The number of young people presenting to psychologists with mental health issues is on the rise.
Article summary:
- Before working with school-aged children, observe them in the classroom setting in advance, so you can see how they interact with their peers and adults.
- Ensure you communicate consent details in an age-appropriate manner.
- Use trusted assessment tools, such as the Revised Children’s Anxiety and Depression Scale.
- Connect through play and the child's interests. Not everything has to link back to intervention; relationship and trust building is just as important.
- Treat parents as key stakeholders. Ensure you understand their parenting values and be clear on the information that you need to share with parents or teachers versus what should remain confidential.
- To mark the launch of the APS's new Children's Mental Health learning module, we spoke with one of its co-creators, Kate Crosher, educational and developmental psychologist, to learn about the foundational elements of effective therapy with young children.
In October 2022, our survey of more than 1000 Australian psychologists revealed that, among children aged 6-12, there’s been a sharp increase in several areas.
These include an increase of 45% in social anxiety disorder, 42% in ADHD, 39% in difficulties in relationships with peers, 35% in problematic screen use and 35% in concerns about learning.
Consequently, demand for psychologists with expertise in treating young people is growing.
However, working with children requires a particular skill set – from communicating about consent in an age-appropriate way to initiating creative, playful activities to working with the parents.
Kate Crosher, educational and developmental psychologist at Enfys Psychology, shares advice about how psychologists can enhance their sessions with primary-school aged children.
1. Observe the child in advance
Before initiating the assessment process, it’s a good idea to observe the child in advance, if possible.
“Observations in the classroom, whether you’re doing formal assessments, or as a precursor to counselling, give a lot of data,” says Crosher.
“They help the psychologist understand the child in their day-to-day interactions with peers and other adults.”
To ensure objectivity, observations should, ideally, take place before any face-to-face meeting.
“Once you’ve met the child, you can’t really go back – they’ll always recognise you in the classroom."
2. Get the assessment process right
When commencing the assessment phase, it’s important to remember that many children are unaccustomed to psychologists.
“Young children need to be taught how to use counselling,” says Crosher.
“Many of them have not been encouraged to talk about feelings and share their thoughts openly. So, our first job is to help them feel comfortable.”
This requires building trust, and often the first opportunity to do this arises when gaining the child’s consent.
“Talking about confidentiality and the limits of confidentiality helps build rapport,” she says. “[It also] ensures the child does not feel betrayed if the psychologist needs to tell someone things they have shared in confidence.”
However, it’s essential that confidentiality be discussed in an age-appropriate way.
“Saying things like, ‘Everything we talk about is private, unless you are in danger or someone else is in danger, or if the law says I have to tell someone, but if I do need to share things, I will talk with you about it’, gives a young child a sense of control about the process.”
The use of assessment tools from the outset is also recommended.
“[This is] even more important with the new competencies from APHRA [the Australian Health Practitioner Regulation Agency] that include ‘Deliberate Practice’ as part of the expected skills all psychologists should have,” says Crosher.
Deliberate practice is purposeful, systematic and designed to improve performance. It includes practising skills, using client outcomes to inform professional development, seeking advice and intentionally building competency using a range of strategies.
“Brief questionnaires, such as the RCADS [Revised Children’s Anxiety and Depression Scale], or Moods and Feelings Questionnaire, can give useful information, but also be used for outcome monitoring and collecting data to track change – rather than relying on subjective impressions.”
3. Connect through attention, interest and play
Many children do not receive regular, quality attention from adults.
“Engaging with [the child] is all about giving them healthy, safe connections with an adult who is genuinely interested in listening and connecting with them,” says Crosher.
This involves approaching the child at their level and taking genuine interest in them and their experiences. Initiating playful, creative activities can be crucial to connecting.
“Young children need to be taught how to use counselling. Many of them have not been encouraged to talk about feelings and share their thoughts openly. So, our first job is to help them feel comfortable.” – Kate Crosher, educational and developmental psychologist
“Sometimes these things might feel ‘therapeutic’, like playing bingo with feelings faces and talking about the different feelings. Other things might not, like making paper planes or playing Uno.
“Not everything has to have a direct link to the intervention – because the intervention and therapy is inherently about the connection and relationship-building with the psychologist.”
4. Build trust through honesty
When it comes to building trust, honesty is paramount.
The psychologist should tell the child what they're doing and why, respect the child’s privacy and follow through on plans.
“Most kids, generally, are fairly trusting. So, most of the time, if you’re showing interest and are being genuine, they’ll be willing to share,” says Crosher.
“Children who struggle to trust are often those who have experienced trauma, or had adults in their life who are unpredictable or don’t follow through with what they say.
“It can take more time for these kids to open up and even understand that adults can be trustworthy.”
5. Work with the parents
When it comes to building a relationship with the child, building a relationship with the parents is just as important.
From the beginning, parents should be treated as clients.
“When working with children, there are multiple ‘clients’ – the child, the parent and sometimes the school, as well,” says Crosher.
“You cannot ignore any piece in the puzzle, as all contribute to the wellbeing of the child.”
This means that, when speaking with parents, psychologists should put on their “counselling hat”.
“Ask parents their thoughts and feelings about the situation, and to think about what is important to them as parents,” says Crosher. “What are their parenting values? They may not use those words, or even understand what that means, but there are a lot of unsaid assumptions in parenting, so learning about the parents’ assumptions is important.
“For example, [the parents might say], ‘children should sleep in their own bed’, ‘time out is a great parenting tool’, ‘academic achievement is the most important thing for a child’ and so on.”
At the same time, psychologists should model the behaviour that, ideally, the parent would show towards the child.
“Often, parents haven’t had healthy parents of their own, so modelling empathy, validation and emotion coaching are important."
Throughout the process, clear communication and transparency are essential.
“This doesn’t mean telling the parents everything,” says Crosher. “Instead, it’s about connecting with them, ensuring they feel heard, and letting them know the limits of confidentiality – while sharing strategies and making sure they’re part of the conversation.”
Given we now know that 50% of mental health issues begin before the age of 14, early intervention can make all the difference.
With the right approach, psychologists can lead the way in equipping our children with the skills necessary to manage and enhance their mental health in later life.
Want to learn more about how you can work effectively with children? APS has launched a new Children's Mental Health module, which Kate Crosher contributed to, which you can learn more about here.