Last week, I had coffee with a fellow Richmond parent who was worried about her 9-year-old. “He used to love school,” she told me, “But now he fights me every morning. Is this just a phase, or should I be concerned?”
It’s a question I hear often in my practice. As parents, we’re constantly wondering if what we’re seeing is typical childhood behavior or something that needs professional attention. The truth is, this decision isn’t always clear-cut, but there are some reliable ways to figure it out.
The Three-Question Test That Changed Everything
A few years ago, I learned a simple framework that revolutionized how I help parents assess their concerns. “I typically ask parents about the frequency, intensity, and duration of the worrisome behaviors. If any of these are out of a typical developmental range, we may suggest therapy for a child.”
This three-part assessment has become my go-to tool. Here’s how it works:
Frequency: How often is this happening? Daily tantrums in a 3-year-old might be normal, but in a 7-year-old, they signal something deeper.
Intensity: How severe are the reactions? There’s a difference between disappointment over a canceled playdate and a complete meltdown that lasts hours.
Duration: How long has this been going on? A few weeks of adjustment after starting a new school is expected. Six months of school refusal is not.
Red Flags I’ve Learned to Watch For
After years of working with Richmond families, certain patterns consistently emerge that suggest professional help would be beneficial.
Sleep Disruptions That Won’t Quit When 8-year-old Sarah started having nightmares every night for two months after her grandmother passed away, her parents initially thought it was normal grief. But when she began refusing to sleep in her own room and her grades started slipping, they realized she needed more support than they could provide at home.
The Withdrawal Pattern I’ve noticed that kids who suddenly stop enjoying activities they once loved are often signaling distress. Whether it’s dropping out of soccer, avoiding birthday parties, or eating lunch alone instead of with friends, significant social withdrawal deserves attention.
Academic Changes That Stick Richmond’s competitive school environment can be tough on kids. When a previously solid student suddenly can’t focus, isn’t turning in homework, or starts getting calls home from teachers, it’s worth investigating what’s happening emotionally.
What Makes Richmond Kids Unique
Our city presents some specific challenges that I see regularly in my practice. Military families at Fort Lee deal with deployment stress and frequent moves. The pressure to get into specialized programs like Open High School or Maggie Walker creates anxiety for many middle schoolers. Even something as simple as navigating Richmond’s diverse neighborhoods can create identity questions for kids.
One thing I’ve learned is that Richmond kids are resilient, but they’re also dealing with unique stressors that parents from other areas might not fully understand.
Age Really Does Matter
The Preschool Years (3-5) At this age, I’m most concerned about extreme separation anxiety, aggressive behavior toward other children, or kids who seem unable to play imaginatively. These little ones should be curious about the world, not consistently fearful or withdrawn.
Elementary School (6-12) This is when I start seeing more anxiety-related issues. Kids who develop school phobia, have frequent stomachaches with no medical cause, or become perfectionists to the point of tears over small mistakes often benefit from counseling.
The Teen Years (13-18) Teenagers are tricky because some moodiness is expected. But when I see complete isolation from family, dramatic personality changes, or risky behaviors, it’s time to get professional help involved.
Why Waiting Usually Makes Things Harder
I wish more parents understood that early intervention isn’t just helpful—it’s often crucial. Last year, I worked with a family who waited two years to seek help for their anxious 10-year-old. By then, her school avoidance had become so entrenched that it took much longer to address than if we’d started earlier.
Think of it like a physical injury. You wouldn’t wait until a sprained ankle became a chronic problem before seeing a doctor. Mental health works the same way.
What Actually Happens in a Child’s Therapy
Parents often ask me what their child will actually do in therapy sessions. The answer depends on the child’s age and needs, but it’s rarely what adults imagine.
For younger kids, therapy might look like playing with dollhouses to work through family stress or using art to express feelings they can’t verbalize. Older children might learn breathing techniques for anxiety or practice social skills through role-playing.
The key is that good child therapists make the process feel natural and engaging, not like “treatment.”
Finding the Right Person in Richmond
Not all therapists work well with children, and not all child therapists are the right fit for your specific kid. Some children respond better to play therapy, while others prefer more direct conversation. Some need someone who understands ADHD, while others are dealing with trauma.
I always recommend meeting with a potential therapist before committing to regular sessions. Most good therapists offer brief consultations to determine if they’re a good match for your family.
The Insurance Reality
Let’s be honest about something most blogs don’t mention: navigating insurance for child therapy can be frustrating. Some excellent therapists don’t take insurance, while others have long waiting lists. Don’t let this discourage you from seeking help. Many therapists offer sliding scale fees, and some employers provide Employee Assistance Programs that include counseling services.
Local Resources That Actually Help
Here in Richmond, we’re fortunate to have several excellent resources:
- Richmond Public Schools Student Support Services – Often the first line of support for school-related issues
- Children’s Hospital of Richmond at VCU Mental Health Services – Comprehensive mental health services
- United Way of Greater Richmond & Petersburg – Call 211 for local resources and referrals
- Virginia Department of Behavioral Health and Developmental Services – State-level resources and programs
Additional Trusted Resources
- American Academy of Child & Adolescent Psychiatry (AACAP) – Comprehensive information about children’s mental health conditions and treatment options
- National Alliance on Mental Illness (NAMI) – Support and educational resources for families dealing with mental health challenges
- Child Mind Institute – Evidence-based information about children’s mental health, development, and learning disorders
Trust Your Gut
Here’s what I tell every parent I work with: you know your child better than anyone else. If something feels off, it probably is. That doesn’t mean you’re a bad parent or that your child is “broken.” It means you’re paying attention and caring enough to seek help when needed.
The decision to pursue counseling for your child isn’t about admitting failure—it’s about giving them tools to succeed. In my experience, the families who seek help early often see the most positive outcomes.
If you’re on the fence about whether your child might benefit from counseling, consider scheduling a consultation with a qualified therapist. Most of us are happy to discuss your concerns and help you determine if professional support would be beneficial for your family.
Remember, taking care of your child’s emotional health is just as important as taking care of their physical health. Both deserve attention, care, and sometimes professional support.
Find an Active and Connected Therapist in Richmond here.
If you’re concerned about your child’s mental health, don’t hesitate to reach out to a qualified professional in the Richmond area. Early support can make a significant difference in your child’s emotional development and overall well-being.