Learn More about Youth Mental Health.

The World Can Be a Scary Place. Anxiety and Depression in teens is on the rise. Understanding and caring for our children’s mental health while they are young can help them realize their potential and reduce the risk of developing mental health problems.

Many children are significantly impacted not only by world events and catastrophes, but also by daily occurrences and life circumstances. The start of school, the news on television, the influx of social media, the death of a friend or grandparent, natural disasters, contentious politics, or even just a bad day at school can affect our children more than we realize.

In these unsettling times, it is more important than ever to remember that caring for a child’s mental health is just as important as caring for his or her physical health. This guide will equip you with a better understanding of how to talk to your children about difficult topics and engage with them in a way that promotes positive mental health.

How much do you know about Youth Mental Health?

We have answered the questions every parent needs to know.

We all have mental health the same way we have physical health and, most importantly, our children have mental health. Mental health is important at every stage of life and plays a critical role in shaping a child’s social, emotional, and cognitive development, all parts of a healthy brain.

Mental health includes all states of health, from wellness to challenges to illness, and describes a person’s state of emotional, psychological and social well-being, which affects the way a person thinks, feels, and behaves.

Just like physical health, mental health lies on a continuum.
Throughout life, all humans experience periods of fluctuation in both physical and mental health, particularly during childhood, as a person’s body grows, develops, and builds up immunity.

Research shows that children’s brains develop well into their mid-20’s. It is important to know that children’s emotions and behaviors CAN BE signs that they are struggling with their mental health, which can happen for a multitude of reasons or for no apparent reason at all.

In fact, some thoughts, feelings, and behaviors can actually be symptoms of diagnosable emotional, mental, or behavioral health disorders that warrant intervention and treatment by a professional. The problem is that it can be difficult to know the difference between signs of concern and typical phases or stages of development. While not all mental health struggles will lead to a diagnosis, that should not be a deterrent to seek help and treatment. When a child shows symptoms of a physical illness, whether it is a sore throat or a broken arm, parents do not hesitate to seek treatment. In the same way, parents should not be ashamed to seek treatment when symptoms of mental health struggles arise.
How do I know if my child is upset, worried, or struggling with his feelings or emotions?

Given that their brains are not fully developed, children do not have the ability to understand, process, and cope with emotions in the same way as adults. In addition, the younger a child is, the less capable he may be of expressing and digesting his emotions. Sometimes this can lead to acting out, displaced anger, sullenness, irritability, moodiness, silence, or withdrawal. Conventional wisdom used to be that children would always speak up or act out if they were upset by something, giving parents a clue of their stress, but more frequently studies are showing that children are internalizing their thoughts and feelings, leading to even deeper levels of distress. You know your child best, so pay attention to signs that he is acting out of character or in a way that is not typical for him.

In today’s world. it is safe to assume that your children will be aware of, to some extent at least, what is going on in the world. Young children may overhear their parents talking, even when it seems like they are not listening, or they may hear things at school or on the bus. Older children will study current events in school.

Complicating today’s parenting, digital marketing experts estimate that most Americans are exposed to around 4,000 to 10,000 advertisements and images each day.* Children with access to televisions, computers and digital devices will see images they don’t have control over. This exposure will bring about unplanned and potentially unwanted thoughts and feelings that children may need help digesting. It is reasonable to assume that children of all ages are exposed to news, stories, or events that can be alarming or disturbing.

Allowing your children to name and address their feelings or concerns about a particular situation or event is an important way to help develop their emotional intelligence and strengthen their mental health. Some children are talkers and some are not. Regardless, taking the time to engage them in discussions about real life events is essential. It may take some children longer to open up. Allowing for a long, patient conversation, if that is what is needed, will help to flush out what they are thinking and feeling. Sometimes asking them how they think a brother, sister, or friend would handle a situation takes the pressure off them and starts the conversation flowing. Make sure to ask and listen, rather than make assumptions or jump in to give your own thoughts or opinions.
* Red Crow Marketing

Each child rationalizes and processes information differently and at different speeds. Some children are naturally nervous and others can let things roll off their backs. You probably already know which your child tends to be. Understanding your child’s unique temperament and perspective is important because some children will need more reassurance than others.

Most mental health professionals agree that it is essential to reassure your child that she is physically safe. While no one can guarantee complete safety at all times, you can reassure your child that she is physically safe at that moment with you. Emphasize that you are always there for her and that you are in this together.

When talking to your child, remember to address three fundamental emotional concerns children have during times of uncertainty:

Will I be alright?
Will my family be alright?
How will this affect my daily life?

As reactions and questions that come up during these conversations can vary from child to child, it may be best to speak with each of your children alone.

You can begin by asking your children one or two open ended questions (e.g., What was the favorite part of your day today? What is one thing that has been on your mind lately? What do you think of what has been happening in the news lately?) Make certain to stop talking and listen carefully. Find out what their words mean to them. A child may say “the world is scary.” Ask her what the word “scary” means to her and see how she views what is actually scary. Do not assume that what is scary to her is the same thing that is scary to you! Children operate their world through perception and often their perception is distorted or very small in view. For instance, children tend to use the terms “always” or “never” to describe situations adults would see as “occasionally” or “sometimes.” Ask them for more details to understand what they mean. Finding out how children perceive situations can really help resolve their feelings.

Most importantly, let your children guide the conversation. Encourage them to ask questions, but only give them answers to the questions they actually ask. For example: if a child asks, “why are people mean?” you can explain in simple, age-appropriate terms that sometimes people make unkind choices – do not jump to talk about mass shootings or all the specific ways people can be mean. If your child is ready to hear more, she will continue to ask questions if you allow her to. If she stops asking questions or seem to become disinterested, chances are she has heard as much as she can handle. When that happens, let her know she can ask more questions anytime.

It seems the word “trauma” is all around us and in the news. Trauma is more common than we think but the term is often misunderstood.

Trauma happens when an intense experience stuns a child like a bolt out of the blue; it overwhelms the child, leaving him altered and disconnected from his body, mind and spirit. Any coping mechanisms the child may have had are undermined, and he or she feels utterly helpless. Trauma can also be the result of ongoing fear and nervous tension.”*

A traumatic event can even include a severe fall, a broken bone, or something as simple as a scary movie. No two children experience an event or situation the exact same way, so their internal reactions are as unique as they are. As a result, an event that causes trauma for one child may not necessarily cause trauma for another.

* Trauma-Proofing Your Kids, Peter Levine and Maggie Kline

Fear, worry, and anxiety are natural feelings that everyone has from time to time and can be appropriate reactions to certain situations. In fact, those feelings can be completely typical responses to a variety of circumstances or stressful situations and can, sometimes, even be healthy.

Fear is most easily identified as a response to something specific that is perceived as a clear and imminent threat.  When there is something to fear, a child may have significant somatic symptoms, such as  increased heart rate, shortness of breath, muscle tension, and even sweat.  Fear can start the fight, flight, or freeze response in a child and can cause a child to act out, become extremely agitated, distracted, or withdrawn. At the same time, fear is generally temporary and the reaction calms down when the threat is no longer present.

Worry is closely related to fear. You may have a child who asks lots of worrisome questions, like “What if lightning hits the house during a rainstorm?” or “What if I break my arm during baseball practice?” While sometimes hard to differentiate, worry is the anticipation of something bad, the train of thought before the potentially fearful event.

Anxiety is also anticipatory in nature and focused on a possible danger, but it is more intense than worry. Anxiety is an overwhelming sense of unpleasantness, discomfort, or apprehension, which can sometimes be related to a specific thought or feeling but oftentimes is unexplainable.  As a result of an overactive fight, flight, or freeze response to anxiety, a child may feel uneasy, complain of headaches or stomach aches, and perceive a threat which may or may not exist.

When a child is feeling fearful, worried, or anxious, it is important to stay calm and allow him to fully express his feelings. These are opportunities for you to help strengthen your child’s resilience by having him acknowledge and face the discomfort caused by fear, worry, or anxiety. It may ease your child’s concerns if you take the time to walk through some of the “what ifs” and reassure him that everyone feels this way sometimes. While it is natural to want to tell your child “there is nothing to worry about,” doing so can be dismissive and cause him to be embarrassed about his feelings.

Anxiety disorders, on the other hand, are mental health conditions that are diagnosed by mental health professionals using assessments that evaluate certain criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition or the DSM-5 for short. Notably, generalized anxiety disorder, separation anxiety, and social anxiety are the most common psychiatric problems experienced by children, teens, and young adults. Studies have shown that having anxiety disorders early in life put children and teens at risk for the development of mood disorders and substance use disorders later in life. The good news is that if detected and treated early, many children and teens will be able to minimize, control, or completely eradicate their symptoms. Early treatment may also prevent the development of other co-occurring psychiatric disorders.

The problem is that it can be difficult to tell when fear, worry, and anxiety is appropriate and when it is a sign of an anxiety disorder requiring treatment. Overall, if a child’s anxiety interferes with or impairs his ability to function properly at home, at school or with friends, it may be time to consult with a mental health professional. Hallmark features of anxiety disorders include when fears and worries are excessive, irrational, out of proportion to the circumstance, difficult to control and/or occur more than occasionally.

The good news is that treatment for anxiety can have a lasting positive effect for children and that working with children and teens on even mild symptoms of anxiety can help them learn healthy coping strategies for the future.

Anxiety is the most common mental health disorder in the United States, according to the National Institute of Mental Health.  While it is easy to dismiss anxiety, it is the #1 reason college students seek counseling.*   

* American College Health Association Study 2016

We all go through periods of sadness. Sadness can be triggered by changes, hurts, disappointments, life events, or loss. Sadness, however, tends to be temporary and does not impact a child’s functioning long-term.

Depression, however, is often unrelated to any specific event (although it can be triggered by one) and often has little or no explanation. Depression in children can be difficult to recognize. Your child may lose interest in things that used to be enjoyable, have a lack of interest that doesn’t make complete sense, or become increasingly irritable, agitated, moody, or lethargic. Some children or adolescents may even appear to simply be lazy, thoughtless, or careless. The tricky part about depression in children and teens is that it can be marked by periods of typical behavior, even apparent happiness, and can easily be mistaken for temporary sadness. It is important to note that depression is experienced differently from boys to girls.

New research is beginning to validate depression in children as young as 4 or 5.

The fact is that children do not try to feel unhappy, so prolonged or frequent emotional discomfort may be a sign of depression. If you are concerned, it may make sense to keep a log of the frequency, duration, or intensity of your child’s feelings, thoughts, and behaviors. Also, keep note of your child’s ability to function. How often is your child unable or seemingly unwilling to do something or participate in an activity that seems typical or ordinary for other children the same age?

The important thing to remember about depression is that the earlier it is recognized and treated, the better the outcome will be. Untreated depression can seriously impede functioning and healthy development and can lead to substance use, school avoidance or dropout, self-harm, and even suicide.

By the time children hit age 17, 13.6 percent of boys and 36.1 percent of girls have been or are depressed.*
Equally worth noting, suicide is the second leading cause of death in children ages 10 to 24.
** Early intervention can help reduce the severity of mental health conditions.

* National Survey of Drug Use and Health from 2009 to 2014
** Center for Disease Control

It is important to understand what a trigger is because it sets forth a chain reaction. Sometimes a trigger is easily identifiable and sometimes it is not. Even when it is not, we can learn to identify the reaction. Helping children identify triggers or catch reactions is a self regulating skill they can use for life.

A trigger is something that sets off a memory (most likely subconscious) or flashback transporting the person back to an event. A trigger can be anything from a taste, touch, smell, noise, image, phrase, action, or even physical feeling. It can also be a combination of these. Triggers are unpredictable and can come at any time for no reason at all.

When triggered, a child may experience a surge of adrenaline that may look like she is acting out or having a wave of uncontrollable emotions. A child may become visibly shut down or uncharacteristically quiet, even disassociated. Young children may even display a regression in behavior.

“Because the functioning has changed, a child’s sense of safety becomes highly distorted, causing a perception of danger when there is none.”*

For example, today’s children will likely have to participate in lockdown drills at school. In times like these children need time to digest and work through how they are feeling. Some children may need to talk. Some children may need to exercise. Drawing and listening to music can also be therapeutic. If your child is not a talker, ask if you can go for a walk together, color alongside her or listen to some tunes. Be with her, even if there is no conversation. Parents can be a calming presence in simple ways.

* Peter A. Levine, Ph.D. & Maggie Kline. “Trauma Through a Child’s Eyes.” North Atlantic Books, 2010-05-18

Brain research has taught us that what our brains forget, our bodies don’t. For this reason, if your child is struggling, you may witness noticeable changes in your child’s behavior, social activities, academic performance, physical health, or appearance.

Signs a child is struggling can include, but are not limited to:

  • Disruption in sleep – Nightmares
  • Lack of motivation
  • Inability to focus, connect, or control impulses
  • Loss of appetite
  • Changes in personal care
  • Long-lasting, intense, painful emotions
  • Intense worry
  • Increased irritability, anger, or moodiness
  • Feelings of worthlessness
  • Increased stomach aches or other persistent unexplainable ailments
  • Disinterest in extra-curricular activities or too nervous to attend

Understanding and Caring for Youth Mental Health

A Report of the Surgeon General notes that mental health and mental illness are not mutually exclusive categories but are points on a continuum ranging from positive mental health through mental health problems to mental illnesses.

Mental health continuously shifts, changes and evolves during a lifetime. This graphic helps to identify the current state of a person’s mental health in relationship to how a person is functioning in the world and includes some of the factors that contribute to various states of mental health.

If you are concerned about your child’s mental health, ask the following questions:
  • Intensity: How intense are your child’s behaviors, thoughts, or emotions?
  • Frequency: How often does your child feel or behave this way?
  • Duration: How long do these individual episodes or periods last?
  • Functionality: Above all else,  how well your child is functioning in life? Is your child impaired in any way at home, at school or with friends?

Emotions or behaviors that are more intense, frequent, or longer in duration than most other children your child’s age, and that are causing impairment, may be signs of concern that indicate that consulting with a mental health professional may be necessary.

Resilience, a component of Emotional Intelligence, can foster good mental health.

“(R)esilience is the capacity we all possess to rebound from stress and feelings of fear, helplessness and overwhelm.”*

As children grow, it is important to teach them that it is just as important to take care of their mental health as it is to take care of their physical health. It’s a fact of life that bad things can and do happen and, while children can not help having feelings of fear, worry or anxiety, they do have the ability to rebound. The key is to help children build and increase their resilience as they encounter challenges in life by helping them acknowledge and move through difficult and painful feelings and sensations.

Science now shows that emotional intelligence enhances young minds and their capacity to integrate skills, attitudes, and behaviors effectively and ethically into daily tasks and challenges. Emotional Intelligence is:

  1. Self-awareness – Your ability to recognize your own emotions and their effects.
  2. Self-management – Distress tolerance. Your ability to manage emotions effectively.
  3. Social awareness – Perspective. Your ability to have empathy and respect for others.
  4. Relationship skills – Communication and social engagement, teamwork.
  5. Responsible decision-making – Identifying, analyzing, and solving problems.

While we may think we are protecting our children by avoiding unpleasant subjects, teaching them emotional intelligence, how to recognize, understand and deal with their emotions,  builds resilience and is one of the most important skill sets needed for lifelong happiness and success.  

* Trauma-Proofing Your Kids, Peter Levine and Maggie Kline

Written with Excerpts from Understanding Youth Mental Health, a partnership with Silver Hill Hospital, New Canaan CT
Excerpts from Understanding Youth Mental Health- Questions Parents Frequently Ask, a partnership with Child Guidance Mid Fairfield County, Norwalk CT
Sandra Birch, LICSW private practice clinician in Manchester, VT