Helping Children with
Emotional and
Behavioral Issues
Jason Duffy, PhD
Assistant Professor - Syracuse University
Therapist – Rochester, New York
Raising Children
 It is easy to raise children, just look at the pictures and
hash tags on Face Book!
FB Hash Tags:
#LoveMyLittleBlessings
#I’mCompleted
#WantMoreChildren!!
Raising Children
 Some Face Book pictures and hash tags that folks
forgot to post!
Corrected Hash Tags:
#WhatWasIthinking?
#IsMyChildPossessed?
#MeetMeAtTheNewJeremiah’sIn10Minutes
Case Study
 According to his parent’s, Jack is a sophomore in high school and
has always done well academically but has also historically
struggled to create strong connections with others – he has only two
friends he sees regularly. When not studying, Jack likes to play video
games such as Pokémon and what he calls “nerdy” card games. He
rarely comes out of his room unless he is going to see his girlfriend,
Jessie, (they have been together for about two months) or one of his
two friends, Joe and Kevin – both of whom are two years younger
than Jack – 7th graders. Two weeks ago his girlfriend told a teacher
that she was concerned about him because Jack said he does not
like his life and is not sure if he wants to go on living. Later he told her
he was only “messing around” but she was still scared by what he
said. Jack had also told her that “nothing really makes me happy
these days – I’m just bored.” Jack’s parents also report that Jack
started wearing long-sleeve shirts recently and that his mom had
noticed what looked like “kinda deep scratches” on his right arm
one day when he was not wearing a long sleeve shirt. When she
asked him what happened, he said that he had just got caught on
some branches in the woods. He has also missed the due date for
several assignments in school over the past four weeks (very unusual
for Jack) and has become very irritated and, more recently,
unresponsive verbally with his school counselor and teachers when
they inquire about why he is missing assignments. His parents have
told him that if his grades fall when report cards come out in three
weeks he will lose his X-Box until the next report card.
Human Development
 Physical, cognitive, emotional, social
 Stage models
 How we define normal and abnormal
 Idiosyncratic progression – individual, culture, time
period, gender, family
 No set agreement on what is right or wrong – healthy
or unhealthy – evolution of “disorder”
 Complexity of HD leads to complexity of diagnosing,
understanding, and intervening
 What is the function of the behavior
Social, Emotional, and
Behavioral Issues
 What are they?
 Can they be separated?
 Examples:
 Depression
 Anxiety
 Conduct Issues
 ADHD
 Emotional Lability
 Self Harm
A Big Deal: Mental Health
and Children:

13 – 20 percent of children living in the United States (up to 1 out of 5 children)
experience a mental disorder in a given year
 Prevalence:
 20% of children will be diagnosed at some point with a mental health issue
 Children aged 3-17 years currently (2015) had:

ADHD (6.8%)

Behavioral or conduct problems (3.5%)

Anxiety (3.0%)

Depression (2.1%)

Autism spectrum disorders (1.1%)
 Overall childhood prevalence rate (3-17)
 46.3 Any MH disorder
 21.4 Severe MH disorder
 Roughly equal between male and female
Center for Disease Control and Prevention (CDC)http://www.cdc.gov/features/childrensmentalhealth/
National Institute of Mental Health (NIMH)http://www.nimh.nih.gov/health/statistics/prevalence/any-disorderamong-children.shtml
Why We Should Care
 The Impact of Mental Health Issues:
 Psychological Distress
 Physical Health
 Immediate impact on health – immune system
 Correlation between early MH issues and later disease
 Relationships
 Learning
 Information processing
 Storage / recovery of Information
 Test performance
Bio-Psycho-Social Model:
Causing, Sustaining, and
Intervening
 The bio-psycho-social approach systematically considers
biological, psychological, and social factors and their
complex interactions in understanding health, illness, and
health care delivery.
Bio-Psycho-Social
Intervention
 Recognize that relationships are central to promoting
change
 Role of trust, caring, openness, and boundaries
 Being a good listener – harder than it seems!
 Try to understand the context surrounding the issue
 Understand the child’s story – emotions, content, subjective exp.
 Decide - with the assistance of others - which aspects of the
biological, psychological, and social domains are most
important to understanding what is happening and to
facilitate positive change in the child’s
 Positive change usually occurs through a multidimensional
approach to helping
 Movement towards integrative care in clinics and training of health
care workers
Some Ways to Help
 Be attentive to changes (Your observations or others)
 Change in emotions, thoughts, behaviors – trust your gut!
 Is this happening in more than one context?
 Home, school, with friends, activities, etc.
Some Ways to Help
 Become Sherlock Holmes and Investigate!
 Some questions:
 When did it start?
 When does it happen?
 How long does it last?
 When is it most intense?
 Where does it happen?
 Where doesn’t it happen?
 Some common catalysts:
 Transitions
 Certain people / social situations
 Food
 Sleep
 Medication
 Story of Bob (Prednisone)
Some Ways to Help
 Seek out assistance – Don’t go it alone!
 School counselors, psychologists, social workers,
teachers, administrators
 Primary care doctor / pediatrician
 Outside mental health experts (social workers,
psychologists, counselors, marriage and family therapists,
psychiatrists)
 Resources – do some homework
 Second opinion
Some Ways to Help
 Learn to really listen and observe
 What’s being said and then what’s really being said
 It’s not always about trying to fix something
 Put down the cell phone; turn off the TV – make eye
contact
 Change levels – what does my body language
communicate?
Some Ways to Help
 Ask specific questions / prompts when possible
 Ex. 1: Parent: How was school today?
 Ex. 1: Child: Fine
 Ex. 2: Parent: Tell me about your test in science today
 Ex. 2: Child: My test was OK, I’m thinking I did well on most of it
Some Ways to Help
 Validate a child’s feelings
 Ex. 1: Seriously, suck it up!! It’s is not that big a deal! I
can’t deal with the crying over you feeling hurt that
Jimmy didn’t invite you over!
 Ex. 2: I can tell this is making you very angry and sad. I’m
sorry this is so hard. I’m here to talk to if you would like to.
Some Ways to Help
 Convey and model that feeling and appropriately
expressing emotions is healthy
 Too often kids are taught to bury their emotions and some
don’t even have the vocabulary to really express what is
happening to them emotionally.
 Also, don’t assume that you and a child both define and feel
sadness, anxiety, anger, etc. the same way – talk about it;
explore it.
 Ex. 1: It is what it is – so, get over it. You can’t do anything at this
point about the fact that you didn’t make varsity. Keep working
hard and you will have a shot next year.
 Ex. 2: I can tell you are upset that you didn’t make varsity this
year. I’m sorry you are hurting. It’s OK to vent when you are
disappointed. I am here to listen and talk to if you want to – I’ve
had disappointments in my own life and know it can feel
devastating.
Some Ways to Help
 Illuminate and provide choices when possible
 Ex. 1: Do your homework now or your not going out this
weekend! I’m sick of getting notes home from the darn
teachers that you are missing assignments!
 Ex. 2: Fine, if you don’t want to do your homework now,
when are you planning to do it? I told you I would help
you set up a work schedule – I’m still willing to do that. It is
your choice. Remember, if I get another email or note
home this week you will lose the ability to go out this
weekend.
Some Ways to Help
 Learn to praise effort and engagement in the process –
not just results
 Ex. 1: Wow! That is awesome that you got a 99% on your
English test on Macbeth! That’s what I’m talking about!!
Honor roll here we come!!
 Ex. 1: I’m impressed with how much effort you put into
preparing for the Macbeth test! Nice job!
Some Ways to Help
 Think out loud – or, reflect after the fact
 Feels silly, but it works!
 Ex. 1: OK, this driver is going really slow in front of me, and
I am starting to get really angry – actually I am furious.
Part of me wants to run this person off the road and then
But, I know that this will only make the situation worse, I
may get a ticket, I could hurt the driver of the other car
or me and my passengers. I am going to instead take
some deep breaths, remember that this is not the end of
the world, and put on some calming music – like
Metallica!!
Some Ways to Help
 Assist children in constructing and maintaining – when
possible - predictable structures in their lives,
reminding them that things can change and that this is
neither good nor bad – it is to be expected in life.
 Safety and Security
 1-2-3 Magic – Dr. Phelan
Some Ways to Help
 Consistency, consistency, consistency!
 Parenting
 Structure in home
Some Ways to Help
 Let children fall – They need to learn to get up, and
they need to know that they can do it!
 Bruce Wayne and his Father
Some Ways To Help
 The relationship between the care giver (parent,
teacher, counselor, etc.) is key – work on it before a
fire starts!
 Research on relationships
Let’s Take A Second Look!
What do you think now?

According to his parent’s, Jack is a sophomore in high school and has
always done well academically but has also historically struggled to create
strong connections with others – he has only two friends he sees regularly.
When not studying, Jack likes to play video games such as Pokémon and
what he calls “nerdy” card games. He rarely comes out of his room unless
he is going to see his girlfriend, Jessie, (they have been together for about
two months) or one of his two friends, Joe and Kevin – both of whom are
two years younger than Jack – 7th graders. Two weeks ago his girlfriend told
a teacher that she was concerned about him because Jack said he does
not like his life and is not sure if he wants to go on living. Later he told her he
was only “messing around” but she was still scared by what he said. Jack
had also told her that “nothing really makes me happy these days – I’m just
bored.” Jack’s parents also report that Jack started wearing long-sleeve
shirts recently and that his mom had noticed what looked like “kinda deep
scratches” on his right arm one day when he was not wearing a long sleeve
shirt. When she asked him what happened, he said that he had just got
caught on some branches in the woods. He has also missed the due date
for several assignments in school over the past four weeks (very unusual for
Jack) and has become very irritated and, more recently, unresponsive
verbally with his school counselor and teachers when they inquire about
why he is missing assignments. His parents have told him that if his grades
fall when report cards come out in three weeks he will lose his X-Box until the
next report card.
Some Resources
 Types of treatments for children and adolescents:
 http://www2.nami.org/Content/ContentGroups/CAAC/
ChoosingRightTreatment.pdf
 Common questions and answers related to child /
adolescent mental health issues:
 http://www.nimh.nih.gov/health/publications/treatmentof-children-with-mental-illness-fact-sheet/index.shtml
 Local resources (besides me, of course!!!)
 http://www.monroecounty.gov/health_providers
For Further Information
Jason T. Duffy, PhD, NCC, ACS, MHC
Email: [email protected]
Phone: 585-506-5654
jasonduffyphd.com
Address:
1344 University Avenue
Suite 230
Rochester, NY 1344