October 2018: Depression & Mental Health Screening Month
In the United States, October is National Depression and Mental Health Screening Month. Perhaps the question we are asked most often is, "How can I tell the difference between normal adolescent moods and depression or some other type of mental illness?"
It is normative for pre-adolescents and adolescents to have big, loud, dramatic emotions. These can shift quickly: one minute they are laughing with their friends and the next they're shouting at you, angry that you embarrassed them by saying, "What's so funny?" It is also normative for middle schoolers to be irritable, grumpy, secretive and irrational or for them to be bubbly, enthusiastic and passionate about a new issue every week. It comes down to trusting your gut: you've lived with your child for 11, 12, 13, or 14 years- if their behavior and mood appears to have changed drastically and you're worried, it is probably a good idea to address it, particularly if it has been going on for more than a few days.
Some of the signs that your child might be experiencing depression vs. general adolescent moodiness can include: withdrawing from others, increased irritability, problems with friends, at school or at home, a lack of interest in activities they used to enjoy, physical pains (headaches, stomachaches, aching muscles), sadness that doesn't abate and extreme fatigue. If you see this in your child, it is important to investigate further. But how?
One answer to is to turn to a professional. Talk with your child's pediatrician about what you're seeing. You can also talk to your child's school staff (counselor, psychologist, facilitator, teacher or special educator) about what they're seeing and how it compares to other students they've had. Of course, the school staff won't use names or disclose any personal information, but they can offer a kind of barometer for social and emotional development. School staff see hundreds more students than the average parent and generally have a good sense of what might be normative and what might need closer attention.
Informal and formal screenings are another way to gauge where your child's moods might fall on the spectrum of normative to concerning. It can sometimes be helpful to ask a therapist, pediatrician, school counselor, school psychologist, or school social worker to formally or informally talk with your child and to assess their mental health. In Newton, the middle (7th grade) and high school students (9th and 11th grades) participate in the Signs of Suicide (SOS) program which is designed to both educate students about the signs of suicide in themselves and others and to facilitate discussions about what to do if those signs are noticed. Students can also complete a brief screening form which looks for signs of depression as part of the program. If the screening form indicates concerns about depression and/or suicide, students talk with a counselor that day.
It is also a good idea for you to talk to your child. Choose a time when it is just the two of you. Driving in the car is an excellent opportunity for this, as no direct eye contact has to be made. Be specific and non-accusatory. Tell your child what you're noticing, why it concerns you and that you are available if your child wants to talk. Remind your child that there are other adults available as well and that you would be happy to help facilitate if your child would rather talk with someone other than you.
For example, you might say, "I've noticed that you seem sad lately. You're staying in your room much more, you haven't been doing things with your friends and you've stopped going to soccer, which you used to love. I'm wondering if something is going on that it might help to talk about with me."
At this point, it is likely that your child will brush you off or tell you that everything is fine. It's okay to reply, "It doesn't feel like it's fine but I won't push you right now. Please know that I am here to listen and if you don't want to talk to me, I can help connect you to someone else. Talking about feelings and situations, while hard, often improves them. I'm always ready to listen."
It's possible to offer some thoughts in the form of statements, that don't require a response from your child. You might say, "I've talked with other parents and they say that the first few months of sixth grade were the hardest ones for their kids and it took some time to adjust. Lots of kids feel sad or down and it helped some of them to talk to the school counselor." You could also say, "I was just reading about how middle school is such a hard time because kids feel so independent but then also feel like no one lets them do anything they want to do. It can make kids feel so angry. Sometimes talking about it with a trusted adult helps." Neither of those statements require a response from your child but they do offer some validation, some hope and even some suggestions that your child can file away and perhaps use in the future.
I have found that one of the best things to tell students is that feelings are just feelings. They can hurt and feel overwhelming and, in the end, they are feelings that eventually pass. Adolescents often have the sense that a feeling or a situation will go on forever and an adult reminder that no feeling (positive or negative) is endless can sometimes help them to let go of it. It's a variation on the adage, "This, too, shall pass."
It is important to remember that what seems small and manageable to the adults, may feel huge and overwhelming to adolescents. That missing homework assignment, the argument with a friend, that embarrassing moment-- all of these may feel insurmountable to your child and they may need to talk about it before they can let it go. Sometimes putting it in perspective can help ("Given the size of the feeling/situation, how long do you think you need to feel upset about it? A few minutes? A few days? The next month? What do you think you need?"), sometimes a reminder that the middle attention span is short can help ("That's something that felt so huge to you and I bet in a day or two no one will remember because something else will happen that will move attention off of you."), and sometimes it can help to simply commiserate ("I can see how awful you're feeling about this. I'm so sorry."). Wordless hugs, if your child is open to them, can be magically helpful too.
In the end, if you are worried that your child might be experiencing depression or another mental health issue, it doesn't hurt to talk with a professional about what you're seeing. Your child's pediatrician can be a good resource as can the mental health staff at your child's school. Make sure to talk to your child, too. Even when it seems like they aren't listening, they are. What you say to them has value, even when they dismiss it and seemingly forget it immediately. Our students, our children are always listening, even when they pretend not to be. It doesn't ever hurt to remind them that you care and that you are here for them, even when they don't want to need you.
Deep breaths and keep trying!
---Dr. J
See below for more information and resources about adolescents and depression
Parent's Guide to Teen Depression
Adolescent Depression
Normal Teen Behavior Vs. Warning Signs
It is normative for pre-adolescents and adolescents to have big, loud, dramatic emotions. These can shift quickly: one minute they are laughing with their friends and the next they're shouting at you, angry that you embarrassed them by saying, "What's so funny?" It is also normative for middle schoolers to be irritable, grumpy, secretive and irrational or for them to be bubbly, enthusiastic and passionate about a new issue every week. It comes down to trusting your gut: you've lived with your child for 11, 12, 13, or 14 years- if their behavior and mood appears to have changed drastically and you're worried, it is probably a good idea to address it, particularly if it has been going on for more than a few days.
Some of the signs that your child might be experiencing depression vs. general adolescent moodiness can include: withdrawing from others, increased irritability, problems with friends, at school or at home, a lack of interest in activities they used to enjoy, physical pains (headaches, stomachaches, aching muscles), sadness that doesn't abate and extreme fatigue. If you see this in your child, it is important to investigate further. But how?
One answer to is to turn to a professional. Talk with your child's pediatrician about what you're seeing. You can also talk to your child's school staff (counselor, psychologist, facilitator, teacher or special educator) about what they're seeing and how it compares to other students they've had. Of course, the school staff won't use names or disclose any personal information, but they can offer a kind of barometer for social and emotional development. School staff see hundreds more students than the average parent and generally have a good sense of what might be normative and what might need closer attention.
Informal and formal screenings are another way to gauge where your child's moods might fall on the spectrum of normative to concerning. It can sometimes be helpful to ask a therapist, pediatrician, school counselor, school psychologist, or school social worker to formally or informally talk with your child and to assess their mental health. In Newton, the middle (7th grade) and high school students (9th and 11th grades) participate in the Signs of Suicide (SOS) program which is designed to both educate students about the signs of suicide in themselves and others and to facilitate discussions about what to do if those signs are noticed. Students can also complete a brief screening form which looks for signs of depression as part of the program. If the screening form indicates concerns about depression and/or suicide, students talk with a counselor that day.
It is also a good idea for you to talk to your child. Choose a time when it is just the two of you. Driving in the car is an excellent opportunity for this, as no direct eye contact has to be made. Be specific and non-accusatory. Tell your child what you're noticing, why it concerns you and that you are available if your child wants to talk. Remind your child that there are other adults available as well and that you would be happy to help facilitate if your child would rather talk with someone other than you.
For example, you might say, "I've noticed that you seem sad lately. You're staying in your room much more, you haven't been doing things with your friends and you've stopped going to soccer, which you used to love. I'm wondering if something is going on that it might help to talk about with me."
At this point, it is likely that your child will brush you off or tell you that everything is fine. It's okay to reply, "It doesn't feel like it's fine but I won't push you right now. Please know that I am here to listen and if you don't want to talk to me, I can help connect you to someone else. Talking about feelings and situations, while hard, often improves them. I'm always ready to listen."
It's possible to offer some thoughts in the form of statements, that don't require a response from your child. You might say, "I've talked with other parents and they say that the first few months of sixth grade were the hardest ones for their kids and it took some time to adjust. Lots of kids feel sad or down and it helped some of them to talk to the school counselor." You could also say, "I was just reading about how middle school is such a hard time because kids feel so independent but then also feel like no one lets them do anything they want to do. It can make kids feel so angry. Sometimes talking about it with a trusted adult helps." Neither of those statements require a response from your child but they do offer some validation, some hope and even some suggestions that your child can file away and perhaps use in the future.
I have found that one of the best things to tell students is that feelings are just feelings. They can hurt and feel overwhelming and, in the end, they are feelings that eventually pass. Adolescents often have the sense that a feeling or a situation will go on forever and an adult reminder that no feeling (positive or negative) is endless can sometimes help them to let go of it. It's a variation on the adage, "This, too, shall pass."
It is important to remember that what seems small and manageable to the adults, may feel huge and overwhelming to adolescents. That missing homework assignment, the argument with a friend, that embarrassing moment-- all of these may feel insurmountable to your child and they may need to talk about it before they can let it go. Sometimes putting it in perspective can help ("Given the size of the feeling/situation, how long do you think you need to feel upset about it? A few minutes? A few days? The next month? What do you think you need?"), sometimes a reminder that the middle attention span is short can help ("That's something that felt so huge to you and I bet in a day or two no one will remember because something else will happen that will move attention off of you."), and sometimes it can help to simply commiserate ("I can see how awful you're feeling about this. I'm so sorry."). Wordless hugs, if your child is open to them, can be magically helpful too.
In the end, if you are worried that your child might be experiencing depression or another mental health issue, it doesn't hurt to talk with a professional about what you're seeing. Your child's pediatrician can be a good resource as can the mental health staff at your child's school. Make sure to talk to your child, too. Even when it seems like they aren't listening, they are. What you say to them has value, even when they dismiss it and seemingly forget it immediately. Our students, our children are always listening, even when they pretend not to be. It doesn't ever hurt to remind them that you care and that you are here for them, even when they don't want to need you.
Deep breaths and keep trying!
---Dr. J
See below for more information and resources about adolescents and depression
Parent's Guide to Teen Depression
Adolescent Depression
Normal Teen Behavior Vs. Warning Signs
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