How to tell if your child needs mental health care

April 18, 2018 Swedish Blogger


  • If there’s long-term behavior change, it’s more than just a phase
  • There are signals that children can suffer from anxiety, depression or general behavior issues
  • Parents can help by encouraging kids to express their feelings

You’ve noticed your child is acting differently. When she’s not arguing with you, she’s shut herself in her room, and she seems more withdrawn than normal. It’s hard for any parent to see their child struggling, but in cases of behavioral changes it can be especially difficult to know if it’s a passing phase or a sign of a deeper mental health issue such as anxiety or depression. Hayley Quinn, Psy.D., a clinical psychologist at Swedish Pediatrics—West Seattle talks about how to decipher behavioral changes. 

Some key signs

Different mental health issues may cause different behaviors, but Dr. Quinn says there are some overarching principles to look for in general:

  • Deviation from a child’s typical behavior. Parents are familiar with how their child moves through the world and interacts with others. Look for changes in behavior without corresponding reason, like lack of sleep.
  • Changes in behavior that last over time.  A child’s behavior may change for one or two days due to a rough week or a family situation that came up and caused stress for that moment. Behavioral changes that lasts over time can be more pervasive — look for shifts away from how the child normally acts and responds to things.
  • The child withdraws from social situations. Pay attention if the child is withdrawing from their family and friends, getting into fights with their friends or just having trouble in social interactions.


There are many different types of anxiety, but overall there are some signs that parents could look at as potential markers of an anxiety disorder, says Dr. Quinn:

  • Excessive worry, with avoidance of the thing the child is worried about. If children are worried about school, trying new things or joining a new group, they may ask to not go to those activities or avoid them in some way. Avoidant behavior will come out when it comes to anxiety.  
  • Children will verbalize their worries. Children who are worried will often use “what ifs”’ in their speech: “What if this happens?” Younger kids may not be able to articulate their worries and may instead seem more nervous or restless.
  • Separation issues. Younger children may cling more to their parents or not want to separate from caregivers.
  • Suffering physical symptoms. Often, younger children and adolescents may suffer from headaches and stomachaches. They generally don’t feel well, and they will complain of general aches and pains. In extreme cases, some children will vomit or have diarrhea.


Often, anxiety and depression will present together—it’s not always one or the other, Dr. Quinn says. But with depression, it’s often associated with sadness or feeling downtrodden. Sometimes it can take the form of irritability, which can also be a sign of anxiety.

“You can see observable change in the child’s mood, whether it’s sad or irritable,” Dr. Quinn says. “It could also be a case where the child is not showing a range of emotion or not experiencing joy, or the child reports she is feeling sad and numb.”

That lack of joy or interest in things is similar to anxiety. But with anxiety, it’s caused by worry or nervousness. With depression, children don’t feel motivated or something doesn’t seem fun anymore. Other signs of depression can include:

  • Expressing negative statements about themselves or their circumstances such as feeling worthless or that their situation seems hopeless.
  • Feelings lasting a long time. There is a difference between sadness and depression. We don’t want to pathologize normal sadness, notes Dr. Quinn. If a pet dies, it’s okay to be sad and it’s okay to be sad for a long time. It’s okay when parents have questions about their child’s feelings, and that’s a great reason to consult a doctor. 
  • Low self-esteem. Some children will be depressed but their self-esteem will still be intact; even though they feel bad, a part of them still knows there are things they are good at. That can be a part of their mental health that is preserved, but for other children low self-esteem can take a toll.
  • Physiological symptoms. With depression, there are often visible changes in a child’s sleep patterns, energy levels and appetite.
  • Younger children can sometimes show more “externalizing behavior” such as lashing out or increased emotionality — maybe they haven’t had a tantrum in years but you’re seeing more of that behavior at an age when it’s not really typical for children to do those things. This behavior can segue into more internalized thoughts and feelings as children grow older.

General behavior problems

Sometimes a child’s behavior can still be in the normal range but parents can benefit from additional support, or sometimes it can reach the level of a clinical problem which can lead to diagnoses such as ADHD or oppositional defiant disorder. “Many families I see, do not have a big clinical problem with their child, but the child’s behavior is severe enough that it’s causing problems in the family,” Dr. Quinn says. You should consider talking with a mental health professional if:

  • You’re starting to notice you don’t have good parenting control over your child. There is a loss as to what to do or a feeling of helplessness or being out of control of a situation. This tends to exacerbate the problem with a child’s behavior. Dr. Quinn says, “In these situations, we look at working with the parents and not the child. This is common with younger children and we’re working with the parents on how they can become more effective in their parenting." 
  • Behavior problems fall into one of two categories. The first is when they have disruptive or problem behavior like intense tantrums, hitting, kicking and biting, with angry responses, either towards parents or other people. The second is when parents have trouble gaining compliance with children — they won’t do something you need them to do. The first is more like getting the child to stop doing something, and the second is more about getting the child to do something you want them to do. That can include refusal or outright defiance, or, for children with ADHD, trouble following direction. This behavior will also be pervasive—the child doesn’t want to obey any requests and it rises to the level that it affects the whole family.

What you can do now

The amount of information out there can be overwhelming for parents, and Dr. Quinn says the parents she works with appreciate getting guidance from a mental health professional.  She also encourages parents to normalize the culture of mental health in the family.

“Talk about feelings from an early age—say 'It’s okay to be sad' or 'your feelings are okay.' As a parent, talk about and model to your child how you handle frustration and sad moments. It’s okay to say things like, ‘I was having a really hard time at work so at lunch I went outside and took a walk and it helped me feel better.’ Sharing and showing your children that these feelings and situations are normal and that there are ways to cope with them is really important to help them if it does come up later down the line--it may make the child more engaged in therapy.”

If you’d like someone to talk with about your child’s mental wellness, find a Swedish health care provider near you. Download Circle by Swedish, the free pregnancy and parenting app with provider-approved answers to your questions about raising healthy kids.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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