Q&A: Age-appropriate therapy and mental health support

We know that our mental health is an important part of our overall well-being at any age. But when is the right time or age to bring in a mental health professional? A national health interview survey found that just 11.3% of kids ages 5 to 11 received mental health treatment in 2021, compared to 18.9% of those 12 to 17. So, what signs should parents look out for, and what's the best approach for children at different ages?

We're joined by Dr. Felix Trede of the East Boston Neighborhood Health Center to talk about age-appropriate therapy.

Is there an age to start bringing your child in for therapy?

Trede said there isn't a specific age range he recommends a child might start therapy, but age can factor in to the type of therapy that might work best.

"You know, younger children say age 3 to 6 will likely benefit more from play therapy, whereas older children might gravitate more towards traditional talk therapy. You know, in my practice, I work with children of all ages and I have some children where we we do a combination of both, you know, where we may have begun doing play therapy and then as the child gets older, will transition into some more traditional talk therapy and still engage in some play therapy, which could be helpful for the child in processing experiences and emotions."

He adds that there are therapies available to children as young as 2, and they often focus on parent-child interaction and equipping a parent will the tools they need to support their child's needs.

"And I think family therapy is also a great option really for families with children of all ages where the therapist could support the entire family in communicating and navigating some of the challenges that may be coming up with the child."

What are warning signs that you may need to bring your child to a professional?

Trede says some signs may be obvious, and others more subtle.

"So if your child is telling you they need help or if people close to them are expressing significant concerns about their mental health, if they're telling you they're feeling depressed, that they're having a lot of anxiety, that they're having thoughts of self-harm or suicide, those are some evidence signs that your child really may need help. It's also important to pay attention to the difference between externalized and internalized symptoms of mental health. And so externalized symptoms are more evident and easier to detect. It could be increases in aggression, risky behaviors, substance use. Those are some examples."

Trede says trickier signs are the more internalized ones.

"The child might be struggling to express some warning signs to look out for when it comes to those internalized symptoms. They include isolation, withdrawal, changes in your child's appetite or sleep, a lack of interest in activities that once gave them joy, increased hopelessness."

He believes it's important for families to normalize talking about mental health so children can be comfortable and confident expressing their struggles.

How to find a provider who is a good fit

Trust between the patient and the provider, but also the parent and provider is an important factor to consider.

"I would start by talking with your child about their preference. Do they have an idea of what kind of person they might feel comfortable with? Do they would they feel more comfortable with a therapist of a certain gender identity or from a certain racial or cultural background?"

Trede says it's a good idea to ask for an initial meeting with a therapist before they meet your child so you as a parent can get a sense of how they make you feel.

"You're the expert on your child, so you might have a sense of whether they would be a good fit to work with your child. So I get that pretty regularly that parents might prefer to meet with me first before I meet their child."

Is medication the right option for my child?

The appropriate use of medication, especially in younger children, is an ongoing debate in the field. And while studies have found early intervention to be helpful in a variety of behavioral and mental health issues, there is no clear-cut answer on what the best approach is.

Trede says being thorough is very important when considering if medication is the right option.

"It's a difficult and sometimes controversial topic. I have encountered situations where I've been concerned that a child may have been medicated inappropriately and that can have negative consequences on their mental health and physical health, possibly," Trede said.

He used an example of how common symptoms of one problem may overlap with another, leading to an incorrect diagnosis. But medication can also have many benefits, and shouldn't be discounted as an option.

"I think my take-home message message is that it's very important to carefully evaluate and diagnose before considering medication for a child in most instances. Right. I would usually recommend, if possible, to begin with, non-pharmacological interventions before considering medication. That being said, there are some circumstances where, you know, intervening with medication early on in treatment may also be important and appropriate. If there are some severe symptoms, for example, psychotic symptoms, if the child is engaging in high-risk behaviors that we're very concerned about, then sometimes earlier intervention with medication may be indicated," Trede said.

Combating stigma

Stigma and cultural sensitivities still hang over the mental health space, and sometimes that can lead parents to be hesitant to reach out to a professional. Trede says his goal is always to connect with his patients and their parents to understand where their hesitancy might come from so they can work through it together.

"I really want to understand a person's particular concerns about access to mental health care, because those concerns often are coming from a valid and reasonable place. Many of the folks we work with have had difficult experiences in the past, perhaps when it comes to either mental health care or medical care or the system. So I really want to hear them out first and validate those concerns. But then with with the person's permission, I might also provide some information that might be helpful. So I might talk to a parent about what therapy with their child would look like and how it could benefit them. Some important pieces that I'd like to talk about are confidentiality and what that means. The importance of involving the parent in the treatment as much as possible," Trede said.

He adds that no one should ever feel pressured to continue a treatment plan they aren't comfortable with or ready for.

Resources

You can learn more about the services available through the East Boston Neighborhood Health Center here.

Find mental health support in Massachusetts here.