Welcome aboard the roller coaster of parenthood, where emotions run wild, tantrums reign supreme and love flows deep.

As children reach toddlerhood and beyond, parents adapt to manage their child’s big emotions and meltdowns. Parenting terminology has adapted too, with more parents describing their child as “dysregulated”.

But what does this actually mean?

More than an emotion

Emotional dysregulation refers to challenges a child faces in recognising and expressing emotions, and managing emotional reactions in social settings.

This may involve either suppressing emotions or displaying exaggerated and intense emotional responses that get in the way of the child doing what they want or need to do.

“Dysregulation” is more than just feeling an emotion. An emotion is a signal, or cue, that can give us important insights to ourselves and our preferences, desires and goals.

An emotionally dysregulated brain is overwhelmed and overloaded (often, with distressing emotions like frustration, disappointment and fear) and is ready to fight, flight or freeze.

Developing emotional regulation

Emotion regulation is a skill that develops across childhood and is influenced by factors such as the child’s temperament and the emotional environment in which they are raised.

In the stage of emotional development where emotion regulation is a primary goal (around 3–5 years old), children begin exploring their surroundings and asserting their desires more actively.

It’s typical for them to experience emotional dysregulation when their initiatives are thwarted or criticised, leading to occasional tantrums or outbursts.

A typically developing child will see these types of outbursts reduce as their cognitive abilities become more sophisticated, usually around the age they start school.

Express, don’t suppress

Expressing emotions in childhood is crucial for social and emotional development. It involves the ability to convey feelings verbally and through facial expressions and body language.

When children struggle with emotional expression, it can manifest in various ways, such as difficulty in being understood, flat facial expressions even in emotionally charged situations, challenges in forming close relationships, and indecisiveness.

Several factors, including anxiety, attention-deficit hyperactivity disorder (ADHD), autism, giftedness, rigidity and both mild and significant trauma experiences, can contribute to these issues.

Common mistakes parents can make is dismissing emotions, or distracting children away from how they feel.

These strategies don’t work and increase feelings of overwhelm. In the long term, they fail to equip children with the skills to identify, express and communicate their emotions, making them vulnerable to future emotional difficulties.

We need to help children move compassionately towards their difficulties, rather than away from them. Parents need to do this for themselves too.

Caregiving and skill modelling

Parents are responsible for creating an emotional climate that facilitates the development of emotion regulation skills.

Parents’ own modelling of emotion regulation when they feel distressed. The way they respond to the expression of emotions in their children, contributes to how children understand and regulate their own emotions.

Children are hardwired to be attuned to their caregivers’ emotions, moods, and coping as this is integral to their survival. In fact, their biggest threat to a child is their caregiver not being OK.

Unsafe, unpredictable, or chaotic home environments rarely give children exposure to healthy emotion expression and regulation. Children who go through maltreatment have a harder time controlling their emotions, needing more brainpower for tasks that involve managing feelings. This struggle could lead to more problems with emotions later on, like feeling anxious and hypervigilant to potential threats.

Recognising and addressing these challenges early on is essential for supporting children’s emotional wellbeing and development.

A dysregulated brain and body

When kids enter “fight or flight” mode, they often struggle to cope or listen to reason. When children experience acute stress, they may respond instinctively without pausing to consider strategies or logic.

If your child is in fight mode, you might observe behaviours such as crying , clenching fists or jaw, kicking, punching, biting, swearing, spitting or screaming.

In flight mode, they may appear restless, have darting eyes, exhibit excessive fidgeting, breathe rapidly, or try to run away.

A shut-down response may look like fainting or a panic attack.

When a child feels threatened, their brain’s frontal lobe, responsible for rational thinking and problem-solving, essentially goes offline.

This happens when the amygdala, the brain’s alarm system, sends out a false alarm, triggering the survival instinct.

In this state, a child may not be able to access higher functions like reasoning or decision-making.

While our instinct might be to immediately fix the problem, staying present with our child during these moments is more effective. It’s about providing support and understanding until they feel safe enough to engage their higher brain functions again.

Reframe your thinking so you see your child as having a problem – not being the problem.

Tips for parents

Take turns discussing the highs and lows of the day at meal times. This is a chance for you to be curious, acknowledge and label feelings, and model that you, too, experience a range of emotions that require you to put into practice skills to cope and has shown evidence in numerous physical, social-emotional, academic and behavioural benefits.

Spending even small amounts (five minutes a day!) of quality one-on-one time with your child is an investment in your child’s emotional wellbeing. Let them pick the activity, do your best to follow their lead, and try to notice and comment on the things they do well, like creative ideas, persevering when things are difficult, and being gentle or kind.

Take a tip from parents of children with neurodiversity: learn about your unique child. Approaching your child’s emotions, temperament, and behaviours with curiosity can help you to help them develop emotion regulation skills.

When to get help

If emotion dysregulation is a persistent issue that is getting in the way of your child feeling happy, calm, or confident – or interfering with learning or important relationships with family members or peers – talk to their GP about engaging with a mental health professional.

Many families have found parenting programs helpful in creating a climate where emotions can be safely expressed and shared.

Remember, you can’t pour from an empty cup. Parenting requires you to be your best self and tend to your needs first to see your child flourish.

Cher McGillivray, Assistant Professor Psychology Department, Bond University and Shawna Mastro Campbell, Assistant Professor Psychology, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Obesity is linked to many common diseases, such as type 2 diabetes, heart disease, fatty liver disease and knee osteoarthritis.

Obesity is currently defined using a person’s body mass index, or BMI. This is calculated as weight (in kilograms) divided by the square of height (in metres). In people of European descent, the BMI for obesity is 30 kg/m² and over.

But the risk to health and wellbeing is not determined by weight – and therefore BMI – alone. We’ve been part of a global collaboration that has spent the past two years discussing how this should change. Today we publish how we think obesity should be defined and why.

As we outline in The Lancet, having a larger body shouldn’t mean you’re diagnosed with “clinical obesity”. Such a diagnosis should depend on the level and location of body fat – and whether there are associated health problems.

What’s wrong with BMI?

The risk of ill health depends on the relative percentage of fat, bone and muscle making up a person’s body weight, as well as where the fat is distributed.

Athletes with a relatively high muscle mass, for example, may have a higher BMI. Even when that athlete has a BMI over 30 kg/m², their higher weight is due to excess muscle rather than excess fatty tissue.

People who carry their excess fatty tissue around their waist are at greatest risk of the health problems associated with obesity.

Fat stored deep in the abdomen and around the internal organs can release damaging molecules into the blood. These can then cause problems in other parts of the body.

But BMI alone does not tell us whether a person has health problems related to excess body fat. People with excess body fat don’t always have a BMI over 30, meaning they are not investigated for health problems associated with excess body fat. This might occur in a very tall person or in someone who tends to store body fat in the abdomen but who is of a “healthy” weight.

On the other hand, others who aren’t athletes but have excess fat may have a high BMI but no associated health problems.

BMI is therefore an imperfect tool to help us diagnose obesity.

What is the new definition?

The goal of the Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity was to develop an approach to this definition and diagnosis. The commission, established in 2022 and led from King’s College London, has brought together 56 experts on aspects of obesity, including people with lived experience.

The commission’s definition and new diagnostic criteria shifts the focus from BMI alone. It incorporates other measurements, such as waist circumference, to confirm an excess or unhealthy distribution of body fat.

We define two categories of obesity based on objective signs and symptoms of poor health due to excess body fat.

1. Clinical obesity

A person with clinical obesity has signs and symptoms of ongoing organ dysfunction and/or difficulty with day-to-day activities of daily living (such as bathing, going to the toilet or dressing).

There are 18 diagnostic criteria for clinical obesity in adults and 13 in children and adolescents. These include:

• breathlessness caused by the effect of obesity on the lungs
• obesity-induced heart failure
• raised blood pressure
• fatty liver disease
• abnormalities in bones and joints that limit movement in children.

2. Pre-clinical obesity

A person with pre-clinical obesity has high levels of body fat that are not causing any illness.

People with pre-clinical obesity do not have any evidence of reduced tissue or organ function due to obesity and can complete day-to-day activities unhindered.

However, people with pre-clinical obesity are generally at higher risk of developing diseases such as heart disease, some cancers and type 2 diabetes.

What does this mean for obesity treatment?

Clinical obesity is a disease requiring access to effective health care.

For those with clinical obesity, the focus of health care should be on improving the health problems caused by obesity. People should be offered evidence-based treatment options after discussion with their health-care practitioner.

Treatment will include management of obesity-associated complications and may include specific obesity treatment aiming at decreasing fat mass, such as:

• support for behaviour change around diet, physical activity, sleep and screen use
• obesity-management medications to reduce appetite, lower weight and improve health outcomes such as blood glucose (sugar) and blood pressure
• metabolic bariatric surgery to treat obesity or reduce weight-related health complications.

Should pre-clinical obesity be treated?

For those with pre-clinical obesity, health care should be about risk-reduction and prevention of health problems related to obesity.

This may require health counselling, including support for health behaviour change, and monitoring over time.

Depending on the person’s individual risk – such as a family history of disease, level of body fat and changes over time – they may opt for one of the obesity treatments above.

Distinguishing people who don’t have illness from those who already have ongoing illness will enable personalised approaches to obesity prevention, management and treatment with more appropriate and cost-effective allocation of resources.

What happens next?

These new criteria for the diagnosis of clinical obesity will need to be adopted into national and international clinical practice guidelines and a range of obesity strategies.

Once adopted, training health professionals and health service managers, and educating the general public, will be vital.

Reframing the narrative of obesity may help eradicate misconceptions that contribute to stigma, including making false assumptions about the health status of people in larger bodies. A better understanding of the biology and health effects of obesity should also mean people in larger bodies are not blamed for their condition.

People with obesity or who have larger bodies should expect personalised, evidence-based assessments and advice, free of stigma and blame.

Louise Baur, Professor, Discipline of Child and Adolescent Health, University of Sydney; John B. Dixon, Adjunct Professor, Iverson Health Innovation Research Institute, Swinburne University of Technology; Priya Sumithran, Head of the Obesity and Metabolic Medicine Group in the Department of Surgery, School of Translational Medicine, Monash University, and Wendy A. Brown, Professor and Chair, Monash University Department of Surgery, School of Translational Medicine, Alfred Health, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Attention deficit hyperactivity disorder (ADHD) is a condition that can affect all stages of life. Medication is not the only treatment, but it is often the treatment that can make the most obvious difference to a person who has difficulties focusing attention, sitting still or not acting on impulse.

But what happens once you’ve found the medication that works for you or your child? Do you just keep taking it forever? Here’s what to consider.

What are ADHD medications?

The mainstay of medication for ADHD is stimulants. These include methylphenidate (with brand names Ritalin, Concerta) and dexamfetamine. There is also lisdexamfetamine (branded Vyvanse), a “prodrug” of dexamfetamine (it has a protein molecule attached, which is removed in the body to release dexamfetamine).

There are also non-stimulants, in particular atomoxetine and guanfacine, which are used less often but can also be highly effective. Non-stimulants can be prescribed by GPs but this may not always be covered by the Pharmaceutical Benefits Scheme and could cost more.

How stimulants work

Some stimulants prescribed for ADHD are “short acting”. This means the effect comes on after around 20 minutes and lasts around four hours.

Longer-acting stimulants give a longer-lasting effect, usually by releasing medication more slowly. The choice between the two will be guided by whether the person wants to take medication once a day or prefers to target the medication effect to specific times or tasks.

For the stimulants (with the possible exception of lisdexamfetamine) there is very little carry-over effect to the next day. This means the symptoms of ADHD may be very obvious until the first dose of the morning takes effect.

One of the main aims of treatment is the person with ADHD should live their best life and achieve their goals. In young children it is the parents who have to consider the risks and benefits on behalf of the child. As children mature, their role in decision making increases.

What about side effects?

The most consistent side effects of the stimulants are they suppress appetite, resulting in weight loss. In children this is associated with temporary slowing of the growth rate and perhaps a slight delay in pubertal development. They can also increase the heart rate and may cause a rise in blood pressure. Stimulants often cause insomnia.

These changes are largely reversible on stopping medication. However, there is concern the small rises in blood pressure could accelerate the rate of heart disease, so people who take medication over a number of years might have heart attacks or strokes slightly sooner than would have happened otherwise.

This does not mean older adults should not have their ADHD treated. Rather, they should be aware of the potential risks so they can make an informed decision. They should also make sure high blood pressure and attacks of chest pain are taken seriously.

Stimulants can be associated with stomach ache or headache. These effects may lessen over time or with a reduction in dose. While there have been reports about stimulants being misused by students, research on the risks of long-term prescription stimulant dependence is lacking.

Will medication be needed long term?

Although ADHD can affect a person’s functioning at all stages of their life, most people stop medication within the first two years.

People may stop taking it because they don’t like the way it makes them feel, or don’t like taking medication at all. Their short period on medication may have helped them develop a better understanding of themselves and how best to manage their ADHD.

In teenagers the medication may lose its effectiveness as they outgrow their dose and so they stop taking it. But this should be differentiated from tolerance, when the dose becomes less effective and there are only temporary improvements with dose increases.

Tolerance may be managed by taking short breaks from medication, switching from one stimulant to another or using a non-stimulant.

Too many prescriptions?

ADHD is becoming increasingly recognised, with more people – 2–5% of adults and 5–10% of children – being diagnosed. In Australia stimulants are highly regulated and mainly prescribed by specialists (paediatricians or psychiatrists), though this differs from state to state. As case loads grow for this lifelong diagnosis, there just aren’t enough specialists to fit everyone in.

In November, a Senate inquiry report into ADHD assessment and support services highlighted the desperation experienced by people seeking treatment.

There have already been changes to the legislation in New South Wales that may lead to more GPs being able to treat ADHD. Further training could help GPs feel more confident to manage ADHD. This could be in a shared-care arrangement or independent management of ADHD by GPs like a model being piloted at Nepean Blue Mountains Local Health District, with GPs training within an ADHD clinic (where I am a specialist clinician).

Not every person with ADHD will need or want to take medication. However, it should be more easily available for those who could find it helpful.

Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.