Writing on the Walls: Behavioral Red Flags in Children and Adolescents     
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Writing on the Walls: Behavioral Red Flags in Children and Adolescents  

Kid with hand on forehead

By Steve Bove

If your child were suffering, you’d sacrifice life and limb to swoop down and save the day. When that pain is emotional, however, visible yet seemingly just beyond your reach, it can feel like you’re being swallowed alive.

Fortunately, although addressing emotional and behavioral health concerns in children can be dizzying and scary, according to Eric Alcera, M.D., associate corporate medical director, Hackensack Meridian Behavioral Health, it does not necessarily require years of specialized knowledge or clinical experience. According to Dr. Alcera, identifying risk factors and symptoms of potential behavioral health issues starts with knowing what to look for, where to seek help, and when to reach out to a professional.

Sometimes determining whether your child needs professional help is as simple as, well, asking them.

“I always tell parents, ‘Talk to your kids. Engage them,’ ” says Dr. Alcera. “Have that conversation. ‘How’s school? How are your friends? What’s been worrying you?’ You might be surprised by how much they tell you. More importantly is to listen without judging or trying to solve the problem immediately. Work with them to understand and be supportive in solving the situation with them if possible. Empowering them to problem solve is a valuable tool for parents to instill in children.”

Dr. Alcera says that anxiety, ADHD and depression are three of the more common disorders he sees among children and adolescents, and that telltale signs of these disorders often include significant, sudden or unexplained behavioral and/or physical issues.

“I tell parents, ‘You know your kids better than I do. Is this a change from their natural behavior?’ These could be in the realm of mood changes, or feelings that seem more intense than normal,” Alcera says. “Physical symptoms — headaches, stomach aches, vague somatic complaints — could be indicative of an underlying mood or anxiety disorder. Kids have a hard time expressing themselves, and often the mind-body connection is so strong that, if feelings of anxiety or depression become too intense, the symptoms may manifest through physical complaints rather than kids being able to express their emotions verbally.”


Changes in sleep pattern/nightmares

Complaints of fever/temperature changes

Decrease in appetite

Difficulty focusing/concentration

Disruptive behavior

Feelings of sadness

Generalized apathy


Mood changes

Pattern Changes

Queasiness or “butterflies in their stomach”

Stomach issues

Somatic Complaints

Trouble at school/home

Withdrawal from daily activities

“A lot of it depends on where they are developmentally. Teens are different from toddlers; toddlers are different from elementary school kids. Each phase is going to have particular things you want to watch out for,” says Dr. Alcera. “With younger kids, stress may lead to new changes in their behavior, such as regression or extremes in their normal reaction to situations. For example, a five-year-old who throws a tantrum only when you talk about “school”, a four-year old who crawls into bed with you when they typically sleep by themselves, or a three-year old who returns to sucking his thumb, wetting the bed or crying for mommy.”

“And as kids get older, pre-teen to adolescents, behaviors can be more complex in this stage. Typical stressors usually revolve around school related issues, what to do after middle/high school and family related issues. This group of kids often manage stress by being more irritable or angry, more complaints of being tired or fatigued, or just complain about being overwhelmed.” This could lead to emotional changes such as being more agitated or depressed, physical changes such as being sick more often, cognitive changes such as being more forgetful or distracted, or behavioral changes such as unusual changes in eating, sleeping or avoiding things they normally enjoy.

More obvious and severe symptoms like physical harm, cutting or substance abuse are situations when parents should immediately seek out professional support.

If any of the aforementioned behaviors strike a chord, or if you are concerned and looking to take the next step, Dr. Alcera recommends talking to the people who see your child on a regular basis, e.g., a teacher, coach, or caregiver. Someone that sees them regularly in a different setting may be able to pick up any acute changes going on, Dr. Alcera says.

“Remember, the majority of the day, your kids are in school and teachers and school staff are a great source of information. Get as much information as you can. Ask them, ‘Is there something going on? Is there something I’m missing?’ That information can be invaluable for parents to convey to the next professional,” he says.

Dr. Alcera adds that “the next professional” does not necessarily have to be a psychiatrist.

“Pediatricians are terrific in terms of determining whether there’s something medically going on, maybe an underlying medical disorder that could be causing some of these issues,” he says. “They can also make the determination if your child needs to be referred to a child psychiatrist or child psychologist/therapist.”

“It takes a tribe… When you have a good team involved, the outcome is so much better,” says Dr. Alcera. “At Hackensack Meridian Health, we build a team around your child. We have crisis services available 24/7, 365 days a year. If your child is in distress, they can come to any one of our emergency departments to get the care they need. We have an array of specialties, from ADHD clinics to therapeutic nurseries to detox centers. It’s not just about medications, it's about making sure that we're addressing not only the child’s needs, but the family's needs and giving them the necessary support at school, at home and at every setting they’re in.”

Dr. Eric Alcera is a Board Certified Child and Adolescent psychiatrist based in Shrewsbury, NJ. He is the associate corporate medical director of Hackensack Meridian Behavioral Health Services. Learn more about Hackensack Meridian Health’s Behavioral Health Services.


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