10 Signs Your Child Should See a Psychotherapist
The myth about childhood
Infants and children vary tremendously in temperament and this is largely determined by their genetic makeup. Some are more sensitive to their environment, some are shy, some thrive on novelty and excitement, some need more sleep. Despite society’s nostalgic and romantic notions about childhood being idyllic and innocent, the fact is that all children experience distress, frustration, disappointment, and anger, on a pretty regular basis. Most children cope well, most of the time, but one in five children has a mental health problem which needs attention and which is likely to get worse, not better, over time (Mental Health Commission of Canada).
Crisis moments are always challenging
Significant stressful events such as a move, a change in school or daycare, a death or divorce, the birth of a sibling, or an illness can result in all sorts of upset feelings and behaviours in children. At these times, nightmares or other sleep disturbance, loss of appetite, loss of enjoyment in activities, aches and pains, crying, anger, and fears are all common and expectable, even if quite severe. However, in a matter of weeks, children usually adapt and life goes on. When children don’t seem to be adjusting, when symptoms persist for several weeks or longer than you think they ought, or when there is no discernable explanation, it’s important to consult your doctor and ask if your child should be seen by a mental health specialist. This is especially important if your child can’t talk about what’s concerning him or her.
Keeping in mind the big picture
Any and every symptom a child displays must be viewed in the context of his/her overall development. Children can be strange and difficult, and react to lots of challenging events with… very challenging behaviours. It’s normal for children to be unpleasant, unpredictable, oppositional, sad, and mad. By ‘overall’ development I mean, “Is she learning, is he having fun, do they have friends, does the teacher think he/she is thriving, fitting in?” Are you, as a parent, sleeping at night, most of the time?
10 instances when a parent would be wise to seek consultation from a professional
1. All children cry sometimes when angry, frustrated, or sad. Most children cry a lot when an important negative event occurs. However, it’s unusual for children to cry several times a day, or every day, either in response to minimal provocation or when there doesn’t seem to be any explanation.
2. Children vary tremendously in how much sleep they need, how deeply they sleep, and how affected they are by disturbances in their sleep patterns. Concerning instances include significant change in a child’s sleep behaviour accompanied by distress, children waking every night with bad dreams, or experiencing night terrors (continuing to sleep even when having an intense nightmare) or children who can’t fall asleep due to fears, and this persists for a several weeks or more.
3. There is considerable variability in children’s eating habits. Some eat everything, some are picky, some have allergies and sensitive digestive systems, some tolerate changes in meal routines, and some do not. This is usually well developed by the end of the first year, and continues. It would only be evidence of a problem if the child’s behaviour was accompanied by significant distress or created distress for the parents and other family members, if there were ongoing battles about food and mealtimes, or if the child refused to eat altogether.
4. All children have aches and pains, upset stomachs, headaches, fevers, and colds. Again, children differ in their ability to stave off illness, to recover from illness, and the degree to which they ‘feel sick’ and upset by being ‘sick.’ Small children often say they have a ‘sore tummy’ when they are nervous or uncertain or even excited- “Mommy, I have butterflies in my tummy.” By age five or six, children learn the difference between nervousness and stomach pain but it’s a slow process. Sometimes, children either don’t learn the difference between emotional and physical distress or can’t express it, and these children have ongoing headaches and stomach aches which prevent them from enjoying themselves and mastering new skills and activities. Mothers and fathers usually have a sense about the cause of their child’s symptoms and when the aches don’t seem to be physical and are numerous, something else is probably at play.
5. Despite challenges, most children enjoy daycare and school and wake up most days, anticipating a pleasurable experience. If your child is commonly resistant, crying, wanting to stay home, wanting to stay with you, clingy and/or fearful that something might happen to you, or them, it needs some investigation. If you consult the teacher or daycare staff and are confident that there isn’t something explicit causing your child’s fearfulness, you might want to explore further with your doctor.
6. Similarly, children are typically excited about playdates, activities, adventures, and new learning of various sorts –some of course, more than others. Shy children may prefer a few close friends and quieter activities than extroverts but they still enjoy social activities, and anticipate them with pleasure. It’s not unusual or concerning if your quiet child doesn’t relish paint ball but it is concerning if he or she doesn’t enjoy anything. Shy, intellectual children don’t necessarily like hockey but they get pretty worked up about puzzles and science experiments. It’s the qualities of interest, curiosity, engagement, and pleasure that matter, not the particular activity.
7. It often takes time and patience and a lot of talk about “using your words” before children stop using their bodies to express anger and frustration. By six years, children have, by and large, stopped resorting to kicking, hitting and pushing but some are more prone to this –usually boys –and some are slower to learn because they are delayed in language development or more impulsive. Little boys who get into trouble by being aggressive are most often truly ‘’sorry,’’ and the behaviour slows and disappears over time. When children kick, hit, and bite routinely, are shunned by other children and parents, are excluded from birthday parties and the teacher reports that he/she is not following the “rules,’’ it’s another matter entirely. This situation is particularly painful for parents who feel ashamed and defensive but they do themselves and their child a big favour by spending time and effort investigating, rather than excusing.
8. Any type of skill development, or new learning requires the ability to take risks. Attention, rehearsal, practice, and failure are ubiquitous in the process of acquiring any new skill, whether you are a genius or a regular person, a baby or a boomer, and whether the new skill is reading or bowling. The more adventurous, confident, and self- assured one is, the better able to take on difficult new tasks and to tolerate failure; the more risk-averse, self-conscious, and tentative, the more difficult it will be to tolerate failure and the less willing to take risks. Again, differences are normal and expectable but a child who won’t participate in activities, refuses to try to learn, and avoids anything competitive, is likely to be very restricted, and very unhappy. It might be emotional, it might be a learning challenge, but it needs investigation.
9. Many children bite their nails, pull their hair, pick and scratch their skin, wet the bed, and occasionally soil themselves. These behaviours are normal or not, depending on the age, the frequency, and whether or not they occur alone, or in combination with other symptoms. Alone, if these behaviours don’t cause distress or interfere with the child’s learning or social life, they will probably disappear by themselves. For example, lots of school-aged children who are perfectly toilet trained, soil themselves when they don’t want to leave an exciting activity. Children who are very tired or sleep deeply, may wet their beds. These behaviours are of concern only when children are isolated, anxious, and/or unable to participate in enjoyable activities or learning.
10. Teachers and daycare staff know children and know what is normal and expectable for girls and boys at each age and stage. They have ample opportunity to observe your child in many circumstances and over a long period of time. They usually are well meaning and usually have your child’s best interests in mind. When teachers or daycare staff repeatedly express concerns about your child, its best to listen and take heed. Something is amiss.
The trifecta for evaluating children’s mental health
My point in this piece is to alert parents and teachers to the more general concerns which might warrant further investigation and I repeat that it’s not a single symptom or behaviour that is significant, but whether or not a child is able to love, laugh, and learn.
About The Author
Janet Morrison, M.A., C. Psych Assoc. is a psychological associate in private practice and a senior lecturer at the Factor-Inwentash Faculty of Social Work, University of Toronto. Over the past 30 years she has assessed, treated and supervised treatment of children in long-term care, as well as, consulted for Children's Aid Society and group homes across Ontario.
Listen to our podcast episode on this topic: Episode 5 | How to Know When a Child Needs a Mental Health Assessment