ASK THE EXPERT-September 2015

She is very lazy , does not want to do any work , scolds everyone and becomes angry at little things . She says she is bored

Category: Adolescent Development Issues  & Behavioral Issues
Response:  Thank you for sharing your concerns. How are you currently managing this behavior? It would be important to know how you deal with her so that you can be guided more accurately. If you either completely ignore her behavior or become too aggressive and strict, both these strategies may not be very helpful.
The best way to work through these issues is by talking to her in a calm manner about the changes that you have noticed in her and giving her the space to share her own views, concerns and thoughts about the matter. It is also okay to let her know how her behaviors effects you and your family and help her identify ways by which she can think of other positive alternates to express her thoughts and feelings e.g. she can keep a check on her tone and choice of words when she is communicating a point of view, delay talking when she is very angry and give herself time to cool off before talking, etc.
Providing her the space to talk, validating and normalizing her feelings may in itself help the behavior settle down, especially If she is going through some emotional turmoil, learning to cope with the changes brought about by adolescence, etc.
Remember that during the adolescent age (roughly starting around ten years and above), many children go through a series of normal emotional, physical and social changes. As a result of these changes there is more interest in peers and opposite sex, less interest in spending time with family and adults, frequent arguments and need to exert their own individuality and identity etc. Some of the things that you mention seem to suggest that your daughter is also experiencing similar changes. The adolescent period can be overwhelming for adolescents, especially if they lack correct information about the changes that they are experiencing or/and if they feel that there is no one that they can communicate with.
Check your own expectations regarding how much time she should be giving to her studies and her role in the house chores etc. and make sure that these are realistic. If you feel that they are, then you can also work with her to set some family norms related to a study routine and acceptable behavior with clearly spelt out consequences for not following the norms. Make sure not to dictate these, but to involve her in the process of making these norms.
All the best

 

My child is very sad all the time and she is loosing her confidence.Day by day she is geting weak

 

Category: Grief and Trauma & Others
Response: We suggest that you talk to her at the earliest to get a better insight into her situation. It would also be important to observe other changes in her behavior and routine especially related to sleep, appetite, studies and interpersonal relationships.
There could be a number of factors that can cause children to feel sad such as a change in their life circumstances at home and school, an upsetting and traumatic experience, etc. We suggest that you talk to her in a supportive and non-threatening manner about the changes that you have observed. Let her know that you would be open to listen to anything, no matter how difficult it is for her to share. This will help build her confidence and trust and she may talk to you more openly.
If after talking to her you feel that she has undergone a traumatic experience, encourage her to see a mental health expert (a therapist) who can help her work through her feelings. She may also benefit from a check up from a mental health expert if she has not undergone any significant life changing experience yet you continue to observe significant changes in her appetite, sleep pattern, energy levels etc. It would be important to rule out and if required treat any form of depression or other mood related disturbances.


 

she did not take interest in studies

 

Category: Lack of Concentration, Attention and Learning
Response: Kindly provide more information about your daughter’s lack of interest in studies to understand her situation better and to guide you accordingly. It would be essential to know about her interest in activities other than studies, and if the lack of interest is a recent occurrence or an issue since her childhood and/or any other change that you have noticed in her mood and behavior.
If the issue is only related to studies and not any other emotional problem such as issues at home, peer pressure, bullying etc., that might be bothering her, you can work in close coordination with her and her teachers so that she can be best helped to overcome her learning challenges. Encourage her to seek help for subjects she does not understand, help her set a daily study routine, break her work tasks into smaller tasks if she looses her concentration on longer tasks and make sure she is getting enough sleep and exercise.
All the best!

 


 

please guide me what motivational tips i can use to make my son study?thanks

Category: Lack of Concentration, Attention and Learning
Response: Motivating children to study is a concern of many parents these days. With the increased academic competition, parents are increasingly feeling the need to help children feel motivated enough to study and learn.
It is essential to keep a check on your own expectations from your child to make sure that these are realistic and age appropriate.
Some of the strategies that can help motivate children are:

  • Keep a family time for reading, where each family member reads a book of his or her choice. If appropriate each person may exchange views and thoughts about the book he/she is reading every week to further strengthen the importance of reading and learning.
  • Encourage your child to explore subjects of his interest. Show interest and enthusiasm in his subjects of interest e.g. pets, geography, gadgets etc. and encourage him to find information and facts about these subjects.
  • Allow him space to share his thoughts, feelings and involve him in family decisions. This will establish his importance in the family and develop in him an overall sense of responsibility.
  • Share your own new learnings with him and let him know how you found information about these things. E.g. through internet, from a book, a friend etc.
  • Ask him about what he is learning in school. The focus should not be on the test results and grades but on what he is learning.
  • Help him organize his home assignments and schoolwork, which will allow him to feel more in control and less overwhelmed with work.
  • Encourage and appreciate achievements even if these are small steps towards a larger goal.
  • Help him focus on his strengths and in identifying ways of overcoming challenges especially related to aparticular subject.
  • Ensure that the child has time to relax and pursue other activities.

My child is very shy kind of pupil he never explain his problemsto teacher what should I do?

Category: Shyness and Under confidence
Response: He is very young and in the process of developing social skills. Some level of shyness at this age is very normal and children exhibit individual differences in this regard.
In general, some of the ways by which you can help him and other children of your class, build their confidence and overcome shyness are:

  • Encourage him and other children to ask questions in the class and let children know that there is no ‘wrong’ or ‘silly’ question. This helps children open up and feel more comfortable and less conscious.
  • Praise him and other children for their   efforts, hard work, qualities and traits.
  • Normalize feelings related to failures and let children know that it is okay to make mistakes.
  • Make sure your own expectations from the children of your class are age appropriate as well as to a level that they can handle.
  • Set limits and discipline children through respectful measures instead of resorting to put downs, insults and corporal punishment.
  • Respect individual difference and avoid comparison with other children.
  • Listen to this child’s needs and explore reasons that maybe making him feel under confident e.g. bullying in school, stressors at home, a change in life circumstances etc.

 


My son is intelligent but some times he doesn't give any response to my instructions and his attention is distracted to some other things around. I'm worried about him and how can I try to change this type of behavior.
Currently I call his name and rotate his face towards me and say "Listen to me" then he follows the instruction otherwise it is up to his mood.
Please, guide me in this regards.

Shaziya Eijaz

Category: Lack of Concentration, Attention and Learning
Response: The strategy that you employ to get your sons attention seems to be an effective one and especially recommended for children who are easily distracted.
Some children have more challenges in paying attention to instructions and tasks including studies as compared to others.   Make sure that your son does not study in a room with too many distractions such as people talking, television, too many toys around etc. Break his main task into smaller tasks so that he can understand them better and is also not distracted. Let him know what he can do once she finishes his work, which will help as an incentive. You can also assess if he is getting ample sleep, nutrition and is not disturbed by any family issues and stressors. All these things can also affect children’s ability to pay attention.
If you feel that the problem keeps happening consistently, and if you get similar complaints from the school, it is suggested that you speak to his teacher and see how you can both help him through a joint strategy, which is followed both at the school and at home.
If you notice no substantial improvement in the behavior despite consistently trying the above-mentioned strategies, you can consult a mental health professional with expertise in dealing with children to explore if he has an attention and hyperactivity or/and a learning disability.


MY SON IS VERY INTELLIGENT BUT HE IS MUCH CARELESS ABOUT HIS BELONGINGS. HE LOSES HIS PENCILS, ERASERS N SUCH TYPE OF MINOR THINGS ON DAILY BASIS. HIS HAND WRITING IS BECOMING V POOR DAY BY DAY, IT MIGHT BE DUE TO LOAD OF WRITTEN WORK IN CLASS. HE SOME TIME USE TO BUNK CLASS BY GIVING EXCUSE TO GO OUT FOR WASHROOM AGAIN N AGAIN.

Category: Behavioral Problems & Lack of Concentration, Attention and Learning
Response: Some children require more assistance than other children to get organized and pay attention towards daily activities. Keep a check on your own reaction and expectations from your child to make sure that they are age appropriate and realistic. The more you get frustrated or/and set the bar too high for him, the more overwhelmed and anxious your child might feel.
Talk to his teacher to see if she also has similar concerns about his behavior and hand writing. You can then work with her to come up with a joint strategy to help him both at the school and at home.
Help him every evening in organizing his school bag and to make a note of all his belongings. Encourage him to account for all his belongings before leaving school and make it a fun activity for him. You may also request his teacher to remind him about this at school. You might have to repeat the instructions several times till it becomes a habit. Make sure you do it consistently but in a firm and calm manner. Talk to him about his habit of frequently leaving the class and give him an opportunity to share his thoughts to identify ways by which he can lessen the number of times he goes out during the class time. Praise him when he shows improvement, even if it is a minor one.


my child is admitted in class one in the above school, and after two months his behaviour has completely changed, he started fighting with others and afraid to face teachers and parents, he behaves while studying as some one is going to beat him. his concentration and confidence has shaken, where as he obtained 86% marks in two check points. moreover he stoped sharing class activities especially any untoward incident with him.
regards
your help is required

Category: Behavioral Issues & Grief and Trauma
Response: The change in your child’s behavior appears to be brought about by some external stressors and pressures. He seems to be upset and scared of something and one would need to explore the cause so that it can be immediately addressed.
Some of the changes that children react t include changes in the family situation, adjustment in a new class, conflicts in the family, exposure to any form of violence within the family or outside, death or illness of a loved one, an accident, experience of bullying, sexual, emotional and physical abuse, etc. if you are aware of a recent change and think that the child maybe reacting to it, then talking to him about that change, allowing him to express his feelings and helping him develop better coping skills will help his behavior to settle down. Try to understand his fears and concerns related to the change and address them accordingly.
If you are not aware of any obvious change, then finding out the reason would be essential before these can be addressed. Talk to your child when he is alone with you, in a calm and non-threatening manner about the changes you have observed in him. Allow him the space to respond. Some of the statements that might help you start the conversation are:
“I have noticed that you appear afraid and sad and are not your usual self. Children can feel this way when something bothers them. This does not mean that children are bad or weak. I want you to know that no matter how big or small that issue is, you can talk to me about it. Talking about situations that make us feel sad, upset or angry or just talking about our feelings help us become strong. When we talk to a parent, a trusted adult, they can help us deal with it in a healthy manner.”
Make sure that you are not harsh, critical or too anxious when you speak to him as he may shy away for talking openly. He might take a bit of time to open up and in the mean time keep observing his behavior and spend time with him on daily basis.
Once you are clearer about the issues bothering him, you can work towards both addressing that stressful situation and helping him cope with it. If needed, write to us for further support or consult a mental health professional for guidance.


Aoa.very intelligent and curious for every thing all the time.want to participate in every activity but soon got bored.and now aggressive towards everyone including siblings,parents,class fellows and friends.?

Category: Behavioral Issues
Some children have more challenges than others in paying attention to tasks or remaining interested in a task for too long. How much of a problem is that when it comes to your child? If it is, make sure to introduce fewer shorter tasks to him that he can complete before moving on to another task and activity. Also make sure that your son does not study in a room with too many distractions such as people talking, television, too many toys around etc. Break his main task into smaller tasks so that he can understand them better and is also not distracted. Let him know what he can do once she finishes his work, which will help as an incentive.
If you feel that the problem keeps happening consistently, and if you get similar complaints from the school, it is suggested that you speak to his teacher and see how you can both help him through a joint strategy, which is followed both at the school and at home. Suggest to the teacher to have your son sit in the front row, so the teacher can bring his attention back to the task; divide his tasks in smaller tasks, etc.
How do you currently deal with his aggressive behavior? It is important to stress that If you resort to force or physical punishment then this would need to stop immediately as use of aggression and force makes children believe that its okay to use force when they are angry. It also makes them more stubborn and less resistant to change. Communication with him would be the key to understanding the issue and then addressing it accordingly. Explore the underlying reasons for him becoming aggressive. Help him understand his feelings and the impact of his behavior on others. Once he becomes aware that this is a problem, work with him to develop social skills to deal with these situations in a better way for example, talking assertively and firmly without shouting; calming himself down and waiting for the anger and frustration to settle before he talks etc. Let him identify ways first and then suggest some additional ones. Also let him know that you will only listen to him when he calms down and is not screaming and shouting.  If your child argues unnecessarily, diffuse this unnecessary power struggle by remaining silent at that time. You can express how you are feeling through facial expressions and body language, by stepping away from the situation and talking later. For example, you can say, ‘I think you are angry and upset and I will talk to you about it later when you are less angry’.
You can use the technique of logical consequence, instead of using physical force. Consequences that are related to the misbehavior, reasonable and given respectfully are called ‘logical consequences’. An example of a logical consequence would be to make a child skip his playtime for the day, cut some amount from his pocket money for using abusive language. Discuss and agree to the consequences with your son in advance so that he knows what to expect. Remain consistent with these. Whenever you feel that he has not resorted to aggression in a situation where he normally does, praise him, as that can be the most powerful way of reinforcing the positive behavior.
Remember that when you try new ways of dealing with these issues and change your existing parenting style, the desired changes may not show immediately unless the parenting style is consistently and repeatedly followed.


Aoa.my daughter is three and half years old. She is in k.g class. She hates school and teachers. She studied well at home but she never completed class work and tore the pages.she makes her own stories and tells lie. I have discussed everything with teacher but no difference occurs in her personality.

Category: Behavioral Issues
Response: Children this age are still learning how to cope with the changes around them as well as learning ways to relate to others and communicate their thoughts and feelings.  Starting school can thus be a daunting task for some of the children who may have more issues settling down in the new environment then others. Making up stories is also part of these early years of development.
Some possible ways to deal with the situation are:

  • Listen to her fears and concerns related to the school so that these can be addressed accordingly. Do not assume what she does not like without talking to her about it either directly or finding it indirectly through play and stories. The stories that she makes up may also provide you with cues to what might be going on in her mind.
  • Make going to school a fun experience and a special activity. Let her choose her bag, decide on what she wants to take for lunch, etc. While your anxiety and stress about this situation is understandable, make sure that when you speak to your daughter you remain calm.
  • Help her identify the good things about the school such the students and teachers that she likes as well as the activities that she likes doing the most.
  • Make sure that she is not having issues in understanding the concepts being taught which may in turn be contributing to her lack of interest in going to school. Provide her the required support she needs in this regard.
  • Address any practical or safety concerns (e.g. bullying) that your daughter has raised, with the concerned school authorities.
  • Appreciate and praise her for her efforts no matter how small they may seem to you.

 

 

 Sir my daughter is studying in cl 6th Silver. She was a shining student in her early classes. But her performance has deteriorated with the passage of time. She has studied at APS Mardan, APS Chinar Campus Murree before joining APS Westridge-III in 2012. I am very disturbed due to her poor performance in her academics. Please advise me what to do tackle this situation.

Category: Adolescent Development Issues & Others

Response: There could be many possible reasons for the change in her academic performance ranging from difficulties due to frequent change of schools and teaching styles, problems with the peers at school, bullying, inability to understand a subject to stressors due to problems at home and/or adolescent changes that your daughter is going through.

Talk to her in an open, calm and friendly manner and share your observations about the changes you have noticed in her. Let her know that she can share anything that bothers her and that you will listen and support her without putting any blame. Once she starts to open up, help her deal with the situation accordingly, by both validating feelings that are normal and by helping her develop positive coping skills. Once the underlying issue bothering her is discussed and resolved, she will most likely be able to get back to concentrating on her studies.


My daughter is very careless.She spends most of her time on the internet playing games and chatting.She pays less attention towards her studies.Please tell me what to do and how to encourage her towards her studies.

Category: Adolescent Development Issues
Response: It might help if you talk to your daughter in an open, calm yet concerned manner about your observations. Make sure to do it in a manner that allows her the space to talk rather than it being a lecture. Work with her to come up with some key rules and norms that she agrees to follow related to the amount of time she will spend studying, on the internet, with friends etc. as well as acceptable behavior. Let her identify consequences, in case the norms are not followed so that she owns and follows the norms. The consequences must be reasonable and given respectfully. Help her develop communication skills so that she can state her feelings and thoughts clearly.
An important aspect to keep in mind is the fact that your daughter is going through adolescence. During the adolescent age (roughly starting around ten years and above), many children go through a series of normal emotional, physical and social changes. As a result of these changes there is more interest in peers and opposite sex, less interest in spending time with family and adults, frequent arguments and need to exert their own individuality and identity etc. Some of the things that you mention seem to suggest that your daughter may also be experiencing similar changes. The adolescent period can be overwhelming for adolescents, especially if they lack correct information about the changes that they are experiencing or/and if they feel that there is no one that they can communicate with. Validate and normalize her feelings and let her know that she can talk to you if there is something bothering her or if she has any questions related to growing up. By communicating openly, you will be giving her an opportunity to discuss and share with you in case she is bothered about something and going through a difficult time.


 

a.oa hope u fine. i h a daughter.wo kuch arasy say boht zadi ho rahi ha .shout kar kay baat karti ha.har wroung thing ko follow kar rahi ha.i dont know what to do.

Category: Behavioral Issues
Response: Has there been a recent change in the family situation or any other stressor that she may be reacting to? If, not then most likely her reaction is part of the normal child development and challenges associated with developing self-control. This is an age where children begin to understand that everything in life would not be according to their demands and that they will not get whatever they want, whenever they want it. Thus, this can have its toll on them. This, however, does not mean that children are not taught self- control, which is extremely essential for positive and healthy emotional development of children. Children often role model adults and through your own behavior and communication you can also teach her how to put her point across. When she screams and shouts to get a demand met, let her know that you can only communicate when she talks calmly. Once she does calm down, listen to her. She will gradually learn to associate that attention is only paid to her when she talks calmly as opposed to when she shouts. It will also help if you set her daily routine related to sleep, eating, play and studies. Set some clear rules about behavior, time for studies and appreciate her whenever she shows positive behavior. Many times, children this age become cranky if they are hungry, have not had a good night sleep, etc. and by simply addressing these, many of the emotions settle down on its own, without any other intervention.

 


 

the girl has written three letters to class teacher tell how much she love her and want to be her friend with lot of emotional remarks as well as romantic words.It seems to be a case of attention seeking attitude,She has been council ed by principal. Parents reported that she does get lot of
attention at home. The girls grades are falling down. plz guide help

Category: Adolescent Development Issues
Response: It appears to be a situation of a teenage crush, which is a normal occurrence during adolescence. A series of emotional, physical, hormonal and social changes start to occur in children roughly around ten years of age. As a result of these changes there is more interest in peers and opposite sex, less interest in spending time with family and adults, frequent arguments and need to exert their own individuality and identity etc.
Crushes or intense liking, preoccupation and interest in a friend, an older person like a teacher or a celebrity are also associated with the adolescent changes. While some children tend to hide their crushes other try to actively pursue the person they have a crush on. Crushes can at times make children feel confused, embarrassed and overwhelmed especially if they are unable to talk to anyone about them.
You can support her through these feelings by:

  •  Helping her understanding what crushes are and validating and normalizing her feelings. Making her feel guilty or being too harsh may not be very helpful.
  • Helping her differentiate between a healthy and unhealthy relationship.  Let her know that while it is normal for children her age to experience these feelings, that there are certain boundaries between a teacher and a student and that such a friendship would come under the category of an unhealthy relationship.

Make sure that the issue is handled with sensitivity and only shared with those in the school administration to whom the issue is relevant.


 

shy , dont faces mob , aggressive , dont takes interest in studies , misbehave with the siblings

Category: Adolescent Development Issues
Response: During the adolescent age (roughly starting around ten years and above), many children go through a series of normal emotional, physical and social changes. As a result of these changes there is more interest in peers and opposite sex, less interest in spending time with family and adults, frequent arguments and need to exert their own individuality and identity etc. Some of the things that you mention seem to suggest that your son may is also be experiencing similar changes. The adolescent period can be overwhelming for adolescents, especially if they lack correct information about the changes that they are experiencing or/and if they feel that there is no one that they can communicate with. It might help if you talk to your son in an open and friendly manner about the change that you have noticed in his behavior and what your concerns are. Make sure to do it in a manner that allows him the space to talk rather than it being a lecture. Validate and normalize his feelings and let him know that he can talk to you if there is something bothering him or if he has any questions related to growing up. By communicating openly, you will be giving him an opportunity to discuss and share with you in case he is bothered about something and going through a difficult time.
To help him deal with his shyness, work on building his self-esteem and confidence. Appreciate his positive qualities and encourage him wherever he falters and feels under confident. Encourage him to pursue his interests. Help him identify ways by which he can overcome his fears and concerns related to certain social situations.
Besides, this, you can also work with him to come up with some key rules and norms that he agrees to follow related to the time he will spend studying, on the internet, with friends etc. as well as acceptable behavior. Let him identify consequences, in case the norms are not followed so that he owns and follows the norms. The consequences must be reasonable and given respectfully. Help him develop communication skills so that he can state his feelings and thoughts clearly without offending others or shying away from the situation. You and your spouse can be the best role models in this regard by communicating with him assertively and clearly yourself.

 


 


he is not studying properly always try to escape from his study and not obeying to his mother

Category: Adolescent Development Issues
Response: During the adolescent age (roughly starting around ten years and above), many children go through a series of normal emotional, physical and social changes. As a result of these changes there is more interest in peers and opposite sex, less interest in spending time with family and adults, frequent arguments and need to exert their own individuality and identity etc. Some of the things that you mention seem to suggest that your son may is also be experiencing similar changes. The adolescent period can be overwhelming for adolescents, especially if they lack correct information about the changes that they are experiencing or/and if they feel that there is no one that they can communicate with. It might help if you talk to your son in an open and friendly manner about the change that you have noticed in his behavior and what your concerns are. Make sure to do it in a manner that allows him the space to talk rather than it being a lecture. Validate and normalize his feelings and let him know that he can talk to you if there is something bothering him or if he has any questions related to growing up. By communicating openly, you will be giving him an opportunity to discuss and share with you in case he is bothered about something and going through a difficult time.
Besides, this, you can also work with him to come up with some key rules and norms that he agrees to follow related to the time he will spend studying, on the internet, with friends etc. as well as acceptable behavior. Let him identify consequences, in case the norms are not followed so that he owns and follows the norms. The consequences must be reasonable and given respectfully. Help him develop communication skills so that he can state his feelings and thoughts clearly without offending others. You and your spouse can be the best role models in this regard by communicating with him assertively and clearly yourself.

Best of luck!


 

MashaAllah very active but often disturbs a lot. exhausts himself and others. aggressive and seems to be hypersensitive

Category: Behavioral Issues
Response: Some children have more challenges than others in remaining calm and not disrupting others. Make sure that your son does not study in a room with too many distractions such as people talking, television, too many toys around etc. Break his main task into smaller tasks so that he can understand them better and is also not distracted. Let him know what he can do once she finishes his work, which will help as an incentive.
If you feel that the problem keeps happening consistently, and if you get similar complaints from the school, it is suggested that you speak to his teacher and see how you can both help him through a joint strategy, which is followed both at the school and at home. Suggest to the teacher to have your son sit in the front row, so the teacher can bring his attention back to the task; divide his tasks in smaller tasks etc.
How do you currently deal with his aggressive behavior? It is important to stress that If you resort to force or physical punishment then this would need to stop as use of aggression and force makes children believe that its okay to use force when they are angry. It also makes them more stubborn and less resistant to change. Communication with him would be the key to understanding the issue and then addressing it accordingly. Explore the underlying reasons for him becoming aggressive and help him understand his feelings and the impact of his behavior on others. Once he becomes aware that this is a problem, work with him to develop social skills to deal with these situations in a better way for example, talking assertively and firmly without shouting; calming himself down and waiting for the anger and frustration to come down before he talks etc. Let him identify ways first and then suggest some additional ones. Also let him know that you will only listen to him when he calms down and is not screaming and shouting.  

 


Sir, my son is 10 years 8 months old, studied in class seven. sir, from the last six months he is feeling fear while sleeping in separate bed. from the age of 4 he is sleeping with his grand mother but now he is afraid to sleep with his grand mother and also on separate bed in parents room.
sir, please guide us how to tackle this situation.

Category: Others & Grief and Trauma
Response: Finding out the reason for feeling afraid would be the first step towards helping your child out. It would be important to explore if he is only afraid of sleeping in a separate bed or if he has developed other fears too e.g. about going alone somewhere, being around certain people, etc.? It would also be essential to know if there any changes in his sleep and appetite pattern, energy levels, mood, etc. All this information will help determine whether the change in behavior is only restricted to sleeping on a separate bed or effecting other areas of his functioning.
Talk to your child in a calm and non-threatening manner about these fears to have a better understanding of the situation. Ask him about other things that bother him or he is afraid of and how he think you as a parent can help him. Make sure that you are not harsh, critical or too anxious when you speak to him as he may shy away for talking openly.
Based on the nature of severity of what you further find after talking to him, if needed, write to us for further support. If the issue does not settle down despite talking to him, then he may also benefit from seeing a mental health expert as it would important to rule out and if required treat any form of anxiety, depression or other mood related disturbances.