Pediatric Behavioral Health

The first few years of life are a precious and exciting time. More than any other period in life,you will see rapid growth in their physical, cognitive, and social abilities. In short months, they go from being able to support their heads to rolling over to crawling and, before you know it, your curious tot is quickly waddling around the room getting into everything within their reach. At this stage, very young children are learning to trust the world around them and, often times, first time parents are learning to trust their new found abilities as caregivers. Enjoy this precious time with your young ones and marvel at how quickly the grow!

Tantrums or Challenging Behaviors
What it is: Tantrums are very common in toddlers and can be one of the biggest challenges for many parents. Although tantrums are part of early development, children are typically able to learn how to self-regulate and express their emotions in a non-disruptive manner. Moving past tantrums is possible with the help of effective parenting techniques.
How to identify: Tantrums can be mild or severe and some of the symptoms can include: explosive anger, frequent meltdowns, and disruptive behaviors. Children who are unable to regulate their emotions often have a build up of emotional intensity that ends in screaming, crying, throwing themselves on the floor, pouting and other difficult behaviors.
How to help: It is important to understand that your child is struggling to express his or her emotions. Knowing this can help to build empathy during these difficult parenting situations. Discovering what is triggering your child emotionally is the first step in solving the problem. They may have tantrums exclusively when they are hungry or tired. Noticing these patterns in behavior will help you be better prepared to manage the meltdown. Do they need additional coping support or appropriate coping skills? Are they struggling to communicate needs? Could you put in a positive behavioral system or a consistent consequence system to better manage the behavior? If the parenting strategies you have been implementing have not been successful, exploring therapy options may be the next step. Therapy can provide parents with effective tools and techniques.
Depression
What it is: Most depressive disorders share the common symptoms of feeling sadness, emptiness, or irritability. When children experience depression it can affect not only their mood, but also, their ability to think and function. Children may experience changes in many parts of their life such as, energy, sleep, relationships, and school performance.
How to identify: Some signs of depression include, irritability, sadness, sensitivity to rejection, changes in sleep and appetite, crying, difficulty concentrating, low energy, reduced functioning in social situations or school, loss of interest in favorite activities, and thoughts of death or suicide.
How to help: Build empathy and understanding by validating emotions and showing curiosity in their lives. Try to avoid problem solving or fixing their symptoms, instead, give them opportunities to do things, praise them for the positive things they are doing, and help them find treatment. Therapy can help kids and teens improve their mood through different strategies including building coping skills, changing negative and unhelpful thoughts to more helpful, and problem-solving strategies. It can help parents understand what their child is going through and give strategies to help.
Anxiety
What it is: Anxiety disorders can cause children to feel overwhelmed by intense fear or worry. These reactions are often out of proportion with the severity of the situation that provoked them. Some worries may include separating from parents, school performance, embarrassing themselves, germs, crowds, and many more. Anxiety can be crippling and difficult to overcome without the proper tools.
How to identify: Some symptoms may include, dizziness, rapid heartbeat, difficulty breathing, sweaty or shaky hands, headaches, stomach aches, muscle tension, restlessness or fatigue, repetitive actions, irritability, trouble concentrating, or excessive worry most days of the week.
How to help: Listening can be one of the most effective ways of helping your child feel understood. Avoid statements such as, “there is nothing to worry about,” or “just relax.” This sends the message that your child’s feelings are not important and should not be expressed and resolved. Instead, modeling healthy stress relief can show your children that there are ways to express and deal with stress. If their stress levels are continuing to increase and their efforts of stress relief are not effective. Therapy can be effective in better managing anxiety through providing kids and teens tools to better manage anxiety, including building tolerance, having more balanced thoughts, and expanding coping skills.
Oppositional/Defiant Behavior
What it is: Oppositional Defiant Disorder often includes three main characteristics. Angry or irritable mood, argumentative or defiant behavior, and vindictiveness. Children will often justify their behavior as a response to unreasonable demands or circumstances. These behaviors may be only in the home or may spread across many settings. This can make it extremely difficult to discipline children.
How to identify: Some symptoms may include, losing their temper often, being touchy or easily annoyed, angry or resentful, arguing with authority, defying or refusing to comply, deliberately annoying others, blaming others for misbehavior, or being spiteful or vindictive.
How to help: If your child regularly defies your authority, holding consistent boundaries is pertinent. If a child thinks that he or she can get away with a behavior once, they will continue to try until it happens again. By implementing consistent discipline, you are creating the structure where children know the limits. If you find that your efforts aren’t work, a therapist may be able to work with you and your child to change the nature of your interactions. Several models of evidence-based therapies can help increase positive interactions and decrease negative ones.
Attention Deficit/Hyperactivity Disorder (ADHD)
What it is: Attention-deficit hyperactivity disorder is a condition that impairs concentration, attention span, and the ability to control impulsive behavior. ADHD can make daily routines challenging. It can greatly impact a child’s performance in school and other activities that require concentration.
How to identify: There are two main types of symptoms, hyperactivity and impulsivity and inattention. Some of the symptoms of hyperactivity and impulsivity include excessive physical activity, fidgeting, impatience, interrupting, and trouble staying still. The symptoms of inattention can include being easily distracted, lack of attention to detail, forgetfulness, and difficulty following directions. All of these symptoms can also lead a child to demonstrate low self esteem. The combination of all of these symptoms can create some challenges for your child and family.
How to help: Helping your child create structure throughout their day can improve their ability to function. Simple techniques such as, creating a calendar, prioritizing tasks by color coding, and having visual reminders posted in the home and at school can help children who struggle with inattention. Addressing a child’s hyperactivity can make quiet times more easy to navigate. Giving your child appropriate ways to fidget or move can help them stay on task. Allowing them to get out their restless behaviors by moving at the designated time can help keep them on task when they are required to be still. Outpatient therapy can assist with putting strategies and scaffolds in place in a way that works specifically for your child and family’s individual needs.
School Stress
What it is: School stress can occur because of test-anxiety, high academic pressure, issues with social interactions, and many other reasons. Some level of school stress is healthy and promotes intellectual growth. When stress become debilitating, it can impair your child’s ability to succeed. If your child was able to function and deal with stress before, but is now experiencing some of the symptoms listed below that may indicate a need for intervention.
How to identify: Children may exhibit symptoms such as, frequent headaches and stomach aches, irritability, bedwetting, difficulty concentration, excessive worry, negative self-talk regarding school, isolation, or changes in eating and sleeping patterns. They may have significant changes in school performance, extracurricular performance, and interpersonal relationships.
How to help: Creating a structured home routine can help reduce some of the anxiety your child may be experiencing. Make sure your child has proper nutrition and an age-appropriate amount of sleep in order to promote healthy brain development. Planning and practicing for anxiety provoking situations may be helpful in easing some of your child’s worry. If these strategies are not working, therapy could be helpful.
Bullying
What it is: Bullying occurs when there is a real or imagined power imbalance. It can include verbal or physical attacks, threats, rumors, or exclusion. It can occur through different platforms such as verbal and nonverbal gestures and messages, and online social media. Bullying is intentional and causes harm to the victim.
How to identify: If your child reports being teased, name-called, taunted, or threatened, these are identifiers. However, your child may not communicate that they are being bullied. Other signs to look for are, changes in mood, low-self esteem, lack of friendships, frequent embarrassment, avoidance of certain situations, new bruises or marks, or isolation.
How to help: Check in with your child, listen, and validate their feelings. Explain how he or she can stand up to a bully by reporting to a teacher, saying “stop”, walking away, or staying near a safe adult. If bullying continues despite your child’s actions, it may be necessary to contact a teacher, guidance counselor, or school official. If your child is experiencing significant distress from bullying, therapy can also be a helpful solution.
Eating Disorders
What it is: When children have an unhealthy relationship with food or abnormal eating habits, it can impact their health and functioning. Some abnormal habits may include extreme fixation on appearance, distorted perception of self, extreme dieting or overeating.
How to identify: Some red flags to look out for include, sudden changes in weight, skipping meals, excessive exercise, fixation on calorie counting or dieting, irregular periods, thinning hair, use of laxatives, frequent trips to the bathroom during meal time, hoarding food, or discolored teeth.
How to help: Therapy can help your child/teenager build a healthy attitude towards eating. We encourage our parents to follow healthy eating habits at home, in order to model positive behaviors for your children. Using positive language surrounding food or body image, instead of labeling food as “good” or “bad”, can be a helpful tool. Avoid criticising your child’s size or body. Eating disorders are serious and can cause medical complications and concerns. If you notice any of these warning signs, seek help immediately.
Parent-Child Discord
What it is: Children and teens are gradually working towards independence as they move through different developmental stages. Sometimes, this part of growing up can cause parent-child conflicts. The escalation of parent-child discord can often progress slowly so it is hard to determine when it has become too difficult to manage. Often times, parents think “this is just a phase,” and continue to allow their child’s behavior to grow in intensity. Parents then find themselves caught in screaming matches, brawls, and emotionally charged fights.
How to identify: If you and your child have been experiencing increasing conflict that is difficult to manage, screaming matches, verbal assaults, physical fights, or increasing emotional distance, this could be indicative of a need for intervention.
How to help: When a child is acting out, it can often be indicative that there is a need not being met. This need may be emotional, behavioral, or cognitive. Problem solving with your family about what might be missing from the care of your child is a good first step. If you are at a loss and need assistance, a therapist could provide you with parenting strategies.
Adjustment to Family Changes
What it is: When the family structure changes due to divorce or other circumstances, children and teens can have a difficult time adjusting. Divorce and separation affects all aspects of children’s lives. They have to navigate separate holidays, splitting time between family members, differing parenting styles, and introduction of new family members. Other family changes such as, birth of a sibling, death of a relative, and moving homes can be difficult for children.
How to identify: In younger children, adjustment difficulties may present as temper tantrums, school refusal, or difficulty during transitions. Some children and teens may exhibit symptoms of depression or anxiety. They may begin to defy authority or seek attention. Some children may exhibit regressive behaviors such as having accidents, baby talk, or sucking their thumbs. If any of these symptoms progress or continue for an extended amount of time, you may want to explore seeking help.
In adolescents or teens, adjustment difficulties may include defiance, isolation, decrease in appetite, increase or decrease in sleeping habits, disinterest in previously enjoyed activities, or lack of verbal communication. If any of these symptoms persist, it may be helpful to seek help from a trained therapist.
How to help: Open communication during these changes gives your child an outlet to express the emotions they are experiencing. When children feel heard and understood, they are less likely to have difficulty in transitions. When gaining a new sibling or family member, including the child in the new routines can help them feel like they are still an integral part of the family. In addition, spending special time with each individual child, no matter what the adjustment, is proven to decrease negative behaviors. During divorce, letting the child know that they are not the cause of the divorce and giving age-appropriate explanations can help ease children’s worry about the unknown. Family changes can be difficult and a therapist can help your family adjust in a healthy way.
Separation Anxiety
What it is: Separation anxiety is common among young toddlers who are separated from their caregivers for the first time. As these toddlers grow up they are typically able to cope with separation. However, some children are unable to cope and develop excessive fear when their caregiver leaves. Their fears may progress into worrying about something bad happening to their caregiver such as, a car accident or death. This anxiety impairs their ability to perform normal daily functions such as school and play.
How to identify: Children may exhibit symptoms of extreme fear or worry, difficulty transitioning to school or other places where they will be without their caregiver, nightmares about separation, and future oriented worry about when a parent might leave them. Physical symptoms could include unexplained headaches or stomach aches, crying, or changes in eating or sleeping habits.
How to help: There are parenting strategies that can help your child with separation. Appearing confident when leaving and reassuring your child that they will be okay will help decrease their fear. If you seem hesitant or reluctant to leave, this reinforces their fear. Providing your child with positive reinforcement when they are able to separate can help to encourage this behavior. If their anxiety persists, it is best to get them professional help early to prevent other disorders from developing.
Gender Identity
What it is: Gender identity is the expression of a person’s internal sense of being male, female, or a combination of both. It can differ from the biological sex of an individual. Children typically begin to notice the difference between boys and girls around the age of two. After this, they begin to develop a sense of their own gender identity. When children identify as a gender that is different from their biological sex, it can sometimes be confusing and worrisome to parents. Gender identity can cause problems when a child’s identity is not recognized or accepted by others. This may affect their self-esteem, social life, overall mental health, and wellbeing. Children who identify as a gender that differs from their biological sex are more at risk for social exclusion, harassment, and bullying. Suicide rates among transgender children and teens are higher than non-transgender child and teens.
How to identify: Children tend to express their gender identity through physical appearance, preferred names, behaviors that are more or less aggressive or gentle, more or less typically masculine or feminine, and social relationships.
How to help: Create a safe environment, listen and validate. Identify resources and network of supportive individuals (such as family, your child’s friends, or professionals) to assist your family and help your child feel as though they belong.
Violent or Aggressive Behavior
What it is: Violent or aggressive behavior can include your child hitting, kicking, biting, or throwing objects at others. Aggressive behavior can happen at home, school, playing with friends, or across all settings. For example, aggressive behavior can occur during tantrums at home or when upset with friends at school.
How to identify: When thinking about about aggressive behavior in children, think about how often it occurs, how long it has been an issue, and how severe the aggressive behavior is. If the aggressive behavior has been occurring for over a month and happens often (once a week to daily) it is cause for concern. Your child may be getting into trouble at school for their aggressive behavior that may result in suspensions. If the aggressive behavior is severe and causing others harm, a mental health professional can develop a plan with your family to address the behaviors and safety concerns. Aggressive behavior can stem from a child having difficulties with emotional regulation, impulse control, or communicating needs. A mental health professional can give your child the tools they need to navigate these difficulties.
How to help: Model remaining calm when frustrated. Encourage children to use their words when frustrated, create safe places in your home for your child to self-soothe. Work with other stakeholders in your child’s life on strategies to teach them self-regulation. Encourage them to use strategies such as taking breaks and deep breaths.
Social Skills
What it is: Possessing social skills refers to the ability of getting along with others and being able to maintain those relationships.
How to identify: Some of the signs are: difficulty making eye contact, inability to respond to simple questions, difficulties with maintaining relationship, struggle to read social cues, aggression, and violence towards others.
How to help: Try to limit TV and screen exposure at home and encourage outdoor and other social activities. Prior to any social activity, practice the skills by role playing at home to help prepare your child with appropriate social behaviors. Encourage your child to join a club or sports team at school and plan strategies to help them cope with social anxiety.