Do You Actually Need Professional Help?

Search this question and eight of the first ten answers are written by places that sell treatment, most of them the most expensive kind. So here is the sentence none of them can afford to write. A great many families who ask this do not need to buy anything, and would be better served by watching carefully for another month than by booking the first thing that comes up. That is not the same as saying everything is fine, and this page is not a clearance. It is the honest starting position.

What is the actual threshold?

Not severity on one night. Three things, all about the shape of a life rather than the size of an argument.

Function. Is anger getting in the way of the ordinary machinery? School, sleep, eating, friendships, whether your teenager can still be in a room with the family, whether anyone in the house is frightened. A teenager who slammed a door in October and is otherwise going to school, seeing friends and sleeping is in a different situation from one who has stopped doing three of those things.

Duration. Weeks and months, not days. Almost every household with a fifteen year old in it has a bad fortnight. What an evaluation is designed around is the last several months, not last night.

Direction of travel. Take a term as your unit. Compared with three months ago, is this getting better, getting worse, or sitting still? Getting worse across a term is the most useful thing you can notice, and the hardest to see from inside the house, because each week only looks a little different from the last one.

Why is there no checklist on this page?

Notice what was not in that section: a count of incidents, a threshold number, a list of behaviours to tick. This site does not publish those, and the reason is that the one professional body which publishes a threshold publishes it as a conjunction, which almost every page that borrows it breaks.

The American Academy of Child and Adolescent Psychiatry, in its Facts for Families sheet on violent behaviour, lists a set of behaviours and, separately, a longer list of risk factors. Its threshold is that a child shows several of the risk factors and the behaviours together. Where that is so, its instruction is unambiguous: an adult should “immediately arrange for a comprehensive evaluation by a qualified mental health professional.”

Lift the behaviour list out on its own, put it under a heading like “warning signs,” and it stops being a clinical threshold and becomes a quiz that every parent of every teenager on earth passes. So this page does not reproduce half of AACAP’s test. The sheet is linked below, it is short, and it is better read whole with both lists in front of you.

Is there anything here that cannot wait?

Yes, and it is a different question from everything else on this page.

The National Institute of Mental Health publishes a list of warning signs of suicide, reproduced here complete, in NIMH’s own groups and wording, with nothing added and nothing promoted to the top.

Talking about: wanting to die; great guilt or shame; being a burden to others.

Feeling: empty, hopeless, trapped, or having no reason to live; extremely sad, more anxious, agitated, or full of rage; unbearable emotional or physical pain.

Changing behavior: making a plan or researching ways to die; withdrawing from friends, saying goodbye, giving away important items, or making a will; taking dangerous risks such as driving extremely fast; displaying extreme mood swings; eating or sleeping more or less; using drugs or alcohol more often.

NIMH’s own guidance sentence is: “If these warning signs apply to you or someone you know, get help as soon as possible, particularly if the behavior is new or has increased recently.”

Read the word rage in that middle group. On a site about teenage anger, that is the most important line we carry: anger sits on the federal government’s own list of things that can mean a young person is in danger. It does not mean an angry teenager is in danger. It means the two questions overlap, and that this one is answered first. The services at the top of this page are staffed around the clock.

Who actually does an evaluation, and what do they ask?

The usual first stop is your paediatrician or family doctor, and AACAP says the same in its sheet on fighting: where ordinary approaches are not working, parents should talk to their paediatrician or family physician. That appointment is cheap or already paid for, it is with someone who knows your child, and it is the normal route to a referral.

Beyond that, an evaluation may be done by a child and adolescent psychiatrist, a psychologist, a clinical social worker or a licensed counsellor, depending on what your area has and what your insurance covers. AACAP’s own position is that “evaluation by a child and adolescent psychiatrist is appropriate for any child or adolescent with emotional and/or behavioral problems.”

What such an evaluation covers is published, and the list is the most useful thing on this page for a parent whose real fear is the unknown. AACAP lists these components:

• description of present problems and symptoms
• information about health, illness and treatment, both physical and psychiatric, including current medications
• parent and family health and psychiatric histories
• information about the child’s development
• information about school and friends
• information about family relationships
• interview of the child or adolescent
• interview of parents or guardians
• if needed, laboratory studies such as blood tests, x-rays, or special assessments

That is the whole shape of it: questions, history, two interviews, occasionally a test. What comes out, in AACAP’s word, is “a formulation”, something that “describes the child’s problems and explains them in terms that the parents and child can understand.” It is an explanation you can read, not necessarily a label, and no page can tell you what yours will say. What happens at a first appointment covers the room itself.

What about residential programmes?

They are what most of the page-one results are selling, so leaving them out would be dishonest.

A residential placement means a young person lives away from home, in a facility, under someone else’s supervision, for a period set by the programme or by a court. A clinician may recommend one, a family may enrol privately, and a juvenile court may order one as part of a disposition. Costs, licensing and oversight are regulated at state level and vary enormously.

This site will not tell you to do it and will not tell you not to. It is a decision with consequences we cannot see from here, and the people who can are the clinician who has assessed your child, your paediatrician, and, where a court is involved, your child’s lawyer. A decision of that size should not be made from a website written by the people who would be paid for it.

What this looks like in an ordinary house

Nadine has a fifteen year old son who put his fist through a cupboard door in October. This is an illustration rather than a real family.

By November she has three browser tabs open: a residential programme four states away, a weekend course promising results, and a therapist with a waiting list. What she does instead is smaller. She writes down, for the eight weeks since October, the days something happened. There are four. He is still going to school, still sleeping, still seeing the same two friends, and the incidents are further apart rather than closer together. Function mostly intact. Duration short. Direction of travel the right way.

She books the paediatrician anyway, because none of that is a clearance. The appointment takes twenty minutes. He asks about sleep, about school, about who else is in the house, and says he wants to see them again in six weeks and would refer if those six weeks go the other way. That is where this example stops, because what she does about the tabs is her decision and not this page’s.

The part worth copying is not the outcome. It is that she found out what she was looking at before paying for a solution to it.

If the answer for you turns out to be yes, what anger management classes actually are explains why a class and a course of treatment are not the same purchase. And if what you really want to know is whether this amount of anger is unusual for a teenager at all, is this amount of anger normal takes that question directly, and is the better page to read first at midnight.