Questions & Answers

Our 17 year old daughter has been seeing a psychiatrist referred through CHEO for 4 years now. She is unable to attend regular high school but we have her in a special program to help her finish school. However, she is no longer able to carry through with her participation. She is unable to take care of herself including her basic needs, and her treatment has not made any progress. We are very frustrated and don’t know where to turn for help. Who should we talk to and how can we get help? We will not give up on our daughter.

One of the hardest jobs for parents dealing with any kind of illness, physical or mental, is the lack of predictability that the course of the illness can take – it is awful feeling out of control with our own health, but even worse when it involves the health of our children. You’ve done a great job getting resources for your daughter, both in terms of her health and her education. But just doing everything well doesn’t always guarantee a quick solution. The Parents’ Lifeline of Eastern Ontario (PLEO – www.pleo.on.ca) is a group of volunteer parents whose own children have struggled with mental illness, and we’ve found them to be a terrific resource for other parents going through a similar challenge. They know what it’s like to feel the frustration you’re telling me about, while continuing to hang in there with a difficult situation. Please give them a call them.

Your daughter is close to making the transition from a children’s system to the adult one, and part of the planning that should happen involves how to ensure she continues to have professional support once she hits the age of 18 – her psychiatrist can be asked about this, and we do have a program in place to help you and your daughter make this transition. Hopefully this change will spark a change for your daughter.

Finally, I would just like to reinforce your decision to stay involved in your daughter’s life, even as she moves towards becoming a young adult. As our children enter adolescence, we know that the focus of their energies can be directed away from family towards peers. However, parents have to work to remain the main “attachment figures” in their youth’s life. While not easy to do, and not necessarily always appreciated by our children, investing the time and energy this takes is important in so many ways. It lets our youth know that they continue to be a priority for us, that we are there for them whatever they’re going through (unlike peers who are more likely to offer conditional rather than unconditional support), and reminds them that they can come to us no matter what. This connection can be promoted by limiting a youth’s time with technology (e.g., cell phones, on-line gaming, social media sites, etc.), and importantly, keeping technology out of the bedroom and away from family activities. Regular family meal times, board games, physical activity (organized and informal), and spending time while travelling in the car “unplugged” (i.e., not listening to music or otherwise using technology) are some activities that can enhance communication and connectedness.

Dr. Phil Ritchie

My 9-year-old was recently diagnosed with Ulcerative Colitis. The first wave of treatment did not work, and now that we're trying new medicines he's afraid that he will "never be better". He says he doesn't want to tell anyone - his school, his Sensei at the dojo - because he doesn't want special treatment. He just wants to "be a normal kid again" and not have to take medicine for the rest of his life. How do I support him, but still get him to see that his medicine will help him live life more normally?

I think that your son’s reaction is understandable, and in some ways, healthy. He is struggling to be a “normal kid” and I think everyone would agree that we want him to be as normal and participate in as many things as he can. Ulcerative colitis may have caused him symptoms that are embarrassing, frightening, and painful. Psychologically, having been diagnosed, your son may now feel that he is different from all his friends, and he may be worried that the initial treatment hasn’t worked and perhaps thinks nothing will.

I think the first place to start is by finding out what he’s feeling. As his parent, you undoubtedly have concerns, some of which may be shared by your son, but you want to be careful that you don’t impose some of your worries onto him. Kids are really good at picking up on our fears, especially when they’re feeling anxious themselves and not too sure what’s going to happen. Feelings of fear, uncertainty, and anger would certainly be understandable, for parents and children alike. If your son is experiencing these, it will be important that you validate them for him. For example, if he seems more irritable at times, ask “do you think that part of you is mad about your illness?” and if he says yes, you could reply something like “I get that, because sometimes I’m mad about the illness too. I know it’s not your fault and not the doctors’ fault, and really it’s not anyone’s fault at all but I’m still mad because you didn’t do anything wrong but still got sick and that’s not fair.”

Your son’s participation in self-defence is also invaluable at such times, and even when he’s not feeling his best, it can be good for him to get out. As parent, you can run some interference for him, letting his sensei know that he may be under the weather sometimes. You can even use examples from his self-defence to explain to him how his illness is going. When the first medication doesn’t work, explain that the first time he tried a kata, it likely didn’t go so well either, but it doesn’t mean anyone stops trying; you have to keep going until something does work. In the same way, the doctors don’t stop trying just because the first medication doesn’t work; they will keep trying, as well. You can also explain how positive self-care (e.g., taking medication, going to appointments, proper sleep, nutrition, etc.) are like training – you can’t walk in and expect to pass a test for your next colour belt without proper training, and in the same way, you can’t expect to optimize your health without also putting in effort along the way.

Finally, I want to talk about encouraging resilience in your son – encouraging his ability to bounce back from adversity, like his diagnosis with Ulcerative Colitis. Evidence suggests that this can be encouraged by having high, but realistic expectations for him (e.g., his continuing to participate in self-defence even when he’s not at 100%). Positive relationships with those around him are also important and as his parent, your relationship with him will be the most important for years to come (even when he’s a teenager, though he may not like to admit it). Finally, emotional regulation and optimism are factors that also appear to help children develop resilience - as his parent, he will learn from seeing you projecting a calm and positive outlook.

As someone with Crohn’s disease, I have some sense of the anxiety provoked by such a diagnosis, but also would extend a sense of hope and optimism about what the future can hold. Good luck.

Dr. Ritchie

My daughter will not eat lunch when she's at school and won't tell me why. She only eats at home when we are with her. She's losts 20lbs since September and I'm worried about her. What should I do?

I have a 17 year old daughter who is being treated for hypothyroidism. However, for the last 5 years she has been slowly withdrawing and not participating in events with anyone. She spends her time reading in a dark room and I really struggle to get her out of the house. She has been referred to a therapist but she won't go. I would like her to see a Dr. at CHEO and I would like her to be tested but for more than just anxiety or depression. She has graduated high school and doesn't know what to do with her life so she has not applied anywhere. The only way I think I could convince her to be assessed is to do it to help her to figure out what to do with her life. If she could then have someone do a complete analysis it would be appreciated. I think it could be more than just a thyroid problem.

My son is 16 years old and has had thoughts of suicide, though he assures my husband and I - and his doctors - that he would never do it. The struggle we have is knowing when to leave our son alone and when not to. We recently wanted to leave to go camping for the weekend and our son did not want to join us. Our son tells us that he is 16 and should be able to make his decisions to go or not to go anymore. How do we know if it's ok to leave him alone for a night or two?

I’m glad you asked.Your concern is certainly legitimate and in our services this is an issue we deal with almost daily. There are some positives in your description -it sounds like he is receiving services and supports which is important. As well, it appears he is willing to disclose his thoughts about suicide and most importantly he is able to distinguish between thoughts he may have versus thoughts leading to action. The fact that he has clearly indicated he would not act on his thoughts is reassuring.

As parents, the key here is to establish and maintain open lines of communication based on mutual trust. Trust on his part that you respect his desire for independence and autonomy and trust on your part that if his suicidal ideation goes beyond thoughts to action or preparation for action that he will signal this to you so that you can provide support at those points in time.

Many adolescents are reluctant to specifically talk about their thoughts but sometimes can agree to provide nonverbal signals (predetermined) to others that they are having a hard time or may be experiencing suicidal ideation - wearing a certain article of clothing or putting a rubber band on a bedroom doorknob are ways of signaling their distress. This gives you some things to check for and saves them from having to express thoughts or feelings that may be difficult to articulate. It's also important to acknowledge that you worry about the risk but that sometimes you have to take the chance to trust him and find other ways to manage your anxiety. At the same time, I would encourage you to trust your gut and any time things seem a little off or not quite right; it's helpful to check that out. If your son provides appropriate reassurance, then great. If his response is vague or in some way not reassuring then it's important to continue to talk openly about the issue until you are reassured.

Monitoring for other changes or behaviors that might suggest significant suicidal thoughts, ideas or plans would include things like a sudden, dramatic improvement in his mood and demeanor (potentially suggesting he has made a decision to end his life and is feeling good about it), significant social withdrawal, giving away his personal property, preoccupations with themes of death or spirituality or obviously other written material about suicide. It may also be helpful to obtain his permission to occasionally access his online social media activities-Facebook, Twitter etc. as more and more commonly now adolescents are turning to social media to express their inner thoughts and feelings. The same goes for texting. Texting has become the preferred mode of communication for adolescents with both parents and peers. The key here is to ask and to be respectful of, his right to confidentiality.

When it comes to managing or communicating about suicidal ideation there is no clear formula and no guarantees. Your best protection is to continue to foster a healthy attachment, that he comes to know that he is valued and loved by you, that you believe in and have faith in his capacities and competencies as a young man, and that you are willing to trust that he can take on the responsibility of maintaining his own safety and integrity.

Hope this is helpful,

Dr. Hazen Gandy

I am at my wit's end with how to help my 7 year old son. He has been experiencing behavioural issues since around the time he was 5 years old. He has become withdrawn, moody, fidgety, and is unable to emotionally cope with anything. I have received complaints from the school about his inability to stay still, and about his constant "pouting", i.e.: if anyone says anything remotely critical or negative (like a teacher trying to correct his work) he completely shuts down and refuses to participate in anything for the remainder of the day. I have gotten tests back with scores of zero for subjects he knows inside-out, simply because he has refused to write the test after a teacher asked him to stay still. At home, he self punishes himself constantly. If I ask him to pick up a toy or tell him he's not allowed to do something, he will drop his head, say he's going to his room, and will refuse to come out because he claims he's "on a time out". He will stay there for hours if I let him, claiming he's not allowed to come out even after we assure him he's not in trouble. He is so quick to shut down. Recently at an amusement park, he discovered there was one ride he couldn't go on, so he claimed there was nothing there for him and stubbornly refused to go on any rides for the remainder of the day. I could go on, but these are just a few small recent examples of his constant state. I worry about how it's going to affect his schooling, and his ability to cope with anything in life, really, if it continues. Any thoughts on how I can help him through this? Or what I'm dealing with?

I’m glad you asked! This is a really good question, and a really tough situation for your 7 year old. It is quite possible that your son has developed unrealistically high standards for himself. And when he can’t meet such standards (and no one could), this creates anxiety for him which in turn, results in his shutting down. At school, if his work or behaviour is questioned, he refuses to complete tests. Similarly, at home or at the amusement park, if there is any suggestion that he is not good enough (or in the case of the amusement park, is not old enough or tall enough), he again shuts down and refuses to engage. This perfectionism really is apparent when he times himself out for hours because he needed to be reminded to pick up a toy.

Perfectionism can sometimes be an easy trap for our children and youth to fall into. Setting high (but realistic) standards for our children can sometimes be a good thing, but some children may interpret this to mean that failure or imperfection is unacceptable. Some of us, as adults, may also have unrealistic expectations for ourselves as parents, and we may not tolerate our own limitations terribly well - something our children may pick up from us. Others may be looking to compensate for our own shortcomings by living vicariously through our children (the classic example perhaps being a parent who was an unfulfilled or untalented athlete who is determined to have his or her child make it to the big leagues). Such pressures may be internalized by children who in turn become perfectionists. Interestingly, you may also have a child who has been exposed to none of these expectations or influences, but just developed such tendencies on his own.

Regardless of how such tendencies developed, we want to encourage a healthier attitude in your son towards imperfection, or said another way, improve his frustration tolerance. A good place to start is in parents being able to embrace and laugh at their own foibles. Our children often love to hear funny stories about mistakes we’ve made, and being able to laugh at ourselves is a great skill to pass on to our kids. We can also show them that there are things we can enjoy doing that we might not necessarily do so well (thankfully this column is just in written format or I would sing to demonstrate). As well, letting our kids know of how we learn from our mistakes is another lesson we can give them.

The recent Olympics provided us with another great opportunity to show our children the importance of persisting after a setback. Canada’s men’s 8 rowing team came last in its first race and only qualified for the finals through a repêchage or second chance race, ultimately going on to win a silver medal; there are high jumpers and other athletes as well who have missed a jump only to go on to later success. There are also countless examples in academics (Albert Einstein), politics (Winston Churchill), and business (Henry Ford) of people who knew much more failure b

Lately, my teenage daughter has been behaving wildly. She’s become disrespectful, bullies her younger sister, and skipped most of her classes – which resulted in her failing her semester. She recently hosted a pool party during our absence, which she knew was against our house rules and became enraged once her father arrived home and kicked everyone out of the pool. So we asked her to leave and come back when she’d be ready to abide by our rules which are quite simple: respect everyone in our household, no bullying of her younger sister, no one allowed in the pool without adult supervision, respect for curfew and no lying whatsoever. While she was away, I cleaned up her bedroom and found bongs, drug pipes, razor blades, lighters, and pocket knives. When she came back, she learned what I had found and that I had thrown it away, and again, went into a wild rage - throwing a kitchen chair across the room and denting my stove; throwing water bottles at us, punching the walls and kicking things. I didn’t know what to do so I called the Youth Services Bureau’s helpline, who told me to call 911. The policemen that came talked to her for a good 25 minutes and she calmed down. My husband and I declined the policeman's offer to press charges (very hard to do with your own kid), so the officer suggested we write up a contract on what we expect from her. She avoided us that night and every night for a bit but did agree to it. But when came time to sign our contract she started with the profanity again and tore it up into pieces. Again, we asked her to leave and not return until she was willing to respect our rules. She was back on Saturday and we told her that there would be one more condition: for her to live in our home, she would have to agree to undergo a full assessment. She has finally agreed to this - but her tantrums seem to be getting more powerful and I am afraid that if we don't seek help for her - it's only going to get worse. I want to help and I want what's best for her - I just don't have a clear view as to how I can do this. I know I can't handle the stress of her rages and tantrums anymore. I thank you in advance for your advice.

You have certainly described a very challenging situation. Contacting the Youth Services Bureau (YSB) crisis line and the Ottawa Police Service are both important steps, as difficult as they may have been, as both organizations may continue to be involved as you help your daughter move towards recovery. I also think it’s important that your daughter has agreed to get an assessment, though you don’t specify whether it is a drug and alcohol assessment, or a more general mental health assessment. Many youth, like adults, can use drugs and alcohol to self-medicate for a mood or anxiety problem. And depression can come across in some people more as irritability than sadness. If your daughter has a good relationship with your family physician, this could be a good place to have her first evaluated. For more information and links to additional resources, please visit www.ementalhealth.ca

It is really important that you have set some limits with your daughter, and while she won’t thank you right now, or at least for a long, long time, she likely will appreciate them one day. I think it is positive that your daughter does keep coming back home and at least saying she will meet your conditions. However, I would also expect that she will continue to test you and challenge your authority as parents. If these challenges become as extreme as the ones you’ve described above, then I think you will likely have to call the police again. And this time, I would suggest you consider laying charges. While I’m not a lawyer, my understanding of the Youth Criminal Justice Act is that in most cases, the courts look to divert someone before ever going to trial. What this means is that after charges are laid, your daughter may be more willing to follow through with getting treatment and respecting conditions set by you and others in positions of authority. In short, it may make it more likely that she gets and accepts help.

As parents, you can also take some steps to reduce conflict and build relationships in the home. Collaborative Problem-Solving is an approach supported by all theOttawaand area groups involved in youth mental health. The YSB may be able to provide you with further information about Collaborative Problem-Solving, or look to the following link: www.thinkkids.org

One final consideration: I am concerned over the impact this may be having on your younger daughter. Bullying by older siblings, if left unchecked, can have a significant impact on the younger child’s wellbeing. As well, you don’t want your older daughter’s behaviour to become a template for your younger daughter.

While the situation you have described is serious, it isn’t hopeless. Enlist the support of those agencies and professionals you’ve already reached out to, and reach out to others, if necessary.

Dr. Phil Ritchie

After watching a scary movie with friends at a birthday party my 12 year old son started sleeping with a night light again. This was almost a year ago and he still uses the night light. Then, he started to close his bedroom door at night and won't sleep with the door open. And just recently, he has begun to close his window as well. I have tried to invite him to take baby steps, such as trying one night with his door open or at least opening his window a small crack during warm nights, but he refuses. He says the sounds he hears and the shapes he sees if he wakes up during the night, scare him. I feel he has built unhealthy sleep habits. Should I be worried? Is this normal for a 12 year old? How can I help him feel comfortable at night?

My daughter has these random Obsessive Compulsive Disorder (OCD) episodes. Her most recent one was because she felt as though she was going to cause something bad to happen to her family if she went on our property or in our house. She was outside for at least 2 hours before I came to get her because it was dark. When I finally forced her to come inside, she was crying and telling me that her head was telling her that she was going to cause something bad to happen. After I finished talking with her she was still having her OCD episode and for the next hour and a half she couldn't move from one spot in our kitchen and when I managed to force her to go to bed, she refused to sit or be in the same room as anyone else, for fear that she would cause something bad to happen. Even the next day she was really uncomfortable in the house and to be around people in our house. You could tell that she was still having a little bit of a panic. My question is should I take her to the hospital if she is having episodes like this? Her episodes are WAY worse if someone in the house is sick. She won't touch anything for a week and she can't be on the same level in the house as the sick person. Are any of these situations that would be best if dealt with at a hospital? Thanks!

If someone has a traumatic experience, then develops a phobia that is directly linked to part of the experience, is it a form of PTSD?

“When it’s very crowded at the mall on a weekend, my daughter suddenly insists on leaving because she feels dizzy and nauseated. Once we’re outside she feels fine. I think big crowds give her panic attacks. How can I help her overcome them without running back to the car each time?”

“My 9-year-old daughter is overweight and pretends to be sick each morning so she doesn’t have to go to school. I’m worried she’s being bullied but when I ask her she gets angry and tells me to leave her alone. How can I get her to open up about whether she’s being bullied?”

“How can I tell whether my teenage son is just going through normal moodiness at puberty or if he is depressed?"