Welcome to Where Parents Talk.

My name is Leanne Castellino.

Our guest today is a child and adult psychiatrist.

Dr.

Christine Crawford is also Associate Medical Director for the national alliance on Mental Illness, nami, the largest grassroots mental health organization in the United States.

She's also assistant professor of Psychiatry at the Boston University School of Medicine and a mother of two.

Dr.

Crawford is the author of a new book called you Are Not Alone For Parents, Parents and caregivers.

It's the second book in a series by NAMI.

Dr.

Crawford joins us today from Boston.

Thank you so much for taking the time.

Thanks so much for having me.

You Are Not Alone.

It's a very appropriately named book and certainly a series because so many families, so many youth, teens, tweens, young people are experiencing mental health issues.

Take us through what concerns you most about what you're seeing in your practice.

When we talk about the epidemic of.

Youth mental health, I think what concerns me the most when it comes to youth mental health is that our kids are really struggling and they're also struggling gaining access to the supports that they need and that there are significant delays in kids being able to get access to treatment such as medications or, or therapy.

And to know that there's such a shortage of youth mental health providers and all of that is contributing to the fact that there are a lot of kids out in the community who are really struggling with how to cope and they're lacking the tools to be able to navigate these challenging times that unfortunately our kids are growing up in.

So I really worry about that because kids are developing really severe symptoms of distress, whether it's being being very sad and depressed and then having thoughts about not wanting to be alive or being exposed to trauma and being struggling with ongoing thoughts related to that trauma without the intensive help and supports that they need.

So I worry about kids presenting to the emergency room in a state of crisis rather than getting the more immediate supports that they need in the community so that they don't have to present in a state of crisis and that making the that they engage in mental health care.

There is undoubtedly an ocean of information resources, tools on this topic out there.

What makes your book you're Not Alone for parents and caregivers different and stand out from the rest of the resources available.

With this book I wanted to create a one stop shop for caregivers, just one book, one resource that they could reach out to no matter which stage they are on in terms of their kids mental health journey.

So this book is relevant if you are just starting to develop concerns about your child's mental health, or you don't even have concerns about your child's mental health, but you want to know what to look out for.

And then also for people who have experienced a number of different ups and downs on their journey, and maybe their kid has more significant challenges.

So it's one book, one guide that parents can use and caregivers can use that can follow them over the course of the child's development.

Because this book really expands youth mental health starting as young as three years old and going up into the high school years and their young adult years.

Right.

So to be able to have one book where over time you can open up the book and say, all right, this is how things looked when my child was in elementary school, but now we're in high school and things look different, you can still use the same book.

The other thing about this book is that it doesn't focus simply on the diagnosis.

It doesn't focus on what is wrong with my kid.

And it's not a book to reach out to so you can diagnose your kid and feel as though you have the capabilities of a mental health professional and to know exactly what is going on.

There are a lot books like that that currently exist that focus on specific diagnosis, but the focus of this book is better understanding your child and their emotional states and their behavioral states.

And I do have a section where I have different groupings of how behaviors and moods can present, but it's really focusing on understanding your child, understanding how you can connect and communicate with your child who may be experiencing different emot and behavioral states.

And I think that connection part, how to communicate with your patient, your child, that is the most important part in this book and differentiates it from the rest.

Dr.

Crawford, it might surprise many parents, caregivers, and others listening to or watching this interview to hear you say as young as three years old.

When you talk about the different ages and stages of knowing you know how to handle potential mental illness issues with your child, Talk to us about what's happening and why we should be aware of this.

Let's say at the age of three, our child being three years old.

Yeah, you're right.

It oftentimes surprise parents when we talk about youth mental health.

For some reason, they think that mental health challenges really become more of an issue when the kid maybe is in middle school or in high school.

But really we see the manifestations of mental health problems very early on in life.

And it's because kids have emotions and they develop and understand those emotions over time, and they're lacking the tools and strategies for how to effectively manage those emotions.

They're going through all of this for the first time.

And so for some young kids, they may experience emotional changes at more intense levels compared to other people, but they're lacking the strategies and tools for how to manage that.

Right.

And so having conversations with your kids about their emotional state is really helpful because that gives them the tools that they can use to communicate their distress to other people.

So, for example, as young as three years old, kids are starting to learn about emotions.

They're learning how to.

To recognize different emotional states in other people.

And they're also learning about what different emotional states look like for themselves, what sort of thoughts they have, how do they feel in their body, and then seeing that reflected in the people in their lives and allowing them to kind of understand what all of these things mean.

And so empowering your kids with the.

The language to talk about their emotions is so helpful.

And you can start that at age 3, because that's when they're really picking up on different emotional states.

Building off of that, too.

Kids are constantly noticing us.

They're constantly watching and noticing all the adults in their lives.

And so it's important, starting as young as three or even younger, to model how it is that you talk about your mood state and how it is you talk about, what tools you use to kind of navigate different emotional challenges.

So, for example, if there is a child who appears to be very angry and they're irritable and they're acting out, and maybe they're four years old, you can say things to them.

Oh, well, I'm noticing that you're yelling a lot more, that you are tensing up your shoulders, and that you're scrunching up your face.

It looks like you're really angry.

You know, when I get angry, what's really helpful for me is to go outside and go for a run.

What are your thoughts about us just going for a walk?

Maybe that will make you feel and look less angry.

You can have that conversation starting as young as 3 and 4, and that could be really helpful and important modeling.

You know, I think it's such an important point that you've just made because depending on, you know, certain cultures, how you were raised, parents, especially of young children, tend to want to tell their kids how they're feeling or predict how they're feeling as opposed to asking them how they're feeling, which, as I'm hearing you describe it, you know, down the line, as you Go through different ages and stages with that child can turn into a bigger issue.

So what would you say to a parent then in terms of managing that listening as opposed to speaking first?

I know it's so hard because as parents, we're so accustomed to entering into problem solving mode and we're so used to just doing things for our kids.

A great example of this, and I'm kind of in the middle of this with my 3 and 4 year old.

I'm always in a rush, trying to get out of the house.

And so I'm dressing them, I'm the one putting on their shoes when really I should take a step back, have some patience and allow my children to kind of do that on their own.

But the reality is, for a lot of caregivers, we're just trying to get through the day really quickly.

And so if we see a problem, we call it out as a problem, we'll label it as a problem, and then we want to problem solve.

But we really need to take the time to kind of allow our children to engage and participate in this experience of understanding themselves, understanding why there may be some changes in their mood state, to understand why there may be some changes in how they're behaving, and to take the time to lean into those conversations.

They may not go as quickly as you like, but you might actually be surprised by what it is that your child shares with you.

So framing some of these conversations, such as coming from a place of curiosity and to say, you know, I've noticed these things and I'm really curious about what might be behind some of these things.

What do you think?

Why do you think it is that you are more worried about going to school?

Or I wonder why it is that you no longer want to go to gymnastics practice when you used to love going.

What are your thoughts about why it's different now?

And you might learn more about what it is that your kid experiences in their daily life.

There might be bullying or other forms of trauma, but it's important to have that curiosity, to have those conversations so you can learn what is really going on with your kid rather than assuming what is going on with your kid.

You talked about what you believe sets you are not alone.

Apart from the other resources that are available.

I'm curious as to the approach that you chose for this book.

Could you take us through that strategy?

Who did you interview and what did you learn?

So it was really important for me to connect with people with lived experience because they have gone through this mental health journey themselves.

When they were a kid growing up, currently, as a kid, as well as caregivers and teachers, they just learned so much along the way as they were going through this journey that I wanted to make sure to capture those experiences and to put them in the book, because a lot of people feel like they are the only families who are going through these things.

But to read the stories of other people who have lived through this, you feel less alone.

Right.

And that was really the premise of this book is to kind of validate the experiences of folks who are navigating the mental health system, which can be very overwhelming, as well as the distress that comes along with having a kid who is struggling emotionally.

And there are a lot of lessons learned from people who have gone through this.

So I wanted to make sure to have a resource available to share all those experiences with people.

So what I did was I interviewed over 80 people, a combination of teachers, caregivers, coaches, parents, as well as young adults and kids, actual kids who have experienced mental health challenges, or adults who have been supporting the mental health of their.

Their kids.

I conducted interviews over zoom for about an hour, and I learned so much from those conversations.

What I learned was that people were obviously concerned about what was going on, but they weren't all that focused on what exactly is wrong with my kid or what exactly is wrong with me.

But it was more about understanding how do I continue to live and to function and to interact with people, connect with my family.

Given all of these challenges that I'm experiencing with my mental health, what do I do outside of my appointments with my mental health providers, where you are spending the majority of your time, you know, in school and other places.

So I learned about the importance of providing tools and strategies for how to navigate all the other aspects of an individual's life who is living with a mental health challenge.

And then I also interviewed mental health experts who cover different backgrounds in terms of psychologists and pediatricians, just to show that, yes, we do have clinical experts, but also people with lived experience are experts too.

So it was nice piling all of that information together and putting it all into this book.

Let's talk a little bit about the science as it relates to youth mental health challenges.

Are there any aspects of the latest findings in this space that you think parents in general really need to know about?

What's important for parents to know is that mental health symptoms can appear early on in life, not just when they're a teenager, but early on in life.

And very significant mental health symptoms we're noticing, can appear in very young kids.

There's been some unfortunate data that has emerged over recent years that kids as young as five can develop thoughts around suicide.

And for many years, it was hard to even imagine that a kid as young as five would contemplate suicide or even attempt suicide.

But we have found that kids of color, especially our black kids between the ages of 5 to 12, are two times more likely to have suicidal thoughts and behavior compared to white children.

That is very alarming to know that suicidal behaviors can start at such a young age.

And we have someone in the book who has an experience in which they attempted suicide at the age of five.

And so it's important for parents to know that severe, serious symptoms can emerge early.

That's why being able to recognize and detect some of these red flag symptoms is so helpful.

And to get kids connected into care is incredibly important.

And to not delay, not delay at all recognizing symptoms.