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11 sneaky signs a child might be struggling with anxiety or depression

Watch for 'door lurking,' irritability or other signs a child might need help.

It’s been a tough year to be a kid. School via Zoom, playdates gone, proms canceled.

The good news is that kids tend to be resilient and flexible, and many have thrived in difficult circumstances. But there’s also compelling evidence that mental health has declined for children and teens across the country.

"What the data is showing us is a significant increase in kids who are experiencing mental health concerns, whether it's anxiety or depression or even for older kids using substances," California Surgeon General Dr. Nadine Burke Harris told TODAY.

For our TODAY All Day special, “Mind Matters,” we spoke to experts about the toll the COVID-19 pandemic has taken on the mental health of our nation’s youth. Experts said to watch for these 11 changes in behavior if they interfere with everyday life.

1. Lack of joy

If a child seems to have less joy from play, parents should take note.Cavan Images / Getty Images

If a child doesn’t seem to enjoy play, says no to sweets or stops taking pride in their appearance, that might be a sign of loneliness or depression.

“One example I like to give is a child who skips dessert … maybe they are not feeling hungry, but it’s also a sign of a point of joy being diminished,” child psychiatrist Dr. Judith Joseph told TODAY.

2. Acting like a baby

A child under stress might be extra clingy or have difficulty separating from parents.Bloom Productions / Getty Images

Children under stress often show signs of regression and may be unable to perform tasks they once mastered. Younger kids (and even teens) may be clingy or have separation anxiety.

"It's not so different than us deciding, 'I'm just not up for handling that thing. I'm just going to go watch some Netflix and eat some ice cream,'" said Laura Markham of “Aha Parenting." A little regression is normal, but if it lasts for more than a few weeks, Markham said, "there's something more going on."

3. “Door Lurking”

Adolescent and family psychologist Jen Hartstein coined this phrase to describe kids who may want to talk when parents are not expecting it.

“It’s a sign they do not know how to say something,” she said. ”As a rule of thumb, parents need to listen more and talk less.”

4. Aches and pains

If a child has frequent tummy aches or headaches, that could be a sign they are hurting emotionally. A pediatrician can check for physical problems and screen for mental health conditions.

“Expressing emotions through my body is what a child will do. So maybe you have a child who always has headaches, there is a good chance that child is feeling anxious or depressed,” Dr. Joseph said.

5. Irritability or withdrawl

Irritability that is frequent or persists might be a sign a child needs support.Annie Otzen / Getty Images

It’s common for teenagers to feel irritable or pull away from parents, but it can also be a signal.

“Perhaps they're experiencing a conflict at school such as being bullied,” Dr. Hartstein said. "These are also signs your child is looking for a way to communicate. Think about why you as an adult feel irritable and withdraw. Usually it’s because something isn’t working at school or at home.”

6. Trouble sleeping

Dr. Burke Harris said sleep is one of the first things to be affected if we are stressed, and sleep is also an important remedy for that stress. If a child is waking frequently or had been sleeping well and is not anymore, that could be a sign they need extra help.

7. Hitting, biting or spitting

When aggression takes over the day, parents should be concerned.Getty Images

Aggression can be another sign a child is struggling.

"Recognize that it’s anger or testing the limits or both, and under stressful circumstances children are going to be angry," said Dr. Tovah Klein, head of the Barnard Center for Toddler Development. A parent should be concerned if aggression is happening at school and "taking on more of the space than playing."

8. Change in appetite

The experts said this is a particularly tough time for people with eating disorders, who may see restricting their diets to exert control. And on the flip side, overeating can be an unhealthy response to stress.

"When we're stressed, we tend to crave high sugar, high fat foods. So we tend to crave more of the junk foods, which is again, another thing that then can affect our health and our well-being," Burke Harris said.

9. Bed wetting and toileting accidents

Potty accidents can be another sign of regression, and usually nothing to worry about. A parent should talk to a pediatrician if the accidents are persistent or coincide with other symptoms.

"It can be shocking if they’re totally toilet trained and never have accidents and now they’re four years old (and having accidents)," Klein said. "It’s a little alarming to a parent, but it’s also normal."

10. Tics or repetitive behavior

Some children may get stuck on behaviors like hand-washing.Ninel Roshchina / Getty Images

Tics are common in children. A child might start snorting, or scratching a phantom itch. Children might also develop rituals, like excessive hand-washing, that help them feel more in control of the world or their feelings.

Usually, these behaviors disappear over time. But if tics are happening for most of the day or interfering with a child's functioning, parents should ask a pediatrician for advice.

11. Meltdowns

Usually, a meltdown or tantrum is a child's way of showing they're having a hard time or angry. Klein calls it "a sign to come closer to your child. What can you do to give them that much more comfort and attention?"

If tantrums are lasting hours or happening so often that the family can't leave the house or take a child to play dates, that might be a sign the child needs extra support.

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