Back to School: Signs to Look for in Children’s Mental Health

When pressures increase on kids and teens, what indications of behavioral health concerns should you look out for? We guide you through how to identify and talk to your kids about mental health.   

With back-to-school time the extra pressures of homework, daily routines and activities, and social dynamics can come into play. With rates of depression and anxiety on the rise among children and adolescents, it's crucial to be attentive to their mental health. Know what signs and symptoms to look for to help address mental health concerns. 

Before the COVID-19 pandemic, there were indications of increasing youth mental health concerns. Between 2007 and 2016, visits to the emergency department for mental health disorders among children rose by 60%, while rates of other ED visits remained static.  

The issue has become so widespread that in 2021 leading pediatric agencies declared a crisis in youth mental health. Massachusetts, for example, has reported stark increases in ED visits for mental health concerns among children. In the state of Colorado, having suicidal thoughts has become the most common reason for children to visit the ED.  

These are concerning stats. As a parent or a guardian, where can you start? There are opportunities to speak to your children about these topics.  

Gianna Vaccarino, a licensed mental health counselor with Array Behavioral Care, shares tips on what to look for and how to respond. Vaccarino has experience treating patients across the lifespan in intensive outpatient and partial hospitalization programs, community-based mental health programs, and telehealth settings. She has treated anxiety, OCD, phobias, and depression and has specialized in the treatment of children struggling with trauma.   

A behavior or a symptom?  

The biggest indicator of mental health issues in children or adolescents is a noticeable change in behavior. However, not every change in behavior is a concern. Some observable changes may be related to growing up or pushing boundaries, rather than mental health symptoms or disorders.   

Parents and guardians can keep an eye out for major shifts or for anxious behaviors, such as picking or pulling skin, hair, or nails. Anxiety can also show up in changes in eating, lack of interest in hobbies, social withdrawal, trouble sleeping, or physical symptoms like stomach aches.  

“It’s important that we differentiate between a mental health symptom and what’s developmentally appropriate,” said Vaccarino.  

Assess and plan, don’t panic  

Parents tend to know their children well enough to wisely assess possible indications of mental health concerns, says Vaccarino. And if they do detect a shift in behavioral or notice self-harming behavior, they shouldn’t immediately panic. Know that there are resources available to you during this time.   

Self-harming behavior can typically be categorized as a maladaptive coping skill. In other words, a sign that children don’t know how to deal with the emotions they are feeling.  

With the help of licensed mental health professionals, self-harming behavior can be addressed. Specific treatments will initially manage the symptom and reduce the behavior, with the goal of understanding the underlying concern.   

Any degree of suicidal thoughts and self-harming behavior should be addressed. When there is imminent suicidal ideation, safety is the priority, and individuals should access an emergency room. 

Talking openly to your children is important  

Once safety has been established, parents should not be afraid of talking about suicidal or self-harming feelings with children. These conversations can be supportive and helpful to children and teens, even if they are not experiencing in a mental health crisis at the time.  

Talking about such difficult thoughts and feelings opens the opportunity for communication. Children can feel comfortable enough to discuss their honest emotions and feelings.  

Research shows that talking about suicide doesn’t encourage or suggest to a child to carry out any type of suicide attempt. In fact, the reverse happens and the likelihood of an attempt decreases.   

Asking directly about suicidal thoughts can expand the conversation, rather than plant an idea says Vaccarino. It can help relieve enormous emotional burdens that a child has been carrying with them. If you are suspecting that your child is engaging in self-harm, ask straightforwardly with the intention to listen without making judgments.  

According to Vaccarino, the most important message to get across is that your child’s safety is important and they are cared for.  

“I would say try your best to just be open and direct about suicidal thoughts because that’s actually what your child probably needs most—to feel like they can talk about it with you and to feel like it’s safe to talk about,” said Vaccarino.  

How to start the conversation about mental health with your child  

Be sincere and use your own verbiage and language to talk to your children, just as you would about any other topic. Assure your child they can share anything on their mind. Some possible conversation openers could include:  

• “I’m worried about you, you don't seem yourself lately. Have you been having thoughts of hurting yourself?" 
• “This is a safe space to talk.”  
• “There’s nothing you could tell me that would cause me to be angry with you.”  

• “I am here to keep you safe.”  

It can also be healthy to broker the topic of mental health treatment and describe one’s own personal experiences. Parents can make simple statements to normalize the idea of going to therapy like: “I was feeling really nervous/anxious/upset so I decided to see a therapist and it helped me a lot.”  

Treatment options 

Depending on where you and your family live, there may be several treatment options and mental health programs like school counselling and group and intensive therapy programs.   

Research has shown that a lack of sleep can be linked to more likelihood of teens feeling sad or hopeless, or considering suicide. This could be an area to explore with your treatment provider and discuss with your child or teen.  

When treatment is not available or your child is facing long wait times, telehealth can provide a timelier link to care. Having access to a specialist through telehealth also offers other unique advantages.  

Advantages of telehealth for children’s mental health  

While many U.S. counties lack access to a psychiatrist, a virtual behavioral health practice like Array can provide access to therapists and psychiatrists licensed to provide care where needed. Through telehealth, clinicians like Vaccarino have been able to offer a wide range of treatment modalities, even play therapy.  

Telehealth is an accessible and effective form of mental health care that offers convenience. “It’s a game changer,” said Vaccarino.  

Vaccarino says children may express themselves more vulnerably from the comfort and privacy of their own homes, while avoiding commute times or the anxiety of new places. Telehealth appointments are also available nights and weekends there is no need to miss school, work, or other obligations.  

Since many kids are used to interacting with video technology, they may also be more accepting of this type of care delivery.    

Therapy and self-care can help—you and your child  

While mental health is an increasing concern among children and adolescents, the good news is they can display resilience in the face of such challenges. Their neuroplasticity exceeds that of adults allowing them to benefit more rapidly from evidence-based care. “Your child has the capacity to feel better,” said Vaccarino. “That is the thing I want people to take away.”  

A note to parents: don’t neglect your own care. Access therapy if you can. And, as much as possible, continue to do the activities that make you feel good. “When you take time to be yourself, you are more attentive outside of that time,” said Vaccarino.