One of the questions I get more than almost any other is a question from parents concerning whether or not their children need to see a therapist. Parents have observed behaviors in their children that they are worried about or they do not see behaviors in their children that they think most "normal" kids should be doing and they are worried. Every situation is different and this brief newspaper column cannot answer all questions, but I hope to give you some guidance so that you might be able to answer this question yourself.
First of all, with any disturbance, whether in adults or children, I first want to know how much the problem is interrupting the person's life. If, for example, a parent tells me her child is extremely shy and doesn't seem to make friends easily. I want to know if the observed behavior (shyness) is interrupting the child's ability to do the things that he or she enjoys. If the shyness doesn't interrupt the child's life and if the parents are able to do the things they need to do despite the shyness in the child, then I usually suggest that the parents not worry about it. Even if the child had a diagnosable disorder, it makes little difference if he or she is functioning well.
On the other hand, a parent tells me that his son has a problem getting along in school. The child is nine years of age and has been disciplined numerous times at school and at church. The parents have chosen to take the child out of two different schools because the administrators and teachers, by the parent's estimation, didn't handle the situation correctly. This is most certainly a problem. The child is not functioning effectively in more than one environment and the behavior is also causing problems for the parents. Whether or not the child has a diagnosable disorder, something has to change.
Using this one rule, I can often guide parents over the phone without seeing the child. I suggest to the parent that if the situation doesn't improve or if they would like me to see the child anyway, then I'll make an appointment with them.
Second, there are some problems that are almost always serious. Children who are deliberately cruel to animals or human beings potentially are deeply troubled individuals. It is abnormal to deliberately be cruel to living creatures. Children who are acting out sexually, depending on the behavior and their developmental ages, also are displaying signs of potential disturbance or trauma. Children who set fires deliberately and repeatedly are of concern to me as well. I will always make an appointment to see the child in my office if these behaviors are reported.
Finally, sometimes the problem is actually with the parent or parents and not the child. Many times over the years I have worked with children who were actually the most mentally healthy people of their family. When I suggest therapy for the parent as a way to help the child, sometimes parents are willing and sometimes they are not. When parents are experiencing the stress of financial burdens, marital problems, abuse, or other significant life stressors, it almost always affects the children in the home. Children in these homes may act out aggressively, they may vandalize property, or they may withdraw. Older children may experiment with cigarettes, drugs, and alcohol. Resolution of these problems requires treating the cause - the distress in the parents' lives.
I would always rather parents seek help when they don't need it than to wait too long when their children do need help. It is easier to deal with problems early. If you think your child may need therapeutic intervention, I discourage using the phone book to find a therapist. Even though there are many competent and exceptional psychologists in the field, there are also some who are not. Seek references from people that you trust - ministers, others who have had their children in therapy, or from people in the profession.
