Based on my experience working with children with explosive behaviors either due to a severe trauma history or mismatched parenting dynamic over the past 11 years, and in my awareness and training of the research on sensitive children, the mental health system is not just broken in serving this population, it can be quite destructive.
I say that because I’ve spoken to and served parents around the world in my career who struggle to support their children with big emotions and who have trusted the mental health system to serve their family to greater peace in their home and they are left empty-handed. I have personally also lost 2 family members to suicide, and another to severe drug addiction, and have a 4th family member who still struggles with intense emotions so I know this space intimately.
In my practice we serve families and children with explosive behaviors as young as 2 via tele-mental health, and have done so consistently years before the pandemic.
Children with explosive behaviors may struggle to follow through with telehealth. The obvious risks involved in stopping treatment altogether are heightened when families endure community trauma, in this case, a global pandemic. The challenges I see many parents face in this time period, however, are not unique to this current circumstance. Parents can be left with very little skill training when they trust a mental health professional to serve their child who struggles with risky behaviors, meltdowns, or suicidal thoughts or actions.
This stems from the common misconception in the mental health field that an internal shift in the child’s ability to manage stressful events will aid the child in generalizing coping skills taught in therapy to outside of the session.
This approach is a massive disservice to families. It leaves children struggling, parents feeling helpless, and unfortunately, eventually frustration, yelling, and resentment become the norm in the family dynamic. Those heightened emotions increase the likelihood for suicidal behaviors, meltdowns and corporal punishment in the household, thus reinforcing the cycle.
When parenting strategies are taught, however, even in a regular and consistent basis (weekly) often they focus on behavior modification: e.g. rewards, consequences, time-outs, time-ins, etc. None of these address the child’s inability to calm him/herself in the moment through parent coaching. Systematic parent coaching can be taught without a child present, and can be offered via telehealth.
For children with intense emotions, however, the relationship with the parent is paramount in shifting the child’s inability to manage disappointment, frustration, anger and worry— all causes of what’s commonly considered misbehavior. This behavior, however, is an indication of a skill deficit, not a purposeful decision on the child’s part. This is a learned pattern in the child to get his/her needs met in any way the child knows how.
Once parents make this distinction, and are given actionable steps to manage their own emotional state while they teach their children to learn to manage theirs, they can avoid misdiagnoses to include Autism Spectrum Disorder, ODD, DMDD, and MDD. This is especially true for Highly Sensitive Children, who make up 50% of the population who end up in therapy, but make up only 20% of the population.
This means parents whose kids state mid-meltdown they wish they could break their own limbs to avoid an anxiety provoking event like a virtual sports practice can stop melting down, acknowledge their emotions and advocate for their needs by saying words like ‘I need you to notice how hard I’m trying to stay calm’ in a matter of weeks. Children who are so emotionally dysregulated in the school setting they are spaced out, behind grade level, melting down daily at home, and being considered for an Autism Spectrum diagnosis can learn to communicate their emotions and stand in front of the class in the next semester reading along with peers in a presentation. Kids who are flipping tables in the classroom can go to receiving MVP lunch with the principal in a matter of months with the right strategy, system, accountability and support.
Most mental health treatment does not provide this level of support. Instead it provides crisis management or medication… as either a last resort or a first intervention upon meeting with parents when these behaviors are present. Parents are frustrated, feel stuck, and worry excessively for their children’s well being as a result. If my child struggled in this way, I would too, and as mental health professionals, we don’t effectively speak out against the ineffectiveness in the system.
Instead, we talk amongst ourselves about how the system is broken and leave agencies to join private practices, or start our own businesses…and then speak in jargon about “hospital season” with colleagues. Hospital season is the season from December to February where most teens with intense behaviors cannot manage their emotions at home without the ability to see their friends…where suicidal behaviors increase as do hospitalizations.
I will admit, as a former supervisor of 9 clinicians in an adolescent Residential Treatment Center, I spoke like that too…because I did not know what else was possible until I chose to accept a higher standard for myself as a professional.
Parents of children with intense emotions, and therefore intense behaviors need to seek an experienced professional to address 3 crucial areas of focus in order to avoid becoming a statistic:
Child mental health care needs to require the systematic involvement of parents. 15 minute check-ins at the beginning or end of the therapy hour do not cut it. Unfortunately, many graduate schools do not teach effective mental health care for children beyond basic child development, let alone parenting techniques, fostering the emotional development of children through the parent-child relationship, and the repair of the parent-child relationship when unsafe behaviors are present.
This leaves the responsibility up to the employer, or the clinician to increase their skillset… which, as previously addressed, leaves families waiting around for the professional to learn what they’re already expected to know in order to serve the families who need help now.
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