When to seek professional help for a child or teen: An interview with Dr. Elina Durchman

Dr. Elina Durchman, Ryther Child and Adolescent Psychiatrist, completed her medical training, general psychiatry and child and adolescent residency training as well as a fellowship in Leadership Education in Neurodevelopmental and Related Disabilities at the University of Washington.


There is no easy answer for when to seek help for your child or teen, but when there is a behavior or mood change, parents should seek professional help. The most common symptoms are acting out in school or daycare. Very young children who don’t know how to verbalize feelings can be aggressive at daycare or preschool. This can be a warning sign that something is going on. There is often a difference between home life and school. Kids can be very calm and happy in the home environment, but very fearful at school.


Why might a child become anxious or defiant regarding school?

Children may become defiant at school because they don’t understand what their teacher is saying. Sometimes a child has a learning disability that hasn’t been recognized, and it’s very difficult for the kids to explain that they have a learning disability. Parents often think the kids are being defiant, and in this situation school can become a stressor. We know that ADHD is a developmental problem that we can measure, and if it’s severe enough the child may need to be on medication.


What are the most common psychiatric issues that you address?

The most common struggles are anxiety, depression and ADHD. Teens in Ryther’s co-occurring program are receiving help to address both mental health and substance abuse issues. I also work with children and teens with bipolar disorder or other disorders on the psychotic spectrum. There are children who have family stressors due to separation of parents and other difficult home situations. These are often triggers for anxiety, depression and other psychiatric issues. Many people are predisposed to certain mental conditions, and episodes of these can be triggered by a traumatic event. However, if children receive mental health treatment, they will often acquire the tools they need later in life to successfully deal with these events.


What are some common stressors among young children?

Many don’t know how to express sadness, wants or needs, and they communicate these by acting out. I often spend time explaining these behaviors to parents. A child might get diagnosed with something like oppositional defiant disorder because they don’t want to go to school. The child will throw a huge tantrum, but often it isn’t about school at all but rather some source of anxiety or fear related to that particular activity. These conditions cause anxiety and fear for the kids. Think of young children being fearful and not knowing how to explain to their parents that they don’t want to go to a certain place. Often their only response is to fight back. A lot of people don’t recognize these behaviors or know where these behaviors come from, and they are often times very grateful and happy when the situation is explained to them.

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