11

Find Professional Help for Your Family

When life throws you a curveball, sometimes you need professional guidance to help your family navigate. The curveball could be troubling behavior changes stemming from an event such as divorce, illness, or death, as discussed in the previous chapter. Or it may be less drastic changes, but unfamiliar or unusual nonetheless—such as your child’s frustration stemming from a suspected learning difficulty, aggressive interactions with peers, or unprecedented withdrawal from friends and family. Remember, your children’s emotions come through in their behavior. Whatever your family is facing, you may feel as if your child’s behavioral issues have tossed you into the deep end of the pool and you aren’t sure which way to swim. Whether it’s temporary or long term, when you find yourself dealing with a challenging situation or a problem that is increasing in its severity, you might decide you need to seek professional help.

Deciding when to get help is subjective; we all have a different line in the sand as to what we can handle and when we feel we’re out of our depth. Only you will know where that line might be for you, and your line and your partner’s line may be far apart.

In the midst of a family catastrophe, it’s obvious there will be big changes to which all members must adapt. In some situations, there may just be a slow drift as your family adjusts to increasing dysfunction without recognizing it. In yet other situations, difficulties may develop or become more prominent as your child gets older. Over months, or even years, you may be running out of ideas or feel like you’re at your wit’s end. You might need an outsider’s perspective, which is where that support network we advocated for you in Chapter 10 comes into play. Having trusted family members, close friends, religious leaders, and others you can rely on is crucial in offering up perspectives on knowing when the situation you are in has crossed a line. Soliciting their thoughts, which may confirm or reject your gut feeling about the situation, should be helpful in deciding whether to consult a professional.

There is still somewhat of a stigma attached to mental health issues, as well as to needing parenting help. It’s important to get past that stigma if you feel overwhelmed or unable to cope. Getting help is not a sign of weakness or failure. It’s doing what’s best for your child and your family.

In this chapter, we identify some of the providers available to you and your family in the event you need them, and offer a number of reasons why you might want to seek professional help. We also list ways in which the behavioral issues we’ve already covered—tantrums, homework, mealtime, bedtime, attitude, and special situation stressors—can rise to the level of needing assistance. Finally, we discuss some safety issues when it comes to behavioral problems.

Determine Whom to Turn to for Help

Regardless of your support network, your child’s pediatrician or your family doctor is often your first line of defense. Since you are your child’s best advocate, you need to speak up when you’re unsure or concerned about a behavior, an issue, or a situation. We know you don’t want to come across as needy, high maintenance, or incompetent, or feel like you’re the only parent who isn’t sure what to do when a child’s behavior escalates, but believe us, your doctor has likely heard your question before. Asking for help doesn’t mean you aren’t a good or a capable parent. Remember, your children’s behavior is their way of communicating emotion or feelings, but sometimes important information can be lost in the translation between their behavior and their feelings. Professionals often can serve as an interpreter and help you zero in on the root of your child’s behavioral problem.

Your pediatrician or family doctor can be the main point-person to triage the situation and either handle it with you or direct you to an appropriate resource. This could include a referral to a specialist for an evaluation of the problem and possibly intervention.

Asking for help doesn’t mean you aren’t a good or a capable parent.

1. An evaluation of a problem helps define what’s going on with your child, offers an understanding of that problem, and provides direction for an intervention. Targets for an intervention can be identified and prioritized within the larger scope of the child’s and family’s specific circumstances and resources.
2. An intervention addresses the specifics as to how to deal with the problem, which could involve anything from tutoring to therapy to medicine to a nutritionist/dietician. Within this phase there are some problems that can be fixed, but more chronic problems will need to be managed through compensation, skill building, and accommodation over the long term.

An evaluation and an intervention are two distinct phases of care and may involve seeing separate providers for each.

Do your homework to find the right licensed p rovider.

When selecting a provider, keep in mind that most professions require a license or special certification as a means of ensuring basic qualifications, and requirements vary by state. Be sure to do your homework to find the right licensed provider for the issue with which you are seeking help. Here’s a quick reference to what some of the most commonly referred types of specialists do:

• Psychologist: Typically possesses a Ph.D., Psy.D., or Ed.D. Psychologists study and evaluate mental processes and behavior and provide mental health assessments and interventions. There are numerous subspecialists within psychology, including a child clinical psychologist, who specializes in psychological adjustment and disorders of mental health; a neuropsychologist, who specializes in the relationship between the brain and cognition/behavior; and a health psychologist, who specializes in the relationship between a child’s mental health and physical health conditions.
• Psychiatrist: An M.D. who specializes in the prevention, diagnosis, and treatment of mental disorders. Psychiatrists can prescribe medications, and many possess a subspecialty working with children and adolescents.
• Social Worker: Helps people cope with many problems in their everyday lives. Clinical social workers can diagnose and treat mental, behavioral, and emotional issues. Some social workers also provide case management to help with hardships such as financial difficulties.
• Marriage and Family Therapist: Treats couples and families experiencing difficulties with interpersonal relationships.
• Counselor: Provides intervention and sometimes assessment services to empower individuals, families, and groups in dealing with issues related to mental health and education, as well as behavioral challenges within both of those categories.

Other resources for you and your child are his school teacher, nurse, counselor, and principal. These professionals work with children and see your child on a regular basis, so their perspectives can be valuable. The special-education department at your child’s school can also be a wealth of local information about issues ranging from learning problems and behavioral issues to mental health diagnosis and treatment. Additional resources may be available by contacting your insurance company; employee-assistance program at work; or your state, county, or city governments.

Whomever you see, it’s important to feel that the person you choose is credible and that you can trust his or her opinion. Various professionals and even specialists within the same broad profession may have different ways of approaching issues, and you should ask questions to feel confident that you are approaching evaluation or treatment in a manner that makes sense to you. Assessment and treatment of childhood issues should not feel like a mystery—there is no magic to the diagnosis and treatment of child and family issues.

Assessment and treatment of childhood issues should not feel like a mystery.

If you’re seeking parenting guidance, you should have some level of agreement with the behavioral and parenting approach that the professional typically uses. If you’re seeking therapy for your child, the fit between the therapist and your child is very important to facilitate effective treatment. There are numerous characteristics that may make a difference or play a role in helping you select a provider to work with your child. These include:

• Qualifications, experience, specialist certifications
• Geographic convenience
• Financial considerations (cost, insurance coverage)
• Gender
• Age
• Religious orientation (if important to you)

Good therapy can be uncomfortable at times as issues are addressed and progress is made, so don’t jump ship at the first mention that your child didn’t like something this professional said or did. At the same time, the relationship is important, so if you or your child are having trouble making a comfortable connection with the therapist, discuss the issue with him (professionals typically don’t take this personally!). In some cases, arrangements may have to be made to transition to another specialist.

How to Decide to Call a Professional

There are many reasons why you might decide to see a professional for your child, yourself, or your entire family. As stated in the beginning of this chapter, each person’s line is going to be different, and it’s sometimes hard to know if you’ve crossed it. One way can be to take stock of the ways this problem you are having has impacted or obstructed your family or your child’s life. This can mean an interference with social relationships, cognitive or academic development, emotional wellbeing, behavioral competence, or even physical health. The greater amount of disruption from the normal track the child’s life has taken until this point, the higher the stakes of your family situation and the more you should consider leaning on professional help.

Evaluating and determining treatment is the job of the professional you bring in, and not yourself as a parent. We’re explaining this not only in order to demystify the process of mental health evaluation, but also to give you some clarity in determining whether a situation in your family crosses the line between coping at home and needing help to cope.

In Dr. Pete’s pediatric neuropsychology practice, he’s seen many parents who tell him they waited and waited to seek help. Whether these parents delayed due to a stigma of taking their child to a psychologist or because they thought the problem would resolve itself, most of them stated they wished they had sought help much earlier.

The bottom line is that if you feel your child’s quality of life is being negatively impacted, call and see if you can get some help. You can call for your own peace of mind, to increase your confidence in the track you’ve taken thus far, and in order to reduce your stress, as well as for the health, wellbeing, and safety of your family.

Here are some examples of services that professionals can provide for children having specific types of troubles:

• Testing and/or intervention for a learning problem, attention problem, developmental concerns
• Assessment and/or intervention for a mental health condition, such as depression or anxiety
• Evaluation and/or intervention for a behavior disorder
• Evaluation and/or intervention for social difficulties

The list of reasons why you might seek help is long. This list encompasses only a few common ones and certainly is not the totality of reasons parents might seek help for their child or family.

Here are a couple of real-life examples needing varying degrees of assistance:

1. Michael and Tonya were concerned that something was going on with their seven-year-old son, Elijah. All of a sudden he was acting out in school, becoming aggressive at recess, and refusing to do his homework. They were fielding notes from Elijah’s teacher at least once or twice a week, and then the principal started calling. They were both pretty stressed about the situation, having never before dealt with behavioral issues of any magnitude.

Michael and Tonya went in for a parent conference with the teacher, principal, and a school guidance counselor. In checking back through the instances of problem behavior at school, they pinpointed an uptick focused on the block of time the class works on reading, and recess, which falls directly afterward. Armed with that knowledge, they had Elijah tested for a possible learning disability in reading.

After getting the results of the evaluation, Michael and Tonya were able to make a more informed decision and use the resources available to them to get targeted help for Elijah. Once he felt more comfortable in reading class, he was able to behave better and the instances of aggression on the playground decreased dramatically. When he got help from a tutor, Elijah went back to completing his homework without meltdowns.

2. Rico and Maribel’s daughter, Giulia, found herself suddenly without a core group of friends when her social group changed suddenly in the middle of fifth grade. As middle school loomed, her parents were increasingly concerned that Giulia seemed depressed. At home, she moped and lost interest in many activities and started complaining of a headache every morning before school.

Rico and Maribel talked first to the school guidance counselor, who shared some of the same concerns and recommended a psychologist. The psychologist they saw was similarly concerned about depression, but said the diagnosis wasn’t certain at this point given that Giulia seemed to be reacting to changes in her social group. She gave Rico and Maribel some specific actions they could take to provide their daughter with additional social opportunities.

Meantime, the school guidance counselor asked Giulia to show a girl who’d just moved to town around the school, allowing for a natural new friendship to form. Rico and Maribel were able to reach out to that girl’s family and foster the growth of that friendship. Together, the girls joined a recreational volleyball league and made friends with several teammates. Giulia’s parents capitalized on her love of art by signing her up for a weekend oil-painting class, where she received positive feedback and a boost to her confidence. Rico and Maribel kept vigilant for signs of social distress and even depression in Giulia and the psychologist stated the family is welcome to return for a session should something else come up.

If you read through the previous chapters about specific behavior problem spots but felt your own troubles went beyond what was reflected in the strategies or examples, you might want to consider calling a provider for help. Parents can educate themselves on all aspects of childhood development, employ every strategy correctly and fully, and still not solve the problem.

In some cases, you may need an outside perspective to see the problem clearly. In other cases, your child may need a professional evaluation and intervention. What follows are some of the problem areas that we’ve previously discussed and indicators that professional help may be needed:

• Tantrums that are intense and continuing at the same frequency even though you are using the right Universal Strategies, or habitual tantrums that involve destructive and/or violent behavior.
• Homework-related issues that have been the basis for a battle every night with the child hating school, refusing to do homework assignments, and grades declining.
• Mealtime problems when the child is so disruptive that the family literally can’t have a meal.
• Bedtime problems when the child doesn’t sleep, affecting his or her performance at school during the day and/or family members’ sleep at night. (A common red flag is communication from a teacher about the child’s problems staying alert or paying attention).
• Attitude behaviors that have turned into a battle of wills, with every interaction seeming negative, deeply affecting the parent–child relationship.
• Social issues if the child is experiencing peer neglect, and certainly if he is experiencing peer rejection, is being bullied, or has been accused of bullying.
• Catastrophic family stressors such as a terminal illness or death of a parent or sibling, as well as when there are signs of stress with a divorce or a move.

Recognize When a Behavior Is a Serious Concern

The safety of your child and your family is your first priority. Any time you feel as if a child’s behavior presents a danger to himself or to others, you must reach out for help.

If a child’s behavior presents a danger, reach out for help.

Keep in mind that in children of this age, behavior is their way of communicating emotion. They may not have all the words, or even the self-awareness, to explain that they are having a problem. Instead, they may act out, or withdraw, as a way of expressing their feelings. A marked change in behavior is often a key indicator of stress. Change doesn’t always mean there’s a problem, but it should be a red flag for you to consider what’s going on around your child.

Examples of some of the behaviors that can be serious include the following:

• Talking about or attempting to harm self or others
• Aggressive, violent behavior
• Depressed or irritable mood
• Social withdrawal
• Feelings of worthlessness, hopelessness
• Anxiety, extreme fear or avoidance (of a person or place)
• Bullying or being targeted for negative interactions from a peer

When considering these behaviors, look, too, to your child’s social media accounts if she is allowed access. Permitting your child to use social media is a parent’s decision, but not something we advocate in the age range of 3 to 11 years old. Nonetheless, reviewing your child’s activity history can allow you to spot a problem. In some cases, a child may be feeling worthless, anxious or violent or show other emotions we have discussed without taking concrete action on those feelings. However, she may test the waters by posting clues on her social media pages that she is having these feelings.

She may test the waters by posting clues on her social media pages.

It is critical that parents who allow access to social media monitor their children’s activities. For the child’s safety, anything a child posts should be taken with the same degree of seriousness as if he had said it out loud. If it’s innocuous, then you can teach him a hard lesson about appropriate posting. Otherwise, you may have caught something in its early stages and can take steps to address it immediately.

Don’t take chances. If your child’s behavior leads you to suspect there is something serious going on under the surface, contact your family doctor or other professional listed in this chapter and ask for help.

• • •

Deciding to seek professional guidance for your child or your family is not always easy, but it can be the best thing you’ve ever done to help them. Steer clear of the stigma of getting professional help by not buying into it and know that you are investing in your child’s long-term emotional and physical health. Whether you seek assistance from a psychologist, psychiatrist, therapist, counselor, or other type of professional, your child, and indeed your entire family, can benefit.