Knowing the Signs of Teen Trouble…Nov. 11, 2015

By Ann Needle
The long list of adjectives to describe it range from “fun” to “frustrating,” yet the term “adolescence” did not exist (officially) until 1906. It can be a tough time for both teens and their parents — but when does that challenge turn into a crisis?

An internationally recognized expert on adolescent behavior spoke to a room-ful of parents and caregivers earlier last week at the Perkins School in Lancaster, outlining how to spot the signs that normal development is something else.
Throughout his talk on “Parenting Teens: When Is It Time to Seek Help?”,  Dr. Barent Walsh stressed that many of the worrisome aspects of adolescent behavior, frustrating as they are, do not call for professional help. From ages 10 through about 20, Walsh explained, “Adolescents have to go through about 10 ‘tasks’ in a telescope fashion.

Those 10 tasks of adolescence involve developing a health body image; controlling impulses; learning abstract operations; moving from family toward independence, peers, and reciprocal friendships; developing intimate relationships, a positive sense of lovability, and competence; developing personal values; and reconnecting with parents as fellow adults.

Most of these tasks have warning signs that parents should be seeking help if something isn’t going right, Walsh said. And, some teens are more vulnerable than others to trouble in certain tasks.

For instance, Walsh noted that parents of children with compromised health, such as those with Type 1 diabetes, should be aware that a healthy body image may be harder to come by for these adolescents. Unfortunately, it is normal for a teen with diabetes to try and “fit in” by not following his or her prescribed regiment of diet and medications, Walsh said. He also mentioned that the suicide rate for Type 1 diabetes is higher than for others.

When it comes to developing relationships in adolescence, Walsh emphasized, “It’s the most intense periods of friendships during the entire lifespan. There’s a lot on the line.”  He warned that a pattern of friendships or romantic involvement where the adolescent isn’t being respected is dysfunction calling for closer attention.

It is also a bad sign if the teen can’t seem to find a friend, he said. This is typically the teen who, when stepping off of the bus at school, doesn’t even look around to see who he or she knows, something typical of teens with healthy friendships. These loners are the ones whose caregivers should be stepping in and getting them involved in just about any structured group activity they may take to, from art or music classes to sports, Walsh urged.

Signs of Danger
Not surprisingly, Walsh urged caregivers to seek immediate help if adolescents adopt self-destructive behaviors. Substance abuse can especially be a symptom of an adolescent having a tough time with impulse control, trying to handle it with an abnormal amount of risk-taking behavior, he said. While parents should keep a close eye on a senior in high school found drinking or smoking pot, Walsh maintained, “The bottom line is it’s bad if they start early; 11th or 12th grade experiments differ from those in middle school.”

Another common self-destructive behavior Walsh cited was cutting, where the person uses a razor or other object to nick their limbs or other body parts. Cutting can be a way of coping when any of the 10 adolescent tasks go awry, but Walsh mentioned it is especially related to poor body image and trouble regulating emotions. It has also become “normalized” on social media, with Walsh reporting that an alarming 14% of high school and middle school students in Massachusetts claimed they have self-injured.

Another reason adolescents turn to cutting may be that it is what Walsh called “an oddly effective coping behavior.” One theory states that, given the same part of the brain handles physical pain and emotions, when the pain of cutting abates, the brain may feel emotionally better as well, he said.

While most cutting is not life-threatening, Walsh cautioned that any self-injury calling for medical treatment, or done continuously, is closer to crisis level — or could signal a suicide attempt to come.

“Suicide [attempt are] different. Suicide is about utter misery,” said Walsh. “At that point, the person thinks their troubles can’t be reversed.” He pointed to suicide as the second-highest cause of death in American adolescents behind accidents. However, the U.S. is out-paced in teen suicide by countries that include Japan, where stress over college admissions and a culture of suppressing emotions adds to adolescents’ worries, Walsh explained.

Ironically, adolescent suicide rates are highest in developed countries, where citizens have what Walsh termed “the luxury of worrying about emotions, not survival.”

Anything setting off alarms in a teens’ behavior means calling on a professional at least for an evaluation, Walsh noted. Meanwhile, for caregivers looking to navigate their adolescents’ more minor issues, he recommended the “DBT Skills Manual for Adolescents,” available as a paperback or a downloadable PDF from Guilford Press, which discusses ways to help teens cope with many of the more manageable issues that arise with adolescents.