If you’ve got a teen or preteen at home, you may be feeling confused or concerned about the ups and downs of their emotions and behavioral changes. Mix in a global pandemic and you may see increased stress and tension levels from your teens as they navigate changes to their routine, while having limited access to coping strategies such as seeing friends or doing extracurricular activities.
Parents may be quick to dismiss some of these actions as normal teenage angst or moodiness, which is why it can be difficult to spot depression in teens.
“The developmental task of a teenager is to challenge their parent,” says Dr. Steven Jewell, director, pediatric psychiatry and psychology for Akron Children’s Hospital. “They’re at the stage in their development where they’re beginning to branch out and move away from their family of origin and create an independent identity for themselves. It’s just a normal part of development and becoming an adult. That process of development is pretty defiant. It’s a teenager’s version of the terrible twos.”
Signs of Concern
If you’re concerned that your teen might have depression, there are a few things you should monitor. According to Jewell, there are three major life domains where kids should be functioning well: relationships with family, friends and school.
“If you’re seeing a major decline of functioning in any one of those three areas, or a moderate decline in two or more of those areas, then that is probably a sign that you should look a little more closely to see what’s going on and have an evaluation,” he explains.
Additionally, keep track of any physical changes, such as your child’s appetite, sleeping habits, energy levels and concentration, which can be affected by depression.
“The part of the brain that regulates mood and that keeps mood stable is also responsible for regulating other life functions,” Jewell adds.
Another thing to watch for are suicidal thoughts, the one symptom that makes depression a potentially fatal illness.
“In the midst of an argument the kid says something along the lines of ‘what’s the point of living, I might as well be dead’ or saying nihilistic and hopeless kinds of statements can be an indication,” Jewell says. “Or it can be more subtle, like the kid who is making plans to give away their most prized belongings.”
Suicide is the No. 1 cause of death among Ohioans ages 10-14 and the second leading cause of death among those 15-24, according to a 2019 report from Ohio Department of Health.
Identifying symptoms can help parents recognize a pattern and seek help as soon as possible.
How to Bring it Up
In many cases, if teens are feeling depressed, they won’t bring it up to their parents or ask for help, so it’s important for parents to be prepared to initiate the conversation.
“Oftentimes kids don’t want to stress out their parents — they don’t want to cause additional distress to those that they care about,” says Dr. Kate Eshleman, a child psychologist at the Center for Pediatric Behavioral Health at the Cleveland Clinic. “I think the other thing is when your mood is particularly down, just as part of that symptom, you don’t have the motivation to ask for help and engage in the help process.”
Eshleman suggests creating an open line of communication with your teen by checking in every day, asking how they’re doing and what’s going on in their day.
“If you create that opportunity to have those regular conversations, it makes those difficult conversations a little less difficult,” she says.
When you’re ready to discuss the topic of depression with your teen, approach it with an open attitude and offer help. Let your child know that you’ve noticed changes in his or her behavior or mood, but be supportive.
“It’s easy as a parent to get frustrated,” Eshleman says. “If you notice the child hasn’t been doing their chores as much, it’s frustrating. You may have the tendency to approach it that way, but try to go in with an open attitude, showing you care and that’s why you’re asking.”
Taking Steps to get Help
One of the first people you can reach out to is your child’s family doctor or pediatrician. Your established provider can help you differentiate what’s normal behavior and what’s not normal.
“More and more family docs and pediatricians are screening for depression and are realizing this is a serious public health issue,” Jewell says. “For example, all of the Akron Children’s Hospital pediatricians screen for depression at the well child visits starting at age 12.”
Additionally, you can check with your insurance company to see what providers are covered and schedule an evaluation with a behavioral health professional.
I have been told by professionals dealing with adolescent depression that it is important not to be afraid to ask if the teen is thinking about suicide. This does not put the thought in their head, as we parents fear, but rather opens up a conversation which may be too hard for the child to bring up.
If the child says they have been thinking about it, it’s important to stay calm and let them know you are there to talk with them, and then arrange for professional help to learn about next steps for help.
As one who worked at Akron Children’s Hospital with parents whose children had been admitted for mental health concerns including suicidal ideation or attempts, I felt it important to share this.