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Mental, Emotional, and Behavioral Healthcare for Adolescents: Part II

Angela Oswalt Morelli , MSW, edited by C. E. Zupanick, Psy.D.

In addition to the general symptoms listed previously, some behavioral health concerns have very specific warning signs. Eating disorders may be indicated by significant changes in eating behaviors such as: binging on very large amounts of food; hiding food in personal spaces such as the bedroom; avoiding food or activities in which everyone is eating; developing unusual rituals around food such as cutting everything into tiny pieces and then eating a specific number of pieces; immediately using the restroom after meals (to purge), or extreme amounts of exercise. More information about eating disorders can be found in our Eating Disorder topic center.

anxietyYouth who are struggling with an anxiety disorder can seem anxious most of the time. They may constantly worry that something bad is going to happen; that they will fail, make a mistake, or do something horridly embarrassing; or they may anticipate the worst possible outcome. These youth may begin to avoid situations or circumstances where they anticipate these negative experiences will occur such as avoiding parties for fear of embarrassment, or quitting the debate team because they are certain they will make a mistake and disappoint their teammates. They may become so worried or nervous that they avoid going to school or feel unable to leave the safety of their home for fear of what might happen. Other anxious youth may feel like they constantly need to check and re-check things like making sure the front door is locked, or checking to see if they remembered to put their homework into their backpack. Sometimes anxious youth may experience panic attacks that seem to just "come out of the blue." People who experience panic attacks describe feeling like they can't breathe, or that their heart is racing, and experience intense fear. Panic attacks are a symptom of several different types of anxiety disorders. More information about anxiety disorders can be found in our Anxiety Disorders topic center.

Troubled youth often develop problems with alcohol and other drugs but even seemingly happy and well-adjusted children can develop drug use problems. If youth come home smelling like alcohol, smoke, or another chemical-like smell the parents don't recognize, it could indicate that they are using the substances that cause those smells, or are hanging out with other youth who do. Conversely, some youth may come home smelling too nice. Their breath may be too minty-fresh, or their clothes smell like a bottle of Febreze®. This could also indicate they are trying to cover up or to remove the smells of alcohol, tobacco, or drugs. Furthermore, if youth appear to have impaired mental or physical functioning, this can also be a serious indication they are using substances. Impaired functioning may be indicated by: slurred speech; difficulty maintaining a sensible conversation with others; difficulty remaining on task; stumbling, falling, or other balance difficulties; or appearing to be disconnected from everyone else.

Many teens with substance use problems try very hard to hide their substance use from their parents; so, even if the parents do not observe their child's impaired functioning, they may notice their child becoming much more secretive about their activities and their friends, and they may begin to avoid their home and family much more than usual. If parents or healthcare providers suspect a youth is using drugs, blood tests can be ordered to check for substances in the child's system. However, these tests may not tell the whole story since they can usually only detect drugs used within the last 72 hours. However, alcohol can only be detected within a few hours of use, while marijuana may be detected for nearly a month after use. For these reasons, some parents may choose to bypass the doctor's office and use the over-the-counter drug tests available online and in many drug stores. For more information about alcohol and other drugs please see the section on Safety.

Depression is another behavioral health concern that affects youth. Unfortunately, many people mistakenly dismiss a teen's "moodiness" as just a normal part of adolescent development, and therefore teens with depression do not receive the treatment they need. According to the National Institute of Mental Health, only 1 in 3 teens with depression receive the treatment that they need and therefore, they unnecessarily suffer and struggle on their own. While a depressed mood on most days may indicate depression, frequent anger and irritability can also indicate a depressive disorder, as can changes in appetite, changes in sleep, and a disregard for basic hygiene and personal appearance. Parents should be alert to these symptoms and if they have concerns, they should discuss this with their child's healthcare provider.

Teen suicide

A primary symptom of depression is a sense of hopelessness. Sometimes when youth feel this kind of deep despair, they begin to consider suicide as a solution to end their suffering. But depression is not the only cause of teen suicides. The majority of suicides are completed under the influence of alcohol and other drugs placing teens that use alcohol and drugs at greater risk. Many suicides are impulsive in nature, while others occur after a great deal of planning and thought. Victims of bullying, and victims of abuse are at risk, as are teens that feel isolated and lonely. In short, there is no one single cause for the disturbing problem of teen suicide. In fact, suicide is the second leading cause of death in young people age 15-24.

Parents should be on the look-out for possible warning signs that their child may be at risk for suicide. First of all, youth who are struggling with any emotional or behavioral problems, and/or who use alcohol and other drugs, have an increased risk for suicide. More specifically, parents should take seriously ANY comments their children make about wanting to die or wanting to kill themselves. Comments like, "I'd be better off dead," "I'll just kill myself," "No one would miss me if I were gone," "I wonder what it would be like to die" should ALWAYS be taken seriously. These comments may be made verbally, or these kinds of comments may be written in a journal, an email, a text message, or a website posting (such as Facebook®). While some youth indicate they are considering suicide by making direct comments about death and dying, other youth may be more indirect: making a will, planning their funeral, or giving away beloved possessions. A frequently missed indicator of an eminent suicide is when a previously depressed person suddenly begins to feel better, has more energy, and seems to have miraculously turned the corner. Their loved ones may be relieved to see such remarkable improvement. But this "improvement" may be due to the fact that once a depressed person has made the decision to attempt suicide, and begins to plan a suicide, they begin to feel better, more at peace, knowing that an end to their suffering is now in sight.

If parents notice any of these symptoms, they should immediately reach out to their child and seek professional help. Many parents are reluctant to discuss suicide with their teens for fear that such a discussion will only worsen a bad situation; but, usually people considering suicide are relieved to release this secret burden and want to be helped. Suicidal thoughts are often accompanied by the belief that no one cares about them, or understands their pain. When parents initiate such a discussion, they are communicating that they do care, and want to understand what their child is experiencing. Parents and teens can receive guidance and direction from the local crisis center, or the National Suicide Prevention Hotline at 1-800-273-TALK (8255) which is open 24/7 every day of the year. If parents suspect their youth is in immediate danger, they should not leave the child alone and should escort the child to the nearest emergency room. Parents can find more information about teen suicide at the National Association of School Psychologists.