Finding effective help for emotional and behavioral problems in children can be daunting because there are a number of different kinds of professionals who offer it. And the range of treatments available can be even more confusing. How do you know if the person you are seeing is a good choice for your child, and what he or she is recommending is appropriate?
We often meet parents whose children have been treated for emotional or behavioral problems who confess that they don’t really understand the treatment their child has been getting.
If it’s medication, they’re not sure what kind, why it was chosen, or how the right dose was determined. If it’s therapy, they’re not sure what is supposed to happen in treatment, or how exactly it’s expected to help the child.
At the Child Mind Institute we feel strongly that knowing what you should expect from your clinician helps parents make good decisions for their kids.
There are a very wide range of therapies and medications that can be effective for kids, and no two children’s needs are exactly alike. But there are some general standards that you can use to determine whether the care your child is getting follows best practices.
1. Diagnosis comes before treatment. First, the cardinal rule is that before beginning treatment your child should have a diagnosis. This means that your child should be given a thorough evaluation that includes the clinician interviewing you and your child and, in many cases, using standardized assessments. The evaluation process is important because a cluster of behavioral or emotional symptoms can mean a lot of different things, and treatment won’t be effective unless it’s targeted to the right problem.
2. Treatment should have a specified goal. Whether your child’s clinician is offering therapy or prescribing medication, she should be able to explain what the treatment she is proposing is and how your child’s mood and behavior should respond to it. She should also tell you how those changes will be measured. The clinician’s willingness and ability to communicate this information is important.
3. Treatment should be evidence-based. The clinician should be able to tell you what research supports the use of the treatment she is proposing, and how effective it was in reducing the symptoms it is designed to target. There are studies measuring the results of both behavioral therapies and medications specifically in children, and often comparing the two.
4. Your practitioner should have expertise in using this treatment. Training and experience are important whether your clinician is prescribing medications or engaging in therapy. Experience providing this treatment specifically to children is also important, as children can respond differently to medications or may require different kinds of therapy than adults. It’s appropriate to ask the clinician how many children he has treated with this medication or this specific therapy.
5. A clinician prescribing medication should take great care in establishing the dosage. This usually involves starting with a very low dose and building gradually to an effective level. This is because children vary widely in their responses to medication that acts on the brain—there’s no such thing as a dose that works for most kids, even adjusted for their weight. Only careful attention to finding the right dose will make it clear whether or not the medication works for your child, how well it works, and whether there are problematic side effects. Read more about finding the right dose.
6. A child taking medication should be closely monitored as he changes and grows. As children develop, their response to medication can be expected to change. Guidelines vary, but a rule of thumb is that 6-month check-ins are considered best practice, with more (and sometimes much more) frequent visits when a new medication is started, an old one is discontinued, or a dosage is changed.
7. In behavior therapy, you should be involved along with your child. Behavioral treatments can be very effective for children, and evidence shows that they are most effective when parents are given an active role in helping children get better. Your clinician should be enlisting your help to continue treatment outside sessions in the office. Teachers, caregivers, and other adults who spend time with your child should be on the same page, too.
8. Professionals should work together. Whatever treatment your child is receiving, you will want the professionals in your child’s life to communicate and cooperate with each other. Children do best when pediatricians, psychiatrists, psychologists, and teachers share information and agree on goals and the steps to achieve them.
9. Your child should feel comfortable with the clinician. Developing a good rapport is important because your child needs to be able to share his thoughts and feelings with his clinician. And for kids doing behavior therapy, trusting the clinician is essential for making progress. Treatment will be undermined if a good relationship isn’t established.
10. You should have good communication with the clinician. You should feel comfortable sharing your observations and concerns with your clinician, and know that they are being taken seriously. The clinician-family relationship is important, and when it isn’t working it can impact treatment.