Live webchat with Dr Sally Hodges
Dr Sally Hodges joined us for a webchat on 24 January 2011 to discuss children's mental health. She is a consultant clinical psychologist at the Tavistock and Portman NHS Foundation Trust, specialising in children's disabilities. She talked to Mumsnetters about ways to help children with anxiety and how to get the most out of services available.
Dr Sally led the launch of Cam's Den, a website aimed at seven to 10 year olds to combat the stigma surrounding mental health issues and help children learn about emotional wellbeing.
aristocat: My friend's daughter is five, and pulls her hair out. She has been referred to a GP, but is there anything my friend can do to help her daughter in the meantime?
Sally: I'm glad that she is getting help for this. Sometimes it's hard not to focus on the problem and comment about it, but sometimes taking the emphasis off the actual problem can help. For example, if your friend is able to reward her daughter for periods of time when this doesn't happen, that might help.
MmeLindt: Several members of my husband's family suffer from mental health issues. One sister is bipolar, the other sister has suffered from depression and a niece has recently been admitted to hospital suffering from a breakdown. A cousin attempted suicide some years ago, after battling depression.The family are rather secretive, and not good at discussing their feelings. We have only recently learned about the niece, but have no details. It happened several weeks ago. My husband worries about our children, particularly our daughter - whether the likelihood of her developing some mental health issues is higher, because of the family history. What can we do to help our daughter avoid this?
Sally: The fact that you are doing things differently for your immediate family is really important; you are able to think about and talk about these issues which will make a difference. How mental health difficulties develop is very complex and in most cases not purely down to a biological basis. The environment has a real and powerful influence on mental health. Talking about concerns and providing a thinking space to deal with issues for your children will help them deal with adversity, and will really reduce the likelihood of more serious difficulties.
PixieOnaLeaf: My daughter is 12 and was discharged from hospital last week after being admitted in November after an asthma attack which was so severe that she had to be ventilated. She is finding it very difficult to 'come to terms' with the attack and is, I think, frightened that she is going to have another attack which will prove fatal, although she won't admit this to me, or her counsellor (who she is doing play therapy with her). She finds most aspects of life very difficult, but is having a number of panic attacks every day and is really struggling to cope with them.
We have been told that we just need to be there for her and support her and that she'll get better with time. Is this a normal reaction to what's she's experienced? Is there anything other we can do than just waiting for her to get better? To be honest, I just feel useless.
Sally: Please don't feel useless, your capacity to think about your daughter and her distress will be helping her, even though she is still anxious. It will get better. What you are describing can happen - she went through an extremely traumatic experience and she is trying to find a way of dealing with this, but clearly with thoughtful support.
LolaShh: My daughter has been diagnosed with a whole host of anxiety-related disorders and avoidant personality disorder. She's attended cognitive behavorial therapy (CBT) since she was 16, but currently she's at an in-between stage. She's now too old for Child and Adolescent Mental Health Services (CAMHS), but not old enough for the adult mental health services. What on earth can I do to help her? Are there any books you can recommend for either me or her, or just any advice would be welcome.
Sally: She shouldn't be too old for CAMHS - the service is funded through to age 18 and many areas have specialist young people/adolescent services. I would go back and talk to your GP about this, to see what's available in your area.
moosemama: My son is nearly nine, and was diagnosed with Asperger syndrome just last week. In addition to that, he suffers from really bad anxiety and is highly reactive emotionally (not violent, just angry - lots of shouting and meltdowns etc). Until recently, his anger was saved for home, where he felt safe, but it's now seeming to erupt at school more and more often and I can see this becoming a huge issue if things don't improve quickly.
Where should we go - or what route should we take to get him emotional support and help with understanding and handling his own emotions? He is a lovely, bright boy, but I fear without some help around handling his emotions he will never realise his potential. The assessment centre suggested we contact CAMHS, but we've already done that via our GP and been turned down flat, despite at the time having an extremely anxious, school-refusing eight year old. Is there anyone else out there that can help?
Sally: I am really sorry to hear that your son has not been offered support from CAMHS and it's really hard to understand why given your thoughtful description of his difficulties. Sadly, with reduced resources, CAMHS sometimes do have to make difficult decisions, but you are right to be concerned, there is considerable evidence to show that intervening early can make a big difference to outcome, and that waiting for a more serious problem to develop is not the most sensible response. At the Tavistock we run a specialist service for children and adults with autism/Autism Spectrum Disorder, on the NHS.
asdx2: Is depression in a teen with autism inevitable? Are treatments successful? How do you protect a child's self-esteem when they become aware of the disability?
Sally: It's not inevitable, but statistically is it more likely. Treatments can be successful, but they do need to take into account the contributing factors in the development of depression, sometimes it's to do with the wider system issues, like difficulty in relationships, across all areas in school, or home, and shouldn't be viewed as a purely 'biological', and therefore inevitable, problem. I agree that self-esteem issues can be a problem, but talking about and reflecting on these can help.
DottyDot: My first son is now nine years old and we've discovered over time he finds it very difficult to settle into school at the beginning of the academic year. He doesn't show it at school - the teachers love him because he loves order and processes (and gets lots of stars reminding them when it's time to do things), and academically, he's great, but at home we see how difficult it is for him. This year he started not being able to eat in September - almost forgot how to chew and swallow food and although he's much better now (it tends to ease up by December or January), he had several choking episodes at home, and is still taking around an hour to eat any meal.
Do you have any advice on how we can best prepare him for each September, starting in a new class, with a new teacher? Is it worth approaching the school in the July before, to talk to his new teacher? At the moment school are unaware he struggles, because it doesn't impact on them and we've debated about how much of a 'big deal' to make of it.
Sally: I think it's possible to prepare without it being a 'big deal' talking to the school in advance of the coming term is a sensible idea. Take the emphasis off the food during mealtimes: rewards around success will help.
wasuup3000: My daughter is in Year 7 at school. She has a non-verbal learning difficulty (assessed as significant 0.1 on her scores in WISC tests), selective mutism and, since a extended virus some weeks ago, has developed pains in her arms, legs, hands and joints in general.
She goes to a small, friendly secondary school, which she wanted to go to at first but now it seems that we are getting into the old 'I don't want to go' cycle that we have been on for two extended periods twice before. Every day she has a headache, feels sick or can't walk. I sometimes have to shove her out the door (she has home school transport). It is very draining just to get her off to school and she has three brothers, one who has ASD as well, who see this daily. Then she comes home upset, saying it's all my fault if she has had a bad day. Can you advise?
Sally: Your daughter is clearly showing her distress about something and it sounds like you have been working hard to try and support her. Is the school working with you to help her, sometimes having someone from school come to the home to talk through options, like shorter days, or support and counselling in school?
sickofsocalledexperts: Why it is that the behavioural methods of applied behaviour analysis (ABA) are so hated by the education and health establishments in this country, when they are so successful in helping autistic children like my son?
Every time I mention to one of the experts I come across that ABA is having good results in improving my son's concentration span, ability to learn, ability to talk and anti-social behaviours, they look at me as if I have just confessed to using witchcraft! Why is this country so against behavioural methods, whereas in the US, ABA is the absolute standard for young autistic children as an early intervention. Actually, the only exception to this universal prejudice is the nice clinical psychologist who I saw at CAMHS, who was very much more open-minded.
Sally: I can't really speak for all professionals, but I would take the view that each child with autism is an individual and different approaches work for different people; if it's help to you and him then that's great.
ellnlol: I'm an educational psychologist and regularly meet families where ASD or Asperger syndrome has been diagnosed or is suspected. While on a personal level I have a good relationship with several colleagues in CAMHS, we seem often to get into the situation of each agency saying 'it's not us, it's them', to address difficulties, especially around anxiety or non-attendance, which is no help to the families and frustrating and professionally embarrassing for the agencies.
We've been talking about 'joined up services' for years, but so many families still get let down. Where do we go next, and how do we make schools (especially in the secondary phase) more accessible, helpful, safe and enjoyable places for this increasing population of young people?
Sally: I agree that this can be a problem, and in times of even more pressurised resources, I guess it might be easier to hope that others are picking issues up. I also agree that this is not acceptable and that we know that outcomes are better for children where there is greater linking up. It's a big question indeed. For what it's worth, face-to-face contacts with the professional network at the beginning of involvement always helps me understand where other professionals are coming from.
Hammerlikedaisies: Do you think that mental health services are going to be able to survive the government's changes to the NHS?
Sally: This is a good question and one that child mental health professionals are concerned about. One of the main worries is that services to vulnerable children can be marginalised, particularly as children don't have a voice as adults in the same way. I guess it's our responsibility as parents and professionals to raise the need for good quality mental health services for children wherever possible. This is especially important for specialist CAMHS, for example, for children with disabilities or children in care, who have particular needs that cannot always be met in mainstream services.
crazypanda: We are having real problems with our school accepting our child's needs, which are currently awaiting diagnosis. The school punish him like a naughty child, but he can't help the things he does. Although I'm always on the phone to school, and at meetings, nothing ever gets properly sorted out.
Sally: I guess this might be a case of the school not really understanding his needs. Can you get the school to link up with the diagnosing professionals to get a better understanding of his needs?
HairyMaclary: I have a 5.10 year old son with moderate spastic diplegia CP, who is very aware of what is different about him already. He is academically bright, but socially and emotionally immature. Both his paediatrician and myself feel that he would really benefit from talking to somebody, as he does have 'meltdowns' and has started to become very anxious about the many hospital visits, especially any involving anaesthesia.
CAHMS have refused him three times and we have now been referred to the complex needs team but have been waiting for a response for over six months - we have chased them up! I can foresee that if he's not helped in managing his feelings and emotions now, it could easily cause problems in the future. We're very open at home but I feel he needs more, and we're not sure how to get this help for him.
Is there any particular type of therapy you could suggest? Is it worth giving him yet another set of people to see, probably in hospital which would add to time away from school and further emphasise differences? How can we access this help if the complex needs team refuse to see us?
Sally: Again, another very thoughtful question. It is worth helping your son access some kind of talking treatment, it doesn't have to be in a hospital, many CAMH services can be provided somewhere locally and even in school if this was appropriate. As to what you can do at home, it's hard to say if there would be anything more than you are already doing, which is being receptive to his needs and helping him prepare for things. Good luck with accessing help.