The Top 5 challenges for Teenagers today? Dr Jane (IMC Camden) and Dr Natalie (Alliance Counselling) discuss

Young people’s mental health and wellbeing has never been so important. The statistics below show just how big the problem for young people is:

• 1 in 6 young people aged 16-24 has symptoms of a common mental disorder such as depression or an anxiety disorder (UK)
• Half of all mental health problems manifest by the age of 14, with 75% by age 24 (UK)*

As parents of teens, being aware of where the pitfalls lie is vital.  Dr Jane Foley from IMC Camden and Dr. Natalie Games from Alliance Counselling discuss the Top 5 Challenges facing teenagers today.

1. Depression

Dr Jane:
While occasional bad moods or acting out is part and parcel of the teenage years, rebellious and unhealthy behaviours or attitudes in teenagers can be indications of depression. Depression can cause low energy and concentration difficulties and can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.  It can have a bearing on home life as well as school life leading to poor attendance, a drop in grades and frustration with school work which all feed into a vicious circle of negative symptoms.

Some symptoms of depression may be less obvious and may be an attempt to address low self esteem.  These include reckless behaviour, reckless driving, binge drinking, unsafe sex, violence and self harm.  Other symptoms may be more obvious and characteristic of depression but it can be difficult to work out where this is just ‘typical’ teenager patterns or a sign of something more concerning. The following is a list of behaviours which may indicate depression:

• Not enjoying, or not wanting to be involved in things that they would normally enjoy.
• Changes in appetite or sleeping patterns.
• Being easily irritated or angry for no reason.
• Their performance at school is not what it should be or as it once was.
• Involving themselves in risky behaviour that they would usually avoid, like taking drugs or drinking too much alcohol.
• Experiencing difficulties with their concentration.
• Seeming unusually stressed, worried, down or crying for no reason.
• Expressing negative, distressing, bizarre or unusual thoughts.

Teen depression tends to disrupt everyday family life and it can seem that it has become impossible to live harmoniously.  There are plenty of things you can do to help your child start to feel better. The first step is to learn what teen depression looks like. It is good to encourage your child to talk to someone, be it a parent, teacher, GP, counsellor or psychologist. Once it is someone they trust and feel are on the ‘same page’ as them, that is the important thing.  Try and teach them the importance of accepting and sharing their feelings. Encourage them to try and not to isolate themselves — it makes depression worse. Get the whole family to adopt healthy habits in exercise, sleep, eating and internet use. Encourage the whole family to adopt fun ways to manage stress and anxiety, even simple things like eating together or playing board games together can have a very positive effect on stress levels.

Dr. Natalie G:
Teenagers do have their ups and downs but if they’re down or highly irritable with most people, most of the time then something could be wrong.  Depression which is a psychological illness goes far beyond feeling sad or blue.  If you’re worried that something is wrong, then seek an evaluation from a trusted clinician. You can also help by having a conversation with your teenager.  The best places for these difficult conversations are in the car with limited eye contact, in the park while kicking a ball or just before bed when their defenses are down.

Listen more, talk less and be your teenager’s biggest supporter.  Try to reengage your teenager in activities to boost their confidence and skills – sport, drama, art or music.  Help them find their spark.  Talk about positive self-talk whilst modelling it – what we think is how we feel, and resilient teenagers (and adults) talk compassionately and supportively to themselves.

2. Eating Disorders

Dr Jane:
Eating disorders are complex psychological disorders that affect every aspect of a person’s functioning. Generally it affects people in the following ways:

• Behaviour – thought processes around food, eating and exercise become disordered and often in extreme and destructive way. e.g. restricting food, overeating, purging and over-exercising.
• Thought – thoughts become distorted, irrational and extreme and very ‘all or nothing’ or ‘black and white’. These distorted thoughts and ideas, in turn encourage, trigger and influence the disordered behaviours.
• Emotionally – behaviour and thinking becomes distorted this causes emotional distress and chaos. In addition to this, eating disorders develop to due to underlying emotional distress or turmoil of some kind.

When a person feels compelled ( i.e. that they have no choice) to engage in disordered eating (e.g. restricting, bingeing, purging, over-exercising or they will feel out of control, panicky or anxious when they are not controlling their eating) it is in the realm of an ‘eating disorder’. A person may have an eating disorder when their anxiety levels brings about the compulsion to eat in a certain way, where they are driven by a fear of gaining weight or feel out of control if they don’t do ‘it’.

Some ideas to keep in mind:

• An eating disorder is not primarily about food – this is one part and it is how the emotional distress and turmoil manifests itself
• An eating disorder is a destructive coping mechanism so stopping/letting it go/trying to recover is frightening, difficult and will trigger resistance
• People can and do recover from eating disorders

Eating disorders are complex problems in which both the physical and psychological health of a person are intricately linked.  Recovery from an eating disorder often requires both medical and psychological help (Natalie will discuss this further).  It is recommended that people with eating disorders have access to advice from a consultant psychiatrist, a psychotherapist and a dietitian, as well as a GP, so that all of their needs can be addressed.

Dr. Natalie G:
Teenagers who feel good about their bodies have parents who focus on positive ways to maintain a healthy weight as opposed to encouraging dieting.  The most important consideration for parents to enhance body satisfaction is to role model exercise within a healthy limit, encourage their children to be active and emphasize balanced eating rather than labelling foods as “good or healthy” or “bad or unhealthy”.  It is best to describe foods as “anytime foods” or “sometimes foods” (taken from the masters at Sesame Street).  In this way, you are able to educate your child about processed and unprocessed foods.

Another important consideration is to avoid discussing your own body image problems or obsess about your own weight in front of your child(ren). Parents are encouraged to focus on their teen’s body in terms of what it can do (strong, healthy, vibrant etc) and her/his achievements rather than their appearance.  Early intervention for eating disorders is key for successful treatment as recovery rates for these disorders when present for a long period of time are alarmingly low.  Seek help if you have any cause for concern.  No-one should spend their life at odds with their body.

3. Self-Harm

Dr Jane:
Self-harm is a symptom of underlying mental or emotional distress. Young people who self-harm mainly do so because they find it helps relieves distressing feelings and helps them cope with problems in their lives. It is rarely about trying to end their life but it is important to ask about suicidal thoughts in this situation.

A wide range of factors may be involved. Very often there are multiple triggers, or daily stresses, rather than one significant change or event. Factors can include:

• feeling isolated
• academic pressures
• suicide or self-harm by someone close to the young person
• family problems, including parental separation or divorce
• being bullied
• low self-esteem.

Evidence from young people themselves suggests that social isolation can be a key factor in self-harm for some. Understanding among parents, teachers and others who come into contact with young people is also likely to have a positive impact.

There is stronger evidence that finding ways to distract from self-harm can be very important for many young people. Distraction techniques that are reported as being effective for some young people. Techniques used may be using a red pen to mark rather than cutting, rubbing with ice, hitting a punch bag or flicking elastic bands on the wrist. But even more important than distraction techniques is addressing underlying anxiety, depression and other psychosocial issues and developing strategies for management of stressful situations and in turn improving resilience.

Dr. Natalie G:
Drinking, using drugs, engaging in eating-disordered behaviour, and cutting are disastrous long-term solutions for emotional distress. If your teen has started to engage in these behaviours you may want professional help to stop and understand them.  If your teen is relying on self-destructive ways to manage powerful feelings (deep sadness, self-hatred, anger, loneliness and guilt) they also need to learn helpful ways to cope with these feelings.  These behaviours can be very upsetting for parents.  Of course you may feel shocked, sad, confused or angry but do try to stay calm and try not to jump to conclusions or find solutions.  Try not to take it personally if your teen does not want to talk to you about the situation.  Be understanding that this is a difficult situation for them.  Parents could suggest that their teen write them a letter or email about their thoughts and feelings if they don’t want to talk directly or encourage them to talk to another trusted adult.  In the meantime, continue to work on promoting healthy engagement in activities such as drama, music, sport, arts to build self-confidence.  Please do not ignore early signs of these self-destructive behaviours.

4. Toxic Relationships

Dr Jane:
Adolescence is a time when children are working out who they are and who they like. This can lead to changing friendship groups and this can sometimes lead to interpersonal challenges including toxic relationships. Signs of a toxic relationship are:

• The other person in a relationship constantly puts you down and makes you feel bad about yourself
• You are arguing one day, and things are great the next
• They often make you feel guilty
• They are jealous of your other friends
• You feel like it’s your responsibility to fix things
• You change yourself to please them
• You worry about setting them off and feel like you have to watch what you say
• You feel anxious or unwell when you know you’re going to see them
• They text and call you constantly
• You have lost confidence in yourself
• They break your trust

Encourage your child to surround themselves with people who make them feel good and educate them about setting boundaries with the people in their life so that they understand what is appropriate behaviour.  It is important your teenager feels empowered to walk away from unhealthy relationships.

Dr Natalie G:
Quality relationships are one of the greatest predictors of wellbeing and hence having a few close friendships teaches teens the ability to learn important emotional lessons such as empathy, build emotional intelligence where they not only consider their own thoughts and feelings but take into consideration other’s mental states.  Not all teens make friends easily.  Often there are good reasons and with your support, they will learn to build better skills. There are three situations when parents need to worry about their teen’s social life: if your child does not have a social group or ‘tribe’, if your child is a victim of bullying or if your child bullies others.  In any of these situations, please do seek some additional help from your teen’s school or professional help.

5. Staying Safe Online

Dr Jane:
It is important to be alert to negative things which can happen online and adolescents are particularly vulnerable to exploitation on line. This can include exposure to inappropriate content, cyberbullying and people not being who they seem. Encourage your children to take these steps to staying safe when setting up a social media profile:

• Use first names or a nicknames when talking online, or when setting up a social network profile
• Be honest
• Be honest about age
• Choose a password
• Keep accounts private by choosing a password that others wouldn’t be able to guess and only share the password with parents/guardians
• Keep settings to private
• Delete and block unknown contacts
• If somebody your child does not know adds them as a friend, delete and block their request
• Don’t share offline
• To stay safe, avoid sharing personal information with someone you don’t know offline

Encourage them to be open with you about their online activity and start conversations about safe internet use early.  Be a good role model and establish rules around internet use but exercise flexibility in your approach so that your child learns to be responsible for their own safety too.

Dr Natalie G:
Remember that our teen’s brains are under construction and hence many of them are not able to predict the consequences of their behaviours. Therefore, it is crucial for parents to teach, monitor and protect your child when it comes to online safety.  It is imperative for parents to teach their child(ren) to be responsible, safe and smart internet users.  We know that the benefits of technology including social media outweigh the disadvantages and hence parents and schools need to get smarter about educating children and adolescents about cyber safety and social media.

Dr Jane Foley is an Irish trained GP based at IMC Camden.
Dr Jane has extensive experience in Obstetrics and Paediatrics and has worked in schools in Australia.
To make an appointment please call: 6733 4440

Dr. Natalie Games is an Australian trained Clinical Psychologist based at Alliance Counselling.
Dr. Natalie has worked with children, adolescents and families in public and private settings and has also worked in schools in Australia, UK and Asia.
To make an appointment please call: 6466 8120 or visit
www.alliancecounselling.com.sg

Please be aware that Alliance Counselling are holding a series of Workshops  on parenting with Dr Natalie Games and guest speaker Dr Michael Carr-Gregg and on 18, 19 & 21 September . For more information click here.

• * (Source: Kessler RC et al. (2005). ‘Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication’.