by Rocco Landesman
HHS Secretary Kathleen Sebelius offered remarks at the first ever-convening between our two agencies in March 2011. Photo by NEA staff
Today is Children’s Mental Health Awareness Day, an annual observance that encourages communities across the country to discuss, celebrate, and raise the visibility of issues and resources around the mental health of our nation’s young people. The national effort is spearheaded by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services (HHS). I spoke with HHS Secretary Kathleen Sebelius to learn more about Children’s Mental Health Awareness Day and how the arts can play a part in this important issue.
ROCCO LANDEMSAN: What is National Children’s Mental Health Awareness Day and how did it come about?
KATHLEEN SEBELIUS: National Children’s Mental Health Awareness Day started as a grassroots effort in Oklahoma in 2004 when a SAMHSA Children’s Mental Health Initiative grantee celebrated community partnerships in an effort to raise awareness about children’s mental health. The idea caught on and in 2005 SAMHSA supported a national awareness day to help bring visibility to the local activities. The number of national Awareness Day collaborating organizations has grown from four in 2005 to 134 in 2012.
We use this observance each year to raise awareness about the resilience of children with mental health problems and the effectiveness of mental health services. This year Awareness Day is being celebrated with a national event in Washington, DC, and more than 1,100 communities and 130 national organizations will be involved in Awareness Day activities.
LANDESMAN: I know this is the seventh year of this program. Is there a particular focus to this year’s events?
SEBELIUS: The theme of the national event is “Heroes of Hope.” We define a “Hero of Hope” as a caring adult who provides ongoing support to a child or young person in need. This year there is a special focus on children and youth served in child welfare, juvenile justice, and education systems who have experienced a traumatic event and have thrived in spite of the challenges they face. Through dance, poetry, and spoken word, youth will pay tribute to Heroes of Hope at the National Awareness event. During the event, I will have the opportunity to present an award to Cyndi Lauper for her work on behalf of homeless LGBT youth.
LANDESMAN: How can the arts play a part in supporting the mental health of children—whether or not they are trauma survivors? And can you please speak briefly about some of the medical and scientific research that supports the positive linkages between the arts and health?
SEBELIUS: Art therapists work with youth to express their emotions when words alone are not sufficient. Creative expression of their feelings can help young people process challenges associated with trauma and conflict. Engaging young people with mental health problems in the arts can increase self-esteem and coping skills and can help them reach their full potential.
Some of the more promising work in this area was featured in a 2011 white paper The Arts and Human Development: Framing a National Research Agenda for the Arts, Lifelong Learning, and Individual Well-Being. When we released the paper with the NEA, we also jointly launched an Interagency Task Force on the Arts and Human Development comprised of 15 federal entities, including SAMHSA.
LANDESMAN: What are some practical ways in which we can support the mental well-being of our children at home or in school?
SEBELIUS: There are many ways that adults can support the well-being of the children and youth in their lives, including: spending time with them, creating positive expectations, cultivating their interests, reinforcing them with praise and encouragement, providing appropriate limits and boundaries, and building their self-confidence.
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According to a study published in the Early Childhood Research Quarterly journal, three little words may help young children increase their self-control abilities. Those three little words aren’t what you think. Encouraging children to “use your words” builds their vocabulary, which helps children to regulate emotions and behavior. Researchers discovered that vocabulary development proved to be even more important in helping boys increase their self-control abilities.
Claire Vallotton, PhD, and Catherine Ayoub, PhD, followed children participating in the National Early Head Start Research and Evaluation study from the time they were 1 year old up to 3 years old. They discovered that boys with a strong vocabulary showed a dramatic increase in their ability to self-regulate as compared to boys with vocabularies not as strong.
Research in Action: ABC Music & Me
ABC Music & Me supports the development of key school-readiness skills, such as listening, self-control, and turn-taking. Our weekly lessons also significantly boost language and literacy skills, including vocabulary development. Picture vocabulary cards support unit-by-unit vocabulary, comprehension, memory, and pre-literacy skills. We give teachers the tools they need to increase a child’s vocabulary knowledge and then actively begin “using their words” in the class.
Ron Huxley Regulates: I was drawn to this article at the work “regulation.” This has become a big word in children’s mental health and hopefully parenting education will follow suite. Attachment researcher Daniel Siegal defines regulations as “the way the mind organizes its own functioning…fundamentally related to the modulation of emotion…Emotion regulation is initially developed from within interpersonal experiences in a process that establishes self-organizational abilities.”
Stated in plain English, regulation is how children achieve self-control and manage impulses. Language, as the original blog post describes assists us in forming structure to our emotional energy and manage them. It is crucial in our brain development and connects to other important social constructs like moral behavior, abstract thinking/reasoning, planning, and judgement.
A question we could ponder is which comes first, the chicken or the egg? Do we develop language and then achieve regulation or do we achieve regulation and then master language. I think they go together myself.
Share your thoughts…
Research articles often have a “duh” factor when it comes to outcomes in various studies. After you read them you think “I could have told you that!” The up side of academic studies is that they point a laser light of attention on areas of life that need attention. Society seems more willing to spend money and time on correcting problems when we draw a big circle around a social problem in the lab.
This was true, for me, of a study on the level of parental insightfulness and maternal depression (see clip below). The findings of the study was that mom’s (why do we always study moms!) who were depressed are less likely to be able to see life from the vantage point of their children. This results in less emotional attachment and parenting effectiveness. The obviousness of this research is that mom’s or dad’s that are depressed are less likely to see much of anything outside of their own internal pain. This isn’t a slam on depressed parents. I have experienced it and it isn’t purposeful. Depression is usually due to a chemical imbalance and requires professional interventions that may or may not involve medications.
I mention this study on the blog because I want draw a big circle around this issue and say that the long-term effects of a poor attachment between parent and child can have some serious effects on self-esteem and future relationships. I guess this is a call to action for anyone who feels they are depressed, even occasionally. Help yourself and your child by getting some help. There is plenty of help available, from changing diets to clinical therapy. I have found that playing with my child lifts my mood even when I was tired and emotionally down.
“Insightfulness is seen as the mental capacity that provides the context for a secure child–parent attachment. It involves the ability to see things from the child’s perspective and is based on insight into the child’s motives, a complex view of the child and openness to new information about the child. To test our hypothesis that maternal insightfulness is related to maternal depression, we utilized the Insightfulness Assessment (IA) developed by Oppenheim and Koren-Karie to conduct and analyse interviews in which mothers discussed their perceptions of video segments of their interactions with their children. We compared the results of a control group of 30 mothers without a diagnosis of depression with a sample of 23 mothers diagnosed with depression (International Classification of Diseases, 10th Revision). As expected, depression was negatively related to maternal insightfulness.”
Source: onlinelibrary.wiley.com Share what you have done to increase your mood and deal with depression by leaving a comment below or posting on our Facebook ParentingToolbox Page.
My wife and I have a joke that we tell each other and family members: It takes a minimum of 17 hugs a day to feel normal. I will confess that there is no scientific research that supports 17 hugs per day therapy…at least not yet. Nevertheless, we have come to recognize that need for touch and have adopted the idea that hugs, at least 17 is what gets us through the daily life hassles.
At a recent conference on Attachment Theory, where there was some real scientific data, a presenter on Post Traumatic Stress Disorder stated that data suggests that the little stressors of everyday living can add up to the same effects of someone who has undergone a single, major life trauma, like a robbery or death of a loved one or car accident. We let these little incidents of life go by without any real concern. Perhaps we feel embarrassed to admit how much a poor marriage or teenager defiance or even workplace stress really does affect us.
Can parents acts as prevention specialists for our children. As adults, we need 17 hugs just to maintain normal living. Our children need them to counter the cumulative effects of stress on their lives to avoid PTCS – Post Traumatic Childhood Stress. If you don’t believe there is a such a thing, just observe children interacting on a play ground. There are some mean things thrown back and forth on the jungle gym, let me tell you! Add to that some homework pressures and the constant media bombardment of negative words and images and what child wouldn’t feel slightly traumatized? As parents, the least we can do is give some touch therapy with a few hugs a day.
John Bowlby, the great attachment theorist, stated that attachment is essential to normal development (see my blog post on this here). Guardians are supposed to be our safe haven from life. Home should be a place of refuge from the constant stress of school and work. Granted, there are chores and homework to be done but how can you carve our 30 minutes a day for some connection. Parents are quick to use Time-Out, how about some Time-In? It might be good for mom and dad too.
Starting today, give a few more hugs than usual. It is OK to start slow and work your way up. And yes, teenagers love them too. You just have to be a little more crafty in your approach.
I have spent a lifetime being defensive. The world, frankly, is a harsh place to live and over time one can become quite hyper vigilant and self-protective. It takes some risk to put yourself out there after suffering rejection and betrayal. Unfortunately, that is the only way to live in an intimate relationship with other people, like your family.
I get that there are abusers out there and it may not be wise counsel to open yourself to that. I am not asking for anyone to be a victim. I am addressing the more basic, day-to-day willingness to be open and non-defensive. I have spoken about the benefits of this in other posts on TransPARENTcy, etc. It may be worthwhile to read those posts.
Try an experiment with me: Put your worst foot forward. Instead of covering up your mistakes or telling little white lies about your parenting performance, try sharing a parenting issue you really want to change about yourself. You will have to pick the right moment and to be safe, the right person at first. After you do that, ask for some honest feedback. I mean really honest. Look the person in the eye and don’t talk until they are done. If they hedge their comments, ask for further clarification until you get to the bone of truth. Finally, state your appreciation and willingness to consider incorporating that information. Take the next 24 hours to do just that.
I wonder what response this will initiate in others? I am curious what it will do to you if you can live in a non-defensive position? Protecting ourselves takes energy. Lots of it. What would happen with all that creative juice if you applied it to making your parenting better versus avoiding change?
Change is uncomfortable but nothing real and satisfying is achieved by avoiding it. The biggest therapeutic truth I know (I didn’t say I always practice it) is that you have to go through the pain to get to the other side. I wonder what that other side will look like for you in your closest relationships.
- tranPARENTcy (parentingtoolbox.com)
Is your child sad or appear to have no affect at all? Is your
child preoccupied with the topic of death or other morbid
topics? Has your son or daughter expressed suicidal
thoughts or ideas? Are they extremely moody or irritable
beyond the normal hormonal twists and turns of childhood?
Has there been a drastic change in your child’s eating or
sleeping patterns? If you answered yes to any of these
questions, your child may be suffering from a common but
devastating mental health disorder, called depression.
Depression occurs in 8 percent of all adolescent lives.
Research indicates that children, in general, are becoming
depressed earlier in live. The implications of this is that the
earlier the onset of the illness the longer and more chronic
the problem. Studies suggest that depression often
persists, recurs, and continues into adulthood, and
indicates that depression in youth may also predict more
severe illness in adult life. Depression in young people
often co-occurs with other mental disorders, most
commonly anxiety, disruptive behavior, or substance abuse
disorders, and with physical illnesses, such as diabetes.
Teenagers often turn to substances to “self-medicate” the
feelings of depression. They reject prescribed medications
because of the way it makes them feel and because of the
negative social implications of being labeled as depressed.
Drinking alcohol and using other substances may make
teenagers feel better for a short period of time but the need
to continually use these substances to feel “high” creates
dependence and poses a serious health risk. Depression
in adolescence is also associated with an increased risk
of suicidal behavior. Suicide is the third leading cause of
death for 10 to 24-year-olds and as much as 7 percent of
all depressed teens will make a suicide attempt.
Signs that frequently accompany depression in
adolescence include: • Frequent vague, non-specific
physical complaints such as headaches, muscle aches,
stomachaches or tiredness • Frequent absences from
school or poor school performance • Talk of or efforts to
run away from home • Outbursts of shouting, complaining,
unexplained irritability, or crying • Being bored • Lack of
interest in playing with friends • Alcohol or substance abuse
• Social isolation, poor communication • Fear of death •
Extreme sensitivity to rejection or failure • Increased
irritability, anger, or hostility • Reckless behavior • Difficulty
Parents often witness these warning signs but fail to act on
them. Why? Because some teens hide the symptoms from
their parents or parents chalk it up to a stage or
moodiness. Many teenagers go through a time of dark
looking/acting behavior with all black clothing and bizarre
hair arrangements. This can throw a parent off of the trail of
depression by the bewilderment of teen actions and
behaviors. In addition, many teens react aggressively when
confronted about possible depression by their parents
causing mom and dad to back off.
When dealing with teen depression, it is always better to
“be safe than sorry.” Coping with an adolescent’s anger is
much easier to deal with then handling his or her successful
suicide or overdose. When parents first notice the signs of
depression, it is important to sit down with their teen and
ask them, gently but firmly, if they are feeling depressed or
suicidal. Contrary to popular belief, asking a child if he or
she has had any thoughts of hurting or killing themselves
does not cause them to act on that subject. If the teen
rejects the idea that they are depressed and continues to
show warning signs, it will be necessary to seek
If the child acknowledges that he or she is depressed,
immediately contact your physician and seek the assistance
of a mental health professional that works with children and
adolescents. In addition, parents can help their teen by
confronting self-defeating behaviors and thoughts by
pointing out their positive attributes and value. Parents may
need to prompt their teen to eat, sleep, exercise, and
perform basic hygiene tasks on a daily basis. Doing these
daily routines can dramatically help improve mood. Try to
direct the teen to hang out with positive peers. Steer them
away from other depressed adolescents. Explore
underlying feelings of anger, hurt, and loss. Even the
smallest loss of a friend or pet can intensify feelings of
sadness. Allow the teen to talk, draw, or journal about their
feelings without judgment. And for suicidal teens, make a
“no-harm” contract for 24 to 48 hours at a time when they
will not hurt themselves.
With proper care and treatment, depression can be
alleviated and suicidal behaviors prevented. Parents and
teen may even find a new, deeper relationship developing
between them as they work through the dark feelings of
National Institute of Mental Health Web Site. “Children and
Depression: A Fact Sheet for Physicians.”
- Depressed Teenagers: The Problem, Risks, Signs, and Solutions (parentingtoolbox.com)
It was one of those lazy Sunday afternoons and the sky was beautiful blue. White, billowy clouds were floating by as I sat and watched them on my front porch. The only problem with this day was I felt guilty about not being more productive. I felt like I “should” be doing something. Pulling weeds, reading some important journal paper or updating my blog. I remember this feeling as a parent too. There always seem like there is so much to do and I was always so far behind on something. Shouldn’t I be doing laundry instead of playing catch in the backyard with my kids or working on some craft? There were many times my guilt drove me to try and do household chores and play with the kids at the same time. Let’s just say, it wasn’t very effective in either area.
Many of us NEED to listen to that inner voice. That bathroom really does need some more attention but for the majority of parents, guilt is a constant critic. It is driven by the need for perfection. It fears what others will think of us. It causes us to forget that our children are more important than a clean dish put away into the dishwasher.
As a grandparent, you realize that the moments slip away into days into years into decades and then there are gone. When you realize all the magical moments missed with your child because you just had to prune the rose bush or scrub the shower (or for you working parents, work an extra hour or two in your home office), that is when the real guilt settles in. It is for what you could have done with your child if I wasn’t just so tightly wound up over the little things.
Here’s my parenting expert, grandfatherly advice: Spend an entire weekend just interacting with your children and let guilt go for two entire days! Just two days mind you. That means the beds don’t get made, the dishes may stay in the sink (OK, you can put them away after they go to bed) and the home office door stays shut. Oh yeah, and the electronic devices are off. Yes, off!
If you didn’t catch my radio show interview this morning you can listen to the archived mp3 at http://toginet.com/shows/theparentsplate/articles/1314 Brenda Nixon, host of the Parents Plate radio show, invited me to chat about the controversial diagnosis of Reactive Attachment Disorder (RAD) and the current state of mental health treatment of traumatized children today. I shared some great ideas in our hour long discussion that you will want to listen in on…everything from how children are diagnosed to attachment neuroscience to practical parenting tools. I even shared on why children with attachment impairments “Monster Up!” – a phrase I coined. Take a moment to download or stream the show at http://toginet.com/shows/theparentsplate/articles/1314
I recently watched a movie called “Unthinkable” (CAUTION: Movie spoilers ahead) and was shocked by the intensity of the violence. At first I turned it off then later went back to finish watching the movie. There was something about the plot line that drew me back in. The subject matter was simple: A terrorist sets up nuclear bombs throughout America, is captured, and then tortured to tell their locations. Yes, tortured. Aside from the more obvious political messages here, there was a subtler, frightening psychological message.
No matter how much the terrorist was tortured physically or mentally he never broke. He suffered but he continued to play mind games with this capturers till the very end. What would hold a person together despite such horrific punishments? I realized what the answer to this question was when the terrorist stated that “he deserved this” for all the bad things he had done. The movie never really described what these “bad things” were but it was enough of a mindset for him to endure unbelievable torture. His captors tried everything to break him: reason, empathy, brutality, mind games, more brutality and finally more brutality. They just kept upping the ante on the terrorist with the belief that eventually everyone breaks. He didn’t.
What struck such a cord in me was that many of the children I work with, who have been mistreated, have this “terrorist” mindset. Their behavior says: “What can you possibly do to me that I have not already endured in a much younger, more vulnerable state as an infant or young child?” So many of the children who adopt this “defiant” attitude have a deeper narrative that they deserve the punishments they are getting. Children internalize their abuse and believe that they are responsible for what happened to them. In fact, they often believe that they are “damaged goods” unworthy of love or kindness or anything good. They may set up caregivers to make them angry and want to punish them. It is easy for an adult caregiver to play right into this narrative and reinforce the very thing they want to change in the child. They may not beat them or leave them in a closet for days but we do use other punishment-based techniques (lock them up, move them from home to home, shame them with words or actions, make them carry out sentences, etc) all with the hopes that they will express their guilt and shame and change their behaviors.
I think the end goal is a worthy one. We want to help the child see things differently but our methods need some updating. Hope for this is coming from the field of neuroscience which is why you will see so much of this in this blog. It may not be the final answer but it is allowing us to see the small, hurting child behind the big terrorist mask. It is telling us that children’s brains and minds are affected by their mistreatment and we must go back and redo attachment-based treatments to help them rebuild the mental and physical capacity for love and affection and moral reasoning too.
I know it sounds like I am hard on the adult caregivers. I guess I am but we are the ones who have to do something different. We can’t expect the child to “get it” and explain it to us. We have to look deeper to see the alternative narratives for the child to live out. That will take time and patience. Unfortunately, we caregivers are products of our own culture and parenting narratives. A shame-based approach to parenting is how many of us were raised and so, it is the only approach we know how to use. If time out for an hour in a child’s room doesn’t work, what else is there? More time in the room? Perhaps we should yell louder or threaten more? Obviously not. The answer to my title: How can you punish an abused child, is simple. You can’t.
The mission of the Parenting Toolbox blog is to give parents more tools. I used to teach a lot of court-ordered parenting classes where parents where referred to learn non-punitive parenting skills. I quickly learned that you got no where trying to debate the punishment mindset. I realized that I couldn’t really win the “spank/no spank” argument. I might get some compliance from the parent but there was no change in insight. My focus became teaching other things the parent could do by giving lots of parenting tools. This worked. It is my vision to see parents better equipped and hurt children healed with this blog as well.