When to Seek Help for Your Child

When you’re a parent, worry comes with the territory.


For most of us, the worries start as soon as we know a baby is on the way. (Will my child be healthy?) Once the baby arrives and we’ve counted fingers and toes, we’re on to the next worry … and the next … and the next. As parents, we’re painfully aware of the many things that can go wrong. And many times, we also know, somewhere in the back of our minds, the things worrying us are normal stages in our children’s growing-up years.


So how do you strike a balance – keeping an eye on social, emotional and educational progress, but not envisioning the worst if cousin Anna is talking earlier than your 1-year-old or the neighbor’s child is an eager reader in first grade and your 6-year-old doesn’t even sound out all his letters? How do you determine whether your child is going through a perfectly normal struggle with learning, shyness or nerves, for example, or whether he really needs professional help?

And what about the more murky area of a child’s behavior and relationships within your family – an explosive, defiant teen or an 8-year-old who seems completely oblivious to the limits you set? How do you know – and accept – when the problem is not one you can fix at home?


Start, the experts agree, by trusting your gut. “Parents know their children best,” says Ronald Becker, M.D., a development behavioral pediatrician at Boston Children’s Hospital.


“It’s an important sign when a parent is worried,” agrees Joshua Sparrow, M.D., a director of Brazelton Touchpoints Center also at Boston Children’s Hospital and co-author with T. Berry Brazelton, M.D., of Touchpoints: Your Child’s Emotional and Behavioral Development. As a parent, you’re often on target when you suspect something is awry. But even when you’re not, “You deserve help in figuring out what’s happening with your child,” says Sparrow.


What to Watch For


Child health and development experts tell parents to pay attention when a child of any age experiences a setback in behavior or the ability to function.


Charles Sophy, M.D., author of Side by Side: The Revolutionary Mother-Daughter Program for Conflict-Free Communication (HarperOne, 2011), cites sleeping, eating and social skills as common areas where significant setbacks can occur. Ask yourself:


• Has it become harder for my child to get to sleep or stay asleep?


• Is he or she suddenly disinterested in food or, alternatively, overeating?


• Is there a change in his or her social abilities? More hitting? More isolation?


• Is my child less able to express his or her feelings in an age-appropriate way?


Changes in behavior can be developmentally normal, such as a 5-year-old whose sleep is temporarily affected by nightmares or an adolescent expressing her emerging independence from the family by communicating less with her parents. Still, a cluster of symptoms, persistent difficulties, or just an intuition that what you’re seeing goes beyond a typical stage are all signs that warrant investigation.


As a child gets older, concerns often arise around school or friendships. Take note of any sudden drop in academic achievement or interest in school, recommends Carla Sharp, Ph.D., author of Social Cognition and Developmental Psychopathology (Oxford University Press, 2009). While some kids may have struggled academically, she says, “If your child is making up reasons not to go to school, something is wrong.”


When it comes to social contacts, ask yourself:


• Can my child maintain safe, appropriate relationships?


• Does his or her level of distress over personal relationships seem excessive?


“Children,” Sparrow points out, “are a good gauge of each other.” He encourages parents to pay attention to how other children react to your child. “If you notice that other children don’t take to your child, chances are he’s noticed that too.”


“Notice when children are dissatisfied with themselves, troubled by how they’re doing, as a repeated theme,” Sparrow says. “It might mean a child is depressed or anxious, or it could reflect a child’s awareness of delays he’s encountering. It might mean he’s noticing, ‘I’m out of my league here.’”


Go It Alone or Get Help?


Noticing the warning signs doesn’t necessarily mean that you’re observing a full-fledged problem with your child’s development. Some changes in kids’ moods and behavior are what therapists identify as “adjustment reactions.” These differ from developmental issues in that they’re often reactions to something that happened, or is happening, in a child’s or teen’s life. Ask yourself:


• Does my child seem more fearful because of a recent or impending change of schools?


• Has his temper been flaring since a close friend moved?


• Does my tween act more lethargic or irritable (depressive symptoms) since his grandparent died or his parents got divorced?


If your own efforts to ease your child’s angry or upset moods aren’t working, then counseling, family therapy and even medication, if needed, can help.


“Parents worry too much about seeking help,” observes Caroline Fisher, M.D., Ph.D., vice president and chair of Samaritan Mental Health, program director of Samaritan’s Psychiatry Residency program and head of child psychiatry. “If it’s not time to get help,” she says, “the therapist will say so.”


Fisher is particularly concerned that many parents don’t seek help quickly enough when a child is refusing to go to school. At any age, she says, if you can’t get your child to go to school by setting and maintaining firm limits, “Get urgent help. The longer a child is out of school, the worse a school phobia gets.”


Parents sometimes accept problematic behavior among their kids as normal. This happens often with depressed teens, Fisher notes.


“Most teens are pleasant, decent people most of the time. If yours is not, look at addressing that,” she says. “Everyone gets grouchy some of the time, perhaps teens more than others, but if they are not pleasant the majority of the time, there may be a problem that parents should check out.”


Some children’s vulnerabilities are tough for parents to admit to, especially if they mirror those of the parent. But because some disorders are genetic and others are learned at home, it’s important to keep our eyes open for these issues in our kids. Common but overlooked examples include a history of substance abuse, anger problems, anxiety and depression.


Now What?


If problems persist and you’re questioning whether outside help might be needed, here’s a protocol to follow:


1. Talk to your child’s pediatrician. “There’s no need to jump to a medical specialist,” Becker says. “Your family doctor can set you in the right direction and get the ball rolling with referrals, if needed.”


2. Act promptly. Often, people wait unnecessarily to seek help, Becker notes, and then they may have to wait again to get an appointment. Many behavioral, social or developmental issues can be resolved by a psychologist or clinical social worker. If a specialist, such as a developmental psychologist or developmental pediatrician, is needed, that professional’s evaluation will vary depending on the problem. In some cases, formal testing will be recommended.


3. Be thorough. A serious diagnosis should never be made, or accepted by you as a parent, based on only a few minutes of interaction with the child.


Remember that different therapists have different approaches regarding who participates in the therapy. Some want to see the entire family from the outset, no matter what the problem is. Others work with a child alone and consult intermittently with the parents.


When it comes to a child’s issues requiring psychological health, therapy or counseling, hesitancy or reluctance is understandable. But mental and behavioral health experts want to put parents at ease.


“There are lots of reasons for a parent to not understand or be afraid of what therapists do,” Sparrow acknowledges. Parents should most certainly expect the therapist to be comfortable with them, available and welcoming, he says. “Ask all the questions you want.”


Janet Strassman Perlmutter is a freelance writer, licensed social worker and a child and family therapist in Massachusetts.

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22 Feb 2016

By Janet Strassman Perlmutter