Signs Of Depression And Anxiety In Teens, And How To Help : Life Kit Over a year into the pandemic, many teens are missing milestones and struggling with their mental health. Here's how to spot red flags and when to get help.
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How To Talk — And Listen — To A Teen With Mental Health Struggles

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How To Talk — And Listen — To A Teen With Mental Health Struggles

How To Talk — And Listen — To A Teen With Mental Health Struggles

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K: I could not stand being home doing work because, like, I told you I was living with my best friend. So we had, like, 14 people in one house, and, like, half of those people are kids. It's just loud, and I just couldn't focus.

E: Everything is hard because there's no end to it. It just - it's really sad to, like, see what was supposed to be, like, the best years of your life, like, go down the tubes.

ANYA KAMENETZ, HOST:

That was E, who lives in Alexandria, Va. And before that, you heard K, who lives in New Orleans. They're both 16 years old. We're not using their full names because the topic of this episode is how adolescents are struggling with mental health. And you're going to hear from them as well as some therapists about why this time has been so tough, especially for some teenagers, and how caring adults can help. I'm Anya Kamenetz, a reporter for NPR, and this is a parenting episode of LIFE KIT.

It's been about a year now since schools closed all over the country. Things are still pretty far from normal in a lot of ways, whether that's sports or parties or travel or jobs. And all of this is taking its toll on teenagers.

ELISA NEBOLSINE: What I've seen happen - in 25 years, I've never seen this - is I've seen my anxious kids become more and more depressed, and the level of suicidality I'm seeing in kids is the highest it's been.

KAMENETZ: And so that's Elisa Nebolsine, a therapist who works with teens in the D.C. area, and she's describing what she's been seeing in her practice. And she's one of four different youth advocates who actually have reached out to me in the past several months and said, hey; you're a reporter. Can you please do a story about this? I need you to know the teens are not OK. And, you know, what that also means is that if you who's listening, someone you know is going through it right now, you're not alone. This is so common. And there are so many teenagers like E - and frankly, people of all ages - who are having some really tough times and some late nights.

Are you on your phone when you're awake?

E: No. That's the weird part. That's why I'm just, like, hmm (ph). Everyone always assumes I am, but I'm not.

KAMENETZ: What are you doing? Like, what were you doing - yeah. The last time you stayed up until 4, what were you doing?

E: I was crying and thinking.

KAMENETZ: But things did get better for E, and, you know, they can get better for the teens in your life. And you can help.

This is a parenting episode of LIFE KIT about adolescent mental health. And my takeaway No. 1 is to understand how teenagers are struggling to meet their needs right now, from the most basic physical level to emotional and developmental needs. So at the physical level, sleep is a huge factor that we heard a lot about from the professionals and from families. You know, at puberty, your sleep patterns are changing. And going to bed really late or not getting enough sleep or shifting your schedule day to day - all of this can really mess with teenagers' moods. E, the teen in Alexandria, said that was really true for her.

E: I never stayed up super-late pre-pandemic, but now I stay up so late for no reason. At the very beginning, it was like I wouldn't sleep for days.

KAMENETZ: And healthy eating is something else that can be kind of difficult right now. For some teens, that means maybe they're snacking all day out of boredom. On the other hand, there's also lots of families - too many families - for whom COVID has affected their livelihoods, and that includes their ability to get enough to eat. And there's actually research showing that when a family is experiencing food insecurity, the teenagers in the house are three times more likely to have mental health problems.

So this is all an ecosystem. It's all related. And families obviously have very different amounts of control over their circumstances. But what the professionals told me is that as a preventative measure, if you want to promote wellness in your household, it's really important to try to make sure that kids' bodies are as healthy as they can be. You know, maybe that might mean taking away their phone at night. It might mean assigning kids to walk the dog.

This is Dr. Khadijah Booth Watkins, who works with adolescents at Massachusetts General Hospital, and she's the other mental health professional who's going to be helping us out this episode. And she highlighted the importance of physical movement.

KHADIJAH BOOTH WATKINS: The biggest thing, I think, is making sure we're being physically active because, you know, with the sedentary lifestyle that COVID has forced us into, you have to really be deliberate about being physically active.

KAMENETZ: And Elisa Nebolsine echoed this point. Try to get teens moving. Invite them to shoot hoops, maybe, or even pay them to help you with yard work. Nebolsine says this is a major strategy in cognitive behavioral therapy, which she practices, also called CBT.

NEBOLSINE: One of the main treatments with CBT and depression is behavioral activation. That activation precedes motivation.

KAMENETZ: Because even if they don't feel like it in the moment, they will feel better later. Physical needs are the foundation of mental health for people of all ages, but they're just the first step. Nebolsine says teen brains need friends, novelty and to set and reach goals for themselves. And they're having a really hard time getting those needs met right now.

NEBOLSINE: I mean, their brain is wired for new experiences, for new learning, for social connection, for romantic connections, for status and hierarchy and all these different kind of developmental tasks that they are not getting access to.

KAMENETZ: What's also true is that just like food, clothing and shelter, we all need warmth and human connection. And right now some families are grieving because they have lost people during the pandemic, and other teens are suffering because of lack of access to their friends or to other caring adults besides their parents. E put it this way.

E: It's like being in solitary confinement except different because, like, your brain is still developing. And this is, like, a time when you need to be out of the house and you need to be, like, seeing people and you need to be forming friendships.

KAMENETZ: Dr. Booth Watkins really backed up E's point.

BOOTH WATKINS: They're not able to engage and interact in the way that they're used to. But I think that, again, creates a lot of loneliness and sadness.

KAMENETZ: So beyond emotional and relationship needs, like Nebolsine mentioned, young people have the need to achieve and learn and gain the respect of others. For a lot of adolescents, those needs are met by their education, and that is facing some roadblocks right now. I want to go back to K, the other teen you heard at the top. She lives in New Orleans, La. And when we talk over Zoom, she has a lot of energy. She's bouncing on a yoga ball, and sometimes you can hear her clap to underline what she's saying.

K: I was the girl that was always at the top of the class.

KAMENETZ: But that was before COVID. When she had to learn from home...

K: I just couldn't seem to get through my classes in a timely manner. Like, this semester went - I would be like, OK, I'm going to do it. I'm going to do it. And then the semester would end, and the class - I will have to take it all over again.

KAMENETZ: And so part of the problem was that, you know, she was living in this really full house, helping take care of kids while the grown-ups were at work.

K: So I had to be with them in the kitchen and sit everybody down, make sure they had everything that they needed. Like, it wasn't just me making sure that I was on my Zoom call. Like, I have to get these meeting passwords for all their teachers, too. I have to make sure I had everything for them. And so, yeah, it was very overwhelming.

KAMENETZ: And K is not alone. So many families are seeing their teens struggle with remote learning. They may not have the same support that they're used to. They're missing the motivation that comes from learning alongside peers. And like K, some teens are taking on adult stresses and responsibilities.

NEBOLSINE: And if we think about adolescent development, we've put a pause button on what they're supposed to be doing.

KAMENETZ: So if you've listened this far and you have a teenager in your house or in your life that you really care about, you might be wondering, how can I tell if this young person is just having a bad day, hitting that pandemic wall, temporary stuff - because let's face it; we've all had bad days in the last year - or on the other hand, is it a really serious problem, something where we need to make some changes or maybe call in some professional help? This is our takeaway No. 2. Learn to spot the red flags.

BOOTH WATKINS: Well, anytime something feels unsafe. That's the easy answer.

KAMENETZ: That's Dr. Khadijah Booth Watkins again. She says one of the red flags is what she calls loss of function.

BOOTH WATKINS: So, you know, can't go to school or I can't sleep. I can't eat. Loss of any of these major functions that are just, you know, bare-minimum requirements.

KAMENETZ: Dr. Booth Watkins also said that if there's a teen who suddenly stops taking showers or maybe they abandon their usual makeup routine in the morning, that could be a red flag. And of course, you can also learn a lot by having a conversation.

BOOTH WATKINS: If someone is talking about extreme turmoil and pain, that is, again, interfering with their ability to function.

KAMENETZ: And this could include language about wanting to hurt yourself or not wanting to be around anymore. If you have any questions about talking to a young person who may be suicidal, our mental health reporter Rhitu Chatterjee did a whole article about that. We'll link to that on our episode page. And if you or someone you know may be considering suicide, the National Suicide Prevention Lifeline is 1-800-273-8255. And you can also text Crisis Text Line at 741741.

Nebolsine adds to this that there's a really helpful rule of thumb for the way that depressed people talk about their lives and what's going on, and that is PPP - personal, pervasive and permanent - personal meaning they see their problem as a personal flaw.

NEBOLSINE: I can't do anything. I can't even learn right while I'm on these virtual learnings.

KAMENETZ: Pervasive meaning it's across different categories of someone's life.

NEBOLSINE: What is there in my life that isn't affected by this right now? I am in my room. I'm sick of my parents. I'm fighting more with this person. I don't go outside. I don't have new experiences. I'm not allowed to get a job.

KAMENETZ: And permanent meaning they don't know when it's going to go away, just like E put it at the beginning of this podcast.

E: Everything is hard because there's no end to it.

KAMENETZ: Both E and K had a history of diagnoses like depression or anxiety, which many teens do. And layered on top of that for E during the pandemic, it was like she had all these hours with nothing to fill them. And K kind of had the opposite problem. She was trying to balance her schooling with helping taking care of the children that she lived with.

K: I have a lot going on mentally. It's been a lot there but especially during COVID. Like, I'm already anxious. Like, I'm anxious to meet a new person. It takes me a lot to even want to be, like, around people. So imagine me having to take care of all these people in one household with all the noise. I'm very noise-sensitive. Like, I'm very noise-sensitive. If it's too loud, like, I just - I'm over it.

KAMENETZ: So that might be an example of the extreme turmoil and pain that Dr. Booth Watkins was talking about. So let's say this sounds familiar. You're seeing a loss of function. Kids are not eating, or they're eating all the time. They're not sleeping much, or they're sleeping way too much. They're not able to handle remote school. They're not feeling motivated at all. And when you try to talk to them, they're expressing so much pain. They see their situation as personal, pervasive and permanent.

Our next takeaway is, what do we do now? And this is our takeaway No. 3. Have the tough conversation. Ask kids what's on their mind, and make sure that you validate their feelings. Don't downplay them. For example, let's say a kid is sad about missing out on a big 16th birthday party. You know, you might be tempted to say, oh, it's not a big deal, or, you know, we're lucky that you're even worried about this. Dr. Booth Watkins suggests instead...

BOOTH WATKINS: You're right. It sucks. And I hate that you're not going to have your 16th birthday, and you really deserve it, and you've earned it.

KAMENETZ: And then maybe you can problem-solve with them a little bit.

BOOTH WATKINS: And I'm so sorry that it's not going to happen for you in this way. Is there something that we can do to make your 16th birthday special?

KAMENETZ: And she also suggests that we ask teens to apply the best friend test to the ways that they're talking about themselves.

BOOTH WATKINS: Would you tell your best friend, you know, that was stupid? Or would you tell your best friend, like, that - you know, something negative?

KAMENETZ: Speaking of something negative, I mean, let's be honest. So many parents have been stretched to their limits during this pandemic. And if we don't have the resources and support that we need, we can't be the most effective parents because we need to be able to take a step back when our teens are having a tough time and not center our own distress, our own reactions, to keep our own equanimity as we listen to our kids.

BOOTH WATKINS: The biggest tool in the toolbox of a parent is being able to model - so being able to model resilience, being able to model self-compassion, being able to model mindfulness. That's the biggest and the most effective tool - and then, you know, teaching our kids how to do those things, teaching them how to be resilient.

KAMENETZ: Now, after you have one of these conversations, depending on how it goes and how your teen is doing, you might want to seek out help from a professional. If money's an issue, you can Google for sliding-scale therapy and your location. You can check with a local graduate school to see if they have student therapists available. Maybe check in with your teen's school for resources.

These days, of course, a lot of therapy's over video, and the good part about that is you're not limited to people in your immediate area. There's two online platforms you can check out. One is called Open Path Collective. That's a nonprofit committed to affordable therapy. And the other one is teencounseling.com. And we'll put all of this info on the episode page.

So let's say you notice some red flags. You have that tough conversation. Maybe you're finding a therapist. Our takeaway No. 4 is about making the time for fun and togetherness. It may sound strange since families feel like they're together all the time, but so often everyone is in their own corner of the house on their own devices. Dr. Booth Watkins said...

BOOTH WATKINS: Whether it's dinner or whether it's a family night - but making sure that we deliberately spend time where we are all together and, you know, you can lay true eyes on your child to see what they look like, you know, what they're talking about, what their facial expressions look like. It'll say a lot because, again, you know your child better than anybody.

KAMENETZ: Dr. Booth Watkins has a family that she knows does paint by numbers together. You can do a special dinner like taco Tuesday. And these are all just different chances to check in and quietly observe your teens. And ideally, they're also going to be fun and a stress reliever for everybody. And speaking of fun, consider if there are safer ways for your kids to get out in the world. E's mom told me that for them, that looked like having a slumber party in the backyard for a few kids for E's birthday.

UNIDENTIFIED PERSON: We started being a little bit more flexible probably earlier than some because it was becoming so clear that...

E: It was going to be a long time.

UNIDENTIFIED PERSON: Yeah, and the isolation was impacting all of us.

KAMENETZ: So for K, by last June, everything kind of came to a head, and she spent a few days under psychiatric treatment at a hospital. Then she went on a COVID-safe trip to Atlanta. And now she's living back at home, and she says things are going a lot better.

K: It's very quiet. So, yeah, I just move myself around this space for a little while just so I can focus on schoolwork a little because honestly, I'm trying to graduate this semester. And I would be devastated if it got pushed back. Like, I would probably cry.

KAMENETZ: As you can hear, K's really committed to graduating high school early. She's also on the student council, and she also has an internship in a local park growing food for the hungry. Elisa Nebolsine says community service and activism are actually amazing for teenagers' mental health because, she says...

NEBOLSINE: One of the tasks of adolescence is we have this sense of meaning that we ourselves are invested in, that is bigger than us, that helps the world at large.

KAMENETZ: And K's school, too, is starting to come back in-person hybrid. She goes to an alternative high school called The Net. And the hybrid schedule, she says, is great because...

K: The Net is a very social school. Like, we are a very fun school. We're used to being, like, in the hallways, like, jocing (ph) with teachers, stuff like that.

KAMENETZ: Jocing with the teacher, she says. That's New Orleans slang for, in this context, like, playing around.

K: I'm finishing now. Like, it's getting better now. You know, there's hybrid. And, like, you can actually - it's a lot better than the beginning of COVID.

KAMENETZ: So let's say you have been successful introducing some healthier routines in the house - some low-key, hopefully fun times to connect, some taco nights and some bright spots in your teen's social life. And maybe professional help is also part of the mix. We're going to move on to takeaway No. 5, and this is about maybe adjusting your expectations and praising the progress that you do see. So Dr. Booth Watkins says you might consider setting up an incentive program to help encourage behaviors like going to bed on time or signing in for school on the computer. It could be a gift card or even their favorite candy. And she says don't underestimate the power of parental approval all by itself.

BOOTH WATKINS: Sometimes something as simple as positive praise - like, you know, maybe they weren't able to sit through a whole class, but they sat through a whole class today. Maybe they sat through half a class. You know, I saw that you sat through half of that class. Like, that was really great. I know it really took a lot out of you.

KAMENETZ: So this is not just about manipulating our kids to do certain things. This is about a whole mindset here. We need to be looking for the good as parents - praising it, lifting it up and having compassion, frankly, because the goalposts may have moved, right? This is a global pandemic that our kids are living through. And E and her mom really agree on this point.

UNIDENTIFIED PERSON: We've come a long way, and she was able to pull her grades together. But, you know, beginning of January, 3 out of the 4 grades were an F. And, you know, she did an amazing job getting things to a point where - I think you have Cs, even maybe...

E: Yeah. I'm, like - I'm average, which - I think that my old self would be disappointed. But now I'm just - I'm proud.

KAMENETZ: And K also told us that she feels like she's grown from this experience.

K: I'm the type of person to push past my emotions.

KAMENETZ: And she says that she's learned not to do that and also to take a step back.

K: Just focusing on me and what I need to do and looking at the bigger picture, knowing that in time, I'm going to have everything I desire.

KAMENETZ: A degree, a career in medicine - everything she desires.

So let's have a little recap here. My takeaway No. 1 for you is to understand teens' specific developmental needs and why it is so hard to meet many of them right now.

NEBOLSINE: Their brain is wired for new experiences, for new learning, for social connection, for romantic connection, for status and hierarchy and all these different developmental paths that they are not getting access to.

KAMENETZ: Our takeaway No. 2 is to learn to spot the red flags. It's a loss of basic functions, which could include signing into remote school. It's kids talking about what's getting them down in a way that is personal, pervasive and permanent. And, says Dr. Booth Watkins...

BOOTH WATKINS: Well, anytime something feels unsafe, that's the easy answer.

KAMENETZ: Takeaway No. 3 is to take care of yourself so you can be a good model for your kids when they need you. And be ready for a conversation where you model mindfulness and resilience, you validate their feelings and you help them speak to themselves kindly. And remember; professional help is always an option.

Our takeaway No. 4 is about making time for fun and togetherness. That includes regular family time, like a game night, and also considering the safest way for kids to get out in the world and connect with friends and others.

And takeaway No. 5 is about adjusting your expectations and finding things to praise as you help kids get back on track to their goals. K is looking at the big picture now, she says.

K: Because I know after I graduate, I'm going to have my car, my apartment. Like, everything’s going to fall into place. My insecurities - like, all of that doesn't matter anymore because I'm here and I finally made it.

KAMENETZ: So for more LIFE KIT, check out our other episodes. We did a whole series on kids and screen time. You can find all of them at npr.org/lifekit. And if you love LIFE KIT and want more, subscribe to our newsletter at npr.org/lifekitnewsletter. And I just want to reiterate here, if you or someone you know may be considering suicide, the National Suicide Prevention Lifeline is 1-800-273-8255, and the Crisis Text Line is reachable at 741741. And now a completely random tip, this time from listener Casey Carlson.

CASEY CARLSON: So I'm a working mom. I have a 2-1/2-year-old and a 3-year-old, and I became very frustrated with not being able to find a matching sock. There's all these cute socks that you can buy for kids, but you can never find the matching socks. So I threw all the socks away. And I got my one daughter all the same socks of one color, and I got my other daughter all the same socks of another color. Now we just throw all the socks in one box, and we know whose socks are whose, and it makes life so much easier.

KAMENETZ: If you've got a good tip, leave us a voicemail at 202-216-9823, or email us a voice memo at lifekit@npr.org.

This episode was produced by Audrey Nguyen. Megan Keane is the managing producer. Beth Donovan is the senior editor. Our digital editors are Beck Harlan and Clare Lombardo, and our editorial assistant is Clare Marie Schneider. I'm Anya Kamenetz. Thanks for listening.

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