When considering a child’s mental health, it’s critical to keep their entire world in perspective.
It is common for parents to wonder and worry about whether their child’s behavior is within normal developmental guidelines, or whether it is an indication of an emotional or mental health problem. Some problems, like substance abuse, self-harm or aggression are more obvious than others, such as anxiety, depression or learning challenges.
When considering a child’s mental health, it’s critical to keep their entire world in perspective. Kids live in a world largely out of their control. They don’t get to select their school, teacher, or even their home or family. So sometimes a worrisome behavior is a reaction to what is going on around them, and does not always mean that the child is exhibiting a mental health disorder.
There are three general guidelines that help determine childhood mental health:
- Determine the level of impairment caused by the child’s behavior
While this varies by child and family, parents must evaluate how disruptive their child’s behavior is, and if it’s upsetting normal development. For instance, if a younger child is anxious when leaving a parent and responds well to various soothing techniques, they are probably experiencing an ordinary developmental behavior. However, if the child’s behavior keeps them from participating in activities, or causes a parent to be chronically late for work (threatening job security), or they continue the behavior as they age—the child likely needs help.
- Be heard
Sometimes parents have a feeling something isn’t quite right with their child and raise the concern with their pediatrician. Many times parents are anxious and wish to confirm that certain behaviors are normal. Parents frequently identify behavioral and learning disabilities through their observations. Parents are the experts of their own children, and if they have a feeling that something isn’t right, it should always be taken seriously.
- Always check it out
The first step in identifying a potential behavior issue is to check in with family members, friends and your child’s school. Talking about age-appropriate behavior with others and comparing how your child is acting compared to others helps to determine if your child needs help. For example, depression is a common concern for parents of teenagers. Adolescence is a time of typical moodiness, but depression is never a normal state for anyone. It’s important to look at your child’s behavior compared to the wide range of typical behaviors for their developmental stage.
If your child stays in his or her room constantly, but still participates in activities with friends, that’s a good sign that there isn’t a severe problem. But if he or she used to love playing soccer and now refuses to join the team, or won’t go out with friends anymore, that’s more concerning and could indicate depression or another problem. Teachers can share how your child acts in school—whether he or she participates as usual, jokes with friends at lunch or is sullen and distant. Peer-related activities are the last to suffer. However, a child who goes out with friends may still need help.
There are many resources for parents seeking information about their child’s specific situation. The Child Mind Institute offers an online “Symptom Checker” (https://childmind.org) and the American Academy of Child & Adolescent Psychiatry (www.aacap.org) delivers research and “Facts for Families.” Psychology Today (www.psychologytoday.com) provides a membership directory of local therapists, including philosophy of care and specialty, and calling “211” also offers regional information.
Julie Balaban, MD, leads the Children’s Hospital at Dartmouth-Hitchcock’s (CHaD’s) Child and Adolescent Psychiatry Team and serves as Assistant Professor of Psychiatry and Pediatrics, Section of Child and Adolescent Psychiatry, at Geisel School of Medicine at Dartmouth.