Mental health disorders are more common in young children than many people realize — and a number of them aren’t getting the help they need. Here’s how to spot the signs.
Your 2 year old has been in full-blown tantrum mode for over an hour. Toys are being flung across the room, punches are flying any time you get near, and there’s even the risk of being bitten if you dare to get too close.
Is this typical toddler behavior, or the sign of early mental health issues?
Your 7 year old doesn’t want to go to school. Every day she comes home crying, and every morning she begs to skip. You see the panic in her eyes. You know it’s real.
But is she just a kid who doesn’t like school, or is this what anxiety looks like for her?
If you’ve found yourself in situations like these, wondering whether or not your child needs the help of a mental health professional, you’re not alone.
A recent study released in JAMA Pediatrics estimated that 7.7 million children — roughly 16.5 percent nationwide — have at least one mental health disorder.
Yet, about half of those children don’t receive any kind of treatment from a mental health professional.
The reasons for this disparity in care can be extensive.
Danielle Rannazzisi, PhD, a child psychologist practicing in New York, explained to Healthline it’s not just about a lack of access to care. She said a lot of parents also struggle with recognizing certain behaviors as symptoms of true mental illness, as opposed to just “feeling blue” or “getting nervous.”
Then there’s the stigma attached to seeking mental health treatment.
“We’ve made some advancements as to how mental health is viewed in this country, but we still have a long way to go.” Rannazzisi explained. “There are still negative connotations associated with mental illness that discourage people from admitting that they are in need of treatment and seeking it out.”
She said a lot of parents worry about their children being labeled with a diagnosis that will then follow them throughout adolescence and adulthood.
That fear can prevent them from presenting the full scope of the issue to their child’s practitioners.
Also, with a nationwide shortage of child psychiatrists, it can be difficult for parents to even find the right people to ask the questions they need.
Financial concerns can come into play as well.
“For individuals without health insurance, mental health treatment can be cost-prohibitive,” Rannazzisi said. “Even for individuals who are able to find a mental health provider who accepts their insurance, copays for therapy and medications can add up quickly.”
The flaws in the data
Given those barriers, it’s no wonder more kids aren’t receiving the help they need.
But Dr. Marian Earls, board-certified in both general pediatrics and developmental and behavioral pediatrics, and an American Academy of Pediatrics (AAP) representative, isn’t convinced the numbers from the most recent report are entirely accurate when it comes to lack of treatment.
She pointed out that kids with ADHD are primarily treated by their pediatrician or family care practitioner, without the need for seeing a mental health professional.
“The AAP says that primary care should be able to monitor mild to moderate anxiety, depression, and ADHD,” she explained. “I can’t tell from the data whether or not they accounted for that, since they asked the parents if they had a referral out to a mental health professional.”
Earls makes a good point.
The most recent data comes from the 2016 National Survey of Children’s Health, which relies on parents to answer a variety of questions about their children.
The question evaluated for the purpose of this study was, “During the past 12 months, has the child received any treatment or counseling from a mental health professional? Mental health professionals include psychiatrists, psychologists, psychiatric nurses, and clinical social workers.”
Earls went on to say, “I don’t know that it’s so shocking that there are so many children who aren’t seeing a mental health professional. Many of them may be receiving the care they need for mild to moderate issues through their pediatrician.”
Identifying issues sooner
Still, as a developmental and behavioral pediatrician, Earls is interested in ensuring mental health issues are caught as early as possible.
“I think the bigger take-home to this research is the number of kids who have disorders,” she said.
“We should be regularly asking kids about how they’re doing, identifying issues as they’re emerging, and working on earlier intervention, before these issues become a crisis.”
Parents can play a role in helping that to happen by bringing concerns to their child’s pediatrician as soon as they have them.
Rannazzisi says that signs your child might need help include:
- significant mood changes including persistent negative mood or frequently changing moods
- significant behavior changes, for example a straight A student begins failing classes
- excessive fear or worries
- loss of interest in people, objects, and activities they used to enjoy
- difficulty concentrating
- a decline in self-care (e.g., hygiene, grooming)
- difficulty initiating or maintaining social relationships
- physical symptoms such as headaches, stomachaches, changes in appetite, and sudden weight loss or gain
- self-injurious behavior
- substance use
Because she specializes in identifying issues with very young children, Earls mentioned paying attention to feeding problems and interactions with others even as early as infancy.
For school-age children, she said that their willingness to go to school or participate in the family can bring up reasons for potential concern.
But what about the parents who simply aren’t sure if what they’re seeing is the sign of a mental health issue versus a child simply behaving badly — as most children will occasionally do?
Rannazzisi says parents should look at two things in that case: severity and duration.
If your child’s behavior is “severe enough to significantly impact” their daily functioning at home or school, it’s worth bringing up.
And while she says all kids go through phases, “mental disorders are not transient in nature. If the symptoms are persisting for weeks at a time, that would be a major red flag for me.”
When in doubt, Earls suggests starting by bringing your concerns to your child’s pediatrician.
“We don’t want to pathologize a normal developmental stage,” she explained. “A lot of parents might not understand that their 2 year old biting can be normal. So being able to access people who have experiences with those age groups is important. If you have a pediatrician whom you trust, start there.”
Rannazzisi agrees. “I would encourage parents to speak with their child’s doctor, as well as their child’s school-based mental health team. They can provide you with resources and recommendations for getting support both at home, school, and in the community.”
If you’re concerned about your child’s mental health, know that there’s help available, and that mental health issues are in no way a reflection of you or your parenting.
The first and hardest step is sometimes just making that call for help.