Q&A: When should I worry about my child's mental health?

Mar 28, 2024

Hi! I’m Jacqueline Nesi, a clinical psychologist and professor at Brown University, co-founder of Tech Without Stress, and mom of two young kids.

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How can I tell the difference between normal behavior and something more serious? Are there signs of mental health problems in kids that I should be on the lookout for?

One of the most challenging things about parenting, in my opinion, is the gray area. When it comes to our kids, we (or, at least, I) crave black-and-white answers. We want someone to tell us exactly what to do, when, and how, and yet it seems that parenting is just one vast, cryptic expanse of gray. This is highly apparent when it comes to our kids’ mental health. Is our child sad? Or are they excessively sad? Is their challenging behavior “normal”? Or is it something to be more concerned about?

As with all things mental health-related, this is an area where some amount of gray cannot be avoided. Every child is (obviously) unique, and the ways symptoms present themselves can vary a lot.

That said, here are some resources that may be helpful on the question of when to be concerned.

A good place to start is this list of 11 research-backed “warning signs” of mental health concerns in children ages 7-17 (note: most of these are relevant for adults, too). These are not meant to tell you whether or not your child has a diagnosis, they are just a signal that you should consult a professional:

Depression: Feeling very sad or withdrawn for at least two weeks in a row
Suicidal thoughts: Trying to or making plans to harm or kill themselves
Panic attacks: Sudden overwhelming fear with no reason
Severe aggression: Involved in multiple fights, using weapons, or wanting to badly hurt others
Poor impulse control: Serious out-of-control behavior that can hurt themselves or others
Eating disorder: Not eating, throwing up, or using laxatives to make themselves lose weight
Anxiety: Intense worries or fears that get in the way of daily activities
Inattention/hyperactivity: Extreme difficulty concentrating or staying still that puts them in physical danger or causes school failure
Substance use: Repeated use of drugs or alcohol
Mood swings: Severe mood swings that cause problems in relationships
Personality changes: Drastic changes in behavior or personality

For pre-teens and teens—a common time for mental health issues to emerge—you can also take a look at this list from the American Academy of Pediatrics. It includes specific examples of behaviors to look out for, like: notable changes in sleep, canceling plans with their closest friends; a whole new set of friends you’ve never met before; signs of self-harm such as cuts, burns, and bruises; and academic struggles that seem different or more intense (e.g., failing quizzes in their favorite subject).

Finally, for kids (and adults!) of all ages, Mental Health America offers a great list of online screening tools. For parents, they provide a digital version of the Pediatric Symptom Checklist (PSC), which asks 17 questions about a range of symptoms in kids ages 4-17—from worrisome behaviors (fighting, lying) to emotions (worrying, feeling down). It will tally up your answers and give you recommendations based on those answers.

I hope these resources can help you feel more informed, but remember: you know your child best. If you’re worried, trust yourself, and reach out to your child’s pediatrician or a mental health professional.