Determining whether or not your child is experiencing depression or anxiety can be tough. Trying to understand if their tantrums are typical or unusual is also a difficult task. So, how do you know when your child’s behaviors warrant therapy and what type of therapy they need?
Depression can appear in many forms, such as regular irritability, loss of interest in activities, changes in eating and sleep patterns and thoughts of death and/or suicide. Anxiety is considered excessive when it gets in the way and causes problems in daily life. And, if your child struggles with intense emotional reactions, disruptions in mood or behavior, or is easily set off by minor triggers, then they may need assistance.
“Warning signs include any sudden change in mood or behavior, or if you notice that your child or teen is struggling in day to day tasks,” explains Dr. Melissa A. Butler, psychiatrist at Indiana University Health. “If safety towards oneself or others is an issue, or if the emotional or behavioral problems are impacting their functioning, it’s time to seek professional help.”
These problems are best treated with behavioral therapy, such as Cognitive Behavioral Therapy (CBT) or Dialectal Behavioral Therapy (DBT).
CBT focuses on problem solving. “CBT looks at the relationship between thoughts, behaviors or feelings,” explains Dr. Butler. “When someone has depression, anxiety, or ADHD there may be negative or irrational thoughts that lead to certain feelings or behaviors. With CBT, the patient tracks and identifies these thoughts, tests whether they are realistic and is then challenged to replace those thoughts with more positive ones.”
For example, if a child is reprimanded at school for not doing his work and is required to miss recess, he may kick his desk, talk back to the teacher and believe that it’s not fair because people always pick on him. He will document his thoughts in a journal. When he meets with his therapist, they will discuss his thoughts and behaviors, determine if they were rational based on both current and past experiences and, if not, they will work to replace those thoughts with positive ones. In this case, they could recognize that he received an appropriate reprimand for not completing his work, but that he is usually treated well.
CBT also works on managing behaviors, such as those associated with anxiety or depression. If a child is experiencing anxiety, the therapist may work on relaxation techniques to help ease anxiety in stressful situations. For depression, a CBT therapist may focus on creating an activity schedule to guarantee that the child does not withdraw from friends and important events.
Dialectal Behavioral Therapy (DBT) is designed to work with people who have problems with emotional or behavioral dysregulation. These patients are highly sensitive to emotional stimuli – a small incident sets them off, their reactions are very intense and their ability to return to their normal state is much slower than average.
“There are different components of DBT, such as skills training where they learn emotional regulation, distress tolerance and mindfulness skills,” Dr. Butler says. “These skills help patients work on the factors that lead to emotional dysregulation.”
With DBT therapy, parents are a key component. They must learn the skills along with their children and provide a validating environment that focuses on changing behaviors and accepting themselves. For example, a child may learn that her plans to go shopping have been changed. Instead of sulking for a few minutes, she completely melts down – crying, screaming, stomping, kicking or even hitting. With DBT, a parent learns to remove the child from the situation, help them use a skill to calm down and then validates their feelings. Later, they work together to address the situation and determine what can be done differently the next time.
When selecting a behavioral therapy, Dr. Butler recommends parents speak to a variety of providers and ask about their approach. “It’s important to ask if they believe CBT or DBT would be right for your child,” she recommends. “Some therapists combine and integrate different techniques so it is important to understand their approach, experience and training beforehand.”
Selecting the right therapist takes research, understanding and insight into your child’s strengths and weaknesses. And while these programs can be intense, says Dr. Butler, they do obtain results.
-- By Gia Miller