By Pamela Siller
The phone rang once, but was ignored. However, the caller was persistent, and the pattern was repeated. Mrs. Rosen sat at the kitchen table with her head in her hands. She did not need the caller ID to tell her that her daughter’s school was calling yet again. Leah’s problems started when she was a young child. Her early tantrums were passed off as the normal “terrible two’s,” but as her behaviors escalated to throwing objects and hitting people, more people were beginning to take notice. With this came the advice; “you need to give her more attention,” “you need to give her less attention,” “you need to punish her,” “a light spank never hurt anybody,” “never raise a hand to your child.” A person could get dizzy with all the contradictions. It was much easier to just ignore the problem.
Unfortunately things just got worse. Leah began to strike out at her brothers and sisters. The neighbors nervously would hear her yell and scream for hours. When she started school she did not make friends. The aggressive behaviors began to get better at school, but she began to cry and refuse to leave her mother’s side while at home. She began to wake up in the middle of the night crying uncontrollably and remember nothing about it in the morning. She began to become afraid of the dark…and loud noises… and the elevator…and the rain. She did not concentrate in school, and brought home failing grades.
Ms Rosen cannot understand what went wrong. Her three other children never acted like this. She feels so guilty, like a failure, because she feels like she cannot manage to raise her own child. She loves Leah, but can’t understand her, which leads to feelings of distance from her, although she tries to hide it. Her husband assures her that she is a good mother but she cannot believe this.
The school has recommended therapy and medications but Ms. Rosen is reluctant wondering what this move says about her ability to be a good mother. In addition. she fears this will harm her daughter’s future shidduchim As a last straw, Mrs. Rosen got a letter from the school asking her daughter to transfer to another school as this school was not seen to be a productive environment for her, as her behaviors were “too intense”, and “unmanageable.” The school recommended she speak with Mrs. Levy who sent her child to a psychiatrist for an evaluation, and subsequent therapy with the possibility of medications if needed. This was seen to be very helpful and productive.
Unfortunately, children are often not brought into treatment until their behaviors escalate and schools take notice, or parents find the behaviors become unmanageable. There are several reasons this occurs. It can be very difficult for parents to accept that their child is having a problem that they cannot fix themselves. Many feel a great sense of guilt, and unease, exacerbated by worries of stigma. Some parents or family members may suffer from psychiatric difficulties as well, and do not want their children to follow the same trajectory. Often parents are not exposed to the symptoms of depression and anxiety, do not know what they mean, and do not know how they can manifest in children.
Children are not just miniature adults. They perceive events in their lives in many different ways based on their cognitive level. Often, young children see the world as revolving around themselves, and so any coincidence or occurrence may be seen as resulting from their behaviors or thoughts. If a child has symptoms of anxiety or depression, it may manifest as acting out behaviors or irritability. Contrarily, the same feelings can cause tears and fears in a different child, or the same child, at different time. Symptoms and behaviors may differ significantly in different environments, such as school and home, or with different caregivers, such as a parent and a grandparent.
In the above example, Leah may have had difficulties with attachment, which can occur at an early age, and subsequently progress into childhood or adulthood. She may have an undiagnosed learning disorder, ADHD, or anxiety and depression, leading to night terrors and enuresis. The example was left vague, as it is difficult to diagnose a child without a careful evaluation over a period of time. Family involvement is crucial. Therapy takes time, and starts with building trust which is the cornerstone of any relationship. Sometimes medications are needed to help the person start the process of healing.
The most important lesson to be learned is that often if behavioral difficulties, fears, anxieties, and traumas are addressed early, skills can be learned by both the parents and children to rectify the situation in a non-traumatic, and noninvasive way. There is no shame in seeking help; rather it can be the best gift that you can ever give your child.
Pamela P. Siller, MD is a Board Certified Child, Adolescent and Adult Psychiatrist who provides medication management as well as individual and family therapy to children and adults. She maintains a private practice is in Great Neck, New York. Dr. Siller is also an Assistant Professor of Psychiatry at Westchester Medical Center, where she works in the adolescent inpatient unit, and is a staff psychiatrist at Interborough's mental health center in Brooklyn. She can be reached at 917-841-0663.