“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?
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.
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.
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