When should a parent consult with a child and adolescent therapist?
Child and adolescent therapists know that it is common for children to experience challenges, struggles, and obstacles as they develop and grow. These can occur at any stage of development, or they can be occasioned by either typical or unexpected life events. In early childhood, a child may be slow to accomplish toilet training, or they may experience some anxiety attending school for the first time. Many a middle-schooler is daunted by the prospect of juggling multiple classrooms, teachers, and peer groups—all while undergoing the changes of puberty. Teens will quite often find their mood-management skills engulfed by tidal-sized waves of emotions; or, they begin testing limits & questioning authority at home and/or at school. For the late-stage teen, the encroachment of adulthood can be fraught with near-overwhelming pressures to grasp hold of autonomy and responsibility. At any point in time, life events can intrude and threaten to unravel the very fabric of their existence: residence and school changes; getting cut from a team; an injury or illness; parental separation or divorce; an accident or natural disaster; or the loss of a parent, sibling, friend, or family members to death. The complexity of scenarios multiplies exponentially within the matrix of a multi-child family; and let’s not under-accent the influence of cultural variants sculpting yet further dimensionality to each nuance noted above.
As a child or teen is faced with new situations, demands and expectations, it is common for that child to experience emotional ups and downs characterized by sadness, fear, anger, self-doubt, and confusion. These reactions tend to be acute but often short-lived, and do not significantly interfere with the child’s life or disrupt the family’s integrity. Parents are able to support their child through their difficulties in ways that enable the child to grow and become stronger; sometimes, it can be a child and adolescent therapist, a relative, an empathic teacher, or trusted pastor who is available to offer needed guidance and support. Even peers or siblings can intervene with precociously-wise and sober advice that can put things aright. The child and the family unit is able to resume a previous level of functioning, achieving both growth and a sense of stability as the challenge is “worked-through”.
Don’t Get Discouraged, Get Empowered
Occasionally, however, a child’s reaction to life’s pressures can become moderately to severely maladaptive. The problems that result do not resolve; rather, they linger, worsen, and accrue further complications. Depression deepens, anxieties intensify and spread, friendships are lost or activities jettisoned, grades plummet, arguments get more shrill, doors slam and stay shut as the youth becomes more distant and socially isolated. Alarming coping mechanisms may appear, such as cutting, substance use, and running away. Statements of futility or morbid thoughts about “not going on living’ or being “better off dead” start to appear.
In these situations, parents’ attempts to help their child may have been limited in scope, largely unsuccessful, or can inadvertently worsen the problem. Approaches that used to work quite well, or which worked for other children or other family members just don’t do the job this time. The child may be having a problem similar to one the parent themselves (or a sibling) had, or at just about the same age; all too often, this kind of “developmental déjà vu” can leave a parent befuddled and bereft of an answer. Stuck again, they find themselves over-identified with the child-in-need and unable to access and implement their many positive parenting skills.
While lack of effective responding by the child, can bring on feelings of helplessness and despair for the parent, the child might then be left feeling vulnerable, angry, panicked, and increasingly helpless. Symptoms worsen, grades plummet, acting-out becomes more dramatic-- the stress and distress is palpable and thickening. Another sibling, or one of the parents might begin to fall ill, whether somatically, emotionally, or though an addictive pathway or conduct problem.
These scenarios may start in the shallow end of the pool, but they do not remain there, no matter what or how hard the parents try to help, or even where others may step in to lend support. These are all signs that a particular family—or perhaps any family—is well out of its depth in forming an adequate or thorough response to the child’s distress or symptoms. Subjectively, the parent might feel like their child is going under, and they can seemingly do nothing to make it stop. They might even feel like they—and perhaps others--are taking on water, too. Both child and parent cry out for relief or rescue. At this time, child or adolescent therapy can help.
Here is where consulting a Mental Health professional and child and adolescent therapist is strongly indicated—or should have already occurred. Even when late in coming, contacting a professional for help should be pursued. Even short of contacting a therapist, soliciting the opinion of a doctor, teacher, spiritual leader, relative, or friend--maybe even calling a confidential hotline about the prospect of seeking a mental health referral can be an essential step in seeking the necessary reassurance to make the call to a professional.
When to Reach Out
As a licensed child and adolescent therapist, perhaps it is an understandable bias that I might encourage parents to reach out for a consultation closer to the beginning of the problem formation. I think it is positive when parents try to solve their children’s problems, or when they look for natural community support to do so. When that can work, it will work, and it’s a great source of accomplishment, joy, and satisfaction when it does. It sets a good example for children, and promotes positive attachment and self-reliance. Sometimes, though, I believe it is best to reach relatively more quickly for professional mental health consultation.
One rule of thumb might be for a parent to think of it in a matter analogous to how they might look at their children’s health, and the decision as to whether or not to call a doctor or head to the emergency room. If your child has a small cut or scrape, you can handle that at home; a deep, profusely bleeding gash that requires stitches means a trip to the ER. A sprain you can often treat with some ice; when a bone breaks, you don’t even open the freezer—you have a doctor put on a cast. If you have a skill set or “tool box” to deal with the problem, and have done so before, try to handle it again. If you feel that the problem is outside of your experience or depth, if you feel a sense of shock or alarm about the problem, or if it has any characteristics of being very odd, dangerous or life threatening, this is when you should start looking for professional help right away. After even a brief assessment, a competent and ethical practitioner should be able to help make the decision whether you, the parent, can handle the problem without professional intervention, or if perhaps you can benefit from some short-term help with parenting support, or advocacy aimed towards the school or doctor, or maybe by referral to another type of specialist (e.g., Speech or Occupational therapist). Ideally, a strong and ethical practitioner will only recommend what they think your child needs in terms of treatment.
In my own assessment process, and as a child therapist, I look at a number of different factors in determining the appropriateness of treatment. I call them “profiles” and they guide me towards knowing when a child or parent is in “deep enough” to warrant further treatment. Perhaps keeping these profiles in mind can help parents to judge more keenly and impartially when to seek out professional help.
Child and Teen Therapy Profiles
Disruption in daily adaptive functioning
Problems with appetite, sleep, motor skills or sensory functioning, and level of energy or alertness. Changes in quality of self-presentation, meaning hygiene and grooming. Notable changes in routines, achievement, identity, or life-direction. Plummeting grades, radical change in attire or musical taste, abandonment or abrupt shifting of goals or interests, clear change in peer group. Teens often explore new people, things, and ideas, so not every new trend means that your child is in emotional trouble—but it can, especially when accompanied by other profile attributes.
Significant delay or failure to meet expectable developmental milestones; or, regression to earlier levels of functioning
Children may have difficulty meeting or maintaining developmental goals as a result of stress. Crawling, walking, speech, toilet training, as well as a numerous other motor and cognitive markers may be disrupted temporarily due to environmental stress such as; divorce, parental discord, birth of a sibling, beginning school, loss of a primary attachment figure, and trauma. As children move from preschool, to Kindergarten and onto first grade, emotional and cognitive demands become more challenging. Following a sequence of directions; picking up on social nuances; and an elevation in executive functioning; are required to manage more complex curriculum, and in establishing age appropriate interpersonal skills. Children who have sensory sensitivity; become overwhelmed emotionally at school; struggle making friends; have emotional outbursts/are difficult to soothe; and have a very rigid sense-of-self yet are not in-tune to the feelings and or desires of others, are often times labeled a behavioral problem or ADHD. Autistic Spectrum Disorders can be difficult to identify, as the overt behaviors can look like difficulties with attention and impulsivity. Academic support should be explored through the child’s school, in addition to emotional/behavioral treatment by a child therapist.
Notable decrease in socialization
Withdrawal from friends and family. Child or teen seeks isolative activities and declines or is avoidant of previously enjoyable family or social interactions. The TV or X-Box becomes the companion of choice. Lots of time curled-up on the bed or sleeping. The door is more often closed than not. Associated features might be as seen in profile 1 (e.g., deterioration in grooming and hygiene).
Significant difficulties in the handling of emotions and impulses
This often first appears in terms of managing feelings of anger, frustration, or disappointment. Frequently irritable, reactive, and defensive when engaged by parents, peers, and teachers. Outbursts lead to items being thrown, property being damaged, doors being slammed, aggression to self or others. Changes in mood and behavior that effect sleep, nutrition, and hygiene (see profile #1). Quality and intensity of mood: Fragile mood, frequent bouts of sadness, tearfulness, fatigue, apathy, lack of capacity to feel joy or pleasure, unrelenting feelings of guilt, and morbid/suicidal thoughts or self-harming gestures are characteristics of clinical depression. At the other end of the mood spectrum, one might see intense spikes in energy, need for little sleep, irritability, or broad, unpredictable “mood swings” that could be indicators of a clinically elevated, or hypo-manic mood disorder. Haughtiness, extreme arrogance, and contempt for others may be in evidence. At the outer edges of this condition, there will be reckless impulsivity, greatly inflated self-esteem verging into grandiosity, illogical thinking and hallucinations. Alcohol, street drugs, over-the-counter or prescription meds are often used and abused in order to alter mood states and/or self-medicate; in extreme depressive states, this can become dangerous, even lethal. Self-harm gestures, such as cutting or burning the skin, are often used to manage and re-direct overwhelming emotions, and thus can take on very addictive qualities, as the pain produced leads to the release of endorphins, and the achievement of a sense of euphoria.
Excessive worry or fear
This can include something specific or a general sense of heightened anxiety about themselves or others which (as in Profile #1) causes disturbances in the child’s normal routine -- and increasing difficulty for the parent to keep the child participating. Associated features might be touchiness and irritability; emergence of somatic symptoms (e.g., headaches, stomachaches, tiredness); nightmares or other sleep disturbances; or regressed behaviors (e.g., clinging, bed-wetting, weeping, whining). Rituals used to counter the anxieties might appear, such as hand-washing, repetitive or odd series of movements, checking or counting routines, insistence on sameness or predictability.
Emergence of problems with conduct.
At first, characterized by problems with behavioral management. Skipping classes, declining grades, angry defiance to requests, non-compliance with routines, and an increase in lying or other manipulative behaviors. Shifts to anti-social peer group may appear, along with shift in identity and purpose. Group memberships might also involve participation in a drug subculture as well. Frequently, problems in the community start to appear, such as shoplifting, burglary, assaults against others, severe truancy, fire-setting, and running away from home for more than a few hours. Parents must get help for this profile very early in the development of the problem, before a large shift in identity occurs, and before involvement of law enforcement and the juvenile justice system takes control away from the family.
Emergence of problems in cognition and thought
This often affects the capacity of attention: forgetful of homework/class assignments, easily distracted, often disorganized, and has difficulty staying focused and completing tasks. It is important to note if there are problems with short or long-term memory, and if basic orientation capacity is intact (i.e., awareness and accuracy with regard to knowing time, place, person, and purpose). Sudden inability to apply previously learned skills can be an important sign as well; this can include loss of academic skills, motor skills, or procedural knowledge (e.g., how to change a light bulb or fix a flat tire). Anytime that a child has a blow to the head, has a seizure, or loses consciousness for any reason (e.g., spiking a high fever, getting beaned by a pitch, nearly drowning, drug overdose), parents should remain vigilant in noting any changes in cognition. Difficulties in processing thoughts is a feature of several disorders; this might manifest as taking an inordinate amount of time to think through and express the answer to rather basic questions, accompanied by verbal content that is incomplete or inadequate. Sometimes, thoughts may be expressed in an illogical, disconnected, fragmented, bizarre, or highly metaphorical manner that leaves the listener befuddled. It is important to note if your teen expresses the notion that he is either sending or receiving thoughts through the television or other medium, or if they believe thoughts are being extracted from their mind. If this is occurring, it is likely that they will be developing paranoia, which can also lead to hostility and extreme fearfulness.
Issues around sexual preference and identity
For teens with issues around sexual identity and sexual preference, adolescence is a particularly vulnerable time when they need to know that they are accepted and loved for who they are, as they are. “Coming out” can often have features of problems with mood, anxiety, and socialization that may greatly subside once the underlying issue is disclosed and accepted. If rejected, the mental health issues may significantly worsen. It is important for parents to know that the Mental Health profession does not recognize anything that is inherently pathological about someone who identifies as Lesbian, Gay, or Bisexual. Obviously, there are many cultural and personal beliefs to the contrary, leading to volatile family processes that require much patience and mutual-respect on the part of everyone involved.
Any frank admission or known occurrence of substance use or abuse, suicidal ideation or gestures, pregnancy, abuse trauma, separation/abandonment/ loss trauma, auditory/visual hallucinations, eating disorder, or general distress
At this point, there is certainly no “guess work” needed. Because of the trust, sound communication, and strong attachment/relationship your child has with you, they are clearly asking for help. Any of these disclosures requires immediate intervention by a Therapist or Mental health professional.
Any overt behavior that involves aggression, self-harm, fire-setting, school failure, anti-social activity, or which appears odd or bizarre.
These last two profiles obviously have considerable overlap with the previous seven, but are meant to convey the sense of a “cry for help” situation where your child either literally or by action tells you they need help. You don’t need to do any further observing or uncovering: there it is. These are all situations that should lead to timely consultation with a Mental Health professional. As they say, “Don’t try this at home”. Get help and support right away from a professional child or adolescent therapist. These are problems that no parent is expected or advised to handle by themselves.
After the Consultation
Children's reactions to stressful life circumstances range from mild and short-lived to severe and long lasting. When a child's problems do not resolve within a reasonable time frame psychological intervention is recommended. Child therapy offers children the opportunity to identify, discuss and understand problems and to develop necessary coping skills. Therapy also provides the opportunity to address parental concerns, educate parents regarding their child's unique needs, and assist them in meeting these needs in an appropriate, effective fashion. Finally, it is important to recognize that without appropriate and timely treatment a child's problems may become severe and lead to more serious, long-lasting difficulties.
I feel strongly that parental involvement is a crucial component of your child’s treatment. From the initial assessment and throughout our work together, parental involvement is valued and encouraged, after all, you are the best resource I have in getting to know your child’s current struggles as well as their many gifts. Parents are relied upon for information concerning their child’s development, behavior, and relationships, which helps us develop and track treatment goals. I view parents as partners in the treatment process and rely on them to provide critical feedback regarding the effectiveness of our interventions as they are developed and implemented.
There is nothing worse than when your child is in pain and all of your best efforts cannot take their pain away
As a result, parents can feel a great sense of helplessness, fear, and guilt that can cause parents to become stuck with their child in the problem. If you are reading this then you are tired of seeing your child struggle and you are searching for relief for your child. You’ve had enough of feeling helpless, guilty, and fearful. You are looking for a way to be unstuck, and for ways to grow as a parent. You are in action and working on finding a child-adolescent-therapist who can support change, who teaches positive coping skills, and who will foster growth and development. If a family member fits one of the above mentioned profiles or if you have questions regarding a loved one, I encourage you to contact me so that we can discuss your concerns and begin therapy and the healing process.