Does a parent you treat have significant mental health symptoms, or a high-conflict marriage or divorce? If so, it’s important to consider how this may affect children, even infants, in the family.
According to the American Academy of Child and Adolescent Psychiatry, children living with a parent suffering from bipolar disorder, depression, ADHD, anxiety, schizophrenia, or substance abuse issues, can greatly increase risk to that child’s social and emotional well-being. The family is a system, and children sometimes serve functions within it to keep the family intact while forming patterns of feelings, thoughts, and behaviors that cause pain to the child and those around her.
Treatment for the parent is critical in helping the child, and so is early intervention in assessing a child’s social and emotional health. Often mental health professionals treating adults with severe emotional difficulties forget that the children may also need help and support in dealing with a parent’s difficulties.
How to Talk to Your Client about the Children
Inducing guilt in a client about how his mental health impacts his children is generally counterproductive, which sometimes results in therapist and client colluding to avoid talk about parenting and children. So how can you explore this while helping your client understand this is not about blame?
Sometimes it’s helpful to emphasize, and empathize with, how challenging parenting can be for anyone, let alone someone struggling with mental illness, or the persistent conflict of a divorce that forces two people to continue a relationship because they must co-parent their children. Letting a child therapist into the family’s life can support not just the child, but the parents, and ensure that the relationship between parent and child gets, or stays, on a healthy developmental track.
When to Seek Help for a Child
Some children reveal their internal experience–thoughts and emotions–through obvious behaviors and interactions with others. These children “externalize” their struggles. Here are some typical externalizing behaviors that signal the child may benefit from evaluation by a therapist:
Ages 0-5 years
- Not reaching developmental milestones, such as speaking, walking, toilet training
- Severe worry or anxiety, either by the child’s report or by refusal to sleep or take part in activities
- Frequent, unexplainable tantrums
- Aggressive behaviors toward siblings or parents
- Parental feelings of disconnection with infant or child
- Parental feelings of powerlessness to satisfy infant or child
- Parental feelings of overwhelming and persistent anger toward infant or child
- Persistent inactivity or lethargy
Age 5-11 years
- Marked fall in school performance
- Poor grades in school despite trying very hard
- Severe worry or anxiety, either by your child’s report or as shown by regular refusal to go to school, go to sleep or take part in activities
- Frequent physical complaints
- Hyperactivity; fidgeting; trouble staying in one’s seat; constantly on the go with or without difficulty paying attention
- Persistent nightmares
- Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures
- Frequent, unexplainable temper tantrums
- Threats to harm or kill oneself
Other children “internalize” rather than externalize, These children often don’t make it to therapy until their teen years or later when maladaptive and painful patterns of emotions and behaviors have become much more engrained. This is because children who internalize their struggles don’t cause problems for the people around them, so their suffering is more hidden. Signs that a child is experiencing internal difficulties might include:
- Isolating behaviors
- Only demonstrating positive emotions rather than a range of healthy human feelings
- Excessive compliance with parental expectations or desires
- Persistent sadness, expressed verbally or by appearing down
If you are a clinician of a parent struggling with mental health, or you are a parent in that struggle, and you have questions about the children’s mental health, feel free to give me a call to consult. Play therapy and infant- or child-parent therapy can help strengthen relationships, help children regulate their emotions and reduce painful behaviors, and support the progress you or your client is making.
Cathy Eisenhower, LPC: (202) 318-3958