Podcast: How Can We Support Child and Teen Mental Health?

Jenn talks to Dr. Fairlee Fabrett about how parents can support the mental health of their children and teens. Jenn and Fairlee discuss how to manage the stress of our loved ones while keeping our own stress in check and when it is time for family members to talk to a mental health provider. Fairlee shares ways to support child and adolescent mental health, offers tips to initiate conversations about well-being, and answers audience questions.

Fairlee C. Fabrett, PhD is the director of training and staff development for McLean’s child and adolescent division. She is also the director of McLean’s post-baccalaureate clinical fellowship, through which she provides supervision and mentorship to recent undergraduates. Dr. Fabrett has extensive experience in evidence-based assessment and treatment for depression, anxiety, and behavioral disorders (including ADHD) in children and adolescents. Dr. Fabrett also has experience in providing culturally sensitive and effective treatments for individuals and families of minority groups.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

So, hello folks, and thank you so much for joining us wherever you are, whatever time it is there, whatever the weather looks like to talk about ways to support child and teen mental health.

I’m Jenn Kearney, and I’m a digital communications manager for McLean Hospital, and I am joined today by Dr. Fairlee Fabrett.

And this isn’t new shocking news but kids are really busy. I grew up in a household where I’m one of three. We had multiple kids, like, friends over, activities, social events, extracurriculars, you name it.

My parents used to joke that they should have installed a revolving door instead of a standard front door. But like 20-plus years later, things are even more hectic. We’ve got the internet. We’ve got all these new developments and kids are just busier.

Plus if you add in the events in the last several years, it seems like tomorrow is just really unpredictable. Whether it’s COVID-19, school, extracurriculars, whatever your kids are dealing with, it can be really difficult to manage the stress that our loved ones are feeling and keeping our own stress levels in check.

So I am super excited to have Fairlee with me today. We’re going to talk about ways to support child and adolescent mental health, tips to initiate conversations about how our kids are feeling, how we can care for loved ones while also looking after ourselves because putting on your own oxygen mask first is very important, and more.

So I’ll give a brief intro of Fairlee before I start throwing questions her way. So if you are unfamiliar with her, Fairlee Fabrett, PhD, is the director of training and staff development for McLean’s Child and Adolescent Division.

She’s also the director of McLean’s post-baccalaureate clinical fellowship. She has extensive experience in evidence-based assessment and treatment for depression, anxiety, and behavioral disorders, including ADHD in children and adolescents.

She is also a native of Mexico. So Dr. Fabrett has experience in providing culturally sensitive and effective treatments for individuals and families of minority groups, including family conflict and the way cognitive and family processes operate differently among minority populations.

So Fairlee, I’m so excited to have you join me today. So first and foremost, thank you so much. I’m going to throw a pretty loaded question your way first.

What does mental health support look like for kids, and is there variation in supporting the mental health of our kids? Does that change depending on their age?

Fairlee: That’s a very, very good question. And it is a very big question too, very hard to tackle in a small answer.

So when we think about supporting our kids’ mental health, we need to think about all the factors that go into our kids’ emotional and developmental needs. So for instance, the majority of kids benefit from having routine and structure.

So the more we can do to give them predictable days, a routine that we try to abide to, is going to be important for them because they know what’s coming. Some kids need it more than others of course but this is something that we should strive for, some predictability, especially right now when everything or most things feel very unpredictable.

Another thing that’s really important for kids and their mental health is connection to others, giving them the chance, the option, or facilitating their involvement with peers is very important.

And I’m not just saying letting them play video games because online they connect with their peers. No, no, no. I’m talking about face to face if possible or having play dates or doing something social, getting them out of the house.

Communication also is key. And I know we’re going to be talking about how to ask your kid how they’re doing, but, you know, maintaining an open avenue of communication is key. Knowing how they are. Being curious is important.

I mean, we also know that physical exercise is important and doing active things. Now sometimes we have kids who are not into sport. So I would say another way, another avenue in which you can go about protecting and strengthening their mental health is helping them figure out their identity.

What are they into? Are they into drama club? Do they want to be playing chess? And then doing anything you can to support that. That’s how you help maintain and make their mental health strong, like, stable.

And of course it would depend on age. Like, sometimes our teenagers are into things that our kids are not. Like, it does depend on how old the kid is and you start to take their lead.

But it’s important to just keep these avenues flowing. Imagine there’s, like, little rivers and we just have to keep the flow going. That’s a very short answer to a huge question, Jenn.

Jenn: I mean, I think you did a great job of being really succinct about it. So, I know I’m going to be asking you a lot of loaded questions. So I appreciate any information you can give.

I know you had mentioned helping kids discover their identity. What are ways that we can actually encourage kids to discover their identity without projecting how we perceive them to be, like, onto them?

Fairlee: Oh yes, that’s such a good question. I’m going to just encourage parents and any caregiver, you can be a grandparent, you can be an aunt, uncle, stay curious.

This is the best way, in my opinion, to tackle anything that comes your way with regards to children. So, with regards to their identity, you stay curious. But to be curious, you also have to be aware of your own bias, right?

So, like, maybe you really want your kid to play soccer. You’ve dreamt about having a child who’s a soccer player and you can’t wait and they get to five years old and they don’t want to. You take them to soccer practice, they hate it.

Time to give up, time to listen to their needs and start exploring. Sometimes you have a very vocal kid who’s going to tell you what they want. You take their lead or you provide them with different opportunities and then something might stick.

Maybe nothing does, but you continue to provide opportunities for them. I would say that’s how their identity, in this sense, starts to show.

If we’re talking about gender identity, which is another huge thing which I’m afraid to tackle right now, but it would also be staying curious and letting them talk about it, explore it, experiment with it in their minds, and know that it’s okay.

Like, you just need to listen, to stay curious, and to be very mindful to not impose your wishes onto them because that’s when the struggles start to come up and their feelings of sadness and frustration.

And this honestly applies to every sort of identity. Let’s say you have a kid who is a mixed ethnic background, and they start identifying with your partner’s ethnic background and not yours and you’re angry. You also remain curious, and you let them have a process.

So I’ll say my best advice for helping your kids find their identity is to stay curious and be respectful. You want them to be their own person.

And for this, you give space, you ask questions, you let them think about it. And if they ask for your opinion or if you need to set a limit, you do. But curiosity is key.

Jenn: One of the other things you had mentioned in your first question was routine. I know that people of any age benefit from routine. I do my best when I have a set alarm, I get up, I do my business, so on and so forth.

Kids are the same exact way, right? But how can we tell if our kids are in need of more or less routine? Like, what is that point of understanding what’s beneficial and what might actually be not so great.

Fairlee: Sometimes kids make it very clear to you that they need the routine. So, for example, you change something because it just happened, because it was a tough day.

And then you need to skip a meal or go to activity A before B, even though they were expecting it differently. And there’s a huge tantrum and you see their distress and you don’t really understand where it’s coming from.

I would say at that point, my guess would be that you have a child that benefits from keeping the routine and respecting it. As they start to grow old, the way I would suggest it is to, like, start to experiment.

Let’s say you told them, “Oh, we’re going to go run this errand and then we’re going to do dinner,” and then you change it on them when they’re a little older and they’re like, “Oh, why,” “It’s okay, okay.” And they relax.

That means that they’re starting to get used to more unpredictability in their schedule and they have the resiliency to be okay with it because they know that eventually they’re going to get to do whatever they want to do.

And they’re okay with that. I think, in this sense, you also take their lead and read their distress. You will have kids who would benefit from structure for a longer time. And you know, it’s okay. Like you, Jenn, I need a schedule. I follow my hours.

When I was in college, I had nap time in my schedule. Like, that’s how bad it was. And you know, it continues to work for me, and I follow it and I’m very predictable and it just works. So I would say, again, staying curious and following your kid’s lead, it’s very important.

Jenn: One of the things you’ve addressed a few times is, like, staying curious and asking questions. And I’m curious about ways to check in on our kids and teens, just to see how they’re doing and, like, let them know that we’re there for them without being too prying.

Like, what are some examples of getting curious without necessarily going into full blown parent mode?

Fairlee: This is a good question because especially adolescents reach a point where they just don’t want to tell you much. I will say, try to find spaces and times to talk about that is not necessarily like, “Oh, we need to have a conversation. Like, I have a couple questions for you. We need to talk.”

I would say when you’re in the car…I’m honestly against teenagers just putting their headphones in when they’re driving along with their parent. I know a lot of them do. I would say please try to avoid that as much as you can.

But, you know, in the car or maybe you’re making dinner or maybe you’re eating dinner, that’s when I would start to ask questions. And a great way to maintain curiosity and that, or not like present yourself that you’re prying, is to be curious and be really mindful of your reaction.

You don’t want to jump into problem solving mode, into preaching, into giving advice. No, no, no. You want to get to know your kid. You want to know what they’re up to.

So, in instances when the conversation can just happen, organically, take advantage of it. Be curious, ask open ended questions. Just, maybe you don’t know what this is, but an open ended question is when you ask something that doesn’t start with, “Do you like,” or “Would you this or that.”

You don’t give an option necessarily. You keep it open. So you said, “Oh, what happened in school today?” Instead of, “Did you have a good day” or, “Hey, what was your favorite part of the day today?”

Instead of, “Did you like recess?” Because that gives more opportunity. They might still say nothing or “I don’t know.” And that’s okay. You continue to take their lead and you maybe ask another question.

You just stay in this curious stance and if they do share something that is heavy…Let’s say they got into a conflict with a friend or there was some misunderstanding with the teacher and they tell you about it.

Please, please, please be super mindful of your response and stay curious. So, ask more open ended questions or validate what it is that they’re saying. So maybe you say something like, “Oh God, that sounds really hard. I’m sorry you had a fight with your friend.”

Or you say something like, “I would’ve also felt really sad if that happened to me” because you’re just reflecting the feeling back to them. And try to stay away from that, “I’m sure you’re going to be fine,” “Oh, they’re going to talk to you about it tomorrow,” or, “Oh, I’m going to talk to the teacher because I can’t believe they did this.”

No, no, no, no. This is the time to build trust. They need to know you have their back. And the best way to do this is to listen, to understand their feelings, and if you’re not sure what they’re feeling, ask.

“What are you feeling right now? Like, I’m super sad, like, are you feeling sad? Like, what else are you feeling?” Just stay curious. And I think this would not come across as that you’re prying. It would show that you care.

And let’s say, they say, “I don’t want to talk about it anymore.” You make it clear to them, “Hey, I’m around. Please come knock on my door,” or “I’m going to be down in the kitchen,” or “I’m going to be cleaning the car.”

Really. “Like, come get me because I want to talk to you about this. I want to help you figure it out.” I think that’s something parents could do.

Jenn: And I know that there are other ways to support kids and teens other than talking to them, right?

So, like, what would be some examples of being supportive and encouraging that isn’t saying, “Hey, if you had a bad day, I’m here for you.” ‘Cause some kids, like, that’s not…their preferred response isn’t actually a conversation.

Fairlee: Yeah, oh, that’s a good question. I always think about this. I forget where I read it. I don’t know if it was a theory book or fiction. I don’t remember.

But someone said, anytime your child, especially younger kids comes from school and is asking to play with you, that’s a way for them to ask for support or love without really wanting to talk about anything that happened.

And I have it in my mind all the time. When my daughter comes home and she says, “Can we play it together?” I’m like, “Oh, okay.” And we play, and I don’t ask anything. Maybe later, but not in that moment. So I’m following the lead.

So, spending one on one time with your kid is super important. Especially if you have more than one, making it a point and saying like, “Hey, let’s go do this.” “Do you want to go get a coffee?” “Do you want to go play basketball?” “Do you want to watch this show together?”

Spending one on one time and following their lead. You have a kid that loves puzzles and you hate puzzles. Doing it with them would be a good idea because this is how you support, that you care for them, that you’re there.

Sometimes conversations happen during these moments when you are just doing a physical activity together or drawing together or coloring. If they’re older, maybe it’s a show like “Arrested Development.”

I don’t want to see a show that you really don’t care about. Do it, because this is showing support. They’re connecting with you. They feel like they matter in that moment and you’re taking their lead.

It’s important to...there’s so many things in our kids’ lives that we control or other people control, so many routines that they have to follow, that anytime we have a chance to let them tell us what they want to do, I would say go for it.

Especially if it’s nothing that is putting their safety at risk, like driving fast or stuff like that. But that’s something else you can do instead of talking or in addition to having, like, an open conversation with them.

Oh, another thing, sorry, Jenn. Reading, especially for younger kids, sitting down and reading together. And this is great because they can also learn how to read, maybe, or practice reading.

So this is something, Jenn, that I would say it also starts to change with their age. And this is, again, something that you follow their lead.

Playing. You know, if your kid is into Legos, if your kid is into stuffed animals, like, something like that, that’s other ways to support them and to be mindful of their mental health and check in with them without the talking.

Jenn: One thing that you had mentioned that I want to ask a little bit more about is, if you have multiple kids in the household, I think a good example would probably be, especially if one of the kids needs a little bit more attention than the other, whether it’s an infant or a sick kid, how can parents balance and address supporting their different kids who may have very different needs?

Fairlee: That’s, yeah. This is something that I would say for sure we have to pay attention because sometimes when your attention, and we see this a lot in our programs at McLean, right?

Like, there’s a family that has one kid that requires so much attention and so much consistency and limit setting and interventions that the rest of the kids start to feel like they’re not as important, that they don’t matter.

Some of them internalize it, get a little depressed. Others are like, “Wait, do I need to ask that also to get your love and attention? I’m going to do that.”

To not get there, this is going to be really hard for parents, I think. But my advice would be, to almost, like, set a limit for yourself on what you’re going to be doing with the kid that needs, like, a lot, a lot of attention.

So, like, saying, like, “I know they’re struggling and I also have another kid, so I’m going to have to shift gears.” If you have a family member that can help, you can do that. And then, at that moment, start interacting with the other child and make it clear, be like, “Hey, let’s do something together.

Today has been so tough. Your sister has been so, like, so challenging for me right now. I’m super tired and I see you and you’re struggling. Let’s hang out. What do you want to do?” And connect.

If you are on your own, if you’re a single parent, ah, this is just so hard. I would try to find opportunities. Like, if when one of the kids is in school, that the kid that needs the most attention, maybe they’re in school or in daycare.

I would even say, like, maybe they can keep half a day of school. Like, just spending time with them one on one is so important to feel the attention, the love, and the care. But you do need to almost, like, set a limit for you.

And I know this is really hard. That’s why I’m hesitating, because it’s like, you don’t want to do that as a parent. Like, you don’t want to be like, “Oh, like, I can’t pay attention to you,” to pay attention to this kid.

Especially if this one is struggling so much. But I just think we need to acknowledge that we have other children there that need our love and support. So this is really tough. But, you know, research out there says that you don’t need to do that much either.

Like, one on one, 15 minutes a day, one on one, of undivided attention to your kid, taking their lead, doing the activity of choice, would go a long way. And then when you look at it that way, you’re like, “Oh, it’s not so much to ask.”

Jenn: And also something to keep in mind that, like, 15 minutes to a four or five year old when they may not have a full grasp of time, may seem like an eternity.

And to you, you may feel like you’re depriving your kid of more attention whereas they maybe only really needed 10 minutes of your time. So understanding that balance as well, too.

Fairlee: Exactly. Exactly.

Jenn: One thing I’m curious about is, I know this a little bit anecdotal, but, like, I’m one of three girls and I know that growing up my sisters and I tended to go to my mom with whatever we wanted to talk about, whatever we needed.

If our partner ends up being the one that our kids go to for support and conversation, how do we help turn it into more of a team effort versus a solo endeavor? I know family, it’s a dynamic, it’s part of being a full team, but sometimes that burden can be shouldered more often than not by one parent.

Fairlee: Yeah. You bring up a really good point. And to be able to do that, to be able to share the load, let’s say as a mom, right?

To be able to share the load, you need to feel a little bit secure in who you are and the importance that you have for your kids, because it’s going to require you, again, saying no or setting a limit and turning them away towards their father or the other partner, mother maybe or their grandparent, and saying something like, “Hey, I would love to help you.

And I’m wondering if you could ask your other mom or, like, your dad or your grandma to help you with this because I’m, like, in the middle of something and, you know, like, I really want to hear you out, but I know they would love to hear from you too and help you out. Like, could you do that? And then I can join you all later.”

It’s hard because some of us want to feel super powerful and we can tackle all things and we’re good. And I also think it’s important that they develop a relationship that’s trusting and that is secure with other adults. It doesn’t have to be your partner. It could be an aunt or someone that’s, like, really present in their lives.

‘Cause this is practice, right? This is practice for when they grow up and they want to have attachments with other people. But they need the opportunity to do that. And if you’re always the one responding to everything, then there’s no opportunity.

So you almost need to, it’s going to hurt a little, but you need to be like, “Alright, what if you go ask your other mom or your grandma about this,” and then you just deal with it on your own. And you know they love you and you know they care about you and you know you can help them later, and you’re giving them this tool to open up and trust in someone else.

Jenn: I think one of the things that you’ve alluded to is, a lot of times when we are trying to support our kids, we end up shouldering a lot of what they’re, we’re encouraging them to stop internalizing whether it’s stress of school, things going on with their friends, uncertainty about what they want to do with the rest of their lives.

There’s a ton of stuff that, like, parents can end up feeling the burden of unintentionally. So, how can we help manage the stress that our kids, teens, young adults are feeling while also managing our own stress levels on top of that?

Fairlee: Yeah. That’s a very good question. There’s two things of what you said, Jenn, that caught my ear. One is that, sometimes, as parents, because we don’t want to see our kids suffer, we protect them too much.

Or we prevent them from feeling consequences. That would be natural consequences. And we’re trying to do them all. We don’t want them to be bored.

I mean, just think about our culture right now. Parents jump all these hoops just because they can’t tolerate their kids feeling bored when boredom is such a good emotional experience to have because it allows for you to be creative, to think outside the box, but, okay.

So we sometimes try to prevent our kids from suffering and we just protect them and we’re not helping them build their resiliency. We are doing a disservice to our kids whenever we are like, “Oh, I don’t want them to feel bad.” Or, “I don’t want them to go through this. I don’t want to tell them the truth about this because it’s going to hurt.”

We are carrying more on our shoulders and not allowing them to figure out how to feel these things and still be okay. If we, as parents, are not able to deal with our feelings and our level of stress in a productive way, we’re not going to be able to deal with our kids’ feelings either.

If we show our kids that we can’t deal with their feelings because they’re too much and we can’t see them distressed, we can’t see them angry at us, they are not going to know how to deal with their feelings.

So we have to model, like Jenn’s saying, like, we end up taking too much, but we need to do something about this, right? Like, we need to manage our own level of stress because the better you are in your mental state, the better parents you’re going to be, the better friend, the better coworker, the better sister, the better wife.

So, there’s many things you can do. There’s many, a ton of different strategies. I can mention a couple, but it’s all in the service. And I’m saying this because this is something you need to keep in mind.

It’s in the service of being a better person, a better parent, and to model to your kids what they can do in those moments. So, you had a hard day. Right now what people do a lot is come home, put the TV on. “I just need to check out for a second. I’m just going to watch this mindless show.” That is really, Jenn…

Jenn: I’m guilty. I work from home and I’m guilty of doing that, so, yeah.

Fairlee: But Jenn, when you’re feeling really distressed, really distressed, wouldn’t it be, I mean, if you watch a show, mindless show, you turn off the TV, the distress is still there, right?

Like, you’re still feeling, I mean, it was a pause. I’ll walk outside. I mean, I know it’s the winter. Believe me, I hate it, I hate it. But a walk outside would work because it’s physical activity, it gets you thinking, it gives you some alone time.

Maybe you connect with friends like you’re trying to have your kids do, you do yourself. You connect with friends, you could journal, just sit there and journal. As parents, you can do that. Just, like, write something down.

You could also do basic things that are key to taking care of yourselves. But sometimes we forget about this, but that is, like, eating healthy, drinking a lot of water, and sleeping, that’s basic.

And it’s so important, it’s, like, the first level of this pyramid of needs. So, like, there’s many, many little things that you can do to manage your stress and always thinking, ‘cause I know some of you are going to think, “Oh no, that’s selfish. I can’t leave my kid, like, me taking time to go on a walk. What an awful parent I am.”

No, no, no. Keeping in mind that you’re doing this, one, because you need to be healthy in your mind and in your body and in your heart to be able to be a good person, and thinking about the example you’re giving your kids.

They see you, they see you, they see the strategies that you use, and you have to maximize that. And this is a good opportunity for that.

Jenn: We did have somebody write in, they wanted to ask you about their six-year-old who seems to get frustrated a lot with being perfect. And if she fails, she goes right into tantrum mode. Do you have any suggestions for how to handle this?

Fairlee: This is a good age to work on this. Why am I saying this? Because when you get to adolescence, it’s a little tougher. This wanting to be perfect takes over more areas of the sense of self and can be a little bit more complicated.

So, six-year-old, let’s see. I would say... I would do a mix of things. I would, when we’re playing, I would show my mistakes, and I would say like, “Oh my God, like, look what I did. I did it wrong.” And then I would say, “It’s okay. I still had such a good time. Like, it’s okay that I did it wrong. It’s okay that I made a mistake.” You’re going to be modeling.

If, let’s say the perfectionism in your kid is about clothing or hair, and I’m saying this because one of my kids is going through that, when I do my hair and I make a mistake and they point it out and I say, “It’s okay. It’s just hair. You know, it’s like, whatever, I’m going to have a good day anyway.”

Modeling. When it’s time for them, and they made a mistake, in the moment if they’re really, really, really having a hard time, you need a reset. So, in that moment, there’s no talking and, plus, they’re six, but, there’s no talking.

So I would say, change the venue, go outside, bring in, like, a distracting thing, help them calm down, and then when they’re calm, if they are, ‘cause at six years old, you’re able to talk to a kid.

So, I would say, “Listen, I know you really had a hard time. And, you know, we make mistakes all the time. So I’m going to help you figure out ways to deal with your feelings, like with how angry you get, next time when we play together. But I’m going to remind you before we start playing.”

So, next time when you play with them and I actually don’t know what the frustration is, sorry, like what area? But, I would say, before you start playing, say like, “Hey, we’re going to play. But remember what we talked about? So, this is what we’re going to do. As soon as you start to feel angry, let me know. And we’re going to practice...”

I don’t know, like, if they get mad really quickly, you can practice doing jumping jacks as they’re getting angry. I swear this is going to help. Or, you know, “We’re going to be doing a little bit of breathing as we’re working,” or “We’re going to be talking about it as we do it.”

And just, like, modeling for them, saying something like, “Oh, I’m doing this. I might make a mistake, but it’s okay. ‘Cause I can try again.”

And knowing that they’re not going to be perfect for a while, but, basically, you’re going to be working on modeling your own mistakes, talking about why it’s okay to make mistakes, especially if they’re doing the best effort, and allowing them to make mistakes.

Don’t try to, like, prevent them from making a mistake or, like, moving all the environment around so that everything’s perfect for them and they don’t have a tantrum. They need these tantrums.

They need these tantrums because they need to figure out how to regulate themselves. Especially now. It’s going to be easier now than later. Does that make sense?

Jenn: Absolutely. One thing I’m curious about is that different kids need different types of support, different levels of support.

Are there any signs or symptoms that parents, caretakers, teachers, et cetera, should be on the lookout for that might indicate that a kid isn’t getting the support that they need or the type of support that works for them?

Fairlee: Yeah. Okay. And this is something to pay attention, especially now, as we know things are getting slightly worse for our kids. As parents, as caregivers, as teachers, as any adult, it’s important that you pay attention.

If you start to notice a difference in function. And what I mean by this is, let’s say you used to have a kid who would wake up early in the morning, do their thing, maybe tantrums, and pretty active.

Let’s say all of a sudden this kid is having a hard time waking up, looks a little bit more sad, which is nice in a way, ‘cause they have, maybe, less tantrums ‘cause they have less energy, but there’s, like, a change in function.

That’s when your alarm should start to make a little noise. It’s like, “Wait, what is happening that they’re functioning seems different.” Let’s say your kid starts to avoid their friends. They’re teenagers, and they’re getting invited to parties. And they’re saying like, “No, I don’t, I don’t really want to go.”

Or you ask like, “Hey, have you talked to your friends? Have you been texting?” “No, no, I really haven’t.” Alarm, because you know level of functioning and connection and relationships are key for anyone. And these are some of the first things that start to go when kids start to feel bad.

Mood changes, if they’re drastic, let’s say all of a sudden your kid is really irritable. And, if it’s an adolescent, it’s, like, way more than the typical adolescent irritability. And you also notice a change in their, maybe they’re spending more time in their room.

Maybe they come home from school, they go into the room and they don’t come out until dinner and they’re more irritable. Alarms, alarms should be going on in your head. Also, if their sleep has changed, if their eating habits have changed.

I mean, there’s a lot of different things that you can actually pay attention to. Now, would you need to immediately say, “Okay, you need to talk to someone.” Maybe not. Maybe you could say like, hey, I am a supporter of transparency as much as you can with your kids.

So, if I were in those shoes, I would come out and say like, “Hey, I’ve been noticing these things. Are you feeling okay? Like, I’m getting a little worried.” And just putting it out there and maybe they’re going to say, like, “Leave me alone, no.”

And then you’re like, “Okay,” but then you continue to pay attention. And this is when you say, “Listen, maybe you don’t want to talk to me. It’s okay. Maybe you don’t want to talk to my partner. Maybe you don’t want to talk to your grandparents. We could find someone for you to talk to, like, it’s okay to ask for help.

And this is something... sometimes it’s nice to have someone outside of your family to talk to and, you know, just, like, complain about us, complain about everything that’s going on in your life. Like, would you like that?”

And just kind of start to put in, to like plant a seed, the seed of, like, the possibility of getting additional support.

Obviously if you start to see a little bit more or worsening of all the things I’ve mentioned, or if you start to notice that your kid is saying things that sound really hopeless, I would say at that point you take matters into account and you say, “Okay, we’re going to see someone, I’m getting really worried.

And I want you to have support. Like, I love you and I want you to do well.” And if it’s a little worse and that’s when you go to the emergency room and then get some support there.

Jenn: Do you have any ways for parents to approach the conversation of suggesting, maybe you should talk to somebody that’s, like, not me or mom or tia or grandma, especially when there’s still, there’s still a lot of stigma in kids about maybe talking to a licensed mental health professional.

Do you have any advice for how to start that conversation without them immediately going, “Nope, I’m good. I don’t want to talk to anybody, I’m fine.”

Fairlee: There’s no magic way. I’ll say it depends... It depends on your kid. I think that there’s some kids who you will try your best to bring it up in a very non-confrontational way, and they’ll respond that way and say, like, “Nope, I don’t want to hear it.”

And they just won’t be interested. I always, I sound like a broken record, but I’ll go back to curiosity, just coming out and saying like, “Hey, I’m wondering about this. I’m noticing this in you. I’m thinking this would be a good idea.”

Maybe you know of someone in your family who already sees a therapist, you could bring it up, like, normalizing this is so important.

You know, you can start with your kids, even if you’re not ready for them to go to therapy, you could start by saying like, “Hey, like, did you know there’s people out there that work with,” you know, for younger kids, we call them the feelings doctor, “there’s feeling doctors that they know, they help you with how you feel.”

Normalizing it. And there’s a lot of kids right now that are in therapy. And I feel like they’re starting to share with their friends. Like, I’ve seen some teenagers that already knew about therapy because their friend is in therapy.

And that’s how they thought of getting into therapy because their friend is in therapy and it’s going better, so I want to do the same. So, you just, the only thing you can do as a parent, I think, is bring it up first in a very curious way, suggesting it when they’re having a hard time.

Bring up the benefits of talking to someone who’s not in your family, someone who’s going to see you differently. Like, they don’t have the history with you. And, like, talking about that and putting it in a positive way, I think is the best thing you can do.

And you might still be faced with, like, “Nope, not interested.” And that’s it. Like, you bring it up again, maybe in a month, like, you just don’t give up. Don’t pretend it’s not happening. A lot of parents, sometimes, because they’re so afraid of seeing that their kid is actually struggling, they don’t act.

And then the kid interprets that as like, Oh, they don’t care. You know, I was sad and they didn’t pick it up.” And then the parent tells us like, “Oh, like, I did see it. But, like, I thought it was a phase.”

Like, it’s almost like you don’t want to see that your kid is struggling. So, open eyes, remaining curious, and not being afraid of asking. And also, oh, sorry, Jenn, I’m going on a tangent here. But like, the other thing I wanted to say is that, like I said, I like transparency.

And I’ll say, when you’re asking questions to your kids about how they’re doing and what they’re thinking and how they’re feeling, share with them, like, allow them to see you as a human too.

And you can share like, “Man, I had a really hard time at work today because I was in a situation where I felt like I wasn’t doing my best. That was really hard.” And maybe your kid’s going to be like, “What? Like, why are you saying this, Mom?”

That’s okay, that’s okay. You’re showing vulnerability, you’re talking about how something was hard for you, and you’re like, “That was really hard, like, I felt really bad for a little while.” And you’re showing that you’re still there. You’re okay.

So, I try to always encourage parents to do this. Ask and share. Like, it’s a conversation. Like, you want the kid to see you talk about that, like, hear you talk about being sad. Like, a lot of parents try to never show sadness in front of their kids. Why?

Sadness is healthy. It’s okay to feel sad. The issue is when it interferes with our functioning, which hopefully is not happening because you’re parenting them. But, like, showing, like, “My God, I’m so sad today. Like, this is what happened. Like, my friend’s mom died. And, like, I feel terrible for them.” And, like, showing that creates empathy, and you’re modeling. It comes down to that too.

Jenn: I think one thing that’s important to recognize throughout this whole conversation is that, like, parenting doesn’t stop at a certain age. Like, you are a parent and caretaker for life. And that means that there are things that can come up even when your kids are adults.

We had someone write in saying, “My adult daughter is always angry at me, and she blames me for all of her faults.” Meanwhile, the person who wrote in is constantly trying to make up for mistakes that they made when their daughter was younger and feels like these challenges are their fault.

So, they’re looking for advice about forgiving themselves and moving forward without the guilt of everything that’s happened in the past.

Fairlee: Oh, it’s an interesting scenario because it has two perspectives. Like, I’ve worked with young adults, maybe not adults, but, like, young adults who are constantly blaming their parents for whatever’s going on in their life.

And the work is on, like, “Alright, this happened, this is how you were treated by your parents. How do we move forward? Are you willing to stay more years stuck in this? Like, what can we do to help you move forward in the presence of this disappointment that you suffered when you were younger?”

That’s the work that would happen with the daughter. With the mom, I will say, I don’t know if you’ve done this, ‘cause you said you’re trying to make up for it. I don’t know what that means. But, sometimes, especially if this is a grown daughter, having a conversation.

Maybe you’ve done this. Again, like, I don’t know the details, but, like, saying, “Hey, like, I know I wasn’t the best mom. And I know I did A, B, C, D, and I’m sorry.” Sometimes parents don’t say I’m sorry. It’s important for your kid to hear this.

So you say, “I’m sorry I did this. I’m sorry I put you in this place. I can’t change the past. I’m super interested in having a relationship with you right now because I value you and I want to be in your life, and I’m here.

And I know you’re sometimes very angry at me for things of the past, but I want a chance. I want to see where we can go.” And then, on your own, and if you see a therapist with your therapist, continue to work on that, like, yes, yes, you were maybe not the best parent then.

And maybe you made some mistakes. We all do. But you’re here now. What can you do now to be a better parent?

So, maybe when your daughter is angry at you and irritable and, like, maybe saying things to you that are coming out of this anger or frustration, in that moment, in your present moment, acknowledging that, “You know what, right now I’m being the best I can.

And I know this is coming based on the past and I’m not going to jump on that. I’m going to stay where I am. I’m not going to engage in this fight. I know this fight has nothing to do with my present and I’m going to continue to love me and my daughter and do the best I can.”

It’s going to be a lot of work because of course we jump into those patterns that we used to have for, like, years, but you’re trying to be the best parent now. And that’s the work in the moment.

And forgiving yourself is, maybe it’s going to be about learning how to live with those mistakes that you made and being, like, “I’m so sad I did that and I’m in a better place and I can be a better parent and that’s okay.”

It’s kind of like moving forward with the process of all of these regrets that maybe you have and still choosing to move forward. That’s what I would do. That’s my advice to you as a mom.

Jenn: I want to be cognizant of how much time I have with you. At the same time, I would be doing all of us a disservice if I didn’t talk to you about culture and how support looks different based on the culture that a family descends from.

Fairlee: Yeah.

Jenn: What are some of the major differences that you can think of in what support might look or feel or sound like that culturally might impact a child’s mental health?

Fairlee: Oh, that’s such a good question, Jenn. I’m so glad you asked. Okay.

Jenn: I know. This is difficult because I’m like, well, depending on the culture... There are thousands of cultures. So, I completely understand. I’m basically trying to ask you to put up, like, all the sand on the beach into one funnel.

Fairlee: Okay. Alright. There’s a lot to say about this, and I’m going to try and touch upon the most important parts that I found to be effective when working with parents that are of a minority culture raising their kids in the majority culture.

So, we’re not in another country, we are in the U.S. And some of us are from Mexico or other countries. Some of us have, like, a family culture that is just, is there. And we have to keep in mind that we’re not raising our kids in a vacuum.

We’re raising our kids in this society, with things that go on here in this culture. And maybe there’s things that our culture clashes with and we don’t agree with. And maybe the way we were parented was really effective with us while we were not living here.

So, I have a couple of examples that come to mind when I’ve worked with parents that are Latino, others, Black Americans, and something that comes up a lot is this difficulty validating feelings in your kids.

A lot of parents, when you see your kids struggling, almost the immediate response is to say, “You’re going to be fine. Why don’t you do this and that, go talk to this kid. You know, next time, defend yourself.”

Like, we jump into problem solving mode immediately. I’m not saying that parents that are born and raised in this country don’t do that, they do. I’ve also worked with them. But it’s just very common in some of the families that I work with that are from underprivileged backgrounds.

Like, this is what they do. And I think a lot of it comes from fear. Like, you don’t want it to be a problem. You don’t want your kid to struggle. So, like, you just want to solve it right there and then.

But our kids are not growing up in those countries. Our kids are growing up here, and the way we need to react to them is different.

So, there’s a lot of work in helping these parents validate and stay with the feeling and allowing the kid to be sad and to cry and allowing them to talk about why it’s hard and to just listen and not problem solve.

We can problem solve later, for sure. But allowing for that space is very important. Also, with relationships...this comes a lot with sex. Like, trying to adjust the parent’s background and their sense of parenting, what it must look like and adjust it to the majority culture is a struggle for sure.

A good step would be to acknowledge that to your kid and say like, “Hey, listen, you just did this. I wasn’t expecting this to happen. I’m not sure how to react. I need to think about this. I need to think about this because I was raised in a way that maybe this wouldn’t have happened back in the day.

So, like, I need to think about what we’re going to do.” And say that open and honestly, and acknowledge that the way you were raised is very different from the way that this society pulls for you to raise.

Now, I will say that having a sense of family, familismo is the term in Spanish in the literature. We use it too. Familismo, family. It’s important for a lot of these minority families. Like, having a sense of, like, being connected to your family is going to be a protective factor for your kids.

And you also need to work on letting them be independent and autonomous. And this is a struggle for a lot of parents. I don’t know Jenn, I don’t know where to go. Like, this is huge. You just need to acknowledge that it’s different.

That you’re, as parents, you need to acknowledge that you can’t just parent the way you were parented and that you need to think about factors impacting your kid and try to do the best you can.

And if you can’t, like, you talk to someone, you talk to other parents that are in the same situation, but it’s just important to know that we all need to adjust and adapt to the situation and the circumstances.

Jenn: I’m curious too, because you have experience with child and adolescent mental health, extensive, and combined with the cultural experience that you have.

One of the things that I’ve realized from talking to so many clinicians and mental health providers is that, depending on the cultural background, whether it’s Asian American or Latin American or Black American, depending on the background, it’s entirely possible that people aren’t seeking mental health treatment because of religion or stigma or bringing shame into the family.

They just don’t want to talk about it. If there is a child or teen that feels like they’re struggling, is looking for more support, how can they look for it if that history of support isn’t already established in the family?

Fairlee: Hmm. I’ve seen a lot of families really, really struggle with this, families where they don’t even believe in mental health issues. Like, they really think it’s like, you suck it up. Like, you just work through this.

Like, they don’t even want to call being nervous, anxiety. You know, they just don’t want to use these words. How do you go about it? I think encouraging these families to be open to the possibility that they need additional help is important.

I mean, if you have a family that’s in this situation and they’re refusing mental health services, maybe you really encourage them to go to a priest. And you hope that the priest will say, “Hey, maybe you need help.”

‘Cause there are, right now, like, there’s a lot of more people trying to normalize asking for help, trying to normalize therapy. Maybe a kid would end up saying something at school. This is what’s happening a lot right now.

And then the counselor at school contacts the family and the family sometimes is like, “Nope, we’re good. We do not need any help. Everything is good here.” So then it’s up to the counselor to work with the kid a little bit to try to see like, do they need more help?

Like, what is going on really? And then to determine, maybe they need to get services involved. Maybe they need to have more meetings with the parents to help them understand. And a lot of psychoeducation would be very important for this family.

It’s just, like, I’ve done this with families before when they were not even my patients, but, like, people are in my community who would say, like, “My kid is having a really hard time. Like, all of a sudden they can’t talk.”

And I would say things like, “It sounds like they’re dealing with anxiety.” “No, no, no, there’s no anxiety in my family.” And then I would say, like, “Well anxiety shows up in different ways in people. It could be this, it could be that, it would be very good for your kid to talk to someone.”

And they would say, like, “No, no, no.” And then I would just keep at it, ‘cause that’s something you can do with each other. It’s just, like, I see it really just planting the seed or, like, helping them be curious a little bit or to just not shut it down.

But, you know, sadly, a lot of the parents that we end up seeing in programs when their kids need residential or inpatient level of care, a lot of them are parents that refuse treatment for their kids.

And it just got to a point where they needed to go to a hospital and then sometimes even then the parents are like, “No, we’re good, no medication.” But, you know, at least there’s time there. And the space to be like, “No, no, no, your kid needs more support.”

So, it’s hard. But I would say, hopefully the members in the community, teachers, counselors, priests, neighbors, like, people that are a little bit more open to this, can normalize it by talking about it with these parents that are not. And we hope that they will open up to the idea later on.

Jenn: Do you have time for one more question?

Fairlee: Yeah. Of course.

Jenn: Awesome. So I actually think this question is a really nice way to, like, tie up the whole session, our conversation, into a nice little box with a bow. We had someone write in saying that one of their jobs is going into high schools and talking about mental health.

So, based on what you and I have talked about over the last hour, what do you think would be some key points that this person could mention to teens if they only have 60 minutes to get through to them?

Fairlee: 60 Minutes per week or total?

Jenn: It seems like total, but I’m not too sure.

Fairlee: Okay. You know, I have actually fantasized with being sent to schools and just, like, give some education to every school, which, of course, is never going to happen.

Jenn: Well, this person has your dream job then.

Fairlee: Okay, so something that I would say is very important. Give psychoed on feelings. We want our kids to feel anxious. A lot of kids end up in therapy because they’re like, “I don’t want to feel anxiety. I don’t want to feel sad.”

A lot of our teens especially, and now younger kids, but especially our teens engage in behaviors that are unhealthy because they don’t want to feel, they don’t want to feel sad. “I cut.” “I don’t want to feel bored.” “I, what, drive recklessly.” “I don’t want to feel ignored.” “I send nude pictures around.”

So, a lot of kids end up engaging in these behaviors because they can’t tolerate what they’re feeling. But every single feeling is important and it makes sense. Evolutionarily, it makes sense why we feel anxious and we should feel anxious.

We should feel sad, and anger is super good. It’s a great motivator. All of our feelings make sense. So, I would start with that, helping them understand that we need them all. We want them all and why.

And you can even get a little geeky and talk about the parts in your brain that get activated with each feeling. And, like, what parts of your body get more blood flow with each of the feelings. Then, talk about, that you feel them in your body and do some psychoed about that.

And then also to tack on skills in that moment and be like, “Alright. So, like, if you are feeling like you are really anxious and you’re starting to feel short of breath, what can you do?” Like, something to take home.

If you only have 60 minutes. If you had a little more time, then I would add talking about how we all have thoughts that are unhealthy, unhelpful, very negative. And that’s okay, that’s our mind. We have them. We don’t have to do anything.

A thought can come in and leave without us doing anything. We don’t have to act. I would also work on mindfulness with these kids, but it depends on the amount of time you have, but, you know what, I would, on those first 60 minutes though, if you can bring up mindfulness.

Not with that word necessarily. I would say something just like, helping you be in the moment or, like, being aware or being, or noticing, like, don’t call it mindfulness. A lot of teenagers don’t like that word, but I would also do that in the first 60 minutes, mindfulness and education on emotions. They’re important, yeah.

Jenn: And I know I’ve eaten up a little bit more of your time than I said I would.

Fairlee: It’s okay.

Jenn: It seems like a really great time to end the session. Fairlee, I just want to say thank you so much. I think there’s, when I talk to providers, I’m always humbled because there’s just such eloquence and empathy that comes through in everything that you say.

So, thank you for bringing that eloquence and empathy to all of us. And to folks tuning in, this actually concludes our session. I know we talked about some difficult stuff today with both parents and kids that may be struggling.

As a reminder to folks, if you are encountering anything difficult, the Samaritan’s 24/7 helpline is actually confidential, free, and it’s open virtually 24/7, 365. You can call or text them anytime. The number is 877.870.4673.

And again, Fairlee, thank you so much this was-

Fairlee: Oh, thank you. Thank you for having me, Jenn. This was fun, I liked it.

Jenn: I’m so happy to hear that. It’s my pleasure. And anybody tuning in, like I always say, be nice to one another, but, most importantly, be nice to yourself. So, thanks again and have a great day.

Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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