Intervention for children's mental health issues

It is never an after-the-fact remedy of "correcting problems after they occur", nor is there a unified template that is universally applicable. The core is to build a three-level support network that links families, schools, and communities. It prioritizes early screening and early warning, and implements hierarchical and classified matching intervention plans. The ultimate goal is to help children establish a stable psychological sense of security, rather than forcibly shaping "standard healthy children."

Last week, I was working at the consultation post of the District Maternity and Child Care Department. I met a mother who brought her third-grade son. She cried as soon as she entered the door. She said that her child had been diagnosed with ADHD and had been prescribed medicine, but she did not dare to give it to her for fear of side effects. I took the child and chatted alone for ten minutes, and then I found out that my parents were getting divorced in the past six months, and my grandma kept saying "Your mother doesn't want you anymore" at home. When he was in school, the teacher always made him stand because he couldn't sit still. The penholder he chewed on the pencil was full of tooth marks. It wasn't that he couldn't control it, but he wanted to bite it when he was nervous. Later, I contacted their family for family consultation, and communicated with the class teacher to give the child more positive feedback. Two months later, the mother sent a message saying that the child’s pencil-biting problem was gone, and he could sit still for most of the class without taking any medicine.

Don't tell me, the controversy over the boundaries of intervention in the industry has never stopped. Most psychiatrists in the public system follow an evidence-based approach and strictly benchmark the diagnostic criteria of DSM-5. They use CBT (cognitive behavioral therapy) when indicated and use medication when it is moderate to severe. Don't rely on "love and tolerance" - I have accepted it before. I encountered a 10-year-old child with severe anxiety who suffered from insomnia and shaking hands for three consecutive months. He vomited as soon as he arrived at school. His parents refused to take medication for half a year. Later, he took low-dose sertraline as prescribed by the doctor, combined with CBT once a week, and he was able to go to school normally in two months.

But on the other hand, most humanistic counselors who do children's consultation do not agree with the logic of "diagnosis first and then intervene", and feel that many so-called "symptoms" are actually children's normal reactions to adverse environments. There was a fourth-grade child who was diagnosed with oppositional defiant disorder. He fought against his parents at home and rebelled against his teachers at school. Later, he changed to a class teacher who didn't always scold him in public. Within half a year, all his "symptoms" disappeared, and even the doctor who had previously recommended medication was surprised.

I have been doing grassroots children's psychological intervention for almost 6 years, and the biggest pitfall I have encountered is the early superstitious standardized manual. When I first took up the job, I felt that following the process was correct. I distributed a unified intervention manual to all primary schools in the area, requiring teachers to follow the steps when encountering children with abnormal moods. Until one time when I went to school for a follow-up visit, I met a little girl who was left behind. The teacher taught her to "express her demands reasonably" according to the manual. As a result, the child turned around and tore up the paintings she had saved for half a year. Later, I found out that she had just talked to her mother who was working outside on the phone the day before. Her mother said that she would not come back for the Chinese New Year this year. At that time, all procedures and skills were useless. I squatted in the corridor and sat with her for 20 minutes. She cried enough, picked up the broken paintings and glued them together, saying that I would give them to her when my mother comes back next year, and there would be no problem.

In fact, the data from the 2023 National Youth Mental Health Screening has made it very clear: 62% of the mild psychological problems screened are adaptability problems - such as not adapting to the new school, adding younger siblings to the family and feeling neglected, and being isolated by classmates. These do not require medical intervention at all. As long as the surrounding environment is adjusted and enough emotional support is given, most of them can get better on their own. Among the remaining moderate to severe problems, less than 10% actually require medical intervention.

The misunderstandings of many parents nowadays are that they either take it too seriously, thinking that "children can have any troubles, it will be fine when they grow up", or they take it too seriously, and when they see their children not talking or their grades declining, they think it is depression, and they rush to see a doctor or a counselor, which only puts more pressure on their children. To be honest, the first thing I say to parents when I meet them now is not "Your child has a problem". Instead, I first ask "Have there been any changes at home recently?" Did anything happen at school? ”Many times, the problem is not with the child, but with the environment around him.

To put it bluntly, psychological intervention for children is like supporting the branches of a newly grown sapling. You don't just go up and break it off when you see it growing crookedly, let alone cut off the leaves casually. You have to squat down first to see if the soil under the roots is not fertile enough, if there are other trees nearby blocking the sun, and if the wind has been too strong recently and caused it to sway. If there is a problem with the roots, you will only break it if you forcefully break the trunk.

The longer I do this, the more I realize there is no standard answer. Some children will be fine if you play with them in the sandbox three times and they will pour out all their grievances. ； Some children do have differences in their nervous system development, and they have to take medicine for the first half of the year to live a normal life. ； Some children's problems are caused by their parents, and the whole family needs consultation for more than half a year to get better.

In the final analysis, what we do is never to turn our children into "normal and good children" in everyone's eyes. It just lets him know that no matter whether he is happy or sad, naughty or quiet, even if he is really different from others, there is someone who can take care of him.

This is enough.