It's important to recognize and treat mental illnesses in children early on. Once mental illness develops, it becomes a regular part of your child's behavior. This makes it more difficult to treat.

But it's not always easy to know when your child has a serious problem. Everyday stresses can cause changes in your child's behavior. For example, getting a new brother or sister or going to a new school may cause a child to temporarily act out. Warning signs that it might be a more serious problem include

• Problems in more than one setting (at school, at home, with peers)
• Changes in appetite or sleep
• Social withdrawal or fear of things he or she did not used to be not afraid of
• Returning to behaviors more common in younger children, such as bedwetting
• Signs of being upset, such as sadness or tearfulness
• Signs of self-destructive behavior, such as head-banging or suddenly getting hurt often
• Repeated thoughts of death

To diagnose mental health problems, the doctor or mental health specialist looks at your child's signs and symptoms, medical history, and family history. Treatments include medicines and talk therapy.

Being mentally healthy during childhood means reaching developmental and emotional milestones and learning healthy social skills and how to cope when there are problems. Mentally healthy children have a positive quality of life and can function well at home, in school, and in their communities.

Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, which cause distress and problems getting through the day. Many children occasionally experience fears and worries or display disruptive behaviors. If symptoms are serious and persistent and interfere with school, home, or play activities, the child may be diagnosed with a mental disorder.

Mental health is not simply the absence of a mental disorder. Children who don’t have a mental disorder might differ in how well they are doing, and children who have the same diagnosed mental disorder might differ in their strengths and weaknesses in how they are developing and coping, and in their quality of life. Mental health as a continuum and the identification of specific mental disorders are both ways to understand how well children are doing.

What are common childhood mental disorders?

Among the more common mental disorders that can be diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), anxiety (fears or worries), and behavior disorders.

Other childhood disorders and concerns that affect how children learn, behave, or handle their emotions can include learning and developmental disabilities, autism, and risk factors like substance use and self-harm.

What are the symptoms of childhood mental disorders?

Symptoms of mental disorders change over time as a child grows, and may include difficulties with how a child plays, learns, speaks, and acts, or how the child handles their emotions. Symptoms often start in early childhood, although some disorders may develop during the teenage years. The diagnosis is often made in the school years and sometimes earlier; however, some children with a mental disorder may not be recognized or diagnosed as having one.

Can childhood mental disorders be treated?

Childhood mental disorders can be treated and managed. There are many treatment options based on the best and most current medical evidence, so parents and doctors should work closely with everyone involved in the child’s treatment — teachers, coaches, therapists, and other family members. Taking advantage of all the resources available will help parents, health professionals, and educators guide the child towards success. Early diagnosis and appropriate services for children and their families can make a difference in the lives of children with mental disorders.

Who is affected?

Childhood mental disorders affect many children and families. Boys and girls of all ages and ethnic/racial backgrounds and living in all regions of the United States experience mental disorders. Based on the National Research Council and Institute of Medicine report, which gathered findings from previous studies, it is estimated that in 2007, 13–20% of children living in the United States (up to 1 out of 5 children) experienced a mental disorder in a given year, costing individuals, families, and society an estimated $247 billion per year.

What is the impact of mental disorders in children?

Mental health is important to overall health. Mental disorders are chronic health conditions—those that go on for a long time and often don’t go away completely—that can continue through the lifespan. Without early diagnosis and treatment, children with mental disorders can have problems at home, in school, and in forming friendships. This can also interfere with their healthy development, and these problems can continue into adulthood.

What you can do

Parents: You know your child best. Talk to your child’s healthcare professional if you have concerns about the way your child behaves at home, in school, or with friends.

Youth: It is just as important to take care of your mental health as it is to take care of your physical health. If you are angry, worried or sad, don’t be afraid to talk about your feelings and reach out to a trusted friend or adult.

Healthcare professionals: Early diagnosis and appropriate treatment based on updated guidelines are very important. There are resources available to help diagnose and treat children’s mental disorders.

Teachers/school administrators: Early identification is important so that children can get the help they need. Work with families and healthcare professionals if you have concerns about the mental health of a child in your school.

Mental health is an important part of overall health for children as well as adults. For many adults who have mental disorders, symptoms were present—but often not recognized or addressed—in childhood and adolescence. For a young person with symptoms of a mental disorder, the earlier treatment is started, the more effective it can be. Early treatment can help prevent more severe, lasting problems as a child grows up.

Warning Signs

It can be tough to tell if troubling behavior in a child is just part of growing up or a problem that should be discussed with a health professional. But if there are behavioral signs and symptoms that last weeks or months, and if these issues interfere with the child’s daily life at home and at school, or with friends, you should contact a health professional.

Young children may benefit from an evaluation and treatment if they:

• Have frequent tantrums or are intensely irritable much of the time
• Often talk about fears or worries
• Complain about frequent stomachaches or headaches with no known medical cause
• Are in constant motion and cannot sit quietly (except when they are watching videos or playing videogames)
• Sleep too much or too little, have frequent nightmares, or seem sleepy during the day
• Are not interested in playing with other children or have difficulty making friends
• Struggle academically or have experienced a recent decline in grades
• Repeat actions or check things many times out of fear that something bad may happen.

Older children and adolescents may benefit from an evaluation if they:

• Have lost interest in things that they used to enjoy
• Have low energy
• Sleep too much or too little, or seem sleepy throughout the day
• Are spending more and more time alone, and avoid social activities with friends or family
• Diet or exercise excessively, or fear gaining weight
• Engage in self-harm behaviors (such as cutting or burning their skin)
• Smoke, drink alcohol, or use drugs
• Engage in risky or destructive behavior alone or with friends
• Have thoughts of suicide
• Have periods of highly elevated energy and activity, and require much less sleep than usual
• Say that they think someone is trying to control their mind or that they hear things that other people cannot hear.

Mental illnesses can be treated. If you are a child or teen, talk to your parents, school counselor, or health care provider. If you are a parent and need help starting a conversation with your child or teen about mental health, visit MentalHealth.gov's Parents and Caregivers page. If you are unsure where to go for help, ask your pediatrician or family doctor or visit NIMH’s Help for Mental Illnesses webpage.

It may be helpful for children and teens to save several emergency numbers to their cell phones. The ability to get immediate help for themselves or for a friend can make a difference.

• The phone number for a trusted friend or relative
• The non-emergency number for the local police department
• The Crisis Text Line: 741741
• The National Suicide Prevention Lifeline: 1-800-273-TALK (8255).

If you or someone you know needs immediate help, call 911 or the National Suicide Prevention LifeLine at 1-800-273-TALK (8255).

Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, which cause distress and problems getting through the day.

Healthcare professionals use the guidelines in The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-5), to help diagnose mental health disorders in children.

• Anxiety and depression in children
• Oppositional Defiant Disorder (ODD)
• Conduct Disorder (CD)
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Tourette Syndrome
• Obsessive-Compulsive Disorder (OCD)
• Post-traumatic Stress Disorder (PTSD)

Other conditions and concerns that affect children’s learning, behavior, and emotions include learning and developmental disabilities, autism, and risk factors like substance use and self-harm.

Many children have fears and worries, and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although some fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression.

Facts

• Anxiety and depression affect many children
  • 7.1% of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety.
  • 3.2% of children aged 3-17 years (approximately 1.9 million) have diagnosed depression.
• Anxiety and depression have increased over time
  • “Ever having been diagnosed with either anxiety or depression” among children aged 6-17 years increased from 5.4% in 2003 to 8% in 2007 and to 8.4% in 2011–2012.
  • “Ever having been diagnosed with anxiety” among children aged 6-17 years increased from 5.5% in 2007 to 6.4% in 2011–2012.
  • “Ever having been diagnosed with depression” among children aged 6-17 years did not change between 2007 (4.7%) and 2011–2012 (4.9%).

Anxiety

When children do not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include

• Being very afraid when away from parents (separation anxiety)
• Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)
• Being very afraid of school and other places where there are people (social anxiety)
• Being very worried about the future and about bad things happening (general anxiety)
• Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Anxiety may present as fear or worry, but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.

Depression

Occasionally being sad or feeling hopeless is a part of every child’s life. However, some children feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations they are able to change. When children feel persistent sadness and hopelessness, they may be diagnosed with depression.

Examples of behaviors often seen in children with depression include

• Feeling sad, hopeless, or irritable a lot of the time
• Not wanting to do, or enjoy doing, fun things
• Showing changes in eating patterns – eating a lot more or a lot less than usual
• Showing changes in sleep patterns – sleeping a lot more or a lot less than normal
• Showing changes in energy – being tired and sluggish or tense and restless a lot of the time
• Having a hard time paying attention
• Feeling worthless, useless, or guilty
• Showing self-injury and self-destructive behavior

Extreme depression can lead a child to think about suicide or plan for suicide. For youth ages 10-24 years, suicide is among the leading causes of death. Read about youth suicide prevention

Some children may not talk about their helpless and hopeless thoughts, and may not appear sad. Depression might also cause a child to make trouble or act unmotivated, causing others not to notice that the child is depressed, or to incorrectly label the child as a trouble-maker or lazy.

Treatment for Anxiety and Depression

The first step to treatment is to talk with a healthcare provider, such as your child’s primary care provider or a mental health specialist, about getting an evaluation. Some of the signs and symptoms of anxiety or depression in children could be caused by other conditions, such as trauma. A mental health professional can develop a therapy plan that works best for the child and family. Behavior therapy includes child therapy, family therapy, or a combination of both. For very young children, involving parents in treatment is key; the school can also be included in the treatment plan. Consultation with a healthcare provider can help determine if medication should be part of the treatment.

Managing Symptoms: Staying Healthy

Being healthy is important for all children, and can be especially important for children with depression or anxiety. In addition to getting the right treatment, leading a healthy lifestyle can play a role in managing symptoms of depression or anxiety. Here are some healthy behaviors that may help:

• Having a healthy eating plan centered on fruits, vegetables, whole grains, legumes (beans, peas, and lentils), lean protein sources, and nuts and seeds
• Participating in physical activity each day based on age
• Getting the recommended amount of sleep each night based on age
• Practicing mindfulness or relaxation techniques

ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

Signs and Symptoms

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

Types

There are three different types of ADHD, depending on which types of symptoms are strongest in the individual:

• Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

• Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

• Combined Presentation: Symptoms of the above two types are equally present in the person.

Because symptoms can change over time, the presentation may change over time as well.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies of twins link genes with ADHD.

In addition to genetics, scientists are studying other possible causes and risk factors including:

• Brain injury
• Exposure to environmental (e.g., lead) during pregnancy or at a young age
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

Diagnosis

Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Diagnosing ADHD usually includes a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Treatments

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment before medication is tried. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with ADHD. In addition to behavioral therapy and medication, having a healthy lifestyle can make it easier for your child to deal with ADHD symptoms. Here are some healthy behaviors that may help:

• Developing healthy eating habits such as eating plenty of fruits, vegetables, and whole grains and choosing lean protein sources
• Participating in daily physical activity based on age
• Limiting the amount of daily screen time from TVs, computers, phones, and other electronics
• Getting the recommended amount of sleep each night based on age

Get Help!

If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older).

The Centers for Disease Control and Prevention (CDC) funds the National Resource Center on ADHD, a program of CHADD – Children and Adults with Attention-Deficit/Hyperactivity Disorder. Their website has links to information for people with ADHD and their families. The National Resource Center operates a call center (1-800-233-4050) with trained staff to answer questions about ADHD.

ADHD in Adults

ADHD can last into adulthood. Some adults have ADHD but have never been diagnosed. The symptoms can cause difficulty at work, at home, or with relationships. Symptoms may look different at older ages, for example, hyperactivity may appear as extreme restlessness. Symptoms can become more severe when the demands of adulthood increase.

Many children occasionally have thoughts that bother them, and they might feel like they have to do something about those thoughts, even if their actions don’t actually make sense. For example, they might worry about having bad luck if they don’t wear a favorite piece of clothing. For some children, the thoughts and the urges to perform certain actions persist, even if they try to ignore them or make them go away. Children may have an obsessive-compulsive disorder (OCD) when unwanted thoughts, and the behaviors they feel they must do because of the thoughts, happen frequently, take up a lot of time (more than an hour a day), interfere with their activities, or make them very upset. The thoughts are called obsessions. The behaviors are called compulsions.

All children may experience very stressful events that affect how they think and feel. Most of the time, children recover quickly and well. However, sometimes children who experience severe stress, such as from an injury, from the death or threatened death of a close family member or friend, or from violence, will be affected long-term. The child could experience this trauma directly or could witness it happening to someone else. When children develop long term symptoms (longer than one month) from such stress, which are upsetting or interfere with their relationships and activities, they may be diagnosed with post-traumatic stress disorder (PTSD).

Examples of PTSD symptoms include

• Reliving the event over and over in thought or in play
• Nightmares and sleep problems
• Becoming very upset when something causes memories of the event
• Lack of positive emotions
• Intense ongoing fear or sadness
• Irritability and angry outbursts
• Constantly looking for possible threats, being easily startled
• Acting helpless, hopeless or withdrawn
• Denying that the event happened or feeling numb
• Avoiding places or people associated with the event

Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD).

Examples of events that could cause PTSD include

• Physical, sexual, or emotional maltreatment
• Being a victim or witness to violence or crime
• Serious illness or death of a close family member or friend
• Natural or manmade disasters
• Severe car accidents

Treatment for PTSD

The first step to treatment is to talk with a healthcare provider to arrange an evaluation. For a PTSD diagnosis, a specific event must have triggered the symptoms. Because the event was distressing, children may not want to talk about the event, so a health provider who is highly skilled in talking with children and families may be needed. Once the diagnosis is made, the first step is to make the child feel safe by getting support from parents, friends, and school, and by minimizing the chance of another traumatic event to the extent possible. Psychotherapy in which the child can speak, draw, play, or write about the stressful event can be done with the child, the family, or a group. Behavior therapy, specifically cognitive-behavioral therapy, helps children learn to change thoughts and feelings by first changing behavior in order to reduce the fear or worry. Medication may also be used to decrease symptoms.

Prevention of PTSD

It is not known exactly why some children develop PTSD after experiencing stressful and traumatic events, and others do not. Many factors may play a role, including biology and temperament. But preventing risks for trauma, like maltreatment, violence, or injuries, or lessening the impact of unavoidable disasters on children, can help protect a child from PTSD.

Mental Health in Childhood

Raising a child can be challenging. Even under the best circumstances, their behaviors and emotions can change frequently and rapidly. All children are sad, anxious, irritable, or aggressive at times, or they occasionally find it challenging to sit still, pay attention, or interact with others. In most cases, these are just typical developmental phases. However, such behaviors may indicate a more serious problem in some children.

Mental disorders can begin in childhood. Examples include anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, depression and other mood disorders, eating disorders, and post-traumatic stress disorder (PTSD). Without treatment, these mental health conditions can prevent children from reaching their full potential. Many adults who seek mental health treatment reflect on the impact of mental disorders on their childhood and wish they had received help sooner.

When to Seek Help

Even under the best of circumstances, it can be hard to tell the difference between challenging behaviors and emotions that are consistent with typical child development and those that are cause for concern. It is important to remember that many disorders like anxiety, attention deficit hyperactivity disorder and depression, do occur during childhood. In fact, many adults who seek treatment reflect back on how these disorders affected their childhood and wish that they had received help sooner. In general, if a child’s behavior persists for a few weeks or longer, causes distress for the child or the child’s family, and interferes with functioning at school, at home, or with friends, then consider seeking help. If a child’s behavior is unsafe, or if a child talks about wanting to hurt him or herself or someone else, then seek help immediately.

Young children may benefit from an evaluation and treatment if they:

• Have frequent tantrums or are intensely irritable much of the time
• Often talk about fears or worries
• Complain about frequent stomachaches or headaches with no known medical cause
• Are in constant motion and cannot sit quietly (except when they are watching videos or playing videogames)
• Sleep too much or too little, have frequent nightmares, or seem sleepy during the day
• Are not interested in playing with other children or have difficulty making friends
• Struggle academically or have experienced a recent decline in grades
• Repeat actions or check things many times out of fear that something bad may happen.

Older children and adolescents may benefit from an evaluation if they:

• Have lost interest in things that they used to enjoy
• Have low energy
• Sleep too much or too little, or seem sleepy throughout the day
• Are spending more and more time alone, and avoid social activities with friends or family
• Fear gaining weight, or diet or exercise excessively
• Engage in self-harm behaviors (e.g., cutting or burning their skin)
• Smoke, drink, or use drugs
• Engage in risky or destructive behavior alone or with friends
• Have thoughts of suicide
• Have periods of highly elevated energy and activity, and require much less sleep than usual
• Say that they think someone is trying to control their mind or that they hear things that other people cannot hear.

First Steps for Parents

If you are concerned about your child’s mental health, you can start by talking with others who frequently interact with your child. For example, ask their teacher about your child’s behavior in school, at daycare, or on the playground.

You can talk with your child’s pediatrician or health care provider and describe the child’s behavior, as well as what you have observed and learned from talking with others. You also can ask the health care provider for a referral to a mental health professional who has experience and expertise in treating children.

Choosing a Mental Health Professional

When looking for a mental health professional for your child, you may want to begin by asking your child’s pediatrician for a referral. If you need help identifying a provider in your area, you can call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). It’s especially important to look for a mental health professional with training and experience treating children, particularly your child's specific problems.

Asking questions and providing information to your child’s health care provider can improve your child’s care. Talking with the health care provider builds trust and leads to better results, quality, safety, and satisfaction. Here are some questions you can ask when meeting with prospective treatment providers:

• Do you use treatment approaches that are supported by research?
• Do you involve parents in the treatment? If so, how are parents involved?
• Will there be “homework” between sessions?
• How will progress be evaluated?
• How soon can we expect to see progress?
• How long should treatment last?

Assessing Your Child’s Behavior

An evaluation by a mental health professional can help clarify problems underlying your child’s behavior and provide reassurance or recommendations for the next steps. An evaluation offers an opportunity to learn about your child’s strengths and weaknesses and to determine which interventions might be most helpful.

A comprehensive evaluation of a child’s mental health includes the following:

• An interview with the parents to discuss the child’s developmental history, temperament, relationships with friends and family, medical history, interests, abilities, and any prior treatment. It is important for the mental health professional to get a picture of the child’s current situation—for example, a recent change in schools, an illness in the family, or another change that affects the child’s daily life.
• Information gathering from the child’s school, such as standardized tests and reports on behavior, capabilities, and difficulties.
• If needed, an interview with the child and the mental health professional’s testing and behavioral observations.

Treatment Options

The mental health professional will review the evaluation results to help determine if a child’s behavior is related to changes or stresses at home or school or if it’s the result of a disorder for which they would recommend treatment. Treatment recommendations may include:

• Psychotherapy (“talk therapy”). There are many different approaches to psychotherapy, including structured psychotherapies directed at specific conditions. Effective psychotherapy for children always includes:
  • Parent involvement in the treatment
  • Teaching the child skills to practice at home or school (between-session "homework assignments")
  • Measures of progress (such as rating scales and improvements on “homework assignments”) that are tracked over time.
• Medications. As with adults, the type of medicines used for children depends on the diagnosis and may include antidepressants, stimulants, mood stabilizers, or other medications. Medications are often used in combination with psychotherapy. If multiple health care providers or specialists are involved, treatment information should be shared and coordinated to achieve the best results.
• Family counseling. Including family members in treatment can help them to understand how a child's challenges may affect relationships with parents and siblings.
• Support for parents. Individual or group sessions for parents that include training and the opportunity to talk with other parents can provide new strategies for supporting a child and managing difficult behavior in a positive way. The therapist also can coach parents on how to communicate and work with schools on accommodations.

Working With the School

Children who have behavioral or emotional challenges that interfere with success in school may benefit from plans or accommodations provided under laws that prevent discrimination against children with disabilities. Your child’s health care providers can help you communicate with the school.

A first step may be to ask the school whether accommodations such as an individualized education program may be appropriate for your child. Accommodations might include measures such as providing a child with a tape recorder for taking notes, allowing more time for tests, or adjusting seating in the classroom to reduce distraction.

Each year, children and adolescents experience disasters and other traumatic events. Parents, rescue workers, and members of the larger community can help children start the process of recovery and overcome these experiences.

What is trauma?

When people think of trauma, they often focus on physical injuries. However, people also can experience psychological trauma after witnessing or experiencing distressing events.

Trauma can be caused by natural disasters such as hurricanes, earthquakes, and floods. It also can be caused by acts of violence—such as terrorist attacks and mass shootings—as well as motor vehicle and other accidents.

Reactions to trauma can be immediate or delayed. Responses may differ in severity and can include a wide range of behaviors and responses, sometimes influenced by culture.

Factors that may make people more sensitive to trauma include:

• Having direct involvement in the trauma, especially as a victim
• Having severe or prolonged exposure to the event
• Having a personal history of prior trauma
• Having a family or personal history of mental illness or severe behavioral problems
• Having limited social support or a lack of caring family and friends
• Having ongoing life stressors such as moving to a new home or new school

Common Responses to Trauma Among Children

Children age five and younger may:

• Cling to parents or caregivers.
• Cry and be tearful.
• Have tantrums and be irritable.
• Complain of physical problems such as stomachaches or headaches.
• Suddenly return to behaviors such as bed-wetting and thumb-sucking.
• Show increased fearfulness (for example, of the dark, monsters, or being alone).
• Incorporate aspects of the traumatic event into imaginary play.

Children age six to 11 may:

• Have problems in school.
• Isolate themselves from family and friends.
• Have nightmares, refuse to go to bed, or experience other sleep problems.
• Become irritable, angry, or disruptive.
• Be unable to concentrate.
• Complain of physical problems such as stomachaches and headaches.
• Develop unfounded fears.
• Lose interest in fun activities.

Adolescents age 12 to 17 may:

• Have nightmares or other sleep problems.
• Avoid reminders of the event.
• Use or abuse drugs, alcohol, or tobacco.
• Be disruptive or disrespectful or behave destructively.
• Complain of physical problems such as stomachaches and headaches.
• Become isolated from friends and family.
• Be angry or resentful.
• Lose interest in fun activities.

In addition, children and adolescents may feel guilty for not preventing injury or deaths. They also may have thoughts of revenge.

Many of these are normal and expected early responses, which for most people will lessen with time. If they last for more than a month, contact a licensed mental health professional.

If You or Someone You Know Is in Crisis and Needs Immediate Help

Some symptoms require immediate emergency care. If you or someone you know is thinking about harming themselves or attempting suicide, seek help right away:

• Call your doctor.
• Call 911 for emergency services or go to the nearest emergency room.
• Call the National Suicide Prevention Lifeline, a 24-hour toll-free hotline, at 800-273-TALK (8255). The deaf and hard of hearing can contact the Lifeline via TTY at 800-799-4889. The Lifeline is available 24 hours a day, seven days a week.
• Contact social media outlets directly if you are concerned about a person’s social media updates or dial 911 in an emergency.

Take any comments about suicide or wishing to die seriously—even those said by children and adolescents. Even if you do not believe your family member or friend will attempt suicide, the person is in distress and can benefit from your help in finding treatment.

Disaster Distress Helpline

The Substance Abuse and Mental Health Services Administration’s Disaster Distress Helpline provides crisis counseling (24 hours a day, 365 days a year) for those experiencing emotional distress due to natural or human-made disasters. This service is provided in more than 100 languages and is confidential. To contact the helpline:

• Call or text 800-985-5990.
  • Spanish speakers can call 800-985-5990 and press 2 for 24/7 bilingual support.
  • The deaf and hard of hearing can contact the Helpline via TTY at 800-846-8517.
• Visit Disaster Distress Helpline's website.

Help in the First Days and Weeks

After a disaster or other traumatic event, there are steps people can take to help adult trauma survivors cope, making it easier for them to provide better care for children and adolescents. These include creating safe conditions, remaining calm, being friendly, and connecting with others. Being sensitive to people under stress and respecting their decisions is important.

When possible, help people:

• Get food.
• Find a safe place to live.
• Get help from a doctor or nurse.
• Connect with loved ones or friends.
• Find information on where to get help.

Don’t:

• Force people to tell their stories.
• Probe for personal details.
• Say things like “everything will be OK” or “at least you survived.”
• Say what you think people should feel or how people should have acted.
• Say people suffered because they deserved it.
• Be negative about available help.
• Make promises that you can’t keep, such as “you will go home soon.”

What can parents do to help children and adolescents?

After a traumatic event, parents and family members should identify and address their own feelings—this can allow them to help others. Explain to children what happened and let them know that:

• You love them.
• The event was not their fault.
• You will do your best to take care of them.
• It’s okay for them to feel upset.

Do:

• Allow children to be sad or cry.
• Let children talk, write, or draw pictures about the event and their feelings.
• Limit viewing of repetitive news reports about traumatic events. Young children may not understand that news coverage is about one event and not multiple similar events.
• Give extra attention to children who have trouble sleeping. Let them sleep with a light on or let them sleep in your room (for a short time).
• Try to keep your usual routines (or create new routines), such as reading bedtime stories, eating dinner together, or playing games.
• Help children feel in control when possible by letting them make decisions for themselves, such as choosing meals or picking out clothes.
• Contact a health professional if, after a month in a safe environment, children are not able to perform their usual routines.
• Contact a health care provider if new behavioral or emotional problems develop, particularly if these symptoms occur for more than a few weeks:
  • Flashbacks (flashbacks are the mind reliving the event)
  • A racing heart and sweating
  • Being easily startled
  • Being emotionally numb
  • Being very sad or depressed

Don’t:

• Expect children to be brave or tough.
• Make children discuss the event before they are ready.
• Get angry if children show strong emotions.
• Get upset if they begin bed-wetting, acting out, or thumb-sucking.

Children’s reactions to trauma are strongly influenced by adults’ responses to trauma. Parents can help children by being supportive, by remaining as calm as possible, and by reducing other stressors, such as:

• Frequent moves or changes in place of residence
• Long periods away from family and friends
• Pressures to perform well in school
• Fighting within the family

When monitoring healing, remember:

• Healing takes time.
• Do not ignore severe reactions.
• Pay attention to sudden changes in behaviors, speech, language use, or strong emotions.

What can rescue workers do to help?

During and after a traumatic experience, rescue workers can help by:

• Identifying children, adolescents, and families in need of urgent and immediate medical or mental health services.
• Staying with and helping to calm children and adolescents in acute distress. Signs of acute distress include trembling, rambling, becoming mute, or exhibiting erratic behavior.
• Protecting children and adolescents from physical danger, exposure to additional traumatic sights and sounds, and onlookers and the media.
• Kindly but firmly directing children and adolescents away from the event site.
• Connecting—and keeping—children and adolescents with family and friends.

Rescue workers can reduce survivors’ fear and anxiety by using compassionate communication. When communicating with survivors, rescue workers should:

• Clearly identify themselves and their role in disaster response.
• Communicate calmly, slowly, and with empathy.
• Be factual, avoid answering questions outside their area of expertise, and avoid speculation.
• Acknowledge and be tolerant of strong emotions and behaviors.

What can community members do after a traumatic event?

After a traumatic event, community members should identify and address their own feelings as this may allow them to help others more effectively.
Community members can help children and adolescents by:

• Offering their buildings and institutions as gathering places to promote support
• Helping families identify mental health professionals who can counsel children
• Helping children develop coping skills, problem-solving skills, and ways to deal with fear
• Holding parent meetings to discuss the event, their child’s response, and how parents can help their child
• Being sensitive to different cultural responses to trauma and stress