What to do if you are concerned about your teenager’s mental health

Mental health problems do occur among children and teenagers. Current statistics suggest that about 15% of young people between 12 and 15 experience a significant mental health problem (Lynch et al, 2004). Among young Irish men aged 15 to 24, suicide is the most frequent cause of death (National Office of Suicide Prevention, 2011).

Mental health problems among young people are not a cause for panic but it is important to be aware of what’s happening in your teenager’s life so you can help them if required.

Is my teenager’s behaviour normal or could it be a sign that they need help?

I’m sure many parents out there can empathise with those who say that the teenage years with their children can be challenging.

Neurodevelopmental research (that is research that looks at growth of the brain or central nervous system) has shown us that brain development is not completed until we are in our mid 20’s. The frontal cortex located just behind our forehead is the area of the brain responsible for decision making, reasoning, problem solving, memory, impulse control and social behaviour among many other skills. This area is almost entirely restructured during our teenage years. So much is changing within the teenage brain and body that behaviour, emotional regulation, empathy and sleeping patterns are just a few of the functions that are affected.

Parents are often baffled by what is a ‘normal’ issue for their teenager and what is something more concerning. As adults we compare teenage behaviour to our own when we were the same age. This often causes great anxiety for parents as because of changes to our social norms, teenage behaviour now looks very different to normal teenage behaviour of even 5 or 10 years ago.

If there is something concerning you I recommend speaking to other parents who have teenagers of the same age. Are the same issues concerning them too? Even if you don’t agree or condone the behaviour that you are worried about, sounding out whether your teens friends are doing the same things well help you get a sense of what is ‘normal’ for a teenager now. Get to know your child’s friends and their parents too. Communication among parents can help provide a safe environment for teens as well as reassurance when things are tough.

Remember, the primary goal of the teenage years is to develop healthy independence; while it is difficult to watch your sweet and loving child become prickly and defensive towards you which can sometimes be the case, this separation from you as they develop their own sense of self is an important developmental stage and healthy independence should be facilitated.

It’s worth developing an understanding of what to expect during the teenage years. I’ve put together the chart below to help parents understand what is normal for teenagers and what might be an issue they need to address. Obviously this list isn’t conclusive but hopefully it’s helpful.

Normal behaviours – Rapid mood swings, increasing numbers of arguments and rebellious behaviours. Increased resistance to your instructions and requests.
Issues of concern – Persistent feelings of sadness, worry, anger that last more than a few days. Talking about suicide. Frequent violent outbursts in which others get hurt or property gets destroyed, skipping school and behaviours which draw the attention of the Gardai

Normal behaviours – Changing appearance; changing style, dying hair, wearing provocative clothing
Issues of concern – Changing appearance when it’s accompanied by other extreme behavioural changes such as losing weight and self-harm. Excessive neglect of personal neglect and hygiene.

Normal behaviours – Withdrawal from parents and increased reliance on peers, increased need for privacy and secrecy
Issues of concern – Spending a lot of time alone, disconnected from peers and social activities. Begins spending time with a much older peer group, or peers who encourage negative behaviour.

Normal behaviours – Increased resistance to attending school
Issues of concern – Skipping school, significant decrease in school performance. Everyone will have hiccups now and again but if your kid has been getting B’s and C’s until now, starting to fail all their classes could indicate a problem

Normal behaviours – Decreased concentration, needing prompts to remember to complete tasks, being distracted easily
Issues of concern – Decreased concentration to a point where it impacts on ability to keep up with schoolwork and begins to affect their daily functioning.

What should I do if I am concerned about my child?

1. Trust your instincts; you have raised your child according to a unique set of values and principals. You know your child well (although during the teenage years it may feel like you don’t!). You will know if your child is acting out of character. Some parents feel like they may be over-reacting and worrying about something unimportant; if your instinct is telling you that something is wrong then it’s important to get some help. After all, if it is nothing then that’s great but if your child needs support, the sooner they get this the better.
2. Don’t be afraid to act on concerns by asking your child what’s going on in a caring way or telling them calmly that you are worried for them. Though some children will initiate a conversation and talk with their parents without being encouraged to talk, others are likely to give you a hard time for doing this as their need for privacy and separation from parents is increasing. But checking in with them from time to time gives them the message that you care, that you are interested and that you want to help them if you can.
3. Trust is a huge issue for teenagers. Often they might feel like their parents will be very critical of them or angry at them if they tell them what is going on. Sometimes teens worry that if they tell their parent about how they feel then they will add to the family’s stress. They might even worry that their parents won’t be able to cope.
4. Reassure your child that whatever the problem is, you want to help them and not to make it worse and this won’t stop you loving them and wanting to be with them through this time. Reassure them that whatever is going on you are able to cope with it, that you will figure out a plan together and that everything will be okay.
5. If you are disciplining your child make it clear that you have a problem with a particular behaviour that they might be doing but that you still love them as a person, this is important to help them maintain a healthy sense of self-esteem and can be done by saying something like ‘You are great and I love you very much, your behaviour is separate from you and needs to change because it is insert unsafe/risky/will get you into trouble/hurtful to others etc.
6. It can be difficult to persist with concerns for your teenager when you are met repeatedly with silence, anger or defiance. Yet if there is a problem it has to be addressed and it’s up to you as the adult to keep trying to do this.
7. Take some time to address your own feelings about the situation and keep extreme emotional reactions in check when talking to your teenager. Even though this is hard, becoming very upset or angry yourself only pushes them further away at a time when you need them to trust you.
8. Talk to other parents and find out what their experiences have been; have they any advice as to what you can do? Don’t be afraid to use the internet to explore your options, there is plenty of information available there.
9. There are a number of very effective interventions available to help teenagers who have a diagnosable mental health problem or are struggling to cope with life events. These include psychological and pharmacological interventions. The HSE and a number of voluntary bodies run free services across the country for young people who are experiencing difficulty. They can either provide these interventions or at the very least put you in touch with someone who can. Know that these services are out there and want to help.
10. If you are worried about your child’s mental health, contact your G.P. Write a list of your concerns down before you attend as it can be hard to remember everything. Tell your G.P. what the problems are and ask them specifically what services are available in your area and how you can get a referral for these services.
11. A google search of mental health services for teenagers in your local area should provide you with information on what’s available. You may be able to self-refer to some of these.
12. Getting professional help is not a sign of weakness or of failure but a sign that you want things to be better for your family. If you think your teenager may have a mental health problem then the earlier you get professional help the better. Don’t be afraid to seek support.

Common mental health problems among adolescents

Depression:

• Symptoms include but are not limited to:
• Persistent sadness or hopelessness
• Persistent anger, irritability and hostility (see above for what is and isn’t normal
• Changes in sleep and appetite
• Withdrawal from friends
• Loss of interest in age appropriate activities
• Feelings of worthlessness and guilt (they might say things like, I’m no good, I’ll never be good enough, I’m stupid)
• Significant deficits in concentration
• Suicidal thoughts
• Fatigue
• Unexplained physical symptoms like aches and pains

Anxiety – this includes a subgroup of disorders such as Panic Disorder, Obsessive Compulsive Disorder, Post-traumatic Stress Disorder, Generalised Anxiety Disorder, Phobias etc.

Anxiety at times in our lives is very normal and in fact useful so don’t worry too much if your teenager expresses anxiety before an exam or important social event. However, if symptoms of anxiety persist on an ongoing basis and begin to impact upon your child’s life stopping them from engaging in normal activities, they may have be experiencing anxiety.

Ongoing symptoms of anxiety can include:

• Intense fear of specific situations
• Fears of separation from parents and family
• Frequent nervousness across situations
• Worrying excessively about different things
• Physical symptoms such as feeling short of breath, trembling hands, racing heartbeat, abdominal discomfort (where there is no medical cause)
• Extreme self-consciousness

Eating Disorders

There are a variety of different types of eating disorder with different symptoms. If you notice significant weight changes, or changes to the way your child eats which appear restrictive, talk to them about it. Notice what they think and feel about their weight. If they express terror or disgust at how they look this needs to be explored.

Oppositional Defiant Disorder (ODD)

ODD is a behavioural disorder that must be present before the onset of teenage years. It involves angry and irritable mood, argumentative, defiant and vindictive behaviour. It is usual for all of us to exhibit periods of defiant behaviour as children (and dare I say adults!). However, if these symptoms persist over at least 6 months and are impacting on a child’s functioning it may be time to seek treatment.

Conduct Disorder (CD)

CD refers to a repetitive pattern of behaviour which violates the basic rights of others (to safety for example) or violates age-appropriate societal norms. Behaviours include aggression towards people and animals, deliberate destruction of property, deceitfulness and theft, violation of family rules (such as staying out late, running away) etc.

Psychosis

While this is relatively uncommon affecting only 1% of the population, symptoms do emerge in adolescence. Psychosis involves a loss of touch with reality where the person might have sensory experiences that are not real (they see/hear/smell/taste or touch things that are not there) or develop very fixed false and sometimes magical beliefs (also known as delusions). Deterioration in organised thinking, speech, motivation and physical movement are also symptoms of some forms of psychosis. If you think that your teenager may be experiencing psychosis you must get medical assistance as soon as possible.

Disclaimer: The information provided on this blog is intended for information purposes only and represents solely the opinions of this author. If you are seeking diagnosis or treatment of a mental health problem you should consult your GP or mental health professional. The information on this website is NOT a substitute for proper diagnosis, treatment or the provision of advice by an appropriate health professional.