Brittany Thomas, MS, MSW, LGSW

Several months ago, I had dinner with some childhood friends. They each have young children of their own, so you can imagine the fun filled conversations that were shared about the joys of parenthood. The running theme of the night was focused on how each of them in their own way manage their child’s “ naughty” behaviors and the embarrassment they often feel when having to do so in a public space. As they each shared funny moments and their fail proof “go to method” of managing a tantrum, one of my friends identified concerns about recent changes in her son’s behaviors.  She was concerned it was more than just being “naughty” and she wanted to know if there was something else going on in his little head to cause the behaviors she was seeing. Her question ignited a different conversation which allowed each of them to see their child’s behavior from a different perspective. So, how can you tell the difference between acting out behaviors because you told your daughter “no” and acting behaviors related to an undiagnosed mental illness.

Before a mental health diagnosis can be made, it is important that medical and health conditions are first out ruled. Parents should start first with their child’s pediatrician or family health provider. Doctors can be the first people to note any concerning behaviors or conditions that may require further assessment. Physical conditions such as ear infections can impact hearing which may in turn impact the way a child responds to redirections. Medical conditions that may impact fine and gross motor skills, speech, feeding and toileting abilities should be out ruled first before a mental health diagnosis is considered. Once this has been determined and symptoms still remain, your doctor can help make recommendations for additional screening and assessments that can be done by a mental health professional that specializes in diagnosing mental illness in young children.

When making a mental health diagnosis in young children, there are several signs to monitor and factors that need to be considered. Often people have difficulty imagining someone so young, like a three year old, having a diagnosable condition may warrant attention. However it is quite possible. Genetics, family history and environmental factors can play a huge role.

Here are some factors to consider:siblings1

  1. Family history of mental illness: It is important to be aware of any mental illnesses that may run in your child’s family.  Children may be more vulnerable to certain disorders that may be passed down through genetics.
  2. Brain development:  The brain’s development plays a major role in your child’s functioning. Any abnormalities that may occur in the brain can be linked to deficits in how your child thinks, feels, and acts. It is also important to note any head injuries that may have occurred. This can play a role how your child functions, especially if there are noted changes in behaviors following an injury.
  3. Recent changes for the child or the family: Changes may include moving to a new home, a parent changing jobs, birth of a sibling, or going to a new school.
  4. Significant loss: This may include the death of a family member, a friend moving, the end of a significant relationship, or divorce.
  5. Experiencing trauma: Witnessing or experiencing a traumatic event such as physical, sexual, verbal or emotional abuse, experiencing a natural disaster or a traumatic event such as a car accident.

When looking for signs that warrant a mental health assessment, the key thing is to focus on significant behaviors or problems that are new, have changed in any way or continue to occur. In young children it may be hard to distinguish what is considered “developmentally appropriate” and what may be of concern. However, when behaviors or problems have increased in frequency, duration and intensity, these behaviors have now become symptoms that may need to be address before they get worst.  It is important to also note if symptoms are present in one or a multitude of settings such as home, daycare or school and if they are significant enough that they impact the ways the child functions in these settings.

These are some behaviors or problems that should be monitored to determine if additional steps should be taken for a mental health assessment:

  1. Change in eating, sleeping and toileting habits: Are there increases or decreases in appetite, weight change, difficulty falling asleep, frequent nightmares, bed wetting or difficulty using the bathroom?
  2. Changes in your child’s mood: Is your child frequently irritated, sad, frustrated or angry? Do they have difficulty socially interact with their peers or engaging in social activities?
  3. Regression of skills previously obtained: Is your toddler, who was potty-trained, wetting again at night? Are they having difficulty sleeping alone or difficulty talking and expressing their needs and feelings?
  4. Demonstrated behaviors with specified individuals or environments: Is there difficulty leaving them alone with other adults or in other settings? Are they afraid of a certain place or environment they use to frequent?
  5. Increases in duration and frequency of noted behaviors: Are they having tantrums 4x a day instead of two? Are they taking longer to be soothed when they are hurt or feel sad?

So if you have any concerns related to your child’s mental health, take the necessary steps to determine if there is a mental health diagnosis present because it may be more than just a temper tantrum.