Elementary Red Flags: K-5th Grade

This handout provides guidance on differentiating between typical behaviors and potential mental health red flags in elementary school students.

Typical Behaviors (K-5th Grade)

• Occasional shyness or clinginess, especially in new situations.
• Testing boundaries, occasional defiance.
• Age-appropriate fears (e.g., monsters, darkness).
• Difficulty sharing or taking turns sometimes.
• Occasional sadness or frustration from disagreements with friends.
• Brief periods of hyperactivity or difficulty sitting still.
• Developing independence, wanting to do things "by myself."
• Seeking attention through various behaviors.

Potential Red Flags (Atypical Behaviors)

• Persistent sadness, irritability, or tearfulness for more than two weeks.
• Frequent, severe temper tantrums or outbursts that are unprovoked or disproportionate to the situation.
• Significant changes in eating or sleeping habits (e.g., sudden weight loss/gain, difficulty sleeping, nightmares).
• Loss of interest in activities they once enjoyed, including play.
• Excessive worries or fears that interfere with daily activities (e.g., separation anxiety, fear of school).
• Regression in developmental milestones (e.g., sudden bedwetting after being potty-trained, thumb-sucking).
• Difficulty concentrating that is persistent and severe, leading to significant academic decline.
• Social withdrawal or extreme difficulty making and keeping friends.
• Frequent physical complaints (headaches, stomachaches) with no medical explanation.
• Talk of hurting oneself or others.
• Destructive behavior towards property or animals.

Middle School Red Flags: 6th-8th Grade

Middle school is a period of significant physical, emotional, and social change. This handout helps distinguish typical adolescent development from behaviors that may signal mental health concerns.

Typical Behaviors (6th-8th Grade)

• Increased desire for independence and peer acceptance.
• Questioning authority and rules.
• Experimenting with identity and different social groups.
• Occasional moodiness or irritability due to hormonal changes.
• Increased focus on personal appearance.
• Developing stronger friendships, sometimes leading to temporary exclusions.
• Testing boundaries with language or minor rule-breaking.
• Fluctuations in academic motivation.
• Increased privacy needs.
• Occasional sadness or anxiety about social situations or grades.

Potential Red Flags (Atypical Behaviors)

• Persistent sadness, hopelessness, or significant irritability for more than two weeks.
• Withdrawal from friends, family, or previously enjoyed activities (lasting more than a few days).
• Significant changes in academic performance (sudden decline, excessive missing assignments, truancy).
• Increased risk-taking behaviors (e.g., substance use, promiscuity, severe defiance).
• Significant changes in eating habits or preoccupation with body image (e.g., extreme dieting, binging, purging).
• Severe sleep problems (persistent insomnia, sleeping excessively).
• Frequent complaints of physical symptoms (headaches, stomachaches, fatigue) with no medical cause.
• Expressions of self-harm or suicidal thoughts (even if presented as jokes).
• Extreme mood swings that are rapid, intense, and interfere with daily life.
• Engaging in bullying or being significantly bullied with no resolution.
• Explosive anger or aggression that is unprovoked or disproportionate.

High School Red Flags: 9th-12th Grade

High school students face immense pressure academically, socially, and as they plan for their future. This handout helps identify serious mental health concerns amidst typical adolescent challenges.

Typical Behaviors (9th-12th Grade)

• Intensified focus on peer relationships and identity formation.
• Increased academic pressure and stress about future plans.
• Occasional stress, anxiety, or sadness related to school, relationships, or future.
• Increased independence and desire for autonomy.
• Developing romantic relationships.
• Experimenting with personal style and values.
• Occasional conflicts with parents or authority figures.
• Fluctuations in energy levels or motivation.

Potential Red Flags (Atypical Behaviors)

• Prolonged sadness, apathy, or loss of pleasure in nearly all activities (anhedonia) for extended periods.
• Significant and rapid changes in weight, appetite, or sleep patterns that are not medically explained.
• Expressions of worthlessness, excessive guilt, or pervasive hopelessness.
• Talk of death, dying, or suicide; engaging in self-harm behaviors (e.g., cutting, burning, scratching).
• Severe social withdrawal, increased isolation, or cutting off close friends.
• Chronic reckless behavior, severe substance abuse, or engaging in dangerous, impulsive activities.
• Extreme and rapid mood swings, agitation, or sudden, uncharacteristic outbursts of anger/violence.
• Pronounced decline in academic performance, consistent truancy, or dropping out of extracurriculars.
• Difficulty concentrating, significant memory problems, or disorganized thinking that interferes with daily functioning.
• Persistent, intense anxiety, frequent panic attacks, or excessive worry about various aspects of life.
• Hallucinations, delusions, or other signs of psychosis.

Case Study Discussion Activity: Spotting the Signs

Instructions: In your small groups, read the case study assigned to your group (or choose one relevant to your grade level). Discuss the questions below, identifying potential red flags and considering initial response strategies.

Discussion Questions for Each Case Study:

1. What specific behaviors or changes in the student concern you?
2. Do these behaviors seem typical for their age, or do they lean towards being atypical/red flags? Why?
3. What are your immediate next steps as a teacher? (e.g., observation, conversation, documentation)
4. What school resources might be appropriate to involve for this student?

Case Study 1: Elementary School (Grade 3)

Scenario: Ms. Lily, a third-grade teacher, has noticed a significant change in Maya over the past month. Maya, usually a bubbly and engaged student, has become withdrawn. She often sits alone during recess, avoids group activities, and has stopped raising her hand in class. Ms. Lily also noticed that Maya frequently complains of stomachaches, especially on Monday mornings, and sometimes cries silently at her desk. Her academic performance, particularly in reading, has started to dip.

Case Study 2: Middle School (Grade 7)

Scenario: Mr. Chen, a seventh-grade science teacher, is concerned about Alex. Alex, who was once a consistent B student and active in the school band, has recently started missing assignments, and his grades are slipping. He often comes to class looking tired and irritable, and his usually neat appearance has become disheveled. Mr. Chen overheard Alex making a cynical comment to a friend about "everything being pointless" and has also noticed new, faint scratches on Alex's forearm during gym class. Alex has also become uncharacteristically argumentative with peers and teachers.

Case Study 3: High School (Grade 10)

Scenario: Ms. Davies, a tenth-grade English teacher, is worried about Liam, who used to be an enthusiastic participant in class discussions and a strong writer. Recently, Liam has become very quiet, rarely contributes, and often appears distracted or staring blankly during class. His essays, usually insightful, are now rushed and disorganized, and he has missed several deadlines. Ms. Davies also noticed a significant weight loss and that Liam often wears long sleeves, even on warm days. His close friends have expressed concern that he rarely hangs out with them anymore and seems to be constantly online but unresponsive to their messages. There have been rumors from other students about Liam experimenting with vaping and occasionally smelling of smoke.