Understanding your child's mental health

When a child suddenly starts refusing school, it can feel confusing, upsetting and difficult to manage. For many parents, it may seem to happen “out of nowhere”, especially if their child previously coped well with school or enjoyed attending.

School refusal is often linked to emotional distress rather than defiance or laziness. Some children become so overwhelmed by anxiety, pressure, social difficulties or emotional exhaustion that attending school starts to feel unmanageable for them. In some cases, even getting dressed, leaving the house or approaching the school gates can trigger intense distress.

This experience is sometimes referred to as emotionally based school avoidance (EBSA). It describes situations where a child wants to attend school on some level, but feels unable to cope emotionally with the experience of being there.

There are many reasons why this can happen. A child may be struggling with:

Sometimes there isn’t one clear cause. Small stresses can gradually build over time until a child reaches a point where school no longer feels manageable.

Useful links:

• Attachment disorder
• Oppositional defiant disorder

It can be very difficult to see a child become distressed before school, especially when mornings begin to feel tense, emotional or unpredictable. Some children may become tearful or withdrawn, while others may panic, shut down, complain of physical symptoms or become angry and overwhelmed.

When a child feels overwhelmed, mornings can quickly become associated with stress and fear. Trying to force or rush the situation can sometimes increase that distress further, particularly if a child already feels unable to cope.

Although every child is different, some approaches may help reduce pressure and create a greater sense of safety and predictability.

These can include:

It can also help to think about what your child may be finding difficult specifically. For some children, distress may relate to friendship issues or academic pressure. For others, it may be linked to anxiety, autism, ADHD, sensory overwhelm or difficulties managing uncertainty and transitions.

Working collaboratively with school can also be important. In some situations, small adjustments such as a quieter start to the day, pastoral support, reduced timetables or safe spaces can help a child feel more able to attend.

Autism can look different from child to child. While some autistic children show more widely recognised signs from an early age, others may develop coping strategies that make their difficulties less obvious, particularly in social situations.

Because of this, autism doesn’t always present in the same way in girls and boys, and some children may not be recognised as autistic until later childhood, adolescence or even adulthood.

Many autistic children experience differences in:

• communication and social interaction 
• understanding social situations 
• sensory processing 
• emotional regulation 
• routines and change 
• focused interests or patterns of thinking 

However, how these differences appear can vary greatly.

Because of this, autistic girls may sometimes be misunderstood as simply shy, sensitive or anxious, rather than recognised as neurodivergent.

It’s also important to remember that autism rarely looks exactly the same in every child. Some children may struggle more with sensory overwhelm, while others may find social uncertainty particularly difficult. Some may thrive academically while still finding everyday life emotionally exhausting.

Useful links:

• Autism in boys
• Autism in girls
• Signs of autism

Neurodivergence is an umbrella term used to describe differences in how people think, learn, process information and experience the world. It can include conditions such as autism, ADHD, dyslexia, dyspraxia and Tourette syndrome, among others.

Every neurodivergent child is different, and there’s no single set of behaviours that applies to everyone. Some children show signs from a very young age, while others may appear to cope well until social, emotional or academic demands increase as they get older.

Parents often describe having a feeling that their child experiences things differently to other children, even if it’s difficult to explain exactly why.

Signs of neurodivergence can appear in different ways, including:

Some children may mask their difficulties, particularly in school or social settings. This means they work very hard to appear as though they are coping, even when they feel overwhelmed internally. In these cases, distress may become more noticeable at home, where a child feels safer to release emotions.

It’s also common for neurodivergence and mental health difficulties to overlap. Some neurodivergent children experience anxiety, low mood, burnout or emotional exhaustion, particularly if they’ve spent long periods trying to cope without the right understanding or support.

Useful links:

• Neurodiversity
• Autism assessments
• ADHD assessments

Intrusive thoughts are unwanted thoughts, images or worries that can suddenly enter a child’s mind and feel difficult to let go of. They are often upsetting, confusing or frightening for the child experiencing them, particularly if they don’t understand why they are happening.

Many children experience occasional intrusive thoughts, especially during periods of stress or anxiety. However, for some young people, these thoughts can become more persistent, distressing or difficult to manage.

Intrusive thoughts can take many different forms. A child may experience:

Children are often deeply distressed by these thoughts because they usually go against who they are and what they care about. 

Younger children may struggle to explain intrusive thoughts clearly. Instead, parents may notice behaviours such as:

Some children may also become embarrassed or worried that their thoughts mean something about them as a person. Reassurance, calm communication and avoiding judgement can help a child feel safer talking about what they’re experiencing.

Intrusive thoughts are commonly linked to anxiety and OCD, although they can also appear during periods of stress, overwhelm or emotional difficulty more generally. Having intrusive thoughts does not mean a child wants to act on them.

Useful links:

• OCD and guilt
• Reframing negative thoughts workbook

Supporting a child with OCD can feel confusing and emotionally exhausting at times, particularly when their worries or behaviours seem difficult to understand from the outside. Many parents describe wanting to reassure their child constantly, while also worrying about saying or doing the “wrong” thing.

Obsessive compulsive disorder (OCD) is a mental health condition that involves unwanted, distressing thoughts, images or fears, known as obsessions. These obsessions often create intense anxiety, which a child may try to reduce through repetitive behaviours, routines or mental rituals, known as compulsions.

One of the most helpful things parents can do is try to respond with calmness and understanding, rather than frustration or punishment. Children with OCD are often already frightened or overwhelmed by their thoughts, and feeling judged can increase shame and anxiety further.

It can help to:

At the same time, many parents find themselves becoming drawn into OCD patterns without realising it. This might include repeatedly reassuring a child, helping them avoid feared situations or adapting family routines around compulsions. While this often comes from a place of care and protection, it can sometimes unintentionally reinforce the cycle of anxiety over time.

Because of this, support for OCD often involves helping both the child and family understand how OCD works and how to respond in ways that reduce anxiety gradually and safely.

If OCD symptoms are affecting your child’s daily life, school attendance, relationships or emotional wellbeing, professional support can help. Many children benefit from therapies designed specifically for OCD, helping them understand intrusive thoughts, build coping strategies and reduce the hold anxiety has over their daily life.

Useful links:

• OCD symptoms in children
• ADHD and OCD overlap

Some children experience emotions very intensely. What may seem like a small disappointment or change to one child can feel overwhelming, frightening or impossible to manage for another.

When a child has very strong emotional reactions, it’s often a sign that they are struggling to regulate or process what they’re feeling, rather than deliberately overreacting or trying to cause difficulty.

This can look different from child to child. Some young people may become tearful, anxious or withdrawn, while others may shout, panic, lash out or appear suddenly overwhelmed. Emotional reactions can sometimes seem unpredictable or much bigger than the situation itself.

Younger children are still developing the skills needed to understand, express and regulate emotions. Older children and teenagers may also struggle if they feel misunderstood, emotionally overloaded or unable to communicate what they need.

Although these moments can feel difficult, approaching them with curiosity rather than punishment can often help a child feel safer and more understood. This doesn’t mean accepting harmful behaviour, but trying to recognise that there is usually something underneath the reaction itself.

Tantrums and meltdowns can sometimes look similar from the outside, but they are often driven by very different experiences underneath.

A tantrum is usually a child’s way of expressing frustration, anger or wanting something they can’t have. Tantrums are a normal part of development, particularly in younger children who are still learning how to manage emotions and communicate needs.

A meltdown is different. Meltdowns are usually caused by a child becoming emotionally, mentally or sensory overwhelmed to the point where they temporarily lose the ability to regulate themselves. This is not typically something a child is choosing or controlling intentionally.

For some children, overwhelm builds gradually throughout the day before reaching a point where they can no longer cope. Parents sometimes describe this as their child “holding it together” until they reach a safe environment at home.

Understanding the difference can help parents respond more effectively. While tantrums may benefit from consistent boundaries and calm responses, meltdowns usually require support aimed at reducing overwhelm and helping a child feel safe again.

Useful links:

• ADHD emotional dysregulation
• Sensory processing differences
• How to self-regulate emotions

Many parents wonder whether their child’s difficulties are something that will pass with time or whether professional support may be needed. Deciding when to seek specialist help can feel daunting, particularly if you’re unsure how serious a situation is or what type of support would be most appropriate.

Different mental health professionals support children in different ways. For example:

• Child psychiatrists are medical doctors who specialise in children and young people’s mental health, and can assess diagnoses, oversee treatment plans and prescribe medication where appropriate
• Therapists and counsellors often provide talking therapies and emotional support
• Psychologists can help assess emotional, behavioural and developmental difficulties

Not every child experiencing emotional difficulties will need to see a psychiatrist. Some young people benefit from support through school, counselling or therapy alone. However, psychiatric support may be helpful when a child’s mental health is having a significant impact on their daily life, safety or ability to function.

Psychiatrists can also help when there is uncertainty around what a child may be experiencing. Sometimes symptoms overlap between different conditions, and an assessment can help build a clearer understanding of a child’s needs, strengths and difficulties.

Importantly, seeking psychiatric support does not automatically mean a child is “seriously ill” or that intensive treatment will be required. For many families, it simply provides clarity, reassurance and guidance about the most helpful next steps.

Useful links:

• Therapy vs counselling
• Our young people's services

Many parents worry about this when their child is struggling with their mental health. It’s common to question past decisions, replay conversations or wonder whether you should be responding differently. When emotions are running high at home, it can be difficult to know what the “right” thing to do is.

In reality, there is rarely a perfect response to complex emotional situations, and most parents are doing the best they can with the information and support they have at the time.

Children and young people don’t need parents to handle every situation perfectly. What often matters most is feeling safe, supported, listened to and cared for consistently over time.

Mental health difficulties are also rarely caused by one conversation, parenting decision or moment of conflict. Emotional wellbeing is shaped by many different factors, including personality, experiences, relationships, school pressures, neurodivergence, stress and life events.

When a child is struggling, parents may naturally try a range of approaches:

Sometimes one approach may help in a particular moment, while at other times it may not. This doesn’t necessarily mean you are failing or making things worse. Children’s needs can change over time, especially during periods of emotional distress or development.

It’s also important to remember that many behaviours linked to anxiety, OCD, neurodivergence or emotional overwhelm can be difficult for families to navigate without guidance. Parents are often trying to respond to situations they were never expecting or prepared for.

Supporting a child with mental health difficulties can be emotionally demanding, and parents need support as well. Asking for help, seeking guidance or wanting reassurance does not mean you are failing your child. In many cases, it reflects how much you care about getting things right.

Anxiety in children and young people can appear in many different ways. Some children talk openly about worries or fears, while others may show signs through changes in behaviour, mood, sleep or physical symptoms instead.

A certain level of anxiety is a normal part of growing up. Many children experience worries around school, friendships, change or new situations from time to time. However, anxiety may become more concerning when it feels persistent, overwhelming or starts affecting a child’s daily life.

Children experiencing anxiety may:

Some children may become quieter and more withdrawn, while others may appear angry or frustrated instead. Anxiety does not always look like nervousness from the outside.

Younger children may struggle to explain what they are feeling emotionally, so anxiety can sometimes appear through physical symptoms or behaviour changes. Older children and teenagers may hide worries because they feel embarrassed, don’t want to burden others or are finding it difficult to describe what’s wrong.

If anxiety is beginning to affect your child’s wellbeing, friendships, sleep, confidence or school attendance, additional support may help. Early support can help children better understand their feelings, develop coping strategies and feel more able to manage worries over time.

Useful links:

• How to help a teenager with anxiety
• Panic attacks in children

Many children and young people experience periods of emotional difficulty as they grow and develop. Feelings such as worry, sadness, frustration or stress are a normal part of life, particularly during times of change or challenge.

However, there are times when additional support may be helpful, especially if difficulties are becoming more persistent, intense or are starting to affect a child’s everyday life.

Professional mental health support may be worth considering if your child is:

Sometimes difficulties may appear more subtle. A child may seem highly anxious, emotionally exhausted or constantly “on edge”, even if they are still managing to attend school or maintain routines outwardly.

It’s also important to remember that children do not need to reach a crisis point before support is appropriate. Early support can often help prevent difficulties from becoming more severe over time and can give both children and parents strategies to better understand and manage what’s happening.

If you feel unsure, it can help to trust your instincts. Parents often notice when their child is struggling, even if they cannot immediately explain why. Reaching out for advice or an assessment can be a helpful first step in understanding what your child may need and exploring what support options are available.

Useful links:

• Six signs of self-harm for parents
• Depression in teens
• Bipolar in teens