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


The life of a therapist can bring unexpected adventures. Once a client literally hid from me. She slid behind my extra desk chair for most of the session until I got creative, suggesting that we leave the office completely to get a snack from the nearest vending machine. That’s when we really started talking.

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

Children’s therapy – when done right – is very different from adult therapy. For one thing, adults usually come to therapy of their own volition, while children and teens are often brought in by worried parents or caregivers. Children may be frightened, uncertain or reluctant to speak. In some cases, they may even see therapy as a punishment.

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

This mismatched model is a big part of why we have an urgent children’s mental health crisis on our hands today – a crisis that has led children’s hospitals across the country to warn of long waiting lists to receive care and to 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 type of support they need. Too often, children’s needs are not triaged by professionals to guide them to the right kind of care, whether it is lifestyle changes, therapy, medication management or other forms of support. 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 suffer from conduct disorder, 18% from anxiety and 15% from depression. This means that children with ADHD generally need a team of clinicians to support their care. Yet pediatric behavioral health providers rarely work in coordinated teams. This forces families to serve as ad hoc liaisons between multiple medical facilities and care systems – a complicated role that many parents and caregivers don’t have the training or 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 like coaching or digital tools can dramatically improve a person’s symptoms and quality of life. child. For example, a child who is acting out may benefit from coaching that helps them manage their mood by addressing issues such as stress, anxiety, and sleep issues. Self-guided content can also help parents make changes directly at home or serve as a way for older children to take ownership of their care. A truly effective pediatric behavioral health care program must include these options in addition to clinical care.

In addition, a care program for children must involve adults in children’s lives. While a child may spend an hour a week at a clinician’s office, they spend 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 an essential key to success.

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

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

For too long we have forced children to settle for services designed for adults. We’ve subjected them to unnecessary trial and error, alienated their parents and teachers, limited options, and created bureaucratic roadblocks that fracture and compartmentalize the care they receive. The results have been 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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