My son was three when I took him to see a mental health professional for the first time. Ari was little, but challenging in so many ways. He refused to walk outside when it rained. He’d scream whenever water splashed on his clothes. He would never fingerpaint in nursery school; he didn’t like to get his hands dirty. By the time he developed an obsessive habit of tucking in chairs at the kitchen table, I knew it was time to do something.
I first described his symptoms to our paediatrician. “This sounds a little outside the norm. I’m going to refer you to a child psychiatrist,” he said, scribbling notes into Ari’s chart. I looked at my son, so gorgeous and complex, and realized I was scared.
What if something really was wrong with his mental health? What if it was serious? I wanted to backtrack. Maybe this was a big overreaction. So what if Ari wanted to tiptoe through the rain? Was there any harm in using a paintbrush instead of his fingers? As we drove to the appointment a few weeks later, I felt sick to my stomach.
Statistics from the Hincks-Dellcrest Centre, one of Canada’s leading children’s mental health centres, indicates that one in five children suffer from a mental health problem, including depression, anxiety and conduct disorders. This can lead to family crises, school disruption, violent behaviour or even suicide in extreme cases. Early intervention makes a big difference in improving a child’s mental and physical well-being, decreasing stress in the family, promoting greater school success and reducing delinquency later in life. There are even financial benefits for society: Every dollar spent on prevention and intervention in early childhood saves seven dollars in future social and healthcare costs.
What’s startling is that only one in five children who need help receive it, due to factors that include a shortage of children’s mental health professionals, the lack of awareness parents have about options and a stigma about children’s mental health in general.
I admit I was concerned about the stigma. Would Ari be ostracized if my friends found out? Would other moms judge me and think I was an incapable parent? Worst of all, would Ari think something was wrong with him? Still, we walked in the psychiatrist’s door together and never looked back.
Worrisome changes in your child’s behaviour, such as withdrawal, sadness, anxiousness and a sudden disinterest in hobbies, can be a sign that she needs professional help. Experts say these changes can be triggered by things like parents separating, the loss of a loved one, moving, bullying or even difficulty with academic workloads. My son’s new anxieties coinciding with my separation from his father made it clear that something wasn’t quite right, but I had to connect the dots to figure out if emerging habits, like a nose-scratching tic, were somehow related to his new family reality. It can be tricky; not all the warning signs of mental health issues are obvious.
“Some children might exhibit physical symptoms, such as the sudden onset of unexplained head or stomach aches, changes in appetite or sleep disturbances,” says Stella Kavoukian, a mediator and therapist in Toronto who works with children and adults. “These concerns may need to be checked out by the child’s regular doctor, but are often associated with stressful experiences in her life and can be alleviated by speaking with a therapist. Parents aren’t always equipped to know what to do.”
Teachers can be good sources of information about how your child is coping in social and academic settings, and doctors can help figure out if things like headaches or a regression in behaviour, such as bedwetting, might be a medical issue or a sign of emotional distress.
Daphne Mizrachi* found herself contemplating finding a therapist for her son, Eddie, when he was nine. There were mean kids on the bus, and he began to fear the ride to school, had difficulty sleeping and lost interest in his favourite things, like hockey and Lego. Mizrachi felt frustrated and sad for her son. “I know kids will be kids, but there seemed to be no reprieve or help for little ones on the bus when they were having problems.”
Mizrachi tried coaching Eddie, giving him advice on how to ward off bullies, but after more than six months of her son’s inability to fall and stay asleep, and him begging to be driven to school, she knew she needed help that the school wasn’t providing. But she quickly came up against another obstacle: her husband. “He was outraged by the idea of getting Eddie help. He thought others would think there was something wrong with Eddie—and that Eddie would think something was wrong with him, too,” she says.
Convinced help was important, Mizrachi took Eddie to see a social worker at their local child and youth centre. “Within three sessions with a counsellor, Eddie was able to open up. He told me he liked talking to his counsellor, and he never showed any resistance when it was time for his appointment,” she says.
The therapy made a world of difference. Eddie gradually returned to his normal demeanour and sleeping habits and his interest in activities returned. “It wasn’t instant like a light switch being turned on, but it did seem to be a very quick ‘recovery’ once he was able to let out everything he had kept inside all those months,” Mizrachi says.
The main message from experts: If your child is struggling, you’ve spoken to his teacher and paediatrician, and you’re not sure how else to help, it may be time to speak to a professional who specializes in children’s mental health.
In Kavoukian’s experience, many parents feel it’s helpful for their child to see someone for support and to have a neutral, safe space in which to discuss their feelings. Children can be wary of being open in front of a parent; they don’t want to cause parents to worry or risk hurting their feelings. “Learning to identify and articulate feelings will also help the child feel more in control and develop communication skills,” she says.
No matter which type of therapy you choose, chances are you and your child will be nervous about going to counselling. So what’s the best way to approach it? “I tell parents to introduce the notion by saying something like, ‘We met someone who talks to people about their worries, thoughts and feelings. We thought it might be a good idea to meet with her. We liked her, and we think you’re going to like her too,’” Kavoukian says.
Sometimes, therapists may invite parents to partake in part of a session. There may also be homework for the family so that parents are part of the process. It may be as simple as talking to your child each night about the best and worst parts of her day and discussing how she handled it or what she learned from it.
There are no rules for how long your child may need to see the therapist. Often, self-esteem-related issues and those involving loss take longer to address. For other problems, like anxiety, your child might benefit from having a few sessions and then returning for check-ins when needed.
Ari’s therapist had games and toys in her office and colourful drawings on the wall. At our first appointment, she spent time talking to Ari by himself and to me and my ex separately. She told us that Ari had some anxious tendencies that could develop into anxiety if we left them and gave us tools to help him overcome his quirks before they grew out of control. “Let him experiment with paint and other tactile objects so he can have experience getting his hands dirty,” she suggested. “Reassure him that he can change into another shirt when the one he’s wearing gets wet.”
Slowly but surely, it began to work.
Mizrachi puts it best: “For any parents worried about the stigma of getting their children therapy, I would ask them what’s most important, the health and happiness of your child or the opinions of judgmental parents who don’t even know your situation?”
We have been doing our best to listen to Ari, to empathize and help him work through his anxieties. Now six, Ari is still a worrier, but he has come a long way. I hadn’t realized how far until recently, when his ice cream splattered onto the floor. He picked it up with his hand, plopped it back on the cone, wiped his hands on his shirt and continued to lick his ice cream. I’d never been so proud.
How do you find a therapist? Your doctor, friends or teachers may have recommendations and may also be aware of local agencies that can provide support for your child’s individual needs, such as support groups that deal with issues like bereavement or divorce.
Fees and referral requirements vary for each type of service. As a general guideline, you may need a doctor’s referral to see a psychiatrist. You do not need a referral to see a therapist in private practice, but if the services are covered by private health insurance, you may be required to submit a referral letter. Some community organizations offer services free of charge.
Social workers generally charge between $125 and $175 hourly, and their fees are income tax deductible. Psychologists’ fees are usually upwards of $200 an hour. Their services are covered by provincial health insurance if the psychologist is employed by a hospital, community clinic, social agency or school. If you’ve seen one privately and have extended health benefits, they may cover a portion of the fees annually.
Therapy can offer significant benefits for children, but sometimes it’s actually the parents who could use some support.
“Children are resilient, and not every child needs to go for counselling for every form of stress,” says Abdul Rahman, a psychiatrist at Alberta Children’s Hospital in Calgary. “Most minor stressors need normal coaching and support by a parent. There are many loving and caring parents who themselves just need a boost of coaching for specific issues that may be interfering with normal functioning of a child.”
Angela Bain* discovered the benefits of a type of counselling called parent coaching. “I’ve found that instead of rushing my son to appointments, it’s better for me to see my parent coach and get the tools and advice I need to parent him better,” says Bain, a mom of five. Her son, Matthew, now 12, has been seeing therapists on and off since he was three—and so has she.
“So much of how Matthew copes with issues like ADHD, defiance and anxiety is how I deal with it. When things go off the rails, I put myself in his shoes, and I try to be kind. I might want to yell at him when he’s teasing his siblings, but parent coaching has taught me to do what doesn’t come naturally in the moment.”
*Name has been changed
A version of this article appeared in our July/August 2015 issue with the headline, "Does your kid need a therapist?" p. 41.