Natural growth spurts and sudden changes in children's lives may cause them temporary distress, which in turn can lead to worrisome behavior. Working together, teachers and parents can usually guide them through these challenging times. Unfortunately, there are occasions when distress is more than temporary, and children need more support than parents and teacher can provide. The following early childhood case studies illustrate situations that call for additional help. But situations like these can occur at any childhood age.


In the fall, Mrs. Rumson thought it was just that Allison was having trouble adjusting to group activities. But now it's January, and the kindergartner still avoids group activities. When she does participate in something like an art project, she often ends up in tears because she isn't happy with her work.

The teacher suggested that one of Allison's parents spend some time in the classroom during the early weeks of school. But Allison still seemed sad and frightened. Months have passed and she eats little, cries easily, and complains of frequent tummy aches — for which the family pediatrician can find no explanation.

Mrs. Rumson has tried to make Allison feel more comfortable in school by taking a few minutes every day to join the little girl in play. At first, Allison seemed to have little energy or enthusiasm for their play. Then one day she used the hand puppets to tell a short, sad story about a girl who was lost. Since then, the puppets have "told" the teacher one sorrowful tale after another. Mrs. Rumson is pleased that Allison trusts her more now, but the little girl is still sad and hasn't made any friends, and in fact, lashes out if another child approaches to listen or touch the puppets. And when she gets angry like that, Allison stops playing and begins to rock and suck her fingers. Mrs. Rumson is at a loss about how to help her.


"Wait, Nicholas!" Mr. Ambrose shouted, just in time to stop the kindergartner from jumping off the top of the monkey bars. It was the third time the teacher had rescued Nicholas that morning — and this was becoming a daily routine. A few seconds later, the child raced around the playground, bumping into one group of children who were playing ball and another two who were jumping rope.

Indoors is no different. Nicholas has a hard time making it through story time without jumping up, poking someone, or shouting out. Sitting still and concentrating on quiet projects seems impossible. During lunch and snack, he's rarely in his seat and often spills his milk or juice. Similar things happened in nursery school, but in kindergarten his behavior is more worrisome — it's interfering with his own learning and is disruptive for others. Nicholas' parents have willingly shared their concerns. His mother explained that Nicholas was always very active, even before he was born. "Then, when he was a toddler, I often was tired, but at the end of a day with him now, I felt exhausted." His father added that they'd hoped Nicholas would settle down in school. "The doctor said he might outgrow his 'fidgeting' by kindergarten." Nicholas's teacher and his parents are at a loss about what to do next.

Assessing the Need for Help

Although they haven't put it into words, these parents and teachers have tacitly agreed that it's time to seek outside help for Allison and Nicholas. Arriving at this decision is never easy. Others in the same position may find it helpful to consider these questions:


  • How long has the situation existed? Children often behave in ways that mystify and upset the adults around them, but usually for relatively brief periods of time. Sadness like Allison's is not at all uncommon during the early weeks of school or during transitional periods in a child's life. Hers, however, has gone on too long. Likewise, brief spurts of hyperactivity may be disruptive, but Nicholas' long-term behavior merits more attention.


  • Are there more than one or two symptoms? Low frustration tolerance, an occasional tantrum or nightmare, fearfulness or intolerance of changes in routine, a few social difficulties — by themselves, these may not be cause for special concern. On the other hand, if a child is troubled with many of these problems, it's time to consult an expert.


  • Have the teacher and parents tried to help in many appropriate ways, with little success? Nicholas' teacher has tried to calm him. Allison's teacher has tuned into the little girl's sad feelings. All of the parents spent time in the classroom, shared their concerns, and worked together with the teachers. Still, the problems have persisted and even worsened.
There's no doubt that Allison and Nicholas should be referred to a qualified specialist in children's mental health. Where good rapport already exists between teacher and family, parents are more likely to feel relieved knowing that more help is forthcoming for their children -- and for them.

Steps for making a referral

1. Keep careful reports. Begin documenting behavior and conversations with parents as soon as you become aware that there is a serious problem.

2. Discuss the situation with your principal. Most schools have a referral process already in place.

3. Talk with parents, perhaps along with the principal. Have all written records handy in case they are needed.

4. Be prepared to offer specific suggestions (if asked). Most schools have a special-services team of social worker, psychologist, and psychiatrist. Others offer outside referral sources, although parents may prefer to take their child to another qualified person whom they have learned about through a family doctor, pediatrician or local mental health agency. Encourage parents to seek an individual who will work with them as well as with their child, and who will welcome input from the teacher.

5. Recommend that children receive a thorough physical examination. If this has not been done recently, check if behaviors could be medically linked.

Remember: In talking with parents, it's important to discourage them from blaming themselves. Welcoming advice about your own role in helping their children will go a long way toward reassuring them.