Q&A with clinical child psychologist Dr Angharad Rudkin about helping your child deal with new and challenging situations - ANSWERS BACK

[RachelMumsnet]

This week we have Dr Angharad Rudkin, a chartered Clinical Child Psychologist on hand to answer your questions on how to help children deal with difficult situations, for example divorce, separation, bereavement, house moves or starting school.  

Dr Rudkin has years of experience of working with children and their families who are experiencing difficulties ranging from toddler tantrums to family breakdown. She is also frequently consulted about child psychology issues by the media, including television and radio. Post your questions before midday Monday 16 September we'll post up her answers on Monday 23rd September. Everyone who posts a question will be entered into a draw to win a £40 hamper from Organix.

This Q&A is sponsored by Organix

[Holliewantstobehot]

Hi I have a nine year old son who has dyspraxia, struggling a lot with verbal processing. He has been very explosive and sometimes violent on and off for the last six months. I thought it was because he was stressed as he was not being supported at school, but he has just told me he has no friends and is being bullied at school. I am going to tackle this with his teacher tomorrow but would love to know how to support him. He has lost a lot of self confidence and is avoiding socializing 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 as he said he felt too anxious.

[NutcrackerFairy]

Hello, I have a 4 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.
However he then started to struggle - crying hysterically when I left him in the morning, started wetting and soiling himself at school [I think possibly due to stress and unfamiliarity with surroundings but also in the hope that I would be contacted to come and change him], having nightmares and waking up crying...

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

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

FWIW 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.

[bsc]

DD is 7, and just gone into junior school. She suffers with anxiety, and her behaviour is off the wall when she is anxious about things.
She is seeing CAMHS, but she won't engage with them (i.e. won't tell them anything that's true... everything she mentions is fantasy!) they aren't getting anywhere, and want to assess for AS.
WHich is fine, if she has AS, she has AS... but it doesn't help me help her with her anxieties!

How can I help her?
She is off the wall at the moment- going back to school, with new staff, new classmates, completely different routine has shaken her badly (despite doing a lot of preparation for it beforehand). She is stroppy, rude, having enormous meltdowns regularly, tears, screaming fits, stamping her feet, behaving maniacally.

She won't tell us anything, won't let us help her, won't admit anything is worrying her. She won't even write down worries, and put them in a box- she just writes that everything is fine.

I comfort her, and reassure her as much as is possible, we tell her we're here for her, will support her, will share her worries. I don't tell her off for her behaviour, as I know now she cannot control/help it- anxiety has taken over (apart form the rudeness- we reinforce how to speak to one another nicely, she knows how to, and until the last 3 weeks, almost always did).

She is so obviously very unhappy

[DrRudkin]

@insanityscratching

Dd 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 a little information given often but she finds it upsetting. She wasn't able to stay in the class for the whole of the puberty chat (given twice) even with TA support as she was so overwhelmed. It 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.
What should I be doing and how can I help her?

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 that this is what your daughter is doing. So, you are absolutely right in continuing to give a little information on a frequent basis, as this shows her that you are not also avoiding the issue and that you think it is manageable. Keep the conversation factual rather than emotional based, for example that body changes occur for a reason (i.e. to take us towards having children eventually), that the blood of periods is not the same as the blood from an injury, that periods will probably settle into a monthly pattern and will therefore become more predictable over time etc.

Take natural opportunities to have these short conversations as they arise, such as when you’re driving her to gym, 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 is 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 a grown up with ASD? It may be worth chatting with her about being an adult with ASD (possibly meeting with one, or at least reading about them on the internet) and the benefits of ASD (being focused, specialising in an area and therefore becoming an expert, seeing things from a different angle etc.) so that she can start to see that the place that puberty is taking her – adulthood- may not be so scary after all.

In terms of her fear of blood, this can be relatively easily treated through a few sessions of Cognitive Behaviour Therapy (CBT), so that may be worth thinking about in the future some time.

[DrRudkin]

@Punkatheart

My daughter's father left us two years ago and she went into shock, with 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.

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 risk taking 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, ignores and takes what is thrown at you. This does not mean that you can’t set clear boundaries of what is acceptable and non-acceptable behaviour (indeed, when life is un-predictable, having these clear boundaries is even more important than ever), just that she may well not 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 the behaviours are and acknowledging them with her (e.g. “When you run away I wonder if it is because you are feeling out of control and scared”). This may help her make more sense of what she is going through, and will help you to make sense of, and put up with, her aggressive behaviour.

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

However, 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. While waiting for counselling you can also chat to Relate (who help families in difficulties not just couples), Young Minds (www.youngminds.org.uk) and Gingerbread (www.gingerbread.org.uk). 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.

[DrRudkin]

@GrrArgh

My son is 9, an only child, and practically all his life has had trouble respecting physical boundaries. When he was a toddler, he was always the one who would just hit another kid with a stick for no reason. He bit and lashed out when angry. Now at his age, he is getting into repeated trouble and I am ashamed to say has recently bitten another child (in anger and defence as far as I am aware). He is highly verbal and lashes out with words too; he cannot not speak, he pipes up in class all the time and we've had to stop going to certain out-of-school activities because of his constant sarcastic interruptions and pushing other children.

At home his environment is calm and unchallenging and he plays in the street with other children happily, with minimal trouble. He's industrious and imaginative. We are moving house and school in the next few months, and he is not keen, but seems reasonable when we talk to him about it (we reassure him we will keep in touch with friends). However it coincides with a recent spate of incidents.

I don't want to label him as a bad kid (of course he is sweet and kind too), but this is the label he is using for 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 and 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 that. We have basically been dealing with the aftermath of him hurting other children all his life and we are at our wits' end.

What can we do? Please don't say explain to him the power of his words, explain to him that he can't do this, ground him, take his toys away: that is the only advice we have ever had and it has made no difference.

‘Something of a busy brain’ was exactly what I was thinking too 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 and who gets into quite a tizz sometimes, especially when in a group setting and away from home.

The combination of these characteristics (which I imagine he’ll have had since birth) with the proposed change of school and house will, I imagine, be influencing his current behaviour. Although you have clearly taken the time to talk to him about the moves and their consequences, and although when talking to you he probably does feel calm and ok about it, I imagine that outside of these conversations he may feel a bit unhappy and worries.

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. Of course, what these physical outbursts do is push people away, at the very time the he needs to be comforted. They also carry the risk of getting a reputation for being the “naughty” one, which only increases their feelings of sadness. 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 of 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 are often children who have other sensory idiosyncrasies such as liking noises to be really loud or really quiet, 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 perhaps) as some sensory training may help him get to know and understand his sensory prefernces.

I also wonder whether it would be worth further exploring the ‘busy brain’ comment by seeing a Clinical Psychologist for an assessment.

[DrRudkin]

@pickledsiblings

My son (aged 9) has dark/negative thoughts that he has been able to articulate well since about age 4. They are usually things that he doesn't want to think like that 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 for me.

Your son is clearly very articulate, and it sounds as if he enjoys a close relationship with both of you in which he can reveal his innermost thoughts. The kinds of thoughts he has expressed are relatively common in children – especially children who are more questioning and analytical (the “deep thinker” type).

Keep an eye out for changes in your son’s behaviour, such as changes in his sleep pattern, his appetite and his mood, as well as changes in behaviour (e.g. not wanting to go to football, refusing to go to school), which may suggest that the thoughts are troubling him more. If this occurs it would be worth going to your GP to chat over any concerns and to discuss if a referral to a specialist team would be of use.

Otherwise, I would encourage you just to keep offering him the opportunity to chat about his thoughts, and respond in a reassuring yet light hearted 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, keep your son busy with sports, activities and playdates as these will all help distract him temporarily from his internal world.

[DrRudkin]

@impecuniousmarmoset

My 5 yo DD has started reacting excessively to minor injuries (tiny cuts and bumps suchlike) - they send her into a panic attack, with extreme sobbing/howling and complete inability to get herself under control for extended periods (20mins+). She has other minor possible sensory issues (intolerance of sock seams and tight trouser bands, tendency to be v. passive socially, and withdraw totally in groups of children - totally fine one on one), but is otherwise happy and thriving. No particular major life upheavals otherwise, though we are expecting a third baby which she appears very happy about. We're at a loss with how to deal with these episodes - they are obviously extremely distressing to her, quite dramatic and apparently totally at odds with the actual pain involved. Any suggestions would be appreciated!

Your daughter sounds like a sensitive young girl who also lacks confidence socially. This can make being a 5 year old at school a difficult task at times. 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, as 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, so 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 now as much a habit, and a way of gaining reassurance and comfort from you, as anything else. You need to help her break the pattern between hurting herself and great distress. You could do this by chatting to her about hurting herself and what she can do to comfort herself, as well as what you – or another adult – can do to help. By agreeing a ‘plan of action’ for when she hurts herself, your daughter may feel less distressed and adrift when it happens. It may also be worth having a system of rewarding her when she copes ‘appropriately’ (and this is something you’ll have to agree with her e.g. only crying for 2 minutes) to 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. You could talk to your Health Visitor or GP about who could help with this.

[DrRudkin]

@InmaculadaConcepcion

Hello Dr AR!

My DD (3.5 yo) has a common but distressing problems - she withholds her stools. We're not sure what triggered it, but it went on for about a year before we got her onto a laxative programme, which she has been on for over nine months.

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

DD has to take two sachets of Movicol everyday to ensure regularity and frankly, 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?

Thanks!

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 really be quite a complicated one! The process of toilet training can account for this somewhat, but also our temperaments can influence it. Constipation tends to start after a child has had some very hard and painful poos, which leads to them not wanting to poo again so they withhold it. 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 physically more settled. Keeping her well hydrated, and eating lots of fruit will help her to maintain softer, more regular poos more naturally than taking the sachets. In terms of the more psychological aspects, there are certain things which can help to reduce the association of poo=anxiety. For example, 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 or 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 knowing it really, and this will be the start of a new pattern being set. Then, agree a date together of when she won’t have a nappy on any more. I know you will feel anxious abut this triggering withholding again, but if it does, by now you know how to manage this quickly. Star charts can be really useful at this age too, though they tend to only work for about two weeks at a time.

I know it is so very easy to say, and 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 light hearted 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.

[DrRudkin]

@Hopezibah

My son (aged 9) who has ASD 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 (sibling has changed schools) and a change of timetable too where we are doing things on different days. We know that change unsettles him - and we use things like social stories and going through plans with him, but then he still refuses to take part / join in / do what he's supposed to at the crucial moment.

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

It is worth mentioning that rewards or sanctions have very little effect on him.

thank you.

Your son is getting to an age when relatively easy going children can become harder to manage. When ASD is thrown into the mix, this can really be a difficult age to manage. Your son will be growing in awareness, both of his ability to say no to things, but also how he is different to non-ASD peers, and this will be having 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 (as creating order and predictability is a very natural way of protecting yourself against the anxiety brought about by uncontrollable events).

In answer to your question, yes, to a degree this behaviour can be managed, but not changed. You are already using good strategies with strong visual element, 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 to families of children with ASD. Often, tips from other parents are more valuable than 10 hours with a professional. Having said that, although NHS provisions are hugely dependant on the area you live in, 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 PDD or ODD. In the meantime, these periods of adjustment will always create an increase in hard-to-manage behaviour, but planning for them and adapting to their presence will help you all get through them.

[DrRudkin]

@theQuibbler

Hello - I 'd like to know if you are able to recommend any books that would give some ideas on how to deal with the issues my son will face, now and in the future. He's 7 and has mild educational learning difficulties, but he is now at the age where he is aware that he is different and he is getting teased by the other children. 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, hence the need for some strategies to concentrate on him, rather than my own anxieties.

Thanks,
TQ

There is a great website – //www.youthinmind.info – which provides a catalogue of books for different issues, each one 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 or more general self-esteem boosting books such as “Am I really different” by van Dart. As your son becomes more aware of his differences, it is really important to also help him focus on how he is the same as others too. Rounding off your bedtime chats with positives such as “3 things that went really well today” or “I am pleased I am me because….” will help your son to also understand that he can have nice chats with you without it having to be about a problem per se. If you still have some worries it may be worth having a chat with his teacher too 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 does feel good at will help minimise the slump these periods can bring about.

[DrRudkin]

@Holliewantstobehot

Hi I have a nine year old son who has dyspraxia, struggling a lot with verbal processing. He has been very explosive and sometimes violent on and off for the last six months. I thought it was because he was stressed as he was not being supported at school, but he has just told me he has no friends and is being bullied at school. I am going to tackle this with his teacher tomorrow but would love to know how to support him. He has lost a lot of self confidence and is avoiding socializing 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 as he said he felt too anxious.

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 well explain his explosive behaviour as, 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 isn’t understanding what others are saying sometimes, and he may be finding it difficult to express himself verbally, so will tend to show his feelings more physically.

I hope the meeting with his teacher went well. Schools can often bring in mentoring/buddy schemes to help children who are having a difficult time. At home, it would be worth asking your son who he does feel 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 e.g. play football in the garden, play a computer game, and 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, keep encouraging him to continue with other activities including swimming as this will maintain his confidence in those skills.

Continue to model confident social behaviour yourself so that your son can learn how to manage different social situations. 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.

[DrRudkin]

@Waswildatheart

My 11 year old DD gets extremely anxious about staying overnight anywhere without us. She really, really wants to, e.g. Go on an overnight school trip, and we book her on but she gets progressively more stressed so we have to cancel. 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? Year 7 whole year (school is making a big deal about everyone going) two night activity break is coming up in November so any guidance would be great please.

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 being separated for sleep overs and long school trips really doesn’t sit comfortably with everyone. It would be good for you to find out more about her anxiety – is she worried about being apart from you, and if so what does she think is going to happen to her or you if separated? Or, is she worried about being with her friends? These are two subtly different issues and one that can give you a clue as to how to tackle the anxiety.

However, either way, there are general factors to consider. Anxiety is always more intense on the run up to an event (“anticipatory anxiety”). Once we are in the dreaded situation, more often than not, our anxiety is far more manageable and we get through it. If we give in to the anticipatory anxiety, and don’t do the thing we have feared, we never find out that actually we can cope with it.

So, your daughter needs to practice not giving in to the anticipatory anxiety. It is best to start off small, so work out with your daughter who would be a good person to start thinking about having a sleep over with. Ideally, someone she trusts and who’s family she knows well, and who doesn’t live too far away. Set up with that friend a ‘sleep over trial’ with the understanding that if at any time she can come home. 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 both help her tackle her anxiety with commitment. As her confidence grows so will her armoury against anxiety and the braver she will feel. Your daughter, and you, need to know that she will be able to cope with being apart from you, and this is best done one small step at a time.

(NB It may be worth looking at a brand new website – www.mindfull.org – which offers information for 11-17 year olds on anxiety as well as other emotional issues. )

[DrRudkin]

@linspins

Hello. Like CC77 my dd has tics - for example blinking and rolling eyes sideways, making odd 'huffing' noises with her breath, touching her fingertip to her tongue, and clapping hands together, or slapping thigh. They come and go - she is also a fidget generally, and a bright child, a thinker too. I have seen a GP twice, both times told it's just a phase and nothing to worry about. But these tics can distress her, and can wear her out. We've tried to make sure there is nothing too stressful in her life, and tried lavender foot massages at bedtime. I wonder what causes tics and if there are ways to alleviate them?

Hello. Like CC77 my dd has tics - for example blinking and rolling eyes sideways, making odd 'huffing' noises with her breath, touching her fingertip to her tongue, and clapping hands together, or slapping thigh. They come and go - she is also a fidget generally, and a bright child, a thinker too. I have seen a GP twice, both times told it's just a phase and nothing to worry about. But these tics can distress her, and can wear her out. We've tried to make sure there is nothing too stressful in her life, and tried lavender foot massages at bedtime. I wonder what causes tics and if there are ways to alleviate them?

[DrRudkin]

@ThePFJ

My DS of 5 years old loves his vegetables which is a miracle I know....and is happy to try anything like a vegetable.... anything else and he screams the house down... we usually have to force it into his mouth, at which point he says 'Actually I like that'. But he forgets that every time we give him something new he likes it..... And I do not like having to 'make' him try things. We try to explain to him that it is important to try new foods.... but it's hard going.... Any advice?

Please Please Please??? Thank you so much xxxxxxxxxxx

I did smile when reading your question, as it really is the opposite of what I usually hear (usually it is trying to get them 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. 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 7, children are far happier to try new things. In between these ages, children tend to stick with what they know and be pretty risk averse when it comes to 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), but if he doesn’t then his main meal is not affected. If he experiences food and dinner times as being fun and social times, then as he grows up he is more likely to be curious and relaxed around new foods. So, keep it fun, 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!

[DrRudkin]

@bsc

DD is 7, and just gone into junior school. She suffers with anxiety, and her behaviour is off the wall when she is anxious about things.
She is seeing CAMHS, but she won't engage with them (i.e. won't tell them anything that's true... everything she mentions is fantasy!) they aren't getting anywhere, and want to assess for AS.
WHich is fine, if she has AS, she has AS... but it doesn't help me help her with her anxieties!

How can I help her?
She is off the wall at the moment- going back to school, with new staff, new classmates, completely different routine has shaken her badly (despite doing a lot of preparation for it beforehand). She is stroppy, rude, having enormous meltdowns regularly, tears, screaming fits, stamping her feet, behaving maniacally.

She won't tell us anything, won't let us help her, won't admit anything is worrying her. She won't even write down worries, and put them in a box- she just writes that everything is fine.

I comfort her, and reassure her as much as is possible, we tell her we're here for her, will support her, will share her worries. I don't tell her off for her behaviour, as I know now she cannot control/help it- anxiety has taken over (apart form the rudeness- we reinforce how to speak to one another nicely, she knows how to, and until the last 3 weeks, almost always did).

She is so obviously very unhappy

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 and it sounds as if you daughter has latched onto this as the only coping strategy for her worries.

It is important to realise that whether she has AS or not will have an impact on how you help her manage her worries as young people with AS have to live with often quite high levels of constant anxiety (after all, 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. However, 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 (easier said than done I know). 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 for her. I would hope that meetings in CAMHS will help her move towards an understanding, even if progress seems slow.

[DrRudkin]

@NutcrackerFairy

Hello, I have a 4 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.
However he then started to struggle - crying hysterically when I left him in the morning, started wetting and soiling himself at school [I think possibly due to stress and unfamiliarity with surroundings but also in the hope that I would be contacted to come and change him], having nightmares and waking up crying...

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

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

FWIW 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.

Oh dear, it certainly does sound as if your son is not enjoying being away from you and being at school right now. 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 time of adjustment, and this will also give your son the message that;
(1) going to school is something he has to do and that
(2) you and school are a team in helping him to do this. 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, so help them to do this by talking about what will happen when you pick them up at the end of the day e.g. that you need to go to the shop to buy some milk, you’ll go to the park or will cook his favourite dinner. Make sure that your son is getting to bed early enough to get a good sleep in, as tiredness reduces our capacity to cope with stress. Try not to dwell on school during the weekend and evenings to ensure that you enjoy rest time together.

I hope that since you wrote this question there may have been some progress as your son gets used to going to school. If not, do ask school for advice and support as 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.

[DrRudkin]

@SavoyCabbage

Hi, I emigrated to Australia when my daughters were 2 and 5. They are now 7 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. But that's another story.

They are going to leave everything they know. Their home. School. Friends. Possessions. It takes months for our things to be shipped.

When we came, my oldest was told to stand in the shade on her first day of school. She didn't know what shade was! Now they won't know about snow, dinner ladies, tights, phonics, bonfire night etc.

I want to know how to help them with the change and feel safe and secure when the only constant is me and each other.

This sounds like a big move for all of you, and one that still carries a lot of uncertainty with it. However, it is worth remembering that children are incredibly resilient and cope much better with change than we adults do. So it is possible that your worries are not necessarily their worries. Children have very sensitive emotional antennae, which are finely tuned to their parents’ stress and worries, however hard we try to hide our worries from 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, looking on the internet or reading in books about where you are going – what the weather will be like, what celebrations and special days there are. Focus on the similarities with Australia as well as the differences.

You are absolutely right – you will be their constant. This doesn’t mean that you have to have all the answers and be a perfect mum. You will just need to listen to, 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 will be a big time of change for all of you. Helping your children to focus on the opportunities this will create while supporting them with the challenges it will bring, can also make it an exciting time.

[DrRudkin]

@crowson

Hi,

My 5 year old daughter has trouble settling into some new situations. When she moved up to a new swimming class she was fine for a couple of weeks and then for the next 5 or 6 weeks would cry during every lesson and would always complain of having tummy ache on the morning of her lessons. She usually loves swimming and had been looking forward to the class. She has also recently started trampolining and was really looking forward to going, but when she got there wouldn't try anything and just cried for the whole hour.

She doesn't like not being able to do things and is quite a perfectionist. She also can't recognise that other children she sees may be older or more experienced and compares herself to them which upsets her as 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 try and explain to her what to expect, and try to encourage her by telling her that she has done well at swimming etc, but she still gets upset. How can I stop her from getting upset in these new situations?

I am pleased that your daughter is having no problems at school as that is a sure sign that she is functioning well in general. 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 lesson to start off with, but maybe as she saw others improving or getting things quicker than she did, her worries increased).

Perfectionism tends to run in families, and for perfectionists, life can be quite difficult at times. Good is never good enough and this can lead to perpetual feelings of worry, sadness and frustration. It is very important to model non-perfectionistic behaviour to your child.

For example, 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/most able all the time.

Also, 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. 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.

[DrRudkin]

@NomDeClavier

Ever since we moved house 3 months ago DS (2.5) hasn't used the toilet or the potty. He was doing really well, although not toilet trained, but now he sits on the potty or toilet and doesn't do anything. He usually soaks his nappy within 5 minutes of it being put on and asks for a change so he clearly needs to go. I can't help but think this is linked to the move, and also the fact we're expecting DC2 in December, and somehow this is stressing him but nothing seems to help him relax.

How can we help him adjust to the new toilet?!

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) and anticipating the change in the family, and 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 a bit more? 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, offering rewards that are important to him and immediate (e.g. sticker, time with you, a TV programme) will help his motivation. In more general terms, it may be that giving your son an opportunity to have some control over the new house will help him settle e.g. he can choose a new duvet set, or new colour for his room. Chat to him about the house move and about his new sibling while sitting drawing together or playing lego. 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 help him to feel free and relaxed (e.g. running in the park, swimming). He will adjust to the new toilet once he has adjusted to his new house and new family. Good luck.

[DrRudkin]

@EustachiaVye

Hello Dr Rudkin, My dd (aged 10) lost her grandfather suddenly three months ago. She was very close to him indeed and misses him terribly. Since his death, her attitude has worsened. She refuses to do what she is asked, but I'm not sure whether this relates to the bereavement or is part of her growing up (or both!) There have been a few incidents where she has wet herself.
I wonder whether a bereavement counsellor would help? I think my worry is that perhaps she will then dwell on her sadness even more. Sometimes she appears to be fine. 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 my concern is that I will miss some underlying fear that she has on her mind. Thank you for any advice you can offer.

Your poor daughter must be missing her Grandad an awful lot. Her wetting herself is a concrete sign of this distress. As you so 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 sometimes 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 a bereavement, some things do stay the same, and 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 and let her know that she can talk to you any time about his death and all the questions that it can bring up. 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 way that you describe then it may be worth asking her if she would like to chat over it with someone outside of the family. However, in the meantime, if you notice any significant changes in her sleeping, eating and mood that lasts 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.


By listening to your daughter and being a mum who has clear expectations of her but who understands that she is going through a hard time right now, you will be picking up on any worries and managing them well I bet.

[DrRudkin]

@thornrose

Hi, my dd is 13 and her dad died very suddenly 3 years ago. (She has AS which may or may not be relevant.) 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.

I just worry that she needs something I'm not giving her in order to help her feel a bit better.

I suppose I am asking if this seems "normal" or should I be looking at getting her some bereavement counselling?

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 will bring about 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 too as it will impact on how she thinks about things.


So, it is hard to know if this is “normal” or not. Being there for her as she moves through grieving process. My advice would be to trust your instinct as a mum and if you think that her grieving is impacting on her functioning significantly (e.g. stopping her from going to school or being with friends, or attending clubs) 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 (www.autism.org.uk) could offer some specific information around ASD (to help understand how this could be impacting on the process), and Winston’s Wish (www.winstonswish.org,uk) has a Helpline which you could call for more advice and support.

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

[DrRudkin]

@PenguinBear

I am a teacher and could really do with some advice about supporting a 4 year old child through the bereavement of his father. He seems to have no boundaries at home and his behaviour can be very erratic and would like to know how best to handle this?
Thank you!

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 day to day routines and care and house moves. The one constant for these children is school, 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 an reassurance even if he isn’t particularly chatty at times.


Children experience islands of grieving meaning that they can seem fine for a while before falling back into intense sadness, triggered either by something external or by a developmental change.

You have picked up that your pupil is suffering from a lack of boundaries at home (very common after a bereavement). It may be worth having a chat with his mother and other family members who are offering support, to think how you could all work together to get him through this academic year at least. Seemingly small practical changes can make big different, such as you putting a reminder note in his bag for mum to pack the PE kit, or having school lunches instead of packed lunches, or linking mum with another parent who can offer lifts to school. All of these realtively small practical changes can mean that there is more time (for your pupil and his mum) to process the intense emotions involved in grieving.

Winston’s Wish are a super charity that work with children who have been bereaved. Their website has an excellent section for schools on how to support bereaved children (www.winstonswish.org.uk). Best of luck to you.

[DrRudkin]

@CC77

Hi,

For as long as I can remember my son has had what I would call a 'tick', 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 e.g. 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. I have never been able to establish who I should see about this - I asked a health visitor when he was going through his blinking phase and she just referred me to an optician and didn't really get it. The actions become more pronounced around the start of a new school term (now) or in new situations where he is overwhelmed. Should I just accept this is comforting to him, or should I be addressing it? Many thanks.

Tics are relatively common at some point in a child’s life. However, 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. They feel a bit like sneezing; you have some control over it but when the urge is too great, you simply have to let it happen. Children describe feeling a build up to a tic, and, depending on how relaxed or stressed they are and where they are then can either hold it in or not. Somewhat confusingly with tics, the more stressed children are the more likely they are to tic, but also if they are very relaxed at home watching television, for example, they can tic a lot too then. Often, children can hold the 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. However, if a child’s behaviours are more like a compulsion to do something to stop a bad thing happening (e.g. 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) and is treated slightly differently. For both issues, there are medication options but the main form of treatment would be behavioural treatment i.e. teaching the child about the tics, finding out the risk times for them and learning how to manage and accept them. If you feel that your childrens’ tics are getting in the way of their 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.