Unbabbled Episode 7: Mental Health

Basics of Mental Health in Children with Lily Yoder

Children with communication disorders and learning differences are more likely than their neurotypical peers to have mental health conditions, such as depression and anxiety. In this episode Lily Yoder, Licensed Professional Counselor (LPC) and Registered Play Therapist (RPT), joins us to discuss the basics of mental health in young children and the overlap between communication disorders, learning differences and mental health disorders. She shares indicators your child might need intervention to work through their struggles, information on how to seek help and gives clarification on the roles of a licensed professional counselor, psychologist and psychiatrist. 
Lily is the Director of Student and Family Services at The Parish School. She earned her BA in Psychology from Baylor University and her MA in Psychology from Houston Baptist University. Before joining The Parish School in 2018, Lily had over 10 years of experience providing counseling and play therapy to children and families in a variety of settings. She has significant experience with young children, ADHD and anxiety disorders, and is a member of the Sam Houston Chapter of the Association for Play Therapy.


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Stephanie:                        00:05                   Hello and welcome to Unbabbled a podcast that navigates the world of special education, communication delays and learning differences. We are your hosts, Stephanie Landis and Meredith Krimmel, and we're certified speech language pathologists who spend our days at the parish school in Houston, helping children find their voices and connect with the world around them. In today's episode, we sit down with Lily Yoder, licensed professional counselor and registered play therapist. Lily has over 10 years of experience providing counseling and play therapy to children and families in a variety of settings. She has extensive experience working with children with ADHD and anxiety. Lily is a social emotional support specialist and newly appointed director of family services at the parish school. She works closely with parents, students, and educators to provide therapeutic interventions in the classrooms and at home. We chatted with lily about the basics of mental health in young children and the overlap between communication disorders, learning differences and mental health disorders really provides warning signs. Your child might need specialized intervention to work through their struggles, information on how to seek out help and gives clarification on the differences between licensed professional counselors, psychologists and psychiatrists. Welcome Lilly.

Lily:                                    01:24                   Hi

Stephanie:                        01:24                   We so excited to have you here to talk about mental health, which we know is a huge topic, but we just kind of want to skim the surface and give our listeners a little bit of information on what mental health looks like for children and things that they can look out for. So to start us off with, just give us a little bit of information about your background.

Lily:                                    01:46                   I'm a licensed professional counselor and a registered play therapist and currently at the parish school. I'm the social emotional support specialist on campus.

Meredith:                         01:55                   Fantastic. Lily, tell us a little bit what brought you into the field of mental health?

Lily:                                    02:00                   I've always enjoyed working with children and so originally when I had gone into school taking my bachelor's, my idea was to be a pediatrician to work with children. Probably about halfway through the program I was like, you know what, Med school is a lot of years and I'm not sure I want to become a doctor, but I still really wanted to work with children. And when I had gone in, I had gone in for a bachelor's in psychology, which I was really, really interested in. And at one point in one of my courses I had to do a project on play therapy. And at that point I think that's when I decided that I wanted to be a therapist and I wanted to work with children and that I was going to get my play therapy credential at some point, which I did.

Stephanie:                        02:47                   well that's great. I think when a lot of people hear the term mental health, they think more of adults. Can you talk a little bit about what mental health looks like in children?

Lily:                                    02:58                   So mental health is just your emotional, psychological and social well-being. It's how you handle stress, how you cope with stress and it affects how you feel, how you think, and just kind of how you act. So what that might look like in children. And this is definitely not an exhaustive list because there are just so many different, I think behaviors or things that would warrant mental health, but depending on their age and what's going on. Maybe you have a child that is constantly complaining of stomach aches or headaches. Maybe you have a child that is crying a lot or seems sad a lot without a specific reason. Clingingness, difficulty separating from a parent temper tantrums or I'm getting angry a lot or anger easily behavior, lots of behavior problems maybe at school or difficulty managing behavior at home or at daycare. Thoughts of I guess comments from the child about fears or worries. You know, again that are not necessarily age appropriate because developmentally some of these are going to be typical within that age of development, but out of that age of development would warrant more concern. Bedwetting, bedwetting and daytime wetting as well can both be signs that maybe your child is struggling emotionally.

Meredith:                         04:28                   What kind of diagnoses might you see in a child who would benefit from mental health services or even like play therapy or any other type of child therapy?

Lily:                                    04:36                   I've seen a lot of different diagnoses in therapy that I have worked with and I try and I always encourage parents or people or providers to look more at, um, the behaviors or you know, what their, what feelings or child is displaying or what they are saying as opposed to specific diagnosis. For example, I see lots of children with anxiety and with anxiety disorders and sometimes it is a neurological or chemical imbalance related anxiety, but sometimes it's anxiety that's related to chronic stressors or a significant stressor in their life that so they wouldn't necessarily qualify for an anxiety disorder, but they would still be showing symptoms of anxiety, which would still benefit from therapy or play therapy. But to give a list: anxiety disorders, depression, social anxiety, selective mutism, ADHD, mood disorders, autism spectrum disorders, children that have have complicated medical diagnosis in histories. A lot of times we'll have mental health or emotional issues just related to dealing with the struggles of having a complicated medical history, having to go to the doctor's office a whole lot or stay in the hospital for extended periods of time or get shots on a weekly basis. All of that can definitely trigger some emotional issues for a child trauma and abuse, PTSD and then just what they call stress related disorders, which again is just a significant reaction to significant changes in a child's life.

Meredith:                         06:27                   So if you're thinking your child might benefit from mental health services, what, what things do you think parents need to know in regards to the different types of therapies offered and what type of therapy they should be looking for for their child specifically?

Lily:                                    06:40                   Well, I think for any child, majority of the time you're going to want to see a therapist that is a registered play therapist mainly because that means that that therapist has the training and expertise in using toys, play-based materials, expressive art materials to be able to work with a child and in a way that is the most developmentally appropriate mode of therapy for them. A lot of therapies that are used for adults are talk based therapies. And as we know as an adult it's hard to process and explain the difficult emotions or feelings that we have going on in our life. So if it's difficult for adults to to do, imagine how difficult that is for a child to do when majority of the time a child is going to act out what they are perceiving or expressing or feeling rather than just say, hey, I'm feeling kind of mad right now and play and, and toys are just, just naturally come to a child. They just play at whatever age. And I know that some children, um, it may have developmental delays and so they may not necessarily play at their chronological age level, but they still will engage in some type of play. And so play is the easiest way for a child to process the feelings that they're having, their, their situations, their perceptions, just what they are experiencing in the life around them.

Stephanie:                        08:24                   Are there any other therapy techniques maybe individually or for the family that parents can look out for?

Lily:                                    08:31                   Yes, I think you know for some of your older children and for some of your specific anxiety related disorders, you will see some success with cognitive behavioral therapy. Again, I always encourage a therapist that knows how to use play therapy to help adapt. Just kind of those cognitive behavioral skills. Cause again it's higher cognitive skills that are required to do that. And then family therapy. So you know, a lot of therapists, especially ones that work with children will work with families too on just dealing with, you know, parent and behavior management and how do we deal with a child that is different than our other child or that has special needs and how do we, how do we create healthy roles and patterns in our family that support this child or us as a family.

Stephanie:                        09:19                   Yeah. That way it's not just on the child to deal with it, but they have the whole support and interacting with the family. Right. Found that that's very useful in dealing with a lot of language based difficulties as well. Yeah. So I was surprised even having gone through school, I'm learning all about language disorders when I started working, how many children really did struggle with both the language side of things and as I was working with them I found more and more that there were some underlying things that I couldn't reach and was so excited then to work with mental health professionals on that. Have you come across often that there might be some overlap and Comorbidity of children who have language or learning difficulties or communication difficulties and the mental health side?

Lily:                                    10:06                   Yes, and actually I would say that almost every child that has communication difficulties or learning disabilities or any kind of neurodevelopmental delays are going to have emotional issues because again, every person has like a baseline ability to cope and deal with stress and when we experience stress just as human beings in general, what happens is that as the stress increases, our ability to cope begins to decrease and our behaviors or our negative feelings or will begin to increase. So with a child that has a communication delay or learning disability, they have pretty much chronic stress because if it's not being addressed, this situation is hard for them 24, seven and so their ability to maintain that stress is going to be difficult. They're, they're gonna struggle with that ability. Um, so just going along with having those diagnosis, they're going to struggle with some emotional, maybe it's anxiety, maybe it's avoidance of doing tasks like learning in school or avoidance of situations where they might have to talk or communicate in a way they might rely on other behaviors to get their needs met that are easier for them to do as opposed to communicating or using their words or that kind of thing. And then on top of that, I think that there are children, well, let me back up for those children sometimes when their needs are met, when the communication disorder or the learning disability has been identified and there are supports in place to address that, you will see some of those emotional issues decrease. But for some children, those emotional issues may not go away and that would be an indication that yes, maybe there's a kind of a co-morbid mental health diagnosis continuing to occur that needs to be addressed. And you may see with some children if the family members, if there's an increase or if there's a family history of mental health, then that would be something to monitor and look out for that maybe there's a Comorbid diagnosis for that child as well.

Meredith:                         12:34                   That makes so much sense because if you're doing something that's hard for you all the time and you're not getting the support you need that you know that that stress would just continue to increase and that your needs for emotional support will increase as well.

Lily:                                    12:45                   Yes. Unless the child, I mean, and for some children it's amazing how resilient our children can be and how for some and again every child is different. You will have some children that have some great, what what I've heard called compensating strategies. So meaning they find their, they find ways to get their needs met and some of those compensating strategies may be very, I guess here we would use expected and like get them through. And for some of those compensating strategies for other children may not necessarily be the most expected, but it works for the child in the moment but may cause problems in a school setting or at home or with a family or in relation to peers or that kind of thing.

Stephanie:                        13:28                   Yeah. And it also makes sense that, you know, if you don't have the words to be able to communicate that you're struggling and you don't have the receptive understanding to be told like, oh, when you're feeling upset you can use this strategy. Then yeah, developing typical alert, natural ways of coping is going to be more difficult. Yeah. So if there are parents out there and they're seeing some of these in their signs in their children that maybe they already have a communication disorder and they see that their child is having difficulty with emotional regulation, having big fallouts or complaining frequently if their stomach or head hurting. And that starting to click in their heads. What can parents do? What would be their first step in trying to reach out for resources or help?

Lily:                                    14:16                   I think it would be talking with their pediatrician. A pediatrician for the most part should be able to let them know whether that's you know, an age appropriate concern or not should be able to monitor it. And you know, definitely staying in contact with the pediatrician. But if it continues to occur, you know, cause sometimes some pediatricians will be like, well maybe that's kind of an age appropriate behavior or let's just keep an eye on it. Continue to bring it up with your pediatrician if it continues to occur to just kind of let them know that, you know, this doesn't seem, I guess typical or normal for the age. And then they be able to provide just kind of resources or referrals to get that further evaluated. For kids that maybe already have communication delays or learning disabilities, it might be talking with those professionals or providers that are providing the therapies. Maybe speech therapy or occupational therapy. Maybe they're working with a psychologist who, you know, diagnosed the, the learning disabilities or the diagnostician. Then it might be chatting with them as well. You know, here are some concerns that we have seen. Who, who could you refer us to or who could we seek more information from? A lot of them will probably have a few names or be able to point a parent in a right direction as far as where they can go to seek out further information about those concerns.

Stephanie:                        15:36                   As I learned more about mental health professionals, I found that there are people with a variety of backgrounds. Can you explain briefly the difference between maybe wanting to go see a psychologist, a psychiatrist, and a licensed professional therapist or counselor?

Lily:                                    15:53                   So a psychiatrist is a, is a medical professional medical doctor that provides psychiatric or psychotropic medication for anxiety or ADHD or depression or symptoms. That would, would be, that would be related to those diagnoses.

Stephanie:                        16:10                   So a parent would go to see them if they were looking for medication?

Lily:                                    16:13                   If they were looking for a medication to treat the symptoms that go along with some of those diagnoses, that kind of thing. A psychologist is a professional that has a phd and majority of the time most of our psychologists will do evaluations, comprehensive evaluations to kind of diagnose and assess what's going on. All of these professionals can diagnose and assess. A psychologist is going to do a lot more comprehensive testing. Self-Reports parent reports, teacher reports, meaning they will give forms, rating forms to the parent or teacher to fill out and that they will review. They will do an assessment of a child and maybe give achievement tests to the child or an intelligence test to the child. They get very just thorough information about the child and will also provide recommendations regarding treatment. Whether they think a child would benefit from seeing a psychiatrist, whether they think a child would benefit from seeing a therapist as well as recommendations for the school and recommendations for home. Some of your psychologists will also do therapy and counseling, but what differentiates them from a licensed professional counselor or licensed clinical social worker is that they majority of the time do those comprehensive assessments.

Stephanie:                        17:37                   So as a parent who's looking out to get not so much of an evaluation, but to go straight for having therapy, they would look more towards a licensed professional counselor.

Lily:                                    17:49                   Yes, a licensed professional counselor, a licensed clinical social worker or a licensed marriage and family therapist.

Meredith:                         17:55                   Can you give us some tips as parents or some ideas of things we can do with our children when they're going through short term stressors in their life, like a move or a death in the family or a flooding event like what happened with the hurricane? What are some ideas that families can do to support them, their children through these moments and at what point do we realize that it's no longer short term and maybe we need to reach out for a little more support?

Lily:                                    18:17                   There are two different parts to that question and why I want you to think about is what upcoming stressors, what stressors are occurring that are upcoming that we already know about. Because obviously if we're, if we know that we're moving for example, or if we know that there's an upcoming change that we think might be difficult for our child, then providing them, the term I've heard used here a lot is front loading the child, but basically preparing them ahead of time that this is the change that is going to occur. Maybe it's taking a calendar and having the child mark off the days, putting the change on the date, on the calendar, marking off the days until that change occurs. For a lot of our kids, we use a lot of social stories. So creating a social story which basically just says this is what is going to happen. This is how you might feel. This is what you can do to kind of deal with those feelings. And a lot of times the social stories are great ways for a child to kind of work through that change for uh, for someone for stressor that occurs that's kind of unexpected, you know, after that I think it's giving your child reassurance, I'm trying to maintain as much as possible a sense of predictability or consistency in their routine. So maybe it's sticking with the same routine that you had before or maybe it's creating a routine or something just more structured to help them feel safe. Something like Hurricane Harvey is an even more trauma related stressor. So at that point I definitely think again, it's providing reassurance, helping your child to feel safe and secure structure and routine. And again, maybe talking through, let's talk about what are some feelings that we often feel during, during situations like this and what can we do with those feelings? Who can we talk to? And if you, if you notice that your child seems to be struggling emotionally, significantly with that stressor and it doesn't seem to go away, even though the stressor has gone away. And I would, and again I think every stressor is different so you know how long you expect a child to deal with emotions from Harvey, we're going to have a longer period of time of them saying, well it's still kind typical for them to be still showing a lot of emotion about it versus maybe a move. But if it seems to be an extended period of time or you're concerned, then it's definitely seeking out a professional who can give you a better understanding or saying, you know what, this is still kind of typical for this situation or no, this definitely sounds like your child is struggling more and could benefit from some therapy services. I think just as a parent it's just remembering that you are the expert of your child and so if you're wondering or you're, if you're concerned about something about, about your child, about maybe how much you know there, how many temper tantrums they're throwing or you know that they seem to complain a lot about their stomach hurting or you know, even if you're concerned that, you know, I wonder if this is typical, like do other kids go through this? If you feel like something, if you're having those questions, then I think it's important to ask to ask a professional, to ask your pediatrician to kind of talk about it with others and just kind of go with your gut or your instincts about it. And if, if someone tells you, oh no, it's fine, it will, it's a phase, but you're feeling like, well it doesn't seem to be ending or I'm still really concerned, then bring it up again or go talk to another doctor or another professional. It will help you to understand better your own child or what you guys are going through when you are asking those questions from another professional. But it also helps kind of just de stigmatize mental health because I think that's, that's another big thing that talking about mental health I think is a scary thing for a lot of people. And as a society it's, you know, something that we're trying to get people to talk about it more and more because I think people would be surprised how many children or adults really are struggling with some mental health or emotional health problems and could benefit from therapy. And how many out there actually already receiving therapy? Just others don't know about it. And so just bringing it up and talking about it. And sometimes the best referrals are from parents and family members of up, you know, friends of friends, like the, their children went through, went to therapy and then referred their family or their friend over there because that person said, you know, hey, like I'm kind of concerned about my child. So talk about it.

Stephanie:                        23:33                   I think that's wonderful. And I think that you're right with parents. Parents do know their children really well and if you are feeling that that deep concern there than it is worthwhile to seek out as much information as you can because you know the doctors are experts in certain areas. But as you said, like every parent is expert of their own kid. Well our last question that we ask every guest is that we ask if you had one piece of advice to give our listeners as either parents or educators, what would you like to impart on them? And this can be something related to mental health. It could be something very serious, it could be something a little more lighthearted, whatever you would like our listeners to know.

Lily:                                    24:14                   I have two things.

Stephanie:                        24:16                   Great. Give us both.

Lily:                                    24:17                   My two favorite things to tell parents that I have worked with in the past. One is that children do not come with an instruction manual and that every child is different. And because of that, you know, we can't say that one thing that has worked with one child will also work with another child. And so it's okay if you know, if you try something and it doesn't work okay. It's just, you know, keep trying until you find something that works. And then the second thing is that I tell my parents that I work with all the time, and this is, this is the hard one and this is the tough one and this is one that I struggle with just as a mother of my own two children, but is realizing that as a parent when we start feeling really emotional in response to our child, that a lot of times that means that it is not what the child is doing but it is something that is a struggle within us in that moment. And to kind of take a break separate, do what you can to kind of collect yourself on, you know, take that deep breath and then come back to approach that child. I think our own children have ways of triggering the things that we as adults kind of struggle with. And at that point it's not about that child anymore and it's about us. And when we are trying to regulate ourselves in that moment, we aren't being present enough to help our child with what they're struggling with in the moment. So take a break and it's okay and you know, just take care of yourself for the moment and then come back to your child.

Stephanie:                        26:10                   I think that's both of those are wonderful pieces of advice and thank you so much for taking the time to chat with us today. I know that I have learned a lot and have enjoyed this

Meredith:                         26:19                   Me too. Thanks. Thank you so much.

Lily:                                    26:20                   You're very welcome. Anytime.

Meredith:                         26:25                   Thank you for listening to the Unbabbled podcast. For more information on today's episode, including a link to a recent blog on mental health and everyday well-being, please see our episode description. For more information on the parish school, visit parishschool.org, subscribe to the Unbabbled podcast on your app of choice to automatically receive new episodes. And if you like what you're hearing, be sure to leave a rating and review. As always, a special thank you to Stig Daniels, Amy Tanner and Amanda Arnold for their hard work behind the scenes. Thanks again for listening.