Regardless of the treatment provider you choose or the level of care to be provided, effective treatment should begin with a comprehensive initial assessment/evaluation of your child’s difficulties and related treatment needs. The length of time it takes for an initial assessment varies from 2-5 hours (conducted over 1-5 sessions), depending on the treatment provider’s professional training and/or treatment philosophy. The goal of the assessment is to determine what is causing and/or maintaining your child’s difficulties and how to effectively intervene. In order to have a comprehensive understanding of your child’s difficulties, many treatment providers will want to get input from other caretakers, school officials and other agencies or treatment providers working with your child. A treatment provider will need your written consent in order to speak to anyone outside of you and your child.
At the conclusion of the assessment, your treatment provider should report to you what he/she thinks is going on with your child, if there is a diagnosable psychiatric disorder and the best course of treatment. A child’s emotional, behavioral and/or social difficulties can be explained many different ways. Remember that it is possible to get varying opinions from different professionals.
Different Diagnoses And Their Implication For Treatment:
Generally, I explain a child’s emotional, behavioral and/or relationship difficulties in one of two ways: difficulties caused and maintained by a life stressor or difficulties caused and maintained by a psychiatric disorder.
Difficulties caused and maintained by a life-stressor can be linked to a specific environmental trigger including developmental/physical changes, conflict with family or friends, parents’ divorce, illness or death of a family member and/or some other negative life event. A child experiencing difficulties caused and maintained by a life stressor typically responds well to individual outpatient therapy and the experience of being listened to, understood and emotionally supported. Even if therapy is not provided, there is a good chance that the child’s difficulties will stabilize and improve as the child matures and/or the life stressor passes.
Difficulties caused and maintained by a psychiatric disorder appear to be independent of a life stressor even though several might be occurring in an individual’s life. A child experiencing difficulties caused and maintained by a psychiatric disorder, may or may not respond to individual outpatient therapy. The less motivated a child is to acknowledging and working on his/her life difficulties, the less likely individual outpatient therapy will be effective. Treatment often needs to be supplemented by other therapies including family education, family therapy, parent/child management training, group therapy, self-help programs and medication. Having an accurate diagnosis is essential to developing and implementing the most effective treatment plan possible. An inaccurate diagnosis can result in ineffective treatment and, in the worst-case scenario, an intensification of symptoms. If treatment is not provided, there is a good chance that the child’s difficulties will continue to intensify and cause ongoing relationship, school and general life impairment.
The following are categories of disorders for which children and teenagers commonly need treatment:
- Mood Disorders
- Anxiety Disorders
- Disruptive Behavior Disorders
- Eating Disorders
- Substance Abuse Disorders
- Thought Disorders
- Personality Disorders
The table below identifies specific disorders within each category and the most effective treatments as prescribed by a variety of mental health researchers. It is intended to provide you with a general overview that can serve as a starting point for accessing additional information from your child’s treatment provider and other credible sources.
Please keep in mind that the table below does not provide a complete list of effective treatments; rather, only treatments backed by consistent research evidence are presented. There are many treatments without consistent research evidence that are considered worthwhile by treatment providers and may be selected as a primary treatment for your child. If you ever have any questions or concerns about the type of treatment that your child is receiving, speak to your child’s treatment provider about it. I believe a skilled and effective treatment provider will welcome your inquiry and be willing and able to explain his/her rationale for the treatment being administered.
When it is indicated that there is no consistent evidence of an effective treatment or medication, it does not mean that no treatment exists for a disorder, but rather, that no one treatment has produced consistent positive research findings. In such cases, treatments commonly used with some degree of effectiveness are indicated.
TABLE 1 – CATEGORIES OF DISORDERS & THEIR TREATMENT
Disruptive Behavior Disorders
*References supporting the above table appear in the back of this handbook.
Please note that there are a number of disorders that are resistant to individual talk therapy (as defined in section 2 of this handbook). With disorders that are considered biological in nature and/or characterized by a child’s unwillingness to acknowledge life difficulties, a lack of motivation for change, blaming others for one’s life difficulties and/or a resistance to participating in therapy, the focus of treatment becomes the family dynamics and parenting style. The hope is to assist parents and family members in creating a home environment that serves to reduce stress, teach healthy coping strategies and motivate the child to work on changing maladaptive patterns of thoughts, emotions and behaviors.
If you bring your child to a treatment provider with the hope that he/she will be “fixed”, it can feel invalidating and frustrating to hear that the focus of treatment will need to be on your family dynamics or parenting style. The recommendation may seem to imply that you are in some way the cause of your child’s difficulties. If you are given the recommendation of parent training or some other family focused intervention, please understand that it is not an indictment of your parenting but rather a reflection of the nature of your child’s difficulties and the limitations of standard individual outpatient therapy. Traditional “instinctive parenting” needs to be supplemented by parenting strategies and skills specific to your child’s difficulty.