Treating Children's Mental Health with Therapy

Overview

A public health approach to children's mental health includes promoting mental health for all children, providing preventive intervention to children at risk, and providing treatment for children with identified disorders.

Mental, emotional, and behavioral disorders in childhood can cause long-term problems that may affect the health and well-being of children, families, and communities. Treating a child's mental health problems as soon as possible can help children reduce problems at home, in school, and in forming friendships. It can also help with healthy development into adulthood.

Psychological therapy is a key component to improving mental health. Depending on the type and severity of the problem, psychological therapy for children may be used in combination with medication.

A brief overview of therapy

Psychological therapy is meant to treat a mental health condition or help a child manage their symptoms so that they can function well at home, in school, and in their community.

When children are young, it is common for therapy to include the parents or caregivers. Sometimes therapists work with the parents or caregivers alone. Older children may meet with a therapist alone as well. Some types of therapy include working with the whole family or other important adults in the child's life (for example, a teacher).

Parent-focused approaches typically mean that parents talk with the therapist about the child's behavior and feelings. Psychological therapy with children can include talking, playing, or other activities to help the child express feelings and thoughts. Therapists may also observe parents and caregivers and children together and then make suggestions for finding different ways to react.

Psychological therapy for children can be done one-on-one or in groups. Sometimes, a combination of therapies and treatment approaches is the most effective approach for helping a child.

Evidence-based therapies

Behavior therapy

Behavior therapy teaches children and their families how to strengthen positive child behaviors and eliminate or reduce unwanted or problem behaviors.

One type is parent training in behavior management.

• The therapist works with parents or caregivers to strengthen the nurturing relationship between parents and children and learn or improve skills to manage their child's behavior.
• Parents or caregivers are encouraged to practice skills with their child.
• Teachers can also be trained in behavior management to help the child at their childcare center or school.

With older children or adolescents, the therapist usually can also work directly with the child to teach skills and address mental health needs. Parents or caregivers should still be involved to support and strengthen the skills their child is learning and strengthen parent-youth relationships.

Cognitive-behavior therapy

Cognitive-behavior therapy focuses on changing the thoughts and emotions that can affect a child's behavior negatively.

• The therapist helps the child become aware of their thoughts and feelings.
• The therapist also helps the child evaluate if feelings or thoughts may be distorted or illogical, and then helps the child through the process of changing the thoughts as well as the emotional reactions and behaviors that go along with them.
• Cognitive-behavior therapy can involve working directly with the child as well as working with caregivers and children together.
• Even when a therapist works with a child or adolescent directly, it is important for parents or caregivers to be involved and providing support to the therapeutic relationship.
• Engagement of parents and other caregivers is important for treatment at all ages, but the nature of parent involvement will likely differ depending on the developmental age of the child or adolescent.

Finding the right therapy for your child

For the most common childhood conditions, like behavior disorders, anxiety, or depression, approaches using behavior therapy and cognitive-behavior therapy are more likely to reduce symptoms than other therapy approaches.

Based on the scientific evidence available, different therapies seem to work well for different types of problems.

Parent training in behavior management works well for disruptive behavior disorders, including oppositional defiant disorder and conduct disorder. Child behavior therapy also works well for disruptive behavior disorders.

Cognitive-behavior therapy works well for conditions such as:

• Disruptive behavior disorders
• Depression
• Anxiety disorders
• Obsessive-compulsive disorder
• Eating disorders such as anorexia bulimia
• Post-traumatic Stress Disorder (PTSD)

Additional types of therapy can be effective for adolescents.

• Adolescents with disruptive behavior disorders may respond well to family therapy, an approach that includes multiple members of the family and focuses on learning better communication skills and ways to settle conflicts.
• Adolescents with depression may respond well to interpersonal psychotherapy, an approach in which the therapists help the adolescents learn ways to handle relationship problems.

Other therapy approaches may also be effective but have not been studied enough for researchers to understand if they work well. Information on what works best for which family is also still limited.

Finding support

Therapy is most effective if it fits the needs of the specific child and family. A helpful first step is for families to think of what questions or problems they are seeking help for. When contacting mental health providers to seek care, many will ask parents or caregivers to briefly explain what they are looking for help to address.

Families can seek out referrals for a mental health provider through multiple avenues, including the child's school, a primary care provider, or through health insurance. They can also ask for advice from trusted family or friends who may have some experience with providers in the local area.

Some families may choose to talk to a pediatrician or other healthcare provider as a first step.

• Sometimes, health problems such as poor sleep, difficulty hearing, or learning problems can cause behavioral or emotional symptoms, or make them worse.
• A provider or pediatrician may want to find out if your child has any health problems before referring your child for therapy. Before starting therapy, a mental health provider typically conducts a comprehensive evaluation of your child's mental health to figure out what type of therapy might work best.
• To find a pediatrician near you, visit HealthyChildren.org, a service of the American Academy of Pediatrics (AAP) practice organization.

If you need insurance coverage, learn more about enrolling in Medicaid, Children's Health Insurance Program (CHIP), or a Marketplace plan at HealthCare.gov. If your child does not qualify for insurance coverage, you can get low-cost health care at a nearby community health center.

Mental health specialists

Here are additional tools to help find a healthcare provider familiar with treatment options:

• Psychologist Locator, a service of the American Psychological Association (APA) Practice Organization.
• Child and Adolescent Psychiatrist Finder, a research tool by the American Academy of Child and Adolescent Psychiatry (AACAP).
• Find a Cognitive Behavioral Therapist, a search tool by the Association for Behavioral and Cognitive Therapies.
• American Association of Marriage and Family Therapy Locator
• American Board of Professional Psychology Locator
• If you need help finding treatment facilities for mental and substance use, visit FindTreatment.gov.
• Hospital and University Related ADHD Centers
• National Association of Social Workers

Resources

• Comprehensive Psychiatric Evaluation (aacap.org) - American Academy of Child & Adolescent Psychiatry (AACAP) fact sheet
• Evidence-based Therapies - Effective Child Therapy - Society of Clinical Child and Adolescent Psychology
• Children and Mental Health: Is This Just a Stage? - National Institute of Mental Health
• CDC's Treatment of ADHD
• CDC's Mental Health Homepage