When to seek psychiatric evaluation for a child
Childhood and adolescent mental health concerns present differently than in adults. A child may show changes in mood, behaviour, school performance, social interactions, sleep, or appetite that persist beyond what would be expected. Parents, teachers, or the child themselves may notice these changes.
Reasons for referral include persistent anxiety or worry that interferes with school, low mood or irritability lasting weeks, sudden behavioural changes, difficulty concentrating (which may suggest ADHD), repetitive behaviours or intrusive thoughts (possible OCD), trauma reactions, self-harm, or significant changes in social functioning. Early evaluation helps distinguish between normal developmental variations and conditions requiring treatment.
- Persistent anxiety, worry, or fear interfering with school or social life
- Low mood, withdrawal, or irritability lasting more than two weeks
- Sudden behavioural changes or decline in school performance
- Difficulty concentrating, hyperactivity, or impulsivity (possible ADHD)
- Repetitive behaviours, intrusive thoughts, or avoidance (possible OCD)
- Self-harm, suicidal thoughts, or significant social withdrawal
Related: Psychiatry → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Evaluation process
Child and adolescent psychiatric evaluation involves gathering information from multiple sources: parents/caregivers, the child or adolescent (age-appropriate), and teachers or school reports where possible. Dr. Shrestha assesses developmental history, family psychiatric history, presenting symptoms, school functioning, social relationships, and any medical factors.
The evaluation is conducted in a non-threatening, age-appropriate manner. For younger children, play and observation may supplement clinical interview. For adolescents, private time is offered to discuss concerns confidentially. Treatment recommendations are made collaboratively with parents/caregivers and the young person, with careful consideration of developmental stage and family context.
| Age group | Evaluation focus | Family involvement |
|---|---|---|
| Preschool (3–5) | Developmental milestones, behaviour, parent-child interaction | Primary involvement |
| School-age (6–12) | Academic performance, peer relationships, mood, behaviour | Active involvement |
| Adolescent (13–18) | Mood, self-harm, substance use, identity, peer issues | Involved with adolescent consent |
Treatment approach
When treatment is recommended, Dr. Shrestha prioritises psychotherapy (including age-appropriate CBT) and family-based interventions as first-line approaches. Medication is considered cautiously, only when symptoms are moderate to severe, causing significant functional impairment, and when psychotherapy alone has been insufficient.
If medication is recommended, the benefits, risks, and alternatives are discussed thoroughly with parents/caregivers and the young person. Monitoring for side effects is close, and medication changes are made promptly if needed. The goal is always the minimum effective intervention that supports the child’s development and wellbeing.
- Psychotherapy (CBT, family therapy) as first-line treatment
- Medication considered cautiously, only when clearly indicated
- Benefits, risks, and alternatives discussed thoroughly before starting
- Close monitoring for side effects and response
- Regular review with family involvement throughout