Mental Health Treatment Options for Children and Teens with Disabilities
Treatment options for mental and emotional health can involve a number of different modalities, including individual and group therapy, behavioral management, medication, emergency hospitalization, and residential or inpatient care. Similar to IDEA’s legal requirement that a child with a disability be educated in the least restrictive environment, mental health treatment should also be in the least restrictive environment available and appropriate for the child, such as at home or at a therapist’s office. However, some situations may require more intense treatment, such as placement in a residential facility, or a hospitalization. These options are usually considered only if the child is a danger to themselves. Kids can receive treatment that is school-provided or private, but most often, it’s both. It’s best to find evidence-based treatments that are suited for your child’s unique situation, strengths, and needs.
Dr. Emily Haranin, PhD, clinical psychologist at Children’s Hospital Los Angeles, tells us that treatment options will depend on the “child's mental health symptoms and how their developmental differences impact the way they interact with the world around them. Many evidence-based mental health treatments initially developed with and for neurotypical individuals can be very effectively tailored to meet the unique and individual needs of children with co-occurring developmental differences.”
Assessment of mental health conditions
Before a mental health treatment plan is set in motion, your child will need an assessment. Signs and symptoms can present differently in our kids than those of their peers, which is why it’s important that providers have as much information as possible regarding the child’s baseline personality, mood, behavior, and skill level to accurately assess any changes, and are experienced enough to understand these nuances. CASP explains, “It’s imperative to consider a student's development in the assessment of behavior or emotional disorders” and says that the student’s “social-emotional and cognitive milestones and what is within normal limits for the student' s gender and/or age group should be considered.”
Direct screenings of a child are only one piece of the assessment puzzle. CASP states that multi-method assessments are recommended, which include classroom and home observations, parent and teacher rating scales, parent and teacher interviews, and direct assessments/interviews of the child. Note that direct assessments for our kids may look different to those of their peers for many reasons, especially when conventional screening tools don’t take into account a child’s reading comprehension levels or language skills and often require complex responses. This is often why parent and teacher reports are so important when assessing our kids.
To make sure your child is being properly assessed, ensure that multiple assessment methods are being utilized — including observations, parent or caregiver reports, and developmentally appropriate assessment tools and methods. There are a few parent and teacher rating instruments that have been developed for kids who have developmental disabilities, for example the Reiss Scales for Children's Dual Diagnosis and the Nisonger Child Behavior Rating Form, that can supplement clinical observations and interviews.
After the assessment, the professional will share with you their thoughts and opinions, possibly a diagnosis, and suggest a treatment plan. It’s important that all options are worked into your child’s overall health plan, fit within their developmental level, and work well with other services or medication they are receiving.
Therapy for children and teens with mental health conditions
The CDC explains that psychological therapy is meant to “treat a mental health condition or help a child manage their symptoms so that they can function well at home, in school, and in their community.” There are many different styles of therapy, but for kids, this may often include talking, playing, drawing, or other activities that help the child express their feelings and thoughts. Therapy can be one-on-one, in a group, or both, but usually, the most effective therapy will involve parent participation, “homework” assignments outside of sessions, and measures of progress or goals tracked over time. The most common types of therapy your provider may recommend include:
Cognitive behavioral therapy (CBT), a skills-based therapy that focuses on becoming aware of and changing the thoughts and emotions that can affect a child’s behavior negatively, often most effective for disruptive behavior disorder, depression, anxiety, and PTSD. Dr. Matt Biel, chief of child and adolescent psychiatry at Georgetown University Medical Center, explains: “What kids who do CBT for anxiety or OCD learn is how to recognize their thoughts, compare it with their feelings, check the reality or the importance of their thoughts, regulate or self correct those thoughts into a more useful place. Use behavioral strategies to make sure that they're not just sort of being bossed around by their anxiety or their OCD.”
Dialectical behavioral therapy (DBT), which focuses on emotional regulation and reducing invalidating patterns of behavior that are not effective, such as self-harm, suicidal thinking, and substance abuse. It can also be used to treat eating disorders, depression and mood disorders, disruptive behavior disorders, ADHD, and anxiety.
Behavior therapy, where parents and children learn to promote desirable behaviors and reduce unwanted behaviors. Most common for ADHD and disruptive behavior disorders.
Tailoring therapy to the child’s developmental level and thinking style is important, says the APA. They recommend breaking down treatment into steps; using a multisensory approach; combining visual aids with verbal instructions; working on just one skill (such as deep breathing) for an entire session; and demonstrating for family members. If a child is non-speaking, talk therapy might not be the best option, but finding a therapist who is experienced in using alternative modes of communication will be helpful. For example, if your child has autism, apraxia, or selective mutism, a therapist who uses gestures, picture boards, drawing, play therapy, or AAC devices can be considered. There are many other types of treatment your child’s therapist may utilize: art, music, and/or dance can help your child express and cope with their emotions or mindfulness, and breathing exercises or meditation can help reduce stress and anxiety.
Remember, kids — whether younger or teenagers — may not want to talk about their feelings or struggles. Teens may feel resistant, especially if they feel shame or hopelessness around their struggles. It’s important that the mental health specialist who works with your child is the right fit for them (which may take a few tries), can build rapport, and understand their perspective.
For more information about therapy options for kids, visit the CDC’s website.
Medication used in treating mental health conditions
Medication can be used to help with a child with mental health challenges, but it should be just one one of several treatment approaches, according to Yale Medicine. The doctor or psychiatrist will weigh several questions before prescribing medication that is evidence-based to reduce the child’s presenting symptoms and monitor the child over time. While Yale Medicine states that medication should be used if other options, like therapy, aren’t effective, medication can be helpful as part of a comprehensive treatment plan if that’s the right decision for your child.
If medication is being considered, your child should see a psychiatrist (or another provider if you can’t access a psychiatrist) for a comprehensive evaluation as finding the right medication and determining how much a child requires specialized expertise. Yale Medicine says, “Some symptoms that seem worrisome — such as tics or separation anxiety — may be transient or related to development. Others may indicate problems at home, at school or in another part of a child’s life.” During the assessment, there should be a discussion on the risks and benefits of a particular medication, especially if the child is taking other medication, such as for ADHD.
There are many types of medication for mental health challenges, including anti-anxiety medications and antidepressants. Medication often involves a “trial and error” approach, especially when a child has a co-occuring diagnosis. This is why it’s imperative that the specialists you see have experience treating children like your child. For example, a child might be prescribed medication for ADHD, when actually they may be struggling with depression or anxiety, making it hard for them to concentrate in school. Taking the wrong medication may result in unwanted side effects, so making sure you have a provider who is invested in closely monitoring your child is key.
It’s completely normal to be hesitant when given the option to add medication as a treatment for your child. You don’t know how the mediation will affect your child. Will it be too much (or too little)? Will they have to take it forever? Will it cause other symptoms, like loss of sleep? How will they take it at school? Will they be treated differently by others because of it? These are all valid concerns to have and questions to ask your child’s specialist.
Dr. Stutman explains, “Psychiatrists have to really build trust with the parents, explain it, and maybe find other parents who also felt that way and who saw the benefits. If things are serious, or if the suffering has gone on and other interventions have not worked, medication is a very viable therapy. Also, it's important for parents to understand that they don't need to share their information with everybody. It's private information, and if somebody's saying something that's hurting you, you can shut it down because they're not psychologists, they're not therapists, and they have no right to tell you about that. If your kid had diabetes, or a seizure disorder, you would give them the medication, no question. So why is mental health something different? Just because it's invisible doesn't mean that it's not really happening.”
In crisis situations, medication may be even more important and may help kids reach a baseline where they are able to more readily cope with their emotions. Dr. Stutman tells us that if a child is expressing suicidality, parents should find a psychiatrist as soon as possible, especially because they’re hard to find and many have a waitlist. “An evaluation is really important,” she explains, “to rule out that a higher level of care is needed. I think that parents have this stigmatized understanding of medication that is so harmful. I've had so many kids come in that have suffered for years. I've had teenagers tell me, ‘Oh my god, this has changed my whole life. If only I would have done this sooner.’ It's not a failure, and in fact, if a child is dealing with a major stressor for years on end, then that's activating their fight or flight, that's activating cortisol and adrenaline. And those, when they're in high quantities for long enough, are a neurotoxin.”
Intensive care options
Inpatient emergency hospitalization could occur if your child is expressing or behaving in a way that is endangering themselves. The hospital will assess your child to see if they are an imminent danger to themselves or others and recommend a course of action. They may decide to keep your child on observation in a safe environment for 72 hours as they assess the situation. During this time, you may contact their primary care provider, psychologist, or therapist to inform them of what has happened and ask if they can meet with the assessing staff at the hospital. If you feel that your child is still in danger but the hospital won’t keep them, the Child Mind Institute recommends “asking who is liable if your child makes a suicide attempt within the next 48 hours. You can also consider writing the words, ‘Parent has communicated to medical staff that they feel the child is not safe to return home’ on the discharge papers before signing.”
Partial hospitalization programs, intensive outpatient programs, and day treatment can be options for kids who need therapeutic care on a longer-term basis. These programs might provide individual and group therapy, skills training, and medication management onsite at the treatment facility for several hours per day over the course of weeks or months. Some of these programs may also include onsite schooling.
Residential treatment may be recommended for kids who don’t respond to outpatient services or have significant mental or behavioral health needs. This is the most restrictive placement, and the child will live at a treatment facility where they are closely monitored by trained staff while receiving intensive therapeutic services.
It’s important to note that many families feel alone and struggle to find care for their kids during and after emergency situations, especially families with Medi-Cal. Some parents report long emergency room waits (days and weeks) because no inpatient bed was available, or their kids being sent far from home because of the scarcity in local pediatric hospital beds for them locally (only 16 California counties have inpatient mental health hospital beds for children and adolescents). If you have Medi-Cal, call the number on your membership card for mental health services. You can also call your local county mental health line. Mental health services for Medi-Cal are typically available through your Medi-Cal managed care plan or fee-for-service Medi-Cal providers and include individual and group mental health evaluation and treatment (psychotherapy), psychiatric consultation, and psychological testing to evaluate a mental health condition.
To find out more about emergency treatment options, Child Mind’s Guide to Emergency Hospitalization is a great resource for parents, as well as PACER Center’s Overview of Mental Health Care and Treatment Options for Children and Youth.
And for more information, read our articles Mental Health for Kids with Disabilities 101 and Supporting Kids' Mental Health at Home and in Crisis.
3 Tips for parents exploring treatment options
Dr. Haranin shares three tips for parents when looking for services:
- First, “Ensure the provider has expertise and experience in working with youth with intersecting developmental and mental health conditions.”
- Second, “The provider should insist that you, as the parent or family, are involved in treatment. It is important for parents to be involved in whatever treatment is being provided so that you’re able to support your child outside of the therapeutic environment.”
- Lastly, she explains that, “One of the biggest barriers to finding appropriate care is that often, services for developmental disabilities and mental health disabilities are provided through different service systems. It can be helpful for parents to learn a little bit about service systems in their state and to know what those systems are designed to provide. Many family advocacy groups and patient advocate groups offer these types of training online.”
Note for parents
If your child is exhibiting dangerous behavior and you need to intervene to stop an attempted suicide, or prevent one, call 911 or or your local emergency mental health access number, or take your child to the hospital. Here are some options for immediate support:
- Call the National Suicide Prevention Hotline at 800-854-7771, and find more resources on the DMH website. You can also use the the national suicide line by calling or texting ‘988’ or chat online on 988 Suicide & Crisis Lifeline’s website (website for Deaf and hard of hearing here).
- Disaster Distress Helpline: Call or text 800‑985‑5990 for 24/7 support.
- Crisis Text Line: Text HOME to 741741 for 24/7 crisis support.
- California Suicide & Crisis Hotlines
- CalHOPE Peer-Run Warm Line: Call 833‑317‑HOPE (4673) 24/7 for non-emergency support specific to COVID-19 stressors.
- California Warm Peer Line: Call 855‑845‑7415 for 24/7 for non-emergency support to talk to a peer counselor with lived experience.
- California Youth Crisis Line: Youth ages 12-24 can call or text 800‑843‑5200
- TEEN LINE: Teens can talk to another teen by texting “TEEN” to 839863 from 6pm – 9pm, or call 800‑852‑8336 from 6pm – 10pm.
- National Suicide Prevention Deaf and Hard of Hearing Hotline: Access 24/7 video relay service by dialing 800‑273‑8255 (TTY 800‑799‑4889).
- If you have Medi-Cal, you can call the number on your membership card for mental health services. You can also call your local county mental health line. To find out what services are covered, call the Medi-Cal Managed Care and Mental Health Office of the Ombudsman at 888‑452‑8609. They are available Monday through Friday, 8 a.m. – 5 p.m.
- Parents, caregivers, children, and youth up to the age of 25 can receive support at the California Parent & Youth Helpline. Call or text 855‑427‑2736 to speak to caring and trained counselors. Live chatting is also available on their website.
- NAMI California has resources for family members supporting loved ones with mental health conditions. You can call their HelpLine at 800‑950‑NAMI to get information, resource referrals and support from 7 a.m. – 3 p.m.