Back to School Tips for Parents and Caregivers Featuring Dr. Christine Crawford and Barb Solish

Going back to school can be tough for kids – and their parents. In this episode, Barb Solish, from NAMI’s Office of Innovation, guest hosts for a conversation with child and adolescent psychiatrist Dr. Christine Crawford. Hear from Dr. Crawford about what parents are worried about, how to address screen time for children, and modeling behavior at home. Plus, hear about what mental health warning signs parents can watch for and when to escalate concerns.  

To hear more from Dr. Crawford, check out her recent appearance on The TODAY Show and her previous “Hope Starts With Us” interview. 

You can find additional episodes of this NAMI podcast and others at nami.org/podcast.

"Hope Starts With Us" is a podcast by NAMI, the National Alliance on Mental Illness. It is hosted by NAMI CEO Daniel H. Gillison, Jr.

Episode production is provided by NAMI staff, including Traci Coulter and Connor Larsen.

Transcript

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I'm just curious about that. And then they say, you know, with going back to school, like, you know, I don't want to be left out because I'm going to start middle school and all the cool kids hang out together, and I don't want to be left out. And then you can actually provide some support that's helpful for your teen, you know, for how to navigate that. But coming from a place of curiosity about their phone use, the apps that they use, and how they're using it can be really helpful. Welcome to Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. I'm your guest host Barb Solish, NAMI's National Director of Innovation joining Hope Starts With Us today. Thank you so much for joining this community by tuning in. So NAMI started this podcast because we believe that hope starts with us. Hope starts with us talking about mental health. Hope starts with us making information accessible. Hope starts with us providing resources and practical advice. Hope starts with us sharing our stories. Hope starts with us breaking the stigma. If you or a loved one is struggling with mental health condition and have been looking for hope, we made this podcast for you. Hope starts with all of us. Help is a collective and we hope that each episode, with each conversation brings you into that collective so that you know you are not alone. Hi everyone! My name is Barb Solish. I am not NAMI's National, Director of Innovation, where I get the honor of overseeing NAMI's work to help young people and also the support of adults in their lives to get the tools and the resources that help them thrive. While new clothes, backpacks, teacher assignments are exciting, we also know that there's a lot of stress that comes when students head back to the classrooms in the fall. There are reasonable jitters about new schools and stress about sports and activities starting all back up again after the lull of summer. But there's also a compounding issue, and in some ways, a hanging cloud of youth mental health. The latest data that came out this summer showed that 1.5 million adolescents in 2024 had a major depressive episode and did not receive mental health treatment. And over 10% of adolescents had serious thoughts of suicide. We've also known for a long time that 50% of all mental health conditions start before age 14, and 75% by age 24. So these concerns can really start earlier than people may think. Youth are struggling and parents and teachers everywhere are worried and want to know what they can do to help. And that's why I am so grateful that today's guest could join us, Dr. Christine Crawford. Dr. Crawford is NAMI's Associate Medical Director. She's the author of NAMI's second book, You Are Not Alone for Parents

and Caregivers: 2:52

the NAMI Guide to Navigating Your Child's Mental Health. She's also the Vice Chair of Education for the Department of Psychiatry at Boston University School of Medicine, and a practicing child and adolescent psychiatrist. So, Dr. Crawford, thank you for joining the podcast today. As we get started, could you tell us more about your experience and what led you to NAMI? Yeah. So first off, thank you so much for having me. I'm so excited to talk about this topic. It's so important. But one of the reasons why I was drawn to NAMI was when I was a psychiatry resident and I was in training, I was often surprised by how we were so focused on the clinical care that we were providing during the session, but we weren't really talking about how to support our patients outside of these sessions while they were at home or out in the community. And so I really felt the need to educate myself about different resources that I could share with my patients so that they had all the support that was truly necessary in order for them to thrive, in order for them to be more engaged in treatment, but also for them to just feel as though they're part of a community, which is so incredibly helpful. When people are living with conditions in which they feel like they're the only ones living in these sort of conditions. So I really love the idea of being able to tap into the amazing community that is NAMI that's not only just, you know, available in people's backyards, but it's everywhere across the country. So it's been such a pleasure to be part of this amazing grassroots organization and to be able to share my clinical perspective, but also to share my personal experiences, my own lived experiences. And so I just love NAMI for all of that. And I love that NAMI likes to talk about families with young kids and kids and teenagers. So that's been truly rewarding just to see all of the programming and support that have been in place for that group. Awesome. Thank you, Dr. Crawford. So we are right in the midst of the back to school season. So in your practice and in your work at NAMI, what are some key concerns that you're hearing from parents and caregivers? So transitioning from the summer months to school in the fall, it's really difficult for a lot of kids of all ages. And oftentimes that has to do with the fact that for a lot of kids, the summer times are unstructured months. It's an unstructured period of time. And then they have to suddenly transition to a very structured environment in that school in which there's a brand new routine that can be a difficult transition for a lot of kids. And then also when people are enjoying the summer months, they're enjoying it, right? You know, they're not met with the academic demands or the social pressures that come up. You know, when kids are in school, so they tend to be a little bit more relaxed, less anxious because things are a little bit easier. Things are actually in their control. But when they go back to school, they're in a brand new classroom. They're surrounded by brand new kids, peers, and then they have to figure out how to navigate the whole social environment, that can be difficult. But then also having to wake up early in the morning, having to, you know, shower, get your backpack ready, getting your lunch ready, getting out the door and getting to the bus stop. There's so many different steps, and that can be really difficult for folks to transition to going back to school. I'm also hearing from a more clinical perspective about anxiety. Anxiety is huge. And oftentimes, you know, as parents and caregivers, we want to provide immediate reassurance to our kids whenever they're expressing anxiety about anything. Oh, you don't have to worry about school. Everyone's going to love you. Don't worry about it. But when we minimize and invalidate the concerns of our kids, we miss out on opportunities to actually provide them with different tools and strategies for how to mitigate some of that anxiety, and how to be more successful when transitioning into school. So anxiety is a big thing. Worrying about, you know, being able to make the transition and getting back into routines. Those are kind of the big things that I'm hearing from parents as well as from some of my patients. Yeah, change is hard, big changes, especially, you know, coming from a, like you said, a relaxed, happy summer to a structured school day like that is a big difference for a child. And so that makes a lot of sense. And talking about change, you know, the way that students now use technology and screens at school is a big shift for a lot of parents. Not to, like, date myself too much, but my high school experience did not include a smartphone. I am a parent of a two year old, so she's not quite in school yet. But I can tell you, I am already thinking and worrying about these issues. So what tips can you offer parents who want to address the use of technology and screen time concerns, etc., particularly when it comes to their kids mental health? So a couple of things when it comes to screens, and I'll just kind of take a step back and kind of talk a little bit more broadly about technology. Use Screen Time with kids of all ages. Oftentimes as parents were terrified of the amount of time that our kids are on the screens because we're worried that it's going to have a negative impact on their social skills, a negative impact on their ability to pay attention to different things. We're just worried about what it's like for our kids' developing brains if they're on iPads, if they're on social media, if they're on the phones, you know, for a large part of the day. But what I remind, parents and caregivers is that if we keep saying to our kids, get off the iPad, get off the phone, get off of social media, it's like telling you to stop using Google as an adult, right? It just wouldn't make any sense to these kids, right? Because we are living in a different world and us as parents and caregivers, there's a fear of this different world because we haven't lived in it before, and we did not live in this type of world as kids and teenagers. Right? And so we only know what we know. We only know based off our experiences growing up. We only know how to parent based off how our parents parent to us way back when, before there was, you know, smartphones and iPads and what have you. So literally everybody is doing this for the first time. And I think if we think about it like that, hopefully that invites a little bit more flexibility in our thinking around how we can best support our kids and kind of navigate this kind of technological world. So the other thing, too, is that I encourage parents to make curious about what's driving, the use of the phone or what's really driving, the increase, you know, screen time. Because it could be for a whole host of reasons. You know, thinking about teenagers and adolescents who might be on social media on their phones. You know, rather than just saying you need to get off of social media altogether, it's bad. But to be curious. Oh, you know, I've noticed that you're on your phone. I'm just curious as to which social media apps you use. Actually familiarize yourself with the apps, familiarize yourself with the language that's being used on social media. Know what reels are. Know what, you know, your For You page is all about so that you can have an actual conversation with your kid, exploring their world. And so getting curious about what it is that they're exploring on their phones and sitting next to your kid, especially the teenagers who are on social media, and looking over to see what are some of the videos that are popping up as they're scrolling, because you can actually learn a lot about the world that your kid lives in just by looking at their For You page, because these things that pop up in the videos or things that they're thinking about all the time, things that they're curious about, things that they want to learn a little bit more about. So if you're seeing that sitting next to your kid, there's lots of videos coming up about how to deal with anxiety, how to get along with kids in your classroom better. You can look over and just say, I've noticed that there's a lot of videos popping up about anxiety. I'm just curious about that. And then I say, you know, with going back to school, like, you know, I don't want to be left out because I'm going to start middle school and all the cool kids hang out together, and I don't want to be left out. And then you can actually provide some support that's helpful for your teen, you know, for how to navigate that. But coming from a place of curiosity about their phone use, the apps that they use and how they're using it can be really helpful. Now, what gets a little tricky is when we're talking about kids who are a bit younger, who are on the iPads, they're watching YouTube Kids or YouTube Shorts. They're watching a whole host of videos. And what's oftentimes concerning for parents and caregivers is that they're quickly going through these videos. Right? Gone are the days of sitting down and watching a 30 minute Sesame Street episode. Now, episodes for, you know, kid-related programming, it's like five, seven minutes now. You know, they have, like, mini versions of My Little Pony and Bluey now, you know, because the attention spans of our kids, it has actually changed. It's a lot shorter now. And so I really encourage parents to find ways in which they can support their kid in being able to better tolerate longer videos. Just so that the concern around their attention span and then constantly needing to seek like instant gratification if they don't like something, gotta to move on to the next. You can kind of slow that down a little bit if you try to incorporate more movie nights, or if you're sitting next to your kid and you're watching that full episode of Bluey and maybe suggesting, hey, this five minute episode, I don't know, I kind of want more Bluey, let's watch the full one. I do think that could be a nice way to, you know, kind of support the kid's interest, but also being mindful of some of the concerns around all these fast paced videos and what have you. That is so interesting, especially the attention span piece. I mean, wow, I think about my own attention span and also just the tolerance level. It goes back to what you're saying about, like tolerating the anxiety of going this, you know, going back to school and like and learning those resilience tactics too. I think it's all really connected. And, and we all are learning together. And that's very NAMI, you know, you are not alone in this. You know, I know that on top of being a psychiatrist and an expert in these issues, I also happen to know that you are a really, really great mom yourself. So tell us, how do you model good technology use at home? That's a great question because I'm a child psychiatrist and I don't even get it right. And I think that as parents, we really have to give ourselves some grace, because number one, we're doing this for the first time. And number two it's really trial and error. And number three, you sometimes have to use different approaches for each one of your kids, right? So it's not always a one size fits all sort of situation. So not only are you doing something for the first time, but you have to do it in a variety of different ways. So it can be really difficult to do. But what I often tell parents and when I remind myself is that what the best that I can do in this moment is just to be able to model how it is I can navigate this technological world. I think we put a lot of pressure on ourselves as parents to read all the fancy books, use all the fancy approaches, and to do that thing. But if you aren't even doing that thing for yourself, or it isn't something that is natural to you is going to be hard to sustain that? And so what I focus on is, okay, what is it that my girls are seeing for me? What sort of behaviors do they see for me on a regular basis? How do they experience the way in which I communicate not only with them, but with other people? And so being mindful of the fact that each and every moment I'm around my kids, I'm literally teaching them how to be human beings, like how to navigate the social world, how to navigate just the complexity of the world today. Right? And so there are a couple of things that I focus on and I'm really intentional about. I'm really intentional about talking about their feelings, their emotions, and what it is that they're going to do about it. So I actually might verbalize this. I say this out loud. So say if I'm driving and I live in Massachusetts and Boston drivers were the worst. And we have, you know, this, tendency of using some choice words when people aren't kind of, you know, being respectful and mindful of just basic traffic rules and regulations. And so if there's a moment in which I am displeased with the driving of someone else, you know, I'll say, you know--I'll get upset and then I'll say to my kids, you know, Man, that driver really made me upset. And they cut me off. And I'm just so, so upset in this moment right now. Gosh, you know, I gotta make sure that I pay better attention to the road because people aren't driving that well. It's important to see that, especially while angry, because a lot of kids, because especially young kids, they're very egocentric. They feel like everything is about them. So if they see you angry or frustrated and they don't know why, they might think that they're the reason why you're angry. They might feel like they have to have the sense of responsibility of making you feel less angry and they might feel this kind of sense of urgency to make you happy or to do something so that you're not mad and that that anger isn't going to carry over into your interactions with that. And so that's why when I'm angry about something, I'm very clear about what I'm angry about and about like, what it is, and I'm going to do about it. Also when I'm experiencing feelings of, you know, anxiety or sadness, I actually say that to them. You know, I'll say to them, you know, especially if I'm overwhelmed and I'm at home trying to make dinner and doing all these other things, I'll actually say, you know what? I am so overwhelmed right now because your sister's asking me to do this. You're asking me to do this? My phone is going off. There's so many things on my mind right now, and I don't really know where to start. So, I'm just going to kind of give myself a break. Do you mind just giving me a couple of minutes so I can figure out how do I kind of navigate all of these different things that I have to do. Now, a lot of people think that sort of language and that sort of modeling, you do that when kids are older, but it's really important to start very young, like even when your kids are three, because that's when they start to learn about different emotional states, how to recognize different emotions, not only in themselves but in other people, and how to label those emotions, so they already know how to do this. So I'm just really intentional about kind of, you know, talking about my emotional state and what it is they do to kind of navigate having really big and intense emotions. And really funny story, Barb, that I'll share with you is that I recently had to--you know, I've been doing a lot of traveling, and I had to leave for a trip in the middle of the night, and I decided not to wake up. My four year old just left in the middle of the night and thought, oh, well my mom can just let her know what's been going on. But when I came back, she said to me, "Mommy, when I woke up and I couldn't find you in the bed, you know, I got really scared. I was worried, I didn't know what had happened to you. And then I got angry with you because you didn't tell me where you were going. So from now on, when you leave this house to travel, you ought to wake me up in the middle of the night." Now, mind you, she's four. I'm not embellishing or making any of this stuff up. But she said all of that. And she was right. She held me accountable for the fact that she was able to name all of these different emotions that she went through, and why was pretty cool. I was like, pat on the back. Yeah. And I got to do better at this when I travel. That is pretty incredible to be able to label and say, I actually have a solution here, here are some options. And there were great ones. Yeah, those are so help. All those tips are so helpful. And I'm definitely going to keep in mind the modeling because I do sometimes get frustrated while driving. So there's many opportunities for this. So I know we expect sort of a certain level of anxiety when it comes back to back to school season. But I think a lot of parents aren't always so sure when they should get concerned. And I think that's true for all ages. I'm thinking about, you know, times parents have asked, is it hormones or is it something more serious? And I think the spotlight on the youth mental health crisis has made this an even bigger concern. So what should parents look out for when it comes to mental health? Yes, I think for anxiety as well as other kind of emotional states that parents and caregivers could be worried about, whether or not it's a problem or not, I keep it very simple for everyone. If the emotional state or if the behavior gets in the way of the kid's ability to do the things that they should be doing each and every day, then that's a concern. If it impairs their function, it's a problem. And using the example of anxiety, which is an emotional state that we all experience and it can be really helpful, it really motivates us to get things done and motivates us to prepare. But sometimes when the anxiety gets to a level in which you might be spending way too much time over preparing and then you actually don't do the thing, that's a problem, right? If you have a lot of worries and fears about going to school and about being in the classroom, and you just keep avoiding and avoiding going, and then you don't go to school, that's evidence of functional impairment when it comes to your academic and social functioning. So I really remind parents that if you are concerned that there's a shift and a change in their ability to function, then that's a red flag. What that can actually look like is you kind of having a sense of your child and really paying attention to your child and knowing your child well. That's number one. That's the most important thing. Because a lot of people, especially in this day and age, they think they know other kid, but not really, you know what I mean? Like, we have a lot of folks living under, you know, the same roof, you know, in the same household. But it seems like everyone's in their own corner of the house, you know, because maybe they're on their phones or maybe they're doing this and that. And so it's hard for people to really notice the kid in the house or notice other family members, like to truly notice them and see them. And so I really encourage parents to, you know, think about ways in which they can always stay connected and attuned to their kids. And so whether that's having regular conversations with them, asking the same questions in the car or, you know, during dinner times, that's a really helpful way for you to remain connected to your kid. So first and foremost, you want to know them, you want to notice any changes in their behavior, their ability to function. And if you're noticing that they're experiencing these difficulties, not only at home but at other places, then that's a definite red flag. So if this is consistent behavior or emotional state, that seems to be visible in multiple areas and domains of a kid's life, then that certainly is concerning. And I really recommend that parents and caregivers actually reach out to their pediatrician. A lot of parents think, oh, well, I gotta figure this out. I gotta go and Google or ChatGPT and figure this out. I gotta buy the book. No, no, no. You go to your pediatrician because mental health concerns or primary care concerns, and they'll be able to provide you with guidance around, is this developmentally appropriate. Is this definitely evidence of functional impairment. And if it is, here are some resources, that you can tap into that are available in your community that could be helpful. That's so great because I think people, you know, get to--they spot the signs, they get concerned, and then they're like, oh gosh, now who do I call? What do I do? So to have a pediatrician as the first stop is such a helpful guidance. Is there any other resources you would recommend for parents who are concerned about their kids? Yeah. So I also think that tapping into the resources at your kid's school is actually really helpful. I think that having a relationship with your kid's teacher is just gold. It's so incredibly helpful because your kid is spending a lot of time at school, and so they might present differently at school. They might actually be happy and engaged, but when they're home, they look different. Or the teacher might, you know, say to you, yeah, I've noticed that they've been keeping their head down on the desk. They're more withdrawn. I've noticed a change over the last couple of weeks. So your kid's teacher could be a really, really helpful, source of data, helpful source of information about your kid's mood and their behavior. And that is really helpful information for you, again, as you're getting to know your kid better. But also, fortunately, there are a number of schools across the country that do have mental health support embedded in the school. And so being aware of those mental health resources within the schools can be incredibly helpful because they might have counseling that's available, psychologists you can meet with your kid weekly in school and in fact, in Boston, there are health centers that are embedded in the middle schools and the high schools in the city. And within those health centers, we have clinicians that provide weekly individual psychotherapy to students in the school. Right? And a lot of parents don't even know that resource exists. So the familiarizing yourselves with all of the wealth, the resources are available in kids' schools is very important. And if you happen to live in that community that has limited mental health resources embedded in schools, you know, again, trying as best as you can to tap into some of the resources available through your primary care providers office, you know, for your kid. But I'll also kind of step outside of the clinical realm and say, tap into your community, right? Because people who know how to best support kids, they all didn't stay in school for a bajillion and one years, right? It's not just the clinical aspect that's important. So, you know, wanting to meet with other parents who live in the community to hear about which resources they've use, or even to get support from other families in the communities, you know, so that, you know, you're not going through something similar. And Barb, as you're well aware, NAMI has a whole host of programs and supports for families, you know, as they're trying to figure out how they can best support their kid's mental health. So I also encourage people to tap into these community resources and to not forget about NAMI. I love that that is so incredibly helpful. The community--community is powerful and we are all raising all our kids together. So I think that's very important. And yes, NAMI is here for folks. This has been an incredible conversation. But before we conclude, I want to ask you the question

that we ask every podcast guest: 29:13

the world can be a difficult place, and sometimes it's hard to hold on to hope. That's why for each episode, we dedicate the last couple of minutes here for a special segment called Hold On to Hope. So, Dr. Crawford, can you tell us what helps you hold on to hope? What helps me hold on to hope is the fact that we're able to get up and do this another day, right? Sometimes it can feel like you're in a hopeless situation, that you don't have the tools and the answers to navigate it, but then you wake up the next day, right? And so I just hold on to this idea that I have multiple opportunities to figure this out. I have multiple opportunities to try things out, multiple opportunities each and every day to make new connections, form new connections, tap into new resources. I think that we sometimes lose hope because we think that we've explored all options. But I always try to remind myself, no, there's another day. And in that future day, perhaps there's a new option or solution that I have yet to think about that will come across my mind and will be helpful. Now, I know that it's hard for a lot of folks to do, but, you know, especially as, you know, a provider for a lot of young kids and families, I remind them that, you know, even if they are having difficulty finding hope or holding on to hope that I'm actually doing it for them because they're showing up, you know, they're putting one foot in front of the other. They're coming in to see me. And that keeps me hopeful because they keep showing back up. And eventually over time, they'll be able to see that hope that I've been carrying for them that they were able to carry for themselves. But when I'm feeling hopeless, I remind myself that there are other people in my life who are carrying the hope for me into the next day. And so I just try to remind myself of that. That's so beautiful. My mom used to always say that tomorrow is another day. Tomorrow is another day. I find hope that you, people like you, are out there holding hope for people. And I'm so grateful I got to spend time with you today. So thanks for being here and sharing your experience and your wisdom. NAMI is so lucky to have you and I am particularly grateful to get to work with you. Oh Barb, I love that. Thank you, I love it, love it, love it. This has been Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. For parents and caregivers who have children returning to classrooms this fall, please visit NAMI.org/backtoschool. You'll find resources that provide guidance and tips to help you connect with your child and support the development of healthy mental wellness strategies. You can also share this page with educators to help them facilitate the classroom space that encourages mental health literacy. And if you're looking for mental health resources, you are not alone. To connect with the NAMI HelpLine and find local resources, visit NAMI.org/help. Text "helpline" to 62640 or dial one 800-950-NAMI (6264). Or if you are experiencing an immediate suicide, substance use, or mental health crisis, please call or text 988 to speak with trained support specialist or visit 988lifeline.org. It has been a pleasure to be your guest host today. Thank you for listening and be well.