Several people have written privately to ask how we knew when we needed outside help for Big Guy, and how we knew we needed meds. We've been through the wringer for seven years now, so I've accumulated two or three cents' worth of thoughts on the topic. Here's what I know:
If you're thinking you child might just be going through a really bad stage, write down a list of the troublesome behaviors, and then set yourself a date four months later to review where you are. You need a benchmark against which to gauge progress. If things mellow, great. If they don't, or if they have gotten worse, get help. Stages pass; problems fester.
If the size of your child's reactions don't make sense given the size of the triggers, you're probably dealing with something bigger than you can resolve on your own. When you look for help, there are two things to know:
1. If takes a lot of lead time to get in for a psych evaluation. You want to start earlier than you think you need to; if things improve during the two months while you're waiting, you can cancel the appointment.
2. It often takes more than one try to find the right therapist and child psychiatrist. If you find someone and it isn't working, try someone else. And then try someone else. Don't assume that because one therapist is useless to you, everyone else is clueless. (On our first try we got someone who suggested using a star chart, when we were restraining Big Guy for two hours each night as he raged. Uh... no.)
Another reason to schedule an evaluation sooner rather than later is that some meds take a long time to kick in. Trust me, if you're dealing with depression or severe anxiety and you wait until you're in major crisis to start meds, you're going to be a really unhappy parent. You may have to wait 4-6 weeks for the full effect of the meds to kick in (that's after the two months you've waited to see the pdoc) -- and the meds dosages are rarely right the first time around. You have to ramp up to the right level, in stages. And sometimes one medication doesn't work, and you have to taper off that one while you're starting another. It is not a science. It's an extended study in experimentation.
I think a lot of people get their knickers in knots thinking about meds, because they forget that they are trying meds. If they help your child, great. If they don't, you can change your mind. It's a reversible decision. The main point of meds is to make it possible for your child to succeed in ways he or she can't, currently.
I'm not a medical professional, and can't diagnose more than any other mom. But if you are worried about your child and want to talk, you can email me at LotsaLaundry1 AT gmail DOT com.