When a child starts acting out in class, suddenly shuts down socially, or their grades take a nosedive, it’s tempting to label the behavior as “defiant,” “lazy,” or “attention-seeking.” But often, those surface-level symptoms are just the tip of the iceberg—signs that a child or teen is wrestling with something deeper. For pediatricians and school counselors, recognizing this pattern can be the turning point in getting that young person the help they really need.
Anxiety, Depression, and Trauma Don’t Always Look the Way You’d Expect
Children rarely say, “I’m anxious,” or “I feel depressed.” Instead, they show us. A six-year-old with chronic tummy aches and angry outbursts may be managing early anxiety. A high-achieving middle schooler who suddenly refuses to go to school may be overwhelmed by internal pressure or quiet panic. Teens, especially, tend to internalize their pain. For them, withdrawal, irritability, or dropping interests they once loved are often signs of emotional burnout or depression—not just attitude. Trauma, in particular, can lead to a fight-or-flight response that looks like hyperactivity, zoning out, or “troublemaking,” especially if it’s not fully processed.
How Therapy Helps Kids Express What They Can’t Always Say
This is where therapy becomes more than just a referral—it becomes a lifeline. At O’Neill Counseling, we specialize in helping kids tell their stories through the lens of behavior. Using developmentally sensitive approaches like play therapy, sand tray, and talk-based modalities, our therapists meet children where they are, without forcing them to articulate what they may not even understand yet. Play allows children to externalize and process emotional content safely, giving clinicians and caregivers critical insight into what’s happening beneath the surface.
Supporting Families to Support the Child
Our team also emphasizes family-based support, because the child never struggles alone. Family dynamics, even unintentionally, can reinforce cycles of anxiety, trauma, or avoidance. We work directly with parents and caregivers to help them understand their child’s behaviors not as personal attacks—but as communication. Often, small shifts in parenting approaches or creating a more regulated home environment can bring profound relief to a struggling child. And for teens, we build rapport through trust, respect, and collaboration—helping them feel seen, not judged.
When to Refer a Child or Teen for Counseling
So when does it make sense to refer a child or teen for therapy? Here are a few key signs:
- Sudden or prolonged drop in academic performance
- Persistent defiance, aggression, or withdrawal
- Chronic physical complaints without a medical cause
- Trouble with attention, sleep, or appetite
- Changes in social behavior (isolation or peer conflict)
- Regression in behavior (e.g., bedwetting, tantrums)
- Known exposure to trauma, loss, or family disruption
If you’re a pediatric provider, educator, or program working with youth, we invite you to partner with us in supporting their emotional wellness. You don’t have to carry the weight alone. Let therapy be an extension of your care.
For more information about our services, visit child counseling, explore our holistic family counseling approach, or learn how trauma therapy and anxiety counseling at O’Neill Counseling can help your young patients and students thrive.
Karen Majdalani, LMFT (Lic. #132761) holds Master’s degrees in Psychoanalysis and in Marriage and Family Therapy, and has been practicing since 2015. She co-founded O’Neill Counseling with Sean O’Neill to provide affordable, insurance-based therapy for families, children, teens, and couples in Orange County. At O’Neill Counseling, she leads a team of associate therapists with diverse expertise, including trauma recovery, EMDR therapy, anxiety and depression treatment, and child and adolescent disorders. Karen is passionate about creating a safe and supportive space for growth, healing, and connection.