Supporting Young Children

What is normal?

As with adults, the signs and symptoms of mental health concerns can vary significantly from child to child. The onset of warning signs can be slow or sudden. Children grow and change quickly entering new phases and out growing others. Children have many moods, thoughts, feelings and behaviours that are part of normal development, including the ones listed below:

• Outbursts (including anger) or mood swings
• Worrying so much that they are getting stomach aches or headaches
• Nightmares and a lack of sleep that affect your child’s day
• Avoiding formerly enjoyable activities, including spending time with family and friends
• Unusually quiet, sad or reserved, preoccupied
• Change in appetite – eating considerably less, or more
• Behavioral issues at school or challenges to get your child to attend school
• Behavioral changes at home or acting out
• Grades are slipping and your child shows a lack of concern
• Sleep hygiene and personal hygiene issues
• Changes in, or lacking, energy or motivation

When to be concerned

While many of the items listed above can be part of normal development, they can also be signs of an underlying mental health concern or disorder. Consider contacting your child's doctor or pediatrician if the challenges listed above:

• are intense
• persist over long periods of time
• are inappropriate for the child’s age
• interfere with the child’s life

Mental health disorders

Parent seek professional health and medical attention when children and youth have a physical illness or injury. When children have symptoms of a mental illness, they need their parents to respond in the same way.

Remember, most mental health issues experienced in adulthood have their beginnings in these earlier years. It’s important to recognize early signs and symptoms and get help soon.

Some of the most common mental health disorders among children include:

• Anxiety disorders - There are a variety of anxiety disorders that impact young children including: separation anxiety, social anxiety and generalized anxiety. Common signs of anxiety in young children is extensive worrying. Anxiety can be caused by a number of factors, however events such as: traumatic events, moving, starting school, parents' divorce/illness, birth of a new sibling, or other significant lifestyle changes are common triggers.
• Depression and other mood disorders - Rates of depression amongst children and youth have increased over the past few decades. Teenagers are more likely to experience depression than younger children, however it depression can onset at a young age.
• Schizophrenia - One of the biggest myths around schizophrenia is that it is not treatable. Schizophrenia is a serious mental illness, however with the right supports people can go to school, work, volunteer and live active and full lives.
• Post-traumatic stress disorder (PTSD) - Can follow witnessing or experiencing frightening or traumatising events such as emotional, physical, or sexual abuse, being the victim of bullying or violence, or surviving a disaster or accident.
• Eating disorders - Usually start in the teenage years and are more common in girls than boys, however they can onset earlier. Common eating disorders include: binge/stress eating, anorexia nervosa, and bulimia nervosa. Eating disorders are not the same as picky eating. Left untreated eating disorders can have serious impacts on physical health and cognitive development.
• Self-harm - is a common problem among young people. It can include: skin picking, pulling out eyelashes or hair, cutting, and other variations. Self-harm is often used as a coping mechanism to help process emotional pain.

For an overview of mental health conditions and treatment options, see the Canadian Mental Health Association mental health info page.

Neurodivergence

Neurodivergence isn't a disability or a mental health condition. Neurodivergent refers to individuals whose brain development or cognitive processes differ from what is considered "typical". These individuals have different strengths and different struggles from those whose brains develop more typically. Some people who are neurodivergent have impactful or visible medical conditions, others can have conditions that are more challenging to identify--often referred to as "invisible" impacts. While neurodivergence is not a mental health condition, being neurodivergent in a world that was not designed for diverse ways of learning and processing can impact mental health and overall wellbeing. Signs of neurodivergence can also mimic other health conditions and developmental growth phases, making it more difficult to understand what is happening for your child. Common types of neurodivergence include:

• Attention-deficit/hyperactivity disorder (ADHD) — also known as attention deficit disorder (ADD)
• Autism spectrum disorder
• Dyslexia
• Dyspraxia

The Verywellmind website has some additional information you may find valuable.

As with adults, mental health concerns and mental illnesses in children are caused by a complex interplay of environmental, biological, genetic, and personality factors. Information and research into causes and risk factors is constantly revealing new insights and findings. Having mental health challenges as a young child does not mean the child will have challenges throughout their entire lives. Many conditions present in childhood and resolve with effect supports and treatment. Some do continue through-out the lifespan, making early intervention and support especially important. Some of the factors that are known to increase risks of mental illness are:

• Witnessing or experiencing traumatic events, emotional or physical violence, or sexual abuse
• Environmental factors such as not feeling safe, supported, or cared for
• Lack of access to adequate housing and nutrition
• Lack of education, learning rich environments, or leisure activities including play time and time outdoors
• Lack of access to effective health care
• Having a long-term physical illness
• Having a parent who has a chronic illness (physical or mental) or substance use disorders
• Bullying or other forms of humiliation and discrimination
• Parents separation or divorce
• The death of someone close to them (including pets)
• Caring for a relative, taking on adult responsibilities
• Lack of family support or professional treatment for mental health concerns 

The range of environmental, biological, genetic, and personality factors that increase the risk of mental health challenges also provides parents with a range of strategies that are known not only to foster overall healthy development, but to also reduce the risk of menta health concerns. Supporting children's emotional development is as important as supporting their physical development.

Learning to acknowledge and process feelings, how to deal with disappointment and set backs, as well as developing resilience and the inner skills needed to cope with whatever life throws at them will set the stage for children to grown into healthy, well-rounded adults. Some factors that help keep children mentally well include:

• Overall good health -- physical health and mental health are interconnected. Eating a balanced diet, and regular exercise and play time are important for overall development and wellbeing
• Just like adults need time to unwind after work, children need the time and freedom to play, relax, and be kids (both indoors and outdoors)
• Loving, supportive home environment where everyone gets along and cares about each other (most of the time) helps to create the sense of safety and stability that fosters healthy development.
• Going to a school or daycare that looks after, cares for, and fosters the wellbeing of its pupils
• Taking part in social activities (family and community)
• An environment where mental health is understood, supported, and nurtured
• Feeling loved, supported, trusted, understood, and safe
• Having choices, options, and a sense of control over their lives (as is developmentally appropriate)
• Validating feelings and modeling supportive ways to process feelings and build resilience

As parents, it can be agonizing for us when our children are hurting. Not only is it heart-wrenching to watch them struggle, but we can also feel helpless and unsure of how to help. Supporting a child or other family member can also take a significant toll on our own wellbeing. It is important to take care of ourselves at the same time we take care of our loved one. Easier said than done.

There are several things you can do to support young children who are struggling with mental health concerns.

• Listen to your child and take their feelings and needs seriously. They may want a hug or not want to be touched, they may want your help to change something or you to give them space to do it themselves, on a difficult day they may need your help to complete simple tasks.
• Ensure they know you love them despite their struggles. Child can think having a mental health challenge makes them bad somehow, or even unlovable. Ensure they know you love them and are there with them through the process.
• Assist them with the creation and maintenance of routines, or to learn and remember to use strategies and techniques, that help them cope.
• Provide practical help with scheduling and attending appointments, as well as finding services. Go with them to appointments so they know you are active and present with them through this process.
• Respect their wishes, even if you don’t agree with their choices. Forcing someone, especially a child, to choose a particular treatment or service provider can damage relationships and additional psychological damage.
• Monitor changes and key an eye open for setbacks and improvements and provide feedback to your child and health practitioners.
• Increase your own emotional intelligence, empathy, and compassion. The more you understand about the impacts of mental health conditions the easier it is to engage in supportive action.
• Take care of yourself. As mentioned above, taking care of others takes a toll on your own wellbeing.

Children’s Mental Health Ontario (CMHO) has numerous resources on their website, including a Parent Resource section and peer support groups.

The good news is, there are many effective and reliable resources available. Learning more about mental and how it effects children is a key part of ensuring your child's wellbeing. Below are some resources you may find helpful:

• Canadian Mental Health Association
• The Hospital for Sick Children (SickKids)
• Children's Mental Health Ontario
• Children's Hospital of Eastern Ontario (CHEO) - CHEO mental health resources page for resources on specific concerns
• American Mental Wellness Association
• Mental Health Foundation (UK)

Finding the services you need can be time consuming and challenging. Strong advocacy skills are often needed to obtain the right support for your child. It can be difficult to know where to start. Below is a list of suggestions that may help:

• Physicians/Pediatricians: Your child’s doctor is often a good starting point. Physicians treat a variety of health conditions, and usually have a list of services and practitioners they can provide. Some programs and treatments, such as Psychiatrists require a physician referral. Your child’s doctor is an important member of their health care team, so it can be helpful to bring them into the process early.
• The Employee and Family Assistance Program, delivered through Homewood Health Inc., provides employees of the University of Waterloo employees and their dependent family members with a range of health and wellness services.  The program is a complement to the current benefits program, at no additional cost to employees. Find out more about Homewood Health's services.
• Canadian Mental Health Association: CMHA has a resources and information on their website, as well as links to resources.
• The Hospital for Sick Children (SickKids): SickKids has a children’s mental health hub on their website. They also have many services to support child mental health. Accessing physician may require a referral from your child’s doctor.
• Children's Mental Health Ontario: CMHO has extensive resources on their website to support children struggling with mental health and their families including, resources, supports for parenting, and peer support groups.
• Ask a Friend: Referrals are still one of the best ways to find the support you need. Parents with children experiencing similar challenges are often happy to share information about services – they remember how difficult it was trying to find the help they needed.
• Campus Wellness "Other Resources Off-Campus" listing: Campus Wellness has a limited list of therapists in Waterloo region. Many of these therapist work with children.
• EngSoc Off-Campus Mental Health Resources listing: EngSoc compiled a list of Counsellors in the Waterloo region. The list is not exhaustive, but it is more extensive than the Campus Wellness listing.
• Provincial or National Programs and Associations: There are many programs and associations that were created to support individuals dealing with specific mental health challenges, such as the Mood Disorders Association of Canada. Many of these associations maintain a list of resources, programs, and practitioners.
• Provincial and National licensing organizations: In Canada, Mental health practitioners must be licensed. Many provincial and national licensing bodies, such as provincial psychological associations, College of Registered Psychotherapists of Ontario, and Talking Can Help have listings on their website to help you find a counsellor.
• Pharmacists: Pharmacists are trained in a number of drug and non-drug approaches to supporting wellbeing. Some even specialize in pediatric medications. Pharmacists are an important member of your child’s health team. Many Pharmacists are aware of community-based programs and practitioners.