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All posts for the month June, 2015

Over the years, my practice has had an increasing number of parents calling with concerns about their child refusing to where the clothes traditionally associated with a certain gender – little boys demanding pretty skirts, little girls refusing to wear dresses. Notably, most of these parents are not concerned about the sexual or gender diversity choices of their child. More, they are concerned about trying to bully proof them for fear that they may be harassed or maltreated by others because others cannot accept their preferences.

Identity formation is an important milestone in adolescence and sexual orientation is just one part of many things that an adolescent sort out about themselves in the lead up to the adult years…and sometimes even beyond that.  An adolescent may take some time before they decide their sexual orientation. The average age of coming out is about 16, but that does not mean that young people have all of their gender identity issues sorted out by 16.

A study of over 7000 year 7 and 8 students found that 15.1{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de} of the group identified as Lesbian, Gay or Bisexual (LGB) or questioning their sexuality. Sadly this 15.1{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de} were more likely to report bullying, homophobic victimisation, truancy, depression, alcohol and substance use and thoughts of suicide. Lesbian, Gay, Bisexual (LGB) and Gender Diverse young people are over represented in teen suicide numbers.

Those young people in the study who were questioning their sexuality and still hadn’t come to a clear resolve about their sexuality were worse off than those who clearly identified as LGB. We have known for some time now that kids who are coming out as LGB are in need of support, but this study also showed that teens who are questioning their sexuality and have not yet decided or worked it out, are even more at risk of concerning outcomes.

It seems that the early teen years are a time when young people may need particular support around the sexual aspects of their identity.

School can play a big role in reducing negative outcomes for LGB teens and those questioning their sexuality. Schools that promote a positive climate and a lack of homophobic victimisation actually work to protect all children (not just the LGB or questioning kids) from negative outcomes on their mental health. However, it’s not just the prevention of bullying that needs to be targeted. Homophobic teasing also needs to be dealt with through procedural and policies of school and right down to the teacher student and student-student interactions.

Like for many things that can be hard work, good support can moderate the impact of stress associated with identifying as LGB or gender diverse as a teen.

Young people with support have much better mental health outcomes. Support can come from a number of sources and it seems that different support is associated with certain outcomes in the process of a teen coming to terms with their sexual orientation.

Support from friends tends to have more of an impact on disclosure or coming out. However, family support was better than friend support for promoting self acceptance.

It also seems that those who identify as bi-sexual have the lowest levels of support and are therefore at the highest risk for troubling outcomes.

Family support is a crucial part of the picture when it comes to LGB teens or those still questioning their orientation. There are some very helpful resources around to help parents support their children around LGB and transgender issues. Beyond Blue has an excellent resource for families called “Families Like Mine” that provides some evidence-based information and ideas for best support.

Generally speaking, here are some quick tips for supporting a LGB and gender diverse or questioning child. Of course, all of these tips are easier to implement when you have already worked to establish open communication and are available for your child.

  • get your head around the language – your child or children may be able to assist you so don’t be afraid to ask
  • remember that an LGB or transgender relationship is not a terrible thing, but also, like any other relationships, they are not always easy. They all take dual effort and should never be violent or abusive.
  • being LGB is not, in itself , a barrier to a happy life
  • some parents worry about whether they can still be a grandparent – like all young people, LGBT couples can chose to have a family or not
  • it’s not your child’s role to look after you. Young people who feel that they have to protect or act as parent to their parents offer struggle with a range of mental health concerns. Be sure that if you need support that you get it from other sources.
  • if you suspect that your child may have a certain sexual preference or gender identity, but they have not disclosed it, don’t ask. Let them lead.
  • If your child discloses that they are confused or identify as LCB or transgender:
    • have your child guide you about what they need
    • there is plenty of information out there and plenty of support groups – virtual and face to face. Perhaps you could explore these together if that’s what your child wants to do.
    • be honest about how you feel –if you are confused, say so, but if your child looks happy, it’s always great to acknowledge that you are glad they are happy and that they are loved, too. You can be confused and happy at the same time!
    • sometimes a young person might tell one parent but not the other. Do what you can to ensure that you and your partner both support your child.

Your concerns or worries about your child/student/client being discriminated should not hold you back from being supportive. if you do feel your child is being discriminated against because of their sexual orientation, act as you would for any other time you might think a child is being treated unfairly over any other issue like race, disability or religion.

One of the most common concerns raised by parents, teachers and carers of teens is alcohol and substance use. The concerns are solid. Given that an adolescent brain is still growing and at a very rapid pace, any damage caused while it is still developing could have a big impact on future brain health.

Generally speaking, with the growth in teenage body and brain comes a growth in the desire to experience new things. Those new things need to be exciting and not the usual day to day hum of the family household. Changes to the pleasure centre of the brain during the teen years mean that the young person can become more dissatisfied with home and want to push boundaries, meet others, fit in with others, and spend more time with people outside of their family. This lure of a wider world can bring more exposure to things not experienced in the home and things for which young people have some information, but not necessarily wisdom.

The rapid brain development that occurs in the teen years does not occur evenly across the brain. The cortex which allows for critical thinking and problem solving is a little slower to develop. This means that there is an urge to try new things coupled with a lack of “sensibleness”. If exposed or offered alcohol or illicit substances, these, quite normal, brain changes, can impact decision making.

This means that teens are driven to want to seek and experience more in the world, but do not yet have an adult way of thinking about the risks and consequences.

Schools and government agencies spend much time on providing the education that young people need to make informed decisions. Drug and alcohol information is being incorporated into school curriculums very early.

When my youngest was eight years old, he came home excited because a boy in his class knew how to spell dexamphetamine!

It is important that young people have the basic information necessary to know how to take care of themselves and others with respect to alcohol and substance use, but the information alone may do little to impact on whether someone says “yes” to the experiences offered by alcohol and other illicit substances. Information does still not stop most teens, even the very best-behaved ones, from pushing the boundaries from time to time or spending time with other close friends who are frequently blurring the boundaries. The desire to fit in that comes during the teenage years is a strong determinant of teen behaviour and can definitely sway teen decision making.

Of course, individual teens will have different personalities. Some may be more anxious and want to experiment with alcohol and other drugs as a way of coping. Similarly, some may be quite pessimistic and hopeless and say “yes” when offered alcohol or drugs as a way to manage low feelings. Some teens are definitely impulsive and act without too much careful thought when offered new experiences. Some may enjoy the thrill of alcohol and drugs because they enjoy sensation seeking.

Exciting new research from Patricia Conrad and her colleagues has found that prevention of teen alcohol and substance use (particularly, cannabis) works better when individual’s personalities are targeted. She has found that using Cognitive Behaviour Therapies (even just two sessions) that target the different thinking associated with each of these personality groups can assist in ways beyond just education alone. By ensuring that teens have coping strategies specific to their particular risk/personality type we seem to be able to protect more teens from dangerous alcohol or substance illicit intake.

So, there is no definite way of completely alcohol- or substance-proofing your teen, but there are things that can be done that might contribute to preventing early alcohol or substance-related harm.

  • Be clear about your own values around alcohol and drugs and practice what you preach. Healthy adult drinking means no more than 1 or 2 standard drinks each day/night with one or two alcohol-free days/nights per week. If you need help with your own alcohol or substance use, be sure to get it.
  • Provide your child with information and talk to them about the information. When they bring home those handouts from “yet another D and A session”, be sure to read them because the knowledge we have about different illicit substances can change quickly. See if you can engage them in a conversation about whether they thought the session was good and what they think might make it better.
  • Get to know your child’s friends and, if possible, the parents of their friends so that you can establish good communication and a safety network.
  •  If your teen is having a party, register the party with your local police. The Police have lots of handy tips on safe partying. Sadly, Police attend many unsafe parties so they know what they look like.
  • Know your child. If they are a risk taker, ensure that they have other ways to meet this drive in them through sports and activities. If they are prone to anxiety or low mood, it can be handy to get them to see someone who can talk to them about expanding their coping tool box in healthy ways.
  • Spend regular time with your teen. Even though they are growing fast, there should always be some activity or interest (music, cooking, sport, pets) that you share and that you can use to stay connected with them through the teen years.

While a growing teen brain is a marvellous thing that allows a young person to be able to be so capable and so clever at so many levels, teens cannot do it all on their own.  There’s no way to pop a teen into a magic, protective bubble.  There is good reason why they are likely to push against too much protection as the teen years are the ones where they try on lots of things and begin to discover the sort of adult they will become.   It’s hard to do this if there is no room for mistakes.  As seemingly independent as they may be, teenagers still need their parents and carers to provide good boundaries, good examples as well as warmth and loving kindness.

For more information about teenage mental health, you may like to pop along to a workshop.

Some children are picky eaters. They limit the amounts they will eat –  some reject foods and some are unwilling to try new foods. Contrary to what many may think, picky eating is not linked to eating disorders late in life. However, picky eating and meal time behaviour problems are linked to other behavioural problems in children.

Picky eating usually has its basis in three areas: developmental stages, personal preferences and family practices.

From the earliest of developmental stages, a child’s food intake is very much driven by depletion. As they feel hungry, they will seek food. As an infant grows, so do their nutritional requirements and they begin to need solid foods. Although, it is usually when the child becomes a toddler that they can begin to get picky about food. It has been suggested that this may have, at one stage, served an evolutionary purpose. In a period on history where we foraged for all of our food, if a child was cautions or refused to eat new or unfamiliar foods, the child was protected from eating toxic or poisonous things. So, some picky eating can be a “stage of life” thing.

Young children know what they like.

They have preferences. Young children have no regard for food nutrition and cannot yet read the nutritional labelling on food products. They eat things because they like the way that they taste.

Food is more than taste –how food looks and feels can influence whether children like a food or not. Some children have tactile aversions to the ways that certain foods feel in their mouth or prefer or reject food based on its appearance or colour.   Your general practitioner might refer to a specialist to explore the tactile defensiveness further, but usually only if the sensitivity is prolonged and there are other types of rigidity affecting the child.

For most children, though food preference is strongly linked to the preference of their family / parents. Researchers  have found that the tastes that young children prefer or enjoy are influenced by the flavours that they are exposed to in breast milk.   Families can also strongly influence what food is offered to the child or how a child eats.

Often, in an attempt to manage picky eating, the dining experience can become quite the playground…and sometimes even a war zone.

Parents can get over-concerned about picky eating. This can cause them to pressure and cajole a child into eating. Forcing a child to eat more may seem rational for parents who come from an environment where a lack of food was a problem – from war-torn, impoverished backgrounds or even from very large families. Some cultures also have a strongly held belief that to feed a child is to love a child and that a child is not being well-parented unless it is chubby and well-fed. It is also a relatively common practice to use food to calm or reward a child. So, there are often layers or multitudes of ways that a child’s environment influences food choices and eating behaviours.

Additionally, parents can encourage pickiness by only offering a limited repertoire of foods. Some parents will only offer children the food that they will eat or will even cook separate meals for their child. When it comes to picky eaters, we know that they are often reluctant to try new foods. Families, knowing this reluctance, will often avoid exposing the child to new foods. This is where picky eating can become entrenched. If picky eating is sustained for longer than two to three years, medical professionals do begin to get concerned about nutritional deficits and especially so when the child is limiting meat or good protein substitutes and fruit and vegetables for highly processed foods.

More recent research  has found that there are fewer picky eaters in families where eating is enjoyed. A worried or hostile environment can lead to picky eaters or to children who eat because they are made to by controlling others and not because they are paying careful attention to their bodies own demands for food. Eating problems were lower in families who enjoyed eating and also, those who enjoyed cooking.

So, with all of this information in mind, some tips to avoid picky eating in children….

  • Realise, that as a child develops, their appetite will change. For example, from an infant to a toddler, a child’s nutritional requirements and appetites decline and their eating patterns can become unpredictable. This is normal and you do not need to force the child to eat large quantities if they are healthy and growing.
  • If a child is not eating a meal, do not battle. Offer them another nutritious choice at the next meal or snack time. Always continue to offer healthy choices.
  • Be sure to keep food zones battle free. Mealtimes associated with worry and frustration and not pleasure will only grow eating problems. Turn off the television and involve your children in the enjoyment of the whole process of growing, buying, cooking and eating food.
  • Children need to be exposed to new foods before they will accept then. Sometimes it will take multiple exposures. Be sure to expose children to new tastes.
  • Try incorporating a “try something new night” each week or so where the whole family tries a new cuisine, vegetable or style of cooking. Explore foods and cultures together and celebrate trying rather than the amount of calories consumed.

….food for thought, maybe?

A bio-psychosocial look at mental health during the adolescent years including:

  • Brain development
  • Identity formation
  • Risk taking & extremes – substances/self-harm
  • Relationships
  • Socialising and social media
  • Counselling, parenting and support

“A framework for understanding what might be going on for her”

Perfect for those families who have a pre-teen heading off to high school or in the early high school years!

Suite 8 – 100 Burnett Street, Buderim, QLD

Wednesday 17th June 6pm -7:30pm

 Limited places available – numbers are kept small to ensure your questions can be addressed.

Phone 0400 150 106 or email admin@shonainnes.com to secure your place. Cost $45.

Shona Innes is a clinical and forensic psychologist with over 25 years of helping children and grown-ups and consulting to carers, welfare staff and government bodies. Shona speaks on ABC Sunshine Coast every Thursday morning about child and teen mental health. She is also author of the internationally published Big Hug book series designed to help young people through difficult times or tricky situations.