Many parents I work with say the something to the effect of: "I wasn't sure if it was bad enough."
That phrase stops me every time, because it captures something important about how we think about mental health for kids and teenagers. We tend to imagine that therapy is for a crisis - for something dramatic and undeniable. But in reality, the situations that bring families into my office are almost never a crisis. They're quiet. They're oftne times a slow accumulation of small things. They're a parent watching their kid from across the room and feeling like something is off, but not being able to name it.
If you're in that place right now, this guide is for you.
The signs below aren't a checklist for pathology or diagnosis. They're the patterns I see most often in my work with children, teens, and families in Los Angeles - the things that, when addressed early, tend to make a real difference. You don't need to see all seven of these to reach out for support. One is enough, if it's been going on for a while and it's affecting your child's life.
Every kid melts down sometimes. That's developmentally normal. But if your child is regularly having emotional reactions - rage, crying, complete shutdown - that seem much larger than the situation warrants, that's worth paying attention to.
What this might look like: a minor homework frustration turns into a 45-minute meltdown. Being told "no" to something small leads to hours of sulking or screaming. A small disappointment - a friend canceling plans, a bad grade - triggers what feels like despair.
In clinical terms, we call this emotional dysregulation. It doesn't mean something is seriously wrong with your child. It often just means they haven't yet developed the internal tools to manage big feelings - and that's exactly what therapy can help build.
For teens especially, this can look less like tantrums and more like volatility: sharp mood swings, quick escalation in arguments, or the sense that they're living on an emotional hair-trigger.
One of the most reliable signals I look for is a change in engagement. When a kid who used to love soccer suddenly doesn't want to go to practice, or a teen who had a full social life has started spending every weekend alone in their room, something has shifted.
Social withdrawal can be a sign of depression, anxiety, or significant stress. It can also be a response to something specific - bullying, a friendship rupture, social anxiety that's grown too big to push through.
It's worth noting that some amount of pulling back is normal for teens, who are in the process of building independence. But there's a difference between a teenager who wants more privacy and one who seems genuinely disconnected from the things and people that used to bring them joy. Trust your knowledge of your own kid on this one.
Anxiety in children and teenagers is extremely common - and, in moderate amounts, not always a problem. Some anxiety is protective and motivating. But when anxiety starts to shrink a kid's world, it becomes something to address.
Signs that anxiety has crossed into territory worth exploring:
Untreated anxiety in young people tends to compound. The more a kid avoids the thing that scares them, the bigger and scarier it becomes. Early intervention - learning coping skills, understanding the anxiety response, gradually facing fears in a supported way - can interrupt that cycle before it becomes deeply entrenched.
School is where kids spend most of their waking hours, and it's often one of the first places that emotional struggles show up. A child who's depressed may lose the ability to concentrate. A teenager dealing with anxiety may start avoiding tests or assignments to escape the dread. A kid navigating a difficult home situation may simply not have the cognitive bandwidth left for academics.
If your child's grades have dropped significantly, if teachers are reporting disengagement, or if homework has become a daily battle that didn't used to be that way - it's worth looking underneath the surface. Academic struggles are often a symptom of something emotional, not a standalone issue.
This is especially true if the drop is sudden or tied to a specific period - after a family change, a move, the start of a new school year.
The mind and body are not separate systems, when kids are struggling emotionally, it often shows up physically first.
Watch for:
None of these signs alone are diagnostic of anything. But a pattern of physical complaints alongside other changes in mood or behavior is worth taking seriously. A good first step is always a visit to your child's pediatrician to rule out any medical causes - and then, if everything checks out medically, a conversation with a therapist makes sense.
This one matters enormously, and I want to name it clearly.
If your child or teenager has said things like "I hate myself," "I wish I wasn't here," "Nobody would care if I was gone," "I'm stupid" or "I'm worthless" - even once, even in what felt like passing - take it seriously. These kinds of statements are not always signs of a crisis, but they are always signs of pain. They deserve a conversation, not a dismissal.
Kids and teens often say hard things in moments of frustration and don't always mean them literally. But when these sentiments are repeated, or when they carry a weight that feels different - more flat, more certain - that's when you may need extra support.
You don't need to panic. But you do need to respond. Asking directly - "Hey, you said you felt like nobody would care. Can we talk about that?" - is not going to plant an idea. It's going to open a door.
If your child has expressed thoughts of hurting themselves or suicidal thoughts, please reach out to a mental health professional right away, or call or text 988, the Suicide and Crisis Lifeline.
Life hands kids and teenagers difficult things: divorce, a move, a death in the family, a health scare, a friendship that blew up, a traumatic event at school, an experience they haven't told you about. Big things don't always produce visible distress right away. Sometimes kids adapt, push forward, and seem fine - and then, months later, something surfaces.
If your child has been through something significant in the last year or two, it's worth having a check-in with a therapist even if they seem okay on the surface. Therapy doesn't have to be for a crisis in progress. It can be a space for processing, for making sense of something that was hard, for building resilience before the cracks show.
This is especially true for children who tend to internalize - the kids who seem fine, who don't make a fuss, who say "I'm okay" reflexively. Those kids are often the ones carrying the most.
This is the question I hear most from parents, and it's a fair one. Teenagers especially can be resistant to the idea of therapy - it can feel embarrassing, or like an admission that something is wrong, or just like one more thing being done to them rather than with them.
A few things that tend to help:
Frame it as a space for them, not a fix. "This isn't because something is broken. It's because you deserve to have a place that's just yours, where you can say anything."
Don't oversell it. Kids and teens are good at detecting when adults are performing enthusiasm. Keep it low-key: "Let's just try one conversation. If you hate it, we'll figure something else out."
Let them have input. If possible, give them some choice - in the therapist, in the day, in something. Even small amounts of agency help.
And if they're reluctant? That's okay. Most of the kids I've worked with came in skeptical and warmed up quickly once they realized the space was actually for them - not a place to be evaluated or corrected.
No one knows your child better than you do. If something in this list resonated - if you found yourself nodding at more than one of these signs, or thinking of a specific moment that's been sitting with you - trust that. Parental instinct about a child's wellbeing is one of the most reliable things I've encountered in clinical practice.
Reaching out doesn't mean committing to years of therapy. It means having a conversation to understand what's going on and figure out whether support might help.
If you're in the Los Angeles area and you'd like to talk, I'm here. I offer a free consultation for families and parents - a chance to share what's happening and see whether working together might be a good fit.
Schedule a free consultation here. No pressure, just a conversation.
Max Cadena is a Licensed Clinical Social Worker (LCSW) based in Echo Park, Los Angeles. He specializes in therapy for children, teens, young adults, and families, with in-person sessions in Echo Park and telehealth available across California.
These resources informed this post and may be useful if you want to learn more.
