to Seek a Mental Health Referral
By Barbara Keith Walter, PhD, MPH and Dennis Clements, MD, PhD,
health disorders are more common in children and adolescents than
many people realize. Studies show that at least one in five children
and adolescents have a mental health disorder. At least one in 10,
or about six million, has a serious emotional disturbance.
is a child displaying enough concerns with emotions, behavior, development,
or school performance to warrant a referral to a mental health specialist?
adults, children and adolescents can have developmental, learning,
or mental health disorders that interfere with the way they think,
feel, behave, and learn.
untreated, mental health disorders can persist into adulthood and
can be very costly to individuals, families, communities, and the
health care system. Untreated disorders can lead to school failure,
family conflicts, substance abuse, violence, crime, and suicide.
there are many barriers that make it difficult for people with mental
health disorders to receive appropriate care, including:
of health insurance, insurance restrictions, and other financial
Complex and fragmented mental health service delivery systems
Perceived stigma that discourages families from seeking care
Lack of culturally appropriate care
Lack of available mental health professionals with expertise in
treating children and adolescents
of a Problem
The American Academy of Child and Adolescent Psychiatry (AACAP Facts
for Families, No. 24, July 2004, or http://www.aacap.org/publications/factsfam/whenhelp.htm)
has described the following signs which may indicate a problem that
requires further evaluation from a qualified mental health professional:
Children (Ages 5 to 10)
fall in school performance
Poor grades in school despite trying very hard
Severe worry or anxiety, as shown by regular refusal to go to school,
go to sleep, or take part in activities that are normal for the
Hyperactivity, fidgeting, or constant movement beyond regular playing
Persistent disobedience or aggression (longer than six months) and
provocative opposition to authority figures
Frequent, unexplained temper tantrums
Pre-Adolescents and Adolescents (Ages 11 to 18)
change in school performance
Inability to cope with problems and daily activities
Marked changes in sleeping or eating habits
Frequent physical complaints
Sexual acting out
Depression shown by sustained prolonged negative mood and attitude,
often accompanied by poor appetite, difficulty sleeping, or thoughts
Abuse of alcohol or drugs
Intense fear of becoming obese with no relationship to actual body
weight; purging food or restricting eating
Threats of self-harm or harm to others
Self-injury or self-destructive behavior
Frequent outbursts of anger, aggression
Threats to run away
Aggressive or non-aggressive consistent violation of rights of others;
opposition to authority, truancy, thefts, or vandalism
Strange thoughts, beliefs, feelings, or unusual behaviors
considering whether your child or adolescent would benefit from
seeing a mental health professional, it is important to not just
focus on individual signs and symptoms, but to look at the intensity,
frequency, and persistence of the presenting symptoms and the degree
to which they interfere with the childs functioning.
it is also very important to be aware that you should seek an urgent
evaluation if you believe that your child is at immediate risk of
harm to themselves or others or there has been an acute deterioration
of thinking, emotions, or behavior that could place the child at
risk for harm to self or others.
to Go for Help
Once you have decided to seek help for your child or family, it
is often confusing to know where to start.
often find it helpful to discuss their concerns with a family member,
friend, teacher, school counselor, church leader, or primary health
variety of mental health practitioners can also be confusing, and
your insurance may have a specific network of providers from which
you must choose or services you might need a referral or prior authorization
to use with your insurance benefits.
addition, in many communities, there is a shortage of specialists
trained in the identification, diagnosis, and treatment of childhood
should try to find a mental health professional with advanced training
and experience with the evaluation and treatment of children, adolescents,
and families. However, it is also very important to find a good
match between your child, your family, and the mental health professional.
are a variety of mental health professionals who can evaluate and
treat children and adolescents with mental disorders, including
child and adolescent psychiatrists, developmental and behavioral
pediatricians, pediatric neurologists, clinical or pediatric psychologists,
clinical social workers, psychiatric nurses, pastoral counselors,
and a variety of other types of licensed counselors and therapists.
of these professionals have training in the evaluation and treatment
of children and adolescents, but the nature and extent of their
should always ask about the professionals training and experience.
While some physicians, nurses, and social workers are trained in
administering some tests as part of their assessment, psychologists
typically receive specialized training in administering and interpreting
developmental, psychological, and educational tests.
in most states only physicians, such as child and adolescent psychiatrists,
developmental and behavioral pediatricians, and pediatric neurologists,
can prescribe and monitor medication.
Keith Walter, PhD, MPH, is a pediatric psychologist who is an assistant
clinical professor of medical psychology in the Department of Psychiatry
& Behavioral Sciences at Duke University Medical Center and
the clinical coordinator of the Behavior, Development, and Mental
Health Team at Duke Children's Primary Care. Dennis Clements, MD,
PhD, MPH, is the chief medical officer of Duke Children's Hospital.
For information, visit www.dukehealth.org
information presented on this site is intended solely as a general
educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.