Christine M. Crawford, MD, MPH, is the associate medical director for the National Alliance on Mental Illness (NAMI), which is the country’s largest grassroots mental health organization, and the author of “You Are Not Alone for Parents and Caregivers: The NAMI Guide to Navigating Your Child’s Mental Health. She is an Assistant Professor of Psychiatry and Vice Chair of Education at the Boston University School of Medicine and also provides outpatient psychiatric care to children and adolescents at Boston Medical Center. Additionally, she’s the Medical Director for the Boston Public Health Commission’s School Based Clinician Program, in which she provides direct guidance on how best to support the socioemotional well-being of children within the Boston Public School System.
Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author. Gabe is also the host of the “Inside Bipolar” podcast with Dr. Nicole Washington.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To book Gabe for your next event or learn more about him, please visit gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.
Christine Crawford, MD, MPH: Thanks so much for having me.
Gabe Howard: Thank you so much for being here. Let’s just jump right in and start with the most common questions that parents have. And that’s how do they tell mental illness issues apart or mental health issues apart from normal childhood issues like teenage angst or just testing boundaries? Because I know that many parents are concerned that they are pathologizing normal childhood behavior.
Christine Crawford, MD, MPH: It’s such an important question, but what’s really interesting about this question is that there are a lot of parents who really do want to make sure that their kid’s mental health is okay, and it can be really confusing and overwhelming because like you said, teenagers especially, they can go through certain growing pains. They can become more Isolative, not wanting to talk to you, may seem to be a little bit more irritable. And it’s so challenging for a lot of parents to be able to differentiate between someone just acting like that because they’re a teenage versus not. But the most important thing that parents need to keep in mind is that as a parent, you know your child best. And what that means is you’ve been able to notice patterns in their mood and their behavior over the course of time. And so what I share with parents and caregivers is if you happen to notice any changes in their pattern of behavior, in the pattern of their mood, symptoms, the way that they’re presenting to you and to other people, then that can indicate that there’s some sort of shift in their overall mental health, and sometimes those changes in the pattern of their behavior and their mood can happen relatively quickly and seemingly overnight, which should certainly kind of raise the red flags or sound the alarm that something might be going on. So it’s really about understanding your kid, understanding their patterns, and being curious as to what might be might be behind some of these subtle changes.
Gabe Howard: When we think about subtle changes. I’m thinking about the average teenager, right? They hit puberty, they start dating. They feel that their parents are stupid, old, outdated, don’t understand the world, and they stop engaging with them. That seems to happen overnight. It really does seem like children go from being, you know, I love mom and dad to I. I don’t want to be around mom and dad, and they’re so boring and awful and they don’t know anything almost instantly. How do we tell if a child is really withdrawing from life, or if they’re just withdrawing from their parents.
Christine Crawford, MD, MPH: Yeah, it’s a great question because it is actually developmentally appropriate for young people to spend less time talking to their parents to not share everything with their parents, but rather they’re sharing it with their friends. They’re connecting more with their friends and using their friends as emotional supports. And you’re right, that change and that shift can be quite alarming to parents. But one of the things that tends to pop up with, with, with teenagers is that they still want to be able to connect with their parents, but parents are struggling with how to connect and how to have these conversations. Especially if they’re if they’re not around. And so if you notice that, yeah, there’s a change in the relationship that you have with your kid, but you’re noticing that there are changes with how they’re interacting with people outside of the house. That is certainly a time in which you would want to be curious as to what’s behind the change. So in the book, I talk about this framework that I thought about called the distress radius. And so that’s the idea of looking to see if there is a change in your kids’ behavior or in your in their mood that only is noticeable within the home, within the interaction between you and the kid? Or is this something that kind of has spread out, that has gone outside of the the walls of the house that are now being seen in school? We’re seeing it in their relationships, with their friends, with extended family members. We’re seeing it in their extracurricular activities. Maybe they’re no longer interested in them. Maybe they’re struggling academically. So we start to see that the changes, the concerns in terms of their behavior, and the mood has kind of expanded beyond the walls of the home, then that could be something to be very curious about, and certainly says a lot more than just a typical teen being a teen.
Gabe Howard: NAMI has done a really good job of educating parents, caregivers, teachers, coaches, all of the people who are in a child’s life that talking to your children about suicide does not give them the idea for suicide. This is a persistent myth in our society, and NAMI has really worked hard to express that. No, if a child feels that nobody cares about them and then you don’t talk to them about their mental health issue. Mental illness concerns or suicidality concerns, you’re actually reinforcing the behavior. So I wanted to touch on that real quick just in case anybody is unaware. These are important discussions to have. And the research shows that having them is important. But my question is children don’t want to talk to their parents. We’ve just been talking about that. So what should a parent or caregiver do if their child refuses to talk to them about it because the parents are doing the right thing, they’re sitting their kid down. They’re saying, I’ve noticed these concerns. And their child doesn’t want anything to do with it. Do you have any advice or techniques for parents to use in those situations?
Christine Crawford, MD, MPH: So in the situation where you are trying to engage with your kid, you have concerns and they’re not listening to you. Please understand that it’s not a one and done thing where you just have one conversation and hope that you can change everything in that single interaction. It might actually take multiple interactions in order to really be able to connect and understand with what’s going on with your kid. So what does that actually look like concretely? If you are noticing concerns in your kid and you’ve heard from other people that they have made comments about hurting themselves or attempting suicide, or maybe you’ve come across some information that has made it clear that they have some of these thoughts, and you approach them about it and they shut it down. Okay. But what you need to do in that moment before you just walk away is that you share with your kid, I am here for you. I know you’re going through a difficult time, but I want you to know that you shouldn’t feel afraid to talk to me about any thoughts that you have. Because, number one, kids are afraid of how their parents are going to react if they happen to bring up suicide. They need to know that sharing this information and being vulnerable with their parent will make it such that they’re able to be safe, because a lot of people are worried about what’s going to happen when they disclose this information to someone else, they might think, okay, there’s going to be severe consequences down the line. You want to communicate I want to know what’s going on. I am here for you. Please don’t be scared because I just want to help out, okay? And then the next thing is to let them know whenever you’re ready to talk, I am here. Now, the other thing, Gabe, that a lot of listeners are probably thinking about, Dr. Crawford, that doesn’t make any sense. If I see my kid doing X, y, Z and they are harming themselves, I’m not going to ease my way into a conversation. Plant the seed that I.
Gabe Howard: That was going to be be my next question,
Christine Crawford, MD, MPH: Exactly.
Gabe Howard: Dr. Crawford, like, what if you can’t wait? What do you do if you’ve reached crisis point?
Christine Crawford, MD, MPH: Yeah. Yeah. So if it’s a point of crisis, the bottom line is, is that suicide is the second leading cause of death in young people. It really is that serious. We know that it’s serious. And so if there are immediate safety concerns, you bring them to the emergency room. That’s the bottom line. Because parents and caregivers should not play the role of psychiatrist or A psychologist or social worker if there’s an immediate concern, you caught them in the act. They’re saying, I can’t control these thoughts. I’m having these thoughts all the time. You bring them to the emergency room and across the country now we have what’s available, 988, a three-digit number that people across the United States can call if they happen to find themselves in a mental health emergency. And that includes being around someone who’s having suicidal thoughts. They have the opportunity to connect with a mental health professional who can kind of walk them through next steps, or even reach out to emergency support so that they can come and help the person out in the community. So certainly do that. And then lastly, I’ll say primary care providers are actually trained on how to provide support and guidance around some common mental health issues. And so if you happen to forget the number of 988, or you’re not yet comfortable driving your kid to the emergency room, or calling 911 to have an ambulance come in? You can call your pediatrician. You can call the primary care provider for the kid, and they can guide you through this.
Gabe Howard: One of the biggest concerns that parents have, and one of the reasons that they’re worried about taking their child to see a psychiatrist or their general practitioner about mental health is the phrase, I don’t want my kid to be on medication. I don’t think my kid needs medication. All they can do is give them medication, and I’m against that. But there’s so many other treatments and interventions for mental health issues. Can you talk about some of those?
Christine Crawford, MD, MPH: Yeah. I mean, there’s so much stigma when it comes to to mental health and especially when it comes to mental health issues in, in kids. And I know that stigma creates a huge barrier to having parents bring their kids in to, to be evaluated. But I always say, first and foremost, if your kid’s mental health is not sound, if it’s not strong, then everything else is going to fall by the wayside. They won’t be able to take care of their physical health. They won’t be able to do well in school. So I really encourage people to bring their kids in for an evaluation so that you can better understand your kid and how your kid’s brain works, right. And also so that you can learn how you can more effectively support your kid and provide your kid with whatever tools that they need in order to succeed. When you bring your kid in to see a mental health provider, oftentimes they are meeting with you and the kid to just understand the kid, understand your relationship with the kid. And like you said, Gabe, oftentimes we are really trying to emphasize the importance of providing kids with tools. We’re very good about providing tools to kids, about how to navigate this complicated world. Practical tools make sure you look both ways before you cross the street. Make sure you put on your seatbelt. But when it comes to mental health, we just assume that kids will just naturally learn about how to deal with stress and really intense emotions, but that’s not how it works.
Christine Crawford, MD, MPH: So bringing your kid in to therapy, if they happen to have a concern, you are literally providing opportunities to fill that kid’s toolbox with different strategies that they can use to navigate really big moments and navigate really big feelings. And that’s what it’s about. But for some people, in order to be able to access those tools that are being provided in therapy, they might need medication. And so therapy is always standard with all treatment involving kids who have mental health challenges. But for those who aren’t sleeping, who aren’t eating, whose physical body is just not functioning in a way that will allow them to be engaged in therapy, sometimes medication is brought up so that they can get to a point of functioning in which they can actively participate in therapy and engage in therapy.
Gabe Howard: That does bring up a couple of questions for me. So I’ve got like two directions that I want to go, and I’m going to give them both to you at the same time. And you can choose your own adventure, Dr. Crawford. The first one is what role do family dynamics play in a child’s mental health issue? And the second question is, do children ever grow out of this? Many parents are worried that they’re going to stigmatize their child for life, that they’re going to get a diagnosis that’s going to carry them well into adulthood. Is that the case? If you’re diagnosed with a mental health issue as a child, that it’s necessarily going to stay forever, or can it be temporary?
Christine Crawford, MD, MPH: Yeah. So in terms of the diagnosis question, I talk about this in my book, You Are Not Alone, because a lot of parents struggle with a diagnosis that they received for their kid when the kid was seven. During that period of time, when the kid was seven, there were certain dynamics at play in the household. They were in a certain grade. There were certain situations that were happening around them. And also developmentally, they’re at a different stage in life. So they might have gotten one diagnosis. But then kids grow up, they develop, their situations, their family situations change, their peer relationships, their world evolves. Right. And so a diagnosis at age seven is not going to have a lot of meaning at the age of 15, 16 and 17 because there are entirely different person. So I talk about how the diagnosis is really just language that is used to describe a set of symptoms that are presenting at a certain period of time. And so it’s just language that is used to summarize what it is that we’re seeing in a kid in that moment. Right. And those symptoms, things can look differently. And we use different language to describe what it is that we’re seeing in front of us at 15 and 16. Right. So I talk about how a diagnosis is not a static fixed thing just because you have one diagnosis during a period of time, it does not live with you forever because people and things change.
Christine Crawford, MD, MPH: Right? And so a lot of people think, oh, these shrinks, they don’t know what they’re talking about. No, it’s actually the opposite. What we’re doing is we’re reflecting on the kid who’s presented in front of us right now, and we’re having a conversation about this kid who’s in front of us right now. So then in terms of family dynamics, family dynamics are everything because the adults who are living in the homes of these kids are serving as the mental health role models. They’re the ones who the kids are looking to for how to deal with anxiety, how to deal with sadness, how to deal with anger. And if the adults in the home are struggling with that, that’s having a direct impact on the mental health of the kids in the home. The other thing is, is that connections between the family members and the kid is just so critical for the kid’s development of their own social, for their own self-esteem, for their understanding of their relationship to the world, because they are testing that out with their relationships with the family members in their homes. As a psychiatrist, I meet with all family members who come to the visit.
Christine Crawford, MD, MPH: I meet with them at the beginning. I have a conversation during each visit with them because I don’t live with the kid. I see them once a month for 30 minutes, but these families see them each and every day, so they have a better understanding about the pattern of behavior, the pattern of moods that they’re seeing in the kids. And then we also need to understand how the family members are responding and reacting to the kid who might be expressing big feelings, big behaviors, and what have you. So, I also need to provide guidance on how they can compensate with the kid, how they can respond to the kid that doesn’t further add fuel to the fire. And so the family piece is so, so important. And a lot of family members believe if you bring your kid into treatment, we’re just treating the kid. No, no, no, no, we can’t treat the kid just in a vacuum. We really have to address the needs of the whole entire family unit. So I empower family members by knowing that they are an active part of treatment, and they need to show up to the appointment being ready and prepared to engage, especially when it comes to appointments with me.
Gabe Howard: You know, I know a lot of parents think to themselves, I don’t know what to do. That’s why they’re listening to the podcast. They’re not sure if they should call somebody. They’re not sure where to go. They’re not sure if they should have them evaluated. They’re worried they’re going to stigmatize their child. And now you’re saying, hey, you need to be heavily involved in the outcome. And I imagine a sense of panic is probably shooting through some members of the listening audience right now. So I know we’re almost out of time, but I’d be remiss if I didn’t end with how can parents best support their child during mental health struggles? Because they still have to be parents. They can’t just let their child do whatever they want because they’re struggling. A child would immediately take advantage of that. But we also know that in some mental health cases, the child is not being And manipulative. They’re sick. How can a how can a parent even begin to tease all this out, to make sure that they’re doing the right thing in supporting their child?
Christine Crawford, MD, MPH: I think that parents need to understand neurobiology and that kids are literally doing the best that they can with the brains that they have. And for a lot of kids, what we know to be true is that the back part of their brain, which has all of the emotional centers there, are more developed than the front part of the brain that really helps pump the brakes, that helps the brain engage in rational thinking, helps the brain say I think there’s a better way to handle this situation. I’m not going to raise my voice. I’m going to use my manners. I’m going to use this deep breathing skill. No no, no. The connections between the back of the brain to the front part of the brain that has all that great problem solving is not as strong. Right. And then when you add trauma to it, when you add certain stressors that kids are exposed to, it makes it even harder for that back part of the brain to communicate with the front part of their brain. No kid wants to be angry and dysregulated all the time. They’re distressed by that, but they are using those behaviors to communicate to everyone else that I’m struggling. And it’s so hard for us as parents to tolerate that because it’s too much. It gets in the way. It’s disruptive, but it’s really just understanding the neurobiology, understanding that this is the way that the kid can best communicate their distress in this moment.
Christine Crawford, MD, MPH: You also need to understand that I need to just be consistent. I need to be there. And yes, you need to set limits and you need to set boundaries, but you also need to set them from a place of understanding. And so if you are, you know, using certain means of punishment to get through to a kid, it’s not going to be effective given the brain that they have and given the way that their brain is connected. So that’s why bringing your kid in for treatment will allow you to better understand your child’s unique brain. And to learn different tools, you need to fill up your toolbox to as a parent for more effective tools for how to engage with your unique child. A lot of parents are like, I didn’t have this issue with Susie with Tommy, but Susie and Tommy had different brains. So we really need to approach this from a standpoint of how can I better understand my kid’s brain? How can I develop a set of tools to more effectively engage with my kid, given the brain that they have? And how can I parent in a more effective way for the kid who’s right in front of me? Giving the brain that they have?
Gabe Howard: Dr. Crawford, thank you so much for being here. Before we go, can you tell folks about your book and where they can find it and why they should pick it up?
Christine Crawford, MD, MPH: Yeah. So my book is called “You Are Not Alone for Parents and Caregivers,” and it is a comprehensive guide about youth mental health that covers all the topics that we just discussed today in terms of understanding your kid’s brain, how to communicate with your kid who has mental health issues, how to communicate to people in your lives about your kid’s challenges, and then also how to recognize mental health issues in kids as young as three all the way up to when they’re 18. So check it out at YouAreNotAloneBook.org, and make sure to visit NAMI.org where you can learn more about the book. But you can also learn about our amazing organization, especially those who have kids with mental health issues.
Gabe Howard: Dr. Crawford, thank you so much for your time.
Christine Crawford, MD, MPH: Thanks for having me.
Gabe Howard: Well, you are very, very welcome, Dr. Crawford. And I want to give a great big thank you to all of our listeners. My name is Gabe Howard, and I’m an award-winning public speaker who could be available for your next event. I also wrote the book Mental Illness Is an Asshole and Other Observations, which you can get on Amazon, but you want to go to my website, gabehoward.com and get a signed copy with some free show swag. That website again is gabehoward.com. You can also follow me on Instagram and TikTok @AskABipolar. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. And do me a favor. Recommend the show. Sharing the show with the people you know is how we’re going to grow. Share in a support group. Send somebody a text message, send somebody an email and I will see everybody next time on Inside Mental Health.
Announcer: You’ve been listening to Inside Mental Health: A Psych Central Podcast from Healthline Media. Have a topic or guest suggestion? E-mail us at [email protected]. Previous episodes can be found at psychcentral.com/show or on your favorite podcast player. Thank you for listening.
