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 parents.
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 substance abuse.
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 home
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 daily activities
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 worries
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.
It can't hurt to get an evaluation if you're worried about your child, but sometimes it can hurt to wait too long. Trust your instincts when your kids are struggling.
Note: This article does not take the place of consulting with a mental health practitioner. If you have concerns about the mental health of your child, seek help immediately.