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May is Mental Health Awareness Month, and serves as a reminder of how crucial mental health treatment is for the well-being and emotional growth of teens and young adults. Addressing emotional, behavioral, and psychological challenges early on helps build strong coping skills and sets teens up for positive long-term outcomes.

Dr. Nancy Dodson of our Hastings-on-Hudson office is a board-certified physician in Pediatrics and Adolescent Medicine. To provide guidance on the complexities of adolescent mental health, we sat down with Dr. Dodson, to discuss everything from early signs of mental health issues, to helping teens navigate substance use, and more.

What are some common signs or symptoms that parents should look out for that might indicate their adolescent is struggling with mental health issues?

Identifying mental health issues in teens can be tricky, as their struggles don’t always look the way you expect them to. Depression and anxiety may not look like sadness or crying; watch for sleep changes, increased irritability, withdrawing from social activities, and losing interest in hobbies. Anxiety also often stems from feelings of inadequacy, rather than from specific fears. Teenagers will tell me they feel like they’re less pretty, accomplished, or smart than their peers.

Eating disorders can also be tricky to notice. Not every teenager is going to say, “I think I’m fat and I want to lose weight.” A lot of times it starts as a hyper focus on health, or an introduction of a strict exercise regimen in the service of being healthier, that becomes more and more stringent and compulsive.

How can parents differentiate between normal teenage mood swings and potential mental health concerns?

I remind parents that adolescence itself is defined as a time of storm and stress. Having mood swings, big emotions, putting friendships over family, developing intense interests, and craving independence are all part of the package; that’s their developmental role in life. Where it becomes concerning, is when these big feelings start causing real suffering.

If they’re feeling consistently down for more than a couple of days, if they’re having trouble socializing or going to school, if they’re engaging in any kind of self-harm or dangerous behaviors, or they become highly rigid around their food intake, that’s when parents should start to worry. It’s about observing how seemingly normal mood swings are affecting their day-to-day functioning.

What role does social media play in adolescent mental health, and how can parents help their teens navigate its impact?

I tell teens (and this goes for all of us), that if you want to feel bad about yourself, spend some time on social media. I’ve had teens delete TikTok and Instagram because they found that these apps just made them feel worse about themselves. The key is to be intentional about how we use our phones. Teaching kids from early on that phones should have a circumscribed role, and modeling those behaviors yourself can be so impactful.

Teaching mindfulness is about instilling that when you’re doing something, to just be doing that one thing. There are sacred spaces where phones do not necessarily belong, like family mealtime, and bedtime. Model a great bedtime routine by creating a comforting space with no screens, and instill that your kid’s only job at bedtime is to go to sleep. Everything their phone has to offer will be there for them in the morning, and they are not missing anything.

I also encourage kids to fall in love with books. Escaping into a good book after a rough day gives your mind a break and is a really positive, protective thing.

Are there any specific risk factors that increase the likelihood of mental health issues emerging during adolescence?

Environmental stressors, traumatic events, or toxic social situations, are all risk factors for mental health issues. Parents should take a proactive approach by maintaining open lines of communication and demonstrating unconditional love and support.

Teens can also inherit predispositions towards mental health conditions from their parents, however this doesn’t mean that the child will definitely suffer from the same issues, or that those issues can’t be reframed into something positive. For instance, those prone to anxiety often possess traits like attentiveness and conscientiousness. Individuals prone to depression may exhibit deep empathy and compassion towards others. You can help your child understand their mental health issues in a way that reframes them in a positive light, which can be empowering.

What are some strategies parents can use to create a supportive environment at home?

Parents should adapt their communication style to meet their teen’s preferences. Find a comfortable place to talk to them. Some teens prefer to sit on the floor versus at a table, or it may be easier for them to open up on a walk, or in the car. Offering options like texting an emoji to indicate their mood can provide a non-intrusive way to check in. Reassuring them that they won’t be pressured to share more than they’re comfortable with is key to maintaining trust.

Parents can also consider sensitivities their teens may have to clutter, bright lights, or noise in the home which can exacerbate mental health challenges. Understanding their individual sensory needs and preferences, and working to create a conducive environment within the four walls of the home, can significantly contribute to positive outcomes.

What steps can parents take to prevent or address substance use in their teens?

Parents can have more of an impact here than they realize. By communicating clear information about the risks, especially the distinction between occasional and chronic use, they can help prevent dependence, addiction, and other adverse effects.

When it comes to cannabis, parents should address the normalization of its use and misconceptions around its perceived benefits. Teens may perceive cannabis-induced relaxation as stress relief, when what they’re actually experiencing are often withdrawal symptoms indicating dependence. Vigilance regarding the increasing popularity of vape pens among teens is also crucial, as teens can easily conceal chronic use.

With alcohol, parents should emphasize delaying the onset of drinking as long as possible. Delaying that first drink exponentially reduces the risk of long-term alcohol-related problems. Normalizing binge drinking, especially in social circles, is also a major predictor of future alcohol use disorders.

How do pediatricians effectively communicate with adolescents about their mental health concerns, especially if the teen is hesitant to open up?

As a pediatrician, building a strong relationship by showing genuine care and concern establishes trust and encourages teens to share what they’re going through. Creating a comfortable environment, and being patient, even if there are moments of silence, sends the message that you are not in a rush which can help them feel at ease.

Using universal language is helpful, too. Rather than asking about specific behaviors, such as binge eating, pediatricians frame questions in ways that normalize common struggles. For example, rather than directly asking if they are binge-eating, we may say, “Many teens end up eating in secret at night. Does that ever happen to you?” This approach signals that what they’re experiencing is common and nothing to be ashamed of.

Furthermore, reassurance that the exam room is a safe and non-judgmental space where adolescents can share without fear of reprisal is vital. However, it’s crucial that we clarify that if there are concerns for their safety, involving their parents may be necessary.

What are potential consequences of untreated mental health issues in adolescence, in the short and long term?
In the short term, untreated mental health conditions can impact daily functioning and quality of life, leading to difficulties in school and relationships, and increase the risk of self-harm, and suicidal ideation or attempts, which are life-threatening emergencies.

What I want every parent and teen to know about suicidal thoughts is that they are almost a universal for teenagers. Many teens at some point have thoughts of wanting to end their life or wishing that they were dead. (This goes back to adolescence being such a time of storm and stress.) That feeling, in nearly all of those cases, is a very acute feeling. Someone called it “a car crash of the mind.” If you can stay safe during that acute period, the feeling will diminish over time. So, teaching a child to stay safe during those moments can look like having protective thoughts and options for outreach.

They can write down helpful words in their phone like: “things will get better,” “your parents love you very much,” “your life is extremely valuable.” Having an open dialogue and promising their parents that they absolutely would call for help, whether it be to family, a suicide hotline, or their doctor can be a life-saving touch point, too.

If your child mentions wanting to harm themselves, always take it seriously. This includes comments about dying, self-harm, or an attempt to end their life. Act right away and call your child’s doctor or health care provider.

In the long term, untreated mental health issues can have lasting effects on development, identity formation, social connections, and are associated with an increased risk of developing more severe and persistent mental illnesses later in life.

It is crucial for parents, caregivers, and healthcare providers to recognize the signs of mental health issues in adolescents, and intervene early to provide appropriate treatment and support. This may include therapy, medication, lifestyle changes, and creating a supportive environment at home and in the community. Additionally, promoting open communication and reducing stigma surrounding mental health can encourage teenagers to seek help when needed and facilitate recovery and resilience.

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If you would like to discuss mental health concerns, please contact your child’s pediatrician, who can facilitate a referral to our internal mental health team.

CRISIS HOTLINES

Dial 988 for the Suicide & Crisis Lifeline, a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. It provides Spanish-speaking counselors, as well as options for deaf and hard of hearing individuals. It is only available in the United States. A 24-hour online chat service is also available.

Text HOME to 741–741 for The Crisis Text Line, a 24/7, nationwide crisis-intervention text-message hotline.

Dial 866–488–7386 for The TrevorLifeline | Text START to 678–678 for Trevor Text. The Trevor Project is a nationwide organization that provides a 24-hour phone hotline, as well as 24-hour webchat and text options, for LGBTQ+ youth.

Dial 877–565–8860 for Trans Lifeline, a nonprofit organization that is created by and for the transgender community, providing crisis intervention hotlines, staffed by transgender individuals.

The Youthline is a free teen-to-teen crisis support and help line run by a nonprofit. Between the hours of 4 -10 pm PST daily, teens are available for peer support via phone and text. Otherwise, the line is staffed by adult crisis responders 24/7.
CALL (24/7): 877-968-8491
TEXT (4–10 pm PST): ‘teen2teen’ to 839863
CHAT (4–10 pm PST) https://www.theyouthline.org/