For years, many parents and advocates have spent the month of May trying to break through the noise to assert the importance of mental health awareness. This year, for better and for worse, mental health has decidedly occupied the spotlight. More than ever, we are having national conversations about mental health and wellbeing.
Unfortunately though, our attention this year has turned to mental health largely because we have reached a crisis point, especially when it comes to adolescents.
A crisis already in-progress
Late last year, the Surgeon General was already sounding the national alarm, issuing an urgent new Advisory on Protecting Youth Mental Health. This was in the wake of the American Academy of Pediatrics’ declaration of a “national emergency in child and adolescent health” last fall. Both of these announcements sounded similar themes: the challenges are not new but they are intensifying and the systems of support for children and adolescents in crisis are woefully inadequate to meet the growing demand.
Of course it is tempting to blame everything bad on COVID-19. But adolescent mental health indicators did not start trending downward when the pandemic turned our lives upside down. According to the CDC, the teen suicide rate had already grown 60% from 2007 to 2018. Just prior to the pandemic, 13 percent of adolescents reported having a major depressive episode, up 60 percent from 2007. The pandemic has intensified a crisis already in progress, placing enormous strain on a group that was already struggling.
It turns out that changes in the teenage brain act as both kryptonite and superpower when it comes to mental health.
Mental health and the teenage brain – sensitivity to stress
There is certainly a lot of talk about adolescence as a “risky” time in our lives. Dire warnings about risky driving and irresponsible decision-making related to drinking or drugs have dominated the headlines for years. While some of these characterizations are derived from brain science, focusing solely on risky behaviors can narrow and flatten our understanding of young people’s strengths and vulnerabilities.
We will need to understand both to support them.
It turns out that changes in the teenage brain act as both kryptonite and superpower when it comes to mental health. It’s true that the executive center of the brain is “under construction” during adolescence. During this phase of reorganization, executive function skills like considering consequences (hence the focus on risky decisions), impulse control, perspective taking, and emotional regulation and coping can be more challenging.
This all happens at the very same time that the emotional centers of the brain go into overdrive. This makes teenagers especially sensitive to strong emotions, rewards, threats, and – yes – stress. Connecting the dots, it is no surprise that both “typical stress” as well as more significant mental health challenges might accelerate during adolescence. There is certainly no shortage of personal, social, and environmental stressors in young people’s lives today. Researchers do believe that neurological changes during adolescence increase a teen’s vulnerability to depression and anxiety compared to childhood.
Understanding this about the teenage brain does not mean that every young person is destined to be diagnosed with a mental health disorder. Indeed, the near wholesale focus on challenges can also obscure one of the other main insights from the latest science: the adolescent brain is primed for learning.
Mental health and the teenage brain – sensitivity to support
The plasticity and change that can make adolescence challenging also create a “window of opportunity” for learning and growth. Research even shows that the teenage brain shows more communication between the striatum (where we seek rewards) and the hippocampus (where we store memories) than adult brains do. In other words, the teen brain is flexible, growing, and exquisitely designed to learn from experiences.
This is true at home, in the classroom, and when it comes to mental health interventions. Young people need to learn through experience that some amounts of anxiety, feeling overwhelmed and worry are normal. They also need to know that when these feelings become unmanageable, things like anxiety and depressive disorders are treatable and can become manageable with appropriate interventions and time.
Once again, brain science begs us to ask big collective questions about how we care for ourselves and each other. The science is clear that we would be wise to better design systems, both online and offline, with adolescent health and wellbeing in mind. Their brains are exquisitely designed to benefit from more supportive systems.
In the meantime, the science also underscores the importance of our smallest scale interactions.
What should we pay attention to on the scale of our interactions?
Back to the basics.
When it comes to prevention, it’s easy to overlook the basics because they seem obvious. But attending to movement, sleep, nutrition, and connection is the foundation of good mental health. Without a solid foundation, even the best interventions can fail to have an impact. It’s helpful to run through a quick checklist as we consider the basics:
- Is my teen getting outside?
- Is my teen sleeping enough? Are devices out of the bedroom at night?
- Is my teen moving their body in some way every day?
- Is my teen experiencing belonging and purpose in some part of their life? Is there some activity and community that sparks their interest (even if their interests are very different from our own)?
Watch out for over-responding or under-responding.
One of the hardest parts of parenting a teenager is to separate the “normally abnormal” bumps on the road to adulthood from warning signs that indicate more serious problems. As parents we can err in one of two directions that can backfire.
Over-responding: It’s easy to overreact to the ups and downs of adolescence in ways that create unnecessary anguish or even pathologize typical development. Teens need to know that some amounts of stress, distress, worry, and sadness are normal. We can validate feelings without assigning clinical significance to every sign of discomfort or anguish.
Under-responding: On the other hand, we absolutely do not want to sideline or downplay signs of mental illness and rob our teens of the help they may desperately need, mistakenly writing it off with, “They’re just being a teenager,” or “They’ll grow out of it.” Ignoring patterns and signs that kids could use extra support can have serious consequences for our kids.
Know the signs.
Practicing emotional literacy and learning more about specific mental illnesses in adolescence can help us strike a balance between these two extremes. For example, all of us can learn more about worry and make plans for anxiety prevention in our families. We can learn to greet feelings like friends and step up as our kids’ emotion coaches when they need it most.
But we can also get familiar with illness-specific symptoms from organizations like the National Alliance on Mental Illness (NAMI), Mental Health America, or the Office of Adolescent Health so that we better understand warning signs and resources. We shouldn’t ignore worrisome patterns that persist over time that could indicate a possible mental health problem including things like:
- Consistent and persistent irritability
- Changes in appetite or sleep–too much or too little
- Unexplained physical changes or physical complaints
- Low energy
- Changes in social motivation/activities (online of offline)
- Feeling down and hopeless for long stretches
- Recurring thoughts of death or suicide
- Substance abuse
Be clear and direct.
Talking about mental health can be really scary as a parent so it makes sense that many of us avoid it. It is tempting to “talk around it” or assume that someone with more training should lead the conversation. But experts agree that approaching our teens with compassion, listening to them, and talking in direct and clear language is essential. This can range from “low pressure” conversations like normalizing mental healthcare to engaging young people in shows and media designed to spur conversations about mental health to “higher pressure” conversations like addressing concerns about suicide directly. Dr. Lisa Damour’s recent interview with Dr. Jonathan Singer called, “What do parents need to know about suicide?” has helpful tips and scripts for talking with kids about suicide, nonsuicidal self harm, and other concerns. Well Beings has also created a Mental Health Language Guide with language, tools, and guidance for talking about mental health with youth.
Remember, asking teens about suicide and mental health concerns does not make young people more likely to have them. It makes it more likely that you have a window into them.
Expand your circle of support.
Everyone knows a teenager who is really struggling right now. Parents are scrambling to find care for their teens, young people are trying to support their peers, and clinicians are working to provide teens with the care they deserve.
For adults and teens alike, it is tempting to withdraw, carry it alone, or downplay the challenges. But anxiety and depression thrive in isolation and feed on loneliness. Among our first steps in a mental health challenge of any kind is to widen our circles of support. This can include talking to parents, trusted elders, support groups, primary care providers, school-based mental health professionals, or other clinicians.
Among our first steps in a mental health challenge of any kind is to widen our circles of support.
Taking teenagers’ sensitivity seriously.
One of the cognitive distortions that teens can easily fall into is over-generalizing, or “all-or-nothing thinking.” In other words, things are all good or all bad. All risks or all rewards. When overgeneralizing comes up, it can be helpful to break things into parts and practice both/and thinking. This kind of cognitive flexibility takes practice for us adults too.
For example, we can do all the right things and be parenting a child who is in deep pain and struggling to cope. We can be on the road to healing and acknowledge that the road is scary, uncertain, and long. We can be seeking support and rage that the waitlists are overwhelming. We can talk about prevention and refuse to engage in blame or shame.
Similarly, remembering that the teenage brain is flexible, growing, and built to learn isn’t about sidestepping today’s challenges. Instead, it serves as a reminder that teenagers are not just the sum of their risks and vulnerabilities. They have incredible strengths and opportunities too.
The teenage brain is sensitive – to both stress and to repair. Let’s be sure young people know about both.