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Some time during their lives, many children will experience emotional or behavioral difficulties that require outside intervention. In fact, according to recent estimates (Brandenburg, Friedman, & Silver, 1990), approximately 14 to 22% of all children in the United States have a diagnosable emotional, behavioral, or developmental disorder. Therefore, when parents or school officials, observe emotional or behavioral difficulties, they need to know how to obtain help. With this in mind, the purposes for this essay are: (a) To depict childhood problems that are serious enough to warrant outside intervention and (b) to offer some suggestions for seeking help for your child.

The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, or DSM-IV (American Psychiatric Association, 1994), contains many categories of childhood disorders. The more common ones fall into three broad categories: emotion (mood and anxiety), behavior (aggressiveness, over activity, or oppositional/defiance), and development (mental retardation, learning problems, physical disability). Each of these disorders is characterized by specific symptoms or behaviors that are considered maladaptive and are inconsistent with the child’s developmental level. Also, many of these symptoms that characterize childhood disorders also exist to a lesser degree in typical children. Therefore, it is important to distinguish between “normal” and pathological behavior.

From a developmental psychopathology perspective (Mash & Dozois, 1996), childhood disorders are perceived as deviations from normal development. Therefore, when emotions, behaviors, or development differ from “typical” in noticeable ways, parents have a legitimate cause for concern. At that time, they might consider assessment and/or therapeutic intervention. So what are some of the symptoms or behaviors that signify a serious problem? How long do they need to exist? How intense or noticeable do they need to be?

Mood Disorders generally involve the presence of depressive episodes, fluctuating mood, or mild depressive symptoms that extend for a period of time. When children appear depressed, look for feelings of sadness or emptiness (which also might be masked by irritability). Also, look for a diminished interest in most normal activities, feelings of worthlessness or guilt, a reduced ability to think or concentrate, or recurrent thoughts of death or dying. Physical symptoms, such as weight fluctuation and sleep disturbance, might be present. Finally, your child’s mood may fluctuate between sadness and thoughts of inflated self-esteem, flight of ideas, talkativeness, and distractibility. Symptoms should exist to a marked degree for a period of six months or longer to be considered significant.

Anxiety Disorders imply excessive fearfulness, worry, avoidance, or panic in response to specific situations or a general state of affairs involving excessive worry. In children, look for intense fear, avoidance, apprehensiveness, terror, or feelings of impending doom. The anxious feelings may be triggered by people, places, or situations and may be specific or generalized. Anxiety can also be in response to specific events or extreme trauma. Physical symptoms often involve a pounding heart, sweating, trembling, chest pain, dizziness, or nausea. Again, symptoms that exist to a marked degree for a period or six months or linger are considered to be significant.

Behavior Disorders may involve aggressiveness, over activity, or opposition and defiance to adults. Children who are overly aggressive often bully others, initiate physical fights with others, use weapons against others, show cruelty to people or animals, destroy property, steal from others, stay out all night, skip school, or run away from home. Overactive children have a difficult time giving close attention to schoolwork, have difficulty focusing and sustaining their attention to tasks or play, often do not appear to listen when spoken to by adults, have difficulty organizing tasks, often fidget with hands or feet, leave their seat in the classroom at school, often appear “on the go,” and often blurt out answers before questions or directions are completed. Children with oppositional defiance usually appear as negativistic, defiant, hostile, argumentative, and disobedient to adults. In general, symptoms that appear for six months or longer are considered significant.

Developmental Disorders generally involve difficulty with learning or recalling new information at school, speaking or understanding language, exhibiting behavioral or emotional symptoms secondary to physical disabilities, or appearing delayed in their general or specific development.

When you, as a parent, observe emotional or behavioral problems in your child, it important to examine whether the symptoms you see are typical for the child or whether they are excessive for his/her age and developmental level. (Example: Excessive worry for a five-year-old about to attend school for the first day would look different than worries for a teenager who stays in the home for several months and is afraid to socialize with her/his peers.) If you feel that an evaluation is called for, then you might seek assistance from a Pediatrician, Psychologist, or Psychiatrist. 

A Pediatrician is a medical doctor (MD) who is trained in childhood disorders that involve physical or medical conditions. 

A Psychologist usually has a Ph.D. and is trained to conduct psychological evaluations and/or therapy with your child. 

Finally, a Psychiatrist is also a medical doctor (MD) who specializes in childhood emotional or behavioral disorders that may also have medical or physical components. Pediatricians and Psychiatrists are also qualified to prescribe medication to your child, if necessary. 

In general, Social Workers and Licensed Psychotherapists are trained counselors who provide therapeutic treatments to children. They generally do not provide assessments or evaluations. Note: Mental health providers generally are licensed in their home state to provide services within their specialty to the general public.

  • When choosing someone to perform a diagnostic evaluation or to provide therapeutic treatments, the following questions are usually appropriate to ask:

  • What kind of training and educational background do you have to provide services to my child?

  • How long have you been licensed to provide services and how long have you been in practice?

  • Do you specialize in working with children and/or adolescents?

  • How much training and experience do you have in working with this type of problem?

  • What is your treatment philosophy and approach to working with children?

  • How will we as parents and family members be involved in treatment?

  • What types of evaluation will you perform and how will you share the results with us?

  • Will you discuss our child’s diagnosis and treatment plan with us early on in the therapeutic process?

  • What are your fees? Will you accept payment from our insurance plan? How may we arrange payment to you?

  • Are you able to prescribe medication to our child?

  • What is the anticipated length of treatment?

  • How will we be able to recognize improvement and what should we look for in our child?

  • What treatment programs and facilities do you use?

  • What is your policy on confidentiality?

As a parent, you need to be an informed consumer. It is always acceptable, and good practice, to voice concerns and apprehensions. It is also customary to take a day or two to think over treatment proposals and it is acceptable to seek a second opinion. Hopefully, you will feel comfortable about participating in your child’s evaluation or treatment. You, as a parent, have valuable information to share with the examiner or therapist that will be helpful in making an accurate diagnosis and/or in treating specific problems. Most mental health providers are competent and caring individuals who have the experience and expertise to assist you with your child. They usually will welcome the opportunity to discuss your concerns in a constructive and professional manner.

REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Brandenburg, N. A., Friedman, R. M., & Silver, S. E. (1990). The epidemiology of childhood psychiatric disorders: Prevalence findings from recent studies. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 76-83.

Mash, E. J., & Dozois, D. J .A. (1996). Child Psychopathology: A developmental-systems perspective. In E. J. Mash & R. A. Barkley (Ed.), Child psychopathology (pp. 3-60). New York: Guilford Press.

Copyright by Edward R. Johnson, Ph.D.  Last modified: September 16, 2002
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