When Does a Child Need Professional Help?

Emily Love

By Emily Love, LCSW-C
Therapy Services
Jewish Community Services

As a child therapist at Jewish Community Services (JCS) and the mother of tween girls, I often get inquiries from friends seeking advice about their elementary or middle school children. Specifically, they ask how to tell if there is an issue of concern, such as anxiety or depression, and when is the right time to seek professional help.

Parents tell me they are worried because they are noticing changes in their child, such as several nights of not sleeping well, changes in eating habits, gaining or losing significant amounts of weight or seeming sad or worried. But because it’s difficult for kids to verbalize or articulate their thoughts, they often act out. Parents feel increasingly concerned or even fearful, because they don’t know what’s going on in their kids’ heads.

What are the “red flags” that signal parents that there is a significant problem that should be addressed? We may be tempted to think: “it’s a phase, she’ll grow out of it,” or “it’s a part of normal development,” or “there’s nothing wrong with my child” (until another person or teacher points it out). When should parents pay attention and try to figure out what’s going on?

Anxiety
Everybody has some degree of anxiety in social situations, and some level of fear and anxiety is normal during a child’s development. Over time, most anxiety subsides as children begin to learn what to expect from their environment and their relationships with others. It’s also extremely common for children and adolescents to show high levels of anxiety at various times, without it signifying an anxiety disorder.

Signs of excessive anxiety include chronic headaches or stomach aches, irritability, sleep disturbance, perfectionist tendencies, or problems with school performance. Anxiety interferes with or impairs a child’s ability to do something that other people in the same situation could do, resulting in the child’s avoiding the situation he or she fears. Often the child’s avoidance impacts the parents’ day to day activities when, for example, the child shadows mother and father around the house, insists on sleeping with a parent, or interferes with the parents going out by themselves.

Depression
All children and adolescents experience occasional sadness or “depression,” resulting in irritability, acting out, low mood and energy and poor concentration. This is different from clinical childhood depression, which is characterized by a sad mood that is both prolonged and severe. A depressed child will be sad or irritable for most of the day, nearly every day, and will show a noticeable decrease in interest or pleasure in activities he or she once enjoyed. The child may also have feelings of worthlessness. The problems are severe when they cause distress or impair the child’s functioning at home and/or school, or when the child expresses little desire to live.

What can parents do? Be mindful of your child’s behavior. Trust your instincts when you think something is bothering your child. Ask your child questions to find out specific information, such as: “Who do you sit with at lunch?” and “Who do you play with on the playground?” Their answers can give you clues about whether they are feeling isolated, sad or picked on.

One of the best things parents can do is to learn to communicate well with their children. Active listening is a key part of effective communication. By allowing your child to initiate a conversation, and by listening, you can build a trusting relationship that encourages your child to talk through problems with you and find solutions.

It’s also important not to anticipate where or how the conversation is going to go. Pre-determining the problem or solution will not lead to finding out the underlying issue. If the problem is interfering with your child’s day-to-day life, such as eating, playing with others, going to school or falling asleep, it is time to seek professional help.

For resources for parents, jcsbaltimore.org/parenting/
To learn more about anxiety in children — jcsbaltimore.org/2012/parent-talk/a-fresh-look-at-childhood-anxiety-whats-the-tipping-point/.

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