The Question That Haunts You
“Is this normal?”
Your 7-year-old cries every morning before school. Your 11-year-old has started pulling out their eyelashes. Your 15-year-old sleeps 14 hours a day and says they don’t see the point of anything.
Is this just a phase? Is this normal kid stuff? Or is this something more?
You don’t want to overreact. But you also don’t want to miss something serious.
Here’s what you need to know: Mental health challenges in children and teens are common, real, and treatable. And recognizing them early makes all the difference.
This article breaks down the most common mental health conditions in young people—what they look like, how they’re different from “normal” struggles, and what to do if you recognize your child.
Why Mental Health Issues in Kids Look Different
Children and teens often can’t articulate what they’re experiencing. They don’t have the emotional vocabulary or self-awareness to say, “I think I’m experiencing depression.”
Instead, mental health issues show up as:
- Behavioral problems
- Physical complaints
- Academic decline
- Social withdrawal
- Irritability and anger
Parents often see the behavior and miss the underlying condition.
The tantruming 8-year-old might have anxiety. The “rebellious” 14-year-old might have depression. The “lazy” 16-year-old might have ADHD.
This article will help you see beneath the behavior to the root cause.
1. Anxiety Disorders
The most common mental health condition in children and teens.
Approximately 1 in 8 children has an anxiety disorder.
What it is:
Excessive worry, fear, or nervousness that interferes with daily functioning.
Types:
Generalized Anxiety Disorder (GAD):
- Chronic, excessive worry about multiple things
- “What if” thinking constantly
- Physical symptoms (stomachaches, headaches, fatigue)
Social Anxiety Disorder:
- Intense fear of social situations
- Fear of being judged, embarrassed, or humiliated
- Avoidance of social interactions
Separation Anxiety Disorder:
- Excessive fear of being away from parents or caregivers
- Common in younger children, but can persist into adolescence
- Physical symptoms when separation is anticipated
Panic Disorder:
- Recurrent panic attacks (intense fear with physical symptoms)
- Fear of having another panic attack
- Avoidance of situations where panic attacks have occurred
Specific Phobias:
- Intense, irrational fear of specific things (animals, heights, blood, etc.)
- Avoidance behavior
Selective Mutism:
- Inability to speak in specific social situations despite speaking normally in other contexts
- Usually begins in early childhood
What it looks like:
Toddlers/Preschoolers (ages 2-5):
- Excessive clinginess
- Frequent tantrums
- Difficulty separating from parents
- Physical complaints (tummy aches)
- Sleep problems
Elementary age (6-12):
- Constant worry (“What if…?”)
- Perfectionism
- Refusal to go to school
- Physical complaints (stomachaches, headaches)
- Avoidance of activities
- Reassurance-seeking (“Am I going to be okay?”)
Teens (13-18):
- Social withdrawal
- Panic attacks
- Avoidance of school, social events, activities
- Substance use to cope
- Irritability
- Physical symptoms (rapid heartbeat, sweating, nausea)
- Sleep disturbances
How it’s different from normal worry:
Normal: Worried about a test, calms down after it’s over
Anxiety disorder: Worries about everything constantly, can’t calm down even when reassured
Normal: Nervous to start at a new school
Anxiety disorder: Refuses to go to school for weeks, has panic attacks at the thought
What to do:
- Therapy: CBT (Cognitive Behavioral Therapy) is highly effective for childhood anxiety
- Medication: SSRIs may be prescribed for moderate to severe anxiety
- School accommodations: 504 plan or IEP modifications
- Exposure therapy: Gradual facing of fears in a controlled way
2. Depression
Approximately 2% of children ages 6-12 and 6-8% of teens have depression.
What it is:
Persistent sadness, emptiness, or irritability along with cognitive and physical changes that impair functioning.
What it looks like:
Elementary age (6-12):
- Persistent sadness or irritability
- Loss of interest in activities they used to enjoy
- Changes in appetite or weight
- Sleep changes (too much or too little)
- Fatigue or low energy
- Physical complaints (stomachaches, headaches)
- Difficulty concentrating
- Social withdrawal
- Expressions of worthlessness (“I’m stupid,” “Nobody likes me”)
- Talk about death or dying
Teens (13-18):
- Persistent sad, empty, or irritable mood
- Loss of interest in activities
- Changes in appetite or weight (either direction)
- Sleep disturbances (insomnia or hypersomnia)
- Fatigue
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or making decisions
- Social withdrawal
- Substance use
- Self-harm
- Suicidal thoughts or behaviors
How it’s different from normal sadness:
Normal: Sad for a few days after a loss or disappointment
Depression: Sad or irritable most days for weeks or months, even without a clear cause
Normal: Still enjoys some activities
Depression: Loss of interest in everything, even favorite activities
Normal: Functioning at school and with friends
Depression: Declining grades, social withdrawal, inability to function normally
Important note:
Depression in children often looks like irritability, not sadness. If your child is constantly cranky, angry, or defiant, consider whether depression might be underlying it.
What to do:
- Therapy: CBT, DBT, interpersonal therapy
- Medication: SSRIs (under psychiatric care)
- Safety assessment: If suicidal thoughts are present, immediate evaluation needed
- Family therapy: To improve communication and support
3. ADHD (Attention-Deficit/Hyperactivity Disorder)
Approximately 9% of children ages 3-17 have been diagnosed with ADHD.
What it is:
A neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and/or impulsivity that interferes with functioning.
Three types:
- Predominantly Inattentive: Trouble focusing, easily distracted, forgetful
- Predominantly Hyperactive-Impulsive: Can’t sit still, acts without thinking
- Combined: Both inattention and hyperactivity/impulsivity
What it looks like:
Preschool (3-5):
- Constantly in motion
- Difficulty sitting for meals or stories
- Impulsive (grabs toys, hits without thinking)
- Doesn’t seem to listen
- Difficulty with transitions
Elementary age (6-12):
Inattentive symptoms:
- Difficulty paying attention in class
- Makes careless mistakes
- Doesn’t seem to listen when spoken to directly
- Difficulty organizing tasks
- Loses things frequently
- Easily distracted
- Forgetful
Hyperactive symptoms:
- Fidgets constantly
- Can’t stay seated
- Runs or climbs excessively
- Can’t play quietly
- Talks excessively
Impulsive symptoms:
- Blurts out answers
- Interrupts others
- Can’t wait their turn
Teens (13-18):
- Inattention leading to academic problems
- Difficulty with executive function (planning, organizing, time management)
- Forgetfulness (missing deadlines, losing items)
- Internal restlessness (feels “on edge”)
- Impulsive decision-making
- Risk-taking behavior
- Emotional dysregulation
How it’s different from normal kid energy:
Normal: Sometimes distracted or wiggly, can focus when motivated
ADHD: Consistent across settings (home, school, activities), causes significant impairment
Normal: Occasionally forgets homework
ADHD: Chronically disorganized, loses things daily, can’t keep track of responsibilities despite trying
What to do:
- Behavioral therapy: Teaching skills and structure
- Medication: Stimulants (Adderall, Ritalin, Vyvanse) or non-stimulants (Strattera)
- School accommodations: IEP or 504 plan (extended time, preferential seating, breaks)
- Parent training: Learning strategies to support ADHD child
- Exercise and sleep hygiene: Essential for managing symptoms
4. Obsessive-Compulsive Disorder (OCD)
Approximately 1-2% of children and teens have OCD.
Average age of onset: 19 years old, but can appear in childhood.
What it is:
Intrusive, unwanted thoughts (obsessions) that cause anxiety, followed by repetitive behaviors or mental acts (compulsions) performed to reduce the anxiety.
What it looks like:
Elementary age (6-12):
Common obsessions:
- Fear of contamination (germs, illness)
- Fear something bad will happen to loved ones
- Need for symmetry or exactness
- Intrusive thoughts about harm
Common compulsions:
- Excessive handwashing
- Checking (locks, doors, stove)
- Counting
- Repeating actions until they feel “right”
- Ordering/arranging
- Seeking reassurance
Teens (13-18):
- Same as above, plus:
- Sexual or violent intrusive thoughts (which cause extreme distress—they don’t want these thoughts)
- Religious obsessions (fear of sinning)
- Mental compulsions (counting, praying, repeating phrases silently)
How it’s different from normal rituals:
Normal: Child wants to line up toys or has bedtime routine
OCD: Child experiences intense anxiety if ritual isn’t performed perfectly, ritual takes excessive time, interferes with functioning
Normal: Wants hands clean before dinner
OCD: Washes hands 20+ times a day until they’re raw, panics if they touch something “contaminated”
What to do:
- Therapy: ERP (Exposure and Response Prevention)—the gold standard for OCD
- Medication: SSRIs (often at higher doses than for depression/anxiety)
- Do NOT accommodate compulsions: Accommodation makes OCD worse
- Family therapy: Parents need to learn how to support without enabling
5. Trauma and PTSD
More than 2/3 of children experience at least one traumatic event by age 16.
What qualifies as trauma:
- Physical, sexual, or emotional abuse
- Neglect
- Witnessing domestic violence
- Loss of a loved one
- Serious accident or injury
- Natural disaster
- Community violence
- Medical trauma
What PTSD looks like in children:
Young children (6-12):
- Regression (bedwetting, clinginess, baby talk)
- Nightmares
- Reenacting trauma in play
- Separation anxiety
- Irritability and angry outbursts
- Difficulty concentrating
- Physical complaints
Teens (13-18):
- Intrusive memories or flashbacks
- Nightmares
- Avoidance of reminders of trauma
- Negative thoughts (“It’s my fault,” “I can’t trust anyone”)
- Emotional numbness
- Hypervigilance (always on alert for danger)
- Irritability or anger
- Reckless behavior
- Substance use
- Self-harm
- Suicidal thoughts
How it’s different from normal stress:
Normal: Child is upset after scary event, gradually returns to normal functioning
PTSD: Symptoms persist for more than a month and interfere with functioning
What to do:
- Trauma-focused therapy: TF-CBT (Trauma-Focused Cognitive Behavioral Therapy) or EMDR
- Safety first: Ensure child is in a safe environment
- Avoid forcing them to talk about it: Let them process at their own pace in therapy
- Medication: May be used for severe symptoms
6. Eating Disorders
Peak age of onset: 12-25 years old.
Types:
- Anorexia Nervosa: Restriction of food, intense fear of weight gain, distorted body image
- Bulimia Nervosa: Binge eating followed by compensatory behaviors (purging, excessive exercise)
- Binge Eating Disorder: Recurrent episodes of eating large amounts of food with loss of control
- ARFID (Avoidant/Restrictive Food Intake Disorder): Limited food intake due to sensory issues, fear of choking, or lack of interest in eating
What it looks like:
Elementary age (6-12):
- ARFID is more common in younger children
- Preoccupation with body size or shape
- Food rituals
- Avoidance of certain foods
Teens (13-18):
- Preoccupation with weight, food, calories
- Restricting food or food groups
- Skipping meals
- Eating in secret
- Excessive exercise
- Frequent bathroom trips after meals
- Wearing baggy clothes
- Social withdrawal
- Irritability
- Physical signs: weight loss, dizziness, fainting, hair loss, brittle nails
How it’s different from picky eating or dieting:
Normal: Selective about foods, tries new things occasionally
Eating disorder: Severe restriction, fear response to food, obsessive thoughts about food/body
Normal: Wants to eat healthier
Eating disorder: Eliminates entire food groups, counts every calorie, panics about eating certain foods
What to do:
- Specialized treatment: Eating disorders require specialists (therapists, dietitians, medical doctors with ED experience)
- Medical monitoring: Eating disorders can be life-threatening
- Family-based treatment (FBT): Evidence-based for teens with anorexia
- Residential treatment: May be necessary for severe cases
- DO NOT comment on their body or food intake: Work with professionals on how to communicate
7. Self-Harm
Approximately 17% of teens have self-harmed at least once.
What it is:
Deliberately hurting oneself, most commonly by cutting, but also burning, hitting, scratching, or other methods.
Why kids self-harm:
- To cope with emotional pain
- To feel something when they’re numb
- To punish themselves
- To communicate distress
- To regain a sense of control
Self-harm is NOT attention-seeking. It’s a sign of serious distress.
What it looks like:
- Unexplained cuts, burns, or bruises (often on arms, legs, stomach)
- Wearing long sleeves even in warm weather
- Possession of sharp objects (razors, box cutters)
- Isolation
- Emotional numbness or intense emotional pain
- Often co-occurs with depression, anxiety, trauma, or eating disorders
What to do:
- Stay calm (don’t freak out)
- Ask directly: “I noticed the cuts on your arm. Can we talk about what’s going on?”
- Get professional help immediately (therapy, possibly psychiatric evaluation)
- Remove access to means (lock up sharp objects)
- Do NOT punish them—it will make it worse
- Learn what they’re coping with and address the root cause
8. Suicidal Thoughts and Behaviors
Suicide is the 2nd leading cause of death in ages 10-24.
Warning signs:
- Talking about wanting to die or kill themselves
- Looking for ways to die (researching methods)
- Talking about feeling hopeless or having no reason to live
- Talking about being a burden
- Increased substance use
- Withdrawing from friends and activities
- Giving away possessions
- Saying goodbye
- Sudden mood improvement after severe depression (can indicate they’ve made a decision)
What to do:
- Ask directly: “Are you thinking about killing yourself?”
- If yes: DO NOT leave them alone. Remove means. Call 988 or take to ER.
- Create safety plan (see Safety Plan article)
- Get professional help immediately
What to Do If You Recognize Your Child
Step 1: Talk to them (see Age-Appropriate Conversations article)
Step 2: Contact your pediatrician
Start with a medical evaluation to rule out physical causes.
Step 3: Get a professional evaluation
Child psychologist or psychiatrist can diagnose and recommend treatment.
Step 4: Implement treatment plan
Therapy, medication, school accommodations, family support.
Step 5: Monitor and adjust
Treatment is not one-size-fits-all. Be prepared to adjust.
What You Need to Remember
✓ Mental health challenges in kids are common and treatable
✓ Early intervention matters—don’t wait for it to get worse
✓ Behavior is often communication—look beneath it
✓ Your child isn’t choosing to struggle—their brain is struggling
✓ You’re not a bad parent—mental illness happens to children of great parents
Recognizing the problem is the first step. Getting help is the second. And you’ve already started.
