How do I help my child with mental health issues?

Q: National news stories report youth are facing a mental health crisis. What behavioral health trends are you noticing in your practice?

The number of youth reporting significant symptoms of anxiety and depression continues to rise. The latest Youth Risk Behavior Survey from the Centers for Disease Control was alarming.

From 2011 to 2021, high school students reporting persistent feelings of sadness or hopelessness increased from 28 percent to 42 percent. For female students, the numbers rose to 57 percent. When high school students were asked if they had seriously considered attempting suicide in the past year, rates increased to 22 percent overall, and to 30 percent for female students.

Q: Some suggest isolation during the pandemic and pressures to conform to online opinions of attractiveness and success may be impacting youth suicide rates. How are children different from (or similar to) patients you saw when you began your career?

I wish there was a single reason affecting suicide rates, but it’s an issue with multiple underlying causes. Our world is much more interconnected than when I began practicing medicine. Children and adolescents are always “on stage” and face enormous pressure.

School, sports, social interactions with family and peers and social media all play a part.

For preteens and teens the normal social stressors today are combined with the almost unlimited immediate access to people and information through those handy devices in all our pockets. Despite the ability to connect to people digitally at any hour, many youth feel socially isolated. Many of their interactions are digital rather than verbal or in-person.

Those electronic interactions just don’t have the same impact, and the pandemic exaggerated the imbalance between inperson and digital social interactions.

When schools closed and interactions with peers and extended family were suspended, children lost many natural in-person social interactions. Older adolescents went through physical and emotional changes without the normal social interactions that typically accompany them. Many, many children lost family members and loved ones due to illness. That is still particularly hard for children and adolescents who seek safety and security in their lives.

I’m not exaggerating when I say being a kid these days is hard.

Q: What traits and/or symptoms of mental health issues do you watch for?

Children and adolescents may be irritable and withdrawn, have trouble sleeping or change their eating habits. School or sports performance may decline because they are having trouble concentrating or lack motivation. Some children show more sadness or crying. Some family members don’t notice anything. It’s not unusual to see results for youth depression screenings completed by a parent/teenager pair that don’t match.

Adolescents are good at hiding what is going on. It may be friends, coaches, teachers or extended family members who notice changes. We screen patients at wellness visits, and sometimes you just get a feeling that something isn’t right from what you hear or see in the room.

Q: How do you assure parents and their children that you’re on their side and that help is available?

Talking openly about mental health is much more acceptable today than for previous generations— but some stigmas remain. Stigmas sometimes keep parents and youth from seeking help. Other times, I find adolescents don’t want to be a bother or worry parents or other adults. Or they may think the way they feel is “normal.” In the clinic, we try to identify youth with risks of depression, anxiety and suicidality by using standardized screening tools at wellness visits. It puts those symptoms and feelings into a non-judgmental format and tells patients and families that mental health is just as important as knowing what your growth curve looks like. The most important piece is asking youth how their lives are going, listening to learn and developing relationships with the patient and family over time. It makes it much easier to talk about mental health.

Q: What are the next steps if there is a mental health concern? To whom do you refer the patient?

Children and adolescents who have significant mental health concerns almost always benefit from seeing a psychologist or mental health therapist. Sometimes that’s for diagnostic evaluation to make sure we are treating the right thing. For example, is their anxiety primary, or is it really due to

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