Children and Mental Health Concerns
Children like adult’s experience emotions related to anxiety, sadness, fear, anger, etc. As children grown and develop it is not uncommon for them to experience more intense emotions related to growing and maturing. It is common for children to experience occasional problems as they grow and mature. Children often begin to experience problems “fitting in” and making friends, developing identities separate from their parents, sibling conflicts, homework, teachers, school, and bedtime. Normal challenges and or issues are typically brief and short lived. However, when challenges exist for an extensive period of time or intensifies in severity this maybe a red flag, signally professional help is needed. The need for professional help can be determined if all attempts to help the child resolve his or her negative emotions, symptoms appear to be getting worse, or negative thoughts and behaviors appear to be escalating.
To further determine if mental health intervention is needed, the child’s behavior needs to be observed by a professional. Typically, whenever a parent feels like a child’s behavior may qualify for professional help, it does. Rather than assuming the child will outgrow the negative thoughts and feelings those closest to the child should err on the side of caution to ensure safety. As a Forensic Psychologist, specializing in familial dysfunctions and Marriage & Family therapist, once I receive a referral for treatment or a parent brings his or her child in with concerns about behavior I engage in an observation of the child (referrals are often submitted by other mental health professionals, health plans, social services agencies, or schools). In my experience with children and families the youngest child I have worked with was age 3. I start off by observing the child in situations that poses no challenges or conflict, then observing the child emotions and behaviors as he or she negotiates challenges and resolves conflicts. Observation is key to both identifying and or determining of mood, thoughts or behaviors are interfering with daily functioning. i.e., is the child’s behavior age appropriate, is are thoughts, mood, behavior interfering with school and academia, are there any interruptions in sleep or appetite, or having difficulty concentrating. I have also found it helpful for parents to complete a questionnaire outlining the areas of concern, when behaviors were first observed, recent changes in home or school environment. Many times negative changes in a child’s mood and behavior can be linked to changes at home (recent parent divorce/separation, death of a parent or other significant family member, a new sibling, recent move, etc.), or changes in school (struggling academically, feelings of not fitting in, or being bullied).
Mental health services may also be an option when a significant family change is occurring or has already occurred, even when the child has not displayed negative moods, thoughts, or actions, such as parents divorcing. A child may also mental services when there are signs of regression (bed wetting, thumb sucking, chronic whining, crying or unusual fears). A child’s fear and anxiety surrounding parent separation could also serve as an indicator that services may be needed. Children would certainly benefit from psychological services when the issues or challenges they face are complicated and beyond their scope of understanding and negotiating.
Children’s whose symptoms, mood, or behaviors are severe should be seen and treated immediately. Symptoms require immediate attention include homicidal or suicidal ideations, life threatening behaviors, auditory, olfactory, or visual hallucinations. If a child poses a threat to adults, other children, or animals psychological services are needed. Once it has been decided a child requires psychological treatment parents need to be involved and stay involved. Feelings of abandonment can heighten fear and exacerbate existing symptoms.
Children whose behavior appears to stem from a tense home environment
Children residing in homes that consist of high conflict tend to be more anxious and fearful, plagued with self-doubt or uncertainty. As a result of tensions at home a child’s self-esteem can be compromised as he or she struggles to avoid upsetting a reactive parent. Children in this situation struggle with being “good” all the time, never making mistakes, and unusual parent pleasing. Children who fear being the target of a high-conflict parent’s wrath, also strive to be invisible, thereby, side stepping a perceived mind field. This fear and anxiety can create problems in school by interfering with concentration and trusting others.
Children who struggle in the areas listed above would benefit from the following therapy options; Cognitive behavioral therapy (CBT) which is a type of psychotherapeutic treatment that can help patients understand the thoughts and feelings that influence behaviors: Dialectical Behavior Therapy (DBT) can be used to treat older adolescents who have chronic suicidal feelings/thoughts, engage in intentionally self-harmful behaviors or have Borderline Personality Disorder; Family Therapy which focuses on helping the family function in more positive and constructive ways by exploring patterns of communication and providing support and education; Play Therapy involves the use of toys, blocks, dolls, puppets, drawings and games to help the child recognize, identify, and verbalize feelings; and Psychodynamic Psychotherapy which emphasizes understanding the issues that motivate and influence a child's behavior, thoughts, and feelings. It can help practitioners and other mental health professionals identify a child's typical behavior patterns, defenses, and responses to inner conflicts and struggles. I recommend when there are situations where a child’s issues stem from a high-conflict home, both child and parents should receive mental health services, family therapy as well as individual therapy.
Children can be treated by psychiatrists, psychologists, marriage & family therapists, social workers, and mental health counselors. However, the professionals should have prior experience working with children exhibiting advanced symptoms. Working with children and adults differ significantly as children are not often able to properly identify what they are feeling, how what they are feeling has impacted or is impacting them, when onset symptoms occurred or are more likely to occur, etc. Professionals without prior experience and treatment of children should make a referral to more experienced professionals with a history of treating children. Applying an adult approach or treatment model to children is not effective as it requires a level of understanding and sophistication exceeding the scope of comprehension for a child.