Adolescence is often considered the most difficult time in life.
The American Academy of Pediatrics task force in mental health estimates that up to 21 percent of adolescents meet the diagnostic criteria for a mental health diagnosis, and that more than half of adults with mental health problems had symptoms prior to 14 years of age. Major depressive disorder ranges from 7.9 percent to 9 percent in the teen population.
The developmental, social and emotional tasks of the adolescent are complex. From the time a child enters middle school, he or she should be moving toward a stronger feeling of who they are and of their ability to affect their future. However, the many issues facing adolescents today derail this progression.
As parents and doctors, we need to constantly monitor how adolescents in our lives are handling and adjusting to their lives and circumstances.
It is important to monitor for the classic signs of depression. First, a gradual or sudden change away from normal patterns of interacting with the world occurs. This may take the form of lack of interest in friends, school or normal activities and problems with grades.
There are almost always changes in depressed mood, however, anger and acting out can also occur. A change in appetite, often a lack of interest in food, can occur. Sometimes this is paired with anorexia. Conversely, food consumption may increase in chronically depressed adolescents. Teens with obesity have higher rates of depression and should routinely be screened for symptoms.
Sleep hygiene should also be addressed. Traditionally, the depressed adolescent will be
sleep all the time, as a way of disengaging from their environment. Recently, we are seeing other disrupted sleep patterns, including an inability to sleep, or waking frequently at night.
Depression is also a common response to failed relationships. Breaking up with a boyfriend or girlfriend is a significant risk factor for suicide and should be promptly referred. All of these areas should be explored, along with possible drug use, as a cause or effect of depression.
The best advice for parents is to talk to your teen about what is going on. Follow grades, school interactions, mood, peers and friends, and the overall energy level of your child. Snoop around if you are concerned, look for clues in your child’s bedroom and monitor electronic usage.
If your teen is withdrawn and will not talk, this is a red flag. Talk to your child’s doctor about how your child is doing. There are depression rating scales to help determine if a child is depressed or if there is underlying anxiety. Your child’s doctor can help you decide the appropriate resources.
For parents, I recommend the healthychildren.org website. There is an excellent section on emotional wellness, family life and communication with articles on coping with stress, communication, signs of overload, nutrition and sleep, and many more.
Any adolescent who is threatening suicide or having suicidal thinking should be evaluated in the emergency room by a trained mental health professional. One of the best books I have come across regarding helping raise independent and well-grounded children is “Building Resilience in Children and Teens” by Kenneth R. Ginsberg.
Dr. Phillip McGuiness completed his internship and residency at Oregon Health & Science University and has been a pediatrician at The Vancouver Clinic since 1982.