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Depression

How to Know When Your Child Needs Help

Most children have mental health symptoms, but how much is too much?

Key points

  • When a child has mental health symptoms, evaluating the severity is important.
  • The context of a child's symptoms and impact on family life matters, too.
  • Effective help is available, though it may be hard to find and take time.
  • Even if your child doesn't need help now, there may be preventive work to be done.

We know that children commonly experience mental health distress. The recent Youth Risk Behavior Survey showed that nearly 60 percent of teenage girls experienced persistent sadness and 25 percent have thought of attempting suicide. Before the COVID Pandemic, we would commonly say that one in five children met the clinical criteria for a diagnosis such as depression, anxiety, or ADHD. Unfortunately, only 20 percent of these children got the evaluation and treatment they needed.

Some of this gap is due to systemic problems. We can’t, as individual pediatricians or parents, snap our fingers and have access to affordable, accessible, high-quality child therapists and psychiatrists. But what we can control is the decision point for when we pursue a formal diagnosis and consider whether treatment will help.

Let’s use the example of anxiety. Josh and Lisa have a child, Annie, who has always liked things just so. When she was a toddler she would not wear certain fabrics or colors. She was selective about the foods she ate. She would often melt down about changes to the routine or new birthday parties. She had some trouble separating from her parents for babysitters, and when starting preschool, Josh and Lisa had to sit in the lobby of the school for a few weeks longer than the other parents.

But Annie is doing pretty well. She has friends and is a bright little girl hitting her milestones on time and always getting a positive report at parent-teacher conferences. She sometimes has trouble falling asleep but generally gets enough sleep and eats a varied enough diet that she doesn’t require a nutritional evaluation.

This is often the story that we tell ourselves as parents and we tell our doctors at our physicals. But this information is not enough or us to decide if Annie needs an evaluation or to consider treatment. We have to scratch a bit deeper to understand what life is like for Annie and her parents to make a good decision.

When I help parents to think through these decisions, often my questions cluster around understanding the burden and impairment from the symptoms.

The day-to-day burden of Annie’s mental health concerns falls on her but also on the rest of her family.

  • How much time do the parents spend daily reassuring and encouraging Annie to participate in school and her activities?
  • How long does it take to get Annie to bed each night?
  • Does Annie complain about tummy aches or headaches often?
  • Does she have meltdowns or tantrums on a regular basis?

Understanding the impairment from her symptoms is important, too.

  • Are there activities in which the parents want Annie to be able to participate but she has been unable to because of anxiety? For instance, birthday parties, camp, or playdates?
  • Have Annie’s family members missed out on things they wanted to do because of her strong preferences?

It’s not a parent’s job to distinguish between whether the symptoms their child is experiencing are part of their temperament or part of a diagnosis. It’s very difficult to do so—a child’s temperament isn’t going to change and is part of who they are. Some children are strong-willed, sensitive, or spirited and can be a challenge to parent, and some children will have a diagnosis of anxiety, depression, or ADHD.

But when a child and a family feel the burden of mental health symptoms that limit their everyday ability to enjoy their life, it’s time to get an evaluation and consider treatment. It’s impossible to evaluate a child independently from understanding the context of their life—often it’s not just their symptoms but the fit of their symptoms within their family and school lives. That is knowledge that only a parent has and can share. The truth is that whatever the root cause of the child’s symptoms, evidence-based therapies like PCIT, CBT, and DBT can help children and parents gain skills to feel better.

If you don’t think your child needs professional help after considering this, great. But the fact that you clicked through this article makes me think there may be something there. Just as parents encourage their children to gain literacy and numeracy skills, we can also encourage our children to gain social and emotional skills so that if things do escalate in the future, they are prepared to cope.

Consider whether your child can hit these milestones, and, if not, maybe explore ways to help them:

  • Can your child name feelings (sad/mad/nervous) in others?
  • Can your child name their own feelings?
  • If your child can recognize feeling bad, have they learned any strategies (rest, deep breathing, positive self-talk, etc.) to help?
  • Does your child know whom and how to ask for help?

If your child has good coping and self-regulation skills, great! The next step is to look at their social and communication skills, because we know supportive relationships are protective factors:

  • Does your child have a few close friends?
  • Does your child know how to maintain healthy friendships?
  • Does your child know how to be a supportive friend to others?

While we think of core parenting skills as ensuring children are fed, rested, and clean, most parents need these next-level, advanced parenting skills. Whether your child has a diagnosis or a need for formal mental health support or not, as a parent you need to know what’s out there and when to ask for help. This work is challenging, but when it’s done well, it has enormous value to your family and your children. If it feels like a lot, it’s because it’s complex and it’s hard, but remember, in thinking through this you aren’t alone. The goal of my book and this blog is to try to help fill this gap, but know your pediatricians, schools, and communities are full of people who are there to support you in your parenting journey.

To find a therapist near you, visit the Psychology Today Therapy Directory.

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