The stories are as individual as a fingerprint, but they contain the same tragic elements.

A child who once was resilient and cheerful becomes unrecognizable in adolescence. Perhaps cutting herself, perhaps inflamed by a kind of mania that turns every conversation into a wild conflict, perhaps rejecting old friends or indifferent to activities that once were fulfilling. In some cases the story includes trips to the emergency room—maybe because of an overdose of pills or an episode of such wild behavior that everyone in the family was afraid.

And in nearly all these stories agonized parents—feeling guilty, helpless, and increasingly desperate—watch their child spinning out of control.

These elements are not the stuff of raging hormonal imbalance or garden-variety adolescent angst but of depression or bipolar disorder.

"Adolescents are obviously moody," says University of Pennsylvania psychiatrist Dwight Evans, author of If Your Adolescent Has Depression or Bipolar Disorder: An Essential Resource for Parents (Oxford University Press). "But when someone has a diagnosable clinical illness there is lots more going on than just moodiness."

Evans and his co-author, Linda Wasmer Andrews, offer parents and others a map for navigating the complicated landscape of these illnesses that affect about 14 percent of teenagers in America. Parents are generally the first to observe changes in their children, the first to seek help when something seems not to be right. But how is it possible to distinguish between normal acting-out and bipolar disorder?

Being able to do with little or no sleep for days without feeling tired, for example. Speech that is much too fast, changes topics too quickly, or cannot be interrupted. Or expressing an unrealistically high opinion of oneself or one's abilities. Adolescents with bipolar disorder can sustain their anger for hours without relenting and destroy things intentionally in a fit of rage.

"One Sunday she started smashing every glass object in her room," one parent in the book recalls. "Then she went and squirted toothpaste all over the bathroom."

Adolescents who are depressed are at the other side of the behavior spectrum. They become uninterested in friends and activities and dislike going to school. They complain of tiredness or boredom and have trouble getting along with others. Often they are unusually irritable or aggressive, or get into trouble, whereas before they didn't. About 15 percent of adolescents have diagnosable clinical depression and an additional 10 percent suffer from a lower-level depression. In other words, in any high school classroom one out of four kids is likely to be in some depressed state, some much more serious than others.

"The adolescent is not acting in these ways for the sake of being challenging or difficult,'" says Evans. "They are suffering from an illness that is real. A parent has to take the posture of not giving up and advocating for the adolescent in all different situations, whether it's the mental health system or the school system."

And the consequences are serious. In June, researchers at the National Institutes of Mental Health and Harvard University released the results of a comprehensive study of mental illness in the United States. They found that half of all lifetime cases of mental illness begin by age 14 and that, untreated, many of these disorders can lead to substance abuse and more-difficult-to-treat psychiatric illnesses, even suicide.

Most important, however, is that these illnesses can be managed effectively. Evans points out that "one should realistically be very hopeful, especially with the treatments that are available today."

When adolescents with emotional disorders receive treatment, then the future can be one filled with promise, rather than despair. And finally, that is the hope and the vision that sustains all parents, during the complicated period of life called adolescence.

For More Information: http://www.nimh.nih.gov