In this four-part series, we are going to dive into the experience of a mental health diagnosis for children: how to know if a child should be tested, what to look for, what questions to ask, how to explain a diagnosis to the child, and more. Dr. Méroudjie Denis, a Licensed Psychologist and our Director of Clinical Program Innovation will break it down. 

In part one, we explored the stigma and fear that surround a mental health diagnosis.

In part two, we are looking at testing for mental health concerns.  

What reasons would a parent or caregiver have for testing? How do you know when to get your child tested? 

One of the things that gets in the way of getting kids tested, in addition to the stigma and fear, is that it’s not always clear when to pursue it. It’s sort of like when you have a rash on your arm. You have to wonder if it’s something that might just be a flare up and will go away on its own, or if it’s cause for concern. Then, if you do decide to do something about it, you have to know that a dermatologist is the right kind of doctor for that issue, then you have to find one, see if your insurance covers it, and the list goes on. And in many ways, identifying whether and how to treat a rash on your skin can be a lot easier than doing that for a mental health concern.  

So, the first step to any of this is the realization that a child’s struggle may be beyond a typical trajectory for a child of their age. We don’t always want to compare children, as every child is unique, but there is an overall range of typical development that we can pay attention to.  

What that means is that it’s not always helpful to compare two children, like siblings or cousins. For example, if a first-born child is reading at age four, parents don’t need to worry that something is wrong if their second child isn’t reading yet at four. But we can say that a typically developing child should be reading somewhere between the ages of four and seven, so if a child is finishing up first grade and still struggling to read, it might be cause for concern. The same applies to behavior. It’s perfectly reasonable that a 2-year-old might throw himself down on the floor and have a tantrum. This is because 2-year-olds don’t have the language and self-regulation skills to express their feelings. If a 5-year-old is consistently throwing himself on the floor in tantrum, that might be more cause for concern.  

So, I will say that while it’s important to pay attention to the issues that seem concerning, it’s also important to know what is normal. Just because a 5-year-old needs to be reminded three times to brush her teeth every evening doesn’t mean she has ADHD. It means she’s a 5-year-old.  

Short of knowing every developmental milestone range, what filter could a parent/caregiver use to know when something may be cause for concern?  

The question I would consider is: is there anything getting in the way of this child’s ability to do what they need to do to live a healthy and productive life? That includes: are they able to make and maintain friendships? Are they learning and retaining knowledge? Are they able to take care of their daily needs? If you have a child who is able to do all of these things, there probably isn’t cause for testing. A child may have some traits that make them a little quirky or unique, or maybe even a little challenging for the parent, but that doesn’t mean it’s an issue that must be diagnosed. For example, if they have something like texture sensitivities to food but they manage to eat a healthy diet, or their room is always kind of messy, but they can pick it up when reminded… these things are normal part of childhood.  

On the other hand, if the child is having a hard time learning at school and their teacher has expressed concern, or if they have limited peer relationships or don’t seem to be able to connect with others, or if they have frequent behavior challenges that seem larger than should be reasonable based on the experience, these are reasons to consider having a child evaluated by a professional.  

With older kids, it can be hard to tell the difference between typical teen struggles and more severe mental health conditions. It’s very normal for teens to go through different behavior changes as their hormones change and peer relationships, dating and other teen experiences take center stage. Especially as we come out of two years of the pandemic, which has brought so much trauma to so many, we are seeing more teens who are experiencing heightened anxiety or some periods of low mood. 

And if you’re just not sure…? 

It never hurts to start the conversation. Parents and caregivers can always ask the child’s teacher, the pediatrician, the school counselor or any other professional who has experience with their child to see if they recommend testing. If the child is old enough, I would recommend parents checking in directly with the child. This can sound like, “I noticed you are sleeping a lot more and spending more time on your own. You also haven’t been out with your friends lately. Is everything ok? 

And of course, I strongly believe that we need to support all children who need it with mental health care, whether it is behavior issues, learning challenges, attention difficulties, children who might have experienced a traumatic event, all children should have access to a professional who can support them. It doesn’t necessarily mean they have a clinical diagnosis, but they should be supported. This support can be preventative care that deters the need for a formal diagnosis later on. 

In part three, we will dive into the testing process.