How to Talk to Kids About Mental Health

Questions to ask to be sure children and teens are doing OK

Laurie Allen
Mental health professionals have seen an uptick in the number of children with more severe anxiety and other issues since the COVID-19 pandemic began.

The upheaval brought about by the COVID-19 pandemic and related issues hasn’t bypassed children and adolescents. They, too, experience anxiety and mental health problems in ways that aren’t always obvious.

“Most kids don’t wear their feelings out there for the world to see,” says Parker Huston, pediatric psychologist and medical director of the On Our Sleeves program at Nationwide Children’s Hospital.

If there is one thing parents can do to ease their children through difficult times, it’s talk with them about how they are feeling. “The best thing you can do is start the conversation early,” says Huston. “If you haven’t initiated those conversations, do it today.”

Ironically, COVID has made it easier to talk about mental health in both adults and children. “It’s been a fulcrum to leverage these discussions, and has driven these conversations,” adds Huston.

One in five children is living with a mental illness, and 50 percent of all lifetime mental illnesses start by age 14. Huston says anxiety is becoming one of the most commonly diagnosed disorders in children and “happens when the brain communicates that all is not well and it needs to be changed.” Mental health professionals have seen an uptick in the number of children with more severe anxiety and other issues since the COVID-19 pandemic began, he notes. “This school year is not business as usual.”

Anxiety manifests in a number of behaviors, such as anger and aggression or, conversely, withdrawal and avoidance. “We get a lot of referrals about suspected attention deficit disorders,” adds Huston. “Sometimes lack of ability to focus and concentrate is ADD, or it may be they are so anxious and worried they may not be able to turn down the volume.”

Huston says younger children don’t have the emotional language to express complex emotions, so adults can take cues from behavioral signs, such as irritability, changes in sleep, not wanting to spend time with friends or not wanting to do things they normally like to do. Adolescents might voice anxiety and depression by saying, “I feel hopeless.” Or, they may say it like this: “What’s the point?”

Parents should consider consulting a professional when these kinds of attitudes persist and interfere with normal functioning. School counselors can be an excellent resource at times like this, in addition to clinical therapists, Huston says.

“It comes back to talking to kids,” he adds. “It’s the foundation. I tell people nothing is going to happen in the first two sessions of therapy. Those are about building trust [and a relationship].”

Huston says it’s OK for parents to start conversations with easier topics, such as asking their children to name the best thing that happened that day. They then can move to talking about the more negative situations and emotions. Ask children what specifically made them uncomfortable.

Adults also should be aware of how their words and actions impact children. “We have more influence, sometimes unknowingly, than we think. Kids are very perceptive,” Huston says.

While adults shouldn’t shield youngsters from reality, it’s important to find a way to filter that in how they speak to their children. When parents say, “I’m terrified” or “I hate the way your school is managing this,” children feel the blow.

“There’s a difference between the conversation you have with your family at the dinner table and the one you have after the kids go to bed,” he adds.