By the time many kids sit down on my office couch, they've
been struggling with things like anxiety, low self-esteem and even depression
for quite some time. More often than not, they don't know how to even begin to
express their emotions. They feel stuck and they don't know how to be happy.
I find that parents often wait to seek out therapy for kids, attempting instead to provide help on their own before seeking
professional support. Other times, kids don't exactly express the level of their
anxiety or sadness.
Either way, it can be confusing and overwhelming for
Kids tend to be pleasers by nature. To that end, they have a
tendency to hide their emotions as best as possible. They don't want to cause
added stress for their parents. It's also natural for kids to have worries and
feel very sad at times. Kids face a number of stressors these days, and each
day has the potential to be either really great, a complete pressure cooker or
something in between.
The fact is that not every worrier has an anxiety disorder
and not every bout of sadness leads to clinical depression. Kids experience emotional shifts and struggle. That's part of growing up.
Understanding when the struggle shifts from average childhood behavior to requiring
professional intervention is crucial.
Anxiety and depressive disorders are on the rise among young
children. According to the National
Institute of Mental Health, anxiety disorders affect 1 in 8 children. When
childhood anxiety disorders are left untreated, children are at risk for poor
school performance, difficulty making and maintaining friendships and even
It's important to know when to seek help.
You know your child best, so trust your gut if something
doesn't feel right. Your pediatrician or family doctor can recommend a
psychotherapist specializing in children and adolescents. If you notice any of
the following red flags, make that phone call as soon as possible:
1. Issues beyond the
When kids are struggling with their mental health, problems
tend to arise in more than one place. You might see behavioral changes at home,
school, on the playing field and even with friends.
2. Social isolation
If your child suddenly withdraws from friends (as in refuses
all playdates and eats lunch/spends recess alone), pay close attention. Social
isolation can be a sign of depression and/or anxiety.
3. Changes in normal
All kids have growth spurts and periods of time when they
eat or sleep more or less than average for a few days, but if you notice big
changes in eating and sleeping habits that last for more than two weeks, you
should call the doctor and schedule a check-up as soon as possible.
You also want to take note of frequent nightmares,
difficulty falling asleep and difficulty staying asleep. Changes in behavior
that cause you to think twice usually mean something.
4. Excessive fears and
It's perfectly normal for kids to worry at times. The older
they get, the more "real world worries" (think car accidents and natural
disasters) creep into their thoughts. That's okay. Empathy and reassurance can
be a big help for little worriers. If excessive fears and worries (as in
worrying about every single thing that can possibly go wrong) keep your child
from going to school, getting out the door, participating in her usual
activities (sports, play, etc.) and begin to impact her day more often than
not, you should seek help.
We tend to think of things like cutting and suicidal
thoughts as self-harm, but the truth is that little kids can engage in other
behaviors that also fall into this category. Hair pulling, digging fingernails
or other sharp objects into skin or repeatedly banging their head against
something hard are just a few things to watch for. Again, you know your child
best. When a new behavior is repetitive, lasts more than two weeks and seems
self-injurious in nature, call a professional.
6. Talking or thinking
about death a lot
It's perfectly normal for kids to think and talk about death
(what does happen when you die?),
particularly when they've experienced a loss. It's very difficult to process
the concept of death and what happens to your body after you die.
If your child expresses any (and I do mean any) suicidal thoughts or actions
(talking about wanting to die, making plans, writing goodbye notes), get an
evaluation. Do not shame your child or redirect your child not to say those
things. Provide support and unconditional love, and get help.
7. Regressed behavior
More often than not, regressed behavior is the first sign of
a child in need of emotional support. Bedwetting (when your child is night
trained), clingy behavior, separation issues (including school refusal) and
frequent (intense) meltdowns should all be considered calls for help.