Supporting Kids and Teens During the Youth Mental Health Crisis

Many infants and toddlers born during or shortly before the pandemic have not had the same access to learning socialization skills as older children. Your child may be signaling that they are uneasy around peers if:

• They resist being separated from you, even for short periods of time.
• They get clingy or cry when around peers.
• They act shy, withdrawn or uncomfortable around other kids.

Dr. Holzman has several recommendations for easing your baby or toddler into social settings:

Quality time

First, make sure you’re spending quality time together playing and doing things you both enjoy. “Spending quality time one-on-one playing and doing everyday things contributes to a sense of wellbeing and safety that can help children feel safe branching out and playing with others,” Dr. Holzman said.

Demonstrating social skills

Next, model social skills for your kiddo and label them out loud. Share, listen, take turns – and narrate what you’re doing as you go. “You can say something like, ‘Oh, I see you’re interested in those blocks, so let’s play with those together,’” said Dr. Holzman. “I see you like the blocks so I’m doing what you’re doing.”

Showing encouragement

When you notice your child putting something like reciprocity or compassion into action, point out what they did specifically and encourage them. “You can say something like, ‘I noticed you took turns when you were playing with the trains, and when your buddy fell down you helped him up,’” Dr. Holzman said. “That’s a great way to be a good friend.”

Reading

Read books about friendship and being a good friend. “Books can be a great way to learn and process,” Dr. Holzman said.

Some children are experiencing anxiety about being away from their parents and caregivers after spending long periods of time at home. Signs of separation anxiety in younger children include tantrums or crying and clinging at drop-off, while older children may avoid situations that present a separation, such as a parent going to run errands without the child.

“It may even be hard for them to be in different parts of the house and they prefer staying in the same room or on the same floor as their parents,” Dr. Holzman said. “Sometimes they struggle to fall asleep by themselves.”

Dr. Holzman recommends the following strategies for families dealing with separation anxiety:

Ask what’s bothering them

Have a conversation to find out what is bothering your child. Dr. Holzman describes this as, “Notice, ask, listen and affirm.” For example, you could say, “I noticed you were upset when we got to school; could you tell me what you were feeling and what upset you?” Then listen and affirm that you’ve heard them.

Start small

Take small steps toward a normal routine. “If a child is having a hard time with a parent leaving the house, Holzman suggests starting by going in another room for a period of time and seeing how that goes, and then the next day going for a bit longer, and then eventually leaving the house for a short errand, and so on. “Take small steps toward the goal and listen to which situations make it more distressing,” Dr. Holzman said. “It can be hard to remain empathic because we may want to go places but they may not feel ready. What feels like baby steps to us may feel really big to them.”

For older children who are avoiding leaving their parents due to anxiety, Dr. Trovato recommends a similar approach of starting small and working your way up. For example, you could begin by having your child go get you coffee at a nearby café and then work up to longer outings.

Make time

Be sure you’re spending at least 10 minutes of one-on-one, quality time with your child each day. When children have enough time and attention from those they love most, it can feel less daunting to venture out into the unknown.

Encourage and reward progress

Dr. Holzman recommends things like creating a sticker chart for a child who’s resisting going to sleep alone. “It’s tempting to use discipline or threats to get kids to stay in their rooms at night, but that can backfire,” he said. “It’s better to find ways to motivate with encouragement, like, ‘If you stay in your room, we’ll put a sticker on your chart.’”

Unlike toddlers, older children who are struggling to reintegrate socially are less likely to cry, have tantrums or physically cling. Instead, they are more likely to avoid social situations that seem overwhelming.

For instance, your child may resist going to school or say they no longer want to participate in activities that they enjoyed before the pandemic. They may also avoid interactions with people outside your family or inner circle, preferring to let you order for them at a restaurant or otherwise communicate on their behalf.

Because they had a period of isolation and missed key social developmental opportunities, Holzman said many children are struggling to catch up and re-adjust to in-person social settings. “Things that seem small to us, like going to the store or ordering lunch, may trigger discomfort and even anxiety for them,” Dr. Holzman said.

For kids who had some level of social anxiety before the pandemic, two years of isolation and lockdowns made it worse. “The trigger was suddenly gone so the symptoms went away and they got this short-term relief from anxiety,” Dr. Trovato said. “But long-term it makes the anxiety worse. The initial fear is still there and your brain wants you to keep avoiding those interactions, but if you do, it keeps you in the cycle. We want to train the brain to deal with the situation. The more we’re exposed, the more we can cope.”

Here are some ways to help school-age children and adolescents readjust to social activities:

Observe, ask questions and listen

“Listen and really hear before you jump to solutions or offer advice,” Dr. Holzman said. “Say things like, ‘I noticed that you seem more stressed when we come to school— can you tell me about that?’” Then, instead of offering a solution immediately, listen and repeat back to show you have heard. That makes kids feel safer and more validated.”

Start small

Find ways to take little steps that help them feel comfortable in public settings. Dr. Trovato often has kids begin with things like ordering at dinner, going to Starbucks and ordering something for a loved one, asking a question at an information desk in a public place or planning activities or social interactions in smaller, more controlled settings than at school.

“Create small exposures that increase little by little,” Dr. Trovato said. “Send the message that you know they can do it. If you don’t encourage them to venture out, or if you do too many things for them because they’re not comfortable, you’re sending the message that they can’t do it.”

Focus on activities they enjoy with friends

If you sign your child up for sports or another activity, see if you can find a friend whom they trust to also participate. You can try reaching out to other parents to arrange activities that include at least one or two people who feel “safe” to your child.

Help them plan

If you sense that your child’s motivation is low due to anxious avoidance, Dr. Trovato recommends saying something like, “Hey, it’s been a while since you’ve seen so-and-so. Look at this new movie that just came out. Want to check that out?”

“You don’t have to shove activities down their throat,” she said. “But if you’re seeing them avoid them, you can experiment with ways to help them get unstuck.”

Provide encouragement and perspective

Kids are often self-conscious in social situations because they think people are judging or disliking them. Remind them that most people are too busy to be hyper-focusing on your child’s appearance or nervousness. “We think everyone is focused on us but they’re not,” Dr. Trovato said. “We’re not the main character of anyone’s story but our own.”

You can remind them of this by asking questions like, “The barista sees 50 people per hour; do you think they’re really concerned about the way you ordered?” Or, “Do you think they’ll remember that in a week or a month?”

Encourage positive self-talk

Encourage your child to talk to themselves the way they would talk to a close friend. If they seem to be disparaging themselves often, ask if they would say such things to someone they loved.

Help them create a list of affirmative statements or strengths that feel real to them, such as, “I’m helpful, I’m a good friend, I’m thoughtful, etc.” Dr. Trovato said. “Then have them post the list and review it each morning or before they have an interaction that feels challenging.”

Help them strike a balance

Strive for balance and don’t overdo social events. If over the weekends or summer you notice your child retreating back into their social cocoon, plan some small social interactions such as a play date or an outing to an activity so they don’t completely retreat again, Dr. Trovato recommends. But don’t plan so many activities that they don’t have time to rest or be alone. “You want them to have down time and engage in the things they really like, so schedule some social stuff but not too much and not every weekend,” Dr. Trovato said. “Just make it part of your week-to-week or monthly schedule so their brain gets more and more engaged and used to it.”

Provide inspiration

Encourage your child to read books about friendship or read them together.

While separation anxiety can be a normal part of development, Dr. Holzman says that if it lasts for more than four weeks, parents should seek out support from a behavioral health specialist. “A lot of our interventions now include the whole family,” he said. “If it’s a young child, we would help the parents with strategies, while with older kids we would likely recommend individual therapy that may include caregivers.”

After being away from in-person settings such as school for long periods, some children are experiencing behavioral problems or emotional outbursts as they reintegrate. Returning to a setting that feels new, foreign or anxiety-provoking can produce a fight-or-flight stress response that manifests as an emotional outburst or negative behavior, psychologists say.

If children feel overstimulated by a lot of people and noise or get overwhelmed about being able to confidently engage during a transition or social setting, some react by getting angry, engaging in conflict or being mean. (We’ve heard about everything from arguments over wearing or not wearing masks to cyber and in-person bullying based on appearance. More on this below.)

If your child seems to be overreacting or has started acting out, here are some things you can do:

Again, listen

Explore what the behavior may be stemming from by asking questions and listening. Before launching into any advice, ask what is happening with your child and how they feel, then listen to what they say (and repeat it so they know you’ve heard them). Listening and validating how they feel is key.

Help them understand their reactions

Explain the stress response and what may be happening in their body. “When we get upset or angry our body speeds up, so we don’t know what to do with that energy,” Dr. Trovato says. “I like to explain the fight or flight response and then talk about ways to release angry energy that are safe and not harmful.”

Help them find an outlet for their stress or energy

Find safe ways to release anger and stress. Talk with them about what might help them get out the angry energy. “Physical activity is great, and every kid can come up with something that works for them,” Dr. Trovato said. “Some kids love stress balls, some want to run or walk really fast, and others like to ride bikes.”

Encourage empathy

Take the perspective of those harmed by the behavior. If your child is acting out or being mean to other kids, you can ask questions that encourage them to understand the impact of their behavior, Dr. Trovato said. “You can say something like, ‘That was a really rough thing you said, and a lot of people saw and heard. What would that be like if that was done to you? How would you feel?”

Adolescents are prone to what are called compensatory behaviors. Essentially, they are trying to cope with difficult emotions and find some relief. For some, that means trying to gain control. Others try letting go of control.

Compensatory behaviors can show up as:

• Substance use
• Disordered eating
• Losing interest in activities they used to love
• Risk taking

First, check in with them. Get specific tips for checking in on your teen during the pandemic.

If your teenager is seeking control through compensatory behaviors, here are some additional resources to help point you in the right direction:

• Disordered eating: Watch our video series with FAQs about eating disorders.
• Perfectionism: Read about when perfectionism becomes a problem.
• Marijuana use: Browse our resources on talking to kids about marijuana.
• Substance use: Find articles about other substance use in teens from the American Academy of Pediatrics.
• Sexual health: Read articles about making healthy decisions about sex from the American Academy of Pediatrics.

Some children respond to stressful situations like the return to in-person school by discharging their discomfort onto others in the form of bullying. This has been happening online and in-person (though school nurses and psychologists report that it’s most often online) since kids returned to school.

Some signs that your child may be experiencing bullying include low mood and withdrawal, avoiding activities they usually like, appetite changes, or constantly checking their social media or apps.

If your child is dealing with bullying, here are some ways to help.

If your child is being bullied

Check in

Ask open-ended questions. If you suspect your child is being bullied, Dr. Trovato recommends asking questions that allow them to share what’s happening, such as, “What did you do for lunch today? Who did you sit with? Who did you play with? What did you do at recess?”

Before suggesting anything, be sure to listen, show your child that you heard and then empathize with their experience.

Help your kids advocate for themselves

If your child is in elementary school or younger, ask them who they can go to for help. “Not just giving them the answer or fixing it for them empowers them to problem-solve,” Dr. Trovato said.

Brainstorm solutions

Help them come up with solutions and strategies that work for them. “What works varies by child, so it’s important to brainstorm with them about what would be best to try,” said Dr. Trovato. “It’s also a more active, collaborative approach that engages their brain and helps them be proactive.”

When someone is feeling overwhelmed, it can help to pause before responding or reacting. Brainstorm with your child about what they can do in that situation. Here’s one example:

Go to a safe place to calm down and problem-solve

Think through whether this is a person who could be easily avoided or someone who is in a daily class or activity

Create a possible solution for each scenario

“There is no one solution,” said Dr. Trovato. “I had a patient who was being targeted on Snapchat. They were understandably upset, and their reaction was to respond in the moment, which fueled the fire. So, we brainstormed about ways to disengage. What worked for them was deleting Snapchat for a while and focusing on people who made them happy; the cyberbullying stopped within two days. For someone else, the conversation may be more like, ‘We were friends but now they’re being mean to me. Was there a misunderstanding we can talk about?’”

If your child is bullying others

Check in

Explore what feelings or issues the behavior may stem from by asking questions and listening. Before launching into a lecture or advice, ask what happened, why and how they feel about it. Be sure to listen to what they say and repeat it so they know you’ve heard them. Even if something seems factually “wrong” to you, validate their experience.

Help them empathize

Take the perspective of those harmed by the behavior. Ask questions that encourage them to understand the impact of their behavior, Dr. Trovato said. “You can say something like, ‘So-and-so said their feelings were really hurt by you calling them that. How would you feel if someone said that or posted that about you?’”

Find healthy outlets for stress

Help them identify non-harmful ways to release anger and stress. Talk with your child about what might help them get out the anger they have discharged onto someone else. “Physical activity or fidget toys are great,” Dr. Trovato said. “Some kids love stress balls, some want to run or walk really fast, while others might choose to ride their bike.” The key is to find safe, productive, non-aggressive ways that youth can funnel their energy.

Languishing can include a lack of motivation and interest, feeling stagnant or stuck, and struggling to start behaviors and concentrate on tasks. Many parents have reported their kids feeling this way. 

For much of the pandemic, kids experienced major disruptions to their daily routines and adjusted to new learning environments that required more effort with less satisfying results. This ongoing experience of having to put in more while getting out less often leads to a feeling of emptiness and lack of fulfillment in our day-to-day experiences.

Signs of languishing include youth showing little to no emotion and appearing flat, not expressing excitement about things in their lives and completing work in a robotic way. Parents likely have seen this in their children at some point during the pandemic. For some, this is an ongoing state of emotion for months. 

If you’re concerned your child is languishing it’s helpful to talk directly to them about it, explain to them what languishing is, and validate their emotions. Just naming an emotional experience helps improve a child’s mood and validating their struggle is an excellent way to connect and support your child.

Having kids spend time each week engaged in a low-stress activity that creates positive emotions is another way to help with languishing. This allows kids to get fully absorbed in the present moment, which helps calm negative emotions associated with languishing.

If your child’s mood does not improve or they seem to be languishing for long periods, they may be experiencing something more serious, like depression.

Depression was already a growing problem before COVID-19, but two years into the pandemic, the rate of pediatric depression has soared. Changing routines, isolation, loss of social connections, learning gaps and, in some cases, loss of loved ones, has led to more children feeling hopeless and overwhelmed.

"Kids are struggling in a way we haven't seen before," said clinical psychologist Jenna Glover, PhD. Before the pandemic, between 10% and 12% of teens experienced anxiety and depression at a clinical level, she said. Now, that number has risen to roughly 25%.

All of us are going to have good days and bad days. Allow your child the space to grieve everything they are missing.

Early signs that your child may be struggling include:

• Being irritable and tearful
• Acting out or throwing tantrums
• Seeking constant reassurance
• Changes to sleeping or eating habits
• Isolating more
• Feeling less motivated or not being able to get things done, like schoolwork or chores
• Not enjoying the activities they would normally

In young people, depression can often show up as irritability and anger rather than sadness. Your child may be depressed if they show any of these signs:

• Prolonged anger, frustration or tearfulness
• Consistently appearing withdrawn or unmotivated
• Changes in appetite
• Withdrawal from activities they normally enjoyed
• Withdrawal from relationships or lack of interest in them
• Trouble sleeping or sleeping excessively
• Lack of enjoyment for anything
• Frequent crying
• Irritability
• Feeling sad most of the day for more than a couple weeks
• Moving or speaking slowly or too quickly
• Difficulty concentrating or remembering information (this can include a drop in academic performance)
• Increased thoughts about or references to death or suicide, including self-harm behaviors

If your child is demonstrating a consistently low, sad or irritable mood for more than a week or having major changes to their sleep or eating behaviors, talk to your pediatrician to screen for anxiety and depressive symptoms. If they show clinical signs of depression or anxiety, your pediatrician can also help direct you to community resources and mental healthcare.

Of course, waiting lists for therapy and mental health services during the youth mental health crisis are long. The good news is that there are steps caretakers can take to support children and teens every day, or while waiting.

If your child is depressed, here are some things you can do to support them:

Promote open communication and trust

Ask how they’re feeling and what’s on their mind, and then listen to what they say. Make sure to show that you’ve heard them and validate their feelings.

Limit screen time

Too much time spent online can increase feelings of isolation, anxiety and depression, according to Dr. Glover. Technology is an unavoidable part of kids’ lives, but too much time spent on social media or gaming can lead to online bullying that sparks violence or self-harm, as well as addiction that prevents kids from showing up for life in a healthy way.

Create opportunities for healthy activities

Encourage exercise, especially outdoors, and plan in-person social activities and creative ways to explore the world.

Search for peer support

There are groups of parents who have connected online to support each other and help each other support their children who are struggling with mental health issues. Search Facebook and Google for meet-up groups for parents of children struggling with depression and seek out some peer support.

Talk to your child about suicide

If you’re worried that your child may have thoughts about suicide or hurting themselves, here’s where to start.

• Ask them directly if they are thinking about suicide: Sometimes people worry that by asking they’ll plant the idea of suicide, but you’ll actually create space for support.
• Call for help in an emergency: For urgent, confidential advice about an adolescent or teenager who is suicidal, call the Colorado Crisis Line or the National Suicide Prevention LifeLine.
• Make your home safer: Adolescents can be impulsive. Lock up and secure any and all firearms, toxic chemicals and medication.

Learn even more with these in-depth resources:

• Why you should talk to kids about suicide
• Teen suicide prevention: teaching teens to ask

During Colorado's child and youth mental health crisis, waiting times for mental healthcare can be long and frustrating – but don't give up!

While you wait for an evaluation, therapy or other treatment for your child, here are some additional ideas for where to look for shorter-term help and support.

Contact your pediatrician

Primary care physicians can screen for mental health conditions such as depression and even prescribe medication. They can also help you find the first available behavioral health appointment.

Try the I Matter program

All Coloradans under 18 are now entitled to three free therapy sessions through the I Matter Program.

Consider group therapy

While finding individual therapy is challenging right now, some practices are offering options that expand access to care. For example, our Pediatric Mental Health Institute is offering additional outpatient group therapy sessions for quicker access. These sessions often provide support to caregivers, too.

Think outside the therapist

Fortunately, therapy is not the only place where children can find support, structure and love to help them through tough times. Here are a few other ideas to help you seek support for you and your child:

• Visit your place of worship: Find out if your religious or spiritual community has groups or activities that might be of interest to your child. A trusted spiritual advisor might also be available to listen and lend support.
• Contact your child's school or teacher: Some schools have in-house counselors, youth activities or other programs that can provide structure before, during or after school.
• Seek out trusted adults: If your child is struggling or having a hard time opening up to you, they may benefit from spending time with a trusted family member or friend who has gone through something similar.
• Contact Colorado Crisis Services: Though it might seem like it, you do not have to be considering suicide to reach out to the Colorado Crisis Line. In fact, there is no wrong reason to call. Visit their website to learn some of the many reasons people call for support. Remember, they offer free, confidential, professional support 24/7/365.