Recognising Early Signs of Mental Health Issues in Children

Early detection and intervention in addressing children’s mental health issues are paramount in ensuring the healthy development and overall well-being of young people. The formative years of a child’s life are critical, as this is when cognitive, emotional and social foundations are established. Identifying and addressing mental health concerns during these years can significantly alter the trajectory of a child’s life, paving the way for positive long-term outcomes.

When mental health issues are recognised and treated early, children are more likely to develop coping skills, resilience and emotional regulation abilities. This proactive approach not only alleviates immediate distress but also mitigates the risk of more severe mental health problems in the future. Early intervention creates a supportive environment, helping children to thrive academically, socially and emotionally.

Changes in Behaviour and Mood

Changes in behaviour and mood are often among the earliest and most noticeable indicators of potential mental health issues in children. Recognising these signs can be crucial for timely intervention and support. Some key things to consider include:

• Behavioural changes – children who suddenly become more withdrawn or isolate themselves from friends and family might be experiencing anxiety, depression or other emotional distress. This can include things like avoiding social activities, not wanting to go to school or preferring to spend time alone.
• Aggressive or disruptive behaviour – increased aggression or disruptive behaviour can be a sign of underlying mental health issues. Examples include frequent emotional dysregulation (this is normal in younger children), fighting with peers, defying authority figures or exhibiting hostile behaviour.
• Changes in academic performance – noticeable changes academically or loss of interest in schoolwork can indicate cognitive or emotional challenges. Examples include a decline in completing homework, decreased concentration or lack of enthusiasm for learning.
• Sleep disturbances – problems with sleep, such as insomnia or excessive sleeping, can be related to anxiety, depression or stress. Examples include difficulty falling asleep, frequent nightmares or changes in sleep patterns.
• Changes in eating habits – sudden changes in appetite, whether increased or decreased, can be associated with emotional distress or eating disorders. Examples include skipping meals, overeating or showing a sudden aversion to certain foods.
• Mood changes – persistent sadness or irritability – extended periods of sadness or irritability can be indicative of depression or mood disorders. Examples include frequent crying, seeming unusually down or being easily frustrated.
• Excessive worry or fear – constant worry or fear that interferes with daily activities may suggest anxiety disorders. Examples include obsessive concerns about safety, excessive worry about separation from parents, or persistent fears about specific situations.
• Mood swings – rapid or extreme mood swings might point to a mood-related condition. Examples include alternating between hyperactive, euphoric states and depressive, lethargic periods.
• Loss of interest in activities – losing interest in activities they once enjoyed can be a sign of depression or other emotional issues. Examples include no longer wanting to play favourite games, reluctance to engage in hobbies or lack of interest in socialising.
• Physical complaints without a clear medical cause – frequent physical complaints, such as headaches or stomach aches, without a clear medical reason can be associated with anxiety or stress. Examples can include regular visits to the school nurse, or complaining about feeling sick or unwell to avoid certain situations.
• Self-harm or talk of suicide – any signs of self-harm or talk of suicide should be taken extremely seriously and warrant immediate professional intervention. Examples include cutting, burning or expressing thoughts of wanting to die.

Early detection of these behavioural and mood changes is crucial because:

• Addressing issues early can prevent them from developing into more serious mental health conditions.
• Early intervention allows for appropriate support and treatment, which can significantly improve outcomes.
• Untreated mental health issues can affect a child’s development, academic performance and social relationships.

You should encourage open and non-judgemental communication with the child to understand their feelings and experiences. Consult with mental health professionals, such as psychologists or counsellors, for assessment and guidance. Create a supportive and understanding environment at home and school to help the child feel safe and valued. Recognising and addressing these early signs can make a significant difference to a child’s mental health and overall well-being.

Physical Symptoms and Complaints

Physical symptoms and complaints in children can often be manifestations of underlying mental health issues. This phenomenon is sometimes referred to as ‘somatisation’, where psychological distress is expressed through physical symptoms. Several factors and mechanisms can contribute to this:

• Anxiety disorders – children with anxiety disorders may experience various physical symptoms such as headaches, stomach aches, muscle tension and fatigue. These symptoms arise due to the body’s physiological response to stress, including the activation of the autonomic nervous system, which can cause gastrointestinal issues, increased heart rate and other physical complaints.
• Depression – depression in children can present with physical symptoms like chronic pain, fatigue and changes in appetite or sleep patterns. Children might not always have the verbal ability or awareness to express their feelings of sadness or hopelessness, so these emotions manifest as physical complaints.
• Attention-Deficit/Hyperactivity Disorder (ADHD) – children with ADHD may experience restlessness, difficulty sleeping and stomach aches. The physical hyperactivity and impulsivity associated with ADHD can also lead to frequent injuries and somatic complaints.
• Post-Traumatic Stress Disorder (PTSD) – children who have experienced trauma may report physical symptoms such as headaches, stomach pains and muscle aches. The stress and anxiety related to the trauma can lead to somatic symptoms, which are often a way for the child to communicate their distress.
• Stress and adjustment disorders – major changes or stressors, such as moving to a new city, parental divorce or bullying, can lead to somatic symptoms. Children might develop headaches, gastrointestinal issues or general fatigue as a result of the stress and anxiety associated with these changes.

Psychosomatic disorders are conditions where psychological factors play a significant role in the onset, severity and duration of physical symptoms. Common examples include irritable bowel syndrome (IBS) and chronic pain syndromes, where stress and emotional factors significantly influence the physical condition. Young children, in particular, might not have the vocabulary or cognitive development to articulate their emotional distress. Instead, they may complain of physical symptoms to express their discomfort. For instance, a child who feels anxious about school might report having a stomach ache or feeling sick regularly in the morning before school.

Stress and emotional distress can activate the hypothalamic-pituitary-adrenal (HPA) axis, leading to the release of cortisol and other stress hormones, which can cause physical symptoms. Children may engage in behaviours that contribute to physical symptoms, such as poor eating habits, lack of sleep or physical inactivity, all of which can be influenced by underlying emotional issues. Children with mental health issues might have heightened sensitivity to bodily sensations, making them more likely to notice and report physical discomfort.

Social and Academic Challenges

Social and academic challenges in children can be significant indicators of underlying mental health issues. These can include:

• Difficulty in making friends – children who struggle to make or keep friends might be experiencing social anxiety, low self-esteem or depression. Social withdrawal or avoidance can be a coping mechanism for children who feel anxious or overwhelmed in social situations. Consistent isolation from peers and a lack of interest in social activities can suggest depression or anxiety. Children might avoid interactions due to fear of rejection or because they find it hard to derive pleasure from activities they once enjoyed.
• Aggressive or disruptive behaviour – aggression, severe emotional dysregulation or defiance can be signs of underlying emotional distress, such as anger issues, conduct disorders or ADHD. These behaviours may reflect a child’s frustration or inability to cope with emotions in a healthy manner.
• Bullying (victim or perpetrator) – children who are frequently bullied or who bully others may be experiencing significant emotional distress, anxiety or a lack of emotional regulation. Victims of bullying often suffer from low self-esteem and anxiety, while children who bully other children may be exhibiting externalised symptoms of their own issues.
• Decline in academic performance – a sudden drop in grades or academic engagement can be a sign of depression, anxiety or learning disabilities. Mental health issues can impair concentration, memory and motivation, directly affecting academic performance. Having difficulty focusing, staying on task or frequent daydreaming may indicate ADHD, anxiety or other mental health conditions. Anxiety can make it hard for children to focus, while ADHD affects their ability to sustain attention and follow through on tasks. Frequent absences from school can point to anxiety, depression or other mental health problems. Children may avoid school due to social anxiety, fear of failure, or because they find it overwhelming. School refusal behaviour often suggests anxiety disorders, including separation anxiety or social anxiety. The prospect of school can be overwhelming for children experiencing these conditions, leading to avoidance behaviours.

Family History and Risk Factors

Family history and environmental factors play significant roles in contributing to children’s mental health risks. Both genetic predispositions and the contexts in which children grow up can deeply influence their mental well-being.

• Family history – mental health disorders such as depression, anxiety, bipolar disorder and schizophrenia often run in families. Genetic factors can make children more susceptible to these conditions. Specific genes may influence how a child’s brain develops and responds to stress, potentially increasing the risk of mental health issues.
• Parental mental health – children often learn coping mechanisms and behavioural responses from their parents. If parents exhibit unhealthy coping mechanisms due to their own mental health issues, children may adopt similar behaviours. Parental mental health problems can lead to a stressful home environment. Chronic exposure to parental conflict, inconsistent parenting and emotional unavailability can negatively impact children’s mental health.
• Environmental factors – living in poverty is associated with increased stress and fewer resources, contributing to a higher risk of mental health problems in children. Limited access to healthcare, education and recreational activities can exacerbate these issues. Children in disadvantaged communities may experience violence, lack of social support, and poor educational opportunities, all of which can negatively impact their mental health.
• Trauma and Adverse Childhood Experiences (ACEs) – experiences of physical, emotional or sexual abuse, as well as neglect, can lead to long-term psychological trauma and increase the risk of developing mental health disorders. Frequent changes in caregivers, loss of a parent or exposure to family violence can create feelings of instability and insecurity, contributing to mental health issues.
• School and peer influences – negative peer interactions, including bullying and social exclusion, can lead to anxiety, depression and other mental health problems. High academic expectations and pressure to perform can result in stress and anxiety, particularly if children lack adequate support.
• Parenting styles and family dynamics – authoritarian or overly permissive parenting styles can contribute to mental health problems. Supportive and nurturing parenting, on the other hand, is associated with better mental health outcomes.
• Family cohesion and communication – strong family bonds and open communication can provide a protective buffer against mental health issues, while dysfunctional family dynamics can exacerbate them.

Social media use has also been linked to having a negative impact on children’s mental health in some cases. Internet use can expose children to dangers, such as cyberbullying, online grooming and sexual abuse. Children can easily be exposed to unsuitable or harmful materials online which can cause emotional harm. Think U Know provide some helpful online safety advice and resources.  

The interaction between genetic predisposition and environmental factors is complex. Certain genetic traits may make children more sensitive to environmental stressors. For example, a child with a genetic predisposition for depression may be more likely to develop the disorder when exposed to chronic stress. Environmental factors can influence the expression of genes. Stressful environments can lead to epigenetic changes that increase the risk of mental health disorders.

While there are significant risks, there are also protective factors that can mitigate these risks. Strong, supportive relationships with family members, teachers and peers can provide emotional support and resilience. Access to physical activities, nutritious food, and opportunities for creative expression can improve mental well-being. Also teaching children about mental health, coping strategies and emotional regulation can empower them to manage stress and seek help when needed.

Recognising early signs of mental health issues in children is crucial for ensuring timely intervention and support. By paying close attention to behavioural changes, emotional distress and developmental milestones, parents, educators and healthcare professionals can identify potential concerns and take appropriate action. 

Early detection allows for the implementation of effective strategies that can significantly improve the child’s overall well-being and long-term mental health outcomes. Encouraging open communication, reducing stigma and promoting mental health education are essential steps in creating a supportive environment where children can thrive. Ultimately, proactive recognition and intervention can pave the way for healthier, happier futures for children facing mental health challenges.

If you think your child is showing the symptoms of a mental health condition, it is important not to ignore this as, just like mental health issues in adults, a mental health issue in a child will not go away on its own. 

If you’re worried about a child, whether you are a friend, family member or teacher, encouraging them to talk about how they are feeling can be a very helpful first step. Sometimes children are more likely to open up to a trusted adult who is not their parent. This may be because they don’t want to cause their parent to worry, or they may be particularly worried about something that is happening at home, therefore someone who is not as close to the situation may feel easier to talk to. 

If you can encourage them to talk, gently ask what is wrong. If the child does not want to talk, do not apply too much pressure on them as this could make them even more reluctant to open up. You can then repeat the process at another time until they are ready to talk. 

Children often express themselves through play. They often act out a real-life situation that they have experienced in order for them to process it and make sense of the world. This is a good opportunity for you to show curiosity and engage with them. You could observe them in their play and ask questions or you can join in their play. Let them take the lead on this. 

Stressed or upset children sometimes play fighting games with their toys. You can talk to your child about this with curiosity in order to find out if there is anything wrong. It is also important to remember that fighting games can also be completely normal developmentally and this type of rough and tumble play can be healthy for children. The benefits of rough and tumble and imaginary play can include:

• An outlet to regulate emotions through the release of energy and tension.
• Connection through play due to physical contact, imagination and eye contact.
• An opportunity to play with the experience of having power and control and be in charge of their own world.
• ‘Good characters’ versus ‘bad characters’ can teach children about right and wrong.
• An opportunity to learn about respecting others and boundaries.

During this type of play, you can put boundaries in place to ensure it is safe. If the rough and tumble play becomes aggressive or violent, this could be a cause for concern.

As children can learn so much through play and it can often be a more useful way of connecting with a child than just by simply talking, it is often used as a tool when working with children. 

If a child opens up to you about how they are feeling, whatever is causing the problem, you should take it seriously, even if it seems trivial to you. If your child does not want to talk to you, let them know that you’re concerned about them and that you are there if they need you. You should encourage them to talk to someone else they trust, such as another family member, a friend or someone at school. It may be helpful for you to talk to other people who know your child and speak to your child’s school so that they can offer some support.

If you are worried that any child is being abused, or if a child discloses something to you that you are worried about, you can speak to the NSPCC who will be able to offer advice and tell you how you can report your concerns. 

If you are worried about your child’s mental health, you should make an appointment to see your GP. Your GP can refer your child to a local children and young people’s mental health service (CYPMHS) which is able to provide specialist help. CYPMHS is used as a term for all services that work with children and young people who have difficulties with their mental health or well-being. You may also be able to refer your child directly to this service without seeing your GP. Specialist CYPMHS are NHS mental health services that focus on the needs of children and young people. They are multi-agency teams that often consist of:

• Psychiatrists
• Psychologists
• Social workers
• Nurses
• Occupational therapists
• Support workers
• Specialist substance misuse workers
• Education mental health practitioners – who work in mental health support teams in schools and colleges
• Children’s well-being practitioners
• Primary mental health workers

Accessing support from a specialist CYPMHS is different depending on where you live, and waiting times can also vary. Most CYPMHS have their own website, which will have information about how to access the service, including phone numbers, so you can get in touch directly to ask for advice.

You may also find it helpful to speak to:

• Someone at your child’s school
• Your Health Visitor
• Your health visitorSomeone at your local children’s centre

Conclusion

If you or your child is being supported by social services or the youth offending team, your key worker will also be able to refer your child to CYPMHS.

If you need help for a mental health crisis or emergency, you should get immediate expert advice and assessment. Here you can find access to an urgent NHS mental health crisis helpline.

If you are worried about any aspect of your child’s mental health, you can call the charity Young Minds free parents helpline for advice on 0808 802 5544. Their lines are open Monday to Friday from 9.30am until 4.00pm.