Everyone has ups and downs, but there are times when parents may notice their college-age children are showing signs of real trouble and need a therapist.

It might be as obvious as a drop in school performance, or as subtle as a sudden and consistent mood change.

But unlike a physical ailment, in which parents could consult a doctor, mental health issues often carry a stigma, and parents may be reluctant to send an overstressed or depressed child to a therapist. They may not know where to look for one. Or money may be an issue.

According to the National Alliance on Mental Illness, one in four young adults has some sort of mental illness. Anxiety, depression, and panic attacks top the list of ailments, reports the American College Health Association. And a recent survey of current and former college athletes by Georgetown University Medical Center found depression levels were much higher in current college athletes, upending the researchers' thesis. The finding suggests the need for more studies on depression among college athletes, although researchers suggest "overtraining, injury, pressure to perform, lack of free time, or stress from schoolwork" were factors.

"Parents know their own children so well," says D'Arcy Lyness, a psychologist in Wayne and an editor at the website KidsHealth.org. "They often can pick up subtle signs. I can't see a downside to offering teens help. The trick is not to see it as a flaw but to reach out with a vote of confidence and support."

David Palmiter, a psychologist and professor at Marywood College in Scranton, agrees. "The sooner these problems get addressed, the better the prognosis." He cites shame - the fear that something is "wrong with their child" - as the top reason more people do not seek care.

"A lot has changed in a generation," says Lyness. "When many parents were young, we viewed mental-health issues differently than we do now. There are changes in how we approach treatment and what works. We now have evidence-based treatments for kids who are depressed that can work - with or without medication."

"Kids fall apart in college for a number of reasons," says Vivian Seltzer, a psychologist and professor at the University of Pennsylvania. "College can be very competitive. High achievers can be reduced to a common denominator, which can be shocking since for many years they've been at the top of the class."

Most kids reorganize themselves and do very well, she adds. But there can be other stressors, among them financial pressures, parental expectations, romantic issues, and drug problems. And when well-meaning parents express concerns, newly independent kids don't want to talk about things "or give off a hostile or off-putting comment," she says.

In such cases, Seltzer suggests that parents first find someone to talk to - from a trusted doctor to a social service agency to a psychologist versed in college issues - to see if they're overly concerned or if a real problem exists. Before going, she suggests identifying major characteristics of their children's behavior "so you'll help the provider know what they're looking at."

Once you've determined your child needs help, you can suggest visiting a college counseling center, undergoing a college-based mental-health screening, or talking to an empathetic professor.

When evaluating therapists, Palmiter finds the most important qualification is operating from an evidence-based approach, i.e. peer-refereed science that supports treatment. He recommends that peer endorsement and evaluations can lead parents to a good practitioner, and notes that therapists with American Board of Professional Psychology accreditation have submitted their clinical work for peer review and evaluation. Parents can also phone the Pennsylvania Psychological Association (717-232-3817 or use its online psychologist locator (www.papsys.org/). Many clinicians have websites that often list their qualifications.

Along with regular counseling services, many universities have training clinics where graduate student counselors supervised by faculty or licensed professionals see students and members of the community for a nominal fee. The American Psychological Association also keeps lists of therapists who work with adolescents. (See "Find a Psychologist" under Quick Links at www.apa.org.)

"A good practitioner will perform a pretherapy evaluation and recommend a plan of treatment," says Palmiter. "The evaluation should include an interview with the family, time with the child, a review of relevant records and behavior files."

"When people come to see me, I don't know if we're going to work together; I might not be a good fit. All they're doing first is getting an evaluation."

Based on the evaluation, in which Palmiter identifies the strengths as well as the weaknesses of the patient, he works on setting up a treatment plan. "I ask patients to imagine a videotape in the future that contains three or four signs or goals that will show that our work together is succeeding. Where do they want to go?"

Money, he says, should not be a deciding factor. "Persistence is key," he says. When money is tight, he suggests seeking out community health clinics and asking for their best therapists. Groups like Catholic Social Services (www.catholicsocialservicesphilly.org) and Jewish Family and Children's Service of Greater Philadelphia (www.jfcsphilly.org) also offer inexpensive help. And once an evaluation has been performed, he says, patients should not hesitate to ask doctors in private practice if they are willing to offer fees on a sliding scale.

"What's most important is that parents give a message of love and support," says Lyness. "The message should be that, 'I know you're having trouble and I want to set you up with someone who's experienced with this. I care about you and just want you to feel better.' "