The Face Of Childhood Mental Illness
Surface-level behaviors often hide deeper issues.
juany mesa canalejo / Shutterstock I exited my daughter’s school building clutching a manila envelope to my chest. The door’s latch clicked behind me. Keeping my eyes down, I walked down the path to my car, which sat idling in the otherwise deserted bus lane.
It’s only a three-minute drive from the school to the house, but I couldn’t resist. My kindergartner’s special education evaluation had been going on for months, and finally, I held the results in my hands. Heart racing, I slipped my fingers under the flap and pulled out the thick stack of papers.
I flipped through the pages with equal parts eagerness and worry.
I was hopeful that the contents would confirm what I already knew about my daughter — a reassurance that I wasn’t imagining things or helicoptering, that the concerns I’d held about her learning for so many years were valid.
At the same time, I had braced myself for the possibility that the school evaluators would determine that, despite her obvious struggles, she no longer qualified for special education services. I was prepared to have to fight for what I knew my child needed.
I had completely buried the worry that, rather than minimizing my concerns, the school would find something bigger than I’d overlooked — something I wasn’t ready to face.
As I scanned through the educational portion of the report, it quickly became clear that the school’s evaluation matched my informal teacher-mom assessment pretty closely.
My daughter was bright and bubbly, but she was pretty behind academically, even for a five-year-old. She could talk her way out of the most complex of situations, but couldn’t string a basic sentence together when reading. She knew all the letter sounds, but couldn’t decode even the simplest words. Her number sense was okay, but she struggled with working memory.
I was satisfied with these results, in a way, because I knew they would lead to a healthy discussion about my daughter’s needs and how they’d be supported at school. I was so relieved that their assessment agreed with mine, I almost didn’t even look at the psychological assessment.
But in the interest of closure, if nothing else, I turned the page.
Anxiety is a family affair
Everyone in our family, to some extent, suffers from anxiety. Both of my daughter’s grandmothers have severe anxiety that they deal with in different ways — one by self-medicating; the other by manifesting physical ailments; both by denying there’s a problem.
My husband and I both have battled different forms of anxiety as well, often coping and compensating in unhealthy ways. All my siblings-in-law have anxiety on some level. I’m an only child, but I come from a long line of self-medicators.
It’s the family legacy — one we’ve all come to work around, grudgingly accept, or even embrace.
I’d long seen signs of anxiety in my daughter, even before she could talk.
Separation was impossible. I abandoned my plans to go back to work because, no matter whom I left her with, and for how long, she would just sob inconsolably the entire time. This happened well into her toddlerhood.
She never stops moving. Often, when trying to get her to sleep for the night, I would have to hold her legs still so she could settle enough to go to sleep. Once she finally started talking, she never stopped that, either.
She’s a worrier. She thinks about how people will see her if she does something silly or makes a mistake. She thinks about things that have already happened, things that haven’t happened, and things that will never happen. She, along with her father, rules the land of, “Yeah, but what if…?”
When I read that my daughter had tested in the clinically significant range for anxiety, then, it wasn’t much of a surprise. We all have anxiety, and we are coping pretty well, after all. (Weren’t we?) We could help her.
Mental illness in children can look very different than it does in adults
The next rating knocked me off-kilter indeed. Depression, it read. Borderline clinically significant. That, I was not expecting.
Anxiety sucks, but it’s the enemy we all know.
Depression scares the shit out of me.
Not least because, apparently, my child had been walking around one point away from clinical depression for who knows how long, and I hadn’t had a clue.
How can a five-year-old be depressed? I asked myself. She didn’t seem depressed. She wasn’t sleeping all the time or crying all the time. She seemed to take an exuberant interest in daily activities — not like the actors in all the antidepressant advertisements.
All those actors, though — all those symptoms we’re told to look out for — depict depression in adults. Depression in children doesn’t share all the same symptoms. And no one ever seems to talk about depressed kids.
When I compare symptoms of depression and anxiety in kids, in fact, I see more depressing features than anxious ones in my child.
She’s irritable and has a short fuse. Her emotional cup runneth over. One tiny “glitch,” as we call it, can elicit a disproportionately thunderous reaction. She moves to fury faster than anyone I’ve ever met — or despair, depending on the situation.
She complains all. the. time. Everything is the worst; everything is a problem. It’s impossible to reason with her. Isolating consequences just gives her more time to ruminate on how horrible everything is.
She assumes the worst possible outcome. “You’ll probably say no.” “They’ll probably laugh at me.” “I’ll probably just mess it up.” She calls this her probably power. It’s pretty powerful, indeed. Just not in the way we envision most superpowers.
She can’t concentrate. Okay, there’s a lot wrapped up in this, including anxiety and a learning disability. Because of all these factors, she feels worthless and incapable of meeting expectations most of the time.
She’s always got something wrong with her. She is a frequent flyer in the school nurse’s office, despite being (aside from her food allergy) the healthiest kid I’ve ever met.
Symptoms seem small at first, but grow bigger with time.
I had our county’s Early Intervention staff out to the house when my daughter was two years old. I was widely admonished for this, mostly by people a generation older who thought they knew better than me. “Kids develop in their own time,” they said. “Don’t rush it.” (Funny, these were the same people who constantly admonish me for doing too many things for my kids.)
When she qualified for special education services, and when both her preschool and her elementary school subsequently increased those services, having noticed her difficulty coping at school, and when I took her to have an outside evaluation done to get to the bottom of her issues, the same people continued to shake their heads. She presented fine to them, so they reasoned there wasn’t a problem.
But they weren’t the ones trying to teach her to read, or trying to sit down and do one — ONE! — math problem with her. They weren’t trying to navigate social situations when she has all the words in the world but doesn’t know which ones match the emotions she’s feeling at the moment. They weren’t fielding phone calls from her teacher saying that she’d been crying for the last hour or two of every day, all year long.
Her learning disability, anxiety, and — yes — depression got in the way of even attempting new things. As a defense mechanism, she would change the subject or complain loudly about something unrelated. When that didn’t work, she would yell, scream, cry, hit herself, and say how much she hated herself.
It breaks our hearts and, to be honest, it drives us crazy. We can see how simple these things are — how easy they’d be for her to access if only she took a moment to try. Most of her concerns are so obviously unfounded that, especially when she’s been going on about them for an hour, it’s easy to want to say, “Enough already. It’s not a big deal. Just snap out of it.”
But she won’t, because she can’t.
And one day, these tiny worries will likely become bigger, as will her capacity to act upon them. Which scares me to death.
Mental illness is not something you can “snap out of.”
It is legitimately hard for me to understand my daughter’s mental health issues. The rest of us are justified, my mind says, shamelessly eager to logic away anything uncomfortable. We’ve survived countless traumatic experiences and dealt with all manner of grown-up responsibilities. There’s a reason we’re in a puddle on the ground.
But this pure, innocent, perfect little girl — with a loving home, a trauma-free upbringing, and a good life — has no reason to be anxious and depressed.
But mental illness doesn’t work like that. It doesn’t need a reason to be; it just is.
Maybe she was born with depression and anxiety. Maybe her anxious and depressed family members being anxious and depressed all around her somehow made her anxious and depressed, too. Probably it was a little of both. But, regardless of how those feelings got here, and irrespective of how inconvenient it may feel for the rest of us to experience them, they’re a part of who she is.
And being frustrated with who she is isn’t going to change a thing.
Instead, it is incumbent upon us to give her a space to develop the coping skills the rest of us never knew we so desperately needed.
Early intervention gives kids a chance to learn their triggers and get a handle on them before the stakes are raised
My daughter is now almost eight years old. She has seen a counselor of some form or other since she was two. As of this school year, she sees the school counselor at least twice a week, and she sees an outside therapist every two weeks.
Because she has this level of support, and because she has two parents who eventually learned to recognize (to varying degrees of reliability) when surface-level feelings and behaviors are signals of something deeper, she is much more well-adjusted than she would otherwise be. She can identify when her behavior is because she’s feeling anxious or sad, and she’s beginning to try strategies to deal with these emotions in a productive way.
My little girl will be under our roof for another ten years or more. Hopefully, in that time, we will all be able to work together to help her learn to manage her feelings and actions, no matter where they originate.
For now, I take a deep breath. I exhale and let flow outward all the times I wish I’d been more nurturing, more understanding, less dismissive.
I inhale and take in the promise of a new morning. Each moment of this life I share with my pure, innocent, perfect little girl, is an opportunity — a chance to show her that I know her. I see her. I love her, and I will be right next to her through even the roughest waters, even — especially — when she doesn’t know how to navigate them herself.
Nikki Kay writes fiction, poetry, and personal essays about parenting, mental health, and the intersection of the two. Check out her column at Invisible Illness.