Notice the Signs: Common Disorders Among Children & Teens
It’s not always easy being a kid. Children and teens face daily challenges and stressors that can be compounded by a variety of common issues, ranging from depression and anxiety to eating disorders and ADHD. We talked to local experts about how parents can watch for warning signs and take action to get their kids the support they need.
What they look like: The median age of onset for both bulimia nervosa and anorexia nervosa is 18, but Dr. Sarah Garwood, an adolescent medicine physician at St. Louis Children’s Hospital, says there is a growing number of preteens developing eating disorders. “Warning signs include making excuses not to eat with the family and changing dietary habits, such as eliminating entire food groups,” she explains. “Children also may make comments about disliking their bodies or wanting to lose weight.” She adds that actual weight loss sometimes can be tricky to gauge. It doesn’t come with disorders like bulimia, and in cases of anorexia, the change can be gradual, so parents might not notice initially.
What parents can do: “It’s always best to start with a visit to your pediatrician,” Garwood says. “They can give you advice and connect you with more resources and support.” With anorexia, the first priority after diagnosis is weight restoration. After nutritional rehabilitation, therapy can help adolescents work through body image issues and form a healthier perspective. At home, Garwood suggests having as many family meals together as possible.
To help address eating disorders preemptively, she says to avoid talking about weight and body shape with young children. “Don’t criticize the weight of others or talk about needing to lose a few pounds yourself,” she notes. “Instead, make the conversation about healthy bodies and smart eating decisions. If your child is complaining about her body, help her focus on all of the good things it can do, not what it looks like.”
Eating disorders are twice as prevalent among girls.
What it looks like: Excess weight puts children and teens at risk for high blood pressure, type 2 diabetes, high cholesterol, joint problems and more. If you’re worried about your child’s weight, Garwood suggests consulting
your pediatrician. “It’s really important that you don’t shame your child for being overweight,” she adds. “The goal is to have a healthy body image while making better choices about diet and exercise.”
What parents can do: “It’s important to be good role models,” Garwood says. “Demonstrate proper exercise and diet and don’t talk negatively about your body. Your kids will see the relationship between having a healthy attitude about your weight and taking good care of your body.” She adds that it’s important to focus on health. If your child makes lifestyle improvements but doesn’t see a drastic change in weight, spotlight how the changes are the right steps toward being healthy
Obesity impacts around 18.5% of children and adolescents in the U.S.
What it looks like: “An anxious brain overestimates the probability and severity of a negative reaction,” says Jennifer Kamer, a licensed professional counselor with the Saint Louis Behavioral Medicine Institute. “The No. 1 coping mechanism people employ is avoiding whatever triggers that response.” Adolescents may try to get out of going to school or choose not to participate in class. Those dealing with social anxiety may avoid making eye contact or resist tasks that necessitate interacting with strangers, like ordering food or going through a check-out line.
While anxiety disorders often are triggered by puberty, they still can affect younger children, according to Kamer. “Kids under 13 don’t always have the vocabulary to describe what they’re feeling,” she says. “They often discuss anxiety in terms of physical symptoms. They may not want to speak in class because it gives them a headache, or meeting new people might cause a stomachache.” Younger kids also might seek reassurance by asking repeated questions about the source of their anxiety. For example, if they are scared of storms, they may repeatedly ask an adult to check the weather.
What parents can do: Kamer notes that it’s important to be educated about the issue. There are many books and resources available, including support groups. She also suggests talking with teens about what triggers their anxiety and how certain actions make them nervous. For younger children, Kamer cautions against constant reassurance. “While it lowers their anxiety in the moment, it is not a healthy, long-term solution,” she says. “It reinforces that their fears are valid.” Instead, she suggests introducing them to mindfulness activities, which can help them relax.
More than 30% of adolescents have an anxiety disorder, and 8.3% struggle with severe impairment.
What it looks like: Obsessive compulsive disorder is more common in teens than children. Only 25% of cases present before the age of 14, according to Dr. Jennifer Heithaus, a SLUCare development pediatrician at SSM Health Cardinal Glennon Children’s Hospital. “OCD is characterized by obsessive, intrusive thoughts and compulsive behaviors,” she explains. Indicators for the disorder are any behaviors repeated over a significant portion of the day.
Heithaus adds that the intrusive thoughts and compulsive behaviors don’t always seem connected. “There can be a logical link, such as excessive hand washing because of preoccupation with germs, but it can be any repetitive behavior done to relieve the thought,” she says. “Someone may think he’ll be in a car crash if he doesn’t touch the car door five times before getting in.”
What parents can do: OCD tendencies can look like anxiety or depression, Heithaus notes. She suggests consulting a professional about any significant behavioral changes that impact your child’s school performance, social life and extracurriculars. “OCD is a unique disorder,” she says. “Your physician can help connect you with a psychologist who is trained to help with these types of behaviors and thoughts.”
Early-onset OCD impacts around 3% of children and adolescents.
What it looks like: Isolation and a loss of interest are common indicators, according to Kamer. Changes in appetite, sleeping more and difficulty concentrating also are signs that adolescents are struggling with depression. “To make themselves feel better, teens often turn to an outside source, such as alcohol, drugs or self-harm,” she adds. “Boys especially may seem irritable or angry.”
What parents can do: “Depression includes a ‘shutting down’ factor, so it can be hard for children or teens to talk about what they are feeling,” Kamer says. “The most important thing is that parents have calm and empathetic responses. Being too critical can be invalidating, and adolescents internalize that there is something wrong with them.” Professional counseling can help parents work collaboratively with their children, and your family doctor or pediatrician can refer you to additional resources.
An estimated 3.2 million adolescents in the U.S. have had at least one major depressive episode.
What it looks like: “Attention-deficit/hyperactivity disorder is a developmental disorder, so it is present all along,” Heithaus says. “In younger kids, it often looks like a high activity level and can be easy for parents to pick up on. With age, the hyperactivity tends to lessen, and in its place, you’ll see more inattention and disorganization.” Warning signs of inattentive ADHD include an inability to keep up with schoolwork and a messy room. Heithaus adds that it sometimes looks like a learning disability since it impacts academic performance.
What parents can do: Parents should work closely with their children’s schools. Heithaus notes it’s likely that teachers will observe the same warning signs. “The school can provide services and make modifications to help students with ADHD,” she says. “You also can consult with your pediatrician to determine if medication is necessary. Many kids benefit from working with a psychologist as well.”
ADHD affects three times as many males as females.
Additional sources: National Institute for Mental Health, Centers for Disease Control