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Mental Health for All Children and Youth

What is meant by “child and adolescent mental health”?

  • The term “child and adolescent mental health” refers to the social, emotional, and behavioural well-being of children and adolescents, and is considered an integral part of healthy development.

  • Just as with physical health, no one goes through life without some mental health problems. This is as true in childhood and adolescence as it is in adulthood.

  • Many such problems are a normal part of life. For the most part, we learn and grow from them.

  • For children and adolescents, however, adult awareness, sensitivity, and guidance often are very important to help them to learn and grow from such problems.

  • For some children and adolescents, the problems are serious enough that supports and guidance from the main adults in their lives (e.g., parents and teachers) are not sufficient, and specialized assistance is needed. Without such assistance, the problems can cause much stress and heartache to the children and adolescents, as well as to their families, their teachers, and the community. In addition, such problems can lead to even more serious mental health problems in adulthood.

What can parents do?

  • The daily activities of parents and families, as well as parents’ positive relationships with their children and adolescents, actively promote the mental health of their children and adolescents.

  • Parents’ roles and relationships impact children and adolescents’ feelings of self-worth, dignity, identity, and belonging. Through interactions with their children and adolescents, parents are in a unique position to strengthen these important elements of mental health.

  • Parents also are in an excellent position to observe mood changes or behaviours that seem excessive or unusual, perhaps lasting longer than average, which could indicate a mental health problem requiring consultation and intervention.

  • “Sometimes you just can tell that something is not right.”

Guiding values and assumptions of this Resource for Parents

  • The specific information and suggestions in this Resource for Parents are grounded in a set of values and assumptions about how all members of society understand and relate to one another.
    • As a parent, you are working to provide your children and adolescents with every possible opportunity to succeed and reach their full potential.
    • All persons (children, adolescents, and adults) are different and have unique needs, but:
      • We are all more alike than different
      • We are all of value, no matter what
      • We all need to be treated with respect and dignity, no matter what
      • We all have both strengths and limitations, and
      • We need one another.

  • One might think about children and adolescents’ mental health as on a continuum ranging from developmentally normal, through problems that may be addressed in everyday life, to problems that require expert assessment and intensive clinical interventions.

  • Depending on the child or adolescent’s age and stage of development, and the temperament, social context and unique needs of the child or adolescent, a particular behaviour or difficulty that a child or adolescent is having may be part of normal development.

  • In this Resource, behaviours that are part of the normal development of a particular child or adolescent are considered to be in the Green Light area.

  • If a behaviour goes somewhat beyond (e.g., in frequency or intensity) what would be considered a normal part of a particular child or adolescent’s development, the behaviour is considered to be in the Yellow Light area. This is the type of behaviour that often causes parents concern and that warrants further consideration.

  • How do you tell if a behaviour has moved into the Yellow Light area? The first general rule is to trust yourself. You know your child or adolescent. Trust what you hear and see.

  • In particular, it is important to watch for behaviour that changes, becomes more intense, or occurs more often than before. These can be signs that a behaviour is moving into the Yellow Light area.

  • Behaviour that interferes to a significant extent with a child or adolescent’s functioning in the home or community, or with normal development and normal pursuits, is considered to have moved into the Red Light area and to be serious enough to engage the help of a mental health specialist.

  • As with movement into the Yellow Light area, movement into the Red Light area often is indicated by an increase in a behaviour’s intensity, frequency, and/or duration.

  • Movement into the Red Light area also can be indicated by a lack of response to attempts to help, with the behaviour continuing or intensifying, or with new concerning behaviours appearing.

  • Each chapter in the ABCs Resource for Parents presents a description of behaviours relevant to the title of the chapter as they might appear in the Green Light, Yellow Light, and Red Light areas, depending on the developmental stage of the child or adolescent (Early Childhood, Middle Childhood, Early Adolescence, Adolescence).

  • When you observe a behaviour that is puzzling or worrisome, what might be behind it?

  • Our beliefs about what is behind a behaviour often determine whether or not we continue to worry about it and, if so, what Course to Follow might help.

  • There usually are several factors acting together that affect a child or adolescent’s behaviour.

  • None of these influences should be seen as particularly positive or negative, good or bad on its own.

  • For example, no two families are alike, and particular family characteristics will influence a child or adolescent’s behaviour in particular ways (just as the child or adolescent’s behaviour will influence the family.) A particular characteristic in your family might be normal to the background and culture of your family, and have a positive influence on a child or adolescent’s mental health. The same characteristic in a family with a different background and culture could have a negative influence.

  • The purpose of exploring beliefs is to help parents understand how those different influences work.

  • It also is important to resist the temptation to look for one-dimensional, simplistic explanations for behaviour, as the factors that underlie behaviour can be very complex.

  • Each chapter in this Resource for Parents presents information about various factors that are known to influence the behaviour under discussion.

  • Most chapters discuss these factors under the following headings: (a) biological, congenital, and health; (b) family; (c) disabilities; (d) differences; (e) cultural and/or religion; and (f) trauma., loss, and/or turbulent environment.

  • However, cutting across all of these factors are the five concepts discussed below: normal development, temperament, social context, perception of “difference,” and risk factors and resilience.

Normal Development
  • Development during childhood and adolescence is generally understood to consist of several somewhat distinct stages, each with its own developmental tasks.

  • Developmental tasks are those abilities that are developed or that are expected to be developed during a particular developmental stage. The tasks involve particular physical abilities, cognitive development (i.e., thinking, remembering, understanding), social development, and emotional development.

  • Children and adolescents vary in the ease with which they accomplish these tasks, with some needing more support and practice than others. However, all children and adolescents experience bumps along the way.

  • For the four age ranges addressed in this Resource, some examples of major developmental tasks are as follows:
    • Early Childhood (3 to 5) – ability to use pencils and paintbrushes; elaboration of running, jumping, large motor movements; learning the letters of the alphabet; learning to count; developing the ability to verbally communicate needs and thoughts; learning basic problem-solving skills; developing the ability to sit still, listen, and follow directions; learning to share and take turns; developing sensitivity to other children’s feelings; developing a basic understanding of and regulation of own emotions.  opportunity to succeed and reach their full potential.
    • Middle Childhood (6 to 12) – increased neuromuscular skills that allow playing team games; cognitive development that increases ability to reason and more sophisticated problem-solving skills; adjusting to changing body image, self-concept, and gender roles; becoming a more active family/group participant; becoming less dependent on family and gaining satisfaction from other adults and from peers; learning pro-social attitudes and skills; learning how to handle strong feelings and impulses appropriately.
    • Early Adolescence (13 to 14) – learning to handle the maturing body and to develop a variety of physical skills; learning to think analytically and abstractly; developing skills to relate to a variety of people, including those of the opposite sex; beginning independence from parents, while maintaining attachment and interdependence; learning to manage a wide range of sometimes intense emotions.
    • Adolescence (15 to 18) – learning to handle a mature body and developing a stable sexual identity; developing a personal worldview that includes ethical values and a philosophy of life; developing a sense of membership in a broader community of persons; preparing for personal and economic independence from parents; learning to take primary responsibility for own emotional and behavioural expression.
  • Temperament is another underlying factor that you will find discussed frequently in this Resource.

  • As a concept, temperament is closely related to the concept of personality; however, temperament is thought to be primarily biologically or genetically based, to be observable already in early infancy, to interact with the environmental experiences of the individual and, thus, provide the foundation for a person’s developing personality.

  • Babies have been found, from birth, to vary in their activity level, sensitivity to physical stimulation, emotional intensity, sociability, adaptability to change, and persistence.

  • Although parents report babies with some combinations of these temperament characteristics (e.g., high sociability and ready adaptability to change) to be “easy” to parent, and babies with other combinations (e.g., high activity level, high emotional intensity, and low adaptability to change) as “difficult” to parent, all combinations are considered to be “normal” and to present their own joys and challenges to healthy development.
Social Context
  • A child or adolescent’s social context also has a strong influence on his/her behaviour. 

  • Behaviour that is appropriate in one social context could be an indication of a serious problem in another social context.

  • Social context includes such concepts as family structure, family circumstances (e.g., financial, health, location stability, losses, traumas), family religion and/or culture, and the community in which the family lives.

  • All social contexts have strengths and weaknesses.

  • With respect to family structure, whether the family is intact (both parents in the home), a single-parent home, or a blended family influence the social context of your child or adolescent. The number of children in the family, and whether extended family members or others are part of the family’s daily living, also influence your child or adolescent’s social context.

  • With respect to family circumstances, the child or adolescent’s social context is influenced by whether there are major financial pressures for the family, chronic or acute health problems in family members, how often the family has moved, and whether the family has experienced any major disruptions, traumas, or losses, and how recent those might have been.

  • With respect to family religion and culture, what the family believes and values, and what religious and cultural practices the family observe influences the social context of your child or adolescent.
Perception of “Difference”
  • In addition to having much in common, we also differ from one another and have unique individual needs. 

  • Differences that produce unique needs include such factors as gender, our particular abilities/disabilities, and sexual orientation.

  • Some children and adolescents have attributes or challenges that lead them to perceive themselves, or lead others to perceive them, as different from “the norm.”

  • Differences involving intellect, learning challenges, sexual orientation, living in a non-traditional family, or family substance use are not in themselves mental health problems for a child or adolescent, but can cause stresses that affect a child or adolescent’s mental health.

  • The stress may have its origins in your child or adolescent’s own concerns about the “difference,” or in how others treat your child as a result of their perceptions of the “difference.”

  • Regardless, they are factors to consider when one is trying to understand some of the behaviours your children exhibit.
Risk Factors and Resilience
  • In the ABCs Resource, you will find frequent reference to the related concepts of “risk factors” and “resilience”.

  • Risk factors are individual, family, and community circumstances that increase the probability of mental health problems developing.

  • Known risk factors include having a “difficult” temperament, living in poverty, and exposure to violence.

  • However, it is important to remember that many children or adolescents who live with identified “risk factors” actually behave just fine and live lives that are primarily positive, without the development of significant mental health problems.

  • Children and adolescents who exhibit the most challenging behaviours often live with more than one risk factor, and it’s the cumulative effect of the risk factors that becomes the major problem.

  • However, even with many risk factors in their circumstances, some children and adolescents thrive and do not develop mental health problems. These children and adolescents are said to be resilient.

  • Why some children and adolescents are resilient and others are less so is not well understood. However, it is thought that in addition to risk factors there are “protective factors” in the environments of children and adolescents that can protect those living with multiple risk factors.

  • Prevention programs often focus on increasing children and adolescents’ resilience to risk factors by emphasizing the importance of adding protective factors into the child or adolescent’s daily environment.

  • Protective factors include such things as having caring adults in the family or school, developing meaningful relationships with other adults, having opportunities for positive group involvement and contribution, and receiving praise and recognition for accomplishments.

In general
  • Although many children and adolescents cope well as they grow older and move from grade to grade, others need extra supports in order to progress socially, emotionally, behaviourally, and academically. 

  • Most parents already are providing, or helping their children or adolescents find, the supports they need for their growth process, though they may not be thinking of these in terms of children and adolescents’ mental health.

  • In dealing with mental health problems, a good general guideline for Courses to Follow is “the earlier the intervention, the better the outcome.”

  • Preventing problems from developing in the first place is an excellent beginning.

  • Similarly, being aware of the first sign of trouble in order to prevent a problem from developing further should be the philosophy that underpins any course of action by a parent.

  • The home environment has a major role to play in preventing problems from developing or from increasing in seriousness. This is especially true for behaviours in the Green Light and Yellow Light areas.

  • Special attention to a child or adolescent’s early problems can be very important to reducing the likelihood of actions moving further along the seriousness continuum toward the Red Light area.

  • In some circumstances, the parent will find that formal school and/or community supports and resources also are needed. This is especially true when a behaviour has moved into the Red Light area.

  • For behaviours that are more serious, an important rule is to avoid labelling the behaviour or the child or adolescent, especially with diagnostic terms (e.g., “depression”).

  • In the ABCs Resource for Parents, this is known as the “No Diagnosis Zone,” which is indicated by its own icon [insert icon].

  • Premature or inaccurate labeling or diagnoses can be harmful to the child or adolescent and to the parent’s relationship with the child or adolescent.

  • Another important rule when deciding on a Course to Follow is that crises situations (e.g., threats of suicide, serious physical threats to others) need to be responded to immediately in order to prevent serious harm from occurring. Although a longer-term Course to Follow may need to be developed to help the child or adolescent, whatever needs to be done to prevent immediate serious harm needs to be carried out as soon as possible.

  • Although there are many joys and satisfactions in parenting, parenthood can be at times difficult and worrisome. Therefore, a permanent Course to Follow is the ongoing availability of personal support, such as a circle of friends and relatives for informal mutual advice and encouragement.
The Home
  • A positive home environment has been found to be one of the most important factors in promoting good child and adolescent mental health, whether in the prevention of the occurrence of mental health problems, in preventing mental health problems from getting worse, or in reducing the impact of mental health problems on a child or adolescent’s everyday life.

  • What is a “positive home environment?” Generally, it is what you strive to provide in your home every day, and includes:
    • an underlying philosophy of respect (between parent and child/adolescent, and between siblings) that helps provide the protective factors of: 
      • support
      • caring relationships
      • respectful interactions
      • acceptance of differences
      • opportunities for success, involvement, and contribution, and
      • recognition
    • clear expectations and predictable routines;
    • modelling of:
      • optimism
      • positive behaviour
      • understanding and acceptance of feelings
      • regulation of emotion, and
      • constructive conflict resolution
    • creation of an environment that helps the child or adolescent take pleasure and interest in life.

  • In discussions of Course to Follow in this Resource for Parents, each chapter includes suggestions for the home environment and activities of particular relevance to the behaviours discussed in the chapter.

The Child/Adolescent
  • Sometimes in developing or implementing a Course to Follow, it is very important to speak with your child or adolescent directly.
  • When speaking to your child or adolescent about a problem, it is important to keep the following general points in mind:
    • Take it slowly. When you are first trying to find out what may be happening, a child or adolescent may not know how to express it or may not be comfortable in sharing the specific details.
    • Avoid being judgmental, either verbally or non-verbally. Avoid blaming or admonishing the child or adolescent. Children and adolescents are more likely to open up if they know you will not be judging them.
    • Convey interest, verbal and non-verbal reassurance, and eye contact. These can help indicate to the child or adolescent that he or she is understood and not being judged.
    • Listen, listen, and listen!
    • Convey sensitivity to the child or adolescent’s problem and show empathy for what the child or adolescent might be going through.
  • In discussions of Course to Follow in this Resource for Parents, each chapter includes suggestions for talking to your child or adolescent about the particular behaviours being discussed in the chapter.
Support Network
  • On an ongoing basis, it is often helpful to have a network of friends and relatives with whom you can consult and share ideas about promoting good mental health in your children or adolescents and about dealing with mildly to moderately concerning behaviours. In addition to friends and family, parent education programs offered in the community can provide ideas and support. 

  • With Yellow Light behaviours, you may want to speak to your child or adolescent’s teacher(s) to gain their perspective and ideas. If you have similar concerns, a collaborative plan may help.

  • However, behaviours in the Red Light area almost always require special supports and interventions that go beyond what can be done in the home or classroom.

  • Mental health professionals available in the school or community can help assess the seriousness of the situation, provide or refer the child or adolescent to specialized services if needed, and provide you with ideas for helping your child or adolescent at home while the child or youth is receiving specialized services.

  • Above all, remember not to be afraid to ask for help if you sense that something is wrong! 

  • Each of the chapters in this Resource will include, in its discussion of Course to Follow, suggestions about when to take a situation to the formal school resources level.