Carl Maronich (Host): This is Wellness Waves, the podcast from Bergen New Bridge Medical Center. I'm your host, Carl Maronich, and I'm joined today by a panel of behavioral health experts. And we'll be talking about Loving Without Losing Yourself: the Mental Health Challenges in School-Aged Kids. With me from Bergen New Bridge Medical Center are Angela Prestifilippo, Director of Outpatient Behavioral Health Services; Hannah Marcus, Clinical Manager of Eating Disorder Services; and Eryn Walczak, Director of Withdrawal Management and Stabilization. Welcome to each of you.

Eryn Walczak, MA, LCADC, CCS: Thank you.

Angela Prestifilippo, LPC, NCC: Thank you.

Hannah Marcus, MA, LPC, CEDS, ACS: Thank you.

Host: In this conversation, we're going to explore what kids are going through and what it really takes for parents and caregivers to support them without sacrificing their own well-being, a hugely important topic. And let me start by asking for parents of school-aged children with mental health issues, what emotional or psychological burden do you see most often going unspoken? And why do you think it's so hard for parents to name it? And Hannah, maybe we can start with you.

Hannah Marcus, MA, LPC, CEDS, ACS: Sure. I think parents often blame themselves when they start to see behavioral or interpersonal issues with their children. When they blame themselves, it tends to elicit a cycle of shame. And, you know, we also know with shame tends to come a lot of silence. And so, they're going to have a really hard time reaching out for support for themselves, but also for support for their child.

And so, it kind of creates this cycle of not speaking about the issue. And when it's not spoken about, unfortunately, that tends to exacerbate the issue and can, you know, create larger problems that, you know, may have been preventable had it been addressed earlier.

Host: You know, maybe to start here at the top, talk about some of the specific issues that fall into these categories. I think, and someone having some experience with this when my daughter was younger, you know, it's easy to kind of say, "Oh, well, that's this issue, it's not so bad. That's not an issue I need to worry about." And so, maybe we could give a definition to some of these issues so parents really understand the kinds of things we're talking about.

Hannah Marcus, MA, LPC, CEDS, ACS: My thing is eating disorders, right? And so, you know, we live in a society where you know, disordered eating, restrictive eating to a certain extent is normalized, right? And so, a lot of times parents won't necessarily realize there's an issue or they will try to minimize it, say that maybe, you know, "It's not such a big deal. They're just trying to lose a couple pounds," that sort of thing. I also think, and I'll, you know, defer to Eryn a little bit more on this one, but I can imagine too with, you know, high school students in particular, there's a normalization around substance use. And so, a parent might have a hard time accepting a potential substance issue or, you know, earlier signs of that. But, Eryn, I'll defer to you a little bit more on that one.

Eryn Walczak, MA, LCADC, CCS: So, a lot of the concerns for substance use mirror what Hannah was talking about just in a little different context. There is a lot of stigma around substance use specifically. And so, they're oftentimes similar to what Hannah was saying that parents will blame themselves. There is a lot of guilt and shame, especially when you look at it from a cultural lens, right? So, different cultures deal with or don't deal with and handle mental health crises, substance use, eating disorders differently. So, looking at the context of that will definitely show how the family acknowledges when there's a potential issue.

In conjunction with that, a lot of parents I know are hesitant to identify the concerning symptoms because they would rather push it under the rug for fear of making it real. So by identifying that they see these issues, they then feel responsible and know that they have to address them. And for whatever reason, their own personal struggles, their own personal trauma, that wound may be a little bit too deep for them to fully acknowledge as real.

Host: How do parents balance being mom and dad and becoming a care coordinator, advocate, sometimes crisis manager? And what does all that role shift do to their own mental health?

Eryn Walczak, MA, LCADC, CCS: I would say speaking on the parents of these school-aged kids and their own traumas, for those who haven't fully addressed them or really acknowledge them or may not have the understanding of what mental health looks like, it's quite hard for them because as a parent, as I am one myself, it's really important that you learn and acknowledge your own triggers, your own trauma, and how that affects not only your parenting style, but the family unit as a whole. So, those parents who are already struggling with that in conjunction with advocating for their child, dealing with crisis situations and going to the schools and having all of these meetings, it can be quite stressful for the whole family unit.

Angela Prestifilippo, LPC, NCC: In terms of parents navigating, struggling with their child in crisis, as Eryn was sharing and Hannah is going to also share, I also agree that it is very difficult when we note ourselves in our child or we see parts of our family in our child. However, life shows up. We're asked to show up as parents and step up for our children, however internally we're in turmoil because everything that we have suppressed or repressed is coming to the surface, along with recognizing that you're seeing yourself in your child. And so, as Eryn was sharing, this becomes extremely difficult to navigate because you are consistently in some turmoil on your own, because you have never faced your own struggles and your trauma

And genetically speaking as we say, the apple doesn't fall far from the tree. We're all more alike than we are different. So, I think it's really important to highlight that our children are going to carry the beautiful parts about us and some of those raw parts. With that, we need to acknowledge that it's okay. It is okay to be able to step into the role as a parent and say, "I need to help my child," while getting some of my own help if they're aware of that. And so, my hope and goal would be that they are working with a treatment team that will be able to guide them.

Hannah Marcus, MA, LPC, CEDS, ACS: I would also just want to add too that I think when an adolescent, when a child is struggling with something so complex and medically compromising like an eating disorder, like substance use, like self-harm, it can get really, really easy to, you know, as you said, really only be the crisis counselor, really only be the care coordinator. And that can sometimes take over the parent-child relationship. And so, I think it's really important for parents to remember that their child is not their eating disorder. Their child is not the alcohol, you know, whatever it might be. And remind themselves and the child of that because, you know, it's really easy to—and we see this a lot on social media now—define yourself by your mental health issues. And we are not our mental health issues even though there are some, you know, diagnoses that might indicate otherwise it's not true.

And so, remember to, you know, be a parent and do the things that you love to do with your child, right? And that way, it can kind of remind both parties that, you know, this is still someone who loves to go to the beach. This is still someone who, like, loves Disney movies, you know, what have you. You are not an eating disorder who is also a person. You are a person who happens to be struggling with eating right now, you know, that sort of thing.

Eryn Walczak, MA, LCADC, CCS: Something to note is for parents who may have an understanding or have gone through treatment for their own struggles, it's important to remember that, as parents, we tend to see our children as an appendage of ours, which is reasonable. They spent nine months for, you know, the people who carried their children within us. It's easy to see them as part of us, which is reasonable. However, we also have to remember that these children are individual in their own selves.

So, being mindful of the tendency to pathologize based on our own experiences and make assumptions as to what would be the best care or intervention for that child based off of what we feel worked for us or didn't work for us. Because coming in with that automatic assumption may prevent the child from getting the services that would benefit them in their individual circumstance, or potentially invoke treatment that may be harmful to them because it's not what works best for them. Remembering that the child needs to be seen as a whole picture within themselves outside of their parents' struggles.

Host: And what are some common early warning signs that parents might miss and particularly mask them by, you know, some success? "He's the best on his team, so it's okay," or "She's getting good grades, so it's not so bad." You know, what's your suggestion on how parents should deal with those kinds of things?

Hannah Marcus, MA, LPC, CEDS, ACS: Noticing really significant changes, whether that be in mood, isolation, friend groups, grades, really significant personality changes are typically an indicator that something could be going on. I would also say, you know, you gave the example, "Oh, really good grades, star athlete of, you know, fill in the blank team." That can also sometimes reflect perfectionism, which, you know, accompanies distress, right? And so, kind of checking like, "Okay, you know, my daughter, you know, she's really proud of herself. She works really hard. She does really well." But is she crying when she comes home with a 90? And is she beating herself up because she got a 95 instead of 100? Kind of asking yourself or noticing like, "Do I ever feel like I have to walk on eggshells around them? Am I noticing, as I said, really significant changes? That sort of thing can often be like an early warning sign that something is going on.

Eryn Walczak, MA, LCADC, CCS: Hannah, you hit the nail on the head. Everything I was going to say, you completely covered it. It's important to know what your child's baseline is, right? So, what is their typical behaviors? What is it that you can kind of predict how they will handle certain situations or what their general demeanor is and noticing even if it's a slight deviation from that baseline. So, they're a little bit more irritable, which can be common in teenagers, as we know, but is it more noticeable than what's considered normal, right? Sleeping more, sleeping a lot less, erratic behavior, even changes in their typical wardrobe, right? Outside of, you know, some slight changes, but have they done a complete 180 with how they dress, how they act, changing their hair, weight changes, obviously extreme weight gain, extreme weight loss in a small amount of time. These are all factors to consider.

Host: Many parents describe intense guilt, as was talked about a little earlier, for needing breaks or struggling themselves. How do you help parents understand that caregiving burnout is not a failure, but a signal?

Eryn Walczak, MA, LCADC, CCS: I would say that it has a lot to do with the reality of the village, the concept of a village being lost around this time for the parents of young children, right? So, being able to identify a support group that you can speak with about it and remembering that we're all human, right? No, there is no such thing as a perfect parent. There's no such thing as a perfect friend or grandparent. It's just learning that we're all in this together. You know, I'll speak as a parent, we're all in this together. And being able to develop that trust and support with other people around you is really important.

Host: When food or body image or control issues emerge in a child, how can parents support recovery without turning every meal or moment into a battleground? And what self-care boundaries are essential for parents in this issue?

Hannah Marcus, MA, LPC, CEDS, ACS: Recognizing that you are a parent, right? You're not a therapist, or even if you are, you're not your child's therapist, you're not a dietician, you're not a psychiatrist, you know, what have you. And so, recognizing that you are a support person. But in this case, that is really all you can be and knowing the limits of that, right?

So, kind of saying, you know, if they're not eating a meal, you know, "Can we take a bite or so?" Or, you know, asking maybe what's going on. But even though it can be frustrating not getting angry at the child for not eating or like, showing that frustration certainly. And this, you know, applies to really any parent of a child with any or no mental illnesses, really trying to avoid giving any weight feedback, whether that's weight gain or weight loss. Because even if someone's not struggling so much with their weight or with their eating patterns, getting that weight feedback can just not really feel good. You know, especially in an era where we're dealing with, you know, issues related to GLP-1s and things like that. But, you know, to digress, just again, recognizing what those limits are and that if you find that mealtime is becoming such a stressful event and something that is, you know, surrounded by family fights and arguments and, you know, distress and things like that, it might be time to loop in some professional help. And there's nothing wrong with that. You know, it's something that a lot of adolescents and adults even struggle with at some point in their lives. And again, it's not a reflection of parenting or, you know, anything like that. But just really remembering to stay in that parenting role and not trying to force yourself into a more therapeutic one.

Angela Prestifilippo, LPC, NCC: And I always say, just the way we treat physical or medical challenges that our kids might wake up and have a really bad cold or wake up and not feeling well, we don't carry guilt and shame about, "Oh my goodness, like they're not feeling well. Let's bring them to the doctor to get them checked out and I hope they get the antibiotic they need."

When it comes to, you know, eating or any kind of mental health disorder in general, we carry this guilt and shame that eats us alive as parents because we ask ourselves, "What did we do to cause this?" And I think, as Hannah's saying, it's so important for us to separate who we are as mom or dad or guardian to support our children in saying, "Okay, we acknowledge that our child needs some support." And although in this case it's not physical and we don't run them to the medical doctor, well, they need to see someone, and that's where we come in to start and continue working on breaking that stigma.

Host: What are some strategies parents can use who feel they're constantly in survival mode?

Hannah Marcus, MA, LPC, CEDS, ACS: Remembering to take care of themselves. Whether that is a therapist, meditation, journaling, engaging in some type of activity, just really making sure that they're doing something to help their nervous system relax a little bit. You know, when you're in a stressful situation, when you have a child who is experiencing some type of, you know, illness, disease, what have you, it's natural to, you know, go into that survival mode and think, "I have to do more. I'm not doing enough. I have to do absolutely one hundred percent of everything I can." And, you know, that's important. And, of course, you want to be there to support your child. But, you know, we've all heard the expression, you can't pour from an empty cup, right? And so if you're not taking care of yourself as a parent, you're going to burn out. You might even develop some resentment, and that is not something that anyone wants to experience. And so, I think remembering that as much as the care of your child is important, the care for yourself is equally important and should not be neglected.

Eryn Walczak, MA, LCADC, CCS: ' Because the reality is you can't effectively parent if you're dysregulated yourself. And the same goes for maintaining your partnership, whatever that looks like. A lot of partners tend to lose that part of their relationship when they're constantly in crisis mode with a child with mental illness, substance use, eating disorders, and they tend to get disconnected, and it causes, like Hannah was saying, a lot of resentments and hostility and tension within the home, which the children feed off of. So like she was saying, developing a strategy for how you can re-regulate your nervous system and, in turn, also mirror that to your children so they can see that it's okay to step away when you're overwhelmed, and they can also kind of shadow or mirror your behaviors.

Host: Using that same point a bit, when there are other children in the home who aren't going through these same issues, what should they be mindful of in dealing with other children as they're working through these other issues?

Angela Prestifilippo, LPC, NCC: We are not what we're struggling with. It might be a part of what we're facing, but a child who's struggling, might need some more attention. However, as a family, we need to continue to come together, connect and do the things that we love as a family. And we need to continue to be able to spend quality time with each of our children, um, depending on some of those things that they enjoy without taking away from our other children.

Now, it's easier said than done. What I would say is we will need to have a family conversation around, "Hey, little brother's struggling with something. Mom and Dad are going to have to give a little bit more attention. What we're going to do is this to ensure that everyone is feeling supported and that we continue to do the best we can for our family together."

So, I think it's very important to acknowledge what's happening in the family so that it's talked about and it's not secretive and that it's not shamed and that it's not continued to be stigmatized. However, also recognizing that life is still happening. We still need to function, and we also can still have fun and do great things together.

Hannah Marcus, MA, LPC, CEDS, ACS: Everybody really expresses distress in different ways. And so, if one sibling is more externalizing, where maybe there's a lot more yelling, more tantrums, risk-taking behavior, that sort of thing, that sibling is going to naturally get a little bit more attention, so at least at the beginning from the parents than someone who might be struggling more with like isolation, quiet self-harm, restrictive eating, quieter substance use, you know, that sort of thing.

And so, just to also remind parents that just because one sibling appears to be fine and seems okay, they could be, you know, suffering in more silence than one might expect. And so, yes, of course, to let them know that sibling A is struggling in a different way at this point, you know, that sort of thing. And also, making sure that sibling B is still being checked in with, receiving support in whatever way that they need to as well.

Eryn Walczak, MA, LCADC, CCS: The concept of the invisible child, which refers to a child, that is a sibling for someone who is struggling with severe mental health, eating disorders, substance use, that feeling of invisibility, right, which relates back to the term the invisible child, is something that we have to be mindful of. These siblings tend to be, like Hannah was saying, more quiet, more reserved, maybe even isolating because they don't want to engage in the problem, or they don't want to cause more stress to their parents. So, regular check-ins with these children, making things more special for them, taking them out one-on-one, or even just having an open conversation without guilt or shame about how they're feeling, how this situation is affecting them. "What can I do to support you while your sister is going to treatment or your sister is having a hard time? Tell me how you're feeling so I can better support you." And even bringing in professionals for that child, even from a preventative standpoint, to make sure they still feel seen and heard.

Host: How would you suggest clinicians, schools, and other systems help to normalize parent support as part of a child's treatment?

Eryn Walczak, MA, LCADC, CCS: I think providing those resources to parents, either on an anonymous basis, or providing a safe space or a resource center for parents to come and talk about their issues and be able to obtain the resources and the help necessary for themselves is vital.

Angela Prestifilippo, LPC, NCC: I also think it's really lovely to bring parents in or parent night or other evenings at the school level to bring in clinical experts to talk about and provide psychoeducation on how to support parents, and acknowledge the reality that in every single home, everyone has struggles, and how can we navigate together by providing these resources and utilizing our community, and our school as a resource has also been very successful in the community.

Host: One thing that was mentioned a little earlier is social media. And what would your suggestions be to parents of how they can realistically kind of protect their child with mental health issues from what happens on social media without becoming the screen police?

Hannah Marcus, MA, LPC, CEDS, ACS: I think making sure that parents are helping their kids fact check when possible. A lot of times kids are, you know, just repeating the things that they find online, the things that they are seeing in TikToks. And when you hear them say something that either you know is incorrect or doesn't really sound correct, calling it out and saying like, "Hmm, are you sure about that?" Like, "Let's maybe fact check that." I think it's also important to, as the kids today say, touch grass from time to time. And so, making sure that, you know, they're not spending all their time in their room on their phone because they need to get out in the real world. And remembering that, you know, isolation facilitates isolation, right?

And so, social media gives the illusion that they're socializing and engaging with others when in reality they're not. That really still comes from that face-to-face contact. And, you know, that's something that we're starting to see now as the COVID generation, those who were very young during COVID are becoming teenagers. And, you know, I can certainly speak for my program, Eryn, I'm not sure if this is something that you're seeing, but we are starting to see some social deficits and social anxiety in the generation who was really raised on screens.

Eryn Walczak, MA, LCADC, CCS: I would 100% agree. And one tactic that I found useful is to have those open and honest, you know, conversations, even as uncomfortable as they may be, about what is realistic and what is fabricated within social media, especially TikTok, Instagram. Hannah, I'm sure you know, you see all of these content creators promoting this detox cleanse and this diet and promoting that certain substances are safe and this is what worked for them.

And bringing the child forward on your own, either before, during, or after exposure kind of helps them lay the groundwork for just double thinking or fact-checking, like Hannah was saying, even without realizing it. Because if you don't bring that to their reality, they may not even be aware of what is a realistic expectation versus something that is fabricated for views, I guess, as the kids call it. And also, teaching them to have a check-in with themselves mentally and with their body sensations. So, do you notice that after being in your room for two hours on TikTok, you start to get more agitated, you start to have a headache, you know, your back hurts, things like that. Are you noticing that you haven't responded to your friends in two days because you're looking at TikTok Reels or uploading things on Instagram? Are you noticing that you're ruminating more about your body image or things like that? Like, what does your feed look like? Is it all, you know, body positivity, or is it promoting, like I said, these detox cleanses and a certain standard of beauty? Teaching them what that physically feels like within their body and how to check in and realize what may be affecting them.

Host: When substance use shows up in school-aged kids and are using these things to cope with anxiety, depression, or body image issues, how can you help parents think about, you know, dealing with it without panicking?

Eryn Walczak, MA, LCADC, CCS: So, that's the main point, is to not panic. To come into an open and honest conversation, regardless of how uncomfortable it may be, with, like Hannah was saying, fact-checking it. So, bringing to light the fact that there are people that use substances for A, B, and C reason, right? Whether it be anxiety, depression, just they claim that it's fun. That's a real thing, and educating them on what that may look like without the previous D.A.R.E. perspective of just say no, just don't do it.

We found over the years that that wasn't effective because they don't understand why they're saying no, right? Especially kids nowadays, they need a reason why they should be saying no, and breaking it down for them from a developmentally appropriate perspective as to what substance use will look like now and the possibility of how it will affect them both immediately and in the future, while also maintaining that open communication where they can ask questions.

They can talk about, you know, "My best friend was smoking, and I really wanted to try it because I wanted to fit in." Okay, well, what does that look like to you? Having that conversation where they feel safe enough to bring their interest to you, because that would be the only way you can monitor and know and educate to keep them safe.

Host: Before we let you guys go, let me ask, what do you want to make sure people take away from this conversation? And maybe we'll start with you, Hannah.

Hannah Marcus, MA, LPC, CEDS, ACS: So, I think just remembering that parents are people, caretakers are people, and that while it is very important for them to care for and ensure that their child is getting the treatment that they need, you also need to take care of yourself. You can't do it all for them and do nothing for you. And so, making sure that, like, you really are taking that time, even if it's 10 minutes a day, to just re-regulate, relax, and care for yourself in whatever way works for you.

Eryn Walczak, MA, LCADC, CCS: I would say as a reminder, just like Hannah said, you are a person outside of being a parent, and remembering who you are and make sure to check in with yourself as well as remember that the family is a unit. So, making sure the whole family unit as a whole is working together and copacetic and doing the best you can with what you know and reaching out for help when it seems like you need it.

Angela Prestifilippo, LPC, NCC: I think the analogy that, or what we hear when we're flying on a plane, in terms of if you are sitting with your child and, you know, the oxygen needs to be turned on, please put it on yourself first before you put your child's on, is the best image and takeaway I can give. Because the reality is, if we are not grounded in our own regulation and we are not taking care of ourselves, when life knocks at the door and our children are struggling, we are not going to be able to manage. We are going to react. That's where challenges come in when we're working with our children who are struggling. So, taking care of us so that we can take care of them is so important.

Host: Thanksto all of you for sharing your insights and giving guidance on loving your child without losing yourself. For more information, go to newbridgehealth.org. And if you enjoyed this podcast, please share it on your social channels and check out the entire Wellness Waves library of topics that may be of interest to you. This is Wellness Waves from Bergen New Bridge Medical Center. Thanks for listening.