How to Talk With Family Members About a Kid's Mental Health
Those who help care for children need to know details about their challenges.
Posted May 28, 2020
Many parents rely on others to help care for their kids. Grandparents or other family members often play an important role in taking over for parents during the work week, on weekends, or over holidays. For parents who have a child with a mental or behavioral health challenge, it’s important for grandparents—and anyone who provides care—to understand:
- the nature of the challenge
- the rules and structure at home
- the details of any treatment plan
- the ways different situations are routinely handled
If there’s one thing we know about medical and psychiatric challenges, it’s that consistency is key for a child’s treatment. This is just as true for a child with asthma, diabetes, or a healing fracture as it is for a child with depression, anxiety, or Attention Deficit Hyperactivity Disorder (ADHD). But it’s not always clear that we as parents should share our kids’ mental health issues with other family members the same way we do for other medical conditions. Whether it’s due to stigma, shame, or the lack of a consistent plan, it often doesn’t happen. And parents aren’t alone in this. Many clinicians who care for kids with psychiatric disorders often fail to spell out the features of the disorder and treatment at home, school, and when others are helping with caretaking.
This lack of communication about a child’s challenges flies in the face of research on successful treatment for mental health. Consistency of care across environments and among caregivers is essential for addressing negative behavior and promoting positive long-term outcomes.
Let’s consider some basic principles about child mental health to help fill this need.
1. Understanding Challenging Kids
As Dr. Stuart Ablon tells us in his explanation of the Collaborative Problem Solving model, kids—no matter how difficult—want to please their parents, meet expectations, and be loved and admired. But when kids behave in ways that appear moody, oppositional, defiant, or withdrawn, it’s easy to feel that they are choosing not to do what is expected of them. Sadly, this assumption is typically not the case, and reacting to challenging behavior with this in mind can make things worse. When a child doesn’t meet behavioral standards, it’s usually a lack of “skill” not “will”—kids behave well if they can. Similarly, kids with mental health challenges do not have the ability to behave according to our norms, and it’s up to us to find effective ways to help them. This is an important concept to keep in mind for any conversation.
2. Defining and Destigmatizing Mental Health Problems
Whether myths about psychiatric disorders derive from cultural beliefs, lack of public education, or a history of devaluing people with psychiatric syndromes, mental illness is among the most common medical conditions globally. Parents can do a lot to dispel misbeliefs and false information. Talking to your pediatrician or mental health clinician, or reading articles about your child’s challenges, can help you explain to grandparents the facts about the illness and the specific ways it plays out at home, in school, and with friends.
Most of all, besides offering basic information or directing them to credible resources, help them empathize with your kid. Help them to understand it’s no one’s fault—not your child’s, not yours, not theirs. Let them know that psychiatric disorders can be treated successfully through behavior therapy and/or medications. Let them know that these challenges have about as good an outcome as common medical problems such as migraines, gastrointestinal problems, and other illnesses of childhood.
3. Including and Empowering Caregivers With Home Treatment
Every child with one or more mental health challenges should have a treatment plan. This ideally includes some structure to the day (waking, going to bed, time and place for school work, screen time), including any medication doses and times, as well as therapeutic regimens that can be learned (Cognitive Behavioral Therapy, meditation). It’s also important to know whom to call for emergencies, whom to call for on-the-spot coaching (if available), and effective ways to help manage emotions and challenging behavior (therapeutic conversations, time outs, time alone in one’s room). Ideally, these should be written out for parents, the child, teachers or school nurses, and grandparents.
Once everyone knows the game plan, the likelihood of success is better, and any attempts to stray from the plan are minimized—at least on paper.
4. Clarifying That We Are All Part of the Problem and the Solution
All medical and psychiatric disorders have biological, psychological, and social components.
Take high blood pressure, for example. It tends to run in families, indicating a genetic or biological risk factor. But we also know that stress and anxiety can have an impact. Diet, exercise, obesity, and economic burdens can also affect blood pressure, as can feelings about one’s workplace, relationships, and living situation. We have, to some extent, control over many of these influences. The same is true for mental health issues.
Consider this: children and teens live in complex, multi-layered environments, and both parents and grandparents can play a role in easing or exacerbating stress that affects a child’s disorder or challenge.
If we embrace this idea, we can do two things. First, it allows us to take personal responsibility for our own behavior and see ourselves as agents of change. Second, it allows us to share ownership of mental health and refrain from a tendency to label the child as “the problem.”
Negative labels have incredible power and are very damaging. Many kids who struggle with a mental health challenge already deal with low self-esteem. They struggle with feelings of inadequacy, lack of competence, and fears of rejection, which can lead to the child seeing themselves as impaired and at fault and incorporating their “short-fallings” into their identity.
This is one significant way in which mental illness differs from medical illness. It’s rare indeed to label a child with hypertension, asthma, or diabetes as an impaired person. We can do better. We can redefine our concept of mental illness. Much of this starts with open conversations within our own families and communities.
5. Explaining What Works With Each Child (and With Siblings)
Every child or teen is different, and so is every mental health challenge. In addition, some children will have two or more disorders. For example, ADHD often comes in “packages” with depression, anxiety, or obsessive-compulsive disorder. Caretakers need to understand what any given disorder is and how it reveals itself in your child. To make life even more complicated, it is not uncommon for more than one child in a family to have a mental health disorder. This means caretaking requires understanding more than one treatment plan.
We also need to consider how one child with a mental health challenge affects any other siblings that need attention. It’s pretty easy, and sometimes necessary, to focus on the child with more challenging behavior. But this can leave the sibling who does not have a behavioral problem to feel left out or even resentful.
For each child, you need to take into account their personality: some kids are passive and isolating, while others are more irritable or aggressive. These traits should be considered during caretaking. Parents are the experts on their kids and can give grandparents or other caretakers helpful tips on things like this. For example:
- Does your child need “transition periods” between activities? Sometimes kids have trouble keeping up with their schedule and need “announcements” or timers when the next activity is scheduled to begin.
- If your child refuses to do some required task, like homework or shutting off the TV, what helps to maintain the schedule?
- When do you give any medications, and how long does it take for them to kick in?
6. Crafting an Interactive Conversation and Asking for Questions and Observations
Clearly, there’s a lot to talk about with family members so they can learn about your child's or teen’s mental health challenges. It’s always best when these conversations are two-way.
Encourage them to ask questions. You could reinforce that this was once (and maybe still is) new to you, too, to help them open up. They may have questions about such things as:
- What do you do if there is a meltdown?
- Do you use rewards or punishments for various kinds of behavior?
- When should the rules be bent? How rigid do we need to be?
- What are the rules about hanging out with friends?
Just as you would with your child, please consider ongoing conversations with grandparents or other caretakers. Try to make caretaking a mutual effort with regular reflection on what each of you sees and does with the kids. It’s also helpful to get input and feedback from the kids. Brief family meetings are always helpful and don’t have to be formal. Sometimes it’s good to have conversations over dinner or in the car.
Taking care of children and teens is ideally a family affair—after all, it takes a village. Our kids do best when they know that we are all working together to focus on everyone’s health and well-being.
This is an abbreviated blog post. The original was first posted on the Clay Center for Young Healthy Minds at Massachusetts General Hospital