I received a phone call this past winter from a parent who had attended one of my workshops a few weeks before.

“Dr. Walsh, I definitely feel like I know a lot more about what is going on inside my daughter’s brain after your workshop. But I have to say that it feels like my daughter is a lot more extreme.

“What do you mean? Can you give me some examples?” I responded.

“Oh all kinds of things. She just doesn’t seem like herself. I get it that all teens are tired and grumpy sometimes, but my daughter never wants to get out of bed anymore. For anything! She seems so down, isn’t eating well, and doesn’t want to see any of her friends. This started at the beginning of the school year and that was two months ago! I am getting nervous that this isn’t just typical teenage stuff.”

“You are right that the adolescent brain is subject to rapid mood shifts and bouts of the blues.” I said. “But I am glad that you called. A sad mood that descends and never lifts is a sign that something else might be going on.”

Distinguishing typical ups and downs from a mental health condition

This parent is not alone in her confusion about how to interpret changes in her teen’s behavior. 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. We can overreact to the typical ups and downs of adolescence and create unnecessary anguish for ourselves and our kids. On the other hand, we can miss signs of mental illness and rob our teens of the help they may desperately need, mistakenly writing it off with “She’s just a teenager,” or “She’ll grow out of it.”

Understanding common mental illnesses in adolescence can help us strike a balance between these two extremes. Organizations like the National Alliance on Mental Illness (NAMI), Mind Zone, Office of Adolescent Health and National Institute of Mental Health among many others have lots of resources for parents and teens alike about mental health that can help you identify warning signs and resources.

As you read through lists of symptoms on these sites remember that you will be able to identify things that describe your teen on each list. It isn’t until you see clusters of behaviors that persist over time that you should be concerned that your teen may be living with a mental illness.

In addition to illness-specific symptoms, don’t ignore other signs that could indicate a possible mental health problem including:

• Consistent and persistent irritability
• Changes in appetite or sleep–too much or trouble sleeping
• Unexplained physical changes or physical complaints
• Low energy
• Changes in social motivation/activities
• Feeling down and hopeless for long stretches
• Recurring thoughts of death or suicide
• Substance abuse

Stamp out Mental Health Stigma

Just because you have identified some red flags doesn’t mean that your teen is going to be eager to talk with you about it and explore treatment. Researchers at Case Western Reserve University recently found that the vast majority (90%) of young people living with mental illness and taking medications experience some form of stigma. Given the importance of peer opinion during adolescence, social stigma can lead to feelings of shame, secrecy, and isolation and often significantly delay treatment. This can also mean that teens go to great lengths to hide symptoms from friends and loved ones.

However, good news emerged from the same study: the attitudes of parents and schools either buffer or magnify young people’s feelings of shame and isolation. By showing support, love, and normalizing mental health issues you can help your teen overcome stigma and begin the journey to wellbeing.

Parenting With Mental Health Awareness:

1. Don’t wait for warning signs to talk about teen mental health. Talk early and often about both physical and mental health.
2. You are not protecting your child from stigma when you ignore signs of mental illness. The transformative power of early diagnosis depends upon parents talking openly about mental health and treatment.
3. Ask your school about resources for students with mental health challenges. Be sure to ask not only about clinical support but also about the school’s “culture” around issues related to mental health (e.g. student advocacy groups, speakers, “stigma-busting” campaigns, etc..).
4. Look for a cluster of symptoms that persist over time if you are concerned that your teen has a mental health problem.
5. Don’t ignore signs and symptoms of mental illness that persist.
6. Don’t panic. Tremendous strides have been made in recent years and young people have every opportunity to live a healthy, resilient life with treatment and care.
7. If you’re worried, seek advice from a teacher, social worker, therapist, coach, or other adult who knows your child.
8. Get recommendations from people you trust for the professionals or programs that are competent, caring, and have experience with adolescents.
9. If you need professional help, find out exactly what your insurance policy covers and ask as many questions as you need to find out what your options and rights are.
10. Don’t accept care from a professional who seems rushed, appears unfamiliar with your teen’s case, or doesn’t address your concerns.
11. Be open to recommendations about medications, but make sure you learn about side effects.
12. Don’t accept a medication-only treatment plan for an adolescent. The research is clear that medication with some form of counseling is far superior to medication alone. The medication may correct chemical imbalance in the brain, but it does not teach teens coping skills.
13. Get help and support for yourself.
14. Don’t ever give up on a young person living with mental illness.