By Nil Kartal, Child and Adolescent Psychologist
Quick answer: If you are asking “does my child need therapy?”, the most useful test is not any single behaviour but three things together: a change from how your child usually is, that has lasted more than a few weeks, and that is getting in the way of ordinary life (school, friends, sleep, family). Big feelings are normal. Big feelings that do not pass, that your child cannot recover from, or that are shrinking their world are the signal to ask for help.
Parents rarely ask this question lightly. By the time someone types it into a search bar, they have usually been watching something for a while and talking themselves out of it: he is just tired, she is going through a phase, all kids do this. Sometimes that is right. This post is about how to tell the difference, based on ten years in Dubai schools watching which children were flagged too late, and my work now with children aged three to twelve at Belle Vie.
Does my child need therapy? Start with three questions
Before any list of signs, hold your worry up against these:
- Is this a change? A child who has always been cautious is different from a child who was outgoing until three months ago. Change from baseline matters more than the behaviour itself.
- How long has it lasted? A rough fortnight after a new sibling, a house move or a falling-out with a friend is expected. Several weeks with no sign of settling is worth attention.
- What is it costing? Is your child avoiding school, losing friends, not sleeping, not eating, or is the family organising itself around the difficulty? Impact is the clearest reason to act.
If the answer to all three is yes, you do not need to wait for anything worse. That is the moment to book a first conversation.
Signs in younger children (roughly 3 to 7)
Young children show distress through the body and through behaviour, because they do not yet have the words. Things that are worth noticing when they persist:
- Tantrums that are longer, more intense or more frequent than they were, especially past the age of five, or meltdowns your child cannot recover from without a very long time.
- Separation that has become a daily battle: clinging, panic at the school gate, refusing to be left with a familiar adult.
- Regression: bedwetting after being dry, baby talk, wanting to be carried everywhere, new fears of the dark or being alone.
- Sleep problems that persist: nightmares most nights, refusing to sleep alone, waking distressed.
- Frequent tummy aches or headaches with no medical cause, particularly on school mornings.
- Play that has become repetitive, aggressive or stuck on one frightening theme.
- A nursery or school teacher saying, gently, that they have noticed something.
Signs in older children (roughly 8 to 12)
School-age children can talk more, but they often will not, particularly to their parents. Look for:
- Withdrawal: less time with friends, dropping activities they loved, spending most of their time alone in their room.
- Irritability or anger that seems out of proportion, or a child who has become “difficult” when they were not before. In this age group, low mood often looks like anger rather than sadness.
- Worry that runs ahead of them: constant questions about what might go wrong, needing repeated reassurance, refusing new things.
- School refusal, a sudden drop in grades, or a teacher reporting that they are not themselves in class.
- Changes in eating, or comments about their body or appearance that worry you.
- Friendship trouble that is not resolving, including being excluded or bullied, online or in person.
- Saying things like “I wish I wasn’t here” or “everyone would be better off without me”. Take these seriously every time and do not wait.
Signs parents most often miss
In my experience, three things get overlooked.
The quiet child. Loud distress gets noticed. The child who becomes very compliant, very good, very quiet after something difficult often does not, because on the surface nothing is wrong. Sudden good behaviour after a hard event can be its own signal.
Physical complaints. Anxiety in children very often arrives as stomach aches, headaches, feeling sick, or “I’m too tired”. If the paediatrician has found nothing and the pattern lines up with school days or particular situations, it is worth thinking about the emotional side.
The move. Families relocating to Dubai expect the first few weeks to be hard. What surprises them is the child who seemed fine for the first term and then falls apart in the second, once the novelty is gone and the loss of home, friends and grandparents lands. Delayed reactions are common and they are not a sign that you did something wrong.
What is developmentally normal
Some of what worries parents is simply childhood. Fear of the dark and of monsters between three and six. Occasional lying and testing limits. A stormy week when a sibling arrives. Shyness in new groups. Pre-teen moodiness and door-slamming. Not liking school some days. None of these on their own means a child needs therapy. The difference, again, is persistence, change and cost. If a child is generally happy, functioning and able to recover, you are probably looking at a phase.
What happens if you do book
Booking a first appointment does not commit you or your child to anything. At Belle Vie the first session is with parents only: we talk through what you have noticed, when it started and what has been going on around it. Sometimes the outcome is reassurance and a few things to try at home. Sometimes it is a short piece of work with your child. Sometimes it is a recommendation to see someone else, such as a speech therapist or a paediatrician, first. Any of those is a good outcome. What you get either way is a clearer picture, which is usually what parents most want.
If you would like to know more about how sessions work for different ages, the child therapy in Dubai page explains play therapy, adapted CBT and how parents are involved. For choosing a psychologist, see how to find a child psychologist in Dubai.
Frequently asked questions
Is my child too young for therapy?
From around three, play-based therapy is possible. Under three, we work with parents.
Will I be blamed?
No. Parents are the most important part of a child’s recovery and we work with you, not on you. Most difficulties have many causes and none of them is “bad parenting”.
Should I tell my child they are going to see a psychologist?
Yes, in simple, honest terms suited to their age: “someone whose job is to help children with big feelings”, “a place with toys where you can talk or play”. We can help you find the words.
What if my child refuses?
Very common, especially with older children. We often start with parents only and build from there. Children rarely refuse a second session once they have had a first one that did not feel like an exam.
My child’s school suggested it. Does that mean something serious?
Usually it means a teacher who knows your child well has noticed a change. Schools see children in a setting parents do not. Take it as useful information, not a verdict.
Related reading: child therapy in Dubai, adolescent therapy, what play therapy is, settling a child in Dubai without English, anxiety therapy and Nil Kartal’s profile. The American Academy of Child and Adolescent Psychiatry’s When to Seek Help for Your Child is a good second opinion.