Children’s mental health: A handbook for common issues

What Is Children’s Mental Health?

Children’s mental health is not so different from adult mental health except in one key respect. To achieve well-being, people of all ages require a positive quality of life, social connections, and the ability to maintain a baseline level of functioning despite the normal pressures of life. Children, who are still growing, also have the added criterion of meeting their developmental milestones. So to be mentally healthy, children are expected to behave in socially appropriate ways, experience emotional well-being, have friends, and cope well with mental health disorders and other challenges.

The majority of mental health disorders begin in childhood, by the age of 14. In fact, approximately 15 million children in the US could be diagnosed with a mental health disorder. But as the Centers for Disease Control and Prevention (CDC) states, “Mental health is not simply the absence of a mental disorder.” Adverse childhood experiences (ACEs), which are traumatic events that can impact long-term physical and emotional health, continue to be associated with poor outcomes. So it’s important that children are routinely screened for ACEs and toxic stress as well as mental health and developmental conditions like anxiety, depression, autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD). 

Here’s another thing to remember about mental health in early childhood and beyond: It’s not just immediate families that need to be there for children, adolescents, and teens who are struggling with behavioral, emotional, developmental, or neurodiversity issues. Entire communities need to be educated about how they can help. Neurotypical and mentally healthy individuals can all benefit from learning more about mental health disturbances. Society as a whole is better off when these kids get the assistance they need. 

Ideally, a child has numerous sources of positive adult support and intervention in their lives, ranging from parents/caregivers to school counselors, teachers, coaches, and peers. If mental health problems are recognized early, children can receive the treatment they need to reach their full potential. 

How Do You Explain Mental Health to a Child?

To explain mental health to a child, you use the same guidelines you’d use to address any sensitive subject with a young person. For example, you use age-appropriate language and you let them ask you questions. But unfortunately, mental health is an especially provocative issue to discuss because of the stigma that can still surround it. So here are a few additional recommendations from the National Alliance on Mental Illness (NAMI):

• Compare mental health issues to medical problems. A child understands that when you are sick, you see a doctor and/or take medicine to get better. When your mind is off-balance, you see specialized healthcare providers so you can feel and function better. 
• Use concrete examples that are easy to understand. 
• Make it clear that the condition is not the child’s fault, and be sure to emphasize their strengths as well. 
• Keep the lines of communication open for questions and changing circumstances. Mental health should be an ongoing conversation. 
• Include other family members in discussions. A child struggling with a mental health condition in isolation may feel that they have something to be ashamed of when that couldn’t be further from the truth. For children, mental health is a family affair, and everyone needs to be on board with similar information, acceptance, and support. 
• Empower the child to help themselves. Teach them steps they can take to be healthier and reduce any symptoms that cause them distress.  

How Do Parents Affect Their Children’s Mental Health?

The best way parents can affect their children’s mental health is in a positive way, by recognizing signs that their child is struggling and then connecting them to the resources they need. But caregivers make mistakes, and they can fall victim to circumstances outside their control. For better or worse, young children are dependent on their caregivers for just about everything, so their neurological development and emotional maturation are critically affected by the people raising them. Here are some ways that parents can have an outsized influence on children’s mental health:

• Poverty. More than 1 in 5 US children who live below the federal poverty level have a mental health issue. And people who are lower on the socioeconomic ladder will experience more barriers to mental health support. 
• Genetics, which can contribute to a wide range of mental health issues.
• Poor parental mental health. Just as a parent shouldn’t neglect their child’s mental health, they shouldn’t neglect their own either.
• Environmental stress, including abuse and trauma.

Adverse childhood experiences (ACEs) are associated with lifelong problems like chronic health conditions, toxic stress, and poor job potential. These experiences disproportionately affect ethnic and racial minorities in the US. But children with ACEs can successfully be treated with trauma therapy. Here are some examples of ACEs:

• Parental incarceration
• Family violence (e.g., witnessing a mother being abused)
• Community/neighborhood violence
• Gang violence
• Parental instability
• Teen pregnancy
• Substance use in the family
• Mental illness in the family
• Losing a parent (could be through separation or death)
• Sexual, physical, or verbal abuse
• Physical or emotional neglect

How Does Divorce Affect Children’s Mental Health?

Children are extremely sensitive to stress and tension in their home environment, so naturally marital conflict and divorce will take a toll on their emotional well-being. Divorce can cause anxiety or behavioral problems, yes, but parents also need to consider the harm that an unhealthy, unhappy marriage can have on their children. Whether parents stay together or break up, they need to try to do the following in order to protect their kids:

• Show their children love and support
• Make sure kids know that they’re not to blame
• Keep communication lines open
• Not badmouth the other partner in front of the kids
• Model healthy coping skills
• Maintain consistent discipline and routines between households

How Can I Nurture My Child’s Mental Health?

The best ways you can nurture your child’s mental health are by spending quality time together so you know them well and can recognize when something is amiss, by accepting them no matter what, and by directing them to helpful resources like therapy when they’re suffering. If your child is diagnosed with a mental health condition, educate yourself on how you can support your child and be intimately involved in treatment. It’s important to have accurate health information since you are your child’s number one advocate and caregiver. 

Mental health support at home isn’t one-size-fits-all. For example, a child with obsessive-compulsive disorder (OCD) may not benefit from family accommodation behaviors, where loved ones help them fulfill their compulsive rituals. A mental health professional can help guide interventions at home through family therapy. 

Another great way you can nurture your child’s mental health is by taking care of your own. Unresolved issues have a tendency to crop up during high-stress parenting moments, and we all have a tendency to repeat cycles and patterns that we learned in our own childhoods. You can learn to model healthy coping and communication skills that can influence your child’s mental well-being.   

How Do I Know If My Child Has Mental Health Issues?

Mental health issues can sometimes be difficult to diagnose in children because 1) all children have behavioral ups and downs; and 2) it takes many years to develop emotional regulation. But if your child displays a new concerning behavioral pattern for longer than a few weeks and it causes distress or interferes with school/home life, it may be worth taking a deeper look into what’s going on. 

Child psychologists usually distinguish between mental health symptoms that younger children versus older children might exhibit. Here’s a breakdown of what to look for:

Young children who could benefit from professional evaluation might:

• Experience intense irritability or tantrums
• Frequently express fears and worries
• Have inexplicable stomach-aches or headaches
• Be unable to stop moving or talking except when engaged with a screen
• Experience sleeping issues, nightmares, or daytime sluggishness 
• Lack of interest in socializing or struggle to make friends
• Repeat behaviors in order to prevent something bad from happening
• Struggle at school

Adolescents and teenagers who could benefit from professional evaluation might:

• Experience anhedonia (lose interest in activities they used to enjoy)
• Have low energy
• Experience sleeping issues or daytime sluggishness 
• Spend more time alone, avoiding friends and family
• Develop disordered eating or body image issues
• Harm themselves by cutting or burning their skin
• Engage in substance use or risky/destructive behaviors
• Seem manic, requiring little sleep
• Hallucinate or become paranoid
• Think about suicide. Note: In these instances, don’t leave your child alone and seek professional help immediately. 

Overall, the main red flags to look out for are extreme or unusual behaviors, or negative behaviors with a sudden onset, that seem uncharacteristic for your child, no matter how old they are. 

What Are the Most Common Mental Health Issues in Children?

According to the CDC, the most common mental health issues diagnosed in US children ages 2-17 are the following:

• Attention deficit/hyperactivity disorder (ADHD), affecting approximately 6.1 million kids
• Behavioral problems, affecting approximately 4.5 million kids
• Anxiety, affecting approximately 4.4 million kids
• Depression, affecting approximately 1.9 million kids

Children can also experience the following conditions:

• Autism spectrum disorder (ASD), which is usually identified by the time a child is two and a half years old, according to the American Academy of Child and Adolescent Psychiatry (AACAP).
• Tourette syndrome
• Oppositional defiant disorder (ODD)
• Conduct disorder (CD)
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Eating disorders
• Bipolar disorder (manic depression)

What Is the Most Common Mental Disorder in Childhood?

The most common mental disorder in childhood is attention deficit/hyperactivity disorder (ADHD), which is diagnosed in 9.4% of children aged 2-17 years. Boys are more likely to be diagnosed with ADHD than girls. The majority of children who are diagnosed with ADHD also have at least one other mental, emotional, or behavioral condition. ADHD can be treated with behavioral therapy or a combination of therapy and medication, depending on the child’s age. Children with ADHD who are under 6 are typically treated with therapy alone. 

ADHD can affect attention, behavior, and executive functioning. All children may act impulsively or be hyperactive from time to time, but kids with ADHD have symptoms that chronically disrupt learning and development. Fortunately, evidence-based treatment can help them be successful. 

What Is Child Anxiety?

It’s not surprising that so many children are afflicted with anxiety and anxiety disorders considering we live in an age of global pandemics, global warming, and school shootings. If the world sometimes seems like a scary place to grownups, imagine how it appears to kids. 

Occasional bouts of anxiety are a sign of psychological health. After all, anxiety is a normal human response to distressing situations. But when anxiety begins to interfere with school, friendships, activities, and home-life, your child may need to be evaluated for an anxiety disorder. 

Many kinds of anxiety can affect children:

• Phobias
• Social anxiety
• Separation anxiety
• Selective mutism
• Generalized anxiety disorder
• Panic disorder
• Obsessive compulsive disorder (OCD)

Many of the different kinds of anxiety have overlapping symptoms, thus it’s important for your child to be evaluated by a mental health professional before you come to any conclusions. There are a number of common symptoms that might indicate a child’s anxiety disorder:

• Physical complaints
• Sleeping issues
• Avoidance
• Clinginess
• Trouble focusing
• Tantrums
• Extreme self-consciousness

Child anxiety is often successfully treated in the same way that adult anxiety is: with cognitive behavioral therapy (CBT). Some therapists use a specific kind of CBT called exposure and response prevention (ERP). In some cases, medication can help in addition to therapy. 

How Do I Get Help for My Child’s Mental Health?

Sadly, many parents encounter barriers to mental health support for their children. There aren’t enough child psychologists, school counselors, and other specialized mental health providers available to meet the existing need. Finances can also stand in the way of getting help. For example, a single parent may find a child therapist who accepts their insurance, but that therapist is an hour away.

And of course, millions of children and families didn’t receive the childhood mental health resources they needed when they were home from school (distance learning) during the pandemic. Fortunately, Thriveworks has child therapists and psychologists in offices across the country who are also able to help in an online setting (if that works better for your family).

Every child who needs a helping hand should have one. Mental health care is just too important to neglect at all stages of life. If you think that your child might be dealing with a developmental, emotional, or behavioral issue, you can begin by talking to other adults in your child’s life. Regulars like teachers, school counselors, and other family members can perhaps share their observations and help give you a fuller picture.

If something seems wrong, you want to intervene and course-correct as early as possible. Be prepared to do some work yourself. Child therapy is really family therapy because children are still so dependent on their caregivers. Your child’s emotional well-being is critically tied to you and the home life you provide. You are a major part of treatment and recovery. With your help, your child can find the best ways to let their light shine.