Depression, anxiety, ADHD. How do you know whether your child is displaying age-appropriate tantrums or moodiness, or if they potentially have a mental health problem?

Mental health conditions can manifest earlier in life than you may think. “When we ask the teenagers we treat how long they’ve been feeling like this, you’d be surprised by how many will say, ‘I’ve always felt this way’,” says Dr Androula Ladikos, a child psychiatrist at Mediclinic Denmar Mental Health Services. They’ll often say they didn’t know who to tell or didn’t think it was important or didn’t want to worry their parents.

“We need to have this awareness, otherwise that’s a window of opportunity and a chance for a better quality of life missed,” says Dr Ladikos. “With the brain being such a neuroplastic organ [meaning it can change and adapt through growth and reorganisation], it’s unfair not to offer an intervention if we can.” But how do you determine whether your child may have a mental health disorder?


Teens and tweens

If you notice any drastic changes in your teen’s behaviour, consider getting them professional medical help.

Slamming doors or grunting in response to questions are common teenage behaviours. But if you feel their behaviour is becoming dysfunctional or out of control, consult a mental health professional, says Dr Philip van Rensburg, a clinical psychologist who works with teenagers at Mediclinic Denmar Mental Health Services.

“As children become teenagers, their moods usually become more extreme,” he explains. “Their irritation levels are higher and if they’re down, they’re very down. The frontal lobe, which controls emotional regulation, is still developing. It’s difficult for them sometimes to identify their feelings as symptoms of depression or anxiety.”

In establishing a deeper problem, Dr Van Rensburg suggests looking at your teen’s functioning. “If there’s a drastic change in their normal behaviour, take notice. For example, if suddenly their marks drop, they’re regularly ill, don’t want to go to school, avoid their friends, constantly stay in their rooms, don’t want to go out or talk to anyone, then consider medical intervention to ensure there are no deeper issues at play.”


Random and unprovoked tantrums may be a sign your child needs medical assessment.

You need to also look at children’s behaviour in the context of their developmental level to determine whether it’s normal, says Dr Ladikos. “A two- to three-year-old child will tantrum when they can’t get something right because they don’t yet have the language to express how they feel. So they’ll often react with a change in behaviour. You look at what the triggers or the behaviours are and whether they’re provoked or unprovoked. Usually, unprovoked temper tantrums are a concern because it’s difficult to identify a trigger and they’re unpredictable.”


Teens and tweens

Attention deficit hyperactivity disorder (ADHD) has three categories of problems: concentration, impulsive behaviour, and hyperactivity. “Regardless of when children are diagnosed, their concentration issues must have been prevalent before the age of 12,” explains Dr Van Rensburg.

Symptoms include:

  • Struggling to concentrate
  • Hyperactivity (may or may not be present)
  • Sensitivity to sounds
  • Postponing tasks
  • Not task orientated
  • Forgetfulness
  • Impulsivity.

“People think ADHD kids are lazy or can’t concentrate at all, which is not the case,” he adds. “These children can play video games for days. They use their thumbs to play – there is activity going on, so they can concentrate. But don’t give them a history book they’re not interested in – that’s when their minds drift. If they’re interested in the task, they can concentrate and focus.”


ADHD can present very young but it’s difficult to diagnose before the age of three-and-a-half, when children start socialising, says Dr Ladikos. “Here, you don’t necessarily see symptoms in the nursery school classroom because there’s a lot of structure, and the teachers are very hands on. We normally pick up signs of ADHD in the playground, where there’s limited supervision. That’s when they get very impulsive, climbing as high as they can or suddenly hitting a friend.”

Factors to consider include a strong genetic history, obstetric complications, and early separation from parents.“Often attachment or attention-seeking behaviour can be misinterpreted as hallmarks of a naughty, difficult child. Always put behaviour into context and know what is and isn’t normal.”

It’s important to monitor your child for persistent signs of depression or anxiety.

Teens and tweens

In children of all ages, COVID-19 increased incidences of depression and anxiety as they couldn’t meet their innate need for socialisation, says Dr van Rensburg. Signs include:

  • Persistent low mood or constant worrying
  • Change in sleeping patterns
  • Lack of energy
  • Reduced appetite
  • Reduced concentration
  • Short-term memory loss
  • Increased irritability and frustration
  • Crying about insignificant things
  • Increased sensitivity
  • All-or-nothing thinking.

All kids get anxious, says Dr Ladikos. “They go through different phases where they’re scared of the dark or of the boogey man under their bed – they have very rich fantasies. What they hear and see can affect their anxiety levels, but if they’re excessively anxious, this must be investigated. Signs of anxiety in a child include:

  • Won’t separate
  • Won’t go to school
  • Constantly has headaches and tummy aches.

“Sometimes anxiety is genetic,” says Dr Ladikos. “There’s a lot of transference from a very anxious parent to a child.” With any mental health concerns, look at the family history, the home situation, and any traumas the child may have experienced. “The developmental level of the child is also key when investigating symptoms and making a diagnosis.”

No one is ever too young to get depressed, but it can be difficult to diagnose with younger children as they don’t have the language to adequately express how they feel.

“However, their behaviour will tell you there’s a problem,” says Dr Ladikos. Everything from clinginess to a change in sleeping or eating patterns, to failure to make expected weight gain can signal depression. “Sometimes we must show them pictures of faces, because most children from age four years, and sometimes younger, can identify facial expressions and indicate which one represents how they feel.”

Play therapy is a way to provide psychotherapy for younger children.

Psychotherapy is essential – whether it be through play therapy for smaller kids, or cognitive behavioural therapy (CBT) for teens to challenge destructive thought patterns. This can be combined with the lowest effective dose of medication, if needed. “The benefit of medicine – often an absolute blessing – must always outweigh the risk,” says Dr Ladikos.

“The combination of the two – therapy and medication – creates a win-win situation,” adds Dr Van Rensburg.

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