Does my 9 year old girl need mental help?

[Pepet]

I am divorced with a 9 year old girl from another marriage, a 4 year old son from a current marriage and a part time 8 year old step daughter.  My ex-husband and I have opposing views on parenting.  My daughter has been in counseling off and on since the age of 5 for displaying "concerning" behaviors that may/may not be related to the divorce.  We were never able to find out as she does not talk.  We have seen issues such as anxiety, depression, over eating, self mutilation, aggression toward animals, dishonesty, extreme reaction to stimulous (pain - ie. I can't brush her hair for her).  I have tried to get her help and I keep runnign into brick walls.  This morning my husband's ex called to tell us that my daughter wrote on the back of her step sister's journal "Things we are going to steal" and then listed items such as a laptop, cell phone, make up, money and pills.  When we went into her room to find my daughter's journal, there were writings about being in love with a boy in school (who is not so wonderful) and how she loves him, wants to kiss him, pictures of them face to face with their tongues out.  I am so alarmed that I am not sure of what my next step should be.  It's like she has a double life.  I have tried to get her in to a psychiatrist for some time now and have not been able to - the ones I have called from my health plan don't call back.  What should I do and where do I go for help?  My ex husband says I amke too much of a big deal and he's sure this will pass.

[Kevin Kennedy, Ph.D.]

You are on the right track to think that the situation requires professional intervention. Whether or not the emotional and behavioral problems have arisen in part due to your divorce is not really important at this point. The focus should be on obtaining help. I cannot say why you are encountering such a hard time getting access to help. Do you want to indicate where you live? If so, I might be able to offer some practical suggestion about resources in your area.

[MomInIowa]

I would not wait or let this pass, it is not a phase.  This is a young girl with some serious psychiatric issues if they are as severe as they sound in your post.  She needs to be seen by a licensed mental health professional, not a psychiatrist. There is a difference between the two. I am a social worker and my husband is a Psychologist.  A Psychiatrist is a doctor with a specialty in mental health for medication management. They do not perform therapy as a main part of their practice. They prescribe the meds and monitor the behaviors based on this. A psychologist or licensed therapist/social worker are the people who do a majority of the testing and assessments for mental health diagnosis and therapy. They are the interactive part of things and usually a Psychiatrist and psychologist work together.  I would talk to your local school psychologist to find out if they can do the testing or if they know of some well known people who can. These are Masters level social worker or counselors who have so many years of experience as well as passed a state licensing requirement. You can look in the phone book under counselors or social workers. You can also contact your local DHS office to find out if there are family or child services offered to help you with this situation, this is separate from child welfare or protective services. Iowa has a waiver program for children with severe mental health issues that provides interventional services and assistance to the families to help deal with this.  Similar to the way they would assist with a child with a severe physical disability.  Not all states offer this though. It sounds to me that she is bi-polar.  We have heard a lot about this in the media especially with it being speculated about some celebrities and their erratic behavior. Bi polar disorder is a serious and devastating psychiatric disorder if it is not treated properly with counseling intervention and medication management.  Part of the reason you may not be getting called back by a psychiatrist is because you usually need to be seen by one of the other professionals to be tested and diagnosed before the Psychiatrist becomes involved. The major depression is what tips it off the most.  This combined with the other behaviors. These are all ways to cope with her emotions. In bi-polar disorder your emotions are constantly changing from manic (which sounds like the stealing, dishonesty and elation with a boy at nine years old) and the depressive coping skills (mutilation-to deal with the frustration and emptiness, overeating to fill an emotional void, and the aggression towards animals).  The aggression and self mutilation is what gets me scared, so please do not let this go. Please watch her closely and do not let her be alone.  Please pursue this and do not give up.  You are right to be concerned and need to see someone.  It is NOT a phase.  I also wonder if she is acting out sexually. Hyper-sexuality at a young age can be a sign of bi-polar disorder if she is acting on it. This would also be a sign of possible abuse. It is hard for me to accurately guess since a true assessment has to be done with a licensed counselor or social worker. But please do not wait. If you do not get proper intervention when she gets older you will not be able to do much.  

[Pepet]

I have had her in help at other times - social workers and psychologist.  They say she does not open up to them and so there is nothing they can do.  No one has talked about any testing and at school, she had trouble with bullying last year and the school psychologist was useless.  we live in Northwestern NJ.  The only reason I was pursuing psychiatrist was because the pediatrician advised us to do so when we brought her there for her constant stomach aches as they are "all in her head".  I am really frustrated - and then when you factor in who does not participate with the insurance plan it is doubly frustrating.  We do have mental illness in the family - her paternal grandmother is schitzophrenic and we have depression on my Dad's side and ADHD with 2 of my sister's 4 kids.

[Kevin Kennedy, Ph.D.]

You might contact the Department of Behavioral Medicine at Hackensack University Medical Center.