Is This Just a Stage?
Points to Remember
- Always seek immediate help if a child engages in unsafe behavior or talks about wanting to hurt him or herself or someone else.
- Seek help when a child’s behavior or emotional difficulties last for more than a few weeks and are causing problems at school, at home, or with friends.
- A thorough evaluation can help determine if treatment is necessary, and which treatments may be most effective.
- Early treatment can help address a child’s current difficulties and can also help prevent more serious problems in the future.
An evaluation by a health professional can help clarify problems that may be underlying a child’s behavior and provide reassurance or recommendations for the next steps. It provides an opportunity to learn about a child’s strengths and weaknesses and determine which interventions might be most helpful.
A comprehensive assessment of a child’s mental health includes the following:
- An interview with parents addressing a child’s developmental history, temperament, relationships with friends and family, medical history, interests, abilities, and any prior treatment. It is important to get a picture of the child’s current situation, for example: has he or she changed schools recently, has there been an illness in the family or a change with an impact on the child’s daily life.
- Information gathering from school, such as standardized tests, reports on behavior, capabilities, and difficulties.
- An interview with the child about his or her experiences, as well as testing and behavioral observations, if needed.
Even under the best of circumstances, it can be hard to tell the difference between challenging behaviors and emotions that are consistent with typical child development and those that are cause for concern. It is important to remember that many disorders like anxiety, attention deficit hyperactivity disorder, and depression, do occur during childhood. In fact, many adults who seek treatment reflect back on how these disorders affected their childhood and wish that they had received help sooner. In general, if a child’s behavior persists for a few weeks or longer, causes distress for the child or the child’s family, and interferes with functioning at school, at home, or with friends, then consider seeking help. If a child’s behavior is unsafe, or if a child talks about wanting to hurt him or herself or someone else, then seek help immediately.
Young children may benefit from an evaluation and treatment if they:
- Have frequent tantrums or are intensely irritable much of the time
- Often talk about fears or worries
- Complain about frequent stomachaches or headaches with no known medical cause
- Are in constant motion and cannot sit quietly (except when they are watching videos or playing videogames)
- Sleep too much or too little, have frequent nightmares or seem sleepy during the day
- Are not interested in playing with other children or have difficulty making friends
- Struggle academically or have experienced a recent decline in grades
- Repeat actions or check things many times out of fear that something bad may happen.
Older children and adolescents may benefit from an evaluation if they:
- Have lost interest in things that they used to enjoy
- Have low energy
- Sleep too much or too little, or seem sleepy throughout the day
- Are spending more and more time alone, and avoid social activities with friends or family
- Fear gaining weight, or diet or exercise excessively
- Engage in self-harm behaviors (e.g., cutting or burning their skin)
- Smoke, drink or use drugs
- Engage in risky or destructive behavior alone or with friends
- Have thoughts of suicide
- Have periods of highly elevated energy and activity, and require much less sleep than usual
- Say that they think someone is trying to control their mind or that they hear things that other people cannot hear.
Assessment results may suggest that a child’s behavior is related to changes or stresses at home or school, or is the result of a disorder for which treatment would be recommended. Treatment recommendations may include:
Psychotherapy (“talk therapy”). There are many different approaches to psychotherapy, including structured psychotherapies directed at specific conditions.
Medications. Medication may be used along with psychotherapy. As with adults, the type of medications used for children depends on the diagnosis and may include antidepressants, stimulants, mood stabilizers, and others.
Family counseling. Including parents and other members of the family in treatment can help families understand how a child’s individual challenges may affect relationships with parents and siblings and vice versa.
Support for parents. Individual or group sessions that include training and the opportunity to talk with other parents can provide new strategies for supporting a child and managing difficult behavior in a positive way. The therapist can also coach parents on how to deal with schools.
If your child has behavioral or emotional challenges that interfere with his or her success in school, he or she may be able to benefit from plans or accommodations that are provided under laws originally enacted to prevent discrimination against children with disabilities. The health professionals who are caring for your child can help you communicate with the school. A first step may be to ask the school whether an individualized education program or a 504 plan is appropriate for your child. Accommodations might include simple measures such as providing a child with a tape recorder for taking notes, permitting flexibility with the amount of time allowed for tests, or adjusting seating in the classroom to reduce distraction.