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Recognizing Mental Health Problems in Children

The statistics are staggering. One in 6 children ages 6 to 17 in the United States has a mental health disorder such as depression, anxiety or attention deficit hyperactivity disorder. To make matters worse, healthcare providers worry this number has increased during the coronavirus disease 2019 (COVID-19) pandemic.

How do you know if your child has a mental health disorder, and what are the signs that it’s time to seek a professional’s help? We talked to UNC Health child and adolescent psychiatrist Amy Ursano, MD, to learn more.

What is considered a mental health disorder in children?

Mental health disorders emerge as serious changes in the way children typically learn, behave or handle their emotions, causing distress and problems getting through the day that last for a few weeks or longer, according to the Centers for Disease Control and Prevention.

“If it’s interrupting development and interfering with their ability to learn, have friends and be with family, that can be cause for concern,” Dr. Ursano says.

For example, it is normal for elementary school-age children to be scared of severe weather, such as hurricanes and tornadoes. However, if that fear of bad weather leads to a preoccupation with watching the Weather Channel or searching the internet obsessively and wanting everyone to come inside anytime there is a drop of rain, that is a red flag.

“Those extremes are the ones you worry about,” Dr. Ursano says. “If it’s exhausting the family and leading to arguments and confusion on everyone’s part, those are probably signs that it’s worth talking to somebody about.”

What are signs that your child may have a mental health disorder?

It’s sometimes hard to distinguish between what is a normal part of child development and what is cause for concern, Dr. Ursano says.

If you’re not sure, a good first step is to check with friends, family members and your child’s teachers to see if they have noticed anything unusual about your child’s emotional state or behaviors or if they have experienced something similar with their own children.

“Often those folks are keyed in to what’s going on with your child socially, emotionally and behaviorally,” Dr. Ursano says.

Children may not be able to express worry in words, but instead may experience physical side effects such as “lots of tummy aches, headaches, muscle aches and pains,” Dr. Ursano says.

Another cause for concern is if your child has changes in his or her sleep patterns—either sleeping too much or not enough. Also, pay attention if your child is struggling in school, having difficulty paying attention in class, has frequent tantrums or is intensely irritable much of the time.

Older children may skip school, have crying spells, eat too much or too little, or have low energy.

“While some of these behaviors are normal, pay attention to how long they last,” Dr. Ursano says.

For example, these behaviors are not an unusual response to an acute event, such as a death in the family, or something stressful, such as a close friend moving away. But if they are not tied to a stressful event and last for more than a few weeks, it could be a sign of something more serious.

Finally, if your child loses interest in things that he or she used to enjoy or is spending more and more time alone, avoiding social activities with friends or family, it’s a good idea to have him or her evaluated for a mental health disorder.

How can you find help for your child’s mental health disorder?

First and foremost, if your child’s behavior is unsafe, or if your child talks about wanting to harm him or herself or someone else, seek help immediately. Call 911 or go to the nearest emergency department.

If you’re unsure but think your child may have a mental health disorder, talk to your child’s pediatrician.

“They can refer you to contacts within your community that you could trust,” Dr. Ursano says. “There are so many wonderful mental health providers, including child psychiatrists, psychologists, counselors and social workers, and your pediatrician can help you find the best fit.”

It’s especially important to look for a child mental health professional who has training and experience in treating the specific problems that your child is experiencing. Another resource is a local academic medical center or university.

“University settings are a great place for easy referrals,” Dr. Ursano says. “They are good about networking to find who might best fit your child’s needs.”

How are child mental health disorders treated?

Treatment usually includes psychotherapy (talk therapy) for your child, but it also can include medication, family counseling and even therapy for parents, too. That’s not because you did anything wrong as a parent, but rather to teach you how best to support your child given his or her mental health needs.

When finding a therapist, keep in mind that it may take time to find the right fit for your child.

“You may have a very reputable clinician that you’re working with, and maybe you all hit it off great and it’s a good fit, but maybe it’s not, and that’s OK,” Dr. Ursano says. “You want to be able to feel like you can speak your mind and that you’re heard in the way you want to be heard. You want to trust that you can work well together in helping your child.”


If you think your child may have a mental health disorder, talk to your child’s doctor. Need a doctor? Find one near you, or set up a virtual appointment.