It can be difficult to know where to go for your child’s mental health problems. Here I will give you information that will get you and your child on the right path. If you have not already had your child evaluated, you should make an appointment with a child psychologist. It should be a psychologist/therapist/LCPC/psychiatrists that specializes in children and adolescents (or that has additional training specific to children) because mental illness exhibits itself much differently in children and adolescents than in adults. Asking around for recommendations might help you find the right professional sooner. If there is a long waiting list, you should schedule an appointment with their primary care doctor to start the process. The primary care doctor may have a child psychiatrist that they consult with or may be able to make a preliminary diagnosis. But I highly recommend following up with a psychologist/therapist/LCPC/psychiatrist for a complete assessment. A full assessment can last at least a couple hours if not longer in some instances. Below you will see the types of information they will be gathering from you and your child. You should leave with a preliminary diagnosis unless they need to gather more information at another time. They should explain the plan of care and how long they expect to be seeing your child. If you are not comfortable with the diagnoses, get a second opinion.
I would like to take a moment to interject some do’s and don’ts for this meeting.
Do go in prepared with everything listed below.
Don’t let your fear of judgment keep you from being open and honest
Do talk about your child’s strengths. ( Many kids feel they are bad kids when they have been unable to manage their behaviors. They need to know they are worthy of love and acceptance. This will help.)
Don’t run off a list of all of your child’s “faults”. (Imagine how hurtful this would be.)
Do explain that although he tries so hard he struggles with… He is not his behavior. He struggles with these behaviors.
Don’t (try not to) get defensive. ( We can sometimes perceive judgment where none exists.)
Do be open to suggestions. ( If you have tried it before, explain how you went about it and ask if there is another suggestion.)
Don’t use this as your therapy session. (You will need your own support but this is not the time)
Do schedule yourself an appointment with a clinician to help you with the stress of parenting a child with a mental illness.
Don’t blame yourself. (Often times a mental illness has a genetic component to it. This means your child may have come hardwired to potentially develop a mental illness.)
Do remember you and your child are on the same team. The goal should be for him to feel better. When he can do better he will.
To be sure your child gets an accurate diagnosis, it is important to come armed with information. So leading up to the appointment you should start keeping notes. They are going to want to know what symptoms your child is experiencing, when and where they experience them and when they first started. This also needs to be documented from your child’s perspective because they may have been struggling long before you knew about it and may not feel comfortable speaking up in the first meeting. Also, it is important to note the signs that you see. Do they shut down, lash out, hide in their room, refuse to go to school etc. And again you will want to note when where and for how long. Do you notice it is after visiting someone or just after school…? A calendar with good days and bad days might be helpful in documenting and seeing if there is a pattern. Don’t feel bad if the behavior problems are only exhibited at home. This is often the case since they have had to hold it together all day and now that they are home they feel safe to fall apart. They are going to want to know your child’s sleep schedule and whether they have trouble falling asleep, staying asleep, or waking up. Bring with you a complete family history including family members who may have drug or alcohol dependence since this can be a sign of self-medicating an undiagnosed mental illness. Document family members that exhibit signs of depression or extreme anger which also could be indicative of an undiagnosed illness. It is also important to note that childhood adverse experiences can cause your child to have symptoms very much like a mental illness that in fact just needs time, therapy, and parent education. So if you know your child has experienced some difficult things, it is important to fully disclose this during the assessment process. It does your child no good to be put on medication when it is not a mental illness.You will also want to go in with pad and paper to take notes. We always think we will remember everything that is said, but we generally do not. Keep in mind that as the clinician gets to know your child the diagnoses might change. This is due to there being so many overlapping symptoms that until all the information is gathered, it is difficult to accurately give a diagnosis.
There are several qualified professionals that deal with mental health. The difference is to what degree they received. A psychologist will have a master degree or a doctorate degree in psychology. LCSW stands for the licensed clinical social worker. As the title says, they received their master degree in social work which may or may not contain much in the way of therapy training. A therapist could have an LCSW or a degree in psychology. There are also community counselors that may only need a bachelor in some form of human behavior; ie, social work, human services, or psychology. It really boils down to the path that they chose to take. But, as previously mentioned, not all routes have a focus on therapy. It is important to understand what their credentials are and what specific training they have. It is not out of line to have them explain these things to you along with what approach they will be using to help your family.
If you are advised and so choose to obtain medication for your child’s symptoms, you would need to see a psychiatrist or a psychiatric nurse practitioner. The psychiatrist who will have a doctorate degree and will have had additional training in pharmacology. The psychiatric nurse practitioner has their advanced practice degree and has taken additional courses in therapy, psychiatry, and pharmacology.
Here on out, I will refer to psychologists, therapists, and LCPC’s as clinicians and psychiatrists and nurse practitioners as doctors. What to look for in a clinician/doctor? One of the main things that I already mentioned is that they have specialized training in pediatrics. The next thing is to find out what type of therapies they are well trained in. Not all clinicians are created equally.
Here are some of the evidenced-based therapies that are out there today. We have CBT cognitive behavioral therapy this is used to challenge flawed behaviors and thoughts that can often lead to increased anxiety and depression. There is also DBT dialectical behavior therapy. This is similar and actually, an offshoot of CBT accept the goal is less challenging for the client but helps the client to recognize the need for change. Some clients feel easily judged. These are the client’s that seem to do better with DBT. DBT incorporates mindfulness training which is about acceptance and living in the now. There is also ACT acceptance and commitment therapy which uses acceptance of the client’s past, thoughts, and feelings without feeling the need to hide from them. It also uses mindfulness to learn acceptance and the need for changing negative behaviors associated with those memories.
Mindfulness also helps the adolescent in this therapy approach to begin taking action toward change. ACT uses defusion to separate words from emotions (Ruiz, 2010). In ACT, cognitive defusion techniques are applied in an attempt to alter undesirable functions of thoughts and other private events instead of denying their existence. (Bass, C., Van Nevel, J., & Swart, J. (2014)
Then there is MDT Mode Deactivation Therapy. This was developed for working with aggressive youth with conduct disorders.
This was originally developed to be a proactive strategy in the response to trauma and abuse (Beck, 1996). The main goal of this therapy approach is to work together with the youth in collaboration to help in discovering how to change their current maladaptive behavior from being socially unacceptable to being acceptable with normal healthy responses to trauma and stress (Bayles, Blossom, & Apsche, 2014). As such, MDT has then shown to be very effective in the reduction of physical and sexual aggression among aggressive male adolescents (Apsche, 2010). (Bass, C., Van Nevel, J., & Swart, J. (2014)
In order to get the care your child needs it is important to look into evidenced-based therapies. This is not an all-inclusive list, nor are they fully defined. But I wanted to give you information that I wished I had when we started our journey through the mental health system. It is imperative that there is a large family component to their therapy. Even if you have a healthy home, it is likely that there are changes that could be made to better support your child. Sometimes we think that we are going to drop our child off, and they are just going to fix him. But the fact of the matter is that this is going to take a team effort. Everybody including siblings needs to be involved. Many of our homes are not as healthy as they once were. When we are thrown into unexpected chaos, we generally do not perform at our best. This is why everyone needs to be involved and supported through the process of understanding what needs to be happening now. Psycho-education should be a large part of the services your family is receiving. Psycho-education helps everyone understand what the struggles of mental illness are and how they affect the entire family. These are things that were sadly missing from my son’s care. I hope this information will be helpful in getting you and your child the proper help that is needed.
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