The terrible news of the killings in Paris is already flooding screens repetitively and there will be more and more images and discussions to come. News like this is, understandably, big and has a big effect on our mood and the thoughts and feelings we express out loud.

When things like this happen and there is a change in mood, the younger people in your household may have questions or they may be, also understandably, quite distressed by what they see and hear.

What words can possibly explain the complexities of terrorism attack on innocent people? We owe it to our children to give then the information they need to process it all in the ways that help them understand, but also in ways that don’t distress them.

Different children will react in different ways to big, terrible events. Some of this difference will be due to their age and abilities to get their thoughts around it all. Preschoolers may be upset because they can see it is upsetting the grown up in their life. Teens might be upset because of the injustice and unfairness of it all. Children will also have difference reactions based on their own individual temperaments and coping abilities. Some sensitive little people may have more questions and be more unsettled by the news. Some may have recently lost a loved one and the grief may be fresh in their minds.

If you have little folk in your household, try not to expose them to long hours of repeated news coverage. These days, there are many ways that you can quickly keep up to date. Exposing yourself to lengthy, repeated, footage can make you feel helpless and vulnerable as well so tune out form the long haul and just check in from time to time.

Don’t try to avoid the news or hide it from your children. Be sure to check to see if your children have any questions or worries and do your best to answer them. If you cannot answer them, it’s okay to let your child know that you don’t know that answer.

Some things in life we just don’t know yet, but there are lots of things we do know….we know that some people will be sad, we know that people will be angry, we know that people will be working hard to make things safe again, we know people will have different ideas about what is important and …. (this is a great time to tell your kids) that you know they are super-important to you.

With the big screens off for awhile, it would be a great time to spend time with the family. You could break out a board game or a pack of card or go for a walk or family bike ride. Do some things you enjoy doing as a family.

Celebrate our freedom to do lovely things with our kids by doing lovely things with your kids.

Reassure worried children that they are safe and that members of their family are safe. You might like to find a globe or a map and show them where Paris is compared to where they live. It’s also important to emphasise that while it is a terrible thing that has happened in Paris, it’s a very rare thing. Big, terrible, rare things always make the news. Daily, happy, fun things still happen, but they don’t often make headlines.

Some little ones who are more easily upset, may need you to spend a little longer with them at bed time until they settle. Try to stick to the evening routines and as you say your “good nights”, remind them of the lovely plans you many have together for the very next day.

If your child feels sad, encourage then to express their sadness. They may kike to draw a picture or make a card to send to someone. They may like to donate some of their things to a charity. Helping others or doing nice things for others is a way that we can feel better when we have little control over a big world event.

If you have a little one in your household, or indeed, if you yourself, struggle to settle after a few nights and days and distress starts to interfere with the day to day things needed in life, be sure to check in with your General Practitioner.

You may also be interested in understanding more about young people and terrorism  or if you need to talk further with your child about grief and death, Life is Like the Wind can help.

Should you be worried if your daughter leaves all but her lettuce leaf on her dinner plate….or your son is at the gym for the fifth time already this week? What do you say if your child is on his second plate of bacon or won’t wear the school sports pants because it “makes my bum look big”?

Our body image is the way we see, think, feel and behave with regard to our bodies.

Body image has more to do with our perception of ourselves and others than it does with our body’s measurements. It is not surprising then, that if someone is feeling unhappy about themselves, about where they fit in their family, with their friends and with their world, that they can target their body as tangible source of dissatisfaction. Extreme body image problems can lead to all sorts of dangerous problems that include serious eating disorders. Body image can be a factor in self harm and suicidal behaviours.

In my many years of clinical practice, the research into eating disorders has advanced considerably, but it is still considered among mental health professionals to be one of the most difficult and intractable mental health disorders among the young.

Traditionally an area for teen girls, we are finding that eating disorders are starting to creep – they are creeping across genders with more males diagnosed, creeping to earlier ages of onset, and creeping to more presentations in the elderly as well.

The human body is one incredible machine.  From its earliest moments of creation where cells divide and specialize, through to the coordination of learning to walk, the miracle of learning to think and speak, the amazing ability to coordinate ourselves to accomplish all manner of things, to fight off disease, no other creation on Earth comes close to the totality of what a human body can do. So, what can happen to cause a person to develop such an unhealthy relationship with their own body?

There are a number of factors that seem to be linked with unhealthy body image. Understanding some of these may give us insight into how we can talk with young people about their bodies in ways which could promote healthier images or perceptions of their amazing bodies.

One factor we know about is age. Body image issues can arise at any age and some people have spoken to me about children as young as three of four mentioning that they are concerned about being “fat”. Clearly, given that much of our sense of self and our urge to belong or fit in, peaks in adolescence, so we do see the teen years as a time where we begin to notice more body image issues. Adolescence is also a time of increased growth, change in body fat distribution, changed sleep cycles and increased appetite and desire for sweet eats. If these changes co-occur with other distress, the link between body image and life dissatisfaction can be made – especially if other factors rewarded, criticized or modeled by influential friends or family cement the link.

Certain sorts of young people may be more prone to body image distress. Those who are perfectionistic, highly competitive, high achievers or those who are often benchmarking themselves in comparison to others are more prone to body image issues. So, too, young people who are very rigid in their thinking (“black and white”) who find it hard to find compromises or to meet some middle ground can be more at risk of unhealthy body images. They tend to make lots of rules for themselves around food, eating, shape, size and achievements so they judge their bodies very harshly if they think that they are not reaching a certain benchmark.

If a young person feels badly about themselves and the world because they have other issues with self esteem or depression, this can also affect their body image. Low self esteem or a depressive episode can be linked to unhealthy body image.

Teasing can negatively affect body image. So many of the young people I have seen in my practice for body image issues can pinpoint a time or day where someone teased them in relation to their body.

It may be that their brother has told them that their “bum does look big in that” or their “tuck-shop lady arms”. Being teased seems to lock in an association between feeling unhappy and having a body that does not measure up in the eyes of others.

Family and friends who are obsessed with diet and exercise can be a big problem. While cardiologists may be happy with this trend, I have seen more and more of these families over recent years. The families I get concerned about are the ones where the teen, despite being a healthy height-weight ratio, is criticized or teased for eating “Jatz crackers” after school or because they would rather sleep-in instead of getting up for early morning boot camp. It is not hard to see where these teens might begin to link feelings of dissatisfaction to their bodies – their families are modeling and, perhaps inadvertently, telling them that they don’t measure up.

In addition to families who have many food rules and strict exercise regimes, family or friends who constantly talk about body shapes – their own or others – are risky when it comes to teen body image. Researchers and authors of “If you’re fat, then I’m humongous” found that women often talk about being fat because they think it is a way of feeling better about themselves, but it actually has negative impacts on body image, rather than positive ones.

These days, in addition to traditional media, young people are also exposed to social media. New research about Facebook, the “selfies” and images portrayed has just been done at Melbourne University.  They found that those who make comparisons to other bodies on Facebook (usually their close friends) internalized a thin ideal and were more dissatisfied with their bodies.

The thing about Facebook (and perhaps many other forms of visual social media),  is that it provides a constant stream of comparison to images where much effort has been put into covering or deleting blemishes, carefully straightening hair, mastering the “hip-bone-propped-forward selfie stance” and all unfavorable pictures have been deleted, un-tagged or edited away.

When you step back and consider it, our young people (and ourselves) are frequently bombarded with messages that could easily set them up for poor relationships with their own bodies. We need to arm them with the knowledge and experiences to buffer them against the onslaught.

Be sure young people have a have a range of things that they are good at and enjoy. Psychologists refer to it as experiencing “pleasure and mastery”. It does not particularly matter what area or activities it involves, but it is important that there is space in young people’s lives for small pleasures and for doing things, however small, that they feel they are reasonably good at. Not too many rules and not too much benchmarking, just things that give them regular opportunities to experience warmth, pleasure and some self satisfaction. Physical activity is always a great option, but don’t beat your young people up to get them to engage or expect that a teen will want to wake up pre-dawn for that gym class.

It is also important that we help young people broaden their horizon and look outward rather than spend too much time alone with their thoughts. To think about helping others rather than competing or benchmarking themselves with others is important.

Crucial to a young person’s healthy body image is the role modeling at home. Make less/no fat talk, less/no food and exercise rules and more family fun and acceptance of diversity. Oh, and while I’m at it, less/no materialism and social comparison. There’s nothing like a family who feel like they need to keep up with the Joneses to engender a sense of dissatisfaction in the household.

Help your kids be media savvy – not just about body shape or size, but also about aging and wrinkles.

Help your kids understand that to sell a product or to gather a following, people will try to make them feel bad or dissatisfied. It won’t help young people, but it well help profit margins. Also, remember to let them know that this extends to the cleverly crafted advertisements that pop up in their social media feeds as well as in video content they may watch on the internet.

Have a word to those who are prone to tease in your family and your extended family. Traditionally, this would be the fathers, step fathers and brothers, but maybe this is changing? Be sure to explain to them the role that easing can play in body image issues and step in to stop it when you see it slip out again. Also, have a word to those who are being tease about the reasons people do such “dumb stuff”. Help the teasers and the teases find some other way to communicate and to find some mutual ground.

Remember, and spread the word, that our bodies are amazing – whatever their shape, age, wrinkliness, sagginess, bounciness or wobbliness. We should do what we can do to let them work at their best, but not be slaves to too many hard and fast rules about how best to operate them.

Guidance, experience and guidelines…not rules, measurements, health “guru-freaks” and rigidity.

For other information on body image, try the Butterfly Foundation ,  https://www.eatingdisorders.org.au/ or the great fact sheet at http://www.nedc.com.au/files/Resources/Body{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de}20Image{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de}20Fact{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de}20Sheet.pdf

The Spring Carnival is in full flight….the fillies, the fashion and the flutters. Hmmmm…..”flutters”. “Flutters” is one of those words that makes something that could be very serious seem like it’s a tiny, wee thing that is harmless, perhaps even beautiful. For some, a flutter is poison.

Problem gambling, in essence, is when someone has difficulties limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or the community.

We know of the stories of parents leaving their children in unattended motor vehicles for long stretches of time while they gamble as casinos or poker machine venues. We know that a problem gambler can get to the point where they spend all of the household’s income… and then some. The effect of this on young children is obviously problematic leading to financial problems and relationship issues in families. According to Australian statistics, problem gamblers are more than six times more likely to divorce than non-problem gamblers. Clearly, family separation has a clear impact on children.

What about children who become problem gamblers? Before you scoff and picture a child standing up on a box to reach a one-armed-bandit, consider how easy it is to gamble these days without even leaving home…in fact, without even leaving your bedroom. These days, it is easier than ever to gamble. People can gamble day and night on their smart phones, tablets or home computers. Television advertisements remind us that we can bet while we watch the season’s final of our favourite sporting codes. People can bet on the outcomes of nearly anything and can gamble in online bingo-type games 24 hours a day, seven days a week. For those who have an urge, there are plenty of ways to follow through at a moment’s notice.

When adults with problem gambling are asked, many will report that they started their problem gambling during their teen years. Young people (age 18-24) spend more money on poker machines that any other age group (and you thought it was those grey-haired nanna’s, didn’t you?).

Statistics tell us that problem gambling in children is linked to a range of factors:

• Children with parents who have gambling problems are 10 times more likely to become problem gamblers
• Children who are rated as having emotional distress by their teachers during the kindergarten years were more likely to be gambling by the time they reached year 6 in school. The link between anxiety, depression and emotional distress particularity becomes an issue for early gambling when it involved high levels of impulsivity.
• We also know that when gambling is portrayed as both glamorous and as a means of achieving financial freedom leaves a strong impressions certain adolescents may crave. If they strongly desire financial good fortune or yearn to be seen as attractive to others, gambling is portrayed as a means to these ends. However, like their adult counterparts, many teens gamble as a means to escape – to avoid a feeling or set of circumstances in their lives that is not working of them or does not feel good

Not all children who play cards as youngsters will go on to become problem gamblers. Most children will grow up to gamble occasionally for fun and be able to walk away before they risk too much money, too much time, or too many social and relationship issues.

So, as perhaps you consider heading on out that door for a champagne cocktail and a “flutter” in the office sweep, you can be reassured that most children will be okay when it comes to gambling, but what signs might indicate that your child may be one that does have issues with gambling?

Things may need a closer look if:

• your teen has more money than they usually would
• they are asking for more money than they usually would for food, bus trips of other incidentals…or worse, expensive belongings are missing
• their day to day language starts to us more betting terminology – some uselful examples can be found here. http://www.bettingterminology.com.au/get-your-betting-terminology-right-329.html
• they are spending time on internet gambling sites or watching more television broadcasts that may have a link to gambling
• there’s a change in their mood or usually pattern of socialising (always something to check in with for a range of youth issues)
• they are skipping school or having relationship issues

I’m not sure that it’s completely possible to guarantee, 100{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de}, that your child won’t become a problem gambler, but if you want to take some steps towards preventing problem gambling in your kids, the research would suggest you talk with your kids about gambling.

To send healthy messages to young people about gambling and ensure that they can keep it fun and healthy:

• Ensure that you take any steps to deal with gambling if it’s a problem for you or for someone that you love
• Teach children about gambling and the signs that gambling may be a problem for someone. When those advertisements pop up on television or computer screens, have a bit of a chat about what your child thinks they are and what they think they mean and what they are trying to get people to do
• Help children with their decision making and problems solving and ensure they can weigh up the pros and cons of things before they take action. If your child is impulsive, it’s especially important that you promote problem solving and encourage them to stop and think before that act
• Let them know the true odds of winning and help break down some myths and fallacies about gambling
• Share fun teaching them card games and how to follow a team without needing to introduce money into the picture.

If you need to get help for yourself or for someone who is worrying you with their gambling, there are some fabulous resources for people with problem gambling as well as their families available at Gambling Help Online http://www.gamblinghelponline.org.au/

Kids Help Line has some great resources for young people who have worries or low mood as well as having some information in relation to money issues http://www.kidshelpline.com.au/teens/get-info/hot-topics/money-matters.php

If you are a teacher or a mental health professional, there are a range of useful resources available using skills training, Cognitive Behaviour Therapy and Relapse Prevention Models.

The “best bet” is to spend time with your young people and help them with day to day decisions, taking considered time before acting, getting help early if there are any signs they are not coping with their lot in life, and making sure they can have fun without their needing to be some gain or win.

It seems just so wrong to even be thinking about children perpetrating acts of terrorism or extreme violence. There’s a part of my head that just doesn’t want to go there. I find myself trying to duck and weave to avoid the scandalous, over-inflated, anxiety-provoking media articles designed to keep us glued to screen and print. At times like these when my head and my heart want to be going in separate directions, I know the place I can find solace is in solid research and facts.

When I take the “oh-this-is-too-awful-to-think-about” factor out of it, the sorts of questions my head is left asking go something like:

• How does this happen?
• Surely, these kids are not doing it alone, are they?
• Where are their parents?
• Why aren’t they spending their time doing what other kids enjoy doing?
• Could I ever begin to imagine some young person that I know doing something so violent and extreme?
• How can we keep a level head about this and get children the help that they need before they hurt others?

Studies into Isreali teens growing up in terrorist zones shows they are much more prone to risk taking associated with Post Traumatic Stress concerns, especially for boys.   We also, sadly, understand the role that child soldiers play in other war-torn places on Earth. However, in peaceful places where people are not fighting for their lives on a daily basis, what’s the link between children and violence? Youth violence in more “peaceful” zones is normally attributed by researchers to factors such as substance use, early exposure to family violence and abuse, impulsivity, early aggression or poor regulation and certain anti-social attitudes towards police, schools or authority figures. Violence in the name of terrorism or for an extremist cause is much less likely amongst violent young offenders in Australia. So, where do we begin to focus if we want to prevent acts of terrorism by young people in Australia?

The Centre on Religion & Geopolitics has analyzed a cross-section of 114 propaganda sources ranging from April 2013 to summer 2015 from three Salafi-jihadi groups: ISIS, Jabhat al-Nusra, and al-Qaeda in the Arabian Peninsula.  I think this should be mandatory reading for everyone who cares about other people and who has a concern for the welfare of lonely young people all around the world.

By taking the time to look at the ideals that the researchers uncovered in the three pro-violence jihadi groups, we can see some of the links that may be attractive to children and young people. We can also see how they differ from mainstream Muslim groups or ideals of other faiths.

Indeed, despite ISIS, Jabhar al-Nusra and al-Qaeda all promoting themselves as different and unique, analysis has revealed that they have more principles in common than principles that differentiate them. In particular, their core values overlap significantly and differentiate them from mainstream faiths. There are three areas of values that analysts found were at the core of the pro-violence jihadi groups: 1. Creedal Values: 2. Honour and Solidarity; and 3.“End of Days”.

When you know or have spent time with sad, disenfranchised youth, you can start to see the appeal of each of these core values.

Creedal values – Many faiths have a creed, but not many have objectives that are largely about an “enemy” and about “ending humiliation”. Whilst most violence perpetrated by young people in our country is considered anti-social and comes from a certain combination of risk factors involving impulsivity, family violence, and substance use. The links to risk-taking behaviour in young people differ when they are growing up in a zone of recurrent terrorism. The child attracted to the values of violent jihadi groups is likely looking for help, structure and a guide to live by that will help them manage the feelings they have perhaps generated from being victims of racism, taunts or bullying.

You almost get the feeling that some, very hurt, young people are looking for a “family” that can give them a recipe or roadmap to help them travel through the social-emotional war zone that is, for some, adolescence.

Having rules spelled out in a creed provides some rules to live by. For many, this provides black and white thinking and easy ways of making decisions. Things either fit or they don’t. People are with you or against you. A creed provides structure. It provides a sense that you will always have a right answer, even in really complex, emotional or ethical situations.

Solidarity offers a community of people who think the same way as you. It gives you the chance to belong with others who share a common purpose or common responsibilities. It gives you an escape from loneliness and a feeling of sameness and camaraderie.

Honour – a source of respect, a system of merit a way of judging yourself and others. It gives you a chance to be one of the great ones. No longer one of those lonely, “out group” young men that has been hurt by “in group”, “cool kid” bullies who have all of the latest gadgets that their parents’ money can buy.

End of days – There’s nothing like a deadline to get you motivated and get you taking action sooner rather than sitting back and thinking about it all without actually taking any action. Turning ideas into willing action -the idea that there will be a day coming where all those who have filled the creed will be celebrated and reap benefits and those who do not will suffer.

So, in all, these groups offer lonely and disappointed children and youth a chance to belong. If you join, you will belong to a group that has solid and clear values. It will be an honourable choice and you don’t need to be good at making friends. You will get your payback and your enemies will get the hard times that they deserve.

And so…to my questions… Thinking about it like this makes it clearer to me how it could all happen – how a young, disenfranchised, lonely youth might find all he is seeking in a pro-terrorism group. Certainly, they are not doing it alone. While their individual acts of violence might be solo, they are backed by ideas and support that is perhaps stronger than they have felt “backed and supported” in awhile…perhaps ever. You can imagine these lonely young boys living under the same roof as their parents. Perhaps they rarely leave the house except to gather with some like-minded others. After all, they can access all of the support and ideals and enthusiasm online on their laptops or smart phones. They may even belong to a religious community, but if it isn’t offering them enough, isn’t youth-focused enough and doesn’t give them the immediate answers they need when they feel hurt or left out, then they will, like other young people, look elsewhere to get their needs met.

So, in a way, they are spending time doing what other kids are doing. They are looking for a place to fit and to belong and they find it in the structure and idealism of the groups that encourage them to hurry up and do something that will secure their place as heroes in the eyes of others – if not now, on some approaching future day of reckoning. Sadly, now I know I could imagine some of the young people I have met getting caught up in situations that lead them to committing acts of terrorism in the name of a certain group. Perhaps, these children differ a little from those I have worked with in Youth Justice systems over the years because they are not necessarily affected by substances, school refusing, impulsive, domestic violence and the other factors normally associated with youth violence in Australia.

How can we keep a level head about this and get children the help that they need before they hurt others? I think that, until we have an evidence base to work on (young people are always good at getting involved in issues well ahead of the research and researchers are often caught on the hop and needing time to build reliable data) the answer lies in inclusion. We need to do our utmost to include young people of all races, religions, gender identities, music genres in all that we offer. We should celebrate our diversity and help young people who, by the very nature of their developing brains, are simultaneously seeking to belong and build their own identities to get to know, explore, compare, listen to and weigh up the pros and cons of all the choices there are for them in our amazing country.

The answer does certainly not lie in attacking people of other races or religions or going on witch hunts for their children.

While it goes without saying that we should do our utmost to keep all children safe from harm, we need to be careful that in so doing we don’t shut them away from meeting, learning about and being with others.

Again, I encourage you to read…http://tonyblairfaithfoundation.org/religion-geopolitics/reports-analysis/report/inside-jihadi-mind.

I know that you may not want to “go there”, but it’s well worth the trip!

Depression in young people is something we hear more about these days, but sadly, it is still something that goes undetected and can seriously affect a young person…even to the point of suicide. There are many programs out there that attempt to make things better for young people and mental health. The great news is that young people are more aware of mental health issues than in years gone by. In fact, I would go so far as to say that young people are very interested in their mental health and in learning more. The other great news is that young people are better at help seeking then they once were. The not-so-good news is we still do not have an iron clad way of preventing depression in young people and the terrible news is that there are still many depressed young people who go undetected. However (more great news…) we can prevent depression from worsening if we work with high risk groups and with those who have the early signs of depression.

We know that young people at risk for depression may have a family history, some past traumatic experiences, a personality type or come from some marginalised or minority group because of their race, gender identity or even risk of homelessness. We also need to keep an eye out for the early signs of depression in young people. Warning signs to watch are:

• Bodily signs – tiredness, change in appetite, change in sleep patterns or a change in energy levels
• Emotional signs – feeling worthless, sad, low self worth, anger, guilt, fear and worry, change in personality, flatness to mood
• Behavioural signs – agitation, aggression, withdrawal, isolation, avoidance of preferred activities, self harm, poor self care/cleanliness/hygiene, poor school attendance, reduction in school grades
• Thinking signs – preoccupation with death, difficulty staying focused, reduction in memory, indecisiveness

I know that many of these things sound like day to day symptoms of being “just a young person” and that is why it can be hard to detect, but be aware of change and be especially mindful if things remain concerning for longer than they might normally be. Also keep a close eye on young people if there are stressors in their friendship groups, if relationships end, if they have issues with drugs or alcohol, if they have a disability or chronic medical illness or if there has been a death in the family or in their social circles.

Once we’ve noticed the signs…what to do then?

Well, this is where all sorts of people in all sorts of professions selling all sorts of snake oil might come into play. If we want them to get a depressed young person to a happier place, we want to get them there by the most direct route and with the least mucking about. This is an important, sometimes even a life and death, issue – too important for any mucking about.

If you knew the fastest route from here to, say, Hawaii was a plane and you wanted to get there as quickly as possible, why would you walk?

The research clearly tells us that the best way to get a depressed young person to a happier place is by using a qualified psychologist or other mental health professional. In Australia, AHPRA register health professional and you can check any registered professionals qualifications or even make complaints at the AHPRA website. If we are looking for the best person to assist a young person on their journey to mental wellness, we also need to make sure that the services are youth-friendly and culturally responsive and that the young person is supported to develop an ongoing relationship with the psychologist or other mental heath clinician.

Okay – so we have the type of professional we need. What techniques should we be looking for? Aerobatic manoeuvres are likely unnecessary on a trip across the Pacific.

If we want to get a young person well in the fastest, most straight forward way, the research tells us that Cognitive Behaviour Therapy (CBT) or Interpersonal Therapy (IPT) work best with young depressed people.

CBT encompasses a variety of sub-types, but at its essence focuses on thinking and behavioural habits that precipitate and perpetuate depression and looks at a variety of techniques to change thought patterns and behaviours. With young people, it is especially important that the psychological work that is done is done with respect to the context of what is happening for the young person and that there is appropriate involvement and collaboration with family, support people and even school.

Sometimes if the young person has a moderate or severe level of depression, some medications may be warranted. Medication for young people with depression can be controversial because young people are much more at risk of suicide when they are agitated and the early side effects of many antidepressant medications are agitation. Current guidelines suggest that medical practitioners should consider an SSRI, but that they need to monitor the young person closely after prescribing pharmacological treatment and that best outcomes occur when the medication occurs in conjunction with CBT or IPT. Also, when things start to get better, best practice guidelines tell us that we should continue to provide treatment and monitoring for a further six months.

Also, while we are flying to our destination, it’s important that we have a safety plan.

Flight attendants repeatedly tell us about the need to know what to do in the “unlikely event of an emergency”. A young person’s psychologist or mental health clinician and medical practitioner should also discuss an emergency plan with the young person and the young person’s support team.

Knowing what we know about young people and the path to recovery from depression, we should not stop looking for other routes that could be even more effective, more comfortable, less expensive, or less effort. More research into mental health is always warranted because we still have a way to go to make the journey smoother – especially for those with really complex issues.  Meanwhile, I would encourage everyone who has an interest in the mental health of young people to read the Clinical Practice Guidelines published by Beyond Blue who have done an amazing job of reviewing the available evidence to help clinicians with good practice points.

If the destination is mental health, then, at this point in time, the best way to get a young, depressed person there is CBT or IPT with a qualified psychologist or registered mental health practitioner who can build rapport with young people and appropriately involve their families or others to ensure the safest, most effective journey with the happiest of landings.

When you think about health, what do you think about? How fit you are? Whether you have a disease or not? Being injury free?

Most people think about health as being something they either have or do not have, when, generally speaking, we are probably all on a spectrum of health. Some people who have chronic illnesses can be considered healthy if their conditions are managed well. However, like many things, when we start to think about health or sickness as something we either have or don’t have, we can open up a dyad of absolutes in our thinking that can generate anxiety. If I’m not healthy, I must be sick!

If you are a little person, your brain will tend to see things more in absolute terms. If you are told often enough that germs will make you sick, or “don’t’ touch that you’ll get germs”, then the idea of germs linking to illness and probably death can easily become something that dominates the thinking of an anxiety prone child.

How old were you before you understood exactly what a germ was?

In order to avoid explaining complicated medical situations to children, many adults just tell them that a germ made them sick. Anyone who knows even the slightest thing about germs and the immune system know that many people can be exposed to the same virus or bacteria and some will become ill and others will not. The more you understand about health and the human body, the more you know that it is complex relationship. Health involves a complicated interplay of a person’s biology, their environment, their psychology (or the way they are thinking about it) as well as the society they live in and the society’s expectations about health and wellness. To put poor health, or death, down to germs can be dangerously oversimplifying things for some little people who are vulnerable to health anxiety.

Sadly, some children can become so preoccupied with germs or getting sick that they begin to shape their lives in ways that make it very hard for them to enjoy day to day life, even though all of their vital signs are healthy!

When too much importance is placed on germs or health, the intense focus can actually make a young person mentally unhealthy and very unhappy.

Having a fear of germs or illness can become excessive and can lead to behaviour that is unhelpful – focusing too intently on body signs, checking poo and wee, washing hands excessively, not eating food that is close to its “use by” date, avoiding sick people, not being able to use public toilets, avoiding school camp or even school for fear of getting a germ that might make them sick….and die. Some children with a fear of germs or a health anxiety can need lots of reassurance from friends or family. They can ask too many questions about a person’s health, they cannot visit a sick friend or relative for fear of getting sick themselves or they may even be unable to watch medical shows on television. Factors on the outside of them can combine with factors in their thoughts. Sometimes, because they are so hyper aware of any possible symptom in their body, a rumbling tummy combined with news of a heath scare can combine to produce debilitating anxiety.

Some parents with health anxieties can exacerbate the problem for their children. At the earliest sign of any tiredness or fatigue, they are on the computer asking Dr Internet about child Leukemia. Yes, on some occasions tiredness is a sign of a disease state in a child, but there is a sensible response to exploring symptoms and there are over-anxious or even avoidant responses that can exacerbate a child’s anxiety.

Researchers are finding that people who are anxious about their health often do have certain vulnerabilities linked to their childhood. Sometimes, things have happened in their early life and their early attachments may be insecure, leaving them feeling vulnerable and prone to attack even before their brains have developed the ability to talk or think about it in words. It could be that a child has experienced poor health in their early years or that someone in the family has experienced very poor health. Sometimes, children can be left thinking that they have to be sick in order to be cared for and have their needs met. Sometimes, they have such a lousy time of it that they become hyper-vigilant to any sign that they might get ill again. There is also some new evidence that suggests that people who are anxious and monitor their health too closely, may also need more skills in being able to get along with people so that they do not feel so distant from others and do not need to worry about being sick in order to have warm interactions.

Clearly, the health anxieties in children and adults are complex, and if a child is being affected by a fear of germs or being sick in a way that limits their involvement and enjoyment in life, it is worth having a professional consider all of the factors that could be contributing and then working through the factors to find some relief for the affected child.

So, let’s stop giving germs a bad reputation!

Instead, let’s work on helping children to have balanced thoughts and beliefs about health.  To this end…

• Teach children about their bodies in age-appropriate ways. Human bodies are truly amazing things – let’s celebrate what they can do rather than go looking for signs of illness.
• Encourage a healthy relationship with “germs”. Do some research with your child about germs and the roles they play in our health and in making the World tick.
• Don’t avoid talking about death or illness, but modify the conversation to match your child’s understanding and to gradually extend and expand on what they know. If they have questions, find ways that you can answer them together or go, together, and ask someone who may know more about it than you do.
• Rather than making too many rigid rules about cleanliness, try to go with general guidelines. I think a general guideline might be that you wash your hands before you help with the cooking or before you eat your dinner, but if you do miss one or two occasions there’s no need to panic.
• Watch for avoidance and checking.  Keep  children involved in life, even if they are genuinely not well for a time, keep the relationships and learning going if they need to miss school or dance class/basketball/swimming.
• If your child has a an excessive fear of germs or getting sick that is starting to get in the way of them having a happy and involved life, then take them to your GP to consider a referral to a qualified psychologist or mental health practitioner.

No more bad press for germs!

Having just returned from speaking at the Australian Summit on Bribery and Corruption, I was overwhelmed by the huge amounts of money large corporations commit to preventing bribery and corruption in their organisations and the huge amounts of time, money and resources government officials put into prosecuting offenders. It made me think about parallels between organisations and families. These large organisations, and indeed Governments, really want their employees and citizens to be honest and to be decently rewarded for good work. I think that is exactly what many parents want for their families, too – to raise children who are honest and decent people.

So how do we raise children to become honest citizens of the world?

Children go through different phases with good and evil. Let’s consider lying. To tell a lie, actually requires quite a bit of cognitive work. To tell a good and convincing lie requires a big lot of cognitive work. It requires thinking about what happened, predicting consequences, being able to predict what other people might do and being able to understand what other people might believe – lots of social skills are required to be clever about lying to others.

When we assess a child’s moral development, we note that they go through stages as their brains develop and their understanding broadens. In the middle of last century, Kohlberg had a theory that many who have studied child development will recognise. Kohlberg posed a range of dilemmas to children of certain ages and was interested, not so much in whether they got the answers right or wrong, but in the reasoning or justifications that were used to arrive at the answers. One of the more famous dilemmas involves a woman dying and needing treatment….

In Europe, a woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost him to make. He paid $400 for the radium and charged $4,000 for a small dose of the drug. The sick woman’s husband, Heinz, went to everyone he knew to borrow the money and tried every legal means, but he could only get together about $2,000, which is half of what it cost. He told the druggist that his wife was dying, and asked him to sell it cheaper or let him pay later. But the druggist said, “No, I discovered the drug and I’m going to make money from it.” So, having tried every legal means, Heinz gets desperate and considers breaking into the man’s store to steal the drug for his wife.

When asking children about these dilemmas, Mr Kohlberg believed that children developed through stages in regard to their responses. He suggested that children in their earliest phases of moral development believe that the right thing to do is the thing that won’t get you into trouble or the thing that avoids punishment. If you ask someone at this stage of development if it is okay to take a biscuit from the jar without asking they would say “no” because “you would get in trouble”. In the early years of child development, the wrong thing is defined as the thing you could be caught doing and then get in trouble for. If you are not caught, then there’s no trouble. (I know you are all thinking about adults you know who are still at this early stage of development).

As a child progresses through life and develops morally, the child starts to understand that there is a need for people to do the right thing because it keeps the world in order, makes life predictable and keeps society settled. There is more consideration of other people. Good people are “nice” and they do the “right thing” by others.

With still more development, a child begins to realise that people can have different views and experiences of the world and that these determine what the right thing to do might be. Rules and Laws are important, but children (normally teens by this time) can understand that there is a more universal “good” and that sometimes people try to change or oppose laws because there is a really important reason for doing so that might affect lots of people.

If you search the internet using any search engine to enquire about how to raise honest children you can really see the influence that culture and religion might have on parenting ideas.

One of the things that Kohlberg’s theory has been criticised for over the years is that it ignores the role that culture and experience have on a child’s developing sense of what is right and what is wrong. If you live in a third world country where food and shelter are scarce, there might be different opinions about what is right and wrong. We only have to look at how one culture can be divided about topics like gay marriage or asylum seekers to know that people’s lives are shaped by experiences that lead them to maintain certain beliefs about what is right or wrong. Views of what is “right” are influenced by opinions of their family, the opinions of their friends, workmates, the books they read (what really is “happily ever after”?), the information they regularly surf on the internet, or the things they have witnessed in their lives. Is it okay to offer someone more money to get that surgery faster?  Is it okay to go to jail for protesting about something you really believe in? There will always be some cultural influences on these answers, but it will depend on what the adults in the child’s life believe and how they act and respond to perceived injustices and wrong doings.

What will the child get in trouble for and what will they see others get in trouble for…or get away with?

The ability to understand right and wrong has implications beyond parenting. The ability to be able to tell right from wrong is really important in legal matters involving children. In our society, we recognise that children will differ from adults in their ability to know and understand right from wrong. Under the age of 10, a child cannot be convicted of a crime in Australia. Between 10 and 14 we enter a bit of a complex zone where Courts will usually require that a child can only be convicted of a crime if it was clear that they knew the difference between right and wrong at the time. For children 14 years to 17 or 18, a young person can be convicted of a crime, but we tend not to send then straight to custody and have a range of other options we as a society prefer to take as we recognise that they may not fully understand the wrongfulness of their actions. In some states in Australia, there are adult youth justice options for youth up to 21 years of age where more vulnerable offenders can be sentenced to Adult Youth Justice options and not to adult prisons.

So… if we move from the big heavy stuff of crime and Courts and come back to day to day life in the average Australian home, where are we up to with lies? Is it okay to tell a lie if the truth might upset someone? Is there such a thing as a white lie? How does a secret or withholding the truth differ from a lie? What is sarcasm – how come someone can say one thing with their words but say something else with their tone and is this okay? It’s all very complex and it’s lucky that most children actually take it all on board with the cleverness of their developing brains and the guidance of their families and educators. These clever and developing brains are hungry for information and we should give it to them in regular bite-sized pieces that show them the similarities and differences that different ideas and cultures bring to people choices about what they do. The world is complex. There will always be dilemmas for which there are no clear answers. Meanwhile, though, it is perhaps always wise to check whether we, the grown-ups, are living in line with our values and how we demonstrate these to children in moment by moment ways.

Like all other aspects of parenting, your child’s moral development will depend on what they see and experience in their home life, school and surrounds. Parents need to be clear about what they value and parent to match the values that are important to them.

When we are helping little ones (or grown-ups) to learn to regulate their emotions, we are teaching them to label and safely express how they feel. We aim to help them to match their behaviour to certain situations, to turn their energy levels up and down – a little like we might adjust the volume of a stereo or the temperature of an oven.

Sometimes we need to build our energy up – like when we need to get going for the day or when we are about to play sport. Sometimes we need to turn it down, like when we are getting ready for bed or ready to concentrate and learn at school or at work.

We can adjust our feelings output levels and intensity using a range of techniques like changing our breathing, changing what we “say” to ourselves internally or by doing different exercises. Music can also help us to turn the volume up and down on certain feelings. We can immerse ourselves in a particular emotion by adding a certain background sound track to a moment.

Some music works for us emotionally because our reactions to it leave us feeling a certain way. Researchers know that we are very likely to select the music we play so that it is congruent or feels the same as our mood. We can also use music to help us move from one emotional state to another.

Just like emotions, music can be high or low energy and it can have a pleasant vibe or a more unpleasant edge to it. We can change our mood and our energy levels by exposing ourselves to certain music. Up beat, happy music can energise us. Quiet, lilting, melodic, perhaps classical music, can lower our energy and can calm us.

Researchers have also reported that music that is classified as “extreme” can make you feel calmer. Punk or heavy metal music can help people connect and share an emotion. People can connect with the anger or the rage that is being expressed in the beat and in the lyrics. They can relate to it, then release.

Music and songs can also help immerse us in memories. It can take us back in time to happier, sad or rebellious phases of our life. Familiarity and repetition can soothe us, so it is not surprising that we often go back through our music collections looking for a certain track from a certain point in our life to immerse ourselves in a certain feeling. However, musical memories can also leave us with an annoying advertising jingle stuck in the recesses of our minds for days.

Movie makers have known about the power of music to effect emotions for a long time. In a movie soundtrack, music is used to play with your emotion. Music can help to build suspense and even to add fright to a scene.

Music can help you build your emotions and then perhaps release them when the beat drops. Dance and techno music often uses a rising beat, then a pause, and then “the drop” where all of the tension is released. A dance can be a physical and emotional work out and the repetition of certain movements can be soothing. Humans tend to pace, jiggle or rock when agitated and this can help them soothe themselves.

So, if you are dealing with someone who has trouble regulating their emotions, or who is still learning to regulate emotions, think about the ways that music can be used to help them.

For instance, if you are driving along and in need of manipulating the mood in the back seat of the vehicle, perhaps you can try to play a certain track in the car. Many parents will attest to reaching a destination with nursery rhymes ringing in their ears and minds for the day, but somehow feeling a little more sane or less stressed. Please be aware, though, that changing the music should not be excuse to push beyond stress levels that are affecting the driver’s concentration. Oh, and at the risk of sounding patronising but needing to be safe, you should always pull over to change the music if you are driving a vehicle – we don’t want anyone getting in a situation that requires emergency sirens in the sound track.

You can also use music choice as another way of talking to children about feelings. “I feel a bit uptight – let’s choose something a bit soothing”. “I feel happy – let’s choose something up beat and celebrate”. As you watch films together, you can highlight that you expect something scary is about to happen because the music is changing and explain that movie makers do that on purpose. Perhaps, you can all have a go at making some emotional music, too. Crack out the instruments, or even the pots and pans from the kitchen.

Just like all things in life, expose your child to a variety of music genres and cultures so they can sample what works for them. Perhaps the repetition and the movement associates with learning to play an instrument can introduce them to a way to soothe or regulate their emotional selves for years to come?

With Fathers’ Day upon us this weekend, perhaps it’s time to think about what fathers need – not in the underwear, socks, and new fishing gear department, but more in terms of what really makes them happy. What do fathers need to be happy, mentally healthy and to be well?

Proudly, a lot of recent useful research into the mental health of our Dads has been completed here in Australia. When we go searching through the research on psychology and Dads there are a few themes that emerge:

• Dads are subject to different gender and parenting norms
• Dads experience mental illness differently to women
• Men use different strategies to manage their health problems
• Men may be more reluctant than women to seek help for health and welfare concerns.

I have had the privilege of working with lots of fathers, but on reflection, this is usually because they have been made to see me because their child is at risk, their parenting is being reviewed by a welfare agency or because they are under some sort of Court Order to get some help. Sadly, there is a subsection of fathers who are mandated to receive mental health treatment because they have come to the attention of authorities in relation to concerns about their parenting or because they may have broken the Law.

It’s really important to recognise, though, that while a very small minority of men (just like some women) with mental illness do pose a risk to their families, the majority do not. It’s stigma that stops many good men receiving the mental health support that they need.

Fathers can come to the attention of mental health professionals:

• Because they have a mental health concern and they are seeking help
• Because they have just become a father and may have issues with peri-natal adjustment or
• Because their children or partner have mental health concerns

Across the world, men are less likely to present with symptoms of depression, but more likely to present with issues related to substance abuse, especially alcohol. When we take a closer look at men who abuse alcohol, we often find co-existing depression and anxiety.

Researchers have tried to better understand the difference between fathers who seek help and fathers who do not. It appears to come down to weighing up the pros and cons of “coming out” about their mental health. Some fathers feel that coming out about their mental illness gives them greater support and less worry about being “found out”. Sadly, some have experienced stigma and wished that they had not told others. Clearly, when a Dad speaks about having mental health issues, we need to do more to make them feel supported and to keep them engaged in treatment so that they can return to a happy quality of life.

It is also clear that we need more work done on educating the community about mental health issues for men. We need to think carefully about the way we give information to fathers. While it has for a long time been thought that men are less help seeking than women, we do now know that men prefer to get information through lay advice. The challenge for professionals is to support lay people or easily available avenues of support to have the best professional and scientific advice that can be offered. Beyond Blue have some great resources for men.

We need to keep an eye on new Dads. When parents become parents for the first time or for each subsequent new baby, there is a risk that the changes that occur around the new bub can throw coping systems into a spin. While we have been aware for some time now that mothers need support around a new bub, we now know that fathers can also be vulnerable at this point in time.

Interestingly, Fathers have different risk factors around post-natal health than mothers. With fathers, the researchers[i] have now established that there are some specific factors around Dad that will predict how he goes post-natally. Dads are at higher risk of post natal mental health issues if they are have poor job quality, poor relationship quality, if their child’s mother is psychologically distressed, if they have a partner in a more prestigious occupation and if they have low parental self efficacy.

Another time that fathers come to the attention of mental health clinicians is when a father is parenting a child (or adult child) who has a mental illness or disability. Fathers of children with mental health concerns often report feeling powerlessness and a sense that things are “a constant struggle”. It is thought that fathers are more likely than mothers to cope by keeping themselves distracted or busy, or want to find logical and rational answers – this can sometimes leave mum to cope with all of the feelings stuff. However, those who are working with fathers need to know that they will be more inclined to require and take on board practical information with regard to their child and they should make this available.

Generally speaking, Dad’s are happier when they have a job that values them, an intimate partnership that is healthy, when they have active involvement with their children and when they feel good about their capacity to parent.

When Dad’s mental health does get wobbly, mental health services need to provide family friendly services, they need to specifically ask after dad’s mental health and ask whether Dad is happy with his parenting or would like some help to learn to have more efficacy in their parenting.

So, my wish for fathers this fathers’ day is:

• Workplaces that consider flexible arrangements for dads (as well as mums)
• A supportive partner, family, mates and community
• More available services for fathers themselves but also services for children that are father-inclusive
• More available advice around mental health that is professional and scientific but that looks like it’s “mate’s” or “lay” advice as Dad’s seem to find information easier to digest in this way.

Have a happy Fathers’ Day, Dads!

[i] Giallo, R., D’Esposito, F., Christensen, D., Mensah, F., Cooklin  AR., Wade, C., Lucas, N., Canterford, L., Nicholson, J.M (2012). Father mental health during the early parenting period: Results of an Australian population based longitudinal study. Social Psychiatry and Psychiatric Epidemiology, 47(12):1907-1916. doi: 10.1007/s00127-012-0510-0.