Getting Professional Help For Your Child
Many parents looking to methods we have discussed in the articles and sources on this website want to know whether their child might need professional help and how one even knows at what point help is advisable. It is reasonable to be perplexed for all sorts of reasons. First, children are changing markedly as a function of normative development. During development problem behaviors in varying degrees of severity can come and go. Tantrums, aggression, lying, anxiety, moodiness, breaking things, and so on can come and go and often do. Second, many psychiatric disorders such as depression, anxiety, autism, and others are on a continuum (or spectrum). So unless something is very extreme, it may be hard to tell that now is the time to seek help and now something is needed to change things. There are some guidelines that may be helpful. Perhaps, the most important of these is when in doubt, seek a professional
opinion. I state that because the research shows that more often than not, there is a delay in identifying a problem and seeking treatment—often years. Because providing treatment earlier rather than later is likely to be more effective, better to err on the side of caution and obtain a professional opinion. There is no substitute for a face-to- face examination with a mental health professional who hears your concerns and description of the problem and meets with the child or adolescent.
How To Decide If Professional Help Is Needed
Apart from the overall guideline, when in doubt seek an opinion, there are more specific guidelines that may be useful. Below are signs that one looks for as to when a problem is more than the usual.
- Impairment in daily functioning: Does the child’s behavior interfere with meeting the usual role expectations at home or at school. Many children may have anxiety, for example, but does this make it so the child is immobilized or cannot attend school or interact with others? Impairment looks at the consequences of having a problem.
- Behaviors that may be dangerous or risk of being dangerous to oneself or others: Does the child engage in an activity that itself is dangerous or could easily become dangerous. Engaging in match play, threatening harm to oneself or to others, engaging in self-injurious behavior, and doing something that places a peer, sibling, or pet at risk for injury are some of the examples.
- Stark changes in behavior or characteristics of the child or adolescent: Has the child shown a marked change in everyday behavior? This could be a very active child who is now more withdrawn, mopes around the house where she used to want to be out with friends, eats a lot more or less, is all of a sudden having problems with sleep, or other routines that have never been a problem.
- Signs of distress: Is the child showing signs of stress that coincide with exposure to an event (in the home, natural disaster)? This can include any event that is having impact (distress) as reflected in lack of sleep, nightmares, anxiety, clinginess, or impairment, as mentioned previously. Many of these are transient but and might go away in a day or two, but if they continue and represent a stark change from the child’s usual way of behaving before the event, this would be another reason to seek an opinion.
- Child is unmanageable at home or at school: Do you, teachers, or others in the care of your child believe that behavior is out of control? In this case, someone, perhaps you, feels that you have tried everything and your child or adolescent cannot really be managed. Perhaps he or she does not come home or you do not know his or her whereabouts. Or perhaps there is noncompliance, explosive tantrums, and property destruction. The unmanageability can be in one setting (home or school) or both, but either one is critical.
- Unusual behaviors and signs that are well out of the ordinary: Does your child show signs that are quite different from what his or her siblings show and are clearly beyond the everyday fluctuations one might see in emotions, thoughts, or behaviors? These might include endless repetitive behaviors, hearing voices that tell him or her to do dangerous things, or crying continually because of sadness. Here the emotions, thoughts, or behaviors seem extreme and not merely a little more of what children typically show.
As I noted, these are guidelines. Each requires judgment and each requires more information than my brief comments provide. That is the main reason for the overarching guideline: when in doubt seek a professional opinion.
“How does a parent or teacher know when to seek help? Most parents have worked out a rough routine for deciding when to take a child to the doctor for a physical ailment. But deciding when a person has the mental health issue that requires a visit to a professional is not so clear-cut a process. The data are less precise, since there’s no psychological equivalent of a thermometer, and in this area of health care, most parents tend not to have decision-making routines as ready to hand. But there are criteria you should look for to decide whether professional help beyond this book is needed.”
— The Kazdin Method® for Parenting a Defiant Child
Getting Help: Leads and Contacts
If you decide to seek help, it is especially important to be a careful and critical consumer. All sorts of information on the web of what is appropriate or effective is available but much of that information is inaccurate or out of date. There is a great deal of scientific research on effective treatments, whether some form of psychological treatment or medication, but it is extremely hard to tell what is known, what is opinion, and what is myth or disproven just by a web search to find information about clinical disorders or treatment.
Resources for Reliable Information about Mental Disorders and their Treatment
If you are trying to find therapist for children or families, you can try the websites of the National Register of Health Services Providers in Psychology or the Association for Behavioral and Cognitive Therapies, or you can ask the psychological association in your state (for example, the California Psychological Association, New York Psychological Association, or Illinois Psychological Association). Type the state followed by “Psychological Association” in your favorite search engine and the site will come up.
Finding a person who might be able to help is one step. It is also important to find out if there’s good evidence for a treatment’s effectiveness. The Cochrane Library, which can be found online, provides rigorous reviews of evidence related to medical and psychological treatments. For example, on any of the usual search engines, one can type in “Cochrane review for hyperactivity in children” (depression, social anxiety, etc.) and see some of the treatments that have been studied. Similarly, another reliable outlet is the National Institute for Health and Care Excellence (NICE). Searching that source such as “NICE guidelines for treating childhood anxiety” would provide information based on scientific findings. Here is a list of sources to search either to understand the nature of disorders of children and adolescents or their treatment.
A Sample of Government Agencies
- National Institute of Mental Health
- Center for Disease Control and Prevention
- Substance Abuse and Mental Health Services Administration
- (Your State’s) Psychological Association
- National Institute for Health and Care Excellence
A Sample Non-government Professional Organizations
- American Psychological Association
- American Academy of Child & Adolescent Psychiatry
- American Academy of Pediatrics
- Canadian Psychological Association
Key Questions to Ask Before You Begin Treatment
Let us say you have found a professional to help provide treatment for your child. Before you begin is important to meet the professional and have answers to your questions—you may have many. In addition, the following questions are critically important:
- What is the treatment you provide for my child’s problems?
- How long have you been providing this treatment?
- Has this particular treatment been studied, and does it have scientific evidence in its favor?
- What are treatment options other than the one you provide?
- Will there be any concrete ways to evaluate how well my child is progressing?
- About how long is treatment likely to last?
Seeking help for your child is a weighty decision. Professionals are trained and committed to helping. Seeking an opinion is the first step and the most critical. The guidelines may be of help.