How to recognize depression and anxiety in kids and teens

Satish Shashidhara, DO, is a board-certified child and adolescent psychiatrist. He serves as the Division Chief of Child and Adolescent Psychiatry, Inova Behavioral Health Services.

As the lasting impacts of the COVID-19 pandemic have made all too clear, depression and anxiety are increasingly common among children and adolescents. Generally speaking, one in 12 young people between the ages of 3 and 18 will be diagnosed with depression, and one in 10 will be diagnosed with anxiety. While relatively few young children are diagnosed, in older adolescents 20 to 30% experience an anxiety or depression diagnosis. These conditions vary in severity and have a range of causes including factors we can’t control, like genetic predisposition, and factors we can affect, like our environment.

It is difficult to watch your child suffering and feel like there is nothing you can do to help. But there is good news – there are things we can do to help children who are suffering with depression or anxiety manage symptoms and live full lives. And like most health conditions, the earlier we address these symptoms, the higher the chance that we’ll be successful.

Early intervention has a range of positive effects. It can help to stop a mental health disorder from getting worse while supporting higher academic achievement, positive social interactions, and overall mental and physical wellbeing. In other words, we can affect the long-term trajectory of a child’s life when we intervene early. And we have so many tools at our disposal including a wide variety of evidence-based therapeutic approaches as well as medication, when needed.

What’s the difference between normal sadness or worry and a mental health issue?

Everyone feels sad or anxious at times. In most cases, these feelings do not represent a diagnosable disorder. How does a parent know where the line is between typical behavior and a problem? Depression and anxiety exist along a spectrum, so it can be difficult to figure out. Generally speaking, there are two things to watch out for:

• Symptoms that affect the individual’s ability to function in their lives – go to school, participate in family and community responsibilities, and enjoy time with friends and hobbies
• Symptoms that persist – rather than a passing mood, symptoms last a long time or are getting worse over time

From a parent or caregiver’s perspective, a good rule of thumb is to talk with your child’s primary care provider or a behavioral health specialist if you notice problematic changes that don’t seem to be going away.

Common early warning signs of mental health disorders in young people

In children (12 and under)

Since they’re still learning how to identify and talk about thoughts and emotions, the most obvious symptoms in children are behavioral. Examples include:

• Hyperactive behaviors
• Frequent temper tantrums, disobedience or aggression
• Changes in school performance
• Excessive worry or anxiety
• Frequent nightmares

In teens (12 to 18)

Figuring out which behaviors are expected for teens and what might be signs of mental illness can be tough. Warning signs generally rise to the level of affecting teens’ functioning in home or school settings and include:

• Feeling excessively sad or low
• Problems concentrating and learning or confused thinking
• Avoiding friends and social activities
• Difficulties understanding or relating to other people
• Changes in sleeping habits
• Feeling tired, low energy levels
• Excessive worrying or fear
• Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing aches and pains)
• Changes in eating habits
• Inability to carry out daily activities or handle daily problems and stress
• Difficulty perceiving reality (delusions or hallucinations)
• Inability to perceive changes in one’s own feelings, behavior or personality (lack of insight)
• Prolonged or strong feelings of irritability or anger
• Extreme mood changes including uncontrollable “high” mood with or without risky behaviors
• Thinking about suicide or violence

Strategies for supporting children and adolescents

Creating a supportive environment comes from communication and active engagement. Here are some ideas to try:

Open a line of communication, and be flexible as to how your child needs you to respond. Sometimes, a child just wants you to listen without much response. Other times, a child may want advice. Still other times, a child may be seeking reassurance or validation rather than a solution.

Even if you haven’t talked about mental health in your family before, it’s never too late to start normalizing discussions about feelings. A great follow-up, no matter what your child shares, is, “Do you want to talk about that? Tell me what you need. Do you want advice, or do you want me to just listen to you? I’m happy that you’re talking with me about this.”

For parents of younger children, encouraging effort can work well. When your child experiences a roadblock, it can help to say, “It seems like you might be stuck. What else can you try?” or “What do you think you should try next? What might you do differently next time?” By doing so, you can help the child continue to explore and learn, while giving them a strong sense that they have a safe “home base” to return to.

If your child or teen is not having a lot of success with current therapy, don’t give up – often, a different therapeutic approach, or a different therapist, may be more effective. A given therapist might be wonderful at the job, but that therapist may not be a great fit for your child – and that’s okay. Finding the right fit between therapist and child is key to a productive therapeutic partnership.

Don’t let the perfect be the enemy of the good. It takes courage to change the way you communicate with your child or teen, and like all parents, you’ll make mistakes. Acknowledging when you fall short, and trying again, is a powerful way to model love and resilience for your child.

Conclusion

Helping your child deal with a mental health challenge can be difficult, but you’re not alone. Inova Kellar Center provides comprehensive mental health and substance use disorder treatment programs and an innovative special education school support families throughout Northern Virginia. Its services include:

• Individual, family and group outpatient therapy
• Outpatient psychiatry and medication management
• Intensive outpatient program
• Partial hospitalization program
• The Kellar School, a therapeutic education program for students who qualify for special education services

Individuals are learning and developing at an astonishing rate during childhood and adolescence. By proactively addressing mental health issues during this time, parents and caregivers can help set children and teens up for success by giving them coping tools they can use to deal with stressors throughout their lives.

Take the first step toward healing

If your child or teen is struggling, don’t wait. Discover why families across Northern Virginia trust Inova Kellar Center compassionate, expert care tailored for children and adolescents.