Understanding childhood distress

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How can I tell when something is wrong?
How can I help my child?
Where can we go for help?
What sort of help will be offered?
What can parents do to help?
Useful organisations
Further reading

"I thought she was just being a pre-teen; moody and argumentative. But then she seemed to fall out with all her friends. She'd get into trouble at school, because she didn't hand in her homework, even when I knew she'd done it. She kept losing all her stuff. She was in a foul temper all the time - picking fights - and I knew she was unhappy, but she wouldn't talk to me about it, and kept saying she was all right. In the end, she broke down and said she didn't want it to go on any more. The alarm bells really started ringing, then."

This booklet is for anyone wanting to know more about childhood distress. It describes how to tell if something is wrong with a child or young person, what sort of help to give and who to contact for further support or advice.

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How can I tell when something is wrong?

Children change rapidly and develop all the time. In addition, they have to learn to cope with many different situations and unfamiliar challenges, as well as with stresses that may be going on in their daily lives. It's not surprising that most children will feel sad, anxious, angry or upset from time to time. It's simply part of growing up. They may tell their parents about their feelings, or they may express them through short bouts of moodiness, disruptive behaviours or odd aches and pains.

As long as such children appear to be coping with ordinary activities, and as long as these feelings don't last too long, there's probably no real cause for concern. The best help in these situations is for parents to be available to listen, to talk things through and to offer appropriate reassurance or support. If the young person seems to be unwilling to talk to a parent, then they might be encouraged to talk to a sympathetic relative or friend.

Some children will experience difficulties that are more severe or long lasting, or may react to setbacks in a more extreme way. They may indicate to their parents or another person that they are distressed or unable to cope, either directly or more often through various hints. But more commonly, they will show their distress through changes in mood or behaviour, either at home, at school, or with their friends.

They may seem unusually tearful, irritable, aggressive or lethargic, for example, or display little pleasure in activities they used to enjoy. They may have difficulties in sleeping, lose their appetite or constantly complain of pains for which the doctor can find no physical cause. They may not be able to concentrate or keep up at school. They may withdraw from friends or family life, or they may be behaving in a very childish or self-destructive way. Sometimes children manage reasonably well in one area of their life for a time, but not in others. For example, they may show odd moods or behaviour at school, but not at home, or vice versa.

It's important that there should be close contact between parents and teachers, so that problems can be picked up at an early stage. Occasionally, one particular aspect of a child's behaviour or mood may be so extreme or upsetting that it indicates that help is urgently needed. For example, they may cut themselves, run away, or say they no longer want to go on living. However, it's usually a mixture of odd moods and behaviours that persist over a period of time that give the clue that something may be wrong. Parents usually know their own child best, and should trust their own intuition. If they are worried, they should ask for help and not listen to people who say they are being over-anxious or fussing, or that their child is just going through a phase.

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How can I help my child?

Children may need help for a wide variety of reasons. They may be victims of some form of abuse or bullying, or be distressed by family conflict. They may be failing at school, or unable to make friends, or their behaviour may be out of control. They may have eating problems, or they may just seem very anxious or depressed, or they may feel pressured into growing up too soon. It may be that certain children are more vulnerable than others; that they are reacting to tensions within the family, that they interpret experiences in a particularly negative way, or that too many stresses occur at once.

Most parents will feel very upset and guilty if their child is distressed, and wonder what they did wrong. Don’t blame yourself for the problem, which probably has a number of contributory causes. Focus on sorting out the difficulty and building up your child's confidence. It’s important to bear in mind that problems occur in every family. In these circumstances, children may well need some outside help in dealing with their problems and in handling their feelings. Help might take the form of advice to parents, support for the young person themselves or help for the whole family in sorting out the difficulties. There are a number of reasons why the sooner such help can be offered the better:

• The young person will be feeling very lonely and distressed, and parents will be very anxious because they don't know what to do.
• Difficulties that continue for a long time are likely to impede a young person's normal development, affecting progress at school for example, or relationships with family and friends.
• Struggling with problems will sap the young person's confidence and self-esteem, making it increasingly hard for them to cope.
• Problems are usually much easier to deal with in the early stages, before they have become entrenched.
• Problems that are not dealt with may resurface in adult life and have a serious effect on the young person's future.

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Where can we go for help?

Family doctor
When a parent is worried about a child, and not sure what the problem is, the first person to consult is usually the GP. The GP will want to make sure that there is no physical illness or condition that may be causing or contributing to the difficulty, before discussing what to do next. Some GPs take a special interest in children and families, and may offer help themselves, or they may refer you on. The most usual type of referral is to a child and adolescent clinic. If the GP does not suggest a referral, parents can ask for one themselves. In some areas, they can refer themselves to such clinics.

Child and family consultation services
There is usually one such clinic in each area, but it may be known by a different name, such as: child and family centre; family and young persons unit; child and adolescent mental health service or psychology services. All such clinics deal with a wide range of problems from the mildly worrying to the more severe. Clinics will generally see young people up to the age of 16 with their families, but also occasionally on their own. Some clinics will also see young people up to the age of 18, if they are living at home and still at school, or if they have been seen before. Parents can also be seen on their own. For details of such services, contact YoungMinds. (See Useful organisations for details of this and other organisations offering help.)

Schools
It helps if teachers are aware of any problems and can work with parents and the young person to try and sort out difficulties. Parents should let the school know if their child is particularly upset, perhaps because of a divorce or bereavement, so that support can be offered and allowances made. The school may put parents and children in touch with sources of help, such as a school nurse, an education social worker or an educational psychologist.

Social services
Parents can contact their social services department to ask for information on services for children in their area. They can also ask to see the social worker on duty to talk over any problems. Depending on the problem, the social worker on duty may suggest other helpful organisations or services, or may be able to offer further help from social services.

Youth counselling, advice and information centres
These centres, run by a variety of organisations, cater for young people, usually between the ages of 12 and 25. Some young people who want more privacy and independence may prefer to use these services, as parents are not involved. For details, contact Youth Access (listed under Useful organisations).

Helplines
Parents and young people sometimes find it easier to talk to someone about their worries over the phone. A number of helplines are listed under Useful organisations.

Help within the community
Parents need to be persistent to find the help they need. Sometimes, such help may be available from someone who is experienced with young people within their own community, such as a person from their local place of worship or youth centre. Talking to other parents who have experienced similar problems can also be very helpful for the family.

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What sort of help will be offered?

Professionals may offer a range of help, but it's important not to expect instant solutions. Sometimes, things may take a long time to work out, or there may be no simple answers.

Family therapy
This aims to help families make the best use of their strengths and weaknesses. It does not delve into deeper feelings or the past, but focuses very much on what is going on at present. The whole family will work together with professionals to try and find appropriate ways of dealing with problems that may have contributed to the young person's distress, without attributing blame. Often, quite small adjustments in behaviour or attitudes are all that is needed. Five or six sessions, with intervals of several weeks, may be all that's required to give everyone enough confidence to find better ways of handling situations. Each session usually lasts an hour.

Individual counselling or psychotherapy
This offers the young person time for themselves in which to work through their difficulties and feelings, with the help of a therapist and in complete confidence. In counselling, the focus is more likely to be on problems the young person is experiencing at present, while in psychotherapy earlier experiences are explored in order to gain a better understanding of the present situation. Both approaches can help boost young people's self-esteem and enable them to find ways to tackle the problems.

However, it may take some time for the young person to get used to the therapist's way of working and to benefit from the sessions. It is important to persuade them to be patient. Sessions usually last 50 minutes to an hour, and are generally on a weekly basis.

Behaviour therapy
This is a practical approach that is often effective in dealing with problems such as phobias and obsessions. The young person will explore various common sense ways of overcoming their fears with the therapist. They may keep a diary or monitor their anxiety on a scale of one to ten, throughout the day, to gain a clearer understanding of their problem. They will usually practise carrying out certain tasks at home. They may decide to confront their fears directly, with the support of the therapist, or through a more gradual approach, perhaps with the help of a relaxation technique. Sessions, which usually last an hour, may be weekly, at first, and then at longer intervals as the young person gains confidence. Satisfactory improvement often occurs in 10 to 20 sessions, sometimes fewer.

Group work
Working in a group can be very helpful for some young people, particularly once they reach adolescence. They are often able to be more open with their peers, and to accept criticism from them, in a way they would find impossible to do with adults. They can also learn a great deal from what other young people say, and by working through their own problems and helping others to work through theirs.

Groups may be held for a variety of reasons, such as looking at how relationships are formed, finding ways of dealing with eating problems, learning to be more assertive, or improving social skills. Groups vary in size, but there are usually one or two therapists for about six to ten young people. They will usually meet weekly, sometimes for a set period, such as ten weeks, sometimes for longer.

Art therapies
Children who have difficulty in expressing their feelings through words may respond well to an approach involving art, drama, movement and dance, or music. These therapies are often carried out in groups, but they may also be offered on a one-to-one basis.

As well as being helpful in enabling young people to get in touch with their feelings, they are often highly enjoyable and satisfying activities. They can also help to break down young people's sense of isolation and increase their confidence. No particular skill or ability is needed to participate in these kinds of therapies.

Listening and advice
Professionals, and indeed experienced volunteers, can often help by listening and enabling parents and young people to clarify just what the problem is. They may be able to offer advice and support, as well as information, so that families can make the best use of resources.

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What can parents do to help?

Collect information
The more information parents have about their child's particular problem, the more confident they will feel in supporting their child. Some organisations produce helpful leaflets and booklists, or run helplines. (See Useful organisations for details of national organisations.)

Citizen's Advice Bureaux (CABs), GP surgeries, patient advice and liaison services, social services departments and local libraries should all be able to provide information on useful local and national organisations and services. It's worth consulting as many organisations and people as you can, to get the full range. There are books and leaflets available on many problems, including eating distress, bullying, or difficulties following a divorce. Ask any appropriate organisation, or enquire at your local library or bookshop. There are many different views about such problems, so it's worth reading several books or booklets. (See Further reading.)

Write things down
If you write down just what is worrying you about your child, as it occurs, it can help you see whether there is some sort of pattern in your child's behaviour. It will also remind you of what you want to say, including what questions you might want to ask, when seeking advice. It's also a good idea for parents to keep a record of any conversations with professionals, so that they know who said what and when. This is particularly helpful if you receive conflicting advice.

Be persistent
Parents may need to look hard for the right sort of help. It's very important not to give up. Contact local and national organisations for advice. Asking for help is an indication that you are caring parents, not a sign you have failed.

Look for your strengths
Parents often lose confidence in themselves when there is a problem in the family. It's important to remember problems in childhood and difficulties within the family are very common. You should try to focus on the many skills you have as parents and get support for yourselves, if necessary.

Remember the other children
Although you may be particularly worried about one child, it's important to make sure the needs of any other children are not ignored. You should ask relatives or friends to give them extra support and attention, if you yourselves are too stressed.

Never give up
Parents should make sure that they make time to listen and that the young person knows that they are always there for them. Doing things together often helps to improve communication and boost the young person's confidence. Parents should not feel they have to be perfect and get it right every time. What matters is that you care, and that you are there to support your child.

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Useful organisations

British Association for Counselling and Psychotherapy (BACP)
tel. 0870 443 5252 minicom: 0870 443 5162
web: www.bacp.co.uk
Provides details of local practitioners

British Association of Behavioural and Cognitive Psychotherapies (BABCP)
tel. 0161 797 4484
web: www.babcp.org.uk
Can provide a register of members including child and adolescent therapists

Childline
helpline: 0800 1111
web: www.childline.org.uk
Free 24-hour helpline for children and young people in the UK

Get Connected
Carphone Warehouse Support Centre, North Acton Business Park, Wales Farm Road, London W3 6RS
helpline: 0808 808 4994
email: help@getconnected.org.uk
web: www.getconnected.org.uk
A free service including a ‘webchat’ facility for young people advising on how to get the best help

NCH Children’s Charities
helpline: 0845 762 6579
web: www.nch.org.uk
Supports vulnerable children, young people and families

NSPCC
helpline (adults): 0800 800 5000
helpline (children and young people): 0800 1111
web: www.nspcc.org.uk
Specialises in child protection and the prevention of cruelty to children

Parentline Plus
helpline: 0808 800 2222 tel. 020 7284 5500
web: www.parentlineplus.org.uk
Support to anyone parenting a child

Samaritans
Chris, PO Box 9090, Stirling FK8 2SA
helpline: 08457 90 90 90
email: jo@samaritans.org
web: www.samaritans.org
24-hour emergency telephone helpline

Youth Access
tel. 020 8772 9900
web: www.youthaccess.org.uk  
Information on youth counselling

YoungMinds
tel. 020 7336 8445
parents information service: 0800 018 2138 (for any adult with concerns about the mental health of a child or young person)
web: www.youngminds.org.uk 
National charity committed to improving the mental health of all babies, children and young people. Provides information for both parents and young people

Useful websites

www.citizensadvice.org.uk

www.nice.org.uk
Provides guidance on treatments and best practice, including for childhood depression and self-harming

Further reading

About self-harm (Mind and Barnardo’s)
Coping with depression in young people: a guide for parents C. Fitzpatrick, J. Sharry (John Wiley and Sons 2004)
Cutting the puppet strings Young People in Mind (Great Yarmouth and Waveney Mind 2004)
Diet of despair: a book about eating disorders for young people and their families A. Paterson (Lucky Duck Publishing Ltd 2002)
How to cope as a carer (Mind 2006)
How to cope with exam stress (Mind 2006)
How to help someone who is suicidal (Mind 2004)
How to parent when you’re in a crisis (Mind 2004)
How to survive family life (Mind 2004)
Making sense of counselling (Mind 2004)
Making sense of psychotherapy and psychoanalysis (Mind 2004)
The Mind guide to managing stress (Mind 2006)
My name is Pete (Mind 2007)
Understanding anxiety (Mind 2006)
Understanding attention deficit hyperactive disorder (Mind 2006)
Understanding autistic spectrum disorders (ASD) (Mind 2004)
Understanding depression (Mind 2007)
Understanding eating distress (Mind 2004)
Understanding learning disability (Mind 2004)
Understanding obsessive-compulsive disorder (OCD) (Mind 2004)
Understanding phobias (Mind 2004)
Understanding pre-menstrual syndrome (Mind 2004)
Understanding the psychological effects of street drugs (Mind 2007)
Understanding seasonal affective disorder (SAD) (Mind 2007)
Understanding self-harm (Mind 2007)
Understanding talking treatments (Mind 2005)
Who’s hurting who? Young people, self-harm and suicide H. Spander (Handsell 2001)

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This booklet was written by Sally Burningham
First published by Mind 1997. Revised edition © Mind 2007
ISBN 9781874690337
No reproduction without permission