Kidsburgh Mental Health Guide: What are warning signs of mental health difficulties in kids?

Kids are constantly changing and growing. But when a child’s behavior changes in ways that surprise or worry us, parents may wonder whether they’re seeing a bumpy-but-typical transition or a larger struggle with mental health. 

In a recent Kidsburgh survey of more than 700 Pittsburgh-area families, 60% told us they think often about their kids’ mental health. But more than 25% of survey respondents told us they weren’t sure how to look for signs of mental health distress.

Many children do need support in navigating their emotions and handling mental health challenges. 

We recently polled 260 local educators and school employees. Nearly 90% told us they’ve seen an increase in anxiety among students in the last five years. More than 75% told us they’ve seen a rise in depression and more than 50% have seen a growing number of students struggling with issues of gender and sexual identity. 

Below, you’ll find advice we received from a range of local experts — pediatricians, pediatric behavioral health specialists, school counselors and community experts on mental health — on the warning sign behaviors that could signal that a young person is struggling to be mentally healthy. 

What to look for  

Toddlers through kindergarten kids

At this age, it’s common to see periods of frustration, says Megan McGraw,  a behavioral health specialist at UPMC Children’s Community Pediatrics-Bass Wolfson. As young children learn to navigate their world, they can get angry or weepy or just feel grumpy. These feelings are a normal and healthy part of life. 

It’s even common to see some regression during challenging times: Kids may be more fearful at bedtime or struggle to separate from a parent when they’re transitioning into a new grade at school, for example. If caring adults remind the child that they are safe and loved, usually these periods don’t last very long. 

But if heightened emotions seem to get in the way of their daily life, or a child seems very frequently angry or sad, it’s important to investigate further. 

Notably increased crying, nightmares and “somatic complaints” (talking about discomfort in their bodies when they don’t seem to be ill or injured) are warning signs that the child may be struggling emotionally. Also, major changes in appetite and sleep disturbances (or fatigue, despite sleeping) are worth noting. 

Even young children can try to talk with you about these experiences. “They may not know exactly what anxiety means, but they can describe what they feel like,” says Diana Schwab, a child development specialist at Kids Plus Pediatrics. 

Rather than directly asking if something is wrong, “invite kids to wonder about it,” she says. “Give them language to wonder.” 

Denita Parrish, a community mental health advocate and certified in Mental Health First Aid trainer who works with the Pittsburgh nonprofit Steel Smiling, says even young kids can talk about their feelings if you help them.

“The way I’ve explained it to my kids is that we all go through different emotions. Sometimes we’re happy, sometimes we’re sad, and sometimes we can’t explain how we feel, but it just doesn’t feel right,” Parrish says. 

If you explain the names for different feelings and reassure a child that everybody experiences these things, they may begin to find words to explain what they feel. 

Also, remember that “behavior is communication,” says Schwab. So watch how your child is playing. Does it seem that they’re not having any experiences of joy and they’re struggling to regulate their feelings while playing?

If you’re seeing behaviors that worry you and you have the sense that something isn’t right, it’s important to reach out for advice and help. Parents are the experts on their own children, says Schwab, so trust your instincts if you feel help is needed. 

Elementary school kids

In school-age students, experts say it’s a warning sign if a child becomes withdrawn — communicating less with others, pulling away from friends and wanting to be alone more than usual. 

And although it’s not uncommon for school-age kids to shift from one group of friends to another, noticeable struggles with social relationships are also worth noting.

One educator surveyed by Kidsburgh pointed out that if a child seems to be exhibiting “attention-seeking behavior,” that isn’t necessarily something to disregard. This behavior “tells us something and should be taken seriously.” 

 One warning sign may be a sudden dip in grades for a child who hadn’t previously struggled at school. Loss of appetite, sleep problems and atypical outbursts of anger can also be a sign that the child is struggling emotionally.

It is important to note that anger is a common reaction. “Anger helps you feel big and strong when you’re small,” Schwab points out. But while it may not be a sign of a deeper problem, it’s valuable to teach kids how to express their anger in ways that aren’t destructive. 

Middle school and high school kids

With tweens and teens, some degree of pulling away from parents and communicating more with peers is very normal. And “it’s not necessarily bad that they’re pulling away,” says Alaina Schrader, a nationally certified school counselor who works with students in the Pittsburgh area.

Interests and groups of friends can shift at this age, as kids try on different identities. And if a child prefers spending more time on their own, that isn’t necessarily a sign of a problem. 

But if you’re asking yourself how your child could suddenly be so different than before, it’s worth looking closer, Schwab says.

Isolation and noticeable changes in eating and sleeping habits can be signs of emotional struggle. And while problems with drug or alcohol addiction aren’t always visible, it’s important to notice changes in physical appearance and behavior. 

Occasionally, parents notice sudden extroverted behavior or intensity that hadn’t been present before. 

“If there’s a change in behavior, we want to investigate what that’s telling us,” says Schwab. 

Don’t be afraid to talk with teens and tweens about addiction and let them know you want to help them take good care of themselves. The same goes for challenges with sexual identity and gender identification. Let your child know you’re a safe and trusted person to talk with about these issues. 

Schwab points out that some emotional struggles don’t require ongoing therapy. It may be that things improve after just a few sessions where a teen (or a concerned parent) can meet with a mental health expert and talk things out. 

Gathering more information about your child’s mental wellness 

Along with paying attention to your child’s moods and behavior, and discussing what they are feeling, it’s valuable to check in with others who know your child. Ask anyone in your community who knows your child well or sees the child regularly. This could be babysitters, family members or neighbors who see your child regularly.

Ask teachers or sports coaches, as well. Some parents worry that a child might be categorized as a problem if they reach out for support. But educators tell Kidsburgh that parents don’t need to worry about stigma. They believe a school won’t judge a child differently simply because the parent has concerns about their child’s mental health. Seek help as soon as you feel it’s needed. Don’t wait until the situation becomes more extreme. 

How to communicate supportively with kids about mental health concerns

Sometimes the easiest way to talk with kids about feelings is while you’re out for a walk or a drive. At home, you could begin a project together (like cooking or baking), then let the child know how you’ve been feeling. Then ask about their feelings. 

If you have specific concerns about their mental wellbeing, describe the behaviors you’ve been noticing and let the child know that you’re ready to help.

With teens and tweens, it may be that your first attempt to discuss how they’re feeling won’t yield much progress. But if you make it clear that you’re there to support them, they may begin to open up. And you can keep on trying.   

For younger children, one valuable way to begin talking about feelings around COVID-19 is asking a child what’s changed and what hasn’t since quarantine began last March.

At any age, it’s not productive to have emotional conversations right after a heated argument. It’s harder to get someone to share their feelings honestly when conflict is happening. 

Where to go for help 

Along with the many resources listed in the other sections of this guide (school resources and community resources for mental health support), one of the best places to begin seeking help is your pediatrician’s office. 

“It’s very common for parents to bring kids into the pediatrician with a concern. That might be behavioral or sometimes it feels physical — they’ve got stomach aches or they seem to be sleeping a lot or those kinds of things,” says Dr. Gary Swanson, program director of psychiatry residency training at Allegheny General Hospital. 

Once the family comes in for an appointment, the pediatrician can explore physical and emotional aspects of what’s happening and help find solutions. 

Pediatricians can answer mental health-related questions, direct you to the support you might need and serve as a bridge until your child (and/or you) can access counseling and other mental health resources. Pediatricians can also help with behavior health evaluations for conditions like ADHD. 

Mental health issues are serious, but if we talk with kids about the importance of addressing mental health and we treat the problems that arise, we can help kids of all ages through these challenging times. 

Welcome to the Kidsburgh Mental Health Resource Guide. Looks for additional guides: Where parents can access community services in Pittsburgh, the meaning of mental health in kids and how your school can help.

For more Kidsburgh mental health articles, visit here. 

This story is part of the Kidsburgh Mental Health Series, funded by a grant from the Staunton Farm Foundation. The Foundation is dedicated to improving the lives of people who live with mental illness and/or substance use disorders. The Foundation’s vision is to invest in a future where behavioral health is understood, supported, and accepted.