Cheryl Sewell

The signs that go beyond normal ups and downs, and how to tell when it's time to reach out for support.

Most children and teenagers go through periods of being moody, withdrawn, anxious or out of sorts. Growing up is genuinely hard, and a certain amount of emotional turbulence is a normal part of development. So how do you tell the difference between a rough patch and something that needs professional support?

Signs worth paying attention to

As a general guide, it's worth considering support when you notice:

• Changes that have lasted more than a few weeks, rather than a few days
• A noticeable shift from how your child usually is — socially, emotionally or in their sleep, appetite or energy
• Difficulties that are starting to affect school, friendships or family life
• Increased irritability, tearfulness, or withdrawal from things they used to enjoy
• Your child telling you, in their own way, that they're struggling
• Your own gut feeling that something isn't quite right — parents are often the first to notice, even before they can articulate why

Trust what you're noticing

You don't need to wait for a crisis before reaching out. In fact, early support is often more effective and can prevent difficulties from becoming entrenched. Counselling isn't just for when things have become serious — it can also be a helpful, proactive space for a child to build coping skills, work through a specific challenge, or simply have somewhere to talk that isn't home or school.

If you're unsure, it's completely reasonable to reach out for a conversation before committing to anything. Part of my role is helping parents work out whether counselling is the right next step, and what that might look like for their particular child.

You don't need to be in crisis to benefit from therapy. Here's how to recognise when support could help.

There's a common misconception that therapy is only for people in crisis, or for problems severe enough to be diagnosable. In reality, most people who come to see me are simply going through something difficult and want somewhere to think it through with support.

You don't need a "big enough" reason

People seek counselling for all kinds of reasons — a relationship ending, work stress, a major life transition, feeling stuck or unmotivated, grief, low self-esteem, or simply wanting to understand themselves better. None of these need to have reached crisis point to be worth talking about.

Some signs that counselling might help include:

• Feeling persistently overwhelmed, flat, or anxious, more days than not
• Struggling to cope with a change or challenge using your usual strategies
• Noticing the same patterns or difficulties showing up again and again — in relationships, work or mood
• Wanting an objective, non-judgemental space to talk something through
• Feeling like you're "getting by" but not actually doing well

Therapy as a space to reflect, not just a fix for a crisis

Therapy can be a space for genuine reflection and growth, not only crisis management. Many people find that having a regular, dedicated space to process what's going on for them — with someone trained to help them notice patterns and build practical strategies — is valuable in itself, regardless of how "serious" their situation is.

If you're weighing up whether to reach out, that uncertainty is itself a completely normal part of the process. You don't need to have it all figured out first.

Anxiety shows up differently depending on age and stage. Understanding the signs in each.

Anxiety is one of the most common reasons people seek support, but it doesn't always look like "worry." It shows up differently depending on age and stage of life, which is part of why it can go unrecognised for a long time.

In teenagers

Anxiety in teenagers is often mistaken for other things — moodiness, defiance, or simply "being a teenager." Common presentations include:

• Avoidance of school, social situations, or specific activities
• Physical complaints such as stomach aches or headaches, particularly before school
• Irritability or anger, rather than obvious worry
• Perfectionism, or intense fear of making mistakes or being judged
• Reassurance-seeking, or repeatedly asking the same questions
• Difficulty sleeping, or being unusually tired

In adults

Adult anxiety can be more internalised, and is often masked by high-functioning coping. Signs can include:

• Persistent overthinking or difficulty switching off mentally, especially at night
• Physical symptoms such as muscle tension, a racing heart, or fatigue
• Avoidance of situations that trigger anxious feelings
• Irritability, or feeling constantly "on edge"
• Difficulty relaxing, or feeling guilty when not being productive
• Over-preparing or over-checking to manage uncertainty

Why the difference matters

Understanding how anxiety shows up at different ages helps in recognising it earlier, and responding to it in a way that actually helps rather than accidentally reinforcing it — for instance, allowing a teenager to avoid every anxiety-provoking situation can unintentionally make the anxiety stronger over time. Evidence-based approaches like CBT focus on gradually building confidence to face difficult situations, rather than avoiding them altogether.

Low mood can look very different across ages — from withdrawal to irritability to changes in energy.

Depression doesn't always look like sadness. It can be easy to miss, particularly because it presents quite differently depending on age.

In teenagers

Rather than appearing visibly "down," depressed teenagers more often show:

• Irritability, anger or a short temper, more than sadness
• Withdrawal from friends and activities they previously enjoyed
• Changes in sleep — sleeping much more, or struggling to sleep at all
• Drop in school performance or motivation
• Increased sensitivity to criticism or rejection
• Changes in appetite or energy levels

In adults

In adults, depression can be masked by "keeping busy" or continuing to function outwardly while struggling internally. Common signs include:

• Persistent low mood, flatness, or loss of enjoyment in things that used to matter
• Fatigue or lack of motivation, even for simple tasks
• Difficulty concentrating or making decisions
• Changes in sleep or appetite
• Withdrawing from social contact
• Feelings of guilt, worthlessness, or being a burden

What to do if you notice these signs

Whether in yourself or someone you care about, these signs are worth taking seriously — particularly if they've persisted for more than two weeks and are affecting daily functioning. Depression is highly responsive to treatment, and reaching out early tends to lead to a faster and smoother recovery.

If you or someone you know is having thoughts of self-harm or suicide, please contact Lifeline on 13 11 14, available 24/7, or present to your nearest emergency department.

Understanding the anxiety behind school refusal, and practical steps to support your child back.

School refusal — when a child or teenager experiences significant distress about attending school and consistently avoids it — is more common than many parents realise, and can be one of the most stressful experiences for a family to navigate.

It's usually not defiance

It's important to understand that school refusal is typically driven by underlying anxiety, not simple defiance or laziness. It can stem from social anxiety, academic pressure, bullying, separation anxiety, or a general sense of overwhelm. The refusal itself is often the visible tip of a much larger emotional iceberg.

Why pressure alone doesn't work

A natural instinct is to push a child to "just go," or to use consequences to force attendance. Unfortunately, this often increases distress and can strengthen the avoidance pattern over time, because it doesn't address the anxiety driving the behaviour in the first place.

What tends to help

• Identify the underlying driver. Is it social, academic, sensory, or related to separation? The right approach depends heavily on the cause.
• Work collaboratively with the school. A graded return plan, developed with teachers and student wellbeing staff, is usually far more effective than an all-or-nothing approach.
• Validate the feeling, without necessarily accepting avoidance as the solution. "I understand this feels really hard" is different from "then you don't have to go."
• Build coping strategies gradually, so your child has tools to manage the anxiety itself, rather than only ever avoiding the trigger.
• Get support early. The longer school refusal continues, the harder it tends to become to reverse, so early intervention matters.

Every family and every child is different, and a plan that works well for one young person may not suit another. I work closely with both parents and schools to build a tailored, graded plan that reduces anxiety while supporting a genuine return to school.

Practical ways to help your teenager manage pressure without adding to it.

The HSC years bring a level of academic and emotional pressure that can be genuinely difficult for teenagers to manage — and difficult for parents to know how to help with. Here are some practical, realistic ways to support your teenager through it.

Keep perspective, and help them keep it too

It's easy for the HSC to start to feel like the single most important thing that will ever happen. Gently helping your teenager hold a wider perspective — that this is one part of their life, not the whole of it — can reduce the intensity of the pressure without minimising how much it matters to them right now.

Focus on process, not just results

Praising effort, consistency and good study habits (rather than only results) helps build resilience and reduces the all-or-nothing thinking that fuels exam anxiety. A teenager who believes their worth is tied entirely to an ATAR is at far greater risk of anxiety and burnout.

Practical ways to help

• Encourage regular breaks, sleep and movement — these aren't distractions from study, they're what makes study actually effective
• Help them build a realistic study schedule rather than an idealised one
• Keep communication open without constant checking in on marks or progress
• Model calm — teenagers pick up on parental anxiety more than we realise
• Watch for signs of burnout: exhaustion, withdrawal, loss of motivation, or a persistent sense of dread

When to seek extra support

If your teenager is showing signs of significant anxiety, panic, or if study is being replaced by avoidance and shutdown rather than genuine rest, it may be time to bring in additional support. Learning practical anxiety-management and study-related coping strategies early can make a meaningful difference to how the rest of the year unfolds.

They're often used interchangeably, but understanding the difference matters for how you respond.

Stress and anxiety are often used interchangeably, but they aren't quite the same thing — and understanding the difference matters, because it affects how best to respond.

Stress is usually tied to a specific cause

Stress is generally a response to an identifiable external pressure — a work deadline, a big event, financial pressure, or a demanding period of life. It tends to resolve once the source of the stress is removed or resolved. Some stress is even helpful; it can sharpen focus and motivate action in the short term.

Anxiety often persists beyond the trigger

Anxiety, on the other hand, is a felt sense of worry, fear or unease that can persist even when there's no immediate, identifiable threat — or that continues well after the original stressor has passed. Anxiety often involves anticipating future problems, and can come with physical symptoms like a racing heart, tension, or difficulty sleeping, even when things are, on the surface, going fine.

Why it matters

Because stress and anxiety respond differently:

• Stress is often best managed through practical problem-solving, workload changes, or time management — addressing the actual source.
• Anxiety often needs a different approach — one that addresses thought patterns, avoidance behaviours and the body's threat response, since there may not be a single practical "fix" to remove.

In practice, the two often overlap and feed into each other — ongoing stress can develop into anxiety over time, and anxiety can make everyday stress feel far more overwhelming than it otherwise would. If either is persistent, affecting your daily functioning, or simply not improving despite your best efforts, it's a reasonable time to seek support.

The signs that therapy is working, even when progress doesn't feel obvious week to week.

Progress in therapy isn't always as obvious as feeling instantly better after a session. It's a common and completely understandable question: how do I know if this is actually working?

Signs therapy is helping, even when it's subtle

• You're noticing patterns in your thinking or behaviour that you weren't aware of before
• You're starting to respond differently to situations that would previously have thrown you
• You feel more equipped to sit with difficult feelings, rather than needing to immediately escape them
• You're applying strategies from sessions in your day-to-day life, even in small ways
• Difficult conversations or decisions feel slightly more manageable than they used to
• You leave sessions with something concrete to think about or work on, even if the session itself was hard

Progress isn't always linear

It's normal for progress to feel two steps forward, one step back — particularly when working through something genuinely difficult. A hard session is not the same as an unhelpful one; sometimes the most useful sessions are the ones that feel the most uncomfortable at the time, because that's where real change is happening.

What if it doesn't feel like it's helping?

If, after a reasonable period, you're genuinely not noticing any shift — in your understanding of yourself, your coping, or your day-to-day experience — that's a completely valid thing to raise directly with your therapist. A good therapeutic relationship should be able to hold that conversation openly. Sometimes it means adjusting the approach; occasionally it means that a different therapist or modality might be a better fit, and that's a legitimate outcome too, not a failure on your part.

At the end of each session, there should be some sense of what you're working on next — a concrete thread connecting one session to the next, rather than each conversation feeling disconnected from the last.