Reprinted from the Harvard Graduate School of Education Article, Making Caring Common.
It's noon on Sunday and your teenager-usually an early riser-hasn't emerged from the dark cocoon of their bedroom. You crack open their door, tiptoe pasty must mounds of last week's laundry, and squint to see your child's face. They're still sleeping.
As a parent, it's natural to worry when your teen's behavior changes, whether they've started sleeping more, seeing friends less, or are picking at their food when they used to have seconds. The good news is that most of the time, these types of changes in behavior are not cause for concern. Still, there's ample reason for parents to be on the lookout for red flags. According to the Centers for Disease Control and Prevention, an alarming number of adolescents report poor mental health. nationally, one in six children and adolescents ages six to 17 experiences a mental health disorder; 50% of all lifetime mental illnesses begin by age 14. Untreated, adolescent mental health issues can lead to physical, emotional, and mental health consequences into adulthood.
Because early detection and intervention can help significantly, it's essential for parents and other family members to support teens by learning about common mental health conditions, understanding the signs that their teen might be experiencing a mental health issue, and familiarizing themselves with ways to begin a conversation with a teen who might be struggling. The information below aims to help parents and other family members understand possible red flags and being these important conversations.
"Untreated, adolescent mental health issues can lead to physical, emotional, and mental health consequences into adulthood."
Common mental health conditions:
Depression is the most common mental health condition among teens. Depression is characterized by prolonged feelings of hopelessness and/or sadness, a loss of interest in activities, and other impediments to daily functioning, such as eating and sleeping, for a period of at least two weeks. Depression can be triggered by a combination of things, including difficult or traumatic life events, genetics, and environmental factors.
Like depression, anxiety disorders are common during adolescence. Anxiety is characterized by excessive worry, stress, and fear that can impeded day-to-day activities. Symptoms can be both emotional, including feelings of dread, distress, restlessness, and irritability and physical, including shortness of breath, racing heart, sweating, headaches, and stomachaches. Social anxiety and panic attacks are common in teens with anxiety, and teen anxiety can often lead to depression or substance use and abuse.
Attention-deficit/hyperactivity disorder (ADHD) can result in academic and social stress due to difficulty with focus, organization, impulse control, and emotional regulation. Parents can support teens with ADHD through treatment, by advocating for accommodations at school, and by supporting teens in strengthening their social skills.
Eating disorders are common in adolescents and adults and are typically more common in women than men. Eating disorders including anorexia nervosa, bulimia nervosa, and binge eating disorder and are characterized by excessive concern about food, body weight, and body image. Physical symptoms include eating too much, or excessive vomiting; emotional symptoms include social withdrawal, low self-esteem, feelings of embarrassment or shame, and irritability. Without treatment, eating disorders can lead to severe medical issues.
Teens who have experienced a traumatic event or trauma from physical, sexual, or verbal abuse can experience posttraumatic stress disorder (PTSD) and other impacts of processing trauma. Trauma can affect daily functioning and cause symptoms that are similar to depression and anxiety. Teens with trauma also can have trouble concentrating, poor short-term memory, and hypervigilance or flashbacks.
Suicidal ideation, or thoughts of death by suicide, is common among adolescents, especially high school students. On average, 20% of high school students seriously consider suicide and 9% attempt suicide. In the U.S., historically marginalized populations are at higher risk of suicide. Black Americans, Indigenous populations, and youth who identify as LGBTQIA+ are considered high-risk groups. If you suspect that your child may be experiencing suicidal thoughts, especially if they seem to be suffering from extreme depression, seek help immediately. The Crisis Textline and the National Suicide Prevention Lifeline are both excellent resources.
Substance abuse is one of the many risk-taking behaviors that can begin in adolescence. Substance use is often linked with mental health disorders such as anxiety and depression and is used as an unhealthy coping behavior. Substance abuse can include a misuse of alcohol, marijuana, prescription drugs, over-the-counter drugs, psychedelics, or other drugs.
"Sudden or significant changes in your teen's behaviors, academic performance, or emotional responses could be an indication that something more serious is going on."
What are the warning signs?
Sudden or significant changes in your teen's behaviors, academic performance, or emotional responses could be an indication that something more serious is going on. As outlined above, specific mental health issues present a variety of symptoms and warning signs. The list below highlights some common red flags (the National Alliance on Mental Illness offers a more comprehensive list here):
Sudden drop in grades
School avoidance
Eating too much or too little
Sleeping too much or too little
Frequent physical complaints (headaches, stomach aches)
Social withdrawal (from friends, family, previous social connections)
Excessive worry or fear about daily activities
Frequent mood swings (including both "highs" and "lows")
Prolonged periods of irritability or anger
Excessive sadness or lack of energy
Ideas of self-harm or suicide
What do I say?
Whatever the circumstance, it's important to first validate your teen's experience, practice careful and genuine listening, show empathy, and normalize seeking help. Above all, make sure that your teen knows that you are there for them unconditionally. The phrases below may be helpful in starting and following up on a conversation.
What to say if you think your teen may be experiencing mental health issues:
Some of what you've shared with me makes me concerned about how you're doing. How do you feel? Is there any way I can support you?
I'm concerned about how you're doing because you've been sharing some difficult emotions and seem to be going through a hard time. How are you today? Is there a way I can support you?
I've been noticing some changes in your behavior lately. (Share your observation of the warning signs, i.e., "You've been sleeping a lot and haven't see your friends during break." or "You seem a little sad lately, did something happen recently?") How are things going for you lately? Is there a way I can support you?
What to say if your teen tells you about an issue they are facing related to or impacting their mental health:
Thank you so much for telling me about this. I know it's not easy to talk about. Let's work together to think through solutions and ways to support you.
I'm so glad you shared this with me. It seems like you're going through a hard time.
I'm glad you brought this up. I am so sorry you are going through this. Let's brainstorm what would be helpful. We will work together to find a solution.
How to follow up to learn more about your teen's mental health:
How are you feeling today?
How often do you feel (insert difficult emotions shared)?
When did you start feeling this way?
Have you talked to others about this?
How do you cope, or feel better, when you are feeling this way?
Have you tried to get help in any way?
How can I help you?
What would make you feel better today?
What do I do next?
Teen mental health issues are common and treatable, and it's critical to seek help for your teen if they are struggling. Resources like the National Alliance on Mental Illness website (NAMI) and the Jed Foundation's Mental Health Resource Center are excellent places to start; your child's pediatrician or school counselor may also be helpful.
Parents and other family members play crucial role in helping their children navigate the challenges of adolescence-including mental health challenges-and setting them on the path to health and well-being into adulthood.