Is This Just a Stage?
Points to Remember
· Always seek immediate help if a child engages in unsafe behavior or talks about wanting to hurt him or herself or someone else.
· Seek help when a child’s behavior or emotional difficulties last for more than a few weeks and are causing problems at school, at home, or with friends.
· A thorough evaluation can help determine if treatment is necessary, and which treatments may be most effective.
· Early treatment can help address a child’s current difficulties and can also help prevent more serious problems in the future.
When to Seek Help
Even under the best of circumstances, it can be hard to tell the difference between challenging behaviors and emotions that are consistent with typical child development and those that are cause for concern. It is important to remember that many disorders like anxiety, attention deficit hyperactivity disorder and depression, do occur during childhood. In fact, many adults who seek treatment reflect back on how these disorders affected their childhood and wish that they had received help sooner. In general, if a child’s behavior persists for a few weeks or longer, causes distress for the child or the child’s family, and interferes with functioning at school, at home, or with friends, then consider seeking help. If a child’s behavior is unsafe, or if a child talks about wanting to hurt him or herself or someone else, then seek help immediately.
Young children may benefit from an evaluation and treatment if they:
· Have frequent tantrums or are intensely irritable much of the time
· Often talk about fears or worries
· Complain about frequent stomachaches or headaches with no known medical cause
· Are in constant motion and cannot sit quietly (except when they are watching videos or playing videogames)
· Sleep too much or too little, have frequent nightmares, or seem sleepy during the day
· Are not interested in playing with other children or have difficulty making friends
· Struggle academically or have experienced a recent decline in grades
· Repeat actions or check things many times out of fear that something bad may happen.
Older children and adolescents may benefit from an evaluation if they:
· Have lost interest in things that they used to enjoy
· Have low energy
· Sleep too much or too little, or seem sleepy throughout the day
· Are spending more and more time alone, and avoid social activities with friends or family
· Fear gaining weight, or diet or exercise excessively
· Engage in self-harm behaviors (e.g., cutting or burning their skin)
· Smoke, drink, or use drugs
· Engage in risky or destructive behavior alone or with friends
· Have thoughts of suicide
· Have periods of highly elevated energy and activity, and require much less sleep than usual
· Say that they think someone is trying to control their mind or that they hear things that other people cannot hear.
First Steps for Parents
If you are concerned about your child, where do you begin?
· Talk with your child’s teacher. What is the child’s behavior like in school, daycare, or on the playground?
· Talk with your child’s pediatrician. Describe the behavior, and report what you have observed and learned from talking with others.
· Ask for a referral to a mental health professional who has experience and expertise dealing with children. (Additional information on identifying a mental health professional is at the end of this brochure.)
An evaluation by a health professional can help clarify problems that may be underlying a child’s behavior and provide reassurance or recommendations for next steps. It provides an opportunity to learn about a child’s strengths and weaknesses and determine which interventions might be most helpful.
A comprehensive assessment of a child’s mental health includes the following:
· An interview with parents addressing a child’s developmental history, temperament, relationships with friends and family, medical history, interests, abilities, and any prior treatment. It is important to get a picture of the child’s current situation, for example: has he or she changed schools recently, has there been an illness in the family, or a change with an impact on the child’s daily life.
· Information gathering from school, such as standardized tests, reports on behavior, capabilities, and difficulties.
· An interview with the child about his or her experiences, as well as testing and behavioral observations, if needed.
Assessment results may suggest that a child’s behavior is related to changes or stresses at home or school; or is the result of a disorder for which treatment would be recommended. Treatment recommendations may include:
· Psychotherapy (“talk therapy”). There are many different approaches to psychotherapy, including structured psychotherapies directed at specific conditions. Information about types of psychotherapies is available on the National Institute of Mental Health (NIMH) Psychotherapies page (www.nimh.nih.gov; search term: psychotherapies). Effective psychotherapy for children always includes:
o Parent involvement in the treatment (especially for children and adolescents)
o Teaching skills and practicing skills at home or at school (between session “homework assignments”)
o Measures of progress (e.g., rating scales, improvements on homework assignments) that are tracked over time.
· Medications. Medication may be used along with psychotherapy. As with adults, the type of medications used for children depends on the diagnosis and may include antidepressants, stimulants, mood stabilizers, and others. General information on specific classes of medications is available on NIMH’s mental health medications page (www.nimh.nih.gov; search term: medications). Medications are often used in combination with psychotherapy. If different specialists are involved, treatment should be coordinated.
· Family counseling. Including parents and other members of the family in treatment can help families understand how a child’s individual challenges may affect relationships with parents and siblings and vice versa.
· Support for parents. Individual or group sessions that include training and the opportunity to talk with other parents can provide new strategies for supporting a child and managing difficult behavior in a positive way. The therapist can also coach parents on how to deal with schools.
· To find information about treatment options for specific disorders, visit www.nimh.nih.gov/health/.
Choosing a Mental Health Professional
It’s especially important to look for a child mental health professional who has training and experience treating the specific problems that your child is experiencing. Ask the following questions when meeting with prospective treatment providers:
· Do you use treatment approaches that are supported by research?
· Do you involve parents in the treatment? If so, how are parents involved?
· Will there be homework between sessions?
· How will progress from treatment be evaluated?
· How soon can we expect to see progress?
· How long should treatment last?
Additional information related to identifying a qualified mental health professional and effective treatment options is available on the NIMH website at www.nimh.nih.gov/findhelp as well as through other organizations listed in the Resources section of this brochure.
Working with the School
If your child has behavioral or emotional challenges that interfere with his or her success in school, he or she may be able to benefit from plans or accommodations that are provided under laws originally enacted to prevent discrimination against children with disabilities. The health professionals who are caring for your child can help you communicate with the school. A first step may be to ask the school whether an individualized education program or a 504 plan is appropriate for your child. Accommodations might include simple measures such as providing a child with a tape recorder for taking notes, permitting flexibility with the amount of time allowed for tests, or adjusting seating in the classroom to reduce distraction. There are many sources of information on what schools can and, in some cases, must provide for children who would benefit from accommodations and how parents can request evaluation and services for their child:
· There are Parent Training and Information Centers and Community Parent Resource Centers throughout the United States. The Center for Parent Information and Resources website lists centers in each state.
· The U.S. Department of Education has detailed information on laws that establish mechanisms for providing children with accommodations tailored to their individual needs and aimed at helping them succeed in school. The ED also has a website on the Individuals with Disabilities Education Act, and the ED’s Office of Civil Rights has information on other federal laws that prohibit discrimination based on disability in public programs, such as schools.
· Many of the organizations listed in this brochure as additional resources also offer information on working with schools as well as other more general information on disorders affecting children.
Information on specific disorders is available on the NIMH website and in our publications and health information pages. The organizations below also have information on symptoms, treatments, and support for childhood mental disorders. Participating in voluntary groups can provide an avenue for connecting with other parents dealing with similar issues.
Researchers continue to explore new means of treatment for childhood mental disorders; the “Join a Study” section below provides information on participating in clinical research.
Please Note: This resource list is provided for informational purposes only. It not comprehensive and does not constitute an endorsement by NIMH.
The following organizations and agencies have information on mental health issues in children. Some offer guidance for working with schools and finding health professionals:
· American Academy of Child and Adolescent Psychiatry. see Facts for Families on many topics
· Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator
Addressing Disorders Affecting Children
The NIMH is conducting and supporting research that could help find new and improved ways to diagnose and treat mental disorders that occur in childhood. This research includes studies of risk factors, including those related to genetics and to experience and the environment, which may provide clues to how these disorders develop and how to identify them early. NIMH also supports efforts to develop and test new interventions, including behavioral, psychotherapeutic, and medication treatments. In addition to providing ways to diagnose and treat disorders in childhood, research can help determine whether beneficial effects of treatment in childhood continue into adolescence and adulthood.
Participating in a Research Study for Children
Children are not little adults, yet they are often given medicines and treatments that were only tested in adults. There is a lot of evidence that children’s developing brains and bodies can respond to medicines and treatments differently than how adults’ brains and bodies respond. The way to get the best treatments for children is through research designed specifically for them.
NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions. During clinical trials on conditions affecting mental health, treatments being tested might be new behavioral treatments, new drugs or new combinations of drugs, or new approaches to enhance existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
Please Note: Decisions about whether to apply for a clinical trial and which ones are suited for your child are best made in collaboration with his or her licensed mental health professional. For more information on clinical research, visit NIH Clinical Research Trials and You: For Parents and Children.
Finding a Clinical Study
Researchers at the NIMH conduct research on numerous areas of study, including cognition, genetics, epidemiology, and psychiatry. These NIMH studies take place at the National Institutes of Health’s Clinical Center in Bethesda, Maryland, and require regular visits. To find studies for children and teens being conducted at NIMH, visit Join a Study: Children. You can find out whether a study would be appropriate for your child by talking with the contacts listed for each study.
In addition to trials underway at NIMH, there are clinical trials testing mental health treatments that are being conducted across the United States and around the world. To find a clinical trial near you, you can visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials. ClinicalTrials.gov gives you information about a trial’s purpose, who funds it, who may participate, locations, and phone numbers for more details. This information should be used in conjunction with advice from mental health professionals.
For More Information
Mental Health Treatment Locator
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at https://findtreatment.samhsa.gov/. For additional resources, visit https://www.nimh.nih.gov/findhelp.
Questions to Ask Your Doctor
Asking questions and providing information to your doctorealth care provider can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Visit the Agency for Healthcare Research and Quality website for tips at www.ahrq.gov/patients-consumers.
For more information on conditions that affect mental health, resources, and research, go to MentalHealth.gov at http://www.mentalhealth.gov, or the NIMH website at http://www.nimh.nih.gov. In addition, the National Library of Medicine’s MedlinePlus service (https://medlineplus.gov/) (En español: http://medlineplus.gov/spanish) has information on a wide variety of health topics, including conditions that affect mental health.
National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301–443–4513 or
Toll-free: 1–866–615–NIMH (6464)
TTY Toll-free: 1–866–415–8051
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 18-4702