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Does My Teen Need Treatment?

Advice on how to assess teenagers who are under stress.

 

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The Intelligent Divorce Project has recently we have been focusing on The Malignant Divorcebecause divorce related violence is often in the news. With this submission, "Teenagers: To Medicate or Not to Medicate," we are introducing a new recurrent theme to our blog, dealing with Raising Healthy Children. We hope that our site allows the reader to learn about divorce from a variety of viewpoints. The children of divorce certainly deserve their place in this discussion.

While some of the information found in Raising Healthy Children is specific to divorce, much of what we will be talking about can be useful to all parents, married, never married or divorced.

We hope that you find this series useful. Feel free to give us feedback.

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Teenagers are rarely easy. Normal adolescents, bless their hearts, can be moody, demanding, self centered and otherwise preoccupied at the expense of their studies or the family. When things go wrong, it can be rocky going. Depression, eating disorders, oppositional behavior and drug use are just some of the quagmires lying in the way of healthy adolescent development. Treatment can be a Godsend; even medications when appropriate can help many of the problems that teens may face.


So, do we just run to medicate an adolescent when he or she starts to show symptoms during a divorce? The side effects of medications are real, but not doing any treatment may lead to far worse. This discussion is part one of an overview that can help you to get it right. For a more complete treatment of this issue, look at the Intelligent Divorce book series, which provide chapters on the successful evaluation and treatment of teens in who are in trouble.

The teenage brain is a developing organ that won't reach maturity until twenty-five or so, and the psychological roller coaster of emerging independence and sexuality can be daunting for girls and boys alike. Add a divorce (or any real stress), and figuring out what's going on psychologically can be tricky. While your adolescent may be inherently inconsistent, moody, or test limits, during a divorce there are additional pressures to deal with over which he has little control - like the dissolution of the family as he knows it, perhaps warring parents or just worries about what the future may hold.


So how do you tell the difference between an upset teen and a teen that needs treatment, and maybe medication? 

Five important questions can help.

  • First, does your child's problem precede the divorce? Some kids are by nature anxious, moody or inattentive. You may already have him in treatment for ADHD or another diagnosis. For kids like this, the stress of divorce can worsen an already existing problem. Anxious kids can become more anxious, depressed kids more depressed and so on. A good therapist or doctor can assess what is going on. It may be that your child will benefit from counseling, where she can express her concerns, learn adaptive techniques and feel strengthened. It may be that you and your ex are contributing to your child's stress and that the therapist can help you keep your arguments to times when your teen is not present. This may take away a big burden and lighten up the symptoms that you have been concerned about.
  • The second question is related to the first. Does my child show evidence of significant moodiness, extreme anxiety and the like? You should take careful note if your child stays in bed an excessive amount, or goes for long periods of time without showering or changing clothes. Or is she so anxious that she can't fall asleep or get her homework done because she is worrying all the time. Be on the lookout for flights of manic energy, sleeplessness and grandiosity. In these instances, you might be up against a bigger problem than mere teenage moodiness. Mood and anxiety disorders tend to run in families so get a handle on the mental health history of your extended family - and inquire about your ex's side as well. If your child is adopted, you will have to dig further: did the biological parents have these issues?
  • The third question concerns the degree of dysfunction - how bad has it gotten? Psychological problems, whether they are mood or anxiety disorders, attention deficit or other issues, are defined not just by the symptoms but also by how the problem actually impacts basic functionality. If you notice that your son is acting depressed, but he's far from suicidal, he does well in school, he has good friends and an active social life, and he generally gives off an attitude of contentment, you are most likely dealing with normal teenage angst. If your daughter is anxious and complains about the divorce or your parenting, but lives life well, she is probably okay. Complaining is not a psychiatric diagnosis. If, on the other hand, your son protests constantly that he's "fine", but you clearly witness that he's having trouble getting out of bed in the morning, his friends are no longer calling, and he's lost interest in what used to give him pleasure, this well may be an actual depression. And some kids become "very good" in divorce, like super kids because they are so anxious. Be aware that your child may be so worried about her situation that she will do anything not to rock the boat. This can be a cause for concern.
  • The fourth question is about drugs and alcohol. Is my child self medicating? The typical adolescent in America has access to alcohol and many kinds of drugs. He may claim that marijuana "cuts the edge off" or that drinking lets her bond with her friends. Or, it may all be in secret and behind your back. Be careful. I have seen too many casualties from chemically dependent teens, including poor grades, depression and even fatal car accidents. Twenty five years of practice has made me very sober about alcohol and drugs. If your child is using significantly, normal treatments won't touch the core problem.
  • The fifth question is hard to answer for yourself because you as a parent are in the thick of it: how badly are we - as parents - hurting our children because of our inattention, anger, self preoccupation, moodiness or the way we pull them into the middle of our conflict? When this fifth question is answered strongly in the affirmative, you will almost certainly need outside help. In cases like this, it is a shame to medicate a kid when he or she is overwhelmed by realistic pressures from home. Therapy and/or medication takes a back seat to the divorcing parents working on getting their act together and if this can't happen because the acrimony is too intense, then just know that meds and therapy may work, but it is a sad second choice.


Now let's assume that you have answered the five questions and have brought your child in for an assessment. Often the first stop is your pediatrician who knows your son or daughter well and can help find a therapist who can do the job for you, such as a psychiatrist, a psychologist a social worker or a drug counselor trained in dealing with teenagers.


In Part Two of this blog, to be published shortly, we will look at how treatment decisions are made and give you a handle on how to work with your mental health professional to make sure that your child is getting the best of help. There are a number of treatment strategies available, and not all require pharmaceuticals. If, however, medication is required, you will need to be reassured that proper steps have been taken to ensure minimal side effects and an effective treatment.


The goal is to help you teen gain the strength and stability to deal with obstacles that are getting in his way, be it a troublesome divorce, a girl breaking up with him or just the challenges of being an adolescent (not easy). Your son or daughter should look back at this moment as a time that you stepped up and got them the help they needed, when they needed it.


You can get this right. 

 

Mark Banschick, M.D., is a psychiatrist and author of The Intelligent Divorce book series.

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