Most parents who call me start with some version of the same sentence: “I’m not sure if this is serious, but…” Then they tell me about a child who has stopped sleeping well, or who melts down every morning before school, or who seems quieter and sadder than they used to be.
If you’re asking whether your child needs therapy, you’re already doing something important. You’re paying attention. This article is here to help you sort out what’s a normal part of growing up, what’s worth a closer look, and what to do next.
Children struggle sometimes, and that’s normal
Every child has hard stretches. A four-year-old has tantrums. A seven-year-old gets nervous before a spelling test. A twelve-year-old slams a door after a fight with a friend. None of these, on their own, means something is wrong.
It also helps to know you’re not alone when things feel harder than that. According to the CDC’s children’s mental health data, drawn from the 2023-2024 National Survey of Children’s Health, about 11% of children ages 3 to 17 had current, diagnosed anxiety, 8% had a diagnosed behavior disorder, and 4% had diagnosed depression. These are common challenges, and they’re treatable.
What makes a behavior worth a closer look?
The question isn’t usually whether your child is struggling. It’s how much, for how long, and how much it’s getting in the way. The Child Mind Institute suggests parents think about a few things:
- How long has it lasted? Something that follows a recent upset, like a move or a new school, may settle on its own. Behavior that has lasted a month or more is more likely to need help.
- How intense is it? A few tears at drop-off is different from a child who screams and clings for an hour.
- Is it outside what’s typical for their age? A teacher, school counselor or pediatrician sees many children and can often tell you whether your child’s reactions stand out.
- Is it getting in the way of life? This is often the clearest sign. Is it causing conflict at home, trouble at school, or problems with friends?
A practical tip from the same article: write down specific examples. “He had a meltdown every school morning this week and missed the bus twice” is more useful to a pediatrician or therapist than “he’s been difficult.”
Signs by age
Children show distress differently at different ages. These lists draw on guidance from the National Institute of Mental Health and the American Academy of Child and Adolescent Psychiatry. No single sign means your child has a disorder. They’re prompts to look more closely.
Younger children (roughly 3 to 8)
- Frequent tantrums, or being intensely irritable much of the time
- Often seeming fearful or worried
- Frequent stomachaches or headaches with no medical cause
- Regularly refusing to go to school because of worry
- Trouble sleeping, or being very tired during the day
- Pulling away from other children, or struggling to make friends
- A marked drop in how they’re doing at school
- Ongoing disobedience or aggression that lasts longer than six months
Young children often can’t put feelings into words. Their worries come out in their bodies and in their play. That’s one reason I use play therapy with children 3 to 12. In my playroom, a child can show me with toys, sand and art what they can’t yet say.
Older children and teens
- Losing interest in things they used to enjoy
- Low energy, sleeping much more or much less, or big changes in eating
- A sad or negative mood that lasts
- Severe mood swings
- Worries that get in the way of daily life
- Spending more and more time alone
- A marked decline at school
- Using alcohol or drugs
- Self-injury, or talk of harming themselves or others
With teens, change is the thing to watch. Moodiness is part of adolescence. A teen who used to love soccer and now won’t leave their room, or whose grades have dropped sharply, is telling you something.
If worry is the main theme, you may find my page on anxiety in children and adults helpful.
When to act right away
Some signs need help today, not after a waiting period. If your child talks about wanting to die, threatens to hurt themselves or someone else, or you find signs of self-harm, act now.
- In an emergency, call 911.
- Call or text 988, the Suicide and Crisis Lifeline, available 24/7.
- Washington County Crisis Line: 503-291-9111.
It’s okay to ask your child directly whether they’re thinking about suicide. HealthyChildren.org, from the American Academy of Pediatrics, notes that asking honest, loving questions does not increase risk. Stay with your child, keep them away from anything they could use to hurt themselves, and contact your pediatrician about a safety plan. You’ll find more crisis numbers on my resources page.
Start with your pediatrician
Your child’s pediatrician is a good first call. They can check for physical causes (stomachaches, sleep problems and tiredness can have medical roots too), and they can help you decide on next steps.
HealthyChildren.org suggests a few ways to prepare:
- Note the changes you’ve seen, such as in sleep, eating or withdrawal, and bring those notes.
- Talk with your child beforehand. Something like “I care about you and want to make sure I understand how you’re feeling” can open the door.
- Expect the doctor to ask questions or use a short questionnaire. Teens should get some private time with the doctor.
The pediatrician may be able to help in the office, or may refer you to a counselor, psychologist or psychiatrist.
Talk to the school, too
Teachers see your child for hours a day, in a setting you don’t. Ask them what they notice. Is your child withdrawn in class? Struggling to focus? Getting along with others at recess? A school counselor can also tell you whether your child’s behavior stands out compared with classmates, and what support the school can offer.
A quick checklist before you call
You don’t need to be certain before reaching out. But if several of these are true, it’s a good time to talk to someone:
- [ ] The behavior has lasted a month or more.
- [ ] It seems stronger or more frequent than in other children the same age.
- [ ] It’s causing trouble at home, at school or with friends.
- [ ] Your child seems unhappy, worried or stuck, and it isn’t lifting.
- [ ] Other adults in your child’s life have raised concerns.
- [ ] You’ve tried the usual things and they haven’t helped.
- [ ] Your gut is telling you something is off.
What the first steps with me look like
When a family contacts me, I start by meeting the parent on their own. I want to hear your child’s story from you: what you’ve noticed, when it started, and what you’ve already tried. That way your child doesn’t have to sit through a conversation about their problems.
For children 3 to 12, I usually work in my playroom, because play is how young children communicate. Teens tend to prefer talking, and I use approaches such as CBT and mindfulness with them. Throughout, I keep you informed about the themes I’m seeing and share ideas you can use at home. You can read more about how I work with children and teens.
Reaching out doesn’t commit you to anything. Sometimes a conversation shows that your child is going through a normal rough patch and needs a little extra support at home. Sometimes it shows that therapy would really help. Either way, you’ll have a clearer picture.
Talk it through with me
If you’ve been wondering whether your child needs therapy, I’d be glad to talk it through with you. My office is in King City, a few minutes from central Tigard, and I offer a free phone consultation so you can ask questions and see whether we’re a good fit. Call me at 503-495-5072 or send me a message.
Sources
- Centers for Disease Control and Prevention. Data and Statistics on Children’s Mental Health. https://www.cdc.gov/children-mental-health/data-research/index.html
- National Institute of Mental Health. Child and Adolescent Mental Health (health topic page). https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health
- American Academy of Child and Adolescent Psychiatry. When To Seek Help For Your Child, Facts for Families No. 24. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/When-To-Seek-Help-For-Your-Child-024.aspx
- Child Mind Institute. Should I Get Care for My Child? https://childmind.org/article/should-i-get-care-for-my-child/
- American Academy of Pediatrics, HealthyChildren.org. How to Talk About Mental Health With Your Child and Their Pediatrician. https://www.healthychildren.org/English/healthy-living/emotional-wellness/Pages/How-to-Talk-with-Your-Child-and-Their-Pediatrician-About-Mental-Health-Concerns.aspx
- American Academy of Pediatrics, HealthyChildren.org. What should I do if my child or teen is thinking about suicide? https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/what-should-i-do-if-my-child-is-thinking-about-suicide.aspx