Anxious about your son’s anxiety? Sad about your daughter’s depression? If you’re concerned about your child’s mental health, you might be thinking about therapy. If you are, you’re in good company.
Your child’s physical and mental health are both part of the same package. Mental illnesses, like depression, can increase the risk for physical health problems, like diabetes and heart disease. And although we might like to think of childhood as a time of carefree happiness, that’s often not the reality. More than 17 million children—about one in every five kids—are affected every year by mental health problems like depression and anxiety.
If you’re concerned about your child, trust your instincts—and seek help. “Therapy can absolutely be helpful in a child’s life,” says Miyume McKinley, LCSW, a clinical social worker and child therapist in Los Angeles, California. “Children and teens are still developing and coming to understand their emotions. Working with a therapist gives them an opportunity to express their feelings with a professional who can help to steer their lives in a healthy direction.”
Finding the right treatment for your child can feel like a big undertaking, and you might have so many questions that you find your head spinning. This guide will help you make sure your child is getting the mental health care that they need.
Next to you, that’s the person who knows the most about your child’s health. Plus, the pediatrician is a professional who can spot behavioral health disorders.
“Pediatricians are trained to treat the whole child, and they can screen for psychological problems,” says Mark Stein, PhD, a psychologist at Seattle Children’s Hospital. “Mental health problems don’t happen in isolation, and there are lots of physical issues, like sleep disorders and poor nutrition, that can contribute to behavioral issues.”
Consider your pediatrician as your number-one resource. “If the behavioral problem turns out to be clear cut, pediatricians can often treat your child, at least initially,” says Dr. Stein. “And if it’s more complex, they’ll know if it’s time to call in a mental health professional. Pediatricians have connections with behavioral specialists and keep lists of referrals at their fingertips.”
Your child’s teacher and guidance counselor are also great resources for finding good behavioral health care. Kids don’t live in a vacuum, after all, so if you’ve noticed some behavior problems at home, chances are good that the school personnel have noticed something, too. Arm yourself with information—find out what the teachers and counselors have to say.
While you’re there, ask for recommendations for good local therapists. But be cautious, suggests Dr. Stein, and ask for criteria for success and a timeline for reevaluation: “If there seems to be a school-related issue, school districts are required to evaluate to determine the need for educational services. But don’t depend on the school to diagnose a psychiatric disorder in a school environment.”
You may be able to ask the school psychologist to do a psychoeducational assessment to determine your child’s learning style, strengths, and areas of need. Sometimes this type of testing uncovers learning disabilities your child might be struggling with.
Don’t be alarmed by the alphabet soup of mental health titles. Therapists come in lots of different varieties, and all of them are licensed and qualified to help your child, from licensed clinical social workers (LCSWs), to psychiatrists (MDs), to psychologists (with training at either the master’s or doctoral level), to licensed marriage and family therapists (LMFTs). There are even specially-trained coaches for kids with attention deficit disorder.
“All of them can provide mental health care for your child,” explains McKinley. “The real question is not so much the letters after their name, but their experience and their specialty. They might focus, for example, on depression and anxiety, or attention deficit hyperactivity disorder (ADHD). Find out if the therapist can provide services for the issue that you’re concerned about. And definitely find someone who works with children.”
But, even so, it is still good to understand the difference between social workers, psychologists, and psychiatrists. It mostly comes down to education.
A social worker has attended graduate school and received their master’s degree, by completing two or three years of coursework with a concentration in an area of interest to them, such as community mental health, policy development, or children, youth, and families. Many school programs focus on identifying the needs of and supporting underserved populations as a part of their curriculum. After obtaining a master’s degree, 3,000 hours of therapy must be practiced—under the supervision of a licensed mental health therapist—in order to sit for the licensing exam. Anyone who passes the licensing exam is a Licensed Clinical Social Worker (LCSW).
A psychologist will have also earned a master’s degree, but then decided to continue on to earn their doctoral degree. This entails another two to four years of studying human behavior, development, psychotherapy, and assessment, as well as research, statistics, and ethics, and one to two years of a full-time internship. In some states, they may be able to prescribe medications.
A psychiatrist usually holds an M.D. or D.O. degree, meaning that they attended medical school and studied biological functioning with a residency specializing in mental illness and its treatments, with an emphasis on medications.
In all cases, any of the above can practice psychotherapy. You want to find someone who has experience with your child’s age group or issue. In some cases, they may accept health insurance. Ultimately, the best therapist is one you and your child feel comfortable with.
There’s no blood test or scan that can provide an instant mental health diagnosis. Instead, there’s a process that good therapists follow to determine exactly what your child’s issue is. Though there are some variations from office to office, these are the steps you can expect:
Sometimes it takes a couple of sessions before your therapist can offer a diagnosis, after considering all of the information that’s been gathered from you and your child, as well as their observation of your child.
“Sometimes the diagnosis is really straightforward,” explains McKinley. “The therapist might be able to say pretty quickly, for example, ‘Your child’s symptoms indicate that she/he has depression.’ But sometimes, more information is really critical.”
When that happens, your therapist will schedule another appointment. “Once the diagnosis is made,” says McKinley, “when appropriate, I always keep communication open so that I am always aware of what is happening outside of session[s]. In addition, I always educate the parent(s) on their child’s diagnosis and what they can do to support their child.”
Most importantly, do not sign off on a treatment without a diagnosis. If anything, this is a red flag that this is not the mental health professional you should be seeking care from.
You’ve got a diagnosis; now it’s time to figure out what to do about it. That’s where the treatment plan comes in. Therapists vary in their training, experience, and approach to treatment. There are lots of approaches to choose from. They may range from cognitive behavioral “talk” therapy (CBT), to group therapy sessions for teens, to training the parents in parenting skills to address behavior problems, to anxiety modification.
“Very few disorders are treated with just one kind of therapy,” explains Dr. Stein. “Typically, we combine treatments to achieve the best response and for the child or adolescent to learn new skills—with ADHD or depression, for example, we often use both medication and therapy. I’d be really wary of a provider who suggested only medication.”
If your practitioner suggests medication along with therapy, ask them about employing the Genomind Professional PGx Express test to help inform their treatment decision. Done through a simple cheek swab, this genetic test is designed to help select appropriate pharmacologic treatment by analyzing 24 genetic markers that help determine how quickly the body metabolizes medication, or how a particular medication will affect the body. It can help your doctor determine the amount to prescribe and possibly alleviate the trial-and-error process of treatment, which can be difficult for a child to endure.
Even though therapists don’t have a crystal ball, they do have a pretty good idea of how long it’ll take for your child to begin to experience some improvements.
“At the very beginning, when your child is given a diagnosis and offered a treatment plan,” says Dr. Stein, “parents should know at what point they can expect things to get better. What was the problem that your child started out with? Will they see changes in four weeks, or ten weeks? Be concerned when therapists say they can’t predict a timeline.”
Here are some tips for keeping the therapy moving along successfully—and helping your child become a healthy, happy kid.