Signs Your Child May Benefit From Counseling

Nick Parker

3 hours ago

6 min read

A child may benefit from counseling when a change in mood or behavior lasts for weeks or longer, upsets your child or the family, or gets in the way of school, home life or friendships. The signs look different in a six-year-old than in a sixteen-year-old, so it helps to know both.

Key points

Look at how long a change lasts, how much distress it causes, and whether it disrupts daily life.
Young children often show stress through tantrums, stomachaches, sleep problems and clinginess.
Older children and teenagers are more likely to withdraw, lose interest, or take risks.
A teacher or your child's doctor can tell you whether they see the same thing you do.
Any talk of self-harm or suicide needs help right away, not a wait-and-see approach.

How do I know if my child needs counseling?

Every child has hard days. Many children have occasional fears, worries or disruptive behavior, and most of the time these pass without any outside help. That is why a single bad week is rarely the thing to measure.

The National Institute of Mental Health suggests three questions instead. Has the behavior or feeling lasted for weeks or longer? Is it causing distress for your child or your family? Is it getting in the way of how your child functions at school, at home or with friends?

If the answer to any of these is yes, an evaluation is reasonable. Asking for one does not mean something is wrong with your child or with your parenting. It means you want a trained person to take a look.

Signs in young children: preschool and elementary school

Young children rarely say "I feel anxious" or "I am sad." They show it in their bodies and their behavior. Signs that a younger child may benefit from an evaluation include:

Frequent tantrums, or being irritable much of the time
Often seeming fearful or worried
Stomachaches or headaches that keep coming back with no known medical cause
Being in constant motion and unable to sit quietly, except during a favorite activity
Sleeping too much or too little, frequent nightmares, or seeming sleepy during the day
Little interest in playing with other children, or trouble making friends
Struggling in school, or a recent drop in grades
Repeating actions or checking things many times out of fear that something bad may happen
Regularly refusing to go to school, go to sleep, or join activities that are normal for the child's age

Signs in preteens and teenagers

Older children are better at hiding what they feel, and some pulling away from parents is part of growing up. What matters is a clear change from how your child usually is. Signs to take seriously in an older child or adolescent include:

Losing interest in things they used to enjoy
Low energy, or sleeping far more or far less than usual
Spending more and more time alone and avoiding friends or family
A marked decline in schoolwork, or great difficulty concentrating
Severe mood swings, or frequent outbursts of anger
Excessive dieting or exercise, or an intense fear of gaining weight
Smoking, drinking or using drugs
Risky or destructive behavior, alone or with friends
Self-harm, such as cutting or burning the skin, or thoughts of suicide

What is typical, and what is worth a call?

A preschooler who melts down when overtired, a second grader who is nervous before a sleepover, and a middle schooler who is moody after a falling-out with a friend are all showing ordinary reactions. They tend to be tied to a clear cause and to ease within days.

A sign is worth a call when it sticks around, spreads to more than one part of life, or keeps your child from doing things other children the same age do. Pay closer attention after a big change, such as a loss, a divorce or separation, a move, a new school, or bullying. These are times when children are more likely to struggle.

Trust what you see. Parents know their child best, and you do not need to be certain before you ask a professional for an opinion. For teenagers in particular, our parent guide to teen anxiety and school stress goes into more detail.

Do not wait on these

Your child talks about wanting to hurt or kill themselves, or about hurting someone else.
You find signs of self-harm.
Your child's behavior has become unsafe.
If your child is in crisis, call or text 988 (the Suicide and Crisis Lifeline) or call 911. Our office does not provide emergency services.

What should I do next if I am worried?

Talk with your child. Pick a calm, private moment and say what you have noticed, without blame. An honest, open talk about feelings can often help, and it tells your child that you are paying attention.
Ask the other adults in your child's life. Teachers, coaches and caregivers see your child in settings you do not. Ask whether they have noticed the same changes and when they started.
Talk to your child's doctor. A pediatrician or other health care provider can check for a medical cause and can refer you to a mental health professional who works with children.
Schedule an assessment with a counselor. A first appointment is a conversation, not a commitment. If you are unsure how to explain it at home, see how to talk to your child about therapy.

How Balanced Life can help

Balanced Life Counseling Services works with children, teens and families at our offices in Salisbury and Bethesda, Maryland, in person and by telehealth. You can read about counseling for children and counseling for teens, or about family therapy when the whole household is affected.

We are accepting new patients. To ask a question or set up a first appointment, contact our office, and see insurance and fees for the plans we accept and our self-pay rates.

Frequently asked questions

At what age can a child start counseling?

There is no single starting age. Signs that a child could benefit from an evaluation can appear in the preschool years, and some forms of therapy for children, such as play therapy, use toys, drawings and games instead of relying on conversation alone. If you are wondering whether your child is old enough, call and describe what you are seeing. We can tell you whether one of our clinicians is a fit for your child's age and needs.

Is it just a phase, or should I be concerned?

A phase usually has a clear trigger, stays in one area of life, and fades within days or a couple of weeks. It is more concerning when a change lasts for weeks or longer, causes real distress, or interferes with school, home or friendships. If you cannot tell which one you are looking at, that uncertainty is a good enough reason to ask a professional.

Should I talk to the school before calling a counselor?

You can do both, in either order. Teachers often notice changes in attention, friendships and mood that do not show up at home, and their observations help a counselor understand the full picture. If your child needs support during the school day, the school can also tell you whether accommodations, such as an individualized education program, may apply.

Does asking for an evaluation mean my child will get a diagnosis?

No. An evaluation is a way to understand what is going on. Sometimes the result is reassurance and a few ideas to try at home. Sometimes it points to a condition such as anxiety or depression, which can be treated. Either way, you leave with more information than you had, and the decision about what to do next stays with you and your child.

Sources

If you are in crisis or thinking about suicide, call or text 988 (Suicide and Crisis Lifeline). In an emergency, call 911.