Should I be worried? How do I know if my child needs to see a psychologist?

by Joalida Smit

The three-step guide to help you think like a psychologist

Grupo de niños cogidos por los hombros sonriendo

Psychological intervention is not something we should take lightly, it is a serious investment in time, energy and money; although it may be unsettling for the entire family, it can also be a very empowering experience. I believe that the decision to intervene should be based on careful consideration and thinking about what may happen if we DO NOT intervene:

We need to ask ourselves how this offending behaviour may impact on a child or young person’s future if we do nothing. Will this go away by itself? And if not, what will they believe about themselves, and the world they live in? What impact could non-action have on their personality, relationships and ability to take on the world? These questions may not have clear answers, and we may never know what the future holds. Nevertheless, here I share with you my three-step method for thinking like a psychologist about children’s behaviour and when to seek help…


Step 1: How long? How often? How much?

Behaviours, thoughts and feelings come and go. Some may stick around for a bit only to be replaced by something else. With children the only constant is change and within reasonable bounds, this is as it should be – childhood is a time for testing out thoughts and feelings, see how the world responds and then adjusts accordingly. Over years this process of testing and adjustment is how we build up a model of how the world works, what we can expect from others and what others can expect from us.

How long?

Behaviour that has stuck around longer than feels comfortable, despite negative messages from the environment, may indicate that all is not well and that we may need to examine why this is happening. Perhaps the behaviour is inadvertently being reinforced (more attention, having control or releasing some negative feeling in themselves) or the young person has become stuck, perhaps not having a “mental model” or way to think about a troubling situation to be able to resolve it successfully.

Regardless of the reasons, even mild panic, sadness or fearfulness that is not addressed can have a massive impact on a young person if it is allowed to stick around for too long. Why you may ask, because their worlds become centred on managing these emotions; a precocious self-consciousness may emerge focused on managing their feelings, thereby reducing their capacity for spontaneity, exploration and learning through play. At its worst, a child may form negative beliefs about themselves based on their emotional experiences and this can lead to a lifetime of low self-esteem and poor coping. Thus even mild emotional or behavioural issues may have a great impact on child development if allowed to run its course unaddressed.

How often?

Too much of anything is rarely a good thing (apart from chocolate perhaps). Over time, mild but frequent difficulties can actually become quite debilitating. Thus for example, a child who experiences frequent bouts of mild panic or anger during the day may become so over-focused on their feelings they may also not be able to judge experiences, relationships and events positively as these encounters are ‘tainted’ by their intrusive feelings. It may also show a child’s struggle to achieve mastery over their emotional worlds. These are the vulnerable kids –the ones we need to watch carefully. We hope they “get over” their anxieties, and some do, but in my experience, all they need is one negative setback to push them over the edge, so to speak, with massive panic or rage attacks as a consequence.

How much?

Within formal diagnostic systems used by psychiatrists and psychologists severity is defined as the extent to which behaviour interferes with daily life. Psychologists are often called in when behaviour or mood crosses a threshold of what parents may feel is acceptable. These kids are clearly in need of help, they suffer from panic attacks, aggression or depression. They may be easily overwhelmed, with intense and frequent outbursts. Regardless of their difficulty, their stories are often the same: The offending behaviour or mood had been there for a while, we thought it would get better, it even looked as if it was getting better, then suddenly an event occurred which resulted in a major setback. This event could be something innocuous to an outsider, but to the child it means something particular. These situations always unsettle me – there were evidence of a vulnerable child, or controlling, manipulative behaviour, but the adults were, rightly so, conservative in their approach and the “watch-and-wait” strategy was unfortunately not a good one. Once these kids reach us the treatment usually requires in-depth and long-term work, something that may perhaps have been avoided if the “too long” and “too often” criteria were used to evaluate the young person’s behaviour before it reached a critical threshold.


Step 2: What? Where and when?

Understanding the context in which undesirable behaviour occurs also needs consideration. Thinking about what happens (behaviour), where (at school, at home, in public or private) and when (early morning, evenings, all day, before or after lunch) can give clues to WHY it is happening. Understanding is thus the first step towards treatment, and it does not always need professional help! I believe that most parents over time become natural psychologists to survive parenthood! Using the what, when and where may be sufficient to circumvent behaviour becoming an ingrained habit or more severe over time.

For example, we have all experienced the meltdown or emotional outburst at bedtime – we know that tiredness is the trigger, so there is context. Bringing bedtime earlier may shift the behaviour to moaning and tears, but avoid a full-blown saga. However, severity and frequency still needs consideration. Thus if meltdowns occur at bedtime every night with much intensity despite attempts to change the where and when, it may indicate that there is an underlying anxiety or fear that your child feels unable to articulate. If context cannot easily be established, and the WHY seems elusive, we may need to be more concerned as the WHY may be hidden within some psychological process that cannot be shifted by changes to the environment alone. In these situations it may be important to involve the child’s teacher as your child may be responding at home to something that is occurring in another context, possibly at school.


Step 3: Ask the teacher

Teachers have a great advantage over psychologists; whilst we only see one child at a time, teachers see 20, even 30 kids of the same age, all at once for a good few hours a day. In this context it becomes easy to spot the outlier; the one who is sad, anxious, misbehaves or picks fights with others. Often parents become angry with teachers, perhaps for pointing out that there may be a difficulty. Parents feel picked on, their child singled out and not understood; and this may all be true. But even if you disagree, or dislike the teacher, bear in mind, that they may see something you do not! As a psychologist I always take what teachers are saying seriously and I would urge you to do the same.

Child psychologists are familiar with the angel-terror phenomenon: they child who is angel at home and enormously challenging at school. These kids are the ones that often cause friction between teacher and parent. It is important that these children are identified early and supported as over time their peer-relationship and school history can become fraught with conflict and tensions and they rarely reach their academic potential. Their school behaviours may even hide underlying learning difficulties or boredom and it is in their interest to be helped to ensure school remains a joyful experience.


These three steps should provide a baseline for thinking about your child and their behaviour. However, as a mother, I would also say this: Listen to your “gut feel”, your inner voice – if you think something is amiss, it probably is. Most importantly don’t ignore concerns. Don’t be afraid to ask for help – you may find that the solution may not be a long involved two-year therapy process; many issues can be addressed and shifted without extended direct work. Also, bear in mind that by the onset of adolescence it becomes harder to intervene in your child’s life. Change is then based on the quality of your relationship with them, and your ability to help them make different choices. But ultimately the choice will become theirs.

This brings me back to the beginning. Ask yourself: What do you think will happen if you do not intervene? Will your child have the coping tools to survive the challenges of early adulthood? Without a crystal ball these questions cannot be answered, but with my three-step guide I hope that you will be empowered to think about the question more thoroughly.

Joalida Smit is a Clinical Psychologist and Neuropsychologist who specialises in emotional, behavioural and cognitive concerns of children, adolescents and young adults (age 2-25).
For more information contact Joalida Smit

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