Three teens playing with a Frisbee in the park

In 2023, more than 5.3 million adolescents ages 12-17 years (20.3% of adolescents) had a current, diagnosed mental or behavioral health condition (anxiety, depression, or behavior/conduct problems). Growing up can be challenging as children navigate developmental milestones, school demands, and peer relationships. While we celebrate children's achievements, many young people struggle with mental health issues that can significantly impact their daily lives and long-term well-being.

Based on US data from 2022–2023: 11% of children ages 3-17 had current, diagnosed anxiety (9% of males and 12% of females). 8% of children ages 3-17 had current, diagnosed behavior disorders (10% of males and 5% of females). 4% of children ages 3-17 had current, diagnosed depression (3% of males and 6% of females). Parents, caregivers, and professionals play crucial roles in recognizing these challenges early and connecting children with appropriate support. Fortunately, effective treatments are available to help young people develop coping skills, manage symptoms, and thrive.

Table of Contents

  • Understanding Child and Adolescent Mental Health
  • Therapy and Counseling for Children and Teens
  • Tips for Talking to Children About Therapy
  • Understanding Medication for Children and Teens
  • Addressing Teen Substance Use
  • Resources for Teen Substance Use
  • Real-World Examples: How Therapy Helps
  • Frequently Asked Questions
  • How Therapy Can Help / Find a Therapist

Understanding Child and Adolescent Mental Health

Mental health challenges during childhood and adolescence represent a significant public health concern. Nearly 1 in 3 (31%) youth ages 12 to 17 had a mental, emotional, developmental, or behavioral problem in 2022–2023, slightly higher than the previous 30% estimate. Nearly 1 in 5 (18%) youth ages 12 to 17 have had at least one major depressive episode in the past year — about 4.5 million adolescents — according to a 2023 federal survey.

Key improvements to youth mental health from 2021 to 2023 include: Decreases in the percentage of students overall who experienced persistent feelings of sadness or hopelessness (from 42% to 40%). Decreases in the percentage of female students who experienced persistent feelings of sadness or hopelessness (from 57% to 53%) and who seriously considered attempting suicide (30% to 27%). Despite these improvements, many young people continue to face significant challenges.

Common mental health conditions affecting children and adolescents include:

  • Anxiety disorders: In 2023, approximately 16.1% of 12- to 17-year-olds had a current anxiety diagnosis, while 31.9% will experience an anxiety disorder at some point during their teen years
  • Depression: In 2023, approximately 8.4% of 12- to 17-year-olds had a current depression diagnosis
  • ADHD: During 2020-2022, approximately 14.3% of 12- to 17-year-olds had ever been diagnosed with ADHD
  • Behavioral disorders: Including oppositional defiant disorder and conduct disorder
  • Eating disorders: Almost 3% of 13- to 18-year-olds have ever had an eating disorder

Therapy and Counseling for Children and Teens

A school counselor or doctor may help you find a child therapist. They can refer you to someone with training and experience working with youth. Treatment has helped many teens with mental health issues. CBT delivered as part of collaborative care programs in primary care has shown promise in terms of effectiveness, and an RCT of IPT-A delivered in school-based health clinics was similarly encouraging.

Many types of therapy focus on processing feelings and experiences. This can be challenging for young children. Counselors often use methods that let children express themselves nonverbally.

Play Therapy

Play therapy represents a developmentally appropriate intervention for young children. The overall treatment effect for play therapy interventions was 0.80 standard deviations. Parker et al. (2021) conducted a meta-analysis of 23 Child-Centered Play Therapy (CCPT) studies conducted from 1999 to 2018 including 904 children who were referred for disruptive behaviors. They reported statistically significant improvement with a moderate effect size (.48) for overall behavioral problems in comparison to peers in waitlist or alternative treatment groups. The median age for Parker et al.'s sample of children was 6.0 years, indicating the effectiveness of CCPT with young children.

Examining 52 Child-Centered Play Therapy (CCPT) studies conducted from 1995 to 2010, Lin and Bratton reported CCPT to demonstrate a statistically significant positive improvement with a moderate treatment effect (.47) on outcomes including problem behaviors, relationship stress, self-efficacy, and academic performance. The mean age of children represented in their meta-analysis was 6.7 years, indicating that play therapy is unique in demonstrating effects with young children. Additionally, Lin and Bratton found CCPT to have an even higher effect size for children of color (.76).

Other effective approaches for children include:

  • Sand tray therapy: Allows children to create scenes in sand that represent their inner experiences
  • Art therapy: Uses creative expression to help children process emotions
  • Eye movement desensitization and reprocessing therapy (EMDR): Can be helpful for youth who have experienced trauma, as it tends to rely less on discussion

Family Therapy

Family therapy may benefit children and teens by involving the whole family system in treatment. In this mode of therapy, family members attend sessions together. They may also go to some sessions alone. Family therapy can help teens and parents keep their relationship healthy. It may also help address changes in the family as children grow.

Family-based systemic interventions are effective for a proportion of cases with anxiety disorders, depression, bipolar disorder, grief following parental bereavement, and self-harm. Seidel et al. (2024) found that worldwide, the pooled prevalence rate in young people for anxiety disorders was 6.5%, and for depressive disorders it was 2.6%. Systemic family therapy in children and adolescents with mental disorders: A systematic review and meta-analysis.

A recent review of the current evidence base including meta-analyses and systematic reviews suggests that for various child-focused problems including sleep, feeding, and attachment problems in infancy; conduct problems; recovery from child abuse and neglect; somatic problems; eating disorders; and first episode of psychosis, family therapy offered independently or in conjunction with other modes of therapy is effective.

Parent-Focused Interventions

You can address parenting skills in therapy. Parent-child interaction therapy (PCIT) is one effective approach. This treatment may help when a child's behavior becomes difficult to manage.

Significant PCIT effects emerged on (a) increased positive parenting, reduced negative parenting, and disruptive child behavior (small-to-medium intention-to-treat effects and medium-to-large per-protocol effects); (b) gains in parent inhibitory control on the stop-signal task (small-to-medium effects); (c) gains in parent-reported emotion regulation and (d) positive, affirming self-perceptions (small-to-medium effects), relative to the SAU control group. PCIT's effects on gains in parent emotion regulation were mediated by reductions in observed negative parenting.

Research studies demonstrate that PCIT is effective across a variety of DBP conditions, showing significant reductions in child behavioral problems and parenting stress. Significant improvements were observed across all outcome measures for intervention completers (n = 204). Caregivers reported increased positive child behaviors (d = 0.87) and decreased parenting distress (d = -0.30).

Tips for Talking to Children About Therapy

Children may feel afraid to confide in an adult they do not know. These tips may help parents and caregivers talk to children about therapy:

  • Let them know they are not in trouble. Many children worry they've done something wrong
  • Practice active listening. Give your full attention and validate their feelings
  • Take them seriously. Children's concerns are real to them, regardless of how they may seem to adults
  • Stay open, authentic, and relaxed. Your calm demeanor can help reduce their anxiety
  • Normalize the issue they are experiencing. Let them know many children face similar challenges
  • Explain that the therapist is there for help and support. Describe therapy as a safe space to talk and learn new skills
  • Explain confidentiality. Let children—especially teens—know therapy gives them a safe and private space to share. Acknowledge you will be alerted if there are threats to their safety

Understanding Medication for Children and Teens

Research often highlights the benefits of combined treatment. A physician or psychiatrist may prescribe medication for mental health. But combining medication and therapy can be very effective. Many experts recommend therapy when medication is prescribed. They argue medication is overprescribed as a "quick fix."

Large pediatric randomized, multicenter trials, including the Multimodal Treatment Study of ADHD (attention deficit hyperactivity disorder) [MTA] and the Treatment for Adolescents with Depression Study (TADS), have begun to identify specific advantages of multimodal treatment compared with psychopharmacology alone. Advantages of combined treatment include improvement of both symptoms and family functioning.

For adolescents, cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT-A), CBT in combination with antidepressant medication, and collaborative care programs were all classified as well-established. Medication management and combined treatments (medication plus behavior therapy) for children with ADHD have been found to be effective in targeting core ADHD symptoms. Combined treatments are effective in improving non-ADHD symptoms (e.g., disruptive behaviors and anxiety symptoms) and functional outcomes (e.g., academic achievement, parent-child relations, and social skills).

Therapy can teach coping and self-management skills. But it may be the case that further treatment is recommended. Your child may be prescribed an antidepressant, antipsychotic, stimulant, or other psychotropic drug. If this happens, consider finding a therapist to pair with that treatment.

Addressing Teen Substance Use

Teens are known to experiment with alcohol or drugs. This behavior can have a severe impact. It can harm a teen's development. Substance use can affect social life and behavior.

Current substance use rates among teens (2023-2024):

  • In 2023, 1.86 million adolescents aged 12 to 17, or 7.2% of teens nationwide, reported using drugs in the last month
  • Alcohol use remained stable for eighth graders, with 12.9% reporting use in the past 12 months. Alcohol use declined among the other two grades surveyed, with 26.1% of 10th graders reporting alcohol use in the past 12 months (compared to 30.6% in 2023), and 41.7% of 12th graders reporting alcohol use in the past 12 months (compared to 45.7% in 2023)
  • 11.2% of all 12- to 17-year-olds reported using marijuana in the last year

Reported use for almost all substances decreased dramatically between 2020 and 2021, after the onset of the COVID-19 pandemic and related changes like school closures and social distancing. In 2022, most reported substance use among adolescents held steady at these lowered levels, and these latest data show that this trend has continued into 2023.

Many programs exist to help teens with alcohol or drug use issues. Supportive caregivers may play an important role in treatment. It is often effective for them to participate in treating teen substance use. They can monitor the teen's use of substances. Caregivers can help hold teens accountable to therapy goals. They may help teens find healthy coping mechanisms. This can equip teens to handle issues that might have led to substance use.

Sometimes residential treatment programs (rehab) are a helpful option. Rehab provides a safe, supportive environment. It also has medical supervision. Rehab can create a support network and provide structure for residents. This structure can keep people away from triggers that might lead to relapse.

Resources for Teen Substance Use

Examples of treatments for teen substance abuse include:

Teen Intervene. This is for teens who show early signs of drug or alcohol problems. The treatment helps teens set goals. It may help them grow values that could help them avoid drugs or alcohol. Teen Intervene also helps teens find healthy coping strategies. This can help them handle stress without using substances.

Adolescent Community Reinforcement. This treatment looks at factors that lead to substance use. It helps families support the teen working through substance abuse.

Multisystemic Family Therapy. This treatment addresses problems that may occur at school, home, or with friends. It uses a combination of approaches. These approaches include behavioral, cognitive behavioral, and family therapies. These therapies can be used to help families address substance use. This treatment may also help with co-occurring conditions.

Many youths and young adults (23%-63%) who seek mental health therapy drop out before completing the recommended dose of treatment. Youths and young adults who drop out of mental health therapy early have smaller reductions in symptoms and are less likely to maintain improvement at follow-up than youths and young adults who complete treatment. Family engagement is a uniquely powerful aid for youths' and young adults' treatment retention and effectiveness.

Real-World Examples: How Therapy Helps

Conflict between teen and her mother. Zara, 15, and her mom Cassy, 39, start family therapy. They hope to address communication issues. At home, they fight daily. Zara refuses to listen to Cassy. She often leaves the room or house mid-conversation. Cassy nags Zara about chores, schoolwork, and friends. She complains that she misses spending time with Zara. In therapy, Zara reveals she wants her mom to stop nagging. Cassy explains she wants Zara to communicate clearly. The therapist educates them about Zara's stage of development. In their sessions, they learn to communicate in healthy ways. The therapist helps them outline rules for negotiation. Cassy and Zara learn new ways to listen and relate. They find their relationship has become less stressful.

Child who runs away. Camden, 9, runs away from home each afternoon. His parents have him talk with his pastor, teachers, and police officers. They explain the dangers of running away. His behavior does not change. Camden's parents arrange for him to meet with a child counselor. In the first session, the counselor takes a family history. The counselor learns that Camden's mother works all day. His father works overnight, and his older siblings are not often at home. The counselor learns that Camden feels no one pays attention to him. But when he runs away, his parents drop everything to search for him. He becomes the focus of attention. The counselor explains this to Camden's parents. Camden's parents learn that Camden runs away to get attention. Camden and his parents grow a stronger relationship as sessions progress. He receives the attention he seeks in safer ways. He no longer runs away.

Frequently Asked Questions

Q: How do I know if my child needs therapy? A: Because adolescents experience symptoms differently, identifying and diagnosing a mental health disorder can be challenging. According to the National Institute of Mental Health (NIMH), an adolescent might need help if they lose interest in activities that they used to enjoy. Other warning signs include persistent sadness, changes in sleep or appetite, declining grades, social withdrawal, or behavioral problems that interfere with daily life.

Q: What types of therapy work best for children? A: We found that on average 39% of children and adolescents respond after getting treatment (at 1(±2) months after randomization), while 24% respond in control conditions. The RR of responding in psychotherapy versus control was 1.66. The corresponding NNT was 6.3, which roughly means that a total of six patients need to receive therapy to have one more positive outcome, compared to the control group. The most effective approach depends on the child's age, specific challenges, and individual preferences.

Q: How long does therapy typically last for children? A: There is no fixed number of sessions that is adequate for play therapy since each child has his/her unique problems and may require a variable number of therapy sessions; however, in a majority of the cases, 12–20 sessions may be sufficient. Treatment duration varies based on the severity of symptoms and individual progress.

Q: Should medication be combined with therapy? A: An important distinction between medication-only and combination treatment was that the rate of suicidal events was significantly less in the combination treatment arm compared with medication only. The investigators concluded that combination treatment was superior because of accelerated recovery time relative to cognitive behavior therapy-only treatment and reduced suicidality relative to medication-only treatment. Discuss options with your child's healthcare team.

Q: What if we can't afford therapy? A: Unfortunately, though, a majority (54%) of U.S. youth ages 12 to 17 still have difficulty getting needed mental health care, according to the latest National Survey of Children's Health data in 2022–2023. Many communities offer sliding-scale fees, school-based services, or community mental health centers. Your child's school counselor can help identify affordable options.

Q: How can parents support their child's mental health at home? A: Data from adolescents ages 12-17 in 2021-2023 indicate that: 58% report they always or usually receive social and emotional support. 49% report they receive peer support a lot of the time. 66% report they receive parent support a lot of the time. 79% report they have at least one adult in their life who makes a positive difference. Create a supportive environment, maintain open communication, establish routines, and model healthy coping strategies.

How Therapy Can Help / Find a Therapist

Mental health treatment can make a significant difference in young people's lives. Researchers at the National Institute of Mental Health found that unmedicated children with anxiety disorders show widespread overactivation in brain functioning and that treatment with cognitive behavioral therapy led to a clinically significant drop in anxiety symptoms and improved brain functioning.

Four decades of meta-analyses have been used to synthesize the RCT findings and identify scientifically and clinically significant patterns. These meta-analyses have limitations, noted herein, but they have advanced our understanding of youth psychotherapy, revealing (a) mental health problems for which our interventions are more and less successful (e.g., anxiety and depression, respectively); (b) the beneficial effects of single-session interventions, interventions delivered remotely, and interventions tested in low- and middle-income countries; (c) the association of societal sexism and racism with reduced treatment benefit in majority-girl and majority-Black groups.

If you're concerned about your child's mental health, don't hesitate to seek professional help. Early intervention can prevent problems from worsening and help children develop lifelong coping skills. The therapists in our directory have experience working with children and adolescents facing various challenges.

[Find a Child/Adolescent Therapist in Your Area](https://www.goodtherapy.org/find-therapist.html)

Remember that seeking help is a sign of strength, not weakness. With appropriate support, children and teens can overcome mental health challenges and build resilience for the future.

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