When to Stop Second-Guessing and Get Professional Help for Your Child

"Trust your suspicions. Parents know their children best." -
Ronald Becker, M.D.
Developmental behavioral pediatrician

It's normal for a teen to sometimes act depressed, withdrawn or irritable. But if the behavior seems constant, parents should look into the cause and possibly seek professional help.

By Janet Strassman Perlmutter

When you're a parent, worry comes with the territory.

For most of us, the worries start as soon as we know a baby is on the way. (Will my child be healthy?) Once the baby arrives and we've counted fingers and toes, we're on to the next worry and the next and the next. As parents, we're painfully aware of the many things that can go wrong; we can be overly vigilant for even a hint of something amiss in our child's health, development or behavior.

We know that we should trust our instincts. And many times, we also know, somewhere in the back of our mind, that the things worrying us are normal stages in our children's growing-up years.

So how do you strike a balance - keeping an eye on social, emotional and educational progress, but not envisioning the worst if cousin Anna is talking earlier than your 1-year-old or the neighbor's child is an eager reader in first grade and your 6-year-old doesn't even sound out all his letters?

With daily news about autism, attention deficit disorder, learning disabilities, anxiety or depression in kids, many parents move from curious to concerned pretty readily. How do you determine whether your child is going through a perfectly normal struggle with learning, shyness or nerves, for example, or whether he really needs professional help?

And what about the more murky area of a child's behavior and relationships within your family - an explosive, defiant teen or an 8-year-old who seems completely oblivious to the limits you set? When do you seek help outside the intimate boundaries of your own family? How do you know - and accept - when the problem is not one you can fix at home?

We asked a range of experts the questions on many parents' minds: How do I know if my child needs professional help? How will I know if my child's behavior or development is normal?

Start, the experts agree, by trusting your gut. "Parents know their children best," says Ronald Becker, M.D., a developmental behavioral pediatrician at Children's Hospital in Boston.

"It's an important sign when a parent is worried," agrees Joshua Sparrow, M.D., a child psychiatrist also at Children's and co-author with T. Berry Brazelton, M.D., of Touchpoints: Your Child's Emotional and Behavioral Development. As a parent, you're often on target when you suspect something is awry, Sparrow says. But even when you're not, he says, "You deserve help in figuring out what's happening with your child."

What to Watch For

Child health and development experts tell parents to pay attention when a child of any age experiences a setback in behavior or the ability to function.

Charles Sophy, M.D., medical director of the Los Angeles Department of Family and Children's Services, cites sleeping, eating and social skills as common areas where significant setbacks can occur.

Ask yourself:

o Has it become harder for my child to get to sleep or stay asleep?

o Is he or she suddenly disinterested in food or, alternatively, overeating?

o Is there a change in his or her social abilities? More hitting? More isolation? Is my child less able to express his or her feelings in an age-appropriate way?

Changes in behavior can be developmentally normal, such as a 5-year-old whose sleep is temporarily affected by nightmares or an adolescent expressing her emerging independence from the family by communicating less with her parents. Still, a cluster of symptoms, persistent difficulties, or just an intuition that what you're seeing goes beyond a typical stage are all signs that warrant further investigation.

As a child gets older, concerns often arise around school or friendships. Take note of any sudden drop in academic achievement or interest in school, recommends Carla Sharp, Ph.D., a clinical psychologist and assistant professor of child psychology and psychiatry at Baylor College of Medicine in Houston. While some kids may have struggled academically all along, she says, "If your child is making up reasons not to go to school, something is wrong."

When it comes to social contacts, the issue is not whether you like your child's friends, Sharp says, but whether the child has real friends.

Ask yourself:

o Can my child maintain safe, appropriate relationships?

o Does his or her level of distress over personal relationships seem excessive?

"Children," Sparrow points out, "are a good gauge of each other." He encourages parents to pay attention to how other children react to your child. "If you notice that other children (don't take to your child), chances are he's noticed that too."

"Notice when children are dissatisfied with themselves, troubled by how they're doing, as a repeated theme," Sparrow says. "It might mean a child is depressed or anxious, or it could reflect a child's awareness of delays he's encountering. It might mean he's noticing, 'I'm out of my league here.'"

It's also important for parents to pay attention to their own reactions, Sparrow adds. "When parents are angry, disappointed or embarrassed by a child, those are important general indicators" that something is wrong. It could be something off kilter in the parent's expectations, he says, but such reactions can also point to a child's undiagnosed developmental difficulties. Either way, it's a sign that the parent should consult with the child's pediatrician, who can then refer parent and child to a psychologist, counselor or other specialist if necessary.

Go It Alone or Get Help?

Noticing the warning signs doesn't necessarily mean that you're observing a full-fledged problem with your child's development. Some changes in kids' moods and behavior are what therapists identify as "adjustment reactions." These differ from developmental issues in that they're often reactions to something that happened (or is happening) in a child's or teen's life.

Ask yourself:

o Does my child seem more fearful because of a recent or impending change of schools?

o Has his or her temper been flaring since a close friend moved away?

o Does my tween act more lethargic or irritable (depressive symptoms) since his or her grandparent died.

If your own efforts to ease your child's angry or upset moods aren't working, then counseling, family therapy and even medication, if needed, can help. The issues may become more serious or ingrained if neglected, but they needn't remain as long-term challenges.

Keep an eye out for these kinds of behavioral or mood changes at times of transition, especially if there's been a divorce, a death in the family or other significant losses. Above all, say health professionals, don't be afraid to ask for outside help.

"Parents worry too much about seeking help," observes Caroline Fisher, M.D., Ph.D., medical director of a pediatric behavioral health practice. "Parents spend too long worrying about if it's time. If it's not time (to get help)," she adds, "the therapist will say so."

Fisher is particularly concerned that many parents don't seek help quickly enough when a child is refusing to go to school. At any age, she says, if you can't get your child to go to school by setting and maintaining firm limits, "Get urgent help. The longer a child is out of school, the worse a school phobia gets."

Parents sometimes accept problematic behavior among their kids as normal. This happens often with depressed teens, Fisher notes. While teens are moody by nature, Fisher reminds parents that adolescents, on the whole, are not depressed, irritable or withdrawn all the time.

"Most teens are pleasant, decent people most of the time. If yours is not, look at addressing that," she says. "Everyone gets grouchy some of the time, perhaps teens more than others, but if they are not pleasant the majority of the time," there may be a problem that parents should check out.

Some children's vulnerabilities are tough for parents to admit to, especially if they mirror those of the parent's, psychotherapists say. But because some disorders are genetic, and others are learned at home, it's important to keep our eyes open for these issues in our kids. Common but overlooked examples include a history of substance abuse, anger problems, anxiety and depression.

Now What?

If problems persist and you're questioning whether outside help might be needed, what do you do?

1. Talk to your child's pediatrician. "There's no need to jump to a (medical) specialist," Becker says. "Your family doctor can set you in the right direction and get the ball rolling" with referrals if needed.

2. Act promptly. Often, people wait unnecessarily to seek help, Becker notes, and then they may have to wait again to get an appointment.

Many behavioral, social or developmental issues can be resolved by a psychologist or a clinical social worker. If a specialist, such as a neurologist, developmental psychologist or developmental pediatrician, is needed, that professional's evaluation will vary depending on the problem. In some cases, formal testing will be recommended, especially if a learning disorder is suspected. Other disorders are diagnosed by observation of the child, together with a thorough interview about the history of the problem.

3. Be thorough. A serious diagnosis should never be made - or accepted by you as a parent - based on only a brief conversation or a few minutes interaction with the child.

Remember, too, that different therapists have different approaches regarding who participates in the therapy. Some want to see the entire family from the outset, no matter what the problem is. Others work with the child alone and consult intermittently with the parents. Still others focus on the parent as the agent of change with the most time, access and leverage with the child.

When it comes to child issues requiring psychological help, therapy or counseling, a parent's hesitancy or reluctance is understandable. But mental and behavioral health experts want to put parents at ease.

"There are lots of reasons for a parent to not understand or be afraid of what therapists do," Sparrow acknowledges. Parents should most certainly expect a therapist to be comfortable with them, available and welcoming, he says. "Ask all the questions you want."

Janet Strassman Perlmutter is a freelance writer, licensed social worker and a child and family therapist.



American Academy of Pediatrics - - The AAP's books on child health and development and its Web site (which lists those books) cover children's developmental milestones, signs of disorders and when to seek professional help.

o American Academy of Child & Adolescent Psychiatry - - The AACAP's Web site includes an index of "Facts for Families" on a host of developmental or behavioral issues.

o First Signs - 978-346-4380 - This nonprofit organization helps parents and pediatricians recognize early signs of autism and other developmental disorders.

On the Web

o Keep 'Em Off My Couch - - This Web site of Dr. Charles Sophy, medical director for the Los Angeles County Department of Children and Family Services, is an online parenting newsletter with sound advice for all kinds of child and family life issues, from separation anxiety to sibling rivalry to divorce.


o Touchpoints, 0-3: Your Child's Emotional and Behavioral Development, by T. Berry Brazelton, M.D., and Joshua Sparrow, M.D., De Capo Press, 15th ed., 2006.