy will last them a lifetime and are a real investment in their future.

FAMILY THERAPY AND PARENTING SKILLS TRAINING

It can be incredibly stressful for the whole family if you have a child who has behavioural issues. Your daily family life may be rife with arguments, confrontations, and stress. Siblings can often suffer when one child has specific behavioural issues; marriages are often placed under huge amounts of stress and marital discord can make your child’s behaviours worse as they may feel they are to blame - but still not know how to stop.

Evidence has shown that family therapy and parenting support can help tackle and reduce disruptive or problem behaviours and are often based around how parents behave immediately after their child’s aggressive behaviour.

With the help of a parenting coach, therapist, family therapist or psychologist you will learn:

  • Praising appropriate behaviour
  • Effective communication
  • How to ignore the problem, attention seeking behaviours
  • How to behave consistently with regards to consequences
  • How to embed and support the skills your child is learning from their therapy

Attending sessions as a couple can often be hugely powerful and ensure there is a ‘united’ from at home. This can take a great deal of pressure off the family and give everyone the space they need to help the child affected.

Causes of behavioural problems

One of the questions we get asked most is “Why does my child behave like this?” – it is perfectly understandable to want to understand what might be causing the behavioural issues and therefore, how to support your child. We can help.

BEHAVIOUR PROBLEMS ARE COMMON

There is no one cause for behavioural problems such as ODD (oppositional defiant disorder) or conduct disorders. Your child’s behaviour is a complex relationship between many different elements.

We know that behavioural concerns are very common (about 8% of teenage boys have behavioural problems, 5% of under tens) but the reasons for this aren’t always clear.

As a parent, this can be incredibly frustrating and it’s normal to feel worried, stressed, embarrassed, or even shamed by your child’s behaviour. You might feel like you are a bad parent or can’t control your child and be worried about what other people think about you. Although understandable, these thoughts are rarely justified: behavioural disorders have complex causes.

 

CAUSES OF BEHAVIOURAL ISSUES

There are often several factors that can be responsible for why a child or teenager behaves in a certain way, including:

  1. Genetic factors – we know that some children are more inclined toward behavioural problems because of their genetic make-up. A family history of mental disorders can increase this risk.
  2. Other mental health conditions, such as ADHD, Autism, depression and anxiety are often accompanied by behavioural problems, such as shyness, anger or school avoidance.
  3. Physical issues - damage to certain parts of the brain can result in a child being unable to control some of their tendencies or being more inclined to aggression.
  4. Bullying or difficulties at school can result in a child ‘acting out’ with aggressive or violent behaviours as a way of them dealing with their experiences at school.
  5. Issues within the home, such as parental discord, family bereavements or illnesses and parental mental health issues can mean children and teenagers develop behavioural problems.
  6. Difficulties learning acceptable behaviours from others (which can be because of Learning Difficulties or language problems) can make it hard for children to learn socially appropriate behaviours.
  7. If your child has experienced trauma or abuse, even at an early age, they may be more likely to develop behavioural problems.
  8. Alcohol and drug usage can trigger behavioural issues within children. Parents aren’t always aware their child is using drugs or alcohol, but research has shown the use of substances like cannabis can have a significant impact on your child’s behaviour.

 

HOW TO HELP YOUR CHILD OR TEENAGER

Research has shown that early intervention is key to getting effective support and treatment for your child or teenager. About 70% of children with a mental health problem don’t get the right help at the right time – this can mean that the issues grow worse or develop into something more severe.

The reasons for not getting help early enough are often that parents feel their child will grow out of the phase, that it is a normal part of development or because they feel shame or embarrassment about their child’s behaviour.

Private psychiatry for children and young people

Knowing when the right time is to get outside help for a loved one isn't easy. If you're considering whether a psychiatrist might be able to help your child, an experienced clinical adviser can listen, offer advice, and help you reach a decision.

It's normal for concerned parents and carers not to know what type of support their child needs. Just call us on 0333 3390115, explain what's been happening, and we'll advise you on what we think will be most helpful for you and your family.

 

How do I choose a therapist for my child?

The first step is a phone call with our friendly, experienced team of assistant psychologists. Then, if you would like to book an appointment, we can arrange a session with a child and adolescent psychiatrist suited to your child's needs. It's essential to get the fit right, so we always try to match you with a clinician with whom we think you and your child will feel comfortable.

 

How we work

  • Appointments are available at nationwide locations or online
  • Sessions usually last between 60-120 minutes, depending on the type of appointment
  • You will receive a report that will include a diagnosis (where one is clear) and treatment recommendations
  • Any further treatment, including medication, can be with us, another provider, or through your local NHS GP

 

Preparing for the assessment

It's natural for you and your child to feel a bit apprehensive before the assessment, but rest assured, we select all our clinicians based on their expertise and their ability to make clients feel at ease, so please try not to worry. If your child is nervous about talking to a stranger, they may find it helpful to bring notes or drawings demonstrating how they feel to the session. This approach often helps when a child struggles to explain thoughts and feelings through words alone.

 

Can I attend the appointment?

We ask parents of children under 18 to attend the assessment with their children. The consultant will want to speak to you about your child's history and current health but may also want some time alone with your child so that they can assess behaviour without parental influence.

 

How long with the session last? 

Standard appointments last between 60 and 120 minutes. However, assessments for certain conditions and those with more complex requirements may need longer. We will discuss this with you if we think a longer appointment is required.

 

Should I bring anything to the appointment?

We will send your child's psychiatrist the information you provide in your initial phone call with us. However, before the appointment, we recommend you consider the issues discussed in the call and anything else you feel might be relevant. Make notes if you think it will help and bring them to the appointment to help ensure you don't forget to mention anything. 

 

Your child's report

Following your appointment, we will send you a full psychiatric report. The time it takes to produce the report often depends on how quickly we receive responses to any questionnaires needed. The report will include a detailed diagnosis, where one is clear, and any treatment recommendations.

 

Prescriptions

If the psychiatrist recommends medication, we suggest asking your NHS GP if they will be willing to prescribe it. In most cases, your GP will likely issue a prescription upon receipt of your psychiatrist's report. However, they will sometimes refuse to prescribe more expensive medications, such as some of those used to treat ADHD.

 

What happens after the assessment?

Following your appointment with the psychiatrist, we may recommend that your child see a psychologist or Psychotherapist for further treatment. We can help arrange this treatment privately or you may wish to be treated by the NHS.

 

TALK WITH A QUALIFIED PROFESSIONAL

A free, confidential call could quickly put you on the path to regaining control. All calls are answered by a trained assistant psychologist who will listen and ask questions, before suggesting the most appropriate treatment.

 

 

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