Every stage of childhood is marked with a change in parenting, and each stage has unique joys and challenges. When your child seems unable or unwilling to embrace the challenges, at what point should you ask for help beyond your parenting network?


  “When your child is in distress and they are not functioning in their basic roles at school or the family, it is time to seek help,” says Laurene Allen, agency director at the Family Guidance Center of Milford. “’Functioning’ means: Are they getting up and going to school and participating? Are they making friends, being part of the family?” 


  All kids have days they don’t want to go to school or their sibling’s soccer game. When children are in distress for whatever reason, this protest can be extraordinary and can interfere with the function of the family. Distress can manifest as problems academically or interacting with peers in the classroom, or acting out within the family. Children in distress may express fear about an activity or they may have trouble controlling their anger. 


  Everyone has a unique learning and coping style, but often parents or school counselors will be able to tell when a child just isn’t functioning well. 


  “Three of the most common diagnoses for therapy referrals are anxiety, depression, or being on the autism spectrum,” says Michael Cirillo, PhD, ABPP-CN, clinical neuropsychologist and cofounder of Cornerstone Behavioral Health in Worcester.


  If parents believe it is time to seek professional help, there are three tiers of services to which they can turn. 


1. Counselors. This is a mix of mental health professionals, including licensed social workers and mental health nurses. Councilors are licensed in their field and have extensive training in working with families and children. Often it is a counselor who does the initial assessment with a child or family.


2. Psychologists. These professionals are trained to provide counseling, psychotherapy and testing. Some of the tests they may conduct include IQ tests, visual motor integration tests, memory tests, and personality tests. Psychotherapy includes various talk therapy, group and individual counseling, and family therapy. 


3. Psychiatrist. Psychiatrists are medical doctors with additional training in mental health. They can prescribe medication, which can effectively treat many disorders.


  In children, anxiety and depression can be caused by many factors, some quite similar to adults, and others unique to developing young people. “Kids experience loss issues and that can be expressed in anxiety or sadness,” Allen says. “That is especially true if you have a really sensitive kid. Learning struggles in school can cause some kids a lot of anxiety. Sometimes if parents, or the kids themselves, have had serious medical issues this can be expressed as anxiety. And sometimes we see kids with a lot of anxiety who have experienced abuse or trauma.”


  “All kids have some fears and worries, but when they are significantly interfering or taking up a lot of time, you should seek help. Two common expressions of anxiety in kids: avoidance and social anxiety,” Cirillo says. 


 





  Avoidance is just like it sounds, kids try their best to avoid going to school, activities, and events. While every child might like to avoid school on a big test day, or picture day if they have a funny haircut, when this behavior gets extreme or it is getting more and more difficult to get a child to an activity, it is called avoidance. Social anxiety is beyond just having butterflies on the first day of school or before a school dance. Social anxiety interferes with a child doing something in which they want to take part.


  Childhood depression depends on the age (and stage of a child), but anytime a child is sad for days that turn into weeks, a parent should seek help. This is especially true in teens and tweens. 


  “Adolescents sometimes can hurt themselves, scratching, hair pulling, and things like that. It is often schools who hear about distress like this from peers,” Allen says. 


  If a school counselor has recommended that a child be evaluated to determine if he falls on the autism spectrum, that will likely be performed by a mixed team of mental health professionals as children need to be evaluated on social skills, motor functioning, and cognitive processes. 


  Generally, a mental health team starts with an evaluation and the complexity of that report determines what happens next. 


  “If the child had a diagnostic, psychological, or neuropsychological evaluation, parents will receive the results in a report. The evaluation will include things like background, when the problem started, medical history, any previous treatment, and information about education. It will include the results of any tests given by team. And it will include the diagnosis and treatment options,” Cirillo says. 


  Kids are sometimes an amplifier of distress in the family. Counselors may broaden the therapy to include family counseling. Family counseling centers and family therapists can provide parents with guidance on care decisions and general parenting issues.


  “We are parenting in complex times,” says Allen. “Sometimes parents ask themselves ‘Am I on the right track?’ and seeking a consult with a family counselor can really help. That can help parents learn how to talk to their kids and help things fall into place.”