Podcast: Mental Wellness for Kids and Teens

Jenn talks to Dr. Lisa Coyne about the importance of mental wellness in children and adolescents. They discuss checking in on mental well-being during COVID, ways to get more involved in family activities, and how to address technology use. Lisa answers audience questions about child and teen mental health and explains how parents and guardians can best support their loved ones.

Lisa W. Coyne, PhD, is an assistant professor of psychology in the Department of Psychiatry, part-time, at Harvard Medical School, and is a senior clinical consultant at the Child and Adolescent OCD Institute (OCDI Jr.) at McLean Hospital. Dr. Coyne is the author of “The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years,” a book for parents of young children.

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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.

Thank you so much for joining us today if you’re joining us live or recorded. Thanks for coming to hang out with us for about the next hour. I hope wherever you are in the world, you are doing well.

I’d like to introduce myself. I’m Jenn Kearney, and I’m a digital communications manager for McLean Hospital. And today’s subject is all about mental wellness for kids and teens, and it’s really important for quite a few reasons.

So first of all, mental health and mental illness, two completely different terms. Mental health and wellness even varies between whether or not you’re dealing with a kid or you’re dealing with a teenager, and considering that our brains aren’t even fully developed into our 20s, I think, is it like 26?

Lisa: More. Actually they’ve learned that our brains continue to develop and change through our lifespan, but the new sort of classification of what young adults or what teenagers are goes to age 25 or six.

Jenn: So, yeah, so at this point we can’t even limit the notion of mental development and the impact of mental wellness into kids and teens. It’s college age, adolescents, it’s grad students, it’s young adults. It encompasses so much more.

So during the session, we’re going to talk about child and teen mental health, mental wellness, how to address it with your kids, how to initiate those conversations. If you’re unfamiliar with Lisa, Dr. Coyne is amazing. She is a psychologist. Senior clinical consultant.

Lisa: Jenn’s very sweet.

Jenn: She’s one of my favorite recurring co-hosts because we have some of the best conversations. I’m a little biased, but we have some of the best conversations.

Lisa: It’s kind of fun to chat.

Jenn: She is a senior clinical consultant for the Child and Adolescent OCD Institute at McLean Hospital which is otherwise known as OCDI Jr.

She is also the recent coauthor of “Stop Avoiding Stuff,” which is a book that instills microskills so you can address your fears and deal with them anyway. It’s on my nightstand, I try to get a couple of pages every night. It’s great.

Lisa: That’s awesome.

Jenn: So, Lisa, hi.

Lisa: Hi.

Jenn: I’m so excited to see you, every time I’m just like my face hurts from smiling, I’m just so happy to see you.

Lisa: It’s great to see you too.

Jenn: So I want to start it with a pretty overarching question. So sorry that this is a doozy, but why should parents and guardians be so aware of mental wellness for kids and teens?

Lisa: Why should they? Wow! Well, because it’s a really important part of growing up. And I think that if we step back really far and we kind of think big picture and play the long game here, one of the primary goals of parenting is to help your children grow up as who they are, right?

As flexible, adaptive young people who will thrive, right? And the things that they’re going to need to thrive are going to include behavioral flexibility, psychological flexibility, meaning not that their goal, our job is not to, we can’t always protect them from all of the challenges of life, right?

So when that’s the case, our job is to help them adapt, right? Help them develop resilience, help them develop the ability to persevere, right? To see what’s beautiful in life, to see what’s joyful, even when there is adversity. And so I think all of those things are important.

So when we think about mental wellbeing in kids, I think that it’s really important to step way back out. And I’m going to ask if folks or parents listening to us today really think about like what’s the big-picture goal? What’s the value for you underneath your parenting style? Right?

And I’m kind of lucky. I have a teenager who’s 15 and I have a 21-year-old, and they’re great kids, both of them, and they’ll always be my kids, right? Even when they’re grown up.

But I think that for me personally, one of my values is to communicate that I love them no matter what, that’s a core value, right? So no matter what they mess up what fights we have, no matter if they get good grades or bad grades, if they make terrible mistakes, if they are rude, I love them no matter what.

That doesn’t mean those behaviors are always okay, but it does mean that I’m there, and that if they reach out, I will be there no matter what. And then the other thing is just to help make a space for them to be the people that they’re going to evolve to be, right?

And parenting shifts over development where when you have, and the goals are different at different stages of your child’s development. And that’s really important to think about too, right?

All the things that will shift kind of how you support your child’s mental health and wellbeing involve their experience of adverse events in childhood. Right? COVID is a pretty big one because it’s just so disruptive to all of the routines and the things that are going on.

So your parenting is going to shift in contexts where there are challenges that come up for your kids. And so thinking about how do you best support them?

And again, a good guide is to always step back and think about what’s the big picture here? Not this one interaction or not this one incident, but like what’s my overall goal? What’s my overall value?

Jenn: So I did want to ask about a little bit about this disruption because COVID has been something that at this point it’s what? 10 months in. So where. It’s funny.

Lisa: Feels it’s never-ending, doesn’t it?

Jenn: Sometimes it does, but.

Lisa: Yeah.

Jenn: It’s been such a huge disruption and a shift in our thinking, in our balance and our routines. How do we try to shift our kids’ routines and the acknowledging of that and like recognize that they might need their own time to decompress without totally letting them go off the rails?

Lisa: Yeah. And I think that that’s, just the fact that you asked that question, it’s an important question noticing that like we have to shift how we shift things for our kids and how we communicate and express our own emotions as parents about this event, this ongoing event is going to shape their perceptions of it as well. Right?

And so that’s a really important thing to notice. If we treat it like it’s horrific, uncope-able with, not that that’s a word, are kids are going to feel that, right? And so thinking through how can we as parents be flexible?

And I’m mindful too that at this point in the pandemic, and I don’t know if this is our listener’s experience, but I know that the numbers are so high of COVID, and so many of us either have lost someone or know someone who has had COVID or has lost someone or have had it ourselves.

And I think that just to kind of pause and take a breath here that while we’re thinking about our kids’ mental wellbeing, it’s also important to take care of ourselves. Right?

So you asked a question about routines and things like that, and I’ll answer that. And then we can come back, we can circle back around to kind of like, it’s like that old adage, when you’re on an airplane, you put on your own oxygen mask first. Right? We can circle back around to that.

So with our kids, there’s demands that folks are trying to manage now like if you’re a working family, if there’s one or two of you working and your kiddos are at home and they’re also in school or if they’re going back and forth from school, there’s managing all of those routines and the things that they have to do.

And then there’s, and this is going to be a different answer for kids of different ages, right? So I think that allowing some flexibility with scheduling is helpful. I think rather than thinking about how can I schedule instructor? Routines are important ‘cause they anchor us in our days, even if they’re simple ones.

Routines in which there are nodes during your day, where you spend at least a few minutes together as a family, with your kids, you don’t have to do anything special, maybe it’s washing the dishes together, maybe it’s a snack together, maybe it’s just kind of those moments that are in between things, but make sure you connect and anchor your day with that persistently and consistently across the pandemic.

That’s really important. Okay? And make opportunities to check in how are you doing? What’s going on? And even if they won’t tell you anything, like for example, teenagers are going to be like, I’m fine Or why are you asking? What’s wrong with you mom? Or whatever.

Do it anyway. Do it anyway. Make those points of connection focal in your day as anchors. Allow some flexibility, and a useful thing to think about is do the hard stuff first and then allow time for the other stuff, the gaming, the doing nothing, the chatting with my friends on Zoom, the whatever. Okay?

And that’s just a useful principle. First, the hard stuff, then the stuff I feel like doing. And the more you teach kids to do that, it’s kind of like, you’re helping them with that long-term goal of flexibility like I have to go to work and then I get my paycheck.

I have to do the dishes so I can have a clean dish in my general later, those kinds of things. Let’s see. I’m trying to think if there’s anything else. One of the things that has been found and discussed in the research literature is that when kids feel like they have a role in the family, it is helpful and it is associated with lower incidents of risky behaviors, especially in adolescents.

So what does that mean? What does that look like? Well, it means that you have these nodes of connection where we’re all connected as a family during your day, but it also means maybe giving your child a developmentally appropriate task that’s their job.

Can you get the mail for me? Can you put the shoes in the basket by the door? Can you unload the dishwasher? Can you walk the dog? Whatever it is, give them a role. Can you set the table? Can you get everybody a glass of water for dinner?

It can be something really tiny, but it builds, right? That we all are important in this family. We all share the tasks. And again, that’s going to support the development of that flexibility as they go.

And then there’s tons of research on family mealtime, right? Having at least one meal together as a family, even if you’re running around, even if you, I wouldn’t encourage you all to sit in front of the TV and do this, but even if it’s just brief, even if you’re all standing up at the breakfast bar in your kitchen if you have one, that’s an important piece that will help. Okay?

And just making those spaces and make a commitment to do that. That’s going to support your kiddos’ mental health.

Jenn: I wanted to ask you briefly about, you mentioned that everybody feeling like they’ve got a responsibility and a level of importance in the family.

How can we knowledge the importance of kids without necessarily making it seem like they’re growing up too fast and understanding that we’re in a really difficult time where there are essential workers or people who can’t work remotely, or people who are teachers themselves that understanding what so many things out of our control, kids might have to be babysitters for their younger siblings or sometimes chip in and make dinner themselves.

Is there a way to acknowledge it and also and express that it’s a, I don’t want to say it’s a burden we’re all sharing, but is there a way to express it so that they don’t feel like they’re carrying the weight of the family themself?

Lisa: Yeah. And I think that’s really important. And I think that when you come up with these little tasks, I don’t think they should be developmentally appropriate. Right? So getting somebody glass of water is not going to carry the weight to the family.

At the same time, there is a mistake that parents sometimes make, especially if their kiddos are very verbal or very bright. People often mistake that intelligence and sharpness for emotional intelligence.

And sometimes they will speak to kids as though they’re older than they are and hold them responsible for things that are not developmentally appropriate. So if you do, if you are one of those parents that has a sharp kiddo, right?

Or who one is very, very verbal, it’s really important to remember that developmentally, even though they might talk to you, if they’re 10 and they’re talking to you like a 15-year-old, they are emotionally a 10-year-old. Okay?

I think other things that are important to help kids not grow up so fast are being a careful monitor of what is coming in on social media and coming in on screens in the house. I think that’s critically important.

And creating open communication with your kiddos about kinds of things they’re interested in, kinds of things they’re talking about so that you at least know and can monitor that. Right? But I think having very small tasks is not going to make your child grow up too fast at all.

So for example, even if you have a three or four-year-old, a really simple one is we put the toys away after we play with them. That’s it. And they help, you help them. Right? So let’s put the toys away.

And I used to do this. I spent a lot of time, even in preschool classrooms at head-starts for many, many years. And it’s a really simple thing like, and that’s something that kids learn as young as three, three to five, at those ages.

Say when we play, then we put the toys away, and I will help, right? And so you each pick up a block and you put it in the bin. So that’s just sharing, right? That’s not going to overburden them.

So I think that that’s really important to know. Don’t have them do your taxes or anything. That’s probably not a good idea. But other than that and to give you another example for teenagers, this is something that was fun, and this is just, I’m just giving you examples.

So you don’t need to go out and do this but like in our family, the things that kids are not learning in school are things like how to manage their own money, how to cook, how to do laundry.

And so when mine hit the teen years, our daughter, I think we said when she was 15 or 16, we said, so here’s the thing, what if you’re responsible for one dinner, and we’ll teach you how to make it?

Like whatever it is, we’ll buy the ingredients that you want. Here’s some really simple ideas and here’s some simple recipes, would you be willing to help us by making dinner one night a week? And she did.

And you know what? There’s nobody in our house that makes a better spaghetti Bolognese, it’s really good. And you know what else? She just brought us some croissant that she made herself, and she’s 21 now. So benefits.

Jenn: Wow!

Lisa: I know Scott’s probably like, that’s a good idea ‘cause I know he’s a cook too.

Jenn: Oh, that sounds so good.

Lisa: So, yeah, and just teaching little things like here’s how to do your laundry, I’m going to show you how, and now I’m not going to fold your clothes for you. You are, right? And little things like that just to teach themselves efficacy as well.

And that’s for the kids and the teenagers. But you can go younger than that. I’d be curious to hear, I want to poll the audience, how young is too young? When are they old enough to do their own laundry? I’d love to see that, you guys type in in the chat.

Jenn: Oh God, Scott’s-

Lisa: I’m sure it’s different with every family, but…

Jenn: It’s definitely different with every family, and I-

Lisa: For sure.

Jenn: Yeah, I’m one of the folks who was privileged enough that my parents did my laundry. For a very long time, partly out of-

Lisa: That was so nice.

Jenn: Partly out of concern as being one of three girls that if I wanted one thing clean, that they thought I would just run a load of laundry with one item in it. They’re probably not wrong.

Lisa: That’s so funny. Well, I absolutely do my husband’s laundry because he’s not allowed. He’s just ruined so many of my clothing that I just take away, you’re not allowed. Just don’t even do it. Stop shrinking the linens by putting them in the dryer.

Jenn: I did get a notification, survey says eight years old.

Lisa: Alright, there you go.

Jenn: Yeah. That’s some good food for thought for the future.

Lisa: And here’s the thing. People are culturally different, and that is 100% okay. Right? There is not a hard-and-fast rule for the right time to do this.

And America, when we acknowledge our diversity and all of the many places we’re from and how we grew up and what we did, every family is going to be different. Right?

And that is 100% okay ‘cause that’s part of the fabric of your family and that’s what makes you, right? Again, the taxes, I don’t know. My teenager’s pretty smart, I’m thinking maybe.

Jenn: They are pretty computer-savvy, so I feel like they might be able to walk through like a TurboTax or H&R Block. You know they know.

Lisa: I think they could teach you how to do a TikTok.

Jenn: I think TikTok is a black hole. We can talk about, when we talk about digital habits, we can totally talk about TikTok. This is for kids.

Lisa: Right.

Jenn: So we had somebody write in, and I know every time I get an email that says, we’re thinking about you in these unprecedented times, I’m like if I hear the word unprecedented one more time, so help me God.

Someone wrote in, people are getting tired of hearing that kids are resilient, and I could not agree more with this. They wanted to know after 10 months of this, should we still feel the same way considering we’re facing another six to 12 months of this?

Lisa: I’m not sure what that question means. Should we feel the same way that our kids are resilient? I hope they’re resilient. And the hard.

Jenn: I think it’s more that should we continue to rely on resiliency?

Lisa: Oh. So when I say that kids are resilient, it’s in a hopeful sense in the sense that this is hard for all of us. We are all getting taxed, and no one more than kids, right? So I hope that they’re resilient. It doesn’t mean that we need to make them rely on their own strength all the time. Right?

And part of fostering mental wellness in your kiddos is really about wherever they are, meeting them where they are. And there’s going to be a huge range. One of the things that my mentor always used to talk about in grad school was that the range of what normal behavior is vast. It’s really, really vast.

And so we know that during the pandemic, probably one in two families are reporting that their kids are experiencing increased behavioral problems. Right? And I think that’s predictable. It is hard, but I think we need to really meet them where they are.

If they are struggling, we need to make a space for that. And that we need to ease up, we need to provide more support. If they’re doing well we need to make sure we monitor that and check in with them and create these nodes in the family.

But again, step back and think about the big picture, right? If we want to foster effective, flexible, thriving kids, we need to model what do we do? How do we take care of ourselves when we’re feeling low? And it is 100% important, right?

It’s critical to teach them how to engage in self-care, self-soothing, how do you let yourself have like a mental health moment where you just are like, you know what? I’m having a bad day, I want to have chocolate and I want to snuggle up in my bed with my dog. Great. Great. Right?

The goal though is to help them to take care, like help them learn how to do these things themselves with your support, and of course that’s going to vary across development. So that they have those skills in place when you’re older. Right?

But meeting them where they are developmentally depending on how they’re coping and things like that. So that’s the way. And I think I understand the sentiment behind the comment too that like I don’t want our kids to have to be strong all the time either, that stinks. Right?

It does stink. And people are probably pissed that the world is asking this of them. And yeah, we should be. This is awful. This is a terrible situation especially in the U.S. Don’t get me started, but it didn’t need to be this path. It really didn’t.

And so all we have now though, right? Is instead of mulling what could have been or what should have been, is where do we go from here? And I have a colleague who says this really important thing. And she says, you can only take a step from where you are, not where you think you should be. And this is where we are.

So in terms of should we feel the same? I don’t know. I don’t think so. I think that we’re getting more and more worn around the edges.

And I think that one of the things that it’s important for families to know and acknowledge is that when we as parents feel more worn around the edges, we’re more at risk of not being supportive in the ways our kids need.

And again, that’s why we should be careful to take care of yourselves as well. And acknowledge, make a space, don’t push it away, things are hard. Take a few moments and check in with yourself as a parent and just notice where you’re at. Do you need some time? Do you need to take a break?

Because the other thing that the data from the pandemic have showed is there’s a huge increase in substance use, there’s a huge increase in domestic violence. There’s an increase in stress, anxiety, depression, and in parents, it is far outpacing non-parents.

So if you are feeling worn out, yeah, that is the story and that is what has happened. So it’s important to kind of make a space for that too.

Jenn: They had chimed in saying that resiliency for six months is a lot different than resiliency for 20 months.

And to put it, I’m not a parent, I know a lot of parents to put it in an analogy that I can understand a 5K is so much more different than a marathon. You can do, you can three miles, not a problem, eight times that distance, unfathomable.

Lisa: But here’s the thing. And those too Jenn as a runner, it’s a great metaphor. You run really differently if you’re going to run 26 miles versus five. So I think that this is a great comment, whoever wrote that, because I think my advice would be pace yourself.

There’s a saying from Tara Brach, and she said, I think I’ve mentioned it before on this webinar, right? She’s a Buddhist psychologist, and she’s a really wonderful speaker and writer and she’s got a lot of books out and Jenn can give you the links to those afterwards.

But she says, suffering begins the moment we start wishing the present is different than it is. Right? And we all wish it was different. I wish it was different. And also there’s a piece about allowing this to be what it is right now and taking a step from there, conserving your energy.

The other thing too is that I start to get a little batty when I think about the big long-term. And so that is something that you might think about it like your mind time-traveling, like, oh my gosh, eight months! Like that’s a long time. 20 months is a long time. Right?

Think about today. Think about the next hour. Think about what can you do? Where are you at? What’s important in this moment? That’s how I get through the days. Right?

And if my mind races off to the future, as it often does, and all of our minds do, that’s how they’re built, I kind of bring it back and go, I can’t do anything about the next 10 months.

What I can do, what’s in my control is what I do today. And what do I want that to be about? So I’d encourage you guys to think about it like that and try that and see if that helps.

Jenn: Do you have any thoughts on what the biggest impact on elementary-age mental wellness would be in terms of what’s changed for these kids due to COVID?

Lisa: So I think that it’s going to depend on the individual kiddo. I think that definitely we’re going to see some differences and they’re going to be out of out of the track for learning, but again, brains are plastic, which means that they’re always developing and thriving and they will catch up. Right?

So there’s not going to be any permanent deficits from this, although I’m sure kids are not going to be where they would have been had they not had this disruption in their school. I think too for elementary school-aged kids, what’s happening at that age is you’re starting to shift from playdates to friendships. Right?

And so I think, and you’re also starting to shift from your parents organizing playdates for you to you kind of making friends and you asking and you initiating as a child to do those things. So I think that we’re going to see some issues with that. I think that this is going to shape how kids interact socially, right?

It’s, it’s just a really strange time. And so you might see a dip in those kinds of things when kids go back to school. If you have kids and they are active, right? It’s going to be really tough for them to pay attention on Zoom, but it’s also going to be harder for them to transition back into the classroom.

It’s going to seem really weird. It’s remembering how to interact with a group full of kids in your classroom, how to listen to a teacher, how to organize your stuff, that’s all going to be something that they’re going to be out of practice.

But that’s how I would think about it is they’re going to be out of practice and we need to make a space to give them some time when we all get back to normal, and some kids are back in school. Right? So that’s good. But again, that could be taken away depending on how the numbers are going.

So I think there are things that are problematic, but they’re also one other way to think about this is what are your kids learning now that they wouldn’t have learned? Right? We can’t get out of this, at least not without time and many vaccinations happening.

So one way to think about it is what can we teach them from this? How can we make this something useful? Are there parts of this that could be useful? Because I promise you, if you write it off and go, no, it’s all bad, that’s going to be your kiddo’s experience of it. Right?

And that, while it may be so, it is kind of crappy. Is not going to really help them cope. So thinking about, okay, is this a time where we can really appreciate our time together as a family? Is this a time?

It’s really the perfect time to teach them coping. How to be with this hardship, how to sit with uncertainty, right? And how do we rely on each other as a family to get through it? So those are some pieces that might be useful. It’s a great time to do long-term projects with your kids that you can do over time, a little bit today.

Jenn: And I think that’s stuff that’s so applicable as you’re teaching it to somebody else, you’re also reinforcing those same beliefs within you, which is going to help you in the long run too.

Lisa: Right. Yeah. This one’s about, we’ve all had to be flexible with this. We’ve all had to say yes to things that we really rather would not have.

And there’s, I think one important piece here too is for us as parents, but also for our modeling for our kids to really think about what parts of this are under my control? And what parts aren’t?

And if there’s stuff under your control, by all means handle it. But if there’s stuff like how am I going to deal with the next 10 months of this? I can’t control that. I don’t know what’s going to happen. So is that help? Does that serve me to try to do to predict?

Maybe, maybe not, but what I know is I can connect with my kiddos right now. I can check in on them today. I can make them a sandwich. I can make sure that they’re not on some inappropriate website instead of in school, et cetera. Right?

I can teach them a basic skill, things like that. So think about, and help them understand stuff that’s in their control and not in their control, because I think if this is teaching us anything, it’s what is the meaning of acceptance? Right?

And when I say acceptance, I don’t mean enduring or tolerating. That’s nonacceptance. What I mean is saying this really stinks, and yes, this is where we are in learning how to sit in that hardness, that hardship and move through it one step at a time from wherever you are.

Jenn: So we had somebody write in saying they have a teen who’s fully remote for school and really struggling. They are seeing some indicators of anxiety and depression, but they’re not really sure where to start or what to do.

Lisa: Yeah, that’s hard. And teens at that age are usually very, it’s they’re reluctant to talk to you as parents, and that’s probably normal. I wouldn’t take it personal. That’s the first thing I would say.

The second thing I would say is it sounds like whoever wrote this in is already noticing some changes in behavior. So I think without prying, letting them know you’re here, right? In little moments, right? But consistently like every day or a couple times a day, I’m here just checking in on you. If you ever want to talk, I’m here. Right?

The other thing that you can do is you can model yourself, right? And this is going to sound, actually I don’t know how it’s going to sound, but I’m going to try this one on. So one of the things that you can do as a parent is to say, we haven’t talked in a while, I don’t know how you’re doing.

And I’m finding this really hard. It’s tough. And I’m noticing that my mood is normally so great. Do you notice that? I’m sorry if you do, and if I’m quiet, I’m not always feeling on top of the world. How are you doing? You go first. If you want your kiddo to talk to you, talk to them.

And can you imagine if you’re a teenager and you’re trying very hard to be grown up about things, to hear your parents say, hey, you know what? I get vulnerable too. Wow! Right? And they might shut you down. A lot of kids would, but a lot of kids wouldn’t.

And even if they don’t talk to you in that moment, that is something I think that’s really important, right? To teach your kids, it’s okay to be vulnerable. It is okay. It is not a weakness to feel sad. It is not a weakness to feel stressed and to not feel okay.

Talk to them, share with them and that’ll start paving the way for them to share back. The last thing is if you’re really worried, sometimes kids will not talk to their parents. So I encourage you to get them some help and say, would you like to talk to someone?

It’s just sometimes it’s helpful to have a space to put stuff down, and I get that I as your parent, I’m not the person that you probably want to talk to, and you need your privacy. Would you like me to find somebody just you try it? And if you hate it, you don’t have to go, but just try a couple times. What do you think? Okay?

Present it like that. That’s how I would say it. And give them their privacy. Right? The therapist, if they do see a therapist will be sure to share with you if there’s anything that you need to know about safety or harm. But making sure that your kiddo has a place to talk about those things could be very helpful.

Jenn: So are there any like hallmark or red flags for child and teen mental health? And additionally, I know that you said, offering, if you don’t want to talk to me about it, do you want to talk to somebody else about it? What happens if they say no? What would the next step be if you think they need help?

Lisa: That’s a really good question. So first things first, the warning signs, behavioral changes. So changes from the norm. Like if you have a gregarious kid who all of a sudden this isolating all the time, if you’re noticing changes in mood that are significant and sustained, right?

If you’re noticing irritability that’s new, increased fears, a lot of kids are experiencing increased fears and stress and things like that. Any sort of self-harm, if you’re noticing, right? Of any kind is really a red flag of course. Increased secretiveness. There might be something going on with that.

Those are all things that are subtle, but you want to kind of increase your monitoring of those things and really see what’s going on. Now, with kids who are not showing these things or if they seem like they’re struggling and they’re refusing help, I wouldn’t necessarily do anything other than to keep offering.

But if you feel like or you have knowledge that your child is harming or engaging in risk behaviors like substance use, right? Then I would say, so we’re going to get some help, and we’re going to go together, and yes, you’re coming, because you’re the parent. Okay?

It’s always better to engage kids’ willingness to do things, but if there is an issue of risk, you go and you take them, right? For help.

Jenn: So if there’s clear signs that a teen is using drugs, how can parents or academic professionals address this beyond saying, you need help? Do you have suggestions for ways to break the ice to get them to be more receptive to the conversation?

Lisa: I think what I would do is as a parent, I would seek help for me in the consult with a child psychologist, or a child social worker and say, here’s, what’s going on. I’m really concerned. What should I do? Have guidance, don’t do it on your own.

The second thing is if there are substances that you think your child is using and you have them in your house, get them out of your house. Make it harder for those substances to be present. That’s the next thing. And I think being very direct and talking with them about what is and is not acceptable is going to be something really important.

This isn’t one where you want to kind of like engage, you just want to say, in our house, we do not allow this, and this is a rule, right? And if you’re really struggling, if it’s gone beyond like the experimentation stage, I think that that’s definitely a time to get support and intervention.

The other thing is kids often don’t do this stuff alone. So some of them do, but lots of times they do with peers. And so I would think very carefully about who their friends are, do you know them? What are they doing? Where are they?

And have some rules about what is okay and not okay in terms of kids’ ability to move around outside the house. Right? About monitoring them, et cetera. About like what are they doing? Whose house are they at? Things like that. I think those are things that are important.

So keeping an eye on all of those things. The other thing too is that kids are more likely to, everyone’s home is going to be different, right? And if the home has a lot of substance use in it, kids are going to model from that.

And so if parents are using a lot, and we do know the pandemic is leading to increased rates of substance use, you want to think really carefully about what your kids are seeing and what they’re learning from what they’re seeing, very important.

Jenn: So what can parents do if their teenagers are refusing to take on responsibilities around the house? There’s individual who wrote him and said, it seems as if consequences aren’t enough to change their behavior. And I do have a follow-up question to this too, but I’m going to address one at a time.

Lisa: Ah! And by consequences, I am assuming that this person means punishing. So consequences, punishment is never a useful way to teach someone what to do. And let me back up. Okay? It doesn’t work. And it doesn’t work in lots of ways that are super unhelpful. So you’re right It doesn’t work.

So backing up, thinking about how do you shape behaviors you want to see? Right? And this is independent of whatever our attitudes are about rewards, earning things, how we were raised, how it worked back then, I’m just going to give you the science, and you guys can apply it and try it out and see, okay?

But if you want to shape behavior, meaning teach behavior and see more of it, you need to reinforce that behavior. And to reinforce means using a consequence that is going to make that behavior more likely. Right?

So if I want my adolescent to walk the dog, scolding and yelling, not going to help, right? What it’s going to do is make him avoid me every time he sees me coming in the door, mom’s going to yell at me again for not walking the dog. Right?

And that is in fact what you see when you use a lot of punishment, is the kids going to associate you with the punishment, right? And it’s not going to be something that’s going to help them do the thing. Instead, what you might do is you have to figure out what could I do to make this behavior more likely? Right? What is it that would encourage them to do it?

So if I say, hey, you know what? I really appreciate it if you walk the dog, and in return, I’d be willing to let you have another, I don’t know, for however long you walk the dog, you can have an extra that many minutes gaming time. What do you think? Or something like that. Right?

Even a thank you, even like sometimes, rewards don’t need to be things. They can be just, hey, you know what? I really appreciate that you walked the dog. That’s so helpful. Thank you. Very mature of you. Good job. And in the rain too, hey, you walked the dog without asking. That’s really kind. I appreciate that. I love to see who you’re growing up.

Jenn: Yeah, the genuine words of affirmation.

Lisa: Yeah, yeah.

Jenn: Sometimes your word don’t have to be tangible.

Lisa: Right. The other thing too is that you want to think about like what’s the thing that I’m asking them to do? Is it too big? Can I ask them for something smaller and then can we work up from there? Just something little.

But just keep in mind that like scolding, punishing, not so helpful. What is helpful is putting something in place, if they do they get, right? And that’s a really useful way, I think, and a quick way to remember this, like you do, you get.

We put this in the book actually that Jenn’s reading. It’s not about parenting or anything, but that’s just how we behave. Right? If I do this, I get that, mom thinks well of me, dad thinks well of me, I get $1, whatever, or I get to borrow the car on the weekend if it’s a teenager.

Jenn: It’s building your reward system.

Lisa: Exactly. And we all work for rewards. And I know sometimes people are like, well, that’s a bribe. Really?

It can be used as a bribe, but that’s not what we’re talking about here. I don’t work too much without either a paycheck or the knowledge that I have been altruistic and I have made a difference in the world. Those are my rewards. Right?

So yeah, I’ll work for free because I know I’m being of service somewhere. Right? Even if I don’t get paid. So you got to figure out what’s going to be a good reward? Now, if this doesn’t work in your family, you don’t have the right reward. Okay?

We haven’t figured out, we don’t have enough information about like what is it that will motivate us? But that’s a longer conversation, but in general, that’s the principle. You do, you get, so think about that.

Jenn: So my follow-up question was when does stubbornness and a lack of caring about these consequences indicate that they should see a professional?

Lisa: Mm-hmm, that’s a really good question because I think there’s this zone in the adolescent years where kids really can change and they can get very, very, they seem very more concerned with themselves than anyone else.

I think that in part that’s a very normal transitional phase. They are so concerned with who they’re going to become in the world, how to fit in, am I going to have friends? Am I ever go on a date with anyone ever? It’s a pandemic, how are we going to do this? Right? That’s important.

So, and there’s actually, there’s data on this too, that in teen years, you do see an increase normally, right? Of argumentativeness, of stubbornness, of disengagement from you as a parent and things like that.

Where you want to start to get concerned is if this pattern continues and intensifies to the point where it is impairing your family, where if it’s impairing that child’s ability to get on in the world with peers, with teachers, is it happening in more than one environment?

Is it like something that happens at home but they’re angels outside and getting straight A’s but they’re a jerk to you guys? Right? That’s a very different thing and that might be something where families might want a little help about like how are we getting on as a family?

But if you’re looking for, does my child need help with this as a behavior problem that they have? Those are the things you want to look at. We call functional impairment across more than one domain.

Is it really sustained? Is it really impairing their ability to be in the world? Is it messing up their academics? Are they explosive? Are they breaking things? Are they destructive?

Those are all pretty good danger signs, right? So I think those were the pieces. By the way, there’s a great website where you can look this stuff up. It is the American Psychological Association Division 53, which is one of their sort of special-interest groups.

They have a website of evidence-based therapy where you can actually read about different issues that kids can have across the spectrum of development from evidence-based. And it’s called effectivechildtherapy.com, I believe, and Jenn will make sure we have that and we can put it up for you after this.

Jenn: Any thoughts on taking on family volunteer opportunities to help engage teens who are resistant to-

Lisa: What a great idea? Great idea.

Jenn: I agree.

Lisa: If you can get your kiddo to do it, that would be amazing. Instilling pro-social values, right? Values of that we have a social contract to each other in the world, right? That we’re not alone. We have evolved as herd animals, right? And caring for each other, having skills of cooperation, seeing the world, right?

If you’re doing work, if you’re working with people who are underserved or something like that, just, or in a different culture, anything, it’s all a learning opportunity to give your child different vantage points of how things are elsewhere in the world. I can’t think of something, and showing them that this is important to you as a parent by doing it with them is great.

More of that sort of thing would be awesome. I think it’s amazing. You’re also giving your kiddos the experience to notice that they can be agents in their own world, right? That they have things to offer. I think it’s really important.

Jenn: Pre-pandemic, I used to volunteer at the veterans’ shelter in downtown Boston and do breakfast with them like once a month, and there was actually a family that used to go and I saw them a few times and I asked about how do you actually get your kids to come with you?

And the dad’s response was, we take them out to breakfast after. And then they had noticed over doing this, they did it once a month and it was like three or four years that they had been doing it.

And it started as like a proposal from their church to go out and do something for the community. And they said that they all look forward to it now. So things like that, they have, it might not be an immediate reaction, but there is such long-term benefit to it.

Lisa: Absolutely. And that again highlights that principle of like, even if they don’t know if they’re going to be reinforced or find fun, the volunteering part, you do, you get. Come with me, do this thing and then we’ll go out to breakfast afterwards. Right? I think that’s really important.

Jenn: Couple more questions for you. And I know we’re getting close to that hour, so I’m going to try to make it as snappy as possible. I work in a school. Many students are exhausted and unmotivated. How do we best support kids like this?

Lisa: God bless you if you’re a teacher in this pandemic. I just feel like you guys have been asked to bear such a burden that’s not really yours to bear, and I’m sorry, seriously. How do you motivate them?

Jenn: Oh, I’m sorry. I’m sorry, I’ve also received the clarification that this person wrote in from Ecuador. So hello from Ecuador.

Lisa: Hello from Ecuador.

Jenn: I’m not sure if that is actually going to change any of your response, but hello from Ecuador. And hi back.

Lisa: Hello! I think make a space for kids to be struggling. Right? That’s the first thing. The second thing is I always had luck when I was teaching teachers how to manage classrooms, join the kids, and then, so don’t start with scolding. That’s just going to put everybody off, right?

Join them where they are, and then after a bit of silliness or a bit of empathy or whatever it is where they are, bring them back to focus, and make it as fun as you can. Give them roles too, ‘cause kids are often like, it’s useful for them to have things to do even in the classroom, and this was a trick.

One of my other tricks was if you have a kiddo in the class that’s particularly disruptive, he was always like my helper. I’d be like, oh my gosh, you’re such a leader. Can you help me and do this for me? And like, thank you. That is so, I knew I can count on you.

So what I do is I’ll sort of grab them and teach them or treat them like they’re about to do the next right thing, treat them like they are valuable that they’re helpful. And then they start to see value in themselves. So good luck. Nice to talk to you from Ecuador.

Jenn: And thank you for all that you do in your teaching.

Lisa: Yes

Jenn: It was not easy before a pandemic, and it is certainly more challenging now. So someone wrote in saying, my ten-year-old daughter has expressed fear and anxiety during bedtime about the fact that everyone will die someday.

Do you have any tips for a child who’s struggling with the discomfort of understanding her own mortality?

Lisa: And I was reading that and it’s nice ‘cause I read it ‘cause that was one of the first questions that popped up. And ah! It’s such a hard one. And I think that making her speak that the most important thing is to be honest, direct and make a space for your kiddos to express their fears.

That’s a scary thought and it’s going to be okay. And you know that we have a long life before we die. Something like that.

There’s a lot of books, and what I can do is maybe, none are popping up in my mind right now, but there are a number of books that talk about this and kids’ books that might be useful. And nighttime fears are really developmentally normal in kids too and not unpredictable.

So I think at bedtime, one of the things that can happen is you could add something to your routine, like reading together, like having making a space for them to share these fears, et cetera.

And just kind of making that a time that you guys can spend together and go, yeah, I know. And this is the thing, it’s we as parents always want to make our kids feel better, right? And sometimes we can do things that are not so helpful by telling them not to worry or how to make it go away.

A far better thing to do would be to say, I get how scared you are. Yeah, that’s a scary thought, and you know what? I’m here and it’s going to be okay. And just kind of like making a space for them to tell you about it and just being direct I think.

Jenn: So we’ve got time for one more question, and I think this is a vital one. A child needs help, where do I start if I want to find a professional for them to speak with?

Lisa: Very first person you should start if you don’t know is your pediatrician. That’s the easiest thing to do.

Then depending on what help means or what kind of help, tell your pediatrician what’s going on, and the mental health providers that would be probably I would start with would be a psychologist or a social worker who works with kids. There are licensed mental health counselors, et cetera.

Another place you could go is call your school psychologist or your guidance counselor at school. They have good resources and they’re linked in to lots of professionals in the community usually where they would be able to give you references.

Third place, community mental health centers often have resources for kids as well. So that’s a good place. But I would start with those three things and work from there.

Jenn: Lisa, I just wanted to say thank you to you so much. This has been fantastic, and still really impressed with our timing to be able to like get this right to the T. I’m high-fiving you from afar.

Lisa: High five.

Jenn: And thank you to everybody who joined us. This actually concludes today’s session. We hope that you’ll join us again soon, but until next time, be nice to yourself, be nice to other people and don’t forget to wash your hands.

So thank you so much. And thank you again Lisa, hang in there.

Lisa: Bye everyone. Bye.

Jenn: 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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