Your Teenager: Just Moody... or Something More?

Feb. 25, 2015

“Is my teen normal?”

As a child and adolescent psychiatrist and father of 3 teenagers myself,  I get asked this question by people in my community all the time—at the grocery store, at the community pool and at cookouts. It’s pretty clear to me this is an important public health concern for the people I know.

First, anxiety is normal and often healthy. It relates back to our human wiring—the evolutionary protection for being prepared for threats, like an incoming mastodon. In the modern day, we still have the same kind of alarm system even though the stresses are different.

For instance, it is natural to get anxious before the SAT exam because of the weight our society places on it. It’s perfectly acceptable to get anxious before your first week at sleep-away camp or trying out for a school play. Anxiety can be motivating to a point, but anxiety can also be overwhelming and disabling.

One way to answer the question is to look at your teen’s level of functioning. Does the anxiety reduce his ability to perform at school or engage with friends? Are the symptoms of anxiety stopping her from pursuing what she wants?

When It Could Be a Mental Health Condition

Anxiety disorders often co-occur with other conditions, such as depression. Major depression in teens is an important public health concern and, like anxiety, often responds to treatment. Depression is characterized by more than 2 weeks of persistent sadness (or irritability, hostility) coupled with most of the following warning signs: sleep troubles, appetite changes, physical complaints, negative or hopeless thinking, concentration problems, loss of interest in activities and, most concerning, suicidal thoughts.

Family history of mood and anxiety conditions can increase the risk for some teens. People with trauma histories may be quicker to experience threat and anxiety based on the past. Teens who are stressed by divorce, are being bullied—on social media or at school—or who have problems “fitting in” in social circles are also at risk.

A full clinical assessment from a health care provider is a worthy investment of time and resources to determine a diagnosis if you’re seeing any of the signs I mentioned in your teen. There are a few medical concerns that can mimic anxiety and depression, so it’s a good idea to look for those—examples are thyroid disorders and substance use disorders.

Once a comprehensive assessment is made, the next step is forming a treatment plan that your teen can buy into. It is challenging yet essential to get your child’s acceptance and collaboration into any plan to approach these issues. While some kids will quickly acknowledge their vulnerabilities, others will be more resistant. This spectrum is natural and expected—not everyone will want support.

Communicating with Your Child

How do you talk with a teen you are worried about? Listening to them is the best first rule. Speak from your own experience. I don’t encourage parents to lead with a diagnosis—I begin with a supportive focus on the functional problems they are having, like with friends for example. This can often be something both the parent and teen can connect on. Loving a teen into care can be difficult, but keeping lines of communication open is key. You don’t need to get to yes on everything, but you may need to get to a professional. I tell parents that their job is to get their teen to my office, but it’s mine to get them back for a follow-up visit.

At the end of the day, I may not be able to give a well-rounded answer at the soccer field, but I hope that what I’ve shared will help if you are concerned about your child’s mental health. 

NAMI offers information for family members and caregivers on coping with mental health challenges in your family, and we also have information for teenagers who are dealing with mental health conditions themselves. The American Academy of Child & Adolescent Psychiatry also has a wealth of resources for families and teens.

Comments
Sybil Btown
Thanks for all the information from parents who have the same problems with BiPolar Disorder!
7/26/2018 1:07:42 AM

Pat DeVries
I agree with Kasi. The mental health system is completely broken. Funds are being diverted from it yearly to other areas that the government sees as more needy, and our kids suffer. They see guns as the problem, not our kids mental health. We as parents can try everything in our power to get our kids the help the need and they can still fall into the deep pit of dispair and self loathing. My daughter has been to DBT's, (individual and group therapy- a 6 month course), home based therapy, has a psychiatrist, psychologist. We have a wrap around group and she has a community living support person. She also has a probation officer. Her home environment is stable with alot of support and school is supportive with a social worker and para-pros in each class in case she has anxiety attacks. But, try to get her help from any of the psychiatric hospitals around here,( we have 2 adolescent ones), and they have to have tried to kill themselves for an admission. When they are cutting and hoarding pills and threatening to drink toilet bowl cleaner and no one will help....it is very hard on the family. I know that the challenges my daughter faces are not my fault, and that I cant always stop her from hurting herself, but it is frustrating that the mental health system and the government doesn't realize the HUGE problem that is out there.
2/8/2016 10:06:33 AM

Kasi
I found this article while researching anxiety. to Pauline Marie and your comment "kids with mental illness often have a bad home environment.." I implore you to learn more about mental health and where it starts! Indeed, self-esteem is important, and there are many kids who reflect there anger and hurt in a negative way that is hard to help or control. However, some people are born into this world with Bi-Polar disorder, Generalized Anxiety Disorder, Autism (which can include mental health), Depression, etc.
My son was premature, which lead to many health issues including autism and anxiety disorder, but also a genius IQ. My husband and I have been married 20 years, he is an only child, not adopted, has lived in the same house his whole life in a middle class area, and we are as boring and normal as they get. He actually has a wonderful group of 4 guys that are as gifted as he is and I couldn't ask for better. And yet, his anxiety and other disabilities have worsened and we have tried everything! Medication, gifted schools, sports, music, regular psychiatrist visits. But when that mental health issue is constantly in flux, or is seemingly taking hold, it puts the breaks on most areas of life. Over the years I've cried buckets of tears fighting for my sons health and education. I know we are damn good parents. And having individuals (as well as the many teachers and counselors He's had) do not understand or help when you make assumptions that it's because of bad home environment. I agree that we often don't see the signs where we could have intervened. That is true for adult suicide, or even heart attack prevention. But I will not be reduced to my sons challenges being my fault, because I know otherwise.
I certainly the rest of the parents reading this realize that your kids mental, anxiety, depression, challenges are not all your fault. You are giving love by learning more, educating others, and trying to find and get the right help. Sometimes it's the Heath system that fails us because of the time it takes to get what they need. Never stop fighting for your kids.
1/11/2016 2:47:16 PM

Pat
My daughter was diagnosed as bi-polar at age 8. She is also ADHD.. She has been on Lithium, Seroquel, Wellbutrin, Lamictal etc. She is an angry child and cycles rapidly even with medication and monthly visits to her psychologist and psychiatrist. She is followed very closely and still uproots our family. I don't feel that you ever really have control of mental illness, no matter the form. My daughter has never been abused or neglected. At age 13 she made her first suicide attempt and spiraled down from there even on her medications and with hospitalizations. She has had 3 attempts, and attacked her sister and myself once. She has had 3 hospitalizations and all of this is in 5 weeks time. We are trying for further testing and will probably seek residential treatment for her since she is not safe to herself or us at this time. Early diagnosis, treatment and even discipline is not always going to change the outcome. It may lessen and/or help the symptoms but it doesn't cure. You also need to love and encourage and support this child as much as any other child in the family While not leaving anyone behind. It is a most difficult, painful, heart wrenching, and scary thing to do. Loving a child with mental illness is not easy, but she is still my child and I love her with all my heart. I just can't live with her right now and that breaks my heart in two.
3/31/2015 1:36:56 PM

Maureen G
Preventative services are not readily available if you have a teen that ran out of her medication. In Florida you just wind up getting treated like a juvenile delinquent. The Dr. did not return calls from the pharmacy to refill my daughters medication , the Hospital would not admit her in the ER. All of this could have been prevented if she received more help or medication in time. Not every psychiatric situation should be classified as a teenage Baker Act to be admitted into a hospital. That is what they told us in Florida. Not all problems begin in the home. Sometimes teenagers get bullied and they do not have enough support channels or group therapy with other teens that have been affected by bullies.
3/18/2015 5:53:16 PM

Catherine
Mary W. - Feeling guilty about a loved ones suicide is very common. I encourage you to attend a family members of suicide group for support. We do the best we can with what we have.
3/10/2015 6:33:48 PM

Pauline Marie
I agree. Kids with mental illness often have a bad home environment which leads to a bad school environment which then leads to a bad adult life. All children should be taught self-love and self-esteem and should feel good about themselves and THAT SHOULD COME FROM HOME!
3/2/2015 4:10:34 PM

Diane T.
When my daughter entered puberty, a lot of drama ensued. Moodiness, hostility, defiance, depression, you name it. One month we had a very well-adjusted child, content and happy, popular in school and at the top of her class academically. Seemingly over night she was raging in a manic way, while using oppositional-defiant tactics whether in school, home, on sports teams, etc. She threw her childhood friend out as easily as one would discard an old pair of shoes and bullied her. Her new friends were losers with attitudes. My husband and I were bewildered.

I'm a woman, I suffered intense postpartum depression briefly after each pregnancy and had episodes of PMS. Since the behavior coincided with puberty, we felt it had to be raging hormones. We didn't have her professionally examined EARLY ON and by the time I realized her behavior fell outside of the "wide range of normal" parameters for teenagers, she was untreatable. She would disappear or lock herself in the car in order to avoid doctors appointments and she refused to take the medication that was prescribed for what was eventually diagnosed as bipolar disorder. In addition, in order to go through the normal process of individuation all teenagers need to do to grow up healthy with a core identity, our daughter had a slash and burn policy. She took us down and shattered our family.

All of our energy went into trying to save the sick child and we kept our younger daughter in our peripheral vision; we could see she was doing well and basically neglected her. Like the stuff of textbooks, our younger daughter saw her sister getting our undivided attention for her atrocious behavior and she began to act out. The way I neglected "the golden child" while trying to help the sick one is one of the biggest regrets of my life.

I will always wonder how things would have turned out if I had grabbed my daughter by the scruff of her neck early on, got a professional evaluation and had her taking her meds along with her Flintstone vitamins. Would she have been diagnosable early on while we still had control, I don't know.
3/2/2015 11:09:12 AM

Pauline Marie
Teen mental illness often starts from the home environment then can get worse in school. The common factor is lack of self-esteem. Parents should have self-esteem and bring up kids to love themselves no matter what. I know because I was brought up by a mother who OD 'd and died when I was 17. It's taken 43 years to learn what self-esteem is.
3/1/2015 8:24:54 PM

Kiren Jain
My 20 year old daughter has bipolar condition. She was diagnosed at age 16. It seems a bit easier to communicate with her now in person, but while being out of town at college, it is hard to keep the lines of communication open. I would like more advice on how to communicate better with her.
2/26/2015 2:13:49 AM

Mary woodbury
I wish I could have read this article before my 17 year old son committed suicide this past thanksgiving. We tried to get him help but his therapist failed him so terribly and now I know so did
we.
2/26/2015 12:12:29 AM

shari griggs
I have a 16 year old granddaughter who lives with me. I believe she needs to be evaluated. She complains of anxiety issues and panic attacks. And bouts of sadness. Her mother has been treated for several years for these same complaints. How do I find a doctor that will fit her needs best?
2/25/2015 11:10:28 PM

shari griggs
I have a 16 year old granddaughter who lives with me. I believe she needs to be evaluated. She complains of anxiety issues and panic attacks. And bouts of sadness. Her mother has been treated for several years for these same complaints. How do I find a doctor that will fit her needs best?
2/25/2015 11:08:16 PM

Ann Costello
Go to NEABPD.com to find info and sign up for Family Connections...a free 12 week course to learn DBT skills to listen, be mindful and remain calm.
2/25/2015 8:04:24 PM

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