Navigating the Mental Health Crisis in Children

In many families, discussions about mental health only happen in whispers. While conditions like heart disease or diabetes are openly recognized, mental illness still sometimes feels embarrassing or more personal. The reasons for that contrast are complex but not new. Mental health has been poorly understood throughout history -- physical conditions were often considered bad luck or maybe bad genes, but mental issues like anxiety or depression were thought of as evidence of witchcraft or attention seeking behavior. Fortunately, today we know better, though some of those stigmas and attitudes can be hard to shake.

More than half of Americans will be diagnosed with a mental disorder at some point in their lifetime, and those issues don’t just appear out of the blue. The first signs of mental health issues often appear when we’re children. In fact, young people in the U.S. are experiencing more mental health issues than ever before – and it’s not just pandemic-related stress. The rising trend in depression and anxiety among school-aged children started before COVID and has a variety of causes. In some cases, mental health conditions develop in response to a specific factor in child’s life, like trauma, prenatal health, or exposure to toxins. Other times, it’s biology. Just like diabetes, many mental illnesses run in families and are linked to abnormalities in genes. Of course, stress and environmental factors may exacerbate already existing issues.

The growing trend in adolescent issues prompted a task force to recently recommend mental health screenings as part of kids’ well visit checkups. The task force recommends anxiety screenings for children 8 years old and above, and depression screenings for children 12 and older. The screenings include surveys and questionnaires that can identify children who are at risk for anxiety and depression. If a screener determines that a child needs more support, your physician will recommend follow-up visits to determine if treatment is necessary and what kind is most appropriate.

Because the task force’s recommendations are not binding and have not been adopted by all pediatricians, experts recommend educating yourself on the signs of anxiety and depression in children. If you notice your child exhibiting some of the signs below, talk with their pediatrician and ask about screenings. While not every child will be diagnosed or need treatment, it’s important that your child knows that there is help available if they ever need it and that mental health conditions are common and treatable.

Signs of anxiety in children:

• Changes in appetite or eating habits, either eating more or less
• Sleeping more or less than usual
• Falling grades
• Relationship changes
• Irritability or anger
• Sensitivity to criticism
• A loss of interest in activities
• Physical symptoms, including headache and stomachache
• Problems separating from caregivers and resistance to going to school or sleeping alone

Signs of depression in children:

• Feelings of sadness and hopelessness
• Social withdrawal
• Sensitivity to criticism or rejection
• Irritability or anger
• Changes in appetite or eating habits, either eating more or less
• Sleeping more or less than usual
• Trouble concentrating
• Fatigue
• Physical symptoms, including headache and stomachache
• Relationship changes
• Thoughts of death or suicide
• Feelings of worthlessness or guilt
• Trouble concentrating

Check out the American Academy of Pediatrics’ resources on mental health for kids.