Researchers tracked 1,059 participants between the ages of 8 and 9 up to ages 11 and 12. They assessed the children annually for four years but only asked about self-harm the last year. Predictors of future self-harm included symptoms of depression or anxiety, being the victim of bullying, and recent alcohol experimentation. By the last year, 3% of the children reported engaging in self-harm. The 11- and 12-year-olds who did self-harm were more likely to have few friends, display poor emotional control, show antisocial behaviors, carry a weapon, and be in mid to late puberty. Researchers determined that society needs to make a greater effort around young people’s mental health due to these reported considerations.
Young Children’s Mental Health Can Be Overlooked
Though 20% of young people struggle with mental health conditions at some point—half developing an issue by age 14—this vulnerable group isn’t provided the resources and help they need. “Children can be overlooked when they struggle with mental health challenges. Adults interpret their behavior as being ‘rude,’ ‘disrespectful,’ ‘unmotivated,’ ‘lazy,’ or ‘not well-behaved,’” says Dr. Eva Lazar, a psychologist at The Lazar Center. “In reality, the child is struggling with mental health challenges and needs to be treated as such.” Children may internalize their emotions, making it harder for an adult to notice that they’re struggling. “It is easy for parents and teachers to miss the signs of internalizing problems—things like anxiety and depression—in children because oftentimes children don’t know how to express what is happening within them,” says Jessie Borelli, PhD, an associate professor of psychological science at University of California, Irvine. “They don’t know how to put their problems into words and may think they are the only ones experiencing the problems they have, which in turn contributes to a sense of isolation and may make them less likely to want to talk about their problems," Borelli adds. Parents and school officials can better educate children about mental health and proactively intervene and help children cope with these normal issues healthily. “Mental health should be a conversation at the school, home, and everywhere,” says Dr. Hillary Blake, PsyD, a child psychiatrist at Riley Children’s Health.
Signs a Child Is Self-Harming
The first step is determining which signs to look out for. “Young children do not often have the language to express their pain, which is why their actions, particularly self-harm, communicate so much significance,” says Dr. Sabrina Romanoff, a Harvard-trained clinical psychologist.
Wearing Long Sleeves in Warm Weather
“Children who exclusively wear long-sleeved shirts, sweatshirts, or pants when it is very warm outside may be harming and hiding marks from self-harm,” says Borelli. “Teachers or school counselors may wish to check in with those students who wear clothing that covers their entire body during the hot months, as this may be a sign that they are uncomfortable showing their bodies for reasons related to self-harm.” She stresses that long clothes may not have anything to do with self-harm, so it’s important to ask open-ended questions instead of assuming the answer.
Lost Interest in Previously Enjoyed Activities
If you notice that your child seems completely disinterested in activities that used to excite them, this may be a sign they are dealing with depression. Have an open conversation and watch them closely, says Lazar.
Mood Shifts and Increased Agitation
Everyone has off days, but a drawn-out low mood change may indicate that a child is susceptible to self-harm. “Children will often exhibit strong changes in mood relating to increased symptoms of anxiety and depression, including agitation that is more prevalent in adolescent presentations of the disorder,” says Romanoff. Instead of calling out a child’s mood or indicating that they are acting poorly, take time to discuss what may be bothering them.
Sudden Poor Performance In School
A quick grade dip in subjects a child previously excelled in may be a sign they’re experiencing a mental health issue. “A red flag is when children engage in school avoidance or if they stop performing academically when historically they did not struggle in school,” says Lazar. Ask your child about the change in performance without judgment to determine a potential cause.
Cuts or Bruises That Can’t Be Accounted For
A more obvious sign of self-harm is the regular appearance of cuts and bruises. “These cuts are often linear, parallel, [and] usually found on the insides of the arm, inner thigh, or sides,” says Romanoff. “Look for other signs like unexplained scratches or recurring marks that your child struggles to account for.”
How Parents Can Intervene Effectively
Parents can do a great deal to help their children deal with mental health issues.
Listen and Observe
While your child may not outright say they’re struggling with mental health issues, they may be showing you. “It is important to listen to what they are communicating with their actions instead of through spoken language. Actions often provide insight into true intention,” says Romanoff. “Don’t get distracted by the content if they are telling you they’re fine but are communicating the opposite through action.”
Talk Openly About Your Feelings
It’s easy to take “fine” or “OK” as responses to your child’s day, but opening a dialogue where you both discuss your feelings can create a safe environment for them to return to when needed. “It is recommended that parents have an open environment to talk about mental health with their children,” says Blake. “Oftentimes, this is a topic that is not discussed in families.” Borelli concurs: “Parents can also model healthy emotion regulation and emotion expression behaviors for their children by talking about their feelings. For instance, when they are feeling stressed about something, they can talk about what they are feeling and talk about what they are doing to manage their stress.”
Validate Your Child’s Feelings
“Parents should take time to check in with their children regarding stressors, mood, [and] friendships. When parents talk to children, they should be sure to validate their child’s feelings, rather than invalidate or dismiss them,” says Blake. Again, a child may not fully understand or feel comfortable sharing their emotions and need a nonjudgmental, caring person to help them work through their thoughts—whether it be a parent or mental health professional.
Be Proactive
Now is not the time to give your child space to figure things out on their own. If you notice concerning behavior, symptoms of depression, or believe something is wrong, Romanoff recommends addressing it with your child. Instead of taking an accusatory stance, be ready to listen, problem solve, and meet your child where they are.
Remove Items That May Be Used to Self-Harm
If you are worried that your child may be self-harming, removing items they may use to harm themselves is another crucial step to take. Borelli recommends parents consult with a mental health professional on which objects to get rid of or put away.
Take Your Child Seriously
It will be hard for a child to share that they’re self-harming or suicidal, so any small mention should be taken seriously. “Some parents may become desensitized when their children talk about suicide consistently and tend to write it off as being dramatic or as a developmental phase,” says Romanoff. “Always take your child’s communication about self-harm seriously, as they are attempting to send you a message in the best way they know how.”
How Schools Can Help
Schools can create an informative and safe space for mental health discussions and issues, on top of parental intervention.
Integrate Mental Health Education
As of 2018, New York state requires mental health education from kindergarten to twelfth grade, but the law is an anomaly. Professionals believe integrating this into schools can make a big difference for children. “Schools should focus on providing school-wide prevention programming that addresses ‘first-aid’ mental health skills, prosocial skills, positive coping mechanisms, and social inclusion,” says Lazar. “These early intervention programs can serve as a protective step for vulnerable and at-risk children.” The addition of a social-emotional curriculum can teach children to express their feelings openly and that there is no shame in experiencing negative thoughts. “In these programs, children learn about emotions, cognitions (thoughts), as well as adaptive tools for managing emotions,” says Borelli. “By introducing these programs in an educational environment, these programs help to destigmatize emotions and negative beliefs about self, which ought to help children who are struggling feel they can reach out to a teacher or parent to talk about their distress," she says.
Train Teachers to Recognize the Signs of Poor Mental Health
The entire scope of adolescent mental health shouldn’t fall to teachers, but with the right training, they can help create an environment accepting of mental health struggles and notice when a child needs help. “Teachers should be trained to integrate these skills as part of the classroom environment and to serve as the first line of defense in identifying vulnerable children,” says Lazar. “Training teachers and educating all children [about] mental health at a young age will destigmatize mental health challenges and create a caring and supportive school environment.”
Options For a Child to Get Help
With the right help, a child can safely deal with their mental health issues.
Seek Help From a Trained Mental Health Professional
If money or health insurance are not a problem, speaking with a mental health professional is an important, immediate step to take for children at risk for or already self-harming. “Find a trained psychologist with a great deal of experience in self-harm assessment and treatment who can help your child better understand [their] suffering and effective ways of coping,” says Romanoff. A mental health professional can determine if a child is dealing with a specific mental health condition and provide actionable steps for both children and parents.
Learn Healthy Coping Mechanisms
While a mental health professional can suggest healthy coping mechanisms, not everyone has access to one. In this case, potential coping skills can be explored safely by a parent and child. Romanoff notes the benefits of a diverse social support network of peers and family members and also the importance of finding healthy outlets for emotional distress as an alternative to self-harm. These can include anything from taking a cold shower to any type of vigorous exercise to “approximate the sensation of release [without the] negative effect,” says Romanoff. Some other coping mechanisms to try are:
Meditation Journaling Doing something creative such as cooking, drawing, or building. Self pep-talks Asking for support when needed, instead of turning inward
