The difference in mental health services for youth and adults.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.


Children’s mental health.
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One size does not fit all.


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When it comes to mental health services what’s needed and what’s actually provided can vary tremendously. Treatment for each client should be individualized.

Therapy for children needs to be appropriate for both their age and their developmental stage. There are also some differences in the way the counselor or therapist may need to approach treatment. In selecting a therapist, it’s important to find someone with both the training and experience required to work with the person receiving services. Here are some of the differences between mental health services for youth and adults.

The therapist needs to speak the same “language” as the child.

Children don’t have the vocabulary to describe feelings. Children often express themselves by actions rather than words. For very young children therapy is best done through speaking the language of “play.” How a child expresses themselves through action will change as they age.

What’s appropriate for a baby to say at age six months will be very different from what they should be saying at five years. The same is true of their behaviors and the way in which they play.

The therapist needs to consider “who is the client?”

Children are usually referred to therapy because an adult has either recognized the problem or is afraid the child may develop a problem. The counselor must consider whether the reason this child is in therapy is because the child is doing something an adult doesn’t want them to do or because they aren’t doing something the adult wants them to do.

More than one female single parent has brought their male offspring in for counseling because they did not want that child to “be just like their father.” In these cases, often the father was either physically abusive, drug-addicted, or engaged in criminal activity. Unfortunately, being told repeatedly that you are “just like your father” can be extremely damaging to the child’s development.

A similar problem happens when male parents are raising female children and, in their effort, to prevent their daughters developing sexuality, they continually accuse the daughter of promiscuity “just like your mother.”

In cases like these, where a parent is projecting their own issues and negative life experiences on to their children, the counselor tries to help the child develop the skills to make their own healthy choices. Frequently, what needs to happen is for the parent to get into therapy for their issues and for help in becoming a more effective parent.

The counselor will at most see the child for an hour a week, while the parent will provide the care for that child for 167 other hours each week.

Lifespan development issues are important.

If a child isn’t hitting their developmental milestones, walking, talking, learning schoolwork and appropriate behavior on time, this warrants a referral to medical or mental health professionals. Unfortunately, many parents have unrealistic expectations for their child. Parents often push their children to do things that they are not developmentally ready for. I’ve had parents request that their child be assessed for ADHD because the child was getting B grades instead of straight A’s.

Children may be afraid to tell the truth.

While the child is often the one identified as having the problem, it’s entirely possible the problem is with the home situation. Children who grow up in a home where parents have frequent violent fights may be awake all night. When they go to school, they can’t concentrate because of their lack of sleep and their fears about what is going on at home while they’re at school. If they witnessed domestic violence, they might learn to use hitting as a way to get what they want.

While the child is referred for assessment for attention problems the real issue may lie with the parents. Children are afraid to report problems at home for fear that their parents will punish them or that they may be taken away from their parents.

Many children are taught not to talk to strangers and to never talk about families “business” outside the family. Children from lower socioeconomic status homes may be embarrassed. Children may have been instructed not to talk about parents who are engaged in illegal activity, or they may be reluctant to talk about having a parent or caregiver who is incarcerated.

Many problems are not identified until the child gets older.

I see many files for teenagers in which they were treated in the early grades for developmental issues. Later they were treated for attention deficits. In middle school and high school, they may have been treated for bad behavior. It’s not until late high school or college that some of these clients are diagnosed with severe depression.

It’s important that anyone working with children not write off poor attention and behavioral problems as a result of “bad child” diagnoses. A specialist in child developmental issues should be looking for serious mental health issues such as anxiety disorders and depression.

Children may need help in developing life skills.

Counselors working the children must be careful not to think that it’s the child who has the problem. Sometimes what the child needs are the skills to cope with a dysfunctional family and a challenging world. Social skills are tough for some children to develop. The majority of adults who develop anxiety disorders had the symptoms by the end of middle school.

Counselors may need to normalize the challenges of growing up. Most children go through a stage of feeling insecure and worrying about whether they measure up. Helping the young client through the transition periods can reduce or possibly even prevent the development of anxiety disorders, eating disorders, and other mental health problems that are the result of judging themselves in overly negative ways.

These are some of the major differences between working with children and adults. The techniques and materials the counselor uses are also likely to be different. Please feel free to leave additional questions or comments.

Staying connected with David Joel Miller

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