How to Know When Young Children Need Therapy

This is a question that troubles a lot of parents and caregivers, so if you’re asking yourself this question, don’t worry, you’re not alone. A lot of people are surprised when I tell them that I often work with very young children. Some of the doubts people express have to do with children’s ability to hear, understand, and remember stressful events. It’s true that young children experience the world really differently from older children and adults. You might think back to your own childhood and think, “Sure, there were some hard times, but I never had to go to therapy!” These are all really valid reasons to wonder whether therapy is necessary for a young child.

I’m glad people feel skeptical about sending young children to therapy, because I don’t think it’s good for anyone to get therapy they don’t need. In fact, I think that drawing way too much attention to stress when kids are having a normal reaction to stress can make things worse! But I also know that kids give off some really subtle signs that they’re having a hard time, and that sometimes even the most well-intentioned parents and caregivers can miss those signs, and therefore miss a chance to help before the problems get worse. So I’m here to help you get a better sense of what is a normal stress response, and what are some signs that your child needs you to reach out for some professional help.

Young children face lots of stressors. Some common stressors children experience include developmental changes, like learning to crawl and walk, learning to eat solid foods, trying new foods, potty training, welcoming (or not welcoming) a new sibling, teething, family structure changes like break-ups and divorces, season and weather changes, moves, changes to the people they see regularly like a babysitter or neighbor, and many, many more. The littlest changes in routine can trigger a stress response for young children. Consider this: if something in your family life is stressful to you, it is most definitely stressful to your child, and many things that are not particularly stressful for you are stressful for your child. For young children, everything new that happens, including positive things, is stressful because it is a new thing for them to understand and master. That takes lots of mental energy and sometimes physical energy and is hard on our little ones!

Some stressors that young children experience are more serious than the ones listed above. Despite your best attempts, your child may have seen, heard, or experienced something traumatic, such as being physically abused or witnessing physical abuse, losing a parent or loved one, experiencing a serious and life-threatening illness, or one of these other adverse experiences. When this happens, it is strongly advisable for you to take your child to see a trauma-informed therapist to screen your child for symptoms of PTSD regardless of what you are seeing at home. The therapist will be able to use specialized tools and skills to determine in partnership with you whether your child needs therapy to help cope with the experience.

Most children will experience some brief regression in their skills and activities during these stressors, lasting a few weeks at most. You might notice your child sleeping or eating differently, speaking less often, playing less or differently, changes in behavior at home and/or school, appearing angry or irritable, becoming tearful often, having frequent tantrums, being aggressive, acting more impulsively than usual, having accidents, clinging to you, or otherwise behaving unusually. Here is a similar, more thorough checklist for you to consult. Your job as a parent during this time is to reassure your child as much as possible and tolerate their regression; you are their rock, and they need to know that regardless of the changes and stressors taking place in their life, you’ll be there for them.

When the changes you’ve noticed last longer than a few weeks past the change or stressor, you should begin to consider whether your child needs some additional help to cope with the stress. This is the time to contact a therapist for a screening and assessment.

In your first few visits with a therapist, they will want to collect a lot of information about you and your child. While you may be eager to jump right into therapy, it’s important that your therapist take the time to assess your child for symptoms of an emotional health need so that they can provide the kind of therapy that is right for your child, or refer you and your child to a different kind of specialist. Not all therapists treat all types of issues presenting in early childhood. Your therapist might refer you to early intervention, the public schools for testing, a developmental pediatrician, a psychological testing agency, an occupational therapist, or an ABA specialist, just to name a few! If that feels overwhelming for you, don’t worry: your therapist will be able to explain the reason for this referral.

In order for a therapist to bill your health insurance, they must diagnose your child. If you are paying for therapy out of pocket, a diagnosis is not required, but therapists are still ethically compelled to let you know if they believe your child meets criteria for a mental health diagnosis. Therapists may use multiple different tools to assess and then either diagnose your child, or refer you elsewhere if they feel that more intensive assessment is needed to produce an accurate diagnosis. A mental health diagnosis is protected health information, which means that no one needs to know except for you and your therapist (and your insurance company, for billing purposes). Many parents fear that a diagnosis will cause their child to be “labeled” in school. The truth is, a diagnosis is kept private unless you authorize it being shared outside of therapy. Your child’s school does not need to know your child’s diagnosis unless you think it will help your child access services and education more effectively.

I hope this has helped you understand the process of choosing whether and when to bring your young child to therapy, and what the beginnings of the process look like. If you are asking the question, you are already doing the right thing for your child!