What is it?

Emotional regulation or self-regulation is the ability to control “big feelings” or emotions, when they have them, including the way they experience and express them. Some children are born with self-regulation challenges. However, young children under the age of 6 are little people with big feelings and sometimes, angry outbursts can be the only way they know how to express their feelings.

What are the common signs of emotional dysregulation disorder in children?

• Angry outbursts without a justified reason 
• Excessive crying, often more intense and lasting longer than what is situationally appropriate Physical aggression toward others
• Self-harming thoughts and behaviours

When is it time to seek professional help? 

Infants can show signs of emotional dysregulation, and some then grow up to have behavioural and emotional problems. It may be time to seek professional help when the child is showing signs of extreme fluctuations of mood and emotions and their inability to regulate their emotional state is beginning to affect their family, peers, school performance, and long-term mental health.

What can be done? 

• Build emotional literacy by encouraging children to accurately identify and name feelings. 
• Play therapy involves the use of toys and games to help the child recognize, identify, and express feelings. 
•  Provide psycho-education and teach a child how to identify unique body signals and how to connect them with their feelings. 
• Teach self-regulation and coping skills using positive language and mindfulness strategies.
• Cognitive behavioural therapy (CBT) can help a child recognize unhealthy behaviours and learn how to change them.

What makes some children more vulnerable to emotional dysregulation? 

• Family history of mental health challenges and brain-based disorders 
• Trauma, adverse childhood experiences and toxic stress

Where can I access support?

Talk to the child’s family doctor or pediatrician to help identify if the child’s behaviour is normal for their developmental stage. 

Talk to the child’s guardianship worker to explore what options are available for assessment so their diagnosis and treatment plan can be included in their Care Plan. The guardianship worker will help make appropriate referrals for specialized supports and services.

Get an assessment through your local Child and Youth Mental Health team. Your local CYMH office offers a range of free and voluntary mental health services and supports for children from 0-18 years of age and their families. These services include assessments, therapy and treatment, education and referrals to specialized programs and resources. There are 100 intake clinics for children, youth and their families at convenient locations throughout BC. 

You can also contact a private psychologist or counsellor through the BC Association of Clinical Counsellors or the BC Psychological Association. You can use website filters to search for a counsellor in your community that specializes in certain mental health challenges.

What is it?

Eating disorders are problems with the way a child eats that affect them physically and mentally. Eating disorders in young children can create a lot of stress for families.

What types of eating disorders are common in children?

Anorexia Nervosa (AN) 

Anorexia is a form of self-starvation. People with anorexia nervosa have an intense fear of gaining weight and a distorted body image. 

Common signs of anorexia in children include:

•  low body weight
• fear of gaining weight, even as he or she is losing weight
• having a distorted view of their body weight, size, or shape
• refusing to stay at the minimum normal body weight for their age
• denying that they feel hungry
• being socially withdrawn, grouchy, moody, or depressed

Bulimia Nervosa (BN) 

Children with bulimia overeat or binge uncontrollably. This overeating may be followed by purging (self-induced vomiting. 

Bulimia has two types:

Purging: A child with this type overeats habitually and then forces themselves to throw up. Older children may also misuse laxatives and diuretics, enemas as a form of purging. 

Non-purging: Instead of purging after overeating, a child with this type uses other unhealthy ways to control weight such as exercising too much.

Common signs of bulimia in children include: 

• usually, a low body weight but sees themselves as weighing too much
• habitual binge eating, often in secret
• self-induced vomiting, often in secret
• excessive exercise 
• anxiety
• depression 
• obsession with food, weight, and body shape 

Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/restrictive food intake disorder is both a sensory and eating disorder. Children with ARFID lack interest in food or refuse to eat food due to fears of aversive experiences such as choking and vomiting. 

ARFID is different from developmentally appropriate behaviours such as “picky eating” or “fussy eating” among children. Some children have extreme sensitivity to the colour, smell, texture, taste, or temperature of certain foods. 

ARFID is not due to lack of access to food, cultural practice, anorexia, bulimia, or a concurrent medical condition. Doctors will not diagnose ARFID if a child’s symptoms can be explained by cultural practice or lack of access to food or if a child’s weight loss can be explained by a physical condition or other mental health or neurodevelopmental disorder.

Common signs of ARFID in children include: 

• low interest in food or refusal to eat due to a fear of choking or vomiting
• reluctance to eat meals with others
• delayed growth 
• weight loss or failure to gain weight 

Binge-eating Disorder (BED) 

Binge-eating disorder involves eating very large amounts of food with no purging. 

Common signs of binge-eating disorder: 

• eating large amounts of food rapidly despite not feeling hungry, often and in secret 
•  lack of control during binging episodes
• rapid weight gain
• obesity
•  immobility
• social isolation
• diabetes
• dental issues
•  breathing difficulties

Night-eating Syndrome (NES)

Night-eating syndrome is an eating disorder in which children eat large amounts of food after the evening meal, often waking up during the night to eat. It is different from binge eating disorder because children with binge eating disorder usually do not have to wake up to overeat during the night. 

Eating Disorder Not Elsewhere Classified (EDNEC)

EDNEC is a form of dysregulated eating that does not fit the diagnostic criteria of anorexia, bulimia or binge-eating disorder. An example of EDNEC is orthorexia, an eating disorder characterized by an unhealthy obsession with healthy eating.  

Pica

Pica is a compulsive eating disorder in which a child habitually eats non-food or non-nutritional substances such as hair, soap, paper, plastic, or flaking paint.

When is it time to seek professional help? 

Early intervention is key to treating eating disorders in young children. Research shows that children as young as three years old become aware of different body types and social attitudes toward weight. Setting the course for a lifelong healthy relationship with food starts during the early years of childhood. Talk to the child’s family doctor so they can help detect the early onset of an eating disorder and prevent it from continuing.

What can be done? 

Psychotherapy

Psychotherapy refers to a wide range of techniques and methods used to help children who are experiencing difficulties with their emotions or behaviour. There is good evidence for the effectiveness of psychotherapy as a treatment for depression in young children. Some common types of psychotherapy include: 

• Cognitive behavioural therapy (CBT)
•  Dialectical behavioural therapy (DBT)
•  Interpersonal therapy (IPT) 
• Mindfulness-based cognitive therapy (MBCT)
• Family-based therapy

Children with eating disorders can benefit from nutritional counselling with a registered dietitian or nutritionist where they can work on improving food-related behaviours through an individualized program. 

Medication

Medications such as antidepressants, antipsychotics, or mood stabilizers may be prescribed for eating disorders and other concurrent disorders such as anxiety or depression. 

What makes some children more vulnerable to eating disorders? 

• Biological factors such as genes and brain chemistry: Scientists have found that hormones or brain messengers like serotonin and dopamine contribute to eating disorders. Studies of families have also found that having a first-degree relative (e.g. parent or sibling) with an eating disorder increases a person’s risk of developing an eating disorder. 
• Psychological factors such as temperament and coping strategies
• Environmental factors such as anxious parenting, adverse childhood experiences, cultural ideals, weight stigma and exposure to media promoting an ideal body image 
• Being bullied about weight

Where can I access support?

Talk to the child’s family doctor or pediatrician to help identify if the child’s behaviour is normal for their developmental stage. 

Talk to the child’s guardianship worker to explore what options are available for assessment so their diagnosis and treatment plan can be included in their Care Plan. The guardianship worker will help make appropriate referrals for specialized supports and services. 

BC Children’s Kelty Mental Health Resource Centre connects people with eating disorders to resources and supports all around the province. You can use their wayfinding tool to help you locate supports available in your community. Programs for young children under the age of 6 who are exhibiting symptoms of an eating disorder may be limited but they can direct you to resources.

What is it?

Behavioural disorders may be diagnosed when children exhibit challenging and disruptive behaviours that are uncommon for their age at the time, persist over time, or are severe.

What types of behavioural disorders are common in children?

Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) typically starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, caregivers or teachers.  

Some of the typical behaviours of a child with ODD may include:

• Easily angered, annoyed or irritated
• Frequent temper tantrums
• Argues frequently with adults
• Refuses to obey rules
• Seems to deliberately try to annoy or aggravate others
• Low self-esteem
• Low frustration threshold
• Seeks to blame others for any misfortunes or misdeeds

Conduct Disorder

Children with conduct disorder have a difficult time following rules and behaving in socially acceptable ways. Their behaviour can be hostile and sometimes physically violent.

 Some of the typical behaviours of a child with conduct disorder may include:

• Frequent refusal to obey parents, caregivers or other authority figures
• Physical aggression (e.g. cruelty toward animals or bullying) 
• Lack of empathy for others and trouble expressing remorse
• Eagerness to start physical fights
• Frequent lying or manipulation
• Blaming others for bad behaviour

Intermittent Explosive Disorder

Intermittent explosive disorder (IED) is a mental health disorder in which children exhibit short episodes of intense, uncontrollable anger or aggression. 

Some of the typical behaviours of a child with IED may include: 

• Frequent outbursts 
• Inability to resist impulses or anger
• Intense explosions that can cause physical harm to people or animals, or damage to objects

 Low tolerance for frustrating situations, resulting in large and aggressive outbursts

What can be done? 

Behavioural disorders are complicated and may include many different factors working in combination. For example, a child who exhibits conduct disorder may also have ADHD, anxiety and depression.  

Diagnosis methods may include:

• Diagnosis by a specialist, which may include a paediatrician, psychologist or child psychiatrist
• In-depth interviews with the parents, caregivers, child and teachers
• Behaviour checklists or standardized questionnaires

Treatment for behavioural disorders is usually multifaceted and depends on the particular disorder and factors contributing to it, but may include:

• Parental/caregiver education: teaching the caring adults in the child’s life how to communicate with and manage their behaviour
• Family-based therapy: the entire family is helped to improve communication and problem-solving skills
• Cognitive behavioural therapy (CBT): the child is taught to recognize unhealthy thoughts and behaviours and learn how to change them
• Social training: the child is taught important social skills (e.g. playing cooperatively with other children)
• Anger management: the child is taught how to recognize the signs of their growing frustration and given a range of coping skills designed to defuse their anger and aggressive behaviour. Relaxation techniques and stress management skills are also taught.
• Medication

What makes some children more vulnerable to behavioural disorders? 

• Family history of mental health challenges and brain-based disorders 
• Fetal exposure to substance abuse
• Adverse childhood experiences and toxic stress

Where can I access support?

Talk to the child’s family doctor or pediatrician to help identify if the child’s behaviour is normal for their developmental stage. 

Talk to the child’s guardianship worker to explore what options are available for assessment so their diagnosis and treatment plan can be included in their Care Plan. The guardianship worker will help make appropriate referrals for specialized supports and services. 

Get an assessment through your local Child and Youth Mental Health team. Your local CYMH office offers a range of free and voluntary mental health services and supports for children from 0-18 years of age and their families. These services include assessments, therapy and treatment, education and referrals to specialized programs and resources. There are 100 intake clinics for children, youth and their families at convenient locations throughout BC. 

You can also contact a private psychologist or counsellor through the BC Association of Clinical Counsellors or the BC Psychological Association. You can use website filters to search for a counsellor in your community that specializes in certain mental health challenges.

What is it?

Autism spectrum disorder (ASD) refers to a group of neurodevelopmental disorders that affect how people communicate, learn, behave, and socially interact.

What are common signs of ASD?

Children and youth with ASD usually experience two types of symptoms:

1.  Social impairment and communication difficulties

• Avoids or does not keep eye contact
• Does not respond to name 
• Does not show facial expressions like happy, sad, angry, and surprised 
• Does not play simple interactive games 
• Uses few or no gestures (e.g. does not point at what you point to or wave goodbye)
• Does not share interests with others 
• Does not notice when others are hurt or sad 
• Does not pretend in play 
• Shows little interest in peers
• Has trouble understanding other people’s feelings or talking about own feelings 
• Does not play games with turn-taking 

2. Repetitive or restricted behaviours

• Lines up toys or other objects and gets upset when order is changed
• Repeats the same words or phrases over and over 
• Plays with toys the same way every time
• Is focused on parts of objects 
• Has obsessive interests
• Must follow certain routines and gets upset by minor changes
• Flaps hands or rocks body in circles
• Has unusual reactions to the way things sound, smell, taste, look or feel
• More sensitive or less sensitive than others to sensory experiences (pain, temperature, texture, smell, taste, or sound)

Other signs: 

• Delayed language skills
• Delayed movement skills
• Delayed cognitive or learning skills
• Hyperactive, impulsive, and/or inattentive behaviour
• Epilepsy or seizure disorder
• Unusual eating and sleeping habits
• Gastrointestinal issues 
• Unusual mood or emotional reactions
• Anxiety
• Lack of fear or more fear than expected
•  Self-harm

When is it time to seek professional help? 

ASD symptoms can vary greatly from child to child depending on the severity of the disorder. Children should be screened for developmental delays during periodic checkups.

You may also want to consider these tools:

First Signs®

Autism Navigator®

Modified Checklist for Autism in Toddlers (M-CHAT)

What makes ASD difficult to diagnose in children?

• Symptoms of one disorder can look like another disorder. 
• Symptoms of one disorder can hide symptoms of another disorder.
• Symptoms can vary greatly from child to child. 
• There are only a few guidelines and tests that help to diagnose other mental challenges in children with ASD.

What can be done?

Educational/behavioural interventions

Early behavioural/educational interventions have been very successful in many children with ASD. In these interventions, highly structured and intensive skill-oriented training sessions are used to help children develop social and language skills. 

Applied Behavioural Analysis (ABA) is a type of therapy that can improve social, communication, and learning skills through reinforcement strategies.

Modified Cognitive Behavioural Therapy (CBT) is an example of behavioural intervention. Cognitive Behavioural Therapy (CBT) teaches people to examine and change the way they think (cognitive), act (behaviour) and feel (emotionally and physically). Cognitive Behavior Therapy (CBT) is beneficial to people with Autism Spectrum Disorder (ASD) but scientists suggest that the method needs to be modified in relation to the child’s cognitive profile. 

Medications

While there is no medication that can treat ASD itself or even its main symptoms, there are medications that can help with related symptoms such as anxiety, depression, schizophrenia and obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioural problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity in people with ASD.

What makes some children more vulnerable to ASD? 

Scientists believe that both genetics and environment likely play a role in ASD. ASD is a complex disorder that is the result of many interacting genes as well as the result of genes interacting with the environment.  

Autism is more common in children born prematurely. Studies suggest that ASD could be a result of disruptions in brain growth very early in the child’s brain development. These disruptions may be the result of weakness in genes that control brain development and regulate how brain cells communicate with each other.

Where can I access support? 

An early diagnosis is important so that the child can get the help they need. Talk to the child’s family doctor or pediatrician. The doctor can refer the child to the BC Autism Assessment Network (BCCAAN) for further assessment and diagnosis.

Contact Autism Information Services BC (AIS BC), a provincial information centre for autism and related disorders. AIS BC has information on assessment, diagnosis and treatment options, and you can reach them by phone, in person or via email.

Talk to the child’s guardianship worker to explore what options are available for assessment so their diagnosis and treatment plan can be included in their Care Plan. The guardianship worker will help make appropriate referrals for specialized supports and services.

What is it?

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder. In some children, they’re noticeable as early as three years of age. Children who have ADHD have higher levels of inattention, impulsivity, and/or hyperactivity than their peers.

What are the symptoms of ADHD in children?

There are three types of ADHD.

1. Inattentive. Most symptoms fall under inattention, distraction and disorganization.

• Trouble paying attention to details
• A tendency to make careless mistakes in schoolwork or other activities
• Difficulty staying focused on tasks or play activities
• Apparent problems with listening
• Difficulty following instructions
• Problems with organizing tasks or activities
• Avoidance or dislike of tasks that require mental effort
• A tendency to lose things like toys, notebooks, or homework
• Easily distracted
• Forgetfulness in daily activities, such as forgetting to do chores

Because children with this form of ADHD are less likely to disrupt the classroom or other activities, their symptoms may not be noticed as quickly.

2. Hyperactive-impulsive. Most symptoms are related to hyperactivity and impulsiveness.

• Fidgeting or squirming
• Difficulty remaining seated
• Excessive running or climbing
• Difficulty playing quietly
• Always seeming to be “on the go”
• Excessive talking
• Blurting out answers, interrupting the questioner
• Difficulty waiting for a turn or in line
• Problems with interrupting or intruding on others’ conversations, games or activities

2. Combined. It is a mix of many inattentive symptoms and hyperactive-impulsive symptoms.

The physical signs of ADHD cannot be detected by a lab test. Typical ADHD symptoms may overlap with those of other physical and psychological disorders.

ADHD doesn’t cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as:

• Learning disabilities, including problems with reading, writing, and math skills 
• Anxiety disorders 
• Depression
• Disruptive mood dysregulation disorder: severe irritability, anger, and frequent, intense temper outbursts
• Oppositional defiant disorder (ODD) 
• Conduct disorder 
• Bipolar disorder
• Tourette syndrome  

When is it time to seek professional help?

Young children with ADHD are more likely to experience difficulties in daycare or school, including problems with peer relationships, learning, and a higher risk of injuries. An early diagnosis is important so that the child can get the support they need to minimize challenges. 

Since the early years is a critical time for brain development, it is important for children to learn positive behaviours and for caregivers to learn how to support their unique individual needs, even for young children who are showing some symptoms of ADHD but do not have ADHD. It’s best to address problematic behaviours sooner rather than later. 

What can be done?

ADHD is best managed with a combination of medications and counselling. Effective treatment of childhood ADHD involves behavioural skills training, behavioural school intervention and medication. Behavioural skills training can help parents and caregivers develop a positive relationship with the child and encourage positive behaviour. Behavioural skills training has been shown to work as well as medication for ADHD in young children. 

Any good treatment plan will include follow-up and monitoring. In some cases, the symptoms of ADHD become less severe or change as the child grows older, particularly if the child’s environment is conducive to their development and their self-regulation skills improve. 

What makes some children more vulnerable to ADHD?

Many genetic studies indicate that ADHD runs in families. However, it is important to understand that ADHD is a complex disorder that is the result of many interacting genes as well as the result of genes interacting with the environment. Other risk factors for ADHD include exposure to environmental toxins (e.g. lead or pesticides) during pregnancy or childhood, premature birth or low birth weight or brain injury. 

Where can I access support? 

An early diagnosis is important so that the child can get the help that they need. Talk to the child’s family doctor or pediatrician. The child may be referred to specialists (e.g. psychologist, behavioural specialists, psychiatrist, neurologist, or developmental pediatrician). 

Talk to the child’s guardianship worker to explore what options are available for assessment so their diagnosis and treatment plan can be included in their Care Plan. The guardianship worker will help make appropriate referrals for specialized supports and services. 

Your local Child and Youth Mental Health team may be able to provide an assessment or refer the child to specialized resources in your community. Your local CYMH office offers a range of free and voluntary mental health services and supports for children from 0-18 years of age and their families. These services include assessments, therapy and treatment, education and referrals to specialized programs and resources. There are 100 intake clinics for children, youth and their families at convenient locations throughout BC. Please note that not all local Child and Youth Mental Health teams provide assessments and support for ADHD. Call your local Child and Youth Mental Health office first to ask if they provide this service.