There are so many things that can trigger psychological responses in children, from the daily stressors of school to issues at home. Children can respond to life stresses in a variety of ways, but anxiety and depression are the most common.
Over the years, I have seen children acting out in school — fighting with other children, bullying, talking back to teachers, refusing to follow school rules, and blatantly disruptive. Some actually want to be expelled from school so they can stay home. Why? They are worried about their parents who may be out of work and losing their home, or divorcing.
Children are being bullied at school. Many kids are struggling with undiagnosed learning problems, or trying to cope with untreated psychiatric disorders. Some have hearing or vision problems and do not know it. Sadly, some are being physically, psychologically, or even sexually abused at home, and have no one to turn to, no one they can trust.
School nurses and psychologists may have been the first to get the axe when schools could not meet their financial budgets. Music, art, drama, and other “fun” school activities may be absent now. Low grades may keep capable children from participating in sports. Classrooms may be impacted to the point where teachers do not have the time to really get to know their students anymore. They may see a child acting out or failing, but may not have the time or the emotional energy to delve into the child’s life outside the classroom.
I was to see a 16-year-old young man for a physical in a few days. His mother called me so she could tell me her concerns. For the previous six months, he had been in a serious relationship — his first real girlfriend, according to his mother. A few weeks ago, he was dumped for reasons unknown to the parents. His mood crashed to the point where he was sleeping all of the time, spending any home time in his room, not eating, not hanging out with friends, skipping school, and refusing to share his feelings with either parent. The mother asked that I intervene and try to help him.
Alex was not excluded from school; he excluded himself from school and his life in general. The “red flags” were waving, but the mother did not feel he was suicidal; just depressed.
After his examination, I told Alex (not his real name) that his mother had called and was very worried about him. I excluded the mother from the room so that we could talk in private. Some parents are unbelievably supportive and loving, but teenagers in crisis often reject love of any type. He laughed when I asked him if he was considering harming himself. He did not entertain the thought, nor did he have a plan. It is considered “normal” to think about suicide, but if a person has a suicide plan or even an attempt, he needs immediate psychological intervention.
As I looked at this healthy, athletic, intelligent young man and listened to his story, I could not stop thinking of the son of one of my colleagues, a boy of the same age. Several years ago, after a break-up with his girlfriend, he took his own life. He wrote his last will and testament on his computer, gave away his possessions to his friends, said good-by to his parents, and took a fatal overdose. There were no obvious signs, according to my colleague, but if there were, he missed them.
I moved a few other appointments so that I could spend extra time with Alex. He was candid and honest about his feelings. He promised to let his parents back in to his life, and his parents promised to be supportive and not judgmental. Alex was offered counseling and even medication if he felt it would help. He did not feel that he needed anything more than some personal time to heal his broken heart. He has my e-mail and private phone number, but I doubt he will need it.
Throughout the week, I get a several “worried-well” patients. Basically, there is nothing physically wrong with them other than vague somatic complaints: headaches, belly-aches, fatigue, sleepiness, lack of motivation/enthusiasm, and other potential signs of school-avoidance. A large number of these children are under stress of some sort.
After seeing Michelle, a preteen, at least three times over the last month for tension headaches and stomachaches, I decided to delve deeper into her young life.
“If you had three wishes — things that you could magically change in your life at home or school — what would be your wishes?”
With tears in her eyes, she said that she only had one wish. She wished that her Dad would come and visit her. He has another family now and lives in a neighboring town. He had missed her birthday.
Now, we were both crying.
Look around you. Is there an Alex or a Michelle that needs your help, or needs a friend?
Open the door.
Ask the questions.
Offer your hand.
You may save a life.
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