Archives for posts with tag: children’s mental health

Although I see kids for psychotherapy, most of my time as a psychologist is spent as a diagnostician. I gather background information, I do tests, I scour through records, and I do lot of thinking and a lot of writing. Then I meet with parents and I go over the results.

Most of the time, parents are satisfied and grateful for the report and for my recommendations. I believe that this is a testament to their parenting and also a reflection of my experience delivering complicated information about serious problems. There are other times when I am pretty sure that the news I am going to share is going to be much different than expected and it’s going to be viewed as bad. At these times, I’m tempted to tell parents, “I don’t make the news; I just report it.”

But to do so would be flip and unprofessional. I have to keep my eye on the highest priority, which is to communicate clearly and respectfully in order to provide good patient care.

Since I specialize in conditions that impact school functioning, I do a lot of intelligence testing. As I tell parents, there is no be all and end all measure of intelligence or of every type of intelligence. But the tests I use are rigorously developed and evaluated; they are useful in helping answer questions about why children are not doing as well with school as one would expect.

Working at grade level is the expectation. But some children do not work to grade level in many areas. This can be due to a number of things such as learning disability, ADHD (although ADHD does not always impact academic learning), or lower than average intellectual ability. Lower than average intellectual ability includes intellectual disabilities but some children just have lower than average intelligence; in other words, they do not have the degree or pervasiveness of difficulty that we used to call “mental retardation”. And to make matters worse, these students usually struggle in school without special education support because they do not easily fit into one of the special education categories.

The kids who are “merely” below average often fly under the radar. If they have a cooperative nature, work very hard, and gets lots of parent support, they can actually do quite well in school until material gets less concrete and more abstract. These are the kids who start sticking out in adolescence, a time when for most teens, abstract thinking skill development accelerates rapidly. (Alas, if they could apply these higher order thinking skills to making better life decisions…)

I sometimes find myself doing private testing for an early adolescent child who has had a history of learning difficulties, which have accelerated only to learn through testing that the probable reason is low intelligence. Then I have to think about how to share this “bad news”.

There are parts of our society that confuse “goodness” with intelligence. Intelligence is a good thing but it does not make a person good nor does low intelligence make a person “bad”. Most of intelligence appears to be inherited. Another bit is subject to environmental experiences. Most people are average.

When it comes to talking to the parents about the results of these evaluations, it is very difficult to say, “Your child is a very hard worker and is actually doing better in school than we would expect.” That’s not exactly the best news to hear.

So, we do a lot of talking and I do a lot of explaining and placing things into context. I do a lot of talking about what it takes to be a happy and successful person in life, things that are not necessarily related to high intelligence.

But I try to make the challenges clear, too. A lot of kids get yelled at for not doing better at school even though they are working EXTREMELY hard. A lot of kids also need as many educational resources that a school district and family can afford to provide. They are “it takes a village” kids. I have to make my best argument for getting the child as much support as possible but I can’t do that if I gloss over the difficulties.

I wish every child had the same resources and same opportunities but they don’t. It’s my job to try to make sure that they can do their best with the particular package of strengths and challenges that they have. I remind myself of older kids that I see who have beaten the odds and moved mountains. Invariably, they are hard working kids, with parents who have provided early and long lasting support, with supportive teachers and healthcare providers.

Sometimes, but certainly not always, great things can result from the bad news.

About ten years ago, we planted two trees in front of our house. They were the same size and the same kind of tree, styrax japonicus (Japanese snowbell). We made planting holes of the same size and fertilized the bottom of each hole identically. They receive about the same sun exposure and I watered them in the early summers, the very same amount. Water drainage may be slightly different as one of the trees is a tiny bit uphill from the other.

If those trees were my children, one could say that I loved them equally and that they both came from “good homes”.

This is what they look like:



The first tree is the picture of health. The second tree is about half the size and oddly shaped. This difference became noticeable several years ago. Although the size difference has increased, at least the little tree is looking healthier these days. It is actually going to bloom this year. It didn’t for a few years and I actually wondered if it was going to make it. The leaves, however, are already yellowed with age on the small tree but not the big one even though they have not had leaves for more than a few weeks. When the tree was misshapen and stopped blooming, I sought out advice and gave it extra care and attention. Maybe I’ve actually given that little tree more love than the big tree.

I really don’t understand why the little tree is making such poor life choices. I really don’t understand why it isn’t trying harder. I really don’t understand why that tree doesn’t care enough and isn’t living up to my expectations. Doesn’t it appreciate everything I’ve done for it?

Yes, those are really ridiculous statements about a tree, that for whatever reason outside of its control, has a much harder time growing and thriving than the tree next to it.

However ridiculous those statements are, they are applied to children daily. Yes, I know that children have brains and trees do not. But children are vulnerable and developing beings. They need much care and support.

And you know what else? Some of them, for whatever reasons beyond their control, have a much harder time growing and thriving than others. Some of these reasons have to do with mental health.

An estimated 20% of children and adolescents in the U.S. have at least one diagnosable mental disorder. That’s a lot of people and most of them do not receive mental health services. Most of the children and adolescents in my practice have more than one mental disorder. A lot of the kids I see display behaviors that are frustrating, irritating, and annoying to their parents and teachers. And sometimes the intensity of their misery and lack of thriving is downright scary.

Unfortunately, time and time again, children even the very youngest of them, are blamed for their mental disorder with quick explanations such as, “He is choosing to act that way.” “She just needs to try harder.” “He just doesn’t care.” “She shouldn’t be behaving this way anymore.”

Sometimes those statements are just plain wrong. And sometimes there is truth to them but they are not a solution. People act as though these statements are the final word and nothing is to be done. So I ask, “Why is it so hard for this child to make healthy choices? How can we help?”

I ask, “Why is it so hard for this child to motivate himself? How can we help?”

I ask, “Why is this child not meeting developmental expectations? How can we help?”

A good bit of the time, there are adults around the child who “step up to the plate” to help. They do so despite the amount of parenting stress. They do so despite the unfair number of students in their classrooms. We also need to provide more support to parents, teachers, and the other caregivers who are the most important influences in the early part of children’s lives.

These are very difficult roles that most of us choose to take on in life. Frustration is inevitable. Sadness is inevitable. Confusion is inevitable. But the children are not responsible for the fact that it is harder for them to grow, thrive, and meet our expectations. The fact that their jobs are harder to do often translate to our jobs being harder to do.

After all of these years, my little tree is very much alive and I actually think it is interesting and pretty. I wonder how it would have grown if I’d just yelled at it?


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