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Mental Health in Middle Childhood

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Stock photo of a young boy crouched into a corner in a library.
Boy sitting sadly in a library. | Courtesy of Mikhail Nilov via Pexels.

May is Mental Health Awareness Month, and when people think of youth struggling with mental health, they often think of students in middle and high school. But children in the awkward stage of “middle childhood,” from ages 6 to 12, can struggle with anxiety and depression just as much as older kids, with puberty and entering middle school adding to the stress.

And for some children, puberty is coming earlier and earlier—starting in girls as young as 8 and boys as young as 9. At that age, children may not have enough life experience to process and understand the complicated feelings that come with that stage of life.

We spoke with Dr. Sheryl Gonzalez Ziegler, a clinical psychologist, author of “The Crucial Years: The Essential Guide to Mental Health and Modern Puberty in Middle Childhood (Ages 6-12)” and TEDx speaker who’s worked in her field for more than 20 years, to learn how parents can support their children during this difficult time in life.

Responses were edited for clarity.

What are some common causes for mental health struggles among children and young teenagers?

Screen time and social media—not the amount or the quality, but the exposure. Think about how curious you were as a kid. You had a ton of questions about things, but there were very limited places to get answers. Now, whenever a child has a question, they can go on social media to get answers. Kids are exposed to YouTube at as young as 18 months. You do not have full control over what they are watching, or what ads come up.

The loneliness epidemic also plays a role. Kids are spending more time on screens and in structured activities like school. They’re spending a lot less time in unstructured social settings, and just playing can have a real social impact. That’s why mental health really collapsed for a lot of kids during the pandemic. To have healthy development, especially as a child, you learn a lot through play and friends. That’s how you learn, and grow and figure out rules and boundaries. And when that was limited, it exposed what was already happening.

How can a parent tell that their child might be experiencing anxiety or depression if the child doesn’t know how to explain what they’re feeling?

There are four things that mental health practitioners look at: disturbances in sleep, appetite and mood and a loss of interest in things. As adults, we know that when we are stressed and worried, our sleeping habits and our appetites are affected. Mood is probably the hardest one, because it seems the most obvious, but it might not be connected to anxiety or depression. You want to figure out if a child’s moodiness is connected to something going on or if it’s out of nowhere. And a lack of interest is just losing interest in friends, places or hobbies they normally enjoy. These are the four guiding lights for parents to me, and if they’re worried about their kid’s mental health, they should check in on these four categories.

How does earlier puberty affect a child’s mental health?

Puberty starts in the brain, so kids start out with emotions they may not understand. And then, physical signs come and make them feel self-conscious and uncomfortable, which can actually lead to anxiety. When it comes to a changing body, when that happens so young, kids might not have the mental resources or education to understand what’s happening
to them.

In older generations, puberty started at around 12, so you were able to handle those changes. But puberty is happening earlier and earlier for some kids, and they tend to struggle with body image issues, poor self-esteem and less self-confidence.

How can a parent support their child when they’re struggling with their mental health?

First of all, you have to be educated and understand [your child’s] age and stage. Parents are hyperfocused on their child’s health from ages 0 to 5, since everything feels new. But once they hit 6 and go off to kindergarten, we lay off as parents since they’re with another adult and other kids all day. Parents should understand that their kids are still developing mentally, physically, emotionally and socially, and while those milestones aren’t the same as walking, talking and rolling over, they’re just as important.

Be sure to communicate with your child a lot. It doesn’t have to be for long stretches of time, but it should be often. Normalize conversations about puberty, because it’s coming.

Tell your kid, “Puberty starts in the brain, and that means I won’t be able to see it. But if you’re feeling all sorts of feelings all over the place, there’s nothing wrong with you. That’s normal. Talk to me about it.”


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