By Kathleen McCarthy
Be Inkandescent magazine
Sullen, uncommunicative teens: We’ve all seen them; some of them even live in our own homes. How can a parent or concerned adult identify which teens are doing just fine beneath the remote or confrontational attitude, and which need professional help?
Dr. Lisa to the rescue.
A clinical psychologist, and a national speaker and author who regularly appears in the media, Lisa Boesky, PhD, shown above, is the author of When to Worry: How to Tell if Your Teen Needs Help—and What to Do About It.
Reading the Signs of Trouble Ahead
Boesky began her career working in mental health hospitals and correctional facilities with some of the most challenging and troubled teens. “It was clear to me that not one of them developed severe—and sometimes dangerous—emotional or behavioral problems overnight,” she says. “They showed signs of suffering for months, and often years, before an arrest or hospital admission.
“But it can be difficult to hear the cries of teenagers, because they usually don’t say, ‘I need help.’ If anything, their words often communicate just the opposite,” she observes.
“Some of the parents of the adolescents I worked with knew that something was not right with their child, but were told, ‘She’s just going through a phase,’ or, ‘Don’t worry, he’s just a typical teen.’ So they took a wait-and-see approach. And things got worse.”
Her goal in “When to Worry” is to teach parents to recognize the subtle and obvious signs of teens who are struggling—and the specific things they can do to help them.
The book is divided into three sections.
- “What’s Normal and What’s Not,” is filled with examples of specific teens, and each chapter in this section addresses “Worry Signs” for the condition discussed, and “This Sounds Like My Teen, But What Else Could It Be?” Each chapter ends with concrete suggestions for parents of teens struggling with problems related to moods, inability to pay attention, energy, stress, obsessions, substance abuse, body-image and food and weight concerns, self-injury, and suicidal thoughts, as well as those who break rules and laws, and who lose touch with reality.
- “Getting Help” tells parents how to get the right evaluation and treatment for their teen (and even what to do if you disagree with the diagnosis or if treatment doesn’t work).
- “Family Matters” includes chapters on parenting teens with special needs, and “Don’t Forget Your Oxygen Mask: The Importance of Self-Care.”
The book’s Appendices includes a list of resources and a psychotropic medication chart.
Boesky reassures parents that even if they aren’t perfect, bad parenting is rarely fully to blame for a child’s problems, and teens report actually wanting to spend more time with their parents than they currently do.
Scroll down to read Boesky’s Q&A with Be Inkandescent.
Be Inkandescent: What kind of struggling teenagers are hardest to help?
Dr. Lisa Boesky: Teens without support from a parent, guardian, or some type of parental figure. If teens could do it on their own, they would.
Be Inkandescent: How do you counter the notion some parents have that if their teenager is acting out, the teen should be punished rather than helped?
Dr. Lisa Boesky: Many sick teens in need of treatment are unfortunately viewed as “bad teens in need of punishment.” Extreme defiance, rebellion, and acting out are typically much more than they appear—and a lot can be done to decrease this negative behavior.
Relying solely on punishment can actually make a youth’s difficulties worse.
Too many parents have seen too many talk shows advocating sending “troubled teens” to boot camps and military-style programs. Those programs do not have any long-standing positive effect unless they contain strong, evidence-based education and treatment programs.
Punishment teaches youth what not to do. But that is only one piece of the puzzle. Holding teens accountable for negative behavior is essential; however, when teens are struggling, it is key to find out why and then address a teen’s individual issue(s).
An adolescent may need help with educational issues, mental health issues, substance abuse issues, social issues, or a host of other issues. A comprehensive mental health evaluation can often help clarify what the issues are and what type of intervention may be most effective (such as skill-based talk therapy, medication, etc.).
Be Inkandescent: What are some types of problems that teenagers have that should be addressed but are typically made light of or overlooked?
Dr. Lisa Boesky: Many adults, including some doctors, do not know how to recognize major depression (clinical depression) in teenagers. Most people associate depression with sadness, crying, sleeping all the time, and isolation. But teens who are depressed are often irritable, agitated, and angry. They may be restless and unable to sleep. They can be verbally or physically assaultive. A “sad” teenager can easily be mislabeled a “mad” or “bad” teenager.
Because teenagers are trying to separate/individuate from their parents, their world is usually much more private than it’s ever been. They have thoughts, feelings, and behaviors that they don’t want to share with their parents. Some teens suffer with such intense fears and anxiety that it can interfere with their day-to-day functioning and their relationships with friends or family members.
Be Inkandescent: Are there notable differences in the problems that boys versus girls typically struggle with—and in the approaches that work with each?
Dr. Lisa Boesky: Both boys and girls can suffer from any of the mental health disorders. However there are some gender differences in the way youth are diagnosed. For example, boys are more likely to be diagnosed with attention-deficit hyperactivity disorder (ADHD) and conduct disorder. Girls are more likely to be diagnosed with major depression, an eating disorder, and most of the anxiety disorders.
This may be due to gender differences in brain chemistry, biology, and/or socialization. But it also may be due to the way we as a society view the behaviors of boys and girls, as well as the degree to which girls and boys are comfortable (or uncomfortable) disclosing their struggles.
The most effective approaches with both boys and girls tend to be present-focused and skill-based, with a focus on helping youth better understand and manage their emotions and their thinking.
Be Inkandescent: Do you find parents and teens are generally open to and interested in getting a mental health evaluation for their teen, or resistant/suspicious?
Dr. Lisa Boesky: Getting a mental health evaluation is such an important step for families who have a teen who is struggling. Too many parents (and doctors) jump straight to treatment without identifying what exactly it is that should be treated.
Some parents welcome the evaluation process. They are deeply concerned about their child, have tried myriad things without success, and are desperate to understand what is happening with their child.
Parents, and their teens, can experience relief if the evaluation shows that nothing serious is going on. But they may also be relieved if something is going on and the evaluation not only pinpoints what it is, but helps point to the types of interventions that can help reduce their child’s suffering, bring more peace to the family home, and help their teen be more successful.
On the other hand, some parents fear their child will be “labeled” or that the parent may be blamed in some way for their child’s struggles. Sometimes parents are afraid of what they might find out from an evaluation.
In my experience, if the evaluation is done by a qualified mental health professional and done appropriately, most parents are glad they took this first and very difficult step. Some wish they had done it sooner.
Be Inkandescent: Anyone who has filled out a job application has had to answer the question, “Have you ever been treated for a mental health issue?” What advice do you have for parents who feel their child could benefit from professional mental health counseling, but are reluctant to saddle their child with a treatment or diagnosis that may hinder their child’s professional opportunities for years to come?
Dr. Lisa Boesky: The concern is a realistic one. It breaks my heart that there is still stigma associated with mental health disorders in the year 2012. But the reality is that an unidentified or untreated mental health disorder is probably more likely to hinder a child’s future professional opportunities than the stigma related to receiving a diagnosis or treatment.
And treatment is much more effective when symptoms are addressed in the early stages.
One reason for this is that many conditions worsen over time. In addition, adolescents’ difficulties usually start to negatively impact their school performance, relationships with family and friends, and self-esteem. Untreated emotional and behavioral problems place teenagers at significant risk for alcohol or drug use, further compromising their health and happiness.
It is my understanding that the American Disabilities Act prohibits employers from asking questions such as, “Have you ever been treated for mental health problems?” as well as questions related to an individual’s medical history on a job application or during a job interview.
Employers who discriminate against a qualified applicant based on their mental health or medical history are breaking the law. However, these types of questions are allowed once someone has received a job offer.
Parents should discuss their concerns with the professionals they are working with and should ensure they work only with professionals who have the appropriate education, training, and clinical experience to specialize in adolescent mental health.
Be Inkandescent: How can parents know if the mental health professional they’ve consulted is right for their child?
Dr. Lisa Boesky: Not all professionals are created equal, and this is particularly true in the realm of mental health. Long waiting lists to get an appointment do not necessarily reflect superior service.
Though certainly tempting to find a professional whose office is nearby, or whose services are covered by one’s insurance company, what matters most is finding a qualified mental health professional who has the education, training, and clinical experience with the age group of one’s child and the type of issues the child is dealing with.
“When to Worry” describes the different types of mental health professionals, as well as a list of key questions to ask each of them to determine if they are a good fit for a teen and his or her family.
It is usually better for parents to take their teen to a clinician who evaluates a range of young people, unless they are fairly certain that their child has a particular disorder and needs a specialist.
Be Inkandescent: What do the teens you see wish that their parents knew or wish they could tell their parents?
Dr. Lisa Boesky: Teenagers still need their parents. Adolescents remain very connected to their parents, despite shying away from physical affection and often not wanting to be seen with them in public.
Although they want to be independent, adolescents still care about what parents think of them, want to make them proud, and listen to what they have to say (even if they don’t follow the advice).
Teenagers typically won’t ask their parents’ opinion on music, clothing, hairstyles, or the latest technological gadget. However, they still rely on their parents for morals, values, and emotional support.
Parent–teen conflict typically increases in early adolescence and decreases during late adolescence. Most disagreements are related to everyday issues such as chores, curfew, and homework. Despite the rise in arguments, most teenagers describe the relationship with their parents as positive and close.
Be Inkandescent: Is there anything you would like to tell parents of teenagers?
Dr. Lisa Boesky: Each child’s experience during the adolescent years is individualized and influenced by family, culture, and community. The combination of extreme emotions, increasing intellect, distancing from family, and increased conflict can make the developmental stage of adolescence difficult for youth and their parents. Despite these challenges, the majority of teenagers:
- Feel positive about their lives.
- Get along with their parents.
- Have friends to whom they feel connected.
- Have a positive view of their future.
Because teens with emotional and behavioral disorders are at increased risk for early sexual behavior, teen pregnancy, car accidents, trouble with the law, dropping out of school, and unemployment, they require extra support and guidance.
Professional help is important when needed, but is not a cure-all. A parent’s role is indispensable for their teen’s recovery.
Dr. Boeskey’s “When to Worry” website, www.whentoworry.com, is specifically for parents and includes lists of resources, such as ways to find a professional, support groups, crisis numbers, and stories from parents and teens.