Children are not miniature adults – and deserve behavioral health care tailored specifically for them

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Life as a therapist can bring unexpected adventures. I once had a client who literally hid from me. She hid behind my extra office chair for most of the session until I got creative, suggesting that we completely leave the desk to go to the nearest vending machine for a snack. That’s when we started talking.

My client, if you haven’t guessed it already, was a shy kid.

Therapy for children – when done well – is very different from therapy for adults. On the one hand, adults usually come to therapy on their own, while children and adolescents are often brought in by worried parents or caregivers. Children may be scared, uncertain, or reluctant to speak. In some cases, they may even view therapy as punishment.

So it makes sense that we should approach therapy – and behavioral health care in general – differently when it comes to children. Sadly, children are still frequently thrown into adult-centered models of treatment that just don’t work well for them.

This inconsistent model is a big part of why we have an urgent child mental health crisis on our hands today – a crisis that has children’s hospitals across the country warning of long lists of children. ‘waiting to receive care and declare a state of emergency. To address this, we must create, from the ground up, a behavioral health care system designed to meet the unique needs of children.

What would such a system look like? To begin with, a pediatric behavioral health care system must begin by helping families determine the kind of support they need. Too often, children’s needs are not professionally assessed to guide them to the right kind of care, whether it is lifestyle changes, therapy, medication management or other supports. Instead, parents and caregivers end up going through a frustrating trial and error approach just to find a treatment plan that might work for them.

This is particularly troubling because children are much more likely than adults to have multiple behavioral health issues that require coordinated, multidisciplinary care. Take the example of children with Attention Deficit Hyperactivity Disorder (ADHD): 27% of them also have a conduct disorder, 18% anxiety and 15% depression. This means that children with ADHD generally need a team of clinicians to take charge of their care. Yet pediatric behavioral care providers rarely work in coordinated teams. This forces families to serve as ad hoc links between multiple medical facilities and health care systems – a complicated role that many parents and caregivers have neither the training nor the time to undertake.

Families also struggle to find care for behavioral health issues that are just beginning to develop, despite the fact that options such as coaching or digital tools can dramatically improve symptoms and quality of life. a child. For example, a child who takes action may benefit from coaching that helps them manage their mood by dealing with issues like stress, anxiety, and sleep issues. Self-guided content can also help parents make changes directly at home or empower older children to take charge of their care. A truly effective pediatric behavioral health care program must include these options in addition to clinical care.

In addition, a child care program must involve adults in children’s lives. While a child may spend an hour a week in a clinician’s office, he or she spends many hours each day at home and at school. Collaboration between parents, teachers, and a child’s treatment team to reinforce lessons and habits is a critical key to success.

Parental involvement is particularly important, as behavioral training of parents is an essential part of a child’s behavioral health care. Dyadic care models that include parents in child care have been shown to be three times more effective than child care alone.

These approaches, taken together, create a model of behavioral health care that meets the unique needs of children. This is the role model we need to make of the norm if we truly care about the behavioral health of children.

For too long we have forced children to rely on adult services. We have subjected them to processes of unnecessary trial and error, kept their parents and teachers apart, limited options and created bureaucratic obstacles that fracture and compartmentalize the care they receive. The results were nothing short of tragic, as evidenced by the current crisis in pediatric behavioral health.

Now is the time to change.

Photo: metamorworks, Getty Images


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