Mental Health Awareness in Adolescents and Teenagers

In 2021, the American Academy of Pediatrics teamed with other organizations to declare a national emergency in youth mental health. The challenges faced during the Covid-19 pandemic severely affected the mental health of adolescents and teenagers. Globally, 1 in 4 youth were experiencing clinically elevated depression symptoms, and 1 in 5 were experiencing anxiety. These estimates were double the pre-pandemic estimates.

Over a year later, many families and healthcare providers report that adolescents and teenagers struggle with anxiety, depression, suicidal thoughts, and other mental health concerns. Adolescents and teenagers face many normal biological and social changes during these formative years, so it may be difficult for families to determine if their child's feelings, thoughts, emotions, and actions are developmentally normal and appropriate or if there are warning signs of a deeper issue.

While the lingering effects of school closures and other Covid-19-related stressors have attributed to mental health concerns in adolescents and teenagers, today's youth face additional challenges. Pressure to achieve high grades or gain college admission, pressure to perform well in sports and other extracurricular activities, busy schedules that do not allow enough time for rest and unstructured fun, bullying (both in-person and online), persistent societal fears, the possibility of discrimination, and problems related to poverty, stability, and security all weigh heavily on youth.

According to the American Academy of Pediatrics (AAP), the most common mental health conditions seen in the U.S. among adolescents and teenagers are ADHD (10% of ages 3-17,) anxiety that interferes with everyday functioning (9.5%), depression (4.5%,) eating disorders, and self-harm, which may be underreported.

Overt symptoms like mood swings, irritability, anger, and tearfulness can be common in adolescents and teenagers due to normal hormonal changes during these years. More profound signs that families and medical providers will look for to determine if a child is experiencing a mental health condition may be:

•  Notable changes in sleep, weight, eating habits, or other everyday patterns

• Loss of interest in the things they usually love or quitting activities that they enjoy

• Withdrawing more than usual from friends, family, and community

• Canceling plans with their closest friends with little or no explanation

• Academic struggles that seem different or more intense: for example, failing quizzes in their favorite subject or refusing to do homework that once would have seemed easy

• Running thoughts or worries that won't leave them alone

• A whole new set of friends you've never met before

• Refusing to talk about what's bothering them, even after you've made it as safe as possible to discuss hard issues openly

• Obsession with a particular goal, possibly with the belief that if they don't achieve it, their life will never be the same

• Signs of drug, alcohol, or other substance use

• Signs of self-harm, such as cuts, burns, bruises, etc., that your teen tries to hide or can't explain fully and credibly

• Sexual activity or interest that seems new or more intense than before

It should be noted that caregivers of adolescents and teenagers will know their child best and having one or two of these behaviors may not indicate a more profound mental health crisis.

As a parent, family member, or caregiver considers starting a conversation with their adolescent or teenager about a possible mental health condition, the AAP recommends the following steps for the most successful interaction:

• Make it safe for your child to discuss tough issues with you. Children often avoid discussing tough subjects if they expect to be judged, lectured, or punished.

• Resolve to listen more than you speak. A child may shut down if their parent or caregiver fails to see and hear them fully.

• Consider ways to avoid putting your child on the defensive. Instead of starting with phrases like "You have been acting strange lately," it is recommended to try "We have noticed that you have not wanted to join us for family dinners or family game night over the last several weeks."

• Accept some silence. Youth experiencing mental health struggles often feel shame and fear, making speaking up difficult.

• Realize that mental health stigma still exists. Despite much progress in this area, some children may feel that having a mental health condition means they are broken.

The AAP emphasizes that parents and caregivers should not blame themselves if their adolescent or teenager is experiencing a mental health crisis. Mental health is a vital part of human health, and our youth face challenges unique to their generation. 

Reaching out to your child's pediatrician will be an essential part of the follow-up to a mental health discussion with your adolescent or teenager. Your child's pediatrician can explain treatment options, including medications that might help. They can also refer you to mental health specialists who evaluate your teen. In this way, your pediatrician will become part of a care team that can help you create a treatment plan and a crisis plan that spells out what you will do if things get worse for your child.

In the future, promoting positive mental health and resilience in proactive ways will be important. Parents and caregivers can help adolescents and teenagers find time for self-care and healthy habits. The AAP recommends enjoying time as a family, participating in positive activities, and creating healthy relationships. Promoting positive mental health can then become a daily goal for families.