Bipolar Disorder
Mania is having the opposite picture to depression for at least a week (for example, high energy, fast speech, elated mood, involvement in reckless activities), sometimes accompanied by feelings of grandiosity (being better than everyone else). It occurs in a subgroup of depressed teens, and is also known as "bipolar illness" or "bipolar affective disorder." In bipolar illness, episodes of depression and episodes of mania both occur at different times. Between episodes, the teen may appear normal and function well. It is important to tell your child's doctor if there is a family history of mania as well as depression, as this may affect the treatment plan. (For example, the choice of medication is sometimes different with this information.)
There is a genetic predisposition to bipolar disorder. If the teen has an immediate family member diagnosed with bipolar, there is about a 4.5 percent chance of the child getting bipolar disorder and about a 14 percent chance of getting major depression.
In teens and children, bipolar disorder is sometimes difficult to distinguish from AD/HD and other childhood disorders. Therefore, it requires a thorough diagnostic assessment, and sometimes further assessment of mood patterns over time, before the diagnosis is clear.
Because teens who are manic can engage in dangerous activities and/or lose their perspective on reality, have your teen see a doctor immediately if you think she has this problem. The approach described in this book is not suitable for helping teens overcome manic states. The approach can still be used, however, to help these teens with their depressed states.
Dysthymic Disorder
Dysthymic disorder or dysthymia (pronounced "dis-THI-me-uh) is a type of depression that is less severe than major depression. It is characterized by long-term chronic symptoms that keep individuals from functioning with usual energy levels and from feeling good. There are fewer physical symptoms than with major depression, but more emotional symptoms such as gloomy thoughts and low mood (Kaufman, 2000). Sometimes people with dysthymia also experience major depressive episodes, so it is worth watching for signs that this is happening. If a major depressive episode is occurring, the teen's moods will be clearly worse than usual and she will experience more physical symptoms than usual.
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Tuesday 23 December 2008
Major Causes of Teen's Depression
As in most mental illnesses, we can't really talk about a single "cause" in depression. There are usually both constitutional (inborn) and environmental factors that contribute to the condition, and often there are one or more environmental stresses (such as school demands and frustrations, death of a loved one, a move, or separation or divorce of parents) that act as triggers for a particular depressive episode. As a parent, blaming yourself or your spouse for your son's or daughter's condition is unlikely to be helpful. It is worthwhile having a thorough assessment by a mental health professional, however, as this may clarify the diagnosis and uncover contributing factors that could be changed.
Some teens are initially thought to be depressed but are later found to be suffering from a medical condition that is producing mood changes. Thyroid problems and aheinia (low iron in the blood) commonly cause mood changes, but so too may other medical conditions. Use of certain medications (for example, birth control pills) or street drugs can also affect mood. If your teen hasn't had a recent physical examination, it is well worth pursuing one. Remember to tell the doctor about the mood changes so he or she knows what to look for.
Parents often inquire about blood tests or other examinations that could reveal whether or not their child's brain chemistry is abnormal. Unfortunately, measuring brain chemicals in the bloodstream is not reliable, as there is a cellular barrier or wall between the bloodstream and the brain. Thus, levels of brain chemicals in the bloodstream do not necessarily reflect similar levels in the brain. Brain structure is rarely abnormal in depression, so computerized tomography (CT scan) or magnetic resonance imaging (MRI scan) usually do not help. Brain functioning, as measured by positron emission tomography (PET scan), can be abnormal, but such scans are very expensive, and are usually only available as part of research protocols.
Reactions to traumatic events (so-called "post-traumatic stress disorder") can also mimic depression. Although we all try to protect our children as best we can, it's impossible to monitor teens twenty-four hours a day, so the possibility of a traumatic event should not be dismissed too quickly. Children with pre-existing mental health problems such as anxiety disorders or attention-deficit/hyperactivity disorder are also more vulnerable to developing depression in adolescence.
Note that some things that used to be considered causes of depression are now recognized as part of the illness (for example, pessimistic thinking, social withdrawal, or a tendency to ruminate on past mistakes). Depressed people typically withdraw and see the "glass half empty." Most brief, focused psychotherapies address these symptoms early, by encouraging constructive action and realistically positive thinking. Feelings often take longer to change.
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Some teens are initially thought to be depressed but are later found to be suffering from a medical condition that is producing mood changes. Thyroid problems and aheinia (low iron in the blood) commonly cause mood changes, but so too may other medical conditions. Use of certain medications (for example, birth control pills) or street drugs can also affect mood. If your teen hasn't had a recent physical examination, it is well worth pursuing one. Remember to tell the doctor about the mood changes so he or she knows what to look for.
Parents often inquire about blood tests or other examinations that could reveal whether or not their child's brain chemistry is abnormal. Unfortunately, measuring brain chemicals in the bloodstream is not reliable, as there is a cellular barrier or wall between the bloodstream and the brain. Thus, levels of brain chemicals in the bloodstream do not necessarily reflect similar levels in the brain. Brain structure is rarely abnormal in depression, so computerized tomography (CT scan) or magnetic resonance imaging (MRI scan) usually do not help. Brain functioning, as measured by positron emission tomography (PET scan), can be abnormal, but such scans are very expensive, and are usually only available as part of research protocols.
Reactions to traumatic events (so-called "post-traumatic stress disorder") can also mimic depression. Although we all try to protect our children as best we can, it's impossible to monitor teens twenty-four hours a day, so the possibility of a traumatic event should not be dismissed too quickly. Children with pre-existing mental health problems such as anxiety disorders or attention-deficit/hyperactivity disorder are also more vulnerable to developing depression in adolescence.
Note that some things that used to be considered causes of depression are now recognized as part of the illness (for example, pessimistic thinking, social withdrawal, or a tendency to ruminate on past mistakes). Depressed people typically withdraw and see the "glass half empty." Most brief, focused psychotherapies address these symptoms early, by encouraging constructive action and realistically positive thinking. Feelings often take longer to change.
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What Professionals Can Determine Whether a Teen is Depressed?
There are many mental health professionals - psychiatrists, psychologists, nurses, nurse practitioners, social workers, child and youth workers, child care workers, child care associates, counselors, and others - who work with depressed teens. It is sometimes overwhelming to know who to seek help from!
First, we advise you to rule out any medical conditions that may be causing the depression. It is also important to clarify from the outset whether your teen is experiencing a clinical depression. In order to get a diagnosis for your teen and rule out medical factors that may be contributing to the depressed mood, it is necessary to see a child and adolescent psychiatrist. The psychiatrist is a medical doctor who will rule out medical conditions by conducting a simple physical exam and order blood tests, if indicated. He or she also has the qualifications to prescribe and monitor medications if this becomes a recommended part of treatment for your child.
If a medical doctor has already ruled out physical conditions and you want a mental health diagnosis, you could consult a registered child psychologist instead of a psychiatrist. A psychologist cannot prescribe medications in most states or Canada but can assess, diagnose, and treat the teen for depression.
Other mental health professionals listed may conduct clinical assessments using validated questionnaires to help guide their assessments. They use knowledge of biological, psychological, and social factors in working with teens and their parents. However, they do not provide a formal diagnosis. They may, however, treat a child who has already been diagnosed.
If your child will need ongoing treatment, we recommend finding a mental health professional (like those listed above) who:
• specializes in child and family mental health,
• is qualified to provide cognitive-behavioral therapy
• is someone your teen will feel comfortable with and can relate to,
• is flexible, and
• is able to see your teen as an individual.
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First, we advise you to rule out any medical conditions that may be causing the depression. It is also important to clarify from the outset whether your teen is experiencing a clinical depression. In order to get a diagnosis for your teen and rule out medical factors that may be contributing to the depressed mood, it is necessary to see a child and adolescent psychiatrist. The psychiatrist is a medical doctor who will rule out medical conditions by conducting a simple physical exam and order blood tests, if indicated. He or she also has the qualifications to prescribe and monitor medications if this becomes a recommended part of treatment for your child.
If a medical doctor has already ruled out physical conditions and you want a mental health diagnosis, you could consult a registered child psychologist instead of a psychiatrist. A psychologist cannot prescribe medications in most states or Canada but can assess, diagnose, and treat the teen for depression.
Other mental health professionals listed may conduct clinical assessments using validated questionnaires to help guide their assessments. They use knowledge of biological, psychological, and social factors in working with teens and their parents. However, they do not provide a formal diagnosis. They may, however, treat a child who has already been diagnosed.
If your child will need ongoing treatment, we recommend finding a mental health professional (like those listed above) who:
• specializes in child and family mental health,
• is qualified to provide cognitive-behavioral therapy
• is someone your teen will feel comfortable with and can relate to,
• is flexible, and
• is able to see your teen as an individual.
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How to Locate a Professional to Help Your Depressed Child
There are different ways to locate a professional to help your child. Probably the best way is by word of mouth through family and friends or others such as teachers or members of church or community organizations. If you are comfortable asking those you know for some names, it can never hurt to give them a call and check out their recommendations. You may also wish to consult your phone book or use the Internet as long as the Internet sites are reputable and affiliated with recognized professional groups. I recommend the website of the American Medical Association (www.assn.org) to help you locate a child and adolescent psychiatrist and the website of the American fcychological Association (www.apa.org) to find a child and adolescent psychologist.
You may also wish to contact your family doctor or a public health nurse who could recommend a mental health professional. Additionally, a crisis line, especially one for teens, or any major mental health center in your area, should be able to provide names of individuals and services to meet your teen's and family's needs.
You may personally know a child and adolescent mental health professional who could give you ideas about services for you and/or your teen. You may be tempted to ask this professional to see your child. We strongly advise against this for several reasons. First, it often becomes awkward for you, your teen, and the professional to respect the need for privacy and confidentiality. You may want to get more details about your teen's therapy, and, because you know the professional, feel more comfortable asking for it. The professional may want to share more details than she might otherwise do since she knows you. As a result, your teen may hesitate to share his feelings with the professional because he fears she may tell you or judge him. Maintaining professional boundaries is important to the success of any therapy, and in these cases, there is more opportunity to break those rules, ending in dissatisfaction for all.
How Can You Prepare For The Assessment?
When you make the first call to the professional/agency don't be shy about asking qestions. You have every right to know the professional's qualifications, as well as the type of therapy that she provides. Ask her what the research says about her therapy approach. Ask if she provides both assessment and treatment. You may wish to know how long therapy typically lasts. You should feel comfortable that your questions are answered. If you ask about wait lists, don't be surprised if the wait list is over six months for a first-time assessment. Wait lists can be long, and if you ever feel that your teen is deteriorating or needs immediate assistance, don't hesitate to take him to the Emergency Room of your local hospital.
Often parents worry that they will be judged by professionals when they seek help for mental health issues. Mental health care professionals are there to support families, not judge and blame them. They are there to help design a treatment plan that takes all the pieces into consideration. Teens and parents should feel comfortable asking questions. We hear many kinds of questions from parents and teens, such as those listed in the sidebar at left.
Common Questions Parents Ask
• Can you help us?
• Is my child's problem treatable?
• What is the diagnosis?
• Do we need more testing?
• Should my child get treatment?
• Is it my fault?
• Should I get treatment?
• What are your recommendations?
• How long is treatment and how much will it cost?
• Can you recommend some books to read?
• What happens next?
• What is your cancellation policy?
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You may also wish to contact your family doctor or a public health nurse who could recommend a mental health professional. Additionally, a crisis line, especially one for teens, or any major mental health center in your area, should be able to provide names of individuals and services to meet your teen's and family's needs.
You may personally know a child and adolescent mental health professional who could give you ideas about services for you and/or your teen. You may be tempted to ask this professional to see your child. We strongly advise against this for several reasons. First, it often becomes awkward for you, your teen, and the professional to respect the need for privacy and confidentiality. You may want to get more details about your teen's therapy, and, because you know the professional, feel more comfortable asking for it. The professional may want to share more details than she might otherwise do since she knows you. As a result, your teen may hesitate to share his feelings with the professional because he fears she may tell you or judge him. Maintaining professional boundaries is important to the success of any therapy, and in these cases, there is more opportunity to break those rules, ending in dissatisfaction for all.
How Can You Prepare For The Assessment?
When you make the first call to the professional/agency don't be shy about asking qestions. You have every right to know the professional's qualifications, as well as the type of therapy that she provides. Ask her what the research says about her therapy approach. Ask if she provides both assessment and treatment. You may wish to know how long therapy typically lasts. You should feel comfortable that your questions are answered. If you ask about wait lists, don't be surprised if the wait list is over six months for a first-time assessment. Wait lists can be long, and if you ever feel that your teen is deteriorating or needs immediate assistance, don't hesitate to take him to the Emergency Room of your local hospital.
Often parents worry that they will be judged by professionals when they seek help for mental health issues. Mental health care professionals are there to support families, not judge and blame them. They are there to help design a treatment plan that takes all the pieces into consideration. Teens and parents should feel comfortable asking questions. We hear many kinds of questions from parents and teens, such as those listed in the sidebar at left.
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No question is silly. If your mental health professional does not ask you if you have questions, don't be shy about sharing your list with her! If the therapist tells you that she does a "different type" of therapy, or that it takes a long time before you will see progress, or that it is a new therapy that no one in the area offers, get more information! These are red flags! And always ask for explanations if you do not understand something.Common Questions Parents Ask
• Can you help us?
• Is my child's problem treatable?
• What is the diagnosis?
• Do we need more testing?
• Should my child get treatment?
• Is it my fault?
• Should I get treatment?
• What are your recommendations?
• How long is treatment and how much will it cost?
• Can you recommend some books to read?
• What happens next?
• What is your cancellation policy?
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What Does a Psychiatric Health Assessment Consist Of?
A psychiatric or mental health assessment is essentially a conversation or interview taking place between the professional, the parent (s), the teenager, and possibly other family members. It usually consists of a set of questions aimed to help the professional better understand the problem so that a diagnosis and recommendations for treatment can be made.
Each assessment varies according to the professional's style and preference. Sometimes, it consists of an interview with the child, an interview with the parent(s), and sometimes a family interview as well. A comprehensive assessment will last on average for two to three hours and may take place over one or more office visits. Sometimes information is collected with parent(s) and teen together. Depending on the age and level of maturity of your teen, more may be collected from you than from the adolescent himself. However, professionals often will interview teens on their own.
An individual interview with the child provides the opportunity for him to freely share thoughts and feelings about his life, his relationships at home and at school, and any other issues in a confidential manner. We encourage individual time with teens, as it helps them express concerns that they may feel uncomfortable sharing with their parent(s) present. In addition, it gives the teen a message that his individual perspective is valued and respected. It may promote a positive therapeutic alliance between the teen and the professional. When the presenting concern is related to depression, it is also likely that the professional will ask questions about suicidal thoughts and suicidal behavior. Asking about suicide does not "put ideas into child's head," but rather provides assurance to him that people care for him. It gives the child the opportunity to talk about it, if in fact he has contemplated it.
In general, during the interview with the parent and teen, or with each alone, the professional will get a detailed picture about:
• the current concerns and stresses at home, at school, and in the community,
• the history of the problem,
• the child's development, health, illness and treatments, and medication,
• family relationships,
• school and friends,
• parent and family medical/psychiatric history.
If needed, laboratory studies such as blood tests, x-rays, or special assessments (for example, psychological, educational, speech and language evaluation) will be obtained during the assessment.
You and your teen may also be asked to complete questionnaires that further contribute to the assessment. We use a set of questionnaires that have proven to be accurate in determining the intensity and severity of the depression. Some examples include: the Children's Depression Inventory (CDI) (Kovacs, 1983) and the Beck Depression Inventory (BDI) (Beck, 1961), which has been revised and updated over the years. Questionnaires designed to determine whether another condition such as AD/HD or anxiety is present may also be used.
Following the interviews, the professional arrives at a diagnosis and recommendations, which are shared with the teen and family. A treatment plan, which considers all information from the interviews and questionnaires, is developed and shared with you. If you are not comfortable with the recommendations, feel free to ask questions and raise your concerns. It is important to discuss any hesitations you have about the recommendations. It is more important to identify obstacles in the treatment plan at the outset than to go along with something that you don't believe will work.
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Each assessment varies according to the professional's style and preference. Sometimes, it consists of an interview with the child, an interview with the parent(s), and sometimes a family interview as well. A comprehensive assessment will last on average for two to three hours and may take place over one or more office visits. Sometimes information is collected with parent(s) and teen together. Depending on the age and level of maturity of your teen, more may be collected from you than from the adolescent himself. However, professionals often will interview teens on their own.
An individual interview with the child provides the opportunity for him to freely share thoughts and feelings about his life, his relationships at home and at school, and any other issues in a confidential manner. We encourage individual time with teens, as it helps them express concerns that they may feel uncomfortable sharing with their parent(s) present. In addition, it gives the teen a message that his individual perspective is valued and respected. It may promote a positive therapeutic alliance between the teen and the professional. When the presenting concern is related to depression, it is also likely that the professional will ask questions about suicidal thoughts and suicidal behavior. Asking about suicide does not "put ideas into child's head," but rather provides assurance to him that people care for him. It gives the child the opportunity to talk about it, if in fact he has contemplated it.
In general, during the interview with the parent and teen, or with each alone, the professional will get a detailed picture about:
• the current concerns and stresses at home, at school, and in the community,
• the history of the problem,
• the child's development, health, illness and treatments, and medication,
• family relationships,
• school and friends,
• parent and family medical/psychiatric history.
If needed, laboratory studies such as blood tests, x-rays, or special assessments (for example, psychological, educational, speech and language evaluation) will be obtained during the assessment.
You and your teen may also be asked to complete questionnaires that further contribute to the assessment. We use a set of questionnaires that have proven to be accurate in determining the intensity and severity of the depression. Some examples include: the Children's Depression Inventory (CDI) (Kovacs, 1983) and the Beck Depression Inventory (BDI) (Beck, 1961), which has been revised and updated over the years. Questionnaires designed to determine whether another condition such as AD/HD or anxiety is present may also be used.
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In addition, it is not uncommon for the professional to ask parents (and the teen) for permission to obtain information from significant others (school teachers, "counselors, specialists, other relatives). Any consent requesting information is signed by the parent and also the teen, if he is of legal age to give his own informed medical consent. (In most states, this age is eighteen, but it is younger in a few states and older in a few states; in Canada it is sixteen.) Even if your teen is not of legal age, it is a good idea to include him in signing consents, as it demonstrates respect for him and may help to engage him in the assessment and treatment process.Following the interviews, the professional arrives at a diagnosis and recommendations, which are shared with the teen and family. A treatment plan, which considers all information from the interviews and questionnaires, is developed and shared with you. If you are not comfortable with the recommendations, feel free to ask questions and raise your concerns. It is important to discuss any hesitations you have about the recommendations. It is more important to identify obstacles in the treatment plan at the outset than to go along with something that you don't believe will work.
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What Are Normal Physical and Mental Changes in Adolescence?
In the past, people thought that adolescence was a time of dramatic emotional turmoil. Recent studies, however, have shown that this is not the case, as 80 percent of teens get through adolescence with minimal or no psychiatric problems. Nevertheless, 20 percent of teens do experience some form of psychiatric disturbance during their adolescent years. Thus, your depressed teen is certainly not alone in her suffering. Besides depression, other symptoms considered "abnormal" include:
• antisocial behavior (for example, illegal activities),
• suicidal statements (including groups of teens who may jointly make suicide "pacts"),
• significant deterioration of school performance, or
• significant anxiety that interferes with day-to-day activities.
These behaviors are considered out of the range of normal and are red flags that need psychiatric attention. If your child falls into this category, get help.
Although adolescence is not necessarily a time of great turmoil, it is a time of great changes—physically, emotionally, mentally, and behaviorally. The changes most adolescents must cope with are discussed below.
Physical Changes
Pubertal development occurs in early adolescence, and with it comes increased self-consciousness in many teens, and some increased need for self-care (for example, using deodorants). There are some gender-specific advantages and disadvantages for adolescents whose bodies mature earlier. Boys who mature earlier have an advantage socially, as their greater size and strength are respected by peers. Girls who mature later have an advantage academically, as they are less distracted by male attention than their early-maturing peers. Whatever the rate of maturation in your teen, try to be sensitive to his or her increased need for privacy and potential embarrassment about physical development. Be positive about growing up and becoming a young man or young woman.
Mental Changes
Until the age of eleven or twelve, children are concrete thinkers. They see things in black and white and have less ability to see the "gray" areas. For example, a concrete thinker who receives a desired phone call from a friend may assume she is liked and popular. Likewise, if she does not receive a desired call from a friend, she assumes the friend does not like her. Hypothetical and futuristic thinking is not a part of concrete thinking.
Abstract reasoning (beginning around age thirteen in most children) allows for speculations and hypotheses about different possibilities, and some increased ability to plan ahead and "look before you leap." Unfortunately, it also allows for more worries and existential concerns (for example, questions about the purpose of one's life, or the nature of the universe or God). In depressed teens, this type of reasoning can lead to unhealthy, prolonged rumination (reviewing the same thought or worry or scenario repeatedly). A depressed teen may think, "I am totally unpopular. No one will ever like me." All teens reflect on their place in the world occasionally, but such negative thinking, especially when left untreated, can become habitual and actually perpetuate further depression.
Another notable change in thinking is that most teens become more able to be organized and goal directed as their brain matures. This may be more evident at school, where they are required to organize their thoughts in essays and open-ended questions. Essentially, their brains are becoming more sophisticated as they prepare for adulthood.
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• antisocial behavior (for example, illegal activities),
• suicidal statements (including groups of teens who may jointly make suicide "pacts"),
• significant deterioration of school performance, or
• significant anxiety that interferes with day-to-day activities.
These behaviors are considered out of the range of normal and are red flags that need psychiatric attention. If your child falls into this category, get help.
Although adolescence is not necessarily a time of great turmoil, it is a time of great changes—physically, emotionally, mentally, and behaviorally. The changes most adolescents must cope with are discussed below.
Physical Changes
Pubertal development occurs in early adolescence, and with it comes increased self-consciousness in many teens, and some increased need for self-care (for example, using deodorants). There are some gender-specific advantages and disadvantages for adolescents whose bodies mature earlier. Boys who mature earlier have an advantage socially, as their greater size and strength are respected by peers. Girls who mature later have an advantage academically, as they are less distracted by male attention than their early-maturing peers. Whatever the rate of maturation in your teen, try to be sensitive to his or her increased need for privacy and potential embarrassment about physical development. Be positive about growing up and becoming a young man or young woman.
Mental Changes
Until the age of eleven or twelve, children are concrete thinkers. They see things in black and white and have less ability to see the "gray" areas. For example, a concrete thinker who receives a desired phone call from a friend may assume she is liked and popular. Likewise, if she does not receive a desired call from a friend, she assumes the friend does not like her. Hypothetical and futuristic thinking is not a part of concrete thinking.
Abstract reasoning (beginning around age thirteen in most children) allows for speculations and hypotheses about different possibilities, and some increased ability to plan ahead and "look before you leap." Unfortunately, it also allows for more worries and existential concerns (for example, questions about the purpose of one's life, or the nature of the universe or God). In depressed teens, this type of reasoning can lead to unhealthy, prolonged rumination (reviewing the same thought or worry or scenario repeatedly). A depressed teen may think, "I am totally unpopular. No one will ever like me." All teens reflect on their place in the world occasionally, but such negative thinking, especially when left untreated, can become habitual and actually perpetuate further depression.
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It's not unusual for teens to challenge familiar and family beliefs at this age. Another "side effect" of abstract reasoning is the ability to argue more effectively. As they come to realize that you are not perfect, teens will identify your faults more readily. Don't take it personally. Set limits when needed. For example, you may wish to say to your teen, "It is OK to express your feelings but it is not OK to yell or scream or swear at me." Remember, for some teens arguing is just a way of exercising the brain.Another notable change in thinking is that most teens become more able to be organized and goal directed as their brain matures. This may be more evident at school, where they are required to organize their thoughts in essays and open-ended questions. Essentially, their brains are becoming more sophisticated as they prepare for adulthood.
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Emotional and Behavioral Changes in Adolescence
Emotional Changes
Beginning in the 1950s, psychologist Erik Erikson described a series of stages and challenges that each individual passes through in their emotional development. In teens, he termed the main challenge "Identity versus Role Diffusion." This is the time when the teen is challenged to ask, "Who am I?" By exploring this question, the teen is establishing an identity that is clear and distinct from the expectations of others. This process includes gradually developing independence from one's family of origin. A teen who successfully meets this challenge will come out of it with a strong sense of identity and clear goals for the future.
Erikson termed the main challenge of the pre-teen years (ages six to twelve) "Industry versus Inferiority," reflecting the need for recognition for one's accomplishments at this age. In the late teen and early adult years, he termed the main emotional challenge "Intimacy versus Isolation," reflecting the struggle to establish and maintain healthy, close relationships.
Erikson referred to these challenges as "stages," but we now know that there is a great deal of overlap among them, and people who do not resolve a particular challenge at one age may return to it later. Thus, adolescents who are still working on "industry" haven't necessarily missed the boat on "identity" and vice versa. For example, a teen who is focused on "industry" may be struggling with feelings of competency. She may be investing more energy into academic activities and expending less energy on self-reflection. Her thinking may be more noticeably concrete as she works to acquire a sense of achievement in school or to master other intellectual activities. A teen focused on "identity" may be less focused on school and more on finding a peer group that shares her values. However, all adolescents face these challenges to a greater or lesser degree.
Behavioral Changes
Identity progresses from establishing yourself as separate from your parents, to finding a group, special activity, or mentor to identify with or idealize, to then finding and accepting your individual identity, warts and all. Because this process takes years, young adolescents often get stuck between wanting to do things independentiy versus wanting their parents' support. (For example, "My mother won't let me go there" is often used to resist peer pressure, even if it's the teen herself who doesn't want to go there!)
The desire for independence also waxes and wanes depending on circumstances. A teen may look very independent one day, and need a great deal of support the next. Try to accept a certain amount of inconsistency with humor, but be clear what the rules are about important behaviors (for example, attending school, coming home by a certain time, and issues related to safety). Teens need to have a say, but parents must still do what's in their best interest. Freedoms should depend on the level of responsibility the teen has demonstrated. Don't expect teens to acknowledge your advice, though. They often appear not to listen even though they are (it's not cool to admit your parents are right).
Encourage your teen to treasure the friends she does have, rather than yearning for those who won't accept her. Also, foster tolerance by encouraging your teen to be respectful, interested, and open to learning from a variety of people with different appearances attitudes, and orientations - whether your child is part of the "in" group or not. This attitude makes for healthier high school environments, and probably wouldn't be a bad thing for the rest of society either.
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Beginning in the 1950s, psychologist Erik Erikson described a series of stages and challenges that each individual passes through in their emotional development. In teens, he termed the main challenge "Identity versus Role Diffusion." This is the time when the teen is challenged to ask, "Who am I?" By exploring this question, the teen is establishing an identity that is clear and distinct from the expectations of others. This process includes gradually developing independence from one's family of origin. A teen who successfully meets this challenge will come out of it with a strong sense of identity and clear goals for the future.
Erikson termed the main challenge of the pre-teen years (ages six to twelve) "Industry versus Inferiority," reflecting the need for recognition for one's accomplishments at this age. In the late teen and early adult years, he termed the main emotional challenge "Intimacy versus Isolation," reflecting the struggle to establish and maintain healthy, close relationships.
Erikson referred to these challenges as "stages," but we now know that there is a great deal of overlap among them, and people who do not resolve a particular challenge at one age may return to it later. Thus, adolescents who are still working on "industry" haven't necessarily missed the boat on "identity" and vice versa. For example, a teen who is focused on "industry" may be struggling with feelings of competency. She may be investing more energy into academic activities and expending less energy on self-reflection. Her thinking may be more noticeably concrete as she works to acquire a sense of achievement in school or to master other intellectual activities. A teen focused on "identity" may be less focused on school and more on finding a peer group that shares her values. However, all adolescents face these challenges to a greater or lesser degree.
Behavioral Changes
Identity progresses from establishing yourself as separate from your parents, to finding a group, special activity, or mentor to identify with or idealize, to then finding and accepting your individual identity, warts and all. Because this process takes years, young adolescents often get stuck between wanting to do things independentiy versus wanting their parents' support. (For example, "My mother won't let me go there" is often used to resist peer pressure, even if it's the teen herself who doesn't want to go there!)
The desire for independence also waxes and wanes depending on circumstances. A teen may look very independent one day, and need a great deal of support the next. Try to accept a certain amount of inconsistency with humor, but be clear what the rules are about important behaviors (for example, attending school, coming home by a certain time, and issues related to safety). Teens need to have a say, but parents must still do what's in their best interest. Freedoms should depend on the level of responsibility the teen has demonstrated. Don't expect teens to acknowledge your advice, though. They often appear not to listen even though they are (it's not cool to admit your parents are right).
Likely Page Break
Heightened self-consciousness means "all the world's a stage" for teenagers, and the audience of their peers becomes very (sometimes overly) important. Young adolescents also tend to form highly exclusive groups or cliques, leaving some feeling alienated. Older adolescents become gradually more accepting of individual differences, usually forming more inclusive social groups toward the end of high school. Until then, kids who are not part of the "popular group" often have to focus on a few peers with a common interest (difficult for some).Encourage your teen to treasure the friends she does have, rather than yearning for those who won't accept her. Also, foster tolerance by encouraging your teen to be respectful, interested, and open to learning from a variety of people with different appearances attitudes, and orientations - whether your child is part of the "in" group or not. This attitude makes for healthier high school environments, and probably wouldn't be a bad thing for the rest of society either.
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How to Deal with Your Teen's Suicidal Risk
Good rules of thumb for dealing with suicidal risk include:
• If you think your child is at risk, go to the nearest emergency department.
• If your child is sent home from the emergency room, remember that you can return there if the situation deteriorates before your next scheduled visit with the doctor.
• It doesn't hurt to lock up medications, sharp objects, or weapons if your child is or has recently been suicidal.
• Safety concerns always take priority over privacy concerns (i.e., this is the one situation where it's OK to search your teen's room).
• Children or teens with suicidal tendencies usually stabilize more readily if they learn to trust one therapist or one group of professionals. This is not the time to "shop around" for new treatments or additional assessments if you and your teen are already working with competent professionals. (Trust takes time to develop, so don't necessarily leave it to your teen's judgment as to whether or not a therapist is competent.)
• Hospitalization can provide a temporary safe haven for the suicidal child or teen, but it doesn't really solve the problem. If prolonged, it can result in your child becoming overly dependent on staff (a detrimental result). Most hospitals these days insist on family involvement from the start, and begin planning for the child's return home starting on the day of arrival.
• Teens who are uncooperative with hospitalization (for example, they refuse to go into the hospital or threaten to run away from it) may have to be admitted to the hospital on an involuntary basis. In Canada, this may require transfer to a so-called "Schedule 1" facility, which is equipped to prevent patients from leaving. They do have a right to legal advice, however, and can challenge their involuntary status. In most states in the U.S., parents can have children who are not of legal age admitted to the hospital without their consent. Check with your child's doctor if considering this option.
As children and teens recover from their crises, it is also important to allow for a gradual increase in freedoms and responsibilities. Teens who are struggling with autonomy can find a "hovering" parent very difficult to live with, sometimes exacerbating their mood. The same principles apply as in a younger child: when the teen behaves responsibly, demonstrating the ability to handle more independence, greater freedom is granted, a little bit at a time.
Finally, let us cite the old adage "an ounce of prevention is worth a pound of cure." If you see your child or teen deteriorating, call the doctor or mental health professional who usually sees her. Scheduling an earlier appointment with a familiar mental health professional is often far more helpful than ending up with an unfamiliar professional in the emergency department.
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• If you think your child is at risk, go to the nearest emergency department.
• If your child is sent home from the emergency room, remember that you can return there if the situation deteriorates before your next scheduled visit with the doctor.
• It doesn't hurt to lock up medications, sharp objects, or weapons if your child is or has recently been suicidal.
• Safety concerns always take priority over privacy concerns (i.e., this is the one situation where it's OK to search your teen's room).
• Children or teens with suicidal tendencies usually stabilize more readily if they learn to trust one therapist or one group of professionals. This is not the time to "shop around" for new treatments or additional assessments if you and your teen are already working with competent professionals. (Trust takes time to develop, so don't necessarily leave it to your teen's judgment as to whether or not a therapist is competent.)
• Hospitalization can provide a temporary safe haven for the suicidal child or teen, but it doesn't really solve the problem. If prolonged, it can result in your child becoming overly dependent on staff (a detrimental result). Most hospitals these days insist on family involvement from the start, and begin planning for the child's return home starting on the day of arrival.
• Teens who are uncooperative with hospitalization (for example, they refuse to go into the hospital or threaten to run away from it) may have to be admitted to the hospital on an involuntary basis. In Canada, this may require transfer to a so-called "Schedule 1" facility, which is equipped to prevent patients from leaving. They do have a right to legal advice, however, and can challenge their involuntary status. In most states in the U.S., parents can have children who are not of legal age admitted to the hospital without their consent. Check with your child's doctor if considering this option.
As children and teens recover from their crises, it is also important to allow for a gradual increase in freedoms and responsibilities. Teens who are struggling with autonomy can find a "hovering" parent very difficult to live with, sometimes exacerbating their mood. The same principles apply as in a younger child: when the teen behaves responsibly, demonstrating the ability to handle more independence, greater freedom is granted, a little bit at a time.
Finally, let us cite the old adage "an ounce of prevention is worth a pound of cure." If you see your child or teen deteriorating, call the doctor or mental health professional who usually sees her. Scheduling an earlier appointment with a familiar mental health professional is often far more helpful than ending up with an unfamiliar professional in the emergency department.
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Types of Anxiety and Depression Medication for Teenagers
Older antidepressants (so-called "tricyclics") targeted both serotonin and noradrenaline, but also affected other nemotransmrtters, unrelated to depression. The most troublesome effects were on the neurotransmitter acetylcholine, resulting in so-called "anticholinergic" side effects (acetylcholine was reduced). These effects included dry mouth, constipation, sedation, and (less commonly) flushing, blurred vision, or urinary retention. In children, there were also several reports of irregular heartbeat with these medications. Therefore, they are currently only used if other medications fail, and always with monitoring of your child's electrocardiogram (a test that monitors the electrical activity of the heart).
Newer medications called "SSRIs" (selective serotonin reuptake inhibitors) do not have these problems, and there is some evidence that they are more effective in teens than the older tricyclics. SSRIs increase only the brain chemical serotonin, and are so-called because they prevent the "reuptake" (removal and breakdown) of this brain chemical. They all work in 70 to 80 percent of depressed children and teens (no one drug stands out), but it is impossible to predict which child will respond to which medication, so some children must try more than one. If another member of the immediate family has done well with a particular drug, however, it is usually worth trying this one in the affected child.
Effective doses in children are highly variable, so most doctors start at a low dose and increase it every couple of weeks as long as the child does not have significant side effects. All these medications take from two to eight weeks to become fully effective after the last dosage increase. Effectiveness usually is evident from improvements in eating and sleeping patterns (early changes), with improvements in mood becoming evident later. Increasing the dose every couple of weeks may result in "overshooting" the optimum dose a bit, given that full benefits may not occur until eight weeks after the last increase. On the other hand, waiting eight weeks between dosage changes would prolong the process unreasonably, so two-week intervals are generally considered good practice. In the hospital (where there is additional monitoring), dosage can be increased more quickly.
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Newer medications called "SSRIs" (selective serotonin reuptake inhibitors) do not have these problems, and there is some evidence that they are more effective in teens than the older tricyclics. SSRIs increase only the brain chemical serotonin, and are so-called because they prevent the "reuptake" (removal and breakdown) of this brain chemical. They all work in 70 to 80 percent of depressed children and teens (no one drug stands out), but it is impossible to predict which child will respond to which medication, so some children must try more than one. If another member of the immediate family has done well with a particular drug, however, it is usually worth trying this one in the affected child.
Effective doses in children are highly variable, so most doctors start at a low dose and increase it every couple of weeks as long as the child does not have significant side effects. All these medications take from two to eight weeks to become fully effective after the last dosage increase. Effectiveness usually is evident from improvements in eating and sleeping patterns (early changes), with improvements in mood becoming evident later. Increasing the dose every couple of weeks may result in "overshooting" the optimum dose a bit, given that full benefits may not occur until eight weeks after the last increase. On the other hand, waiting eight weeks between dosage changes would prolong the process unreasonably, so two-week intervals are generally considered good practice. In the hospital (where there is additional monitoring), dosage can be increased more quickly.
If You Want Immediate Anxiety Relief, Check Out Our New Natural Technique To Stop Panic Attacks and General Anxiety Fast!
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