Does My Child Need Therapy?
As children progress in their growth and development, it is not uncommon for your child to experience emotional and behavioral challenges that may seem concerning and leave you wondering, is this normal?
The information below is only a guide and should not replace medical advice- each child is different and may have their own track of development.
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Emotional Development
Is often silly and enjoys laughing
Experiences a wide range of emotions with intensity
Identifies own and other’s feelings
Shows concern by offering hugs or comfort
Struggles to regulate emotions when tired, stressed, or experiences changes in routine
Throws fewer temper tantrums than at 2 ½
3 ½
Expresses emotions more intensely
Cries, whines, or has more difficulty separating from parents
Is very determined and strong -willed
May have imaginary friends
Seems sensitive and becomes upset easily
Can be inflexible; responds negatively to changes in schedule
Normal Challenges at 3
Frequent potty training accidents when engaged in play, or withholding to avoid missing out on activities
Masturbating in private or in public
Enjoying being naked and frequently taking off their clothes
Asking questions about genitalia and where babies come from with body parts
Wanting to wear costumes or pretending to be a fictional character or animal
Normal Challenges at 3 ½
Biting nails, picking nose, sucking thumb, or chewing on clothes to self-soothe
Excessively blinking or developing facial tics
Refusing to be cooperative or flexible
Whining and complaining
When to Seek Help
Your child’s behavior or abilities seem significantly different from those of other children his or her age
Your child demonstrates extreme separation anxiety, or withdrawals from friends or play
You need parenting support to address concerns or issues related to discipline
Your child experiences a significant change or traumatic experience, including loss, disruption of the home or family environment, abuse, or a medical emergency
You frequently feel disconnected and stressed in your relationship with your child
Your child has extreme temper tantrums or lacks self-control
Your child has significant difficulties sleeping or toilet training
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Emotional Development
Often reacts strongly, with intense feeling of happiness, silliness, anger, and sadness
Needs adult help to find words to express needs, instead of reacting physically
Can be aggressive and bossy
Loves and hates many things
Has a growing sense of humor, and enjoys laughter and silliness
Learns from modeling; needs chances to practice new behavior
May throw temper tantrums
4 ½
Is often fearful or anxious
May have frequent nightmares
May develop phobias
Can stay on-task for long periods of time yet still not long
Is dramatic
Normal Challenges at 4
Aggressive behavior including hitting, kicking, and throwing temper tantrums when angry
Lying when in trouble
Frequent nightmares stemming from new feelings or experiences
Imaginary friends
Fascination with their own bodies and masturbation
Fascination with going to the bathroom and using “potty” words or name-calling
Constant motion and noise
Normal Challenges at 4 ½
Seeming “at odds” with environment
Frequent fears
Fears developing into phobias (typical for this age)
Fears regarding what is real and what is not
Inconsistency, making them hard to predict
When to Seek Help
Your child’s behaviors or abilities seem significantly different from from those of other children his or her age
You child experiences severe or prolonged anxiety or sadness
Your child experiences excessive phobias that interfere with daily functioning
You need parenting support to address concerns or issues related to discipline
You child experiences a significant change or traumatic experience, including loss, disruption in the home or family environment, abuse, or a medical emergency
You frequently feel disconnected and stressed in your relationship with your child
Your child demonstrates highly aggressive behavior behaviors towards you and others
Your child shows little interest in play or playing with others
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Emotional Development
Is calm and confident in his or her own abilities
Feels safe with consistent guidelines and routine
Is positive and optimistic about self and life
Is quieter and at times more withdrawn
Avoids overstimulation
Is able to express feelings verbally
Demonstrates more self-control and less impulsivity
Becomes more independent and gains a sense of competence
5 ½
Is still eager to do activities, but less motivated to please than earlier in the year
Displays extremes in behaviors, both positive and negative
May seem overly demanding and disobedient
Experiences intense rage and fluctuations in emotions
May bite nails, pull hair, or cry to relieve anxiety
Is indecisive
Is hesitant and insecure
Normal Challenges at 5
Frequent nightmares, and often waking up screaming and crying
Enjoying watching television and playing on the computer and needing limits on screentime
Sometimes too obedient and should be protected from overly dominating or aggressive playmates
Lying to avoid punishment
Stealing items from other people
Normal Challenges at 5 ½
Opposition to adults and peers
Complaining frequently
Becoming easily overwhelmed with choices
Tattling
When to Seek Help
Your child’s behaviors or abilities seem significantly different from from those of other children his or her age
You child experiences severe or prolonged anxiety or sadness
Your child does not show interest in developing friendships or playing with friends
Your child has problems in school or another academic environment
Your child displays extreme disobedience or defiance
Your child has frequent accidents or difficulties toileting during the day
You need parenting support to address concerns or issues related to discipline
You child experiences a significant change or traumatic experience, including loss, disruption in the home or family environment, abuse, or a medical emergency
You frequently feel disconnected and stressed in your relationship with your child
Your child demonstrates highly aggressive behaviors towards you and others
You are having difficulty deciding whether your child is ready for kindergarten
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Emotional Development
Is highly sensitive to criticism and correction
Is more emotionally volatile under stress, or when hungry and tired
Is gaining a greater sense of competence and mastery
Is more aware of other’s needs and feelings
Is proud of accomplishments
6 ½
Is calmer and more easygoing
Is likable and affectionate
Has a good sense of humor
Likes to try new things
Normal Challenges at 6
Fear at bedtime and needing a nightlight or security object
Bedwetting or accidents during times of high stress
Lying, which is quite normal for this age, but stressful for parents and adults
Poor sportsmanship in games
Defiance of and arguments with parents as the child tries to gain more independence
More anxiety and fears at bedtime, and needing extra reassurance and comfort
High sensitivity to criticism and correction, to which perceived judgment or failure they may respond with intense emotion
Normal Challenges at 6 ½
Extreme sensitivity to criticism
High levels of anxiety
Performance anxiety
A tendency to lie to win or to get out of trouble
When to Seek Help
Your child’s behaviors or abilities seem significantly different from from those of other children his or her age
You need parenting support to address concerns or issues related to discipline
You child experiences a significant change or traumatic experience, including loss, disruption in the home or family environment, abuse, or a medical emergency
You frequently feel disconnected and stressed in your relationship with your child
Your child demonstrates highly aggressive behaviors towards you and others
Your child becomes highly discouraged when, or, avoids, learning new skills or knowledge
Your child shows little interest in interacting with others or making friends
Your child shows little interest in play or physical activities
Your child is struggling to read or has significant difficulty in school
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Emotional Development
Is often more withdrawn and quieter
Experiences large shifts in mood, and is more sensitive and serious in general
May seem moody and sad without cause
Tends to worry about serious things, such as wars, illness, natural disasters, and money
Is more introspective and self-reflective
May blame others for wrongdoing and has difficulty admitting failure
Cries easily, but often hides his or her tears to avoid embarrassment
Is easily disappointed and clings to his or her own plans
Works had to control his or her temper, voice, thoughts, and body, and often feels fatigued
Likes to observe others
Develops great empathy for others and is highly sensitive to other’s feelings
Normal Challenges at 7
Seeming more withdrawn, quieter, and sadder in general (but this does not necessarily mean that they are depressed or struggling)
Worrying more about death, the loss of loved ones, natural disasters, getting good grades, making friends, and other concerns
Perfectionistic tendencies and repeating a task or assignment multiple times to meet their own high standards
Sensitivity to rejection and failure, and interpreting bad experiences or mishaps as rejection and responding dramatically
When to Seek Help
Your child’s behaviors or abilities seem significantly different from from those of other children his or her age
You become discouraged by your child’s attitude or behaviors
Your child becomes excessively withdrawn
Your child is aggressive and engages or welcomes conflict with you or others
Your child cries excessively or displays extreme agitation
Your child has no or few friends or does not socialize with peers
You need parenting support to address concerns or issues related to discipline
You child experiences a significant change or traumatic experience, including loss, disruption in the home or family environment, abuse, or a medical emergency
You frequently feel disconnected and stressed in your relationship with your child
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Emotional Development
Is outgoing and sociable, with bouts of rudeness and being demanding
Is sensitive and tends to be dramatic
Is able to understand and interpret others emotions
Is able to regulate his or her own emotions
Is self-critical and self-competitive
Experiences more fear and anxiety, but refrains sharing those fears with adults
Normal Challenges at 8
High levels of activity and energy, and a need for physical activity that adults may find surprising
Increased focus and concern about peer relationships and acceptance
Testing rules and limits as they become more independent
Excessive self-criticism
When to Seek Help
Your child’s behaviors or abilities seem significantly different from from those of other children his or her age
Your child wets the bed or has difficulty sleeping
Your child behaves impulsively, lies, or steals frequently
Your child experiences intense anxiety regarding his or her performance
Your child experiences intense anxiety when separated from his or her parents
Your child has difficulty making friends, withdraws from peers, or is overly sensitive to peer pressure
You child experiences a significant change or traumatic experience, including loss, disruption in the home or family environment, abuse, or a medical emergency
You frequently feel disconnected and stressed in your relationship with your child
Your child is struggling in school or failing subjects
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Emotional Development
Tends to worry or become anxious
Gets feelings hurt easily
Is determined, motivated, and independent
Is more mature and generally calmer
Is persistent and sometimes impatient
Is able to take the perspective of others and understand other’s thoughts and feelings
Follows rules and is eager to gain approval from teachers, parents, or peers
Is generally self-confident and dependable
Is able to communicate and express is or her feelings with others
Has strong and intense internal world and emotional experiences
Tends to be perfectionistic
Normal Challenges at 9
Struggling with taking tests and becoming more anxious about academic performance
Excessive perfectionism
Excessive worries
Competitiveness with others
Self-Criticism
Sensitivity and avoidance of situations in which they believe they will fail
When to Seek Help
Your child’s behavior or abilities seem significantly different from those of other children his or her age
Your child’s worries interfere with his or her daily functioning
Your child withdraws from interaction or competition because of fear of failure
Your child is overwhelmed by social interactions or has difficulty developing friendships
Your child experiences severe or prolonged anxiety or sadness
You need parenting support to address concerns or issues related to discipline
Your child experiences a significant change or traumatic experience, including loss, disruption in the home or family environment, abuse, or a medical emergency
You frequently feel disconnected and stressed in your relationship with your child
Your child demonstrates aggressive behavior toward you or others
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Emotional Development
Is relatively calm
Is typically flexible and easygoing
Is comfortable in his or her environment
Needs to be perceived as “good”
Has a strong sense of right and wrong
Demonstrates self-confidence
Is drawn to activities in which he or she feels competent
Uses cognitive skills to regulate emotions
Can become angry quickly, but will calm equally quickly
Prefers his or her environment to be organized and predictable
Normal Challenges at 10
Excessive concern with belonging to the group
Choosing peer values over family values
Desire to spend substantial time with peers
Spending time and energy on maneuvering through social interactions
When to Seek Help
If your child has no friends, dislikes school, or displays emotional and social difficulties. Additionally, if your child does not express a sense of belonging in a recognized group, this might be an area of concern. At the age of 10, children also need to experience a sense of mastery or competence; thus if they are struggling with finding areas of competence, they might need help.