There’s a mental health crisis in America, and it’s not limited to the some 20 percent of U.S adults that experience anxiety, depression and other mental illnesses in a given year; it’s also impacting our children.
According to the CDC, 7.1 percent of children aged three to 17 (approximately 4.4 million) have diagnosed anxiety, while 3.2 percent of children aged three to 17 (approximately 1.9 million) have diagnosed depression. The National Alliance on Mental Illness (NAMI) reports that one in five teenagers between 13 and 18 will experience at least one “severe mental disorder” during their life, as will roughly 13 percent of kids aged between five and 15 years.
For parents, paying attention to our children’s mental health is paramount.
“The presence of a caring adult can make a big difference,” says Dr. Donald Mordecai, MD, national leader for mental health and wellness at Kaiser Permanente. “Studies show that even one safe, stable and nurturing relationship can be a major protective factor in the face of traumatic events.”
The first step, says Mordecai (and every other mental health clinician I consulted for this piece), is to talk about mental health with our kids. Easier said than done, as “how you approach the topic is critical,” notes Mordecai.
So how do we have these conversations and when? What warning signs should we look for, and how can we get our kids the help they need if red flags are waving?
Model positive sharing about emotions and challenges
Children, especially when young, will model the behaviors parental figures demonstrate. By being consistently open about the existence and importance of mental health, you can lead by example.
“Show your child it’s okay to acknowledge feelings by talking about your own,” says Dr. Eli Lebowitz, Ph.D., director of the Program for Anxiety Disorders at the Yale Child Study Center.
Have mental health issues? Disclose it (appropriately)
Part of talking about mental health means being transparent (as appropriate) about how you maintain yours. If you take as prescribed medication for depression, or see a therapist, or even if you just do yoga to stay sane — share that you do this with your kids to stay mentally fit.
“Part of the stigma around mental health can be broken by us about being more matter of fact about it,” says Dr. Alexandra Hamlet, PsyD, a clinical psychologist in the Mood Disorders Center at the Child Mind Institute. “We should talk about it like we talk about physical illnesses. I do think it depends on your kid ( if they’re already anxious, they may catastrophize it, so think about the impact) but otherwise, I think information helps. Perhaps you can say, ‘Mom has to take a pill so that she’s not as sad and it helps her brain stay more positive.’ If you don’t have the answer, or feel put on the spot if they ask you a question about it, it’s totally fine to say ‘Great question. I am going to write that down and think about/research it.’ But if you’re doing something [like taking medication], don’t assume your kid isn’t noticing.”
Ask questions even when nothing is wrong
While you’ll certainly want to up the ante if your child is showing any of the mental health warning signs listed below, you should be asking your kids questions about their lives every day.
The more specific the better. Opt for open-ended inquiries.
“Open-ended questions help to avoid the response of ‘I’m fine,’”, says Melissa Koch, a Licensed Professional Counselor and Assistant Lead Therapist at Alsana. “[Instead], Ask questions like, “What was your favorite part of the day?,” “What was difficult for you today?,” “What would you like me to know about today?”
>> Here are 14 questions to ask your child about their mental health
Neutralize your tone
“Each day I use my tone/inflection to portray that I have no assumptions,” says Lynn R. Zakeri, Licensed Clinical Social Worker in Illinois and mother of two teens. “‘How was the test?’ can sound 10 different ways depending on how it is asked.”
Offer a bit about your day first
“Starting our talk with something interesting about my day that is short and entertaining (whether vulnerable, self-deprecating or full of pride) — can make them feel safer to be honest about their day,” adds Zakeri. “We are trading stories rather than in a power struggle.”
No screens of distractions
Zakeri stresses devoting your full attention during these check-ins.
“Have those talks with no distractions [so] you can remember names and experiences better for the next story,” she says. “‘Oh wasn’t Danny the one who you said was good at basketball?’ Our kids love to be heard by us.”
Emojis can help really little kids communicate
For very little kids who may not be super verbal yet, Koch suggests having them identify “emotion words” using emojis.
“Using a chart that shows emoji faces for them to point to, can be helpful,”says Koch. “If an emotion fits ([as in] 'It looks like you might be angry.') If the emotion doesn’t fit, continue to explore. Open conversation about emotions normalizes them. This can help prevent children from feeling as if something is wrong with them if they have a feeling.”
If they don’t want to talk with you, enlist someone else
“If your child has difficulty sharing things with you they may still be willing to speak with another adult they know,” says Lebowitz. “Before asking a lot of questions, ask your child if they are comfortable talking to you or would prefer to talk with someone else.”
Know the warning signs
“You know your child best: If you notice behaviors that are not typical for your child, be curious about it,” say Koch.
More broadly though, Dr. Mordecai says to look out for the following behavioral changes, which could be warning signs of a mental health issue:
- Restlessness and agitation
- Acting out
- Lack of enthusiasm, energy or motivation
- Forgetfulness and lack of concentration
- Withdrawing from friends and activities
- Dropping grades or frequent school absences
- Changes in eating or sleeping patterns
- Frequent headaches and body aches
- Substance abuse
Don’t shrug off seemingly minor problems
We’ve all been kids, but it’s tough to recall just how intense our feelings were back then. All the stuff we can often better handle as adults (like a dispute with a friend, or negative feedback from an authority) can feel impossible to cope with.
“It's easy to be dismissive of kids when they're struggling because we don't always know that say, a fight with a friend is so negatively impacting them,” says Hamlet, adding that we may also not understand why such a seemingly minor event is really that important. “We might brush it off and say, ‘It will work itself out.” While we mean the best, it’s important to take them seriously and validate the pain by acknowledging it — even if we don’t agree with it.”
Resist the urge to fix it
“One situation I experience regularly when doing joint sessions with parents and their children is that they jump to offering solutions,” says Dr. Viola Drancoli, a clinical psychologist. “They want their kids to know that they are eager to help, but in my experience, kids are more committed to a solution if they come up with it themselves.”
Kids also want to be heard in full, returning to Hamlet’s point about validation.
“They want us to take what they say seriously and not be judgmental,” Hamlet says. “Parents often want to rush into problem solving which can be invalidating.”
Bob Cunningham, Ed.M., senior advisor on learning and attention issues for Understood.org, adds that if you jump right to advice, “you’ll shut down the conversation. Using the phrase ‘Yes, and…’ can help parents acknowledge their child’s issues and encourage them to be open about their challenges. Ask if [your child] has done anything to improve her situation and compliment her on her effort. Follow that with a few questions that put her in control, such as ‘What else can you try?’. Remind her you’re there to help her manage her mental health, and can always speak to her teacher or doctor about the situation.”
How to get help — even if therapy isn’t readily available
If something is wrong, talk to your child’s pediatrician, who should be able to refer you to the appropriate mental health clinician, says Dr. Mordecai.
From there, their clinician will “seek a diagnosis and discuss an appropriate care plan,” says Mordecai. “Treatment can vary based on severity of symptoms, but can include counseling, behavioral therapy, support groups and/or medication.”
If resources are scarce, start by talking with your school counselor, or if they’re not available, talk with a local youth group leader, pastor or other trusted community figure.
“Look at your family and other healthy adults in kids lives: teachers and coaches, too,” says Dr. Barbara Van Dahlen, child psychologist and mother of two, and founder of the Campaign to Change Direction and Give an Hour.
While professional therapy is ideal, Van Dahlen notes that presently, there are simply not enough mental health clinicians to treat every person in need.
Don’t relent if you can’t find the perfect help; for now, focus on the help that is available. “There is a lot parents can feel hopeful about just by knowing the information and using the networks around them,” says Van Dahlen.
You might also consider joining a support group for parents going through similar struggles — just be mindful to not leap to a diagnosis before your child is properly evaluated.
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