By: Richard J. Chung, MD, FAAP- healthychildren.org
If your teenage child is dealing with anxiety, depression or any other mental health concern right now, you're not alone. More than a year after the American Academy of Pediatrics (AAP) joined with other organizations to declare a national emergency in youth mental health, many teens are still struggling.
Still, you may wonder whether the symptoms are part of the biological and social changes all young people go through on their way to adulthood, or something more. As a parent or caregiver, how do you know when to talk with your teen and their doctor about mental health?
Read on to learn more about teen mental health, including signs someone is struggling and may need more support. You can also visit the AAP YouTube channel for a series of videos for teens on mental health. The videos address topics including depression, anxiety, eating disorders, self-harm and other topics. Share with someone you care about:
Pressures teens face
Youth mental health experts have raised concerns about the extreme pressures on children and teens throughout the COVID-19 pandemic. Yet the lingering effects of school closures and other COVID-related stressors are not the only factors in teen stress. Many young people are also dealing with:
Overwhelming pressure to achieve good grades in school or gain admission to elite colleges and universities
The need to be superstars in sports, the performing arts or other extracurriculars
Tough schedules that don't allow enough time for rest, relaxation and unstructured fun
Bullying (whether in person, via social media or both)
Persistent fears about climate change, global conflict and other weighty issues
Discrimination based on race, gender, sexual orientation, weight, religion, disability or other factors
Problems related to poverty or lack of money for safe, stable housing and enough nutritious food.
How will I know if my teen is struggling?
The mental health symptoms you might see in your child will, of course, be unique to them. But as a parent or caregiver, you have a good sense of what their "normal" looks like.
Signs your teen may be having mental health difficulties
In addition to more overt symptoms like mood swings, irritability, anger and tearfulness, you may see:
Notable changes in sleep, weight, eating habits or other everyday patterns
Loss of interest in the things they usually love or quitting activities that they enjoy
Withdrawing more than usual from friends, family and community
Canceling plans with their closest friends with little or no explanation
Academic struggles that seem different or more intense: for example, failing quizzes in their favorite subject or refusing to do homework that once would have seemed easy
Running thoughts or worries that won't leave them alone
A whole new set of friends you've never met before
Refusing to talk about what's bothering them, even after you've made it as safe as possible to discuss hard issues openly
Obsession with a certain goal, possibly with the belief that if they don't achieve it, their life will never be the same
Signs of drug, alcohol or other substance use
Signs of self-harm such as cuts, burns, bruises, etc. that your teen tries to hide or can't explain fully and credibly
Sexual activity or interest that seems new or more intense than before
Keep in mind that having just one symptom on this list doesn't mean your teen is experiencing a full-blown crisis. Biological changes, including the hormone shifts all tweens and teens go through, can affect your child's mood, school performance and more. But if you consistently see one or more of these signs, it's time to open a conversation about mental health with your teen.
What mental health conditions are most common for teens?
Young people face pretty much the same array of mental health challenges that adults do. However, these are the most common mental health conditions seen in U.S. tweens and teens:
Attention deficit/hyperactivity disorder(ADHD) affects nearly 10% of all U.S. kids aged 3 to 17.
Nearly 9.5% experience anxiety that interferes with their everyday functioning.
Around 4.5% live with depression. In teens, depression may or may not look like the stereotyped tearful blues. Symptoms of depression can sometimes look more like anger/irritability.
Though they are less common, eating disorders such as anorexia nervosa and bulimia nervosa can cause major health problems for teens and young adults. Self-harm,thought to be underreported, is another serious concern for tweens and teens.
Are drinking and drugs part of the problem?
Substance use is very common among teens. It can combine with mental health issues (and in most cases, make them worse).
Around 15% of all high-school students say they have used street drugs such as cannabis, cocaine, inhalants, heroin, meth, hallucinogens or MDMA (also called ecstasy or molly). Some 14% report they have misused prescription opioids. Nearly 30% say they've tried alcohol and 14% admit to binge drinking. A frightening 17% got into a car driven by someone who had been drinking, exposing them to a whole new level of danger.
Substance use is a concern all its own—one you should definitely discuss with your teen, even if you don't see signs of mental health issues. But noticing it alongside mental health symptoms raises extra concern. Drinking and drugs are often used to cope with difficult feelings or circumstances. This can signal deep emotional pain that needs to be addressed.
What role does social media play?
Young people spend a lot of time on sites such as Instagram, Snapchat, TikTok and others. One study found that 90% of teens aged 13 to 18 use multiple platforms, with more than 60% engaging with social media every day.
We are still learning about the ways social media can affect human health, especially among children and teens. Healthy use of social media can foster positive connections. However, some young people may face greater risks for negative effects. See "Social Media & Your Child's Mental Health: What the Research Says" for insights that can help you consider social media's impact on your child.
How can I open conversations with my child?
Here are some points to consider as you open the door to discussing your teen's mental health. Ideally, this should be a series of ongoing conversations and "check ins" that you have with your child. This can help support your child's mental health and also give you a foundation for times your child may be struggling more and need more problem-focused support.
Make it safe for your child to discuss tough issues with you. Kids often avoid talking about touchy subjects, especially if they expect to be judged, lectured or punished. If you haven't already made this clear, affirm that your teen can tell you anything. Emphasize that these conversations will take place in a judgment-free zone. Explain that you want to understand what they're going through and provide loving support.
Resolve to listen more than you speak. Nothing will send your teen running the other way faster than failing to see and hear them fully. You will need to manage your own fears during the conversation so you can avoid autobiographical listening. This happens when you filter everything through your own life lens instead of listening for deep understanding.
Consider ways to avoid putting your teen on the defensive. Naturally, you can't be sure how they will react when you ask about their mental health. But fair, factual statements are usually best. Instead of saying, "You've been acting really strange these past few weeks," you could start with an example: "I noticed you hate coming down to dinner lately – and you don't seem hungry at other times. I wondered if something in your life is making it hard for you to enjoy stuff you usually love, like my killer oatmeal cookies."
Accept some silence. Your child might not know what to say at first, especially if they've been trying to hide how they're feeling or manage things on their own. People having mental health struggles often feel shame and fear on top of everything else. This can make it hard to open up to anyone (even someone they trust). Explain that even though you're worried, you can wait for them to think about what they'd like you to know. If they don't come back to you on their own, try restarting the conversation in a few days.
Realize that mental health stigma still exists. Despite much progress, some people still believe that having a mental health condition means someone is broken, untrustworthy or potentially violent. In fact, many don't seek mental health treatment because they're afraid of what others will think of them. If you're concerned about the harm stigma can do to your teen, this article may help.
Points to keep in mind
Mental health is a key part of human health. Parents and teens do not need to feel ashamed or fearful in seeking treatment. It's no different from getting care for a broken bone, a serious infection or any other major health concern.
Try not to blame yourself for your child's struggles. Life is hard, and kids are doing the best they can to manage the pressures they face (just as you are, too). Show compassion for yourself and your child as you move forward.
Even if you have a history of mental health issues yourself, you are not the root cause of your child's difficulties. Showing love, trust and respect for yourself and your teen is the healthiest way to ensure you both find the resources you need.
How can your Kids First Pediatrics Provider support you?
Your provider cares about your child's health and has helped many other parents and caregivers with mental health concerns. Your provider also knows about local resources you can tap to support your teen, now and throughout the healing process.
Pediatric Providers can explain treatment options, including medications that might help. They can also refer you to mental health specialists who can evaluate your teen. In this way, your Kids First provider will become part of a care team that can help you create a treatment plan, as well as a crisis plan that spells out what you will do if things get worse for your child.
What if my teen is having thoughts of suicide?
Suicidal thoughts or actions should NEVER be ignored. If your teen is in crisis right now, call The 988 Suicide & Crisis Lifeline or text 'TALK" to 741741. Trained lifeline staff will help you figure out immediate steps to protect your child.
If your teen is thinking about suicide but not in crisis, it's still vitally important to get help. Call your provider or mental health provider right away to find resources and plan for appropriate treatment and support.
If you're concerned you might be missing the warning signs of suicide, here is an article that may help.
Proactively promote mental health
Also keep in mind that mental health is not just about responding to problems. It is important to promote positive mental health and resilience in everyday, proactive ways.
Even if your teen is doing fine, help them find time for self care and healthy habits. Make time to enjoy each other as a family. Positive activities and relationships can have a protective, "scaffolding" effect on mental health.
We all have good days and bad days, just as days when we feel healthier than other times. Mental health should stay on our radar; promoting it should be among our day-to-day goals.
Need support? Give the Kids First Pediatrics team a call. Raleigh: 919-250-3478 or Clayton: 919-267-1499.
Mental Health During COVID-19: Signs Your Child May Need More Support
How to Talk About Mental Health With Your Child and Their Pediatrician
About Dr. Chung Richard J. Chung, MD, FAAP is a pediatrician and adolescent medicine specialist in Durham, North Carolina. He is a member of the American Academy of Pediatrics Committee on Adolescence.
Teen Mental Health: How to Know When your Child Needs Help