Stressed Teens, Stressed Parents

The parents brought their teenager into the Emergency Department because she was acting bizarrely.  The normally cheerful, outgoing girl was suddenly sullen, irritable, and lashed out at the slightest provocation.  She also seemed paranoid, suspicious of everyone around. Usually ready to hug, she now acted afraid of any contact.  During my physical exam her eyes darted back and forth, and she flinched when I reached out with my stethoscope.

The onset of mental illness can seem sudden.  In medical school they called it “the psychotic break,” where previously well teens become paranoid or delusional, often when faced with new stress, like moving away to college. This break was thought to herald life-long illness like schizophrenia or bipolar disorder.  However, it turns out that most teenage psychological troubles have a slower, more subtle beginning; and if treated early, can have a happier ending.

Seemingly dramatic changes in behavior are often preceded by symptoms that are missed or denied by teens or parents.  These include weight loss and drop in appetite, plummeting grades, chronic abdominal pain or headaches, irritability and combativeness.  These can easily be dismissed as normal teen “phases,” which they often are. Unless they’re not.

Other signs that your teen is coping badly are…having to cope.  Profound stress can push your teen to depression or other maladjusted behaviors.  Are parents divorcing or having other troubles, like infidelity?  If you as a parent think you’re stressed by the situation, it’s as bad or worse for your kids.  Love and security that they counted on their whole lives has now blown up.  Many divorcees state that they wouldn’t have divorced if they’d known what it would do to their kids.  Other profound stressors include moving; a parent’s job loss or other economic hardship; and death of a loved one, like a friend or close grandparent.  If your kid’s facing these issues, be ready to get help.

The more distressing symptoms of mental illness, like our girl above, are clearer signs that it’s time to get help now.  These include alcohol and drug use, sexualization or being sexually abused, eating disorders, or paranoia and hallucinations.

It’s no fun dealing with angry parents who make their teen’s mental illness a battleground.  Often they bring their kids to the Emergency Department demanding that they be drug-tested, to “win” the fight over suspected abuse.  In the most recent instance, after I told a mom that we could not legally force a drug test on a teen, she stormed out of the ER, yelling that it was her right to know.  Fortunately, the teen stayed behind, and we had a good talk about her drug use, her depression, and how she could get help.

Having proof that your teen is using drugs won’t make him or her snap-to.  Looking back, I could have handled the situation better by asking the mom, “how will a positive test help you and your child?” and explore the issue from there, rather than shut her down with the law.  If the girl’s behavior already made mom worried that she’s abusing drugs or alcohol, that behavior is often evidence enough that she needs help, better than a drug test.

Like we discussed above, symptoms of depression or other mental illness can be subtle, or not-so-subtle- weight loss, plummeting grades, chronic headaches and abdominal pain, drug use and promiscuity.  Now that you’re properly scared, where to get that help?

If you belong to a major denomination church, clergy and staff often have training and offer competent counseling.  Your child’s doctor should have a list of mental health services, and some even do counseling and anti-depressant prescribing themselves.  School counselors also should know their cohorts in the community.  You’ll want a counselor that partners with a psychiatrist or other provider who prescribes.  Anti-depressant or mood-stabilizing medication often helps get teens through a bad patch, and keep them steady as they learn new, healthier habits with thinking and interactions.

If you find yourself getting angry at your teen’s behavior, when they’re combative, sullen, or just plain lazy, take a step back.  Maybe they’re not acting this way to piss you off, maybe they’re crying for help the only way they know.  Laziness may just be laziness, or that inability to get off the couch could be depression.  Don’t take it as a personal affront, take it as a call to action.  

Throw Like a Girl

Today’s guest columnist is Dr. Corey Gardner, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

“You can’t beat me!” yelled Jacob, the ringleader of the third-grade boys who controlled the playground at recess.  He was yelling at me, the scrawny little thing in the ankle-length blue dress with flowers on it.

“Oh yes she can, and she will, even in that dress,” countered my friend Reggie.  I stood silently, waiting for the race to start.  Reggie and I had played lots of tag and touch football, he knew my speed, and that no dress would hamper it.  With the distance marked and the rules set, we lined up.  ”Go!”  I took off, blue skirt streaming behind me like a sail. Jacob had no chance.  He couldn’t catch me that day, and from then on the boys let me play as an equal.

This story raises the issue of young girls in athletics.  Multiple studies demonstrate that fewer girls participate in sports.  That number drops off even more once girls hit puberty. There are myriad reasons cited, including disinterest, teasing, body changes, lack of female athlete role models, and believing boys will like them less.  The sports drop-out rate for girls around adolescence is six times greater than for boys.  Only a quarter of high school girls are in sports, compared to over half of high school boys.

When we lose these girls to culture and peer pressure, they in turn lose valuable opportunities: to gain self-confidence, leadership experience, and of course better health. The science is clear that sports and fitness activities stave off obesity and heart disease, substance abuse and depression, and even lower rates of teen pregnancy. Participating girls tend to go on to have better lives, including chances at college scholarships, and better professional development.

Gender equality in physical activity starts in grade school.  Girls need to know that they have a right to enjoy sports, to feel strong and have fun playing.  This includes the right to that recess playground and the chance to run like the wind, even if she’s wearing a blue dress with flowers on it.

The Olympics in Rio last summer showcased many elite female athletes. Simone Biles won five gold medals in gymnastics, including the best and most fun floor exercise in a long time. Then on NBC’s Today show, she even eclipsed her celebrity crush, actor Zac Efron. He was invited on to surprise the gymnast and her team, but he was clearly awed himself. “They won gold medals, they were crushing it the entire Olympics,” explained Efron, “and I was like hiding in a closet waiting to come in.”

Like we discussed above, more girls need to be in athletics, having fun, staying fit, and living their own great moments.  It’s even better when girls play multiple sports, instead of being single-sport “specialty” athletes. However, kid sports have evolved to nurture hopes of creating stars. Sport-specific camps and select leagues provide opportunities for kids to slog away at one sport year-round.  Parents believe they’re doing their kids a service with the extra practice time and experience, grooming them for futures in the major leagues. In fact, the data shows the exact opposite.

Children who are channeled into single sports often burn out by high school. Not only do they get bored playing one sport, but injuries increase significantly.  We see these kids in the Emergency Department, when after going through the same motions year after year, they get worn-out, swollen and painful joints.  That’s no path to success. In fact, coaches like Nick Saban, Urban Meyer, and Brian Kelly prefer and actively scout multi-sport athletes. Most NFL quarterbacks played more than one sport in high school and college.

Changing sports broadens a kid’s peer group- more friends, more fun. Multi-sport kids get more overall fitness, training different muscles necessary for each sport.  And switching joint use spreads out the strain. Finally, kids get less bored not having to throw a zillion pitches day after day, if they get to tumble in the gym instead.

Next time, instead of enrolling your child in another select league, maybe encourage her to try a different sport that season. Who knows, maybe a miniature Alex Morgan will come out on the soccer field, having been hidden behind mediocre T-ball skills.

A Tale of Two Teenagers

Hard to believe, Amy loves the Army.  She’s in boot camp, enjoying lots of exercise, full days, new jargon to learn, and she even likes the lectures on Army protocol. It’s stressful to be sure; it’s supposed to be tough.  Some girls are fainting, some are washing out because they can’t hack it, some stay up too late and lose sleep. Amy has her eyes on the prize- graduating and moving up.  When she gets anxious, she swallows it and moves on. Uncharacteristic for her, she’s eating well and going to bed early.  Her parents are proud, not only for her accomplishment but for how far Amy has come.  Her life wasn’t always this way.

From an early age, Amy was having a rough go.  She had trouble paying attention in first grade, though she was highly intelligent.  She angered some teachers with her pointed, seemingly rude commentaries, though other teachers “got” her. She was tried on ADHD medications, which helped for a time, but then began causing side effects where Amy acted confused and panicky.  By high school, it was clear Amy was depressed.  She was sullen, didn’t get along with most of her classmates, and scraped out poor grades. Despite grasping the material, she just didn’t care enough to get papers in on time or study for tests.

Amy had no obvious reason for depression.  She had two loving, educated parents and two happy siblings.  At the first sign of trouble with attention or mood, she got the best doctors and therapists.  As Amy got older and was able to verbalize what was going on inside, it seemed her depression was “chemical:”  she was just born that way, with no external reasons like bullying or her looks.

Anti-depressant medication helped, as did continued counseling.  Her parents cheered her on through thick and thin, and as she got older Amy’s life began looking up.  College was much better than high school as far as academics and having friends. She had positive dreams for her future.  Joining the Army wasn’t her parents first choice; heck, even with a bachelor’s degree she enlisted rather than take on the responsibility of being an officer. But now they were singing a different tune.

Sharon has it much worse than Amy.  I saw Sharon in the Emergency Department last month.  She came by ambulance after being beaten by a gang of boys.  They ran up behind her, knocked her down, and kicked her repeatedly in the head and chest. There had apparently been some bad blood between Sharon’s friends and other factions in the neighborhood.

From our computer record I saw that Sharon had had a tough life already, though only 15 years-old. She had been seen by us twice for sexual assaults, another time for being beaten up, and once to be admitted to a psychiatric hospital for suicidal thoughts. She came from a rough house in a rough neighborhood.  Her mom obviously had mental illness of her own, from the pressured speech of hyperactivity or drug use, to her peculiar tattoos.  Mom yelled a lot, at Sharon and us, though this seemed to be not from anger but how she usually spoke.

Certainly Sharon’s depression has not gotten the attention that Amy’s did.  Though she had been in hospital for depression, Sharon isn’t on anti-depressants and isn’t in counseling.  Chaos rules her home life: her father’s gone, and she bounces between mom’s and the homes of several other families. Her school and neighborhood aren’t safe.

Despite all this, I have some hope for Sharon.  Kids can be resilient, and Sharon still had an occasional smile and some spunk, despite what just happened.  Mom also did seem to care about her, as did an aunt with her who seemed more emotionally stable.  They agreed that counseling was a good idea, and to see her doctor about a psychiatric referral.

Some kids like Amy are born with depression.  Some like Sharon, besides having inborn depression, also have life stresses that contribute.  Both kids need attention- counseling and maybe medicine to get them through bad patches. If your kid seems depressed, telling them to buck up and act happier isn’t enough.  You should ask about suicidal thoughts, why he is depressed, and see his doctor.  Depression is rough, so better that your kid gets the attention that Amy got, rather than Sharon’s. 

A Tale Of Two Teenagers

Ben grew up with asthma, but at 15 he seemed to have outgrown it.  Then this fall he began to cough and feel tight.  His mom took him to a quick-care, where he was prescribed an inhaler. A few weeks later he caught another cold virus, began to cough and wheeze again, and started using the inhaler he had left in his school bag.

Ben was a busy teenager, and didn’t use his inhaler regularly.  He took puffs only when when he felt tight.  He began to get more tired and out of breath despite the inhaler, but he didn’t tell his mom.  He felt this was his business, and his mom nagged him enough as it was- about his grades, his phone use, his messy room.  He didn’t need more nagging about his medicine.

Then one evening he suddenly couldn’t breathe.  It was a struggle to pull in a breath, and he had to tell his mom.  When she saw that he couldn’t speak and was so air hungry, she called the ambulance. After an hour in the Emergency Department and lots more medicines, he was put in Intensive Care, still wheezing.

Ben’s story is common with teenage asthmatics.  Teenagers generally get poor health care, even those with chronic, potentially life-threatening conditions like asthma or depression.  Littler kids see the doctor a lot, given all the vaccines they need.  They get sick a lot more too, meaning more trips to the office.

When they get to be teens, there’s less reason for kids to go to the doctor.  The vaccines are fewer and far between.  Teens stay pretty well.  When they do get sick, rather than fight to get into their regular doctor, parents sometimes opt for more convenient walk-in clinics.

However, losing contact with your child’s doctor is a problem.  Sure the vaccines are fewer, but when you don’t go to your “medical home” to get seen, you don’t get reminded the important teen vaccines and may miss them: the meningococcal vaccine against meningitis, the tetanus booster, and the cancer-preventing HPV vaccine.  And a walk-in doctor is less likely to ask about your teen’s chronic conditions which need surveillance, like asthma, or depression.

Ashley, 14 years-old, was always a glum kid.  She kept to herself, rarely smiled, had few friends.  About a month ago she broke up with her first boyfriend.  This made her feel even more worthless than usual, and she lately has been thinking that the world would be better without her.  Today she told a friend that she was thinking of taking a lot of pills.

Ashley’s friend, burdened by this knowledge, stewed through several periods at school, and then told a counselor.  Though this made the friend feel like a tattle-tale, she actually saved Ashley’s life. The counselor called in Ashley and her parents, Ashley admitted her suicidal thoughts, and she was brought to the Emergency Department for evaluation.

Depression, like asthma, can be a chronic condition in teenagers.  Like our asthmatic teen from above, teens don’t like talking to parents about their condition.  They are embarrassed by it; they feel like freaks, with their asthma or depression making them different than others.  They also don’t like being nagged.  Throughout her childhood Ashley’s parents harped on her about her depression, and she had been to counseling several times.  She didn’t like counseling: who wants to talk about their feelings when their feelings are so negative?

Having a regular doctor is one way to keep tabs on depression.  At well visits, besides vaccines and school physicals, doctors should be asking teens about their feelings.  If kids seem depressed, their doctor isn’t afraid to ask the harder questions: do you want to kill yourself?  Why are things worse now: is it problems with your parents, your friends, your school?  The ”medical home” is all about prevention, unlike an Emergency Department or walk-in clinic, where it’s about fixing the kid’s immediate problem and moving on.

If you are worried that your teen is depressed and may be suicidal, fortunately Lafayette has the Jacob Crouch Foundation, a suicide awareness and support group.  You can visit their website at to learn suicide facts and myths, how to recognize signs, and how to get help.

Even better, get help earlier by sticking with your kid’s doctor!