Help for Parents with Troubled Teenagers

The teenage years are rife with challenges for both adolescents and their parents. Moodiness, anger, and rebellion are all normal characteristics of healthy development, so distinguishing between normal teen angst and more seriously problematic behavior can be challenging.

Severe behavioral issues are rare before middle school but increase dramatically during adolescence. It is estimated that 1 in 5 adolescents in the United States has a diagnosable mental health disorder, which often begins early in life. Researchers have found that 50% of all mental health problems begin by age 14.¹ Fortunately, there are ways to prevent mental health problems from progressing. Early intervention and treatment can go a long way toward helping children lead healthy lives.

Signs to Look for if Your Teen is Struggling

It is normal for parents of teenagers to worry about whether their children are troubled or not. Even the best-behaved teens can exhibit worrying behavior that indicates they are at risk of or suffering from a mental health disorder. Substance abuse is a common problem in adolescents that can affect any child, from those at the top of their class to those who struggle just to get to class. And behavioral disorders in adolescents are typically hard to miss due to their more obvious disruptive nature than mental health issues or substance abuse problems might be.

If you are worried that your teen is struggling, your instincts may be right. It helps to pay close attention and keep track of specific behaviors and incidents that concern you. Keeping a list of these signs and symptoms can help you in the future if you decide to seek treatment. Behaviors may be nuanced and teenagers are complex, but some common warning signs to look for in your son or daughter may include:²

• Feeling anxious or worried a lot of the time.
• Hyperactivity.
• Frequent tantrums or excessive irritability.
• Engaging in risky or destructive behavior.
• Difficulty sleeping, including frequent nightmares.
• Loss of interest in things they used to enjoy.
• Avoiding spending time with friends.
• Panic attacks.
• Frequent stomachaches or headaches with no physical explanation.
• Overwhelming fear of gaining weight or constantly exercising or dieting.
• Harming themselves or others.
• Repeatedly smoking, drinking, or using drugs.
• Suicidal thoughts or tendencies.
• Thinking their minds are controlled or out of control or hearing voices.

If you are worried about your child, there are many places you can turn for help. The U.S. Department of Health and Human Services houses the national Office of Adolescent Health (OAH), whose page is full of helpful information. It provides a comprehensive overview of various problems facing teens today, as well as tools you can use to better communicate with your child.

Various Types of Behavioral Issues

Teenage behavior can sometimes appear problematic when it is actually normal and relatively harmless.Behavioral problems can be mild, severe, or anywhere in between. Teenage behavior can sometimes appear problematic when it is actually normal and relatively harmless, which can be confusing for a parent. Further complicating matters, normal behavior for one child may be abnormal for another, signaling a symptom of deeper mental health problems. Other times, however, behavioral problems are unquestionably severe and dangerous. The following is an overview of common adolescent behavioral problems that fall at various points on the spectrum from mild to severe:

• Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is one of the most common neurodevelopmental disorders in children and adolescents, affecting about 11% of children between the ages of 4 and 17.³ Children with ADHD may have trouble paying attention, controlling impulsive behaviors, or remaining still for extended periods of time. Depending on the severity of symptoms, ADHD can lead to academic problems, social isolation, developmental delays, and disciplinary problems.⁴ Parents can learn more at CHADD, The National Resource on ADHD.
• Oppositional Defiant Disorder (ODD): ODD is a behavioral disorder sometimes diagnosed in children and adolescents who constantly cause serious problems at home, in school, or with their peers. ODD usually starts between ages 8 and 12.⁴ Examples of ODD behaviors include frequently being angry or losing their temper; arguing with authority figures (parents, teachers) or refusing to comply with their rules or requests; often feeling resentful or spiteful; and deliberately annoying others or feeling annoyed with others.⁴ Parents can find more information about ODD from the American Academy of Child and Adolescent Psychiatry’s Oppositional Defiant Disorder Resource Center.
• Conduct Disorder (CD): Conduct disorder is diagnosed when children and teens display a persistent pattern of aggression toward others and consistently break rules or defy social norms at home, in school, or with their peers. Conduct disorder is characterized by severe behavior problems, including major rule-breaking, such as running away, skipping school, or staying out all night; being overly aggressive, getting into fights, bullying classmates, or hurting animals; maliciously damaging other people’s property; and lying and stealing.⁴ Parents who want more information about CD can check out the American Academy of Child and Adolescent Psychiatry’s Conduct Disorder Resource Center.
• Self-harm: Self-harm is a behavioral problem common in teens and young adults that involves intentionally hurting themselves. This can include cutting, burning, pulling out hair, or incessantly picking at previously inflicted wounds to prevent healing. Self-harm is not a mental illness itself, but rather a symptom of a larger problem of coping with intense emotions, such as anger, stress, and frustration. It is often associated with other mental health problems common in adolescents, like borderline personality disorder, depression, eating disorders, anxiety, and PTSD.⁵ Parents who want to learn more about why their teens are harming themselves and find tips for how to help can go to Mental Health America.

Mental Health Problems in Adolescents

It is normal for teens to feel anxiety about school, friendships, and romantic relationships, but that anxiety should not be so severe that it prevents them from participating in daily activities.The teenage years are rocky in the best of circumstances, but for some children and families, the seas are particularly rough. It is a normal part of development for adolescents to experience a wide and revolving range of emotions, but when symptoms don’t go away, there could be a mental health disorder present.

It can be difficult for parents to decide when to become concerned. For example, it is normal for teens to feel anxiety about school, friendships, and romantic relationships, but that anxiety should not be so severe that it prevents them from participating in daily activities. It is also normal for teens to experience a period of depression following a major life event, such as a death in the family, a divorce, or a move to a new school. But when that depression becomes so severe that it starts interfering with schoolwork, sleeping, eating, and other normal activities, it could be time to intervene.

The following is an overview of mental health problems common in teens, all of which can range from mild to severe.

Depression

Depression is the most common mental health disorder, affecting nearly 1 in 11 teens every year. In 2014, nearly 3 times as many adolescents experienced a major depressive episode as they did in 2005.¹ Depression in teens is characterized by intense feelings of sadness, hopelessness, and anger or frustration that lasts weeks, months, or longer. These feelings are so intense that they make it difficult for teens to function normally, causing them to:⁶

• Stop caring about activities they used to enjoy.
• Fluctuate in weight.
• Sleep much more than usual or have trouble falling or staying asleep.
• Move or talk more slowly than normal.
• Constantly feel tired and without energy.
• Feel worthless or very guilty.
• Have trouble concentrating, remembering information, or making decisions.
• Talk about dying or suicide or attempt suicide.

Parents who want to learn more about depression in teens can read more at Mental Health America.

Anxiety Disorders

When adolescents exhibit so many fears and worries that they interfere with normal daily activities at home, in school, or in social situations, they may be diagnosed with an anxiety disorder. As many as 25% of 13 to 17-year-olds have an anxiety disorder, which may vary in severity. The symptoms may include:^7,8

• Having extreme fears about specific things or situations (phobias).
• Being very afraid of school, public places, and social situations.
• Being extremely worried about the future and bad things that could happen.
• Experiencing repeated episodes of sudden intense fear that are accompanied by physical symptoms such as trouble breathing and a fast heartrate.

Parents interested in learning more about symptoms of anxiety can visit the National Institute of Mental Health.

Eating Disorders

Eating disorders are serious mental health problems that can be extremely damaging to your child’s health and may result in death or permanent physical damage. Contrary to popular perception, they are common in both women and men: Nearly 20 million women and 10 million men in the United States suffer from one at some time in their lives.⁸ Teenage girls run the highest risk of developing an eating disorder, with research suggesting that eating disorders affect more than 13% of girls under the age of 20.⁹ The variations can include anorexia, bulimia, and binge eating disorder. What’s more, eating disorders often co-occur with other mental health problems such as depression, anxiety, and PTSD.¹⁰ Parents who want to learn more about the signs and symptoms, as well as tips on how to talk to their teens, can read the Parents Toolkit developed by the National Eating Disorders Association.

Is Your Teen Experimenting with Drugs and Alcohol?

It is common for teens to experiment with alcohol, tobacco, and drugs—by the time they are seniors in high school, almost 60% of teens will have tried alcohol, 36% will have used an illegal drug, and nearly 40% will have smoked a cigarette.¹¹ In addition, more than 20% of teens will have used a prescription drug for a nonmedical reason.¹¹

Because nearly 90% of addictions begin in the teenage years, it is important to pay close attention to warning signs.
It can be challenging for parents to understand the difference between normal adolescent experimentation and a serious substance abuse problem. As teens develop their independent identities, they are hard-wired to try new things. Coupling that with peer pressure means it is likely that your child will experiment, even if they are well-behaved. But because nearly 90% of addictions begin in the teenage years, it is important to pay close attention to warning signs.¹²

Substance use becomes problematic when it begins to interfere with your child’s daily life at home or at school or when it causes them to engage in risky or dangerous behavior. The following are general signs and symptoms of a substance abuse problem:¹³

• Behavioral changes, such as:
  • Grades going down or problems at work
  • Frequently getting into trouble at school, home, or with the police
  • Engaging in secretive or suspicious behaviors
  • Changes in appetite
  • Abnormal sleep patterns
  • Unexplained change in personality or attitude
  • Mood swings or irritability
  • Unusually hyperactive, focused, or giddy
  • Decline in energy or motivation
  • Frequent isolation
  • Appearing anxious or paranoid for no reason
• Physical changes, such as:
  • Bloodshot eyes
  • Sudden weight loss or weight gain
  • Not caring about physical appearance or hygiene
  • Unusual smells on clothes or breath
  • Slurred speech or difficulty balancing
• Social changes, such as:
  • Sudden change in friends
  • Changes in normal activities or hobbies
  • Legal or disciplinary problems
  • Unusual need for money
  • Using substances even though it causes problems in relationships

If you are worried that your teen is abusing drugs or alcohol, there are plenty of places to turn for information and support. Start with The Partnership for Drug-Free Kids, which is full of tips and tools for parents.

How the Youth is Exposed to New Problems

Adolescence is a tough time for all teens, regardless of whether they have behavioral problems, mental health issues, or substance abuse problems. This is a very transitional phase of life during which your child moves from the protected realm of childhood into the adult world. Kids are not immune to the stresses of the grownup world—in fact, they are particularly vulnerable to it. Everything seems like a big deal to them because they have never seen it before. This means they might have strong emotional responses to things you wouldn’t expect, such as world events and politics.

And the constant exposure to technology and social media makes their teenage years very different from yours. A social life that revolves around pictures of other people’s lives can make image-building a complex issue for your teen. They might emulate trend-makers from their social sharing sites or compete with their friends to appear the most fun and exciting on their social feeds.

The psychiatric community can hardly keep up with the changing technology, but what is clear is that this generation of teens experiences peer pressure in an entirely new way. This could lead to eating disorders as a result of body image issues fed by a barrage of seemingly “perfect” bodies online. It can lead to substance abuse due to efforts to look like the life of a party on Instagram. And it can lead to feelings of worthlessness, depression, and social anxiety, since teens constantly try to compare their happiness to others’.

If you are worried about your child, pay attention to the details and learn what you can about effective communication strategies from these resources:

• Downloadable e-books and guides from the Partnership for Drug-Free Kids.
• Information and a treatment locator from the Substance Abuse and Mental Health Services Administration.
• Resources for families from the Department of Health and Human Services Office of Adolescent Health.