Mental Health | futuresTHRIVE

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Mental Health 101:

Ages and Stages

Just like physical health, mental health shifts and changes throughout every stage of life. The constant evolution of mental health throughout life, coupled with the fact that most symptoms are intangible or invisible, can make it difficult to understand the difference between age-appropriate thoughts, feelings, and behaviors, and signs of concerns.

The classic developmental stages discussed in mental health research were divided into the following groups: ages 0-5, ages 6-11, ages 12-17, and ages 18-24.

However, the new, emerging science now recognizes a vital stage in mental health development referred to as “tween”: ages 9-12. Parents often underestimate how important the tween years are because they tend to focus on academic abilities and social concerns of elementary school and then pivot to worries about safety, drugs, sex, and the rebellious behavioral issues of the teen years. They miss the explosion that is taking place as tweens experience significant changes that blow parents away and shake tweens to their core.


Common Questions About Tween Mental Health

 with Dr. Amanda Craig

Dr. Craig has worked in a variety of settings, including University of Minnesota research departments, juvenile correctional facilities, high schools, fortune 500 companies, substance abuse programs, and university/college classrooms. For over 20 years she has administered counseling and therapy services to adolescents, adults, couples, and families. Currently Dr. Craig owns and operates Manhattan Marriage and Family Therapy PLLC, a private practice based in New York and Connecticut. She also provides services to individuals and organizations as a clinical supervisor, consultant, and group/training facilitator. Her area of expertise is relationship therapy concentrated on couples and tween parenting.  

Why are the tween years (ages 9-12) such an important developmental stage?

Tween brains are changing. In fact, a massive reshuffling in the brain is happening. Scientifically we are seeing a reorganization of neural circuitry and pruning of circuits rarely used, that prompts psychological and emotional changes. These changes often proceed the raging hormone and physical changes of puberty, the part you see as a parent.

Why are tweens so emotional?

In this developmental stage and with the neural pathways sprouting, tweens experience new emotions they do not recognize. While the prefrontal cortex (the thinking brain) is not even under construction yet, the amygdala (the emotional brain) filters experiences, relationships, and thoughts of a tween. This invites more feelings and bigger feelings that comes as a surprise to tweens. And because the part of the brain used for critical thinking and decision making (the prefrontal cortex) is napping, tweens don’t know what to call these emotions, how to express them, why they are happening or how to regulate them.

How do tweens view themselves and their relationships?

Tweens are hyper-aware of themselves. They feel as if everyone is noticing them, watching them, judging them and talking about them. This hyper self-awareness and peer comparison utilize a significant part of their emotional energy. They often feel insecure, unsure and look for validation and reassurance. They also have difficulty receiving feedback because they hear a strong message not simply about their behavior but who they are as a person.

Why do tweens struggle to explain their thoughts and feelings?

Tweens start to have more complex thoughts but don’t have the words to describe them yet. Additionally, tweens are not yet equipped with the critical thinking ability needed to understand and communicate the social and emotional changes they experience and how these changes affect them. Because they lack the language to explain their thoughts and feelings, they often seem awkward, rude, offensive, sensitive or confused. In addition, one minute they can seem mature and adult like and the next revert back to childlike behaviors.

What are some warning signs my tween needs help?

There are several warning signs parents can watch for in order to catch mental health problems early and find supportive resources that will benefit both the parent and the tween.

First, you may notice a mood change that tends to be there most of the time whether the tween is experiencing good things, tough things or neutral downtime. They may have moments of “happy” but revert quickly back to the low mood. A tween who used to be outgoing, and always around you may spend more time in his room or seem quiet. A tween that used to be quiet but experienced joyful activities like reading or art might appear less emotional or engaged. The tween’s mood could also appear more whiney, clingy, needy, agitated or child-like, but the tween cannot describe what he is feeling. Lastly you may see more extreme emotions like anger outbursts, slamming doors or crying tantrums.

Struggling tweens may exhibit negative self-talk that they can’t seem to shake. It is one thing for a tween to say, “I am so dumb” because they received a low test grade and are disappointed in themselves. It is another thing to call themselves “dumb” or “ugly” or say things like “no one likes me” or “it’s never going to get better” when there doesn’t appear to be a trigger for these feelings. The behavior can be a problem when it isn’t related to a particular event but instead is more a state of mind.

Take notice of changes in their energy level. A tween with low energy might be tired over the weekend and into the week. This energy level might be different from past history and present more often on most days for a week or longer. Or, another extreme, you may notice their energy seems hyper, obnoxious more often and they seem unable to calm down.

Finally tweens may lose interest in things they used to like, and not replace them with new interests. They may appear to be “dropping out of childhood” instead of moving towards other friend groups or activities.

    What are some specific behavioral changes I should look out for?
    • Moving away from activities they used to like to do and get joy from.
    • Changing eating habits: They may eat when they aren’t hungry, or pick at their food and not eat, which both can be cases of emotional eating.
    • Finding friendships with peers that are struggling and moving away from friends they can grow and learn with.
    • Exhibiting low energy. Staying in their room Sleeping a lot. Playing endless hours of video games on their phone. Or simply doing nothing.
    • Other significant behavior changes can include eating and binging, scratching wrists or legs, taking things that aren’t theirs to have, or using substances (vape, alcohol, marijuana, pills).
    • Talk about wanting to hurt themselves or seeing life would be better without them or other end-of-life statements. Usually, these statements at this stage are one-liners more than long conversations which are easy to miss.
    What can I do?

    If tweens change and appear to be worried or down, start by asking questions in a gentle caring curious way. See if they will share their feelings, their worries, their thoughts, or the emotions they and cannot shake. Perhaps ask multiple choice questions to give them things to think about words they can use to describe what is going on for them like: Do you think you are disappointed because of your math test, or nervous about try-outs next week or did something happen between you and a friend?

    Instead of giving them a solution or fix, see if you can work together to brainstorm ways to cope with their struggles, use their voice to be assertive or name their emotions. Parents do not need to immediately step in and solve the problem. Sometime tweens just need understanding, empathy, comfort and safety.

    If your concerns persist or your tween is not open to discussing the shifts you notice reach out to teachers, coaches or other adults that interact with your tween to see if they are seeing similar behaviors.

    Seek resources and services from the school which could include academic testing and in school accommodations like an IEP or 504 to help with academic distress or performance issues.

    Consider family therapy or counseling to learn how to communicate and support your tween. Family therapy is nice because it tells a tween we are in this to learn and grow together whereas individual therapy can sometimes leave tweens feeling like they are the problem to go get fixed.

    Having said that, some tweens feel support and comfort by talking to someone outside of their family. Ask your tween if they are interested in a safe place to talk about their thoughts and feelings or just lighten their load with someone outside the family. For these tweens they might appreciate individual therapy.

    If you are seeing extreme behavior changes it would be a good time to get an thorough mental health assessment with a psychiatrist or clinical psychologist. A clinical psychologist can provide testing to determine attention, learning, mood or neurological issues while a psychiatrist can assess for a host of mental health issues and offer recommendation for medical management.

    In extreme cases an assessment might reveal a need for an outpatient program, in patient program or a safety watch if your tween is describing suicidal thoughts or plans.

    If a tween is sharing suicidal thoughts or plans with you or anyone else it is time to seek outside family help. States offer 24-hour crisis lines where you can talk with a counselor. Don’t be afraid to reach out if there is a safety concern. It might save their life.

    At any age, negative emotions such as fear, sadness and anxiety can be appropriate and healthy responses to certain situations. When determining what emotions and behaviors are typical, it is useful to consider the following:


    How intense are the behaviors, thoughts and emotions?


    How often do these feelings or behaviors exist?



    How long do they last?



    Is it causing impairment in the home, school or friendships?

    Common Emotions for Parents to Notice

    If any of these emotions stop your child from participating in life, seeking help is only a call away. There are many resources within any community: including your pediatrician, local non-profits, a mental health provider and even your house of worship.


    The anticipation of something bad. Excessive worry can be one of the first signs of generalized anxiety.


    A specific response to something that is perceived as an immediate threat. Fear typically lessens when the threat is no longer present.


    The overwhelming sense of nervousness or apprehension that can be related to a specific thought or feeling or can oftentimes be unexplainable. Anxiety is similar to worry as they both have an anticipatory nature; however, anxiety is more intense than worry.


    An emotion that can be triggered by negative events such as change, hurt, etc. Sadness tends to be temporary and does not affect a child’s long-term functioning.


    Persistent feelings of sadness that may include a lack of interest in once enjoyable tasks, low energy and poor sleep quality, and high irritability or intense emotional reactivity. Depression is unrelated to any specific event, although it can be triggered by one, and often has little to no explanation.

    Grief Icon


    Grief is the internal part of loss. Grief is real because loss is real. Evolving science show six stages of grief 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance and newly added 6. Finding meaning. Source:

    We all have mental health. When we address it early and often we recognize that happiness is equally important to development. Children show their happiness in many ways including joy, satisfaction, contentment, or general positive emotions. This can take many forms. Take the time to understand what makes your child truly happy. Striking the balance between easy and hard emotions reinforces resilience.