How to know when child needs psychiatric help

Nobody said raising children is easy. It can be even harder if a young child, preteen or adolescent has troublesome behaviors or problems with emotions, anxiety or attention. Maybe someone has already suggested your child might need professional psychiatric help. When do you know it’s time to schedule an appointment?

If your child has only mild mood, anxiety or behavior problems that don’t interfere with their functioning in home or school, they may grow out of their troubles with the passage of time. However, if symptoms negatively impact their own or your family’s day-to-day function, there’s a good chance a professional can help.

Signs that professional help is needed:

• If your child’s symptoms of anxiety, depression, inattention, impulsivity or rage (tantrums) are severe enough to keep them from being successful at home, school, with friends and other children, or in activities they would want to do.
• If you find that you are arranging your entire family’s life around your child’s symptoms. You might not be enjoying activities together or feel like you are doing things for your child that aren’t appropriate, just to keep peace.

You may have heard it’s hard to find a practitioner with expertise in children, but the Baltimore area is well served with psychiatrists, nurse practitioners and psychotherapists who have advanced training in child and adolescent psychiatric medicine and counseling.

Many people start treatment with a psychotherapist and decide to consult a psychiatric prescriber (a psychiatrist or psychiatric nurse practitioner) later. A good time to seek an appointment with a prescriber would be if psychotherapy alone is not helping your child enough, or if you or the psychotherapist thinks your child’s problems might be caused by a biological issue such as ADHD, depression or anxiety.

Things to look for in a mental health provider:

• The provider should be in your insurance network. While you might not wish to put a price tag on your child’s wellbeing, your ability to keep paying for follow-up appointments is important to overall treatment success. Several years ago, it was almost impossible to find child psychiatry providers who were on insurance panels. This is no longer the case. Simply call the number on the back of your insurance card and ask for in-network providers.
• When setting up the appointment, ask whether the provider will spend some time during the appointment in a private meeting with you so that your child or adolescent does not have to hear embarrassing or difficult information presented about themselves. The provider should also use time during this intake appointment to speak with the young person alone if they are willing, or if not, with you there. Ideally, a first appointment is set up for two hours, so nobody is rushed, and a careful medical history can be recorded.
• When the whole group is together, pay attention to whether the provider speaks directly with your child (even if they’re young) and makes them liked and respected, as opposed to speaking “over” your child and only to you.
• Your provider should ideally work in a team with other therapist or prescribers who specialize in working with children. Often situations are unusual or rare, and you want your child’s provider to have ready access to another professional for consultation.
• Can your child bring an emotional support pet, or does the practice have one on staff?

Talking to an unknown adult about personal issues is a challenge for anyone, especially a young person, so respecting your child’s feelings about a provider is important. The good news is that a caring, skilled provider can become one of your family’s most important supporters — in the short term, or for years to come.

Anthony G Massey, M.D. F.A.P.A. is the CEO of Gladstone Psychiatry and Wellness, with offices in Hunt Valley, Mount Washington, Columbia and Bethesda. Gladstone Psychiatry is in network with most commercial insurers, and currently has five full time child and adolescent prescribers with appointment availability. For more information, please visit http://gladstonepsych.com