Child and Adolescent Mental Health

Summary

• Learn what to look for in a child that may be depressed.
• Find out how common childhood depression is.
• Learn what causes childhood depression.

It can be hard to know that children can have depression. Most of us would think, “What does a child have to be unhappy about?” But, things other than life events can cause it. Many people are simply born with a higher risk of being depressed, no matter what happens in their lives. 

The way a child shows his depression is often not like adults. They do not yet have the words, maturity, or experience needed to express themselves in that way. “Depression” is really a pretty big and difficult word for a child to understand.

It is important for adults to look for actions or behaviors that we may not consider depression. For example, a child may very often be cranky or crabby, no matter the fun things going on around them. Of course, they will also show times of sadness or depressed mood. They also will show a loss of interest in many activities that most other children enjoy.

During the course of one’s life, every child, or adult for that matter, will have feelings of depression. It is normal and common. But, in order to know whether the child is just having a bad day or is in need of getting help, you can look for some signs.

For example, the problems you see must happen often, such as for most of every day, for at least two weeks. Both you and the child will see what is going on as a problem in important activities of her life. This might include bad grades at school, not getting along with other people, or avoiding taking care of chores and other duties at home.

Other problems you may see are really all about differences in what would be likely to happen. Here are some things to look for:

• Differences in eating, including decreased or increased appetite, often for sweets, carbs, or comfort foods
• The child does not make expected increases in weight or there is a weight gain that is not because of normal growth and development (such as five percent or higher than what you or your child’s doctor would expect)
• Increased or decreased sleeping
• A change in activity level, either higher or lower
• An obvious drop in energy level
• Complaining every day of feeling really tired (for example, the child might need more time to finish her chores than before, but not because of poor attention or being distracted by other things going on in the home)
• Feeling worthless or guilty
• Problems in thinking, focusing on tasks, or making choices
• Thoughts of death or suicide that don’t stop, making plans to kill himself, or making an attempt

Causes

It is frustrating for parents and guardians as there are no lab tests for depression. There is a link in families. A child of a parent who has depression is up to three times more likely to have it too.

But other things can increase the chance of depression, such as stress. Children who lose a parent or another loved one, who have a problem with paying attention or learning, or who misbehave have a higher chance of depression. Research shows that children who have other psychiatric conditions are more likely to develop symptoms that may turn into depression.

In some cases, depression may be the psychological result of some other health problem, such as an illness that lowers a person’s ability to join in the activities she could before the sickness. It could also be the result of substance use. In any case where depression is suspected, you should seek help from a professional health care provider.

By Chris E. Stout, Psy.D., Clinical Professor, Department of Psychiatry, College of Medicine, University of Illinois at Chicago

©2012-2019 Carelon Behavioral Health

Source: Beardslee WR, Gladstone TR. Prevention of childhood depression: recent findings and future prospects. Biol Psychiatry. 2001;49:1101-1110; Bonin L. Depression in adolescents: epidemiology, clinical manifestations, and diagnosis, www.uptodate.com/contents/depression-in-adolescents-epidemiology-clinical-manifestations-and-diagnosis; Carlson GA. The challenge of diagnosing depression in childhood and adolescence. J Affect Disord. December 2000;61(suppl 1):3-8; Castiglia PT. Depression in children. J Pediatr Health Care. March-April 2000;14:73-75; Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR). American Psychiatric Association, 1999; National Institute of Mental Health, www.nimh.nih.gov/statistics/1MDD_CHILD.shtml; Synopsis of Psychiatry by Benjamin J. Sadock, Virginia A. Sadock and Pedro Ruiz, M.D., L.W.W., 11th edition, 2014.

Reviewed by Mario Testani, M.D., Physician Advisor, Beacon Health Options

Summary

Symptoms of depression include:

• Sadness, crying and feelings of hopelessness
• Changes in eating or sleeping patterns
• Weight gain or weight loss

Children and adolescents can be depressed, just like adults. Depression is more than just feeling sad or blue. It is a medical disorder. It can affect your child’s relationships. It can affect how well they do in school. It can affect how a child functions overall. The good news is that treatment helps both children and teens.

What is depression?

Depression affects people of all ages, sexes and races. It affects people from all income levels. Depression can happen only once or it can happen in cycles. It can also go along with a manic episode. This is a highly excited mood.

Depression isn’t caused by one single event. It’s caused by a many factors working together. And, the causes vary from person to person. It can be caused by lowered levels of chemicals in the brain that send messages to the nerves. While depression can be triggered by stress or tragic events, they do not cause it. Some depression happens without any kind of clear external causes. Studies show that depression can run in families.

Signs of depression

In some children and teens, the signs of depression are similar to the symptoms in adults. These include:

• Sadness, crying and feelings of hopelessness
• Changes in eating or sleeping patterns
• Weight gain or weight loss
• Loss of enjoyment in their favorite activities
• Complaints about physical problems that have no medical basis
• Fatigue, inability to concentrate, boredom
• Loss of self esteem
• Feelings of hopelessness or guilt
• Irritability
• Recurrent thoughts of death or suicide
• Attempts or talk of self harm

Children may also show other kinds of symptoms. They include:

• Being afraid to go to school
• Having exaggerated fears about unusual things, like their parents dying or a plane crashing into their school

In teens, depression can show in many ways:

• Sulking or refusing to take part in family or school activities
• Problems in school such as failing grades or fighting with peers
• Risky behavior like drinking, drugs, sexual acting out or breaking the law

Symptoms of depression may also look like alcohol or substance use disorder. Symptoms can also look like attention-deficit/hyperactivity disorder (ADHD), or other kinds of problems. Watch your child carefully over a period of time. This is the best way to decide if the problems are ongoing, or if your child is reacting to something temporary in his life.

Treatment options

Treatment for depression starts with an assessment by a mental health provider. In some cases, depression is diagnosed by the child’s primary care physician (PCP). Your mental health provider or PCP may also talk to you about your child’s general health. They may ask about what’s going on at home or at school. These questions help them understand what might be causing the depression. Be as honest as possible with the provider. They are not prying. They are only trying to get enough facts to make a correct diagnosis.

Treatment may include medicine. It can also include one-on-one, group or family therapy. Therapy focuses on helping your child to talk about her problems. This can help her learn skills to deal with problems. It can help her see her problems from a new point of view.

School may or may not be a problem for a depressed child. Depression does not always show up as behavior problems in school. Other disorders such as ADHD are easier to see in school. If your child has recently become depressed, the teacher may notice a drop in grades. He may contact you about his concerns.

Some children do not come to the attention of teachers at all. In these cases, their depression causes the child to become withdrawn. Other children will become involved in drugs or alcohol. Some will take part in dangerous activities because of their depression. That is why it is important to be involved in your child’s school life. Changes that might not be obvious at home may show up at school.

Tips for parents

• If you suspect your child is depressed, get help. Don’t dismiss your concerns. Don’t think that the symptoms will go away by themselves. They probably won’t and they might get worse.
• Don’t take the blame for your child’s depression. Even if something you did (such as get a divorce) was a trigger, it’s not your fault.
• Don’t tell your child to snap out of it. Depression is a real disorder. A person with depression can’t just snap out of it any easier than a person who had diabetes.
• Let your child know you are there for them. Remind them you love them. Let them know over and over again, even if they get angry and try to push you away. Thet need to hear this because they are feeling hopeless and worthless.
• Once your child begins to talk, let them talk about whatever they want to. Don’t make judgments or criticize. Just listen.

By Haline Grublak, CPHQ

©2010-2022 Carelon Behavioral Health

Summary

• Teens can have depression, and adults can learn how to find out and what to do.
• Some medical conditions may mimic clinical depression in teens.

How do I know?

It can be hard to realize that teens can get depression. Most of us would think, “What does a teen have to be that unhappy about?” But, depression can have many causes. Many people are simply born with it, no matter what happens in their lives. 

Every person, no matter what age, will have feelings of sadness that lasts. This is normal and common. But, to know whether your teen is just having a bad day or is in need of help, you should look for actions or behaviors that you may not think of as depression.

Sometimes behaviors that are upsetting to you—like angry outbursts, agitation, or crankiness—can be signs of depression. Or you may see blaming others, complaining of feeling treated unfairly, or overreacting to minor frustrations, too.

For some teens, it is easier to know when he has a loss of interest in activities that he used to enjoy. Or maybe she no longer wants to be with friends and family like she used to. All may be signs of depression. Teenage girls are two to three times more likely to have it as boys are.

Some problems may show up within important activities in her life. This can include poor grades at school, not getting along with other people, or not taking care of chores and other duties at home. The problems you see must happen often, such as for most of every day, and last for at least two weeks to be considered clinical depression.

While the basic signs do not differ between children and teens, teens tend to complain more about how they feel. They also may like to be by themselves and are more likely to be crabby or grouchy. Teens are also more likely to be sluggish and tired, to sleep more, and may misunderstand what is going on around them.

Other behaviors to look for in your teen include:

• Sleep problems like sleeping too much, along with problems going to sleep and staying asleep throughout the night, or having nightmares
• Inability to sit still or be still
• Slowed thinking, speech, or even not talking
• Poor attention or memory
• A negative self-image, feeling unworthy of being loved or not valued by others
• Feeling guilty for past incidents, or inappropriately or excessively self-blaming
• Frequent crying spells
• Brooding and irritability
• Becoming overly focused on an upsetting thought
• Anxiety or marked fearfulness
• Complaints of physical discomfort such as stomachaches, headaches, and other vague aches and pains
• Panic/anxiety attacks
• School or academic problems such as truancy or failing grades
• Drug or alcohol use

What else could it be?

Some medical syndromes and disorders may mimic clinical depression in teens. For example, those with multiple sclerosis or hypothyroidism may show symptoms of it. Teens also may have symptoms that are common in not only depressive disorders, but also disruptive behavior disorders, bipolar disorders, anxiety disorders, and attention-deficit disorders, which may be the actual primary problem.

In other instances, using steroids, alcohol, illicit drugs such as cocaine, or exposure to a toxic substance may cause depressive symptoms. For instance, withdrawal from drugs such as cocaine or heroin may cause symptoms that look like those seen in depression.

By Chris E. Stout, Psy.D., Clinical Professor, Department of Psychiatry, College of Medicine, University of Illinois at Chicago

©2012-2021 Carelon Behavioral Health

Source: Beardslee WR, Gladstone TR. Prevention of childhood depression: recent findings and future prospects. Biol Psychiatry. 2001;49:1101-1110; Bonin L. Depression in adolescents: epidemiology, clinical manifestations, and diagnosis, www.uptodate.com/contents/depression-in-adolescents-epidemiology-clinical-manifestations-and-diagnosis; Carlson GA. The challenge of diagnosing depression in childhood and adolescence. J Affect Disord. December 2000;61(suppl 1):3-8; Castiglia PT. Depression in children. J Pediatr Health Care. March-April 2000;14:73-75; Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR). American Psychiatric Association, 1999; National Institute of Mental Health, http://www.nimh.nih.gov/statistics/1MDD_CHILD.shtml; Synopsis of Psychiatry by Benjamin J. Sadock, Virginia A. Sadock and Pedro Ruiz, M.D., L.W.W., 11th edition; 2014.

Summary

• Teens can have depression and adults can learn how to find out what to do about it.
• Depression can be successfully treated.
• Help is available.

If you are reading this, perhaps you are feeling depressed, blue, or sad. Everyone will experience sad feelings at some point in their life. It is actually normal and common.

What is most important is getting help. Formal depression is a very treatable problem, and by reading this, you have taken the first step to getting the help that will make life better for you.

It can be hard for adults to realize that teens can have depression. Many of them may think or even say, “What do you have to be depressed about?” However, things other than life events can cause it. Many people are simply born with a likelihood of becoming this way, no matter what happens in their lives. But no matter the cause, help is available. 

How do you know if it is depression or just a bad day?

The problems you have must happen often, such as for most of every day, for at least two weeks. Chances are your parent(s) or guardian(s) or siblings or friends will also notice that you are having problems in important activities of your life. This can be dropping grades in school, getting into fights or arguments with others, or not taking care of chores and duties at home.

For some, you may not be as interested in activities that you used to enjoy, or maybe you no longer want to be with friends or loved ones that you used to. All of these may be signs of depression. Also, teen girls are two to three times more likely to have it as boys are.

It is also important to know that if you have more angry outbursts, feel agitated, cranky, feel that others are causing problems for you, or feeling like you are being mistreated by others, or are more easily frustrated, all of these feelings can be part of feeling depressed, too.

Perhaps you don’t feel as well as you used to or you prefer to be by yourself these days. Or you feel more irritated by things. Maybe you are more sluggish and tired, maybe you sleep more and you feel like things aren’t as they used to be or should be. These can also go along with depression. 

Other signs to look for in your behaviors and mood:

• Inability to sit still or be still
• Feeling like your thinking is slower than it used to be
• Talking slower or preferring not to talk at all
• Problems with paying attention
• Problems remembering things
• Feeling bad about yourself or who you are
• Feeling unworthy of being loved or not valued by others
• Feeling guilty for things you did in the past
• Blaming yourself a lot
• Feeling like crying a lot
• Feeling irritable and on edge
• Focusing a lot on an upsetting thought
• Feeling anxious, worried, or afraid
• Having stomachaches, headaches, and other aches and pains
• Problems at school (like skipping) or with grades (like failing)
• Drug or alcohol use or increased use
• Differences in how you typically eat; decreased appetite or increased appetite, often for sweets, carbs, or “comfort foods”
• Thoughts of death or taking your own life
• Making plans to kill yourself or actually trying to

What do I do about it?

Let others know, such as your parents or guardians. If this is not an option for you, talk about your feelings with a trusted adult like your coach, counselor at school, minister or rabbi, favorite teacher (even if you are no longer in his class), a mentor, your doctor, a close friend’s parent(s) or guardian(s), or a free help-line counselor.

You do not need to deal with these feelings alone. There is a lot of help out there that really works, including various types of talk therapy and/or medications.

Resources

National Suicide Prevention Lifeline
(800) 273-TALK (8255)

National Hopeline Network
(800) 784-2433

By Chris E. Stout, Psy.D., Clinical Professor, Department of Psychiatry, College of Medicine, University of Illinois at Chicago

©2012-2019 Carelon Behavioral Health

Source: Beardslee WR, Gladstone TR. Prevention of childhood depression: recent findings and future prospects. Biol Psychiatry. 2001;49:1101-1110; Bonin L. Depression in adolescents: epidemiology, clinical manifestations, and diagnosis, www.uptodate.com/contents/depression-in-adolescents-epidemiology-clinical-manifestations-and-diagnosis; Carlson GA. The challenge of diagnosing depression in childhood and adolescence. J Affect Disord. December 2000;61(suppl 1):3-8; Castiglia PT. Depression in children. J Pediatr Health Care. March-April 2000;14:73-75; Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR). American Psychiatric Association, 1999; National Institute of Mental Health, www.nimh.nih.gov/statistics/1MDD_CHILD.shtml; Synopsis of Psychiatry by Benjamin J. Sadock, Virginia A. Sadock and Pedro Ruiz, M.D., L.W.W., 11th edition, 2014.

Reviewed by Mario Testani, M.D., Physician Advisor, Beacon Health Options

Summary

• Learn about your child’s disease.
• Teach your child about his disease.
• Set up a regular schedule.

Many parents initially feel overwhelmed and helpless when their child is diagnosed with a chronic illness. The parent might not know information about the illness or understand the disease, and the child might not comprehend why they have gotten the disease. However, it is possible for parents to help their child cope successfully with their condition. These tips can help.

• Learn about your child’s disease. Knowledge is power, and what you know about your child’s condition can make a big difference. Start by asking your doctor for information. Libraries and national organizations also may be helpful.
• Teach themabout the disease. Young children may not understand why the disease occurred and may assume it is a punishment. Help your child understand the illness by giving them honest, accurate and age-appropriate information.
• Set up a regular schedule. It is important to work with your doctor and form a regular treatment schedule. Arrange medication schedules to minimize doses during school hours. Teach your child to promptly report symptoms and to participate in their treatment as they get older.
• Contact the school. After a treatment plan has been reached, especially if it involves routine and episodic medications, brief the school nurse and the child’s teachers. Make sure that they understand the support your child needs to manage the illness and provide a plan of action for emergency situations. Ask for a teacher who is willing to stay in contact with your child and offer encouragement during hospitalizations and absences.
• Consult the school nurse. Parents often overlook the school nurse as a potential ally. The school nurse deals with chronic conditions, such as asthma, nearly every day and has a great deal of hands-on experience. They will be familiar with medication schedules and may be able to suggest coping strategies.
• Maintain normalcy. It is important for parents to help their child maintain as normal a routine as possible. Keeping this in mind, encourage physical and social activity within their limits.
• Join a support group. It often is helpful for a child to be in contact with others who have successfully adjusted to living with a chronic illness. Many organizations have local chapters with support groups for children and teenagers, as well as parents.
• Maintain a positive attitude. Qualities such as self-discipline and personal responsibility are learned through struggles with a chronic illness, and your child will gain confidence as they learn to cope with the disease.

By Elinor Chumney

©2000-2021 Carelon Behavioral Health

Source: American Academy of Allergy, Asthma and Immunology

Summary

When a problem has an impact on functioning, it is important to seek the help of a doctor or professional therapist. Consider how the problem is affecting the child’s everyday life

All children feel worried and fearful from time to time. Part of growing up is going through new experiences that can cause anxiety. For instance, the first time a child goes to preschool, or rides the school bus, or sleeps over at a friend’s house can create worry. All of these new life events can cause children to feel anxious or fearful. One difference in anxiety in a child and anxiety in an adult is that children may not use the word anxiety. They may not have the vocabulary to talk about their sense of anxiety. We need to listen to what children are able to say about their feelings, and also look at their behaviors.

A child with normal anxiety may worry for a period of time, but will respond to an adult’s soothing and support. After the child hears reassurance, worries tend to go away. An example is a child anxious about a thunder and lightning storm. A parent might say to the child that the thunder sounds loud, but it doesn’t mean bad things are happening. The flowers and trees will like the rain, and the storm will pass quickly. A parent may voice the idea that although you feel scared or anxious, I will keep you safe. A child with normal levels of anxiety will respond to this and settle down.

Recognizing anxiety disorders

In children with anxiety disorders, often the amount of worry is much greater than you would expect given what causes it. Separation anxiety disorder is the primary children’s anxiety disorder. It’s the fear of being away from home or from their family. It is normal for children between the ages of 6 months and 3 years. However, it is thought to be a disorder if it happens to a child who is preschool age or older. Children with anxiety may not respond to parental reassurances. There may be no relief from the child’s sense of anxiety, even with a parent or caregiver offering reassurance.

When anxiety is a disorder, usually it is affecting the child’s functioning at school, at home and with friends. Usually when there is an anxiety disorder the signs of the problem last more than six months. Most children go through tough periods of time where they are more worried or fearful. However, a child with an anxiety disorder is not able to set worries aside. If the worry seems excessive and persists over many months it should be treated. You may want to ask your pediatrician about referral to a licensed child therapist.

Sometimes it is helpful to ask the following questions:

• What is the actual impact of the problem?
• How does my child respond to adult reassurance?
• How does worry affect a child’s ability to make friends?
• How much does a child’s worrying affect the family as a whole?
• How is school going?

When a problem is changing how a child is functioning, it may be time to seek professional help.

Signs that may indicate a child has an anxiety problem

• Repeated toileting accidents
• Overly clingy behavior
• Asks lots of “What if..” questions
• Difficulty with transitions (going places, visiting others, leaving)
• Difficulty relaxing or concentrating
• Big startle response
• Worrying about things before they happen
• Irritability and tiredness
• Constant fearful thoughts
• Frequent complaints of stomachaches and headaches
• Fear about making mistakes or things not being perfect

If a child is experiencing some of the above signs, it may be a good time to tell your pediatrician you are concerned, and ask for help. In addition to finding help, such as a licensed therapist, you can also take action yourself. Consider enhancing your parenting skills to help your child deal with anxiety better.

What parents can do

• Think about whether there has been an upsetting event recently, such as divorce, fighting, death, or family illness. If so, learn more or talk to a counselor about how to help your child adjust to difficult life events.
• Remind your child regularly of your love and support and belief in her.
• Establish more structure in your child’s day so that there is a predictable routine the child follows on a daily basis. Keep the same bedtime routine every day.
• If you work, call and check in on a regular basis with school or daycare providers.
• Join a parenting support group.
• Build your own self-confidence so you can model it to your child.

Trust your feelings and take action if you notice your child is overly anxious. Meeting with a licensed therapist with your child can help you understand your child’s worries. A therapist can provide suggestions for helping your child become less anxious.

By Rebecca Steil-Lambert, M.S.W., L.I.C.S.W., M.P.H.

©2012-2019 Carelon Behavioral Health

Source: http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Anxious-Child-047.aspx; http://www.nami.org/

Reviewed by Charles Weber, D.O., VP Medical Director, Beacon Health Options

Summary

• Medical and nonmedical treatment options are available.
• Federal laws ensure the child will get help at school.
   

A child may go through a mild depressed mood for some weeks or even a few months. Without help, it may last for many months or longer. But, there is good news that treatment is as successful for children as it is for adults.

Individual talk therapy

Childhood depression can be treated with many forms of individual talk therapy, including play therapy, art therapy, and more. In talk therapy, the therapist and child work to develop a warm, accepting, and supportive relationship. The child is then encouraged to express thoughts and feelings about what is going on in his life. The therapist works to lower the child’s upset feelings.

Play therapy can be helpful with some children, especially younger ones. The play could be acting out an emotion that is hard to name. Or it may be by using the expressive arts of music or drawing.

Family therapy

Family therapy can be helpful for a child with depression. This is also true for other members of the family. Siblings may have a hard time understanding that a brother or sister is depressed. Family therapy can help teach parents or guardians and siblings to be more understanding and supportive of the child. They can also learn how to be on the lookout for suicidal ideas or actions.

Medication

Parents or guardians should talk with the child’s doctor or a psychiatrist regarding concerns whether medication is needed to help. There are drugs available for treatment of depression in children. Using them depends on a child’s age, weight, and the type of drug, among other factors that you can talk about with the doctor.

Getting your child to comply with treatment

Getting treatment is needed for a child with depression. But sometimes the child may not wish to see a therapist and/or take the prescribed drugs. This is common. The parent or guardian should be supportive and encourage the child. They can also get ideas from the therapist and doctor that can help. But if the depression is very bad and the child does not want help, hospitalization may be needed.

Hospitalization

In very severe cases that involve a high chance of the child hurting herself, inpatient psychiatric hospitalization might be needed. It is an option for a child if an evaluation by a professional shows a high level of risk of harm.

How to deal with your child’s school

Depending on how intense the child’s depression is, he may have trouble at school as well. Children may need tutoring or other special services if it gets in the way with the ability to learn. Although most school staffs today may be more aware and sensitive to childhood depression, not all are. They may need to be told of the nature of the child’s symptoms and diagnosis, and perhaps be involved in her care. A school nurse may need to hold onto and give meds during the school day as well.

Several U.S. laws require that services be provided to a child who has a disability that gets in the way of his ability to learn or be educated. It may also apply to the family. An evaluation can be given for free by the child’s school district. From there, an individualized education plan (IEP) that describes the services will be created for the child.

By Chris E. Stout, Psy.D., Clinical Professor, Department of Psychiatry, College of Medicine, University of Illinois at Chicago

©2012-2019 Carelon Behavioral Health

Source: Beardslee WR, Gladstone TR. Prevention of childhood depression: recent findings and future prospects. Biol Psychiatry. 2001;49:1101-1110; Bonin L. Depression in adolescents: epidemiology, clinical manifestations, and diagnosis, www.uptodate.com/contents/depression-in-adolescents-epidemiology-clinical-manifestations-and-diagnosis; Carlson GA. The challenge of diagnosing depression in childhood and adolescence. J Affect Disord. December 2000;61(suppl 1):3-8; Castiglia PT. Depression in children. J Pediatr Health Care. March-April 2000;14:73-75; Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR). American Psychiatric Association, 1999; National Institute of Mental Health, www.nimh.nih.gov/statistics/1MDD_CHILD.shtml; Synopsis of Psychiatry by Benjamin J. Sadock, Virginia A. Sadock and Pedro Ruiz, M.D., L.W.W., 11th edition, 2014.

Reviewed by Mario Testani, M.D., Physician Advisor, Beacon Health Options

Summary

• Children can have depression. Adults can learn how to find out and what to do.
• There are medical conditions that look like depression.

Depression is a pretty big and complex idea for a child to get. As a worried parent or guardian, it can be hard to find out if your child has it.

Have a talk with your child

Depending on your child’s age, she may talk about being sad or down in the dumps if you try to have a talk. Keep in mind she may be feeling hopeless, unhappy, or upset, just as an adult can. But the child may not know how to talk about her feelings. Often, she may show the negative feelings through a bad temper, worry, isolation, grouchiness, or other actions. The signs may or may not seem like depression, but can be.

A child’s loss of interest in activities or no longer wanting to be with friends and family can be warning signs. Other upsetting behaviors can also be signs of depression. This can include angry outbursts, crankiness, blaming others, feeling treated unfairly, or overreacting to minor issues.

Other behaviors you can look for include:

• Problems going to sleep, staying asleep throughout the night, and/or waking up too early
• Nervous movements such as the inability to sit still
• Slowed thinking
• Slowed speech or not talking at all
• Blocked attention or memory
• A bad self-image, feeling not good enough to be loved, or not valued by others
• Feeling guilty for past incidents, or inappropriately or excessively self-blaming
• Frequent crying spells
• Brooding and being touchy
• Being overly focused on an upsetting thought
• Worry or marked fearfulness
• Complaints of stomachaches, headaches, and other vague aches and pains
• Panic attacks, especially during separation from a loved one or parental figure
• School or academic problems such as truancy or failing grades

Some adults may have a hard time believing that a child may want to take his own life, so they may never ask the child about it. On the other hand, adults may fear that bringing up the topic of suicide might somehow plant the idea in the child’s mind, but this rarely happens.

If you suspect the child wishes to harm herself, it is important to ask. Even if a health worker may do that best, as a responsible adult you need to know about the potential danger and take the right steps.

It is very important to talk with a health worker because there are other health problems that seem like depression. For example, a child with multiple sclerosis or hypothyroidism may show symptoms of depression. A doctor or psychiatrist can help with this.

Other factors may play a role in a child’s mood or actions. If you think a child you know may have depression, think about the following:

• If the child seems more touchy than depressed and has been for at least a year, he may have a milder form known as dysthymic disorder.
• Children with depression may also have other psychiatric conditions. For example, a child can have attention-deficit/hyperactivity disorder and depression together. It is important to know the difference between them. Both involve being easily upset and not being able to pay very good attention to things they should.

It is not unusual for a child to feel unhappy every so often. But a child with a diagnosis of depression has very bad and painful symptoms for most of the day, almost daily for at least two weeks.

By Chris E. Stout, Psy.D., Clinical Professor, Department of Psychiatry, College of Medicine, University of Illinois at Chicago

©2012-2019 Carelon Behavioral Health

Source: Beardslee WR, Gladstone TR. Prevention of childhood depression: recent findings and future prospects. Biol Psychiatry. 2001;49:1101-1110; Bonin L. Depression in adolescents: epidemiology, clinical manifestations, and diagnosis, www.uptodate.com/contents/depression-in-adolescents-epidemiology-clinical-manifestations-and-diagnosis; Carlson GA. The challenge of diagnosing depression in childhood and adolescence. J Affect Disord. December 2000;61(suppl 1):3-8; Castiglia PT. Depression in children. J Pediatr Health Care. March-April 2000;14:73-75; Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR). American Psychiatric Association, 1999; National Institute of Mental Health, www.nimh.nih.gov/statistics/1MDD_CHILD.shtml; Synopsis of Psychiatry by Benjamin J. Sadock, Virginia A. Sadock and Pedro Ruiz, M.D., L.W.W., 11th edition, 2014.

Reviewed by Mario Testani, M.D., Physician Advisor, Beacon Health Options

Summary

Symptoms of bipolar disorder include:

• Severe mood swings from mania to depression
• Believing they can do things they can’t
• Doing too many things in too little time

Severe mood swings

Bipolar disorder can cause wide mood swings. The mood swings can range from mania (excited, high, or frantic) to depression (sad, hopeless). There are periods of normal moods as well. It can affect people of all ages, sexes, and races. It can affects people at all income levels. It is most often first diagnosed in adults. Once in a while, it is diagnosed in teens. In rare cases, it has been diagnosed in children as young as 5.

In adults, these moods can last weeks or months. In children or teens, the mood swings happen much more often. In fact, in many children, the mood swings cycle many times within a day. The symptoms can be similar to those of disruptive mood dysregulation disorder (DMDD). DMDD is characterized by dark moods and temper tantrums that are not age appropriate.

A child with bipolar disorder may also have other mental health issues, such as attention-deficit/hyperactivity disorder (ADHD). They may also have obsessive-compulsive disorder (OCD). Some may have drug or alcohol problems or oppositional disorders.

Mania

Everyone has mood swings. But, a person with bipolar disorder has extreme mood swings. The moods vary from mania to depression. The person’s feelings may become so intense that they lose touch with the real world. A person who has mania might have these symptoms:

• Feel on top of the world
• Think they can do things they never learned how to do such as play the piano
• Do too many things in too little time
• Sleep very little without feeling tired
• Get bothered or annoyed by small things
• Have poor judgment that leads to risky behavior and to do things they normally wouldn’t do

Depression

In a child with bipolar disorder, the depressive symptoms are like those an adult with depression. Each person with bipolar disorder is different. Some people may get very depressed for a long time, while others have only mild depression. People also have periods of normal moods in between the highs and lows.

Tips for parents

• Don’t forget your parenting jobs. When your child acts out or misbehaves, she should have consequences, even if you think your child’s behavior was caused by her mood changes.
• Don’t blame yourself. Poor parenting, divorce, or lack of discipline does not cause bipolar disorder. Scientists now believe that it is caused by genetic factors and biology.
• Medicine is one of the most useful treatments for bipolar disorder. If the doctor prescribed meds, make sure your child is taking them. It may take a while to find the right mix of medicines, in the right amount. So, be patient.
• Learn all you can about bipolar disorder. Help your child learn all he can about the disorder. Get facts from your doctor, trusted sites on the internet and from parent support groups.

By Haline Grublak, CPHQ

©2010-2019 Carelon Behavioral Health

Reviewed by Philip Merideth, MD, Peer Advisor, Beacon Health Options

Summary

Early schizophrenia warning signs:

• Confused thinking
• Extreme mood swings
• Paranoia, anxiety, or fearfulness

What is schizophrenia?

It is an illness that affects people from all races, genders, and wage levels. This health problem makes it hard for a person to tell what is real or not. It also makes it hard for a person to think and act normally. Schizophrenia is not a split personality. It is not caused by growing up in a dysfunctional family. It is not caused by laziness or being weak. It has a physical cause just like high blood sugar or a heart problem.

Early signs

Some estimates say that 1 percent of all people have it. The first signs most often appear between the ages of 15 and 25, but can show up before the age of 12. If your doctor suspects your child has it, he will look for these early warning signs:

• Seeing things or hearing things that are not real
• Confused thinking
• Problems with telling dreams from reality
• Believing TV, movies, or video games are real
• Wide mood swings
• Odd behavior
• Paranoia, or thinking that others are trying to hurt them on purpose
• Worry and fearfulness

Adult schizophrenia can come on all of the sudden. Children will show slow changes in their behavior. Many parents also say that their child showed signs of being “different” from a very early age.

Treatment choices

Medicines are the main treatment. There are many new ones on hand. If the first type does not help, ask your doctor to try another. Also, it may take time to adjust the dose. Adjusting or lowering the dose can help with unpleasant side effects.

Family and one-to-one therapy can also help everyone cope with the changes and feelings that result from their child’s illness. Structured programs can help your child with her daily living skills. She may be able to sign up for special services or special education programs.

Tips for parents

• When a child first begins having signs of a psychotic illness, it can be scary for the family. Learning all you can about schizophrenia can help ease some of your fears.
• You must work with your child’s doctor to get the pills adjusted. While one-to-one or family therapy can help everyone adjust to the illness, drugs are still the most successful type of care. Many parents let their child stop taking the pills when she starts to get better, only to find she becomes ill again fairly quickly. Finding the right mixture and dose of drugs takes time. Also, as your child grows and changes, she may need to change the type or dose of pills.
• For many people, psychotic disorders are made worse by stress. Once your child is stabilized, work with your child and your doctor to learn how to take care of stress.

Learn to notice the signs of relapse such as strange behavior, withdrawal, or aggression. Work with your mental health professional to find ways to deal with it before it becomes a crisis.

By Haline Grublak, CPHQ

©2010-2019 Carelon Behavioral Health

Reviewed by Philip Merideth, MD, Peer Advisor, Beacon Health Options

Summary

• Gratitude is strongly linked to overall well-being.
• People who are grateful want to help others.
• Parents can help children grow into grateful adults.

A polite and well-mannered child is a pleasure. But a grateful child is … well, is there even such a thing? According to Dr. Jeffrey Froh, a psychologist who studies gratitude in youth at Hofstra University, children as young as 5 years old may be able to feel and show true gratitude. Froh thinks that parents can do a lot to cultivate gratitude in their children, and research reveals many good reasons for doing so.

What is gratitude?

Gratitude is a feeling of thankfulness that you have when somebody does something kind or helpful for you. But people also can have a gratitude trait, which means they are inclined to “notice and appreciate the positive in the world,” says Froh.

The benefits of gratitude make it a trait worth cultivating. “Gratitude is strongly linked to overall well-being. Grateful people are happier, less depressed, less stressed and more satisfied with their lives and relationships,” Froh explains. They also sleep better and tend to cope with hardships and changes in healthy ways.

Froh’s research suggests that gratitude is related to well-being in young people as well. Grateful kids tend to get good grades, have high self-esteem, and care less about what they have. Moreover, gratitude seems to spark a desire to “give back” and make the world a better place. “When you feel grateful, you want to do good things for others,” says Froh.

How can parents raise a grateful child?

Froh has these suggestions:

• Model an attitude of gratitude. Children need to hear their parents express gratitude every day. “Parents need to point out to their kids what they are grateful for and why,” says Froh. This includes gratitude not only for a gift or helpful gesture, but also for friendships, neighbors, good health, the beauty of nature, and so forth. Even reflecting on and appreciating the “good” that comes out of a difficult or bad situation can serve to model an attitude of gratitude.
• Teach children how to express thankfulness. Children should be taught from a very early age to say “thank you.” Parents also can help young children to write thank-you notes for gifts or other kind gestures. These habits may, in time, help to develop heartfelt gratitude. Parents also can help children learn to express gratitude in other ways. Family members, including very young children, can take turns sharing what they are grateful for during mealtime or before bed. Or children can count their blessings through prayer.
• Help children develop empathy. Gratitude is a complex, social emotion that develops as a child becomes less self-focused and more aware of other people’s feelings. “Empathy comes first,” says Froh. To help children step into another person’s shoes, ask questions such as, “How do you think Jane felt after losing the soccer game?” or “Jack is taking his first trip in an airplane. How would you feel if you were him?”
• Help children to see when kind or helpful deeds are done by choice and at some cost to the good-doer. To feel grateful, a child must recognize that a helpful or kind gesture was done on purpose for the child’s sake and that doing so came at some cost. Parents can help children understand these points. Froh gives this example: “It was really thoughtful of Will to share his snack with you today so that you would not be hungry at school, especially since his mom packed cookies as a special treat.”

Froh notes the importance of teaching children that “cost” means more than money, such as resources, time, a missed opportunity, or as in this example, the pleasure of enjoying all the cookies for oneself.

• Do not spoil children. Froh notes that entitled kids struggle to value the role other people, situations and events play in their lives. Overpraising children for a good grade, for example, fails to acknowledge the role of other contributing factors, such as a good teacher or the help of a tutor. Parents who value status and stuff also may thwart the development of gratitude. Materialistic values are inwardly focused whereas gratitude is an outwardly focused concept, says Froh.

The take-home message for parents, says Froh, is that kids who see their parents value the world around them and express gratitude openly and often are likely to follow in their footsteps.

Resources

Greater Good Science Center
University of California, Berkeley
2425 Atherton St. #6070
Berkeley, CA 94720-6070
(510) 642-2490
www.greatergood.berkeley.edu

Thanks: How Practicing Gratitude Can Make You Happier by Robert Emmons. Mariner, 2008.

By Christine P. Martin

©2012-2019 Carelon Behavioral Health

Source: Jeffrey Froh, PsyD, Assistant Professor, Hofstra University, Laboratory for Gratitude in Youth; Froh J, Giacomo B, Emmons R. (2010) “Being grateful is beyond good manners: Gratitude and motivation to contribute to society among early adolescents.” Motivation and Emotion, 34:144-157.

Summary

• There are many aspects of development that contribute to resilience, including competence and character.
• Managing emotions is an important part of resilience.
• Parents can help kids process their feelings in a healthy way to build resilience.

Resilience is often thought of as being able to get back up after getting knocked down. It is a group of skills and traits that help people work through tough times and feelings.

There are many steps you can take to boost resilience in your kids.

There are core competency areas that make up resilience. You can develop these competencies in yourself and your kids. They are:

• Competence: being able to fully finish tasks. You can help by letting your kids solve problems and make mistakes, treating them as a chance to learn. Teach your kids to reflect and focus on their strengths.
• Confidence: believing one can be effective. Give your kids honest and specific praise. Make sure they know you believe in what they can do. Help them learn when they falter instead of shaming. Be sure to offer praise for effort.
• Connection: sharing time and meaning with others. Help your kids find meaningful connections at home, in school, and within the community. Fostering relationships with family and friends can help kids handle stress and find meaning.
• Character: a feeling of right vs. wrong and how to consider others. Reinforce your kids’ good choices and model caring behavior to help build character.
• Contribution: simply put, this means to give. Kids who help others feel good. Provide opportunities for your kids to volunteer or lend a hand when needed.
• Coping: managing emotions during times of struggle. Kids might have negative thoughts when things don’t go their way, but it is important that they learn to see struggles as normal—and a time to learn. Make sure your kids have an outlet when they are upset, such as coloring or playing sports. Model healthy ways to cope with frustration.
• Control: being able to control oneself in different ways. Talk to your kids about setting goals, and how to go after their goals step by step. Praise the hard work they put into working toward those goals.

Emotional resilience

Emotions are a major part of overall resilience, and learning how to manage them—coping, as described above—is key for kids. Help your kids strengthen emotional resilience by helping them process their feelings. If your child is feeling hurt, the most important thing you can do is listen. This helps them feel validated. It is important to normalize all feelings but still have rules about how to act. For example, kids can feel mad but shouldn’t be allowed to hit.

It is also vital to not mistake happiness for being emotionally healthy. Kids need to struggle to build resilience. It helps them learn to weather the storms that inevitably rise. Tell your kids that they will not always feel sad or angry, that this will pass. This allows your kids to know they can handle tough moments in the future.

We all need to learn that upsets are bound to happen, but we can choose how we handle it. At the same time, all feelings are fair feelings. This is a tricky balance, to be sure. But supporting your kids in these ways will help foster their resilience.

By Sarah Stone

©2018-2021 Carelon Behavioral Health

Source: “Resilience Guide for Parents & Teachers,” American Psychological Association, www.apa.org/helpcenter/resilience.aspx; “How to Raise Resilient Children” by Justin Misurell, Ph.D., NYU Langone Health, Child and Adolescent Psychiatry, https://med.nyu.edu/child-adolescent-psychiatry/news/csc-news/2015/how-raise-resilient-children; “How to Raise an Emotionally Resilient Child” by Kenneth Barish, Ph.D., PBS Parents, www.pbs.org/parents/expert-tips-advice/2015/11/how-to-raise-an-emotionally-resilient-child/; ﾓHow to Raise a Resilient Childﾔ by Krissy Pozatek, L.C.S.W., mindbodygreen, www.mindbodygreen.com/0-16635/how-to-raise-a-resilient-child.html; “Emotional Intelligence,” https://kidshealth.org/en/teens/eq.html?WT.ac=ctg

Summary

Model how to:

• Respond to rather than react to stress
• Find control
• Assess problems realistically

As adults, we know it’s tough to deal with stressful issues—problems with jobs, budgets, and family matters. But when we see children struggling with stressful issues, it can be heartbreaking.

For example, what if your child faced a bully at school? What if your child felt nervous about studying for a tough exam? Would you know how to help?

Other stressful issues kids face include tension with teachers, sibling rivalry, and peer pressure to fit into a certain clique.

Share general guidelines for handling stress

• Learn to tolerate your child’s emotions. It can be distressing to see your child experience emotions such as sadness, anger, disappointment, hopelessness, fear, etc. Avoid trying to fix the problem or to change your child’s feelings by promising a treat, a present or another enjoyable experience. Over time, as you tolerate your child’s strong emotions, he will be able to develop realistic and mature ways to deal with the adversities of life.
• Give your child a language to discuss feelings. It’s OK to let him hear you say: “I feel a little out of control today” or “I am very stressed out.”
• Let her observe you working through problems. Your child will benefit from seeing you as a good role model for coping with stress. Otherwise, how can she learn?

Do not work out marriage problems or intense financial pressures in front of your child. However, do let her hear you and your mate discussing an article on relationship enhancement. Do let your child help you clip coupons to make your budget stretch.

• Teach your child to respond, not react, to stress. Responding means that we logically name the problem and figure out a plan to cope. Reacting means we stay stuck on talking about the problem—dramatizing it, until it gains power over us.

Teach your child to take control of problems

Stress arises when we feel out of control. Try to show your child the ropes for locating control. The minute we find control over a problem, we feel better about ourselves. Stress and self-esteem are interwoven. When children have high stress levels, their self-esteem can start to sag.

If your child is facing a problem, these coping measures can work:

• Teach your child to assess a problem realistically. If he doesn’t assess a problem correctly, it will be next to impossible to find good answers. Tell your child, “We must all find ‘control buttons’ that truly match each problem.”

For example, ask your child: “Is a bully just making empty threats—or do we need to get a legal restraining order?” Or, ask, “Will your exam really be that tough? Will it be manageable if you can map out a good study plan?” 

• Point out why it’s good to find the cause of problems. Explain to your child that most problems arise for a distinct reason. For instance, many problems develop when we lack a resource—such as time, money, tools, or information.

For example, is your child’s room messy? Would a bookcase or hooks for hanging things help? Has your child been late for school a lot? Would showering the night before help ease the morning crunch?

• Demonstrate how all parties involved must take ownership. For instance, if your child is clashing with another child, don’t necessarily place blame on one person. Tell both children, “Let’s all get involved in working this out.” This reduces tension and gives everyone a stake in a productive outcome.
• Show your child what she can control. If possible, help your child manage as much of a situation as possible—without any help from you, a teacher, or friends. This gives the child a sense of personal control.

“My robust 3-year-old daughter kept trying to shove my delicate 5-year-old down the stairs,” says Amy. “I told Shelby, ‘You must take control of this situation. Always allow your sister to go down the stairs first. Otherwise, she could shove you to the bottom, because she doesn’t understand the danger.’”

Amy says that Shelby was enormously relieved: “Shelby was proud that she could manage the situation by herself—without having to be a constant tattletale.”

By Judi Light Hopson

©2002-2019 Carelon Behavioral Health

Reviewed by Paulo Correa, M.D., Associate Medical Director, Beacon Health Options

Summary

Look out for disturbing or inappropriate behavior that:

• Happens often
• Is very intense
• Goes on and on

Some days your kid is an angel, and other times you don’t know him. Is this really your child?

Maybe you’ve been busy at work or taking care of other family members, and haven’t noticed how sad he is, or how he shuts himself off in his room or screams at his sister. Today, you notice and are worried.

What’s serious and what isn’t, when it comes to a child’s behavior?

Child psychologists say parents are the experts on their own children. You know her best, and will see changes that strangers—even experts—won’t see.

All kids go through stages. They get mad or sad, don’t eat much, have trouble sleeping, or run into problems with friends. If any unusual behavior happens once in a while, don’t worry.

But, if a problem goes on too long—say, more than two weeks—that behavior could be the sign of something more serious.

Ask yourself, how often does he act like this? How long has she been sad? How big is that temper tantrum? Keep a record so you’ll have details, if you ask a doctor or teacher for help.

Infants and toddlers

Babies are born happy, curious, and interested in the world around them, even if they have a bad day once in a while. If you can’t figure out what makes your baby sad, distant, or afraid, you need to find out.

By the time your child is 2 or 3, expect tantrums. Don’t give in to the child’s demands, but help your toddler calm down and find a graceful way out of the grip of anger.

Your toddler may get fussy about food and clothing, too. Is bedtime a problem? Lots of kids don’t want to stop playing to go to bed. Or, they might have bad dreams. These are normal behaviors in young children.

But, your child might have a serious problem if she does any of the following day after day for a few weeks or months:

1. Is afraid of everyone but mama or papa
2. Doesn’t smile or make eye contact
3. Wakes up screaming in the middle of the night, and can’t be comforted
4. Shows little interest in eating
5. Is scared of the doctor, or frightened by anything new
6. Isn’t interested in other kids
7. Bites, kicks, and spits when mad
8. Throws tantrums that go on for more than an hour
9. Won’t share
10. Prefers to be alone

Child psychologist Rahil Briggs says these behaviors at an early age might predict the child will have trouble “negotiating the demands of the world” later on in life.

To help a child get on the right track, she works with the parent, explaining what the child needs, how to read distress signals, and how to help the child.

After a few short visits, parents see changes in their child’s behavior, and they see how to head off problems in the future. But, if a parent waits until the problem is worse—say, at age 14—it will take “a lot of time, money, and extraordinary effort,” to turn it around, Briggs says. 

School-age children

Is your child school-age child:

• Shut down or withdrawn
• Not playing with friends or talking to family members
• Doing poorly in school
• Getting too much or not the right amount of sleep
• Grouchy or moody

If a pet dies and your child is sad for a few days, don’t worry. And, some children may be going through hormonal changes, which could throw them off balance briefly.

But if outbursts or weepiness lasts for more than two weeks or happens many times a day, you should be worried.

Just like adults, some children suffer from depression. Girls tend to withdraw but boys lash out in anger or violence when depressed, explains psychologist LeslieBeth Wish.

By age 7 or 8, your child should have some friends. If not, try to find out why.

Bullying is a big problem among school-age children. Bullying is bad for the victim as well as the bully.

Not all bullies are outwardly violent. Some get others to do their dirty work. Girls are likely to insult, humiliate or make fun of another child, while boys get physical. Parents should act right away if they suspect bullying, even among very young children. Ask your school for help if your child is either the bully or the victim.

Teens and college students

College counselor Richard Shadick tells parents to listen carefully to what their teens say, when they ask them about themselves and their world.

Do they tell you they are:

• Nervous about something
• Depressed
• Having trouble in school
• Threatened by other kids
• Picked on by teachers or other authority figures

If so, take their concerns seriously and help them solve their problem. Is your teen a risk-taker or someone who hangs out with kids who drink, use drugs, drive fast, or have sex? All teens try on different identities—including that of a risk taker—but the more time a teen spends doing unsafe things, the more parents should be worried, Shadick says.

The most widely found problems he sees among teens are bullying, poor communication at home, academic troubles, and problems at work.

He advises parents to get involved in their teen’s life.

1. Talk to his friends and teachers.
2. Go to school events. 
3. Get to know the parents of your child’s friends.
4. Chaperone school events or trips.

Get involved in a community project with your teen, such as an environmental cleanup, sports, or a fundraising event. 

If you’re worried about a certain behavior:

• Talk to your teen about it. Sit in a quiet place, and have a conversation. Express your concerns clearly, then listen.
• If communication isn’t flowing, talk with others involved in your child’s life, maybe a teacher or boss. Ask other parents for their take on your child.

Look for support from community resources. Find someone you can trust and ask for help, such as a parent. Should you snoop? Only as a last resort, says Shadick, or if it’s a health or safety issue.

“Your teen needs to establish an identity and you don’t want to rob him or her of that step,” he says.

By Paula Hartman Cohen

©2011-2019 Carelon Behavioral Health

Source: Rahil Briggs, PsyD, Co-director, Healthy Steps Program, Montefiore Medical Center, New York, NY; Ellen Wildemann Broom, PhD, Texas Christian University, Fort Worth, TX; Richard Shadick, PhD, Director, Counseling Center, Pace University, New York, NY; LeslieBeth Wish, EdD, MSS, psychologist and licensed clinical social worker, Sarasota, FL

Summary

Types of childhood anxiety disorders:

• Social phobia
• Obsessive-compulsive disorder
• Panic disorder

Normal fears and worries

Fears and worries are a normal part of life. In fact, certain kinds of fears are normal in a growing child. For example, older infants and toddlers might have anxiety when they are away from their parents. Young children begin to develop an imagination. When this happens, they may fear the monster in the closet. Some children have more worries than others. Their schoolwork, ability to make friends, and family relations can worsen because of their fear. Teens that have untreated anxiety disorders may turn to drugs or alcohol to ease their symptoms.

Anxiety disorders

Anxiety disorders are probably the most common of all mental health problems for children and teens. In fact, about one in 10 children will have anxiety at some time during their lives. Anxiety disorders are not often diagnosed. Children may hide the symptoms from their parents and teachers. Sometimes anxiety disorders can go away without help or for no specific reason. Other times, they can be long term. These disorders respond very well to treatment.

There are several types of anxiety disorders that are widely found in children. They include:

• Social phobia is a great fear of being rejected or made fun of in front of others. These children fear situations that typical children do not. They may be afraid to talk to others (adults or peers). They may be afraid to go to class. They seem be very shy.
• Separation anxiety disorder is the child’s fear of being away from home or from their family. It is thought to be a disorder if it happens to a child who is preschool age or older. It is normal for children between the ages of 6 months and 3 years.
• Obsessive-compulsive disorder (OCD) is marked by ritual behaviors. These can include hand washing, rearranging objects, or counting. The child feels he cannot stop the behavior. Children with OCD may also have frequent thoughts they can’t seem to control. These can be thoughts of violence or tragedy. Older children most often know that their fears, thoughts, or actions are not rational. But, they can do nothing to stop them.
• Post-traumatic stress disorder (PTSD) can appear after the child has a trauma such as an accident. It can also appear after a natural disaster or after being the victim of or seeing violence. Symptoms can develop within days after the event. Or, they may take months to develop. They can include nightmares and flashbacks. Or they may include great sadness, feeling angry, and a lot of anxiety.
• Panic disorder is less common in children than in adults. Some children do get panic attacks. An attack can include shortness of breath, pounding heart, and tingling or numbing of the hands and feet. Also hot or cold flashes or a feeling that they will lose control or “go crazy.”

Tips for parents

• Blaming yourself or others is not useful. You may believe the anxiety resulted from something in the child’s life. But, you need to focus on how you and your child can get over the anxiety.
• Be patient with your child. Telling a child to stop worrying or stop washing her hands will not make her fears go away. Be understanding. Try to lessen the child’s fears. But be truthful if her fears are real.
• Encourage your child to create methods that will help him deal with the anxiety. Let him learn to handle it on his own. You will not always be there to soothe his fears. He needs to learn coping methods to use at school and when he is away from loved ones.
• Talk with teachers, pediatricians, and other child care experts. Don’t be embarrassed to ask for help or feel as though you need to have all the answers. Learn strategies that might best help your child face her fears.

By Haline Grublak, CPHQ

©2010-20121 Carelon Behavioral Health

Summary

Types of childhood anxiety disorders:

• Social phobia
• Obsessive-compulsive disorder
• Panic disorder

Normal fears and worries

Fears and worries are a normal part of life. In fact, certain kinds of fears are normal in a growing child. For example, older infants and toddlers might have anxiety when they are away from their parents. Young children begin to develop an imagination. When this happens, they may fear the monster in the closet. Some children have more worries than others. Their schoolwork, ability to make friends, and family relations can worsen because of their fear. Teens that have untreated anxiety disorders may turn to drugs or alcohol to ease their symptoms.

Anxiety disorders

Anxiety disorders are probably the most common of all mental health problems for children and teens. In fact, about one in 10 children will have anxiety at some time during their lives. Anxiety disorders are not often diagnosed. Children may hide the symptoms from their parents and teachers. Sometimes anxiety disorders can go away without help or for no specific reason. Other times, they can be long term. These disorders respond very well to treatment.

There are several types of anxiety disorders that are widely found in children. They include:

• Social phobia is a great fear of being rejected or made fun of in front of others. These children fear situations that typical children do not. They may be afraid to talk to others (adults or peers). They may be afraid to go to class. They seem be very shy.
• Separation anxiety disorder is the child’s fear of being away from home or from their family. It is thought to be a disorder if it happens to a child who is preschool age or older. It is normal for children between the ages of 6 months and 3 years.
• Obsessive-compulsive disorder (OCD) is marked by ritual behaviors. These can include hand washing, rearranging objects, or counting. The child feels he cannot stop the behavior. Children with OCD may also have frequent thoughts they can’t seem to control. These can be thoughts of violence or tragedy. Older children most often know that their fears, thoughts, or actions are not rational. But, they can do nothing to stop them.
• Post-traumatic stress disorder (PTSD) can appear after the child has a trauma such as an accident. It can also appear after a natural disaster or after being the victim of or seeing violence. Symptoms can develop within days after the event. Or, they may take months to develop. They can include nightmares and flashbacks. Or they may include great sadness, feeling angry, and a lot of anxiety.
• Panic disorder is less common in children than in adults. Some children do get panic attacks. An attack can include shortness of breath, pounding heart, and tingling or numbing of the hands and feet. Also hot or cold flashes or a feeling that they will lose control or “go crazy.”

Tips for parents

• Blaming yourself or others is not useful. You may believe the anxiety resulted from something in the child’s life. But, you need to focus on how you and your child can get over the anxiety.
• Be patient with your child. Telling a child to stop worrying or stop washing her hands will not make her fears go away. Be understanding. Try to lessen the child’s fears. But be truthful if her fears are real.
• Encourage your child to create methods that will help him deal with the anxiety. Let him learn to handle it on his own. You will not always be there to soothe his fears. He needs to learn coping methods to use at school and when he is away from loved ones.
• Talk with teachers, pediatricians, and other child care experts. Don’t be embarrassed to ask for help or feel as though you need to have all the answers. Learn strategies that might best help your child face her fears.

By Haline Grublak, CPHQ

©2010-20121 Carelon Behavioral Health

Summary

Symptoms of conduct disorder include:

• Hostility toward others.
• Destroying property.
• Lying, stealing, or shoplifting.

What are conduct disorders?

Children with these disorders often violate the basic rights of others. They break major rules. They may become involved in criminal acts. They may act in a way that is dangerous to themselves or to others. Unfortunately, many people in authority don’t view these children as having a mental health problem. Instead, they are seen as juvenile delinquents. They are thought to be bad kids.

Many of the kids in the juvenile justice system may have a conduct disorder. In fact, it is thought more than over half of all children in the juvenile justice system are dealing with a mental health issue. Many are not getting any treatment while there.

Symptoms of a conduct disorder include:

• Hostility toward others. This is shown in a way that threatens or hurts others. Examples include harming animals, bullying or assaulting others, use of weapons.
• Destroying property. Examples include setting fires or breaking things on purpose. It can also include damage to property or breaking into a home or business.
• Lying, stealing, or shoplifting.
• Running away from home overnight.
• Refusing to attend school.

These behaviors are serious. They can lead to long-term penalties. They can cause a child to drop out of school and even go to jail. So, it is important to get treatment for your child. If your child ends up in the legal system because of this disorder, you need to advocate for him. By being his advocate, you will ensure he gets treatment while he is in jail or detention.

By Haline Grublak, CPHQ

©2010-2019 Carelon Behavioral Health

Reviewed by Philip Merideth, MD, Peer Advisor, Beacon Health Options

Summary

Children’s disorders include:

• Behavior, mood, and anxiety disorders
• Psychotic disorders

As children grow and develop, they move through a range of behaviors. Different behaviors are appropriate at each stage of development. When a child or teen acts in a way that is not normal for his age, adults pay attention. Parents, teachers, and others who know the child become concerned. For example, most 2-year-olds share certain behaviors like tantrums. Tantrums are normal for this age group. But, if a 12-year-old behaves like a 2-year-old, others will think the child might have an emotional problem or a behavioral disorder.

Abnormal behavior

Abnormal or unusual behavior falls into four categories:

1. Acting out is being unruly. It includes being hostile or violent toward others. It can mean being cruel to animals or other children. It can include self-abuse.
2. Withdrawal. This is much more than shyness and should act as a strong signal if a child who once was outgoing becomes very withdrawn. Withdrawn behavior includes depression, refusing to talk, or have social contact with others, regressing to babyhood, or spending all their time on their computer or smart phone.
3. Anti-social behavior includes lying, cheating, manipulating others, or breaking the law.
4. Disorganized behavior means being out of touch with reality. It can also mean seeing or hearing things that aren’t real, or paranoia.

Abnormal behaviors span a range from mild to severe. Children’s disorders can also range from mild to severe. One child’s abnormal behavior can be a temporary response to a crisis in his life and the child won’t have any bad consequences. Yet, another child may need long-term supports and treatment. Each child is different.

Types of disorders

Children’s disorders fall into several diagnostic groups. These are:

• Behavior
• Mood
• Anxiety disorders
• Psychotic disorders

Some children have disorders that don’t fall neatly within a special group. Each diagnosis has its own form of treatment. This is called a best practice. This is why it is important to get the right diagnosis. The origin of children’s disorders is very complex. For this reason, your child’s mental health diagnosis may change. This can happen over the course of his treatment.

By Haline Grublak, C.P.H.Q.

©2010-2019 Carelon Behavioral Health

Reviewed by Philip Merideth, M.D., Peer Advisor, Beacon Health Options

It is easy for parents to identify their child’s physical needs: nutritious food, warm clothes when it’s cold, bedtime at a reasonable hour. However, a child’s mental and emotional needs may not be as obvious. Good mental health allows children to think clearly, develop socially and learn new skills. Additionally, good friends and encouraging words from adults are all important for helping children develop self confidence, high self-esteem and a healthy emotional outlook on life.

A child’s physical and mental health are both important.

Basics for a child’s good physical health:

• Nutritious food
• Adequate shelter and sleep
• Exercise
• Immunizations
• Healthy living environment

Basics for a child’s good mental health:

• Unconditional love from family
• Self-confidence and high self-esteem
• The opportunity to play with other children
• Encouraging teachers and supportive caretakers
• Safe and secure surroundings
• Appropriate guidance and discipline

Give children unconditional love.

Love, security and acceptance should be at the heart of family life. Children need to know that your love does not depend on their accomplishments.

Mistakes and/or defeats should be expected and accepted. Confidence grows in a home that is full of unconditional love and affection.

Nurture children’s confidence and self-esteem.

• Praise them: Encouraging children’s first steps or their ability to learn a new game helps them develop a desire to explore and learn about their surroundings. Allow children to explore and play in a safe area where they cannot get hurt. Assure them by smiling and talking to them often. Be an active participant in their activities. Your attention helps build their self-confidence and self-esteem.
• Set realistic goals: Young children need realistic goals that match their ambitions with their abilities. With your help, older children can choose activities that test their abilities and increase their self-confidence.
• Be honest: Do not hide your failures from your children. It is important for them to know that we all make mistakes. It can be very re-assuring to know that adults are not perfect.
• Avoid sarcastic remarks: If a child loses a game or fails a test, find out how they feel about the situation. Children may get discouraged and need a pep talk. Later, when they are ready, talk and offer assurance.
• Encourage children: To not only strive to do their best, but also to enjoy the process. Trying new activities teaches children about teamwork, self-esteem and new skills.

Make time for play

Encourage children to play: To children, play is just fun. However, playtime is as important to their development as food and good care. Playtime helps children be creative, learn problem-solving skills and learn self-control. Good, hardy play, which includes running and yelling, is not only fun, but helps children to be physically and mentally healthy.

Children need playmates: Sometimes it is important for children to have time with their peers. By playing with others, children discover their strengths and weaknesses, develop a sense of belonging, and learn how to get along with others. Consider finding a good children’s program through neighbors, local community centers, schools or your local park and recreation department.

Parents can be great playmates: Join the fun. Playing Monopoly or coloring with a child gives you a great opportunity to share ideas and spend time together in a relaxed setting.

Play for fun: Winning is not as important as being involved and enjoying the activity. One of the most important questions to ask children is “Did you have fun?’’ not “Did you win?”

In our goal-oriented society, we often acknowledge only success and winning. This attitude can be discouraging and frustrating to children who are learning and experimenting with new activities. It’s more important for children to participate and enjoy themselves.

TV use should be monitored

Try not to use TV as a “baby-sitter” on a regular basis. Be selective in choosing television shows for children. Some shows can be educational as well as entertaining.

School should be fun

Starting school is a big event for children. “Playing school” can be a positive way to give them a glimpse of school life.

Try to enroll them in a pre-school, Head Start or similar community program which provides an opportunity to be with other kids and make new friends. Children can also learn academic basics as well as how to make decisions and cope with problems.

Provide appropriate guidance and instructive discipline

Children need the opportunity to explore and develop new skills and independence. At the same time, children need to learn that certain behaviors are unacceptable and that they are responsible for the consequences of their actions.

As members of a family, children need to learn the rules of the family unit. Offer guidance and discipline that is fair and consistent. They will take these social skills and rules of conduct to school and eventually to the workplace.

Suggestions on guidance and discipline:

• Be firm, but kind and realistic with your expectations. Children’s development depends on your love and encouragement.
• Set a good example. You cannot expect self-control and self-discipline from a child if you do not practice this behavior.

Criticize the behavior, not the child. It is best to say, “That was a bad thing you did,” rather than “You are a bad boy.”

Avoid nagging, threats and bribery. Children will learn to ignore nagging, and threats and bribes are seldom effective.

Give children the reasons “why” you are disciplining them and what the potential consequences of their actions might be.

Talk about your feelings. We all lose our temper from time to time. If you do “blow your top,” it is important to talk about what happened and why you are angry. Apologize if you were wrong.

Remember, the goal is not to control the child, but for them or her to learn self-control.

Provide a safe and secure home.

It’s OK for children to feel afraid sometimes. Everyone is afraid of something at some point in their life. Fear and anxiety grow out of experiences that we do not understand.

If your children have fears that will not go away and affect his or her behavior, the first step is to find out what is frightening them. Be loving, patient and reassuring, not critical. Remember: the fear may be very real to the child.

Signs of fear

Nervous mannerisms, shyness, withdrawal and aggressive behavior may be signs of childhood fears. A change in normal eating and sleeping patterns may also signal an unhealthy fear. Children who “play sick” or feel anxious regularly may have some problems that need attention.

Fear of school can occur following a stressful event such as moving to a new neighborhood, changing schools, or after a bad incident at school.

Children may not want to go to school after a period of being at home because of an illness.

When to seek help

Parents and family members are usually the first to notice if a child has problems with emotions or behavior. Your observations with those of teachers and other caregivers may lead you to seek help for your child. If you suspect a problem or have questions, consult your pediatrician or contact a mental health professional.

Warning signs

The following signs may indicate the need for professional assistance or evaluation:

• Decline in school performance
• Poor grades despite strong efforts
• Regular worry or anxiety
• Repeated refusal to go to school or take part in normal children’s activities
• Hyperactivity or fidgeting
• Persistent nightmares
• Persistent disobedience or aggression
• Frequent temper tantrums
• Depression, sadness or irritability

Where to seek help

Information and referrals regarding the types of services that are available for children may be obtained from:

• Mental health organizations, hotlines and libraries
• Other professionals such as the child’s pediatrician or school counselor
• Other families in the community
• Family network organizations
• Community-based psychiatric care
• Crisis outreach teams
• Education or special education services
• Family resource centers and support groups
• Health services
• Protection and advocacy groups and organizations
• Self-help and support groups

©2022 Mental Health America and National Council for Community Behavioral Healthcare. Used with permission.

Source: www.mhanational.org/what-every-child-needs-good-mental-health

Summary

How to gauge the treatment experience:

• Does the mental health provider genuinely care?
• Do I feel at ease when raising any issues with her?

You may remember taking your child to the doctor for an ear infection. The care was fairly simple. After the doctor examined your child, he prescribed a medicine. He told you to bring the child back for a follow-up in two weeks. If the medicine was given properly, the ear infection cleared up. For mental health problems, the care is not as clear-cut as it is for medical problems. This is because the causes of mental illness are not as clear-cut.

In fact, mental illness may be caused by several factors. These factors could be acting together to cause the disorder. For example, depression may be caused by physical problems, family problems, or problems with adjusting to a new school. Or, it may be caused by several of these factors coming together at the same time.

Communication is key

That is why it is important to be patient. You should work with your mental health provider. Sometimes it may take weeks or even months before you see any changes. Medicine that is used to treat mental illnesses take time to work. Therapy where a person talks about their problems also takes time. It is also important for you to be open and honest about what you think is best for your child. While the mental health provider has special training, you know what’s best for your child. If a certain medicine or other care is not working, speak up. Let the mental health professional know.

Evaluate the experience

Once your child is in therapy, you should evaluate the experience. Not every therapist works well with all families. It is important to have a good match with your therapist so you should gauge your treatment experience by asking yourself the following questions:

• Does the mental health provider genuinely care about my family and me?
• Is he on time for appointments?
• Does she focus on my child’s problems? Or, does she spend time talking about her own feelings and problems?
• Do I feel at ease when raising any issues with her?
• Is he available when my family is in a crisis?
• Am I using the mental health provider in the right way? Am I getting the most out of therapy?
• If I don’t agree with the mental health provider does she listen to me? Do I feel good about these talks?
• Is he helping me to solve problems for myself? Is he helping my family to grow and change at a pace that is comfortable?

If you answered more “no’s” than “yes’s” it may be time for you to find another therapist.

The best treatment experience will happen when everyone works together. This includes the family, the child, and the provider. If you feel like the therapist is not paying attention to your needs or your opinions, find another one. It may take one or two tries before you find a good match.

By Haline Grublak, CPHQ

©2010-2021 Carelon Behavioral Health

As a parent or caregiver, you want the best for your children or other dependents. You may be concerned or have questions about certain behaviors they exhibit and how to ensure they get help.

What to look for

It is important to be aware of warning signs that your child may be struggling. You can play a critical role in knowing when your child may need help. Consult with a school counselor, school nurse, mental health provider, or another health care professional if your child shows one or more of the following behaviors:

• Feeling very sad or withdrawn for more than two weeks
• Seriously trying to harm or kill themself, or making plans to do so
• Experiencing sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing
• Getting in many fights or wanting to hurt others
• Showing severe out-of-control behavior that can hurt oneself or others
• Not eating, throwing up or using laxatives to lose weight
• Having intense worries or fears that get in the way of daily activities
• Experiencing extreme difficulty controlling behavior, putting themself in physical danger or causing problems in school
• Using drugs or alcohol repeatedly
• Having severe mood swings that cause problems in relationships
• Showing drastic changes in behavior or personality

Because children often can’t understand difficult situations on their own, you should pay particular attention if they experience:

• Loss of a loved one
• Divorce or separation of their parents
• Any major transition (new home, new school, etc.)
• Traumatic life experiences, like living through a natural disaster
• Teasing or bullying
• Difficulties in school or with classmates

What to do

If you are concerned about your child’s behaviors, it is important to get appropriate care. You should do the following:

• Talk to your child’s doctor, school nurse or another health care provider, and seek further information about the behaviors or symptoms that worry you.
• Ask your child’s primary care physician if your child needs further evaluation by a specialist with experience in child behavioral problems.
• Ask if your child’s specialist is experienced in treating the problems you are observing.
• Talk to your medical provider about any medication and treatment plans.

How to talk about mental health

Do you need help starting a conversation with your child about mental health? Try leading with these questions. Make sure you actively listen to your child’s response:

• Can you tell me more about what is happening? How you are feeling?
• Have you had feelings like this in the past?
• Sometimes you need to talk to an adult about your feelings. I’m here to listen. How can I help you feel better?
• Do you feel like you want to talk to someone else about your problem?
• I’m worried about your safety. Can you tell me if you have thoughts about harming yourself or others?

When talking about mental health problems with your child, you should:

• Communicate in a straightforward manner
• Speak at a level that is appropriate to a child or adolescent’s age and development level (preschool children need fewer details than teenagers)
• Discuss the topic when your child feels safe and comfortable
• Watch for reactions during the discussion, and slow down or back up if your child becomes confused or looks upset
• Listen openly, and let your child tell you about their feelings and worries

Get help for your child

Seek immediate assistance if you think your child is in danger of harming themself or others. Call 988 to contact the Suicide and Crisis Lifeline.

Source: MentalHealth.gov, www.mentalhealth.gov