All children get shy, angry, sad, or anxious. Here's how to tell when your child's moodiness is something more serious -- and who to turn to for help. Plus, get a guide to the best Web resources on children's mental health, as prepared by the Tufts Child & Family Webguide
Normal or Not?
Every kid has issues. ("Issues" sounds much nicer than "problems," doesn't it?) Take my son Henry. His behavior became really negative when he was about 2 1/2. Friends assured me that it was just the terrible twos. But he was grumpy and angry a lot, and the moodiness continued for the next year. When he was upset, Henry would say that he wanted to run away and, worse, that he wanted to hurt himself. What could a preschooler be so angry about?
I decided to see a child psychologist, even though my husband thought Henry would eventually outgrow this blue period. I wondered if our son was depressed or simply jealous of his baby brother. Were my husband and I somehow to blame? An overwhelming part of me wanted to hear from an "expert" that my son was completely normal and that I was overreacting. But most important, I wanted Henry to feel better.
Normal or Not?
Since emotional and behavioral issues vary with each child, it can be difficult to know whether your kid's frequent tantrums, severe shyness, or rough play warrants special attention. More often than not, these feelings and behaviors are a normal part of development. You should certainly discuss any sudden, dramatic changes in your child's appetite, sleep habits, and activity level with your pediatrician. He can check for a physical cause, such as an illness or allergy.
Mood swings or behavior changes are also common during times of stress. A move, a divorce, or a death in the family can bring on nightmares or bed-wetting. But if these behaviors surface for no clear reason or persist for months, it's worth talking to your child's doctor, who may refer you to a mental-health expert.
"Ask yourself how much your child's behavior interferes with her life and relationships, as well as the lives of family members," says Anita Gurian, Ph.D., a child psychologist and executive editor of the New York University Child Study Center's Website for parents and mental-health clinicians, aboutourkids.org. Your child may have always been fearful of dogs, for example, but if she now refuses to go to the park or won't leave your side because she's scared she might see one, it's time to seek help.
"The question shouldn't be 'Is my child normal?' but 'Is he suffering?' " adds psychiatrist Stanley Turecki, M.D., author of Normal Children Have Problems, Too. If you feel strongly that something is just not right with your child -- even if you can't put a finger on it -- don't bury that feeling. There's nothing to lose and much to gain (if only peace of mind) by seeking a professional opinion. And early treatment is always best.
Finding the Right Help
Once your pediatrician has ruled out physical problems, he can, if necessary, recommend a specialist to evaluate your child's emotional health. Your child's teacher or school guidance counselor may also be able to suggest someone.
The variety of mental-health practitioners -- from child psychiatrists to psychologists, social workers to family counselors -- can be overwhelming and confusing. Take advantage of referral services offered by national professional organizations, such as the Association for the Advancement of Behavior Therapy (www.aabt.org). Or call the National Mental Health Association's resource center, at 800-969-6642, to be connected to treatment providers in your area. Finally, your hospital may have mental-health professionals who can help your child or at least make a referral.
Try to find someone who has advanced training and, most important, experience working with kids and treating your child's particular problem. A comfortable match is also key, Dr. Gurian says. "You should have rapport and a feeling of trust." That means the doctor or therapist shouldn't be put off if you ask questions (which you definitely should), including where she got her training and how much experience she has working with families.
For your first session, the doctor or therapist will likely want to meet with you before seeing your child. She'll take a careful history, asking not only about your child's behavior but about you, your spouse, and the family dynamic. This will help her determine whether the problem (such as a lack of friends) is truly atypical or simply a function of your child's temperament (perhaps she's always preferred a small circle of pals). Teachers, close relatives, and even a regular babysitter may also provide important insights. "A good professional will want to learn about your child in different contexts from different sources," explains Aynn Hartman, Ph.D., a licensed psychologist in Springfield, New Jersey.
When it's time for your child to meet the practitioner, you can reassure her by saying something like "We're going to see a person who talks and plays with kids and helps families solve their problems."
Depending on the concern, the practitioner may want to see you more than your child. Parenting classes or counseling can be especially helpful in treating behavioral issues that revolve around discipline. "A shift in your approach may be all that's needed," Dr. Turecki says. "In many cases, you -- not your child -- will be the first to change."
For emotional issues such as aggression, fear, shyness, and depression, a professional will often work mainly with the child. This could involve individual therapy, including play therapy for younger children, or cognitive-behavioral therapy, which primarily treats phobias or anxiety. Group therapy can build a child's social and problem-solving skills.
Our Happy Ending
After evaluating Henry, the psychologist confirmed my suspicions and fears -- she, too, thought Henry's negativity was a bit troubling for someone so young. She had several recommendations, including that my husband and I have some "coaching" sessions with her. In them, we discussed how we'd react to Henry's angry words and actions and we learned new ways to talk to him that would help him pinpoint his feelings.
We also started Henry in individual play therapy once a week (which later became every other week). He liked going -- the psychologist had lots of great toys and games. And while I don't know everything that went on behind the closed doors, my son started smiling more. Eventually, Henry stopped seeing the psychologist after we all agreed that his behavior had improved dramatically. He's now a loving, happy, enthusiastic kid -- who still gets angry and grumpy now and then, just like all children do.
Did Henry (and my husband and I) really need special treatment, or would my son have simply outgrown his less-appropriate behaviors? Ultimately, I don't know or care -- what matters most is that my son is himself again.
Copyright © 2004. Reprinted with permission from the February 2003 issue of Parents magazine.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.