Mental illness: When your child’s behavior is troubling you

These are difficult times to be a parent. Amidst a still-unstable economy, the stakes have never been higher for parents to ensure their children receive the best education and opportunities. But even the most attentive moms and dads may be fearful after seeing media reports of challenges that everyday children face: ADHD, autism, over-medication, drug abuse— the list goes on.

Underneath the hyped-up stories lie some real causes for concern. For example, about 7.5 percent of children aged 6–17 years who used prescribed medication during the past six months did so to treat emotional or behavioral difficulties. Children are also increasingly getting expelled from preschools for behavioral issues. One in six children has some form of developmental disability or delay— yet less than half the pediatricians in the country screen children for these disorders.

In an environment riddled by these statistics, not questioning yourself as a parent, even if you’re perfect, can be tough. “Will he grow out of this?” “Will she do better in school if she just tries harder and I force her to sit down at night to do her homework?” “My pediatrician is prescribing medication, but aren’t we just overmedicating kids?” These are all common questions that parents today face.

So how can parents help their children if they are concerned about mental health? How can they decide if they should be worried enough about their child’s behavior to consult a professional? I often tell parents to evaluate a child’s behavior using three broad guidelines:

Duration: Is the behavior that concerns you continuing to occur over weeks or months?

Intensity: Is it occurring in several settings (at home and in school, for example) or only in a specific setting? Is it getting more severe as time goes on?

Overall impact on the child’s development and his or her family: Is your family changing its behavior to accommodate the child’s behavior? For example, do you find yourself needing to leave work to pick up your child from school?

The more extreme a behavior’s duration, intensity, or overall impact, the more likely it is that parents should seek help.

As parents apply these guidelines, three contexts are important.

First, it’s better to find out if there is a problem sooner rather than later. Early intervention saves unnecessary suffering. There are effective short-term treatments and yes, even cures, for most mental health issues. Just as we treat other medical issues such as diabetes promptly, we need to treat mental illnesses as early as possible.  

Second, some behaviors— such as a child saying they want to kill themselves— are so serious that, even if they happen just once, they should be taken seriously. Parents should speak to their pediatrician or a mental health professional immediately or, if the situation warrants, go to an emergency room.

Third, children undergo stresses that may manifest themselves differently at different ages.

Infants and Preschoolers: Even little kids can get depressed or anxious. Children in this age group frequently express those issues through increased temper tantrums or irritability.

Children of Elementary School Age: Children can start to manifest fears or anxieties about school or other kids. They can also have difficulty (understandably) sitting through long days without breaks. And they can have difficulty making friends in the early school years and may need extra support in social situations.

Pre-teens and Adolescents: At this age, bullying (especially through social media), promiscuity, and abuse of alcohol and drugs can be major concerns for parents. It can be difficult to tell whether behavior is normal experimentation or something more serious.

At all ages, the guidelines I’ve provided can used to distinguish temporary behaviors that are a normal part of growing up and behaviors that warrant a closer look by a professional.

But taking care of your child’s mental health isn’t all about dealing with problems. Just as important, it’s about the positive things you can do all the time. For example, establish family time at a certain point during the day, help kids express themselves—even in the face of disappointment—and play with children in a non-directive way that allows them to explore their environments safely. These practices can help establish the foundation on which children can build their emotional and mental health for a lifetime.

Dr. Bonny Forrest is a practicing attorney and a child psychologist, with specialized training in pediatric neuropsychology. She has been a researcher and clinician in academic and medical settings such as the Yale Child Study Center, Columbia University and the National Institute of Mental Health.  Dr. Forrest is leading Project SKIP: Screening Kids for Intervention and Prevention, which is screening children for social-emotional, cognitive, and developmental issues