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  • Writer's pictureJoss Burns

When to Be Concerned: Signs of Mental Health Conditions in Children and Teenagers

Updated: Oct 26, 2023


A mother with her teen daughter with concern

The expert insights in this article are provided by Joyce Bartz, LCSW, Retired Assistant Superintendent for Special Services of Evanston/Skokie District 65 and Board Member, MHANS (Mental Health America of the Northern Suburbs).


Taking care of children and teenagers comes with unique challenges at specific ages. What’s more, as they grow and develop, there are going to be trying periods, whether it's behavioral changes or coming into conflict with parents or authority figures.


To a certain extent, this is natural. Pushing boundaries and exploring is an important part of growing up. And when you factor in hormonal changes at puberty, there will be inevitable resulting changes in emotions, interests, and preferences.


That said, these explorations can be extremely difficult for parents to navigate, and it begs the question – when should I be concerned? When does it go beyond normal growth patterns and become a cause for intervention?


Gaining perspective: What the statistics say


It is important to remember that mental health is an exceptionally broad subject that covers a vast range of issues. Many instances can be addressed with light, timely, and caring intervention, and severe cases are comparatively rare.


For example in Illinois, between 115,615 to 148,648 individuals aged 9-17 have what is considered “serious” mental health illnesses. With 12.9 million residents in the state, that equates to around 7%–9%.


On one hand, this statistic is high, as each of those individuals requires and deserves high levels of support to help them cope with what they are facing. That said, if you are a parent and are worried about your child, the chance of them developing a severe disorder is relatively small.


For the most up-to-date statistics on youth mental health, please consult the Mental Health America website.


Mental health is a wide-spread issue


While severe cases are the exception rather than the norm, it is true that most children and teenagers will face a mental health challenge of some description in their lifetime.


Joyce:

“More children than we think display some suicidal ideation. For depression – not sadness or hanging out with kids – depression can lead to changes in eating patterns, difficulty with sleep, or withdrawal. School avoidance is certainly a big issue and a big concern.”


This infographic gives a good overview of what falls under the umbrella of mental health, including triggers, common demographic differences, long-term repercussions, and the benefits of support.


A majority of children and teens often feel sad


For example, 68% of 11-17 year-olds said they frequently felt sad or unhappy, yet boys are two times more likely to exhibit behavioral issues – often because of an inability to deal with or regulate emotions.


Joyce:

“Sometimes I'm more worried about those children who appear sad than I am about those children that appear angry. The angry child, they're acting it out and they're getting some of that stuff out of them – although that too is a worry. That said, those that appear sad are potentially digging themselves into a hole more and I’m more concerned about.”


Harsh discipline can exacerbate the issue


However, while the majority of children will experience some form of mental health challenge in their childhood or adolescence, the measures taken to address the resulting behavioral changes can have the opposite effect.


Young students who have been either expelled or suspended are ten times more likely to perform poorly academically and have a higher probability of going to jail in the future. Instead, an approach based on showing love and care can have much better results.


Emotional support is effective


Restorative discipline practices have been shown to achieve a 67% reduction in suspension over multiple years. What’s more, children who have well-developed emotional skills will see positive results across all areas of their adult life.


Early-warning signs of mental health


As a parent, the question is: when do I talk to my child about their mental health?


The answer is quite simple. If you suspect that there is an issue, the earlier you address it, the better. This could be something just not feeling right, but you aren’t sure what. It could be that your child or teen exhibits behaviors that are different from their peers or you notice problems with friends, schoolwork, or at home.


No time is too soon to sit down and have a respectful, judgment-free talk. On many occasions, this is all it takes to help your child through a difficult period.


Joyce:

“I'm concerned if kids, even over a short period of time, seem unusual in their behavior, whether it's depression, anger, or avoidance of activities. Parents can be extremely busy with work or other crises or something that's happened in their lives and may not always be just right there at that point in time.


I hope that a teacher has noticed a problem that might be going on within the classroom and would be able to communicate with the parent. That would be our hope.”


What are the signs?


If you still aren’t sure, it is best to take action of some kind if your child or teen exhibits any concerning signs for more than three months.


Joyce:

“I'd say a sustained time period. After three months of really feeling concerned, I would seek help.”


Concerning signs could be any of the following:


  1. Withdrawal and isolation This can be spending excessive time alone or avoiding activities they used to enjoy seemingly without any justifiable reason.

  2. Changes in sleep patterns Are they having difficulty falling asleep or staying asleep? Are they sleeping too long? Again, this may be normal behavior particularly among teenagers, but if in doubt, it is better to raise the issue.

  3. Changes in appetiteAny noticeable changes in eating patterns could be cause for concern, whether it is significant weight gain or weight loss.

  4. Physical symptoms Watch out for frequent headaches or stomach aches without a clear medical cause that last for longer than expected or appear to be feigned.

  5. Academic and behavioral changes Some common symptoms could be a decline in academic performance, changes in concentration and focus, or increased aggression or impulsivity.

  6. Substance abuse Particularly in teenagers, they may begin experimenting with drugs or alcohol and increasingly rely on substances to cope with emotions.

More serious warning signs


Many of the above signs could be explained by normal changes in behavior that happen during puberty or the child is simply going through a bad period.


However, there are a number of more serious warning signs that you should act upon right away. They include:


  1. Thoughts or plans of suicide or self harm. If you are not currently with them, ask them calmly to not act on these thoughts until you are with them or can find someone to be with them. These are known as “promise contracts” and can delay a person in severe distress from acting for a limited period of time.

  2. If they are overly suspicious or seem afraid of something unclear, are hearing voices, or exhibit sudden changes in how they think, speak or write.


Importance of seeking professional help


As a parent, you may sometimes feel it is not your place to seek help on behalf of your child – particularly if you judge it to be on the minor end of the scale. After all, as children grow, they should be given a certain amount of space.


However, there are many reasons that a child or teenager might not reach out for help or respond to support, even if they do need it.


Younger children


For younger children especially, what they are experiencing will be confusing to them. A child doesn’t have the capacity for self-reflection in the way that an adult does, which makes navigating it difficult for the parents.


Professionals, on the other hand, are able to communicate with the children in a way that they understand and then make medical judgments based on those assessments.


Teenagers


Teenagers, on the other hand, have to navigate a difficult stage of life, juggling school, friends, peer pressure, and more. While they may want support, there can be deep-seeded feelings of judgment or fear that hold them back.


By bringing in professional support – in a spirit of love and caring – it can help teenagers to break through the barriers they have built up. In this way, they are more likely to feel supported in the future and be willing to receive help.


Joyce:

“Certainly I could go to the schools. In Illinois, you can go to school personnel, whether it be a principal, whether it be the social worker or psychologist, or the teacher, and ask for some help or direction. People will be able to give the family some ideas.


All schools would have a social worker that is assigned to them. They may not have a full-time social worker or nurse, but a social worker will be assigned. They can help to begin to respond and can help the parent tease out next steps, whether further evaluation or to help the child during that critical time period.”


What kind of support do experts offer?


The reality of mental health issues is that they rarely fall into neat boxes. Every child and every situation is unique. This means that the first steps often involve extensive testing to determine what the child or teenager needs and to move forward from there.


Joyce:

“It depends upon the severity of the child's situation. In the beginning, a social worker or similar professional may do an assessment of the child. This could involve observing the child or doing a short interview or a couple of sessions to understand their situation.


After that, we determine the severity. It could be that we develop a behavioral plan. It could be that it's just a good conversation between the parents, the student, and the teacher. It could be that we move forward with something more extensive, some kind of evaluation.


There could always be a learning evaluation or an evaluation for something like attention deficit disorder. Or an evaluation regarding using a screening tool that might be incredibly beneficial looking to see if a child has anxiety or some kind of depressive features. After that we may go to a full case study evaluation where we do more extensive testing via the psychologist and perhaps a speech therapist to determine if there's learning needs or emotional needs that might require an individualized educational plan.”


How to approach your child or teenager


Joyce:

“It is hard and painful for all parents to say ‘I think there's something wrong here and I need to go get some services.’ But it's a huge mistake not to.”


Often, the first step is the most difficult. It is not uncommon to be met with resistance, whether through shutting down or lashing out, depending on the individual, type of illness, age, and other factors.


Whatever the specific circumstance, remember to communicate that you have their best interests at heart and it may require a lot of patience. Encourage open communication, with you or another trusted adult, and build healthy habits as soon as possible.


Remember, strong mental health is a journey that lasts a lifetime. Every step in the right direction is a step worth taking.


Joyce:

“It's not a surprise experience for a kid. They need to hear from their guardian or parent:


‘I care about you and I love you tremendously, but I am a little concerned about X at this point in time. I'm going to take this a step further and I'm gonna ask some people who really know about this stuff so we can work as a team in order to support you and develop the right plan for you.’


In general, I wouldn't beat around the bush. It's important to be honest with your child about your concerns and bring that child – young person, young adult – on board to know about the concerns.”


If you notice any disturbing behavior that causes concern, call or text 988, chat 988lifeline.org, go to your local emergency room, or call 911.


The 988 lifeline is a nationwide service with trained counselors in the Illinois area. Take a free, anonymous mental health test. Read more. For additional assistance, please contact us at Mental Health America of Illinois or 312-368-9070.


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