Managing the Stress of Change for Your Mentally Ill Child

The stress of change can be difficult for any child, but for children with emotional and behavioral disorders, the stress of change hits harder. They often can't predict their own behaviors, thoughts, or feelings, so it makes things worse when they can't predict their environment either. Life isn't very predictable, though, so how do we help our children with mental illnesses better manage the stress of change?

Children with Mental Illness Often Struggle with the Stress of Change

In the world of childhood psychiatric disorders, "changes" are referred to as "transitions." This can refer to anything from transitioning between subjects in classrooms to transitioning to a new medication. We're constantly planning for it and therefore planning for the stress of change makes sense.

My son has attention-deficit/hyperactivity disorder (ADHD), and changing anything about his routine throws him for a loop. If he has Monday off from school, he's forgetting homework or supplies the rest of the week. He also has disruptive mood dysregulation disorder (DMDD), which includes outbursts that are out of proportion to the trigger. Tell him he has only half an hour instead of an hour to play video games and he erupts.

Over the years, I've learned a few things about managing change with him. I've learned to embrace structure and routine, plan extra time for everything, and, most of all, be prepared.

Structure and Routine Help Manage the Stress of Change

It's not always possible in a busy home, but structure and routine alleviate anxiety for kids with emotional and behavioral disorders. If we schedule even small changes, like switching from one task to another, kids like mine are better able to emotionally prepare (Tips for Parenting a Child with ADHD).

Morning and bedtime routines are easiest to control in my home. We wake up at about the same time daily, and we follow the same order of getting dressed, taking medications, eating, and leaving. Of course, this doesn't mean my son isn't still distracted or moody. It just means that, as long as my alarm clock goes off, we can still get out the door mostly on time.

Plan Extra Time to Manage the Stress of Change

Part of building routine is being realistic about timing. My child with ADHD, for instance, will not complete homework as quickly as a typical child. If I plan only 20 minutes for him to finish homework before transitioning to dinner, I'm setting us up for disaster. Part of his DMDD is that he tends to be oppositional as well, so I have to build into the schedule the expectation that he is not going to do what I ask the first time (or the 12th).

I plan for everything to take about double the time I expect it should. I'll add even more time if I'm asking my son to make a change. For instance, I've discovered it takes about 15 minutes on a good day to get to the car in the morning after I tell the kids we need to get to the car. As a result, I start asking them to get ready and packing my things into the vehicle, a half hour before I think I need to leave.

Prepare for Change to Cause Stress

I try to avoid surprises. If I know about a change hours in advance, I'll tell my son hours in advance and start the process of talking him down when he gets angry or anxious. This goes for "good" changes, too.

In fact, that's the hard part. Change never starts as "happy" for my son. If I want him to enjoy a change, he needs to be well-prepared for it and he may not admit to liking the change until after it's done. For instance, I'm not sure when most parents start planning for middle school, but we've been planning his entire fifth-grade year. It's too big to wait for when typical kids prepare.

The moral of the story: Be prepared. Remember empathy, too. However hard it is for us, the stress of change is even harder on our kids.