When should you see a child psychologist? Read about the warning signs to look for in your child, symptoms by age and what happens in the first session.
"Will this phase pass, or should I talk to a specialist?" This is a question that has crossed the mind of many a parent at least once. When your child's angry outbursts become more frequent, when they cannot sleep at night, when they don't want to go to school or suddenly withdraw, you may not know what to do. One part of you says "I'm overreacting", while another worries "what if I'm missing something?" In this article we look, in a calm and clear way, at the situations that may call for seeing a child psychologist, the signs to watch for by age, the doubts families often have and how the first session goes.
What Does a Child Psychologist Do?
A child psychologist is a mental health professional who assesses the emotional, behavioural and developmental difficulties of children and families and works on them using psychotherapy methods. Working with children is quite different from working with adults, because children often express what they are going through not in words but through their behaviour, their play and their bodies.
For this reason, play, drawing, storytelling and age-appropriate activities have an important place in work with children. With younger children, approaches such as play therapy come to the fore, while with school-age and older children, Cognitive Behavioural Therapy (CBT) techniques can be used, adapted to the child's age. An important part of the work is the sessions held with parents.
Psychologist or psychiatrist?
A child psychiatrist is a physician who, after medical training, has specialised in child and adolescent mental health; they can make diagnoses and, where needed, prescribe medication. A psychologist works in assessment and psychotherapy and does not prescribe medication. The two professions are not alternatives to each other but often complement one another. In conditions such as attention deficit, the autism spectrum or severe anxiety, for example, a child psychiatry assessment is important, and the therapy process can run alongside it.
What should you look for when choosing a child psychologist?
Working with children requires different knowledge and skills from adult psychotherapy. It is therefore natural, before you start working with a child psychologist, to ask about their experience with children and adolescents and their training in areas such as play therapy or CBT adapted for children. It is also important that the setting is suited to the child's age and that toys and materials are available.
In addition, talking openly from the start about how communication with parents will work, how often sessions will take place and how confidentiality will be protected strengthens the relationship of trust. Observing whether your child gradually relaxes with the specialist is also a good indicator; shyness in the first sessions is normal, but if after a few sessions the child is more willing to go, that is a positive sign of the relationship that has formed. It is also important for the process that you feel you can talk comfortably with the specialist and that your questions are answered.
When Should You See a Child Psychologist? Signs to Watch For
Every child struggles from time to time as they grow. Tantrums, fears, sibling jealousy, stubbornness and short-lived sleep problems are natural parts of development. To tell whether a behaviour is cause for concern, asking yourself these three questions can be a useful guide:
- Duration: Has this behaviour been going on for longer than a few weeks?
- Intensity: Is the behaviour clearly more frequent or more severe than in the child's peers?
- Impact: Is the behaviour making the child's life at home, at school or with friends harder?
If you answer "yes" to several of these questions, it may be helpful to talk to a specialist.
Emotional signs
- Constant unhappiness, crying, frequent statements such as "nobody loves me"
- Fears and worries that are excessive for their age, a constant expectation that something bad will happen
- Intense difficulty separating from a mother or father
- Loss of interest in activities they used to enjoy
- Saying that they feel worthless or bad
Behavioural signs
- Frequent, intense outbursts of anger, aggression
- Marked and persistent difficulty following rules
- Being unable to concentrate, unable to stay still, being constantly on the move. Our article on signs of attention deficit may be a useful guide on this.
- Withdrawal, distancing from friends
- Refusing to go to school
- A marked increase in behaviours such as lying or stealing
Physical and developmental signs
- Recurring stomach aches or headaches with no medical cause
- Difficulty falling asleep, frequent nightmares, waking in the night
- Marked changes in appetite
- Regression in skills already acquired: a child who has completed toilet training wetting the bed again, returning to baby talk
- Falling markedly behind peers in speech, social communication or play skills
Situations that call for immediate support
Some situations do not call for waiting. If your child is harming themselves, says they want to die, shows behaviours that seriously harm others or if there is a suspicion of abuse, you need to see a specialist without losing time. In an emergency, call 112 (emergency services).
Situations to Watch for by Age
The difficulties children meet also differ according to their developmental stage.
Preschool years (ages 2-6)
In this period tantrums and separation anxiety are quite common. However, an assessment can be useful if tantrums are very frequent, long and severe, if the child cannot adjust to nursery or kindergarten for a long time, if there is a marked delay in speech and social communication, or if regression after the birth of a new sibling lasts a long time.
Primary school years (ages 6-10)
Starting school is a big change in a child's life. Marked difficulty in learning to read and write, problems with attention and concentration, difficulty making friends, refusing to go to school and intense anxiety about exams or failure are signs to watch for in this period.
The transition to adolescence (ages 10-12)
In this period, when physical changes begin, anxieties about body image, difficulties in peer relationships, bullying, screen time getting out of control and exam anxiety that rises with preparation for the LGS (Turkey's national high-school entrance exam) are common issues. A marked break in communication with the family or sudden changes in behaviour also call for attention.
Life Events That Strain Children
Some life events may call for a child to receive support even in the absence of obvious symptoms. Children experience such changes differently from adults and often cannot say what they feel.
- Parents divorcing or separating
- The loss of a loved one, especially a parent or grandparent
- Moving, changing city or country, migration
- The birth of a new sibling
- A parent's serious illness
- Intense conflict within the family, witnessing violence
- Traumatic events such as earthquakes or accidents
The 6 February 2023 earthquakes in Turkey led many children to lose their homes, schools, friends and loved ones. Even children who were not directly affected were exposed to intense images through television and social media. After such events, children may show reactions such as sleep problems, separation anxiety and repeatedly acting out the event in play. Most of these reactions ease with time; but if they last a long time or intensify, it is important to seek support.
The tension that the cost of living and economic hardship create in families can also be passed on to children. Children often sense the unspoken stress at home and may express it through their behaviour.
For families living in big cities, long working hours, time spent in traffic and a child being with different carers throughout the day can also affect a child's emotional balance. In periods when such changes are happening, a few sessions with a child psychologist can help support the child's and the family's adjustment before a clear problem appears. These sessions are also an opportunity for parents to plan how they will explain the change to the child and how they will respond to their reactions.
Doubts Families Often Have, and What You Can Do at Home
Many parents feel various worries when deciding to take their child to a specialist:
- "Will my child be labelled?" The aim of an assessment is not to label the child but to understand them better. Even where there is a diagnosis, it opens the way for the child to receive support suited to their needs.
- "Will it be thought that I'm a bad parent?" Looking for support is a sign of the care and responsibility you feel towards your child. The specialist's job is not to look for someone to blame but to find solutions together.
- "What will people say?" In Turkey, receiving mental health support can still be stigmatised in some circles. However, this is gradually changing, and sessions are carried out under the principle of confidentiality.
- "Maybe it will pass by itself." Some difficulties really do pass with time. But problems that last can affect a child's self-confidence, school success and relationships. An early assessment will at least help you understand what you are facing.
Before you see a specialist, or alongside the referral process, you can do the following at home:
- Observe and take notes: Writing down when, where and in what situations the behaviour appears helps both you and the specialist to understand the situation better.
- Listen to your child: Listening without judgement and without offering solutions straight away makes it easier for the child to open up.
- Keep routines: Regular sleep, meal and play times give a child a sense of security.
- Review screen time: Screen use before bed in particular can affect sleep and emotion regulation.
- Get in touch with the teacher: Observations at school can offer important information you cannot see at home.
- Look after yourself too: A parent's tiredness and stress are passed on to the child. Not neglecting your own needs also does your child good.
Looking for support for your child is not an admission of failure; it is a loving step you take to understand them.
When Should You Seek Professional Support?
To sum up, you may consider seeing a specialist in the following situations:
- If a change in behaviour or feelings has lasted longer than a few weeks
- If the difficulties appear in more than one area (home, school, friendships) at once
- If your child shows regression in skills they had previously gained
- If there has been a marked change after a loss, divorce, migration or trauma
- If your child's teacher or doctor has recommended an assessment
- If you, as a parent, instinctively feel that something is not right
A parent's instinct matters. You are the person who knows your child best; if you feel that something has changed, it is right to take that feeling seriously. We would also like to remind you that the signs we have listed do not on their own mean a diagnosis, and that a comprehensive assessment can only be carried out by a specialist.
How Are a Child's Difficulties Addressed in Therapy?
The first sessions with a child psychologist usually begin with the parents. In this session, the child's developmental history, the onset of the complaints, the family structure, the school situation and the parents' observations are discussed in detail. After that, sessions to get to know the child are planned.
In sessions with the child, there is no question-and-answer interrogation. The child is gotten to know in a room equipped with age-appropriate toys and materials, in a setting where they will feel comfortable. Tools such as play, drawing and storytelling are used as windows into the child's inner world. Where necessary, developmental assessment tools can be used.
After the assessment, a work plan suited to the child's needs is drawn up. In child and play therapy, play-based methods are generally used with young children, while with older children CBT techniques can be adapted to their age. If you are curious about how play-based work proceeds, take a look at our article titled what is play therapy.
Regular sessions with parents are an integral part of the process. In these sessions, the child's development is reviewed, approaches that can be applied at home are discussed and the points the parents themselves are finding difficult are addressed. Where necessary, we cooperate with the school and with child psychiatry.
Frequently Asked Questions
How should I tell my child they are going to see a psychologist?
It is recommended that you give an explanation that is simple, honest and suited to their age. A sentence such as "We're going to meet someone who knows how to talk about feelings and play games" is often enough. It is important not to present the session as a punishment or a threat.
Should I go to the first session with my child?
Many specialists prefer to hold the first session with the parents only. This way, subjects that are not appropriate to discuss in front of the child can be covered comfortably. Meeting the child is usually planned for later sessions.
Can I find out what my child says in sessions?
To protect the child's trust, details shared in sessions are generally not reported word for word. That said, parents are given regular information about the overall course of the process, the main themes that emerge and what can be done at home. Where something concerns the child's safety, it is always shared with the parents.
How long does it take to work with a child psychologist?
The length varies according to the child's age, the nature of the difficulty and how long it has been going on. In some cases short-term parent counselling is enough, while in others a longer therapy process may be needed. The process is planned together with regular reviews.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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