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.

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.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.