Parents know one of their most important jobs is to keep their kids safe and healthy – that means protecting and nurturing not only their physical health, but also their mental and emotional well-being.
Just like with adults, it is normal for children and teens to experience mental health challenges. Mental health concerns are common and just like physical ailments, they must be diagnosed and treated. Increased awareness is helping break down the misplaced stigma that was once often attached to mental health issues.
Unfortunately, the mental health trend line is not improving. Prior to the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention (CDC) reported that as many as one out of five children experienced some type of mental health challenge annually.
The pandemic only exacerbated these numbers. According to the CDC, in 2021, 42% of high school students felt “persistently sad or hopeless” and 29% were considered to be experiencing “poor mental health.”
“One of the many negative impacts of the pandemic was its effect on mental health, especially for children and teens,” explains Dr. Christopher McGonnell, a pediatrician in Frisco. “The sustained period of isolation, not being in school and missing important childhood events took a toll on many young people’s emotional well-being.”
The key thing for parents to remember is that a mental or behavioral health challenge for a child is not uncommon and just like a physical illness, it requires diagnosis and treatment. Your pediatrician is there to help, so don’t hesitate to talk to your child’s doctor about concerns you have.
Below is a look at some of the more common behavioral health issues that can affect children:
ADHD
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental (relating to how the brain grows and develops) conditions affecting children. A child with ADHD may have difficulty concentrating, be frequently hyperactive or behave impulsively. While most children will occasionally display these characteristics, parents should know the signs of a more serious problem.
Symptoms & Causes
Symptoms and signs of ADHD may include:
- Inability to sit still; fidgeting
- Easily distracted or forgetful
- Frequent daydreaming
- Overly talkative
- Risky behavior
- Not getting along with others
“While all children will display some of these characteristics at times, children with ADHD exhibit them more frequently,” says Dr. Rinkal Patel, a Frisco pediatrician. “Children with ADHD will not simply outgrow the condition – ADHD must be properly diagnosed and treated by a physician.”
ADHD is thought to be influenced by genetics. What is known is that ADHD is not the result of “bad parenting” or the child’s diet.
Diagnosis
There is no single test or exam that can diagnose ADHD, and there are several steps in the process to determine if a child has ADHD. The first step is for parents to talk to their pediatrician about their concerns and the behaviors they have observed.
A pediatrician or a psychiatrist can make a diagnosis. The doctor will likely want to visit extensively with the parents and other adults who spend a lot of time around the child, such as teachers and childcare providers.
From there, the physician will observe the child over time in different situations. A diagnosis can be made if the child displays multiple behaviors indicative of ADHD, the behaviors have been present for six months or longer and they are interfering with school or other normal activities.
Treatment
If your child is diagnosed with ADHD, it is important to remember this is a condition that can be successfully and effectively managed.
ADHD treatment often starts with behavior therapy, a process designed to encourage and reinforce positive behaviors and discourage and reduce negative behaviors. Behavior therapy can involve the child working with a therapist, behavior therapy training for parents or a combination of the two.
Behavior therapy is generally the first treatment option used for ADHD. For young children (ages 4-5), behavior therapy is the recommended treatment and has been shown to be as effective as medication. For children 6 and older, behavior therapy combined with medication is generally the recommended treatment.
Medications that help control ADHD symptoms include stimulants, which have been shown to reduce symptoms in up to 80% of ADHD patients. Non-stimulants do not work as quickly but remain active in the body for longer periods of time.
“Parents should also have a conversation with their child’s teacher about ADHD,” advises Dr. Christopher Straughn, a pediatrician in Dallas. “Teachers are not generally trained specifically on the best ways to instruct a child with ADHD, and your physician can provide resource materials for the teacher to help teach the child effectively.”
Other Conditions
It is not unusual for a child with ADHD to also suffer from additional conditions. These are some of the more common conditions that may occur, both in children with and without ADHD.
Oppositional Defiant Disorder (ODD)
ODD can commonly occur with ADHD. Signs of ODD may include:
- Frequent loss of temper
- Argumentative and angry with adults
- Blaming others for their own mistakes
Conduct Disorder (CD)
CD is characterized by serious behavioral problems that may well endanger the child and/or others. These may include habitually breaking important rules, skipping school, bullying, cruelty to animals, fighting and stealing.
Anxiety and Depression
Children with ADHD are more likely to suffer from an anxiety disorder than those without ADHD. About 20% of those with ADHD have also been diagnosed with an anxiety disorder.
It is normal for children to at times be fearful, sad or worried, just as it is normal for adults to experience those feelings. However, if these emotions are so frequent and overwhelming that they interfere with the child’s ability to participate in school or other activities, this may be indicative of an anxiety disorder or depression.
Examples of an anxiety disorder include separation anxiety, in which the child is very afraid when away from his or her family; social anxiety, in which the child feels apprehensive around other people; and general anxiety, in which the child is always worried about bad things happening.
Depression can be characterized by recurring feelings of sadness and hopelessness, being withdrawn and a sense of worthlessness.
With any and all of these symptoms, it is very important for parents to discuss their observations with their pediatrician so the child is able to get the best treatment and help for their situation.
Post-traumatic Stress
Post-traumatic stress disorder (PTSD) is a common condition often associated with military veterans who have seen combat and first responders who routinely deal with tragic situations. Children can also experience PTSD. Events such as a bad car wreck, witnessing or being a victim in a crime, or losing a friend or family member can trigger PTSD.
PTSD symptoms include:
- Nightmares; inability to sleep well
- Pronounced ongoing fear and sadness
- Angry outbursts
- Hopelessness, acting withdrawn
A child or young adult experiencing these symptoms – especially if they follow exposure to a traumatic event – should be evaluated by a medical professional. If a diagnosis of PTSD is made, possible treatments include counseling, various forms of therapy and medication.
When Tragedy Strikes
We don’t have to personally witness or experience a traumatic event to be emotionally impacted. This is especially true in times of a high-profile tragedy, when a child is aware something terrible has happened but does not have the ability to fully process or understand what has taken place. While these situations can be more problematic for children with a behavioral condition, they can have an adverse impact on any child, no matter how happy and well-adjusted they are.
Many parents are familiar with the challenge of explaining to children a terrible event, such as the mass shooting at an elementary school in Uvalde in 2022. Experts have several pieces of advice for parents when a tragedy occurs:
- DO talk to your children about it. If a high-profile event is dominating the news, your child will find about it at school, from friends or online. It is best they hear it first from a parent, who can put the event in the proper context.
- DO try to answer their questions with factual information but leave out the graphic details.
- DO emphasize to your children they are safe. They are safe at home and at school. Their family, teachers and others are there to make sure nothing bad happens.
- DON’T let your child see TV or online news after a tragedy. Children can believe that an event is happening over and over again, not realizing they are viewing a replay of a single event. This was a frequently-reported problem following the terrorist attacks of September 11, 2001 – children thought planes were crashing into skyscrapers for days because the TV networks were showing the same footage repeatedly.
“These types of tragic events are scary for adults; just think how frightening they are for young children,” says Dallas pediatrician Dr. Lily Strong. “It’s important for parents to talk about these tragedies with their kids, emphasizing to them that they are safe, they will be protected and that they are loved.”
Screen Time & Social Media
Placing reasonable limits on the amount of time children can spend looking at a device, whether it’s a phone, tablet, computer or TV, is important for physical and mental health. Excessive screen time can lead to a sedentary lifestyle, which in turn contributes to obesity and other health problems. Too much screen time can also be bad for a child’s mental health.
“Generally speaking, parents should limit their kids’ screen time to two hours per day and ensure they are getting at least an hour a day of physical activity, such as playing outside,” says Dr. Lynda Tang, a pediatrician in Dallas.
Generally, children younger than 13 should not be on social media. Teens should only be on it with their parents’ consent and engagement. Social media is not inherently bad for all kids, but like anything, it should be utilized in moderation. Social media can provide valuable social connections for teens and it can even help them learn. On the other hand, it is easy to overload on social media, which can impact sleep.
“One of the best things we can do as parents to ensure social media use does not become a problem is to establish clearly defined ground rules for screen time in general and social media in particular,” says Dr. Rebecca Butler, a pediatrician in Bartonville. “We also need to model good behavior – that means not constantly being on our phones when our kids are around.”
Help is Available for Children – and their Parents
Children and teens confront a lot of challenges as they grow up – it’s our job as parents to help them navigate those obstacles and help them grow up healthy – physically, mentally and emotionally. Sometimes those challenges turn out to be something more serious that doesn’t resolve on its own – that’s when a medical diagnosis and treatment are so important.
A mental health or behavioral challenge is nothing to be ashamed of. These are conditions that affect many people, young and old. For parents, it’s most important to know how to recognize warning signs and always be prepared to ask your pediatrician when you have questions.
Left untreated, childhood behavioral health conditions can create recurring problems at home, school and into adulthood. However, with your pediatrician’s help, most of these challenges can be managed and effectively overcome in time.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
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