Will My Kid Grow Out of It? is an indispensable guide to the most common mental, neurological, and developmental issues kids—from newborn through high school—may be struggling with. Dr. Forrest draws on more than 20 years of experience treating and advocating for children to help worried parents sort through the health scares, contradictory information, and latest buzz terms to assess whether their child’s behavior is typical for his or her age or a sign that professional attention may be warranted.She uses lay terms to describe sets of behaviors that may be problematic, possible diagnoses, which professionals are appropriate to consult, effective treatments, and the steps to take to get support and services from schools and the state. The book even includes a code allowing readers access to a free online screening tool.
A vital guide to have on hand during a child’s formative years, Will My Kid Grow Out of It? is the most informative, fresh, and essential parenting guide released in years.
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Will My Kid Grow Out of It?
A Child Psychologist's Guide To Understanding Worrisome Behavior
By Bonny J. Forrest
Chicago Review Press IncorporatedCopyright © 2014 Bonny Forrest
All rights reserved.
Where to Start When Your Child's Behavior Is Troubling You
If you have noticed any of the following behaviors in your child, they may have you worrying that things are not quite "normal."
Children of Elementary School Age
exhibits unusual sleep patterns
persistently refuses to go to school
attends school regularly, does homework, but still gets bad grades
is constantly worried or anxious, or is more fearful than others her age
throws frequent temper tantrums for no apparent reason
never slows down
is disorganized, or can concentrate for only a short time
frequently resists or opposes authority figures, more so than other children of the same age
feels the need to stay in rigid routine; repeatedly washes hands or insists on things being "just so"
is delayed in reaching developmental milestones (see appendix A)
does not seem to understand social norms; cannot make friends or understand the feelings or behavior of others
Preteens and Adolescents
is isolated from friends and family
has an intense fear of becoming obese despite normal body weight, or otherwise has an unusually poor self-image
opposes or defies authority figures in ways that often lead to truancy or breaking the law
abuses alcohol, drugs, or tobacco
cuts or otherwise intentionally injures herself
expresses unusually strange thoughts or feelings
How do you know how seriously to take these behaviors? While some of them are clear signs that something is wrong, others may seem like nothing more than a particularly intense phase of normal kid behavior. How can you tell if you should consult a professional, at least for reassurance if not for help?
Here is a straightforward process for tackling that question.
First, consider whether your child's early development is or has been different from the milestones described in appendix A. Read through the chapters in Part II to see if any of the symptom lists describe your child's behavior. If you think you find a match, rather than relying only on your impressions and your memory, take notes about what you observe over time and refer to this chapter's guide on duration, intensity, and overall impact as well as the information on charting behaviors given here to decide if you should take the next steps.
Next, log on to www.ProjectSKIP.com and conduct a screening for your child using the code BOOK1. Again, I want to stress that the online screening is not a diagnosis or a definitive assessment of your child; it is simply an initial step.
Finally, using your notes and the results of the screening, and armed with questions and information you find in this book, talk to your doctor, psychologist, or mental health professional. In that conversation, you will discuss in depth the behaviors that are worrying you and what to do next.
Is This Serious?
There are five guidelines that I suggest parents, teachers, pediatricians, and others consider when assessing the seriousness of a child's emotional, social, or behavioral issues:
the symptom's duration and intensity and its overall impact on the child
the symptom's impact on other areas of the child's development
the symptom's impact on the family
the age at which the symptoms develop and how they change with time
the advisability of early intervention
And, of course, an obvious question is whether the behavior is so serious that you clearly have to ask for help immediately.
I will explain these guidelines by applying them to the cases of two different children who were both struggling in school.
Emma and Donna
Emma was a seven-year-old who was in first grade. She had resisted going to school for more than a year. Even though she had recently begun talking about school in a positive way, saying that she liked her teachers and classmates, she began each day with the same refusal. She simply did not want to get on the school bus. If her parents insisted, Emma would cry, scream, and start to shake uncontrollably. Otherwise, she was cooperative, affectionate, and kind with her siblings and parents.
Although her morning tantrum often resulted in one of her parents driving her to school, once at school she was able to leave her parent comfortably and was not afraid to go to class. She would be slow to warm up to teachers, however, and would stand a bit at a distance simply to watch them when she first met them in the morning. During the day, if called upon, she was often silent at first and then gradually became more engaged and responded to what they had to say. But this pattern was improving. She began taking less and less time to become responsive in the mornings and began to often answer immediately when called on in class. Within an hour of arriving at school, she participated actively in games or lessons. She had made friends and interacted with those friends regularly. The trip home on the bus was uneventful, more like the behavior of other children her age.
Donna was another seven-year-old who had also resisted going to school for more than a year. She would not ride the bus at all and would have a full tantrum if her parents even suggested that she ride it. In addition, Donna had a number of other behavioral difficulties. She frequently wet her bed, and needed to follow a very specific bedtime routine that had to be restarted from the beginning if it were interrupted. She had particular difficulties when she had to move from one activity to another in school, such as moving from quiet time to circle time. She would often become anxious about small changes in her routine, such as a slightly late dinner or not being able to wear her favorite dress several days in a row.
Donna's parents felt overwhelmed by her behavior and were at a loss for what to do. At school, Donna would cry and scream when the parent who dropped her off tried to leave. Once her school day finally started, she participated in most school activities, but she tried to avoid those — such as circle time — that involved a group. She played with only a few children, and often ordered them around or hit them.
Let's see how the guidelines above apply to Emma and Donna. Overall, Emma's struggles with riding the bus to school in the morning were clearly less extensive than Donna's. But let's consider more closely the duration, intensity, and overall impact of the symptoms in each of these children, and also how the symptoms changed over time.
Each girl had been having difficulties for about a year at a time when they were entering the first grade and therefore facing a longer school day with greater expectations. First grade often brings with it stresses that cause behavioral changes. Nevertheless, the duration of the symptoms warrants being taken seriously. I would rate both girls' difficulties an 8 on a symptom scale of 1 to 10, with 1 being mild and 10 being severe.
Donna's tantrums were certainly more intense than Emma's. They happened frequently, often twice a day, and they happened across settings.
Her parents were at a loss about what to do.
Emma's difficulties certainly caused some difficulty in the morning, but they had not as yet changed the family's schedule beyond forcing them to drive her to school more often than they wanted to. Once at school, Emma's day proceeded relatively normally. Her teachers didn't need to invest special effort in her or make special arrangements for her. Outside school, her days were relatively normal.
By contrast, Donna was having multiple problems in multiple areas — with friends, siblings, teachers, and family — and her problems were having a substantial impact on her parents' lives and her teacher's classroom. Her parents were also starting to experience consequences at their jobs because they were often late or had to leave early to pick Donna up from school again. Her teachers invested a great deal of time in trying to make things easier for her so that she could participate more actively in the classroom and in creating plans to help her progress. And there were no signs of improvement that indicated they would be able to end those efforts any time soon.
Progress over Time
Next, let's look at the impact of the symptoms on Emma's and Donna's development — in particular, on their "developmental trajectory," the rate at which they were growing as compared to a normal path for children their age.
First, was the refusal to transition from the house to school in the morning a specific issue, or was it part of a larger set of problems affecting the child more generally? Emma's refusal was a troubling but isolated issue; she was not struggling in other areas of her development. Donna, on the other hand, was struggling in several areas, especially in her relationships with her parents, teachers, and peers. Her habit of avoiding group activities at school reinforced the impression that she had difficulty relating to other children or adults, and that this pattern was starting to affect her ability to learn in school.
Second, what was the child's developmental trajectory? Emma was making progress in separating from her parents and participating in school activities. She had taken steps toward mastering this new developmental task, such as being able to describe to her teachers what upset or scared her. In contrast, while Donna had made some progress in a few areas, such as learning to play more with other children without hitting them, she had not been making as much progress as she should have been across the board: separating in the morning, joining in group activities, and having fewer periods of being upset at school. In fact, she was lagging further and further behind her peers.
Here is a snapshot of our measures:
These guidelines provide an objective, careful way of confirming — or contradicting — your initial impression that your child may need help or may just be going through a phase. Donna clearly needs a full and careful professional evaluation, the sooner the better. For Emma, especially given the value of early intervention if there is an underlying issue, I would advise an initial screening even though her problems are less severe and she is improving. There is no downside to a screening. It will either provide reassurance or identify an issue that warrants a closer look through a fuller evaluation. Assuming the screening shows no underlying issues, the next step could simply be to see if the family's pediatrician or a mental health professional has advice about helping her to emerge from this phase.
While these guidelines should help you decide if your child's behaviors warrant an evaluation, there is no clear-cut test for making that decision. If you're uncertain, consult a professional to discuss the next steps. It's far better to err on the side of learning more, rather than simply hoping for the best.
Some Things Need Immediate Attention
Certain behaviors should cause parents to seek immediate help for their children. These include:
expressing serious thoughts about hurting themselves or other children
engaging in extremely risky behavior (e.g., threatening another child with a knife or other weapon)
experiencing significant physical symptoms such as chronic headaches or self-mutilation
using drugs or alcohol in a way that interferes with their schoolwork, changes their habits significantly, or is otherwise disruptive (some experimentation with drugs or alcohol is typical)
sleeping excessively or displaying energy to the point that it disrupts a normal daily function, such as running around the house at night instead of sleeping or being unable to get out of bed to go to school
Charting the Problem
In addition to using the guidelines described, parents and mental health providers frequently find it helpful to chart a child's behavior to understand it more thoroughly. Ask the following questions when observing your child, then write down the answers each day for a week or more. Take them with you when you consult the professional.
Where does the behavior occur?
During what activities does the behavior occur?
What is the time of day when the behavior occurs?
Who or what kind of person is around when the behavior occurs?
What things happen just before the behavior occurs?
What things happen during the behaviors?
What happens right after the behavior?
What Is an Evaluation?
A psychological evaluation can take several forms. The simplest, which is usually called an assessment or screening rather than an evaluation, typically involves a single interview with a psychologist or other mental health professional, with the goal of beginning to learn about a child and any problems she might have.
In contrast, a full evaluation typically involves several sessions. It begins with the initial assessment meeting but then involves several psychological tests. It also usually includes interviews with parents and teachers, and perhaps with others who play a major role in the child's life, as well as a review of any relevant documents, such as school reports or the results of previous evaluations. It may also include a school observation. In most cases, the parents will be present at the initial meeting, but you may be asked to allow the therapist to talk to or test the child alone after the first session. During that first session, you and your child will need to consent to the questions the child will be asked.
There are many types of psychological tests, and they can be used to explore a range of issues — for example, emotional health, intelligence (IQ), potential learning disabilities, or potential psychological problems. Psychologists are generally the most qualified to use and interpret psychological test results, so tests should be conducted or at least supervised by a licensed psychologist, even if they are actually administered by someone in training who isn't yet licensed. It takes years of training and a wealth of expertise to know which tests to give, how to interpret their results, and how to combine the results with all the other information about a child to reach conclusions and decide upon next steps. Anyone you go to, psychologist or not, should be well trained in the use of these instruments.
Because the evaluation can take different forms and use different tests, if your child is to be evaluated, you should ask what, specifically, the evaluation will involve and the reasons why each test was chosen.
Over the years I have had parents complain that, when they sought help because their child was delayed in talking, crying too much, or displaying some other behavior that concerned them, the professional told the parent, wrongly, that the child would simply grow out of it. Evaluating child development, especially in infants, is a tricky business; professionals are identifying many issues far earlier than they used to, thanks to advances in science, but they can all make mistakes in diagnoses. There are no definitive blood tests that can tell us if a child has a particular mental health issue or not, and kids' symptoms exist on a spectrum from mild to more severe. A good evaluation requires time and the use of interviews, standardized measures, thoughtfulness, and clinical judgment. Clinicians may differ in the result that they reach, but they should not differ in the process they use to make those clinical judgments. They should always take parents' concerns seriously and take enough time to adequately evaluate your child. If you don't feel a professional has done that, you should seek a second opinion.
In addition, there are things you can do right now to shore up your children's mental and emotional health:
Show your love and your concern for their health and well-being.
Be aware of their changing needs as they develop.
Provide dependable care, be consistent in your use of discipline, and avoid severe punishments.
Listen to their worries and anxieties and take them seriously.
Encourage them to talk about their feelings and to work through difficulties.
Praise them and celebrate their accomplishments.
Excerpted from Will My Kid Grow Out of It? by Bonny J. Forrest. Copyright © 2014 Bonny Forrest. Excerpted by permission of Chicago Review Press Incorporated.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Author's Note vii
Project SKIP ix
Part I "Is That Normal?"
1 Where to Start When Your Child's Behavior Is Troubling You 11
2 Diagnosis, Stigma, and the Clinician's Manual 21
Part II Common Concerns and Possible Diagnoses
3 Infant and Preschool Mental Health: Even Babies Get the Blues 29
4 Delayed, Different, Not Fitting In: Does My Child Have an Autism Spectrum Disorder? 45
5 Overactivity and Inattentiveness: Does My Child Have ADHD? 59
6 Anxiety, Fear, Stress, and Obsessive-Compulsive Behaviors: Does My Child Worry Too Much? 73
7 Sadness and Loss: Is My Child Just Sad, or Clinically Depressed? 91
8 Picky Eating and Eating Too Much: Does My Child Have an Eating Disorder? 111
9 Bullying and Aggression: Could My Child Have Oppositional Defiant or Conduct Disorder? 123
10 Problems with Homework: Does My Child Have a Learning Disability? 135
11 Self-Injury, Suicidal Feelings, and Substance Abuse: When Things Get More Difficult 145
Part III Supporting Your Child
12 The Medical Professionals: Who to Turn to, What to Know, and What to Ask 157
13 Getting Services for Your Child from Your School or State 179
14 FAQ: Answers to the Most Commonly Asked Questions in My Practice 191
Epilogue: After Newtown 195
Appendix A Brain Development 101 201
Appendix B Therapies Found to Be Most Effective for Various Diagnoses 217
Appendix C Commonly Used Medications for Mental Health 218
Resources for Help 221