News that a quarter of a million children are receiving help from NHS Child and Adolescent Mental Health Services (Camhs) won’t be surprising to most teachers, social workers, nursery workers and health visitors. They know that in every school year or geographical area there is a small but significant number of people with emotional difficulties that are entrenched and severe.
These are the children for whom general interventions, such as school mentoring, social skills groups and community support do not help or do not help enough. These are the children parents, carers, professionals and communities are most worried about. But it’s not always easy to tell if there is a problem; and if there is, what can parents, carers and professionals do about it?
All children and young people experience powerful anxiety, confusion, distress and rage. Living in a family, making relationships with peers and making mental connections in order to learn are emotional matters. Experiences of disappointment and frustration, at ordinary levels, are as important as achievement and satisfaction.
Play is one way children explore, and try to make sense of and communicate their emotional life. Talking is another. And children usually show how they are feeling through their behaviour.
It’s puzzling or alarming if a child or young person is behaving oddly, if they seem unusually upset, withdrawn, aggressive, controlling or uninhibited in a way that’s hard to understand. Adults can also find themselves repeatedly responding oddly to a child’s behaviour – becoming irritated in an uncharacteristic way, for example – which can indicate that something is up.
With toddlers, children and young people, trying to talk about things at the child’s level can help. Even with babies, parents often notice that they are wondering out loud what the matter is.
Of course the child may not know why they are upset or cross, and may not want to talk about things. It can be nerve-racking for parents to see that something is wrong and that the usual attention, comfort or strategies are not working. And it can be hard to wait and be ready to talk if things shift. Parents talking to each other, with teachers or other professionals, and putting their own observations and thoughts together can help to build a fuller picture.
If parents and teachers can notice there’s a problem and hold their nerve, they often observe that a child’s temporary behaviours – such as sleeping, toileting or eating difficulties, problems with concentrating at school or with friendships, or low or overexcited mood – can be understood as being connected to where they are developmentally, to events at home or at school or changing circumstances in the family. Seeing the behaviour in context can reduce alarm for the adults, which can help with talking about things.
While recognising that a child may have particular difficulties, it’s always important to bear in mind different aspects of their emotional situation. A child may be showing something about their personal emotional situation or about the emotional situation of the whole family. A child always has a home context and culture, a wider social, cultural and economic environment, their own developmental history, and their own individual way of experiencing and interpreting the world.
Helping children with complex emotional difficulties starts with noticing that something’s the matter
When trauma, including traumatic or repeated loss, dislocation, abuse or neglect is part of the child’s experience, they are more likely to find day-to-day relationships hard to manage.
Some children, families and young people have complex difficulties that persist. Talking at home or at school does not seem to help. Things don’t get better when the pressure is off. For these children, a referral to Camhs, usually through a GP, school or social worker, is the sensible next step. A multidisciplinary specialist team can consider the many factors contributing to a child’s persisting difficulties in partnership with the child, the family and the professional network.
Helping children with complex emotional difficulties starts with noticing that something’s the matter. It’s hard to pay attention to what’s happening in a child’s emotional life because it can put parents and professionals in contact with painful states that they don’t understand, feel they can’t help with, or may feel responsible for.
It’s hard to seek help. The figures published this week suggest that more children who need specialist services are getting noticed.
• To download free leaflets on family life from the early to the teenage years written by child and adolescent psychotherapists, please visit Understanding Childhood
Worried about a child’s mental health? Here’s what you should do | Katie Argent
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