Is my child “normal”?

Nearly every parent has asked themself that question at some point, even if we don’t want to admit it. And though our culture seems to be making progress toward reducing the stigma surrounding mental illness, many of us think of mental-health problems as something that affects other people, not us.

As a master’s-level social worker who has treated children with a wide range of psychiatric diagnoses, I used to think that way myself. It’s tragic that these problems affect so many young people. Thank God this will never happen to my kids.

I’m almost embarrassed to admit that I thought that way. I knew that an estimated one in six children ages two to eight in the United States has been diagnosed with a mental disorder. I also knew that psychiatric disorders are often hereditary, and I have a family history of anxiety and depression. The odds that one of these disorders would affect one of my children were pretty good.

Now, many years later, I have four kids, and three of them have been diagnosed with a mental illness. Even though I am a mental-health professional, I felt utterly unprepared to parent one child with a mental illness, let alone three.

After my first child was born, I chose not to renew my license to practice social work. That’s when I began the next phase of my mental-health education: parenting children with mental illnesses. Fortunately, I have learned a few lessons the hard way. I offer them to you.

Don’t try to compare your child to other children without diagnoses

Children with mental illnesses require a different style of parenting, and some things you have tried with your other kids just won’t work.

I can’t count the number of parenting books I’ve read. I’ve pored over expert advice for managing kids’ behavior and dutifully implemented time-outs, reward charts, and stern, authoritative commands. I’ve begun each new “method” feeling hopeful that this one would be the one, only to finish it feeling defeated and hopeless.

The problem with these books is that they are written for parents of neurotypical children. It’s not impossible that their methods will work for your child. It’s just that there are other factors at play that might make them work differently.

For example, my son has explosive anger issues. He most definitely receives consequences for yelling, hitting, and kicking. But he also has coping tools that he’s learned in therapy that we pull out when he’s starting to melt down. One of his tools is snuggling our dogs. When he yells at me, I tell him to go snuggle the dogs. After he’s calm, I give him his consequence.

Some parents might think of snuggling the dogs as a reward for bad behavior, but for my son it’s more like medicine.

If your child is not responding to traditional techniques that work with neurotypical children, I recommend that you talk with your therapist about tools that can help.

Your friends won’t get it, so talk to other parents who do

I’ve listened to other moms complain about their toddlers’ tantrums and thought, My kid attempted suicide last week. I’d love a “regular tantrum.”

This doesn’t help. Forget about what’s happening in your Instagram feed and find a group of parents who are also parenting kids with mental illnesses.

I have two such friends. Recently, I called one of them in tears because my son’s symptoms had gotten worse and I didn’t know what to do. A tiny demand from me sent him into a meltdown. He was punching, biting, and throwing things at me.

A parent of a child without a mental illness would’ve been thoroughly confused. I would’ve spent the entire conversation explaining how my son’s mental illness affects his behavior and how I’d already tried every “regular” method of controlling it.

But my friend had been there before, so she told me the truth: I needed professional help, ASAP. She gave me some phone numbers and offered to babysit my other kids so I could get my son to a provider right away.

You need a tribe of parents who know what you’re going through. You might find them locally or through a social-media group. The National Alliance on Mental Illness has family support groups all over the country — you can search for one in your area here. Or you might try a Facebook group for parents of children with mental illnesses.

Even if your tribe is online only, they can still offer you support and empathy that would be difficult for other people to muster.

Therapy is not passive; it requires work

Many people start therapy thinking that they’re going to receive some magic pill that will “fix” their mental-health problems. I wish it were that easy.

The truth is that therapy is work, and most of the job falls on the patient and their parents.

This might be a bit surprising at first, but the rationale is simple. You don’t live your life inside a therapy room. If your child is depressed or anxious at home or at school, that’s where you will have to address those problems. Therapy is a place to learn how to do that.

Know the symptoms of your child’s illness and work with a therapist on an action plan for dealing with them

The good news is that your therapist probably has a huge bucket of tools to pull from when teaching you how to handle your child’s symptoms. The bad news is that you might have to try several of them before you find one that works.

Therapists and psychiatrists have lots of knowledge and research to draw from when it comes to choosing treatment modalities. They know which drugs and therapeutic techniques are most likely to work for people with certain conditions. But that doesn’t mean they’ll get it right on the first try.

My son’s therapist started off by teaching him to take deep breaths or to count to 10 when he started to feel angry. My job was to recognize the signs that an anger episode was coming and remind my son to use his tools.

This should have worked. It would have worked, if my son had followed my instructions. Unfortunately, whenever I reminded him to take a deep breath, his anxiety would kick in and convince him that deep breaths don’t work. He’d panic, insist I couldn’t help him, and never even try to take a deep breath.

It was a mobile crisis worker who helped him identify the puppy-snuggling technique. This worker asked my son what usually helped him to calm down, and the dogs instantly came to mind. Now we know that if he starts to panic, he goes to the dogs.

Know your community resources

Speaking of mobile crisis workers, these people are a godsend. They have helped my family tremendously. They are part of a program called Crisis Intervention Team that is globally recognized as an effective model for assisting people with mental illnesses who are experiencing a crisis. Think of them as mental-health first responders.

As I mentioned above, there are many children with mental illnesses, and many of these children are in crisis. Suicide attempts and other violence are not uncommon. The systems we traditionally use to help people in emergency situations are ill-equipped for mental-health crises, and too many children with mental illnesses end up in juvenile detention or psychiatric hospitals as a result.

The CIT workers can help people with mental disorders access treatment resources rather than place them in the criminal justice system when their symptoms put them in crisis. I have had to call 911 because of my child’s mental illness twice now. The first time was a disaster: Only police officers were sent, and these officers shouted at my son, berated my parenting, and argued with me about his diagnosis. The second time, I knew to call the CIT as well. The workers turned a stressful, difficult incident into a therapeutic one, and I couldn’t be more grateful.

Many parts of the country have community organizations and hospitals that specialize in treating mental illnesses. You can find contact information for a CIT in your state here. You might also want to Google “mental health community organizations near me” to find out what other resources are available in your area.

Find out where these places are, and save their contact information in your phone. Chances are you’ll need them at some point.

Psychiatric drugs should be prescribed by psychiatrists, not your pediatrician

All three of my children with mental illnesses take prescription drugs to treat their disorders. These medications can be extremely effective and improve quality of life tremendously.

But taking psychiatric drugs without an evaluation from a mental-health provider can be dangerous, ineffective, or both. Unfortunately, this is exactly what many Americans are doing when they get psychiatric prescriptions from their pediatricians and general practitioners.

study by the US Centers for Disease Control and Prevention from 2005 to 2008 found that more than one in 10 Americans age 12 and older were taking antidepressant medication. But less than one-third of those people had seen a mental-health professional in the past year. This is a serious problem.

General practitioners do not have the right training to recognize when a patient might be better served by other evidence-based treatments, like cognitive behavioral therapy or play therapy. Even when medication is appropriate, GPs don’t have the expertise to know which medication will best treat your child’s symptoms with the least risk of troublesome side effects.

For example, symptoms of depression are somewhat subjective. They can include fatigue, difficulty concentrating, social withdrawal, irritability, and sadness, among other things. A pediatrician might see those symptoms and think “depression,” then prescribe an SSRI (a selective serotonin reuptake inhibitor) like Prozac.

The problem is that these symptoms might also indicate other disorders, such as anxiety, disruptive mood dysregulation disorder, or ADHD. A skilled mental-health professional can interview the child and parent and apply their expertise to determine which of these diagnoses is most appropriate and therefore which medication would work best.

I learned the hard way that Prozac, a common prescription for depression and anxiety, can actually increase irritability and rage in children with DMDD.

Whenever possible, you should take your child to see a pediatric psychiatrist or psychiatric nurse practitioner for any psychiatric prescription drugs. And any child taking psychotropic medications should also see a therapist to learn the skills necessary to manage their symptoms every day.

If you absolutely can’t access one of these providers, ask your doctor to read the treatment guidelines developed by the American Psychological Association. This might help them to choose better treatments for your child.

Parenting a child with a mental illness is hard, and it’s a lot of work

It’s important to remember that your relationship with your child isn’t all about work and mental-health care. A good parent-child bond is built on love, trust, respect — and fun. Even though you love someone deeply, it’s hard to really like that person if everything you do with them involves work.

Here’s what my typical day looks like:

Get the kids up. Stand in my daughter’s room while she gets out of bed so that she doesn’t go back to sleep. Give gentle reminders, using my “therapy words,” to get her through her morning routine. De-escalate a tantrum. Prevent disruptions by speaking in a calming voice, even through the morning rush to get ready for school. De-escalate another tantrum. Drive someone to therapy. Fail to de-escalate a tantrum and hold a child down so he doesn’t bite me. Teach someone how to appropriately express their feelings for the millionth time. Talk to a teacher about missing assignments. Referee a sibling fight while I’m cooking dinner. Forget to use my calming voice and work through yet another tantrum.

And on. And on. And on.

Who wants to live life that way? I don’t, and I’m guessing you don’t either. But if we’re not careful, days and weeks can get swallowed up by the sheer volume of work.

That means you need to spend some time together doing things you both enjoy. When you’re balancing school, work, and therapy appointments, it might seem like a chore to pencil in yet another thing. But it’s so important, and I promise it’s worth it. The fun stuff doesn’t even have to take up a lot of time. My kids and I have a blast laughing with each other when we look at funny dog memes on my phone while we’re in the therapist’s waiting room.

Need more ideas? Feel free to use one of mine:

  • Tell a story by letting each family member take a turn adding the next detail. Make it as silly as possible.
  • Play a board game.
  • Make up a silly voice for your pet and have “conversations” where you let the kids answer in your pet’s voice.
  • Talk like a pirate for an afternoon.
  • Play “What If?” — ask your child what would happen if their favorite TV character had to do this homework assignment, or how their school day would change if they had to learn underwater.
  • Have a dance party in your living room.
  • Look through old photos on your phone and reminisce about your favorite memories.
  • Tell them the story of the day they were born.

Take care of your own mental health

Several studies have found that parents of children with developmental disabilities experience more symptoms of depression than parents of neurotypical children. It’s not hard to see why. Parenting children with mental illnesses is stressful, hard work. And while you have this overwhelming responsibility to care for your child and their needs, you can’t forget to take care of yourself, too.

We put a massive amount of time and energy into parenting our kids. But we can’t do it — literally cannot function — if we don’t first take care of ourselves.

If you’ve ever flown on an airplane, you’ve gotten the flight-attendant safety spiel: “In case of a drop in cabin pressure, face masks will drop from the ceiling. Be sure to secure your own face mask before helping others.”

I’m sure you know why you have to secure your own mask first: It’s impossible to help your child breathe if you can’t breathe yourself.

If you’re parenting a child with a mental illness while living with untreated depression, you can’t breathe, mama. You need to see your own therapist, take your own meds, or do whatever else you need to do to stay mentally healthy.

This article was originally published on Business Insider.

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