Every parent wonders at some point whether a child’s moods or behavior are “just a phase.” If you have started asking that question more often lately, you are in the right place. This guide walks through what is typical, what deserves a closer look, and what getting help actually looks like.

Worry, sadness, and big behavior are part of growing up

Keiki (children) melt down. They worry about tests, resist bedtime, and push against rules. None of that, by itself, means something is wrong. The difference between ordinary growing pains and a mental health concern usually comes down to three things: how long it lasts, how intense it is, and how much it gets in the way of school, friendships, and family life. A rough week is a rough week. A rough season that keeps deepening is worth attention.

Struggles like these are more common than most families think

According to the Centers for Disease Control and Prevention, in 2022–2023 about 11% of children ages 3–17 had current, diagnosed anxiety, about 8% had a diagnosed behavior disorder, and about 4% had diagnosed depression — and roughly 1 in 5 children has been diagnosed with a mental, emotional, or behavioral health condition at some point. If your keiki is struggling, you are not alone, and it does not mean you have failed as a parent. It means your child’s health deserves the same care you would give a lingering cough or a sprained ankle.

Signs worth a closer look

The American Academy of Child and Adolescent Psychiatry lists warning signs that a psychiatric evaluation may be useful. In younger keiki, watch for patterns like:

• A marked drop in school performance, or poor grades despite real effort
• Severe worry shown by regularly refusing school, sleep, or activities normal for their age
• Frequent physical complaints — stomachaches and headaches with no clear medical cause
• Constant motion and difficulty settling that goes beyond regular play
• Persistent nightmares, or aggression and defiance lasting longer than six months
• Any talk of harming themselves

In preteens and teens, the picture often looks more like:

• A sustained negative mood, with changes in sleep, appetite, or energy
• Pulling away from friends and activities they used to enjoy
• Extreme trouble concentrating that interferes at school or home
• Severe mood swings, or repeated use of alcohol or drugs
• Intense preoccupation with weight or body image
• Self-injury, hopelessness, or talk of death

No single item on these lists is a diagnosis. What matters is a pattern that persists and interferes.

A picture of what this can look like

Consider a 10-year-old who has always liked school. Over a few months she starts begging to stay home, complains of stomachaches most mornings, and stops inviting friends over. Nothing “big” happened — but the pattern has lasted a full quarter and is getting stronger, not weaker. That pattern, not any single bad day, is what deserves an evaluation. (This is a fictitious example, not a real patient.)

What an evaluation actually is

An evaluation is a conversation, not a verdict. A psychiatric provider spends time with your child and with you, asks about development, school, sleep, family history, and stressors, and often uses brief, well-studied questionnaires. Checking on emotional health this way is now considered standard preventive care: the U.S. Preventive Services Task Force recommends screening for anxiety in children ages 8 to 18 and for depression in adolescents ages 12 to 18 — even when there are no obvious symptoms. An evaluation does not automatically mean a diagnosis, and it never automatically means medication. It means understanding what is going on so the plan fits your child.

How we approach it at OhanaPsych

We start from lōkahi — balance across the connected parts of a child’s life: body, mind and emotions, spirit, and ʻohana (family, including extended family). This is not a marketing phrase; it reflects how Native Hawaiian health frameworks, carried forward by organizations like Papa Ola Lōkahi, have long understood wellbeing — and it happens to be what good child psychiatry looks like. We treat parents and caregivers as part of the care team, because pilina — relationship and connection — is where healing starts. Depending on what we find, care may involve therapy, skills work with parents, school coordination, medication, or a combination. Every option is discussed with your ʻohana, in plain language, before anything starts.

Getting care by telehealth

About 85% of our visits happen by telehealth, and keiki are often more at ease talking from their own home than in an unfamiliar office. We serve families across Hawaiʻi — from Honolulu to Hilo to the most rural parts of the islands — wherever you are located in the state. Some situations call for an in-person step, and we will tell you plainly when that is the case. Interpretation and language assistance are available.

When to seek help now

If your child talks about suicide, hurts themselves, or you are worried about their immediate safety, do not wait for an appointment. Call or text 988 to reach the 988 Suicide & Crisis Lifeline — in Hawaiʻi, this connects to Hawaiʻi CARES, the state’s 24/7 crisis line (direct: 808-832-3100, toll-free: 800-753-6879). In an emergency, call 911.

Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner, OhanaPsych / Ohana Care Clinic
Date published: July 1, 2026   Last reviewed: July 1, 2026   Citations verified: July 1, 2026

References

American Academy of Child and Adolescent Psychiatry. (2017). When to seek help for your child (Facts for Families No. 24). https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/When-To-Seek-Help-For-Your-Child-024.aspx

Centers for Disease Control and Prevention. (2025, June 5). Data and statistics on children’s mental health. https://www.cdc.gov/children-mental-health/data-research/index.html

Hawaiʻi State Department of Health. (n.d.). Hawaiʻi CARES 988. Retrieved July 1, 2026, from https://hicares.hawaii.gov/

Papa Ola Lōkahi. (n.d.). Mental and behavioral well-being. Retrieved July 1, 2026, from https://www.papaolalokahi.org/program/mental-and-behavioral-well-being

U.S. Preventive Services Task Force. (2022). Anxiety in children and adolescents: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents

U.S. Preventive Services Task Force. (2022). Depression and suicide risk in children and adolescents: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-children-adolescents

This article is general health education from OhanaPsych and Ohana Care Clinic. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think your child may have a medical or mental health condition, reach out to us or another licensed provider. In an emergency, call 911.