The reader asked: "With all the mental and emotional health issues that can afflict our youth, how do parents identify if their kids are in psychological trouble?" In partial answer to such a large and complicated question, I offer this.
Deciding what is a significant problem in their adolescent’s functioning is a very difficult diagnostic challenge for parents during their child’s more intense, dramatic, and turbulent teenage years.
They don’t want to overreact and raise a false alarm over some normal developmental change. “He doesn’t confide in us as much as he used to in elementary school, so maybe he’s feeling too troubled to talk.” “She’s become so uncommunicative when we just ask a simple question, maybe it’s because she’s concealing something that is wrong.” Or maybe both early adolescents have just become more private to assert more independence.
However, they don’t want to underreact and treat an unhealthy behavior disturbance as just part of a passing phase. “He’s started lying to us more, but that’s just typical of the age.” “She keeps pleading money from us, but that’s probably just because keeping up with peers has become more expensive.” Or maybe both mid adolescents are starting to experiment with substance use, and are hiding what is really going on.
In general, given the choice between error number one, overreacting, and error number two, underreacting, the first is probably safer to make than the second. When possibly overreacting, they can either stand to be corrected by the adolescent who gives data to contradict their concern, or at least they have let the young person know that they are providing surveillance to protect her or him from falling into harm. By underreacting, however, they risk ignoring what, without obtaining some helping attention, may get seriously worse.
But how can parents identify when a significant adolescent problem has arrived? And when might outside help be useful to seek? Consider seven questions, the honest answers to which might alert parents to the need for outside psychological or psychiatric help?
1) HOW ATYPICAL IS THIS BEHAVIOR? Does it run counter to what you have known to be her or his normal style of character or conduct? For example, the previously placid young person has frequent outbursts of temper that have not often occurred before.
2) FOR HOW LONG HAS THE BEHAVIOR OF CONCERN BEEN GOING ON? Has it been sustained for more than three months despite efforts to address it at home? For example, the traditionally outgoing young person has taken themselves out of the social loop with friends and become more isolated.
3) HOW COMMUNICATIVE ABOUT THE BEHAVIOR IS THE ADOLESCENT ABLE TO BE? Has the young person been unable or unwilling to talk about the change going on? For example, she insists she is okay or that nothing is wrong despite troublesome conduct that suggests the contrary.
4) HOW DISRUPTIVE IN THE ADOLESCENT’S LIFE IS THE BEHAVIOR? Is overall healthy functioning becoming impaired? For example, sleeplessness at night is causing lethargy and fatigue at school during the day.
5) HOW EMOTIONALLY PAINFUL DOES THE BEHAVIOR APPEAR TO BE? Is there is significant level of unhappiness that parents observe on a regular basis? For example, is there apparent nervousness or anxiety in the morning before reluctantly going to school?
6) HOW DOMINANT IS THE BEHAVIOR OF CONCERN? Is it preoccupying the young person’s attention to the exclusion of, or at the expense of, other important areas of life concern? For example, all that the young person can seem to think about is eating little enough to stay thin enough to look okay.
7) HOW ENDANGERING IS THE BEHAVIOR OF CONCERN? Is it creating risks or actually encouraging outcomes of a personally or socially harmful kind? For example, under some influence, regulations are broken and rash decisions are being made.
8) HOW NOTICEABLE IS THE BEHAVIOR OF CONCERN? Have other people with a working knowledge of the young person, perhaps a teacher or coach or activity director, expressed concerns about a troubling change in the teenager to parents? For example, at church the Youth Minister reports the young person has been acting super sensitive to small slights from peers, sometimes to the point of tears.
The rule for parents is that if your answers to these questions are a cause for concern, when in doubt get a consultation and check them out.
Parenting is a lonely job, among the lonelier responsibilities becoming the “the initial expert” about determining if their son or daughter has a psychological difficulty worth seeking help for, finding what helper to go to, and then deciding what advice the helper gives that should be taken or not. One common choice point these days, in a society that is increasingly disposed to pop pills to treat human ills, is whether to proceed with psychoactive (mood and mind altering) medication, if that is what the helper advises? This is a complicated parenting decision to make.
Most psychoactive medications designed to treat such common psychological afflictions in young people as depression, anxiety, compulsivity, and distractability are more palliative than curative. That is, their purpose is to ease without curing, to keep troublesome symptoms from becoming disruptive. This can be a worthwhile service to provide. Not only is distress moderated and energy freed up to cope with daily demands, to enjoy traditional interests, and to pursue valued goals, but medication may ease a person through some tough life transition (like grief from significant loss) and be gradually withdrawn as a hard life adjustment is accomplished.
Obviously there are downsides to be monitored. Any medication is just a potion with a purpose – the good it can do always mixed with possible harm it can cause. There are risks of adverse side effects, while protracted used can become habituated, creating some opportunity for chemical dependence. This constitutes the problem of commission -- the possibility of unintended consequences.
Not so obviously, however, is the risk of helping an adolescent cope with psychological duress by using medication alone. This is the problem of omission -- responding with medication without education. This omission neglects helping the adolescent profit from personal pain by gathering self-knowledge, developing strategies for coping with life, and finding ways to optimize personal functioning. Medication is no substitute for education – learning to understand and manage the psychological hand that one’s nature and life experience has dealt.
For this education to take place, counseling (for short term help) or psychotherapy (for longer term help) can be useful. No parent wishes significant psychological difficulty for their adolescent; however, should it arise, it does provide an opportunity to get to know oneself more deeply and learn to govern oneself more wisely, strengthening the young person for inevitable trials in the years ahead. As an investment in self-education, counseling or psychotherapy can be helpful in ways that medication alone cannot.
My advice to parents: if a psychological problem is severe enough to warrant psychoactive medication, then it is important enough to deserve psychological education as well.
Next week’s entry: Adolescence and Self-Dissatisfaction