How to Tell if a Kid Actually Needs to See a Therapist

As we've reported before, therapy can guide grown-ups through the stresses of adulting. The same holds true for the turbulent teen and childhood years. An assist from a mental health professional often makes the challenges of youth—from recess to relocation to relationships—more surmountable.

But dragging a reluctant child to therapy just because someone died, you've moved, or you're splitting from your spouse can backfire, and it's just not always necessary. "Every child is going to react differently to these situations," says Shana Schnaue, an elementary school counselor in Fairfax County, Virginia, and a spokesperson for the American Counseling Association. "Some kids have the skills they need to cope. Other kids don't. It's when you start to see warning signs that it's really beneficial for parents to reach out for outside support."

So how do you know when your child's crying for help—and what can you do to answer? Watch for these red flags, then raise your concerns in a calm, low-key manner. Point out what you've seen, and gently suggest the benefits of involving an outside expert for everyone involved, suggests Bethany Raab, a Denver-based therapist who's treated teens and college students for a decade.

Sign 1: They're struggling at school.
Mental health and academic difficulties are intimately intertwined, says Anil Chacko, associate professor of counseling psychology at New York University. As early as preschool or kindergarten, kids who lag on learning the alphabet, putting sounds together, and other language-related tasks might benefit from early interventions to improve learning. That, in turn, can protect their social, emotional, and behavioral health for years to come.

As toddlers become elementary-, middle-, and high-schoolers, poor grades—especially if they drop suddenly—can signal a wide range of problems. "Whether they are struggling with depression, anxiety, a bully or even a learning difference, bringing a mental health professional on board can be a huge support to both the child and the family as a whole," Raab says.

Keeping in close touch with your child's teachers, counselors, and other school staff can help you spot issues you might not see outside classroom walls. "Teachers have a broader comparison base to identify kids where there may be some kind of concern," Chacko says. They also can help shed light on the root causes—for instance, whether your student's performance is suffering because of a learning disability or because anxiety or peer conflict is keeping him or her in the counselor's office for hours, Schnaue points out.

Sign 2: They've grown detached.
Being introverted doesn't count as a psychiatric disorder, Chacko points out, and quiet activities like reading shouldn't be stigmatized. However, even kids and teens who tend to be loners typically have at least one or two friends they spend time with. If your child never discusses friendships or activities with peers, something may be amiss, he notes.

That's especially true if a normally gregarious child turns silent or if kids who normally enjoy activities like soccer refuse to take the field, Schnaue says. A loss of enjoyment can serve as a warning sign of depression, or a bully on the team could be kicking your kid to the bench—both situations in which intervention might be appropriate.

Of course, behaviors and family relationships naturally shift over time, but extremes should raise suspicions. "If your child is unusually aggressive verbally or physically, or is withdrawn and refusing to talk with you about it, you might want to consider having a professional help determine what is going on," Raab says.

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Sign 3: Their appearance suffers.
Messy hair might just be a fashion choice, but severe slips in hygiene—wearing the same soiled clothes over and over, skipping showers, not using a toothbrush—might signal depression, bullying, or other big problems with friendships or peer relationships, Schnaue says.

"Often, when you comment on it, you'll get this gruff response—like, 'leave me alone, it's none of your business,'" she says. At that point, it's worth following up with teachers, coaches, daycare providers, or anyone else who regularly interacts with your child if they have relevant observations, she notes. Putting together those pieces can help you, as a parent, determine what you might be able to help change—and when it's time to call for reinforcement.

Sign 4: You get intel from other places.
As a parent, you're an expert on your child's behavior. But since you're not with him or her 24/7, there can easily be things you miss. Sometimes, your kids' friends—or those kids' parents—might be privvy to information you don't have, Raab says. This could range from the relatively banal—say, an overheard conversation about two teens ditching school—to more serious issues, like abusive relationships and substance use.

Though it might be difficult or frightening to hear the news from another source, take these communications seriously, Raab says. And try not to take it personally that your child hasn't come directly to you. Some problems might feel safer to express to a friend or a non-parent.

Sign 5: You spot physical symptoms.
Of course, psychological health isn't all in your child's head. Some behaviors have manifestations and consequences for the rest of his or her body, too. Take substance abuse—you might notice telltale signs like booze on your teen's breath or red eyes and dilated pupils from smoking pot.

Other red flags include visible cuts that might be the result of self-harming, Raab says. Or, you might notice unexplained weight loss or physical evidence of bingeing and purging, which could indicate your child has an eating disorder.

Even if these behaviors aren't disrupting your child's relationships or academic performance, "it's affecting their body and how they're choosing to take care of their body," Raab says. Intervening might protect your child's mental and physical health.

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