Q&A with clinical child psychologist Dr Angharad Rudkin

Angharad RudkinDr Angharad Rudkin answered your questions on helping your child deal with new and challenging situations such as divorce, bereavment and starting school.

Dr Angharad Rudkin is a chartered clinical child psychologist. She has years of experience working with children and their families who are experiencing difficulties. These range from toddler tantrums to family breakdown.


Puberty

Q. Insanityscratching: My daughter is 10 and has ASD. She is just starting puberty and finding it very difficult to cope with her body changing. I have taken the approach of giving her a little information often, but she finds it upsetting. She wasn't able to stay in class for the duration of the puberty chat that was given twice at school, even with TA support, because she was so overwhelmed.

Her situation isn't helped by her sheer terror of blood, so she is on hyper-alert at the first mention of puberty because she is waiting for the mention of periods. How can I help her?

A. Dr Rudkin: Puberty can be a scary, unpredictable time for any young girl. Add on the preference that young people with ASD have towards things being controllable, predictable and regular, then no wonder puberty can be a particularly anxiety provoking time for them.

The natural way of dealing with something that leads to panic and worry is to avoid it altogether and it seems this is what your daughter is doing. Therefore you are absolutely right in continuing to give a little information on a frequent basis. This shows her that you think it is manageable but you are not avoiding the issue.

Keep the conversation factual rather than emotionally based. Discuss that body changes occur for a reason. Here are a few facts you could discuss about periods:

  • They take women towards having children eventually
  • The blood of periods is not the same as the blood from an injury
  • Periods will probably settle into a monthly pattern and will therefore become more predictable over time

Take natural opportunities to have these short conversations as they arise, such as when you're driving her or walking the dog. With teenagers, using these less threatening opportunities to have important chats can be more successful than sitting them down face to face and starting with: 'There's something we need to talk about.'

I wonder if your daughter is also worrying about what happens once she is out of puberty and is an adult with ASD? It may be worth chatting with her about being a grown-up with ASD. You could possibly meet with one, or at least read about them on the internet. Discuss the benefits of ASD such as:

  • Being focused
  • Specialising in an area and therefore becoming an expert
  • Seeing things from a different angle etc.

This will help her to see that the place that puberty is taking her, adulthood, may not be so scary after all.

If the facts about periods don't help her fear of blood, a few sessions of cognitive behaviour therapy (CBT) can help to treat it.
 

Behaviour

Q. Punkathart: My daughter's father left us two years ago and she went into shock. She had a lot of serious physical symptoms and then some very worrying mood issues. She has run away, taken drugs and threatened to kill herself.

I am ill myself with lymphoma and I am finding her beyond challenging. We are signed up for counselling but have been waiting for ages. The worst thing is her aggressive behaviour. How do I deal with aggression? I end up trying to ignore it and then I get cross myself.

A. Dr Rudkin: Your daughter has lost her father, and she is now living with the threat of losing her mother, too. It is likely that she will be feeling intense sadness, as well as fury at the unfairness of it and panic at her lack of ability to control these losses. This will translate into aggression towards you, the person she is closest to and risky behaviour such as drug taking and running away.

I'm afraid that as the adult in the relationship, you will have to be the one who walks away and takes what is thrown at you. This does not mean that you can't set clear boundaries of what is acceptable behaviour. When life is unpredictable, having these clear boundaries is more important than ever, even though she may not always be able to maintain the kinds of behaviour you would like right now.

If you have the energy to, it would be worth trying to figure out what the feelings behind her behaviour are. Try saying something like: 'When you run away, I wonder if it is because you are feeling out of control and scared.' This could help her make more sense of what she is going through. Plus, it will help you to make sense of her aggressive behaviour.

If you can spot when she is building up to being aggressive, try to nip it in the bud by chatting to her about it and/or distracting her. It will be easier for both of you to manage her emotions when they are less hot and overwhelming.

By being the resilient one in the relationship, you are going to be left with a lot of anger and sadness yourself, so it is important for you to get support through this time, too. You can try counselling or one of these resources:

Hopefully, your daughter will be able to access counselling through school, as well as through the NHS.

I wish you both the very best of luck. 

Q. GrrArgh: My nine-year-old son is an only child and has had trouble respecting physical boundaries for practically all his life. When he was a toddler, he was always the one who would hit another kid with a stick for no reason. He bit and lashed out when he was angry.

Now he is repeatedly getting into trouble. I am ashamed to say he has recently bitten another child. As far as I am aware, it was in anger and defence.

He is highly verbal and lashes out with words, too. He cannot be quiet and he pipes up in class all the time. We've had to stop going to certain out-of-school activities because of his constant sarcastic interruptions and pushing other children.

I don't want to label him as a bad kid because he is sweet and kind too but this is how he defines himself. It isn't malice as far as I can tell, it seems to be almost a compulsion to touch and push and hit.

For years when hugging me, he would run at me full pelt and barrel into me, hurting me many times. He hugs me with a horrible squeeze. I have talked to him about it all his life and he has only just been able to stop it. We have basically been dealing with the aftermath of him hurting other children all his life and we are at our wits' end.

He was assessed by EdPsych at age 4.7 and declared to be 'something of a busy brain'.

At home, his environment is calm and unchallenging. He happily plays in the street with other children, with minimal trouble. He's industrious and imaginative.

We are moving house and school in the next few months. He is not keen but seems reasonable when we talk to him about it. We reassure him that we will keep in touch with friends. I'm concerned because the plan to move coincides with a recent spate of incidents.

The previous advice we have received is to explain to him the power of his words, teach him what he can't do, ground him and take his toys away but it has made no difference. 

A. Dr Rudkin: 'Something of a busy brain' was exactly what I was thinking as I read your description of your son. He sounds to me like a very able young boy, but also one who might have a short fuse. He seems to get into quite a tizz sometimes, especially when in a group setting and away from home. I imagine that the combination of these characteristics, with the proposed change of school and house will be influencing his current behaviour.

You have clearly taken the time to talk to him about his behaviour and the consequences. He probably does feel calm and OK about it at the time, but I imagine that outside of these conversations he may feel a bit unhappy and worried.

Boys can display their worries differently to girls. They tend to talk about them less, look as if nothing is fazing them but will then suddenly have quite physical outbursts. Of course, what these physical outbursts do is push people away, when this is the very time he needs to be comforted.

If a child has frequent outbursts, he/she risks getting a reputation for being the naughty one and this only increases his/her feelings of sadness.

"Boys can display their worries differently to girls. They tend to talk about them less, look as if nothing is phasing them but will then suddenly have quite physical outbursts."

It might be worth taking this opportunity to offer your son some counselling. Not so that he can get another sticker chart but so that he can chat with someone outside the family about any worries he may have. It is much harder to engage an adolescent boy in therapeutic conversations, so now would be a good time.

There is a chance that your son experiences sensory stimuli differently to many others. Children who squeeze a bit too tightly often have other sensory idiosyncrasies such as liking loud noises or preferring the feel of a heavy blanket rather than a light duvet when in bed. It may be worth getting this checked out by a specially trained physiotherapist. Some sensory training may help him get to know and understand his sensory preferences.

I also wonder whether it would be worth further exploring the 'busy brain' comment by seeing a clinical psychologist for an assessment. 

Q. Pickledsiblings: My nine-year-old son has dark/negative thoughts that he has been able to articulate well since about age six. They are usually things that he doesn't want to think such as: 

  • He doesn't love us
  • He feels fake when he's well-behaved
  • He comforted his brother but actually didn't really care that he was upset etc

My husband and I have put it down to him being a deep thinker. I tell him that everyone has negative thoughts and to try not to dwell on them. Do you have any advice? 

A. Dr Rudkin: Your son is clearly very articulate. It sounds as if he enjoys a close relationship with you and your husband because he can reveal his innermost thoughts.

The kinds of thoughts he has expressed are relatively common in children, especially ones who are more questioning, analytical or deep thinkers.

Keep an eye out for changes in your son's behaviour, such as differences in his sleep pattern, his appetite, mood, as well as changes in behaviour, eg not wanting to go to football or refusing to go to school. These changes may suggest that the thoughts are troubling him more.

If this occurs, it would be worth going to your GP to discuss any concerns and see if a referral to a specialist team would be of use.

Otherwise, I would encourage you to just to keep offering him the opportunity to chat about his thoughts and respond in a reassuring yet lighthearted way.

Make sure that you also have long intense discussions about more positive things, so that your son doesn't feel that he can only have big chats when something is bothering him.

Also try to keep your son busy with sports, activities and playdates, as these will all help distract him temporarily from his internal world. 

Q. Impecuniousmarmoset: My five-year-old daughter has started reacting excessively to minor injuries such as tiny cuts and bumps. They send her into a panic attack, with extreme sobbing/howling and complete inability to get herself under control for extended periods of about 20 minutes or more.

She has other minor sensory issues, including intolerance to sock seams and tight trouser bands. She has a tendency to be very passive socially and withdraws totally in groups of children but she is fine-one-on-one. Besides these issues, she is happy and thriving.

She hasn't experienced any major life upheavals. We are expecting a third baby and she appears to be very happy about it.

We're at a loss with how to deal with these outbursts. They are obviously extremely distressing to her and apparently totally at odds with the actual pain involved. Any suggestions would be appreciated.

A. Dr Rudkin: Your daughter sounds like a sensitive young girl who also lacks confidence socially. This can make going to school a difficult task. I wonder if she is generally just feeling a little unhappy right now? I would like to know a little bit more about how she is at school and whether the teachers have noticed a change in her. This may throw some light on why, when she does feel some discomfort or pain, it is intolerable.

The unsettling effect of having another baby coming into the family can't be underestimated. It would be worth having some special time with your daughter to chat about this and to reinforce that she is special and unique.

It is likely that the original cause for this pattern of behaviour has been long forgotten and it is almost a habit. It could also be a way of gaining reassurance and comfort from you.

You need to help her break the pattern between hurting herself and great distress. You could do this by chatting to her about injuring herself and what she can do to comfort herself, as well as what you or another adult, can do to help. By agreeing to a plan of action, your daughter may feel less distressed when it happens.

It may also be worth having a system of rewarding her when she copes 'appropriately'. This is something you'll have to agree on with her, such as only crying for two minutes. This could help motivate her to change her behaviour.

In terms of her other sensory issues, if they intrude significantly on her functioning, it may well be worth pursuing an assessment to find out more about their range and possible causes. Talk to your GP about who could help with this. 

Q. Inmaculadaconception: My daughter, who is 3.5 years, withholds her stools. We're not sure what triggered it. It went on for about a year before we got her onto a laxative programme. She has now been on it for over nine months.

She is much better than she was. She has a bowel movement most days without too much trauma, but we still have to remind/cajole/negotiate/pressure her into going. She still insists on using a nappy, despite being potty-trained.

She has to take two sachets of Movicol everyday to ensure regularity. I would really like to be able to start reducing the dose and helping her move towards a better relationship with her BMs. Is there anything we can do? 

A. Dr Rudkin: I will refer to bowel movements as poo in this answer, as that is the word we tend to use when chatting to our children about it.

Our relationship with our bowels can be quite a complicated one. The process of toilet training can account for this somewhat but our temperaments can also influence it.

Constipation tends to start after a child has had some very hard and painful poos. They do not want to experience them again, so they withhold them. This just exacerbates the hardness of the next poo and leads to an increasing anxiety about going to the toilet.

It sounds as if you have done all of the right things in terms of getting her more physically settled. Eating lots of fruit and being well hydrated will help her to maintain softer, more regular poos naturally, instead of taking the sachets.

In terms of the more psychological aspects, there are certain things that can help to reduce her association of poo with anxiety:

  1. Give her a lot of time to just sit on the toilet and have a pleasant time. There is no pressure for her to produce anything necessarily. Sit with her and read books, blow balloons/bubbles or chat. This will make being on the toilet more fun.

    If you can time this period with when she would normally have a poo, then all the better. The aim would be for her to have a poo in the toilet without being too aware of it. This will be the start of a new pattern being set.
  2. I know it is so very easy to say yet so hard to do, but try as much as you can to not show your worry to her. Keep any chats and activities in the toilet lighthearted and fun. Make sure you chat to her about lots of things other than her bowel movements and help boost her confidence in other areas of her life. It really won't be a problem for ever.
  3. Agree on a date together for when she won't have a nappy on anymore. I know you will feel anxious abut this triggering withholding again. If she reverts, you now know how to manage this quickly.
  4. Star charts can be really useful at this age too, though they tend to only work for about two weeks at a time.
     

Socialising

Q. Hopezibah: My nine-year-old son has ASD and has become increasingly unmanageable. We get no support or advice from anyone and I am at a loss what to do.

We think it is because of changes relating to other family members. His sibling has changed schools. We've also changed our timetable, so we are doing things on different days. We know that change unsettles him, so we go through plans with him and use social stories to try to ease his anxiety. Despite these techniques, he still refuses to do what he's supposed to.

Rewards or sanctions have very little effect on him.

Is this a behaviour that can be managed or could there be a further diagnosis needed like PDA or ODD?

A. Dr Rudkin: Your son is getting to an age when even relatively easy-going children can become harder to manage. When ASD is thrown into the mix, it can make things more difficult. Your son is becoming more aware of his ability to say no to things and how he is different to non-ASD peers. This will have an impact on his well-being.

As you so rightly said, the changes that have occurred recently will really throw him. As his anxiety levels increase, so will his rigidity. Creating order and predictability is a very natural way of protecting yourself against the anxiety brought about by uncontrollable events.

This behaviour can be managed to a degree, but it cannot be changed. You are already using good strategies to manage it with strong visual elements, like social stories.

You say that you have had no advice but it is so important when trying to cope with these difficulties to get all the support you can. I would recommend that you get in touch with the National Autism Society who can offer support, activities and information.

Often, tips from other parents are more valuable than 10 hours with a professional. Having said that, it may be worth finding out if you could get any support from your local Child and Adolescent Mental Health Service (CAMHS). They would also be able to advise you on other diagnoses, such as Pervasive developmental disorder (PDD) or Oppositional defiant disorder (ODD). NHS provisions are hugely dependent on the area you live, but do research it.

"As his anxiety levels increase, so will his rigidity. Creating order and predictability is a very natural way of protecting yourself against the anxiety brought about by uncontrollable events."

In the meantime, these periods of adjustment will always create an increase in hard-to-manage behaviour but planning for them and adapting will help you all get through them. 

Q.TheQuibbler: My son is seven and has mild educational learning difficulties. He is now at the age where he is aware that he is different and the other children have started teasing him.

He is usually a jolly little lad but we have started to have bedtime chats where he is sad and heartbreakingly philosophical about how he has to play on his own because no one will play with him.

I want to help him build up his own confidence but I am naturally anxious and over-protective. I need some strategies to concentrate on him, rather than my own fears.

Can you recommend any books that would give me some ideas on how to deal with the issues my son will face now and in the future? 

A. Dr Rudkin: Youth in mind is a great website that provides a catalogue of books for different issues. Each one is read and reviewed by professionals. It would be worth browsing through the titles to see if one catches your eye.

For example, there is the Survival guide for kids with learning differences by Fisher and Cummings. There are more general self-esteem boosting books such as Am I really different by van Dort.

As your son becomes more aware of his differences, it is really important to help him focus on how he is the same as others. Rounding off your bedtime chats with positive discussions such as: three things that went really well today or 'I am pleased I am me because...' These will help your son to also understand that he can have nice chats with you without them having to be about a problem per se.

If you still have some worries, it may be worth having a chat with his teacher to check that there haven't been any significant changes in his behaviour and mood at school. Children can move in and out of periods of concern about being different. It is all part of their growing awareness of themselves and others. Keeping your son's confidence boosted by doing things he feels he's good at. This will direct his attention to something enjoyable. 

Q. Holliewantstobeh: I have a nine-year-old son who has dyspraxia and is struggling with verbal processing. For the last six months, he has had periods of been very explosive and sometimes violent.

He has just told me that he has no friends and is being bullied at school. 

He has lost a lot of self-confidence and is avoiding socialising with any of his peers. He even hid behind me and wouldn't say hello to a boy from his school at the pool on Saturday. He said he felt too anxious. I would love to know how to support him.

A. Dr Rudkin: Your poor son. It is crushing to be teased and bullied by peers, especially when you are not that self-confident anyway.

The peer difficulties may explain his explosive behaviour. Having bottled it all in at school, he will express his frustration and anger at home, where he is more relaxed.

If he has verbal processing difficulties, it is possible that he doesn't understand what others are saying sometimes. He may be finding it difficult to express himself verbally, so he may show his feelings more physically.

Schools can often bring in mentoring or buddy schemes to help children who are having a difficult time.

It would be worth asking your son who he feels he gets on with. Then invite that one person to your house for a short playdate. Help your son plan what they are going to do, eg play football in the garden or playing a computer game. Keep a close eye on how it is going. This will maximise the chances of the playdate being a success, thus boosting your son's social confidence.

In the meantime, here are a few suggestions to maintain your son's self-esteem:

  1. Keep encouraging him to continue with other activities, eg swimming.
  2. Continue to model confident social behaviour yourself, so that your son can learn how to manage different social situations.
  3. At the end of each day, ask your son to write down or tell you three things that he did really well that day. This simple technique has been found to have quite significant effects on mood and is a nice way of rounding off the day.
     

Separation anxiety

Q. Waswildathart: My 11-year-old daughter gets extremely anxious about staying anywhere overnight without us. She really wants to go but then becomes increasingly anxious as the day approaches.

For example, she wants to go on an overnight school trip, so we book her on. She gets progressively more stressed so we have to cancel. It's the same with sleepovers. She is very self-conscious about this and has been teased a little at school. We would not worry if she didn't but she feels like she is missing out.

Are we best stopping all plans, trying to break her in gently or are there strategies that could help? The Year 7 two-night activity break is coming up in November and the school is making a big deal about everyone going, so any guidance would be great please.

A. Dr Rudkin: Your poor daughter is not alone, although she may feel like she is right now. She is still very young and the modern preoccupation with sleepovers and long school trips really doesn't sit comfortably with everyone.

It would be good for you to find out more about her anxiety:

  1. Is she worried about being apart from you? If so, what does she think is going to happen to her or you if separated?
  2. Is she worried about being with her friends?

These are two subtly different issues and can give you a clue as to how to tackle the anxiety. Either way, there are general factors to consider:

  • Feelings of unease are always more intense in the run-up to an event. It is anticipation anxiety. Once we are in the dreaded situation, more often than not, our nerves are far more manageable and we get through it.
  • If we give in to our nerves and don't do the thing we have feared, we never find out that actually we can cope with it. Therefore your daughter needs to practise not giving in to the anticipatory anxiety.
  • It is best to start off small. Work out with your daughter to  figure out who would be a good person to have a sleepover with. Ideally, it should be someone she trusts, who's family she knows well and who doesn't live too far away.

Set up a sleepover trial, with the understanding that she can come home at any time. If she lasts an hour, then that is an hour more than she had done previously. If she lasts the night, then she has really started to break the bonds of her anxiety. Helping her to focus on a reward for doing this and talking to her about how strong and brave she is, will help tackle her anxiety.

As her confidence grows so will her armoury against nerves and the braver she will feel. In time, your daughter, and you, will learn that she will be able to cope with being apart from you.

It may be worth looking at www.mindfull.org. It is a new website that offers information for 11 to 17-year-olds on anxiety as well as other emotional issues.
 

Tics

Q. CC77: For as long as I can remember, my son has had what I would call a tic or an action that he repeats obsessively in times of stress. Whenever one action appears to have stopped, it is not long before I notice he is doing something else with the same sort of compulsion. 

For a few months it was blinking, then it was compulsively wiping food into his hair. The most dramatic was taking big gulps of air mid-sentence and currently it is licking his finger and wiping it on a part of his body.

The actions become more pronounced around the start of a new school term or in new situations where he is overwhelmed. Should I just accept this is comforting to him, or should I be addressing it?

I have never been able to establish whom I should see about this. I asked a health visitor when he was going through his blinking phase. She just referred him to an optician and didn't really get it was a tic. Any information would be appreciated. 

A. Dr Rudkin: Tics are relatively common at some point in a child's life. If they become constant and start interfering with life, then it would be worth meeting with a professional to find out more about them.

Basically tics are involuntary movements. Children describe feeling a build-up to a tic. They feel a bit like sneezing. You have some control over them, but when the urge is too great you simply have to let it happen. Sometimes you are able to manage them, depending on how stressed you are and your location.

The more stressed children are, the more likely they are to tic. However, tics are can often occur when children are very relaxed, eg at home watching television. Children can hold their tics in at school but as soon as they are at home or in the toilet at break time, the tics come out in a flurry.

Tics can be part of a disorder called Tourette's syndrome, which covers a large spectrum of behaviour from small single motor and vocal tics to much larger complex tics.

If a child's behaviours are more like a compulsion to do something to stop a bad thing happening, eg jumping up and down 10 times to stop something bad happening to mum and dad, then that is more likely to stem from an anxiety based difficulty such as obsessive compulsive disorder. This is treated slightly differently.

For both issues, there are medications but the main form of treatment would be behavioural. This would cover:

  • Teaching the child about tics
  • Finding out tic risk times/locations
  • Learning how to manage and accept them

If you feel that your child's tics are getting in the way of his functioning, ask your GP for a referral to a specialist Child and Adolescent Mental Health Service (CAMHS). There may be a bit of a wait to be seen but the professional there should be able to advise you on the best treatment, if any is required.


Bereavement

Q. PenguinBear: I am a teacher and could really do with some advice about supporting a four year old through the bereavement of his father. He seems to have no boundaries at home and his behaviour can be very erratic. What is the best way to handle this? 

A. Dr Rudkin: What a sad situation. When a child experiences a bereavement of a parent, there is so much that they have to deal with, in addition to the immense loss of a person. Often there are financial issues, changes in daily routines and care, and house moves.

School is the the one constant for these children and the structure and familiarity it provides should not be underestimated. It is important to talk about the loss with your pupil. Often people worry about talking about death in case they upset the grieving person more. Believe me, it is more upsetting for the grieving person to not be asked about their experience. Continuing to check-in with your pupil will offer him comfort and reassurance, even if he isn't particularly chatty.

Children experience islands of grieving. This means that they can seem fine for a while before falling back into intense sadness. It can be triggered by something external or by a developmental change.

You have picked up that your pupil is suffering from a lack of boundaries at home, which is very common after bereavement. It may be worth having a chat with his mother and other family members who are offering support and figure out how you could all work together to get him through this academic year.

Seemingly small practical changes can make big a big difference, such as you putting a reminder note in his bag for mum to pack the PE kit, having school lunches instead of packed lunches or linking his mum with another parent who can offer lifts to school. Implementing relatively small practical changes like these, will mean that there is more time for your pupil and his mum to process the intense emotions involved in grieving.

Winston's Wish is a super charity that works with children who have been bereaved. Its website has an excellent section for schools on how to support bereaved children. 

Q. Thornrose: My daughter is 13 and her dad died very suddenly three years ago. She seems to be at the same point with her grief and I expected it to have become less raw as the years went on. She has AS, which may or may not be relevant.

I worry that she needs something to help her and I'm not giving her. Is her behaviour 'normal' for a bereaved person or should I be looking at getting her some counselling? 

A. Dr Rudkin: Children grieve slightly differently to adults, in that they will almost re-experience the grief as they enter another stage of development. Your 13-year-old daughter is entering adolescence, which is a stage of introspection and analysis. This brings new ways of thinking and new emotions. Her bereavement will be re-evaluated and will need to be coped with in light of this.

I think AS will have a bearing on the process of grieving, as it will impact how she thinks about things.

"Children grieve slightly differently to adults, in that they will almost re-experience the grief as they enter another stage of development."

It is hard to know if this is 'normal' or not. My advice would be to trust your instinct as a mum and if you think that her grieving is impacting her functioning significantly, eg stopping her from going to school or being with friends, then chat to her about whether she would like to meet with someone outside the family to talk through her feelings.

The National Autism Society could offer some specific information around ASD and help understand how this could be impacting on the process. Winston's Wish has a helpline that you could call for more advice and support.

I hope that you are getting the support you need, both physically and emotionally, to get through this difficult time. 

Q. Eustachiavie: My daughter, aged 10, lost her grandfather suddenly three months ago. She was very close to him indeed and misses him terribly. Sometimes she appears to be fine but her attitude has worsened since his death. She refuses to do what she is asked. I'm not sure whether this relates to the bereavement, is part of her growing up or both.

She has had fears that I didn't anticipate. For example, she worried that his grave would get overgrown. She was reassured when I explained that the gravel would stop grass growing, but I'm concerned that I will miss some underlying fear that she has on her mind.

There have also been a few incidents where she has wet herself.

Would a bereavement counsellor help? My worry is that with therapy, she will then dwell on her sadness even more. 

A. Dr Rudkin: Your poor daughter must be missing her grandfather an awful lot. Her wetting herself is a concrete sign of this distress.

As you rightly say, his death has coincided with her entering a stage of increased attitude and pushing of boundaries anyway. It is so important that you maintain very clear expectations of her behaviour, so that in the midst of her sadness, she is still aware of what she can and can't get away with.

She may well still push the boundaries and may do this just to test if you really do mean what you say. All of this doesn't mean that you can't acknowledge and sympathise with her sadness and crossness at her grandfather's death. What you will be doing is letting her know that in the midst of an enormous change such as bereavement, some things do stay the same. This can bring comfort to children.

Children do not grieve in a linear way. They will move in and out of periods of grief. All you can do as a mother is offer her support and care through these periods. Let her know that she can talk to you at any time about his death or anything related to it. Your daughter is still very early on in the grieving process and I do not think there is any danger in talking about it whenever she wants. This will not lead to her dwelling on it in an unhealthy way.

I would give her a few months and if she is still struggling in the same way that you describe, then it may be worth asking her if she would like to chat with someone outside of the family.

If you notice any significant changes in her sleeping, eating and mood that last for more than a couple of weeks, it may be worth chatting to someone about it. Your GP can be a good first port of call.

If you can balance having clear expectations of your daughter with listening to her and understanding that she is going through a hard time right now, you will be picking up on any worries and managing them.


Moving and other new situations

Q. Nomdeclavier: Ever since we moved house three months ago, my 2.5-year-old son hasn't used the toilet or the potty. Prior to the move, he was doing really well, although he was not toilet trained.

Now he sits on the potty and doesn't do anything. He usually soaks his nappy within five minutes of it being put on, so he clearly needs to go.

I can't help but think this is linked to the move and the fact that fact we're expecting another child in December. This is stressing him out but nothing seems to help him relax.

How can we help him adjust to the new toilet? 

A. Dr Rudkin: You have got a lot going on. Children often show their worries or sadness through changes in toilet, eating or sleeping behaviours. Your son is adjusting to the new house and new toilet. Plus, he is anticipating the change in the family. This may well be causing a regression in his behaviour.

Have you thought about putting potty training on hold until you have all settled into the house? Taking the pressure off him, as well as you, may well mean that you are both more ready for the process when you decide to go for it again.

When you do go for it, try offering immediate rewards that are important to him, eg stickers, time with you, watching a TV programme, because this will help his motivation.

Offering your son an opportunity to have some control over the new house could help him settle. For example, he could choose a new duvet set or new colour for his room.

Chat to him about the move and his new sibling while drawing or playing together. This will also help him start to make sense of the changes. Make sure that he continues to do the things he enjoyed previously and that make him feel free and relaxed, eg running in the park, swimming. He will adjust to the new toilet once he has adjusted to his new house and new family.

Q. Savoycabbage: I emigrated from Australia when my daughters were two and five. They are now seven and 10 and we are going back in December.

I'm worried about the transition for them, especially as my husband has been refused a visa.

They are going to leave everything they know: their home, school, friends, possessions, etc. Plus it takes months for our things to be shipped.

The only constant they will have in their lives is me and each other so how do I help them feel safe and secure with the change? 

A. Dr Rudkin: This sounds like a big move for all of you and one that still carries a lot of uncertainty. 

It is worth remembering that children are incredibly resilient and cope much better with change than adults do. It is possible that your worries are not necessarily their worries.

Children have very sensitive emotional antennae, which are finely tuned to their parents' worries, however hard they try to hide them.

For this move to be as successful as it can, the key is in the preparation. Ask your children what worries they have, if any and think together about how you can help them manage those worries.

Information is a great protector, so look on the internet or read in books about where you are going. Find out what the weather will be like and what celebrations and special days there are. Focus on the similarities as well as the differences.

You are absolutely right that you will be their constant. This doesn't mean that you need to have all the answers and be a perfect mum. You will just need to listen and be open to their concerns and questions.

Once you have moved, try to keep as many of the familiar family routines going so that there is some predictability in their day. This is also an exciting time, so help your children focus on the opportunities the move will create while supporting them with the challenges.

Q. Crowson: My five-year-old daughter has trouble settling into some new situations. When she moved up to a new swimming class, she was fine for the first few weeks. Then for the next five lessons she would always complain of having tummy ache in the morning, then cry during her classes. She usually loves swimming and had been looking forward to the lessons.

She has also recently started trampolining. She was excited about going but when she got to the class, she wouldn't try anything and just cried for the whole hour.

She is quite a perfectionist and doesn't like not being able to do things. She can't recognise that the other children she sees may be older or more experienced and compares herself to them. It upsets her that she isn't as good as them in her eyes, although she is more than capable.

She started school last September, along with a couple of friends and has had no problems there.

I encourage her by telling her that she has done well at swimming etc and I explain to her about realistic expectations but she still gets upset. How can I stop her from getting upset in these new situations? 

A. Dr Rudkin: I am pleased that your daughter is having no problems at school, as that is a sure sign that she is generally functioning well.

It sounds to me that it is not so much the newness of the situation but the newness of the skill that she struggles with. For example, she was fine in swimming lessons to start off with but maybe as she saw others improving or getting things quicker than she did, her worries increased.

Life can be quite difficult for perfectionists at times. Good is never good enough and this can lead to perpetual feelings of worry, sadness and frustration.

Perfectionism tends to run in families. It is very important to model non-perfectionistic behaviour to your child, eg making a wonky cake, being really bad at kicking a ball but still giving it a go, not being able to speak a language well but still asking for something in that language on holiday. Each time your child sees this, they will be learning that you don't have to be the best all the time.

Praising effort rather than achievement is one of the most important things we can do as parents. This helps to promote a healthy curiousness rather than a fear of new things.

Most of us really do prefer doing things that we feel good at rather than things that make us feel uncomfortable, so make sure that your daughter does a combination of new things that push her comfort zone boundaries and familiar old things that help keep her confidence boosted.

"Praising effort rather than achievement is one of the most important things we can do as parents. This helps to promote a healthy curiousness rather than a fear of new things."

Perfectionism really is an unachievable goal and therefore one that we shouldn't even entertain. Your daughter will find this out over time but it is important that she gets through the discomfort this brings about. Reinforce to your daughter through chatting, modelling and activities that trying our hardest, whatever the results may be, is the key to being happy and successful.


School 

Q. Nutcrackerfairy: I have a four-year-old son who has just started primary school. He was fine the first day as I think he saw the experience as a novelty. Then he started to struggle. He cried hysterically when I left him in the morning and he's started wetting and soiling himself at school. I think possibly due to stress and unfamiliarity of the situation but also in the hope that I would be contacted to come and change him. We have had to come and collect him early three days in a row as he was not settling at all but just sitting and crying. At home, he's having nightmares and waking up crying.

Do you have any advice on how we can help him adjust to school? 

A. Dr Rudkin: I personally think that four year olds are too young to go straight to 9am to 3.15pm days at school but this seems to be the norm for the state schools local to me.

It certainly does sound as if your son is not enjoying being at school, away from you. It is a massive adjustment for both you and him. It is important that you work with the school to figure out a way through this adjustment. This will give your son the message that:

  1. Going to school is something he has to do.
  2. You and the school are a team in helping him to do this.
  3. Be positive about school when you are with him. When you drop him off, smile and wave merrily, even though I imagine as you turn the corner you will be trying hard not to cry.

It can really help a child to have a sense that the day at school will come to an end. Reinforce this by talking about what will happen when you pick him up at the end of the day, eg that you need to go to the shop to buy some milk, you'll go to the park or will cook his favourite dinner.

Try not to dwell on school during the weekend and evenings to ensure that you enjoy rest time together.

Make sure that your son is getting to bed early enough to get a good sleep, as tiredness reduces our capacity to cope with stress.

Hopefully, he will make some progress adjusting to school, given some time. If not, do ask his school for advice and support. He will not be the first one they've seen who struggles with the adjustment, however he is your first one to struggle, so make sure that you also get the support you need from friends and family. 

Q. BSC: My daugher is seven and has just started junior school. She suffers with anxiety and her behaviour is off the wall when she is anxious about things.

The new people and completely different routine has shaken her badly, despite us doing a lot of preparation for it beforehand. She is stroppy and rude. She has enormous meltdowns regularly with tears, screaming fits, stamping her feet, and maniacal behaviour.

I comfort her and reassure her as much as is possible. We tell her we're here for her, will support her and will share her worries. She won't tell us anything and doesn't admit anything is worrying her. Therefore she won't let us help her. She won't even write down her worries and put them in a box. She just writes that everything is fine.

I don't tell her off for her behaviour. I know now she cannot control it and that the anxiety has taken over.  This excludes her rudeness. We reinforce with her how to speak to one another nicely. She knows how to and almost always did previously.

She is seeing CAMHS but she won't engage with them. She won't discuss anything factual; everything she mentions is fantasy. Since they aren't getting anywhere, they want to assess her for AS. I'm fine with this, but how do I help her deal with her anxiety? She is so obviously very unhappy.

A. Dr Rudkin: It must be very difficult for you all. It sounds like your daughter really is struggling to understand her emotions, let alone what to do with them. We all tend to avoid thinking about things that make us feel uncomfortable. It sounds as if you daughter has latched onto this as the only coping strategy for her worries.

Figuring out whether she has AS or not is important because it will an impact on how you help her manage her worries. Young people with AS have to live with quite high levels of constant anxiety. They are living in a world that quite frequently makes no sense to them. 

The more anxious we become, the more controlling we are. It sounds as if your daughter is desperately trying to make the world more predictable and her emotions more manageable by only doing things her way.

This is incredibly hard as a parent to deal with. Reinforcing how brave she is and how she has managed before may help.

When she does start losing her cool, it is very important that you try hard to manage your emotions so that you don't add to the emotional fizz. This is easier said than done.

It may well be that your daughter doesn't actually know what it is that is worrying her, or she may genuinely be finding it very hard to put into words what is going on. I hope that meetings in CAMHS will help her move towards an understanding, even if progress seems slow.
 

Food

Q. ThePFJ: My five-year-old son loves his vegetables and is happy to try any type, which I know is a miracle. If we suggest he try any new food that isn't a vegetable, he screams the house down. We usually have to force the food into his mouth. Then he admits he likes it. The problem is he forgets he like's new foods after he tries them.

I do not like having to force him try new things. We try to explain to him that it is important to try different foods but it's hard going. Do you have any advice? 

A. Dr Rudkin: I did smile when reading your question, as it really is the opposite of what I usually hear. Usually it is trying to get children to eat a vegetable that is causing the difficulty.

As you well know, the dinner table is a perfect setting for a power struggle. If you care more about what they eat than they do, this is fertile ground for a game. Ask yourself:

  • What is it you would like your child to eat more of?
  • Is this for his health or just for his experience?

It is thought that up to the ages of 18 months and after the age of seven, children are far happier to try new things. In between these ages, children tend to stick with what they know and be averse to try new foods.

Each time he eats, you could present your son with an explore plate, alongside his usual dinner plate. If he tries something off his explore plate, he will get a treat. It is important that your son agrees with you what this treat will be. If he doesn't try something, then his main meal is not affected.

If he experiences mealtimes being fun and social, he is more likely to be more relaxed and curious about trying new foods. Make sure you model trying new foods in a positive way and take satisfaction in the fact that he is eating a load of vegetables.
 

Last updated: over 1 year ago