Talking With a Mental Health Professional About a Young Child

Child rearing and family life can confront parents with puzzling demands and challenges. Most of us occasionally wonder if a child is "normal;" some wonder if the time has come to seek extra help from a family counselor or therapist. Professional assistance and guidance may be needed in the following situations:

When there is a pattern of persistent behavior in one or more of the following areas:

• bullying (either as aggressor or victim)
• destructive behavior (repeatedly destroying their own or other children's toys and possessions)
• inability to distinguish between fantasy and reality after age six
• persistent lying
• hurting animals with deliberate intent (Children under age five may not understand that they are inflicting pain.)
• setting fires
• stealing
• loneliness (a child who finds it impossible to make friends)
• prolonged sadness, depression or anger (All children have these feelings sometimes. It is cause for concern when the emotion is a persistent state.)

It is important to remember that many children will exhibit one or more of these behaviors at some point. When problem behaviors become a repetitive pattern, there is cause for concern. For example, a seven‑year‑old may find some matches and accidentally start a fire. Serious as the consequences may be, if explanations and reprimands prevent the child from playing with matches again, counseling should not be necessary. If however the child persists in setting fires, parents should seek consultation.

Many children also go through brief periods when they do not have friends or bully a younger child (or are bullied by another). Sensitive, imaginative adults who invest time and effort can usually help these children. If, however, parents feel that they have done everything they can and the problem persists, professional advice may be very helpful.

When a child's behavior changes suddenly or dramatically
When a usually fearless child develops fears that persist over time, a usually happy child becomes chronically sad or depressed, or a child behaves in ways that are markedly different than usual, parents need to pay attention. Sometimes a single event or misadventure elicits change, and extra attention and help in developing coping skills are all that is needed. But if the behavioral or mood change persists for weeks, a professional may provide helpful insights or suggestions.
It's difficult to decide how long to wait before seeking help. Perhaps the image of a toothache is useful. A few twinges for several days can be treated with over‑the‑counter medication and a "wait and see" attitude. However, if the tooth aches persistently, so that the suffering person thinks of nothing but the tooth, it is clearly past time to go to the dentist. It's the same with "behavioral blips." Every child will exhibit some signs of worrisome behavior. It is the persistence, intensity and duration of the behavior that indicates whether or not help is needed.

When a child's behavior disrupts or significantly interferes with the lives of other family members
For example, the Evans family is unable to enjoy a meal together at a restaurant, because eight‑year‑old Nina will not stay with them at the table and runs around, often screaming and disturbing other patrons. If this behavior happens once, it may not be cause for concern. On the other hand, if it persists and the parents are unable to stop it, it can be defined as a problem.

When a child's behavior interferes with his or her ability to sleep, eat, play or interact with others
Sometimes, children act in ways that are unhealthy and interfere with their own development. For example, Lisa is still so afraid of fire drills at the end of her first six weeks in kindergarten, she does not go to sleep before midnight, but lies awake crying and asking anxiously if her parents "think there might be a fire drill tomorrow." After six weeks, Lisa's Mom may decide that a serious problem exists and outside help is needed. Tommy's Dad may feel that his six-year-old son will benefit from counseling, because Tommy has become so afraid of dogs that he refuses to play outside. Dad feels this is more than a "developmental blip," because it has lasted for several weeks.

These guidelines are only suggestions. Behavior that seems problematic in one family may not seem like a problem in another. Families also differ in their abilities to deal with, and tolerate difficult child behavior. A behavior that is difficult for you may not seem to be an issue for your neighbor or sister. Competent professionals understand these differences and are sympathetic when listening to problems and thinking through solutions.

One characteristic of an effective parent is the ability to find and use community resources. Finding and using a qualified mental health professional may be as important to the well‑being of your family as finding and using other forms of health care.

If you're like most people, you may have trouble distinguishing a psychiatrist from say, a psychopharmacologist. When searching for a mental health care provider, however, you need to be aware of the differences in education, training and experience that each field has to offer. The different kinds of helping professionals are defined below.

Counselor - usually has four years of college plus two or more years of graduate study in counseling, guidance or student personnel work, including one year supervised experience (M.A. or Ed.D.). Since counselors are not regulated by New York State law in New York State, request specific background and credentials.

Family Therapist- usually has four years of college plus two or more years of graduate study in family therapy and a minimum of two years supervised practice after the degree (M.A./Ph.D./Ed.D.). New York State does not require licensure, but clinical membership in the American Association for Marriage and Family Therapists can be used as a guide.

Psychiatrist - has four years of college plus four years of medical school (M.D./D.O.) and one year internship. Any physician can practice psychiatry, but many psychiatrists undertake an additional three year residency program in a psychiatric facility. After completing an approved residency and practicing for two years, they can be considered Board Eligible and may take a national exam to become Board Certified. Qualified to prescribe medicine.

Psychiatric Nurse - has four to six years of college study in nursing (B.S.N. or M.S.) with specialized training in counseling and psychiatric hospitalization.

Psychoanalyst - is generally a psychiatrist, psychologist or social worker who has taken specialized postgraduate training in psychoanalysis. Received personal psychoanalysis and extensive supervision as part of the training.

Psychologist - has four years of college plus four or more years of graduate study in psychology and one year internship (Ph.D./Psy.D./Ed.D.). Clinical or counseling psychology requires the most training and supervision in psychotherapy. To be licensed or certified to practice at the independent level in most states requires a doctoral degree, national and/or state exam, and an additional one or two years practice under the supervision in an approved setting. Master's level psychologist may practice independently, but usually only practice under supervision. Qualified to administer and interpret psychological tests.

Psychopharmacologist - is a psychiatrist (M.D./D.O.) who treats mental illnesses primarily by the use of medications, and who has considerable experience in research and the development of psychiatric medications.

Psychotherapist - is a general term not regulated by law that can be used by anyone. Request specific background and credentials.

Social Worker- has four years of college plus one to two years graduate study in social work (M.S.W.); trained in case work, group work, or community organization. Clinical or psychiatric social workers have the most training and experience in psychotherapy and may choose to be certified after two years of practice and exam (A.C.S.W.).

Therapist - is a general term not regulated by law that can be used by anyone. Request specific background and credentials.

Source: Jennifer Birckmayer, Department of Human Development and Family Studies, New York State College of Human Ecology, Cornell University; Adapted from "Choosing a Psychotherapist‑‑A Consumer's Guide to Health Treatment" by Steven Charles Fischer, Ph.D. Parent Pages was developed by Cornell Cooperative Extension of Suffolk County. HD55

Last updated July 10, 2020