Growing up is hard. Kids experience challenges and frustrations at all stages of development. Emotional struggles and fluctuations are also quite normal. It is natural for kids to feel worried and to experience distressing emotions like sadness and anger from time to time. For the most part, these challenges teach lessons and help fine-tune important life skills. We know that shielding children from discomfort can rob them of valuable learning opportunities, but it can often be difficult to determine if a child's emotional state is within healthy developmental norms. For many parents, determining whether or not to seek out therapeutic intervention for a child can be a very confusing and overwhelming process.
It is important to know that not all worry-prone kids have an anxiety disorder, and not all sullen teenagers are clinically depressed. Parents know their children best, so gut instincts can go a long way in determining if and when intervention is necessary. Other good resources might be a family doctor, pediatrician, or school counselor, all of whom should be familiar with developmental norms and should be able to recommend therapists who specialize in working with children or adolescents. Following is a list of "red flags" that might signal the need for further evaluation. The list is adapted from a recent article by Katie Hurley, LCSW, entitled "7 Red Flags That Your Child Needs a Therapist."
1. Issues beyond the home
Struggles with mental health are typically omnipresent. Behavioral changes will likely occur in more than one place (home, school, sports, with friends, etc.).
2. Social Isolation
Social isolation can be a sign of depression or anxiety. Pay close attention to sudden withdraw from friends or activities that were once enjoyable.
3. Excessive fears or worries
It is perfectly normal for children to worry or feel fearful. When those worries and fears get in the way of the ability to perform normal day-to-day functions, it is time to take a closer look.
4. Changes in normal daily activities
Growth spurts and other developmental shifts can account for changes in eating and sleeping habits. These changes usually last for only a few days. Be on the lookout for changes that last for more than two weeks. Frequent nightmares or difficulty falling or staying asleep are also worthy of note.
We tend to think of cutting when we consider self-harm, but younger children can engage in similar behaviors. Hair pulling, digging sharp objects (such as fingernails) into skin, or repeated head banging are examples of behaviors to watch for. If a behavior is repetitive, lasts for more than two weeks and is self-injurious in nature, call a professional.
6. Frequently talking or thinking about death
It is very normal for children to ask questions about death. Questioning is how we learn to process such a complex concept. However, if a child expresses any suicidal thoughts or actions, get an evaluation. This can include talking about wanting to die, making a suicide plan, or writing goodbye notes. Do not shame a child for expressing these thoughts. Unconditional love, support, and appropriate therapeutic intervention is necessary.
7. Regressed behavior
Regressed behavior might be one of the first signs that a child is in need of emotional support. Bedwetting (in a child that has been toilet trained for quite some time), frequent meltdowns or tantrums and separation issues (such as school refusal) can all be signs that a child needs help.
If you are concerned about your child's emotional health, it cannot hurt to have an evaluation. Waiting too long for an evaluation, on the other hand, can have adverse consequences. As a general rule of thumb, trust your instincts if you believe your child is struggling, and remember there are mental health professionals in the Lower, Middle and Upper schools to help provide support.