Mental Health Issues

"Mental health issues" is an umbrella term. It encompasses everything that affects a child’s emotional well-being and behavior: low mood, severe anxiety, frequent outbursts of anger, withdrawal, sleep or eating problems, and difficulty concentrating. Experts often refer to these as “psychological abnormalities” when such patterns clearly deviate from what is typical for the child’s age and developmental stage.

The term itself does not imply a diagnosis. A child who sleeps poorly for weeks after a move has a problem, but not necessarily a disorder. Only when the symptoms persist, cause significant distress, and interfere with daily life does a condition requiring treatment come into focus. The article on mental health describes what a stable psyche looks like and what helps strengthen children’s mental well-being. Here, we’re looking at the other side of the coin: behavioral issues and the question of when professional help is needed.

Children develop in leaps and bounds. A three-year-old with tantrums, an eight-year-old afraid of the dark, a teenager who withdraws: much of this is part of growing up and will pass on its own. Parents often find it difficult to make this distinction, and it cannot be determined by a single behavior.

Three questions can help you assess the situation:

• Duration: Do the symptoms persist for weeks instead of subsiding after a few days?
• Level of distress: Is the child visibly suffering, withdrawing, appearing desperate, or constantly tense?
• Daily life: Are important aspects of daily life being neglected—such as school, friendships, hobbies, eating, or sleeping?

The more of these apply and the longer the condition lasts, the more likely it is that a professional evaluation is warranted. The terminology used in this context—such as what experts mean by “noticeable”—is often vague in everyday life. Important: A behavioral issue is not a failure of parenting. It usually has multiple causes, ranging from genetic predisposition to family stressors to experiences at school or among friends.

Mental health issues are common among children and adolescents. According to the nationwide KiGGS study conducted by the Robert Koch Institute, about one in six children between the ages of 3 and 17—that is, about 17 percent—show signs of being at risk for mental health issues. This does not mean that all of these children are ill, but many benefit from attention and support.

The most commonly affected areas are:

• Anxiety: excessive worry, separation anxiety, panic, or avoidance; see “Generalized Anxiety Disorder” for more information.
• Depression: About 5 out of 100 children and adolescents have symptoms indicative of a depressive episode.
• ADHD: Problems with attention, impulse control, and hyperactivity.
• Eating disorders: primarily during adolescence, more common in girls.

The COPSY study conducted by the University Medical Center Hamburg-Eppendorf has shown that psychological distress rose significantly during the COVID-19 pandemic and has only partially recovered since then. Crises in a child’s environment thus have a measurable impact on their mental well-being.

If you’re worried, a calm, concrete approach is more helpful than panicking or waiting it out at all costs.

• Observe and take notes: What have you noticed, since when, how often, and in what situations? Jotting down a few keywords over two to three weeks will reveal patterns. Many parents have similar experiences when they first begin to suspect something is wrong.
• Start a conversation: Without interrogating or blaming. Use short sentences, listen actively, and describe what you see (“You’ve seemed sad a lot lately”).
• Involve a pediatrician: A pediatric and adolescent medicine practice is a good first point of contact. They can check for physical causes and refer you to specialists if necessary. The article “The Family Doctor as the First Point of Contact” explains what’s possible and what isn’t in this context.

Other resources include social pediatric centers, parenting and family counseling centers, and school psychology services. Many counseling services are free and operate confidentially.

Seek help if symptoms persist for weeks, if the child is suffering greatly, or if daily life is falling apart. If there are signs of self-harm, suicidal thoughts, or an acute crisis, act immediately—do not wait. The medical on-call service can be reached at 116 117; in cases of immediate danger, call 112; and the telephone counseling service is available 24/7 at 116 123.

A diagnosis and treatment can only be provided by medical or psychotherapeutic professionals, particularly a child and adolescent psychiatrist or psychotherapist (KJP). Rückenwind Eltern supports and coaches you as parents on this journey. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist; she is not licensed and does not make diagnoses. The coaching is not a substitute for psychotherapy or a medical evaluation, but rather helps you determine the next step and bridge the waiting period until you can see a specialist.