Parents are usually the first to recognize that their child has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a parent. The first step is to gently try to talk to the child. An honest open talk about feelings can often help. Parents may choose to consult with the child's physicians, teachers, members of the clergy, or other adults who know the child well. These steps may resolve the problems for the child and family.

Following are a few signs which may indicate that a child and adolescent psychiatric evaluation will be useful. YOUNGER CHILDREN· Marked fall in school performance. · Poor grades in school despite trying very hard. · A lot of worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the child's age. · Hyperactivity; fidgeting; constant movement beyond regular playing. · Persistent nightmares. · Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures. · Frequent, unexplainable temper tantrums. PRE-ADOLESCENTS AND ADOLESCENTS· Marked change in school performance. · Inability to cope with problems and daily activities. · Marked changes in sleeping and/or eating habits. · Many physical complaints. · Sexual acting out. · Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death. · Abuse of alcohol and/or drugs. · Intense fear of becoming obese with no relationship to actual body weight, purging food or restricting eating. · Persistent nightmares. · Threats of self-harm or harm to others. · Self-injury or self destructive behavior. · Frequent outbursts of anger, aggression. · Threats to run away. · Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism. · Strange thoughts and feelings; and unusual behaviors. If problems persist over an extended period of time and especially if others involved in the child's life are concerned, consultation with a child and adolescent psychiatrist or other clinician specifically trained to work with children may be helpful.

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