WHEN Billy Redmond was 4 years old, his teachers at nursery school called home. Billy was having trouble, they told his parents. He was becoming an extreme behavior problem. He was wetting his pants. He wouldn't wait his turn, couldn't work with scissors and crayons, and he was increasingly frustrated at his failures. Billy was lashing out at other kids, hitting them.
The message the Redmonds got was simple: Billy needed help.
The American Psychological Assn. estimates that 15% of the nation's children, defined as those under the age of 18, are in need of some kind of therapy. And there is no minimum age for emotional problems. These days, even toddlers are clients of a wide array of therapies and theories and mental health professionals. "Parents seem to be more aware that children have psychological and psychiatric needs and are more open to seeking treatment than they were 10 years ago," says Kathy Demming, who is in charge of clinical intake for child psychiatry at UCLA's Neuropsychiatric Hospital and Institute. "Parents these days want to make sure their kids have the best possible chance in life, and if there's a problem, they want it solved at an early age."
Of course, 2-year-olds, 5-year-olds, even 8-year-olds don't tell their parents they're having emotional problems. At least not directly. They act them out. Their problems are disorders of conduct--socially disapproved behavior, including lying, stealing and general disobedience--and emotional disorders characterized mainly by such symptoms as tearfulness, sadness, social withdrawal and relationship problems. Even less severe developmental problems, the kinds that most children contend with and grow out of--temper tantrums, biting, bed-wetting, nightmares, thumb-sucking, sibling rivalry--that persist or are extreme or occur out of the normal sequence of development, can indicate deeper problems.
"With preschool-age children, the problems usually present themselves in the (nursery) school environment," says David Paster, a West Los Angeles psychiatrist and chairman of the department of psychiatry at St. John's Hospital in Santa Monica. "Perhaps the child is disrupting the group, not abiding by the rules of the school, may not be learning or have basic developmental or speech problems. These kids tend to get referred to therapists." In elementary-school-age children, Paster says problems might originate with stealing and shoplifting.
Therapists working in all the mental health professions--psychiatry, psychology, psychiatric social work--see children. The process starts with an evaluation, and sometimes ends quickly; some problems are easily diagnosed and solved with consultation or limited therapy. Paster says he sees as many children just one, two or three times as he sees for three years. And Helen Reid, a clinical social worker who is the coordinator of the Cedars-Sinai Early Childhood Center, remembers one diagnosis that combined a knowledge of child psychology and development with a detective's sensibility.
An 8-month-old baby girl was brought to Cedars-Sinai. At home, as she crawled around the floor, she was picking up pieces of lint from the carpet and eating them. In taking a history from the mother, Reid found that the baby had been weaned from the breast a few weeks before, and that during nursing, the mother had worn a kimono covered with little lint balls.
"The baby would just finger those but suck the breast," Reid says. "When she was weaned, she would find those little things to remind her of her nursing experience.
"First of all, we got the child on a bottle. The mother had tried to wean her from the breast to a cup. We got her a pacifier to suck. It was the sucking experience she was missing." And that was the end of lint eating.
But often a child's problems are not solved so simply. They can be biomedical--a neurological disorder, for example--amd might require drug therapy. And sometimes, as in the case of Billy Redmond, a child must undergo a long-term, complex process that combines several elements of psychotherapy.
BILLY Redmond's mother remembers what it was like to confront the problems her child was having. "I went through, 'What am I doing wrong?' " Jane Redmond says. "I thought, 'Am I screwing this kid up? How on earth am I ever going to get things back to normal?' "