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How to talk to children about anxiety and mental health: An age-by-age guide

Talking to your kids about their mental health can feel really challenging, but parents should check in.
/ Source: TODAY

The COVID-19 pandemic has impacted children in so many ways. Many feel anxious, lonely, scared and depressed. But what is normal behavior or a sign of something more? Is that sulking simply part of childhood? When your daughter rejects her favorite video game is that a sign she's losing interest in things she once enjoyed?

"During the pandemic, the kids we used to not worry about — the athletes, the outgoing, extroverted kids — started to be the kids we were worrying about more. The extroverted kids, who loved people, those are the kids we are seeing are confusing parents more," Dr. Jen Hartstein, a family psychologist told Carson Daly for Mind Matters. "The kids who were introverted or the kids who were being bullied have actually thrived more in the pandemic."

Knowing whether behaviors are part of childhood development or signs of a mental health concern can be a challenge. But there’s good news: Asking children about their mental health won’t cause a problem.

“Don’t ignore it. You may not be right. It is better to err on expressing your concerns to a kid who isn’t having concerns,” parenting expert Dr. Deborah Gilboa told TODAY Parents. “Asking people about suicide does not cause them to contemplate suicide. Asking kids about anxiety wouldn’t make them anxious.”

Experts say parents should talk to their children about their mental health from a young age to help them accurately identify feelings and develop coping mechanisms. Getty Images

The experts want parents to start talking to their children at a young age.

"The first part of resilience in mental health is being able to talk about it," Gilboa said.

She notes that dramatic shifts in behavior could indicate a problem. Changes to look out for include:

  • Loss of interest in things they once enjoyed
  • Changes in eating or sleeping habits
  • Avoidance of friends
  • New behaviors
  • Isolation
  • More aches, pains or ailments

If parents notice troubling signs, they don’t have to solve them alone.

“You don’t have to have the answers. Your job is to advocate for your children, to reach out to resources,” Gilboa said. “You are a ‘your child’ expert, not a mental health expert.”

The experts share how parents can talk to their children about their mental health, age by age.

Preschool to Kindergarten: 4 to 6

Parents of young children should help them identify feelings. Gilboa says researchers know that children learn emotions like they learn colors or shapes. If parents teach them the words for 30 different feelings, they learn nuance.

“The best thing we can do for them as preschoolers is give them names,” she said. “When we teach kids to name embarrassed versus ashamed versus anxious versus sad … they get better and better at speaking their truth and naming it.”

While it might be tempting for parents to tell their children how to feel — or not feel — we shouldn't, Gilboa said.

“You’re saying their feelings don’t matter,” she explained. “Telling a kid that an emotional reaction is wrong can make them try to fake it. But that’s not a healthy coping strategy.”

Younger children are often more likely to complain about physical ailments than mental ones. If a child suddenly has tummy troubles, for example, it could be a sign they need to talk to someone.

"Maybe you have a child who always has headaches, there is a good chance that child is feeling anxious or depressed," Dr. Judith Joseph a child psychiatrist told Daly. "Children actually perceive rejection, and interpret it as if it’s physical pain. If your child says, XYZ has a new best friend. That’s a cue that they are experiencing pain by this rejection."

She added that a good way to get children to open up is through role playing.

"You can do this with a doll or action figure toy. Let them be adults and you be the kid, you say, “My tummy hurts, I am sad” and see what you child says, you’d be shocked," Joseph said.

Parents can also help their preschool and kindergarten children with coping mechanisms for handling tough feelings. Does crying help? What about hugging mom or dad? Will drawing help?

When kids use these skills, parents should praise them.

“Catching them doing good is really useful,” Gilboa said.

Grade School: 7 to 10

Parents still should ask about feelings and forget about labels to conditions, such as depression or anxiety.

“We can’t diagnose them. They can’t diagnose themselves. We shouldn't ask any kid this age to try,” Gilboa said. “Ask in terms of emotions.”

If children struggle to explain how they are feeling, parents can ask their children to tell them a story. That way they feel it's safe to open up.

“Kids this age understand that there are some feelings that are frustrating and disappointing to adults,” she said.

Gilboa also suggests that parents play a game with their children every night. Each family member lists their high and low of their day.

“A high gets you a whole story and a low gets a whole other story,” Gilboa said. This shows children that: “I am the person you bring the hard stuff to and I am the person you bring the good stuff to.”

Middle School: 11 to 14

By now children have heard of mental health conditions, such as depression, bipolar disorder or schizophrenia. Give them a pre-test and ask about them what they know.

Parents can say ‘Have you ever heard the term depression? In what context and what do you understand it to mean?’” Gilboa said. “You can say, ‘Do you ever experience that yourself?’”

Middle school students might push back and think their parents are being lame. That’s OK. It’s better to persist and be wrong.

Try saying: “I am asking you this because I see you; I love you; you’re very important to me.”

Middle school students often lack self-confidence and need such reassurances.

Another way to encourage middle school age children to chat is through something called mirroring.

"You may have to mirror. You may want to share. Today XX said this to me at work and it made me feel this way. Have you ever felt this way? Remember no accusing, ask your child for their opinion," Hartstein told Daly. "That allows them to share."

High School: 14 to 18

By high school, teens are trying to figure out how they can talk to their parents about mental health.

“Don’t wonder if you should talk to a high schooler, you definitely should,” Gilboa said. “Every teenager needs to be having a conversation with a trusted adult.”

Moodiness seems par for the course with many teens. But that could also be a sign that something else might be going on.

"We know it’s common for teenagers especially to feel irritable and withdrawn but these could also be a sign that maybe perhaps they're experiencing a conflict at school such as being bullied," Hartstein told Daly. "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."

Parents can ask if their teens are worried about someone else or themselves. But adults should be specific about what they will do if someone is at risk.

“You should be really clear with your teen that if someone’s life is in danger, you will step in,” Gilboa said.

If your teens dismiss your effort to talk about their mental health, ask them for input.

“Give them some autonomy of when and where and how you can approach it to make it more successful,” Gilboa said.

While some teens will talk to their parents, others might feel comfortable talking to another adult. Parents shouldn't take it personally. Gilboa suggests saying something like, “Who are the adults in your world you can trust if you feel you can’t come to me? I won’t be angry. I might be hurt.” But parents should make sure they know who those resources are.

This article was originally published in September 2019.