Dear Tanya,

My friend has three children, aged 18, 15 and 11. Her marriage ended two years ago when her husband began an affair. After he left, his new girlfriend became pregnant.

All the children felt that they had been pushed out but her daughter Annie, 15, was particularly affected and has refused to go to school for some time. The educational welfare officer says that she needs to see the school counsellor. Annie does not want to but won't say why.

She has had several anxiety attacks, saying that she needs to get away from everybody, and has come home from school on the days when she has gone in. She also says that she can't stand being around lots of people, has stopped socialising and going out, and panics when out shopping.

Is there any way to persuade her to see a professional without forcing her? This is a very important year of her schooling and she is artistic, wants to go into fashion design and needs reasonable grades to get into college.

Kate

What a depressingly familiar story - marriage falls apart, parents separate, lives move on, new relationships are forged, bitterness remains and the children suffer.

It doesn't take a genius to work out that Annie is showing how unhappy life has become. Children and young people with emotional and behavioural issues are usually manifesting the unhappiness all around them. Their behaviour is symbolic of a family in emotional crisis.

Anxiety disorder can take many forms: panic attacks, generalised “there-all-the-

time” anxiety, obsessive compulsive disorder. It is usually underpinned by sadness and anger. Called the fight/flight response, it is an inbuilt reaction to threat and fear. When triggered, this response enables our behaviour - physiological, psychological and social - to prepare us to fight the threat or to run away.

Annie is manifesting the “flight” part of this response. Her anger is paralysing her and she withdraws from life, but it is also palpable in her refusal to engage with school or counselling.

In our judgmental society it is all too easy for such young people to be labelled attention-seeking and blamed for their behaviour. In fact, examples of young people who are clearly unhappy and demonstrating this through their behaviour are so ubiquitous in the media that this skews our perception of them.

When did we lose our ability to show compassion? Understanding someone does not mean that their behaviour is being condoned. You and Annie's mother need to let her know, firmly but kindly, that something has to change. She is not well and needs understanding and treatment.

Her sadness and pain must be separated from her symptoms of distress. In other words, she has a right to feel angry and sad- and to be listened to - but she must also be enabled to live her life and not allow her future to be destroyed.

At this point Annie has a choice. She can be a key player in her recovery, but if she keeps deteriorating, others can step in to make her have the treatment that she needs. I know this sounds tough, but it is important for Annie to understand where the boundary lies - to realise that she should engage now because the law does allow mental health practitioners to take people into treatment against their will (although this happens only in extreme cases).

Annie also needs to know that she could be treated as an outpatient or an inpatient. To stay living at home she would need to engage in treatment, which would come via your local Child and Adolescent Mental Health Service and would involve family work as well as an individual programme to help her back into school and assist her to master her anxiety and panic attacks. Inpatient units involve young people living away from home and having treatment plus education at the unit and the unit's school. I suspect that Annie would prefer to be treated in the community.

This all sounds scary and will be too much for her to take in, so it would help her to explore supportive websites. Young Minds (www.youngminds.org.uk) is an exceptional charity with a brilliant website where she can download information, join forums and get advice. The anonymity of the web makes this a good place to start. She can also read testimonials from others with similar difficulties, which may help to reassure her.

It would also be useful to find out about statutory and voluntary services for young people in your area. You should have an outreach team who could visit, and the charity Mind (www.mind.org.uk) could advise on local resources.

One final point: children often produce symptoms to unite their parents. In other words, by becoming incapacitated Annie may bring together her estranged parents who can unite in their concern for her. This would not be a conscious strategy but it is important that Annie is not solely identified as the patient here, and that her parents find the ability to come together to help their daughter to recover from what has been a devastating time for everyone.

If you have a family problem, e-mail proftanyabyron@thetimes.co.uk

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