1. It can be helpful to check in with your child's teacher to find out how school is going for your child academically and socially Many times teachers are surprised when parents ask about anxious children. Often anxious children are well behaved in school and don't cause trouble. However, teachers can tell you if a child looks nervous or uncomfortable in class, has trouble completing tests or assignments, or has trouble taking feedback from the teacher. The teacher will also notice if a child is particularly isolated, ignored by, or actively rejected by his peers.
2. Gather referrals
You can ask a variety of people about referrals. Your child's pediatrician, teacher and guidance counselor are all good options. In addition, the Anxiety Disorders Association of America (adaa.org), Obsessive-Compulsive Foundation (ocf.org), Association for the Advancement of Behavior Therapy (aabt.org), and The Academy of Cognitive Therapy (academyofct.org) all have listings of providers with expertise throughout the world. Parents of other anxious children often are great referral sources. Area psychiatry departments and university counseling centers may also either provide service or be able to provide referrals.
3. Check with your insurance about coverage and therapist availability Make sure to ask your insurance carrier if they have providers experienced with working with children and with cognitive-behavior therapy (exposure and ritual prevention, or ERP, for OCD). Though it takes time, sometimes if you call each therapist referral and ask the same questions, the insurance will pay for another experienced provider outside of their network, if they cannot provide one in their networks.
4. Take some time to observe your child and take notes
It can be very helpful if a parent can give concrete examples of the behavior or emotions that are disturbing to the child and family. Note when things happen (e.g., in new situations, at bedtime, around peers but not adults), and how often they occur. You don't need to write down every instance but some good examples can be useful.
5. Interview providers
It is important that you feel you have a choice with providers and you feel comfortable with the therapist. You should feel free and entitled to ask the clinician about their background and experience. Ask them how they treat anxiety in children and listen for key terms such as: desensitization, cognitive-restructuring, coping skills, and exposure. A clinician hesitant to answer these questions may suggest that you do not want to work with that person.
6. The intake process
Following the phone interview, the clinician will usually set up a first intake visit (the evaluation process may require between 1-3 sessions). This evaluation process varies by clinician but usually includes the following:
A. Interview with parent
This interview varies by clinician. The clinician may ask you to first come alone without your child so that you feel free to talk without your child wondering what you are discussing. Other times, the clinician will split up the session and meet some with the family all together, some with parents alone, and some with child alone, if the child is comfortable. The parent interview will focus on the parents' view of the problem/relevant symptoms and history of the symptoms. The interview will also include assessment of current stressors, current functioning with peers and at school, child's strengths, family psychiatric and medical history, and developmental history. Finally the clinician will likely ask about how the symptoms have affected the family and the marital relationship, and parenting approaches that have or have not worked. Medical and academic records may be reviewed and behavior rating scales completed.
B. Interview with the child
Young children are interviewed alone if and when they feel comfortable. If the child is uncomfortable being interviewed alone, he/she will be interviewed with the parents until some trust is established with the therapist. Adolescents are almost always interviewed alone and sometimes before the parent since establishing a relationship is so important for successful work with teenagers. Often children and adolescents are better than parents at reporting their internal experience. There also may be things that clinicians are good at asking about that parents did not know or the child did not wish to share with the parent. The clinician will ask the child many of the same questions they asked the parent especially about the current symptoms and history of symptoms. The clinician will work to phrase these questions is child-friendly language.
C. Diagnosis and treatment planning
At the end of the evaluation period (1-3 sessions), the clinician will pull all this information together and will share his/her impressions on the relevant diagnoses for your child and treatment plans that address these diagnoses. The clinician should discuss various treatment options with you and answer any questions you may have. This is also the time that you can decide if this is the person you want to work with.
Different providers that can help your child:
Most important is the therapist's experience with children, with anxious children and with the cognitive-behavioral or behavioral treatments described in Cognitive Behavior Therapy. Learn More...
Psychologists are the most likely to have received training in CBT and ERP, but not all psychologists have this training. They either have a Ph.D. (Doctor of Philosophy) or Psy.D. (Doctor of Psychology) both of which involve 4-6 years of graduate training. Psychologists cannot prescribe medication.
Psychiatrists are trained as physicians with additional residency training in psychiatry after completing medical school (M.D.). Psychiatrists are the only professionals who can prescribe medication. Some psychiatrists can provide both therapy and medication, but many only provide medication consultation and management.
Social workers have a master's degree in social work (M.S.W) that involves 2-3 years of graduate training in social work and psychotherapy. Social workers can have a number of different certifications (LICSW, ACSW, CSW).
Brought to you by The Children's and Adult Center for OCD and Anxiety.