It is Day 1 at the 2018 Rural Training and Youth Support Conference and I am learning a lot. The keynote speaker today was Dr Marc Milstein who specialises in communicating scientific papers in practical ways. He spoke about the neuroscience of anger and some of the wider biological and environmental issues. In the afternoon, I attended a talk by Dr Wayne Warburton from Macquarie University on counselling angry and aggressive clients.
It’s always interesting to listen not just to the speakers, but to the questions coming from the audience. This helps me understand the issues that front-line workers are experiencing when working with the youth.
There were three questions that really struck me, and there are no easy answers. It always depends*.
Here are my first impressions:
Is it better to medicate children early for anxiety?
I get this question from worried parents who don’t want their children to feel distressed or fall behind (e.g. miss school). I also see parents at their wit’s end, having tried everything that they can think of. Medication seems like the easy solution, and this is where the danger lies because childhood anxiety is not easy. Children have very little control over their environment. Their attachment relationships, home environment, school environment, and friendships all play a part in how they will develop. As such, intervention for anxiety can not lay solely with changing the child. Medicating a child can mistakenly attribute the ‘problem’ to the child, and children labelled as ‘problem children’ are at risk of poorer outcomes in life. Psychoeducation and family-based or school-based interventions can be effective in assisting a child with anxiety. When I see a child under the age of 13, I will always ask for parent involvement. I find that parent’s regard for their child, and parent willingness to be involved in their child’s therapy, produce the best long-term outcomes.
What is the best treatment for anxiety or depression caused by illness (e.g. an autoimmune disorder)?
In response to this question, there was some discussion about whether therapy would be beneficial at all. Something that psychologists don’t advertise is that many of us are trained in techniques that help us to assist in detecting, clarifying, and problem solving through a client’s reported symptoms. We are experts at helping people experiencing depression or anxiety engage in behaviours that will improve their quality of life. In this way, psychologists can assist in the management of mood in cases of chronic illnesses. Furthermore, with emerging interest in trauma or stress and autoimmune diseases, I would say that therapy still has a part to play.
How would you deal with a student having a meltdown in class?
I can still vividly remember an incident, back when I was a provisional psychologist, where I was confronted by a very angry child. His school reported that he was prone to ‘meltdowns’ and I was fortunate enough to experience one of these firsthand when he picked up a chair and threatened to throw it at me. I can still see this small child with skinny arms lifting this massive chair above his head, pure hatred in his eyes.
At the time, I had no idea what I was seeing. I blurted, “come with me,” and thanked the heavens that he decided to trust me.
Angry kids are like icebergs. The part that rages around destroying the classroom is the part that sticks out of the water. In the moment, it’s important not to take their behaviours as a personal attack, and instead focus on a stance of kind firmness to take charge in a non-threatening way. The real work comes afterwards in adjustments that support a child’s sense of safety and ability to self-regulate. Also, a lot of angry kids are hungry kids, so frequent meal breaks and snacks can help.
It’s getting late now so I will call it a day. I look forward to another day of learning tomorrow.
* N.B. I also asked a question about whether to treat sadness or anger first in adolescent anger management groups. A fellow member of the audience muttered, “you treat the person”, which is always humbling to hear.