With a family history of anxiety and depression, I worry about my 4 year old

unhappy-girlQ: I am writing to you in connection with my 4½ year old daughter. She is a lovely, caring, intelligent girl who is also great fun. However, I am worried about her. She has recently become very sensitive and can seem down in herself. For example, she often makes genuinely funny jokes and clever observations. If her dad or I laugh, she gets very upset, asking us to stop laughing at her. Our reassurances that we love her and think she is funny do not seem to register.

Yesterday another little girl accidentally bumped off her on a family day trip. I barely noticed it as it was very mild but later on in the trip I noticed she looked very sad and down. When I asked her why, she said it was because the other little girl bumped off her. She has a younger brother who is more boisterous and she seems not to know what to do if he grabs or hits her. This does not happen very often and they have a lovely relationship with lots of cuddles and playing.

She attends creche five days per week. I know from talking to her teacher that she has a love/hate type relationship with another little girl of the same age (such as competition about who has the nicest dress, best uncle, and so on) but generally she seems very happy there and the creche has never reported any concerns about her behaviour.

There is a strong family history of anxiety and depression, and I would love your advice on how to best deal with this and watch out for any signs of anxiety/depression in the future as she really is the most wonderful child and I would like to be able to help her, particularly in advance of starting school in September.

A: When you have a personal or family experience of mental health problems, such as depression or anxiety, it is perfectly understandable to be worried as to whether your children might develop these traits and to want to do your best to prevent this.

While being sensitive to your children’s needs in this way can be a good thing, there is the danger you can become “over-vigilant” and interpret the emotional ups and downs of childhood as being signs of problems when they are all very normal.

For example, if you become anxious about your child being anxious, this can make her more anxious and even wonder if something is wrong with her.

Indeed, in my own clinical practice, I have seen several extreme cases where the parents’ worries become dominant, and the family history becomes almost like a self-fulfilling prophecy that the child lives into (though I am not suggesting this is happening in your own situation).

Normal behaviour
Reading your question, the behaviours you describe are all relatively normal for a sensitive four-year-old girl. For example, lots of four-year-olds don’t like it when parents laugh at “cute” behaviours or observations and mis-interpret it as their being mocked or not taken seriously (even though parents don’t mean this at all).

In those instances, it can be best to share your laughter/smiles later with your partner and to respond in the now to your child.

Also, it is very normal for sensitive children to become sad or upset over random incidents that don’t seem troublesome (such as your daughter being bumped by the other girl).

In those situations, it is important to respond supportively by helping her talk and express her feelings, as well as gently supporting her to think the incident through (“I think it was just an accident”) and finally reassuring her (“You can always talk to Mum and Dad”).

Focus on your daughter’s positive traits and qualities
A good way to help your daughter be emotionally resilient in the future is to focus on and draw out the positive aspects of her personality. As you do now, continue to enjoy the caring, clever and fun side of her personality as this is the best way to boost her self-esteem.

In addition, look at the strength in her personality in the way she deals with challenges; for example, rather than seeing her as over-sensitive (for example, to being bumped by the other girl), see this as her being thoughtful and emotionally sensitive.

You can use these qualities to help her learn about emotions and think through social strategies as she gets older.

A good way to encourage your daughter’s positive emotional development is to see the daily challenges she encounters as opportunities for her to develop resilience, learn coping skills and develop emotionally.

The key is to normalise what she is experiencing and to express a positive belief that she has the ability to sort out whatever she is going through (with your support and love).

Dealing with a family history of mental health problems
You don’t say who in the family has suffered from depression and anxiety in the past, so it is hard for me to comment without more details.

In general terms, the goal is to find a sensitive and compassionate way of talking about these issues in the family as your daughter grows up. You want to help her learn to understand and to know how to deal with any challenges that might affect her, while breaking any necessary “prediction” that she will have the same issues. You and your daughter’s father might find it useful to talk through your concerns with a family counsellor or mental health professional.

Dr. John Sharry, Irish Times Newspaper, August 2015. John writes in The Irish Times Health+Family every Tuesday.