Four ways to support your teen’s mental health

Teens face a wide variety psychosocial challenges during the extremely formative adolescent years. (Image: Adobe Stock. Illustration: David Chrisom, Boston Children’s Hospital)

Being a teen is hard enough, but with the current adolescent mental health crisis, parents should know about the psychosocial challenges — from stress to suicidal thoughts — teens face nowadays.

We spoke with Nanci Ginty Butler, LICSW, director of Mental Health Services in the Division of Adolescent and Young Adult Medicine at Boston Children’s to learn more.

Ginty Butler explains that behavioral health symptoms like exhaustion, moodiness, and inattentiveness are often reactions or adaptations to trauma or acute stress.

1. Help your teen regulate their “window of tolerance”

We have smart bodies — constantly scanning the environment around us for threats and safety, even when we aren’t aware we’re even doing it.

“When our body perceives a threat is happening, it responds in ways to keep ourselves safe,” explains Ginty Butler. “This means we might run away, avoid, fight, or choose to numb feelings. Sometimes these behaviors are effective in the short run but turn out maladaptive in the long term.” It’s important to be aware of your teen’s stress response cycle, where they are in it, and how to help them stay inside their window of tolerance.

Our window of tolerance is the zone where we are at our best mental state to digest information and be present in social situations. “We are constantly cycling in and out of our windows of tolerance throughout the average course of the day,” Ginty Butler says.

When we are above our personal window of tolerance, we are filled with anxiety and panic fueled by adrenaline. When we are below, we can feel emotionally numb or distracted. When we are functioning from inside our window of tolerance, we feel alert, calm, and present.

Teach your teen effective tools to regulate and return to their window of tolerance – often called coping mechanisms – when they feel stressed:

  • hydration
  • rhythmic-patterned movement to soothe the nervous system (walking, dancing, tapping on the sides of their body)
  • patterned breathing (like breathing in through the nose and out through the mouth)
  • progressive muscle relaxation (flexing a certain part of the body, then releasing while noticing how those muscles feel)
  • fresh air and sunlight
  • exercise 
  • journaling or another healthy distraction

2. Educate yourself about mood disorders

It’s normal for all people — especially teens — to cycle through different moods. This usually occurs as they cycle in and out of their window of tolerance, depending on what’s going on at any given moment.

Earlier in the pandemic, many people noticed feeling especially sensitive to changes in their environment — and increased feelings of hopelessness or negativity were common in people of all ages. These are typical reactions to stressors. However, when mood changes begin to affect your teen’s daily life for longer than two weeks, they could be a sign of a mood disorder

“In real life, mood disorders do not look like how they are portrayed in media,” Ginty Butler explains. “Depression in commercials often shows people laying in bed for an extended period of time. But in teenagers, depression often presents very differently.”

Adolescents may still attend school daily, go to their extracurriculars, or appear to be socializing “normally,” all while experiencing a mood disorder. In this age group, mood disorders like depression often manifest as bouts of anger or extreme irritability, indecisiveness, memory problems, social withdrawals, and inattentiveness.

“Teens often feel misunderstood by those around them when they have a mood disorder,” she says. “You might understandably become frustrated or impatient with them.” Ginty Butler urges parents to foster open communication with their teen so that they feel comfortable voicing their feelings.

“As parents, we should try to be proactive rather than reactive. This means creating a positive environment to feel supported and finding the right care for our teens.”

3. Be informed of eating disorders

Eating disorders are extremely difficult for both teens and their families. New research has shown a spike in diagnoses and treatment for eating disorders in teenagers.

Common types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder.

It’s important that a young person understands how an eating disorder can damage different parts of their body. Eating disorders negatively affect nearly every organ system. “Eating disorders can affect cognition, hinder rational judgment and impulse control, impede the ability to see situations objectively, and stunt growth and development,” she says.

Each eating disorder has severe physical health consequences. One of the several consequences of anorexia is low bone density, leading to osteoporosis. Binge eating can lead to high blood pressure or type 2 diabetes, among others. Bulimia nervosa causes serious electrolyte problems, leading to serious heart problems, among multiple other complications.

For these reasons, you should step in immediately if you see that your child is losing weight or if you think your child has an eating disorder. Professional help is key. Be sure to approach this conversation with care and without any accusation or anger.

“The good news is that eating disorders, like most mental health issues, are treatable,” explains Ginty Butler. “But they do require medical intervention. Do not hesitate to seek treatment if your child is showing signs of an eating disorder.”

4. Understand the risks of suicide

Sometimes, your teen might be dealing with even more serious mental health concerns, like suicidal thoughts.

Research shows that rates of suicide attempts and other mental health emergencies have risen dramatically in teens during the COVID-19 pandemic. That’s a good reason for parents to be even more watchful for signs of suicidal thoughts and to support their teens as they go through challenging life stages.  

Suicide prevention can include open communication with trusted adults, so ask your teen direct and non-judgmental questions to encourage them to share with you. If they aren’t willing to open up, get help through a professional counselor as an outlet for your teen to learn how to deal with challenges and implement positive coping methods.

If a suicide has occurred in your community or to someone you know, prevention is even more crucial. After a suicide occurs, the risk for suicide increases among survivors, a phenomenon called suicide contagion.

If you or your child is in crisis, call the National Suicide Prevention Lifeline at the new three-digit dialing code 988, or contact the Crisis Text Line by texting HOME to 741741.

“Encourage open communication and be ready to hear what your teen is thinking,” says Ginty Butler. “Offer reassurance and avoid judging the person that died. Don’t focus on the method or speculate on what may have triggered the suicide.”

You should also seek help from a licensed mental health professional if your teen seems to be struggling to process the experience.

Learn more about how the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital provides medical, gynecological, nutritional, and psychological care and counseling care while helping patients better understand their own health and development.

Boston Children’s Primary Care Alliance providers can support you and your child through their adolescent years. Find a pediatrician near you.

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