Should I be worried?

Looking at children's behavior in a different light

Parents often ask whether they should be worried about a child’s mood or behavior. While they may not be aware of any major “red flags,” they wonder whether they might be seeing orangish-yellow flags:

• an adolescent whose moodiness seems extreme, even for puberty
• a student who is hanging in there academically, but seems to be gradually losing confidence
• a child who has a couple of close friends, but also seems increasingly excluded from larger social groups

What is “normal”? What is a “problem”? And what should a parent be doing to help?

I’ve always loved these words from Lawrence Cohen, PhD from his lovely book Playful Parenting:

There are some things that are so predictable and inevitable, faced by almost all children, that it is hard to call them traumas. Nevertheless, they are painful and they sap a child’s confidence. Losing a friend, having a secret betrayed, and being teased are just a few examples.

As parents, we want desperately to help children escape these hard lessons of life, or at least master them when they do happen. We know that lectures don’t work but we keep giving them anyway, just in case, because we aren’t sure what to do. (p. 74)

Knowing how to respond to a child’s pain is something that I wrestle with both as a child and adolescent psychiatrist and also as a parent myself. In both roles, I have increasingly come to rely on a “needs-based approach.”

A needs-based approach considers closely the basic needs of all children, knowing that caring for a child’s biopsychosocial needs is the key to improving motivation, guiding healthy development and building resilience.

These needs are categorized, in ascending order, as (1) physical, (2) safety, (3), connection, and (4) confidence needs.

So if you were to imagine coming to me (or some other professional) to ask whether to be concerned about your child, or how to support him or her during a painful time, I might ask a series of need-focused questions along these lines:

(1) Are they physically healthy?

Does he or she suffer from any notable medical illness that could be better addressed? Does he sleep well at night, exercise, or have reasonably good eating patterns and nutrition?

(2) Does she seem to feel emotionally safe and secure?

Emotional safety includes feeling accepted, that they can be themselves, that they can talk freely with others about problems. Consider the quality of relationships at home, as this is often reflects feeling safe to talk, feel, fail, or explore. Does a young child feel that grownups are helpful? Can a teen talk without being interrupted or invalidated?

(3) Does he or she seem to have meaningful connections?

Meaningful connections aren’t just “relationships,” but a deep sense that there are others who get a real kick out of being involved in his or her life. Connection occurs through shared experiences, humor, prolonged gaze, storytelling or remembering shared experiences. Does your child basically have friends or adults by whom they feel seen and valued?

(4) Lastly, does he or she have some things that make them feel competent?

Does your child hurry to share successes, or experience a feeling a mastery through completion of a project, piece, job or competition? School is a giant mark “for” or “against” a child’s confidence in our modern society. So kids who do not naturally do well in school may benefit from added emphasis on extracurricular or other non-school confidence-building activities.

Please note that these questions are not intended to understand “the cause” of a child’s pain or difficulty. In other words, your child is not struggling because some important need is “not being met”— humans are just more complicated than that! To get at causation is much more complex and, I believe, actually much less helpful.

What I am saying though, is that carefully considering a person’s needs is much more valuable than “identifying” or “fixing” specific problems. Similarly, sensing that a child’s needs for safety, connection, and confidence are being cared for should give us reassurance that they will find ways to resile, grow, and learn in healthy ways through those inevitable difficulties of life. ※

Written by child and adolescent psychiatrist Dr. Matt Swenson on behalf of United Way of Utah County’s EveryDay Strong.