Assessing Childhood Stress

Stress has become a prominent factor in all of our lives due to the complications of living in a fast-paced society in which we are faced with a multitude of daily intrusions on our inner peace. "Inner peace?" you ask. "What's that?" Precisely. For parents, the stress is played out day after day as we struggle to meet economic demands (which often means that both parents work), find affordable day-care, deal with schools, teachers, our kids' homework and academic struggles, etc.

And then, there's the constant parade of extra-curricular activities that demands carting our kids from one practice to another, or to dance lessons, to club activities, or to friends homes.

No wonder we feel like we burn the candle at both ends most of the time and without much let-up. We do! We know we're stressed, and we frequently talk about it, look for ways to alleviate it, or just simply complain about it. But what about our kids? Are they stressed too? And if so, what is the source of their stress and what can we do about it?

Let's start with the sources of children's stress. I usually divide these into two basic categories and then go from there. The categories are internal or inner sources of stress, and external or outer sources of stress. By dividing them up this way, it's easier to figure out how to deal with them. Let's take a look.

Internal Stressors

There are three sources of stress for children that fall under the "internal" category. These are developmental tasks, individual temperament, and physical factors including both individual physical predispositions and illness.

Developmental Tasks

Each developmental phase comes with a series of tasks that a child is confronted with in order that they may master them before moving on to the next level. These tasks often pose various degrees of difficulty that can place a certain amount of stress on the child depending on what kinds of coping mechanisms the child has, and how much support is available from the environment.

Let's say you have a two-year-old who is beginning to struggle with the desire for more autonomy, yet at the same time that very autonomy produces strong feelings of separation anxiety as the child tries to establish some distance from his or her parents.

Or maybe you have a young teen who has just entered puberty and who is experiencing the new surge of hormones that are producing a marked increase in sexual drives and feelings that are overwhelming and confusing.

Or, you might have a six-year-old who is now expected to sit quietly and attentively in school for hours during the day, but who has not quite reached the level of maturity necessary to maintain a sense of calm for long periods of time.

In each of these cases, the developmental tasks imposed on the child from within produce psychological stress that in turn may show up in maladaptive behavior, moodiness, or anxiety.

Individual Temperament

Along with developmental tasks, each child has his or her own individual temperament. Temperament can be defined as the psychological (mental and emotional) constitution that your child has at birth. It is one's innate tendencies, which depending on how one is socialized, can be used to enhance development or hinder it.

If you have more than one child, you can readily understand this concept because most likely your two children have different temperaments that are very obvious to you. For example, one may be an extrovert whereas the other is introverted. Your extroverted child always wants a partner for activity and thrives in the company of others. He or she is very sociable, engaging, and likely, quite active. Your introvert, on the other hand, enjoys some quiet time and likes to entertain him/herself for longer periods of time. He or she may be sociable also, but needs to retreat from too much external stimulation in order to recharge. In fact, as you read this you are probably categorizing yourself into one of these two categories.

Physical Factors

Physical factors include both physical predispositions and the event of illness. Some children are naturally healthy and strong and seem to get by with the minimum of childhood illnesses or physical problems. Others seem to get sick quite easily and often. Such a child may have chronic ear infections, asthma, chronic bouts of colds or influenza, or they may have a more serious illness or disease process that is diagnosed at birth or sometime later in the course of childhood.

I treated a young child that had had bone cancer in his jaw at age four necessitating a long period of hospitalization and treatment. As an older child, he simulated recurring play fantasies in which various pretend characters were either physically mutilated or defective in some way. Such early physical trauma can leave a child with internal stressors that work from within on a subconscious basis.

Even less extreme situations such as chronic ear infections produce stress for a child, and then added stress for the parent who worries, must go to numerous doctor's appointments, stay home from work, and so forth.

External Stressors

These are a little easier to identify, yet sometimes we do not realize that stress can come from both positive and negative sources, and it is important to identify both. You'll see what I mean as we move further into the discussion.

Family Factors

This category refers to the basic interpersonal relationships within the family as well as the general level of functioning of the family as a whole. Some examples are:

• A family in which the parents are struggling unsuccessfully with marital problems, sometimes to the point of leading to divorce.
• An over-zealous emphasis on rules accompanied by the absence of warmth and love is very stressful.
• A lack of emotional nurturing and contact with parents, i.e., parents are so busy that they have little down time with their children.
• Continuous family tensions, violence, or even lack of normal boundaries between parents and children.
• Children placed between parents.
• Children who take on adult roles.
• Children who are targeted as the source of marital stress.

All of these situation cause children a great deal of stress with which they are unable to successfully cope.

Peer Factors

Peer factors become more potent as children move from elementary school into their teens, but even young children are susceptible to peer pressure and peer relationships. The sense of belonging begins in the family, but is greatly felt within the school setting where peers become the vehicle for assessing one's self-worth. Others' reactions to a child can have a profound effect on daily functioning, academic success, and socialization.

During the younger years, peer relationships are comprised of small groups (two to three), and it is this core group that is the source of one's sense of belonging. During adolescence, the small group gives way to larger cliques and crowds, where there is greater pressure to conform. Peer relationships become more complex and have a greater effect on one's overall perception of self. Negative feedback, pressure to conform, and exclusion by the group can be particularly painful, especially when peers promote behavior that conflicts with a child's internalized standards learned in the family.

Activity Mania

"Activity mania" refers to the current state of affairs in our culture that has led us to believe that the more active we are, the better. We work, join clubs, play sports, socialize, take up hobbies, go go go!

The average child gets up very early, eats breakfast on the run, gets to school for a full day of academics followed by a myriad of after-school activities including involvement in a sport, dance lessons, tutoring, going to friend's houses or participating in other social activities.

Then there's homework, dinner, computer and/or television time and off to bed. There is very little to no down time. Moreover, most kids do not have parents at home in the afternoon because their parents work, and so they are either alone or involved in after-school programs or activities. They may not even see their parents until 5 or 6 in the evening at which time there is a rush to complete the evening's activities.

Sometimes when I see kids in therapy, they are so tired because they've not had a minute to relax the whole week. Extra-curricular activities are very important and can be highly beneficial to children of all ages, however, there must be a balance between activity and rest. Kids should have some time to do nothing except tinker in their rooms, lie on the floor and daydream, or just hang around the house and talk. By the way, parents need the same kind of down time.

How Can I Tell If My Child Is Stressed?

There are a number of signs you can look for beginning with simply sitting down with your child and covering how he or she is feeling about school, friends, and family situations, particularly those that have direct impact. Here's a quick list you can use to make your assessment:

• You notice a significant change in mood and/or behavior pattern. In particular, depressed mood, withdrawal, increased observable anxiety, sleep disturbances, changes in eating patterns such as eating a lot more or conversely a loss of appetite, lack of interest in normal activities, or increased agitation. All of these signify that something is causing stress that cannot be coped with successfully.
• Increased bouts of crying or angry outbursts that seem to coincide with a low tolerance for frustration.
• Increased difficulties in managing behavior.
• A sudden disinterest in socializing with friends, or an upsurge in conflicts and fighting.
• Changes in academic performance.
• Changes in relationships with parents and/or other family members.
• Physical complaints such as headaches, stomach aches or digestive problems, or frequent illness.
• Difficulty in getting up and out in the morning accompanied by verbal requests to stay home from school.
• In general, any change in overall functioning that catches your attention and for which you cannot find a cause.

Investigate

If any of the above apply to your child, you might want to start the process of ruling out the various sources of stress that were discussed in the first two sections of this article. Generally, a very open conversation with children can reveal if there are problems at school, with peers, or with others in the environment such as teachers or coaches. A good physical will rule out any real disease process or illness, or perhaps allergy reactions, etc., which could be a source of stress.

Next, you should review with your child the daily schedule and see if there is enough sleep, the right diet, and a balance between activity and rest. If all of these seem okay, then assess possible developmental problems such as the onset of puberty to examine if what you are seeing is just part of the normal developmental progression.

Finally, and most importantly, examine the relationship between you and your child including the amount of positive time and interaction spent. Children who are not getting enough positive attention will find a way to get it negatively. It is very important to keep a check on this, and to get direct feedback from children as to whether they feel important and feel they have access to you when needed.

A quick side note: If you are dealing with a child (usually a teen or pre-teen) that may be involved in drug or alcohol abuse, you would want to be sure and rule this out before trying to figure out what else might be causing the problem. Significant changes in behavior and mood can be a symptoms of substance abuse.

If after trying everything suggested above you find you are unable to uncover the source of stress yet feel that the situation is not resolving itself or is getting worse, you should not hesitate to contact a qualified counselor or therapist. Be sure when selecting someone that they are licensed and have experience with children and/or adolescents, whichever the case may be. Working with children is a different process than working with adults and requires different therapeutic strategies.

For a quick guide to keeping stress in check, read our article posted on this website entitled "Stressbusters for Children."