How to Recognize Mental Illness in Children and Teens

Is it normal kid behavior, or is it something more serious? Learn the signs of mental illness and how to help.

By Kristen Sturt

In 1999, 17-year-old Dylan Klebold helped murder 13 people at Columbine High School before shooting himself in the head. His conspirator, Eric Harris, has since been labeled by experts as a psychopath. Dylan was more likely suffering from undiagnosed mental health issues—including severe depression and suicidal thoughts—that tragically altered the course of his life, along with thousands of others.

Ever since then, his mom has been asking how she missed the signs. In her new book, A Mother’s Reckoning, Sue Klebold scrutinizes Dylan’s upbringing, looking for any indication he was hurting, much less capable of a massacre. It’s a heartbreaking account of how easy it is to miss small emotional and behavioral changes, and how they can lead to bigger problems down the line.

Let’s be clear: Klebold is an extreme example—the most extreme example—of how untreated mental illness can go wrong; the overwhelming majority of impacted kids will never hurt anyone. However, depression, bipolar disorder, schizophrenia, and other conditions, which affect a whopping 21 percent of teens, can be harmful in other ways. Kids suffering from mental illness are likelier to:

  • Drop out of school
  • Abuse drugs and alcohol
  • Commit suicide

Perhaps the most alarming aspect is how early many disorders can affect children. "Fifty percent of lifetime conditions begin by age 14 and 75 percent by age 24," says Ken Duckworth, M.D., Medical Director at the National Alliance on Mental Illness. What’s more, most kids experiencing symptoms don’t receive care for years, if at all. Sometimes it’s because adults don’t know where to turn. Sometimes it’s because they don’t want the child to be ostracized. Sometimes, as with Klebold, it’s because loved ones don’t know there’s anything wrong.

The Signs of Distress

Mental illness is easy to miss in young people, because signs can easily be confused for typical adolescent behavior. Kids and teens are regularly irate, unhappy, and stressed; it’s normal development. "From time to time, children will present with anger, anxiety, sadness, or hopelessness that is representative of appropriate emotional expression," says Kristin Carothers, Ph, D. clinical psychologist at New York’s Child Mind Institute. When those emotions make it difficult to function, however, it should raise red flags: "We are more concerned when those feelings interfere with a child’s ability to attend school, interact with peers, sibling and parents, or cause them to isolate themselves."

Dr. Duckworth encourages family members to be on the lookout for these specific behaviors:

  • "Feeling very sad or withdrawn for more than two weeks, crying regularly, and feeling tired and unmotivated.
  • Sudden overwhelming fear for no reason, sometimes with a racing heart, physical discomfort, or fast breathing
  • Severe mood swings that cause problems in relationships
  • Drastic changes in behavior, personality or sleeping habits (e.g., waking up early and acting agitated)
  • Intense worries or fears that get in the way of daily activities like hanging out with friends or going to classes
  • Extreme difficulty in concentrating or staying still
  • Not eating or doing things to cause themselves to throw up; significant gain or loss in weight
  • Out-of-control, risk-taking behaviors that can cause harm to themselves or others
  • Repeated use of drugs or alcohol
  • Trying to harm or kill oneself or making plans to do so"

Understand that some kids are more prone to mental illness than others, too. "Genetics, environment, and lifestyle all play a role," says Dr. Duckworth. Heredity is one factor; if a child’s parents suffer from schizophrenia, for example, there’s a much greater chance he will, too. Home environment is another big influence: "A stressful job or home life makes some people more susceptible, as do traumatic events like being the victim of a crime." The anxiety and fear created by trauma contributes strongly to mental health problems, particularly depression.

What to Do Right Now

If you suspect your grandchild is suffering from mental illness, the time to act is nowright now. This is doubly imperative if she discloses any intention of harm. "In some cases, grandchildren will share things with [grandparents] that aren’t shared with parents," says Dr. Duckworth. "This requires exercising some discretion in order to preserve trust, but when safety is an issue, secrets shouldn’t be kept ('I took five of Mommy’s pills last night.')"

Many mental illnesses don’t present themselves this clearly or quickly, however, instead developing more gradually over time. Either way, as a loving family member and presumably not the child’s primary caretaker, you have to speak with a parent or legal guardian.

Broach the topic carefully and sensitively. "In the actual conversation, grandparents should employ a non-judgmental stance," suggests Dr. Carothers. "Avoiding judgment will make it easier for an open dialogue to occur and makes room for differences of opinions." Casting blame will put the parent on the defensive, so try to keep the guardian’s feelings in mind; it can be upsetting, confusing, and even traumatic to discover your child is suffering.

Language is crucial, too. Before speaking with a parent, it’s a good idea to rehearse your thoughts and important points. Says Dr. Carothers: "Grandparents should be sure to use specific language to define the types of behaviors they believe are concerning and give the parent an opportunity to respond." Avoiding emotional blow-ups and presenting your information calmly fosters open communication at a time it’s needed most.

Whatever you do, don’t ignore the problem and hope it goes away. "The motto, 'If you see something, say something,' applies," says Dr. Carothers, "and is a good rule of thumb for deciding when to address behaviors that are concerning."

What to Do in the Long Run

If your grandchild is diagnosed with a disorder, it could mean tough times ahead. Your kids and grandkids will need a rock. Be that rock. "Grandparents should try to be as positive and supportive as possible, modeling for parents’ ways to stay calm, and look for positive behaviors the child exhibits despite distress," says Dr. Carothers.

A support system is especially important for moms and dads, because many Americans still believe mental illness to be some kind of moral or parental failing. "Mental illness is not an indication of poor character or 'being bad,'" says Dr. Duckworth. Don’t add to parents’ stress with negativity or criticism of the condition itself: "Do not be judgmental. Do not reinforce fear or stigma surrounding mental illness through expressions or threats like, '[The child is] acting crazy, what do you think people will think?'"

Helping parents understand and follow expert medical advice is another priority, says Dr. Carothers. "Grandparents should try to support parents when they receive evidence-based treatment recommendations from qualified mental health professionals, even if these recommendations seem counterintuitive or different from the way the grandparent parented." It can be difficult to stifle your parenting impulses if they don’t quite align with a doctor’s advice. But even if you think you know better, remember: Ultimately, this isn’t about you. It’s about what’s best for your grandchild. That said, if you’re truly uncomfortable with a treatment option—the doctor didn’t seem engaged or the prescribed therapy is clearly quackery—encourage seeking a second opinion.

Where to Go Next

Perhaps the best part about Sue Klebold’s book, besides bringing attention to a little-discussed subject, is that she’s donating 100 percent of the proceeds to mental health organizations. If your grandchild needs help, or you want to learn more about mental illness and kids, visit these websites for more information:


A grandchild’s mental illness may be the most difficult thing you ever confront. But if it’s done wisely and with love, you may not just help them feel better—you could be saving a life.

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