It might be tough to watch your beloved child morph into a teenage cliché—a back-talking, door-slamming, bedroom-retreating, fickle being. But it might be tougher yet to discern "normal" adolescent behavior from the signs of a materializing mood disorder. The signs are "easy to miss," says Mark Olfson, a professor of clinical psychiatry at Columbia University Medical Center in New York. "They're easy for parents to chalk up to a developmental stage."
Yet half of all mental illnesses arise by age 14. And about 2 million 12-to-17-year-olds, or 1 in 12 of them, experience clinical depression each year, government health officials estimated in May. What's more, says Vermont-based child and adolescent psychiatrist David Fassler, author of Help Me, I'm Sad: Recognizing, Treating and Preventing Childhood and Adolescent Depression, on average a child has had symptoms of mental illness for more than six months before getting help. That lag could have devastating consequences, since untreated mental illness can lead to suicide. The third-leading cause of death among 15-to-24-year-olds, suicide appears to be on the rise among youth and young adults after more than a decade of decline.
Spotting warning signs can be tricky. Many teenagers with depression, for example, exhibit an easily overlooked blend of mood and behavioral issues rather than the symptoms typically seen in adults, experts say. That's precisely what made things difficult for Nancy Casey, 53, of Sudbury, Mass., when her daughter, Shannon, ran into trouble as a high school sophomore.
Shannon, who was juggling advanced courses, the ski team, and a Sunday school teaching job, "started to have what could be looked at as normal adolescent types of behavior...mood swings and extreme reactions to what we might consider day-to-day conflicts," says Casey. Then, one morning, Casey went to wake Shannon for school and realized something was terribly wrong. Her sobbing daughter wouldn't get up. Later diagnosed with depression, Shannon missed six weeks of school. Through a combination of psychotherapy and medication, Shannon, now 21 and in college, gradually got better.
Stress played a role in Shannon's illness, mother and daughter agree, and experts are increasingly fingering it as an underappreciated factor when it comes to youth mental health. In December, for example, Olfson and other researchers writing in the Archives of General Psychiatry suggested that stress from things like pressure to excel in school or to land a good job may precipitate psychiatric disorders, which they found almost half of the more than 5,000 college-age individuals studied had suffered from in the past year. "The level of stress that most adolescents and preadolescents are under [today] is unhealthy," says Madeline Levine, a clinical psychologist and author of The Price of Privilege: How Parental Pressure and Material Advantage Are Creating a Generation of Disconnected and Unhappy Kids. "I think we see that reflected at the one end in depression, suicide, and anxiety disorders being on the rise but also in kids who don't have clinical diagnoses."
Parents can take steps to cultivate resilience in their children, which may help fend off some problems, says Kenneth Ginsburg, an adolescent medicine specialist at the Children's Hospital of Philadelphia and author of A Parent's Guide to Building Resilience in Children and Teens. "Our challenge is to raise kids with a wide repertoire of positive coping strategies, so that when life gets difficult—and it will—they [can] turn to things that will move them forward," he says.
One way parents can do this is by setting a good example when, for instance, coping with setbacks. Another is to focus on raising a balanced person, not a high-achieving performer; if kids are made to feel as though their ultimate goal is to please parents, not themselves, they won't learn how to identify their own strengths and preferences, says Ginsburg. "Happiness, creativity, and the innovative spirit are crushed when kids believe they need to fit into the perfect box," he says.
But even the most resilient children, equipped with the best arsenal of good coping strategies, have personal limits that life and biology can strain, says Ginsburg. So if parents notice that there might be something wrong and kids are no longer coping well, that's the time to seek help. "If you think your child might have a problem, get it checked out," says Fassler. "It's always preferable to err on the side of caution."