Taking Charge of Your Child's Emotional Health

But the journey isn't an easy one. There are many challenges along the way. You worry about your child's physical problems and how they will be resolved. You also wonder whether your child might develop emotional problems.

Does my child have an emotional problem?

One of the most difficult tasks you may confront is deciding whether your child could have an emotional problem. For example, she or he might be afraid to go to school, be prone to "lying," be abusive to a sibling or have difficulty falling asleep at night.

How do you respond? If you have a spouse or partner, he or she could be someone with whom you can share your concern and arrive at a thoughtful conclusion. Sometimes, however, your spouse or partner may not be able to understand why you are worried. As you try to understand your child's behavior, friends, relatives, or even a child's teacher may be helpful in deciding whether your child might have a problem.

One task is to overcome the natural tendency to deny there is a problem. You may also find it difficult to overcome guilt feelings that you might have contributed to the problem in some way. Friends and relatives, with the best of intentions, may try to reassure you that "it is nothing" or that "your child will outgrow it." Maybe your child will, but you deserve the opportunity to talk about your child and give yourself peace of mind. You may decide to seek counseling.

How does counseling work?

Counseling is a special kind of talking. It means bringing to your awareness feelings you have kept inside for a long time. This dialogue occurs between patients or parents and a professional whom they trust.

A counseling relationship allows you to listen to your own words, and also gives you a way of stepping outside of yourself to see how your way of feeling and thinking about parenting affects how you actually behave toward your child and others in your family. With this new perspective, you may be able to figure out how to solve a long-standing problem in a new, creative way. It also provides you with a choice about how you might wish to respond to similar problems in the future.

Who is there to help me?

Once you overcome those obstacles, what might be your next step? Which professional might help you discuss your fears, decide if there is a problem and choose the kind of help your child and you might need? Whom can you trust?

Your community usually provides a variety of resources. Your child's teacher or school counselor may suggest a child psychologist or psychiatrist, a clinical social worker, a behavioral pediatrician, or a mental health center. These are all excellent resources. Since a psychosocial consultation can be provided by different types of professionals, I have labeled such a person with the general term "counselor."

But there may be someone else for you to consider: your own pediatrician. Could he or she play a useful role in helping you plan your next steps?

Your pediatrician has known your family over time. He or she has seen your child for regular checkups and has observed your child's growth and development. You may have mentioned, from time to time, worries about other members of your family including issues of health, loss of job, even deaths in the family. Might not the pediatrician be a possible resource, at least initially, to talk with about your child's emotional health?

Pediatricians will vary in how they may respond to your concern. Some may be pleased to help you with the initial assessment. Others may prefer to identify an appropriate resource for you within the community, reassuring you that you are taking a constructive first step.

Remember, seeing a counselor doesn't mean that your child will require therapy. It merely indicates that additional time and expertise is required than is usually available in the routine office visit.

What types of questions do parents ask?

1. Why isn't there a quick answer to my child's problem?
   
   It would be wonderful if there was. Unfortunately, there are no easy answers. Every child is unique. Both family values and history play important roles in how a child grows and develops. It takes time to address the complex threads that create each child's special situation. And, the solution must make sense to you after taking time for careful consideration.
   
   
2. Why doesn't the counselor just talk to the child?
   
   That may happen later on . Helping children often starts with helping parents. That may involve understanding how you, as parents, are doing. It may also include understanding how you, yourselves, were raised and something of your own early life experiences.
   
   
3. Should one or both parents be present?
   
   Both, if possible. Sometimes each of you may share perceptions about your child that the other may have never been fully aware of, and that exchange of ideas may be as useful as anything that the counselor could suggest.
   
   
4. Suppose one parent is reluctant to come?
   
   That is OK. If one parent comes in, shares her or his concerns and gains useful insights, that often has a positive effect on other members of the family.
   
   
5. Suppose I have questions before the visit?
   
   Don't hesitate to call the counselor with any questions or concerns before you meet. Such meetings are not meant to be mysterious; the objective is not to find problems. Instead, they are meant to help you and your child become aware of how much you have already accomplished and what you can now do in this challenging area of your child's development.
   
   
6. What if I'm not comfortable with the counselor?
   
   Even though the counselor you have chosen may be well-trained and well-intentioned, it is possible that the chemistry between you may seem less than ideal. If you feel you have given it a good try, consider seeking a second opinion. You need to feel comfortable with your choice.

What should parents expect from a counseling experience?

Whoever is the counselor, keep in mind that how they listen to you describe the problem, the questions they ask you to clarify your concerns, and how they go about helping you consider your next steps, should help you take charge of your child's emotional health.

Whatever you and they choose to do, you should feel that you are being listened to in a thoughtful, compassionate way, that you have time to express your concerns, and that you and the counselor are charting a course to begin resolving your child's problem.

The parent as a story teller

Every parent has a family story to tell which may reveal to both you and the counselor what may be at the root of your child's difficulty. The story may be not only about the child but also about your family as a whole. The problem may not only have an immediate history but one that may go back in time, even to several generations. I hope you will feel comfortable sharing that story.

Is the assessment confidential?

You should be reassured that such discussions are absolutely confidential in accordance with the law. Don't hesitate to ask the counselor about confidentiality. Personal information will not be shared with the insurance company or managed care plan. From the standpoint of a pediatrician, the only information that should be disclosed would be that you came in for a consultation, period!

What types of questions might you be asked?

An assessment of your child's behavior problem will be done either by the pediatrician or, more often, by the counselor that he or she recommends. The evaluation of the problem could take as long as an hour in order to get a sense of what is going on. What would represent an adequate assessment?

An evaluation should include a thorough review of your concerns, including when the problem began, whether it coincided with a recent event or if it has been more longstanding. You may be asked what you believe are contributing factors as well as what you have done so far.

If there are two parents, you may be asked if you view the problem similarly or differently, and what each of you think might be the cause.

The counselor will usually ask how your child is doing in a variety of areas, such as eating, sleeping, separation, fears and habits (for example, thumb sucking or nail biting). Depending upon the age of the child, the counselor may ask about the developmental history and how he or she does with discipline, other children or school.

If you have other children, you may be asked how they are doing, and whether there are any marital problems.

You may be asked about your worries for the future if nothing is done about your child's behavior. Sometimes, you may worry that your child may have "inherited" a problem from some other relatives. Or your child may remind you of someone else, particularly a member of your own family.

It may not be easy, but talking with your counselor about those family members who had an impact upon you, talking about the affection and anger that you may have or had toward these individuals, may be helpful. By so doing, you may be able to gradually separate them in your mind from your child, so that you can look upon your child as the separate person he or she really is.

Sometimes there are "family secrets" or worries that may seem related to the development of your child's problem. They may include a family history of alcoholism, abuse or mental illness. Counselors recognize that sharing such concerns may be difficult or painful. Nevertheless because a discussion of the family history can be very important in helping you deal with your child's behavior, I would encourage you to consider passing on such information to the counselor.

There may have been "losses" (for example, a premature death, a serious illness, loss of a job, or a divorce) that you may feel contribute, at least in part, to the development of the problem. You may be encouraged to share those events and how you feel your family may have been affected.

Finally, an assessment should also include a discussion of your child's and your family's strengths and successes.

How can you judge the quality of the outcome?

At the end of such an evaluation by the counselor, you should feel that:

• he or she was genuinely interested in the individuality of your family
• you have not only shared your thoughts and feelings but are also gradually acquiring a feeling of competence in addressing your child's problems
• you have choices in confronting these problems, and you have the capacity for making good decisions

It is worth remembering, however , that such achievements take time.

The visit should broaden your perspective about the family in which you were raised

Of course, the greatest challenge for parents is to help their children become the mature, loving individuals they have the right to become.

But for many reasons, children may remind you of other individuals in your family including your spouse, your parents, as well as yourself or your siblings, in the past or present.

This is normal. Many traits we project upon our children are special, charming, worthy of being passed on. Unfortunately, some of them may not be. In the course of telling your story, you may discover whom you are really describing. Once you do, you may then be able to move on and come to see your own children as the unique children they really are.

The issue of control

Raising children obligates parents to think about how they address the idea of "control" in their own families. Occasionally parents may not agree about how to manage this issue. You may feel vulnerable for one or more reasons.

One or both of your parents might have seemed "out of control" or might have been too controlling. A consequence may be that you may have difficulty giving your own children sufficient guidance or limits for fear of being over-controlling yourself.

Sleep problems

More than 95% of children should be able to sleep through the night by four months of age. On the other hand, some have stated that it is probably the commonest emotional problem of childhood.

When sleep problems are allowed to become a chronic issue, it may say to the child, "You can't cope with loneliness ... You don't have the strength ...You need me to feel secure ..." If that is the case, the challenge is to find out why you believe that to be true.

Alcoholism and mental illness in families

You may worry that alcoholism or mental illness is inherited. It certainly seems as if they are because there is be a higher incidence of such problems in some families compared to others. Your counselor may suggest that such tendencies could be acquired rather than inherited. If that were the case, it raises the possibility that parents and children have a greater potential to become masters of their own destiny.

Managed care and parent counseling

You may believe that pediatricians do not have time for counseling because HMOs do not reimburse pediatricians for such intervention. That seems to be changing. Some HMOs are gradually allowing pediatricians to do so. If you are in any doubt whether your health plan supports this type of intervention, check with them to make sure that this is a covered benefit.

Many pediatricians are aware which health plans support this type of counseling. All that is required is for the pediatrician to state that he or she has spent the requisite time doing so.

Other sources of funding

There are additional sources of financial support that are available to families, depending upon the child's age, the nature and the severity of the problem, as well as the family's financial status.

Resources include early intervention programs for the newborn to three age group including children with developmental or behavioral problems, and Department of Education funds for children with learning disabilities.

If your child is disabled, he or she may be eligible for financial support through Supplemental Security Insurance (SSI). In addition, the state departments of social services, mental health, and retardation may also provide you with support.

Your pediatrician, or the social worker in you community hospital or mental health center, may help you apply for assistance from such agencies and resources.

The child's problem is an opportunity!

While it is painful to confront developmental issues in your children, problems can also be seen as an opportunity to assess how you and your child are doing, and the earlier the better.

As your pediatrician or counselor listens to you, you may discover that the problem has been bubbling under the surface for some time. By reconsidering how your family is doing, you may find ways of constructive intervention that could help your whole family not only address the current problem but also become stronger in the long run.

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