By Dr. Natasha K. Sriraman
Rates of anxiety and depression in children and adolescents continue to increase. While these conditions are treatable with therapy and/or medications, 80% of kids with a diagnosable anxiety disorder and 60% of kids with diagnosable depression are not getting treatment. Surveys have shown that there has been a sudden increase in teens saying they were experiencing symptoms of depression–feeling hopeless, not enjoying life, believing they can’t do anything right.
The teen suicide rate has tripled among girls ages 12-14 and has increased by 50% in girls ages 15-19.
The number of children and teens hospitalized for suicidal thoughts or self-harm doubled between 2008 and 2015. Why? Why are today’s teens more stressed, more anxious than teens just 5, 10 years ago?
Social media is a large part of this puzzle. More and more teens interact with friends, and other people electronically. How many times have we seen our teenagers and their friends sitting next to each other, not speaking, no excited chattering, but on their iPhones? As my daughter writes in her post (The Pressure of Maintaining the Perfect Image), social media has also become a constant source of comparison, thereby eroding self-esteem. As a pediatrician, I see the constant posting to Facebook or Instagram, not only in my teen patients, but many times, the younger mothers in my practice.
Teen girls are expected to be hanging out with the right people, have the perfect figure while showing they are having the best time ever. Unfortunately this comparison doesn’t just occur among teenagers. As a middle-aged woman, I have seen other women, friends comment on how others are skinnier, prettier, have name-brand clothes, etc.
So what can parents do? First, if you have any concerns about your child/teenager, try talking to them. Don’t minimize their feelings or tell them to ‘snap out of it.’ Although we, as parents, may be tempted to since we were raised in a different time, family-type, or culture, the approach has to be very different.
So what can you say? Validate their feelings, let them know that you are there for them—no matter what. ‘I know this is a very difficult time/situation, but I am here for you.’
And it may not need to be the primary parent (mother/father), but it may be another adult that is important in that child/teenager’s life (aunt/uncle/babysitter/close family friend).
Next, please contact your pediatrician. As pediatricians, we are well-versed in adolescent mood and behavior. At every adolescent check-up, your child should receive a screening instrument assessing their mood/sleep patterns. This short questionnaire should be filled out by your teen by him/herself, without any parental input.
The most common one is the Patient Health Questionnaire (PHQ-9). This screening survey will help the pediatrician guide the visit. Also, at this age, the pediatrician will ask the parent to leave the room so they can chat one-on-one with your teenager. While the screening tool is important, this is extremely helpful since it not only opens up a dialogue between pediatrician and patient, but also pediatrician and parent. This allows the child/teenager the opportunity to either write or tell their doctor about what they’re feeling.
Many times, the teen may remain silent while we discuss the results, but discussing these topics not only lets the teen know that what they may be feeling is okay, but also that we, as adults, not only understand, but can help. I have not met anyone that WANTS to feel sad, anxious, or depressed, have you? Please note that while this depression screening tool is administered at the check-ups, it can also be given to the teenager at any visit (sick visit, sports physical), including if the parent brings their child in with concerns about mood disruptions in their child.
From here, the pediatrician will discuss the results with you both while helping to formulate a plan. First and foremost, the pediatrician will assess the severity of the condition before moving forward with the plan. A teenager with active suicidal ideation will be treated differently than a child who has trouble completing daily activities. Once the patient is deemed to be safe, I encourage you, as the parent, to work closely with your pediatrician in formulating a plan with direct input from your teenager. This usually starts with a referral to counseling/therapy with a licensed professional. Cognitive-behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. It helps the child change negative thoughts into more positive, effective ways of thinking, leading to more positive thoughts and behaviors. Based on the needs of the patient, while ongoing therapy is important, medication to help your child may be necessary. Often times, the child is open to medication therapy since they are tired of feeling so badly for so long. I have an in-depth discussion with both patient and parent about how the medication works, how long it will take before they notice a change along with the safety profile/side effects of the medication. I encourage my parents to be in charge of the medication—giving the pill to their teenager every day.
Importance of sleep in any teenager cannot be minimized, good sleep habits are essential for our anxious/depressed teens. Establish a consistent bedtime, remove all electronics from their room (TV, gaming systems, tablets). This also means their phone needs to be out of their room. Pick a time that the phone goes to central area of the house for overnight charging. Instead, the teen can journal, read or sketch before bed to help them relax. Nutritious food, physical activity, predictable routines and social support will also help the child feel less stressed.
I frequently give my teenagers a blank journal for them once I start treatment. I encourage them to write their feelings or even sketch. Deep breathing exercises (meditative breathing) to help minimize distractions and slow down the mind, is also beneficial. Mindfulness is a practice that helps you become aware of your thoughts and can help them reflect on what is going on in your mind.
Continue to talk to your child. Keep the lines of communication open. Show them that they are not alone and that together, you and your child can find the treatment they deserve.
Talk about suicide. Asking these questions in an objective way opens the door for your child to tell you something they might otherwise keep to themselves. Make sure your child has the number of the National Suicide Hotline (1-800-273-TALK (8255)) to call if they do not want to tell you directly. And most importantly, if you own them, remove all the guns from your home. Studies show that rates of suicide are higher in home with firearms.
For parents, confide in a close friend. Find a parent network. Your child’s therapist may recommend family therapy and may help you find a parent support group. There are online support groups and books that may be helpful in your healing. Contact The National Alliance on Mental Illness (NAMI) (www.nami.org) to find your closest chapter and for additional resources. Be sure to take some time for yourself. Remember, it is vital to take care of you!!
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Natasha K. Sriraman MD MPH FAAP FABM is an Academic Pediatrician and Associate Professor of Pediatrics at Children’s Hospital of the Kings’ Daughters/Eastern Virginia Medical School. She is a Co-author of The Chronicles of Women in White Coats and one of the Editors of the womeninwhitecoats.com blog. She enjoys running, yoga, reading and playing on the beach with her kids and puppy! Follow her on Instagram.
