Children, like adults, have mental disorders and as such they need treatment. Some disorders are mild (adjustments, for example), while others can be more severe (see Children and Post Traumatic Stress Disorder Treatment for example). Many studies reveal that 20% of children have a serious mental disorder—that’s 1 of every 518.
After working with ESE youth, onsite in lock up facilities and seeing many youth (and families) in the office, my expertise in this area has grown. Today, I only see a small number of youth in practice and only if a referral is coordinated.
Many times, the best place to begin if you suspect mental illness in a child is to contact a Pediatrician. Probably, most questions about what is “normal” behavior or “abnormal” behavior can be addressed by the Pediatrician, simply because they are specifically trained in the many developmental tasks that children experience. If the Pediatrician suspects that there is a mental disorder, he likely will rule out biological factors first, and possibly refer the child to a specialist for other testing. The referral might include a Neurologist, a Psychiatrist, or a Clinical Social Worker.
The incidence of mental illness in children is seemingly more common — but some research in the US suggests it is not on the rise20. In other parts of the world the increase of childhood mental illness is being realized, but the finding is linked to less stigma and therefore more children are accessing services19. It is argued that the same process is unfolding in the US. Either way, 20% of US children having a mental disorder is not a small number. So why are so many children being diagnosed with mental disorders? Aren’t there be times, when NOTHING is wrong? There are several considerations in answering these questions.
One key reason is that some professionals believe that a diagnosis is the best means to provide treatment. In fact, in some cases the criteria for a diagnosis may not fully exist, but an assumption of a psychiatric disorder is nevertheless suggested. There is cause for such a suggestion15.
Additionally, many parents are more educated about the existence of mental illness in their own lives—and often parents realize that mental illness commonly exists in families for generations. Such an awareness heightens the perceived need for clinical assessment in families. What are the other possibilities for so many referrals from the family?
In 2017 I moved to seeing youth in practice or onsite only by referral and only if the child has already been treated by at least one other professional without success. Because my work with children almost always requires family involvement, and the because these cases are often more complex, I prefer to treat only a small number of youth, and again, only if they are referred from another provider, after being seen elsewhere.
At times a family will seek treatment for behavior problems in their children; the family system is really what is in need of treatment. For example, a child may be referred for non-compliance in the home, and during the assessment it is disclosed that an adult member of the family has been drinking excessively and was recently fired from their job. And while the child was referred for excessive non-compliance, (at school for example) the issue of treatment becomes complex because the child’s behavioral difficulties could actually be a very small component of the full family issue—and in reality the adult who is drinking (and the rest of the family) may need treatment. Sadly, what can happen is the child will continue to receive treatment, even as the family system itself remains highly dysfunctional.
Additionally, as the general public becomes more knowledgeable about mental disorders, medications, and other treatment methods, more children are referred for assessment. A common referral resource is the school system where classroom teachers contact parents asking for assessments due to behaviors that they cannot manage. What are the other possibilities for so many referrals from the classroom?
The teacher is indeed a good source of information is trying to decide if a child needs to be seen by a mental health professional. At times a parent will receive notes from a teacher (and from several teachers) prompting the parents to investigate the problems. One of the first plans is usually a referral to a mental health professional.
A referral is not necessarily a bad idea, but as a first step in an intervention—it might be premature. Many children have been assisted with a behavioral plan and they improve in the school via that method. And because of this issue a behavioral plan should probably be the first plan of action.
In some cases however—depending on which mental health professional you see – medications may initially be prescribed for a child and a behavioral intervention is not attempted. Likewise, some professionals believe in working with children to support the idea that it is better to be non-directive in talk / play therapy—likely more common with preschool aged youth. Credible research supports a more directive behavioral approach even in children who have experienced severe abuse, such as sexual abuse24. So, why is medication so readily and easily prescribed?
What often happens is that a child ends up with a mental illness diagnosis, and is taking prescription drugs (arguably this could be a non-directive intervention) without an ample alternative intervention being tried—first. To complicate matters, is that when the child begins to “settle down” on the medications, teachers and parents become convinced that the medication is working. But this example begs the question: why did the professional prescribe medications rather than attempt a behavioral intervention? That depends on which type of professional assesses the child.
Likewise, children within the child welfare system often have unmanageable behavioral problems making their placement into foster homes and group homes difficult to maintain. Many times a “treatment foster home” or a residential group home will observe a child who is developmentally behind in academic and social settings, leading to mental health referrals. Lastly, if there are outbursts of aggression toward people, animals, or property a child will often be referred for a mental health evaluation and the situation can be more critical. Mental health treatment is deemed necessary in order to keep the child in the placement and so often times the foster or group home is faced with only one choice. What are the other possibilities for so many referrals from the child welfare system?
The complexities of the child welfare system cannot be fully addressed here, but recommendations for a complete transformation of the system have been highlighted for years. Even so, some considerations exist for children who are referred from residential group homes and treatment foster homes. For example, when mental health treatment includes medication management and talk therapy the child is likely going to respond favorably at several levels; hopefully the medications can alleviate the intense behavioral problems to a sufficient degree that talk therapy can address the roots of that aggression (such as the cause for state care placement). If a child in the child welfare system only receives medication management, even if the behavioral problems decrease, there is a very strong possibility that the emotional wounds that exist upon child welfare placement (exacerbated even in the system 21) are not being fully addressed.
It should be re-stated that children, just as adults, have mental and emotional disorders that necessitate treatment. If you’re unsure where to begin—you might set up a consultation. The consideration with children, as more and more are referred for mental health services each year, is to find a treatment provider who will assess the child with a degree of caution—considering a multitude of variables that exist in nearly every scenario.
Fee free to contact us with any questions! Whether it’s a question about the free consultation or one of our school counseling services programs—or some other counseling question—let us know.
* NOTE: The practice of LaRose shifted its service model for minors moving to case by case consultation services for families and children where other professionals are a part of a referral to LaRose. The practice prefers to work with more complex and non-traditional cases and as such accepts minors only on a case by case referral dynamic. Families seeking children services with the practice will be asked to include the referring providers contact information during the registration process. LaRose will follow-up with each case as they are scheduled to determine if the provider referral has been completed (and to obtain a release to contact the referring party prior to being seen). Family and youth consultation services are provided in the self-pay context, using a child and family centered model. Families interested in this referral and treatment approach, who also have concerns about mental illness, negative psycho-social-environmental-developmental dysfunctions—should consult their health insurance plan or medical doctor prior to scheduling a consultation.
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