Steps to Take if Your Child Needs Help
1. It can be helpful to check in with your child's teacher to find out how school is going for your child academically and socially Many times teachers are surprised when parents ask about anxious children. Often anxious children are well behaved in school and don't cause trouble. However, teachers can tell you if a child looks nervous or uncomfortable in class, has trouble completing tests or assignments, or has trouble taking feedback from the teacher. The teacher will also notice if a child is particularly isolated, ignored by, or actively rejected by his peers.
2. Gather referrals
You can ask a variety of people
about referrals. Your child's pediatrician, teacher and guidance counselor
are all good options. In addition, the Anxiety Disorders Association
of America (adaa.org), Obsessive-Compulsive Foundation (ocf.org), Association
for the Advancement of Behavior Therapy (aabt.org), and The Academy
of Cognitive Therapy (academyofct.org) all have listings of providers
with expertise throughout the world. Parents of other anxious children
often are great referral sources. Area psychiatry departments and university
counseling centers may also either provide service or be able to provide
referrals.
3. Check with your insurance about coverage and therapist availability Make sure to ask your insurance carrier if they have providers experienced with working with children and with cognitive-behavior therapy (exposure and ritual prevention, or ERP, for OCD). Though it takes time, sometimes if you call each therapist referral and ask the same questions, the insurance will pay for another experienced provider outside of their network, if they cannot provide one in their networks.
4. Take some time to observe your child and take notes
It
can be very helpful if a parent can give concrete examples of the behavior
or emotions that are disturbing to the child and family. Note when things
happen (e.g., in new situations, at bedtime, around peers but not adults),
and how often they occur. You don't need to write down every instance
but some good examples can be useful.
5. Interview providers
It is important that you feel
you have a choice with providers and you feel comfortable with the therapist.
You should feel free and entitled to ask the clinician about their background
and experience. Ask them how they treat anxiety in children and listen
for key terms such as: desensitization, cognitive-restructuring, coping
skills, and exposure. A clinician hesitant to answer these questions
may suggest that you do not want to work with that person.
6. The intake process
Following the phone interview,
the clinician will usually set up a first intake visit (the evaluation
process may require between 1-3 sessions). This evaluation process varies
by clinician but usually includes the following:
A. Interview with parent
This
interview varies by clinician. The clinician may ask you to first come
alone without your child so that you feel free to talk without your
child wondering what you are discussing. Other times, the clinician
will split up the session and meet some with the family all together,
some with parents alone, and some with child alone, if the child is
comfortable. The parent interview will focus on the parents' view of
the problem/relevant symptoms and history of the symptoms. The interview
will also include assessment of current stressors, current functioning
with peers and at school, child's strengths, family psychiatric and
medical history, and developmental history. Finally the clinician will
likely ask about how the symptoms have affected the family and the marital
relationship, and parenting approaches that have or have not worked.
Medical and academic records may be reviewed and behavior rating scales
completed.
B. Interview with the child
Young
children are interviewed alone if and when they feel comfortable. If
the child is uncomfortable being interviewed alone, he/she will be interviewed
with the parents until some trust is established with the therapist.
Adolescents are almost always interviewed alone and sometimes before
the parent since establishing a relationship is so important for successful
work with teenagers. Often children and adolescents are better than
parents at reporting their internal experience. There also may be things
that clinicians are good at asking about that parents did not know or
the child did not wish to share with the parent. The clinician will
ask the child many of the same questions they asked the parent especially
about the current symptoms and history of symptoms. The clinician will
work to phrase these questions is child-friendly language.
C. Diagnosis and treatment planning
At
the end of the evaluation period (1-3 sessions), the clinician will
pull all this information together and will share his/her impressions
on the relevant diagnoses for your child and treatment plans that address
these diagnoses. The clinician should discuss various treatment options
with you and answer any questions you may have. This is also the time
that you can decide if this is the person you want to work with.
Different providers that can help your child:
