Back to School: Knowing When Behaviors May Indicate Mental Health Issues

Dear Teachers,

Thank you for your dedication to educating and caring for our children. What you do is so important and it’s not an easy job to corral a classroom of children with diverse personalities and behaviors. Some students stand out with their strong presence, others present as quiet and contemplative, and everything in between. Hopefully, as you welcome your new class, you are apprised of the special needs of students, and advised by their parent or guardian about the best accommodations to help them succeed. 

Some of the less often revealed information may be that a child or youth is adopted, living in foster care, living with relatives or family friends, experiencing the divorce of parents, or may be unhoused – with or without their family, or other unsettled circumstances. Any one of these situations can influence a child’s emotional wellbeing and may contribute to changes in their demeanor in the classroom from time to time. I mention this to suggest that changes in behavior may be situational, and not an indication of the onset of more serious mental health issues. 

It is important to explore any outside influences that may be causing concerning behavior changes. If the child or youth cannot tell you what is happening in their world, their parent/caregiver should be consulted and, in any case, partnered with to help the child succeed in school. The uncertainty of foster care or change of placement, court proceedings involving custody, the hardships of being unhoused, and other such realities can influence behavior changes you see in the classroom. Reactions such as grief and depression are completely reasonable responses to such upheavals in a child’s life and can manifest in a variety of ways that look like diagnosable behavioral health challenges. It is important to look for the underlying causes of sudden changes in the behaviors you see. 

Sometimes you are the first to see changes in a child over the course of the school year that merit deeper concern and warrant further exploration. If concerning behaviors last for several months, and you have ruled out external circumstances, consultation with a parent and referral for medical and psychological assessment is appropriate. In young children, you may see the following, according to the National Institute of Mental Health (NIMH).

• Sadness that lasts two or more weeks.
• Changes in being social or staying away from others.
• Hurting oneself or talking about hurting oneself.
• Talking about death or suicide.
• Having outbursts or being very moody or testy.
• Out-of-control behavior that can be harmful.
• Big changes in mood, behavior, or personality.
• Changes in eating habits. (Ask a parent about this, but you might notice lunch or snack time changes)
• Loss of weight.
• Trouble sleeping or sleeping in class. (Ask a parent about this)
• Getting headaches or stomachaches often.
• Trouble concentrating.
• Doing poorly in school.
• Not going to school.

Adolescents and teenagers may be seen as just “being a teenager” if their behavior is erratic or if they are acting out. But they may be struggling with a mental health condition.

These are some of the signs of mental health conditions in adolescents and teenagers, again if external circumstances are not an influence. 

• Being irritable or angry frequently.
• Feeling overwhelmingly sad, scared, worried, or hopeless.
• Experiencing extreme mood swings, alternating between euphoria and dejection.
• Moody and withdrawn behavior. They may stop communicating and prefer to be isolated. They may stop interacting with their friends or communicating with them via phone, text, or social media.
• Losing interest in activities they once enjoyed. For instance, they may love music but suddenly stop going to music classes or show no inclination to practice their instrument.
• Developing a fear of common things or being scared to try new things.
• Having difficulty coping with everyday activities and stressors.
• Being unable to relate to others or express their emotions.
• Changing their appearance drastically or neglecting their personal hygiene.
• Picking fights with friends, family members, teachers, or school authorities.
• Sleeping all the time or having trouble getting a full night’s sleep. (Ask parents) They may often feel tired or low on energy and may fall asleep in class.
• Eating all the time or having no appetite. You may notice changes in their weight or eating habits.
• Having unexplained physical ailments such as headaches, stomach aches, or other complaints
• Having difficulty with learning, thinking, remembering, or concentrating.
• Performing poorly at school and having no interest in schoolwork.
• Using substances such as alcohol, marijuana, or drugs.
• Engaging in risky, unsafe behaviors or causing trouble in their home, school, or community.
• Talking about death or suicide.
• Hearing voices others do not hear.

If you see any of these signs in your students over a sustained time period, meet with their parent/caregiver and check to see what they are observing at home. Don’t hesitate to reach out, as the student’s well-being could be at stake, and you might be validating a concern that a parent is wondering about. An assessment by a medical doctor and a mental health professional can confirm or dismiss a mental health issue and uncover other possible causes of the behavior change. 

If a referral is made to the school psychologist, be sure to share whatever information you have about the child’s history and current home environment, so that they can take possible underlying causes into account in their assessment.

Don’t forget that you spend a major portion of a child’s life with them during the week, and you have the opportunity to get to know them well. You have a profound influence on them during the school year, and your observations are crucial to their well-being. You may observe behaviors that are missed by their family, and it’s important to share what you observe. It could result in early intervention that could make all the difference in the child’s life. 

Thank you for all you do!

For more: Training to become trauma-informed would be helpful in responding to all of your students, regardless of their circumstances. C.A.S.E. offers school counselors, social workers, psychologists, school-based therapists, and other school professionals the “School-Based Mental Health Professionals Training.” It’s an interactive web-based training offered through the C.A.S.E. Training Institute, available through the C.A.S.E. website, at no charge: https://adoptionsupport.org/nti/schools. Because of generous donors, it’s completely free for every school district in our nation!