Should I Be Concerned About My Child’s Behavior?

As children grow and change, parents will see all kinds of behaviors. But whether it’s a toddler having meltdowns or a teenager spending all their time in their bedroom, how can parents know whether that behavior is developmentally appropriate or something to be concerned about?

Dr. Anne Marie Albano, a child psychologist at NewYork-Presbyterian/Columbia University Irving Medical Center and founder of the Columbia University Clinic for Anxiety and Related Disorders, recommends that parents first keep in mind that childhood and adolescence are filled with big changes and challenges — sometimes daily or weekly — so that constant adjusting can manifest in changes in their behavior.

“For any youth, no matter what age, if it’s something new — a new expectation, a new experience, a change in routine that comes with different demands — we’ve got to understand that they go through some adjustment, and the adjustment might be expressed in the form of hesitation, anxiety, and worry,” she says.

While change is a natural part of growing up, there are ways for parents to untangle the root causes of behaviors that they may see — and support their children. Dr. Albano spoke with Health Matters about what types of behaviors parents can expect at different stages; the signs of when there may be a deeper issue; and tips to communicate with children, especially teenagers.

What are some common behavior changes parents can expect as children grow up?
In early childhood, little ones may cry and beg when they have to separate from parents. As they go into elementary school, you’ll see them struggle with anticipating something they don’t want to do — anything from a doctor’s appointment to going to day camp. They may become more emotional, and they up the ante from complaining and crying to being more disruptive, hiding, or refusing to get dressed. With older children, anxiety can grow over a longer period of time. You may notice that your son or daughter drops out of favorite activities or changes how they are interacting in the world.

What are warning signs that a child’s behavior may be a more serious issue?
If a child becomes more and more distressed about a situation, to a point where it starts to interfere with their ability to function, that is a warning sign.

There may be more tears, more anger, slamming doors, yelling — and this continues for several weeks. It could also be in the form of dropping activities, a decline in academic work, or your child is not acting like themselves. If a kid wants to change from baseball to tennis after years of Little League, that’s fine, because they are still engaging face to face with peers and others in their family. If they are stopping an activity and secluding themselves at home, those are some signs that something is not quite right for your kid.

How can parents figure out the reason behind the change?
The very first thing I ask the parents is, “Let’s go back to when the behavior started — what did you first notice?” Then parents have to think about what are contributing factors. Take for example, refusing to leave the house: What is the hesitation? Is it a new teacher? Is being home just more fun? Are they being ridiculed or bullied at school? They might not know how to make friends, or have trouble making friends as they grow older, so they want to avoid school because it’s uncomfortable.

Then we can find something in the environment that needs to be addressed, and help children adapt to what is hard for them or get help if they are being harmed such as with bullying.

How can parents help their child cope with a new challenge, so that they don’t end up acting out?
At every age and stage, we want to help them learn to be as independent as possible. This is where you let infants cry a little in their crib until they learn how to soothe themselves. And for toddlers, let them entertain themselves or pick out their clothes. Instead of always directing them, ask them, “Do you want to wear the red dress or the blue dress?”

We want children to gain a sense of independence and agency, because that reinforces bravery and coping behaviors.

Do you have tips for communicating with teenagers?
One of the first things we ask parents to do is just listen. The biggest thing for older kids is they want to feel understood. They do not want to feel judged, and they do not want you to tell them what to do. They want you to align with them.

You can start by simply reflecting what you are observing. For example, you can say, “You’ve been quiet,” or “It’s been hard for you to get ready for school in the morning.” At this point, if your child says, “I just don’t want to get up,” you can reflect again. “Can you talk to me about what’s getting in the way of you getting ready?” And that opens the door up to the kid saying more.

That is a much different approach from “You are irritable all the time. What the heck is going on?” They feel judged, and it’s intrusive because they might not be ready to say what’s happening.

How can parents distinguish when a behavior is part of a child’s personality, such as being shy, and when it’s related to a specific stressor?
That’s one of the main questions parents have. We want to be very clear: Shyness is not a disease. Shyness is a normally occurring personality trait. The same thing goes for being more expressive, extroverted, and a talker. These are not pathological conditions. There’s a range of emotions and personality expressions and behaviors that make us each a unique being.

Sometimes children do have difficulties on top of their personalities, and it causes them to turn away from things or become disruptive. We call it behavioral excesses. It could be a child excessively getting in people’s space, excessively saying no and being demanding. Or there are behavioral deficits, where nothing is good enough, nothing makes them happy, and no one is worth talking to.

People who are shy, they go to school, make friends, apply to college, and get jobs. It’s when there is so much fear, that’s an anxiety issue. And likewise, the person who doesn’t know when to stop texting or calling someone. That’s too much.

What advice would you give for parents who may want to speak to someone?
The pediatrician’s office, the school counselor, and a social worker are great places to start because it’s a comfortable environment.

And parents should tell their children that asking for help is brave. It’s a strength. When there are serious issues that are causing depression or anxiety, the longer you let that fester, the harder it gets to overcome it. Speaking to someone can open the door to understanding what is going on in the home, school, or community, and make a lifelong difference for your child’s mental health.

Anne Marie Albano, Ph.D., is co-clinical director of the Youth Anxiety Center at NewYork-Presbyterian, professor of medical psychology in psychiatry at Columbia University Vagelos College of Physicians and Surgeons, and founder of the Columbia University Clinic for Anxiety and Related Disorders. Her research is focused on the development and testing of psychosocial treatments for anxiety and mood disorders and in understanding the impact of these disorders on youth. She is an expert diagnostician and cognitive behavioral therapist.