Does my child need professional help?
Here’s a pattern I notice happening in my mom social media groups. A mom reaches out and says, “My child is demonstrating [insert a behavior here]…”. It may be lots of worrying, sleeplessness, spending lots of time in their room, or over (or under) eating. She asks for help: “Is this something I should be worried about?” Lots of people weigh in.
“My child did that and now she’s a student at U of M…all good!”
“Please see a therapist ASAP!”
“Sounds like this specific disorder I read about. Call your pediatrician!”
“My sister-in-law is a surgical resident, and she doesn't think that you shouldn’t give your kids meds!”
“*Following”
This got me wondering…how do parents nowadays decide when a child’s behavior is worrisome? When do you call a medical professional and who exactly do you call?
If you’re reading this, you’re probably feeling worried. You’re worried about a behavior your child is exhibiting. You’re worried about some advice you got in a mom group like the one I mentioned above. Or, maybe you’re worried because you’ve been trying to follow the advice of popular parenting voices online that just don’t seem to be working for you or your child.
As a mental health professional, I want to encourage you, first off, that one worrisome behavior is not indicative of a serious underlying mental problem. If you’re worried your child has a disorder, disability, or other mental health concern, the only way to know for sure is by getting a professional evaluation. In fact, the same set of behaviors or symptoms could contribute to a formal diagnosis for one child, but not another. There are many factors that go into formal diagnosis. Here’s a little more on the science of why that is and when further action may be necessary.
Non-Specific Behaviors
For the most part, any behavior your child demonstrates is what we in the medical field would call “non-specific”. Meaning, we can’t make a diagnosis, or even necessarily determine if something has risen to the level of “problem in need of treatment” based on any one behavior (unless it is so severe that other functioning has been impaired…more on that below).
Behavioral changes are an expected and normal part of child development. As a child gains strength in one area, a challenge is likely to come along with it. It’s sort of like when you train for a race: as you become a better, stronger runner over time, you’ll inevitably experience sore muscles along the way.
A good example of this when it comes to child development is the worries. It is very normal for children, at various points throughout childhood and adolescence, to have spikes in worrying behaviors. Each time they gain strength in perceptual abilities (what they notice happening in their worlds) or in knowledge (what they know is happening in their worlds) they are going to worry as a means to try to make sense of it, build their emotional capacities, and integrate understanding.
So then the question becomes, when should I be concerned? When do I need help? First, let’s think through the problem at hand to determine how to move forward.
Step 1: Is it normal or is it a problem?
You’ve identified a concern, like the one I mentioned in the mom group above. Next, tell yourself more about the concern by asking questions like…
Does it get in the way of your child’s functioning? (i.e. has it become such a problem that your child is not going to school on a regular basis, is refusing to eat for an extended period of time, won’t spend time with family or see friends, or feels like they can’t do things they would otherwise enjoy doing?)
Is it showing up in more than one context? (i.e. is this a problem at home and also at school?)
Is it accompanied by other things that seem like a problem? (i.e. you notice your child is worrying a lot and also crying all the time, waking up at night multiple times, and is also getting angry more than they usually would.)
Is the behavior a problem to you as the parent? (Not just a problem because it’s annoying or exists, but because it seems rigid and anything you or your child has tried together up until this point either has no impact or actually makes the behavior worsen.)
If you answered “no” to all the above questions, your child’s behavior or concern is likely just a natural part of their development. Though you may want to keep an eye on it or speak with a therapist to make sure, it’s unlikely to need intense treatment or lead to a formal diagnoses. However, I do have some suggestions for actions to take next at the end of this article.
If you answered “yes” to any of the above questions, I’d recommend moving on to Step 2.
Step 2: Speak with a Mental Health Professional
The bar for “needing therapy” is low…it fact, it’s always reasonable to consider mental health support for you and your child like you would the support of a pediatrician. If you answered “yes” to any of the above questions and are ready to take further action, finding a great therapist for your child and family is a good next step. A great therapist for your child will be able to tell you about the training they received that is specific to working with children and will do some screening for potential concerns that could need more intensive evaluation. Specifically, no one should diagnose your child with ADHD or Autism without a comprehensive evaluation by a clinical psychologist.
Once your therapist, alone or in partnership with an evaluation, has determined the nature of the problem, they should be able to discuss treatment planning with you. An effective treatment plan for any child should include four sets of recommendations: therapeutic strategies that the therapist will work on during sessions, strategies for you to use at home, recommendations to support your child at school, and, finally, a referral to a psychiatrist or nurse practitioner who has specific training in both treating mental health problems and working with children, if a medication review is determined to be appropriate based on the diagnosis made. All of these components work well together to treat many mental health problems that children may face.
Not all of these components are always necessary. A great therapist will be able to create and implement a treatment plan that is focused on the problem at hand and work with you to tweak it as things evolve for the better.
What if I answered “no” to those questions?
If you work through the questions above, and you decide that the behavior you are noticing does not seem as serious as you initially thought, you have a few options. First, talk to your child…even the very young ones! Get into the habit of engaging with your child as a partner in their own mental health and wellbeing. You might say, “I’m noticing [insert behavior or concern], and wondering how you feel?” They may or may not be able to talk to you about it at first, or they may have real insight to share that can help you move forward together. No matter what, opening up the conversation is what matters most. You can even share a bit about how you might relate. Second, do some observations. When do you notice the problem most? Finally, think carefully about some of the usual suspects that impact children’s (and adult’s) mood and behavior: healthy sleep, good nutrition, hydration, and predictability in routine and relationships.
Many parents I talk to worry that they have to catch problems as soon as they begin. While it’s true, to a degree, that we like to be as proactive as possible when supporting children’s mental health, it’s also true that many behavioral concerns are normal parts of childhood that will ebb and flow on their own. Taking a pause, observing more and reacting less, can be helpful to your child: they learn that it’s okay to feel off from time to time and that time itself can heal. Above all else, always remember: the conversations between you and your child are the most important space that your child can come back to again and again to explore their changing emotions, developing identity, and sense of their own wellness over the rest of childhood and beyond.
Continue the Convo
Dr. Erika Bocknek, founder of Convo, is a former university professor, family therapist, and mom of 3. She has spent 20 years cultivating expertise in the science of parenting, child development, and couple and family therapy. A well-regarded expert and a superfan of the power of nurturing families for healthy development, Dr. Erika is passionate about bringing science to children and families’ everyday lives.