The Best Therapy Model to Use With Children

A variety of afflictions and disorders can beset children and bewilder parents. Children who initially present with one problem often have multiple issues. The best therapy model will depend on several factors, including the nature of the problem, underlying and contributing causes to the problem, the child's age, the resources available and the capacity of the parents to participate effectively in therapy. Because of these complications, a progressive, multidisiplinary, multimodal treatment model may be the most effective.

Identify the Problems

• Use a mulitimodal approach to assessment to identify potentially relevant treatment issues early on. First, evaluate what the primary symptoms and problems are. Initial screening should cast a wide net. For example, if a child presents with behavioral problems at school, evaluate for the presence of cognitive, developmental, attentional, mood and thought disorders.

  A parent can start this process. The Massachusetts General Hospital provides access to online screening tools---some free and some not---at Massgeneral.org that can be used to identify types of mental health disorders that may contribute to the presenting problem. Use these instruments to highlight issues to discuss with your child's primary physician.

  Because of the complexity of mental and behavioral health problems, it is best to involve a medical professional early on in the process. The family physician should evaluate for and rule out possible medical conditions such as metabolic disorders, nutritional deficiencies, environmental allergies, food sensitivities, and respiratory, cardiac or endocrinological disorders that can cause behavioral, cognitive and emotional problems.

Try Initial Solutions

• Use online resources, family, school and doctor's advice during your initial passes at remedying your child's problems. If problems do not improve to your satisfaction, it is time to refine the diagnosis and escalate treatment. It is time to recruit a mental health professional.

  Some websites, such as NIMH.org, describe different treatment models and suggest that certain modalities are more effective with certain problems. For example, cognitive behavioral therapy (CBT), a therapy that focuses on altering the attitudes and beliefs of the patient, is considered to be effective for treating anxiety and depression in older children and adolescents but will be less effective for treating behavior and learning issues due to autism or learning disorders. During early stages, when diagnostic and treatment issues are still being explored, it is not necessary to seek out a particular "flavor" of treatment. Most providers are eclectic and vary their treatment based on the presenting problem. What is most important is to find a psychologist or therapist who is competent and trained to diagnose and treat children. If you have confidence in the diagnosis, then seek a provider who has experience in that area of treatment.

Expand Treatment

• Older children and adolescents often will say things to a counselor or therapist that they won't say to their parent. Individual therapy can help children look at themselves, their problems and possible solutions in a new way. The strength and nature of the therapeutic relationship that forms between a child and therapist is more critical than the type of therapy the provider employs. Does your child like and trust the therapist? Does therapy seem to help? These questions are more important than whether or not the therapist practices CBT, behavior therapy, dialectical behavior therapy, interpersonal therapy or psychodynamic therapy.

  It is always important, and especially when younger children are involved, to expand treatment into the social environment. Family therapy, adjunctive therapy with parents and other caregivers, and parenting training all enhance the power and effectiveness of therapy. These therapies recruit parents and family into the therapeutic process. The child doesn't just get therapy an hour a week but gets parent-implemented interventions throughout the day every day.

  If problems persist, the child's physician or a psychiatrist should perform a medication evaluation. These providers use medications to target biochemical imbalances that cause or maintain emotional and behavior problems. A variety of medications have been approved by the Food and Drug Administration and evaluated by the National Institute of Mental Health to be effective for treating specific mental health problems in children and adolescents.