Physical & Mental Health

Physical & Mental Health

Ages: 7 - 13

Mental Health for School Aged Children

Mental Health for School Aged Children

For autistic school aged children, learning to understand and handle their emotions will help them enjoy life and deal with the natural stresses of life.

Handling daily challenges such as sensory and social communication issues brings stress that impacts mental health. Finding ways to manage that stress and feelings like anxiety and depression are vital for your child to feel their best and because it can affect their physical health.

Helping Your Child Learn How to Express Their Feelings

Encourage your child to express how they feel. Help them understand and connect their emotions like happy, sad, disappointed or angry with what they mean. Teach them that everyone has different emotions and has a right to feel how they feel.

The longer term goal is to help your child gradually learn what more nuanced feelings mean. For example the difference between being angry and frustrated.

Give labels to the feelings your child is having such as, “I see you’re upset right now.” You can help them learn what that feels like by saying things like “I see your cheeks are red,” “You have a frown face” or “You are crying.” It gives your child the feeling that they are accepted, and their perspective understood by others.

Ask questions that encourage them to share more but respect when they do not want to. Turn to a therapist or contact the Milestones free autism Helpdesk if you are concerned your child is struggling and needs more help or you are seeking more strategies.

Especially at this age you need to watch for changes in your child’s behavior. If your child is nonverbal or has limited verbal skills, they are expressing how they feel through their actions, facial and body expressions and through motions like shaking their head no. Having a meltdown or exhibiting challenging behaviors are ways to express feelings of frustration.

Children can use feelings cards or charts that show faces with different emotional expressions like happy, sad or mad to share how they are feeling.

You can ask your child’s teacher, interventionist or guidance counselor to help support your child and practice these skills for expressing and understanding what different emotions are. Some schools do social emotional assessments of children and may have practical strategies and suggestions.

Asking for Help

As your child grows older, it is important for them to learn how to ask for help when something is difficult, and that it is OK to say no to something that they do not want to do or that is uncomfortable for them. Especially for autistic kids we want to be careful not to inadvertently imply they must say yes or be too compliant, putting them at risk for victimization or bullying. You can have your child practice saying “No” for example, while blocking the door when someone tries to come in at an inappropriate time. You can teach your child to say, “I need my privacy” as a concept in their bedroom and in the bathroom.

Dealing with Loss or Change

Big changes or loss can have a huge impact and be hard for your child to express and deal with. Grief is tough for anyone but it is such an abstract idea. Big changes can feel as traumatic as someone they love dying or parents divorcing to losing a pet to having to change a provider.

Allowing Your Child to Try without Stepping In

It can be tempting to help our children if we think they’re having a hard time or not doing something correctly. But if we always step in and “fix” it for them, they don’t learn how to handle frustration and to feel confident that they can figure it out. For example, your child may be working on an art or homework project, and you or a sibling steps in to “fix” it for them before they are done. This can impact a child’s feeling of self-worth, and they may develop learned helplessness.

This is a gradual process. Especially in the beginning it may just be giving your child a short amount of time to try to do something for themselves. If they’re really struggling you could give them a time frame you think is appropriate based on the problem or skills they’re working on and their developmental level. For example, give them 5 to 15 minutes and you can set a timer. Then after that if you still see they are very frustrated and unsuccessful, you could offer some different ideas of how you might approach it. And then you could do it with them (or for them if appropriate).

If your child is using a lot of self-defeating language like “I can’t do it,” “I don’t want to,” “Why bother,” or “No matter what I do it’s not going to work,” it’s important to help them. Work on building confidence.

You can also start with something that your child knows how to do and then introduce an element of complication to start to build in opportunities to ask for help or problem solve. This approach is called "sabotage."

Friendships and Social Challenges

Friendships bring companionship and fun but also hurt feelings. Since our children tend to think literally and struggle with social skills, they may not understand the nuances and steps in friendship. This includes levels of friendship from an acquaintance like a classmate who says hi to them to a real friend who wants to hang out with them after school or text with them.

Look for inclusive communities and social groups that include people who have special needs as well as neurotypical people.

Be open to different types of people including those who have different ways of communicating. Your child’s communication will not be negatively impacted by being around children who do not have communication skills on the same level as theirs. They will still learn in different ways such as empathy and leadership. It is part of teaching your children to be welcoming and open to people who are different from them, and how each person is unique and special.

For parents of children who are more impacted, it’s important for them to have the opportunity to have friends, to be with people and build their skills. Reflect on your own views as a parent and how you can learn and grow.

It’s hard dealing with a friendship ending or someone being mad at them. They may have a hard time understanding the other child’s perspective. For example how the other person is feeling. They may not pick up cues from other children, whether facial expressions, language (especially jokes or comments that are subtle or puns) or body language that a neurotypical child might naturally grasp.

Bear in mind that girls tend to mask more and to mimic who they perceive are friends or people who are friendly. For example if they see a group of girls they like, they may try to copy what those girls are into (even if it isn’t something you would want them to) which can lead to burnout and stress.

Handling Puberty

Make sure your children understand what puberty is and body changes before they happen. Help them handle the emotions and know that changing hormone levels may affect their feelings and perceptions.

Children may question their sexuality or gender preference at a young age including which bathroom they want to use. There is a higher percentage of children in the autism community who identify as LGBTQ. You can get support and learn more about it from your child’s psychologist, social worker, pediatrician or school nurse. Organizations like Milestones can help you find someone in your community to support you.

More information is available in the social skills/communication and friendship articles in the Milestones Autism Planning (MAP) Tool. We will be adding articles about sexuality, dating and relationships to the MAP later in 2022.

Bullying

Bullying is a worry many parents have for their children. Bullying takes many different forms. Starting with social isolation, like inviting everyone in the class to a birthday party but excluding the autistic child. Or a teacher making a child uncomfortable by focusing on a behavior they may not understand is part of the child being autistic.

Watch for changes in your child’s behavior that could be from emotional issues or something happening at school or other places that are difficult for your child. Warning signs include, does your child

  • Seem more emotional than usual?
  • Come home from school and go right to bed?
  • Refuse to go to school?
  • Leave a class or school without permission when it wasn’t common before?
  • Either eating much more or less then they typically would?
  • Have more meltdowns in school than usual?

Work on figuring out what is happening that is causing these signs. It’s likely something is overwhelming them, whether a situation, environment or people. Whether it’s as simple as the wrong kind of food at lunch or something more serious like children made fun of them or a substitute teacher who didn’t know something important about how to work with your child.

Emotional issues impact your child’s ability to get their educational needs met and should therefore be addressed in an Individualized Education Program (IEP) or 504. Get professional help from your child’s counselor, therapist or school guidance counselor that your child relates to.

Autistic children can have mental health illnesses, such as depression and anxiety, at a higher rate than other children. How depression or anxiety is expressed in autistic children may be different than neurotypical children. It’s important to get help from a counselor or therapist with experience treating autistic people.

Additional Resources on Bullying

An Autism Perspective on Bullying: Creating a Culture of Acceptance

Bullying Prevention Resource Guide

Legal Rights Around Bullying

The Difference Between Life Stress and the Need for Outside Help or Diagnosis

It’s important to weigh the difference between common manageable challenges and ones that need outside medical or therapeutic help. Manageable behaviors as opposed to signs that your child may have a mental health condition like anxiety, depression or self-injuring behavior that should be assessed by a professional.

There are various conditions like these that can be common in autistic people or their families and it’s vital to get professional help and support. They are often treated with therapy and/or medication.

While some people may hesitate to bring their child to a therapist, sometimes a child needs a neutral, objective person to talk to who understands their situation. When someone has a medical challenge like diabetes, they see a doctor and may take medications like insulin. The brain is a vital organ that needs support, too. Seeing a therapist is a way to get that support to help the person through.

Bear in mind that many mental health conditions have biological causes like chemical imbalances in the body that can be helped with medications and therapy. An outline of different co-existing mental health conditions is in the Physical and Mental Co-existing Conditions page.

The Milestones Helpdesk can connect you with resources. The service options and recommendations may also change at different ages and stages of their life.

The Milestones Mental Health Tool Kit provides an overview of mental health services available for autistic individuals as well as professional roles and forms of therapy. The Mental Health page also offers information and tips.

Getting Help If You Suspect Self Harming or Suicidal Thoughts

We know these are very difficult topics but it is vital to get help if you suspect your child may be hurting themselves through self-harming behaviors such as cutting (repeatedly, purposely making cuts or marks on themself) or are having suicidal thoughts. Sensitively discussing these issues with your child or asking questions will not cause them to have self-harming behaviors. Find a professional such as a therapist with experience treating autistic children.

Self harming is a sign that someone is in distress. They are not able to access other ways to communicate what is bothering them. It often involves sensory issues, meaning they may experience touch, sound, light/seeing, smell or taste in a much more intense or much lower degree than neurotypical children. Self harming may happen when they are not able to handle that stress or experience in other ways.

If your child expresses wanting to hurt themself or suicide, don’t be dismissive or assume it’s not serious. Don’t be afraid to ask questions. You’re not going to give them ideas. If they express having a plan or specific ideas for how they might hurt themselves, that is an urgent call for help. Call the National Suicide Hotline at 800-273-8255 or visit them online at Lifeline (suicidepreventionlifeline.org).

If your child has a mental health provider you can ask for a crisis appointment but if they do not have one immediately available find out if your community has a mobile crisis center. You can also take your child to the Emergency Room at your hospital.

Make a safety plan right away, especially if there are guns or knives in the house, making sure they are properly locked and stored away, locking up medications, household cleaners, etc.

If they are feeling suicidal, autistic children tend to attempt suicide at a younger age. If you sense depression or anxiety in your child it is important to seek help from a trained counselor or therapist. While not all suicide attempts are with the intent to die, they can end up in a life threatening situation without meaning to.

Trauma-Informed Care

Trauma-informed care is very helpful for autistic children. The idea of trauma-informed therapy is that painful things happen to people and when that trauma happens it impacts the brain and sensory system. This type of therapy is based on how the brain processes trauma, especially important for autistic children who usually have sensory challenges.

Trauma specialists know how to help your child share their story and pain and handle it, using what is meaningful for your child. So ask for a Trauma-Informed Counselor. Ask any potential therapist if they have this type of training and whether they specialize in autistic patients.

Additional Resources

Department of Developmental Disabilities (DODD) Trauma Informed Care Guide

FrontLine 24/7 Crisis Hotline - 216.623.6888

National Suicide Prevention Line - 1-800-273-8255

Crisis Text Line - Text HOME to 741741 to connect with a Crisis Counselor

Ohio Addiction Hotline - 888-796-5986

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